BACKGROUND:Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous.CASE SUMMARY:A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of "clinically explosive myocarditis". The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism.CONCLUSION:LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.

Background Perioperative coronary artery spasm (CAS) following coronary artery bypass grafting (CABG) is a severe or lethal condition that is rarely reported. In addition, rare cases with CAS following CABG in the non-manipulated coronary artery are angiographically documented in the perioperative period. We aimed to report our experiences on the diagnosis and treatment of a case with CAS following off-pump CABG in the non-manipulated coronary artery. Methods A 57-year old male with coronary heart disease and unstable angina willing to undergo CABG was admitted to our department. CABG was recommended as he showed 90% stenosis in distal left anterior descending artery, 90% stenosis in intermediate branch, 90% stenosis in left circumflex coronary artery, as well as 50% stenosis in proximal right coronary artery (RCA). Results After CABG, the patient showed Adams-Stokes syndrome and ST-segment elevation. Then CPR was conducted and coronary angiography indicated perioperative CAS in the non-manipulated posterior descending artery. For the treatment, the patient received nitroglycerin injection into the coronary artery by catheter and pumping of diltiazem. Finally, the patient was discharged on day 7 after surgery. A comprehensive literature search was conducted to summarize the studies focused on the diagnosis and treatment of such condition, which indicated that all of the CAS cases occurred in the manipulated vessels, except one study showing CAS in the untouched native coronary artery which was similar with our case. Conclusions Perioperative CAS in the non-manipulated coronary artery following CABG is a severe or lethal condition that is rarely reported, which deserves close attention by the clinicians in clinical practice.

Stem cell therapy represents a new approach to induce immune tolerance in solid organ transplantation. However, the time-consuming process of stem cell expending limits the range of stem cell treatment. Uncultured adipose stromal vascular fraction is considered an attractive cell source for cell-based therapy. This study aimed to evaluate the effect of stromal vascular fraction on the immune system in donation after circulatory death rat renal transplantation. Stromal vascular fraction cells and splenocytes were co-cultured to evaluate the effect of stromal vascular fraction on splenocyte proliferation and viability. Sprague–Dawley rats were used as donors. and Wistar rats as recipients to establish a donation after a circulatory death rat renal transplantation model. Warm ischemia time was 5 min. Stromal vascular fraction was administered in the rat model following the intra-arterial route. The spleens and grafts of recipients were harvested on days 1, 3 and 7 post-transplantation for assessing acute rejection, infiltration of inflammatory cells, indoleamine 2, 3-dioxygenase expression and T-cell frequency in the spleen. Stromal vascular fraction could inhibit proliferation and induce apoptosis of splenocytes in vitro ( P  < 0.05). The administration of stromal vascular fraction could significantly reduce acute rejection and infiltration of CD8 + T cells and mononuclear macrophages in grafts, and increase indoleamine 2, 3-dioxygenase expression ( P  < 0.05). The frequency of CD8 + T cells decreased, and the frequency of CD25 + Foxp3 + regulatory T cells increased in the spleen of the acute rejection + stromal vascular fraction group on day 7 post-transplantation ( P  < 0.05). Administration of the adipose stromal vascular fraction could attenuate acute rejection in donation after circulatory death renal transplantation by increasing the ratio of regulatory T cells and enhancing indoleamine 2, 3-dioxygenase expression.

Donation after cardiac death (DCD) has become a potential source for transplantation organs. However, ischemia/reperfusion injury (IRI) induced by cardiac arrest has limited the use of DCD organs. Stromal vascular fraction (SVF) without the culturing step has been proposed as a safer and easier source for stem cell therapy, which has emerged as an attractive technology that could facilitate the recovery of renal function and structure from acute kidney injury induced by IRI after DCD renal transplantation. In this study, freshly isolated donor-derived SVF was identified and then delivered intra-arterially into the grafts in DCD rat renal transplantation. Administration of freshly isolated donor-derived SVF could significantly alleviate the IRI of renal grafts and enhance graft reparation by promoting graft cell proliferation and microvascularization in DCD renal transplantation. Moreover, results revealed that the oxidative stress in grafts was significantly alleviated with SVF treatment, and this might be attributed to the overexpression of antioxidative molecules including nuclear factor erythroid-related factor 2, superoxide dismutase-1, and heme oxygenase-1. In conclusion, our study demonstrated that the administration of freshly isolated donor-derived nonexpanded adipose SVF could attenuate IRI and protect the grafts after DCD rat renal transplantation.

