Objective:To explore the clinical features of transplanted renal artery stenosis after pediatric donor kidneys in children.Methods:We retrospectively summarized the clinical data in five cases of transplanted renal artery stenosis undergoing deceased pediatric donor kidney transplantation from May 1, 2014 to June 30, 2021.Donor/receptor characteristics, diagnosis, treatment and prognosis were recorded.The median follow-up period was 29 months.The median age of five donors and recipients was 9 and 132 months respectively.En bloc renal allograft( n=2)and single kidney transplantation( n=3)were performed.End-to-side anastomosis was performed for renal arteries.The median diagnostic time of renal artery stenosis was 10(3-60)months post-transplantation.Except for one 3-year-old recipient with an earlier onset of stenosis, four stenotic cases during a rapid growth period had a maximal height increase of 30 cm post-transplantation.Three of them had a history of surgery at graft site, including previous kidney transplantation( n=1)and transplant urinary tract reconstruction( n=2). All five cases had hypertension and two showed an elevated serum level of creatinine.Ultrasound indicated a significantly elevated flow rate of >300 cm/s( n=4)and CTA/MRA indicated that the degrees of stenosis varied from 50% to 95%( n=5). Results:After balloon dilatation, stenosis either improved( n=2)or relapsed( n=2). Further stenting succeed( n=1)or failed( n=1). One case of stenosis was relieved partially after 6-month observation without any invasive treatment. Conclusions:As a serious complication, transplant renal artery stenosis is common after pediatric donor kidney transplantation.Too small size in donor kidney and rapid recipient growth may be specific risk factors.After diagnosis, balloon dilation is a preferred treatment.Stent placement should be cautiously employed.

Objective:This study sought to investigate the feasibility, anatomical indications and operating points of transcatheter aortic valve replacement (TAVR) procedure in the treatment of pure aortic regurgitation (AR).Methods:The medical records of 4 elderly patients with pure AR who were treated in the cardiology department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2020 to March 2021 were retrospectively analyzed. All patients were implanted with self-expandable valve stents via peripheral artery approach for TAVR treatment. The feasibility, anatomical indications and key points of TAVR were analyzed.Results:The 4 patients with pure AR who were carefully screened had an average age of 66 years, and all achieved TAVR treatment success without serious perioperative complications and death. Postoperative examination and follow-up data showed that cardiac functions and cardiac remodeling indexes were significantly improved.Conclusions:This exploratory study shows that TAVR is technically feasible and effective treatment option for selected elderly patients with native pure AR, which is worthy of further study.

Objective To analyze the risk factors of prolonged residence time in ICU after surgery for Standford type A aortic dissection.Methods A total of 361 patients with surgery for Standford type A aortic dissection were selected.They were divided into prolonged residence time in ICU group and normal residence time in ICU group.Single factor analysis was used at first,and the significant factors analyzed in single factor analysis were analyzed by Multi factor analysis.Results Logistic regression analysis showed that smoking history,systolic blood pressure,white blood cell count,serum creatinine,low density lipoprotein cholesterol,thrombosis in the false lumen,apolipoprotein A-I,ventilator time were associated with prolonged residence time in ICU.Conclusion Smoking history,systolic blood pressure,white blood cell count,serum creatinine and ventilator time are the independent risk factors for prolonged residence time in ICU,and low density lipoprotein cholesterol,apolipoprotein A-I,thrombosis in the false lumen are the protective factors for prolonged residence time in ICU.

Objective To analyze the risk factors of prolonged residence time in ICU after surgery for Standford type A aortic dissection.Methods A total of 361 patients with surgery for Standford type A aortic dissection were selected.They were divided into prolonged residence time in ICU group and normal residence time in ICU group.Single factor analysis was used at first,and the significant factors analyzed in single factor analysis were analyzed by Multi factor analysis.Results Logistic regression analysis showed that smoking history,systolic blood pressure,white blood cell count,serum creatinine,low density lipoprotein cholesterol,thrombosis in the false lumen,apolipoprotein A-I,ventilator time were associated with prolonged residence time in ICU.Conclusion Smoking history,systolic blood pressure,white blood cell count,serum creatinine and ventilator time are the independent risk factors for prolonged residence time in ICU,and low density lipoprotein cholesterol,apolipoprotein A-I,thrombosis in the false lumen are the protective factors for prolonged residence time in ICU.

