The application of on-pump beating-heart surgery for partial atrioventricular septal defect: a report of 87 cases

BACKGROUND

Partial atrioventricular septal defect (P-AVSD) is a common congenital heart disease. Because of the presence of left and right atrioventricular valve deformities and the shift in the atrioventricular node and cardiac conduction bundle, the surgical repair of P-AVSD is difficult. This study was performed to compare the effects on the coronary sinus septum in the left versus the right atrium during surgical treatment for P-AVSD and report our experiences regarding the application of on-pump beating heart surgery under mild hypothermia for patients with P-AVSD.

MATERIALS AND METHODS

The effects of on-pump beating heart surgery were analyzed retrospectively in 87 P-AVSD patients. Of the 87 total patients, 84 with anterior mitral leaflet cleft underwent valvuloplasty and 3 underwent mitral valve replacement. Seventy-seven patients underwent tricuspid valve annuloplasty, 2 underwent tricuspid valve replacement, and 1 underwent left superior vena cava ligation, and 3 patients with atrial fibrillation were treated with radiofrequency ablation. Patients with an ostium primum atrial septal defect underwent autologous pericardial modified Kirklin repair. Of these, 46 patients had their coronary sinus septum separated into the left atrium and 41 had their coronary sinus retained in the right atrium. Fingertip oxygen saturation was compared between patients in whom the coronary sinus was separated to the left atrium and those in whom the coronary sinus was retained in the right atrium.

RESULTS

There was 1 postoperative early death (1.15%) due to respiratory failure, and 1 patient had a III degree atrioventricular block (1.15%) and underwent implantation of a permanent pacemaker. The fingertip oxygen saturation levels of the left atrium group were 96.81 ± 3.17 preoperatively, 95.37 ± 4.62 at 7 days postoperatively, and 94.53 ± 4.95 at 3 months postoperatively. Those of the right atrium group were 98.53 ± 2.84 preoperatively, 97.19 ± 3.57 at 7 days postoperatively, and 96.89 ± 4.19 at 3 months postoperatively. During the follow-up period, which ranged from 3 months to 7 years, the cardiac function was adequately restored.

CONCLUSIONS

On-pump beating heart surgery under mild hypothermia is a safe and feasible method. The retention of the coronary sinus in the right atrium might maintain oxygen saturation.

Long non-coding RNA MEG3 inhibits the proliferation of cervical carcinoma cells through the induction of cell cycle arrest and apoptosis

Cervical cancer remains an important public health problem worldwide. New and effective therapeutic strategies targeting cervical cancer are urgently needed. Long non-coding RNAs (lncRNAs) are newly identified regulators in tumorigenesis and tumor progression. To investigate the role of lncRNA MEG3 in the development of cervical cancer, we examined MEG3 expression in 18 pairs of cervical cancer and matched adjacent non-neoplastic tissues. Real-time quantitative RT-PCR (qRT-PCR) results showed high expression levels of MEG3 in non-neoplastic tissues, but markedly lower levels in cancer tissues. We further investigated whether the restoration of MEG3 expression might affect the proliferation of cervical carcinoma cells. Ectopic expression of MEG3 inhibited the proliferation of human cervical carcinoma cells HeLa and C-33A in vitro. On the other hand, knockdown of MEG3 promoted the growth of well-differentiated cervical carcinoma HCC94 cells. Further investigation into the mechanisms responsible for the growth inhibitory effects revealed that overexpression of MEG3 resulted in the induction of G2/M cell cycle arrest and apoptosis. These results identified an important role of MEG3 in the molecular etiology of cervical cancer and implicated the potential application of MEG3 in cervical cancer therapy.

