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ObjectiveTo compare the safety and effectiveness between biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents (DP-DES) in patients with acute coronary syndrome (ACS).DesignMeta-analysis of randomised controlled trials (RCTs).Primary and secondary outcome measuresMajor adverse cardiovascular events (MACEs) were considered the primary endpoint. Efficacy endpoints included target vessel revascularisation (TVR) and target lesion revascularisation (TLR). Safety endpoints included all-cause death, cardiac death, target vessel myocardial infarction and stent thrombosis (ST).MethodsWe searched PubMed, Medline, Embase and the Cochrane Controlled Register of Trials for comparative studies of BP-DES and DP-DES in patients with ACS from January 2000 to July 2021. Statistical pooling was performed to estimate incidence using a random-effects model with generic inverse-variance weighting. Risk estimates were computed with 95% CIs.ResultsEight articles with seven RCTs that compared BP-DES and DP-DES in patients with ACS were identified and included in the qualitative and quantitative analyses. There was no difference in the baseline characteristics, except for the number of smoking patients (OR: 1.13, 95% CI 1.03 to 1.24; p=0.008, I2=29%), which was significantly lower in the BP-DES group. The meta-analysis demonstrated that MACEs, efficacy endpoints and safety endpoints were similar between the groups at 1 year. However, the incidence of total ST was significantly different between the BP-DES and DP-DES groups in the follow-up period (p=0.0001). Further analysis showed a statistically significant difference in MACEs (OR: 0.71, 95% CI 0.57 to 0.88; p=0.002, I2=0 %), TLR (OR: 0.71, 95% CI 0.51 to 1.01; p=0.05, I2=0%), TVR (OR: 0.70, 95% CI 0.52 to 0.94; p=0.002, I2=15%), total ST incidence (OR: 0.59, 95% CI 0.46 to 0.77; p=0.0001, I2=48%) and ST incidence (OR: 0.63, 95% CI 0.47 to 0.85; p=0.002, I2=0%) over 2 years.ConclusionThis meta-analysis revealed that both stent types demonstrated excellent safety and efficacy profiles at 12 months. However, a slight increase in MACEs, TLR, TVR and ST incidence was observed in the DP-DES group over the 2-year follow-up period, suggesting that BP-DES may be more favourable when treating patients with ACS.Trial registration numberNCT00389220.

The integrated model of prenatal diagnosis and postnatal treatment for congenital heart disease (CHD) leads to an increasing number of operation in infants. This study aims to reveal the risk factors for postoperative early mortality and delayed recovery in infants less than 3 months old, who underwent surgical treatment for CHD in the Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University during the past 5 years.Clinical variables were collected via medical records. Delayed recovery was defined as the time of postoperative intubation, or cardiac intensive cure unit (CICU) stay, or hospital stay longer than its third quartile. Risk factors for early postoperative prognosis and the odds ratio (OR) were analyzed with logistic regression analysis.A total of 511 infants underwent surgical treatment for CHD from January 2016 to June 2020 were retrospectively reviewed, including 217 (42.5%) infants with complex CHD. The median age was 60 days (3 hours-90 days); and median weight was 4.5 (1.7- 8.4 kg). There were 26 postoperative mortalities, making the incidence at 5.1%, including 5 (5/294, 0.7%) mortalities in patients with uncomplicated CHD, and 21 (9.6%) mortalities in patients with complex CHD. Based on multivariable analysis, risk factors for postoperative mortality were diagnosis of complex CHD (OR=5.53,Surgical treatment for infants (3 months) with CHD is still a challenge, particularly for infants with complex CHD and weight under 4.0 kg. We can improve the prognosis of CHD treatment in infants by establishing the integrated model of prenatal diagnosis and postnatal treatment to choose the most suitable time window, avoid symptoms before surgery, and reduce emergency operation.

