The role and mechanism of CXCR4 in renal injury and fibrosis caused by calcium oxalate crystals / 中华泌尿外科杂志

Objective:To investigate the role and mechanism of chemokine receptor type 4 (CXCR4) in renal injury and fibrosis caused by calcium oxalate crystals in mice.Methods:In June 2021, Fifteen male C57/BL6 mice were divided into control group (5 mice), model group (5 mice), and AMD3100 intervention group (5 mice) by random number table method. In model group and AMD3100 intervention group, glyoxylate (100 mg/kg) was injected intraperitoneal for 7 consecutive days for modeling. Meanwhile, the AMD3100 intervention group was also given intraperitoneal injection of AMD3100 (1 mg/kg) for 7 days. The control group was continuously injected with equal volume saline intraperitoneally. After 7 days, peripheral blood was collected from each group to determine the levels of serum urea nitrogen (BUN) and creatinine (Scr) to assess the renal function; HE, Von-Kossa, Picrosirius Red staining was also taken from the left kidney to observe the pathological changes of renal tissue. CXCR4, transforming growth factor β1 (TGF-β1) were detected by immunohistochemistry and western blot. The expression levels of PI3K/AKT pathway-related proteins were detected by western blot.Results:The results of biochemical indexes showed that the serum Scr [(108.03±13.56) μmol/L vs. (39.50±4.48)μmol/L, P<0.01)] and BUN[(5.66±0.48)mmol/L vs. (0.77±0.10)mmol/L, P<0.01) levels were significantly increased in model group compared with the control group. The AMD3100 intervention group was significantly lower than the model group in terms of Scr [(65.77±3.27)μmol/L vs. (108.03±13.56)μmol/L, P<0.05) and BUN [(2.97±0.44)mmol/L vs. (5.66±0.48)mmol/L, P<0.05) levels. The results of kidney pathology in mice showed that renal tubules were significantly dilated with inflammatory cell infiltration in the model group compared with the control group, and a large number of calcium oxalate crystals and collagen fibers were deposited. The extent of kidney damage, calcium oxalate crystals and collagen fibers deposition were significantly reduced in the AMD3100 intervention group compared with the model group. The results of western blotting showed that the relative expression of CXCR4(0.639±0.019 vs. 0.158±0.012, P<0.01) and TGF-β1(0.698+ 0.018 vs. 0.314+ 0.015, P<0.05) was significantly increased in the model group compared with the control group. The relative expression of CXCR4(0.322±0.231) in the AMD3100 intervention group compared with the model group (0.322±0.231 vs. 0.639±0.019, P<0.05) and TGF-β1(0.445+ 0.017 vs. 0.698+ 0.018, P<0.05) were significantly decreased. The results of immunohistochemical staining showed the trend of CXCR4 and TGF-β1 expression in each group consistent with the results of protein blotting assay. Western blotting results showed that the expression of p-PI3K (0.613±0.016 vs. 0.213±0.011, P<0.01) and p-AKT(0.149±0.013 vs. 0.047±0.014, P<0.01) was significantly increased in the model group compared with the control group. The expression of p-PI3K in the AMD3100 intervention group compared with the model group (0.292±0.020 vs. 0.613±0.016, P<0.05) and p-AKT (0.098±0.021 vs. 0.149±0.013, P<0.05)was significantly decreased. Conclusion:CXCR4 inhibits calcium oxalate crystal-induced kidney injury and interstitial fibrosis in mice by targeting the PI3K/AKT pathway.

Logistic regression analysis of death risk factors of patients with severe and critical coronavirus disease 2019 and their predictive value / 中华危重病急救医学

