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15 May 2018, Volume 46 Issue 5 Previous Issue    Next Issue

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Application and progress of hybrid technique in cardiovascular surgery GUO Zhi-gang 2018, 46 (5):  449-453.  doi: 10.11958/20180592 Abstract ( 795 )   PDF (426KB) ( 3606 )   Abstract：The hybrid technique is a technique that combines minimally invasive cardiac surgery with intracardiac intervention. It has the advantages of definite curative effect, good visual field and slight trauma. It provides advanced treatment options for patients with cardiovascular diseases. With the gradual improvement of technical level, diagnosis and treatment concept and medical equipment, especially the popularization of "hybrid operation room", hybridization technology has been applied in many sub-specialized fields of cardiac surgery. In some fields this technology has become a routine treatment program. At present， it is mainly used for treatment of congenital heart disease, coronary heart disease, heart valve disease, aortic disease and atrial fibrillation. Related Articles | Metrics

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Transcatheter aortic valve implantation-yesterday, today and tomorrow JIANG Nan, FU Bo 2018, 46 (5):  454-457.  doi: 10.11958/20180422 Abstract ( 929 )   PDF (483KB) ( 3903 )   Abstract: The incidence of calcific aortic stenosis (CAS) is increasing year by year. Patients with CAS suffer symptoms of angina, dyspnea, syncope as a consequence and poor prognosis. Surgical valve replacement can significantly improve the life quality and prognosis of patients. However, traditional surgery can lead to serious complications, especially for older patients with preoperative complications. As a result, more than 30% of patients were unable to undergo surgical treatment. Transcatheter aortic valve implantation (TAVI), a technique in which a bioprosthetic valve is inserted via a catheter and implanted within the diseased native aortic valve, is a new therapeutic modality for treatment of older patients with severe comorbidities. Many clinical studies have showed that TAVI can significantly reduce mortality. That over 400 000 TAVI procedures have now been performed worldwide. With the accumulation of clinical data, the indications for TAVI can be expanded to young and low risk patients. On the basis of the rich experience accumulated in developed countries in Europe and America, TAVI intervention technology has been introduced in China since 2010. It has a definite clinical effect, which has kindled the hope of life for such patients in our country. Although TAVI surgery is not the gold standard for the treatment of aortic valve disease at the present stage, minimally invasive or noninvasive therapy represents the development direction of the future valvular surgery. Related Articles | Metrics

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Progress in diagnosis and treatment of aortic dissection CHEN Qing-liang, LI Bo 2018, 46 (5):  458-461.  doi: 10.11958/20180452 Abstract ( 896 )   PDF (361KB) ( 3684 )   Abstract: Aortic dissection is a serious disease, and it has a high mortality and disability rates. In recent years, with the application of a variety of imaging tests, especially the development of CT imaging technology, the diagnostic rate of aortic dissection is increased significantly. The recognition and prognostic evaluation of aortic dissection also deepened with the improvement of biochemical detection. A variety of operative modes can be selected according to involved scope of aortic dissection. Especially to the therapeutic method of aortic arch department, not only traditional elephant trunk technique but also Sun’ s operation and triple-branched stent grafting can be selected. Mortality and complication rates have been dropped significantly after using new operative modes. The application of thoracic endovascular aortic repair (TEVAR) turns the invasive therapy to minimally invasive therapy for the treatment of aortic dissection. But TEVAR has strict imaging constraints. However TEVAR’ s indications are extended by debranching operation, which makes the patients with surgical contraindications to conform to the operation indication. In this article, on the basis of development of diagnosis and treatment of aortic dissection in recent years, the current early diagnosis, laboratory examination, prognostic evaluation, and the present treatment methods are summarized for reference in basic and clinical research. Related Articles | Metrics

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Clinical experience of thoracoscopic assisted minimally invasive surgery for congenital heart disease LI Jing-hui, WANG Lian-qun, WANG Qiang 2018, 46 (5):  462-466.  doi: 10.11958/20180418 Abstract ( 963 )   PDF (758KB) ( 3678 )   Abstract: Objective To summarize the clinical experience and the clinical therapeutic effect of minimally invasive surgery for congenital heart disease under thoracoscope. Methods A total of 154 patients of congenital heart disease treated by minimally invasive surgery through thoracoscopic surgery were divided into two groups, adult group (n=112) and minor group (n=42). Through the right chest intercostal incision, thoracoscopic assisted exposure of the surgical field of visual, superior vena cava and femoral vein catheterization, cardiopulmonary bypass were established. The principle of operation was the same as that of thoracotomy. Data of operation time, extraeorporeal circulation time, cross-clamping time, ICU time, length of hospital stay, amount of drainage and the complications were observed in two groups of patients. Results Operations were successful and all patients recovered well. There were no significant differences in operation time, extraeorporeal circulation time, cross-clamping time, ICU time and length of hospital stay between two groups of patients. In adult group, the amount of drainage was significantly increased than that in minor group (P＜0.05). In adult group, there were 4 cases with complications (3.6%), 1 case was changed to median thoracotomy surgery, 1 case was undergone reoperation for bleeding, 1 case had delayed pleural effusion, and 1 case had pneumothorax. In minor group, there were 2 cases with complications (4.8%), 1 case had injury of femoral artery and had bypass operation immediately and 1 case had delayed pleural effusion. There was no significant difference in complications between 2 groups (P＞0.05). There was neither serious complication nor death in both adult and minor groups. Conclusion Minimally invasive thoracoscopic surgery for congenital heart disease is safe and reliable for both adults and minors. It has the advantages of small trauma, less bleeding, less serious complications and quick recovery after operation. However, it takes surgeons some time to grasp the operative skill skillfully, and the operative indication should be controlled strictly. Related Articles | Metrics

