Objective To evaluate the effects of preoperative continued dual antiplatelet therapy (DAPT) with aspirin and clopidogrel on early outcomes in patients underwent off-pump coronary artery bypass grafting (OPCABG). Methods A single-center study was conducted. The 279 unstable angina patients underwent first-time isolated OPCABG at our institution from January 2015 to May 2016 were divided into DAPT group (preoperative aspirin 100 mg/d and clopidogrel 75 mg/d were given until the time of surgery, n=148) and control group (stopped DAPT for 5 days before surgery, n=131). The total chest-tube output, blood-product transfusion requirements, re-exploration rate for bleeding, major adverse cardiac events (MACE) and other in-hospital outcomes were collected and compared between the two groups. Results There were no significant differences in demographic and preoperative clinical characteristics between the two groups. The total chest-tube drainage volume and perioperative transfusion requirements (rate and volume) including red blood cell, fresh plasma and platelets were statistically higher in the continued DAPT group than those of control group (P < 0.05). There were no significant differences in hemostatic re-exploration rate, length of operation, postoperative nonfatal myocardial infarction, ICU stay, ventilation time and duration of postoperative hospitalization between the two groups. Stroke and other severe outside chest bleeding and all-cause mortality were not observed in both groups during the postoperative period and prior to discharge. Conclusion Preoperative continued DAPT is associated with the increased chest-tube drainage and higher blood-product transfusion requirements but it does not increase the dection rate of thoracotomy because of bleeding. This antiplatelet strategy does not alter other investigated outcomes in primary isolated OPCABG patients. The preoperative DAPT may be able to be safely continued in patients referred for primary isolated OPCABG.

Objective To investigate the normal aortic valve histological manifestation and histopathological changes of degenerative aortic valve.Methods In Tianjin Chest Hospital,there were patients due to aortic valve disease undergoing aortic valve replacement surgery in the Department of Cardiovascular Surgery,and in 22 cases,their pathological aorta tricuspid valves were successfully excised from May 2009 to May 2010.The aortic valve tissues were collected,and according to hematoxylin and eosin (HE) staining of the degenerative calcified aortic valves with stenosis,they were divided into pathological valvular calcification locus group and non calcification locus group.Six morphologically normal aortic valve tissues were taken as a control group.The situation of collagen fibers,elastic fibers and collagen content in normal and disorder valves were analyzed by using of IDA-2000 high definition color medical image analysis system.Results With the naked eye,the thickness of the valve leaves with stenosis was increased,and at the valve leaf close to the side of arota,calcified foci were produced.Under light microscope,inflammatory changes were found in the aortic valve endothelium,in the tubular wall,there were aggregations of newly formed capillary with relatively thin wall,cholesterol crystals,cells similar to foam cells and diffuse and nodular calcification commonly seen,Compared with the normal valve,the ratio between collagenous and elastic fibers no matter at calcified or non-calcified region was greater in pathological valve [(3.19-± 1.01)％,(2.62-± 0.34)％ vs.(1.89-± 0.29)％,both P ＜ 0.05],collagen content (ratio =collagen/valve area) was also higher [(65.17 ± 11.48)％,(39.25-± 11.15)％ vs.(22.99 ± 4.78)％,P ＜ 0.05] in pathological valve,and the changes in calcified region were more significant than those in non-calcified region (both P ＜ 0.05).Conclusions Proliferation of collagen and degradation of elastic fibers are obvious in degenerative aortic valve,and the changes are more prominent at calcified region.