Due to the lack of large-sized pulmonary valved conduit products in clinical practice, hand-sewn expanded polytetrafluoroethylene (ePTFE) valved conduit has been used for right ventricular outflow tract (RVOT) reconstruction in many heart centers around the world. This study aims to summarize the early results of the ePTFE valved conduit and the sewing technology of the conduit in combination with the latest progress, and to provide a reference for the application of ePTFE valved conduit.A total of 21 patients using ePTFE valved conduit for RVOT reconstruction in the Second Xiangya Hospital, Central South University from October 2018 to October 2020 were prospectively enrolled in this study. The age at the implantation of the conduit was 4.3 to 43.8 (median 15.1) years old, with weight of (38.9±4.1) kg. In this cohort, 14 patients underwent re-reconstruction of RVOT, including 12 patients with pulmonary regurgitation at 6.3 to 31.0 (median 13.8) years after tetralogy of Fallot (TOF) repair, and 2 patients with failed bovine jugular vein conduit (BJVC). Seven patients underwent Ross operations. Among them, 3 were for aortic valve stenosis, 2 were for aortic regurgitation, and 2 were for both stenosis and regurgitation. The ePTFE valved conduits were standard hand-sewn during the surgery. The 3 leaflets were equal in size with arc-shaped lower edge of the valve sinus. The free edge of the valve leaflets was straight with the length of about 1 mm longer than the diameter. The height of the valve sinus was 4/5 of the diameter. The junction of the valve leaflet was 3/4 of the height of the sinus. The designed leaflets were then continuous non-penetrating sutured into the inner surface of Gore-Tex vessel to make a valved conduit. Valved conduits with diameter of 18, 20, and 22 mm were used in 2, 9, and 10 cases, respectively. The surgical results, postoperative recovery time, and serious complications were summarized, and the changes of postoperative cardiac function status and hemodynamic status of the conduits were investigated.During the implantation of ePTFE valved conduit for RVOT reconstruction, 2 patients underwent mechanical mitral valve replacement with Ross operation, 2 patients with pulmonary regurgitation with repaired TOF underwent left and right pulmonary artery angioplasty, and 1 patient with failed BJVC underwent tricuspid valvuloplasty. The cardiopulmonary bypassing time for patients underwent re-reconstruction of RVOT was (130.9±16.9) min, with aorta clamping for 1 patient to repair the residual defect of the ventricular septum. The cardiopulmonary bypassing and aorta clamping time for Ross operation were (242.7±20.6) min and (145.6±10.5) min, respectively. The duration of postoperative ventilator assistance, intensive care unit stay, and hospital stay were 3.5 h to 7.7 d (median 17.1 h),11.2 h to 29.5 d (median 1.9 d), and 6.0 to 56.0 (median 13.0) d, respectively. All patients survived after discharge from hospital. The follow-up rate after discharge was 100% with median time at 15.0 (13.0 to 39.0) months. No death happened during the follow-up. One patient underwent stent implantation due to right coronary stenosis 2 months after Ross operation. One patient underwent balloon dilation due to right pulmonary artery ostium stenosis 1 year after re-reconstruction of RVOT. The cardiac function of all patients recovered to NYHA class I 6 months after operation. The peak pressure gradient across the valve measured by transthoracic echocardiography before discharge was (9.4±2.6) mmHg (1 mmHg=0.133 kPa), and (18.3±6.1) mmHg at the last follow-up. There was no significant increase in the gradient during the follow-up (Hand-sewn ePTFE valved conduit is feasible for RVOT reconstruction. It is a promising material for RVOT reconstruction which can effectively meet clinical need. In our experience, the ePTFE valved conduit is simple to manufacture with satisfactory early outcomes.In the application of ePTFE valved conduit, attention should be paid to implantation indications and postoperative anticoagulation management, especially to the preparation details of the valved conduit, to obtain better function and durability of the conduit after implantation.

Objective Biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect is preferred, but previously developed surgical procedures are complicated and associated with high mortality and morbidity. We developed a technique using an intraventricular conduit to connect the ventricular septal defect and the aorta in this anomaly in patients aged more than 2 years. Methods Thirty-one patients (age 2-23 years; median, 5.4) with double-outlet right ventricle with noncommitted ventricular septal defect underwent biventricular repair with intraventricular conduit. A 16-mm or 19-mm polytetrafluoroethylene (Gore-Tex; WL Gore & Associates, Flagstaff, Ariz) vascular prosthesis was used to construct the intraventricular conduit rerouting the ventricular septal defect to the aorta, with enlargement of the ventricular septal defect and resecting the hypertrophic muscular bands in the bilateral conus when necessary. Follow-up was made in all patients with a median duration of 93 months (range, 8-140 months). Results One patient died during hospitalization and 1 patient died at 8 months after operation, making the mortality 6.5%. The peak pressure gradient across the left ventricular outflow tract was less than 30 mm Hg in all patients but 1 (3.3%). In the last patient, it increased from 16 mm Hg early after operation to 50 mm Hg at 7 years follow-up. The peak pressure gradient across the right ventricular outflow tract ranged from 6 to 30 mm Hg in all patients. One patient had moderate mitral regurgitation with New York Heart Association class II. One patient had preoperative severe pulmonary arterial hypertension (mean pressure, 50 mm Hg) and was treated with bosentan. Other patients were in New York Heart Association class I. Conclusions Biventricular repair with intraventricular conduit is a relatively simple and safe procedure for patients aged more than 2 years with double-outlet right ventricle with noncommitted ventricular septal defect, with excellent early and midterm outcomes.

Background: The outcomes of mitral valve replacement (MVR) in pediatrics especially in the patients weighing less than 10kg are not always favorable. This study aimed to measure long-term outcomes of MVR in our institution.Methods: Nine young children weighing less than 10 kg underwent MVR with mechanical prostheses from November 2006 to April 2019 were enrolled in this retrospectively study. Kaplan–Meier survival analysis was used for the prediction of freedom from death and adverse events. Chi-square test was performed to compare outcomes for patients based on the ratio of mechanical prosthesis and weight. 14 related literatures were also reviewed to support our study.Results: All patients received bileaflet mechanical prostheses. The surgical technique varied among the patients with prostheses implanted in the intra-annular (n = 5), supra-annular (n=1), or with a Dacron conduit segment in the supra-annular position(n = 3). The valve size/weight ratio ranged from 2.11 to 5.00. After a mean follow-up period of 80.67 ± 63.37 months, the survival rate was 66.67%. One (11.1%) patient underwent an immediate revision MVR after initial MVR for the periprosthetic leak. No patients required surgical reintervention for the development of left ventricular outflow tract obstruction or permanent pacemaker placement during long-term follow-up.Conclusions: The tailored surgical strategy utilized for MVR in infants resulted in reliable valve function and excellent survival. Although revision is inevitable due to somatic growth, the bileaflet mechanical prostheses displayed appropriate durability.

