51岁女性患者，查体发现左心室肿物半个月。超声心动图示左心室占位性病变。2019年4月在全麻下行达芬奇机器人左心室肿物切除术。术后病理示左心室海绵状血管瘤。术后恢复良好。出院3个月复查超声心动图示肿瘤无复发。

Objective To evaluate the long-term efficacy of off-pump and on-pump coronary artery bypass grafting on patients aged more than 70 years old.Methods Chinese and English databases including Wanfang Science and Technology Periodical Full-text Database,VIP Chinese Science and Tech-nology Periodical Full-text Database(VIP),CNKI,PUBMED,Web of Science,Science Direct Online and Cochrane Library were searched by computer.Some randomized controlled clinical trials which compared the effects of off-pump and on-pump coronary artery bypass grafting were collected for meta-analysis.Re-sults A total of 21665 subjects were analyzed,which were 4 data sets collected from 8 studies. The differences in the mortality and the incidence of myocardial infarction were not statistically significant.The contrastive OR for the incidence of stroke was 0.66(95% CI:0.48,0.90)and the contrastive OR for the incidence of renal failure was 0.75(95% CI:0.57,0.99).The incidences of stroke and renal failure in the experimental group were significantly smaller than that in the control group. Conclusion The off-pump coronary artery bypass grafting is better than on-pump coronary artery bypass grafting for patients aged more than 70 years old.

The present study aimed to assess the effects and mechanisms of apigenin in the rat model of myocardial ischemia reperfusion injury. The rat hearts were exposed to the left anterior descending coronary artery (LAD) ligation for 30 min followed by 1 h of reperfusion. In the rat of myocardial ischemia/reperfusion (I/R), it was found that apigenin pretreatment reduced myocardial infarct size, improved the heart rate, and decreased creatine kinase (CK) and lactate dehydrogenase (LDH) levels in coronary flow. This pretreatment also increased catalase (CAT), superoxide dismutase (SOD) activities, but decreased glutathione (GSH), malondialdehyde (MDA) levels. Further more, we determined that apigenin can attenuate serum interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta) and tumour necrosis factor (TNF-alpha) levels. The enhanced phosphorylation of JAK2 and STAT3 was further strengthened by apigenin (2, 4 mg/kg/) in a dose-dependent manner. These results presented here demonstrated that apigenin intake might reduce the risk of coronary heart disease by stimulating JAK2/STAT3 signal pathway, decreasing oxidative damage.

EndMT plays an important role in the relationship between endothelial dysfunction and atherosclerosis. This work will elucidate the biofunction induced by miR-449a and lipid rafts in EndMT and development of atherosclerosis. The differential miRNA expression between atherosclerotic plaques and normal arteries were analyzed. The luciferase activities of AdipoR2 3' UTR treated with miR-449a were determined. ECs were dealt with miR-449a mimics or inhibitors, then cell proliferation and migration were assessed. Moreover, the expression of AdipoR2 and mesenchymal cell markers were analyzed. The influences of lipid rafts related to reciprocity between E-cadherin and AdipoR2 on TNF-α-induced damage in ECs were investigated. ApoE KO diabetic mice were used to explore the potential roles of miR-449a on atherosclerosis. Our results indicated that compared with normal arteries, 17 miRNAs were upregulated and 3 miRNAs were down-regulated in atherosclerotic plaques. The relative expression of miR-449a in plaques was significantly higher than that in normal arteries. MiR-449a suppressed AdipoR2 expression, additionally its interaction protein E-cadherin in ECs. MiR-449a enhanced expression of mesenchymal cell markers, induced cell proliferation and migration of ECs, regulated the interaction between E-cadherin and AdipoR2 interceded by lipid rafts. The miR-449a antagomir could protect against the development process of atherosclerosis in ApoE KO diabetic mice. In conclusion, miR-449a targeted to AdipoR2, and was a crucial mediator of EndMT and atherosclerosis in ECs through regulating E-cadherin bindability with AdipoR2 in lipid rafts. These results suggested that aim to lipid rafts and miR-449a in chronic EC inflammation response, was a feasible therapy strategy for atherosclerosis.