Objective:To analyze the risk factors of death in patients with severe and critical coronavirus disease 2019 (COVID-19) and their predictive value.Methods:Using the clinical and epidemiological database of Yangtze River Shipping General Hospital in Wuhan, the clinical and epidemiological data of 105 patients with severe and critical COVID-19 from January to March in 2020 were collected. Multivariate unconditional Logistic regression method was used to analyze the death risk factors of patients during hospitalization. The receiver operating characteristic (ROC) curve was drawn according to the multivariate analysis results to construct a death prediction model; the prediction value of the model was analyzed.Results:The 105 patients with severe and critical COVID-19 were enrolled with 66 males (62.9%) and 39 females (37.1%). The age was (58.2±14.4) years old. Forty-two patients died in hospital and 63 survived. Among the dead patients, 69.0% (29/42) were male, and 78.6% (33/42) were over 60 years old. Compared with survival patients, the non-survival patients were older (years old: 59.2±12.5 vs. 51.2±11.4), and had more comorbidities, including coronary heart disease, hypertension, myocardial damage and thrombocytopenia (coronary heart disease: 33.3% vs. 11.1%, hypertension: 28.6% vs. 9.5%, myocardial damage: 73.8% vs. 11.1%, thrombocytopenia: 61.9% vs. 14.3%), and received more mechanical ventilation (92.9% vs. 44.4%), with significant differences (all P < 0.01). The variables of gender, age, basic diseases, mechanical ventilation and complications were included in the unconditional Logistic regression analysis, which showed that gender [odds ratio ( OR) = 2.852, 95% confidence interval (95% CI) was 0.122-66.694], age ( OR = 3.257, 95% CI was 0.466-18.584), coronary heart disease ( OR = 7.337, 95% CI was 0.227-87.021), hypertension ( OR = 5.517, 95% CI was 0.258-65.024) and concurrent myocardial damage ( OR = 7.322, 95% CI was 0.278-95.020) and thrombocytopenia ( OR = 3.968, 95% CI was 0.325-35.549) were independent risk factors for death in patients with severe and critical COVID-19 during hospitalization. According to the risk factors, the death prediction model was constructed and ROC curve was analyzed, which showed that the area under ROC curve (AUC) of death prediction model for predicting the mortality of patients with severe and critical COVID-19 during hospitalization was 0.804, the sensitivity was 83.8%, and the specificity was 82.3%. Conclusions:Various risk factors are associated with the death of severe or critical COVID-19 patients, such as gender, age, basic diseases and complications. The death prediction model is constructed by gender, age, basic diseases with coronary heart disease and hypertension, concurrent myocardial damage and thrombocytopenia, which has certain predictive value for the death of patients with severe or critical COVID-19.

Relationship between the establishment of percutaneous renal access and injury of the renal blood vessels using different puncture pathways in an animal model / 中华泌尿外科杂志

Objective:To compare the injury of renal blood vessels using different puncture pathways and access sizes.Methods:Between April 2018 and June 2019, eighty fresh pig kidneys were selected to perform percutaneous puncture and dilation, which was used to compare the injury of renal blood vessels with different puncture pathways and access sizes. The puncture pathway included the centerline of the normal renal pyramid (A), centreline of one side pyramid of the fused renal pyramid (FRP) (B), midline of the entire FRP (C) and midline of the renal column (D). The access size included F8, F12, F16, F20, F24 and F30. Histopathological methods were used to analyze the injury of renal blood vessels.Results:The puncture through paths A and B mainly caused injury to the grade Ⅴ and Ⅵ arteries in renal cortex. The puncture often directly injures the grade Ⅳ artery in path C. The puncture often simultaneously injures the grade Ⅲ-Ⅵ arteries in path D. Grade Ⅲ artery injury began to occur when paths A, B, C, and D were dilated to F30, F24, F16, and F12, respectively. The degree of arterial injury among the four different puncture pathways was significantly different in F8, F12, F16, F20, F24 and F30 ( P<0.05). Statistical differences were found between paths A and D in F12, F16, F20, F24 and F30 ( P<0.05), and between paths A and C in F16, F20 and F24 ( P<0.05). No significant difference was found between paths A and B in all access sizes ( P>0.05). Compared with F8, the degree of arterial injury of the F30 in path A and the F24 and F30 in path B were increased significantly ( P<0.05). Conclusions:Vascular injury in path D was the most serious followed by that in path C. Relatively little vascular injury can be achieved in paths A and B. The vascular injury increased when the path B was dilated to F24, while the path A needed to be dilated to F30.