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Relationship between calcified aortic stenosis and peripheral blood inflammatory cells and lipids in the elderly TANG Yi-peng1,CHEN Qing-liang2,JIANG Nan2, CHEN Tong-yun2,FU Bo2,BAI Yun-peng2 2018, 46 (5):  466-470.  doi: 10.11958/20180410 Abstract ( 751 )   PDF (386KB) ( 3927 )   Abstract: Objective To investigate the relationship between calcific aortic valve stenosis and inflammatory cells in peripheral blood and dyslipidemia in elderly patients (age ≥65 years). Methods A total of 76 elderly patients (≥65 years old) diagnosed as calcific aortic stenosis in our hospital from June 2015 to June 2017 were selected as the case group, and 78 seniors (excluding valvular heart disease) hospitalized due to chest discomfort were selected as the control group. The white blood cell count (WBC), neutrophil ratio (N%), neutrophil count (N), lymphocyte count (L), neutrophil lymphocyte ratio (NLR), hypersensitive C-reactive protein (hs-CRP), N-terminal B-type natriuretic peptide (NT-pro BNP), total cholesterol (TC), triglyceride (TG), apo-α, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and other indicators were tested on admission. All these indicators were compared between the two groups. Results The levels of WBC, N%， N， NLR, hs-CRP, NT-pro BNP， VLDL were higher in the case group than those in the control group. The levels of L and HDL were significantly lower in the case group than those of the control group (P<0.05). Multiple regression analysis showed that smoking, the increased hs-CRP and NT-pro BNP levels were independent risk factors for senile calcific aortic stenosis. Conclusion Senile calcific aortic stenosis is not a simple degenerative disease. It is closely related to systemic inflammatory response and abnormal lipid metabolism. Related Articles | Metrics

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Analysis of the related risk factors of postoperative delirium in patients with Stanford type A aortic dissection BAI Yao-bang, LI Pei-jun△, WU Zhen-hua, BAI Yun-peng 2018, 46 (5):  471-474.  doi: 10.11958/20180420 Abstract ( 1096 )   PDF (356KB) ( 3588 )   Abstract: Objective To analyze the related risk factors of postoperative delirium (POD) in patients with Stanford type A aortic dissection, and to guide clinical practices. Methods The clinical data of 118 cases [81 males and 37 females, average age (55.0 ± 10.3) years] with Stanford type A aortic dissection in Tianjin Chest Hospital from January 2016 to December 2017 were analysed in this study. According to whether developed delirium after surgery, the patients were divided into POD group (n=56) and Non-POD group (n=62). The preoperative, perioperative, and postoperative clinical data were collected. The univariate and multivariate Logistic regression analysis was used to investigate the risk factors of POD in patients with the Stanford type A aortic dissection. Results Single factor analysis showed that the proportions of drinking and cerebrovascular history significantly increased, the proportions of early electrolyte disorder and hypoxemia significantly increased, the levels of granulocytes / lymphocytes, circulatory time and blood volume during operation increased significantly, and the duration from onset to operation was decreased, but fibrinogen level decreased significantly in POD group than those of Non-POD group (P < 0.05). Multivariate Logistic analysis indicated that the more intraoperative consumption of blood (OR=1.733, 95%CI： 1.409-2.129) and early postoperative electrolyte disorder (OR=10.500, 95%CI： 2.930-37.622) were independent risk factors of POD, while the higher level of preoperative fibrinogen (OR=0.157, 95%CI： 0.050-0.635) and longer time from onset to surgery (OR=0.871, 95%CI： 0.808-0.943) were protective factors of POD in patients with Stanford type A aortic dissection. Conclusion The early identification of risk factors of POD, and the active intervention of POD have a positive significance to reduce the occurrence of POD. Related Articles | Metrics

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The clinical curative effect of percutaneous interventional therapy for children with secundum atrial septal defect ZHANG Wei 1,WANG Qiang1,YANG Shi-juan1,XU Nai-xun2,MA Wei-jun2,GUAN Xin3,WANG Bing3 2018, 46 (5):  475-478.  doi: 10.11958/20180448 Abstract ( 791 )   PDF (718KB) ( 3475 )   Abstract: Objective To evaluate the clinical safety and efficacy of percutaneous interventional therapy in pediatric patients with secundum atrial septal defect (ASD). Methods Clinical data of 40 patients (age≤2 years) with secundum atrial septal defect treated in our hospital from February 2014 to December 2017 were analyzed retrospectively. There were 13 males and 27 females in these patients. Ultrasound of heart showed that there were 37 patients with single ASD, 3 patients with multiple ASDs. One associated with pulmonary stenosis (PS), and 1 associated with patent ductus arteriosus. There were 6 patients with pulmonary hypertension, and the diameter of ASD was (10.6 ± 2.0) mm. All patients were proved to have secundum atrial septal defect before intervention. In the intervention, the transport system was delivered along the femoral vein, inferior vena cava and right atrium through atrial septal defect to the left atrium, and the occluder was released there. Results Of the 40 patients, 38 cases were successfully implanted, and the other two patients were not satisfied with the location of occlusion. The diameter of the ASD occluder was (12.0±2.1) mm and the transport sheath 7-9 F. Plug2 occluder was implanted in the patient with patent ductus arteriosus. To the patient with PS, pulmonary valve balloon angioplasty was performed， and then the pressure gradient reduced obviously, after that ASD occlusion was performed. The total follow up period was from 2 months to 3 years. No residual shunt and unsatisfactory device position were found during the follow up period. The pulmonary pressure reduced to normal, and the right atrium and right ventricle were smaller in a different degree. All patients had no arrhythmia and other complications. Conclusion Transcatheter closure of ASD is safe, reliable, and has fewer complications. It is worthy of popularization and application. Appropriate occluder should be selected according to the size and edge of ASD to reduce complications，such as residual shunt and valve injury. Related Articles | Metrics

