Objective:To investigate whether stress hyperglycemia (SH) is an independent risk factor for the occurrence and mortality of sepsis-associated encephalopathy (SAE).Methods:From August 2016 to October 2021, sepsis patients admitted to the ICU of Guangdong Provincial People's Hospital were selected as the study subjects. According to whether they developed to SH (RBG>11.1 mmol/L) within 7 days of enrollment, the pat ients were divided into the SH group and the non-SH group for analysis. Logistic regression was used to analyze whether SH was an independent risk factor for SAE occurrence, and ROC curve was used to analyze the predictive value of SH to SAE. Kaplan-Meier curve was used to compare the 90-day survival of SAE patients with or without SH. Cox regression analysis was used to analyze the risk factors of 28-day and 90-day death in SAE patients.Results:A total of 183 sepsis patients were included, including 62 patients in the SH group and 121 in the non-SH group. Logistic regression analysis demonstrated that SH was an independent risk factor for SAE ( OR=4.452, 95% CI: 2.021-9.808, P <0.001). ROC curve demonstrated that SH could accurately predict SAE (AUC=0.831; Sensitivity=78.4%; Specificity=76.8%; and Yoden index=0.553). Kaplan-Meier curve demonstrated that the 90-day survival of SAE patients with SH significantly declined (log-rank test: P<0.01). Cox regression analysis suggested that SH was a risk factor for death at day 28 and day 90 in SAE patients (28 d, HR=2.272, 95% CI: 1.212-4.260, P=0.010; 90 d, HR=2.456, 95% CI: 1.400-4.306, P<0.01). Conclusions:SH is an independent risk factor for SAE and can predict SAE occurrence. SH significantly reduces 90-day survival and increase mortality at 28 and 90 days in SAE patients.

This study was to investigate the changes of autophagy in pancreatic tissue cells from hyperlipidemic acute pancreatitis (HLAP) rats and the molecular mechanism of autophagy to induce inflammatory injury in pancreatic tissue cells. Male Sprague Dawley (SD) rats were intraperitoneally injected with caerulein to establish acute pancreatitis (AP) model and then given a high fat diet to further prepare HLAP model. The HLAP rats were treated with autophagy inducer rapamycin or inhibitor 3-methyladenine. Pancreatic acinar (AR42J) cells were treated with caerulein to establish HLAP cell model. The HLAP cell model were treated with rapamycin or transfected with vascular endothelial growth factor (VEGF) siRNA. The inflammatory factors in serum and cell culture supernatant were detected by ELISA method. The histopathological changes of pancreatic tissue were observed by HE staining. The changes of ultrastructure and autophagy in pancreatic tissue were observed by electron microscopy. The expression levels of Beclin-1, microtubule- associated protein light chain 3-II (LC3-II), mammalian target of rapamycin complex 1 (mTORC1), and VEGF were measured by immunohistochemistry and Western blot. The results showed that, compared with control group, the autophagy levels and inflammatory injury of pancreatic tissue cells from HLAP model rats were obviously increased, and these changes were aggravated by rapamycin treatment, but alleviated by 3-methyladenine treatment. In HLAP cell model, rapamycin aggravated the autophagy levels and inflammatory injury, whereas VEGF siRNA transfection increased mTORC1 protein expression, thus alleviating the autophagy and inflammatory injury of HLAP cell model. These results suggest that VEGF-induced autophagy plays a key role in HLAP pancreatic tissue cell injury, and interference with VEGF-mTORC1 pathway can reduce the autophagy levels and alleviate the inflammatory injury. The present study provides a new target for prevention and treatment of HLAP.
Acute Disease ; Animals ; Autophagy ; Ceruletide/adverse effects* ; Male ; Mammals/metabolism* ; Mechanistic Target of Rapamycin Complex 1 ; Microtubule-Associated Proteins/metabolism* ; Pancreatitis ; RNA, Small Interfering/genetics* ; Rats ; Rats, Sprague-Dawley ; Sirolimus/adverse effects* ; Vascular Endothelial Growth Factor A/genetics*

Cholangiocarcinoma is a malignant tumor originating from bile duct epithelium, with insidious onset and high degree of malignancy. Most of the patients were diagnosed at the middle and late stages and the survival rate is very poor. The etiology of cholangiocarcinoma is still unknown. Billary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, biliary mucinous cystic neoplasm and intraductal tubular/tubulopapillary neoplasm of the bile duct are considered as precancerous lesions of cholangiocarcinoma. Improving the understanding of precancerous lesions of cholangiocarcinoma, and early treatment of these lesions are important for enhancingthe patients’ quality of life. However, the current understanding of precancerous lesions of cholangiocarcinoma is limited. Development of molecular diagnostic technology is deeply needed. And sensitive and specific biomarkers are urgently needed for the early diagnosis of the high-risk persons accurately, so as to achieve " early detection, early diagnosis and early treatment" . This article reviews how to recognize and deal with precancerous lesions of cholangiocarcinoma.

