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The release of paracrine factors from endothelial progenitor cell (EPC) sheet is a central mechanism of tissue repair. The purpose of this study was to constuct the rat bone marrow derived-endothelial progenitor cell (BM-EPCs) sheet and investigate invest the role of stromal cell-derived factor-1α (SDF-1α)/CXCR4 axis in the biological function of BM-EPCs sheet. BM-EPC cells were identified by the cell-surface markers-CD34/CD133/VE-cadherin/KDR using flow cytometry and dual affinity for acLDL and UEA-1. After 7 days of incubation, the BM-EPC single-cell suspensions were seeded on thermo-sensitive plate to harvest the BM-EPC cell sheets. The expression levels of SDF-1α/CXCR4 axis-associated genes and proteins were examined using RT-qPCR and western blot analysis, and enzyme-linked immunosorbent assay (ELISA) was applied to determine the concentration of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and SDF-1α in the cell culture medium. The BM-EPC cell sheets were successfully harvested. Moreover, BM-EPC cell sheets have superior migration and tube formation activity when compared with single cell suspension. When capillary-like tube were formed from EPCs sheets, the releasing of paracrine factors such as VEGF, EGF and SDF-1α were increased. To reveal the mechanism of tube formation of BM-EPCs sheets, our research showed that the activation of PI3K/AKT/eNOS pathway was involved in the process, because the phosphorylation of CXCR, PI3K, AKT and eNOS were increased. BM-EPC cell sheets have superior paracrine and tube formation activity than the BM-EPC single-cell. The strong ability to secrete paracrine factors was be potentially related to the SDF-1α/CXCR4 axis through PI3K/AKT/eNOS pathway.

p53 is a common tumor suppressor, and its mutation drives tumorigenesis. What is more, p53 mutations have also been reported to be indicative of poor prognosis in lung cancer, but the detailed mechanism has not been elucidated. In this study, we found that DNA primase subunit 2 (PRIM2) had a high expression level and associated with poor prognosis in lung cancer. Furthermore, we found that PRIM2 expression was abnormally increased in lung cancer cells with p53 mutation or altered the p53/RB pathway based on database. We also verified that PRIM2 expression was elevated by mutation or deletion of p53 in lung cancer cell lines. Lastly, silence p53 increased the expression of RPIM2. Thus, these data suggest that PRIM2 is a cancer-promoting factor which is regulated by the p53/RB pathway. The p53 tumor-suppressor gene integrates numerous signals that control cell proliferation, cell cycle, and cell death; and the p53/RB pathway determines the cellular localization of transcription factor E2F, which regulates the expression of downstream targets. Next, we explored the role of PRIM2 in lung cancer and found that knockdown of PRIM2 induced cell cycle arrest, increased DNA damage, and increased cell senescence, leading to decreased lung cancer cell proliferation. Lastly, the positive correlation between PRIM2 and E2F/CDK also indicated that PRIM2 was involved in promoting cell cycle mediated by p53/RB pathway. These results confirmed that the expression of PRIM2 is regulated by the p53/RB pathway in lung cancer cells, promotes DNA replication and mismatch repair, and activates the cell cycle. Overall, we found that frequent p53 mutations increased PRIM2 expression, activated the cell cycle, and promoted lung cancer progression.

Objectives: This study aimed to evaluate the early and rapid diagnostic value and the cut-off value of Heart-type fatty acid-binding protein (H-FABP) for the perioperative myocardial infarction (PMI) diagnosis after off-pump coronary artery bypass grafting (OPCABG) surgery. Method: 109 patients scheduled for first-time, elective, and isolated OPCABG surgery were erolled in this single-center, prospective and consecutive study. Serial samples for measurement of H-FABP at pre-anesthesia induction (T0, baseline), completion of last distal anastomosis (T1), on ICU admission (T2), and at 2h (T3), 4h (T4), 8h (T5), 24h (T6), and 48h (T7) were taken to analyze for H-FABP. CK-MB and cTnI were taken at T4, T5, T6, and T7. Patients were first divided into three groups according to the level of cTnI and ECG changes within the early 24 hours. Results: 44 patients served as a control group, 52 patients identified as myocardial injury group, and 13 patients defined as myocardial infarction group. The level of H-FABP released was significantly higher in the myocardial infarction group than another two groups. Using a cut-off value of 20.53 ng/ml for H-FABP, the sensitivity was 84.62%, 92.31%, and 76.92% immediately, 2 hours, and 4 hours after entering the ICU. The sensitivity of combined H-FABP and cTnI was 92.31% and 84.62% at 4 and 8 hours after entering the ICU. Conclusions: With an optimal H-FABP cut-off level of 20.53 ng/ml, H-FABP was the early and reliable biomarker for PMI diagnosis after OPCABG.

