Extracorporeal circulation (ECC) is an essential operation in many cardiac surgeries, but contact between blood and connecting tubes can activate inflammatory factors and adversely affect complement. Previous studies have often focused on macrophages and neutrophils, while eosinophils have emerged as a new research hotspot due to their potential association with improved outcomes in recovery. The current research investigated the association between eosinophils and clinical prognosis in ECC patients. Data from the MIMIC-IV database were evaluated in this retrospective study, including 1,719 patients who underwent ECC. Eosinophil counts were categorized into tertiles, and their associations with 90-day mortality and the duration of mechanical ventilation were estimated with multivariable Cox regression models and linear regression, respectively. To assess survival results amongst eosinophil tertiles, the Kaplan-Meier survival analysis was employed. A lower 90-day death rate (HR for the highest tertile vs. lowest: 0.3, 95

Extensive loss of cardiomyocytes plays a major role in heart failure development after myocardial infarction (MI). Existing pharmacological treatments targeting cardiomyocyte apoptosis have shown limited clinical efficacy, largely because the underlying molecular mechanisms are unclear and effective drug delivery systems are unavailable. Emerging evidence suggests a critical regulatory role of ubiquitin-specific peptidase 10 (USP10) in cardiomyocyte apoptosis through multiple pathways. USP10 expression and its association with cardiomyocyte apoptosis were evaluated in a murine MI model. A biomimetic nanoparticle coated with neutrophil membranes and encapsulating a USP10 overexpression plasmid (NM-NP-USP10) was developed and characterized. Subsequent investigations evaluated its biodistribution, biosafety, therapeutic efficacy, and underlying mechanisms both in vivo and in vitro. The role of AMPK signaling was examined through the application of the pharmacological inhibitor Compound C. USP10 expression was markedly downregulated in the infarcted cardiac tissue and showed a positive association with cardiomyocyte apoptosis. NM-NP-USP10 preferentially accumulated in the ischemic myocardium and exhibited favorable biosafety profiles. Moreover, treatment with NM-NP-USP10 not only attenuated cardiomyocyte apoptosis but also promoted angiogenesis in vivo. Mechanistically, NM-NP-USP10 activated the AMPK/Akt/eNOS signaling pathway. In contrast, inhibition of AMPK substantially abrogated its anti-apoptotic and pro-angiogenic effects, indicating that AMPK signaling serves as a critical mediator of USP10-induced cardioprotection. These findings identify USP10 as a protective regulator in MI and demonstrate that targeted delivery of USP10 via neutrophil membrane-coated biomimetic nanoparticles facilitates cardiac repair through AMPK-dependent anti-apoptotic and pro-angiogenic mechanisms, underscoring its potential as a therapeutic strategy for MI.

To analyze the outcome of 147 cases of type B aortic dissection with thoracic endovascular aortic repair (TEVAR). We systematically reviewed 147 patients of type B aortic dissection with stent graft deployment in zone 2 or zone 3 by TEVAR from January 2012 to December 2022. These patients were observed by computed tomography angiography after the first and third months and annually thereafter during follow-up. Statistical analysis was performed by SPSS.16. The stent graft of 107 patients was deployed in zone 3, and the stent graft of 40 patients was deployed in zone 2. Severe dissection and surgery-related complications after TEVAR occurred in 19 patients, with complications arising more frequently in zone 2 than in zone 3 (12/40 vs. 7/107, P < 0.005). Endoleak was detected in 10 (6.8 Type of Research: Single-center retrospective cohort study. Key findings: 147 patients of type B aortic dissection with stent graft deployed in zone 2 or zone 3 by TEVAR. Severe dissection and surgery-related complications after Thoracic EndoVascular Aortic Repaie (TEVAR) occurred in 19 patients, with complications arising more frequently in zone 2 than in zone 3 (12/40 vs. 7/107, P < 0.005). Endoleak was detected in 10 (6.8 Take Home Message: This study suggests that TEVAR is the major treatment to use TEVAR if the stent graft can be deployed in zone 3. However, with the higher rate of complications and re-intervention after TEVAR, for patients whose stent graft can only be deployed in zone 2, it is not recommended that TEVAR be chosen as the preferred treatment.

