Objective To observe the expression of integrin αVβ3 in vascular endothelium cultured in vitro at different time points under different level of shear stress. Methods（1）We established a vascular culture system in vitro which could provide steady flow with different level of shear stress, and tested the flow stability when loading different level of shear stress. （2） A total of 50 rabbits were randomly divided into low shear stress group （5 dyn/cm2, n=25）and normal shear stress group（20 dyn/cm2, n=25）. Rabbits in each group were further randomly divided into five different time points as 2 h, 4 h, 8 h, 16 h and 24 h（n=5 at each time point）. The descending aorta of rabbits were harvested and cultured in the vascular culture system in vitro under different level of shear stress. The expression sites and intensity of αVβ3-Integrin in vascular endothelium were examined at 5 different time points in both groups by immunohistochemical staining. Results The vascular culture system in vitro was stable in providing laminar flow with different level of shear stress required for the experiment. Vascular endothelium expressions of αVβ3-Integrin in the low shear stress group were in high level at all the 5 time points and reached its summit at 16 h, when the mean optical density（MOD）value was （1.995±0.194）×10-2. In the normal shear stress group, the MOD value decreased time-dependently at the 5 time points. The MOD values at 2 h （0.059±0.005）×10-2 and 4 h（0. 049±0.002）×10-2 were significantly higher than those at other time points （P＜ 0.05）. The αVβ3-Integrin MOD values of the low shear stress group were significantly higher than those of the normal shear stress group at all the 5 respective time points （P=0.000）. Conclusion Low shear stress can significantly promote the expression of αVβ3-Integrin while normal shear stress decreases the expression of αVβ3-Integrin in vascular endothelium cultured in vitro.
Abstract： Objective To evaluate clinical outcomes of endoscopic vein harvesting （EVH）for coronary artery bypass grafting（CABG） in diabetic patients. Methods In this prospective non-randomized control study, patients with type 2 diabetes who underwent CABG from December 2010 to Febuary 2012 in West China Hospital were enrolled. Based on different vein graft harvesting technique, these patients were divided into two groups: an EVH group and a conventional vein harvesting（CVH）group. Perioperative complications were compared between the two groups. Interventional or CT coronary angiogram was used to evaluate bypass graft patency during follow-up. Results A total of 51 patients with type 2 diabetes were enrolled in this study with 24 patients in the EVH group and 27 patients in the CVH group. There was no statistical difference in age, weight, and comorbidities between the two groups. There was no statistical difference in cardiopulmonary bypass time and aortic cross-clamping time between the two groups （67.2±9.8 min versus 68.3±14.5 min, P＞0.05; 62.4±11.3 min versus 65.2±10.3 min, P＞ 0.05）. The vein graft harvesting time （35.6±6.4 min versus 45.2±11.4 min, P＜ 0.05）and rate of delayed leg wound healing（0.0% with 0/24 versus 18.5% with 5/27, P＜0.05） of the EVH group were significantly shorter or lower than those of CVH group.There was no statistical difference in major postoperative complications with respect to venous graft failure rate and chest pain during short term follow-up（9.1 months in the CVH group and 9.4 months in the EVH group） between the two groups. Conclusion EVH is a safe, effective, minimally invasive and quick vein graft harvesting technique for CABG in diabetic patients.
Objective To investigate the expression of transcription factors including nuclear factor-κB （NF-κB） and activator protein-1 （AP-1） in vascular endothelial cells （ECs） in different flow fields， and provide experimental evidence for mechanical signal effects on gene regulation pattern of ECs. Methods Cultured human umbilical vein ECs were loaded into steady flow chambers of laminar flow or turbulent flow and observed at 6 time points （0.5 h， 1 h， 2 h， 3 h， 4 h and 5 h） based on different load time. Spacial and temporal characteristics of NF-κB and AP-1 expression in ECs in different flow chambers were detected at a protein level by laser confocal microscope. Results In laminar flow， NF-κB expression rose to peak at 1 hour （26.49±1.63， P＜0.05）and then declined. In turbulent flow， NF-κB expression rose to peak at 3 hours （34.41±6.43， P＜0.05）. In laminar flow， c-Jun/AP-1 expression was transiently elevated， reached its peak at 0.5 hour （18.95±5.38，P＜0.05）and then fell to its baseline level. In turbulent flow， c-Jun/AP-1 expression rose slowly but steady to peak（P＜0.05） . Conclusion The effects of turbulent flow on NF-κB and AP-1 expression in ECs are different from those of laminar flow. Up-regulation and activation of NF-κB and AP-1 expression in ECs induced by turbulent flow may cause pathological changes in morphological structure and functional behavior of ECs.
