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1.
Heart Surg Forum ; 24(1): E014-E018, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33635264

RESUMO

OBJECTIVE: Ventricular septal defect (VSD) induced by acute myocardial infarction (AMI) is rare but lethal, with high mortality even after surgical repair. Our aim was to assess the association between the time interval and surgical repair effects in patients with VSD following AMI. METHODS: From January 2003 to December 2017, 14 patients with VSD induced by AMI received surgical therapy in our department. We retrospectively reviewed the patients' clinical manifestations, surgical methods, and outcomes. According to the time interval from AMI onset and surgery, we divided the patients into two groups: Group 1 (N = 9), more than one week, and Group 2 (N = 5), less than one week. A comparison study was performed, and differences were analyzed. RESULTS: The mean age of the entire group was 65.5±3.3 years, with 78.6% males (11/14). VSDs were anterior apical in 10 (71.4%) and posterior inferior in 4 (28.6%) patients. The average size of the VSD was 15.8±5.8 mm. Compared with Group 1, Group 2 had poorer left ventricular function (LVEF 40.8±10.3% vs. 30.4±2.3%, P = 0.035) and a higher rate of urgent procedures (11.1% vs. 100.0%, P = 0.003). The mortality rate was 14.3% (2/14). Mechanical support was more common in Group 2 than Group 1. No resistant shunt or death was found during follow up. CONCLUSIONS: VSD following AMI is safer for more than one week, but surgical treatment is also acceptable for patients requiring urgent surgery due to hemodynamic instability. Mechanical assistive devices can improve the perioperative success rate.

2.
BMC Anesthesiol ; 21(1): 35, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546609

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) support may be considered to reduce mortality but survival and clinical outcomes are uncertain after Stanford type A Aortic dissection (TAAD). We analyzed the data of TAAD patients with postoperative ECMO support in our institution to investigate clinical outcomes. METHODS: In this retrospective cohort study, all clinical data of TAAD patients with postoperative ECMO support from January 2013 to October 2019 in our institution were harvested. Cases with redo or incomplete records were excluded. RESULTS: 22 cases were enrolled, 18 male and 4 female. The mean age was52.85±10.91 years. 20 patients underwent VA-ECMO treatment and 2 patients received VV-ECMO support. The support time was92.54±78.71 hours. 9 patients were successfully weaned from ECMO. 30-day in-hospital survival rate was 27.27 % (6/22). The follow-up duration is from 5 to 74 months. The median follow-up time is 35 months. Only four patients were still alive at the end of the follow-up period. CONCLUSIONS: The mortality of TAAD patients with postoperativesevere circulatory and respiratory dysfunctions is high. ECMO would be considered as a valuable contribution to save lives. But more experience needs to be accumulated to improve clinical outcome.

3.
J Pharmacol Sci ; 145(2): 202-212, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33451755

RESUMO

Acute lung injury (ALI), a common complication of sepsis, is characterized by the impairment and injury of pulmonary function. The nuclear factor kappa-B (NF-κB) pathway is activated in ALI. Tripartite motif-containing 37 (TRIM37) can activate the NF-κB pathway and is closely associated with inflammation. The purpose of our study is to reveal the role of TRIM37 in ALI. The present study revealed that TRIM37 presented high levels in lung tissues of ALI mice, and knockdown of TRIM37 alleviated lipopolysaccharide (LPS)-induced lung injury, inflammatory response, and cell apoptosis in vivo. In addition, knockdown of TRIM37 inhibited the inflammatory response, and cell apoptosis of LPS-treated WI-38 cells. Mechanistically, miR-944 was identified to bind with and negatively regulate TRIM37. Furthermore, NEAT1 was indicated to act as a competitive endogenous RNA to promote TRIM37 expression by sequestering miR-944. Detailly, NEAT1 bound with miR-944, negatively modulated miR-944 expression, and positively modulated TRIM37 expression. The rescue assays suggested that overexpression of TRIM37 rescued the influence of NEAT1 knockdown on cell apoptosis and inflammatory response. Overall, NEAT1 facilitated cell apoptosis and inflammatory response of WI-38 cells by the miR-944/TRIM37 axis in sepsis-induced ALI, implying that NEAT1 may provide a novel insight for the treatment of sepsis-induced ALI.

