Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(Q_R)). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.

Objective To summarize the treatment decision-making strategy and its long-term efficacy for advanced elderly patients with severe valvular heart disease and clear indications for surgery.Methods Clinical data of 196 patients aged 75 years and older firmly diagnosed as severe valvular heart diseases were retrospectively analyzed.The patients were divided into the surgical group (a mean age of 77.4±2.0 years,n=126)and the conservative group(a mean age of 80.5±5.0 years,n =70).Factors affecting therapeutic decision-making were analyzed,and the differences in a long-term survival were compared between the two groups.Results The most common reason for choosing conservative treatment was the recommendation of the doctor giving a preliminary diagnosis and worrying about the high-risk surgery for the patients(62.9％,44/70).Only 26(37.1％)patients in the conservative group were evaluated by cardiac surgeons,among whom 12 (17.1％)patients were considered to have surgical contraindications,and 14 (20.0％) patients themselves or their family members chose conservative treatment for the fear of surgical risks.Patients in the operation group were mainly from the outpatient department of cardiac surgery,and only 8 (6.3 ％)cases were referred from department of internal medicine.Logistic regression analysis showed that female,chronic renal insufficiency,advanced age,pneumonia and emergency hospital admissions were independent predictors for the conservative option(P ＜0.01),while patients with isolated aortic valve disease tended to receive surgical treatment.Overall 5-year survival was higher in the surgical group than in the conservative group (76.4％ vs.39.9％,P ＜ 0.01).Cox regression analysis disclosed that the conservative treatment option was the single risk factor for long-term survival in all series.Conclusions Many factors affect the process of therapeutic decision-making for patients with severe valvular heart diseases,and a multidisciplinary collaboration is the best way for the optimal treatment strategy for those patients.

Objective To evaluate the safety and effectiveness of a newly domestic bovine pericardium using a juvenile sheep model and to provide proof for clinical use.Methods Under the off-pump condition,8 domestic bovine pericardiums were implanted into the pulmonary artery and the descending aorta of 4 juvenile sheep as the trial group.As the control group,four imported bovine pericardiums were implanted into two juvenile sheep.Before the surgery,the juvenile sheep were given a physical examination and some laboratory tests.Ultrasonic cardiographs were taken after 1 month and 2 months of implantation.Sheep were sacrificed after 90 days and compared with the extent of endothelialization,inflammation and calcification of the two groups.Results (1) All the juvenile sheep survived without any complications.(2) Ultrasonic cardiograph showed the absence of leakage,thrombus,calcification,neoplasm or any structural deterioration.(3) Gross examination showed there was no intimal hyperplasia.The thickness and tenacity of all patches had no change compared with the pre-operation condition.All the patches showed smooth and pliable faces without degeneration,as well as absence of macroscopically calcification.(4) There was not any positive result in microbiological tests in both groups.The degree of inflammation,necrosis and calcification had no significant differencs between the two groups.Conclusions The data shows that the domestic bovine pericardium,a newly developed Chinese domestic-design and manufactured bovine pericardium,can exhibit long-term satisfactory safety and efficacy in the implantation of the pulmonary artery and the descending aorta of juvenile sheep.

Objective To investigate the clinical characteristics,surgical experience and mid-term outcome of coronary artery bypass graft surgery in patients aged ≤ 40 years.Methods From Jan.,2009 to Dec.,2015,12 patients with median age of (37.9 ± 2.5) years (range 32-40 years,10 males) were diagnosed with coronary artery disease and underwent coronary artery bypass graft surgery at Zhongshan Hospital,Fudan University.The clinical characteristics included five cases with hypertension,three cases with diabetes mellitus,four cases with hyperlipemia,eight cases with smoking history,seven cases with myocardial infarction.Six cases had at least one branch totally occluded.Two cases once underwent percutaneous coronary intervention surgery and implanted with five and three stents respectively.The perioperative data and follow-up results were retrospectively analysed.Results There was no in-hospital death and no death during follow-up period.Surgical techniques included bilateral internal mammary arteries combined with radial artery were operated in six cases,bilateral internal mammary arteries combined with great saphenous vein in two cases,left internal mammary arteries combined with great saphenous vein in four cases,off-pump in nine cases and on-pump in three cases.The mean follow-up time was (47.8 ± 24.3) months.During the follow-up one case suffered with saphenous vein graft restenosis 5 years after the surgery and underwent percutaneous coronary intervention.Other cases were all alive and assessed New York Heart Association's function class Ⅰ-Ⅱ.Conclusions Younger patients usually suffer with severe coronary artery disease when diagnosed because they often have excellent compensative capacity and the pathogenesis is concealed.The mid-term results of coronary artery bypass graft surgery in patients aged ≤40 years are satisfactory.

