Publications (36)74.67 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: Acute kidney injury (AKI) is a severe complication of cardiopulmonary bypass-deep hypothermic circulatory arrest (DHCA) surgery. Non-coding microRNAs (miRNAs) are considered as key players in kidney physiology and pathology. However, whether they are implicated in DHCA-induced AKI at the early stage post-surgery is less studied, and requires for further investigation. Methods: In this study, kidney tissues were removed at 2 h post-surgery from Sprague-Dawley rats that underwent a 60-min DHCA (18°C), with samples from sham-operated rats as control. Renal RNA isolates were analysed with Affymetrix miRNA microarray 4.0 containing 728 mature rat miRNA probes. Results: Seventy-one miRNAs were down-regulated and 4 were up-regulated in the kidneys of DHCA rats [log2 (fold change, FC) > 1, P < 0.05]. Novel differentially expressed miRNAs, such as miRNA-3068, miR-1949 and miR-3473, were identified in the injured kidney tissues. Putative target genes of the down-regulated miR-30b-5p, miR-199a-5p, miR-148b-3p and miR-10a-3p were subjected to analyses of gene ontology (GO) categories and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The results indicated that these miRNAs targeted a large set of genes involved in essential biological processes related to AKI pathogenesis, such as apoptotic process and response to hypoxia, as well as genes implicated in critical signalling pathways, such as chemokine, lysosome and FoxO signalling pathways (false discovery rate-corrected, P < 0.05). Conclusions: The identified 75 differentially expressed miRNAs hold the potential to serve as novel early markers and novel therapeutic targets for DHCA-AKI.
- [Show abstract] [Hide abstract] ABSTRACT: To assess the effect of basic fibroblast growth factor-binding extracellular matrix (bFGF-ECM) combined with bone marrow mesenchymal stem cells (BMSCs) transplantation on acute myocardial infarction (AMI) and explore the underlying mechenisms. Rabbit hearts were processed by decellularization with sodium dodecyl sulfate (SDS) perfusion, heparin immobilization, bFGF-binding and homogenization, for preparation of bFGF-binding cardiac ECM suspension (bFGF-ECM). Thereafter, the characteristics of bFGF release were analyzed in vitro. Following ligation of the mid-third of the left anterior descending artery, the rabbits were divided into a control group (no treatment), BMSCs group (BMSCs transplantation), bFGF-ECM group (bFGF-ECM implantation), and BMSCs + bFGF-ECM group (BMSCs and bFGF-ECM implantation). Apoptosis and differentiation of implanted BMSCs, and the left ventricular (LV) remodeling and function were assessed. The ex vivo proliferation, apoptosis, migration and differentiation of BMSCs were determined after exposure to bFGF and/or ECM. The ECM could sustainably release bFGF. 24 h and 6 weeks after the operation, improved viability and differentiation of the implanted BMSCs, as well as inhibited dilatation and preserved function of the left ventricle (LV), were significant in the BMSCs + bFGF-ECM group compared with other groups (P < 0.05), although BMSCs and ECM-bFGF groups also showed better results than control group (P < 0.05). Additionally, ECM and bFGF showed a synergistic effect on BMSCs proliferation, viability, migration and differentiation. The combination of bFGF-binding ECM and BMSCs implantation may promote myocardial regeneration and LV function, and become a new strategy for the treatment of AMI.
- [Show abstract] [Hide abstract] ABSTRACT: A modified cannulation strategy to innominate artery was introduced which differs from traditional cannulation method used in aortic surgeries. Case presentation Four patients suffering from aortic dissections with or without other cardiac diseasees underwent surgical treatment by using the modified canulation technique. All patients had an uneventful perioperative period and discharged from the hospital without any complications. Innominate artery cannulation using the modified cannula with “a hole in the back” is an easy and effective strategy for arch surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To explore effects of hepatocyte growth factor (HGF) combined with insulin-like growth factor 1 (IGF-1) on transplanted bone marrow mesenchymal stem cells (BMSCs), for treatment of acute myocardial ischaemia. Materials and methods: After ligation of the left anterior descending artery, rabbits were divided into a Control group, a Factors group (HGF+IGF-1), a BMSC group and a Factors+BMSCs group. Allogenous BMSCs (1 × 10(7) ) and/or control-released microspheres of 2 μg HGF+2 μg IGF-1 were intramyocardially injected into infarcted regions. Apoptosis and differentiation of implanted BMSCs, histological and morphological results, and cardiac remodelling and function were evaluated at different time points. In vitro, BMSCs were exposed to HGF, IGF-1 and both (50 ng/ml) and subsequently proliferation, migration, myocardial differentiation and apoptosis induced by hypoxia, were analysed. Results: Four weeks post-operatively, the above indices were significantly improved in Factors+BMSCs group compared to the others (P < 0.01), although Factors and BMSCs group also showed better results than Control group (P < 0.05). In vitro, HGF promoted BMSC migration and differentiation into cardiomyocytes, but inhibited proliferation (P < 0.05), while IGF-1 increased proliferation and migration, and inhibited apoptosis induced by hypoxia (P < 0.05), but did not induce myocardial differentiation. Combination of HGF and IGF-1 significantly promoted BMSCs capacity for migration, differentiation and lack of apoptosis (P < 0.05). Conclusions: Combination of HGF and IGF-1 activated BMSCs complementarily, and controlled release of the two factors promoted protective potential of transplanted BMSCs to repair infarcted myocardium. This suggests a new strategy for cell therapies to overcome acute ischemic myocardial injury.
