AIM:To observe the changes of nuclear factor-?B (NF-?B) activity and inducible nitric oxide synthase (iNOS) expression in hypoxic pulmonary hypertension(HPH). METHODS:The rat model of HPH was used. The NF-?B activity and iNOS expression in lung tissue were determined by immunohistochemistry(IHC), in situ hybridization (ISH), RT-PCR and Western blot.RESULTS:ISH showed that iNOS mRNA expression in intraacinar pulmonary arteriole (IAPA) in H28 d group(hypoxic treatment for 28 days) was stronger than that in normal group, H5d group and H14 d group. RT-PCR showed that the iNOS mRNA in H28 group was 2.1 times, 1.9 times and 1.8 times higher than that in normal group, H5d group and H14 d group, respectively. The nucleic anti-NF-?B stain was observed in H28 d group, which was significantly stronger, but the I-?B amount was 2.8 times, 2.7 times and 2.5 times lower than that in normal group, H5d group and H14 d group, respectively. CONCLUSION: The activity of NF-?B was correlated with the hypoxic pulmonary vessel structural remodeling and iNOS expression.

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .

Objective To summarize the experience of hybrid repair performed in high risk patients with dissection involving the aortic arch.Methods From Sep.2007 to Mar.2015,hybrid repair was performed in 33 high risk patients with dissection involving the aortic arch including acute (n =8),subacute (n =15),or chronic (n =10) cases.Descripitive statistics were computed for continuous and categorical variables.Results There were 22 male and 11 female patients with a mean age of(69 ± 10) years,and ASA Physical Status Ⅲ-Ⅳ.Simultaneous (n =27) and staged (n =5,mean interval 5.0 ± 1.3 days)endovascular repair were performed via femoral artery.The technical success rate was 100％.The average hospital stay was (16 ±6) days.One case died of cerebral infraction.There were two with strokes,one with pneumonia and two with renal failure as complications.Median follow-up was 47 months (3-66 months).There were four deaths with two were related to aortic artery.Endoleak was found in 3 during follow-up.One type Ⅰ endoleak was cured after remedy hybrid repair.Conclusions Hybrid repair performed in patients at high risk with dissection involving the aortic arch is less invasive with favorable medium and long-term outcomes.

By using immunohistochemistry LSAB method and imaging analysis technique, the expression of α1-antitrypsinase (α1-AT) in 41 cases of bronchioalveolar carcinoma (BAC) was quantitatively detected to explore the relationship between αl-AT expression in BAC tissues and clinical pathology. The results showed that the total positive rate for αl-AT expression was 85.4%. The positive rate for αl-AT expression in alveolar BAC was 100%, with the immunity reactive staining intensity being significantly higher than in papillary BAC, mucinous BAC or sclerosing BAC (P＜0.05). The positive rate in papillary BAC was 93.3%, with the intensity higher mucinous BAC or sclerosing BAC (P＜0.01); The positive rate in both mucinous BAC and sclerosing BAC was 66.7% (P＞0.05); The expression intensity in lymph node metastatic group was obviously lower than that in the group without metastasis (P＜0.01); The patients with mucinous BAC were diagnosed at a younger age than those with other histologic types of BAC (P＜0.05). It was suggested that BAC cells could also produce αl-AT. Detection of α1-AT could be used as a new method to diagnose BAC and might play a role in assessing BAC metastasis.

By using immunohistochemistry LSAB method and imaging analysis technique, the expression of α1-antitrypsinase (α1-AT) in 41 cases of bronchioalveolar carcinoma (BAC) was quantitatively detected to explore the relationship between αl-AT expression in BAC tissues and clinical pathology. The results showed that the total positive rate for αl-AT expression was 85.4%. The positive rate for αl-AT expression in alveolar BAC was 100%, with the immunity reactive staining intensity being significantly higher than in papillary BAC, mucinous BAC or sclerosing BAC (P＜0.05). The positive rate in papillary BAC was 93.3%, with the intensity higher mucinous BAC or sclerosing BAC (P＜0.01); The positive rate in both mucinous BAC and sclerosing BAC was 66.7% (P＞0.05); The expression intensity in lymph node metastatic group was obviously lower than that in the group without metastasis (P＜0.01); The patients with mucinous BAC were diagnosed at a younger age than those with other histologic types of BAC (P＜0.05). It was suggested that BAC cells could also produce αl-AT. Detection of α1-AT could be used as a new method to diagnose BAC and might play a role in assessing BAC metastasis.