Efficacy of oral bosentan for treatment of congenital heart disease-associated pulmonary arterial hypertension / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of oral bosentan in the treatment of congenital heart disease-associated pulmonary arterial hypertension.</p><p><b>METHODS</b>24 patients with congenital heart disease-associated pulmonary arterial hypertension, including 4 receiving heart surgery and 20 with surgical contraindications, were enrolled in this study. All the patients were given oral bosentan and followed up regularly for analyzing the outcomes and side effects.</p><p><b>RESULTS</b>One patient was lost to follow up and one patient died. Systolic pulmonary artery pressure showed no significant changes at 2 (93.6 ± 17.2 mmHg) and 4 months (85.7 ± 25.5 mmHg) of bosentan treatment compared to that before the medication (97.8 ± 14.9 mmHg) (P=0.096), but decreased significantly after a 6-month therapy (80.9 ± 25.0 mmHg, P=0.029). The 6-minute walking distance increased significantly after a 2, 4, and 6-month therapy [(488 ± 98.8, 496.3 ± 89.0, and 491.3 ± 114.2 m, respectively; P=0.004, 0.003, and 0.004 vs the distance before medication (317.0 ± 134.1)]. The New York heart functional classification was improved significantly after a 2, 4, and 6-month therapy [(2.0 ± 0.5, 1.8 ± 0.4, and 1.7 ± 0.5, respectively; P<0.001 vs pre-medication score (2.9 ± 0.5)). Hepatic and renal function remained normal, and ALT and AST showed no significant variations during the medication (P>0.05).</p><p><b>CONCLUSION</b>Oral bosentan can effectively relieve the symptoms, decrease pulmonary artery hypertension, and improve exercise tolerance and cardiac function classification in patients with pulmonary artery hypertension associated with congenital heart disease with good safety and mild side effects.</p>

Clinical study on the treatment of primary premature ejaculation with paroxetine hydrochloride and tamsalosin / 重庆医学

Objective To evaluate the therapeutic effects and adverse events on treatment of primary premature ejaculation (PE) with paroxetine hydrochloride and/or tamsalosin .Methods 225 cases of healthy men ,a history of lifelong PE and an intravaginal e‐jaculation latency time(IELT) < 120 sec were included in this study .The patients were divided into three groups(with 75 cases in each group) .Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks ;group B were given tamsalosin 0 .2 mg/d for 8 weeks ;group C were given paroxetine hydrochloride and tamsalosin for 8 weeks .The effects and adverse events were evaluated by the overall change and fold increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP) .Results The reliable data from 198 patients were achieved .The mean IELT after treatment were significantly improved in all groups than that of before treatment (P<0 .05) .The mean IELT in group C was increased for 8 .15 min after treatment .The in‐creased folds of mean IELT in group C (8 .02 folds) was significantly higher than that in group B (1 .98 folds)and group A (6 .92 folds)(P<0 .01) .The mean PEP scores that include measures of perceived control over ejaculation ,satisfaction with sexual inter‐course ,ejaculation‐related personal distress ,ejaculation‐related interpersonal difficulty were significantly improved in all groups after treatment .The mean PEP scores in group C had more significant improvements than that in group A and B .The prevalence of ad‐verse events in group A ,B ,C were 10 cases(13 .3% ) ,2 cases(2 .6% ) and 9 cases(12 .0% ) ,respectively .Conclusion Paroxetine hydrochloride combined with tamsalosin lead to better therapeutic effects and could be a priority selection for the treatment of pri‐mary PE .

