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MicroRNA-129 Promotes Cardiomyogenesis in Bone Marrow Mesenchymal Stem Cells

Objective To explore the induction of cardiomyogenesis of microRNA-129 （mir-129） in rat bone marrowmesenchymal stem cells （BM-MSCs） and its mechanism. Methods BM-MSCs were isolated from Sprague-Dawley rats and cultured in vitro. Overexpression of mir-129 or both mir-129 and glycogen synthase kinase-3β （GSK-3β） in BM-MSCs was produced with a lentiviral vector system. All the BM-MSCs were divided into four groups: control group （MSCs），Lentiviral vectors＋MSCs group （Lv-MSCs），mir-129 transfection group （mir-129-MSCs），and mir-129＋GSK-3βdouble transfection group （mir-129＋GSK-3β-MSCs）. Five-Azacytidine （5-Aza） （10 μmol/L） was used to induce BM-MSCsdifferentiation into cardiomyocytes. On the 1st，5 th，10 th，15 th and 20 th day after induction，realtime-PCR was performedto detect mRNA levels of GATA-4，Nkx2.5 and MEF-2C. On the 10 th，15 th and 20 th day after induction，Western blottingwas performed to examine expression levels of cTnI，Desmin，GSK-3β，phosphorylated β-catenin and dephosphorylated β-catenin. Results Compared with the control group，at respective time points，mRNA levels of cardiomyogenic genes and expression levels of cardiomyocyte-related proteins of mir-129 transfection group were significantly elevated，theexpression level of GSK-3β was significantly decreased，and the ratio of dephosphorylated/phosphorylated β-catenin was significantly elevated. When both mir-129 and GSK-3β were overexpressed in BM-MSCs，mRNA levels of cardiomyogenicgenes and expression levels of cardiomyocyte-related proteins were significantly lower than those of mir-129 transfection group，and the ratio of dephosphorylated/phosphorylated β-catenin was significantly decreased. Conclusion Overexpression of mir-129 can promote cardiomyogenesis of rat BM-MSCs possibly via inhibiting GSK-3β production and thus decreasing the inhibition of phosphorylation of β-catenin which then enters the nucleus and activates downstream signaling pathways that regulate cardiomyogenic differentiation of BM-MSCs.

左心瓣膜手术后重度三尖瓣反流的外科治疗

目的 总结左心瓣膜手术后重度三尖瓣反流（TR）的外科治疗经验。 方法 回顾性分析自1999年2月至2009年12月上海交通大学医学院附属仁济医院31例左心瓣膜手术后重度TR患者的临床资料，男3例，女28例；年龄35～60岁（38.4 ± 8.3岁）。 31例左心瓣膜手术后重度TR患者均合并心房颤动，有不同程度的右心功能不全表现，其中心功能分级（NYHA）Ⅱ级3例，Ⅲ级24例，Ⅳ级4例。所有患者接受了三尖瓣手术，其中18例采用CarpentierEdwards半硬环行三尖瓣成形术（TVP），13例采用生物瓣行三尖瓣置换术（TVR）。对上述患者术前、术后的临床资料进行比较。 结果 围术期死亡2例，均死于心力衰竭，以右心功能衰竭为主。29例生存患者术后无严重并发症发生，均好转出院。随访29例，随访时间3个月~9年（5.3±2.5年），随访期间均给予强心、利尿等治疗。术后3个月患者心功能均有明显改善（NYHA分级Ⅰ级3例，Ⅱ级19例，Ⅲ级5例，Ⅳ级2例）；超声心动图提示：TR明显改善，右心房内径（50.2±8.8 mm vs. 63.1±12.4 mm，P=0.005）、右心室内径（28.3±7.1 mm vs. 35.7±8.2 mm，P=0.008）较术前明显缩小。 结论 对左心瓣膜手术后重度TR患者，早期应积极地行外科手术治疗；手术方式应根据患者三尖瓣的具体情况和手术者的经验，以选择置入半硬成形环的TVP为主，必要时采用生物瓣行TVR。但对有严重右心功能衰竭（NYHA分级Ⅳ级）患者需慎重选择手术治疗，应以内科保守治疗为主。

Application of Sequential Noninvasive Ventilation in Weaning Patients off Mechanical Ventilation after Coronary Artery Bypass Grafting

Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.