Objective To summarize the experience of surgical treatment for 84 patients with aortic dissection, investigate the surgical technique and perioperative treatment, and to improve surgical results. Methods The operations were performed in 50 patients with aortic dissection of Stanford A， Bentall or Cabrol operations were performed in 24 patients, graft replacement of ascending aorta in 8 patients, Trusler operation in 5 patients, Wheat operation in 5patients, operation of ascending aorta and aortic arch in 8 patients.Stentgraft were used in 34 patients with aortic dissection of Stanford B. Results There were 11 hospital death,the hospital mortality was 13.1%.There were 3 operative deaths.One patient with ascending aortic and hemiarch grafting died of aortic root bleeding;one patient with replacement of ascending aorta died of failure to restart heart beating；one patient with ascending aortic and hemiarch grafting died of rapture of aortic dissection. There were 8 postoperative deaths, including low cardiac output syndrome in 2 patients, lung infection in 2 patients, renal failure in 2 patients， respiratory failure in 1 patient and permanent mental anomaly in 1 patient. The complications were occurred in 16 patients. The followup period was 3 months to 10 years, and carried out in 62 patients（84.9%，62/73).One died of endocarditis, another one died of sudden death. Conclusion The surgicaltreatment of aortic dissection could be carried out safely based on the accurate diagnosis， specific surgical strategy and fine surgical technique.
Objective To modify the method for aortic end strengthening in acute type A aortic dissection operation, and investigate its clinical efficacy. Methods We modified the method for aortic end strengthening in acute aortic dissection operation based on ‘Sandwich method’ in the department of thoracic and cardiovascular surgery of West China Hospital. From January 2006 to December 2008, twentyeight patients with acute type A aortic dissection underwent modified aortic end strengthening operation. We made adventitia turn over and enfold to strengthen the aortic end in 10 cases, and placed stripshaped felt or pericardium belts between dissection (between adventitia and intima)and inner intima and strengthened the aortic end by suture in 18 cases. The hemorrhage of anastomotic stoma and the postoperative early prognosis were observed. Results No bleeding complication was found in all the cases. Two cases died, one died of severe low cardiac output syndrome and another died of multiple organ failure. No nervous system complication was found except that 2 cases had delayed revival. No sternum and surgical incision related complication was found. The rest 26 cases were cured and discharged. Conclusion The modified method for aortic end strengthening can not only strengthen the aortic end but also make people be able to find the petechia of anastomotic stoma clearly, then stitch hemostasia could be done effectively. The method is easy to implement and effective, it should be extend in clinic.
Objective To sum up the therapeutic results of corrective surgery of 164 cases of tetralogy of Fallot (TOF), and explore the optimal time and risk factors of operation,as well as perioperative management. Methods One hundred and sixty-four consecutive cases of TOF underwent corrective surgery. There were simple stenosis of infundibular portion in right ventricular outflow tract in 37 cases, stenosis of infundibulum and pulmonary valve in 14 cases, main pulmonary trunk and left/right pulmonary arteries stenosis in 113 cases, and pulmonary atresia in 5 cases. Autologous pericardial conduit, valved homograft were used for right ventriculo-pulmonary artery connection, respectively. Other anomalies were corrected. Results The surgical mortality was 3.66% (6/164). The cause of death were serious low cardiac output syndrome(2 case), fail to wean from cardiopulmonary bypass after coronary artery bypass grafting (1 case), ventricular arrhythmia(1 case) and postoperative acute respiratory distress syndrome (2 cases). Conclusion It’s necessary to perform corrective operation on younger TOF patients. Low cardiac output syndrome is not the key reason of leading to postoperative complications or death. Preventing remnant obstruction of pulmonary artery and pulmonary complication should be focused during and after operation.