Acute myocardial infarction (AMI) is a severe and even fatal cardiovascular disease. The effect of transcription factors on AMI is intensively explored. Our experiment attempts to probe the role of Sox9 in cardiomyocyte apoptosis after AMI. AMI cell model was established in AC16 cells by hypoxia treatment. Cell viability and apoptosis were assessed. Then, the levels of BAX, Bcl-2, Sox9, miR-223-3p, and MEF2C were detected. The binding relation between Sox9 and miR-223-3p and between miR-223-3p and MEF2C was verified. The expression of miR-223-3p was upregulated using the miR-223-3p mimic, and collaborative experiments were conducted as si-Sox9 or si-MEF2C was transfected into cells to inhibit the expression of Sox9 or MEF2C. Sox9 was highly expressed in cardiomyocyte apoptosis after hypoxia, while Sox9 silencing protected hypoxia-treated cardiomyocytes from apoptosis by enhancing cell viability, quenching apoptosis, and reducing activity of caspase-3 and caspase-9. Essentially, Sox9 bound to the miR-223-3p promoter region to upregulate its expression. miR-223-3p targeted MEF2C transcription. miR-223-3p overexpression and MEF2C silencing could counteract the suppressive role of Sox9 silencing in hypoxia-treated cardiomyocyte apoptosis. Sox9 exacerbated hypoxia-induced cardiomyocyte apoptosis by promoting miR-223-3p expression and inhibiting MEF2C transcription.

BACKGROUND: Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare. METHODS: From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient. RESULTS: During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41-0.80]; P<0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41-0.76]; P<0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35-0.85]; P<0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85-3.52]; P<0.001). CONCLUSIONS: Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis.

目的 比较采用多支动脉与左乳内动脉+大隐静脉桥血管组合的单支动脉冠状动脉旁路移植(coronary artery bypass grafting,CABG)手术的围术期结局.方法 回顾阜外医院在2009-2019年完成的单纯CABG,按使用的旁路血管类别分为多支动脉与单支动脉CABG组,采用倾向性匹配法调整基线差异,比较两组的围术期资料及院内结局,从而评估多支动脉CABG是否与术后主要并发症的发生风险相关.结果 共纳入患者34915例,其中多支动脉组1305例,单支动脉组33610例,匹配后组间比较显示多支动脉组的手术时间[326.6(286.5～361.3) min,277.0 (243.0 ～ 315.0) min,P＜0.001]、体外循环时间[104.0 (88.0～123.0) min,95.0 (79.0 ～ 116.0) min,P＜0.001]、主动脉阻断时间[72.0 (66.0～86.0) min,64.0 (52.0～80.0) min,P＜0.001]均较单支动脉组显著延长,多支动脉组的血制品使用(OR=1.28,95％CI:1.06～1.55,P=0.01)及红细胞使用(OR=1.39,95％CI:1.13～1.73,P＜0.01)均显著高于单支动脉组.院内死亡率以及其他并发症在两组间无显著差异.结论 与左乳内动脉+大隐静脉的单支动脉CABG手术方案相比,多支动脉的CABG显著延长了手术时间,且增加了术后输血及红细胞使用.

目的 评价采用全动脉化与常规左乳内动脉+大隐静脉桥血管组合的冠状动脉旁路移植术(CABG)患者的院内结局差异.方法 回顾性分析本院在2009年至2019年间完成的单纯CABG患者,按采用的桥血管种类分为全动脉组与左乳内动脉+大隐静脉的对照组,通过倾向性匹配法比较两组间在围术期资料及院内结局及并发症方面有无差异,评估全动脉CABG是否与术后主要并发症的风险相关.结果 研究共纳入患者33876例,其中全动脉组266例,对照组33610例,倾向性评分匹配后显示全动脉组的手术时间较对照组显著延长(P<0.001),远端吻合口数明显少于对照组(P<0.001),全动脉组的血制品使用率(P=0.008)、红细胞输注率(P<0.001)、术后房颤的发生率均显著高于对照组(P=0.01).院内死亡率以及其他并发症在两组间无显著差异.结论 与对照组的CABG手术方案相比,全动脉化CABG显著延长了手术时间,且增加了术后输血及房颤发生的风险.

收集病变的升主动脉中膜组织标本为主动脉夹层组;收集同期在本院行尸检且无手术史、大血管病变史的升主动脉壁内组织标本18份为对照组;RT-PCR和Western blot检测有丝分裂阻滞缺陷蛋白(MAD1)mRNA和蛋白表达水平.在体外建立MAD1基因高表达人主动脉血管平滑肌细胞(HA-VSMC)模型,检测细胞增殖和凋亡情况以及凋亡相关蛋白.结果显示主动脉夹层组患者主动脉夹层中MAD1 mRNA和蛋白相对表达量明显高于对照组(P<0.05).随着转染时间的延长,各组细胞增殖水平均逐渐增加,转染48 h、72 h后MAD1过表达组细胞增殖情况低于空白对照组及空载体转染组(P<0.01).转染48 h后,MAD1过表达组细胞凋亡率明显高于空白对照组及空载体转染组(P<0.01).MAD1过表达组含半胱氨酸的天冬氨酸蛋白水解酶Caspase-3、Caspase-8、Caspase-9 mRNA和蛋白相对表达量明显高于空白对照组及空载体转染组(P<0.05).实验结果表明,MAD1过表达可通过抑制细胞增殖,激活细胞外凋亡途径和细胞内凋亡途径来促进人主动脉平滑肌细胞HA-VSMC细胞凋亡,参与主动脉夹层的发生与发展.