Objective To investigate the changes of human epidermal stem cells after transfected with human telomerase reverse transcriptase(hTERT)gene.Methods The plasmid pIRES2-EGFP and plasmid pIRES2-EGFP-hTERT encoding hTERT were transfected into in vitro cultured human fetal epidermal stem cells by liposome-mediated transfection.Then,the positive cells were selected with G418.The mRNA and protein expressions of hTERT were detected by reserve transcriptase-polymerase chain reaction(RT-PCR)and Western blot.The telomerase activity and the proliferation and cycle of human epidermal stem cells were detected by telomeric repeat amplification protocol(TRAP)-ELISA and flow cytometry respectively.Results RT-PCR and Western blot techniques detected weak mRNA and protein expressions of hTERT gene in untransfected and vacant vector transfected cells but high level of mRNA and protein expressions of hTERT gene in pIRES2-EGFP-hTERT transfected cells.Compared with untransfected and vacant vector transfected cells,the pIRES2-EGFP-hTERT transfected cells had higher telomerase activity,with lower proportion of cells at G_0/G_1 phase,higher proportion of cells at S and G_2/M phases and enhanced proliferation ability.Conclusion Transfection with hTERT gene can markedly enhance mRNA and protein expressions,telomerase activity and proliferation ability of hTERT gene of human epidermal stem cells euhured in vitro.

Objective To evaluate the short term outcome after mitral valve replacement with the Perimount bovine pericardial valve. Methods Eighty-eight patients underwent mitral valve replacement with the bovine pericardial valve in hospital were included in this study. Postoperative general condition including mortality and cerebral hemorrhage was observed. The hemodynamic and New York heart disease association (NYHA) heart function classification were recorded by Doppler echocardiograms before operation, postoperative 1 week, 3 months and 1 year after mitral valve replacement. Values of the different time points of NYHA, left atrial diameter (LA), left ventricular end diastolic diameter (LVDD), left ventricular end systolic diameter (LVSD), left ventricular ejection fraction (LVEF) and pulmonary artery pressure (PAP) were compared. The hemodynamic parameters were also compared including the peak cross valve pressure (PG), mean cross valve pressure (MG), peak cross valve velocity (PV) and effective orifice area (EOA) 1 week, 3 months and 1 year after surgery. Results There were two cases (2.3%) dead in one year (one died of cerebral hemorrhage and another one died of thromboembolism). There was 1 perivalvular leakage (1.2%). There was no endocarditis or structural valve deterioration. NYHA cardiac function was improved at postoperative 3 months and 1 year (P < 0.05). The values of LA, LVDD and PAP were significantly decreased at postoperative 1 week, 3 months and 1 year compared with those before operation (P<0.05). Values of LVSD and LVEF were significantly decreased at postoperative 1 week compared with those before operation (P<0.05). The value of LVEF was significantly increased at postoperative 3 months and 1 year (P<0.05). Compared with postoperative 1 week, the values of LA and LVEF were significantly increased at postoperative 3 months and 1 year (P < 0.05). There were no significant differences in PG, MG, PV and EOA between postoperative 1 week, 3 months and 1 year. Conclusion With the excellent performance of cardiac function recovery, left ventricular restoration and hemodynamic, the Perimount bovine pericardial valve remains a reliable choice as a mitral tissue valve.

OBJECTIVE To investigate the patterns of catheter related infection in critically ill patients after cardiac surgery with prolonged central venous catheters. METHODS The materials of culture of catheter tip and subcutaneous segments in 166 critically ill patients after cardiac surgery with prolonged central venous catheters were reviewed. RESULTS The positive pathogenic bacteria ratio of catheter tip segments was 41.0% and the positive ratio of catheter subcutaneous segments was 47.0%.Catheterization longer than 18 days,body temperature higher than 38.5 ℃ and insertion sites of femoral veins were the variables associated with significantly increased risk of catheter related infection. CONCLUSIONS The positive pathogenic bacteria ratio of central venous catheters in critically ill patients after cardiac surgery with prolonged central venous catheters is high,more attention must be paid to catheter related infection,and efficacious interventions must be laid down.