Objective The infection rate and the corresponding intervention measures of postoperative application of ampicillin sodium to reduce abdominal incision after operation. Methods The control group in the conventional antibiotic administration based on preoperative, postoperative combined with ampicillin sodium; research group in the control group based on the use of the corresponding operation room intervention measures. Results The incidence of incision infection in study group (18.18%) was significantly lower than the control group (4.55%)(P<0.05); the control group SDS, SAS scores did not change significantly than before , SDS of the study group, SAS scale score was significantly lower than before (P<0.05). Conclusion Application of ampicillin sodium combined with the corresponding intervention measures can significantly reduce abdominal incision surgery in two postoperative infection rate and is conducive to protect the quality of life of patients, life safety.

OBJECTIVETo investigate the role of holoenzyme containing Protein Phosphatase 2A B56β in regulating CdCl2 induced cytotoxicity.

METHODCdCl2-induced cytotoxicity in normal human cell line L-02, AFB1-transformed hepatic cell line L-02 RT-AFB1 and tumor cell line Bel7402 was measured by modified MTT assay. Stable cell lines L-02 SHAKT, L-02 SHB56β, L-02 RT-AFB1-B56β and Bel7402-B56β were generated by infecting L-02 cells or Bel7402 cells with retroviral vectors encoding lentiviral AKT shRNA, lentiviral B56β shRNA and B56β. The relative cell viability was measured in normal human cell line AFB1-transformed hepatic cell line and tumor cell line when treated by CdCl2 (0, 20, 40, 80, 160 µmol/L). After treated by wortmannin (2.5, 5.0 µmol/L) combined with 40 µmol/L CdCl2, Western blot was applied to measure the expression of associated protein in L-02.Western blot was applied to measure the expression of B56β, MT (metallothionein), AKT, and p-AKT in these cell lines treated by CdCl2.

RESULTSThe levels of MT were 0.12 ± 0.02, 0.06 ± 0.06 in L-02 RT-AFB1 and Bel7402, which were lower than L02 (0.92 ± 0.14) (F = 1 148.16, P < 0.001) when treated by 40 µmol/L CdCl2. When treated by 40 µmol/L CdCl2, the expression of p-AKT in L-02 SHAKT-1 and L-02 SHAKT-2 were 0.08 ± 0.02, 0.08 ± 0.05, which levels were lower than L-02 SHGFP (0.18 ± 0.15) (F = 724.70, P < 0.001); and the expression of MT were both 0.62 ± 0.16 in L-02 SHAKT-1 and L-02 SHAKT-2, which levels were higher than L-02 SHGFP (0.22 ± 0.14) (F = 94.73, P < 0.001). After treated by wortmannin (2.5, 5.0 µmol/L) combined with 40 µmol/L CdCl2, the expression of p-AKT in L-02 were 0.28 ± 0.07, 0.15 ± 0.11, which levels were lower than wortmannin untreated cells (0.52 ± 0.11) (F = 578.57, P < 0.001); and the expreesion of MT were 1.62 ± 0.80, 1.08 ± 0.15, which levels were higher than wortmannin untreated cells (0.69 ± 0.18) (F = 12.34, P < 0.001). When treated by 40 µmol/L CdCl2, the levels of p-AKT in L-02 SHB56β-1 and L-02 SHB56β-2 were 0.57 ± 0.13, 0.59 ± 0.02, which were higher than L-02 SHGFP (0.32 ± 0.02) (F = 87.16, P < 0.001); and the levels of MT were 0.35 ± 0.07, 0.20 ± 0.03 in L-02 SHB56β-1 and L-02 SHB56β-2, which were lower than L-02 SHGFP (1.51 ± 0.13) (F = 2 457.10, P < 0.001). After treated by 40 µmol/L CdCl2, the expression of p-AKT in L-02 RT-AFB1-B56β and Bel7402-B56β were 0.10 ± 0.11, 0.09 ± 0.01, which were lower than L-02 RT-AFB1 (0.36 ± 0.01) and Bel7402 (0.43 ± 0.11) (F = 877.62, P < 0.001); and the levels of MT were 0.92 ± 0.13, 0.95 ± 0.08 in L-02 RT-AFB1-B56β and Bel7402-B56β,which were higher than L-02 RT-AFB1 (0.44 ± 0.12) and Bel7402 (0.77 ± 0.06) (F = 51.97, P < 0.001).

