Glucose transporter 4 (GLUT4), a major contributor to glucose transport in skeletal muscle, is closely related to diabetic treatment. Exercise regulates apparently GLUT4 gene expression which produces many beneficial metabolic adaptations for diabetic patients. Study has shown that both AMPK (AMP-activated protein kinase) and CaMK (calcium-calmodulin dependent protein kinase) signaling pathways are involved in regulation of exercise-induced GLUT4 gene expression in skeletal muscles, but the relationship between these two signaling pathways in regulating the GLUT4 gene is unclear. The purpose of the following study was to investigate the relationship of these two pathways in Caffeine- and AICAR-stimulated skeletal muscle cells GLUT4 gene expression. Muscle contractile activity results in increases in both cytosolic Ca2+ and AMPK activity. To mimic this response, primary cultured rat skeletal muscle cells were treated with Caffeine to raise cytosolic Ca2+ and with AICAR to activate AMPK. The muscle cells were divided into different groups (Control, AICAR, Caffeine, AICAR/Caffeine, Caffeine +Compound C, AICAR/Caffeine +Compound C, AICAR +KN93, AICAR/Caffeine + KN93), which were used for experiments of stimulation by AICAR and Caffeine, inhibition by AMPK inhibitor, Compound C and CaMK inhibitor, KN93 respectively. The results showed that both AICAR and Caffeine induced about 2- and 3-fold increases respectively (P

Objective To assess the effects of thalidomide on VEGF mRNA level in human breast cancer cell lines. Methods Breast cancer cells were treated with thalidomide for 24～72h, RT-PCR was uced to detect the level of VEGF mRNA expression. Results When the concentration of drug is 50μg/L,thalidomide strongly inhibited the level of VEGF mRNA expression. Conclusion Within certain concentration range of thalidomide can inhibit the level of VEGF mRNA expression in breast cancer cell.

Objective To summarize the experience with resurgery for recurrent valvular heart diseases.Methods From June 2004 to June 2015, 28 patients (15 males and 13 females) with ages ranging from 44 to 67 years (55.6±6.5 years) with recurrent heart valve disease underwent resurgery. The reasons for resurgery included perivalvular leakage (7 cases), bioprosthetic valve decline (6 cases in mitral valve and 3 in tricuspid valve), mechanical prostheses dysfunction (2cases), infective endocarditis after valve replacement (2 cases), restenosis of repaired native valve (1 case), and severe tricuspid insufficiency after left-side valve surgery (7 cases). Resurgery included mitral valve replacement in 18 patients and tricuspid valve replacement in 10. All the patients underwent third or fourth or even fifth cardiac surgery for valve replacement.Results There were 2 hospital deaths with a mortality of 7.1% (2/28). The main causes of early-stage deaths were low cardiac output syndrome. The main postoperative complications were respiratory failure in 3, low cardiac output syndrome in 2, reexploration for bleeding in 2 and serious infectious shock in 1. All the patients were found with the great improvement in heart function and the re-implanted prostheses worked well during follow-up.Conclusions Although resurgery for recurrent heart valve disease poses a continuing challenge to cardiac surgeon, it could be performed with the satisfactory results. The keys to a successful cardiac resurgery include appropriate operational timing, refined surgical technique and reasonable perioperative managements.

AIM: To investigate the expression of matrix metalloproteinases(MMPs) in pulmonary arterioles of rats with chronic hypoxia and hypercapnia-induced pulmonary hypertension. METHODS: MMP-2, MMP-9 and MMP-2 mRNA, MMP-9 mRNA were observed in pulmonary arterioles by the techniques of immunohistochemistry and in situ hybridization. RESULTS: ①The mean pulmonary artery pressure (mPAP) and weight ratio of right ventricle to left ventricle and septum (RV/LV+S) of hypoxia-hypercapnia groups were higher than those of normal control group ( P

AIM:To investigate the effect of puerarin on pulmonary vessel collagen metabolism in pulmonary hypertension rats induced by chronic hypoxia and hypercapnia. METHODS: Collagen Ⅰ,Ⅲ and their mRNA were observed in pulmonary arterioles by the technique of immunohistochemistry and in situ hybridization. RESULTS: ① Light microscopy showed media thickness of pulmonary arterioles was much higher in HH(hypoxic-hypercapnia) group than that of NC(normal control) group, and, vessel cavity turned more straiter in HH group than that of NC group.However, the damage of pulmonary arterioles in HP(hypoxic-pueratin) group was much slighter than that of HH group. ② The levels of plasma ET-1 and lung homogenates Hyr were much higher in HH group than those of NC group( P 0.05). CONCLUSION: Puerarin inhibited the deposition of collagen and improved pulmonary vessel remodeling.