4.
J Thorac Dis ; 12(11): 6618-6628, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33282363

RESUMO

Background: To explore the clinical characteristics and prognosis of patients with hypertension underwent emergency surgery for type A acute aortic dissection (TA-AAD). Methods: The present study enrolled 712 consecutive patients diagnosed with TA-AAD and received aortic repair surgery at our hospital between January 2014 to December 2018. Clinical characteristics of enrolled patients were retrospectively reviewed. Patients were grouped by preexisting hypertension history and matched with propensity scores matching method. Patients' clinical characteristics were compared and analyzed before and after propensity scoring. To identify predictors for long-term mortality rate, Kaplan-Meier survival estimation and Cox proportional hazard analysis were performed. Results: A total of 492 patients (69.1% of all patients in the cohort) were included in the hypertensive group and they had increased age and weight compared to patients in the non-hypertensive group. Between two groups, preoperative leukocyte count and serum creatinine level were found significant different (P<0.05). After propensity scoring, 128 pairs (256 patients) were successfully matched. Our analysis showed that there was no significant difference of ventilation duration, 30-day mortality rate, intensive care unit stay and hospitalization time between two groups. However, our data suggested that hypertensive patients presented with less intra-operative aortic valve involvement. There was a significant difference in long-term survival rate (P=0.037) between two groups. Cox regression analysis demonstrated that hypertension was an independent risk factor [hazard ratio (HR), 3.040; 95% confidence interval (CI), 1.124-8.227; P=0.029]. Conclusions: Our data suggested that TA-AAD patients complicated with hypertension had increased age and weight compared to non-hypertensive patients. Concomitant hypertension identified upon hospital administration was an independent risk factor for long-term survival in TA-AAD patients while did not influence the 30-day mortality rate.

5.
J Thorac Dis ; 12(11): 6780-6788, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33282379

RESUMO

Background: Type A Aortic Dissection (TAAD) remains a lethal disease of increasing incidence. However the incidence, standardized treatment and survival rates of TAAD is still a lack in China. This study aims to share the management strategy of TAAD from a developing center of this country. Methods: All subjects identified with TAAD in Nanjing Drum Tower Hospital, China, from Jan. 2002 to Dec. 2018 were included in this study. Of 1,037 individuals, 932 (89.9%) were underwent surgery. Based on annual case volume patients underwent surgery were stratified into three operative stages: Early, Middle and Current stage, and patient characteristics, operative trends and outcomes across the operative stages were assessed. Results: The annual admissions of patients increased from approximately 20 during 2002-2013 (early era), 100 during 2014-2016 (middle era) to 200 during 2017-2018 (current era). The median age of patients increased from 49.0 to 53.0 among different eras (P<0.001). The overall in-hospital mortality was 16.5%, which significantly decreased from 21.3% to 13.1% with eras (P=0.023). The median time from admission to surgery was remarkedly shorted from 30.4 h during the early era to 14.0 h during the current era. Compared with in the early era, the percentages of aortic arch repair were increased in middle or current eras, while total arch replacement decreased. Conclusions: During the last 16 years, the prevalence of TAAD was increasing, and the annual number of operations increased substantially in China. Hospital survival improved over time was challenging prompt management and suitable operations.

6.
Sensors (Basel) ; 20(23)2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33266182

RESUMO

Microwave Staring Correlated Imaging (MSCI) is a newly proposed computational high-resolution imaging technique. The imaging performance of MSCI with the existence of modeling errors depends on the properties of the imaging matrix and the relative perturbation error resulted from existing errors. In conventional transient-radiation-fields-based MSCI, which is commonly accomplished by utilizing random frequency-hopping (FH) waveforms, the multiple transmitters should be controlled individually and simultaneously. System complexity and control difficulty are hence increased, and various types of modeling errors are introduced as well. The computation accuracy of radiation fields is heavily worsened by the modeling errors, and the transient effect makes it hard to take direct and high-precision measurements of the radiation fields and calibrate the modeling errors with the measuring result. To simplify the system complexity and reduce error sources, in this paper, steady-radiation-fields-sequence-based MSCI (SRFS-MSCI) method is proposed. The multiple transmitters are excited with coherent signals at the same observation moment, with the signal frequency varying in the whole frequency band during the imaging process. By elaborately designing the array configuration and the amplitude and phase sequences of the coherent transmitters, the SRFS-MSCI is thus implemented. Comparing the system architecture of the proposed SRFS-MSCI with the conventional random FH-based MSCI, it can be found that the proposed method significantly reduces the number of baseband modules and simplifies the system architecture and control logic, which contributes to reducing error sources such as baseband synchronization errors and decreasing deterioration caused by error cascade. To further optimize the design parameters in the proposed SRFS-MSCI system, the Simulated Annealing (SA) algorithm is utilized to optimize the amplitude sequences, the phase sequences, and the antenna positions individually and jointly. Numerical imaging experiments and real-world imaging experiment demonstrate the effectiveness of the proposed SRFS-MSCI method that recognizable high-resolution recovery results are obtained with simplified system structure and optimized system parameters.