Early results of left atrial appendage closure in cerebral ischemic stroke reduction in patients with mitral valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of left atrial appendage (LAA) closure for cerebral ischemic stroke prevention following mitral valve replacement.</p><p><b>METHODS</b>Retrospective data on 860 consecutive adult patients undergoing mitral valve replacement between January 2008 and January 2013 were analyzed. There were 414 male and 446 female patients, with a mean age of (53 ± 12) years. The patients were divided into two groups according to whether the left atrial appendage was closed during operation: LAA closure group (n = 521) and non-LAA closure group (n = 339).Early mortality, postoperative cerebral ischemic stroke and the risk factors for cerebral ischemic stroke were assessed. Multivariate analysis was performed using logistic regression analysis.</p><p><b>RESULTS</b>Compared with non-LAA closure group, LAA closure group had higher proportion of female gender, higher percentage of patients with cardiac insufficiency, pulmonary hypertension and left atrial thrombus, higher incidence of mechanical valve implantation and concurrent tricuspid surgery, and larger preoperative diameter of left atrium, but lower proportion of hypertension and patients undergoing coronary artery bypass surgery, and shorter aorta cross clamping time (χ² = 6.807 to 122.576, t = -2.818 and 3.756, all P < 0.05). There were no differences in exploratory thoracotomy for bleeding and in-hospital mortality between the two groups. Postoperative cerebral ischemic stroke occurred in 12 patients (1.4%). The incidence of cerebral ischemic stroke in LAA closure group was significantly lower than in non-LAA closure group (0.6% vs.2.7%, χ² = 6.452, P = 0.011).Logistic regression analysis showed that LAA closure was a significant protective factor for postoperative cerebral ischemic stroke (OR = 0.189, 95% CI: 0.039 to 0.902, P = 0.037) while history of cerebrovascular disease (OR = 4.326, 95% CI:1.074 to 17.418, P = 0.039) and preoperative diameter of left atrium (OR = 1.509, 95% CI: 1.022 to 1.098, P = 0.002) being the independent risk factors for postoperative cerebral ischemic stroke. The subgroup analysis showed that, for atrial fibrillation patients, LAA closure was a strong protective factor (OR = 0.064, 95% CI: 0.006 to 0.705, P = 0.025), but LAA closure was not a significant predictive factor (OR = 1.902, 95% CI: 0.171 to 21.191, P = 0.601) in non-atrial fibrillation patients.</p><p><b>CONCLUSION</b>Concurrent LAA closure during mitral valve replacement is safe and effective to reduce the early postoperative risk of cerebral ischemic stroke in atrial fibrillation patients.</p>

Surgical treatment of aortic paravalvular abscess by infective endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical features, pathology and surgical treatment experiences in the patients with aortic paravalvular abscess by infective endocarditis.</p><p><b>METHODS</b>The study consisted of a retrospective analysis of 29 cases with aortic paravalvular abscess by infective endocarditis underwent surgical treatment between January 2001 and June 2013. Among the 29 patients, 22 were male and 7 were female, and the mean age was (37 ± 16) years (range from 11 to 63 years). The primary cardiac disease was congenital aortic valve malformation in 16 patients. There were 15 patients with a history of severe heart failure. Of 29 cases, 8 abscess cavities, 13 pseudoaneurysms and 6 fistulas were found, and complete aortoventricular discontinuity was present in 5 patients with serious infections. Of them, the abscess was above the annulus in 14 patients and below the annulus in 10 patients, and simultaneously involved the annulus above and below in 5 patients. 19 patients were culture positive either positive preoperative blood cultures or positive cultures of surgical specimens, including 9 patients with Staphylococcus infection. The paravalvular defect was repaired by patch in 19 cases, and by local closure in 10 cases. The valvular annulus was reconstructed simultaneously in 16 patients. Aortic valve replacement was performed in 26 patients, and Bentall procedure in 2 patients, including 23 with prosthetic mechanical valve and 5 with biological valve.</p><p><b>RESULTS</b>Of the total 29 patients, 28 patients were recovered, and 1 patient was died of sepsis. During 3 months to 13 years postoperative follow-up (average 4.5 years), one was died of non-cardiac cause, and no patient had recurrent endocarditis and paravalvular leakage.</p><p><b>CONCLUSIONS</b>Aortic paravalvular abscess by infective endocarditis is not uncommon, prone to heart failure. According to the different pathological manifestations, the appropriate surgical approach and strategy can achieve satisfactory outcomes.</p>