Complete Preservation of the Mitral Valve Apparatus during Mitral Valve Replacement for Rheumatic Mitral Regurgitation in Patients with an Enlarged Left Ventricular Chamber

<p><b>Background and Aims:</b> The merits of retaining the subvalvular apparatus during mitral valve replacement (MVR) for chronic mitral regurgitation have been demonstrated in clinical investigations. This study was to investigate the feasibility of total preservation of the leaflet and subvalvular apparatus at the native anatomic position during MVR in a rheumatic population with enlarged left ventricular chamber.</p><p><b>Material and Methods:</b> The techniques of valvular apparatus preservation used during MVR with or without aortic valve replacement were investigated in 128 patients with an enlarged left ventricular chamber suffering from rheumatic mitral regurgitation between October 2003 and December 2007. Seventy patients had the anterior leaflet and subvalvular apparatus excised but the posterior leaflet and subvlvular apparatus preserved during the mitral valve replacement (P-MVR group), and 58 patients had the anterior and posterior mitral leaflets and the subvalvalur apparatus completely preserved at the native anatomical position during the mitral valve replacement (C-MVR group). Echocardiography was performed preoperatively, at discharge, and after 3 months, 1 year, and 3 years to determine the left ventricular dimensions and function.</p><p><b>Results:</b> There were 2 cases (3.4%) of early death in the C-MVR group, and there were 4 cases (5.7%) of early death in the P-MVR group. There were 3 cases of late death 1 year after surgery, of which 1 case in the C-MVR group was caused by congestive heart failure and the other 2 cases in the P-MVR group were due to sudden death. Both groups exhibited significant improvement (<i>P <</i> .05) in left ventricular function instantly and late postoperatively. The reduction of the left ventricular end-diastolic diameter was more significant in the C-MVR group as compared to the P-MVR group (<i>P <</i> .05). A statistically significant increase in fractional shortening (FS) occurred in the C-MVR group compared to the P-MVR group.</p><p><b>Conclusion:</b> This study shows that complete mitral leaflet preservation at the native anatomical position during MVR is feasible in rheumatic patients with an enlarged left ventricular chamber and confers significant short-term and long-term advantages by preserving left ventricular function and geometry. Therefore, it is a safe, simple, and effective surgical technique and should be individualized during clinical use.</p>

Adipose Stem Cell Coating of Biomimetic β-TCP Macrospheres by Use of Laboratory Centrifuge

Biomimetic materials such as coral exoskeletons possess unique architectural structures with a uniform and interconnected porous network that can be beneficial as a scaffold material. In addition, these marine structures can be hydrothermally converted to calcium phosphates, while retaining the original structural properties. The ability of biomaterials to stimulate the local microenvironment is one of the main focuses in tissue engineering, and directly coating the scaffold with stem cells facilitates future potential applications in therapeutics and regenerative medicine. In this article we describe a new and simple method that uses a laboratory centrifuge to coat hydrothermally derived beta-tricalcium phosphate macrospheres from coral exoskeleton with stem cells. In this research the optimal seeding duration and speed were determined to be 1 min and 700 g. Scanning electron micrographs showed complete surface coverage by stem cells within 7 days of seeding. This study constitutes an important step toward achieving functional tissue-engineered implants by increasing our understanding of the influence of dynamic parameters on the efficiency and distribution of stem cell attachment to biomimetic materials and how stem cells interact with biomimetic materials.

Assessment of cancer pain management knowledge in southwest China: a survey of 259 physicians from small city and county hospitals

BACKGROUND

Pain management is a critical issue in the care of cancer patients in China, especially in small city and county hospitals in southwest China.

OBJECTIVE

The study intended to determine Chinese physicians' competence in cancer pain management and to assess their opinions on barriers to optimal pain management.

DESIGN

A questionnaire on pain management was given to 259 fellows after their general orientation meeting at a tertiary teaching hospital. The questionnaire was adapted from an earlier study by the Eastern Cooperative Oncology Group (ECOG).

