Hybrid cardiovascular surgical procedure is an emerging concept that combines the skills and techniques of minimally invasive surgery and interventional catheterization. It allows surgeons to use interventional equipment and techniques during operations, which are traditionally used by physicians, in order to reduce the magnitude of therapeutic interventions and to increase therapeutic effectiveness. This review provides a snapshot of the main application and progress of current hybrid procedures in the field of cardiovascular surgery, including the hybrid therapy of coronary artery disease, congenital heart disease and thoracic aortic aneurysm, also discusses the precondition with which the hybrid procedure should ideally be performed.
Abstract: Objective To induce calcification in aortic valvular interstitial cells (VICs) in vitro and observe the shift of cellular phenotype during the process. Methods Porcine aortic VICs were isolated and expanded by collagenase methods. Fluorescent staining was performed to identify the interstitial cells. VICs at 48 passages were used for experiments. The cells were divided into two groups: the experimental group in which cells were cultured in osteogenic media supplemented with βglycerophosphate, vitamin C and dexamethasone, and the control group in which cells were cultured in normal media. After 2 weeks, calcified nodules were quantified. Calcium deposit was stained and measured by Alizarin Red S staining and assay. Real time reverse transcription polymerase chain reaction (RTPCR) was performed to measure expression of alpha smooth muscle actin (α-SMA) and calcification related factors such as osteocalcin, osteopontin and Corebinding factor α1/Runx2 (Cbfα1/Runx2). Results VICs were successfully harvested from porcine aortic valves, identified by positive staining of α-SMA, vimentin and negative staining of Von Willebrand factor (vWF). VICs could calcify after 2 weeks of osteogenic induction with calcified nodules formed. Quantification of calcified nodules and calcification deposit were significantly higher (Plt;0.05) in the experimental group than those in the control group (156.25±17.38 vs. 2.50±1.29, 17.52±2.04 vs. 1.00±0.22). Real Time RT-PCR indicated that expression of α-SMA, as well as calcification related markers like osteocalcin, osteopontin and Cbfα1/Runx2 was much higher in the experimental group than those in the control group (Plt;0.05). Conclusion VICs are activated during the progress of calcification with phenotype shifting to contraction and ossification, which might be the pathological basis of valvular calcification.
With the development of social economy and medicine, degenerative heart valve disease has become the major part in heart valve disease. Calcific aortic valve disease (CAVD) is one of the most representative manifestations of degenerative valvular disease. Aortic valve calcification (AVC) has been found to be a strong predictor of major cardiovascular events, which makes it necessary to identify an effective way to evaluate the degree of AVC. Numerous methods of quantitative assessment of AVC have been reported. Here, we discuss these methods from the aspects of pathology and imageology.
Objective To study the incidence，clinicopathological characteristics,diagnosis，treatment， and prognosis of synchronous or metachronous primary cancers in patients with gastric cancer． Methods The clinical data of 103 gastric cancer patients with synchronous or metachronous primary cancers from January 1983 to December 2010 were collected and reviewed．Results The incidence of synchronous or metachronous primary cancer in addition to gastric cancer was 2.26％（103/4 552）.The age of these patients was （63.98±11.93） years （30～84 years） when gastric cancer was diagnosed.There were 29 cases of synchronous primary cancer and 74 cases of metachronous primary cancer,in which there were 46 pre-metachronous cancer patients and 28 post-metachronous cancer patients.All the patients had 113 primary tumors of other organs.Colorectal cancer was the most common type of primary cancer in other organs （27.43%, 31/113）,followed by lung cancer （15.04%, 17/113）.The time interval between gastric cancer and metachronous primary cancer was （87.95±92.98） months （7～506 months）,and 65.49% （74/113） of other primary tumors were diagnosed within 5 years before or after gastric cancer. The overall 5-year survival rate was 48.43%. The 5-year survival rate of post-metachronous group （69.52%） was significantly better than synchronous cancer group （36.40%, P=0.009） or pre-metachronous group （42.31%, P=0.023）.In 33 patients who had definite cause of death, 20 patients died of gastric cancer.Conclusions Primary cancer of other organs should be considered in treatment of gastric cancer.Gastric cancer may be the most important factor impacting the prognosis of these patients.
ObjectiveTo establish a simple and stable model of benign tracheal stenosis in SD rats by nylon brush scraping induced mechanical injury, and to observe the pathological changes of tracheal tissue at different time points after modeling.MethodsTwenty SD rats were divided into sham operation group (10 rats) and stenosis model group (10 rats) by random number method. Symptoms and survival conditions were observed, tracheal tissues were obtained, granulation tissue proliferation was observed, and stenosis indexes were measured and compared. Another fifteen rats were sacrificed at different time points (days 0, 2, 4, 6, and 8) after modeling. Tracheal tissues were obtained, HE staining and Masson staining were performed to observe pathological changes with time.ResultsThe survival rate of the sham operation group was 100% on the 8th day after operation, and the survival rate was 0% on the 8th day after operation in the stenosis model group. The difference in survival condition between the two groups was statistically significant (P=0.000 1) by Log-rank test. The stenosis index in the sham operation group was (6.12±1.78)%, and in the stenosis model group was (60.28±12.56)%. The difference in the stenosis between the two groups was statistically significant (P<0.000 01). HE staining results showed that the tracheal lumen was unobstructed and no granulation tissue hyperplasia or stenosis was found in the sham operation group. The epithelial mucosa was intact and smooth, and the cilia structure was clearly visible. It was a pseudo-stratified ciliated columnar epithelium, which was consistent with the characteristics of normal airway mucosa. While in stenosis model group, the lumen was significantly narrowed, and the stenosis was mainly caused by granulation tissue hyperplasia. No epithelial structure was observed, or epithelial structure was extremely abnormal. Masson staining showed that the fibroblasts in the injured site increased first and then decreased, and the collagenous fiber (blue) in the injured site gradually increased with time.ConclusionsA model of benign tracheal stenosis in rats can be successfully established by nylon brush scraping induced mechanical injury. The modeling method is simple, controllable and reproducible. The model can be widely used in the investigation of pathogenic mechanism for benign airway stenosis and efficacy exploration of new treatment.