Emergency coronary artery bypass grafting for acute coronary syndrome: mid-term follow-up results / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with emergency coronary artery bypass grafting (ECABG) for management of acute coronary syndrome and analyze the mid-term follow-up results.</p><p><b>METHODS</b>Forty-five ECABG surgeries were performed in 34 male and 11 female patients (aged 65.6∓5.8 years) for cardiogenic shock (5 cases), acute heart failure (6 cases) and refractory unstable angina (34 cases). Twenty patients received the operation within one week after acute myocardial infarction (AMI) and 18 were preoperatively supported by intra-aortic balloon pumping (IABP). All patients had triple-vessel disease and 15 had left main stenosis. Ten patients experienced two myocardial infarctions and 6 had chronic renal dysfunction including two requiring hemodialysis. On-pump operations were performed in all cases with a mean CPB time of 104.2∓29.7 min and cross clamping time of 69.0∓21.3 min. Cold blood or HTK cardioplegia was used for myocardial protection. The left internal mammary artery (LIMA) was routinely anastomosed to the left anterior descending artery (LAD), and the great saphenous vein (GSV) to other target vessels. The mean number of grafts was 2.9∓0.6.</p><p><b>RESULTS</b>Forty-one patients were cured and discharged and 4 patients died with an in-hospital mortality of 8.9%, including one associated with cardiac event (2.2%). IABP was weaned off within 28.5∓10.6 h after surgery except for one patient who died of multiple organ and system failure (MOSF). Thirty-eight patients (92.7%) were followed up for a mean of 37.3∓16.7 months, during which 2 patients died with a mid-term survival rate of 94.7%. Thirty-five (92.1%) patients had New York Heart Association (NYHA) class I and II. The freedom from cardiac event was 90.5%. Follow-up echocardiography showed significantly improved left ventricular dimension and ejection fraction in these cases (P<0.05), and graft patency was 95.8% for the LIMA and 90.5% for the GSV.</p><p><b>CONCLUSION</b>Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management.</p>

Fabrication of nanofibers with antimicrobial functionality used as filters: protection against bacterial contaminants.

A comparative study of antimicrobial activity is done using three different electrospun nanofibers namely-CA, PAN, and PVC used as control and with various amounts of AgNO(3) being treated with UV-irradiation leading to the enhancement of silver nanoparticles. DMF is used as the common solvent which helps to undergo spontaneous slow reduction at room temperature to form silver nanoparticles followed by UV-irradiation using a 400 W source. The time required for the formation of silver nanoparticles is short and they are more or less well dispersed with few such aggregates. The presence of silver nanoparticles is confirmed using various characterization techniques. The antimicrobial activity is studied using nanofibers with fabricated functionality.

Good outcomes from cardiac valve surgery in the elderly over 70 years / 中华胸心血管外科杂志

ObjectiveTo evaluate the outcomes for elderly( ＞70 years) patients undergoing valvular heart surgery and determine the early mortality and major morbidity associated with cardiac valve surgery in the elderly.MethodsBetween 2005and 2011,1366 patients underwent cardiac valve surgery in our department.115 patients(65 males,50 females) were 70 or older [aged (74.3 ± 3.1 ) years].Rheumatic valvular disease presented in 68 ( 59.1％ ),degenerative valvular disease in 33(28.7 ％),congenital heart disease in 6 (5.2 ％) and the others in 8 (7.0％).20 cases( 17.4％ ) had hypertention,17 cases( 15.8 ％ ) had diabetes mellitus,18 (15.7％) had coronary heart disease.Chronic obstructive pulmonary disease was found in 25 cases(21.7 ％ ),and renal insufficiency was found in 9(7.8 ％ ).6 patients(5.2％ ) had the history of cerebrovascular disease.72 (62.6 ％) had atral fibrillation and 11 cases(9.6％ ) had the history of cardiac valve surgery previously.75(65.2 ％ ) cases were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ.Left ventricular ejection fraction (LVEF) was 0.28-0.72 (0.53 ± 0.01 ).All the patients receieved coronary angiography preoperatively.All the operations were performed on cardiac-pulmonary bypass (CPB) with moderate hypothermia.During CPB,the perfusional pressure was maintained between 60-70 mm Hg and the oxygen saturation for mixed venous blood was kept above 0.70.Artificial ultrafilitration was performed for all the patients during the time of CPB.55 ( 47.8 ％ ) patients had mitral valve replacement ( MVR),3 (2.6％) had mitral valve repair( MVP),33 (28.7 ％) had aortic valve replacement (AVR),16 ( 13.9 ％ ) had AVR +MVR,5(4.3％ ) had AVR + MVP,and 3 had tricuspid replacement.The concomitant procedures included left atrial thrombus scavenging in 18( 15.7％ ),tricuspid valvularplasty in 71 (61.7 ％ ),bental procedure in 6 (5.2 ％ ),and coronary artery bypass grafting(CABG) in 15 ( 13.0 ％).ResultsThe early mortality was 0.87 ％.The major complications included sever low cardiac output syndrome in 6 patients,transient atrial fibrillation in 17,acute renal failure requiring dialysis in 3,delayed ventilation assistance in 12,and stroke in 3.112 (97.4％) patients survived during 6 months period of follow-up,in whom only 8(7.14％) were in NYHA functional class Ⅲ-Ⅳ which was lower significantly compared with that preoperatively.ConclusionHeart valve surgery for elderly patients can get satisfactory result and early mortality and major mortality is low for them.Concerns over the risk of cardiac valve surgery in the elderly should not prevent referral,and elderly patients can do well.