Stem cell-based therapy has been suggested as a promising option for the treatment of renal ischemia-reperfusion injury (IRI). However, how to efficiently deliver stem cells remains a challenge. In the present study, we firstly proposed the utilization of kidney extracellular matrix hydrogel (ECMH) as an injectable scaffold for delivering adipose-derived mesenchymal stem cells (ad-MSCs) into ischemic kidneys. A modified strategy of decellularization and gelation was introduced to prepare the ECMH, by which the bioactive ingredients were retained as much as possible. Bioluminescence living imaging and immunofluorescence revealed that ECMH could significantly elevate the retention and survival rate of transplanted ad-MSCs in damaged kidneys and reduce their escape rate to other organs, which consequently resulted to the enhanced therapeutic effect of ad-MSCs on renal IRI. Further, in vitro evidence demonstrated that ECMH could remarkably reduce the oxidative stress and apoptosis, promote the proliferation, secretion, and epithelial differentiation of ad-MSCs, as well as facilitate cell migration while acting as a sustained-release scaffold. This study establishes an effective approach to enhance the therapeutic potential of adMSCs for renal IRI. Our findings suggest that ECMH derived from organs or tissues would be a promising injectable scaffold for stem cell-based therapy. Statement of significance It remains a challenge to efficiently deliver stem cells to target tissues, which may limit the clinical application of stem cell-based therapy. In this study, we developed a modified strategy of decellularization and gelation to prepare the kidney extracellular matrix hydrogel (ECMH). In vivo and in vitro evidence indicated that the kidney ECMH could improve the retention and survival rate, as well as multiple biological functions of adipose-derived mesenchymal stem cells, thereby contributing to the histological and functional recovery of injured kidneys induced by ischemia-reperfusion. Our findings highlight the use of organs or tissues derived ECMH as a promising stem cell delivery scaffold for tissue repair. (C) 2020 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Two patients diagnosed with cardiac foreign bodies underwent a surgical extraction in our department. The needles in both cases experienced a strange migration: the one disappeared from entry side and presented in the great cardiac vein, the other completely embedded into the septum. We presented two rare locations that may be directive for others.

Purpose 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is valuable for detecting primary and recurrent prostatic lesions. This study aimed to evaluate the efficacy of 68 Ga-PSMA-11 PET/CT as a triage tool for prostate biopsy (PSMA-TB) and compare with transrectal ultrasound-guided biopsy (TRUS-GB) for the diagnosis of clinically significant prostate cancer (csPCa). Methods This single-centre study randomly allocated 120 patients with elevated serum prostate-specific antigen (PSA) levels (> 4 ng/ml) to PSMA-PET or TRUS group. Patients with PSMA-avid lesions (SUVmax ≥ 8.0) underwent PSMA-TB via a single-puncture percutaneous transgluteal approach ( n = 25), whilst patients with negative PSMA-PET underwent systematic TRUS-GB ( n = 35). All patients in the TRUS group underwent TRUS-GB directly ( n = 60). Results PCa and csPCa were detected in 26/60 (43.3%) and 24/60 (40.0%) patients in the PSMA-PET group and 19/60 (31.6%) and 15/60 (25.0%) in the TRUS group, respectively. In the PSMA-PET group, the detection rate of PCa and csPCa were significantly higher in PSMA-PET-positive than negative patients (PCa, 23/25 (92.0%) vs 3/35 (8.6%), P < 0.01; csPCa, 22/25 (88.0%) vs 2/35 (5.7%), P < 0.01). PSMA-TB detected significantly more PCa and csPCa than TRUS-GB in the TRUS controls (PCa, 21/25 (84.0%) vs 19/60 (31.6%), P < 0.01 ; csPCa, 20/25 (80.0%) vs 15/60 (25.0%), P < 0.01). PSMA-PET detected significantly more cases of csPCa amongst patients with PSA 4.0–20.0 ng/ml than TRUS (27.02% vs 8.82%, P < 0.05). No haematuria, urinary retention or pelvic infection was observed after PSMA-TB compare with TRUS-GB. Conclusions 68 Ga-PSMA-11 PET/CT is a feasible imaging technique that may serve as a triage tool for prostate biopsy, and may improve the detection rate of csPCa compared with TRUS-GB, especially in patients with serum PSA 4.0–20.0 ng/ml.