Objective    To analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%]. Methods    The clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years. Results    A total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). Conclusion    Mitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.

Objective To evaluate the effect of left atrial enlargement on atrial myocardial fibrosis degree and levels of the angiotensinⅡ (AngⅡ)/Rac GTPase activating protein 1 (Rac1)/signal transducersand activators of transcription 3 (STAT3) signaling pathways expressing in patients with persistent atrial fibrillation and rheumatic heart disease (RHD). Methods From March to December 2011, 30 patients with RHD who underwent prosthetic valve replacement in our hospital were enrolled, including 16 males and 14 females, aged 42-70 (56.9±6.8) years. Twenty RHD patients with persistent atrial fibrillation as a research group and ten RHD patients with sinus rhythm as a control group (group A) underwent transthoracic echocardiography and right atrial appendage (RAA) tissue samples were obtained from these patients during mitral/aortic valve replacement operation. The research group according to left atrial diameter (LAD) was divided into two groups, ten patients in each group: a group B with LAD of 50–65 mm and a group C with LAD of LAD>65 mm. For each sample, histological examination was performed by hematoxylin-eosin and Masson’s trichrome staining. Light-microscopic pictures of atrial tissues samples were stained and tissue fibrosis degree in each group was analyzed. AngⅡ concentration was measured by enzyme linked immunosorbent assay. Rac1 and STAT3 were measured by western blotting. Results LAD was significantly greater in AF patients with RHD than in the control group. Hematoxylin-eosin staining demonstrated highly organized arrangement of atrial muscles in the control group and significant derangement in both group B and group C with reduced cell density and increased cell size. Moreover, Masson’s trichrome staining showed that atrial myocytes were surrounded by large trunks of collagen fibers in both group B and group C, but not in the group A. There was a positive correlation between atrial tissue fibrosis and LAD. AngⅡ content was positively correlated with LAD. Similarly, Rac1 and STAT3 protein levels were found considerably higher in the group C and group B than in the group A with excellent correlation to LAD. Conclusion In patients with RHD complicated with persistent atrial fibrillation, the degree of atrial fibrosis and the expression level of AngⅡ/Rac1/STAT3 signaling pathways significantly increase with the left atrialenlargement.

OBJECTIVE: To investigate whether CaN-NFAT3 pathway mediates the protective effects of aldehyde dehydrogenase (ALDH) 2 in high glucose-treated neonatal rat ventricular myocytes. METHODS: The ventricular myocytes were isolated from the heart of neonatal (within 3 days) SD rats by enzyme digestion and cultured in the presence of 5-Brdu. After reaching confluence, the cultured ventricular myocytes were identified using immunofluorescence assay for -SA protein. The cells were then cultured in either normal (5 mmol/L) or high glucose (30 mmol/L) medium in the presence of ALDH2 agonist Alda-1, ALDH 2 inhibitor Daidzin, or Alda-1 and NFAT3 inhibitor (11R-VIVIT). Fluorescent probe and ELISA were used to detect intracellular Ca concentration and CaN content, respectively; ALDH2, CaN and NFAT3 protein expressions in the cells were detected using Western blotting. RESULTS: Compared with cells cultured in normal glucose, the cells exposed to high glucose showed a significantly decreased expression of ALDH2 protein ( < 0.05) and increased expressions of CaN ( < 0.05) and NFAT3 proteins with also increased intracellular CaN and Ca concentrations ( < 0.01). Alda-1 treatment significantly lowered Ca concentration ( < 0.05), intracellular CaN content ( < 0.01), and CaN and NFAT3 protein expressions ( < 0.05), and increased ALDH2 protein expression ( < 0.05) in high glucose- exposed cells; Daidzin treatment significantly increased Ca concentration ( < 0.01) and intracellular CaN content ( < 0.05) in the exposed cells. Compared with Alda-1 alone, treatment of the high glucose-exposed cells with both Alda-1 and 11R-VIVIT did not produce significant changes in the expression of ALDH2 protein (>0.05) but significantly reduced the expression of NFAT3 protein ( < 0.05). CONCLUSIONS Mitochondrial ALDH2 protects neonatal rat cardiomyocytes against high glucose-induced injury possibly by negatively regulating Ca-CaN-NFAT3 signaling pathway.
Aldehyde Dehydrogenase, Mitochondrial ; antagonists & inhibitors ; metabolism ; Animals ; Animals, Newborn ; Benzamides ; pharmacology ; Benzodioxoles ; pharmacology ; Calcium ; metabolism ; Cells, Cultured ; Culture Media ; Enzyme Inhibitors ; pharmacology ; Glucose ; administration & dosage ; pharmacology ; Isoflavones ; pharmacology ; Mitochondria, Heart ; enzymology ; Myocytes, Cardiac ; drug effects ; metabolism ; NFATC Transcription Factors ; metabolism ; Nuclear Pore Complex Proteins ; metabolism ; Rats ; Rats, Sprague-Dawley

