Objective To analyze the risk factors and prognosis of carotid artery stenosis (CAS) in patients who under?went off-pump coronary artery bypass grafting (OPCAB). Methods A total of 342 patients scheduled for OPCAB between June 2013 and June 2015 were included in this study. According to results of preoperative duplex ultrasound examination of carotid arteries, patients were divided into CAS group (≥50%stenosis) and control group (<50%stenosis or no stenosis). The risk factors of CAS, death rate and the postoperative complications were compared between two groups. Results There were significant differences in age, smoking history, hypertension and chronic obstructive pulmonary disease (COPD) between two groups (P<0.05). Multivariate logistic regression analysis showed that advanced age (OR=1.050, 95%CI:1.014-1.086, P<0.01), hypertension (OR=2.566, 95%CI:1.299-5.071, P < 0.01) and COPD (OR=7.573, 95%CI:1.106-51.834, P < 0.05) were independent risk factors for CAS in OPCAB surgery. CAS (OR=4.530, 95%CI:1.361-15.078, P<0.05) and the history of percutaneous coronary intervention (OR=7.685, 95%CI:2.289-25.800, P<0.01) were independent risk factors for postop?erative death. Conclusion Risk factors for CAS in patients undergoing OPCAB include advanced age, hypertension and COPD. There is higher risk of death in CAS patients with OPCAB.

Objective To retrospective study the morphological features of normal aortic arch in population of Tianjin area by computed tomography angiography (CTA). Methods From Jan 2016 to Dec 2016, 142 volunteers undergoing thoracic aorta CTA in our institution were retrospectively reviewed. In each patient, 10 measurements were made in GE AW4.6 workstation, including diameters, distances, and angles of branch vessels of aortic arch. SPSS statistical software was used to analyze data. Results The diameter of the origin of brachiocephalic trunk (BCT) D1 was (15.2 ± 3.0) mm, left common carotid artery (LCCA) D2 was (11.8±2.2) mm and left subclavian artery (LSA) D3 was (13.6±1.9) mm. The distance between the BCT and the LCCA (E1) was (4.0±2.5) mm, between the LCCA and the LSA (E2) was (8.2±3.7) mm. The angle between the BCT and arch (α) was 29.5°±14.4°, between the LCCA and arch (β) was 40.3°±17.5°, between the LSA and archγwas 57.9°±21.6°. The angle formed by BCT, LCCA, and LSA(Φ) was 144.1°±10.1°. The distance between center of LCCA ostia and line between center of ostia of BCT and LSA (L) was (4.5±1.2 )mm. Values of D2 and D3 were larger in male than that in female. In the three age groups of 19-40 y, 41-60 y and ≥61 y, values of D1 increased gradually, while α and γdecreased gradually. When in the two age groups of 41-60 y and≥61 y, values of D2, D3, E2 and L were significantly larger than those in the age group of 19-40 y, whileΦwas smaller (P<0.05). Conclusion The data obtained by this study on the diameter and angle of branching vessels arising from the normal aortic arch may provide support for various studies of endovascular repair of aortic arch.

Objective To discuss the practice effect about the waiting area in the hospital building of the daping hosptial ,the third military medical university to be reformed into digital subtraction angiography (DSA) composite operating room .Methods We reasonably choiced the form of purify conditioning ,medical C arm ,smallpox air supply ,and the efficient screening device layout at the end of smallpox air supply .Results The main parameters of the measured results met the national standards of indexes .The fan frequency was 48 Hz running at hundred grade ,and its operation energy consumption was about 25 kw/h ;the fan frequency was 35 Hz running at ten thousand grade ,and its operation energy consumption was about 12 kw/h;the conversion time was very short between hundred grade and ten thousand grade running ,about 10 minutes .Conclusion On the condition that the building environ-ment is not fit to install hanging medical C arm ,we can thorough choose floor type C arm ,adopt “leakage resistance type clean air supply smallpox” ,reasonably modify the form of purify air conditioning to design or modify a hundred grade operating room meet-ing requirement .

ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.