RESULTS

The majority of the fellows believed that 70% of cancer patients suffer pain. Nearly 90% (224/259) indicated that their training in cancer pain management was poor. The fellows stated that concern about morphine addiction was the primary reason they hesitated to prescribe opioids, and they identified inadequate assessment of cancer pain as the most significant barrier to optimal management of cancer pain.

CONCLUSION

The study reflects to some extent the state of pain management in hospitals in southwest China. Medical students and physicians in China need improved pain management education.

Activation of Akt/protein kinase B mediates the protective effects of mechanical stretching against myocardial ischemia-reperfusion injury

Akt/protein kinase B is a well-known cell survival factor and activated by many stimuli including mechanical stretching. Therefore, we evaluated the cardioprotective effect of a brief mechanical stretching of rat hearts and determined whether activation of Akt through phosphatidylinositol 3-kinase (PI3K) is involved in stretch-induced cardioprotection (SIC). Stretch preconditioning reduced infarct size and improved post-ischemic cardiac function compared to the control group. Phosphorylation of Akt and its downstream substrate, GSK-3β, was increased by mechanical stretching and completely blocked by wortmannin, a PI3K inhibitor. Treatment with lithium or SB216763 (GSK-3β inhibitors) before ischemia induction mimicked the protective effects of SIC on rat heart. Gadolinium (Gd³⁺), a blocker of stretch-activated ion channels (SACs), inhibited the stretch-induced phosphorylation of Akt and GSK-3β. Furthermore, SIC was abrogated by wortmannin and Gd³⁺. In vivo stretching induced by an aorto-caval shunt increased Akt phosphorylation and reduced myocardial infarction; these effects were diminished by wortmannin and Gd³⁺ pretreatment. Our results showed that mechanical stretching can provide cardioprotection against ischemia-reperfusion injury. Additionally, the activation of Akt, which might be regulated by SACs and the PI3K pathway, plays an important role in SIC.

Synthesis and cytotoxicity evaluation of oleanolic acid derivatives

Twelve derivatives of oleanolic acid (1) have been synthesized and evaluated for their inhibitory activities against the growth of prostate PC3, breast MCF-7, lung A549, and gastric BGC-823 cancer cells by MTT assays. Within these series of derivatives, compound 17 exhibited the most potent cytotoxicity against PC3 cell line (IC50=0.39 μM) and compound 28 displayed the best activity against A549 cell line (IC50=0.22 μM). SAR analysis indicates that H-donor substitution at C-3 position of oleanolic acid may be advantageous for improvement of cytotoxicity against PC3, A549 and MCF-7 cell lines.

Accelerated and enhanced bone formation on novel simvastatin-loaded porous titanium oxide surfaces

BACKGROUND

With increasing application of dental implants in poor-quality bones, the need for implant surfaces ensuring accelerated osseointegration and enhanced peri-implant bone regeneration is increased.

PURPOSE

A study was performed to evaluate the osseointegration and bone formation on novel simvastatin-loaded porous titanium oxide surface.

MATERIALS AND METHODS

Titanium screws were treated by micro-arc oxidation to form porous oxide surface and 25 or 50 μg of simvastatin was loaded. The nontreated control, micro-arc oxidized, and simvastatin-loaded titanium screws were surgically implanted into the proximal tibia of 16-week-old male Wistar rats (n = 36). Peri-implant bone volume, bone-implant contact, and mineral apposition rates were measured at 2 and 4 weeks. Data were analyzed by one-way analysis of variance followed by Tukey's post hoc test.

RESULTS

New bone was formed directly on the implant surface in the bone marrow cavity in simvastatin-loaded groups since 2 weeks. Bone-implant contact values were significantly higher in simvastatin-loaded groups than control and micro-arc oxidized groups at both time points (p < .05). Peri-implant bone volume and mineral apposition rate of simvastatin-loaded groups were significantly higher than control and micro-arc oxidized groups at 2 weeks (p < .05).

CONCLUSIONS

These data suggested that simvastatin-loaded porous titanium oxide surface provides faster osseointegration and peri-implant bone formation and it would be potentially applicable in poor-quality bones.