ObjectiveTo investigate the effect of different administration methods of tranexamic acid on postoperative pulmonary inflammation response during cardiopulmonary bypass (CPB).MethodsA total of 64 SD rats were included in the study. They were randomly divided into eight different groups. CPB model was established for the operation groups. The rats in the operation groups were given tranexamic acid at low (25 mg/kg), medium (50 mg/kg) or high (100 mg/kg) concentrations before or after the CPB. Blood cells count and coagulation function were assessed 1 hour after surgery. The concentration of interleukin (IL)-1β、IL-6 and tumor necrosis factor (TNF)-α in blood and lung lavage fluid were measured. The infiltration of inflammatory cells in lungs was observed by hematoxylin-eosin (HE) staining.ResultsThe concentration of inflammatory cells in the operation groups was higher than that in the control group (P<0.05). The use of tranexamic acid inhibited the increase of IL-6 and TNF-α in whole blood and lung lavage fluid due to CPB (P<0.05), but there was no significant difference among the experimental groups (P>0.05). Tranexamic acid could reduce the exudation of inflammatory cells in the lungs.ConclusionThe use of tranexamic acid can effectively reduce the release of inflammatory factors and reduce acute lung injury caused by CPB in rat models. But simply increasing the dose or changing the timing of administration is not more effective in reducing the intensity of the inflammatory response.
Right ventricular (RV) failure has become a deadly complication of left ventricular assist device (LVAD) implantation, for which desynchrony in bi-ventricular pulse resulting from a LVAD is among the important factor. This paper investigated how different control modes affect the synchronization of pulse between LV (left ventricular) and RV by numerical method. The numerical results showed that the systolic duration between LV and RV did not significantly differ at baseline (LVAD off and cannula clamped) (48.52% vs. 51.77%, respectively). The systolic period was significantly shorter than the RV systolic period in the continuous-flow mode (LV vs. RV: 24.38% vs. 49.16%) and the LV systolic period at baseline. The LV systolic duration was significantly shorter than the RV systolic duration in the pulse mode (LV vs. RV: 28.38% vs. 50.41%), but longer than the LV systolic duration in the continuous-flow mode. There was no significant difference between the LV and RV systolic periods in the counter-pulse mode (LV vs. RV: 43.13% vs. 49.23%). However, the LV systolic periods was shorter than the no-pump mode and much longer than the continuous-flow mode. Compared with continuous-flow and pulse mode, the reduction in rotational speed (RS) brought out by counter-pulse mode significantly corrected the duration of LV systolic phase. The shortened duration of systolic phase in the continuous-flow mode was corrected as re-synchronization in the counter-pulse mode between LV and RV. Hence, we postulated that the beneficial effects on RV function were due to re-synchronizing of RV and LV contraction. In conclusion, decreased RS delivered during the systolic phase using the counter-pulse mode holds promise for the clinical correction of desynchrony in bi-ventricular pulse resulting from a LVAD and confers a benefit on RV function.
Objective To assess the efficacy of a kind of new material lipid magnetic particle for isolation and detection of lung cancer circulating tumor cells (CTCs). Methods Immune lipid magnetic particles were prepared with reverse evaporation method and they were assembled into kits with EpCAM and EGFR antibody respectively. Their efficacy were evaluated by detecting A549 cells in group A (A549 cells mixed in phosphated buffer solution) and group B (A549 cells mixed in blood from healthy volunteers). Lung cancer CTCs of hospitalized patients were also detected with both immune magnetic particals. Then the detecting efficacy was compared between EpCAM immune lipid magnetic particles and the conventional CellsearchTM system. Results The immune lipid magnetic particles had high capture efficiency for CTCs isolation and identification. The median of EpCAM immune lipid magnetic particles method in detecting A549 cells in group A was 92%, and EGFR was 90%. The median of EpCAM immune lipid magnetic particles method in detecting A549 cells in group B was 85%, and EGFR was 81%. In 13 patients with lung cancer, CTCs can be detected with both immune lipid magnetic particles methods and both medians were 5; In negative control, the medians of both methods were 0 (P＜0.05). EpCAM immune lipid magnetic particles method can detect more CTCs than conventional CellsearchTM system in 3 lung cancer patients. Conclusions Immune lipid magnetic particles have good efficacy for lung cancer CTCs detection and has promising clinical application value. The EpCAM immune lipid magnetic particles have equal efficiency in detecting lung cancer CTCs with EGFR. There is a trend that EpCAM immune lipid magnetic particles is superior to the conventional CellsearchTM system.