Objective:To assess aspirin efficacy in the early postoperative period following off-pump coronary artery bypass(OPCAB)surgery.Methods:Sixty patients undergoing OPCAB surgery were enrolled in the study.Previous aspirin treatment Was terminated 5-7 days before OPCAB and continued to take at the day with food intake after surgery.The functional and biochemical responses to aspirin were evaluated by arachidonie acid (ARA)-induced platelet aggregation.Samples were collected before and on days 1,4 and 10 after aspirin intake(100 mg/d).Results:There were 17 patients(28.3%),9 patients (15%)and 2 patients(3.3%)with aspirin resistance on day 1,4 and 10 of aspirin intake.The overall levels of platelet aggregation(%)were 63(52,70),13(11,22),12(10,14),and 12(11,14)before the surgery and on day 1,4 and 10 of aspirin intake.The level was stable from the 4th day after aspirin intake.It was found that aspirin resistance was not an independent risk factor for the operation.Conclusion:Aspirin did not sufficiently inhibit platelet aggregation at the early stage after OPCAB.It is important to keep potential anti-coagulation therapy in the early postoperative period.

Objective To evaluate the feasibility of strent-graft with Chimney technique in thoracic endovascular aortic repair (TEVAR) of thoracic aortic dissection left subclavian artery (LSA) disease and left common carotid artery (LCCA) disease without good landing zone. Methods A total of 21 patients with thoracic aortic diseases complicated by in-sufficient proximal anchoring area,who were presented in our hospital in recent years,were selected in this study. The clini-cal data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection ( n=11), aortic pseudoaneurysm (n=2), aortic aneurysm(n=1) and penetrating ulcer(n=7). Among all 21 patients,lesion was located in distal to LSA in 18 pa-tients with distance to LSA anchoring less than15 mm,and the lesion was located between the LSA and LCCA in the rest 3 patients.Thoracic aortic stent-graft placement was carried out.The ostium of LSA was intentionally and completely cov-ered by thoracic aortic stent-graft and left subclavian artery or left internal carotid artery stent-graft placement was subse-quently performed. The patients were observed for symptoms of cerebral and upper limb ischemia. The postoperative com-plications such as endoleak and the patency of LSA were assessed with angiography. Results Thoracic aortic stent-graft placement was suceessfully carried out in all 21 patients. In addition,one“Chimney”stent was properly implanted in LSA or LICA in each patient. After the procedure,no complications of nervous system or severe ischemia of upper extremity was observed. Follow-up examinations between to 38 months after the treatment revealed that the aortic stent-graft remained in stable condition without type I endoleak. Meanwhile the blood flow in“chinney”stent was unobstructed. Conclusion Chimney technique can expand the applicability of TSGP with high tolerance. Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe,effective and microinvasive method to treat thoracic aortic lesions.

Objective To observe the change of interleukin-8(IL-8) during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass (OPCAB) for the first time were enrolled. The IL-8 (-251A >T) polymorphisms were analyzed by using polymerase chain reaction (PCR) and gene sequencing. The plasma levels of cytokine, troponin T (TnT). creatine kinase-MB (CK-MB) and creatinine (Cr) were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 (8.4, 37.1) ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 (16.6, 49.5) ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT:0.53 (0.43, 4.92) ng/ml, P = 0.037; CK-MB: 41.5 (28.8, 65.5) U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 (76.4, 121.5) μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels (P=0.036, 0.038). IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day (OR=11.80, 95% CI: 1.87-74.48) and post-operative hospital stay for more than 14 days (OR=38.00, 95% CI:4.15-347. 87) . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis. 、

Objective To evaluate the efficacy and safety of different concentrations of propranolol gel in treatment of infantile hemangiomas(IH).Methods Sixty-three consecutive infants with hemangiomas from Mar.2011to Sep.2012 in Department of General Surgery,Fuzhou General Hospital of Nanjing Military Command,were divided randomly into A,B,C groups and respectively treated with propranolol hydrochloride 1％ (20 g ∶ 200 mg,A group),2％ (20 g:400 mg,B group),3％ (20 g:600 mg,C group),evenly applied to the surface of the hemangiomas,3 times a day.Follow-up treatment was performed for 6 months.Details of adverse reactions,gender,age,tumor location,complications,and hemangioma size,texture,color and recurrence after stopping were recorded,and hospital review and efficacy evaluation were performed every month.Results After 6 months of treatment,A group had effective treatment in 11 patients(52.38％),ineffective treatment in 10 patients (47.62％),B group had effective treatment in 12 patients (57.14％),ineffective treatment in 9 patients (42.86％),and C group had effective treatment in 19 patients (90.48％),ineffective treatment in 2 patients(9.52％).After taking color Doppler ultrasound examination revealed IH thickness revealed significantly thinner.Conclusions External use of propranolol hydrochloride gel is an effective option for superficial hemangiomas,And 3％ concentration of propranolol gel is superior to the efficacy of the other 2 drugs.