Background The outcomes of mitral valve replacement (MVR) in pediatrics especially in the patients weighing less than 10 kg are not always favorable. This study aimed to measure long-term outcomes of MVR in our institution. Methods Nine young children weighing less than 10 kg underwent MVR with mechanical prostheses were enrolled in this retrospectively study. Kaplan–Meier survival analysis was used for the prediction of freedom from death and adverse events. Chi-square test was performed to compare outcomes for patients with different ratios of mechanical prosthesis size and body weight. Fourteen related literatures were also reviewed to support our study. Results All patients received bileaflet mechanical prostheses replacement. The surgical technique varied among the patients with prostheses implanted in the intra-annular (n = 5), supra-annular (n = 1), or with a Dacron conduit segment in the supra-annular position (n = 3). The valve size/weight ratio ranged from 2.11 to 5.00. There were two early death and one late death post-operation. The mean follow-up period was 80.67 ± 63.37 months, the transvalvular gradient was 10.5 ± 1.76 mmHg (range 8 to 12) and the peak gradient of LVOT was 5.00 ± 0.64 mmHg. One (11.1%) patient underwent an immediate revision MVR after initial MVR due to the periprosthetic leak. No patients required surgical reintervention or permanent pacemaker placement during long-term follow-up. Conclusions The tailored surgical strategy utilized for MVR in infants resulted in reliable valve function and excellent survival. Although revision is inevitable due to somatic growth, the bileaflet mechanical prostheses displayed appropriate durability.

Purpose: To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety and effectiveness of these therapeutic options. Methods: PubMed, Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched for comparative studies of transcatheter mitral-valve repair (TMVR) versus surgical mitral-valve repair (SMVR) in elderly patients with severe MR from January 2000 to June 2020. Statistical pooling for incidence estimates was performed according to a random-effects model with generic inverse-variance weighting, computing risk estimates with 95% confidence intervals (CIs), using RevMan 5.3. Results: A total of 14 reports comparing MitraClip with SMVR, enrolling 3355 patients with severe MR, were included in this study. Mean age, Logistic EuroSCORE, and incidence of diabetes mellitus (DM) were significantly higher in the MitraClip group, except the rate of patients with New York Heart Association (NYHA) class of >II and mean value of ejection fraction (EF). The arithmetic mean of freedom from acute mobility was similar. The 2 groups had equal all-cause mortality at 30 days, but different at 1 year (14% versus 9%) and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR ≥3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and 95% at 3 years in the MitraClip and surgical repair group, respectively. Conclusion: Although MitraClip is safe and effective in selected high-risk patients, the surgery may be the only gold standard for “gray” patients. Further studies are needed to determine whether MitraClip should be recommended.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant cancers worldwide. Curative resection is an effective treatment but HCC recurrence rates remain high. This study aimed to establish a novel prognostic nomogram to assess the risk of recurrence in patients following curative resection. METHODS: A total of 410 patients undergoing HCC curative resection were recruited from the Guangdong Provincial People’s Hospital (GDPH). The cohort was divided into a training group (n=291) and a validation group (n=97). The risk factors for HCC early recurrence within 1 year of curative hepatectomy were identified. Finally, a multivariate prognostic nomogram was developed and validated. RESULTS: Age, tumor number, tumor capsule, portal vein tumor thrombi, pathological grade, vascular tumor emboli, activated partial thromboplastin time (APTT), and tumor size were identified as independent prognostic risk factors for HCC early recurrence within 1 year of curative hepatectomy. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.806 [95% confidence interval (CI): 0.755 to 0.857; P