The construction of sponge cities is a crucial measure for the development of an ecologically sensitive urban civilization in China, but a systematic and comprehensive construction control target has not yet been established. Considering the Nanjing Jiangbei New District as an example, this article explores how to decompose the control objectives of stormwater management in urban regions into four levels, namely, urban areas, control planning units, implementation plots, and individual technical measures, which will form the basis for the design of sponge cities. The findings of this study are expected to serve as a reference for other regions of China in the design of rainwater management systems, which form the structural backbone of the sponge cities.

Objective: To investigate the effect of aortic esophageal fistula treatment after thoracic aortic endovascular repair (TEVAR) with artificial vessel bypass. Methods: The clinical data of 6 consecutive patients who received surgical treatment at Shanghai Deda Hospital from September 2019 to June 2021 due to aortic esophageal fistula after TEVAR were retrospectively analyzed. There were 6 males, aged (47.7±8.2) years old (range: 35-56 years old). All patients had recurrent fever, and 4 patients had positive blood cultures. According to the specific conditions of the patients, all patients underwent artificial blood vessel bypass and jejunostomy under general anesthesia without extracorporeal circulation. One case underwent artificially infected vascular segment resection and esophageal repair at the same time. 5 cases underwent artificial infection vascular resection, 4 of them underwent esophageal repair, and 1 case had a large intraoperative fistula and local resection of the esophagus. Sensitive antibacterial drugs were continued after the operation for 6 to 8 weeks. Results: There were 2 deaths in hospital, 1 case of large cerebral infarction early postoperatively, and 1 case of septic shock. The remaining 4 patients recovered well after the operation and were discharged. The follow-up period was 2 to 23 months. During the follow-up period, the remaining patients had no recurrence of infection and esophageal fistula. Conclusion ：In patients with aortic esophageal fistula after TEVAR, the establishment of artificial vascular bypass, the resection of the infected vascular segment, contemporaneous or staged esophageal repair, regular anti-infective treatment can obtain a good prognosis.

OBJECTIVES The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was developed to update EuroSCORE and incorporated refinement and modification of several risk factors. SinoSCORE was designed by Chinese scholars based on 9839 patients who underwent coronary artery bypass grafting (CABG) at 43 participating institutions. This study was designed to validate the EuroSCORE II and SinoSCORE in Chinese patients undergoing CABG and to compare their performance overall and per subgroup. METHODS A total of 4507 adult receiving CABG at our institution between January 2010 and April 2014 were included in this retrospective study. Patients were stratified for cardiovascular risk using EuroSCORE II and SinoSCORE. The performance of EuroSCORE II and SinoSCORE was analysed with a focus on discrimination power and calibration. RESULTS The in-hospital mortality rate for the entire cohort was 1.4%, while the mortality rate predicted by EuroSCORE II was 1.47 ± 1.2% (95% CI 1.43-1.50) and by SinoSCORE was 2.86 ± 3.5% (95% CI 2.76-2.96). The C-statistics of EuroSCORE II and SinoSCORE were 0.728 and 0.716, respectively. The Hosmer-Lemeshow test indicated that EuroSCORE II had poor goodness of fit while SinoSCORE performed slightly better. When patients were divided into quartiles based on predicted risk, respectively defined as group I, II, III and IV, EuroSCORE II underestimated mortality rates of patients scored IV, but overestimated mortality rates in all other groups; SinoSCORE underestimated mortality rates of patients scored I and overestimated mortality rates in all other groups. EuroSCORE II only achieved good discrimination for patients scored I (area under the receiver operating characteristic curve, AUC = 0.707 > 0.70), and SinoSCORE achieved poor discrimination for all subgroups except group II (AUC = 0.754 > 0.70). EuroSCORE II overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in all pathology subgroups. The AUC values of EuroSCORE II and SinoSCORE were 0.694 and 0.687, respectively, for isolated CABG. The AUC values of EuroSCORE II and SinoSCORE were 0.772 and 0.669 for combined cardiac surgery CABG. CONCLUSIONS EuroSCORE II could predict mortality in the entire group and in the low-middle risk group, but not in the high-risk group, in which it underestimated mortality. SinoSCORE overestimated mortality rates in the entire group and in all subgroups. Risk models should be targeted to different heart diseases, and the statistical methods of established risk systems should be improved.