The aim of this study was to investigate the efficiency of endovascular graft exclusion for treating Stanford type B acute aortic dissection (AAD) in aged population. Forty-six consecutive patients aged >= 65 years with Stanford type B AAD underwent endovascular therapy in Tianjin Chest Hospital between 2010 and 2015 were included in this study. All patients received echocardiography, contrast-enhanced CT, hepatic and renal functions tests, and the blood and urine routine examinations. After the procedure, annual review of the whole aortic computed tomography (CT) was performed for all patients before discharge, as well as 3 months, 6 months and 12 months after surgery. All patients were followed up until December, 2015. The outcomes of the whole aortic CT and survival rate were analyzed. Five patients (10.87%) died. Among the 5 cases, 2 showed perioperative death induced by cerebral infarction, 1 died because of newly developed AD 8 months after surgery, and 2 died because of acute myocardial infarction (n = 1) and renal/cardiac failure (n = 1). The other 41 patients (89.13%) were symptom-free with satisfactory conditions. Endovascular stent-graft placement was effective for treating the senior patients with Stanford type B AAD.

目的 探索β-氨基丙腈(β-Aminopropionitrile,BAPN)对鼠大动脉壁的影响,并对比人类夹层动脉瘤发病特点,以期进一步探索符合人类疾病特征的夹层动脉瘤动物模型.方法 在实验动物饮用水中混入BAPN,配成浓度为0.2％、0.4％、0.6％的BAPN溶液,4～5周龄SPF级SD大鼠和3周龄SPF级C57BL/6小鼠饲养7周.实验结束或动物死亡后将其解剖,分离其大动脉,观察大体变化.将大动脉分为升主动脉、降主动脉、腹主动脉肾动脉上段和腹主动脉肾动脉下段4部分,截取每段血管横断面进行HE染色,并测量其血管内径、中膜面积等各项指标.同时,留取行开胸手术的A型夹层动脉瘤患者大动脉进行HE染色,观察其病理改变,与发生夹层动脉瘤的鼠大动脉进行比较.结果 1)BAPN可显著影响大鼠或小鼠采水量及体重增长.2)BAPN可致大鼠或小鼠大动脉扩张,中膜增厚,弹性蛋白减少、排列紊乱,其病理改变符合人类夹层动脉瘤病理改变特征.3)浓度为0.4％的BAPN溶液模型成功率最高.结论 C57BL/6小鼠夹层动脉瘤动物模型可作为一种简便、经济、有效的动物模型进行下一步研究;SD大鼠发生肠破裂、脊柱侧弯等系统病理改变的比例高于夹层动脉瘤发生率,其作为夹层动脉瘤动物模型尚需进一步探索.

There is no consensus on the treatment efficiency of type A aortic dissection (AD) using ascending aorta replacement combined with open replacement of triple-branched stent graft versus total arch replacement combined with stented elephant trunk implantation. The present study was designed to compare the short-and long-term outcomes of patients with type A AD after ascending aorta replacement combined with open replacement of triple-branched stent graft versus total arch replacement combined with stented elephant trunk implantation. Thirty-three patients with type A AD admitted in our department from 2009 to 2014 were included in this study. Twenty-two patients received operations using total arch replacement combined with stented elephant (group A), while 11 received operations using triple-branched aortic arch covered stent grafts (group B). Adverse events and other clinical events were also recorded to compare the efficiency of two different methods. Complications were similar between the two groups. The intraoperative blood loss was significantly larger in group B compared to that of group A. In group A, the left ventricular size and the aortic diameter was decreased, and the left ventricular ejection fraction (LVEF) was elevated after surgery. In group B, the aortic diameter was decreased. No statistical difference was noticed in the survival duration of patients in both groups. The intraoperative blood loss is significantly increased in the patients received triple-branched stent graft compared to those received Sun's procedure. The Sun's procedure is superior to triple-branch graft with improvements in left ventricular size and left ventricular ejection fraction. Both surgery types contribute to the improvement of aortic diameter.