BACKGROUND:Incidence of degenerative mitral regurgitation show a gradual increase tendency,but there is no report on degenerative mitral regurgitation due to pure mitral valve ring expansion in China.OBJECTIVE:To summarze the early and midterm outcomes of pure mitral valve annuloplasty in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion. METHODS :Forty-eight patients with degenerative mitrlal regurgitation due to pure mitral valve ring expansion underwent pure mitral valve annuloplasty, including 23 cases treated with Carpentier-Edwards Physio ring and 23 with SJMTM rigid saddle ring.Affter discharge,echocardiography was used to evaluate heart function and mitral regurgitation degree during the follow-up.The outcomes were compared between the two groups. RWSULTS AND CONCLUSION:There was no early death after operation and all cases were cured and discharged.All patients were followed up for 3 months to 4years,and the cardiac function and mitral valve regurgitation were significantly improved (no mitral regurgitation in 36 cases,trivial regurgitation in 10 cases and mild mitral regurgitation in 2cases).According to NYHA grading,there were 32 cases of level 1 and 16 ceses of level Ⅱ. The echocardiography showed that postoperative left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery systolic pressure and the ratio of regurgitation beam area to left atrial area were significantly lower than those before operation (P < 0.01). The left ventricular ejection fraction increased greatly (P < 0.01). There was no ring rupture, ring avulsion and hemolysis. Postoperative transvalvular pressure was less than 3 mm Hg. However, there were no significant differences in the above-mentioned parameters between the Carpentier-Edwards Physio ring and SJMTM rigid saddle ring groups. The results suggest that the pure mitral valve annuloplasty is excelent in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion, through the right surgical techniques and the right choice of artificial valve ring.

Objective The aim was to evaluate the development of pulmonary arteries(PA) in patients with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries by using a central end-to-side shunt between the ascending aorta and pulmonary arteries and to identify the associated factors for the results.Methods 51 consecutive patients(37 male,14 female) with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries received a central end-to-side shunt between PA and the ascending aorta from May 2004 to June 2013.Ages and weight ranged between 2-86 months and 2.5-21.5 kg,respectively.39 patients with main PA diameters less than 4 mm received the central end-to-side shunt between the ascending aorta and PA,and 14 patients with main pulmonary arteries absence received a modified shunt.Results There were no deaths during operation and follow-up.Compared with preoperative measures,total pulmonary artery index increased from a mean value of(68.8 ± 11.4) mm2/m2 to(129.1 ± 24.9) mm2/m2 (P ＜ 0.001) at the time of six months or the final repair after shunt.The increased pulmonary artery index change was(87.7 ± 27.4) ％ (27.0％ to 150.0％).By multivariate regression analysis,age at shunt,shunt procedure and number of major aortopulmonary collateral arteries were correlated with increasing pulmonary artery index change.Conclusion The central end-to-side shunt between the ascending aorta and pulmonary arteries promoted sufficient growth of the diminutive central pulmonary arteries.Due to the risk of a distortion of pulmonary branches,we interposed a modified procedure for patients with main pulmonary arteries absence.It is technically easy to perform,warrants low risk of shunt thrombosis in the early postoperative period.

