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ABSTRACT: BACKGROUND: To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre. METHODS: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II model. All patients were divided into single valve surgery and multiple valve surgery subgroup. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II model was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS: Observed mortality was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H-L: P=0.013), 3.33% for the original logistic EuroSCORE (H-L: P=0.08), and 2.52% for the EuroSCORE II (H-L: P<0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L: P=0.103) and poor calibration for patients undergoing multiple valve surgery (H-L: P<0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605). CONCLUSION: The EuroSCORE II model give an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation maybe suitable in patients undergoing single valve surgery, and creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is maybe required at our centre in the future.
Heart Lung & Circulation 01/2013; · 1.20 Impact Factor
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ABSTRACT: BACKGROUNDAND AIMOFTHE STUDY: The aim of this study was to develop a logistic risk prediction model for prolonged ventilation after adult heart valve surgery. MATERIALSAND METHODS: This is a retrospective observational study of collected data on 3965 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n = 2400) and a validation dataset (n = 1565). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for prolonged ventilation (defined as ventilation greater than 72 h). Performance of the model was then assessed by observed and expected rates of prolonged ventilation on the development and validation dataset. Model calibration and discriminatory ability were analyzed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 303 patients that required prolonged ventilation (7.6%). Preoperative independent predictors of prolonged ventilation are shown with odds ratio and P value as follows: (1) age, 1.9, P < .0001; (2) hypercholesterolemia, 5.3, P = .001; (3) renal failure, 18.2, P = .004; (4) previous cardiac surgery, 2.4, P = .0002; (5) left bundle branch block, 4.2, P = .011; (6) ejection fraction, 1.4, P = .003; (7) left ventricle weight, 1.5, P = .007; (8) New York Heart Association class III-IV, 1.8, P = .021; (9) critical preoperative state, 4.5, P < .0001; (10) tricuspid insufficiency, 1.2, P = .031; (11) concurrent CABG, 2.2, P = .019; and (12) concurrent other cardiac surgery, 2.1, P = .001. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P = .202 vs P = .291). The ROC curve for the prediction of prolonged ventilation in development and validation dataset was .789 and .710, respectively. CONCLUSIONS: We developed and validated a local risk prediction model for prolonged ventilation after adult heart valve surgery. This model can be used to calculate patient-specific risk by the logistic equation with an equivalent predicted risk at our center in future clinical practice.
Heart & lung: the journal of critical care 11/2012; · 1.04 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. METHODS: This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. CONCLUSION: We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in future clinical practice.
Heart Lung & Circulation 08/2012; · 1.20 Impact Factor
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ABSTRACT: BACKGROUND: The enhancer of zeste homolog 2 (EZH2) was found to be overexpressed and associated with tumor metastasis in esophageal squamous cell carcinoma (ESCC). On the other hand, it was reported that miR-26a, miR-98, miR-101, miR-124, miR-138 and miR-214 could inhibit the expression of EZH2 in some tumors. However, the role of miRNAs in the regulation of EZH2 expression in human ESCC has not been documented. The aim of this study was to determine the role of these miRNAs in the regulation of tumor metastasis via EZH2 overexpression in human ESCC. Methods and results The expression of these miRNAs and EZH2 mRNA were examined by qPCR and the expression of EZH2 protein was detected by western blot. The role of these miRNAs in migration and invasion was studied in ESCC cell line (Eca109) transfected with miRNA mimics or cotransfected with miRNA mimics and pcDNA-EZH2 plasmid (without the 3'-UTR of EZH2). Through clinical investigation, we found that miR-98 and miR-214 expression was significantly lower in ESCC tissues than in matched normal tissues, and the expression level of miR-98 and miR-214 was inversely correlated to EZH2 protein expression and the clinical features such as pathological grade, tumor stage and lymph node metastasis in ESCC. In Eca109 cells, overexpression of miR-98 and miR-214 significantly inhibited the migration and invasion of ESCC cells, which was reversed by transfection of EZH2. CONCLUSIONS: These findings suggest that decreased expression of miR-98 and miR-214 might promote metastasis of human ESCC by inducing accumulation of EZH2 protein.
