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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

Effects of As2O3 on Expression of NF-κB p65, Survivin and Caspase-3 in Human Breast Cancer

【Abstract】ObjectiveTo investigate the effects of As2O3 on expression of NF-κB p65, survivin and caspase-3 in human breast infiltrating duct carcinoma xenograft model on nude mice. Methods A human breast infiltrating duct carcinoma model on nude mice was established and the nude mice were divided randomly into three groups: control group, DDP group and As2O3 group （1.5 and 3.0 mg/kg concentrations）. The expression of survivin mRNA was detected with the method of in situ hybridization and the expressions of NF-κB p65, survivin and caspase-3 protein were measured with immunohistochemistry. ResultsThe positive rates of NF-κB p65 and survivin expression were higher in the control group than those in the DDP group and the As2O3 groups, but that of caspase-3 was on the opposite way (P＜0.01). The positive rates of NF-κB p65 and survivin in As2O3 group were negatively related with the concentrations of As2O3 (P＜0.01), but that of caspase-3 was on the opposite way (P＜0.01). The expressions of NF-κB p65 and survivin protein were positively correlated with that of survivin mRNA, but any of them was negatively correlated with the expression of caspase-3 protein. ConclusionAs2O3 inhibites survivin probably by inhibiting the activity of NFκB p65 and subsequently activates caspase-3, which induces apoptosis of human breast infiltrating duct carcinoma cells and is in a dose-dependent manner.

电视胸腔镜双侧肺减容术21例

目的　总结电视胸腔镜双侧肺减容术（BLVRS）治疗慢性阻塞性肺气肿（COPE）的临床经验，并观察其疗效。　方法　2009年9月至2010年9月，南京医科大学附属南京医院对21例COPE患者行电视胸腔镜 BLVRS，均为男性，年龄（65.71±9.05）岁。采用电视胸腔镜专用切缝器（Endo-GIA）切除过度充气的肺大泡组织，常规用4-0 Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离（6-MWD）的变化，并与术前进行比较，评价手术疗效。　结果　无围术期死亡，术后住院时间（13.20±4.60） d，胸腔引流时间（5.33±3.67） d。术后持续肺漏气 （5.91±3.52） d 12例，出现急性呼吸衰竭1例，广泛皮下气肿2例，合并肺部感染5例，均经相应的处理治愈。随访21例，随访时间6个月，术后6个月第1秒用力呼气容积［（1.63±0.23） L vs. （1.21±0.17） L］、动脉血氧分压［（77.62±6.98） mm Hg vs. （67.54±8.12） mm Hg］和6-MWD ［（430.55±80.49） m vs. （283.48±108.12） m］较术前增加，动脉血二氧化碳分压（PaCO2）、、残气量（RV） 较术前降低（P＜0.05）。　结论　电视胸腔镜BLVRS安全、有效，特别对非均质性肺气肿，可明显改善患者的生活质量，近期效果显著。

Clinical Application of Aortic Proximal Anastomosis Device in Coronary Artery Bypass Grafting

Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007， 50 patients underwent CABG were received the aortic proximal anastomosis device ［Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)］, in which 16 were underwent in onpump CABG and 34 in offpump CABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and longterm effect remains to be further observed.

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.

Treatment of type B aortic dissection without an optimal "landing zone": A case control study

Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD). Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared. Results All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%. Conclusion For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.

Surgical Treatment for Prosthetic Valve Endocarditis after Valve Replacement

Abstract:Objective To investigate the reoperation indication,surgical timing and the key point of surgical treatment of prosthetic valve endocarditis （PVE） after valve replacement. Methods From February 2000 to July 2005,18 patients with PVE underwent surgery ,their clinical manifestation ,process of treatment and their prognosis outcome were analyzed. Results There were 3 patients （16.7 %） of early-death, 1 patient died of septic shock, and 2 patients died of multiple organ failure. Since 2003,there was no operative death for all 11 patients. There were 6 patients with respiratory insufficiency, 2 patients with renal insufficiency,which were recovered after treatment. The 15 survivors were followed up from 1 month to 5years. There was recurrence of infection in 1 patient who died after ineffective medical treatment. The other 14 patients recovered well. Conclusion It has high risk and high mortality for reoperation for PVE. Accurate reoperative indication,optimal surgical timing,radical debridment of infected tissue and correct perioperative use of antibiotics are the key factors to improve the reoperative result for PVE.

老年冠心病患者应用桡动脉行冠状动脉旁路移植术的临床分析

目的 总结老年冠心病患者行冠状动脉旁路移植术（CABG）中采集桡动脉(RA)后无相关并发症发生的临床经验。 方法 回顾性分析191例65岁以上老年冠心病患者(男121例，女70例；年龄65～83岁，平均年龄71.0岁)行CABG时运用RA的临床资料，观察围术期取材相关并发症的发生情况。 结果 RA远端吻合口数为1.30±0.25个／例，获取每支RA时间为25.０±7.5 min。术后发生心房颤动14例，行二次开胸止血4例，心肌梗死３例，脑卒中4例，急性肾功能不全5例，急性呼吸功能不全6例。术中未见RA痉挛，术后无切口感染、切口血肿、患肢感觉和运动异常。住院死亡4例（2.1％）。随访187例，随访时间3~12个月，患者均生存，无远期死亡，桡动脉取材侧肢体感觉及运动功能良好。 结论 老年患者行CABG时采用RA做移植血管，术后并发症少、取材安全，RA在CABG中将发挥越来越重要的作用。

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.