乌司他丁在深低温停循环主动脉手术中的肺保护作用

摘要： 目的 探讨乌司他丁对深低温停循环(DHCA)主动脉手术患者的肺保护作用。 方法 将2006年6月至2008年6月，25例在DHCA下行主动脉手术患者随机分为两组，乌司他丁组(n=14)：男11例，女3例；平均年龄52.21岁；停循环前给予乌司他丁20 000 U/kg；对照组(n=11)：男7例，女4例；平均年龄5682岁；常规DHCA手术。比较两组在DHCA前、DHCA结束、结束后6 h和12 h的肺功能指标和静脉血肿瘤坏死因子α(TNF-α)含量；同时观察两组呼吸机辅助呼吸时间、急性呼吸窘迫综合征（ARDS）、二次气管内插管、气管切开等情况。 结果 对照组围术期因大出血死亡1例（4.0%）。乌司他丁组术后呼吸机辅助呼吸时间明显短于对照组（23.21±9.96 h vs.57.81±55.00 h，Plt;0.05）。乌司他丁组术后发生ARDS 1例，无二次气管内插管和气管切开；对照组发生ARDS 2例，二次插管1例，气管切开2例。DHCA结束后12 h乌司他丁组动态胸肺顺应性（68.69±8.74 ml/cm H2O vs.46.18±11.54 ml/cm H2O）和氧合指数(331.78±35.45 mm Hg vs.281.73±45.32 mm Hg)高于对照组（Plt;0.05）；DHCA结束后12 h乌司他丁组气道阻力［7.16±0.49 cm H2O/(L·s) vs.11.68±1.01 cm H2O/(L·s)］和肺泡动脉氧分压差(147.98±32.84 mm Hg vs.216.45±23.41 mm Hg)低于对照组（Plt;0.05）；乌司他丁组静脉血TNFα含量低于对照组(67.57±9.78 pg/ml vs.92.45±9.52 pg/ml，Plt;0.05）。 结论 乌司他丁对DHCA主动脉手术患者有一定的肺保护作用，能缩短术后呼吸机辅助呼吸时间。

Diagnosis and Treatment for Prosthetic Valve Endocarditis

Abstract: Objective To summarize the experiences of treatment for prosthetic valve endocarditis (PVE), paying special emphasis on some interrelated conceptions of PVE, its microbiology, diagnosis, prevention and treatment. Methods From September 1979 to September 2009, 33 patients diagnosed to have PVE were treated in our department. There were 17 males and 16 females. Their age ranged from 19 to 57 years old with an average age of 34 years. The incidence of PVE was 1.48% （33/2 236）including 1.03%（16/1 551）, 3.00%（7/233）, 2.28%（10/438）, and 0% of PVE in mitral valve replacement (MVR), aortic valve replacement (AVR), double valve replacement (DVR), tricuspid valve replacement (TVR), respectively. Pure medical treatment (Penicillin or Vancomycin with other broadspectrum antibiotics, Fluconazole and Amphotericin) was performed on 22 patients. Combined medical and surgical treatment was performed in 11 patients. The patients underwent operation after adequate antibiotics treatment and general condition improvement. The infective tissue and vegetation were completely debrided after the infective prosthetic valve was removed. Before the new valve was transplanted, paravalvular tissue was cleaned with antibiotics, iodine solution and normal saline. Results Hospital death occurred in 19 patients (86.36%) and only 3 patients (13.64%) recovered in the group with pure medical treatment. The main reasons for death were infective shock and cardiac failure in 9 patients, and cerebral complications including embolism, bleeding and multipleorgan failure in 10 patients. For the group with combined medical and surgical treatment, 10 patients (90.91%) survived and only one patient (9.09%) died of multipleorgan failure. Follow-up was done in 13 patients for 6 months to 15 years averaging 41 months. During the follow-up, only one patient was reoperated because of the paravalvular leak eight year later. There was no PVE recurrence in all the rest patients. Conclusion Compared with pure medical treatment, combined medical and surgical treatment is a better solution for PVE.

Surgical Treatment of Partial Atrioventricular Canal Defect in 66 Cases

Objective To summarize the experiences of surgical treatment for partial atrioventricular canal defect. Methods The data of 66 patients of surgical treatment for partial atrioventricular canal defect from January 1984 to December 2007 were analyzed retrospectively. The cleft of mitral valve presented in all of those patients. There were 52 cases with direct suture on cleft, 8 cases with direct suture with commissurroplasty, 1 case with posterior leaflet plasty, 3 cases with direct suture St.Jude ring and 2 cases mitral valve replacement. The ostium primum atrial septal defects were repaired with patches of Dacron in 12 cases and autologous pericardium in 54 cases. Coronary sinus was situated on the left atrium in 5 and ostium primum atrial septal defects were repaired in Kirklin’s way; the others in MeGoon’way. Meanwhile other heart abnormalities were done. Results There were two early deaths (3.03%), one patient died of heart arrhythmia and one patient died of respiratory failure. Complications of total A-V block was in 2 cases. Both of them were replanted with pace makers.52 cases were followed up, followup time was 5 months to 22 years(mean follow-up 15 years). All patients had better life. Four patients have been re -operated for different reasons post primary operation. One had good result after re-mitral valve replacement. One case died of acute renal failure and the other two died of low cardiac output syndrome. Conclusions Early operation is definitely recommended when the diagnosis is confirmed. Because the structure or function of mitral valve is saved, pulmonary hypertension is avoided and the mortality is lower in the future. The key points of operation are to rectify the mitral insufficiency, repair ostium primum atrial septal defects and avoid atrioventricular block. The patients of mild regurgitation of mitral valve have good results. Provided in those have more than middle regurgitation of mitral valve then their longterm results are poor.