Objective:To compare the early and mid-term results of thoracic endovascular aortic repair (TEVAR) with covered stent and simple medication in treating uncomplicated acute type B aortic dissection (ATBAD).Methods:The clinical data of 203 patients (118 males and 85 females) with uncomplicated ATBAD admitted to the First Affiliated Hospital of Xiamen University from January 2012 to December 2018 were collected and analyzed. The patients were divided into two groups based on the ways of treatment: simple medication group (Med group, 67 cases) and TEVAR group (136 cases). The operative and follow-up data of the patients in two groups were analyzed to evaluate the incidence rate of postoperative complications and the reintervention rate.Results:The follow-up time was (3.7±1.8) years (range: 3-84 months). During the follow-up period, the overall incidence rate of complications was 15.3% (31/203), the reintervention rate was 10.3% (21/203), and the mortality rate was 6.4%(13/203). The incidence rate of aortic-related complications (26.9% vs. 9.6%; P<0.05), the reintervention rate(19.4% vs. 6.6%; P<0.05), and the mortality rate (13.4% vs. 2.9%; P<0.05) in the TEVAR group were significantly lower than those in the Med group, and the differences were statistically significant. Compared with the Med group, the TEVAR group did not show a higher incidence of aortic dissection rupture (7.5% vs. 1.5%; P<0.05) and retrograde type A aortic dissection (4.5% vs. 1.5%; P>0.05). Conclusion:For the treatment of uncomplicated ATBAD, TEVAR is effective and safe. Compared with simple medication, TEVAR can achieve better early and mid-term results in treating uncomplicated ATBAD.

目的 分析覆膜支架腔内修复术(TEVAR)中支架锚定于Zones 2或Zone 3的并发症发生情况.方法 回顾性分析2013年6月至2018年7月117例Stanford B型主动脉夹层患者行TEVAR的治疗及随访资料(出院随访期间意外死亡除外),随访期间,患者均行主动脉CT血管造影检查,了解覆膜支架位置、远端真假腔血栓化程度、主动脉重要分支血流灌注情况、有无内瘘、是否新发主动脉夹层及其他的并发症.结果 术中所有覆膜支架释放成功,27例支架锚定于Zone 2,90例支架锚定于Zone 3.117例随访患者中有14例发生并发症,其中Zone 2发生8例,Zone 3发生6例.随访发现内瘘发生率为6.84％,Ⅰa型内瘘3例,锚定于Zone 2的2例,Zone 3的1例;Ⅰb型内瘘1例,锚定于Zone 3;Ⅱ型内瘘3例,锚定于Zone 2的2例,Zone 3的1例;Ⅳ型内瘘1例,锚定于Zone 3.8例患者接受再次手术干预治疗,包括Zone 2的5例(其中2例行腔内修复术,3例行开放手术)和Zone 3的3例(其中2例行腔内修复术,1例行开放手术).结论 TEVAR治疗Stanford B型主动脉夹层患者将支架锚定于Zone 2,随访期间并发症发生率较高,因此对于支架只能锚定于Zone 2的患者需谨慎选择TEVAR治疗.