7.
J Thorac Dis ; 12(10): 5833-5841, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33209415

RESUMO

Background: To identify risk factors and long-term outcomes for acute kidney injury (AKI) in elderly patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. Methods: This retrospective study enrolled 214 consecutive patients who underwent TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the Kidney Disease: Improving Global Outcomes definition (KDIGO) criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare the long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. Results: Among all enrolled patients, 114 (53.3%) developed AKI during postoperative period. The median age of patients with or without AKI was 68.0 (64.0, 74.0) and 66.0 (62.0, 72.8) years respectively. Renal replacement therapy (RRT) was required in 43 patients (20.1%). The 30-day mortality rate was 21.5% in all enrolled patients with 26.3% in AKI group and 16.0% in non-AKI group (P=0.067) respectively. Longer mechanical ventilation duration was identified as the only independent risk factor for developing AKI by multivariable logistic regression analysis. In addition, our data suggested that the long-term cumulative survival rate was different between two groups. Conclusions: Postoperative AKI after TA-AAD surgeries was common and associated with worsened long-term mortality in elderly patients. Longer postoperative mechanical ventilation duration was identified as the only independent risk factor for the development of AKI.

8.
Ann Thorac Surg ; 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33248996

RESUMO

BACKGROUND: The J-Valve system is designed specifically for trans-apical transcatheter aortic valve replacement (TAVR) and has three U-shaped graspers. With the unique structure, J-Valve is suitable for both aortic stenosis and aortic regurgitation. We used the J-Valve system for patients with aortic valve diseases and observed favorable results. METHODS: From January 2018 to August 2019, 23 patients underwent trans-apical transcatheter valve replacement using the J-Valve system. High-risk patients with diseased peripheral vessels (Small diameter, heavily calcified, and tortuous arteries), pure aortic regurgitation and complex prosthetic valve-in-valve (ViV) cases were enrolled. Ten patients mainly suffered from aortic stenosis, 11 patients had pure aortic regurgitation, and two patients had a ViV aortic valve position. The average preoperative STS score and EuroSCORE II were 8.9% and 8.7%, respectively. RESULTS: The technique success rate was 91.3% (21/23, one patient was referred for open surgery and one patient received intraoperative valve-in-valve), and one patient died because of cardiogenic shock after the procedure (mortality 4.3%, 1/22). One patient suffered stroke postoperatively and recovered well, and no cases needed to undergo permanent pacemaker implantation. During the follow-up period, one patient died because of an acute heart attack. No moderate or severe paravalvular leakage was found. CONCLUSIONS: TAVR surgery with the J-valve system is effective, even when it is traumatic and requires the trans-apical route. The applicability of the J-valve system in pure aortic regurgitation patients is the advantage of this system.