CONCLUSIONProtein phosphatase 2A complexes containing B56β participated in the regulation of MT expression through direct dephosphorylation of AKT, finally affected the cytotoxicity responding to CdCl2. Our study revealed a key signaling pathways of PP2A involved in heavy metals induced cytotoxicity.

Cadmium Chloride ; Cell Line ; Cell Line, Tumor ; Cell Survival ; Holoenzymes ; Humans ; Liver ; Metallothionein ; Metals, Heavy ; Protein Phosphatase 2 ; Signal Transduction

Objective To investigate the role of holoenzyme containing Protein Phosphatase 2A B56βin regulating CdCl2 induced cytotoxicity. Method CdCl2-induced cytotoxicity in normal human cell line L-02,AFB1-transformed hepatic cell line L-02 RT-AFB1 and tumor cell line Bel7402 was measured by modified MTT assay. Stable cell lines L-02 SHAKT, L-02 SHB56β, L-02 RT-AFB1-B56β and Bel7402-B56β were generated by infecting L-02 cells or Bel7402 cells with retroviral vectors encoding lentiviral AKT shRNA, lentiviral B56βshRNA and B56β. The relative cell viability was measured in normal human cell line AFB1-transformed hepatic cell line and tumor cell line when treated by CdCl2(0,20,40,80, 160 μmol/L). After treated by wortmannin (2.5,5.0 μmol/L) combined with 40 μmol/L CdCl2,Western blot was applied to measure the expression of associated protein in L-02.Western blot was applied to measure the expression of B56β, MT (metallothionein), AKT, and p-AKT in these cell lines treated by CdCl2. Results The levels of MT were 0.12 ± 0.02, 0.06 ± 0.06 in L-02 RT-AFB1 and Bel7402,which were lower than L02 (0.92 ± 0.14) (F=1 148.16,P<0.001)when treated by 40μmol/L CdCl2.When treated by 40μmol/L CdCl2,the expression of p-AKT in L-02 SHAKT-1 and L-02 SHAKT-2 were 0.08 ± 0.02, 0.08 ± 0.05,which levels were lower than L-02 SHGFP(0.18 ± 0.15) (F=724.70,P<0.001);and the expression of MT were both 0.62 ± 0.16 in L-02 SHAKT-1 and L-02 SHAKT-2,which levels were higher than L-02 SHGFP (0.22 ± 0.14) (F=94.73,P<0.001).After treated by wortmannin (2.5,5.0 μmol/L) combined with 40 μmol/L CdCl2, the expression of p-AKT in L-02 were 0.28±0.07, 0.15±0.11,which levels were lower than wortmannin untreated cells (0.52± 0.11) (F=578.57,P<0.001);and the expreesion of MT were 1.62 ± 0.80, 1.08 ± 0.15,which levels were higher than wortmannin untreated cells (0.69 ± 0.18) (F=12.34,P<0.001).When treated by 40 μmol/L CdCl2,the levels of p-AKT in L-02 SHB56β-1 and L-02 SHB56β-2 were 0.57±0.13, 0.59±0.02,which were higher than L-02 SHGFP(0.32 ± 0.02) (F=87.16,P<0.001); and the levels of MT were 0.35 ± 0.07, 0.20 ± 0.03 in L-02 SHB56β-1 and L-02 SHB56β-2,which were lower than L-02 SHGFP (1.51 ± 0.13) (F=2 457.10,P<0.001). After treated by 40μmol/L CdCl2, the expression of p-AKT in L-02 RT-AFB1-B56βand Bel7402-B56βwere 0.10 ± 0.11, 0.09 ± 0.01,which were lower than L-02 RT-AFB1 (0.36 ± 0.01) and Bel7402 (0.43 ± 0.11) (F=877.62,P<0.001); and the levels of MT were 0.92 ± 0.13, 0.95 ± 0.08 in L-02 RT-AFB1-B56β and Bel7402-B56β,which were higher than L-02 RT-AFB1 (0.44 ± 0.12) and Bel7402 (0.77 ± 0.06) (F=51.97,P<0.001). Conclusion Protein phosphatase 2A complexes containing B56βparticipated in the regulation of MT expression through direct dephosphorylation of AKT, finally affected the cytotoxicity responding to CdCl2. Our study revealed a key signaling pathways of PP2A involved in heavy metals induced cytotoxicity.