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Application of extracorporeal membrane oxygenation in right ventricular failure after heart transplantation CHAI Jun-wu, WANG Kai, ZHOU Wei, CHEN Hong-lei, XUE Fen-long, KONG Xiang-rong 2018, 46 (5):  478-481.  doi: 10.11958/20180447 Abstract ( 1030 )   PDF (358KB) ( 3710 )   Abstract：Objective To summarize the value of extracorporeal membrane oxygenation (ECMO) in right ventricular failure after heart transplantation. Methods Data of 31 cases with orthotopic heart transplantations from January 2016 to January 2018, in Tianjin First Central Hospital were retrospectively analyzed. Three patients received ECMO support because of right ventricular failure after operation. There were two males and one female in these three patients. Their ages were 52, 38 and 67 years old. ECMO was performed in the heart transplantation (2 patients) and eight hours after the surgery. ECMO was established in these patients via femoral artery and femoral vein, V-A model. The mean blood flow was about 3.0 L/min. Continuous ventilator supports, low temperature sedation, anti-infection and nutrition support therapy were applied in the ECMO procedure. Results ECMO was weaned off successfully in all three patients. The time for ECMO was (144-177) h. All three patients were treated with continuous renal replacement therapy (CRRT). One patient had renal failure, the transition was given to regular dialysis after CRRT treatment, and the regular dialysis treatment after discharged from hospital. The ventilator time was (168.6±24.6) h in the three patients. The duration of staying in the intensive care unit was (31.8 ± 12.5) d. All three patients were discharged from the hospital successfully, and their cardiac function was normal. Conclusion ECMO can be used to treat right heart failure after heart transplantation, and the clinical effect is satisfactory. Related Articles | Metrics

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The minimally invasive treatment for patent ductus arteriosus via the second intercostal incision on the left margin of sternum approach: 31 cases ZHOU Wei, WANG Kai,KONG Xiang-rong, CHAI Jun-wu, CHEN Hong-lei, XUE Fen-long 2018, 46 (5):  482-484.  doi: 10.11958/20180449 Abstract ( 1015 )   PDF (330KB) ( 3444 )   Abstract: Objective To evaluate the clinical efficacy and reliability of the minimally invasive treatment of patent ductus arteriosus (PDA) via the second intercostal incision on the left margin of sternum. Methods Clinical data of 31 infantile children undergoing ligation of PDA in Tianjin First Center Hospital from January 2014 to November 2017 were collected. All cases were performed operation through the second intercostal incision on the left margin of sternum. The operative process of this operation was summarized, and its clinical outcome was analyzed. Results The operation went smoothly, the length of the incision was (2.5±1.0) cm, the operation time was (1.5±0.2) h, the intraoperative bleeding was less than 5 mL, and the average length of hospital stay was (15.1±4.2) d. There were no complications such as death and massive hemorrhage in the perioperative period. The thoracic drainage tube was not needed after the operation. During the follow-up from 1 month to 4 years, catheter recanalization and aneurysm formation were undetected. Conclusion The treatment of PDA with the second intercostal incision on the left margin of sternum is safe and reliable. It has fewer complications and better long-term effect. Related Articles | Metrics

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The clinical research on the screening, diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting PEI Xiao-dong1,LIU Jian-shi 2, CHEN Qing-liang2 2018, 46 (5):  484-486.  doi: 10.11958/20180401 Abstract ( 763 )   PDF (320KB) ( 3719 )   Abstract Objective To discuss the meanings and methods of the screening, diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting (CABG). Methods A total of 612 patients intend to perform coronary artery bypass grafting in Tianjin Thoracic Hospital, and who were with severe stenosis or occlusion with left subclavian artery were screened by non invasive arteriosclerosis before operation. The diagnosis was confirmed by computerized tomography angiography (CTA), then the stenting angioplasty to the left subclavian artery was performed. The off-pump bypass surgery with the left internal thoracic artery（LITA）- left anterior descending artery (LAD) bypass was performed one week after operation. Results The CTA and digital subtraction angiography (DSA) confirmed the results of the left subclavian stenosis according to the non-invasive artery testing. All the 5 patients were performed with the stenting angioplasty to the left subclavian artery successfully, and the residual stenosis rate was <10%. The clinical symptoms were markedly improved after operations in all symptomatic patients, and the systolic pressure difference was <20 mmHg in two upper extremities. The blood flow was enough in LITA during the LITA-LAD bypass. The angina pectoris was improved after the operation. No coronary-subclavian artery steal phenomenon occurred. Neither stroke, myocardial infraction nor death occurred during perioperative period. All the patients were followed up for a time of 6-12 months, and the average time was about 10 months. No posterior circulation, upper limbs or myocardial ischemia occurred, and the systolic pressure difference was <20 mmHg in two upper extremities. Conclusion The non-invasion testing is of unique value in the screening of the left subclavian artery stenosis. Related Articles | Metrics