AIM:Cytochrome P450 epoxygenase 2J2 and epoxyeicosatrienoic acids ( EETs) are known to protect against cardiac hypertrophy and heart failure, which involve activation of 5′-AMP-activated protein kinase ( AMPK) and Akt.Although the functional roles of AMPK and Akt are well established , the significance of crosstalk between them in the development of cardiac hypertrophy and anti -hy-pertrophy of CYP2J2 and EETs remains unclear .Here, we investigated whether CYP 2J2 and its metabolites EETs protected against cardiac hypertrophy by activating AMPKα2 and Akt1.Moreover, we tested whether EETs enhanced crosstalk between AMPKα2 and phosphorylated Akt1 ( p-Akt1), and stimulated the nuclear translocation of p-Akt1, to exert their anti-hypertrophic effects. METHODS:The recombinant rAAV9 vector was coupled to CYP2J2 and the rAAV9-CYP2J2 construct was injected into the caudal vein of AMPKα2-/-and littermate control mice .AMPKα2 -/-and littermate control mice that overexpressed CYP 2J2 in heart were treated with angiotensin II (Ang II) for 2 weeks.Hemodynamic and cardiac functions were also evaluated after 14 days of infusion with Ang II or saline.RESULTS:Interestingly, the overexpression of CYP2J2 suppressed cardiac hypertrophy , including decreased heart size, cross sectional area of cardiomyocytes , markers of cardiac hypertrophy [ brain natriuretic peptide ( BNP) ,β-myosin heavy chain (β-MHC) and skeletal muscle α-actin (ACTA1)] and increased levels of atrial natriuretic peptide (ANP) in the heart tissue and plasma of wild-type mice but not AMPKα2 -/-mice.Measurement of left ventricular ejection fraction and fractional shortening showed that CYP2J2 overexpression prevented Ang II-induced ventricular systolic dysfunction in mice .Moreover, an Ang II-induced reduction in cardiac function, demonstrated by decreased dp/dtmax and dp/dtmin, was prevented by overexpression of CYP2J2.Mechanistically, the CYP2J2 metabolites 11,12-EET activated AMPKα2 to induce the nuclear translocation of p-Akt1, which increased production of ANP and thereby inhibited the development of cardiac hypertrophy .Furthermore , by co-immunoprecipitation analysis , we found that full-length Akt1 and an Akt1 fragment containing amino acids 150-408, which constitute the protein kinase domain , but not other frag-ments of Akt1, bind to the AMPKγ1 subunit.AMPKα2β2γ1 and p-Akt1 interact through the direct binding of the AMPKγ1 subunit to the Akt1 protein kinase domain.This interaction was enhanced by 11,12-EET.CONCLUSION:Our studies reveal a novel mechanism in which CYP2J2 and EETs enhanced Akt1 nuclear translocation through interaction with AMPKα2β2γ1 and protect against cardiac hy-pertrophy and suggest that overexpression of CYP 2J2 might have clinical potential to suppress cardiac hypertrophy and heart failure .

Objective To investigate the relationship between microalbuminuria to estimated glomerular filtration rate (mALB/GFR) ratio and incidence of contrast induced nephropathy (CIN) after underwent percutaneous coronary intervention (PCI). Between March 2010 to August 2011, a total of 137 patients who underwent PCI were selected. Anthropometric measures, lipid profiles, fasting blood glucose, CRP, base creatinine and microalbuminuria were measured before operation. Glomerular filtration rate was calculated by MDRD formula. Contrast volume (CV) was recorded after the operation for each patient. Serum creatinine was measured 24 h, 48 h, 72 h after operation, respectively. CIN was defined as an increase in serum creatinine levels of 25% or 44 μmol/L or more from baseline within 72 h after PCI. All patients were divided into group A (CIN group) and group B (No CIN group). Results Eighteen (13.1%) patients developed CIN(group A). The others were group B (no CIN group). The level of CRP, base creatinine, microalbuminuria and mALB/GFR in group A were significantly higher than that in group B ( P < 0 . 01 ) . GFR in group A was lower than that in group B (P < 0.05). Logistic regression analysis indicated that the level of base creatinine , microalbuminuria GFR and mALB/GFR were independent risk factors of CIN occurrence (P < 0.05). The receiver-operator characteristic curve analysis indicated that a mALB/ GFR ratio of 1.17 was a fair discriminator for CIN,and sensitivity were 94.1%, specifity were 72.5%. Conclusion A mALB/ GFR ratio was a independent predictor of CIN after PCI.