9.
Heart Surg Forum ; 23(6): E797-E802, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33234216

RESUMO

AIM: This study was conducted to investigate the role of the miR-210/Caspase8ap2 pathway in apoptosis and autophagy in hypoxic myocardial cells. METHODS: The miR-control, miR-210 mimic, and miR-210 inhibitor were transfected into rat myocardial H9C2 cells. The transfection efficiency of exogenous miR-210 was determined by quantitative reverse-transcription polymerase chain reaction (qRT-PCR). H9C2 cells were then treated with CoCl2 for 24, 48, and 72 h to generate a myocardial injury model. The apoptosis of H9C2 cells was assessed by flow cytometry. Additionally, a western blot assay was used to determine the expression of the autophagy-associated proteins light chain 3 (LC3), p62 and Beclin-1, and apoptosis-associated proteins Caspase8ap2, cleaved caspase 8, and cleaved caspase 3. RESULTS: We determined that a 48 h hypoxia treatment duration in H9C2 cardiomyocytes induced myocardial injury. Additionally, the overexpression of miR-210 significantly inhibited cell apoptosis. MiR-210 suppressed autophagy by upregulating p62 and downregulating LC3II/I in hypoxic H9C2 cells. Caspase8ap2 was a putative target of miR-210, miR-210 mediated apoptosis, and autophagy of H9C2 cells via suppressing Caspase8ap2. Furthermore, the expression of caspase 8, caspase 3, and Beclin-1 were decreased in response to miR-210. CONCLUSION: miR-210 exhibits anti-apoptosis and anti-autophagy effects, which alleviate myocardial injury in response to hypoxia.

10.
Faraday Discuss ; 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33094299

RESUMO

The luminescent and proton conductive Pt(ii) complex [PtCl(tpy-o-py)]Cl and its HCl adduct [PtCl(tpy-o-pyH)]Cl2 (o-Pt and o-Pt·HCl, respectively; tpy-o-py = 2,2':6',2''-terpyridine-6',2'''-pyridine) were synthesised and their crystal structures, vapochromic behaviour, and proton conduction, were investigated and compared to those of the para isomers [PtCl(tpy-p-py)]Cl and [PtCl(tpy-p-pyH)]Cl2 (p-Pt and p-Pt·HCl, respectively; tpy-p-py = 2,2':6',2''-terpyridine-4',4'''-pyridine). X-ray structure analysis revealed that the intermolecular metallophilic (PtPt) interaction was negligible in o-Pt but effective in o-Pt·HCl. Reversible transformation between o-Pt and o-Pt·HCl coupled with significant colour and luminescence changes was achieved by four different external stimuli, namely: exposure of o-Pt to humid HCl gas to form o-Pt·HCl, heating, exposure to MeOH vapour, and finally drying in air to regenerate the original o-Pt. The intraligand π-π* orange emission observed for o-Pt exhibited negligible dependence on the relative humidity (RH). Conversely, o-Pt·HCl exhibited red metal-metal-to-ligand charge-transfer (MMLCT) phosphorescence at 725 nm, originating from effective intermolecular Pt-Pt interactions, and interesting vapochromic behaviour that was dependent on the RH. Notably, o-Pt·HCl presented higher conductivity than the p-Pt·HCl isomer at RH < 80%. This trend was reversed at RH values > 80%, probably owing to the second water-adsorption-induced transformation of p-Pt·HCl. The cooperative phenomenon between the proton conduction and vapochromic behaviour observed for both o-Pt·HCl and p-Pt·HCl should allow the visualisation of the proton-conducting pathway, without the need for a bulk electrode, via the absorption and emission colours at both macroscopic and microscopic levels.

11.
Stem Cell Res ; 49: 101994, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-33038746

RESUMO

The induced pluripotent stem cells (iPSCs) were generated from peripheral blood mononuclear cells (PBMCs) isolated from a male child with Danon disease. Next-generation sequencing (NGS) revealed a stop gained mutation c.467 T > G in LAMP2 gene. PBMCs were reprogrammed by using non-integrating Sendai reprogramming kits. It is a possible cell model to screen alternative medicine treatment of the Danon disease.