Background: Optimization of blood-saving strategies during open heart surgery in infants is still required. This study aimed to study a comprehensive blood-saving strategy during cardiopulmonary bypass (CPB) on postoperative recovery in low-weight infants undergoing open heart surgery. Methods: This was a prospective study of 86 consecutive infants (weighing

To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD).Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group.The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P .001). The P-value of the McNemar test of TTE-guided 3DPM was.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings.Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.

Objectives To compare the therapeutic efficacy of recombinant human brain natriuretic peptide and prostaglandin E1 in the treatment of pulmonary hypertension after mitral valve replacement. Methods Sixty patients with postoperative pulmonary hypertension were divided randomly into 3 groups that received saline, prostaglandin E1, and natriuretic peptide infusions for 12 hours each. The hemodynamics data were monitored consecutively, and the levels of thromboxane A2 and cyclic guanosine monophosphate were detected pretreatment, after treatment, and 1 week after surgery. Results The arterial pressure, pulmonary arterial pressure, and pulmonary capillary wedge pressure decreased 1 hour after prostaglandin E1 treatment and rebounded after treatment discontinuation. The pulmonary arterial pressure and pulmonary capillary wedge pressure in the natriuretic peptide group decreased 3 hours after treatment; pulmonary arterial pressure decreased less than that of the prostaglandin group, and there was no evidence of hemodynamic rebound after treatment discontinuation. The natriuretic peptide had no significant effects on arterial pressure. In both the prostaglandin and natriuretic peptide groups, cyclic guanosine monophosphate increased after the treatment, which was even higher in the latter group. Prostaglandin E1 could lead to the decrease of thromboxane A2, which was not seen in the natriuretic peptide group. Conclusions Both brain natriuretic peptide and prostaglandin E1 can effectively reduce pulmonary hypertension; however, natriuretic peptide has a slower and milder efficacy. The effects of these 2 drugs in reducing the pulmonary arterial pressure may be mediated through different pathways.

Heparin (HEP) and phosphorylcholine groups (PC) were grafted onto the polyurethane (PU) surface in order to improve biocompatibility and anticoagulant activity. After the surface grafting sites of PU were amplified with the primary amine groups of polyethylenimine (PEI), heparin was covalently linked onto the surface by the reaction between the amino group and the carboxyl group. PC groups were covalently immobilized on the PU-PEI surface through the reaction between the amino group and the aldehyde group of phosphorylcholine glyceraldehyde (PCGA). The surface density of primary amine groups was determined by a ninhydrin assay. The amino group den- sity reached a maximum of 0.88 µmol/cm 2 upon incorporation of 10 wt% PEI. The amount of heparin covalently immobilized on the PU-PEI surface was determined by the toluidine blue method. The grafting chemistry resulted in the comparatively dense immobilization of HEP (2.6 µg/cm 2 ) and PC to the PU-PEI surfaces. The HEP and PC modified surfaces were characterized by water uptake (PU 0.15 mg/cm 2 , PU-PEI 3.54 mg/cm 2 , PU-HEP 2.04 mg/ cm 2 , PU-PC 2.38 mg/cm 2 ), water contact angle (PU 95.3o, PU-PEI 34.0o, PU-HEP 39.5o, PU-PC 37.2o), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), and scanning electron microscope (SEM). The results demonstrated that the PU- PEI surface was successfully grafted with HEP and PC. The hydrophilicity and hemocompatibility of these grafted surfaces were significantly improved. These results suggested that the PU-HEP and PU-PC composite films are promising candidates for blood contacting tissue engineering.

Heparin was grafted onto polycarbonate urethane (PCU) surface via a three-step procedure utilizing, αω-diamino-poly(ethylene glycol) (APEG, M n=2 000) as a spacer. In the first step, isocyanate functional groups were introduced onto PCU surface by the treatment of hexamethylene diisocyanate (HDI) in the presence of di-n-butyltin dilaurate (DBTDL) as a catalyst. In the second step, APEG was linked to the PCU surface to obtain the APEG conjugated PCU surface (PCU-APEG). In the third step, heparin was covalently coupled with PCU-APEG in the presence of N-hydroxysuccinimide (NHS) and 1-ethyl-3-(3-dimethylamidopropyl) carbodiimide (EDAC). The amount of heparin (1.639 μg/cm2) covalently immobilized on the PCU-APEG surface was determined by the toluidine blue method. The modified surface was characterized by water contact angle, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM). The hemocompatibility was preliminarily studied by platelet adhesion test. The results indicated that heparin was successfully grafted onto the PCU surface, and meanwhile the hydrophilicity and hemocompatibility of the modified PCU surface were improved significantly compared with the blank PCU surface.