To analyse the clinical data of reoperations in congenital heart disease and discuss the management strategy of reoperation for congenital heart disease. Methods: We retrospectively studied the clinical data for patients underwent reoperation in congenital heart disease in Cardiovascular Surgery, Second Xiangya Hospital, Central South University from January 2007 to December 2015. Demographic and operative details, in-hospital mortality and major postoperative complications were analysed. Results: A total of 8 647 congenital heart disease surgery procedures were performed, including 147 (1.7%) reoperations. Among the patients, residual septal defect repair (30 cases, 20.4%), planed staged operation (28 cases, 19.0%), and Fontan procedure (20 cases, 13.6%) were the most common kinds of reoperation. In addition, 140 (95%) operations were through repeat sternotomies, 144 (98%) patients underwent operation with cardiopulmonary bypass, and 100 (68%) with cardiac arrest. Cardiopulmonary bypass and aortic cross clamp were maintained for 21-447 (135.5±87.8) minutes and 0-202 (49.9±49.7) minutes. There were 10 in-hospital deaths with a total mortality of 6.8%. The major complications included low cardiac output syndrome (24 cases, 16.3%), renal dysfunction (7 cases, 4.8%), respiratory insufficiency (14 cases, 9.5%), unplanned reoperations for drainage of haemorrhagic cardiac tamponade (4 cases), and delayed sternal closure (2 cases). Conclusion: Repeat sternotomy is the main way of reoperation, but it is not a major risk for operative mortality and morbidity. Improving the management of complex malformation, standardizing the follow-up, choosing the right timing of surgery, and reducing surgical complications will help reduce the risk of reoperation.目的：回顾性分析先天性心脏病再次手术患者的临床资料，探讨先天性心脏病再次手术的管理策略。方法：回顾性分析2007年1月至2015年12月期间于中南大学湘雅二医院心血管外科行先天性心脏病再次手术的患者的再次手术类型、围手术期临床数据、术后病死率及主要并发症发生率。结果：先天性心脏病手术共8 647例，再次手术147例，占1.7%。间隔缺损残余分流修补术(30例，20.4%)、复杂先天性心脏病分期解剖矫治(28例，19.0%)和Fontan手术(20例，13.6%)是最常见的再次手术类型。在147例再次手术中，140例(95%)采用再次胸骨正中切口。144例(98%)行体外循环下手术，100例(68%)被阻断主动脉，心脏停跳。体外循环时间21~447(135.5±87.8) min；主动脉阻断时间0~202(49.9±49.7) min。围手术期死亡10例(6.8%)。术后24例(16.3%)患者出现低心排出量综合征，7例(4.8%)肾功能不全，14例(9.5%)呼吸功能不全，2例延迟关胸，4例再次开胸止血。结论：先天性心脏病再次手术风险较大；重复胸骨正中切口是再次心脏手术的主要途径；提高复杂畸形矫治水平、选择恰当的手术时机、减少手术并发症将有助于降低再次心脏手术病死率。.

Mitral valve replacement in infants is rare and causes a relatively high mortality, especially for patients under the age of 1. Supra-annular valve replacement is a viable technique for infants with a small valve annulus. Here, we report two infants who underwent mitral valve replacement via the supra-annular technique. The age and body weight of these babies were 2 months and 3 months and 4.1 kg and 4.7 kg, respectively. Aortic mechanical valves were reversely implanted with a short segment of PTFE graft. The purpose of this strategy was to insert a larger mechanical valve and delay resternotomy. A two-year follow-up exam showed normal ventricular function without mechanical valve-related complications. This method is useful in treating neonates and infants. Although the technique of mitral valve repair has improved over several decades, mitral valve replacement still is necessary at times. In neonates and infants with a small annulus, implantation of commercially available prosthetic valves in the annular position can be a challenge, and an age less than 1 year is a risk factor for early death [Selamet 2008]. Supra-annular mitral valve replacement (SMVR) is an alternative when a traditional annular implantation is not feasible [Sung 2008]. Herein, we report the cases of two patients, who underwent SMVR with a follow-up after two years.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in the world, among which coronary artery diseases (CAD) are the most common type of CVD. Coronary artery bypass grafting (CABG) using autologous vein and artery grafts is the typical surgical intervention for CAD patients. However, for patients whose autologous grafts are not available, there are no appropriate substitutes for vascular grafts. Investigation of tissue-engineered vascular graft (TEVG) has persisted over decades with significant advancement, utilizing different types of biomaterials. In the past two decades, a great number of studies based on cell-seeding strategies were reported. However, limitations of cell-based strategies made clinical application difficult. With the understanding of stem cells and tissue remodeling process, strategies without cell-seeding emerged as potential methods to achieve in situ regeneration. A cell-free graft may recruit host cells and guide their participation in vascular remodeling. The grafts modified by bio-active molecules showed good results in promoting in situ regeneration and exhibited potential to make the vascular grafts off-the-shelf. In this review, the strategies for cell-free TEVG manufacturing were discussed, including the materials for fabricating TEVGs, the methods of functionalization to promote in situ regeneration, the challenges researchers faced in TEVG investigation, and finally the prospects in TEVG design.

Background/aim Increasing evidence show microRNAs (miRNAs) are engaged in hepatocellular carcinoma (HCC). The aim of this study was to investigate the role of miR-144 in HCC, as well as to identify its underlying mechanism.

Min Yu,* Ye Lin,* Yu Zhou, Haosheng Jin, Baohua Hou, Zhongshi Wu, Zhide Li, Zhixiang Jian, Jian Sun Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China *These authors contributed equally to this work Background/aim: Increasing evidence show microRNAs (miRNAs) are engaged in hepatocellular carcinoma (HCC). The aim of this study was to investigate the role of miR-144 in HCC, as well as to identify its underlying mechanism. Methods: The expression levels of miR-144 were assessed in multiple HCC cell lines, as well as in liver tissues from patients with HCC. We further examined the effects of miR-144 on HCC. The molecular target of miR-144 was identified using a computer algorithm and confirmed experimentally. Results: We found that the levels of miR-144 were frequently downregulated in human HCC tissues and cell lines, and overexpression of miR-144 dramatically inhibited HCC metastasis, invasion, cell cycle, epithelial–mesenchymal transition, and chemoresistance. We further verified the SMAD4 as a novel and direct target of miR-144 in HCCs. Conclusion: Taken together, overexpression of miR-144 or downregulation of SMAD4 may prove beneficial as therapeutic strategies for HCC treatment. Keywords: microRNA, liver cancer, therapeautic target