BACKGROUNDFirst generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST), mainly due to delayed healing and re-endothelization by the durable polymer coating. This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions.

METHODSThe Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology, Beijing, China) in the treatment of patients with de novo native coronary lesions. The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction or target lesion revascularization.

RESULTSA total of 291 patients (Nano group: n = 143, Partner group: n = 148) were enrolled in this trial from 19 Chinese centers. The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months (P < 0.001). The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34 ± 0.42) mm vs. (0.30 ± 0.48) mm, P = 0.21). The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% (P = 0.75) at 2 years follow-up. The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8% vs. 0.7%, 0.8% vs. 1.5%, both P = 1.00).

CONCLUSIONSIn this multicenter randomized Nano trial, the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions. Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.

Aged ; Coronary Artery Disease ; drug therapy ; surgery ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Sirolimus ; therapeutic use

Objective To investigate the effect of CD151 gene therapy on improving myocardial function in swines with myocardial infarction. Methods CD151, antisense CD151 and green fluorescent protein (GFP) were constructed into the recombinant adeno-associated virus (rAAV). Swines were divided into 4 groups: rAAV-GFP group (6 swines), rAAV-CD151 group (6 swines), rAAV-antiCD151 group (6 swines) and control group (6 swines). The swines were performed with coronary artery ligation and intramuscularly injection with rAAV. Eight weeks after vector administration, western blot was used to detect gene expression of CD151. 13N-labeled NH3 positron emission tomography (PET) was used to evaluate myocardial perfusion. Echocardiography was used to assess myocardial function. Results Compared with the control group and the rAAV-GFP group, the rAAV-CD151 group showed higher CD151 protein expression. Compared with the rAAV-GFP group, the defect size of myocardium was decreased[( 11.3±2.4)% vs. (21.1±2.6)%, t= -5.67,P<0.01] and left ventricular ejection fraction (EF), left ventricular fractional shortening (FS), the ratio of anterior lateral wall thickening (△ALWT) and ratio of interventricular septum thickening (△IVST) were significantly improved in rAAV-CD151 group 8 weeks after vector administration [(65.7±4.6)% vs. (54.7±5.3)%, (36.0±2.9)% vs. (27.6±3.1)%,(55.4± 4.9)% vs. (36.8±7.8)%, (35.2±6.0)% vs. (26.7±4.4)%, t=3.98, 3.35, 3.34, 9.27, all P< 0.05]. The level of diastolic ALWT and diastolic IVST was also increased in rAAV CD151 group compared with rAAV-GFP group ( P<0.05).Compared with rAAV-CD151 group, parameters of myocardial function in rAAV-antisense CD151 group were not improved (P<0.05). Conclusions rAAV-CD151 can effectively transfeet the myocardium, increase the expression ofCD151 protein, promote the blood perfusion of myocardium and improve the ventricular function after myocardial infarction.

Objective To concentrate on the morbidity of cerebral microbleed (CMB) in patients with hypertension and to analyze the predilection and risk-factor of cerebral microbleed.Method Hypertensive patients were divided into the simple hypertention group, hypertention group with lacunar infarction and hypertention group with cerebral infarction.All of these 65 patients received examination of susceptibility-weighted imaging.Results Ninety-one focuses of cerebral microbleeds were found in these patients:58.2% of these focuses were in both basal ganglia and cerebral ganglion;35.2 percent were in cortex and subcortex;6.6 percent were in brainstem and cerebellum.The total morbidity of CMB was 33.8 percent, 52.4 percent in the group with lacunar infarction and 38.1 percent in the group with cerebral infarction, both were significantly higher than that of 8.7 percent in the simple hypertensive group (χ2= 8.08,P<0.01 andχ2=3.86, P<0.05).Conclusions The focus of CMB suggested the hemorrhagic tendency in endocranial capillary.CMB can be used as a routine exam for the hemorrhagic tendency in endocranial capillary.Synthetic analysis of risk-factor and the result of SWI help clinicians choose suitable treatment for each patient.

