Cardiovascular disease is a leading cause of death in Chinese population. It is of great significance to further explore the pathogenesis of cardiovascular diseases. Ferroptosis is a recently discovered iron-dependent and non-apoptotic form of regulated cell death, which exerts a regulatory role in a variety of biological events. Some studies have shown that ferroptosis plays an important role in the development of cardiovascular diseases. According to newly scientific reports, we summarized the mechanism and regulation in ferroptosis, and reviewed the results of ferroptosis in common cardiovascular diseases such as cardiac ischemia-reperfusion/myocardial infarction, cardiomyopathy, cardiac hypertrophy, atherosclerosis and abdominal aortic aneurysm.
Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007， 50 patients underwent CABG were received the aortic proximal anastomosis device ［Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)］, in which 16 were underwent in onpump CABG and 34 in offpump CABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and longterm effect remains to be further observed.
Objective To investigate the risk factors of grafts stenosis following coronary artery bypass grafting (CABG), in an effort to benefit the prevention and treatment of graft stenosis after CABG. Methods The clinic data of 197 patients who underwent CABG and received selective angiography between January 1999 and December 2007 were retrospectively analyzed and all patients were subdivided into stenosis group (n=87) and normal group(n=110). Statistic analysis of χ2 test, ttest and multiple logistic regressions were used to find out the risk factor. Results It was demonstrated by angiography that there was graft stenosis after CABG in 87 patients involved 321 stomas (305 in the distal and 16 in the proximal). Univariate analysis revealed that diabetes mellitus，dyslipidemia, distal anastomoses in right coronary artery (RCA) territory, ＜70% stenosis in target coronary artery, ＜1.5 mm in diameter in target artery, saphenous vein grafts(SVG) and offpump CABG were significantly related to stenosis of grafts following CABG, and logistic multivariate regression analysis showed that diabetes mellitus(OR=3.654)， dyslipidemia(OR=2.625), distal anastomoses in RCA(OR=1.694), ＜70% stenosis in target coronary artery(OR=1.763), ＜1.5 mm in diameter in target artery (OR=1.337)and utilization of SVG (OR=1.652) were independent risk factors of graft stenosis. Conclusion Diabetes mellitus，dyslipidemia, distal anastomoses in RCA, ＜70% stenosis in target coronary artery, ＜1.5 mm in diameter in target artery and utilization of SVG are the risk factors of graft stenosis following CABG.
Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.
Objective To summarize and analyze the clinical experience and surgical results of re-do coronary artery bypass grafting (Re-CABG) for reconvert coronary artery disease. Methods Eighteen patients who underwent Re-CABG in this hospital between June 2001 and December 2006 were analyzed. There were 15 males and 3 females aged from 65 to 78 years old. Seven patients were in class III angina(CCS) and 11 patients were in class IV. Coronary artery angiography showed stenosis or occlusion of great saphenous vein grafts in 16 patients, occlusion of left internal mammary artery(LIMA) grafts in 2 patients and new significant stenosis of the native coronary artery in 6 patients. All Re-CABG were done through re-sternotomy. Fifteen patients underwent cardiopulmonary bypass (CPB for their Re-CABG and 3 patients underwent off-pump Re-CABG. The concomitant procedures included left ventricular aneurysmectomy in 1 patient, mitral valve repair in 3 patients, combined aortic and mitral valve replacement and carotid endarterectomy in 1 patient. Bilateral IMA were used in 4 patients, LIMA in 12 patients, radial artery in 3 patients, and the rest of the grafts consisted of great and lesser saphenous vein. Results In on-pump Re-CABG, the aortic cross clamp time was 57±26min (range 45 to 112 min), the CPB time was 78±24min (range 66 to 140 min).The mean number of distal anastomosis per patient was 3.11(range 1 to 5). Intraoperative flow study of the grafts by Medi-Stim Butterfly showed a mean flow rate of 27.0±12.5 ml/min with pulsatility index( PI)less than 4.2. Intra-aortic balloon pump (IABP) was used in 1 patient who underwent concomitant aortic and mitral valve replacement and carotid endarterectomy. Post-operatively this patient developed renal failure and expired 6 days later. There was no residual angina and peri-operative myocardial infarction in the remain 17 patients.The post-operatively mechanical ventilation time varied from 5 to 15 hours, chest drainage varied from 290 to 1 040ml. Seventeen patients were discharged uneventfully. Follow-up from 6 months to 4.5years in 17 patients showed no evidence of recurrent angina. Postoperative coronary artery angiography in 4 patients showed patent grafts. Conclusion Re-CABG can be performed as safely and effectively as primary CABG in spite of the fact that it is more demanding. Selecting the proper target vessels, satisfactory blood flow of grafts, complete revascularization and proper peri-operative management are all key factors to a successful Re-CABG.
Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.
