Objective To investigate the expressions of activating transcription factor 3 (ATF3) and ATF4, and their effects on γ-glutamylcysteine synthetase (γ-GCS) in lung tissues of patients with chronic obstructive pulmonary disease (COPD). Methods Non-cancerous lung tissue specimens ( 5 cm or above away from tumor) were collected from 40 lung cancer patients who underwent pulmonary lobectomy between December 2008 and December 2009. The patients were divided into a COPD group and a control group according to whether they were complicated with COPD. The clinical data were collected including the history in detail, physical examination, chest X-ray or lung CT, and pulmonary function test. The mRNA and protein expressions of ATF3, ATF4, and heavy subunit of γ-GCS (γ-GCS-HS) in lung tissues were detected by in situ hybridization and immunohistochemistry. At the same time, the interaction between ATF3, ATF4 and γ-GCS-HS protein was investigated by co-immunoprecipitation method. The correlation of ATF3 and ATF4 with γ-GCS-HS was analyzed. Results The mRNA and protein expressions of ATF3, ATF4 and γ-GCS-HS in lung tissues of the COPD group were strongly positive, and significantly higher than those in the control group (P＜0.01). The co-immunoprecipitation showed that ATF3 and ATF4 antibodies could cross the clear protein bands in the immune precipitation captured by γ-GCS-HS, and the intensity in the COPD group was significantly enhanced than that in the control group (P＜0.01). Correlation analysis showed that the protein expressions of ATF3 and ATF4 were significantly positively correlated with the mRNA and protein expression of γ-GCS-HS (allP＜0.01). The protein expressions of ATF3, ATF4 and γ-GCS-HS in lung tissues were positively correlated with FEV1%pred and FEV/FVC (P＜0.01). Conclusions Oxidative stress induces overexpression of ATF3 and ATF4 which may paly role in the pathogenesis of COPD. ATF3 and ATF4 may play antioxidative effect by affecting the mRNA and protein expression of γ-GCS.
Objective To explore the diagnosis accuracy of cardiac tumor and effectiveness of surgical treatment. Method We retrospectively analyzed the clinical data of 103 patients with cardiac tumor in our hospital from 2011 through 2014 year. There were 65 females and 38 males, aging from 3 months to 82 years (average age of 59.71±13.80 years). We analyzed age distribution and clinical manifestation of the patients, as well as size and location of tumors. Then we compared effects of different surgical procedures. Result There was no death during evaluation. Early postoperative complications included arrhythmia (47 patients), electrolyte disturbance (13 patients), and cardiac dysfunction (9 patients). One patient with B-cell non-Hodgkin's lymphoma auto-discharged because of cardiac dysfunction. No relapse was obse-rved in the patients with atrial myxoma or lipoma (2 patients) during follow-up. One patient with benign myogenic tumor was lost during the follow-up. Six patients with malignant tumor were with poor long-term effect including 2 patients lost in the follow-up and 4 deaths due to tumor relapse during 1 year after surgery. Conclusion Surgery is still the most effective and major therapy of cardiac tumor.
ObjectiveTo investigate primary healthcare workers' knowledge, attitude and behaviour, and explore the way of guidelines' popularization, application and surveillance mechanism in primary healthcare institutions. MethodsHealthcare workers in seven township hospitals in Gaolan county, Gansu province were given a questionnaire to test their knowledge, attitudes and behaviour regarding Clinical practice guidelines. ResultsAmong the 143 distributed questionnaires, 143 valid were retrieved. The results showed that 80% of respondents knew the guidelines and 51% had used guidelines in treatment, 32% obtained guidelines mainly through distribution by affiliations. The most popular type of guidelines was self-developed by native departments. Respondents (37%) considered difficult availability of guidelines major barriers to popularization, 74% failed to receive training about guidelines, 88% looked forward to special organizations in charge of disseminating guidelines and conducting related training on how to apply guidelines. ConclusionPrimary healthcare workers report low awareness of, attention to and compliance with clinical practice guidelines. The greatest challenge for guidelines' popularization in township hospitals is difficult availability and it is of vital importance for primary institutions to enhance guidelines' implementation and strengthen learning and conduct training.
ObjectiveTo achieve a better early clinical result by modifying the total arch replacement and optimi-zing the procedure of operation. MethodWe retrospectively analyzed the clinical data of 38 patients patients with stanford a aortic dissection underwent the modifed total arch replacement in our hospital from September to December 2014. There were 26 males and 12 females with a mean age of 52.5 years ranging from 21-76 years. Three artery conduits were adopted during the surgical procedure. Right axillary artery and femoral artery cannulation were performed for cardiopulmonary bypass. The artificial graft and the left common carotid artery was anastomosed to provide simultaneous perfusion. Low rate bilateral brain perfusion began when circulation arrested at 26℃. Reperfusion restoration was obtained after the four-branch vascular graft anastomosed to the stent and aortic wall and completed the implantation of the elephant trunk. Then the aortic root and the vascular graft anastomosis were performed to reconstruct the ascending aorta. At last, the left subclavian artery and innominate artery were anastomosed to the branch of the vascular graft under the beating heart. ResultAll 38 operations were successful. The mean hypothermic circulatory time of the whole group was 18.8±4.2 min, the time of ascending aorta blocking was 86.1±14.2 min, the time of cardiopulmonary bypass was 178.4±71.4 min, the time of postoperative awakening was 4.7±2.0 h, the time of assisted mechanical ventilator was 38.7±19.9 h. One patient died because of multiple organ dysfunction syndrome (MODS), 3 patients accepted the hemodialysis, 6 patients suffered from transient neurological dysfunction, 1 patient suffered from paraparesis. There was no further complication during the follow-up of 1-3 months. ConclusionThe modified total aortic arch replacement can shorten the circulatory arrest time, cardiac arrest time and cardiopulmonary time, provide effective organ perfusion, and reduce the neurological complication and visceral damage.
ObjectiveTo evaluate the early and mid-term outcomes of GK bileaflet mechanical valve applied in mitral valve replacement. MethodsTwenty patients with rheumatic mitral stenosis underwent mitral valve replacement in our hospital from March 2008 to June 2011. Ten patients of them chose GK bileaflet mechanical valve for surgery (a GK group, 5 males and 5 females, aged 56.4±8.9 years), while the other 10 patients chose Medtronic Open Pivot mechanical valve (a Medtronic group, 4 males and 6 females, aged 50.2±8.0 years). The preoperative, perioperative and postoperative data were analyzed and compared between the two groups. Cardiac CT angiography (CTA) and transesophageal echocardiography (TEE) were performed to evaluate leaflets opening angle, the morphological features of the mechanical valve and the hemodynamic features in the third year after surgery during the follow-up. ResultsNo mortality, defect, low cardiac output syndrome or bleeding after surgery occurred in either group. The result of 3-year follow-up showed that the function of the mechanical valve showed no difference between the two groups. Cardiac CTA and TEE showed good morphological features in all patients. ConclusionThe GK bileaflet mechanical valve has equivalent effect as Medtronic Open Pivot mechanical valve for mitral valve replacement during the 3-year follow-up.