Analysis of blood flow in sequential and individual saphenous vein grafts in off-pump coronary artery bypass grafting / 中南大学学报(医学版)

OBJECTIVE@#To compare the blood flow in sequential and individual saphenous vein grafts (SVGs) and to analyze the influence of the location of the target vessel in off-pump coronary artery bypass grafting (OPCAB).@*METHODS@#A total of 464 SVGs in 412 patients receiving OPCAB were nested into individual SVG (n=206), double (n=241) or triple sequential SVG (n=15), and analyzed.@*RESULTS@#The blood flow in double and triple SVGs was significantly higher than in individual SVGs [(43.4±22.5), (43.7±19.2) and (28.9±18.7) mL/min, respectively, P<0.001, P=0.047]. There were no differences between flow in double and triple SVGs (P=0.96). Pulsatility index (PI) of the three groups were similar (2.6±1.2, 2.5±1.6, 2.8±0.9, respectively, P=0.49, P=0.49). In individual SVGs to right coronary artery, the blood flow was higher than in the posterior descending branch (PDA) (P=0.047) and posterior branch of left ventricle (PBLV), the flow-time in systole period was longer than diagonals (P=0.003), obtuse marginal (OM) (P=0.013) and PDA (P=0.002), PI was significantly lower than PDA (P=0.033) and PBLV (P=0.032). The blood flow in individual SVGs to diagonals was significantly lower than in other target vessels except for PBLV (P<0.05). Flow in double SVGs to PDA-PBLV was significantly lower than in PDA-OM.@*CONCLUSION@#The mean blood flow in double and triple sequential SVGs is about 1.5 times higher than in individual SVGs. Individual, double, and triple SVGs have similar pI. Flow in individual SVGs to diagonals was significantly lower than in other target vessels except for PBLV.

Surgery in patients of severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction / 中华胸心血管外科杂志

Objective To assess the result of aortic valve replacement(AVR) for patients of severe aortic stenosis(AS)with low transvalvular gradients(TVG) and severe left ventricular dysfunction,and try to identify the determinants of survival,functional status and change in left ventricular ejection fraction(LNEF) during follow-up.Methods From 2005 to 2011,35patients with aortic valve area(AVA) ＜ 1 cm2,LN EF ＜ 0.40 and mean TVG ＜ 30 mm Hg underwent AVR in our hospital.The average age of the patients was 58 yeats old,and 88.6％ of the patients were in New York Heart Association (NYHA) functional class Ⅲ/IV at admission to the hospital.The AVA was (0.70 ± 0.09) cm2,LVEF was 0.276 ± 0.020,TVG was (26.0 ± 2.3) mm Hg,and left ventricular end-diastolic diameter (LNEDD) was (6.3 ±0.4) cm respectively.35 prosthetic valves were implanted,including 20 mechanical prostheses and 15 biological prostheses with the mean sizs of (23 ± 1) mm.Concomitant procedures included mitral valvularplasty in 5.tricuspid valve repair in 3 and coronary artery bypass grafting in 4.Results The perioperative mortaiity was 8.6％.Follow-up period was 3 to 60 monthes.The survival rates were:1-year 78％,2-year 68％,5-year 60％.LVEF increased significantly to 0.358 ± 0.047 one week postoperatively (P =0.008) and 0.426 ± 0.031 six months later (P ＜ 0.01)).LNEDD decreased to (5.7 ± 0.4) cm one week later(P =0.062) and (5.3 ±0.3)cm 6 months postoperatiwely (P ＜ 0.01).NYHA functional class improved from 88.6％ in class Ⅲ/Ⅳ to 35％ (P ＜0.01).Compared with those who surviwd during follow-up,the patients who died during follow-up were older in the year of operation[(63 ± 10) vs (54 ± 11),P =0.017],their NYHA functional class was higher[(3.9 ±0.2) vs (2.9 ±0.3),P =0.003]and the LVEDD for them in one week postoperatively was larger[(6.0 ± 1.0) cm vs (5.5 ± 0.3) cm,P =0.031].Conclusion The left ventricle contractile reserve seems to play an essential role for surgery in patients of severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction.AVR can be performed for them with acceptable results.