- [Show abstract] [Hide abstract] ABSTRACT: We sought to investigate the cerebroprotection of a novel microRNA mechanism by targeting peroxisome proliferator-activated receptor gamma coactivator 1-alpha in a rat model of prolonged deep hypothermia circulatory arrest. The right carotid artery and jugular vein of male Sprague-Dawley rats were cannulated for cardiopulmonary bypass. Circulatory arrest was conducted for 60 minutes when the pericranial temperature was cooled to 18°C. The sham group received the surgical procedure without cardiopulmonary bypass and deep hypothermia circulatory arrest; the deep hypothermia circulatory arrest group received cardiopulmonary bypass and deep hypothermia circulatory arrest; lentivirus control vector or lentiviral vector containing antagomiR-29c was given to the deep hypothermia circulatory arrest + vector group or the deep hypothermia circulatory arrest + antagomiR-29c group by intracerebroventricular administration 5 days before cardiopulmonary bypass (n = 8, for each of the 4 groups). Neurologic function was evaluated by the modified hole board test and beam balance task during 14 postoperative days. Expressions of caspase-3, peroxisome proliferator-activated receptor gamma coactivator 1-alpha, and miR-29c in the hippocampus were measured by Western blot and quantitative reverse transcription polymerase chain reaction. Malondialdehyde was measured using the Malondialdehyde Assay Kit (Beyotime, Jiangsu, China). Pretreatment with antagomiR-29c significantly decreased the expression of microRNA-29c and increased the expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha in the hippocampus (P < .05 vs deep hypothermia circulatory arrest group). The level of malondialdehyde in the hippocampus was lower in the deep hypothermia circulatory arrest + antagomiR-29c group (P < .05 vs deep hypothermia circulatory arrest group). The neurologic functions were markedly protected in rats pretreated with antagomiR-29c as evidenced by improvement of vestibulomotor and cognitive performance during the early postoperative period. In the deep hypothermia circulatory arrest + antagomiR-29c group, histologic scores of the hippocampus were improved and the level of caspase-3 in the hippocampus was lower (P < .05 vs deep hypothermia circulatory arrest group). Inhibition of miR-29c attenuates neurologic injuries induced by prolonged deep hypothermia circulatory arrest through a peroxisome proliferator-activated receptor gamma coactivator 1-alpha pathway. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVES To explore if there is phenotypic switching in the vascular smooth muscle cells (vSMCs) of rat thoracic aortic aneurysms and the role it plays in the process of aneurysm formation. METHODS Male SD white rats were assigned randomly to the aneurysm group (AG) and control group (CG). The animal aneurysm model was obtained by soaking the peri-adventitia with porcine pancreatic elastase (PPE). The rats in the CG were given saline to provide contrast. A vascular ultrasound was used to monitor the diameter of the aneurysm. Specimens were stained with haematoxylin and eosin (HE), and α-SMA, SM-MHC, matrix metalloproteinase (MMP)-2 and MMP-9 were detected with immunohistochemistry staining. α-SMA, SM-MHC, MMP-2 and MMP-9 were conducted with western blot. vSMCs taken from the descending aorta of both of the CG and AG were separated and cultured until Passage 3. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method were used to analyse cell proliferation. Western blot was used to evaluate MMP-2, MMP-9 expression and flow cytometry was employed to assess cell apoptosis. RESULTS Vascular ultrasound showed obvious dilatation of soaked descending aorta. HE staining showed thickening of thoracic aorta and disarrangement of cells after soaking with PPE. Immunohistochemistry staining showed high expression of MMP-2 and MMP-9 but low expression of SM-MHC and α-SMA in the AG. Tissue western blot analysis of the AG showed that the protein gray value was high in MMP-2 and MMP-9, but low in α-SMA and SM-MHC, which had statistical differences compared with CG with a P-value of
- [Show abstract] [Hide abstract] ABSTRACT: High incidences of acute kidney injury after cardiopulmonary bypass (CPB) were observed in previous reports. However, whether deep hypothermic circulatory arrest (DHCA) leads to more severe kidney injury than CPB without DHCA remains controversial. The aim of the study was to investigate the effects of DHCA on renal function in a novel rabbit model of using closed-thoracic DHCA. Experimental study on New Zealand white rabbits performed in the Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University. Thirty rabbits were randomly divided into 3 groups : the sham-operated group (Group A, N=10), the CPB group (Group B, N=10), and the DHCA group (Group C, N=10). Serum creatinine (Scr), blood urea nitrogen (BUN), serum cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), malondialdehyde (MDA) levels, superoxide dismutase (SOD) activities, histopathologic llesions, and apoptosis were assessed. Each single rabbit in Groups B and C died during surgery. Animals received DHCA exhibited more severe kidney impairments than those received CPB and those that were sham operated. Scr and BUN con.centrations at 24 and 48 hours after surgery; cystatin C and NGAL concentrations at 12, 24, and 48 hours after surgery; MDA levels, histopathological lesions, and apoptosis score of the kidneys were the highest in Group C, followed by Group B, and were the lowest in Group A (all P < .05). The activities of SOD were the lowest in Group C, followed by Group B, and were the highest in Group A (P < .05). Our study established a simple, convenient, economical, and long-term surviving rabbit model for the study of DHCA-induced organic injury. Based on more significant kidney injuries, including elevated levels of serum cystatin C and NGAL at an early time, increased lipid peroxidation, decreased renal antioxidative ability, enhanced histological lesions, and increased tubular epithelial apoptosis from DHCA animals, we concluded that DHCA has more kidney dysfunctions than CPB without DHCA.
- [Show abstract] [Hide abstract] ABSTRACT: Intraoperative conversion, especially under emergent circumstances during off-pump coronary artery bypass (OPCAB), is associated with a significantly higher rate of hospital mortality. This study compared the clinical early outcomes of patients emergently converting to cardiopulmonary bypass (CPB) with or without cardioplegic arrest and evaluated the efficacy of an on-pump beating heart technique for these critically ill patients. A retrospective study of patients treated at The First Affiliated Hospital of China Medical University over an 8-year period (2005 to 2013). Between January 2005 and September 2013, 104 patients were emergently converted to CPB during OPCAB. In the first 55 patients (53%), the cardioplegic arrest was performed. In the most recent 49 patients (47%), the on-pump beating heart procedure was used without cardioplegic arrest. There were no significant differences in their baseline clinical characteristics, number of anastomoses performed per patient, and reasons for conversions (P > .05). A significant reduction occurred in the observed mortality between the cardioplegic arrest group and the on-pump beating heart group (25.6% vs 6.1%, P=.008). A statistical difference was found between the cardioplegic arrest group and the on-pump beating heart group in the time of CPB, peak cardiac troponin I, duration of inotropic support, time to extubation, intensive care unit stay, postoperative hospital stay, incidence of new intra-aortic balloon pump support, and pulmonary complications (P < .05). The incidence of blood requirements, postoperative myocardial infarction, new-onset atrial fibrillation, hemodialysis, stroke, infective complications, and resurgery for bleeding were lower in on-pump beating heart group, but the difference did not reach statistical significance (P > .05). The on-pump beating heart technique is the preferred method of emergency conversion to CPB during OPCAB. It has lower postoperative mortality and morbidity than the cardioplegic arrest.
- [Show abstract] [Hide abstract] ABSTRACT: Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles.
Article: Primary malignant cardiac tumors[Show abstract] [Hide abstract] ABSTRACT: The literature on primary malignant cardiac tumors is relatively limited because of their rare incidence. This study aimed to provide a proposed treatment strategy for primary malignant cardiac tumors. The follow-up outcomes of 29 patients with primary malignant cardiac tumors operated, and 8 primary malignant cardiac tumors considered not operable from 1985 to 2013 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. Of operation receivers, ten patients had positive surgical margins and nineteen patients had negative surgical margins. Eleven patients received a post-operative neoadjuvant chemotherapy. Patients rejected to surgery had a lower survival compared with operation receivers (15 vs 23 months, P = 0.011). However, there were no significant differences in survival in patients rejected to surgery than in patients who had positive surgical margins (15 vs 16 months, P = 0.874). Patients who had positive surgical margins had a median overall survival duration of only 16 months, whereas patients with negative surgical margins had a median overall survival duration of 27 months (P = 0.002). There were no significant differences in survival in patients with receiving a post-operative adjuvant chemotherapy than in the rest of the population (20 vs 25 months, P = 0.150). The prognosis for patients with primary malignant cardiac tumors remains very poor. Each patient should be managed on an individual basis, and variety of treatment strategy should be performed. Maximizing the possibility of obtaining negative surgical margins may prolong survival.