A rabbit model to study regression of ventricular hypertrophy

BACKGROUND

The purpose of this study is to develop and characterise a reproducible rabbit model of LVH regression following pressure-induced myocardial hypertrophy.

MATERIALS AND METHODS

Without endotracheal intubation and mechanical ventilation, a median sternotomy was performed. The median incision was made exactly along the midline of the sternum. Ascending aortic diameter was reduced 50% above the aortic valve, which lead to an approximate 75% reduction in crosssectional area. The sham-operated rabbits underwent the same procedures without actual ligation of the aorta. The animals of early DB group and late DB group were subjected to the second operation for removing the ligation eight weeks or 16 weeks after the initial banding surgery, respectively. Echocardiography, haemodynamic assessment, histology, and electron microscopy were used to assess functional and structural aspects of myocardial hypertrophy at each time point.

RESULTS

The pressure overload resulted in robust LVH assessed by echocardiography, haemodynamic assessment, LV weight/body weight ratios, histology, and electron microscopy. Ascending aortic debanding completely or partially reversed LVH. The degree of LVH regression was association with the duration of pressure overload, proved by the fact that restoration of LV structure and function was complete in animals subjected to eight weeks of aortic banding but incomplete in animals subjected to 16 weeks of aortic banding. The animals did not experience severe mechanical ventilatory impairment.

CONCLUSIONS

These results demonstrate an efficient and reproducible method of promoting LVH regression in rabbits without endotracheal intubation and mechanical ventilation.

[The relationship between histological classification of lung cancer and protein tyrosine phosphatase]

BACKGROUND

To investigate the relationship between histological classification of lung cancer and protein tyrosine phosphatase.

METHODS

The expression of protein tyrosine phosphatase in bronchial epithelia from 34 patients with benign pulmonary lesions and 121 patients with primary pulmonary carcinoma was examined by immunohistochemical staining method.

RESULTS

The positive rate of protein tyrosine phosphatase expression was 95.03%±2.10% in 34 patients with benign pulmonary lesions, 43.59%±14.41% in 121 patients with primary pulmonary carcinoma; 47.57%±16.26% in 46 patients with adenocarcinoma, 40.59%±14.04% in 48 patients with squamous cell carcinoma, 42.13%±9.84% in 27 patients with adenosquamous carcinoma; 31.63%±10.34% in 21 patients with poor differentiated squamous cell carcinoma, 41.39%±9.35% in 18 patients with intermediate differentiated squamous cell carcinoma, 59.90%±8.61% in 9 patients with well differentiated squamous cell carcinoma; 34.14%±12.53% in 16 patients with poor differentiated adenocarcinoma, 52.10%±12.19% in 26 patients with intermediate differentiated adenocarcinoma, and 63.05%±15.84% in 4 patients with well differentiated adenocarcinoma. A significant difference of protein tyrosine phosphatase positive expression was observed between benign pulmonary lesions and primary pulmonary carcinomas, and between poor differentiated primary pulmonary carcinomas and well differentiated primary pulmonary carcinomas (P<0.01 or P<0.05).

CONCLUSIONS

Detection of protein tyrosine phosphatase may be helpful to differentiate pulmonary lesions from lung cancer and be regarded as one of the indices in predicting the prognosis of patients with primary pulmonary carcinomas.

Feasibility of alpha tricalcium phosphate for vertical bone augmentation

AIM

Inadequate vertical bone compromises dental implant positioning and subsequent restoration. This study was carried out to investigate the feasibility of alpha tricalcium phosphate (α-TCP) for vertical bone augmentation.

METHODS

Nine cortical perforations were made on each side of the parietal bone of rat calvaria under continuous saline coolant. Polytetrafluoroethylene cylinders were placed under the periosteum and α-TCP particles were applied in the cylinders in the TCP group while the cylinders were left empty in the control group. The animals were sacrificed at 4 and 8 weeks after surgery and analyzed radiologically and histologically.

