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Research progress of ferroptosis in cardiovascular diseases

Cardiovascular disease is a leading cause of death in Chinese population. It is of great significance to further explore the pathogenesis of cardiovascular diseases. Ferroptosis is a recently discovered iron-dependent and non-apoptotic form of regulated cell death, which exerts a regulatory role in a variety of biological events. Some studies have shown that ferroptosis plays an important role in the development of cardiovascular diseases. According to newly scientific reports, we summarized the mechanism and regulation in ferroptosis, and reviewed the results of ferroptosis in common cardiovascular diseases such as cardiac ischemia-reperfusion/myocardial infarction, cardiomyopathy, cardiac hypertrophy, atherosclerosis and abdominal aortic aneurysm.

Diagnosis and Management of Rare Pancreatic Neuroendocine Tumors

非体外循环下冠状动脉旁路移植术

目的 探讨和评价微创非体外循环冠状动脉旁路移植术(OPCAB)的临床效果. 方法 38例OPCAB患者中左冠状动脉主干病变 4例, 1支血管病变10例,2支14例,3支10例,均经胸骨正中切口行 OPCAB,每例移植血管1～5支,平均移植血管2.42支.应用左乳内动脉38支,大隐静脉54支. 结果 全组无手术死亡,36例顺利完成手术,2例转为心肺转流术下冠状动脉旁路移植术.38例均在手术后2～12小时,平均4.9±2.6小时顺利拔除气管内插管.全组均顺利康复,15例手术后1个月内恢复了原工作. 结论对有适应证的患者,OPCAB是一项安全有效的术式.

急性Stanford A型主动脉夹层的外科治疗

Objective To investigate the surgical experience, best timing of operative intervention, technique and clinical effects of surgical treatment for acute Stanford type A aortic dissection. Methods The clinical material, method of operation and follow-up results were retrospectively reviewed for 29 patients with acute Stanford type A aortic dissection in latest 8 years. The main principle of surgical therapy in Stanford type A aortic dissection was resecting the partial aorta of intimal tear to prevent aortic rupture, repairing the intimal tear and replacing or reconstructing the aorta by composite graft, and simultaneously dealing with the heart valve and myocardial ischemia disease. Results Emergency surgery was performed in 13 cases, and sub-emergency surgery for 16 cases. There were 2 cases (69%) early postoperative death. One patient died of severe arrhythmia after emergency surgery, and another case died of multiorgan failure after operation. After operation 6 cases needed to be re-operated for bleeding, 3 cases developed lung infection and respiratory failure, 4 cases delayed waking, 2 cases occurred acute renal failure and one case occurred gastrorrhagia, they all were treated appropriately and recovered. Twenty-four cases? (889%) were followed up for 23.6±101 months. One case died after 16 months postoperatively due to endocarditis and cerebral hemorrhage. One case was recorded of sudden death in 26 months. Currently other patients were still healthy as the normal person. Conclusion Early-time surgical treatment is the key factor for acute Stanford type A aortic dissection to reduce the mortality. Procedures chosen must depend on the location of intimal tear, involved extension, and the condition of aortic valve and aortic root. It is principle as simplifying operation and good effects of treatment.

右冠状动脉 -右心室瘘合并巨大右冠状动脉瘤一例

Surgical Treatment for Patients with Diffused Coronary Artery Disease

Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.

Modified Bentall Procedure for the Treatment of Stanford Type A3 Aortic Dissection

ObjectiveTo summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A3 aortic dissection (AD). MethodsFifty-four patients with Stanford type A3 AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. ConclusionModified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.