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Meta-analysis of lung protective effects of sevoflurane on cardiopulmonary bypass in adult cardiac operation JI Zhen-hua, WU Ting, CAI Lu 2018, 46 (5):  487-492.  doi: 10.11958/20180555 Abstract ( 858 )   PDF (611KB) ( 4005 )   Abstract: Objective To assess the lung protection effect of sevoflurane on adult cardiac surgery during cardiopulmonary bypass (CPB) using Meta-analysis. Methods The databases of Cochrane library, Embase, PubMed, Google scholar, CNKI, Wanfang and Weipu were comprehensively searched by computer up to December 2017 to obtain the published literature on randomised controlled trials (RCT) of sevoflurane for lung protection under CPB. Key words included extracorporeal circulation, cardiac surgery, pulmonary protection, sevoflurane and Meta-analysis. And then a separate quality assessment and data extraction for the selected literatures were carried out by two researchers. The Meta-analysis was performed via statistical software RevMan5.3. Results Eleven RCT literatures and 440 patients in total were selected in this study, in which, 220 cases were for the sevoflurane group and 220 cases were for the total intravenous anesthesia (TIVA) group. The analysis results showed that the application of sevoflurane could significantly reduce the levels of IL-6 (P=0.005) and IL-8 (P=0.01) in the blood, and decrease postoperative tracheal intubation time in CPB group compared with those of TIVA group (P＜0.001). However, there were no statistical differences in the level of tumor necrosis factor-α (TNF- α) (P=0.19), the alveolar-arterial differences for oxygen［P（A-a）O2 ］(P=0.68) and the oxygenation index OI between two groups (P=0.31). Conclusion The application of sevoflurane during CPB could effectively reduce the levels of some inflammatory factors in blood and decrease the postoperative tracheal intubation time. However, there is no adequate evidence to prove the definite lung protection effect of sevoflurane on CPB. Related Articles | Metrics

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Blood conservation strategy in infants undergoing cardiopulmonary bypass during the open heart surgery CAI Lu， WU Ting 2018, 46 (5):  493-496.  doi: 10.11958/20180553 Abstract ( 759 )   PDF (371KB) ( 3534 )   Abstract: In the cardiovascular surgery of infants, especially in complex congenital heart surgery, the advantages and disadvantages of blood supply and demand have gradually attracted clinical attention. Besides, allogeneic blood transfusion may lead to the infection of infectious diseases. As a result, how to minimize postoperative bleeding, reduce the usage of allogeneic blood products, and avoid the damage of blood has become a hot issue for urgent consideration and solution. The blood coagulation system of infants is not mature compared with adults, and the operation of congenital heart disease is becoming more and more complex, which makes the issue of maintaining the blood coagulation system of infants become increasingly prominent. This paper provides a reference for perfecting blood conservation strategy of infants with congenital heart disease, which systematically reviews the application progress of minimized extracorporeal circulation circuits, combined ultrafiltration technology, vacuum assist venous drainage, blood dilution and priming, utilization of antifibrinolytic drugs, and application of autotransfusion. Related Articles | Metrics

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Interpretation of atrial fibrillation guidelines for cardiac surgery in 2017 JIANG Nan 2018, 46 (5):  497-498.  doi: 10.11958/20180621 Abstract ( 745 )   PDF (436KB) ( 3757 )   Abstract：In 2017, the American Society of Thoracic Surgeons (STS), the American College of Cardiology (ACC), the European Heart Rhythm Society (EHRA), and the Asia Pacific Heart Rhythm Society (APHRS) and other institutions published their own guidelines for atrial fibrillation, involving atrial fibrillation screening, drug therapy, stroke prevention, catheter ablation, surgical ablation and surgical treatment. Now, we interpret the relevant parts of the guidelines for cardiovascular surgery. Related Articles | Metrics

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Preparation of doxorubicin modified silver nanoparticle and its anti-tumor activity in vitro YANG Li-jun, CHU Li-ping, WANG Jing, REN Chun-hua, WANG Zhong-qiang, HUANG Fan 2018, 46 (5):  499-504.  doi: 10.11958/20180134 Abstract ( 931 )   PDF (937KB) ( 3516 )   Abstract: Objective To design and synthesize a novel type of combined anti-tumor drug-doxorubicin modified silver nanoparticles (DOX-Ag NPs) with pH response, characterize its physical and chemical properties, and investigate its drug responsive release and anti-tumor activity in vitro. Methods DOX-Ag NPs were prepared by coupling silver nanoparticles (Ag NPs) with doxorubicin (DOX) via a LA-NHNH2 linker. The structure of LA-NHN=DOX was confirmed by nuclear magnetic resonance ( 1 H NMR) and high resolution mass spectrometry (HRMS). The particle size and micromorphology of the nanoparticles were detected by dynamic light scattering (DLS) and transmission electron microscopy (TEM), respectively. The optical properties of the nanoparticles were characterized by UV-vis absorption spectroscopy and fluorescence spectroscopy. The DOX release kinetics of DOX-Ag NPs under different pH conditions were examined by dialysis method combined with fluorescence spectroscopy. The in vitro anti-tumor effects of DOX-Ag NPs were evaluated by MTT assay. Results DOX-Ag NPs were spherical nanoparticles with a particle size of (40.4 ± 3.8) nm. DOX-Ag NPs could rapidly release DOX under weak acid condition. DOX-Ag NPs significantly inhibited the proliferation and cell viability of HepG2 cells in concentration dependent manner. When DOX concentration was 0.5-20 mg/L (Ag concentration was 0.45-18 mg/L), the cell survival rate was significantly lower in DOX-Ag NPs group than that of DOX group and Ag NPs group (P < 0.05). Conclusion DOX-Ag NPs are a combined anti-tumor nano-drug with pH-responsive ability, which can release DOX rapidly in tumor tissues and play an anti-tumor effect through synergistic treatment with Ag NPs in vitro. Related Articles | Metrics

