ObjectiveTo explore the differential expression of Sirtuin1 (SIRT1) in type A aortic dissection at diverse ages.MethodsThe expression of SIRT1 and monocyte chemoattractant protein-1 (MCP-1) in aortic tissue of the patients with type A aortic dissection (an aortic dissection group) and coronary heart disease (a control group) from 2019 to 2020 in the First Hospital of China Medical University was analyzed. In each group, the patients were divided into 3 subgroups according to the age (a younger subgroup, <45 years; a middle age subgroup, 45-60 years; an elderly subgroup, >60 years). The quantitative real-time PCR, Western blotting and immunochemical stainning were used to detect the mRNA or protein expression of SIRT1 and MCP-1. ResultsA total of 60 patients were included in each group, including 79 males and 41 females. There were 20 patients in the yonger, middle age and elderly subgroups for the two groups, respectively. Compared with the control group, the expression of SIRT1 mRNA decreased in the aortic dissection group (the younger subgroup: 4.54±1.52 vs. 8.78±2.57; the middle age group: 2.70±1.50 vs. 5.74±1.07; the elderly group: 1.41±1.33 vs. 3.09±1.14, P<0.001). Meanwhile, SIRT1 mRNA in the aortic dissection group declined with age (P<0.01). Compared with the control group, SIRT1 protein expression decreased significantly in the aortic dissection group (the younger group: 0.64±0.18 vs. 1.18±0.47; the middle age group: 0.43±0.26 vs. 0.69±0.32; the elderly group: 0.31±0.24 vs. 0.45±0.29, P<0.01). The Western blotting results showed that the expression of SIRT1 protein in the aortic dissection group decreased with age (P<0.01). The MCP-1 protein expression of younger and middle age patients in the aortic dissection group was increased compared with that in the control group (the younger group: 0.65±0.27 vs. 0.38±0.22; the middle age group: 1.08±0.30 vs. 0.46±0.36, P<0.001). MCP-1 expression increased with age (P<0.01). The result of immunohistochemical staining for SIRT1 protein was similar to that of Western blotting.ConclusionThe expression of SIRT1 decreases in patients with aortic dissection disease, and declines with age. SIRT1 may play an important role in the treatment and screening of type A aortic dissection.
Objective To investigate the effect of combined delivery of hepatocyte growth factor (HGF) and insulinlike growth factor-1 (IGF-1) on the development of bone mesenchymal stem cells (BMSCs) differentiation by expression of GATA-4，and to supply some evidence for clinical BMSCs transplantation therapy. Methods BMSCs were isolated from the femurs and tibias of the randomly assigned rabbits and cocultured with myocytes in a ratio of 1∶1. Myocytes were obtained from neonatal rabbits ventricles. 150 ng/ml HGF and 200 ng/ml IGF-1 were added into 4 culture bottles of 8 bottles and the other 4 bottles were not. After BMSCs were cocultured with myocytes for 1 day, 3 days, 1 week, and till 6 weeks， differentiated BMSCs were targeted and microdissected with a laser capture microdissection system, and then ribonucleic acid (RNA) was extracted and isolated. The differentiation of BMSCs in coculture was confirmed by immunohistochemistry, electron microscopy, and reverse transcriptionpolymerase chain reaction (RT-PCR). And expression of GATA-4 in BMSCs was detected by semiquantitative RT-PCR. Results Before coculturing, the BMSCs were negative for α-actinin and exhibited a nucleus with many nucleoli. After coculture with myocytes, some BMSCs became αactininpositive and showed a cardiomyocytelike ultrastructure, including sarcomeres, endoplasmic reticulum, and mitochondria. BMSCs cocultured with myocytes expressed cardiac transcription factor GATA-4. IGF-1 and HGF delivery can significantly increased expression of GATA-4 for the differentiated BMSCs as compared with cells of no delivery of HGF and IGF-1. The expression level of GATA-4 in captured BMSCs began to increase at the 1st day, reach the peak at the 2nd week and kept high expression level after the 2nd week. Conclusion BMSCs can transdifferentiate into cells with a cardiac phenotype when cocultured with myocytes. Differentiated myocytes express cardiac transcription factors GATA-4. Administration of HGF and IGF-1 promoted the development of BMSCs transdifferentiate into cardiac phenotype, which is associated with the increase in expression level of GATA-4.