The Correlation of Integrinlinked Kinase and Matrix Metalloproteinases9 Expression with Prognosis of Nonsmall Cell Lung Cancer

 Abstract: Objective To observe the expression of integrinlinked kinase (ILK) and matrix metalloproteinases9 (MMP9) in human nonsmall cell lung cancer (NSCLC) and investigate the correlation of ILK and MMP9 expression with the prognosis of NSCLC. Methods The expression of ILK and MMP9 in 75 specimens of NSCLC resected from January 2002 to January 2004 were detected by immunohistochemistry. According to the median of integral optical density (IOD), all patients were divided into the high or low ILK expression group and the high or low MMP-9 expression group. The relativity of ILK and MMP9 was determined, and the relationship of survival time with clinical features including expression of ILK and MMP-9 was compared by Logrank test. Results Both ILK and MMP-9 were expressed in NSCLC specimens. The expression between ILK and MMP-9 was positively correlated in 75 patients of our group (r=0.79, Plt;0.05). Patients with lower expression of ILK and MMP9 had a significantly longer survival time than those with higher expression of ILK and MMP-9 in the postoperative followup (χ2=15.067,14301,Plt;0.05). The survival time was not correlated with sex,age,smoking history or pathological type(χ2=0450,0078, 1.460, 1.623，Pgt;0.05), while tumor diameter, lymph node metastasis, TNM stage, the expression of ILK and MMP-9 significantly influenced the survival time (χ2=3.963, 15.169,20.529, 15.067，14.301，Plt;0.05). Conclusion  The expression of ILK and MMP9 affects the prognosis of NSCLC. MMP-9 may advance infiltration and metastasis of tumor cells through ILK pathway. In summary, the expression of ILK and MMP9 may play an important role in the evaluation of prognosis for patients with NSCLC.

IABP辅助下非体外循环冠状动脉旁路移植术治疗冠心病合并严重左心室功能不全

目的 总结严重左心室功能低下的冠心病患者行主动脉内球囊反搏(IABP)辅助下非体外循环冠状动脉旁路移植术（offpump CABG）的临床经验，以提高手术的成功率。 方法 66例严重左心室功能低下的冠心病患者，男48例，女18例；年龄68.4±10.3岁；左心室射血分数（LVEF）29.6%±5.3%。所有患者均在选择性IABP辅助下行offpump CABG。根据IABP置入的时间不同，将66例患者分为两组，术前IABP置入组：34例，于术前麻醉诱导后置入IABP；术后IABP置入组：32例，在手术完成后置入IABP。回顾分析其临床资料、手术资料、手术结果。结果  66例患者中每例移植血管3.4±0.7支，采用乳内动脉（IMA）66例，且全部吻合于左前降支，采用大隐静脉（SV）64例，桡动脉（RA）5例，吻合于除左前降支以外的所有冠状动脉。于术后15~48 h均顺利停用IABP；围术期死亡1例，于术后29 d发生低心排血量综合征合并肾功能衰竭，死于多器官功能衰竭。所有患者应用IABP后血流动力学和血气指标明显改善，连续心排血量（CCO）、心脏指数（CI）、混合静脉血氧饱和度（SvO2）、有创动脉收缩压（SABP）、有创平均动脉压（MABP）较术前明显升高，而毛细血管楔压（PCWP）较术前明显降低（Plt;0.05）。术前置入IABP组术后住ICU时间、室性心律失常和低心排血量发生率短于或低于术后置入组（Plt;0.05）。随访60例，随访时间1个月~3年，失访5 例。随访期间无心绞痛复发，无心肌梗死发生，心功能分级（NYHA）Ⅰ~Ⅱ级51例，Ⅲ级9例。无晚期死亡。 结论 合理使用IABP，使严重左心室功能低下的冠心病患者施行off-pump CABG有良好的近期效果，该方法是可行的。

同种异体原位心脏移植六例

目的总结6例行原位心脏移植术患者的外科治疗经验。方法采用Shumway和Stanford方法行心脏移植,供心保护采用经主动脉根部灌注4℃心脏停搏液;术后免疫抑制治疗采用环孢素A、骁悉和强的松联合治疗,根据血环孢素A浓度及心内膜活检调整环孢素A用量。结果6例患者均康复,无手术及术后死亡,术后未发生超急性或急性排斥反应。结论受者-供者选择、供心保护、吻合技术、合理应用免疫抑制剂和围术期并发症的处理是手术成功的关键。