Objective:To analyze the effects of thoracic endovascular aortic repair (TEVAR) with stents deployed in different landing zones on early to mid-term results in patients with type B aortic dissection.Methods:The data of 147 patients with type B aortic dissection receiving TEVAR in the First Affiliated Hospital of Xiamen University from January 2012 to December 2017 were reviewed retrospectively. All of the patients were divided into two groups based on the distance between proximal entry tear and left subclavian artery: (1) ≤2 cm, the stent was deployed in Zone 2 (Zone 2 group, 40 cases); (2) >2 cm, the stent was deployed in Zone 3 (Zone 3 group, 107 cases). CTA data of the two groups at 1-, 3-month and annually thereafter were analyzed to assess the postoperative complication rates (mainly the incidences of endoleak) and reintervention rates.Results:The age of the Zone 2 group was younger than that of the Zone 3 group [(57±9.3)years vs (61±10)years, t=2.04, P=0.04]. The follow-up period was (37.8±20.5) months (range: 6-77 months). In total, there were 18 cases presented with postoperative complications during follow-up, and the complication rate of Zone 2 group was higher than that of Zone 3 group [27.5% (11/40) vs 6.54% (7/107), χ2=11.90, P=0.001]. A total of 10 cases appeared with endoleak, and the incidence of endoleak in the Zone 2 group was higher than that in the Zone 3 group [15%(6/40) vs 3.74%(4/107), χ2=5.82, P=0.025]. A total of 12 patients were treated with reintervention, and the reintervention rate of Zone 2 group was higher than that of Zone 3 group [20%(8/40) vs 3.74%(4/107), χ2=10.27, P=0.003]. Conclusion:For type B aortic dissection, stent landing in Zone 2 is associated with higher rates of complications and reintervention than that in Zone 3.

目的 探讨晚期妊娠合并严重心脏瓣膜病患者围产期综合治疗方法及其临床效果.方法 回顾性分析2007年12月-2017年12月间在厦门大学附属第一医院心脏外科与妇产科联合治疗的32例晚期妊娠合并心脏瓣膜重度狭窄和(或)关闭不全患者的临床资料,对其产前治疗、围产期抗凝策略、麻醉和分娩方式选择、围产期并发症等进行总结分析.结果 32例患者均在有体外循环的条件下,于全身麻醉下行剖宫产结束妊娠.其中,按术前计划行剖宫产同期心脏手术患者11例;2例患者分别于麻醉过程中和娩出胎儿挤压子宫时出现心室颤动,遂紧急开胸于体外循环下继续完成剖宫产术,同期行心脏手术;1例重度二尖瓣狭窄患者剖宫产术后早期出现急性左侧心力衰竭、肺水肿,积极药物治疗效果不理想,紧急返回手术室行心脏瓣膜置换+三尖瓣成形术;18例患者单纯行剖宫产术,顺利度过围产期,另择期行心脏手术.无一例产妇死亡,母婴均,顺利恢复后出院.结论 晚期妊娠合并严重心脏瓣膜病的患者应在全身麻醉、体外循环准备下选择剖宫产做为结束妊娠的方式.并由产科、心脏外科、麻醉科等经验丰富的专家共同协作,根据孕妇心脏基础疾病、心功能状态、胎儿状况等决定分娩时机,以及是否同期行心脏手术.

目的 分析体素内不相干运动磁共振成像(IVIM-MRI)主要参数真实扩散系数(D)及灌注因子(f)和前列腺病理诊断的相关性.方法 87例前列腺检查患者,依照病理结果分成良性前列腺增生(BPH)组(n=44)和前列腺癌(PCa)组(n=43),并根据PCa患者Gleason评分(GS)分为低危组(GS＜7分,n=15)和中高危组(GS≥7分,n=28),对各组患者IVIM-MRI结果进行比较;通过病理结果计算各组患者微血管密度(MVD),分析两组灌注扩散系数(D *)、f与MVD的相关性;采用受试者工作特征(ROC)曲线分析D的诊断效能.结果 BPH组患者D显著高于PCa组,D*和f(不含b=800 s/mm2)显著低于PCa组(P＜0.05);两组f(含b=800 s/mm2)比较差异不显著(P＞0.05).相较于中高危组,低危组患者D*、f(含b=800 s/mm2)和f(不含b=800 s/mm2)显著较高,D显著更低(P＜0.05).BPH组MVD显著低于PCa组(P＜0.05).相关性分析发现,BHP组f值与MVD呈正相关(r=0.772,P＜0.05),PCa组D*与MVD显著正相关(r=0.784,P＜0.05).ROC曲线发现,D值的最佳诊断阈值为0.9×10-3 mm2/s,特异度为86.0％,敏感度为94.1％.结论 IVIM-MRI在前列腺良恶性及恶性肿瘤的严重程度诊断中有着很好的价值,扩散系数D的降低和灌注分数f的升高都是前列腺癌诊断的明显标志.

