Objective To evaluate the effect of sevoflurane on myocardial injury induced by hemorrhagic shock and resuscitation (HS/R) in pigs.Methods Twenty-four Bama miniature pigs (12 males, 12 females) , weighing 20-25 kg, aged 3-5 months, were randomly divided into 3 groups (n=8 each) using a random number table: sham operation group (group S) , HS/R group and sevoflurane group (group Sev).The left and right femoral arteries and right femoral vein were cannulated for blood pressure monitoring, blood-letting, blood sampling and fluid infusion.HS/R was induced by blood-letting maintaining for 1 h, followed by resuscitation with autologous blood reinfusion and infusion of lactated Ringer's solution 2 times the volume of the blood withdrawn.The pigs in group Sev were exposed to 2％ sevoflurane for 30 min before resuscitation.After cannulation, at 30 min after hemorrhagic shock, before resuscitation, and at 30 min, and 1.5, 2.5 and 3.5 h after resuscitation, blood samples were collected from the femoral artery for determination of creatine kinase-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnI) concentration in serum using an automatic biochemical analyzer.Myocardial specimens were obtained at 3.5 h after resuscitation for detection of tumor necrosis factor-alpha (TNF-ot) and interleukin-6 (IL-6) contents (by ELISA) , and phosphor-signal transducer and activator of transcription 1 (p-STAT1) expression (by Western blot), and for examination of the pathological changes (with light microscope).Results Compared with S group , the CK-MB activity and cTnI concentration in serum and contents of TNF-α and IL-6 were significantly increased, and the expression of p-STAT1 was up-regulated in HS/R and Sev groups (P＜0.05).Compared with HS/R group, the CK-MB activity and cTnI concentration in serum and contents of TNF-α and IL-6 were significantly decreased, and the expression of p-STAT1 was downregulated (P＜0.05) , and the pathological changes of myocardia were alleviated in Sev group.Conclusion Sevoflurane can alleviate HS/R-induced damage to myocardia of pigs, and inhibited STAT1 activity and attenuated inflammatory responses in the myocardium are involved in the mechanism.

Objective To investigate the effects of probiotics on the plasma diamine oxidase (DAO) activity and D-lactate, IL-6 and IL-10 levels in patients undergoing open heart surgery under cardiopulmonary bypass (CPB) , trying to elucidate the mechanism of protective effect of probiotics against CPB- induced injury to intestinal mucosal barrier. Methods Forty ASA Ⅱ - Ⅲ patients of both sexes aged 30-64 yr weighing 40-80 kg undergoing open heart operation under CPB were randomized into 2 groups ( n = 20 each) : control group (group C) and probiotics group (group Y) . Group Y received Jinshuangqi (Bifid Triple Viable containing bifido-bacterium, lacto-bacillus, streptococcus thermophiles) 4 pills 3 times a day for 7 days before operation. Venous blood samples were taken from CVP line before operation (T1 ), at 10 min after aortic unclamping (T2 ) and at the end of CPB (T3 ) and at 2, 6, 18 h (T4,5,6) after operation for determination of plasma DAO activity and D-lactate, IL-6 and IL-10 levels.Results Plasma DAO activity, D-lactate, IL-6 and IL-10 levels were significantly increased after CPB was started at T2-6 as compared with the baseline values at T1 in both groups. Plasma DAO activity and D-lactate level were significantly lower at T2-5 , the plasma IL-6 level was significantly lower and plasma IL-10 level higher at T4,5 in group Y than in group C. Conclusion Probiotics can protect intestinal mucosal barrier in patients undergoing open heart surgery under CPB and attenuate inflammatory response.

Clinical, radiological and pathological presentations in two children with epidermal nevus syndrome were analyzed and relevant literature was reviewed.Two patients both had typical epidermal nevus and abnormal cerebral radiography, which was associated with mental retardation, epilepsy, language and movement retardation.One case was complicated with an ocular tumor.Pathological investigations of the epidermal nevus revealed papilliform proliferation in squamous epidermis.The disorder may have a systemic involvement besides cutaneous lesions, with a predilection for the central nervous system.Early diagnosis and therapy may help to improve patients life quality.