Objective To investigate the risk factors of acute kidney injury（AKI）after onpump coronary artery bypass grafting(on-pump CABG) and off-pump coronary artery bypass grafting (off-pump CABG) in order to provide superior renal protective measure after operation. Methods The clinical data of 849 consecutive patients undergone coronary artery bypass grafting（CABG） in a single institution between January 1990 and August 2006 were retrospectively analyzed. A simplex module and a multivariate logistic regression model were constructed to identify risk factors for the development of AKI. Results AKI were occurred in 61 patients （11.8%，61/518） undergone off-pump CABG and 63 patients （19.0%，63/331） undergone onpump CABG. Peak of serum creatinine (Scr) after operation arrived at the 12th hour and 24th hour in patients undergone off-pump CABG and patients undergone on-pump CABG respectively. The rapidly recovering period of Scr in patients undergone off-pump CABG and on-pump CABG were from the 24th hour to the 48th hour and from the 48th hour to the 72th hour respectively.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of postoperative AKI following isolated CABG were associated with heavy body mass index（OR=1.190，1.179）, emergent procedure（OR=2.737，3.678）, diabetes（OR=1.705，2.042）, peripheral vascular disease（OR=2.002，2.559）,ejection fraction≤30%（OR=2.267，4.606）, and New York Heart Association(NYHA) class Ⅲ and Ⅳ（OR=1.861，1.957） were risk factors for the development of postoperative AKI following offpump and on-pump CABG; pulse pressure≥60mmHg and triplevessel disease were risk factors for the development of postoperative AKI following off-pump CABG. But perioperative and postoperative intra aortic balloon pumping (IABP) could make protective effect on kidney for on-pump CABG （OR=0.146）which could lessen development of AKI. Conclusions It is critical period for AKI that renal protection strategies should be performed from general anesthesia until postoperative 48 hours (off-pump CABG) and 72 hours (on-pump CABG). AKI might be the most important stage in which a positive test should increase the physician’s awareness of the presence of risk for renal injury and then preventive or therapeutic intervention could be performed when the situation still is reversible.
Objective To investigate the incidence of perioperative stroke in elderly patients (≥65 years) undergoing offpump coronary artery bypass grafting (OPCAB) versus onpump coronary artery bypass grafting (CABG). Methods WTBZ]We electronically searched PubMed (from 1966 to 2010), Cochrane Library (Issue 12, 2010), EMbase (from 1974 to 2010), CNKI (Chinese, from 1997 to 2010), CBM (Chinese, from 1989 to 2010), and manually searched some journals to collect published or grey literatures of clinical researches on comparison between OPCAB and CABG for elderly patients in the incidence of perioperative strokes. We assessed the methodology quality of included researches and extracted data to conduct metaanalysis by RevMan 5.0 software. Four subgroups (aged 65 to 70 years, 70 to 75 years, 75 to 80 years, and older than 80 years) according to the age of the patients, and subgroups according to the study design were analyzed respectively. Sensitivity analysis was conducted by deleting the studies of low quality. Results We finally identified 17 studies including 5 historical cohort studies and 12 case control studies. No randomized controlled trial was searched. A total of 7 275 patients including 2 521 (34.65%) in the OPCAB group and 4 754 (65.35%) in the CABG group were identified. The metaanalyses of historical cohort study subgroup and case control study subgroup showed statistical difference in stroke incidence between the OPCABG and CABG groups with OR 0.25 and 95%CI 0.10 to 0.62,and with OR 0.25 and 95%CI 0.15 to 0.41,respectively. Statistical difference was tested in three age subgroups (70 to 75 years, 75 to 80 years, and elder than 80 years) and the OR (95%CI) value was 0.35 (0.21, 0.59), 0.14 (0.04, 0.54), and 0.09 (0.02, 0.38),respectively. The difference of stroke incidence between OPCAB and CABG patients in all the three subgroups was significant, while there was no statistical difference in the subgroup aged 65 to 70 years with OR 0.10 and 95%CI 0.01 to 1.68. The sensitvity analysis showed that metaanalysis was stable in case control study subgroup, was not stable in historical cohort study subgroup. Conclusions OPCAB may reduce incidence of perioperative stroke in elderly patients. However, it still needs to be confirmed by more multicenter, largesample, and randomized doubleblind controlled trials in the future.
ObjectiveTo investigate the incidence of acute kidney injury (AKI) after deep hypothermic circulatory arrest (DHCA), to explore the risk factors and prognosis of postoperative AKI, and to establish a relatively accurate preoperative risk assessment strategy and prevention measures.MethodsThe clinical data of 252 patients who underwent deep hypothermic circulatory surgery in our hospital from January 2014 to October 2018 were retrospectively analyzed. There were 179 males and 73 females with an average age of 53.6±11.6 years. The patients were divided into an AKI group and a non-AKI group according to the AKI diagnostic criteria developed by kidney disease improving global outcomes (KDIGO). The data of the two groups were compared, and the risk factors related to AKI after DHCA were analyzed by single factor and multivariate logistic regression.ResultsAmong the 252 patients enrolled, the incidence of AKI was 69.0%. The postoperative hospital mortality rate was 7.9% (20/252). The univariate analysis showed that the patient's age and body mass index (BMI)≥28 kg/m2, left ventricular ejection fraction<55%, preoperative serum creatinine (Scr)≥110 μmol/L, preoperative estimated glomerular filtration rate (eGFR), Cleveland score and intraoperative cardiopulmonary bypass time, intraoperative infusion of red blood cells, intraoperative infusion of plasma, postoperative mechanical ventilation time≥40 h and other indicators were significantly different between the two groups (P<0.05); multivariate logistic regression analysis showed that there was significant difference between the two groups in age (OR=1.040, 95% CI 1.017–1.064, P=0.001), BMI≥28 kg/m2 (OR=2.335, 95%CI 1.093–4.990, P=0.029), eGFR<90 mL/(min·1.73 m2) (OR=2.044, 95%CI 1.082–3.863, P=0.028), preoperative Cleveland score (OR=1.300, 95%CI 1.054–1.604, P=0.014) and intraoperative cardiopulmonary bypass time (OR=1.009, 95%CI 1.002–1.017, P=0.014).ConclusionThe incidence of AKI is higher after DHCA. Patients with postoperative AKI have longer hospital stay and higher risk of hospitalization death. The age of patients, BMI≥28 kg/m2, eGFR<90 mL/(min·1.73) m2, Cleveland score, intraoperative extracorporeal circulation time are independent risk factors for AKI after DHCA.