5例心肌梗死后室间隔穿孔的外科治疗

目的 总结心肌梗死后室间隔穿孔的手术治疗经验。 方法 采用外科手术治疗心肌梗死后室间隔穿孔5例，其中急诊行冠状动脉旁路移植和室间隔穿孔修补术3例，择期行冠状动脉旁路移植和室间隔穿孔修补术2例。 结果 术后死亡1例，该患者发生心肌梗死室间隔穿孔10d后，因心力衰竭而接受冠状动脉旁路移植(移植2支血管)、室间隔穿孔修补和室壁瘤切除术，心脏复跳后心排血量低，安装主动脉内球囊反搏,最终因心律失常死亡。另有1例心脏复跳后开始行主动脉内球囊反搏支持，术后第3 d撤除主动脉内球囊反搏。其余3例患者术后恢复顺利。出院前超声心动图检查提示：未见残余分流。门诊随访4例,随访时间6~15个月，病情较平稳。心功能Ⅰ级1例、Ⅱ级1例、Ⅲ级2例，无残余分流。 结论 结合药物、器械辅助和外科手术治疗心肌梗死后室间隔穿孔可以获得基本满意的早期疗效。

The Short and Medium Term Effect on Myocardial Contractile Force after Implantation of Autologous Endothelial Progenitor Cells

Objective To study the short and medium term effect of myocardial contractile force by implantation of endothelial progenitor cells （EPCs） in the myocardial infarction model. Methods Hundred and twenty SD rats were equally and randomly divided into experimental group and control group （60 rats in each group）. Acute myocardial infarction model was created by ligation of LAD. Autologous EPCs were purified from peripheral blood then implanted into the acute myocardial infarct site via topical injection. IMDM were used in control group. Specimens and muscle strip were harvested at 3, 6 weeks, 6, 8 and 12 months after EPCs implantation for contractile force study and to detect the expression of vascular endothelial growth factor（VEGF）, basic fibroblast growth factor （bFGF） and Ⅷ factor by immunohistology and video image digital analysis system. Results The expression of VEGF, bFGF and the microvessel counts in experimental group were much higher than those of control group（P〈 0.01） at 3, 6 weeks and 6 months after transplantation. The contractile force in experimental group was better than that in control group（P〈0.01） at the same time. But from 8 months after implantation, the contractile force and so on were not up in the experimental group. Conclusion EPCs, after being implanted into infarct myocardium, shows the ability of improvement of the contractile performance in infarcted myocardium by means of angiogenesis and vasculogenesis and the medium term results are persistent.

再次冠状动脉旁路移植术一例

The significance of nuclear factor-kappa B activation in the rat heart during ischemia-reperfusion injury

Objective To investigate the molecular mechanism of multiple cellular factors expressed shortly after ischemia reperfusion (IR) injury from the pathway of nuclear factor kappa B (NF κB). Methods The isolated heart models were established and sixty six rats were randomly divided into experimental group and control group. The deoxyribonucleic acid (DNA) binding activities of NF κB, the inhibitory kappa B (IκBα) levels in cytoplasm and tumor necrosis factor α (TNF α) messenger ribonucleic acid (mRNA) expressions were determined after 5, 15 min ischemia in experimental group, both after 0, 5, 15, 30 min ischemia and concomitantly 5, 15, 30, 45, 60 min reperfusion in control group. Results Augment of DNA binding activities of NF κB and reduction of IκBα in cytoplasm shortly after ischemia results were observed in control group. The level of IκBα was restored after reperfusion, the DNA binding activities of NF κB was further augmented. DNA binding activities of NF κB and TNF α mRNA expressions were lower in experimental group than those in control group. Conclusions NF κB in IR myocardium is activated by two different pathways: p65 p50 heterodimers and p50 p50 homodimers. In addition, the results suggest that early activation of NF κB induced by ischemia in the myocardium could be a signal mechanism for controlling and regulating immediate gene expressions during ischemia reperfusion.