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Screening critical genes for rectal adenocarcinoma using combined mRNA, microRNA alteration and aberrant DNA methylation patterns QIN Hai 1,2,HUA Yang2,SHI Yang2,LI Peng2 2018, 46 (5):  504-508.  doi: 10.11958/20171099 Abstract ( 771 )   PDF (816KB) ( 4193 )   Abstract: Objective To study the underlying pathogenesis of rectal adenocarcinoma (READ) by analyzing the expression data of high throughput miRNA / mRNA and DNA methylation. Methods The miRNA/ mRNA expression profiling and corresponding DNA methylation data were downloaded from the Cancer Genome Atlas (TCGA) database. The differentially expressed mRNAs (DEmRNA)/miRNAs (DEmiRNAs)/methylated regions were identified in READ. The negatively correlation of DEmiRNA-DEmRNAs and DNA methylation-DEmRNAs were obtained. DEmRNA expression was validated through quantitative real-time polymerase chain reaction (qRT-PCR) analyses. Results A total of 1 192 DEmRNAs and 27 DEmiRNAs were screened in the data. And 1 987 miRNA-mRNA regulatory relationships were obtained by screening target genes. In this study, 446 genes with aberrant methylation were annotated, and 6 403 aberrant methylation CpG sites were screened in READ compared to normal controls. Eventually, 50 DEmRNAs (39 down-regulated and 11 up- regulated DEmRNAs) with hyper methylation and synchronously negatively targeted by DEmiRNAs, were identified through the correlation analysis among 446 genes with aberrant methylation and 668 DEmRNAs. The 50 DEmRNAs were significantly enriched in cAMP signaling pathway, circadian entrainment and glutamatergic synapse. Results of qRT-PCR showed that the validation results of expression levels of DEmRNAs were compatible with our study. Conclusion Seven hypermethylation genes (SORCS1, PDZRN4, LONRF2, CNGA3, HAND2, RSPO2 and GNAO1) that are negatively regulated by DEmiRNAs may promote the occurrence of READ. Related Articles | Metrics

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Effects of ibuprofen on the growth and development of oligodendrocytes JIANG Ji-peng1,YANG Kai 2,ZHAO Fei 3,ZHANG Shan-shan4,PANG Ai-bo5,ZHANG Sai 1, CHEN Xu-yi 1 2018, 46 (5):  509-514.  doi: 10.11958/20170978 Abstract ( 1091 )   PDF (783KB) ( 3527 )   Abstract: Objective To study the effects of ibuprofen on the growth and development of oligodendrocytes. Methods A total of 6 clean and healthy adult female SD (Sprague Dawley) rats were used for extracting and culturing of oligodendrocytes (OLs). Lysophosphatidic acid (LPA) was then added, and the morphological changes of OLs pre-treatment and post-treatment were observed. Then 6 newborn rats (born 24-48 h) were used for mixed glial cell extraction from the cortex, then the OPCs were inoculated into the culture plates and randomly divided into control group, ibuprofen group, lysophosphatidic acid (LPA) group and LPA+ ibuprofen group. After the adhering of the cells in each group for three days, cell morphology was observed, and the drugs were added as interventions. The control group was treated with normal saline, and the other 3 groups were added with saline solution of ibuprofen (100 μmol/L), LPA (1.0 μmol/L) and the mixture of them. The cell morphological changes were observed after 7-day intervention. The morphology of OPCs and OLs were observed by immunofluorescence staining through OPCs’specific immune markers (platelet-derived growth factor receptor alpha, PDGFR-α) and OLs’specific immune markers (myelin basic protein, MBP) along with cell count of mature OLs. Western blot assay was used to detect the relative expression level of MBP in each group. Results After the treatment with LPA to the mature OLs, protrusions were shrinking and became very sparse. The morphology of cells developed well in each group after cell adhering for 3 days. After drug intervention for 7 days, more cell protrusions and branches were observed in ibuprofen group and LPA+ ibuprofen group than those of the control group and LPA group. The results of cell count showed that the number of MBP positive cells was significantly higher in the ibuprofen group and LPA+ibuprofen group than that in the control group and LPA group (P＜0.01). The results of Western blot assay showed that the MBP protein expression was significantly less in LPA group than the other three groups (P＜0.01), and the expression was significantly higher in the ibuprofen group than that of LPA + ibuprofen group (P＜0.01). Conclusion LPA has a toxic effect on the growth and development of OPCs, and it has an inhibitory effect on the normal growth of mature OLs. A certain concentration of ibuprofen can significantly inhibit the cytotoxicity of LPA on OPCs and OLs, and promote the formation and maintenance of mature OLs. Related Articles | Metrics

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Study on protective effects of platelet-leukocyte aggregation on myocardial ischemia reperfusion injury and postischemic recovery in rats SUN Jing1,REN Fa-xin1,SUN Xiao-jian1,ZHANG Chuan-huan1,LI Liu-dong1,MU Nan2,DONG Mei 1 2018, 46 (5):  514-518.  doi: 10.11958/20171103 Abstract ( 729 )   PDF (441KB) ( 3561 )   Abstract: Objective To observe the effect of postconditioning (PostC) on the expression of platelet-leukocyte aggregation (PLA) during the process of myocardial ischemia and reperfusion in rats, and to explore the mechanisms of ischemic postconditioning (PostC) alleviating myocardial ischemia-reperfusion injury (MIRI). Methods Sixty rats were randomly divided into six groups: sham, reperfusion injury (I/R), postconditioning (PostC), SP600125 (inhibition of c-Jun N-terminal kinase, I-JNK), anisomycin and postconditioning (Ani+ PostC) and anisomycin (Ani) groups. After constructing the model of myocardial ischemia reperfusion in rats, the levels of myocardial injury markers were detected by using the CK-MB kits and TnI kits. The levels of PLA at different time points were detected by using flow cytometry. The myocardial infarction area were measured by using 2.3.5-Triphenyte-trazoliumchloride (TTC) staining, and the level of phosphorylation of JNK (P- JNK) was determined by using Western blot method. Results (1) The levels of CK-MB, TnI and the infarct size were significantly higher in the I/R group than those in the Sham group (P＜0.05). The levels of CK-MB, TnI and the infarct size were significantly lower in the PostC group and I-JNK group than those in the I/R group (P＜0.05). Compared with the PostC group, the levels of CK-MB, TnI and the infarct size were significantly higher in the Ani+PostC group and Ani group (P＜ 0.05). (2) Compared with the Sham group, the expression levels of PLA significantly increased in the I/R group at different time points after ischemia (P＜0.05). At different time points of MIRI, the expressions of PLA increased gradually in I /R group, Ani+PostC group and Ani group (P＜0.05). At the time point of reperfusion for 60 minutes and reperfusion for 3 hours, the expressions of PLA were significantly lower in the PostC group and I-JNK group compared with those of I/R group (P＜0.05). Compared with the PostC group, the expressions of PLA were significantly higher in the Ani+PostC group and Ani group (P＜0.05). (3) Compared with the Sham group, the expression levels of P-JNK were significantly higher in the I /R group (P＜0.05). PostC and I-JNK inhibited the production of P-JNK (P＜0.05), while Ani promoted the increase of P-JNK (P＜0.05). Compared with the PostC group, the expression levels of P-JNK were significantly higher in the Ani+PostC group and Ani group (P＜0.05). Conclusion PostC can reduce the expression of PLA during reperfusion by inhibiting the phosphorylation of JNK, thereby reducing myocardial ischemia-reperfusion injury. Related Articles | Metrics