目的:探讨核磁共振在中枢神经系统感染性病变的诊断价值.方法:调研2016年3月～2018年2月我院收诊的50例中枢神经系统感染性病变患者--过程中,同期抽调50例健康体检者--对照组进行本次研究.全部患者均在入院后均进行MIR检查及CT检测,统计与比较两组患者的检查结果.结果:观察组的MIR的阳性率为98.00％(49/50),对照组的阳性率为0;两组比较差异显著,P＜0.05.观察组中MRI异常率与CT异常率比较,存在显著差异,P ＜0.05差异显著.结论:磁共振在中枢神经系统感染性病变有重要的意义,提高疾病的诊断率,缩短检查时间,提高治疗效果,减少不良并发症的发生,提高患者预后.

The interaction of chemokine (C-X-C motif) ligand 10 (CXCL10) with its receptor (CXCR3) is a critical process in recruiting donor reactive T cells to a graft and alloantigen-specific memory T (Tm) cells exert a principal function in promoting graft dysfunction during accelerated cardiac rejection. However, whether CXCL10 chemokine exerts any effects on acute accelerated rejection mediated by CD8+ Tm cells in a re-transplant model has remained elusive. The present study established a cardiac transplant model by advanced microsurgery technology and improved organ storage. A novel rat model of cardiac re-transplantation was established at 40 days following primary heart transplant. The experiment included two parts, and when models were established, the rats were divided into two groups: Primary cardiac transplant (HTx) and re-transplantation without treatment (HRTx). In part 1, recipients from part 2, including re-transplantation without treatment (HRTx+NS) and re-transplantation treated with anti-CXCL10 antibodies (500 µg every other day by intraperitoneal injection; HRTx+CXCL10 Abs group). The graft survival time was observed and graft infiltration by inflammatory cells was assessed via histology of cardiac graft sections; in addition, the gene expression and the serum concentration of CXCL10 in each group was assessed. Indexes such as rejection-associated cytokines were assayed by reverse-transcription quantitative PCR and ELISA kits, and flow cytometry of splenocytes was used to detect Tm cells in the re-transplantation groups. The results demonstrated that level of CXCL10 was significantly increased and the graft mean survival time was shortened accompanied with aggravated lymphocyte cell infiltration in the HRTx group when compared that in the HTx group; in addition, the serum levels and mRNA expression of interleukin (IL)-2 and interferon (IFN)-γ were increased, while transforming growth factor (TGF)-β was decreased in the HRTx group. Furthermore, neutralization of CXCL10 prolonged the graft mean survival time and delayed accelerated rejection. Compared with that in the HRTx+NS group, serum levels and graft tissue mRNA expression of IFN-γ and IL-2 were decreased in the HRTx+CXCL10 Abs group, while TGF-β mRNA was significantly increased but the serum concentration was not significantly affected. In addition, there was no difference in IL-10 between the two groups, while delayed accelerated rejection paralleled with inflammatory cell infiltration decreased and the proliferation and differentiation of CD8+ Tm cells in secondary lymphoid organs were reduced in the HRTx+CXCL10 Abs group vs. those in the HRTx+NS group. The present study demonstrated that CXCL10 had a crucial role in cardiac transplantation and re-transplantation, and that treatment with CXCL10 antibodies delays accelerated acute rejection mediated by Tm cells in a rat model of cardiac re-transplantation.