Objective:To assess the clinical value of Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods:The clinical data of 5 patients of distal false lumen enlargement after thoracic endovascular aortic repair for Stanford type B aortic dissection (TBAD) from 2019 to 2020 was retrospectively analyzed.Results:All five patients were male. Combining Gore C-TAG stent-graft segmented release mode with 'periscope’ technique was used. All five patients successfully underwent secondary endovascular repair, no intraoperative thoracotomy or major postoperative complications during hospitalization occurred . Compared to aortic CTA imaging in pre- and post-secondary endovascular repair, the curative efficacy of this method in the treatment of distal reentry tear of aortic dissection was evaluated. It showed that distal reentry tears were covered completely without reperfusion of aortic false lumen, as well as branch stents with well-perfusion based on aortic CTA imaging during the first year following-up.Conclusions:Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection is technically applicable and highly successful with satisfactory short-term results.

AIM:The direct renin inhibitor aliskiren displays antihypertensive and antialbuminuric effects in humans and in animal models . Emerging evidence has shown that aliskiren localizes and persists in medullary collecting ducts even after treatment was discontinued . The purpose of the present study was to investigate whether aliskiren regulates renal aquaporin expression and improves urinary concen -trating defect induced by lithium .METHODS:The mice were either fed with normal chow or LiCl diet (40 mmol/kg dry food per day for first 4 days and 20 mmol/kg dry food per day for last 3 days ) for seven days .Some mice were intraperitoneally injected aliskiren ( 50 mg/kg BW per day in saline ) .RESULTS:Mice injected aliskiren developed decreased urine output and increased urine osmolal -ity when compared with controls .Aliskiren significantly increased protein abundance of AQP 2 and phosphorylated-S256 AQP2 in the kidney inner medulla .Immunohistochemistry and immunofluoresence showed increased apical and intracellular labeling of AQP 2 and pS256-AQP2 in collecting duct principal cells of kidneys in mice treated with aliskiren .Aliskiren treatment prevented urinary concen-trating defect in lithium-treated mice , and improved the downregulation of AQP 2 and pS256-AQP2 protein abundance in inner medulla of the kidney .In primary cultured rat inner medulla collecting duct cells , aliskiren dramatically increased AQP 2 protein abundance which was significantly inhibited either by PKA inhibitor H 89 or by adenylyl cyclase inhibitor MDL 12330, indicating an involvement of the cAMP signalling pathway in mediating aliskiren-induced increased AQP 2 expression .CONCLUSION: The direct renin inhibitor aliskiren upregulates AQP 2 protein expression in inner medullary collecting duct principal cells and prevents lithium -induced nephro-genic diabetes insipidus ( NDI) likely via PKA-cAMP pathways .

Objective To evaluate the effect of sevoflurane on brain injury in a pig model of hem?orrhagic shock in hypothermia environment. Methods Twenty?four Bama miniature pigs, weighing 21-25 kg, aged 3-5 months, were equally randomized into 3 groups using a random number table: sham opera?tion group (group Sham);hemorrhagic shock (group HS); sevoflurane group (group Sev). The animals were anesthetized, tracheostomized and mechanically ventilated. Bilateral femoral arteries were cannulated for continuous mean arterial pressure, and heart rate monitoring, blood?letting and blood sampling. A cath?eter was inserted into the right internal jugular vein for body temperature monitoring. After the animals were awake, they were placed in an environment at-15℃. Hemorrhagic shock was induced by withdrawing 40%of blood volume from the right femoral artery within 15 min ( 30 ml∕kg) in HS and Sev groups. The animals inhaled 2% sevoflurane for 30 min after establishment of the model in group Sev. Before hemorrhagic shock, and at 30, 60, 90, 120, 180 and 240 h after hemorrhagic shock ( T0?6 ) , blood samples were collected from the femoral artery for determination of plasma tumor necrosis factor?alpha ( TNF?α) , interleukin?6(IL?6), nuclear factor kappa B (NF?κB), S100β protein and neuron?specific enolase (NSE) concentra?tions. After blood sampling at T6 , the animals were sacrificed, and brains were removed for microscopic examination of pathological changes, and for determination of Toll?like receptor 4 ( TLR4) expression by Western blot. Results Compared with group Sham, the plasma NSE, S100β protein, TNF?α, IL?6 and NF?κB concentrations were significantly increased at T2?6 , and TLR4 expression was up?regulated at T6 in HS and Sev groups ( P<0?05) . Compared with group HS, the plasma NSE, and S100βprotein concentra?tions were significantly decreased at T4?6 , the plasma TNF?α, IL?6 and NF?κB concentrations were de?creased at T2?6, and TLR4 expression was down?regulated at T6 (P<0?05), and the pathological changes were significantly attenuated in group Sev. Conclusion Sevoflurane can mitigate brain injury in a pig mod?el of hemorrhagic shock in hypothermia environment, and the mechanism may be related to inhibited TLR4∕NF?κB signaling pathway and attenuated inflammatory responses.