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Comparison of the curative effect between delayed PCI and medical therapy on ST-segment elevation acute myocardial infarction LIAO Yan-chun, CAO Yan-jun, ZHANG Hong-yu, WU Zhi-guo, QIU Bao-hua, ZHANG Xia, WANG Shu-jing, MEI Lian-lian 2018, 46 (5):  519-522.  doi: 10.11958/20171388 Abstract ( 745 )   PDF (354KB) ( 3990 )   Abstract: Objective To investigate and compare the curative effect between delayed percutaneous coronary intervention (PCI) for patients with acute myocardial infarction presenting 12-24 hours from symptom onset and medical therapy on acute myocardial infarction patients presenting with ST-segment elevation (STEMI). Methods Using a prospective, open, parallel, controlled research approach, 186 patients with STEMI were divided into delayed PCI group (n＝ 89), which received PCI within 12-24 hours after STEMI and medical therapy group (n=97), which received medical therapy after STEMI. All patients were followed up 1-6 months with average follow-up (5.6±1.4) months. Data of hospitalization period, the cardiac structures detected by echocardiography such as left atrial diameter (LAD), left ventricular diastolic diameter (LVDd), left ventricular ejection fraction LVEF, left ventricular fractional shortening (LVFS), composite end point events and major adverse cardiac events (MACE) were compared between the two groups. Results Compared with medical therapy group, the hospitalization cycle was significantly shorter in delayed PCI group. Data of the LAD and LVDd were significantly decreased, but LVEF and LVFS were increased in delayed PCI group compared with those of medical therapy group at 30 d and 6-month follow-up. The incidence of MACE and composite end point events were significantly less in delayed PCI group than those of medical therapy group (P＜0.05). Conclusion Delayed PCI treatment can decrease the time of hospital stay and decrease the incidence rates of MACE and composite end point events, and improve left ventricular function and prognosis of patients. Related Articles | Metrics

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Clinical analysis and treatment strategy of cerebral contusion in children WANG Peng, SUN Hong-tao, DONG Jun-qiang, TU Yue, ZHANG Sai 2018, 46 (5):  523-527.  doi: 10.11958/20180085 Abstract ( 983 )   PDF (581KB) ( 3831 )   Abstract: Objective To study the clinical characteristics of brain contusion in children and discuss the corresponding treatment strategies. Methods From February 2013 to December 2017, the clinical data of 32 patients (aged 1-14 years) with cerebral contusion and treated in the department of brain of the affiliated hospital of armed police logistics college were collected, including 22 males and 10 females. The age of patients ranged from 1 to 13.5 years, with the average of (6.03 ± 3.96) years. Patients were divided into low age group (1-4 years old, n=14) and high age group (5-14 years old, n= 18) according to their age. Data of the brain damage location and distribution, Glasgow Coma Scale (GCS)/Children’ s Coma Scale (CCS), intracranial pressure (ICP), cerebral edema, airway condition, traumatic epilepsy and electroencephalogram (EEG) were summarized and analyzed. Results The duration of hospitalization was 17-57 d, with the average of (34.2± 11.5) d. All the children were treated with hyperbaric oxygen for 14-51 d, with an average of (36.1±5.1) d. There were no significant differences in the depth of brain damage and the location of brain injury between the two age groups (P＞0.05). The coma scores at the admission and the discharge were significantly lower in low age group than those of the high age group (P＜0.05). The duration of ICP monitoring was 6-15 d, with the average of (7.5±2.0) d. The ICP level and the resonance index (RI) value of cerebral edema monitoring at the admission was higher in the low age group than those in the high age group (P＜0.05). The abnormal time of RI was less in the low age group than that in the high age group (P＜0.05). There were no significant differences in seizures and EEG classification between two groups (P＞0.05). There were 10 cases in each group received the transnasal intubation, and the average days with intubation were longer in the low age group than those of the high age group (P＜0.05). Conclusion The clinical manifestations, imaging features, ICP, the degree of brain edema, seizures and airway management in children of different ages are different. The treatment should be carried out as soon as possible, actively and comprehensively, especially in the clinical management for the children of low age. Related Articles | Metrics