Objective:To confirm the safety and feasibility of totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty for mitral regurgitation(MR) in Barlow disease.Methods:From June 2018 to December 2019, 10 consecutive Barlow’s disease patients underwent totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty. The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results:8 males and 2 females. The mean age was(33.5±11.0) years.There was no operative death and related complications. The mean cardiopulmonary bypass(CPB) time was(142±26)(112-194)min, and the aortic clamping time was(96±18)(78-128) min. The average number of artificial chordae implantation was(3.4±0.7)(2-4) pairs/case. Intraoperative transesophageal echocardiography(TEE) showed the mean mitral valve coaptation length and transvalvular pressure gradient was(1.2±0.2)(0.8-1.5) cm and(1.2±0.4) mmHg(1 mmHg=0.133 kPa), respectively, without MR or systolic anterior motion(SAM). During a follow-up of 1-18 months, there were 7 cases with no MR and 3 with trace MR, with a mean transvalvular pressure gradient of( 1.5±0.6 )mmHg.Conclusion:Totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty was a safe and effective procedure with satisfied early clinical outcomes for MR in Barlow’s disease. However, further randomized and long-term follow-up studies were warranted to determine its clinical effects.

AMP-activated protein kinase, AMPK, is responsible for regulation of exercise-induced GLUT4 gene expression in skeletal muscle. But the molecular mechanisms for this regulation and key protein in this signaling pathway are obscure. There has been growing recognition that histone acetylation probably represents a central mechanism for regulation of gene transcription, and recent studies showed that numerous gene expressions are regulated by nucleosomal histone acetylation, which is modulated through histone acetyltransferases (HATs) and histone deacetylases (HDACs). So we have a hypothesis that the AMPK regulates GLUT4 gene through recruiting HDACs. Skeletal muscle cells cultured with normal (5 mmol/L) and high (20 mmol/L) glucose concentration were incubated with AICAR, and then total and nuclear AMPKalpha2, HDAC5 protein and GLUT4 mRNA were measured. The results show that the AICAR activated AMPKalpha2, reduced nuclear HDAC5,and increased GLUT4 mRNA in skeletal muscle cells; in contrast, the effect evoked by AICAR was blunted in cultured skeletal muscle cells with high glucose. Therefore, the changes of GLUT4 gene expression under different glucose concentration are closely related to the changes of AMPKalpha2 and HDAC5 protein in skeletal muscle cells. This result demonstrates that HDAC5 plays an important role in regulating GLUT4 gene transcription by AMPK signaling pathway skeletal muscle cells.
AMP-Activated Protein Kinases ; metabolism ; Cells, Cultured ; Glucose Transporter Type 4 ; biosynthesis ; genetics ; Histone Deacetylases ; metabolism ; Humans ; Muscle, Skeletal ; cytology ; enzymology ; metabolism ; RNA, Messenger ; biosynthesis ; genetics ; Signal Transduction ; Transcription, Genetic

Objective: To examine minimally invasive tricuspid valve operations applied in tricuspid valve insufficiency patients with previous left-sided valve surgery. Methods: Between September 2017 and June 2019, thirty-six consecutive patients received minimally invasive totally thoracoscopic tricuspid surgery through right thoracotomy at Department of Cardiovascular Surgery, Fisrt Medical Center, People′s Liberation Army General Hospital. There were 13 males and 23 females, aging (56±11) years (range: 43 to 79 years). All the patients had isolated significant tricuspid regurgitation after previous left-sided cardiac surgeries. A right anterolateral thoracotomy incision about 4 cm was made from the fourth intercostal space as main operating port. The arterial cannula was placed in femoral artery. The venous cannula was placed in femoral vein using Seldingger technique. Tricuspid valve operation was performed on beating heart by assist of vena vacuum. Results: Tricuspid valve repair was performed in 7 patients. Tricuspid valve replacement with bioprosthesis was performed in 29 patients. The operation time was (2.9±0.3) hours (range:2.5 to 3.6 hours). There was no conversion to sternotomy during operation. There was no severe complications during operation period. There were no complications related to this cannulation technique. The time of cardiopulmonary bypass establishment was (22±5) minutes (range: 12 to 24 minutes) and pump time was (82±16) minutes (range: 62 to 93 minutes). The length of hospital stay was (9±3) days after operation (range: 5 to 13 days). There was no early death in hospital. All patients were followed up for 3 to 22 months. No patient died. Conclusions One single port-based minimally invasive approach seems to be safe, feasible, and reproducible in case of redo tricuspid valve operations. Only cannulation of inferior vena cava significantly simplified the complexity of isolated redo tricuspid surgery.