- [Show abstract] [Hide abstract] ABSTRACT: A novel technique for total arch repair was developed, and the safety and feasibility of this simplified technique were compared with those of total arch replacement. With the use of a self-designed stented graft, of which the proximal 10 cm is free of stent, 54 patients with acute type I dissection underwent ascending aorta replacement combined with total arch repair (simplified group). The stented part was implanted into the descending aorta as an elephant trunk, and the part free of stent was sutured inside the arch with exposure of the orifices of 3 arch vessels. A total of 41 patients with acute type I dissection undergoing ascending aorta and total arch replacement with stented elephant trunk (total arch group) were enrolled as controls. There was no permanent neurologic dysfunction or paraplegia in both groups. The incidence of postoperative transient neurologic dysfunction and prolonged ventilation was lower in the simplified group (P < .05). The hospital mortality was 3.7% (2/54) in the simplified group and 7.3% (3/41) in the total arch group (P = .44). No significant difference was detected in survival between the 2 groups (P = .78). Complete thrombosis in the false lumen of the residual arch was found in all patients undergoing simplified aortic repair. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P > .05). The risks of aortic event were comparable for both groups (P = .84). The simplified technique of total arch repair is an easy and effective surgical strategy for acute type I dissections.
- [Show abstract] [Hide abstract] ABSTRACT: For patients with acute DeBakey type I aortic dissection without an intimal tear in the arch, the early and midterm outcomes of hemiarch replacement with stented elephant trunk were compared with those of total arch replacement. From January 2006 to December 2011, 197 patients with acute type I aortic dissection were identified without an intimal tear in the arch. Of the 197 patients, 71 underwent hemiarch replacement with stented elephant trunk implantation (hemiarch group) and 84 underwent ascending aorta and total arch replacement with stented elephant trunk implantation (total arch group). The incidence of postoperative transient neurologic dysfunction, low cardiac output syndrome, and prolonged ventilation was lower in the hemiarch group (P < .05 for all). The hospital mortality was 4.2% and 5.9% for the hemiarch and total arch groups, respectively (P = .91). No difference was detected in survival between the 2 groups (P = .56). Complete thrombosis in the false lumen of the residual arch was found in 92.1% of those undergoing hemiarch replacement. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P > .05). The risk of an aortic event was similar for both groups (P = .62). For patients with acute DeBakey type I dissection without an intimal tear in the arch, hemiarch replacement with stented elephant trunk implantation was easily performed, with satisfactory early and midterm outcomes. For these selective patients, total arch replacement with the stented elephant trunk technique did not improve the late surgical results further.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: Coronary artery fistula (CAF) is rare in patients undergoing coronary angiography. Coronary artery ectasia (CAE) is found in 1.2% to 4.9% of patients at autopsy or during angiographic studies. CAF combined with CAE is a extremely rare clinical condition. This study aimed to summarize a treatment strategy for this complex disorder. Methods: Ten consecutive patients who underwent surgical repair of CAF combined with CAE between 2000 and 2012 are reported. The main outcome measure was death. Secondary outcome measures included surgical technique, the extracorporeal circulation time, intubation duration, the intensive care unit stay period and discharge period. Results: The mean extracorporeal circulation period was 103.8 W 25.7 minutes. The mean intubation duration was 10.5 W 3.2 hours. The mean intensive care unit stay period was 2.0 W 0.8 days and the mean discharge period was 11.4 W 2.6 days two patients were lost to follow-up. The other eight patients were asymptomatic and there were no deaths during the follow-up period. Conclusions: Surgical repair for CAF combined with CAE is effective with satisfactory results in adults.