12.
Am J Transl Res ; 12(9): 5032-5047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33042404

RESUMO

Persistent atrial fibrillation (PeAF) is a progressive cardiovascular disease with a high risk for most patients after diagnosis. Poor molecular description of PeAF has led to unsatisfactory interpretation of the pathogenesis of it, resulting in the lack of effective treatments. The aim of the present study was to find several new potential biomarkers for early prevention, diagnosis and treatment of this disease and explore the underlying molecular mechanisms. An absolute quantitation Tandem Mass Tag (TMT)-liquid chromatography-tandem mass spectrometry (LC-MS/MS) approach was applied to identify differentially expressed proteins (DEPs) in left atrial appendage. Totally, 4682 proteins were identified and 4159 proteins were quantified. Compared with control subjects, 118 DEPs (85 upregulated proteins and 33 downregulated proteins) were identified in the atrial tissues of PeAF patients. Using String software, a regulatory network containing 87 nodes and 244 edges was built, and the functional enrichment showed that DEPs were predominantly involved in protein digestion and absorption, regulation of metabolism and focal adhesion. Four proteins, collagen 1 (COL-I), collagen 2 (COL-II), ras-related protein 1 (RAP1) and leucine-rich alpha-2-glycoprotein 1 (LRG1) were selected for validation using Western blot analysis to distinguish PeAF patients and control subjects. The present results provide a comprehensive understanding of the pathophysiological mechanisms of PeAF and the validated biomarkers for the diagnosis of PeAF, which facilitate the development of therapeutic targets.

13.
Genes (Basel) ; 11(10)2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33066131

RESUMO

Stanford type A aortic dissection (TAAD) is one of the most dangerous diseases of acute aortic syndrome. Molecular pathological studies on TAAD can aid in understanding the disease comprehensively and can provide insights into new diagnostic markers and potential therapeutic targets. In this study, we defined the molecular pathology of TAAD by performing transcriptome sequencing of human ascending aortic tissues. Pathway analysis revealed that activated inflammation, cell death and smooth muscle cell degeneration are the main pathological changes in aortic dissection. However, autophagy is considered to be one of the most important biological processes, regulating inflammatory reactions and degenerative changes. Therefore, we focused on the pathological role of autophagy in aortic dissection and identified 10 autophagy-regulated hub genes, which are all upregulated in TAAD. These results indicate that exaggerated autophagy participates in the pathological process of aortic dissection and may provide new insight for further basic research on TAAD.

14.
J Cardiothorac Surg ; 15(1): 315, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059693

RESUMO

OBJECTIVE: To identify risk factors and long-term outcomes of acute kidney injury (AKI) in young patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. METHODS: This retrospective study enrolled 121 consecutive patients less than 40 years old who received TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the KDIGO criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. RESULTS: Among all enrolled patients, AKI occurred in 51 patients (42.1%) and renal replacement therapy (RRT) was required in 15 patients (12.4%). The development of postoperative AKI was associated with increased 30-day mortality (P = 0.041), longer ICU stay time (P < 0.001) and hospital stay time (P = 0.006). Multivariable analysis indicated that elevated preoperative serum cystatin C (sCyC) (OR = 6.506, 95% CI: 1.852-22.855, P = 0.003) was the only independent risk factor for developing AKI. The areas under the receiver-operating characteristic curve (AUC) of preoperative sCyC was 0.800 (95% CI: 0.719, 0.882). Preoperative sCyC had a sensitivity of 64.7% and a specificity of 83.8% in diagnosing postoperative AKI with a cut-off value of 0.895 mg/L. In addition, our data suggested there was no difference discovered regarding long-term cumulative survival rate between patients with and without AKI during a median 29 months follow-up period. CONCLUSIONS: Postoperative AKI after TA-AAD surgeries was relatively common in young patients and associated with increased short-term mortality. Elevated preoperative sCyC was identified as an independent risk factor for AKI with potential diagnostic merit.