Molecular Cancer 08/2012; 11(1):51. · 3.99 Impact Factor
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ABSTRACT: Background: We sought to develop and validate a logistic model and a simple score system for prediction of significant coronary artery disease (CAD) in patients undergoing operations for rheumatic aortic valve disease. Hypothesis: The simple score model we established based on the logistic model was efficient and practical. Methods: A total of 669 rheumatic patients (mean age 51 ± 9 years), who underwent routine coronary angiography (CAG) before aortic valve surgery between 1998 and 2010, were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (≤5%) patients, from which an additive model was derived. Receiver operating characteristic (ROC) curves were used to compare discrimination, and precision was quantified by the Hosmer-Lemeshow statistic. Significant coronary atherosclerosis was defined as 50% or more luminal narrowing in 1 or more major epicardial vessels determined by means of coronary angiography. Results: Eighty-eight (13.2%) patients had significant coronary atherosclerosis. Independent predictors of CAD include age, angina, diabetes mellitus, and hypertension. A total of 325 patients were designated as low risk according to the bootstrap logistic regression and additive models. Of these patients, only 4 (1.2%) had single-vessel disease, and none had high-risk CAD (ie, left main trunk, proximal left anterior descending, or multivessel disease). The bootstrap logistic regression and additive models show good discrimination, with an area under the ROC curve of 0.948 and 0.942, respectively. Conclusions: Our logistic regression model can reliably estimate the prevalence of significant CAD in rheumatic patients undergoing aortic valve operation, while the additive simple score system could reliably identify the low-risk patients in whom routine preoperative angiography might be safely avoided. Clin. Cardiol. 2012 doi: 10.1002/clc.22033 The authors have no funding, financial relationships, or conflicts of interest to disclose. Dr. Guan-xin Zhang and Dr. Bai-ling Li have contributed equally to the work. Dr. Lin-han is co-corresponding author (sh_hanlin@hotmail.com).
Clinical Cardiology 07/2012; · 2.15 Impact Factor
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ABSTRACT: To explore the feature of the edge-to-edge technique and its effect for mitral regurgitation due to myxomatous degeneration.
The in-patient data and follow-up outcomes of 58 patients after the edge-to-edge technique for mitral regurgitation due to myxomatous degeneration from January 2000 to January 2009 were analyzed retrospectively. Of the 58 patients, 32 patients were male and 26 patients were female, and the age range was from 43 years to 65 years with a mean of (56 ± 6) years, and moderate mitral regurgitation was observed in 18 patients and severe regurgitation in 40 patients, and the prolapse of the anterior leaflet was observed in 50 patients and the prolapse of the bileaflet in 8 patients. The edge-to-edge technique was performed in all patients and the annuloplasty was performed in 44 patients.
There was no perioperative death and serious complication. Postoperative transthoracic echocardiography of all the survivors indicated that the dimensions of left atrial and left ventricular were obviously decreased (P < 0.05) and mitral insufficiency was obviously improved (no regurgitation was observed in 9 patients and trace regurgitation in 30 patients and mild regurgitation in 19 patients) and there was no mitral stenosis. Totally 58 patients were followed up from 24 months to 95 months with a mean of (58 ± 20) months. During the follow-up, there were 2 deaths for noncardiac factors. Freedom from recurrent moderate or severe mitral regurgitation at 5 years after operations was 91.9%. According to undergoing combined annuloplasty or not, 58 patients were divided into the edge-to-edge technique group (14 cases) and the edge-to-edge technique + annuloplasty group (44 cases), and the survival analysis shows there was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between two groups (χ(2) = 4.034, P = 0.045) and long-term effect of the latter group was better.
The edge-to-edge technique can be conveniently used and bring about satisfactory perioperative and long-term effects for mitral regurgitation due to myxomatous degeneration. The combination of the edge-to-edge technique and the annuloplasty can improve the long-term effect significantly.
Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2012; 50(1):32-4.