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Submental island flap for repairing oral defect after radical resection of oral cancer MENG Li 1,SHEN Jun2,LIU Hao2,MU Jie2,CHEN Wei 2,ZHANG Jun2,WANG Chao2,YAN Ying-bin2 2018, 46 (5):  527-532.  doi: 10.11958/20171064 Abstract ( 1131 )   PDF (1552KB) ( 3612 )   Abstract: Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from (5 cm×3 cm) to (12 cm×5 cm). The mean operation time was (350.5±50.5) min. The vein of the flap was found to drain into the facial vein, and then returned to the internal jugular vein in 17 patients (68.0%), into the external jugular vein in 4 patients (16%), and into the anterior jugular vein in 4 patients (16%). Twenty-four flaps survived completely, and 1 flap failed due to the damage of the submental artery. Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases. The prevalence of occult lymph node metastasis involving level Ⅰ was 16.0%. The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap. Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein, which are previously overlooked, should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss. Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases. Related Articles | Metrics

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Feasibility of avoiding axillary lymph node dissection in early breast cancer patients with positive sentinel lymph nodes HAN Meng-meng, JIANG Peng-ling, CHEN Wei, ZHANG Min, LIU Mei, ZHANG Sheng, ZHI Xiang-cheng 2018, 46 (5):  532-535.  doi: 10.11958/20171261 Abstract ( 1003 )   PDF (347KB) ( 3674 )   Abstract: Objective To explore the feasibility of omitting axillary lymph node dissection (ALND) in early breast cancer patients with positive sentinel lymph nodes (SLN). Methods Clinical data of 591 patients with primary breast cancer treated in our hospital from September 2014 to September 2016 were collected. According to the SLN status, patients were divided into SLN (-) group (n=320), SLN (+) =1 group (n=172), SLN (+)=2 group (n=72) and SLN≥3 group (n=27). ALND was performed in all patients after sentinel lymph node biopsy (SLNB). The positive rates of axillary lymph node (ALN) were compared between groups. Results The positive rates of ALN were 5.0% (16/320), 8.1% (14/172), 16.7% (12/ 72) and 37.0%(10/27) in SLN (-) group, SLN (+) =1 group, SLN (+)=2 group and SLN≥3 group respectively. There was no significant difference in the positive rate of ALN between SLN (-) group and SLN (+) =1 group (χ2 =1.926， P=0.165). The positive rate of ALN was significantly higher in SLN (+)=2 group than that of SLN (-) group (χ2 =12.062， P=0.001) and SLN (+) =1 group (χ2 =3.876， P=0.049). The positive rate of ALN was significantly higher in the SLN(+)≥3 group than that in the SLN(-) group (χ2 =32.939, P＜0.001) and SLN(+)=1 group (χ2 =15.751, P＜0.001) and SLN(+) =2 group (χ2 =4.714, P=0.030). Conclusion The patients with 1 SLN positive can be considered to exempt from ALND, while the patients with 2 or more SLN positive may be recommended ALND. Related Articles | Metrics

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Clinical study of preoperative radiotherapy plus chemotherapy combined with surgery in the treatment of locally advanced cervical cancer DENG Li-xia1,ZHAO Yan-yan2,LIU Xin-xin1,ZHAO Qing-lian1 2018, 46 (5):  536-540.  doi: 10.11958/20171201 Abstract ( 952 )   PDF (451KB) ( 4714 )   Abstract: Objective To study the clinical data of patients with locally advanced cervical cancer (LACC) treated with preoperative radiotherapy plus chemotherapy combined with surgery. Methods Seventy patients with LACC (stage ⅠB2, ⅡA2 and ⅡB) who were treated in our hospital from January 2012 to December 2016 were selected in this study. All the cases were randomly divided into two groups. The observation group (n=35) was treated with three-dimensional intracavitary brachytherapy plus chemotherapy combined with surgery, while the control group (n=35) was treated with radical radiotherapy. Patients of the two groups were followed up after the treatment. The recent and long term complications were recorded and observed in the two groups. Meanwhile, the survival curves were drawn by Kaplan-Meier, and the difference of total survival rate was compared with the Log-rank method between the two groups. Results The incidence of rectal reaction was less in the observation group than that in the control group (14.3% vs. 37.1%, χ2 =4.786， P＜0.05). There were no significant differences in bone marrow suppression, gastrointestinal reaction and bladder reaction between the two groups (P＞0.05). The incidence rates of radioactive bladder injury (8.6% vs. 31.4%) and radionuclide injury (11.4% vs. 34.2%) were less in the observation group than those in the control group (χ2 =5.714 and 5.185 respectively, P＜0.05). The survival analysis showed that there was no significant difference in the total survival rate between the two groups of stageⅠB2+ⅡA2 and stageⅡB patients (Log rank χ2 =0.081 and 0.376, P＞0.05). Conclusion For patients with locally advanced cervical cancer, preoperative radiotherapy plus chemotherapy combined with surgery can reduce the incidence of related complications, meanwhile, there is no significant difference in the total survival rate and the mean survival time after the treatment of the two methods. Related Articles | Metrics