OBJECTIVETo investigate the expression of hypoxia-inducible factor-1 alpha (HIF-1alpha) and endothelin-1 (ET-1) gene in hypoxic pulmonary hypertension (HPH).

METHODSThe animal model of HPH was replicated. The elastic fiber staining was applied to show the intraacinar pulmonary artery (IAPA). Radioimmunoassay (RIA) and in situ hybridization (ISH) were used for detection of HIF-1a and. ET-1.

RESULTSISH showed that HIF-1alpha mRNA was expressed in the IAPA of all hypoxic rat. The expression was stronger in the H14 d (0.256 9 +/- 0.046 8) and H28 d (0.225 8 +/- 0.045 3) groups than in the H5 d (0.1455 +/- 0.072 2) and control (0.110 9 +/- 0.022 4) groups (P < 0.05), the expression of ET-1 mRNA in the H14 d (0.412 2 +/- 0.078 3) and H28 d (0.368 4 +/- 0.072 9) groups was also stronger than that in the H5 d (0.201 7 +/- 0.034 9) and control (0.185 5 +/- 0.036 1) groups (P < 0.05). The amount of ET-1 in pulmonary arteial blood in the H14 d [(158.78 +/- 25.14) pg/ml] and H28 d [(142.93 +/- 23.38) pg/ml] groups was significantly higher than that in the H5 d [(79.68 +/- 12.54) pg/ml] and control [(65.37 +/- 10.82) pg/ml] groups (P < 0.05). The mean pulmonary arterial pressure (mPAP) in the H14 d [(34.0 +/- 5.8) mm Hg] and H 28 d [(29.0 +/- 4.7) mm Hg] groups was markedly higher than that in the H5 d [(19.0 +/- 3.5) mm Hg] and control [(17.0 +/- 2.8) mm Hg] groups (P < 0.05). A positive rank correlation existed between the mPAP and the amount of ET-1 (rs = 0.747, P < 0.05).

CONCLUSIONSExpression of HIF-1alpha and ET-1 mRNA in IAPA increase under long-term hypoxic condition and both show consistent expression, indicating that the expression of HIF-1a and ET-1 gene contribute to pathogenesis of HPH.

Animals ; Endothelin-1 ; genetics ; Gene Expression ; Hypertension, Pulmonary ; etiology ; genetics ; pathology ; Hypoxia ; complications ; Hypoxia-Inducible Factor 1, alpha Subunit ; Male ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Wistar ; Transcription Factors ; genetics

Objective To summarize the preliminary experience of early anticoagulant therapy after endovascular stent graft exclusion for Stanford B type aortic dissection.Methods From June 2006 to June 2011,75 patients[ 65 males,10 fe males,mean age (59.1±13.5) years,range 22 -81 years ] under went endovascular stent-graft exclusion for Stafford B type aortic dissection in Shanghai Xinhua Hospital.Computed tomography angiography (CTA) was used to evaluate the lesions of aortic dissection before endovascular stent-graft exchusion.The descending thoracic aortic diameters were 22 mm to 42 mm [ mean (30.3±4.0) mm ].The distance from the breakage of dissection to the left vertebral artery(LSA)was longer than 1.5 mm in 29 cases,and shorter than 1.5cmin 46 cases.During the operation,left subclavian artery revascularization was per formed to patient,whose left vertebral artery was advantage and needs to be fully or partially covered From the second day after operation,asprin was given to patint,whose left subclavian artery was fully or partially coverd by endovascular stent-graft(no endoleak and residual distal tear).Early anticoagulant therapy lasted 3 months.The symptoms or signs about nervous system were observed in the early stage of postoperation,and the CTA was examined at postoperative 3 months.Results The operation succeeded in 75 patients.The diameters of aortic stent were 26mm to 46rmm[ mean(34.3±4.0) mm ].Left subclavian ar tery revascularization was carried out for 2 cases of all patients.The left subclavian artery was fully or partially coverd in 58 patients(fully covered in 19 cases,2/3 covered in 15 cases,1/2 covered in 24 cases),and 56 patints(no endoleak and residualdistal tear) were given anticoagulant therapy to prevent vertebral artery thrombosis.2 patients(2.7％)died in the early stage after operation.1 patient died of renal failure,1 patient died of dissection rupture,The duration of hospitalization was 4 to 19 days [ mean (7.9±3.5)days ].No neurological complications occurred in hospital.The follow-up period was 6 to 66 months.1 patient died during the follow-up,1 patient had recurrence of Stanford A type aortic dissection and was cured by ascending aorta and aortic arch replacement,1 patient had recurrence of Stanford B type aortic dissection and was cured by second endovascular stent-graft exclusion.All patients had no neurological complications,such as cerebral infarction and paraplegia.Concluslon Early anticoagulant therapy could safely and effectively prevent the neurological complications (such as cerebral infarction and paraplegia) related to vertebral artery thrombosis for Stanford B type aortic dissection patients whose left subclavian artery was fully or partially coverd by endovascular stent-graft.