目的 探讨右美托咪定在心脏术后患者中的应用效果.方法 200例心脏术后患者,依据镇静方法差异分为对照组和右美托咪定组,各100例.对照组采用丙泊酚镇静,右美托咪定组采用右美托咪定镇静.比较两组镇静效果、机械通气时间、镇静达标时间,不良反应(谵妄、躁动)发生率,血压、呼吸和心率变化情况.结果 右美托咪定组镇静优良率为95.00%,高于对照组的80.00%,差异有统计学意义(P<0.05).用药后,两组患者血压、呼吸和心率比较差异无统计学意义(P>0.05).右美托咪定组机械通气时间、镇静达标时间与对照组比较,差异无统计学意义(P>0.05).右美托咪定组不良反应发生率为3.00%,低于对照组的16.00%,差异有统计学意义(P<0.05).结论 右美托咪定在心脏术后患者中的应用效果确切,可提高镇静效果,维持生命体征稳定,降低谵妄、躁动发生率,安全有效,值得推广应用.

目的 回顾总结24例冠脉搭桥术(CABG)后合并肝素诱导性血小板减少症(HIT)的治疗情况,以提高对该类并发症的治疗效果.方法 回顾性分析24例冠脉搭桥术后合并肝素诱导性血小板减少患者治疗情况.结合临床表现、4T评分及抗体检测情况,在冠脉搭桥术后一经确诊HIT,立即停止肝素暴露,强化抗血小板治疗同时采用非肝素类抗凝药物治疗,血小板恢复后继续采用华法林抗凝治疗.结果 16例患者经检查发现栓塞证据.术后早期因栓塞死亡5例,其余患者血小板恢复正常时间(5.8±2.2)d.出院后随访1个月～3年,1例患者术后2年再次发现乳内动脉及大隐静脉桥血管栓塞,经内科支架植入后好转,其余患者出院后未再出现血栓形成或出血并发症.结论 CABG患者须重视术后血小板计数的变化情况,HIT一旦发生,可能会导致桥血管急性栓塞、急性肺栓塞等致命性后果,早期诊断和治疗至关重要.

OBJECTIVE To observe the effects of chemokines CXCL9 and CXCL10 on cardiac allograft acute rejection mediated by alloreactive memory T cells in a retransplantation model. METHODS Heart transplantation was performed 6 weeks after skin grafting. The mice were divided into 3 groups of control (direct heterotopic heart transplantation without skin grafting); experimental (heart transplantation after skin grafting) and syngraft (C57BL/6→C57BL/6, heterotopic heart transplantation) (n = 12 each). Graft survival and the pathological changes of cardiac graft were observed. And related gene expression in cardiac grafts and serum concentration of CXCL9/CXCL10 were detected. RESULTS The mean survival time of control and experimental groups was 7.75 and 3.25 days respectively (P < 0.01).Serum concentrations of CXCL9 and CXCL10 in recipient mice were higher in the experimental group than those in the control group. Compared with the control group, the relative gene expressions of CXCL9 and CXCL10 were higher in the experimental group. According to pathological examinations, the histological rank of cardiac allograft was Grade 2.27 ± 0.25 in the control group versus Grade 4.12 ± 0.03 in the experimental group (P < 0.01). CONCLUSIONS CXCL9 and CXCL10 play critical roles in retransplantation mediated by alloreactive memory T cells. And acute rejection of cardiac allograft is more extensive in retransplantation.

C-X-C motif chemokine ligand (CXCL) 9 and CXCL10 play key roles in the initiation and development of acute transplant rejection. Previously, higher levels of RANTES expression and secretion were demonstrated in retransplantation or T-cell memory-transfer models. In the present study, the effect of the chemokines, CXCL9 and CXCL10, were investigated in a mouse retransplantation model. BALB/c mice were used as donors, while C57BL/6 mice were used as recipients. In the experimental groups, a heterotopic heart transplantation was performed six weeks following skin grafting. In the control groups, a heterotopic heart transplantation was performed without skin grafting. Untreated mice served as blank controls. The mean graft survival time of the heterotopic heart transplantations was 7.7 days in the experimental group (n=6), as compared with 3.25 days in the control group (n=6; P<0.001). On day three following cardiac transplantation, histological evaluation of the grafts revealed a higher International Society for Heart & Lung Transplantation grade in the experimental group as compared with the control group. In addition, gene expression and serum concentrations of CXCL9, CXCL10, interferon-γ, and interleukin-2 were markedly higher in the experimental group when compared with the control group. Differences between the levels of CXCL9 and CXCL10 in the pre- and post-transplant mice indicated that the chemokines may serve as possible biomarkers to predict acute rejection. The results of the present study demonstrated that CXCL9 and CXCL10 play a critical role in transplantation and retransplantation. High levels of these cytokines during the pre-transplant period may lead to extensive acute rejection. Thus, the observations enhance the understanding of the mechanism underlying the increased expression and secretion of CXCL9 and CXCL10 by alloreactive memory T cells.

