ObjectiveTo observe the short-term therapeutic outcomes of atrial septal defects (ASD) repair using on-pump beating-heart technique assisted by robotic surgery system (Da Vinci Si) or thoracoscopy.MethodsClinical data of 50 patients undergoing ASD repair at the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2018 were retrospectively analyzed. According to the different surgical methods, patients were divided into a robot group and a total thoracoscopy group. In the robot group, there were 35 patients including 11 males and 24 females, at an average age of 42.1±16.8 years, and in the total thoracoscopy group there were 15 patients including 8 males and 7 females at an average age of 38.4±10.9 years. During follow-up, the left ventricular ejection fraction, left and right atrial diameter, and right ventricular end-diastolic diameter in the cardiac Doppler echocardiography were recorded. The operation time, extracorporeal circulation time, ventilation time, postoperative ICU stay, postoperative hospital stay, perioperative pleural drainage and early complications were compared between the two groups.ResultsIn the perioperative period, the robot group had less operation time (3.8±0.3 h vs. 6.1±1.4 h), extracorporeal circulation time (72.3 ± 10.4 min vs. 139.1 ± 32.8 min), ventilation time (5.5±1.2 h vs. 9.5 ± 2.1 h), postoperative hospital stay (6.7±0.5 d vs. 9.8 ± 0.6 d) and thoracic drainage (253.4±26.8 mL vs. 289.3 ± 29.5 mL) than the total thoracoscopy group (P<0.05), while the postoperative complications were not statistically significant between the two groups (P>0.05). All patients were reviewed by color Doppler ultrasound at 1 month after operation. The postoperative dilated right atrium, right ventricle and left atrium were smaller than those before surgery.ConclusionFor patients undergoing ASD repair, robot-assisted and total thoracoscopy can achieve good results, but the robot group has more advantages in terms of operation time, extracorporeal circulation time, ventilation time, postoperative hospital stay and thoracic drainage.
ObjectiveTo study the effect of Tangeretin on non-small cell lung cancer (NSCLC) and the tumor stemness, and to find the molecular mechanism of its effect. MethodsWe used cell counting and cell cloning experiments to study the effect of Tangeretin on the proliferation of NSCLC cells in vitro. The effect of Tangeretin on the invasion of NSCLC cells was detected by transwell assay. We detected the effect of Tangeretin on the proliferation of NSCLC cells in vivo by nude mouse tumor-bearing experiment. The effect of Tangeretin on tumor stemness of NSCLC cells was detected by self-renew assay, and CD133 and Nanog protein expressions. The expressions of PI3K/AKT/mTOR signaling pathway-related proteins were detected by Western blotting (WB). ResultsTangeretin had a good inhibitory effect on the proliferation of NSCLC cells in vivo and in vitro. Cell counting experiment, clonal formation experiment and nude mouse tumor-bearing experiment showed that Tangeretin could inhibit the proliferation activity, clonal formation ability, and tumor size of NSCLC cells in vivo. Self-renew experiments showed that Tangeretin could inhibit the self-renew ability of NSCLC cells. WB experiments showed that Tangeretin inhibited the expressions of tumor stemness markers CD133 and Nanog in NSCLC cells. Tangeretin could inhibit the activation of PI3K/AKT/mTOR signaling pathway-related proteins in NSCLC cells, and the activation of PI3K/AKT/mTOR signaling pathway could partially remit the inhibitory effect of Tangeretin on tumor stemness of NSCLC cells. ConclusionTangeretin can inhibit the tumor stemness of NSCLC cells, which may be related to the regulation of PI3K/AKT/mTOR signaling pathway.
ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.
ObjectivesTo analyze the effect of bronchiectasis (BE) on the clinical characteristics and prognosis of hospitalized patients with community acquired pneumonia (CAP), and to explore the independent risk factors affecting the 30-day mortality. MethodsA national multi-center retrospective study based on the CAP-China network platform. The clinical data of 6056 patients with CAP who were hospitalized in 13 tertiary teaching hospitals in Beijing, Shandong and Yunnan from January 1, 2014 to December 31, 2014 were collected. To compare the differences in clinical characteristics, etiological distribution and treatment prognosis of patients with CAP with bronchiectasis (BE-CAP) and patients without bronchiectasis (non-BE-CAP). Logistic regression analysis was performed to analyze independent risk factors affecting 30-day mortality in hospitalized patients with BE-CAP. ResultsIn the final analysis, 5880 CAP patients were included, and BE-CAP patients accounted for 10.8% (637/5880). Compared with non-BE-CAP patients, more BE-CAP patients were women, and a higher proportion of patients had chronic obstructive pulmonary disease, bronchial asthma, previous history of glucocorticoid inhalation, and a history of CAP within 1 year. BE-CAP patients had more dyspnea and cyanosis, lower arterial partial pressure of oxygen, longer median time to clinical stability (6 d vs. 4 d, P<0.001), and the incidence of respiratory failure was significantly higher than that of non-BE-CAP patients (27.8% vs. 19.7%, P<0.001). Pseudomonas aeruginosa is the most common bacterial infection in BE-CAP patients. Comorbid bronchiectasis has no significant effect on disease severity, total length of hospital stay, and mortality in CAP patients. The 30-day mortality rate of BE-CAP patients was 2.2%. Logistic regression analysis showed that initial treatment failure [odds ratio (OR) 6.675, 95% confidence interval (CI) 4.235-10.523, P<0.001], respiratory failure (OR 5.548, 95%CI 3.681-8.363, P<0.001), blood urea nitrogen>7.0 mmol/L (OR 2.490, 95%CI 1.625-3.815, P<0.001), albumin<35.0 g/L (OR 1.647, 95%CI 1.073-2.529, P=0.022) and CURB-65 score (OR 1.691, 95%CI 1.341-2.133, P<0.001) were independent risk factors for 30-day mortality in BE-CAP patients. ConclusionsBE-CAP patients have more serious hypoxia symptoms and higher incidence of respiratory failure. For BE-CAP patients with failure of initial treatment, complicated with respiratory failure, blood urea nitrogen>7.0 mmol/L, and albumin<35.0 g/L, treatment evaluation should be performed in time to reduce the mortality rate.