Objective To assess and compare the the results of tricuspid annuloplasty performed with the Edwards MC3 and Kay methode.Methods From January 2010 to May 2014, 759 patients with function tricuspid regurgitation(FTR) secondary to left-sided valve disease received tricuspid annuloplasty.Cardiac ultrasound Heartbeat diagram were made to confirm the degree of tricuspid regurgitation, the diameter of tricuspid annulus, the pressure of pulmonary artery and the heart function both in the left and the right, and so on.Of them, 355 cases of male, female 404 cases, at the mean age of(54.1 ± 8.3) years old, with the heart function classical(NYHA) : Ⅰ 13, Ⅱ 177, Ⅲ 400, Ⅳ 169, the mean left ventricles ejection fraction(LVEF) was 0.53 ±0.04, the mean pulmonary artery pressure was(62.5 ± 17.6) mmHg(1 mmHg =0.133 kPa).The diagnosis include rheumatic heart disease 517 cases, degenerative disease 209 cases and infective endocarditis 33 cases.The operation include mitral annuloplasty 132 case, mitral replacement 295 cases, mitral annuloplasty and aortic replacement 20 cases, mitral and aortic replacement 388 cases, CABG 86 cases and Maze Ⅲ methode 23 cases.The degree of tricuspid regurgitation before the operation were class Ⅰ 88, Ⅱ 189, Ⅲ 352 and V 130.From January 2010 to May 2012, 447 cases received Kay' s methods and 312 cases received MC3 annuloplasty ring during May 2012 to May 2014.In the MC3, We use the rings in 28mm size were 79 cases, 30 mm 155 cases, 32 mm 66 cases and 34 mm 12 cases.Results There were no death, reoperation and adverse events in both groups.There were no diffent in the aorta block time, the circulation bypass time, the time of mechanical ventilation, stay in ICU and in the hospital(P ＞ 0.05).All the patient were followed up regularity.The rat of follow up was 90.4％ (686/759), and the mean time of follow up was(39.9 ± 7.7) month.The patients' s EF increased, inner diameter of the right ventricle decreased in both group.There were no severe TR in the patients in the Kay group within 3 months, and 1 case of severe TR 1 year later, as 5 cases at 2 years and 12 cases after 2 years.The regurgitation volume of tricuspid was (3.4 ± 1.4) ml at the moment of 3 month, (6.5 ± 2.1) ml at 1 year, (7.9 ± 2.5) ml at 2 years and (12.4 ± 4.7)ml 2 years later.In the MC3 group, there were no severe TR in the patients during all the stage of fellow-up.There were on regurgitation in the patient within 3 months, 1 case of Class Ⅲ of TR at 1 year and 3 cases of Class Ⅲ at 2 years, without worse TR happen.At the same stage as in MC3 group, the regurgitation volume was(2.9 ±0.9) ml,(3.5 ±1.3) ml and(3.4 ±2.1) ml.The result in MC3 group was similar with Kay group(P ＞0.05) in short term, but much better in the long-term(P ＜ 0.05).Conclusion The Kay methode has good early result, but not the same good in the long-term, which can be applied in the elder persons or the patient without long Life expectancy.And the MC3 ring can correct the FTR enduringly and effectually, specifically the size in small one which behaves perfectly.The MC3 ring should be used in the young patient or the patient wants more.

Objective Atrial structure remodeling is the important pathologic basis of generate and development in chronic atrial fibrillation(AF) of valvular heart disease.To analyze the changed feature of AF in rheumatic mitral valve stenosis (MS) and mitral valve prolapse(MVP) after mitral valve surgery,along with fundamental change of hemodynamics in left atrial.Methods Firstly,divided into sinus rhythm (SR) group and AF group according to cardiac rhythm postoperative 6 months,and then divided into MS and MVP two subgroups with age matched,namely rheumatic sinus rhythm group (RS group),MVP sinus rhythm group(PS group),rheumatic AF group(RAF group) and MVP AF group(PAF group),30 patients in each group.Independent sample t test andx2 test were used in comparison among groups,and matched t test in preoperative and postoperative comparison of each group.Results There are 15 (50％) AF patients before surgery and 10 (33.3％) AF patients postoperative 1 month in RS group.But cardiac rhythm of MVP patients has no significant change.Left atrial diameter(LAD) in AF group was larger than in SR group significantly preoperative and postoperative 1 month and 6 months(P ＜ 0.05),and LAD have no significant difference between RAF and PAF group,P ＞ 0.05 ; LAD in RS group preoperative and postoperative 1 month was larger than in PS group(P =0.008 and 0.018,respectively),but there is no significant difference between RS and PS groups postoperative 6 months(P =0.558).Systolic peak velocity(Smm) at valve ring with PWTDI were(6.0 ± 1.4) cm/s,(6.7 ± 1.8) cm/s and (6.2 ± 1.6) cm/s preoperative and postoperative 1 month and 6 months,lower than normal range obviously; Smm before surgery in PAF group was(9.3 ± 3.7)cm/s,but reduced obviously after surgery 1 month and 6 months and near the level of rheumatic patients.Conclusion Generate and development mechanism of AF in MS and MVP patients exist some extent difference,the rhythm of partial MS patients with chronic AF will turn to and maintain sinus rhythm along with LAD decreased,there is no this characteristic in MVP patients.