Effective drugs and strategies for treating type 2 diabetes mellitus (2‑DM) are urgently required. The aim of the present study was to elucidate the mechanism underlying microRNA (miR)‑6835‑3p regulation of adiponectin receptor 1 (AdipoR1) expression and the miR‑6835‑3p/AdipoR1 signaling pathway in pancreatic islet cells. In addition, the potential anti‑diabetes effect of miR‑6835‑3p on insulin secretion was investigated. Luciferase activity analysis was performed to evaluate how miR‑6835‑3p targets the 3'‑untranslated region of AdipoR1. The SU.86.86 and MIN‑6 cell lines were co‑cultured with or without miR‑6835‑3p inhibitors or mimics, and the insulin secretory functions of these cell lines were then determined. Luciferase reporter analysis revealed that AdipoR1 was a direct target of miR‑6835‑3p. In addition, miR‑6835‑3p overexpression suppressed the mRNA and protein expression levels of AdipoR1 in the SU.86.86 and MIN‑6 cell lines. Furthermore, miR‑6835‑3p exerted negative effects on insulin secretion in SU.86.86 and MIN‑6 cells, which were mediated by regulating AdipoR1 expression. AdipoR1 was a direct target of miR‑6835‑3p; therefore, inhibition of AdiopR1 expression may reduce insulin secretion and may be considered a key regulator of insulin secretion. The results of the present study suggested that targeting AdipoR1 with miR‑6835‑3p inhibitors may be a potential strategy for promoting glucose‑stimulated insulin secretion, and thereby, may be an effective treatment for type 2‑DM.

Objective: Activation of NF-kappa B and p53-upregulated modulator of apoptosis (PUMA) is associated with ischemia-reperfusion injury (I/R) of donor heart. The current study investigated whether targeting NF-kappa B and PUMA could preserve heart grafts in heart transplantation in mice. Methods: Heart grafts from BALB/c mice were preserved in Wisconsin solution (UW) solution (control) or UW solution containing siRNAs targeting NF-kappa B (p65) and PUMA for 48 hours and subsequently transplanted into syngeneic recipients. p65 and PUMA mRNA and protein was detected by qRT-PCR and Western blot assay; NF-kappa B activity was detected by EMSA assay; Heart histology was assessed. Apoptosis was detected by TUNEL staining. Results: (p65 and PUMA) siRNA solution/treated hearts exhibited improved histology, decreased cell apoptosis and diminished neutrophil and lymphocyte infiltration compared with control solution-treated organs. Furthermore, the mean heart graft survival times of the control siRNA solution or UW solution groups was 8 day and 9 days, and 56 days in siRNA solution groups. Conclusions: Incorporation of siRNA targeting p65 and PUMA into organ storage solution provide greater protection from apoptosis, ischemia/reperfusion (I/R) injury, and prolonging graft survival.

The urine excretion of L-carnitine (LC), acetyl-L-carnitine (ALC) and propionyl-Lcarnitine (PLC) and their relations with the antioxidant activities are presently unknown. Liquid L-carnitine (2.0 g) was administered orally as a single dose in 12 healthy subjects. Urine concentrations of LC, ALC and PLC were detected by HPLC. Superoxide dismutase (SOD), total antioxidative capacity (T-AOC), malondialdehyde (MDA) and nitrogen monoxidum (NO) activities were measured by spectrophotometric methods. The 0~2 h, 2~4 h, 4~8 h, 8~12 h, 12~24 h excretion of LC was 53.13±31.36 µmol, 166.93±76.87 µmol, 219.92±76.30 µmol, 100.48±23.89 µmol, 72.07±25.77 µmol, respectively. The excretion of ALC was 29.70±14.43 µmol, 80.59±32.70 µmol, 109.85±49.21 µmol, 58.65±18.55 µmol, and 80.43±35.44 µmol, respectively. The urine concentration of PLC was 6.63±4.50 µmol, 15.33±12.59 µmol, 15.46±6.26 µmol, 13.41±11.66 µmol and 9.67±7.92 µmol, respectively. The accumulated excretion rate of LC was 6.1% within 24h after its administration. There was also an increase in urine concentrations of SOD and T-AOC, and a decrease in NO and MDA. A positive correlation was found between urine concentrations of LC and SOD (r = 0.8277) or T-AOC (r = 0.9547), and a negative correlation was found between urine LC excretions and NO (r = -0.8575) or MDA (r = 0.7085). In conclusion, a single oral LC administration let to a gradual increase in urine L-carnitine excretion which was associated with an increase in urine antioxidant enzymes and the total antioxidant capacities. These data may be useful in designing therapeutic regimens of LC or its analogues in the future.