OBJECTIVE To compare the efficacies of tricuspid valve replacement versus plasty for moderate-to-severe tricuspid regurgitation with right heart failure. METHODS From January 2003 to June 2008, a total of 228 patients with right heart failure undergoing tricuspid valve operations were selected. And the procedures included tricuspid valve plasty (n=127) and tricuspid valve replacement (n=101). During a follow-up period of 65 months, their perioperative data were collected to evaluate the surgical outcomes. RESULTS The abnormal liver function rate and average pulmonary artery systolic pressure in tricuspid valve plasty group were lower than those in tricuspid valve replacement group (P=0.023, 0.033). In replacement group, average aortic cross-clamping time, cardiopulmonary bypass time, ventilation time and stay length of intensive care unit (ICU), the usage of inotropic drug was significantly higher than repair group (P<0.01). The early complication rate (15.8%) and case fatality rate (6.3%) of repair group were much lower than those of replacement group (27.3%, 16.8%) (P=0.042, 0.011). Long-term follow-ups revealed that the tricuspid valve thrombosis rate in replacement group was higher than that in repair group (P=0.036). And the recurrence rate of moderate-to-severe tricuspid regurgitation in repair group was higher than that in replacement group (28.7% vs 8.8%) (P=0.011). The survival rate of patients in repair group was much higher than that of replacement group at 3 months, 1, 3, 5 years post-operation. However, the differences were not statistically significant (P=0.231, 0.089, 0.133, 0.078). CONCLUSION For moderate-to-severe tricuspid regurgitation leading to right heart failure, the early efficacy of tricuspid valve plasty is much better than that of tricuspid valve replacement. The mid-term recurrence rate after tricuspid valve repair is higher than that of replacement.

Objective To investigate the effect of α-1,3-galactosyltransferase (α-1,3GT)silencing through RNA interference on the immunological and the physiological functions of porcine endothelial cells.Methods The primary porcine aortic endothelial cells were isolated and immortalized through transfection of SV40LT.The lentivirus carrying the α-1,3GT shRNA was established and transfected into the cells.The expression of α-1,3GT and α-1,3Gal after transfection was detected.The transfected cells were co-cultured with human serum to establish cell model of xenotransplantation.The effects of α-1,3GT) silencing through RNA interference on the immunological and the physiological functions of porcine endothelial cells were observed by using MTT,flow cytometry,immunohistochemistry and immunofluorescence.Results The physiological function of endothelial cells showed no significant difference before and after immortalization,but the expression of α-1,3GT and Gal was decreased greatly after RNA interference.After co-culture,transfected group cells showed higher proliferation rate but lower apoptosis rate,and their binding capability to human IgM,IgG C3 and C5b-9 was decreased as compared with mismatch and control groups.Conclusion Down-regulation of the α-1,3GT could reduce the binding of porcine endothelial cells to human immunoglobulin and complement.The endothelial cells with a-1,3GT silencing by RNA interference can be used for the study on immunology of xenotransplantation.

Objective To establish pig aortic endothelial cell lines for providing necessary cell model for xenotransplantation research.Methods The cell lines were established following the transfection of primary endothelial cells isolated from the aortas of the immature pig with lentivirus carrying genes for neomycin resistance and Simian Virus 40 Large T (SV40LT) antigen.The SV40LT mRNA,α-1,3-galactosyltransferase (α-1,3-Gal) mRNA and α-1,3-galactose were detected.At last,the response between the cells and human serum was tested.Results The expression of the SV40LT mRNA in cell lines were very high (P ＜0.05).Doubling time of the primary cells and the cell lines was about 21 h and 18 h,respectively.The cells also displayed endothelial cell characteristics since they endocytosed acetylated low density lipoproteins and steadily continuously expressed the yon Willebrand factor (P ＞ 0.05).The high expression of α-1,3-Gal mRNA and α-1,3-galactose [the fluorescence intensity was (498.2 ± 3.5) and (500.6 ± 3.2),respectively] had no difference in the two types of cells (P ＞ 0.05).When co-incubation with human serum,human natural antibodies bound to the two types of cells.Conclusion These results suggest that pig endothelial cell lines retained their original morphological structure and phenotypic characterization,and also had ability to respond to human serum.

Objective: Decellularized liver bioscaffold(DLB) holds great potential in tissue engineering.However,the published methods for DLB vary widely,and there has been no comparative study with regard to the host immune response in vivo.The objective of the present study was to characterize the rat DLB treated with different decellularization methods to determine their structural and biochemical properties for the optimal of DLB derivation.Methods: Livers of adult F344 rats were decellularized using three published methods based on sodium dodecyl sulfate(SDS),Triton X-100 and nonyl phenoxylpolyethoxylethanol(NP-40) combined with enzymes.The obtained DLB were submitted to H&E and Masson staining.The contents of residual DNA,GAG and HYP were determined.Following subcutaneous implantation into C57BL/6 mice,the DLB were collected and histological analysis on day 3,7 and 14.Results: All three methods succeed in the production of DLB that satisfied the current decellularization criteria.The histological results suggested that Triton X-100-and NP-40-based methods protected the liver ultrastructure better than SDS-based method.The results of composition analysis showed that NP-40-based method exhibited the greatest potential of DNA removal and GAG retention compared to SDS-and Triton X-100-based methods(P<0.05).The results of xenogeneic implantation of DLB suggested the DLB generated by NP-40-based method elicited lower level of host immune response and resulted in stronger remodeling results compared to other two methods.Conclusion: Compared to SDS-and Triton X-100-based methods,the rat DLB treated with NP-40-based method has less residual DNA content and more GAG content,and induces more positive host remodeling response following xenogeneic implantation.These data may provide an optimized DLB for further in vivo study.