Background: Increased pulmonary vascular resistance index (PVR) leads to several complications in patients after a Fontan operation. This increase is mainly attributed to the overexpression of endothelin-1 for a long duration after the Fontan procedure. Here, we describe the case of a 3-year-old boy with a failed Fontan operation who was treated with bosentan, an endothelin-1 receptor blocker. Case report: Cardiac catheterization was performed, which showed a main pulmonary artery pressure (MPAP) of 19 mmHg and PVRI of 5.6 woods/m2. Oral bosentan regimen at a dose of 31.25 mg was initiated twice a day. The treatment was continued as pleural effusion and ascites persisted. No adverse events were observed, and the treatment was well tolerated. Pleural effusion disappeared, and ascites decreased markedly after 4 weeks, whereas the MPAP was 15 mmHg and the PVRI was 4.3 woods/m2. After 3 months of bosentan therapy, the MPAP was 12 mmHg and the PVRI was 4.1 woods/m2. Conclusion: We observed that bosentan reduces the PVRI and complications such as pleural effusion and ascites after a failed Fontan procedure.

Sirtuin 5 (SIRT5) is a member of the NAD+‑dependent class III protein deacetylases. Although it is known that SIRT5 deacetylates and activates urate oxidase in the liver mitochondria of mice, the mechanism of SIRT5 in the proliferation of hepatocellular carcinoma (HCC) remains to be fully elucidated. The present study investigated the expression and functional significance of SIRT5 in HCC, and examined the relevant mechanism. SIRT5 was found to be upregulated in HCC tissues and cell lines, and the higher expression of SIRT5 indicated poorer overall survival. Reverse transcription‑quantitative polymerase chain reaction analysis, western blot analysis, chromatin immunoprecipitation analysis, and luciferase reporter gene, proliferation and Transwell assays were performed to elucidate the function of SIRT5 in the regulation of cell proliferation and invasion in human HCC. Functionally, it was observed that the inhibition of SIRT5 significantly suppressed HCC cell proliferation and invasion, whereas the overexpression of SIRT5 promoted HCC cell proliferation and invasion in vitro. E2F transcription factor 1 (E2F1) was identified as a novel target gene of SIRT5. In addition, the knockdown of SIRT5 induced the expression of E2F1, and the knockdown of E2F1 in HCC cells partially reversed the effect of SIRT5 in promoting cell proliferation and invasion. Collectively, these data provide the first evidence, to the best of our knowledge, that the SIRT5 gene has an important regulatory role in liver carcinogenesis, and may function as a novel potential therapeutic target for HCC.

To investigate the outcomes of hybrid procedure in treating 10 infants/children with pulmonary stenosis under transesophageal echocardiographic guidance. Between September, 2009 and December, 2015, 10 infants/children underwent hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis in the Second Xiangya Hospital, Central South University. The age, height and weight at the time of admission were 0.7-42 (14.8±15.8) months, 53-97 (74.8±16.3) cm, and 4-15.5 (9.3±4.1) kg, respectively. Atrial septal defect, patent foramen ovale, patent ductus arteriosus, muscular ventricular septal defect, persistent left superior vena cava and tricuspid regurgitation were found in 2, 6, 1, 2, 1 and 5 cases, respectively. After the operation, all patients were sent into ICU. The mean duration mechanical ventilation, ICU stay and hospitalization were 0.5-41(6.8±12.3) h, 2-85 (31.1±22.8) h, and 6-20 (11.4±5.1) d, respectively. Postoperative transvalvular pressure gradient reduced to 16-45 (31.1±9.8) mmHg, which was decreased significantly compared with that in preoperative (P0.001). There was no death during hospitalization and follow-up. Hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis under transesophageal echocardiographic guidance is a safe and effective treatment.目的：总结10例肺动脉瓣狭窄婴幼儿在食道超声心动图(transesophageal echocardiography，TEE)引导下，经胸小切口行肺动脉瓣球囊扩张术(简称杂交手术)的疗效。方法：2009年9月至2015年12月中南大学湘雅二医院共收治10例肺动脉瓣狭窄婴幼儿，其中男6例，女4例；年龄0.7~42(14.8±15.8)个月，其中新生儿2例；合并房间隔缺损2例，卵圆孔未闭6例，动脉导管未闭1例，肌部室间隔缺损2例，永存左上腔静脉1例，三尖瓣反流5例，均在TEE引导下接受杂交手术治疗。结果：术后所有患儿均入重症监护室继续治疗，呼吸机辅助 0.5~41(6.8±12.3) h。监护室停留时间2~85(31.1±22.8) h，住院时间6~20(11.4±5.1) d。术后肺动脉跨瓣压差降至16~45(31.1±9.8) mmHg，较术前明显降低(P0.001) 。全组无住院死亡，所有患儿术后恢复良好，顺利出院。结论：在TEE引导下行杂交手术治疗婴幼儿肺动脉瓣狭窄是一种安全、疗效优良的治疗策略。.