Objective To investigate the effect of perioperative cardiac rehabilitation on pstoperative recovery of coronary artery bypass grafting surgery.Methods Sixty-eight patients were randomly divided into the rehabilitation group(n=35)and the conventional treatment group(n=33).The average intubation hours,ICU admission hours,hospital stay hours and 6-minute walking test(6MWT) of the two groups were compared.Results The average intubation hours,ICU admission hours in rehabilitation group were shorter than those in conventional treatment group(P<0.01),6 MWT in rehabilitation group was longer than that in conventional treatment group(P<0.01).The 6 MWT had significant difference in pre-and postoperative between the two groups(P<0.01).Conclusion Perioperative cardiac rehabilitation can shorten the hours of intubatton and ICU admission,improve the cardiac function and ability of movement after surgery.

AIM To isolate and culture human aortic valve interstitial cells and to identify their morphology,subtype and membrane molecules distribution.METHODS The endothelial cell layers on the dissected valves were removed and the remaining interstitial layers were minced and digested with collagenase I.Cells were then seeded and maintained on culture dishes.Cells were observed under light microscopy and cellular α-smooth muscle actin was detected with confocal staining microscopy.The expressed interferon(IFN)-γ and tumor necrosis factior(TNF)-α receptors were analyzed by flow cytometry with their corresponding monoclonal antibodies.RESULTS The isolated valves interstitial cells were proved to be myofibroblast.More IFN-γ receptors and TNF-α receptors were expressed on rheumatic aortic valves interstitial cells than on non-rheumatic cells and their expression was patients' sera dependent.CONCLUSION The valves interstitial cells culture system has been established successfully and the membrane molecules differ according to their origins.

AIM:To identify the distribution of tenascin-C(TN-C)in sera and heart valves of patients with rheumatic heart diseases and its significance.METHODS:The sera of normal subjects,patients with congenital valves malformation and patients with rheumatic heart diseases were collected and the TN-C concentrations were measured with ELISA.The heart valves were obtained surgically from patients with congenital malformation or rheumatic heart diseases.The valves were embedded in paraffin and then TN-C distribution pattern was identified by immunohistochemistry.RESULTS:Compared with normal subjects or patients with congenital valves malformation,the sera concentration of larger variants TN-C was significantly higher than that in patients with rheumatic heart diseases.TN-C was mainly distributed on the basement membrane beneath the endothelial cells in the malformed valves,and universally distributed in the rheumatic valves.CONCLUSION:To some extents,TN-C could be taken as biomarker of rheumatic heart diseases and TN-C may be involved in pathogenesis of rheumatic heart valves diseases.

Objective To evaluate the experience of "hybrid technique" in the treatment of complex aortic diseases.Methods From February to December 2007,seven patients with aortic dissection and aortic aneurysm or combined lesions were performed by "hybrid technique" ascending aortic prosthesis replacement plus descending aortic stent-grafting by using Micro-Port CRONUSTM. Results One patient with renal failure discharged voluntarily,six patients had CTA examination two weeks after surgery.There were no torsion,stenosis and occlusion in the prosthesis.Stent-grafts were in good position.No leakage exsisted.True lumen of descending aorta was enlarged significantly and no blood current in false lumen was found.No recurrence occurred during 4-25 month follow-up. Conclusion "Hybrid technique" seems to be an effective,safe,reliable and simple method in curing complex aortic disease.

Objective:To investigate the protective effect of L-carnitine pretreatment against myocardial ischemia-reperfusion (I-R) injury in Langendorff isolated rabbit hearts. Methods:24 rabbit hearts were randomly divided into normal control group, ischemia-reperfusion injury group and L-carnitine group. The normal control group was perfused with Krebs-Henseleit buffer (K-H) solution for 90 min. The I-R injury group was firstly perfused with K-H solution for 30 min, followed by aorta occlusion for 30 min and then reperfused with K-H solution for 60 min. The L-carnitine group was similarly treated to that of the I-R group, except that 10 mmol·L-1 of L-carnitine was added in to the K-H solution before ischemia. The hemodynamic indexes like coronary flow (CF), left ventricular diastolic pressure (LVDP) and it′s first derivative (±dp/dt) were recorded.The activity of malondialdehyde (MDA), superoxide dismutase (SOD), creatine kinase (CK) and lactic dehydrogenase(LDH) in coronary effluent and contents of MDA, SOD and L-carnitine in myocardial tissues were measured in vitro. Results: L-carnitine caused a significant improvement of cardiac function (LVP and ±dp/dtmax increased significantly, and CK enhanced) and a decrease in the release of MDA, LDH and CK in coronary effluent as well as the level of MDA in myocardial tissues, the level of SOD were observed enhanced both in coronary effluent and myocardial tissues. Besides, the content of L-carnitine in muscle was increased (P0.01) and ultramicrostructure indicated a minor injury of heart muscle compared with the I-R injury group (P0.05). Conclusion: L-carnitine pretreatment possesses a protective effect against myocardial I-R injury of isolated rabbit hearts.