Comparative studies on perioperative hemodynamics in coronary artery bypass with or without cardiopulmonary bypass / 解放军医学杂志

Objective To analyze the hemodynamic changes during coronary artery bypass grafting with or without cardiopulmonary bypass.Methods Thirty patients undergone coronary artery bypass grafting from January to June,2006 were retrospectively analyzed.Among them,12 patients were operated on with cardiopulmonary bypass(CCABG)and 18 without cardiopulmonary bypass(OPCAB).The stabilizator(type Octops III)was used to fix target vessels in OPCAB group.In CCBAG group,the extracorporeal circulation was used routinely,and internal mammary artery and saphenous vein were used to anastomose with target branches of coronary artery.The hemodynamic changes at different time points during and after operation were monitored,and the relevant parameters were also recorded.Results The anaesthesia time,intraoperative blood loss and fluid input,and ventilating time after operation in CCABG group were significantly higher than those in OPCAB group,and the postoperative haematocrit(HCT)was significantly lower in CCABG group than that in OPCAB group(P

SURGICAL MANAGEMENT OF 14 CASES COR TRIATRIATUM / 解放军医学杂志

To review the experience in surgical management of cor triatriatum, fourteen patients underwent open heart surgery under hypothermic cardiopulmonary bypass (CPB) from 1986 to 2001 for their cor triatiatum were studied retrospectively. The mean age of the patients was 6 6 years, with a range of 1 to 26 years. Eight patients were men and six were women. Eleven cases were diagnosed by two dimensioned echo cardiography with colour Dopplar imaging. Eleven patients with complete cor triatriatum were operate on enlarging ASD, resecting the fiboromuscular membrane and patching ASD and one patient with incomplete cor triatriatum were operated on through similar techniques and the associated abnormalities were corrected at a time. Nine patients were followed up after surgery from 5 months to 15 years, no patient died and had salutary results. It suggested that two dimensional echo cardiography with colour Doppler imaging can diagnose this condition accurately, surgical treatment of cor triatriatum was satisfactory in longterm follow up.

ATRIAL FIBRILLATION AFTER OFF-PUMP CORONARY ARTERY BYPASS GRAFTING / 解放军医学杂志

70 years, history of stroke, and a tear of the pleura. Conclusions The incidence of AF in CABG and off-pump CABG were almost similar. Old age of the patient was the pathological basis for developing AF, and the history of stroke and a tear of the pleura were the predisposing factors.

Surgical treatment of double-chambered right ventricle: a report of 95 cases / 解放军医学杂志

Objective To summarize the experience in diagnosis and surgical treatment of double-chambered right ventricle (DCRV). Methods From 1990 to 2001, 95 patients with DCRV received surgical correction, including 56 males and 39 females, with an age ranging from 1 to 48. 82 cases had other cardiac abnormalities, 56 of whom had ventricular septal defect (VSD). Right atrium incision was made in 8 patients, right ventricular infundibular incision in 30, and both right atriotomy and ventriculotomy in 57. Results Muscular ring was found in 61 patients, and muscular shelf in 34. No death occurred. Preoperatively, 15 patients and 3 patients were misdiagnosed by echocardiography as VSD and pulmonary stenosis, respectively. The diagnosis was corrected during operation. Conclusions DCRV was often found to be complicated with other cardiac disorders. Echocardiography was the main diagnotic method, but the misdiagnosis was not uncommon. So it was very important to make surgical exploration, especially on tricuspid valve and pulmonary valve during intraventricular operations. Right ventricular infundibular incision was convenient and dependable.