Haosheng Jin,* Min Yu,* Ye Lin, Baohua Hou, Zhongshi Wu, Zhide Li, Jian SunDepartment of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally tothis workBackground/aim: Increasing evidences show that microRNAs are engaged in hepatocellular carcinoma (HCC). The aim of this study was to investigate the role of miR-502-3P in HCC and to identify its underlying mechanism.Methods: The expression levels of miR-502-3P were assessed in multiple HCC cell lines and in liver tissues of patients with HCC. We further examined the effects of miR-502-3P on malignant behavior of HCC. The molecular target of miR-502-3P was identified using a computer algorithm and confirmed experimentally.Results: Downregulation of miR-502-3P was found in both HCC cell lines and human samples. Overexpression of miR-502-3P dramatically inhibits HCC proliferation, metastasis, invasion, and cell adhesion. We further verify the SET as a novel and direct target of miR-502-3P in HCCs.Conclusion: Taken together, overexpression of miR-502-3P or downregulation of SET may prove beneficial as a therapeutic strategy for HCC treatment.Keywords: miRNA, HCC, SET gene, recurrence

Nanobacterium contributes to pathological calcification in human renal stones and psammoma bodies in ovarian cancer. Pathological calcification is also present in cardiac valves with rheumatic heart disease. The aim of this study was to detect, isolate, culture, and characterize nanobacteria-like material from human calcified cardiac valves with rheumatic heart disease.Normal and calcified cardiac valve groups, as well as positive (nanobacteria strain Se90) and negative (serum radiated with 30 kGy of γ-ray) control groups, were included in this study. Part of each valve was immunostained with nanobacterial antibody 8D10, and the remaining parts were homogenized, filtered, and maintained in culture. The cultures were checked with a microscope weekly. Culture medium at different time points was analyzed with a spectrophotometer. The cultures maintained for 3 weeks were further examined with immunofluorescence double staining and transmission electron microscopy.While 26 of 29 calcified valves stained positive for 8D10 antibody, all normal valves stained negative. Mobile tiny particles were observed under a microscope in the calcified valve group and the Se90 group. Optical densities were significantly different among groups (P.001). Immunofluorescence double staining displayed tiny green fluorescence particles in the calcified valve group, in the Se90 group, and in two samples of the normal valve group. Transmission electron microscopy analysis indicated that cultured particles from calcified valves ranging in size from 88 to 341 nm had an obvious cell membrane structure similar to that of Se90.The nanobacteria-like material has been isolated and cultured from calcified cardiac valves with rheumatic heart disease, and its characteristics are similar to those of Se90.

In this study, valved photooxidatively crosslinked acellular bovine jugular vein conduits (BJVCs) were implanted in young dogs to reconstruct the connections of pulmonary arteries and right ventricles, with acellular conduits used as controls. All acellular conduits had moderate to severe valvular dysfunction and were explanted at 1-month implantation (n = 5). Histological examination showed inflammatory cell infiltration and intimal hyperplasia in the walls, and severe inflammatory cell infiltration and thrombosis in the valves. The photooxidatively crosslinked acellular conduits were retrieved at 1-month (n = 5) and 6-month (n = 5) implantations respectively. These conduits had excellent valvular function at retrieval. Their walls and valves were still soft and smooth without calcification and hemangioma. Endothelialization in valves and luminal walls was unsatisfied at 1-month retrieval, and was improved at 6-month retrieval. Host cells infiltrated and migrated from outer layer to the middle layer, with tissue remolding and regeneration found in these recellular regions. Histological examination and tissue content assay demonstrated that degeneration and regeneration of collagens and glycosaminoglycans were comparable, but elastic fibers gradually degraded. Photooxidatively crosslinked acellular BJVCs resist calcification and thrombosis and have regeneration patterns, with excellent hemodynamic performance.

Decellularization means and altering crosslinking approaches were two promising alternatives for glutaraldehyde fixation to biological tissues. Bovine jugular veins (BJVs) were decellularized by a multi-step detergent-enzymatic extraction method, then photooxidatively crosslinked. Gross and histological integrity of which was retained. Ultrastructures showed integrity of collagen fibrils and elastic fibers, and a basement membrane free luminal surface. Mechanical strength test and tissue protein extraction assay demonstrated their tissue stability. After being pre-coated with gelatin, collagen IV and fibronectin, cultured human umbilical vein endothelial cells were planted in the luminal surface of decellularized plus photooxidized BJV patches for seven days. Endothelial cells were denser in pre-coated patches than in uncoated controls. A rat subcutaneous implantation model revealed more resistance against in vivo degradation for further crosslinked BJV patches than decellularized patches at 12-week retrieval. Host cells were all layer repopulated for both. Histological examination and content assay demonstrated collagen and glycosaminoglycan components synthesis for decellularized plus photooxidized BJV patches. Decellularized and photooxidatively crosslinked BJV patches possess tissue integrity, excellent in vitro and in vivo tissue stability and repopulation patterns. Thus, they have potentials as tissue engineering scaffolds in future cardiovascular surgery.

