Two novel oxidized iboga-type indole alkaloids 3-hydroxymethyl conopharyngine (1) and 6-oxoconopharyngine (2) were isolated from the fruits of Tabernaemontana pachysiphon. Their structures were elucidated through comprehensive spectroscopic analysis and electronic circular dichroism (ECD) calculations. Both compounds demonstrated potential anti-glioma activity by inhibiting the proliferation of glioma cells SH-HY5Y with IC50 values of 298.24-579.41 μmol/L, although without a clear dose-dependent effect.

BackgroundFor acute type A aortic dissection involving the aortic root with root diameter no more than 45 mm, there are various aortic root repair techniques. In this study, a novel surgical technique using a pericardial autograft for aortic root repair was introduced. We described its surgical steps in detail and compare its clinical outcomes with direct suture technique. MethodsBetween July 2017 and August 2022, 95 patients with acute type A aortic dissection who underwent aortic root repair were enrolled, including aortic root repair using pericardial autograft (group A, n = 49) or direct suture (group B, n = 46). The patient's clinical data were retrospectively analyzed, and a 5-year follow-up was conducted. ResultsThe 30-day mortality, re-exploration for bleeding, postoperative new-onset renal failure requiring continuous renal replacement therapy, stroke, and paraplegia occurred in 3%, 4%, 11%, 5%, and 2% of the overall patients, respectively. There was no significant difference in the 30-day mortality and complication rate between the two groups. The 30-day mortality and re-exploration for bleeding marked the primary endpoint events. Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique (odds ratio, 0.002; 95% confidence interval, 0-0.159; P = 0.026). The aortic valve insufficiency of the two groups were significantly improved after operation (group A, P < 0.001; group B, P < 0.001). During follow-up, there was no significant difference in short-term survival between the two groups after surgery (log-rank P = 0.75), and all patients were free from reoperation for aortic disease. ConclusionsPatients who underwent aortic root repair using pericardial autograft tended to have reduced 30-day mortality and a lower risk of re-exploration for bleeding. Using pericardial autograft for aortic root repair is a safe and useful approach for patients with acute type A aortic dissection involving the aortic root.

OBJECTIVE:Surgical ablation of atrial fibrillation (AF) has become a routine procedure during concomitant cardiac surgery, however, the extension of lesion sets remain controversial. We sought to compare the relative benefit and risk of different lesion sets through a Bayesian network meta-analysis (NMA). METHODS:Pubmed, Embase, and Cochrane Trials databases were searched for randomized controlled trials (RCTs) comparing the rhythm outcome of AF patients undergoing pulmonary vein isolation (PVI), left atrial Maze (LAM), bi-atrial Maze (BAM), or no ablation during concomitant cardiac surgery. An NMA was conducted to explore the difference of over 1 year AF freedom as well as risks for early mortality and permanent pacemaker implantation (PPMI). RESULTS:A total of 2031 patients of 19 RCTs were included. PVI, LAM, and BAM (OR [95% Cr.I]: 5.02 [2.72, 10.02], 7.97 [4.93, 14.29], 8.29 [4.90, 14.86], p < .05) demonstrated higher freedom of AF compared with no ablation, however, no significant difference of rhythm outcome was found among the three ablation strategies based on the random-effects model. BAM was associated with an increase in early mortality when compared with no ablation (OR [95% Cr.I]: 4.08 [1.23, 17.30], p < .05), while none of the remaining comparisons reached statistical difference in terms of early mortality and PPMI. CONCLUSION:Bi-atrial ablation is not superior to left atrial ablation strategies in reducing AF recurrence for un-selected surgical patients. BAM has a higher risk of early mortality than no ablation, but no difference was found between bi-atrial and left atrial ablation in regard to early mortality and PPMI based on the current evidence.

目的 结论总结新生儿危重先天性心脏病(Critical congenital heart disease,cCHD)术前术后一体化救治经验.方法 收集2019年3月至2021年3月云南省阜外心血管病医院收治的39例新生儿cCHD临床资料,男24例,女15例.其中早产儿4例,双胎3例;顺产25例,剖宫产14例.出生体重1.5～4.2(2.97±0.59)kg,入院日龄0～28(14.0±8.8)天,入院身高40～57(49.0±4.1)cm,入院体重1.6～4.8(3.0±0.7)kg.39例中30例行手术治疗,其中体外循环下心脏直视手术22例,非体外循环手术8例;矫治手术28例,姑息手术2例;延迟关胸2例.结果 术后呼吸机治疗时间19～2778[48.0(156.5,383.0)]h[因结果呈偏态分布,采用M(P25,P75)表示,下同],ICU停留时间2～152[19.3(23.0,31.7)]d,总住院时间8～159[27.3(33.0,48.5)]d.全组无手术死亡;1例并发坏死性小肠结肠炎,家属拒绝行开腹探查术而放弃治疗,自动出院.随访2～24月,1例于出院1周后因呛奶窒息死亡;另1例因心功能差,术后6个月死亡;其余患儿均恢复良好.结论 cCHD新生儿应迅速转移到设备齐全、技术力量强的小儿心脏中心进行救治.术前维持内环境稳定、平衡体-肺循环阻力等综合治疗,对导管依赖型cCHD应用前列腺素E1泵入,可改善患儿的状态,创造良好的手术机会.及时的手术或介入治疗是救治cCHD患儿的关键,精细的围术期管理是救治成功的重要保障.