RESULTS

The augmented bone volumes in the control and TCP groups were 91.5 ± 25.6% and 76.5 ± 49.8% (mean ± SD) of the original bone at 4 weeks, and 136.3 ± 59.7% and 139 ± 62.4% at 8 weeks respectively. There was no significant difference between control and test groups. At 4 weeks the bone height was augmented by 168.8 ± 26.7% and 128.8 ± 62% in the control and TCP groups respectively (not significant), whereas significantly higher vertical bone was achieved in the TCP group than in the control group at 8 weeks (251 ± 32% vs 179.2 ± 30.3%, P < 0.05).

CONCLUSION

After 8 weeks α-TCP is effective in maintaining space under periosteum and potentially would be applicable in vertical bone augmentation.

Prenatal diagnosis of de novo partial trisomy 18p and partial monosomy 18q recurrent in a family with fatal aortic coarctation

Aortic coarctation is a life-threatening defect when it occurs with cardiorespiratory failure. Its genetic cause remains unknown. A woman was pregnant twice, both with male fetuses that had partial trisomy 18p, partial monosomy 18q, and aortic coarctation. The syndrome may relate to the aortic coarctation and pulmonary hypoplasia and is life-threatening. ArrayCGH analysis suggested a de novo 17.7 Mb deletion of chromosome 18q21.33→qter (58,413,193 bp to 76,116,029 bp) and a de novo 12.4 Mb duplication of chromosome 18pter→p11.21 (1,543 bp to 12,438,430 bp) at the telomeric end of chromosome 18. To the best of our knowledge, the present chromosomal breakpoint with rearrangement has not been previously described. This chromosome aberration may be responsible for this syndrome.

Prucalopride in the treatment of chronic constipation in patients from the Asia-Pacific region: a randomized, double-blind, placebo-controlled study

BACKGROUND

The study evaluated efficacy and safety of the 2 mg dose of prucalopride compared to placebo in patients with chronic constipation (CC) from the Asia-Pacific region.

METHODS

Randomized, placebo-controlled, parallel-group, phase III study with 2-week run-in, 12-week treatment phase, and 1-week follow-up. Adult patients with CC (≤2 spontaneous bowel movements per week) received 2 mg prucalopride or placebo, once-daily, for 12 weeks. Primary efficacy measure was percentage of patients with average of ≥3 spontaneous complete bowel movements (SCBMs) per week (Responders) during the 12-week treatment. A key secondary endpoint was Responders during first 4 weeks of treatment. Other efficacy assessments were based on patient diaries, their assessments of symptoms and quality of life, and investigator's assessment on efficacy of treatment. Safety assessments included adverse events, laboratory values, and cardiovascular events.

KEY RESULTS

Efficacy and safety were evaluated for 501 patients who received study drug. On the primary endpoint, prucalopride was significantly more effective than placebo with 83 (33.3%) vs 26 (10.3%) patients having a weekly average of ≥3 SCBMs during the 12-week treatment (P < 0.001). Respective percentages were 34.5%vs 11.1% over first 4 weeks (P < 0.001). On other secondary endpoints, clinical improvement was generally larger and statistically superior (P < 0.001) in the prucalopride group. Most frequently reported adverse events were diarrhea, nausea, abdominal pain, and headache.

CONCLUSION & INFERENCES

Prucalopride 2 mg given once-daily significantly improved bowel function, associated symptoms, and satisfaction in CC over a 12-week treatment period, and was safe and well tolerated by patients in the Asia-Pacific region.