To improve the hemocompatibility of decellular vascular matrix via heparin-iron complex multilayers (HICMs) nanomodification.A novel thrombo-resistant surface for decellular xenograft was developed by alternating linkage of dihydroxy-iron and heparin to decellular bovine jugular vein (DC-BJV), and its surface characterization, biomechanical stability and hemocompatibility were detected by scanning electron microscopy, tensile test and hemocompatibility evaluation, respectively.A toluidine blue colorimetric method indicated the amount of linked heparin was about (808±86) μg/cm2 per assembly-cycle. Scanning electron microscopic (SEM) images proved that HICMs were uniformly linked to and formed nanoscale films around the fibrils of DC-BJV. Toluidine blue staining histologic images showed that HICMs were linked mainly to DC-BJV surfaces. Washing test showed that the release of heparin was (281±43), (422 ± 60), (729±81), (1053±116), (1317±157), (1618±187) and (1945 ± 268 ) μg/cm(2) at 1 day, 1, 2, 3, 4, 6 and 8 week washing, respectively. Tensile tests showed an increased biomechanical stability. Hemocompatibility evaluations showed that PT and APTT of all the trial groups were above the normal reference ranges and that mean platelet count per 10000 μm2 area was 8±4 for HICMs layer-by-layer modified BJV (LBL-BJV) vs 48±16 for DC-BJV.HICMs are firmly linked to DC-BJV, and can form nanoscale thrombo-resistant films, which yield a sustained release of heparin. HICMs nanomodification improves the hemocompatibility of decellular xenograft.

To explore the effect of unidirectional valved patch (UVP) for congenital heart disease (CHD) with severe pulmonary hypertension (PH).We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation, and summarized its short-term to mid-term effect to find an optimum therapeutic regimen.Before the operation, the ECG showed that the mean pulmonary artery pressure (MPAP) ranged 65-72 mmHg, and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg, P(P)/P(A) ranged 0.8-1.05,PVR ranged 8.5-19.2 (under oxygen inhalation 6.8-14.6) wood unit.After the operation, P(P)/P(A) ranged 0.4-0.72 on weaning-off CPB. Postoperative ECG showed the MPAP ranged 32-48 mmHg. No pulmonary hypertension crisis occurred and no patient died. Mechanical ventilation time ranged from 32 h to 8 d and the SaO₂ ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows:22 cases had shunt 5 d after the operation, 11 cases had shunt 1 month after the operation,4 cases 3 months after the operation, and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data: 12 patients had a 1-year follow-up, 5 patients had a 3-year follow-up, and most patients had just 3-month follow-up.UVP can decrease the operative risk in CHD with severe PH at perioperative period. The short-term to mid-term effect is satisfactory, while long-term effect remains uncertain.

Qi Tan, Hao Tang, Jianguo Hu, Yerong Hu, Xinmin Zhou, Yunming Tao, Zhongshi WuDepartment of Cardiothoracic Surgery Second Xiangya Hospital, Central South University, Changsha 410011, People's Republic of ChinaAbstract: Regeneration deficiency is one of the main obstacles limiting the effectiveness of tissue-engineered scaffolds. To develop scaffolds that are capable of accelerating regeneration, we created a heparin/chitosan nanoparticle-immobilized decellularized bovine jugular vein scaffold to increase the loading capacity and allow for controlled release of vascular endothelial growth factor (VEGF). The vascularization of the scaffold was evaluated in vitro and in vivo. The functional nanoparticles were prepared by physical self-assembly with a diameter of 67–132 nm, positive charge, and a zeta potential of ~30 mV and then the nanoparticles were successfully immobilized to the nanofibers of scaffolds by ethylcarbodiimide hydrochloride/hydroxysulfosuccinimide modification. The scaffolds immobilized with heparin/chitosan nanoparticles exhibited highly effective localization and sustained release of VEGF for several weeks in vitro. This modified scaffold significantly stimulated endothelial cells' proliferation in vitro. Importantly, utilization of heparin/chitosan nanoparticles to localize VEGF significantly increased fibroblast infiltration, extracellular matrix production, and accelerated vascularization in mouse subcutaneous implantation model in vivo. This study provided a novel and promising system for accelerated regeneration of tissue-engineering scaffolds.Keywords: nanoparticle, scaffolds, VEGF, control release, vascularization, regeneration

This study aimed to investigate the effect of decellularization plus photooxidative crosslinking and ethanol pretreatment on bioprosthetic tissue calcification. Photooxidatively crosslinked acellular (PCA) bovine jugular vein conduits (BJVCs) and their photooxidized controls (n = 5 each) were sterilized in a graded concentration of ethanol solutions for 4 h, and used to reconstruct dog right ventricular outflow tracts. At 1-year implantation, echocardiography showed similar hemodynamic performance, but obvious calcification for the photooxidized BJVC walls. Further histological examination showed intense calcium deposition colocalized with slightly degraded elastic fibers in the photooxidized BJVC walls, with sparsely distributed punctate calcification in the valves and other areas of walls. But PCA BJVCs had apparent degradation of elastic fibers in the walls, with only sparsely distributed punctate calcification in the walls and valves. Content assay demonstrated comparable calcium content for the two groups at preimplantation, whereas less calcium for the PCA group in the walls and similar calcium in the valvular leaflets compared with the photooxidized group at 1-year retrieval. Elastin content assay presented the conduit walls of PCA group had less elastin content at preimplantation, but similar content at 1-year retrieval compared with the photooxidized group. Phospholipid analysis showed phospholipid extraction by ethanol for the PCA group was more efficacious than the photooxidized group. These results indicate that PCA BJVCs resist calcification in right-side heart implantation owing to decellularization, further photooxidative crosslinking, and subsequent phospholipid extraction by ethanol at preimplantation.