Cancer is the leading cause of deaths around the world, especially in low- and middle- income countries. Pirarubicin (THP) is an effective drug for treatment of cancer, however, there still exists cardiotoxic effects of THP. Rutin is a kind of antioxidative compound extracted from plants, and might be a protective compound for cardiomyocytes. Phosphatidylinositol 3-hydroxy kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway is critical for cellular survival, proliferation and metabolism, and thus we speculated rutin might perform a protective role in cardiomyocytes via PI3K/AKT/mTOR signaling pathway. And in this experiment, we first established a cardiotoxicity model of THP in mice model and cell models, and then found that rutin treatment could increase the proliferation of cells at low concentration. Then we explored the possible mechanism of the protective effect of rutin using Western blotting, quantitative polymerase chain reaction (qPCR) and ELISA methods, and found that the activation of PI3K/AKT/mTOR/nuclear factor-κB (NF-κB) signaling pathway was increased, and expression of downstream molecules involved in antioxidative stress were also increased. We further noticed that concentration of angiogenesis promoting factors were also increased in medium of cultured cells. Thus, we speculated that rutin could increase the activation of PI3K/AKT/mTOR signaling pathway, further decrease the oxidative stress level via increasing the expression of antioxidative stress enzymes with the increasing concentration of angiogenesis promoting factors, resulting in the protective role in cardiomyocytes and cardiac function.

目的 探讨NAT2基因型在云南汉族人群中的分布并研究其基因多态性对瓣膜置换术后华法林稳定剂量的影响.方法 检测研究对象基因型在各位点情况,研究其等位基因频率及基因型表现;研究基因多态性和华法林稳定剂量的关系.结果 各位点基因型及等位基因频率分布符合Hardy-winberg遗传平衡(P>0.05);NAT2(rs1801280)、NAT2(rs1799929)、NAT2(rs1208)经统计学分析,上述基因位点多态性与华法林稳定剂量差异没有相关性(P>0.05).结论 云南汉族NAT2(rs1801280)、NAT2(rs1799929)、NAT2(rs1208)基因多态性可能不是瓣膜置换术后华法林个体剂量差异的影响因素.

目的:研究 VKORC1(rs9923231)、CYP2C9(rs1057910)基因多态性,及其对云南汉族心脏瓣膜置换术后患者华法林稳定剂量的影响. 方法:(1)按条件选取 80 例 2016-01 至 2016-12 在昆明医科大学第一附属医院心脏外科接受心脏瓣膜手术治疗的名云南汉族患者,通过基因测序检测这 80 例患者 VKORC1 (rs9923231)、CYP2C9(rs1057910)的基因多态性.(2)收集上述 80 例患者的身高、体重、体表面积、年龄、性别、手术方式等资料,并依据国际标准化比值 INR 调整华法林用药并记录华法林的稳定剂量.(3)分析华法林稳定剂量与VKORC1(rs9923231)、CYP2C9(rs1057910)、CYP2C8(rs1057910)基因多态性以及临床因素之间是否存在相关性;并用多元回归方程建立华法林稳定剂量模型.

Objective To investigate the CYP2C18,VKORC1 and CYP2C9 genotype distribution situation and the correlation between their polymorphism with warfarin stable dose.Methods A total of 176 Yungui plateau Han patients with continuously warfarin anticoagulation therapy after valve replacement in this hospital from January 2011 to January 2014 served as the research subjects.The venous blood was collected for detecting genotypes at various loci.The genotype and allele frequency distribution were analyzed,and the correlation between the gene polymorphism with warfarin stable dose was analyzed.Results The genotypes and allele frequencies at various loci conformed to the Hardy-Winberg genetic balance (P＞0.05).The polymorphisms of CYP2C18 (rs7896133),VKORC1 (rs9923231),CYP2C9(rs1057910) and CYP2C9(rs4086116) gene loci were correlated with warfarin stable dose (P＞0.05).Conclusion The gene polymorphism of CYP2C18(rs7896133),VKORC1 (rs9923231),CYP2C9(rs1057910) and CYP2C9(rs4086116) in Yungui plateau H an patients may be the influence factors which contribute to warfarin stable dose personalized difference.