Objective To investigate the role of stromal cell-derived factor-1α(SDF-1α)/CXCR4 signal pathway in the therapeutic effects of hypoxic preconditioning endothelial progenitor cell (HEPC) transplantation on acute myocardial in-farction Methods Bone marrow endothelial progenitor cells (EPCs) were isolated from syngeneic adult male Wistar rats. EPCs were cultured under normoxic condition for 4 days and 1%O2+5%CO2+94%N2 condition for 3 days. The effect of HEP-Cs on the migration ability of 100μg/L SDF-1αwas observed. Western blot assay was used to detect the expression of CX-CR4, the solo receptor of SDF-1α on cells surface. Then, 26 syngeneic adult male Wistar rats were randomized into 3 groups:control group (n=8),EPCs group (n=9) and HEPCs group (n=9). The acute myocardium infarction animal model was established. At infarction, the rats received 5-points peri-infarct intramyocardial injections of PBS 200μL, 2×106 EPCs and 2 × 106 HEPCs. After 4 weeks, the haemodynamics parameters of cardiac function were analyzed by echocardiography. Results Compare with EPCs, the migration ability of HEPCs towards SDF-1α was increased significantly. The result of Western blot analysis showed an increased CXCR4 expression on the cell surface. After 4 weeks of transplantation, the left ventricular end systolic diameter and ejection fraction (EF%) were much improved in HEPCs group than those of EPCs group and control group (P＜0.05). Compare with control group, the left ventricular end-diastolic diameter was significantly im-proved in EPCs and HEPCs groups (P＜0.05). There was no significant difference in the improvement of the left ventricular end-diastolic diameter between HEPCs and EPCs groups (P>0.05). Conclusion SDF-1α/CXCR4 pathway was up-regu-lated by HEPCs, which showed the therapeutic effects via EPCs. The adjustment of SDF-1α/CXCR4 signaling pathway is an effective method for the treatment of ischemic heart diseases.

Objective To analyze the benefits and risks of preoperative aspirin treatment in elderly patients undergoing off-pump coronary artery bypass (OPCAB) grafting.Methods From January 2010 to June 2014 in Tianjin Chest Hospital,1 501 consecutive patients aged ＞65 years with mean age (71.1 ± 4.2) years who underwent selective first-time isolated off-pump coronary artery bypass surgery were included in this research.They were divided into 2 groups:aspirin group (longterm use of entericcoated aspirin tablets within 5 days before operation,n =369) and aspirin withdrawal group (aspirin withdrawal for 5 days and over before operation,n=1 132).Univariate analysis and a logistic regression were used to compare the postoperative events between the two groups.To adjust for the remaining differences between groups,propensity score was enrolled into the logistic regression model.Results There were no significant differences between the two groups in all-cause in-hospital mortality,postoperative myocardial infarction,cerebrovascular events,postoperative renal failure,blood dialysis and reoperation for bleeding (all P＞＞ 0.05),but more frequency of red blood cell transfusions were found in aspirin group than in aspirin withdrawal group [74.0％(273/369)vs.62.5％(707/1 132),adjusted OR=1.50,95％CI:1.13-2.00,P＜0.01].Conclusions Preoperative aspirin treatment can increase the incidence of red blood cell transfusion,but cannot increase the incidence of reoperation for bleeding,and has no effect on the postoperative outcomes such as all-cause in-hospital mortality,cerebrovascular events,postoperative myocardial infarction,postoperative renal failure or blood dialysis in patients undergoing selective isolated OPCAB.

AIM: To study the effect of mobilization of stem cells by exogenous recombinant human granulocyte-colony stimulating factor (rhG-CSF) on the repairing process of reendothelialization and neointima hyperplasy on ballon injured rat carotid arteries. METHODS: Male Wistar rats were randomly divided into rhG-CSF group and NS+injury group. The animals were injected daily with 30 ?g/kg rhG-CSF or 0.9% NaCl for 7 days, then underwent balloon angioplasty of the common carotid arteries which were harvested and processed for scanning electron microscopy (SEM), Evans blue staining, morphometric analysis of endothelialization and neointimal formation at 1 h, 3 d, 5 d, 7 d, 14 d after injury. Immunohistochemistry for proliferation cell nuclear antigen (PCNA) and RT-PCR for eNOS mRNA were also conducted for evaluating the proliferation of cells of the vessel wall and the possible mechanism of the repairing. RESULTS: SEM and Evan’s blue staining showed increased reendothelialization of the denuded vessels in rhG-CSF-treated animals compared with that NS+injury animals [(60.6?7.3)% vs (41.6?3.3)%,P