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Effects of Dane Fukang Jiangao combined with GnRH-a in preventing recurrence of postoperative endometriosis FENG Qin-qin, ZHAO Hong-ping 2018, 46 (5):  540-543.  doi: 10.11958/20171288 Abstract ( 877 )   PDF (378KB) ( 4329 )   Abstract： Objective To observe the clinical efficacy of Dane Fukang Jiangao combined with gonadotropin-releasing hormone analogue (GnRH-a) in the treatment of endometriosis (EMT) after laparoscopic surgery. Methods A total of 120 EMT patients treated with GnRH-a after laparoscopic surgery were randomly divided into combine treatment group (n=60) and control group (n=60). In the control group, GnRH-a 3.75 mg was injected subcutaneously on the first day of menstruation and injected once every 28 days. The combine treatment group was given Dane Fukang Jiangao with ora administration 10 g per time, twice a day for 6 months. The changes of estradiol (E2), CA125 and visual analogue scale (VAS) were observed before and after treatment. Kupperman score was used to assess the degree of menopausal symptoms during treatment and follow-up records of recurrence. Results Before treatment, there were no significant differences in the serum levels of E2 and CA125 and VAS between both groups. After treatment, the serum levels of E2 and CA125 and VAS were significantly improved in both groups. And the serum level of E2 was significantly higher in combine treatmen group than that of control group (P＜0.05). The VAS and the serum level of CA125 were significantly lower than those o control group (P＜0.05). Moreover, after treatment the Kuppermann score was significantly better in combine treatment group than that of control group (P＜0.05). There was no significant difference in the recurrence rate in 6 months between the combine treatment group (21.7%) and the control group (38.3%, P＞0.05). Conclusion Dane Fukang Jiangao in combination with GnRH-a can effectively prevent E2 from being too low,reduce the CA125 level after EMT surgery, relieve dysmenorrhea and menopausal symptoms, and prevent recurrence. Related Articles | Metrics

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Epidemiological characteristics and pathogenic analysis of bacillary dysentery in Zhengzhou city from 2004 to 2016 DUAN Jing-jing, AN Ge, LIU Jiang-hua, XU Lan-ying, LI Xiao-hong, HAN Tong-wu 2018, 46 (5):  544-547.  doi: 10.11958/20180124 Abstract ( 602 )   PDF (522KB) ( 4064 )   Abstract：Objective To understand the epidemic and etiological characteristics of bacillary dysentery and provide scientific evidence for the prevention strategies. Methods The surveillance data and serotyping of bacillary dysentery in Zhengzhou city from 2004 to 2016 were analyzed by descriptive epidemiological method. Results A total of 29 284 cases of bacillary dysentery were reported in Zhengzhou from 2004-2016. The average annual incidence was 31.28 per 100 000 and decreased annually (χ2 =103.60, P＜0.001). The peak season was from May to October. The incidence was higher in city than that of county, and male was higher than female. The majority of the bacillary dysentery cases was children under 3 years old, and scattered children were the main population at risk. A total of 385 Shigella strains were isolated and identified from 2004 to 2016, and 72.35% (280 strains) of strains were Shigella flexneri. F2a subtype was dominated, but the detective rate of Shigella sonnei was increased gradually. Conclusion Bacillary dysentery is still one of important infectious diseases in Zhengzhou, comprehensive measures should be taken to decrease the incidence including health education in targeted area and people in epidemic season. Related Articles | Metrics

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The research progress on Notch signaling pathway in the regulation of Treg/Th17 cells ZHANG Shan, LIU Bao-shan 2018, 46 (5):  548-552.  doi: 10.11958/20180137 Abstract ( 827 )   PDF (366KB) ( 6122 )   Abstract: Notch family, a kind of important transmembrane signaling proteins, is highly evolutionarily conserved in the development process of multicellular organisms. Notch signaling pathway can precisely regulate cell development process through the interaction between neighboring cells, such as cell proliferation, differentiation and apoptosis. The regulatory T (Treg) cells and T helper 17 (Th17) cells are new types of CD4+ T cell subsets. In the physiological state of the organism, they can secrete relevant various kinds of cytokines, and systematically regulate the balance of immune system. In recent years, more and more studies have found that close relationship between Notch signaling pathway and Treg / Th17 cell balance, which is extensively involved in the various diseases. Therefore, this paper briefly reviewed the regulation mechanism of Notch signaling pathway on Treg/Th17 cells in diseases such as hematological diseases and autoimmune diseases. Related Articles | Metrics

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A review of the epidemiology and economic burden of herpes zoster and postherpetic neuralgia XU Wen-ti 1,WANG Qi-fan2 2018, 46 (5):  552-556.  doi: 10.11958/20171248 Abstract ( 843 )   PDF (351KB) ( 3721 )   Abstract: Herpes zoster is a kind of acute viral infection caused by varicella zoster virus. The postherpetic neuralgia is the main complication of herpes zoster. Herpes zoster and postherpetic neuralgia cause huge disease burden and economic burden in the world. In this paper, we reviewed the epidemiological characters and economic burden of herpes zoster and postherpetic neuralgia based on the latest studies, and provided a new research direction for prevention and treatment for our country. Related Articles | Metrics

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The research progress of immunotherapy in head and neck squamous cell carcinoma DI Jian-xin, ZHOU Hui-fang 2018, 46 (5):  557-560.  doi: 10.11958/20180038 Abstract ( 1180 )   PDF (329KB) ( 3944 )   Abstract：Despite the continuous progress and development of surgical and comprehensive treatment in recent years, the 5-year survival rate of patients with head and neck squamous cell carcinoma (HNSCC) has not been significantly improved. Therefore, improving treatment efficiency and therapeutic strategies are urgently needed. As one promising novel therapy, immunotherapy has been gradually applied in the treatment of multiple tumors including HNSCC with low toxicity and high specificity. In the immunotherapy of HNSCC, the researchers have further developed a combined systemic therapy from single cytokine therapy and achieved good effects. On the other hand, multiple cancer vaccine therapies including protein/polypeptide-dendritic cell vaccine have been put into clinical trials. In addition, immunotherapy against PD-1 and other immune checkpoints have received extensive attention, and relevant inhibitory antibodies have also been approved for the treatment of recurrent or metastatic HNSCC. Here, we briefly make a review about the progress of multiple immunotherapies for the treatment of HNSCC, including cytokine therapy, vaccine therapy and immune checkpoint therapy. Related Articles | Metrics