Acute respiratory distress syndrome (ARDS) is the most common cause of acute respiratory failure. Extensive researches have been conducted for the pathophysiology of this disease, but the mortality rate remains high. Previous studies have found that catecholamines play an important role in acute lung injury, and newly discover prompted that upregulation of phagocyte-derived catecholamines augmented the acute inflammatory response in acute lung injury which provides a new way of thinking. In the current review, we describe the mechanism of the phagocyte-derived catecholamines augmenting the acute lung injury.
Pulmonary hypertension is a disease characterized by pulmonary artery pressure increased, with or without small artery pathological change, which ultimately leads to right heart failure or even death. Pulmonary hypertension seriously threatens to human health, however, the pathogenesis of pulmonary hypertension is unclear. Previous studies have found that bone morphogenetic protein (BMP) signaling system played an important role in the progress of pulmonary hypertension. In the current review, we describe the mechanism of BMP4 in the development of pulmonary hypertension.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
Acute aortic dissection is featured as sudden onset and high mortality. Regardless early optimal surgical intervention and strict medical therapy, incidence of late complications is still high. Thus, specific imaging techniques and precise measurement of biomarkers to predict complications are needed. In the present study, we reviewed related papers to compare traditional imaging techniques (computed tomography, echocardiography) and magnetic resonance imaging (MRI) in the diagnosis of chronic aortic dissection. In addition, we discussed how to further evaluate aortic dissection by MRI.
Acute lung injury is a kind of common complication after cardiopulmonary bypass. Acute lung injury is attributed to the ischemia-reperfusion injury and systemic inflammatory response syndrome. Several factors common in cardiac surgery with cardiopulmonary bypass may worsen the risk for acute lung injury including atelectasis, transfusion requirement, older age, heart failure, emergency surgery and prolonged duration of bypass. Targets for prevention of acute lung injury include mechanical, surgical and anesthetic interventions that aim to reduce the contact activation, systemic inflammatory response, leukocyte sequestration and hemodilution associated with cardiopulmonary bypass. We aim to review the etiology, risk factors and lung protective strategies for acute lung injury after cardiopulmonary bypass.
The replacement of thoracic aorta and elimination of proximal intimal tear are the classic methods for the treatment of Stanford type A aortic dissection. However, some patients still have residual tears in the distal aorta after operation and lead to dilation of the false lumen due to continuous perfusion. As negative remodeling of distal aorta is closely related to the long-term prognosis of patients, the exploration of related influencing factors has attracted the attention of scholars recently. We aim to review the definition, pathological mechanism and risk factors of unfavorable remodeling after open surgery.
Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.
ObjectiveTo investigate the role and potential mechanisms of neuropilin-1 (NRP1) in the pathogenesis of vein graft failure.MethodsThe rat vascular smooth muscle cells (VSMCs) were transfected with NRP1-shRNA adenovirus and negative control adenovirus respectively. Cell counting kit-8, flow cytometry, Transwell and Western blot were used to investigate the effects of inhibition of NRP1 on VSMCs proliferation viability, apoptosis, migration capacity and its downstream signaling pathway protein expression.ResultsThe proliferation and migration of rat VSMCs could be inhibited after down-regulation of NRP1, and the increase of apoptosis was also observed. Moreover, inhibition of NRP1 significantly reduced Akt and NF-κB phosphorylation in rat VSMCs, but had little effect on activation of ERK1/2.ConclusionNRP1 may promote vein graft hyperplastic remodeling by regulating the proliferation and migration of VSMCs through PI3K/Akt and NF-κB pathways, but further animal study is required.
In the absence of symptoms, silent cerebral infarction can be discovered incidentally during an imaging or neuropathological examination. After cardiovascular surgery with cardiopulmonary bypass, the morbidity is high, and it may contribute to neurocognitive dysfunction, symptomatic cerebral infarction and increased risk of death. The embolus caused by various operations intraoperatively are closely associated with this progress. However, controversies over the prevention still persist. As a result, an overall summary of silent cerebral infarction after cardiovascular surgery with cardiopulmonary bypass will be presented in this review.
ObjectiveTo analyze the differences in proteins between aneurysm/dissection patients and healthy subjects, and subsequently figure out differential proteins related to medial degeneration of aortic aneurysm/dissection.MethodsAortic wall samples were collected from 6 male aortic aneurysm patients (an aortic aneurysm group, mean age 56.50±8.19 years), 6 male aortic dissection patients (an aortic dissection group, mean age 54.17±6.68 years) and 6 male healthy subjects (a normal group, mean age 40.50±9.31 years) between December 2019 and May 2020 in West China Hospital of Sichuan University. Quantitative proteomics was performed using tandem mass tag (TMT) techniques, followed by gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis.ResultsA total of 63 differential proteins were obtained both in the aortic aneurysm group and the aortic dissection group compared with the normal group, with 30 up-regulating and 33 down-regulating. The differential proteins were involved in multiple biological processes and clusted on peroxisome proliferators-activated receptor (PPAR) signaling pathway, extracellular matrix-receptor interaction signaling pathway and complement and coagulation cascades signaling pathway.ConclusionThe identified proteins may help to demonstrate new molecular mechanisms related to medial degeneration of aortic aneurysm/dissection.