病人男,22岁.左前胸刀刺伤22 d.活动后心悸、气促7 d.查体:贫血貌,平卧位颈静脉充盈.左胸第5肋间胸骨旁3 cm处可见一长约1 cm的刀伤瘢痕,心率94次/min,律齐,血压117/64 mm Hg(1 mm Hg=0.133 kPa),胸骨左缘3、4肋间闻及3/VI级喷射样收缩期杂音,心尖部闻及3/VI级吹风样收缩期杂音,P2亢进,肝肋下1.0 cm.心电图示完全性右束支传导阻滞,II、III、avF、V4～V6T波倒置.X线胸片示心影增大,心胸比率0.55,双肺纹理增强;彩色超声示肌部室间隔回声中断0.4 cm,其上缘距三尖瓣隔叶瓣环1.2 cm,二尖瓣前叶距瓣根约0.5 cm处见0.4 cm的穿孔,收缩期见大量血液过孔反流,肺动脉收缩压43 mm Hg。

临床上,行三尖瓣置换(TVR)术者较少见,目前对其手术适应证、手术方法及瓣膜选择均存在不同看法.1990年1月至2003年6月,我院行瓣膜置换手术1030例,其中TVR18例,占总瓣膜置换手术的1.75%.现回顾和总结18例行TVR术的临床经验,并结合国内外资料,进一步探讨其手术适应证、手术方法、瓣膜选择及近远期效果.

目的:探讨前列地尔脂微球制剂(Lipo PGE1)对不稳定性心绞痛(UAP)的临床疗效.方法:采用随机、单盲的方法进行前瞻性试验.将71例伴有心电图ST-T改变的UAP患者随机分为治疗组和对照组.治疗组50例,在常规治疗基础上加用Lipo PGE1 10 μg,Qd;对照组21例行常规治疗.结果:治疗组有效率为94%,显著优于对照组的71.4%(P<0.05 ).两组治疗后心肌缺血次数、心肌缺血时间、最长持续时间、室性早搏次数、阵发性室速次数以及血小板聚集率均较治疗前减少,且治疗后各项指标治疗组显著优于对照组(P<0.05,P<0.01).结论:在常规治疗的基础上加用Lipo PGE1对UAP的疗效明显优于常规治疗,Lipo PGE1是一种治疗UAP疗效确切、安全性较高的药物.

心脏手术绝大多数需在体外循环辅助下完成,体外循环过程对血液成分的破坏程度大,术中丢血和术后渗血较其他外科手术严重,大多数患者需术后输血.如何减少异体输血量、推广自体输血、杜绝或降低输异体血引起的不良反应和疾病正日益受到心脏外科医生们的关注.1999年重组人红细胞生成素(rhEPO)在国内开始临床试验和批准应用,上述问题通过围手术期应用rhEPO得以解决变得更为现实.我们通过对20例应用rhEPO和15例不用rhEPO心脏外科患者不同时期血红蛋白(Hb)、红细胞压积(Hct)、网织红细胞(Ret)的改变及失血量、用异体血量的观察和比较,发现rhEPO能有效避免或减少心脏外科患者术后异体输血,现报告如下.

①目的探讨胸主动脉夹层动脉瘤的外科治疗方法.②方法胸主动脉夹层动脉瘤10例,行Bentall手术6例,升主动脉及主动脉弓半弓置换术2例,胸降主动脉置换术2例.术中选择股动脉插管,对剥离内膜进行了可靠修复;对Bentall术中冠状动脉移植技术进行了改进;在主动脉弓置换时,对脑采取保护措施以减轻或防止脑损害.③结果手术死亡1例,术后近期死亡2例,7例术后随访90d～1.5年,康复良好.④结论手术治疗胸主动脉夹层动脉瘤效果良好.