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ABSTRACT: To observe the trend of change in perioperative blood glucose level in patients undergoing deep hypothermic circulatory arrest (DHCA), in order to evaluate the influencing factors of inciting hyperglycemia and the clinical effects of insulin control.
In the Department of Cardiothoracic Surgery of Changhai Hospital, 176 patients underwent aortic operation under DHCA from January 2000 to January 2010. Blood glucose, arterial blood gas and lactate levels were determined at four time points, including pre-cardiopulmonary bypass (CPB), pre-DHCA, post-DHCA, and at admission to intensive care unit (ICU). Hyperglycemia after surgery was controlled at the level of 6-8 mmol/L by intermittent subcutaneous injection or intravenous micropump injection of insulin. At the same time, the cumulative amount of insulin within 24 hours after surgery was recorded.
The blood glucose (mmol/L) level at pre-DHCA time point was significantly higher than that of pre-CPB (9.62 ± 1.79 vs. 5.04 ± 1.401,P<0.05), and the blood glucose level was further elevated at the time point of post-DHCA (14.91 ± 2.36,P<0.01) and in-ICU (15.32 ± 2.47) compared with that of pre-CPB (P<0.01). The level of blood glucose elevation was positively correlated with blood lactate level. One hundred and thirty-four patients (76.1%) insulin was given with intravenous micropump due to poor effect of intermittent subcutaneous injection of insulin in controlling blood glucose. Among whom 30 patients (17.0%) developed the phenomenon of insulin resistance. Perioperative hyperglycemia during DHCA was associated with old age (≥ 50 years old), primary hypertension, serious aortic valve disease, diabetes or coronary heart disease, emergency operation, CPB time ≥ 3 hours and DHCA time ≥ 45 minutes. The cumulative amount of insulin within 24 hours after surgery was increased significantly. The results of blood glucose (mmol/L) in-ICU were as follows : age ≥ 50 years old or < 50 years old (18.66 ± 2.52 vs. 12.90 ± 2.27); hypertension with and without (18.98 ± 2.55 vs. 12.31 ± 2.34); serious aortic valve disease with and without (19.59 ± 2.95 vs. 12.13 ± 2.23); diabetes with and without (20.62 ± 1.76 vs. 11.75 ± 1.11); coronary heart disease with and without (19.77 ± 2.98 vs. 12.01 ± 2.02); emergency operation with and without (19.78 ± 1.97 vs. 12.23 ± 1.38); CPB time ≥ 3 hours or < 3 hours (19.86 ± 1.89 vs. 11.70 ± 1.15); DHCA time ≥ 45 minutes or < 45 minutes (19.92 ± 1.88 vs. 11.64 ± 1.12), and all of them should statistical difference (all P < 0.05). The cumulative amount of insulin (U) within 24 hours after surgery was as follows: age ≥ 50 years old or < 50 years old (169.5 ± 56.6 vs. 110.2 ± 38.5); hypertension with and without (171.6 ± 64.0 vs. 104.8 ± 34.3); aortic valve disease with and without (171.4 ± 36.8 vs. 109.4 ± 27.6); diabetes with and without (202.5 ± 46.7 vs. 100.4 ± 31.5); coronary heart disease with and without (178.5 ± 38.6 vs. 104.6 ± 26.4 ); emergency operation with and without (178.3 ± 35.7 vs. 102.7 ± 26.8); CPB time ≥ 3 hours or < 3 hours (168.6 ± 37.2 vs. 107.3 ± 27.5); DHCA time ≥ 45 minutes or < 45 minutes (172.5 ± 36.1 vs. 105.4 ± 28.7), and all of them showed significant statistical difference (all P < 0.05). and all of them showed significant statistical difference (all P < 0.05).
DHCA may cause significant increase in perioperative blood glucose and lactate, and even may lead to insulin resistance. Patients often require continuous intravenous administration of large doses of insulin. Perioperative hyperglycemia during DHCA is related to many factors, which should be considered in control of blood glucose.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 07/2011; 23(7):387-91.