Objective To compare the biocompatibility of decellularized liver biological scaffolds (DLBS) made by different methods and discussing the correlation between them.Methods Decellularized liver biological scaffolds were made by transfusing livers of 50 mature F344 rats with three different ways.Glycosaminoglycan (GAG) in the scaffolds was tested,and scanning electron microscope (SCM) and cytotoxicity assays were also used on the scaffolds.The liver oval cells were transfused into scaffolds through the portal vein.Cells on the scaffolds were examined by immunofluorescence (IF),scanning electron microscope,cells adhesion test and albumin excretion detection.Results Scaffolds made by the Method C had better orderliness than other two methods in gross observation,scanning electron microscopy and pore size calculation.The Method C [(44.19 ±3.35) ng/mg] had significantly more GAG than the Method A [(21.63 ±2.78) ng/mg] and Method B [(36.71 ±2.01) ng/mg].The scaffolds made by the Method C [(95.78 ± 2.11) ％] had higher collagen than in those made by the Method B [(91.15 ± 2.21) ％] and Method A [(84.18 ± 3.30)％].The cell adhesion rate of the Method B and Method C was higher than that of the Method A.Albumin excretion in the Method C [(85.77 ± 3.30) mg/106 cells] was greater than in the Method A [(49.37 ±2.43) mg/106 cells] and Method B [(74.66 ±4.80) mg/106 cells].Conclusion DLBS can be prepared by all three ways,but scaffolds made by our new method have better biocompatibility,and our method has significant advantages over the other methods.

Liver transplantation is the best treatment for end-stage liver disease.Because of the severe shortage of donor sources,most of the patients died while waiting for liver grafts.Artificial liver support system can improve the liver function in a short time,and help patients to pass the waiting periods.Artificial liver support system takes place of composition,detoxification and metabolism function of liver,stabilizes the physiological and biochemical index of liver,relieves the burden of liver and helps patients to prepare for the liver transplantation.With the wide application of artificial liver support system,new types of the artificial liver support systems gradually conquered the defects of the old types,but they still have their own defects.This review concludes the merits and demerits of artificial liver systems,its clinical application and the problems so as to help the treatment of end-stage liver disease.

Acute liver failure is a culmination of liver diseases which develop in a common pathophysiologic procession.The mortality rate is very high due to complicated etiology and diagnostic difficulties.Presently,the main method for acute liver failure treatment is dialysis,adjuvant therapy,and liver transplantation.We reviewed new research findings for the treatment of this disease and particular attention was given to practical matters for clinicians to consider in approaching patients.

Hepatocytes derived from mesenchymal stem cells (MSCs) hold great potential for cell-based therapies for liver diseases. The cell-based therapies are critically dependent on the hepatic differentiation of the MSCs with a high efficiency and on a considerable scale. Recent results have shown that decellularized organs provide a three-dimensional extracellular matrix for the lineage restriction of stem cell maturation. In this study, we compared the cell proliferation and hepatic differentiation of murine MSCs in a biomatrix scaffold from rat liver and in the presence and absence growth factors (GF) with a two-dimensional substrate. In the absence or presence of GF, the dynamic cultured scaffold (DCS) stimulated the MSCs to express endodermal and hepatocyte-specific genes and proteins associated with improved functions, and the cells exhibited the ultrastructural characteristics of mature hepatocytes. When transplanted into CCl4-injured mice, the cells pretreated with a combination of the DCS and GF exhibited increased survival, liver function, engraftment into the host liver and further hepatic differentiation. The paracrine effect of the transplanted cells on hepatic stellate cells and native hepatocytes played a key role in the treatment of the liver pathology. These studies define an effective method that facilitates the hepatic differentiation of MSCs exhibiting extensive functions and support further research into the use of a decellularized liver matrix as a bioscaffold for liver tissue engineering.