Clinical analysis of preoperative coronary angiography before valvular surgery with concomitant coronary artery bypass grafting / 解放军医学杂志

Objective To summarize the clinical experience of coronary angiography before coronary artery grafting (CABG) with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old (mean age 60 3.5) with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 50% of its calibre was considered positive, and 75% stenosis (including LMCA stenosis more than 50%) was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases (23.4%) had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0.5%, which was significantly lower compared with patients with valve surgery combined with CABG group (4.2%)(P

Experience of harvesting great saphenous vein without infectious complication in 1050 cases of coronary artery bypass grafting / 解放军医学杂志

Objective To introduce experience of harvesting great saphenous vein (GSV) and surgical techniques to avoid infectious complication in coronary artery bypass grafting (CABG). Methods One thousand and one hundred twenty CABG, including 523 conventional CABG (CCABG) and 597 off-pump coronary artery bypass grafting (OPCAB), were performed by the same surgical team. One thousand and fifty GSV were used as the conduit. Left internal mammary artery was routinely anastomosed to left anterior descending artery(LAD), and GSV and/or radial artery to the other target vessels. Preoperative selection of GSV, operative procedure of harvesting, meticulous postoperative supervision and appropriate treatment of the incision, and the control of risk factors as diabetes mellitus, which composed an integral part of periopertive strategies, are critical to avoid infectious complication. Results No infection occurred. Recovery of two patients with diabetes mellitus was complicated by delayed healing of incision. In ten patients there was a slight exudation from the incision, and they healed without infection after the addition of 2~3 interrupted sutures. Healing was not delayed. Swelling of the involved legs occurred in the majority of patients, and numbness along the incision was also documented in some patients, and it usually recovered to normal three months after operation, after being followed-up for 3 months to 2 years. Conclusion Infection can be completely avoided after the planned procedure of harvesting GSV and meticulous perioperative care.

Perioperative management of the elderly patients undergoing coronary artery bypass grafting / 解放军医学杂志

Objective To introduce the strategies of coronary artery bypass grafting (CABG) surgery for elderly patients over 65 years old. Methods Three hundred and ninety four elderly patients were retrospectively studied, 92.4% of whom were complicated with other diseases. Off-pump CABG (OPCAB) was used in 248 cases (62.4%). For the remaining patients with severely compromised cardiac function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested with extrapleural harvesting technique and grafted to left anterior descending artery (LAD) in 96.2% of patients. Saphenous vein or radial artery was utilized for the other coronary arteries. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Perioperative blood sugar level was controlled at 6-10mmol/L by insulin. Results Grafts of per patient were 3.14?0.55 for on-pump CABG and 2.40?0.81 for OPCAB. Three patients died resulting in a mortality of 0.76%. The incidence of complication was 2.28%. The rest recovered uneventfully. Intubation time of OPCAB was significantly shorter than that of CCABG. Patients were discharged within 11.84?4.95 days after operation. Conclusion Good short-term result, namely low incidence of mortality and complication, could be obtained in elderly patients over than 65 years old undertaking CABG.

Surgical management of coronary artery disease associated with valvular heart disease / 解放军医学杂志

Objective To review the experience of surgical management of coronary artery disease associated with valvular heart disease. Methods From 1998 to 2004, fifty-seven patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60 years. Heart function (NYHA) was class II in 9 patients, class III in 37, class IV in 11. 37 patients had mitral valve lesion, 11 aortic valve lesion, and 9 with lesions of both valves. 26 cases had single-vessel disease, 20 with double-vessel disease,11 with triple-vessel disease, and 9 with main artery lesion. After cardiac arrest with the aid of cold cardioplegia under moderate cardiopulmonary bypass, distal anastomosis of the saphenous vein (SV) to the target vessels was first performed followed by valve replacement (49 patients) or valvular plasty (8 patients). The left mammary artery was grafted to the left anterior descending artery before aortic declamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping was 112.6 min. Results Except one patient, no mortality and severe morbidity occurred during hospitalization. Heart function was improved to class I-II and no one died during follow-up period. Conclusion CABG combined with valve surgery can be safely performed with good results.