Objective To study the clinical efficacy of Off-Pump Coronary Artery Bypass Grafting (OPCABG) in the patients who have left main coronary artery stenosis and three-vessel lesion with low ejection fraction.MethodsFrom January 2010 to December 2010,28 cases with low ejection fraction,left main coronary artery stenosis and three-vessel lesion and received OPCABG were analyzed retrospectively.All cases underwent OPCABG under general anesthesia.The Hb,PLT,ALT,AST,BUN and Cr count before and 3 days after operation were recorded.LVEF andLVEDbeforeand 3monthsafter operationwererecorded.Thedata were compared.Results one case died of respiratory failure caused by pulmonary infection.The mortality rate was 3.75 ％.The value of six parameters are: Hb ( [ 137.94 ± 19.40 ],[ 111.06 ± 12.71 ] g/L),PLT ( [ 210.43 ±48.26 ] × 109/L,[ 148.4 ± 52.20 ] × 109/L),ALT ( [ 27.66 ± 11.51 ] U/L,[ 29.02 ± 16.40 ] U/L),AST ([26.55 ± 10.12] U/L,[27.75 ±8.14] U/L),BUN([6.51 ± 1.00] mmol/L,[6.88 ± 2.53] mmol/L),Cr ([96.35 ± 15.25]μmol/L,[95.11 ± 24.38 ] μmol/L).Comparison of the values showed that Hgb and PLT were different significantly before and 3 days after operations.There was no significant difference in the levels of ALT,AST,BUN and Cr before and after the treatment.Three months later,LVEF and LVED were significantly different from that before treatment ( P ＜ 0.05 ),with LVEF of( [ 36.23 ± 3.41 ] ％,[ 47.23 ± 5.13 ] ％ ) and LVED of( [62.23 ±5.93]mm,[58.08 ±5.02] mm).ConclusionOPCABG produces a satisfactory outcome in the patients who have left main coronary artery stenosis and three-vessel lesion combined with low ejection fraction.There is limited impact of OPCABG on the other organs.The long-term effect and prognosis are still need to be followed-up and analyzed.

This study was designed to investigate the correlation between autophagy and polarization of macrophages in atherosclerosis (AS) plaque in arteriosclerosis obliterans amputees. Femoral artery specimens from arteriosclerosis obliterans amputees were performed hematoxylin and eosin (HE) staining, oil red O and immunofluorescence staining to observe the morphology of atherosclerotic plaque, phenotype of macrophages and autophagy in plaque; using real-time quantitative RT-PCR technology to detect the mRNA level of M1 and M2 type markers in arterial tissue; to analyze polarized signal pathway and autophagy protein levels in macrophages by Western blotting. Arterial specimens staining showed obvious lipid deposition and obvious infiltration of amount of foam cells and inflammatory cells. Macrophages were mainly expression M1 type in percentage in fibrous plaque. Although both M1 and M2 macrophages were upregulated in atheromatous plaque, the increase was dominant in M2 type in percentage. The level of autophagy was significantly higher in the atheromatous plaque than that of fibrous plaque. The expression of tumor necrosis factor- α (TNF-α), monocyte chemotactic protein-1 (MCP-1), inducible nitric oxide synthase (iNOS), interleukin-6 (IL-6) and interleukin-12 (IL-12) mRNA was significantly higher in fibrous plaque than that of atheromatous plaque (P < 0.01 or 0.05), and arginase-1 (Arg-1), transforming growth factor-β (TGF-β), CD163 and interleukin-10 (IL-10) mRNA was significantly lower than that in atheromatous plaque (P < 0.01). The levels of p-STAT1 and NF-κB were significantly increased in fibrous plaque (P < 0.01), while p-STAT6 expression was significantly increased in atheromatous plaque (P < 0.01). The level of LC3-II was significantly higher in atheromatous plaque than that in fibrous plaque (P < 0.01). Macrophages in early atherosclerotic plaque were induced to M1 type through p-STAT1/NF-κB pathway and expressed moderate levels of autophagy; while macrophages in advanced plaques were induced to polarization of M2 type through p-STAT6 pathway. M2 macrophages expressed a higher level of autophagy than M1 macrophages.