Background: Cardiac surgery is associated with inflammatory responses that are known to affect its outcome. The present study was designed to define whether post-operative release of interleukin (IL)-6, 8 and tumor necrosis factor-alpha (TNF-α) is related to the presence of a certain allele in functional polymorphism and its relationship to clinical outcome after off-pump coronary artery bypass (OPCAB). Methods: One hundred and forty-five patients undergoing first time elective OPCAB were genotyped for IL-6(−174G>C), IL-8(−251A>T) and TNF-α(−308G>A) polymorphisms using polymerase chain reaction (PCR) and gene sequencing. Cytokine levels were measured in plasma samples taken before the operation and 4, 24 and 72 h postoperatively by suspension array system. Results: Levels of IL-6 and IL-8 increased significantly after OPCAB. Patients with IL-6−174GG and IL-8−251AA genotypes had higher post-operative circulating levels of IL-6 and IL-8, respectively. Logistic regression showed that IL-8−251AA genotype was an independent risk factor of ventilation time more than 1 day (OR = 11.80, 95% CI: 1.87–74.48) and hospital staying more than 14 days (OR = 38.00, 95% CI: 4.15–347.87) after surgery. Conclusions: OPCAB results in post-operative inflammatory responses. Genetic backgrounds alter the extent of inflammatory response and might relate to clinical outcome of OPCAB.

BACKGROUND AND AIM OF THE STUDY Atrial fibrillation (AF) ablation has become an effective concomitant procedure, which is increasingly used. We questioned whether results are related to surgeon's experience. METHODS Patients (n = 141) with persistent AF (pAF) underwent concomitant left atrial (LA) endocardial ablation, performed by six surgeons. Follow-up (FU) was after 3, 6, and 12 months (mean 8 +/- 4.1 months). FU was 97% complete. Results were analyzed according to surgeon's volume: >20 (group A, n = 85) and

Objectives: Minimally invasive cardiac surgery has been developed to offer patients the benefits of open heart operations with decreased pain and limited skin incision. A limited superior median sternotomy has been shown to provide a good exposure for aortic valve replacement (AVR) and good results. In this study we report the results of minimally invasive AVR compared to standard sternotomy AVR performed in the same period. Methods: From May 1996 to January 1998, 86 patients received isolated aortic valve replacement by the limited superior median sternotomy(group 1). As a control group (group 2), 78 patients were enrolled who underwent isolated aortic valve replacements by standard sternotomy in the same period. Results: Median ischemic time and median bypass time between the two groups showed no significant difference (P . 0:05). Median entire operation time in group 1 was obviously shorter than that in group 2 (P , 0:01). Median postoperative drainage was 229 ml in group 1, 369 ml in group 2. The difference between the two groups (P , 0:05) was significant. Median postoperative respiratory support time was 7.43 h in group 1, 11.26 h in group 2, with significant difference (P , 0:05). Median duration of hospital stay were 6.2 days in group 1, 9.4 days in group 2, with significant difference (P , 0:01). Reoperations for bleeding were two in group 1, four in group 2, superficial wound infection and sternum disruption occurred once in group 1 and four times in group 2. There were two hospital deaths respectively in the two groups (not procedure related). Conclusions: The limited superior median sternotomy provides good exposure to the left ventricular outflow tract, aortic valve, ascending aorta, and even to the mitral valve through the roof of the left atrium. Therefore it seems to be suitable for all kinds of aortic valve operations. Besides less pain, shorter skin incision, shorter respiratory support time and lower blood loss, it has more advantages as opening and closure of the sternum is faster; decreasing infection and disruption of the sternum, and finally decreasing the time required for hospitalization and recovery. q 1999 Elsevier Science B.V. All rights reserved.