OBJECTIVETo evaluate the role of nuclear factor-kappa B (NF-kappaB) and inhibitory kappaB alpha (IkappaBalpha) in hepatocellular cacinoma (HCC) SMMC7721 cells, the consequence of NF-kappaB inhibition in SMMC7721 cells transfected with mutated IkappaBalpha (mIkappaBalpha) plasmid and the effect of stable inhibition of NF-kappaB activity in combination with Doxorubicin.

METHODSWestern blot was used to determine the expression of NF-kappaB and IkappaBalpha in SMMC7721 cells and normal liver cells. Nuclear protein was used to evaluate the binding of the (32)P-labeled tandem kappaB sequence using electrophoretic mobility shift assay and the expression of NF-kappaB using Western blot between SMMC7721 cells transfected with mIkappaBalpha plasmid (SMMC7721-MT) and control cells. Furthermore, cell viability was plotted between SMMC7721-MT and control cells. The binding of kappaB sequence and cell viability between SMMC7721-MT and control cells at different concentrations of Doxorubicin were also investigated.

RESULTSWestern blot analysis for nuclear extract showed more P50 (NF-kappaB1) and P65 (RelA) expression in SMMC7721 cells compared with normal liver cells. The expression of cytosolic IkappaBalpha protein in SMMC7721 cells was less than that in normal cells. SMMC7721-MT cells inhibited NF-kappaB nuclear translocation at 0, 24, 48 and 96 hours. Furthermore, NF-kappaB cannot be detected in the nuclear protein of SMMC7721-MT cells by Western blot. By calculating cell viability, the proliferation of SMMC7721-MT cells was shown to be suppressed more significantly than that of control cells. NF-kappaB in untransfected cells was activated by Doxorubicin in a dose-dependent manner, but that in SMMC7721-MT cells was not induced at low concentrations of Doxorubicin. Compared with untransfected cells, the viability of SMMC7721-MT cells was significantly suppressed at the same concentration of Doxorubicin (P < 0.01).

CONCLUSIONSThe present study demonstrates that upregulation of NF-kappaB and downregulation of inhibitory kappa B (IkappaBalpha) in SMMC7721 cells are related with the growth of hepatocellular cacinoma cells. Stable expression of mIkappaBalpha in SMMC7721-MT cells can inhibit NF-kappaB nuclear translocation and suppress cell growth. Furthermore, stable inhibition of NF-kappaB activity in combination with Doxorubicin can significantly inhibit cell proliferation in SMMC7721-MT cells. Thus, modulation of NF-kappaB may represent an improvement in the efficacy of HCC therapies and be worthy of further research and investigation.

Antineoplastic Agents ; pharmacology ; Blotting, Western ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Cell Division ; Doxorubicin ; pharmacology ; Electrophoretic Mobility Shift Assay ; Humans ; I-kappa B Proteins ; biosynthesis ; Liver Neoplasms ; metabolism ; pathology ; NF-kappa B ; biosynthesis ; physiology ; Tumor Cells, Cultured

Objective To investigate the anti-inflammatory effect and mechanism of wilforine. Methods Anti-inflammatory activity of wilforine was investigated in LPS-induced RAW264.7 cells. The cytokines production of RAW264.7 cells was analyzed by ELISA assay and the cell viability was assessed by CCK-8 method. The expression of TRAF6, the phosphorylation of IRAK, p38, ERK and JNK, the degradation of inhibitory κBα (IκBα) and the nuclear translocation of NF-κB p65 were further investigated by western blot. Results Triptolide had no significant toxicity to RAW264.7 cells at concentrations of 25, 50 and 100 μmol/L. and could significantly inhibit the contents of cytokines NO, IL-1β, TNF-α and IL-6. Wilforine significantly decreased the expression of TRAF6 and phosphorylation of IRAK, and inhibited the phosphorylation of ERK, p38, and JNK and degradation of IκBα, and reduced the level of nuclear translocation of NF-κB p65. Conclusion The anti-inflammatory activity of wilforine of LPS-induced RAW264.7 cells is probably via TLR4/MyD88/TRAF6 signaling pathway.