15.
Heart Surg Forum ; 23(5): E658-E664, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32990586

RESUMO

OBJECTIVES: Functional tricuspid regurgitation (TR) usually occurs with previous cardiovascular surgery, which causes right-side heart failure and affects patient prognosis. Thus, we aimed to assess the risk and outcomes of isolated tricuspid valve replacement (TVR) after cardiovascular surgery. METHODS: We reviewed our hospital medical records and found 107 patients, who had undergone TVR following cardiovascular surgery from June 2009 to November 2017. Follow up was performed by telephone calls, with a mean follow up of 51 months (one to 120 months). Previous surgical procedures of all patients were recorded, and we compared the differences in baseline and preoperative characteristics between the survival and non-survival groups by univariate analysis. Furthermore, logistic regression analysis was performed to identify the risk factors. The variables with a P value < .05 on univariate analysis were entered into a multivariate analysis using stepwise selection. RESULTS: TVR was performed in 107 patients, including 89 survivors and 18 non-survivors during the follow up. There were 38 male and 69 female patients, and the mean age was 53.55 years. Hospital mortality was 16.8% (18/107). The APACHE II (P < .001) and mechanical ventilation time (P = .001) were higher in the non-survival group. The values of B-type natriuretic peptide (BNP), total bilirubin (TB), and blood urea nitrogen (BUN) before and after the operation and some preoperative values were different between the two groups (P < .05). The logistic regression analysis showed that APACHE II score, mechanical ventilation time, preoperative albumin, and postoperative TB were risk factors for TVR after cardiovascular surgery. CONCLUSIONS: Reoperation tricuspid valve replacement is associated with high operative mortality. High APACHE II scores, mechanical ventilation time and postoperative TB were associated with increased short-term mortality risk, while high preoperative albumin levels decreased the risk. Positive reoperation for tricuspid valve prosthesis dysfunction can obtain satisfactory therapeutic effects, and survivors could benefit from the surgery.

16.
Ann Thorac Surg ; 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32950491

RESUMO

Though pregnancy is not recommended under current guidelines in pulmonary arterial hypertension (PAH), some women insist on parturition. The related surgical treatments are controversial, especially to those complicated with Eisenmenger Syndrome (ES). In this report, two cases of severe PAH complicated with ES were reviewed. Due to a lifesaving tenet, bilateral lung transplantation (BLTx) combined with surgical atrioventricular defect correction were performed after careful assessments. Both patients followed up 1 year and displayed no obvious complication. It showed the strategy of BLTx combined with a cardiac correction may be a feasible strategy and worthy of further investigation.

17.
JAMA Netw Open ; 3(9): e2016236, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910197

RESUMO

Importance: Cell therapy may be helpful for cardiac disease but has been fraught with poor cell retention and survival after transplantation. Objective: To determine whether cell-laden hydrogel treatment is safe and feasible for patients with chronic ischemic heart disease (CIHD). Design, Setting, and Participants: This randomized, double-blind clinical trial was conducted between March 1, 2016, and August 31, 2019, at a single hospital in Nanjing, China. Among 115 eligible patients with CIHD, 50 patients with left ventricular ejection fraction of 45% or less were selected to receive elective coronary artery bypass grafting (CABG) and additionally randomized to cell-plus-collagen treatment (collagen/cell group), cell treatment alone (cell group), or a control group. Sixty-five patients were excluded because of severe comorbidities or unwillingness to participate. Forty-four participants (88%) completed the study. The last patient completed 12 months of follow-up in August 2019. Analyses were prespecified and included all patients with available data. Interventions: During CABG, patients in the collagen/cell group were treated with human umbilical cord-derived mesenchymal stromal cell (hUC-MSC)-laden collagen hydrogel intramyocardial injection, and the cell group was treated with hUC-MSCs alone. Patients in the control group underwent CABG alone. Main Outcomes and Measures: The primary outcome was safety of the cell-laden collagen hydrogel assessed by the incidence of serious adverse events. The secondary end point was the efficacy of treatment, according to cardiovascular magnetic resonance imaging-based left ventricular ejection fraction and infarct size. Results: Fifty patients (mean [SD] age, 62.6 [8.3] years; 38 men [76%]) were enrolled, of whom 18 were randomized to the collagen/cell group, 17 to the cell group, and 15 to the control group. Patient characteristics did not differ among groups at baseline. For the primary end point, no significant differences in serious adverse events, myocardial damage markers, and renal or liver function were observed among all groups after treatment; the collagen/cell and cell groups each had 1 case of hospitalization because of heart failure, and no serious adverse events were seen in the control group. At 12 months after treatment, the mean infarct size percentage change was -3.1% (95% CI, -6.20% to -0.02%; P = .05) in the collagen/cell group, 5.19% (-1.85% to 12.22%, P = .35) in the cell group, and 8.59% (-3.06% to 20.25%, P = .21) in the control group. Conclusions and Relevance: This study provides, to our knowledge, the first clinical evidence that the use of collagen hydrogel is safe and feasible for cell delivery. These findings provide a basis for larger clinical studies. Trial Registration: ClinicalTrials.gov Identifier: NCT02635464.