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ABSTRACT: To explore the clinical effects of alprostadil injection on acute kidney injury (AKI) after cardiac surgical procedures by a prospective randomized controlled trial.
A total of 63 AKI-patients after cardiac surgical procedures were randomly divided into the control group (n = 31) and the study group (n = 32). All patients received routine therapy while patients in the study group were additionally given alprostadil injection (10 µg i.v. once every 12 hours) for 7 days. A 11-year-old patient weighing 29 kg was given half of the conventional dose. During the period of control treatment (7 days), 1 patient in the control group and 2 patients in the study group were excluded because of hemodialysis or peritoneal dialysis. Urine volume, urine β-N-acetylglucosaminidase, urine α(1)-microglobulin, urine β(2)-microglobulin, serum creatinine and blood urea nitrogen were measured before and after the control treatment. And the ICU stay duration and the percentage of dialysis after the control treatment were calculated. Adverse reactions of alprostadil injection were observed simultaneously in the study group.
After the treatment, urine volume in the study group was obviously more than that in the control group [(65.9 ± 3.1) ml/h vs (58.8 ± 4.5) ml/h, P < 0.05] while urine β-N-acetylglucosaminidase, urine α(1)-microglobulin, urine β(2)-microglobulin, serum creatinine and blood urea nitrogen in the study group were obviously lower than those in the control group (all P < 0.05). The ICU stay duration in the study group was obviously less than that in the control group [(12 ± 5) d vs (17 ± 5) d, P < 0.05]. But there was no significant difference in the percentage of dialysis after the control treatment between two groups (3.3% vs 6.7%, P > 0.05). And no serious adverse reaction was reported in the study group.
On the basis of routine therapy, alprostadil injection may promote the recovery of renal function in AKI-patients after cardiac surgical procedures.
Zhonghua yi xue za zhi 08/2010; 90(32):2266-9.
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ABSTRACT: To study the inhibition of angiogenin (ANG) expression in human lung squamous cancer cell strain-A549 through adeno-associated virus (AAV)-mediated RNA-interference, and therefore to observe its effect on the growth of cancer cells and tumor formation.
Recombinant AAV expressing H1-promoter-induced small-interference- RNA (siRNA) targeting ANG (AAV-shANG) was constructed, and then transfected into A549 cells. A549 cells and cells transfected with AAV-Null were used as the control groups. The effects of the reduced expression of ANG by RNAi from AAV-shANG on the growth, formation, reproduction, apoptosis, and microvessel-density of the carcinoma were observed.
In vitro experiment showed that AAV-shANG was constructed successfully, There was an significant decrease in the expression of ANG protein 72 h after transfection, compared with the normal A459 cells and AAV-Null cells (P < 0.01). Cell cycle analysis showed that the proliferation index (PI) of normal A549 cells, AAV-Null cells and AAVshANG cells were 0.32 +/- 0.29, 0.35 +/- 0.38 and 0.31 +/- 0.43, respectively. There was no statistic difference in the PIs among the 3 groups (P > 0.05). In vivo experiment using thymus-defect mice showed that, there was an remarkable reduction in the mass and volume of tumors in AAV-shANG transfected group, compared to the control groups. Microvessel-density was 9.4 +/- 1.5, 9.8 +/- 2.1 and 5.7 +/- 1.9, respectively in the 3 groups, a statistic difference among the AAV-shANG-transfected group, the normal A549 group and the AAV-Null transfected group. The percentages of apoptotic cells in each group were (7.7 +/- 3.1)%, (8.5 +/- 5.4)%, (17.1 +/- 8.6)%, respectively, the experimental group being higher than those of the control groups. Positive rates of PCNA were (84.8 +/- 9.7)%, (85.8 +/- 9.8)%, and (70.4 +/- 10.1)%, respectively, the AAV-shANG transfected cancer cells showing a lower PCNA index than the control groups.
AAV-mediated expression of siRNA could reduce the expression of ANG in cancer cells, significantly enough to inhibit cell proliferation, promote cell apoptosis and inhibit tumor growth.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 04/2009; 32(3):188-92.