Although, in recent years, atrial fibrillation (AF) ablation has become an effective concomitant procedure in cardiac surgery, it is unclear whether the outcome of the procedure is determined by the underlying valve disease.Between 2003 and 2005, 191 patients (100 females, 91 males; mean age 70+/-8.7 years) underwent concomitant left atrial (LA) ablation. Among these patients, those with permanent AF (pAF) and mitral (MVD; n = 64), aortic (AVD; n = 37), and combined valve disease (CVD; n = 23) were prospectively studied after three, six and 12 months, and annually thereafter. The predictive values of preoperative variables for postoperative AF were examined.AVD patients were older than MVD patients (74 +/-7.8 versus 66+/-8.6 years; p0.001), and presented smaller atria (48+/- 5.7 versus 53+/-8.0 mm; p0.05), but CVD patients were similar to MVD patients in terms of these parameters (age 70+/-9.3 years, LA diameter 54+/-9.6 mm). Ablation caused no injury or death in any of the patients. Within 30 days after surgery, three (4.7%), three (8.1%) and two (8.7%) of the MVD, AVD and CVD patients, respectively, had died (6.4% overall mortality). The sinus rhythm (SR) conversion rate was 76.8, 63.3 and 58.8% (p = NS) after a mean follow up (FU) of 10+/-4.0, 9+/-4.2 and 10+/-3.9 months (p = NS) in the MVD, AVD and CVD groups, respectively. FU was 97% complete. During FU, four (6.6%), two (5.9%) and four (19.0%) MVD, AVD and CVD patients died, respectively. Univariate analysis demonstrated a shorter AF duration (42+/-49.0 versus 85+/-67.2 months; p0.05) and smaller LA diameter (50+/-8.1 versus 55+/-9.2 mm; p0.05) in patients with SR versus non-SR. Multivariate analysis revealed AF duration (Odds ratio (OR) 1.01, 95% CI 1.00-1.02, p0.05) and LA diameter (OR 1.08, 95% CI 1.01-1.15, p0.05) as independent predictors of SR conversion. Overall, 86% of patients with two or less years' duration of pAF were in SR at FU.AF duration and LA diameter, but not the type of valve disease, predict SR conversion after concomitant ablation of pAF in valvular heart surgery.

Aortic valve disease can be treated successfully by means of the Ross operation. Alternatives to pulmonary valve replacement with homografts are needed. The study aim was to demonstrate the performance of a decellularized porcine xenograft valve (Matrix P) in adult patients after the Ross operation.Between July 2002 and May 2004, a total of 50 Ross operations was performed with the Matrix P for pulmonary valve replacement. Operative results and postoperative hemodynamics were evaluated.The median patient age was 46 years (range: 17-70 years). Among patients, 36% underwent additional procedures, most often repair of aneurysms of the ascending aorta or coronary artery bypass grafts. One patient died from septic multiorgan failure on postoperative day 36. One reoperation on the Matrix P and one reoperation on the aortic valve were necessary; both reoperations were uneventful. Postoperative echocardiography demonstrated low transvalvular gradients that did not tend to increase over time.In contrast to homografts and other xenografts the Matrix P decellularized xenograft showed, postoperatively, no rise in right ventricular-pulmonary artery pressure gradients. Indeed, the valve was seen to behave similarly to a physiologically normal valve in a healthy subject.

An infant, 2 months old, underwent cardiac surgery because of congenital heart defects and pulmonary hypertension. Surgery was performed in hypothermia and cardiac standstill. On the second day after surgery the infant had to be resuscitated due to a combination of acute left-ventricular failure, pulmonary vascular hypertension and a slight right-to-left-shunt. A breakthrough in the treatment was achieved by using levosimendan to improve left-ventricular function and to decrease vascular resistance.

Cardiac surgery in Jehovah’s Witness patients remains a challenge in the presence of concomitant congenital or acquired coagulation disorders and anaemia. We report a case of a 66-year-old female Jehovah’s Witness suffering from severe calcified aortic valve stenosis requiring aortic valve replacement. The anaemic patient suffered from concomitant platelet dysfunction and deficiency of factors V and VII due to gammopathy of immunoglobulin G. The patient was preoperatively treated with recombinant erythropoietin in combination with folic acid and iron, which resulted in an increase of the haematocrit from 0.335 to 0.416 after 22 days of treatment. Haemostasis was improved by high dose aprotinin and additional desmopressin, which could be demonstrated to be effective by a preoperative test. The patients intra- and postoperative course was uneventful, her total chest tube loss was 130 ml, and she was able to be discharged without the need of any blood transfusions. The beneficial properties of erythropoietin and desmopressin in Jehovah’s Witness patients are discussed.

Multislice computed tomography images of a patient with extreme aortic allograft degeneration and Dacron graft calcification after right ventricular outflow tract reconstruction 23 years previously (Figure 1). The extra-anatomic horseshoe graft was taken …