Objective To investigate the clinical application of the right grstroepiploic artery (RGEA) in offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of the 38 patients who underwent RGEA grafts for OPCAB between December 2008 and July 2009 in the First Affiliated Hospital of Nanjing Medical University. According to the difference of grafts, 76 patients undergoing OPCAB were divided into two groups. In the RGEA group, there were 38 patients including 36 males and 2 females with an age of 65.87±6.29 years. For the patients in this group, OPCAB was carried out with RGEA and other routine conduits as grafts. The control group had 38 patients including 35 males and 3 females with an age of 66.68±6.24 years. They underwent OPCAB with left internal mammary artery (LIMA), radial artery (RA), or saphenous vein (SV) as grafts. The intraoperative and postoperative clinical data for patients in both groups were analyzed and compared. Results All operations were carried out without serious complications like reoperation for bleeding, functional delayed gastric emptying, or severe infection, and no operative death occurred. Compared with the control group, operative time in the RGEA group was longer (295.53±45.16 min vs. 262.50±42.44 min,P=0.001), the number of anastomotic stomas [CM(159mm]was less (4.71±0.56 vs. 5.29±0.92, P=0.002), and less intraoperative plasma was consumed (194.74±186.30 ml vs. 565.79±382.70 ml, P=0.000). The 24 h drainage loss (394.71±205.36 ml vs. 536.32±258.85 ml, P=0.008), the blood cell consumption (1.67±1.48 U vs. 2.81±2.48 U, P=0.010) and the postoperative hospital stay (12.47±3.20 d vs. 15.47±9.31 d, P=0.035) were significantly lower in the RGEA group compared with those in the control group. Meanwhile, the time of postoperative mechanical ventilation time was longer in the RGEA group than that in the control group (1 398.82±1 349.94 min vs. 985.39±170.30 min, P=0.036). Seventytwo patients were followed up for a period from 9 to 17 months with 4 cases lost. No myocardial ischemia occurred in both groups of patients. Conclusion RGEA is an effective arterial conduit for OPCAB. It needs high technology and takes long operative time to apply RGEA in OPCAB.
Acute kidney injury (AKI) is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting (CABG) combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) score>Ⅱ, previous cardiac surgery, cadiopulmonary bypass (CPB) time and low cardiac output syndrome (LCOS) are included in many risks prediction models (>3 times). In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy (RRT)-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. The metabolic changes of atrial myocytes, especially lipid metabolism, have a significant impact on the electrical signals and structural remodeling of atrial tissue, and play an important role in the occurrence and development of AF. The reduction of fatty acid oxidation ratio and increased aerobic glycolysis ratio are characteristic changes of tissue metabolic remodeling in AF. In this review, we will introduce the latest research status of lipid metabolism in AF from aspects of AF metabolism, clinical treatment and diagnosis and prognosis.
Objective To investigate the effects of nucleus localization signal linked nucleic kinase substrate short peptide (NNS) conjugated chitosan (CS) (NNSCS) mediated the transfection of microRNA-140 (miR-140) in rabbit articular chondrocytes in vitro. Methods Recombinant plasmid GV268-miR-140 and empty plasmid GV268 were combined with NNSCS to form NNSCS/pDNA complexes, respectively. Chondrocytes were isolated and cultured through trypsin and collagenase digestion from articular cartilage of newborn New Zealand white rabbits. The second generation chondrocytes were divided into 3 intervention groups: normal cell control group (group A), NNSCS/GV268 empty plasmid transfection group (group B), and NNSCS/GV268-miR-140 transfection group (group C). NNSCS/GV268 and NNSCS/GV268-miR- 140 complexes were transiently transfected into cells of groups B and C. After transfection, real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the expressions of exogenous miR-140; Annexin Ⅴ-FITC/PI double staining and MTT assay were used to detect the effect of exogenous miR-140 on apoptosis and proliferation of transfected chondrocytes; the expressions of Sox9, Aggrecan, and histone deacetylase 4 (Hdac4) were detected by RT-qPCR. Results RT-qPCR showed that the expression of miR-140 in group C was significantly higher than that in groups A and B (P<0.05). Compared with groups A and B, the apoptosis rate in group C was decreased and the proliferation activity was improved, Sox9 and Aggrecan gene expressions were significantly up-regulated, and Hdac4 gene expression was significantly down-regulated (P<0.05). There was no significant difference in above indexes between groups A and B (P>0.05). Conclusion Exogenous gene can be carried into the chondrocytes by NNSCS and expressed efficiently, the high expression of miR-140 can improve the biological activity of chondrocytes cultured in vitro, which provides important experimental basis for the treatment of cartilage damage diseases.