Objective:The aim of this study was to compare the perioperative outcomes of a totally thoracoscopic repeat mitral valve surgery under hypothermic ventricular fibrillation with those of a conventional median sternotomy approach for repeat mitral valve surgery and to explore the safety of the totally thoracoscopic repeat mitral valve surgery under hypothermic ventricular fibrillation.Methods:Patients requiring repeat mitral valve surgery admitted by the same surgeon at Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital from January 2018 to January 2022 were retrospectively enrolled. The patients were divided into the totally thoracoscopic group under hypothermic ventricular fibrillation and the conventional median sternotomy group according to the procedure, and the preoperative baseline data and perioperative outcomes were collected and statistically analyzed using SPSS 22.0.Results:A total of 91 patients matched the criteria for study enrollment, 25 in the totally thoracoscopic group and 66 in the median sternotomy group. There was no statistical difference in the preoperative baseline data between the two groups. The totally thoracoscopic group has advantages in mitral valvuloplasty rate(32.0% vs. 7.6%, P=0.008), transfusion rate(72.0% vs. 98.5%, P<0.001), mechanical ventilation time [(19.0±27.8)h vs.(43.3±58.3)h, P=0.009], chest drainage tube time [(2.2±1.9)days vs.(3.7±2.4)days, P=0.004], postoperative chest drainage volume [(489.6±319.1)ml vs.(913.6±568.4)ml, P=0.001], postoperative discharge time[(8.0±2.7)days vs.(13.9±12.8)days, P=0.026]. The totally thoracoscopic group had a longer cardiopulmonary bypass time [(180.8±41.7)min vs.(143.2±39.7)min, P<0.001], and it had an intraoperative ventricular fibrillation time of(100.2±42.5)min. There were no statistically significant differences in the postoperative complication rate(12.0% vs. 21.2%, P=0.481) and mortality(4.0% vs. 4.5%, P=1.000) between the two groups. Conclusion:The totally thoracoscopic approach has the characteristics of less invasion and faster recovery compared with the median sternotomy approach. Hypothermic ventricular fibrillation simplifies the procedure at the ascending aorta while reducing myocardial injury than conventional occlusion of the ascending aorta. Totally thoracoscopic mitral valve surgery under hypothermic ventricular fibrillation is a safe minimally invasive technique.

Objective:To summarize the clinical data of mitral valve surgery completed in a single surgical team in one year, to discuss the etiologic characteristics, methods, results and early postoperative outcomes of mitral valvuloplasty surgeries, and to analyze the epidemiologic trends of mitral valve diseases admitted to the hospital.Methods:A total of 209 mitral valve surgeries completed by the same surgeon in the single surgical team at the Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital, from January 2021 to December 2021 were retrospectively analyzed. Mitral valve surgery accounted for 53.6% of all surgeries in this team during the same period. There were 100 cases(47.8%) in males and 109 cases(52.2%) in females, aged 11-85 years old, with a mean of(53.5±15.2) years old. There were 121 cases(57.9%) of NYHA class Ⅱ and 88 cases(42.1%) of class Ⅲ/Ⅳ.Results:Of the 152 mitral valvuloplasty surgeries, 117(77%) were performed with a totally Thoracoscopic approach. Annuloplasty rings were applied in 145 cases(95.4%), including semi-rigid closed Physio II annuloplasty rings in 118 cases(81.4%), Gore-Tex artificial chordae were applied in 89 cases(58.6%) for a total of 145, leaflet repair in 15 cases(9.9%), edge-to-edge repair in 2 cases(1.3%), commissure suture in 34 cases(22.4%), and chordae tendineae and papillary muscle splitting in 15 cases(9.9%). The repair rate of degenerative mitral valve disease was 100%, and the repair rate of rheumatic mitral valve disease was 48.1%. The echocardiogram was received about one week after surgery, and there was no or trace regurgitation in 91 cases(59.9%), mild in 58 cases(38.2%), and moderate in 3 cases(2.0%). There were 2 cases(1.3%) of all-cause death.Conclusion:Degenerative mitral valve disease have become the leading cause of mitral valve disease in our center, and the proportion of rheumatic mitral valve disease has decreased. Degenerative mitral valve disease has a very high repair rate, and rheumatic mitral valve disease has a relatively low repair rate due to its special pathologic and anatomic characteristics. Most mitral valvuloplasty procedure can be performed in a totally thoracoscopic approach. The application of a mitral valvuloplasty ring combined with Gore-Tex artificial chordae by an experienced surgeon can achieve reliable repair results.