To investigate the characters and surgical treatment methods of anomalous drainage of left superior vena cava to left atrium.Clinical data of 8 cases were analyzed retrospectively.The patients aged from 6 months to 168 months with weight between 6 and 29 kg.The associated cardic lesions existed in all patients: 4 had partial atrioventricular septal defect (PAVSD),including 1 coronary sinus orifice atresia (CSOA), 1 ventricle septal defect (VSD), 1 ventricle septal defect associated with right ventricular outlet tract stenosis (VSD/RVOTS), and 1 atrial septal defect (ASD) and complete atrioventricular septal defect (CAVSD), respectively.No patient died. Preoperation diagnosis was in 1 case, intraoperation diagnosis in 5 cases,and postoperation diagnosis in 2 cases due to reoperation for hypoxemia.Three patients were repaired by intratrium tunnel, and the other 5 were managed by extracardic shunt.This lesion is easily missed in preoperation diagnosis,which can be avoided by awareness and careful inspection.The methods for management of anomalous drainage of left superior vena cava to left atrium depend on time of diagnosis and experience of surgeons.

To study the inflammation response and the biocompatibility of valved bovine jugular vein conduit (BJVC) and valved bovine jugular vein patch (VBJV-P) in treating complex congenital heart disease (CHD).From December 2007 to March 2008, 16 patients with complex CHD were treated. Of 16 patients, 6 underwent conjunction right ventricular to pulmonary artery with BJVC and broaden right ventricular outflow tract (RVOT) with VBJV-P (BJVC group), and 10 underwent broaden RVOT with self pericardial patch (control group). In BJVC group, there were 3 males and 3 females, aging (5.6 +/- 3.6) years, and including 1 case of type I truncus arteriosus, 1 case of type I truncus arteriosus with ventricular septal defect and patent foramen ovale, 1 case of congenital pulmonary atresia with ventricular septal defect and patent arterial duct, and 3 cases of Fallot's tetrad. In control group, there were 5 males and 5 females, aging (4.3 +/- 3.1) years, all being Fallot's tetrad. The periphery vein blood of the two groups was collected during operation and after operation, and the levels of cytokine were detected with ELISA method. Meanwhile the clinical data of the two groups were collected.There were no significant differences at levels of TNF-alpha and IL-6 between BJVC group and control group 1 week after operation (P0.05), and there was significant difference at level of IL-10 [(25.7 +/- 5.0) pg/mL vs (19.5 +/- 4.7) pg/mL, P0.05]. There were no significant differences at levels of IL-6 and IL-10 within groups botvin control group and in BJVC group (P0.05) between 1 week after operation and the anesthesia inducing period. And there was significant difference at level of TNF-alpha in BJVC group [(77.0 +/- 1.6) pg/mL vs (82.9 +/- 1.3) pg/mL, P0.05] and in control group [(78.6 +/- 3.4) pg/mL vs (83.1 +/- 1.9) pg/mL, P0.05] between 1 week after operation and the anesthesia inducing period. There were no statistically significant differences (P0.05) in leukocyte count and body temperature between BJVC group and control group. The X-ray films showed no abnormality in BJVC group and control group before operation and after operation. No hepatic and renal dysfunction occurred in control group; and 2 patients had hepatic dysfunction, which may be caused by antibiotics.BJVC has a good biocompatibility in treating complexity CHD.

To investigate effect of the removal of epithelium and mixed glands from the tracheal allografts on the graft-immunosuppression.Fresh untreated tracheal allografts, cryopreserved tracheal allografts, and 10 off-epithelium tracheal allografts were obtained from 25 male SD rats. Fresh untreated tracheal allografts (40) were divided into 4 groups and dipped respectively in the solution of protease XIV in 0, 0. 1, 0.3 and 0.5 mg/ml at 4 C for 12 hours. Thirty recipient male SD rats were randomly and equally divided into group A (fresh untreated tracheal allografts), group B (cryopreserved tracheal allografts), and group C (off-epithelium tracheal allografts). The transplanted allografts were implanted into the abdominal cavity of other rats by being embedded in the greater omentum. Twenty-one days after transplantation, the tracheal graft segments were surgically removed, and then were initially fixed in cold 10% neutral buffered formalin solution for hematoxylineosin staining. Histological observation and lymphocyte infiltration were performed on the grafts to evaluate rejection.The 0.3 mg/ml protease XIV could remove the epithelium and mixed glands of the grafts completely, but did no damage to cartilage. The cartilages of each group all survived and were revascularized. The lumens of group A were filled with granulation and necrosis tissue. In contrast, group B was filled with a few granulation tissues and group C was not at all. The number of lymphocyte infiltration in group A, B, and C was 29.16 +/- 2.69/HP, 15.17 +/- 2.19/HP, and 11.56 +/- 0.87/HP respectively. There was significant difference between group A and both group B and group C (P0.05), and there was significant difference between group B and group C (P0.05). Therefore, the grade of graft-rejection was group Agroup Bgroup C.The 0.3 mg/ml protease XIV can completely remove the epithelium and mixed glands of grafts at 4 C for 12 hours, and it preserves the normal structure of cartilage. The antigenicity of tracheal grafts can be greatly reduced by removing the epithelium and by the cryopreservation. The prior tracheal allograft in the omentum is feasible for the revascularization of the grafts.