OBJECTIVETo analyze and discuss the feasibility of rabbit carotid artery treated with decellularization and photo-oxidation.METHODSSixty vascular slices of rabbit carotid artery were divided into a fresh group, a cryopreservation group, a glutaraldehyde group, and a decellularization plus photo-oxidation group 15 in each group. To evaluate the physical properties of all the rabbit carotid arteries by testing heat-shrinking temperature, tensile stress and the max elongation of each group. Then by buliding subcutaneous embedding model in SD rats we evaluated the biological stability and the anti-calcification function property of the above rabbit carotid arteries, and the detection means included HE stain, atomic absorption spectrometry and Von-Kossa calcium salt stain.RESULTSThe heat-shrinking temperature, tensile stress and the max elongation in the cryopreservation group were lower or shorter than those of the other groups and the difference had statistical significance (P<0.05). Although the heat-shrinking temperature and the tensile stress in the decellularization plus photo-oxidation group were lower or shorter than those in the glutaraldehyde group (P<0.05), the max elongation in the decellularization plus photo-oxidation group was much longer than that in the glutaraldehyde group (P<0.05). The rabbit carotid artery treated with decellularization plus photo-oxidation showed lower immunogenicity and better biological stability and better anti-calcification property compared with the other groups.CONCLUSIONDecellularization associated with photo-oxidation is a suitable and novel protocol for small caliber artery allograft with a diameter of less than 6 mm which is unbreakable to mechanical properties and conducive to biological stability, which has a broad prospect.

Objective To observe the intluence ot chemokine RANTES influence on cardiac allograft acute rejection caused by alloreactive memory CD4+ T cells (Tm) adoptive transfer.Methods Heterotopic heart transplantation (HTx) from Balb/c donors to C57BL/6 recipients was performed by anastomosis of the vessels of the neck.Mice undergoing heterotopic heart transplantation received either adoptive transfer of 1 × 106 CD4+ Tm from the spleen of alloantigen-primed C57BL/6 mice or no cells (control group).After the cardiac transplantation,the mean survival time (MST),mean histologic rank of rejection,relative gene expression and serum concentration of RANTES in the cardiac grafts.Results (1) The percentage of CD4+ Tm was 26.83％ at the spleen of alloantigenprimed mice; (2) The MST was 5.17 ± 0.17 days in the CD4+ Tm+ HTx group versus 7.76 ± 0.21 days at the HTx group (control group) (P＜0.01); (3) The histological tests revealed that mean histologic rank of rejection activity in the sections of cardiac allografts on the day 5 post grafting was grade 3.92 ± 0.08 in the HTx+ CD4+Tm group versus grade 2.67 ± 0.14 in HTx group (P＜0.01) ;(4) The relative gene expression level of RANTES was 2.6 ± 0.21 in the CD4+ Tm + HTx group,significantly higher than in the control group (P＜0.01) ; (5) The serum concentration of RANTES in the CD4+ Tm+ HTx group was 223.6 ± 16.79 pg/mL,higher than in the control group (120.7 ±9.47 pg/mL,P＜0.01).Conclusion Alloreactive CD4+ Tm contribute to the increased expression and secretion of RANTES,and cardiac allograft acute rejection was more extensive in the CD4 + Tm + HTx group.