[Relationships between soil moisture and needle-fall in Masson pine forests in acid rain region of Chongqing, Southwest China]

From March 2009 to November 2011, an investigation was conducted on the spatiotemporal variation of soil moisture and its effects on the needle-fall in Masson pine (Pinus massoniana) forests in acid rain region of Chongqing, Southeast China, with the corresponding soil moisture thresholds determined. No matter the annual precipitation was abundant, normal or less than average, the seasonal variation of soil moisture in the forests could be obviously divided into four periods, i.e., sufficient (before May), descending (from June to July), drought (from August to September), and recovering (from October to November). With increasing soil depth, the soil moisture content increased after an initial decrease, but the difference of the soil moisture content among different soil layers decreased with decreasing annual precipitation. The amount of monthly needle-fall in the forests in growth season was significantly correlated with the water storage in root zone (0-60 cm soil layer), especially in the main root zone (20-50 cm soil layer). Soil field capacity (or capillary porosity) and 82% of field capacity (or 80% of capillary porosity) were the main soil moisture thresholds affecting the litter-fall. It was suggested that in acid rain region, Masson pine forest was easily to suffer from water deficit stress, especially in dry-summer period. The water deficit stress, together with already existed acid rain stress, would further threaten the health of the Masson forest.

A survey on the current trends in the management of hepatitis B in China

OBJECTIVE

Hepatitis B virus (HBV) infection is a highly endemic disease in China. The guidelines of the European Association for the Study of the Liver and the Asian Pacific Association for the Study of the Liver have improved in recent years. Here, we present a survey of physicians in terms of trends in the management of HBV at a teaching hospital in Southwest China.

METHODS

A questionnaire adopted from an earlier Spanish study was used. Physicians in an affiliated hospital of a Chinese medical university were surveyed.

RESULTS

A total of 120 (100%) physicians (including 68 fellows) answered the questionnaire voluntarily. Eighty percent (96/120) reported experience in the treatment of hepatopathy. Although a huge majority (90.9%, 109/120) were aware of the Chinese consensus recommendations on HBV, only 51.8% (62/120) correctly identified the indications for the treatment of chronic hepatitis B and 42.5% (51/120) correctly described the end-points in treating HBeAg-positive or HBeAg-negative chronic hepatitis. Serum HBV-DNA levels were used to monitor therapy by 84.2% (101/120) of the respondents, the HBV drug resistance test was used by 77.5% (93/120) of the responders, and antiviral prophylaxis was recommended by 65% (78/120) for HBV carriers who would receive immunosuppressive therapy. About 27.5% (33/120) recommended interferon or pegylated interferon as the initial treatment for HBeAg-positive patients; 93.3% (112/120) recommended oral antiviral therapy to HBeAg-negative patients. Physicians working at teaching hospitals were significantly more likely to recommend antiviral prophylaxis for HBV patients who receive immunosuppressive therapy than physicians working at nonuniversity hospitals (83 vs. 51%; P<0.001).

CONCLUSION

The inadequate management of chronic hepatitis B by Chinese physicians calls for an improvement in education, especially for physicians in county hospitals or clinics.

Practical access to four stereoisomers of naftidrofuryl and their binding affinity towards 5-hydroxytryptamine 2A receptor

Naftidrofuryl oxalate (Praxilene®, 1) has been used for the treatment of intermittent claudication for more than 30 years. It selectively blocks vascular and platelet 5-hydroxytryptamine 2 (5-HT(2)) receptors. This drug is marketed as a mixture of four stereoisomers, and so far there is no individual biological evaluation on the single isomers. The purpose of this study is to provide an improved method for the preparation of all four stereoisomers of naftidrofuryl, and more importantly, to distinguish them in terms of their binding affinity to 5-hydroxytryptamine 2A (5-HT(2A)) receptor. The bioassay results revealed that the C-2S configuration of naftidrofuryl was crucial for the binding affinity with 5-HT(2A) receptor, and the C-2' configuration was less important for binding. In conclusion, our study may pave the way to develop single naftidrofuryl isomers with C-2S configuration as inhibitors of 5-HT(2A) receptor that have clinical significance as vasodilators and CNS agents.