Objective To investigate the role of holoenzyme containing Protein Phosphatase 2A B56βin regulating CdCl2 induced cytotoxicity. Method CdCl2-induced cytotoxicity in normal human cell line L-02,AFB1-transformed hepatic cell line L-02 RT-AFB1 and tumor cell line Bel7402 was measured by modified MTT assay. Stable cell lines L-02 SHAKT, L-02 SHB56β, L-02 RT-AFB1-B56β and Bel7402-B56β were generated by infecting L-02 cells or Bel7402 cells with retroviral vectors encoding lentiviral AKT shRNA, lentiviral B56βshRNA and B56β. The relative cell viability was measured in normal human cell line AFB1-transformed hepatic cell line and tumor cell line when treated by CdCl2(0,20,40,80, 160 μmol/L). After treated by wortmannin (2.5,5.0 μmol/L) combined with 40 μmol/L CdCl2,Western blot was applied to measure the expression of associated protein in L-02.Western blot was applied to measure the expression of B56β, MT (metallothionein), AKT, and p-AKT in these cell lines treated by CdCl2. Results The levels of MT were 0.12 ± 0.02, 0.06 ± 0.06 in L-02 RT-AFB1 and Bel7402,which were lower than L02 (0.92 ± 0.14) (F=1 148.16,P<0.001)when treated by 40μmol/L CdCl2.When treated by 40μmol/L CdCl2,the expression of p-AKT in L-02 SHAKT-1 and L-02 SHAKT-2 were 0.08 ± 0.02, 0.08 ± 0.05,which levels were lower than L-02 SHGFP(0.18 ± 0.15) (F=724.70,P<0.001);and the expression of MT were both 0.62 ± 0.16 in L-02 SHAKT-1 and L-02 SHAKT-2,which levels were higher than L-02 SHGFP (0.22 ± 0.14) (F=94.73,P<0.001).After treated by wortmannin (2.5,5.0 μmol/L) combined with 40 μmol/L CdCl2, the expression of p-AKT in L-02 were 0.28±0.07, 0.15±0.11,which levels were lower than wortmannin untreated cells (0.52± 0.11) (F=578.57,P<0.001);and the expreesion of MT were 1.62 ± 0.80, 1.08 ± 0.15,which levels were higher than wortmannin untreated cells (0.69 ± 0.18) (F=12.34,P<0.001).When treated by 40 μmol/L CdCl2,the levels of p-AKT in L-02 SHB56β-1 and L-02 SHB56β-2 were 0.57±0.13, 0.59±0.02,which were higher than L-02 SHGFP(0.32 ± 0.02) (F=87.16,P<0.001); and the levels of MT were 0.35 ± 0.07, 0.20 ± 0.03 in L-02 SHB56β-1 and L-02 SHB56β-2,which were lower than L-02 SHGFP (1.51 ± 0.13) (F=2 457.10,P<0.001). After treated by 40μmol/L CdCl2, the expression of p-AKT in L-02 RT-AFB1-B56βand Bel7402-B56βwere 0.10 ± 0.11, 0.09 ± 0.01,which were lower than L-02 RT-AFB1 (0.36 ± 0.01) and Bel7402 (0.43 ± 0.11) (F=877.62,P<0.001); and the levels of MT were 0.92 ± 0.13, 0.95 ± 0.08 in L-02 RT-AFB1-B56β and Bel7402-B56β,which were higher than L-02 RT-AFB1 (0.44 ± 0.12) and Bel7402 (0.77 ± 0.06) (F=51.97,P<0.001). Conclusion Protein phosphatase 2A complexes containing B56βparticipated in the regulation of MT expression through direct dephosphorylation of AKT, finally affected the cytotoxicity responding to CdCl2. Our study revealed a key signaling pathways of PP2A involved in heavy metals induced cytotoxicity.