- [Show abstract] [Hide abstract] ABSTRACT: Epithelioid haemangioendothelioma (EH) is a rare malignant tumor of vascular origin that usually arises in bone, liver, soft tissue, or lung. EH originating in the pleura has been less frequently described. We describe an uncommon case of pleural EH compressing the myocardium in a 39-year-old woman. The patient was diagnosed with pleural EH confirmed by surgery and immunohistochemistry. She sustained stable disease 14 months after the diagnosis and her symptoms improved after systemic chemotherapy with carboplatine and etoposide. Complete surgical excision of pleural EH followed chemotherapy may prolong survival. doi: 10.1111/jocs.12094 (J Card Surg 2013;28:266–268)
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the effectiveness of mild hypothermia on low cardiac output in patients after cardiac surgery. Twelve patients manifesting low cardiac output after cardiac surgery despite of the use of massive doses of catecholamine and intra-aortic balloon pump (IABP) underwent mild hypothermia during May 2009 to February 2011. Changes in hemodynamic parameters of the patients were measured, including cardiac index (CI),mixed venous oxygen saturation [SvO(2)] and urine volume. In the process of mild hypothermia treatment, bladder temperature of patients was lowered to 33-35 centigrade in order to reduce the body oxygen demand. The CI [ml·s(-1)·m(-2)]of patients after mild hypothermia treatment was increased obviously (38.34 ± 5.00 vs. 30.01 ± 5.00), the same as SvO(2) (0.64 ± 0.07 vs. 0.54 ± 0.08) and urine output [ml·kg(-1)·h(-1): 3.0 ± 2.1 vs. 1.5 ± 1.1, all P < 0.05]. However, there was no significant change in heart rate, mean arterial pressure and blood oxygen pressure. Mild hypothermia is an effective and simple procedure to improve the cardiac function in patients after cardiac surgery complicated with low cardiac output.
- [Show abstract] [Hide abstract] ABSTRACT: Chronic total occlusion of the left main coronary artery (LMCA) is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart (OnP-BH) technique. Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period (1999 to 2009). The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed. The mean extracorporeal circulation period was 80.4 (19.7) minutes. The mean intubation duration was 13.0 (4.6) hours. The mean intensive care unit stay period was 3.2 (0.7) days, and the mean discharge period was 16.8 (3.3) days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 (34.8) months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function. The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to evaluate the hemostatic efficacy and feasibility of direct injection of fibrin sealant into the sternal marrow cavity in senior patients undergoing on-pump coronary artery bypass grafting (CABG). A total of 82 senior patients undergoing on-pump CABG were randomized to the bone wax group (n=40) or the fibrin sealant group (n=42) for the period July 2010 to January 2011. The fibrin sealant-treated group had less chest drainage in the first 24 hours (186.67±49.53 versus 333.75±60.49 mL), less total chest drainage (326.19±67.24 versus 516±88.46 mL), less packed red blood cell (PRBC) administration (3.6±1.25 versus 7.4±2.13 U), less fresh frozen plasma (FFP) administration (5.52±1.64 versus 8.95±1.77 U), shorter intubation time (40.36±8.62 versus 46.25±10.46 hours), and shorter hospital stay (10.45±1.17 versus 11.03±1.37 days) compared with the bone wax group. No significant difference in the incidence of postoperative complications was found. Direct injection of fibrin sealant into the sternal marrow cavity significantly reduces the amount of postoperative blood loss and offers an attractive new treatment alternative for senior patients undergoing on-pump CABG.
- [Show abstract] [Hide abstract] ABSTRACT: A 27-year-old man presented with cough and with edema of the upper half of his body. A posteroanterior chest radiograph revealed a huge circular dense mass that obscured the right lower hemithorax (Fig. 1). Computed tomography (CT) (Fig. 2) and magnetic resonance imaging (Fig. 3) showed a giant anterior mediastinal mass that severely compressed the superior vena cava (SVC) and the right lung. A CT-guided biopsy of the intrathoracic tumor showed B-cell lymphoma. Due to its extensive nature and the risks associated with the location of the mass, the patient was emergently taken to the operating room, without preoperative chemotherapy or radiation therapy. We exposed the heart through a midline incision and found that the mass invaded the superior lobe of the right lung and the 1st half of the SVC (Fig. 4). The patient underwent surgical resection of those structures and radical excision of the intrathoracic mass (Fig. 5). On cut section, the mass looked like fish flesh (Fig. 6). A 22-mm gore-tex® Stretch Vascular Graft (W.L. Gore & Associates, Inc.; Flagstaff, Ariz) was used between the left brachiocephalic vein and the right atrial appendage (Fig. 7). Histologic examination confirmed the diagnosis of primary B-cell lymphoma (Fig. 8). After an uneventful 8-day postoperative course, the patient underwent chemotherapy and radiation therapy. Three years later, he was asymptomatic and in good health.
Guangzhou Medical UniversityFeng-t’ien, Liaoning, China
China Medical University (PRC)Feng-t’ien, Liaoning, China