18.
J Clin Lab Anal ; : e23595, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32978843

RESUMO

BACKGROUND: Monocyte-to-high-density lipoprotein (M/H) ratio has emerged as a novel cardiovascular prognostic biomarker. We aimed to evaluate the prognostic values of M/H with early recurrence in persistent valvular atrial fibrillation (AF) patients after radiofrequency (RF) maze procedure. METHODS: We retrospectively analyzed 131 consecutive persistent AF patients with valvular heart diseases who were followed up 3 months after RF maze procedure. Their clinical data were recorded. Logistic regression analyses were performed for significant predictors. Receiver operating characteristic analysis was used for validation with corresponding area under the curve. RESULTS: 70 (53.4%) patients experienced early recurrence after procedure. Patients with early recurrence were older, have longer AF duration history, larger left atria diameter (LAD), higher plasma C-reactive protein (CRP), lower triglycerides (TG), lower cholesterol (TC), increased monocyte counts, lower HDL cholesterol, and increased M/H ratio. In multivariate analysis, age (OR 1.1 95% CI 1.0-1.1 P = .003), LAD (OR 2.1, 95%CI 1.2-3.5, P = .006), TG (OR 0.35, 95% CI 0.15-0.84, P = .019), M/H (OR 6.1, 95% CI 2.9-13.0, P < .001) were significantly independent predictors of AF early recurrence. M/H ratio demonstrated a significant predictive value (AUC = 0.77, sensitivity 89.0%, specificity 54%). Further, there was a positive correlation of M/H ratio with CRP and white blood cell. CONCLUSION: Preoperative M/H ratio was an independent risk factor of AF early recurrence following RF maze operation. M/H ratio should be considered in prediction of early recurrence for valvular AF patients.

19.
Interact Cardiovasc Thorac Surg ; 31(5): 697-703, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32851399

RESUMO

OBJECTIVES: Acute kidney injury (AKI) is a relatively common complication after an operation for type A acute aortic dissection and is indicative of a poor prognosis. We examined the risk factors for and the outcomes of developing AKI in patients being operated on for thoracic aortic diseases. METHODS: We retrospectively analysed 712 patients with acute type A dissection who had deep hypothermic circulatory operations from January 2014 to December 2018, emphasizing those who developed AKI. Logistic regression models were used to identify predisposing factors for the postoperative development of AKI. RESULTS: Among all enrolled patients, 359 (50.4%) had AKI; of these, 133 were diagnosed as stage 1 (18.7%), 126 were stage 2 (17.7%) and 100 were stage 3 (14.0%). Postoperative haemodialysis was required in 111 patients (15.9%). The development of AKI after aortic surgery contributed to the higher mortality rate within 30 days after surgery (P < 0.001), longer stay in the intensive care unit (P = 0.01) and longer hospital stay (P < 0.001). Binary logistic regression analysis showed that preoperative cystatin C levels [odds ratio (OR) 2.615, 95% confidence interval (CI) 1.139-6.002; P = 0.023] and postoperative ventilation time (OR 1.019, 95% CI 1.005-1.034; P = 0.009) were independent risk factors for developing AKI. Multiple ordinal logistic regression analyses showed that the preoperative cystatin C level (OR 2.921, 95% CI 1.542-5.540; P = 0.001) was an independent risk factor associated with the severity of AKI. CONCLUSIONS: Our data suggested that the development of AKI after surgery for type A acute aortic dissection was common and associated with an increased short-term mortality rate. The preoperative cystatin C level was identified as an indicator for the occurrence and severity of AKI postoperatively. Furthermore, we discovered that longer postoperative ventilation time was also associated with the development of AKI.

20.
BMC Cardiovasc Disord ; 20(1): 379, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819270

RESUMO

BACKGROUND: Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures. METHODS: We performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n = 386) and non-survival group (n = 124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, ß-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of ß-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles. RESULTS: Patients were followed for a median period of 24 months (interquartile range: 11-44 months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used ß-blocker (HR: 2.056, 95%CI:1.236-3.420, P = 0.005) compared with survival group. After propensity matching, the group which always used ß-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P = 0.030). CONCLUSIONS: The risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used ß-blockers in patients with LVEF≤35%. The discharge prescription of ß-blocker should be cautiously administrated in those patients.

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