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ABSTRACT: To observe the effects of Xuefu Zhuyu Capsule (XFZYC), a compound traditional Chinese herbal medicine, on endothelin-1 (ET-1) release in myocardium and vascular endothelium and nitric oxide (NO)/nitric oxide synthase (NOS) system of swines after acute myocardial infarction (AMI) and reperfusion, and to explore the action mechanisms of XFZYC in improving the endothelium function.
Forty-five Yorkshire swines were randomized into 3 groups: sham-operated group, untreated group and XFZYC-treated group. A Yorkshire swine model of reperfusion in AMI was established by ligation of left anterior descending coronary artery for 90 min followed by 2 h relaxation. The content of serum ET-1 and NO was measured by radioimmunoassay before and after AMI and after reperfusion, respectively. Twenty-four hours after operation, all Yorkshire swines underwent diagnostic coronary angiography to delineate coronary arteries. The expressions of ET-1 and endothelial nitric oxide synthase (eNOS) in myocardial tissue of ischemic area were quantified with Western blotting. Microvessel density of the implanting sites was assessed by using HE staining.
Compared with the untreated group, the levels of serum ET-1 after AMI and reperfusion were significantly decreased in XFZYC-treated group (P<0.01), while the NO levels after AMI and reperfusion in XFZYC-treated group were significantly increased (P<0.01). There was no significant difference in diagnostic coronary angiography between XFZYC-treated group and untreated group (P=0.253). Western blotting showed that the level of ET-1 in ischemic area in XFZYC-treated group was lower than that in the untreated group (P<0.01), while the eNOS protein expression in XFZYC-treated group was higher than that in the untreated group (P<0.01). The results of HE staining and microvessel density analysis of the implanting sites all showed that the degree of telangiectasis was reduced, the cardiac muscle damage was improved, and the density of capillaries was increased obviously in XFZYC-treated group as compared with the untreated group.
The endothelium injury may be one of the important mechanisms for no-reflow phenomenon. XFZYC may reduce the no-reflow by protecting endothelium cells.
Journal of Chinese Integrative Medicine 05/2008; 6(4):381-6.
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ABSTRACT: To investigate the prevalence of coronary artery disease (CAD) and the atherosclerotic risk factors in the patients undergoing valvular surgery due to rheumatic heart disease.
Consecutive 651 patients with rheumatic heart disease aged > 40 who were scheduled for valve surgery underwent diagnostic coronary angiography to delineate coronary arteries. Significant coronary artery disease was considered to be present if one or more single coronary branches showed 50% or more luminal stenosis. Symptoms, such chest pain, were evaluated. Established risk factors for CAD, such as diabetes mellitus, systemic hypertension, smoking, and dyslipidemia were evaluated. Previous history of myocardial infarction and coronary artery bypass surgery was also recorded.
Seventy-one patients (10.91%), 54 males and 17 females, were detected as with CAD. The mean age of the patients with CAD was (63 +/- 9), significantly higher than that of the patients with normal coronary arteries [(54 +/- 9), P < 0.01]. The atheromatous lesion mostly involved the left descending branch (38.12%), and 38 patients (53.52%) showed lesions in 2 or more branches. The prevalence rates of diabetes mellitus and hypertension in the CAD group were 32.39% and 29.58% respectively, both significantly higher than those in the non-CAD group (7.41% and 19.48% respectively; P < 0.01 and P = 0.047). The smoking rate of the CAD group was 36.62%, significantly higher than that of the non-CAD group (12.93%; P < 0.01). However, there were not significant differences in the prevalence rates of dyslipidemia and ECG ST-T changes between these 2 groups (both P > 0.05). No relation was found between the rheumatic disease and coronary disease distribution (P > 0.05).
Coronary angiography should be performed in all patients clinically suspected with CAD, aged > 50 and the patients with angina and/or coronary risk factors in order to decrease the occurrence of operative complications.
Zhonghua yi xue za zhi 12/2007; 87(47):3313-6.