ObjectiveTo evaluate the effect of human heme oxygenase 1 augmentation in vein grafts by adenoviral mediated gene transfer of heme oxygenase 1 (Ad hHO 1) on intimal hyperplasia.MethodsTwenty one Japanese white rabbits were divided into three groups: control group, Ad null control group, and Ad hHO 1 group(each group 7 rabbits). During the operation of rabbits jugular vein into carotid artery interposition grafting, harvested rabbit jugular vein segments were exposed for 30min at room temperature to heparin saline, recombinant replication deficient adenovirus encoding hHO 1(Ad hHO 1, 1× 10 9pfu/ml), and nude recombinant replication deficient adenovirus (Ad null, 1×10 9pfu/ml). Quantitative histological studies of the vein segments were performed 28 days after operation. Protein of hHO 1 was detected with method of immunohistochemical staining(S P) in 14 days and 28 days after operation.ResultsThe average intimal thickness, medial thickness and intimal to medial(I/M) ratio were calculated for each group 28 days after bypass operation. Compared to intimal thickness, I/M ratio of control group veins and Ad null group veins,Ad hHO 1 group veins decreased significantly( P lt;0.01). There was no statistically difference in medial thickness ( P gt;0 05). Strong staining of hHO 1 was detected in vein grafts wall of Ad hHO 1 group.ConclusionAd hHO 1 gene therapy may inhibit intimal hyperplasia of vein grafts in rabbits.
Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.
Objective To investigate whether the agonist of delta opoid receptor D-Ala(2),D-Leu(5) enkephalin (DADLE) has the effect of decreasing myocardial injury during ischemia-reperfusion of adult rabbits’ myocardium，so that a new mehanism and way to myocardial protection could be found. Methods Langendorff model was used during the experiment. Thirty rabbits were divided into three groups randomly (each group 10 rabbits). Control group: St.Thomas Ⅱ cardioplegic solution was used; group 1: St.Thomas Ⅱ cardioplegic solution and DADLE (1mg/kg) were used; group 2: St.Thomas Ⅱ cardioplegic solution and naloxone(3mg/kg) were used to induce the hearts to arrest respectively. After arrest the hearts were reperfused respectively. Data of left ventricle development pressure(LVDP) was recorded before and after ischemia. Biochemical indicators of myocardium, lactate dehydrogenase(LDH) were detected before and after ischemia. Some myocardial tissues were used to explore the changes of the tissue of ultrastructure with electron microscope，when the experiment was over. Still some myocardial tissues were to be detected by flow cytometer to evaluate the apoptosis of the myocardium. Results The LDH and LVDP showed significant difference among three groups after ischemia(Plt;0.05); LVDP in group 1 was higher than those in group 2 and control group(69.8±5.8 mmHg vs. 23.4±3.9 mmHg; 69.8±5.8 mmHg vs. 37.9±4.7 mmHg; Plt;0.05), the LDH in group 1 was lower than those in group 2 and control group(1 272.6±59.1 U/L vs. 2 764.4±27.7 U/L, 1 272.6±59.1 U/L vs. 1 884.4±37.5 U/L; Plt;0.05). The apoptosis rate in group 1 was lower than those in group 2 and control group. As could be shown from the ultrastructure: mitochondria structure was nearly normal in group 1; mitochondria structure was injuried severely in group 2; there was a minor injury in control group. Conclusion Agonist of δ opoid receptor DADLE in cardioplegic solution could induce hibernation, which has myocardial protection effect during ischemia-reperfusion injury.
Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
Objective
To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation (FMR) by echocardiography.
Methods
A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree: FMR-None/Trace (FMR-N/T group,n=33), FMR-Minor (FMR-Mi group,n=37), FMR-Moderate (FMR-Mo group,n=34) and FMR-Severe (FMR-Se group,n=13). We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle.
Results
The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree (FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se: 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively). The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree (P＜0.05).
Conclusion
There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.