Objective To study the effect of percutaneous femoral venous cannulation in aortic valve replacement (AVR) through upper hemisternotomy. Methods This was a retrospective study of 65 consecutive AVR patients through upper hemisternotomy between May 2012 and January 2017 at Fuwai Hospital. The patients were divided into femoral vein group (n = 26) and right auricle group (n = 39). Outcomes of the two groups were compared to study the effects of different cannulation methods. Results There was no in -hospital death in the two groups. There was a reoperation for bleeding in the femoral vein group, but no complications at the catheter site and no thrombosis in the femoral vein or pulmonary embolism happened. In the right auricle group, there was an intraoperative convertion to conventional sternotomy due to perivalvular leakage. No other severe complications were observed in both groups. There was no significant difference in cardiopulmanary bypass time, aortic cross-clamp time, operation time, mechanical ventilation time, length of ICU stay, hospitalization costs, length of postoperative hospital stay, blood loss and blood transfusion rate between the two groups. Conclusions Percutaneous femoral venous cannulation is safe and feasible in AVR through upper hemisternotomy. This method is a useful alternative to the right auricle cannulation for patients whose right auricle is difficult to expose or those who are concerned about the cosmetic result.

目的 评估应用3D打印技术指导远离型右室双出口的手术决策、模拟和外科手术的效果.方法 我院2012年1月至2013年12月,在3D打印技术指导下12例远离型右室双出口的患者经历治疗决策、手术模拟并最终完成了外科手术矫治,其中男9例、女3例,年龄(2.9±2.2)岁.3D打印技术指导策略包括:超声诊断确诊为远离型右室双出口,CT检查,基于CT的3D格式文件生成,3D打印心脏模型,外科手术模拟,外科手术.在模拟手术时,外科医生根据模型设计补片形状,室间隔缺损扩大方法,肌束切除方案等.8例患者行双心室矫治,4例行单心室矫治.双心室矫治的患者中6例行单纯心内隧道矫治,1例行心内隧道加动脉调转,1例行双根部调转手术.心室内隧道修补均施行了室间隔缺损扩大术.行单心室矫治的原因主要是非常小的限制型室间隔缺损和三尖瓣主要腱索或者乳头肌跨越主动脉瓣下流出道.结果 全组患者手术中探查所见和术前3D打印模型相关性很好.无手术死亡,无重大并发症发生.1例患者术后有轻度的主动脉瓣下狭窄.没有随访期死亡和再次手术.参与手术的医生对于3D打印模型满意.结论 3D打印模型对于远离型右室双出口的手术决策能提供很好的帮助,并且通过提供外科手术模拟的术前评估从而减少手术并发症,改善手术结果.

1病例资料 患儿女性,9岁,体重33kg,问断发热伴乏力三月余,期间体温一般在38℃左右,偶可达39℃.偶有咳嗽,无咳痰咳血,近三月活动量明显下降,否认晕厥、咯血等,体重无明显减轻.在当地医院行对症抗感染治疗,无明显好转后收入我院.查体:T:36.8℃,P110次/min,R:28次/min,BP102/63mmHg.神清,口唇无发绀.

Objective:To investigate the harvest site complication and long term graft patency rate between autologous radial artery and great saphenous vein for coronary artery bypass grafting(CABG) in elder patients.Methods:We retrospectively analyzed 332 patients at(66.0±4.9) years of age who received CABG with autologous radial artery and great saphenous vein at the same time in our hospital from 2004 to 2010,and compared their early harvest site complication and long term graft patency rate between those 2 kinds of vessels.Before harvest,the radial artery was routinely examined by Doppler ultrasound,and calcium antagonist was used for anti-spasm after the procedure.Result:The in-hospital death were 6/332(1.8%) of patients.There were no significant differences in harvest site pain,hematoma and the limitation of activity between 2 kinds of grafting vessels,P005.While the incidences of numbness,swelling and infection in radial artery harvest site were obviously lower than those in great saphenous vein,P0.05 respectively.There were 307/332(92.5%) of patients follow-up by December 2012 and 177 patients received coronary angiography or CTA examination for graft patency at(58.0±23.7) months after the procedure.The graft patency rates of radial artery and great saphenous vein were 149/177(84.2%) vs.126/177(71.2%),P0.05.Conclusion:With pre-operative ultrasound evaluation and suitable anti-spasm treatment,radial artery could be a better alternative vessel for CABG than that of great saphenous vein in elder patients.