Coronary Artery Disease ; therapy ; Fistula ; therapy ; Humans ; Percutaneous Coronary Intervention

Objective To evaluate the effect of environmental hypothermia exposure on hemodynamics and oxygen metabolism during general anesthesia in a pig model of hemorrhagic shock.Methods Twelve pathogen-free Bama miniature pigs of both sexes,weighing 20-24 kg,were divided into 2 groups (n=6 each) using a random number table:room temperature group (group RT) and environmental hypothermia group (group EH).The animals inhaled 2％ isoflurane for maintenance of anesthesia.The pigs were placed at room temperature (20-22℃) and at low temperature (-10 ℃) in group RT and group EH,respectively.Hemorrhagic shock was induced by withdrawing blood from the right femoral artery within 20 min (30 ml/kg).Before withdrawing blood (T1),immediately after the end of withdrawing blood (T2),and at 1,2,3,4 and 5 h of shock (T3-7),heart rate,mean arterial pressure,mean pulmonary artery pressure,cardiac index and systemic vascular resistance index were recorded.Blood samples were collected from the right femoral artery and internal jugular vein for blood gas analysis,and lactic acid concentrations,hemoglobin,arterial oxygen partial pressure,arterial oxygen saturation,and mixed venous oxygen saturation were recorded.Oxygen delivery index,oxygen consumption index and O2 extraction rate were calculated.Results Compared with group RT,heart rate at T3-7,cardiac index and oxygen delivery index at T5-7,oxygen consumption index at T1-7,O2 extraction rate at T2-6,and lactic acid concentrations at T5-7 were significantly decreased,and mean arterial pressure at T4,5,mean pulmonary artery pressure at T4-7,systemic vascular resistance index at T3-7,and mixed venous oxygen saturation at T2-6 were increased in group EH (P＜0.05).Conclusion Environmental hypothermia exposure inhibits cardiac compensatory responses,increases the peripheral vascular resistance,and aggravates oxygen dysmetabolism during general anesthesia in a pig model of hemorrhagic shock.

Objective To evaluate the safety and efficiency of transcatheter anastomotic leakage closure after surgical procedures for non-infected ascending aortic pathology with different occlusion devices. Methods From Dec. 2013 to Sep. 2015, six cases received interventional therapy for anastomotic leakage after surgical procedures for non-infected ascending aortic pathology using occluders. Four cases were with proximal graft-vessel anastomotic leakage, including two pseudoaneurysms at the site of aortic roots and two ascending aorta to right atrium shunts. The other two cases were with artificial grafts to intraoperative stent anastomotic leakage leading to endoleak type Ib. The anastomotic leakage was totally occluded by single ADOⅡrespectively in four cases. Two detachable coils were implanted in one case with artificial graft to intraoperative stent anastomotic leakage, but mild residual shunt to false lumen was detected by DSA and follow-up CTA. The second interventional procedure was carried out one month later, and one ADO Ⅱ was used to close the residual leakage totally. One PDA occluder was implanted along arteriovenous guide-wire track via aortic root to right atrium fistula in one case. Results All the anastomotic leakages of the six cases were totally excluded by different occlude devices percutaneously. The technical success rate was 100%. Follow-up time was from 1 month to 4 years. The patients' clinical condition improved obviously. Follow-up CTA showed no recurrence of anastomotic leakage. Complete thrombosis and marked shrinkage of the pseudoaneurysm were achieved in two cases, and the partial thrombosis and shrinkage of the false lumen were achieved in 2 cases. Conclusion Trans-catheter closure is an alternative treatment for ascending aortic surgical anastomotic leakage, which may achieve satisfactory short-and mid-term results.

Objective To summraize the safety and efifcacy of modiifed transcatheter closure of atrial septal defect. Methods From Dec. 2012 to Dec. 2013, 100 cases performed modiifed transcatheter closure of atrial septal defect in our center (72 were famale and 28 were male) with average age (37±16) years. The diagnosis was conifrmed by transthoracic echocardiography. All the atrial septal defect closures were completed in the modiifed way by direct delivery of the closure devices without the need of guidence wire. Results One hundred and one defects were identiifed in 100 patients, with 1 patient had 2 defects. The mean diameter of the defect was (20.3±6.6) mm. 100 devices were implanted successfully. Complete closure was revealed in all the patients after the procedure. One patient developed atrial ifbrillation during the procedure. No other serious complication occurred till the last follow-up. Conclusions The modiifed transcatheter closure of atrial septal defect is an effective procedure with high successful rate and low rate of complications.