Objective:To investigate the influencing factors for prognoses of patients with acute basilar artery occlusion (BAO) receiving bridging therapy (intravenous thrombolysis [IVT] combined with endovascular treatment [EVT]).Methods:The clinical and imaging data of 404 patients with acute BAO accepted bridging therapy were collected from Endovascular Treatment for acute Basilar Artery Occlusion (ATTENTION) database. The prognoses of these patients were evaluated by modified Rankin Scale (mRS) 90 d after treatment. The differences of clinical and imaging data between patients with good prognosis and poor prognosis were compared, and the independent influencing factors for prognoses were analyzed by multivariate Logistic regression.Results:Among 404 patients with acute BAO, 156 (39%) had good prognosis and 248 (61%) had poor prognosis. Compared with the good prognosis group, the poor prognosis group had significantly higher proportions of patients older than 65 years, patients with NIHSS scores>20 on admission, and patients with thrombectomy frequency>1, significantly lower proportion of patients with successful vascular recanalization, and significantly different distribution of occlusive sites ( P<0.05). Multivariate Logistic regression analysis showed that NIHSS scores on admission>20 ( OR=0.510, 95%CI: 0.331-0.786, P=0.002), and occlusion site at the distal basilar artery ( OR=2.241, 95%CI: 1.357-3.702, P=0.002), thrombectomy frequency>1 ( OR=0.523, 95%CI: 0.339-0.807, P=0.003) and successful vascular recanalization ( OR=2.022, 95%CI: 1.032-3.961, P=0.040) were independent influencing factors for good prognosis of these patients. Conclusion:Acute BAO patients with NIHSS scores>20 on admission, thrombectomy frequency>1, non-distal BAO occlusion, and unsuccessful recanalization have poor prognosis after bridging therapy.

Objective To report the results of lung transplantation using graft lungs from donation after citizens death.Methods The clinical data of lung transplantation between January 2016 and June 2016 were analyzed retrospectively.Results Totally 20 patients with end stage lung diseases underwent lung transplantation.Of the 20 patients,11 cases (55％) underwent single lung transplantation and 9 cases (45 ％) underwent bilateral lung transplantation.The top two diseases for lung transplantation were pulmonary fibrosis in 11 cases (55％) and emphysema in 6 cases (30％).Four cases (20％) were given intraoperative ECMO support.Median duration of postoperative intubation was 2 days:1 day for single lung transplantation and 4 days for bilateral lung transplantation,respectively.Acute rejections were diagnosed in 9 patients (45％) who were successfully treated with high-dose intravenous methylprednisolone or methylprednisolone combined with anti-human thymocyte globulin.Postoperative pneumonia episodes occurred in 16 cases (80％)and 4 of them were associated fungal pneumonia.Preoperative sputum culture showed positive bacteria in 16 donors (80％) and 17 kinds of strains were identified.Postoperative sputum culture showed positive bacteria in 19 recipients and 4 of them had the same strains as compared with the corresponding donors.One recipient died of primary graft dysfunction in early term (＜ 1 month)postoperatively,two recipients abandoned treatments and died in 1 week after the discharge,and the remaining 17 cases successfully recovered.Median hospital duration was 55 days:35 days for single lung transplantation and 67 days for bilateral lung transplantation,respectively.Conclusion LLung transplantation is an effective treatment for end-stage lung diseases.Carefully selecting donors,well protecting graft lung and proper peri-operative treatment are the key steps leading to successful lung transplantation using grafts from organ procurement organization.

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.