BACKGROUND: Leptin is a kind of polypeptide hormone secreted by fatty tissue, previous studies have shown that leptin plays a certain role in the formation of atherosclerosis.OBJECTIVE: To investigate the effects of leptin on the expression of tumor necrosis factor-alpha (TNF-α) in RAW264.7 cells, and investigate the possible mechanism from the angle of the change of nuclear factor-κB (NF-κB) activity.DESIGN: A controlled observational experiment.SETTING: Department of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiments were carried out in the Department of Biochemistry and Molecular Biology, Tongji Medical College, and the Department of General Surgery, Union Hospital affiliated to Huazhong University of Science and Technology between April 2005 and February 2006.The cultured RAW264.7 cells were divided into leptin treated groups treated with different concentration (12.5, 25, 50, 100 μg/L), I kappa B kinase inhibitor group and blank control group. Each group had 3 sub-wells,and the experiments were repeated for 3 times.METHODS: Mouse macrophage RAW264.7 cells were incubated into a 6-well plate at the density of 109 cells L-1, cultured in RPMI-1640 culture medium containing bovine serum of 0.1 in volume fraction. When the cells grew to 80%, serum-free culture medium Opti-MEM was changed to culture for another 24 hours, and then the cells were divided into leptin groups treated with different concentration (12.5, 25, 50, 100 μg/L), I kappa B kinase inhibitor group and blank control group. After the cells were incubated with leptin for 4 hours, the expression of TNF-α mRNA expression in RAW264.7 cells was detected with reverse transcription-polymerase chain reaction (RT-PCR). After the RAW264.7 cells were incubated with leptin for 1, 3, 6 and 9 hours, the expression of TNF-c protein expression was detected with double antibody sandwich enzyme-linked immunosorbent assay (ELISA). After the RAW264.7 cells were incubated with leptin for different times, the activity of NF-κB was detected analyzed with electrophoretic mobility shift assay. Another, the RAW264.7 cells were treated with or without 50 μmol/L leptin and/or 100 μmol/L PS1145 (I kappa B kinase specific inhibitor)divided into four groups: blank control group, I kappa B kinase specific inhibitor PS1145 (10 μmol/L) treated group, leptin (50 μmol/L) treated group, leptin (50 μmol/L) + PS1145 (10 μmol/L) group. Aftere incubated for 6 hours, the activity of NF-κB and expression TNF-α mRNA were detected respectively.MAIN OUTCOME MEASURES: ① Effect of leptin of different concentration on the expression of TNF-α mRNA and protein in RAW264.7cells; ② Effect of leptin of different concentration on the activity of NF-κB in RAW264.7 cells; ③ Influence of inhibition I kappa B kinase activity inhibition on expression of TNF-a induced by leptin in RAW264.7cells.RESULTS: ① After the RAW264.7 cells were treated with leptin of different concentration, the TNF-α mRNA level was elevated in a dose-dependent manner, and it reached the peak value emerged in the 50 μg/L leptin treated group. ② The expression of TNF-α protein increased in dose-dependent and time-dependent manners, and it reached the peak val ue at 6 hours in the 50 μg/L leptin treated group. ③ The activity of NF-κB was also positively correlated with the leptin concentration, and it was the highest value at 6 hours treated with 50 μg/L leptin (P ＜ 0.05). ④ I kappa B kinase activity inhibition only partially suppressed the leptin induced elevation of TNF-α expression induced by leptin.CONCLUSION: Leptin can increase the expression and secretion of TNF-α in RAW264.7 cells directly in both dose-dependent and time-dependent manners, and the mechanism may be correlated with the activated NF-κB induced by leptin. It may be one of the mechanisms of atherosclerosis induced by leptin.