Objective To investigate the clinicopathologic features, diagnosis and differential diagnosis of pulmonary selerosing pneumocytoma (PSP). Methods A total of 13 cases of PSP were enrolled, and the clinical and imaging findings, pathologic features, and immunophenotype were collected and analyzed, with review of the literatures. Results Thirteen patients were all female, aged from 27 to 69 years old by first discovered, the average age was 53 years old. The maximum diameter ranged from 0.8 - 6 cm. It was mainly discovered accidentally by physical examination. According to the CT findings of 13 cases, all lesions were round or round-like, with a well-circumscribed mass. The “welt vessel sign” was suggestive to the diagnosis of PSP. Microscopically, the tumor was composed of two types of cells (surface epithelial cells and round mesenchymal cells), and four histological patterns (papillary, solid, hemorrhagic and sclerotic zone). Immuophenotype: thyroid transcription factor-1 (TTF-1) and epithelial membrane antigen were expressed on both epithelial cells and mesenchymal cells. Pan cytokeratin (PCK) and cytokeratin 7 were only expressed on epithelial cells, and vimentin on mesenchymal cells. Conclusion PSP is a rare lung benign tumor, preoperative and intraoperative freezing diagnosis are difficult, the diagnosis depends on the morphologic characteristics of paraffin-embedded tissue sections and immunohistochemical staining. The identification of mesenchymal cells with TTF-1 positive and PCK negative is the key to PSP diagnosis.
【摘要】 目的 探討超聲檢查對陰道斜隔綜合征的診斷價值，分析超聲圖像特點，提高診斷率，為臨床選用最佳的手術方式提供依據。 方法 回顧性分析2008年1月-2010年6月經手術確診為陰道斜隔綜合征的15例患者的臨床資料及超聲檢查結果，總結陰道斜隔綜合征的聲像圖特點。 結果 15例經臨床確診為陰道斜隔綜合征的患者，超聲診斷14例，均表現為雙子宮、雙宮頸、陰道或宮頸積液/血，9例左腎缺如，5例右腎缺如。誤診1例，為單子宮伴一側附件巨大囊腫。 結論 超聲具有診斷準確、簡便、無創、重復性好、價格實惠等優點，對于臨床診斷生殖系統畸形具有十分重要的意義，應列為首選檢查方式。【Abstract】 Objective To investigate the diagnostic value of ultrasonography in examining oblique vaginal septum syndrome, analyze the characteristics of ultrasound image to improve the ultrasound diagnosis rate, in order to provide guidance for clinical surgeries. Methods We retrospectively analyzed the clinical data and ultrasound examination results of 15 patients diagnosed to have oblique vaginal septum syndrome in our hospital, and summarized their ultrasonographic characteristics. Results Among the 15 patients, 14 were diagnosed to have the disease by ultrasound examination. The ultrasound image showed a double uterus, double cervix, and vaginal or cervical fluid or blood for all the patients among whom 9 had absent left kidney, and 5 had absent right kidney. One patient was misdiagnosed to have single uterus with giant cysts on one side. Conclusions Ultrasound diagnosis is simple, noninvasive, reproducible, affordable and accurate in diagnosing. It is very useful in clinical diagnosis of reproductive system abnormalities and should be listed as the preferred way of examinations.
Objective To investigate the dose-dependent relationship of bone marrow mesenchymal stem cells(MSCs) transplantation in improving ischemic myocardial dysfunction? in a rat ischemic heart model. Methods Myocardial infarction was induced in 32 inbred F344 rats by acute ligation of the left anterior descending(LAD) coronary artery. One week after ligation, the ratswere randomized? into four equal groups, with eight rats in each group. Equal volume Iscove’s modified Dulbecco’s medium was injected in the control group, 1×103(group 1), 1×105(group 2), and 1×107(group 3) 5-bromodeoxyuridine (BrdU) labeled bone marrow MSCs were injected into the infarcted myocardium. Cardiac function was evaluated by ultrasound before the ligation of the LAD, before the transplantation and the 4th week after transplantation. The expressions of BrdU,Connexin43,Myosin heavy chain β(MHC), and smooth muscle actin α(α-SMA) were detected by immunofluorescence and immunohistochemistry at the 4th week after transplantation. The amount of functional vessels stained by α-SMA was counted simultaneously. Results At the 4th week? after transplantation, the ejection fraction(EF) in goup 2 was more significantly improved than that in group1(0.54±0.20 vs. 0.34±0.16, P＝0.004) and EF in group 3 was more significantly improved than that in group 2(0.71±0.24 vs. 0.54±0.20,P＝0.018), whereas no significant difference between group 1 and control group was detected (0.34±0.16 vs. 0.36±0.15,Pgt;0.05). The BrdU labeled MSCs could be found in host myocardium. The number of cells in group 2 by double staining both for BrdU and for MHC observed in ischemic myocardium were significantly more than that in group 1? (323.20±91.62 n/HP vs. 51.75±27.58 n/HP,P＝0.049) and the same was true between group 3 and group 2(409.75±106.65 n/HP vs. 323.20±91.62 n/HP,Plt;0.001), whereas the result of control group was negative.The majority of transplanted cells were found positive staining both for MHC and for Connexin43 in all groups. There were lots of positive staining of α-SMA whose form were partly irregular in ischemic myocardium indicating that there was neovascularization in group1 and control group. More neovascularization in group2 was found than that in group 1 (28.38±12.79 n/HP vs. 22.75±9.07 n/HP, P＝0015) and more neovascularization in group 3 was found? than that in group 2 (35.63±13.27 n/HP vs. 28.38±12.79 n/HP, P＝0.002) . Conclusion Transplanted into infarcted myocardium, bone marrow MSCs may have significant and dose-dependent potential for cardiomyogenesis with functional recovery from myocardial ischemia.
Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD). Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared. Results All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%. Conclusion For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.