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Research progress of ferroptosis in cardiovascular diseases

Cardiovascular disease is a leading cause of death in Chinese population. It is of great significance to further explore the pathogenesis of cardiovascular diseases. Ferroptosis is a recently discovered iron-dependent and non-apoptotic form of regulated cell death, which exerts a regulatory role in a variety of biological events. Some studies have shown that ferroptosis plays an important role in the development of cardiovascular diseases. According to newly scientific reports, we summarized the mechanism and regulation in ferroptosis, and reviewed the results of ferroptosis in common cardiovascular diseases such as cardiac ischemia-reperfusion/myocardial infarction, cardiomyopathy, cardiac hypertrophy, atherosclerosis and abdominal aortic aneurysm.

Diagnosis and Management of Rare Pancreatic Neuroendocine Tumors

非体外循环下冠状动脉旁路移植术

目的 探讨和评价微创非体外循环冠状动脉旁路移植术(OPCAB)的临床效果. 方法 38例OPCAB患者中左冠状动脉主干病变 4例, 1支血管病变10例,2支14例,3支10例,均经胸骨正中切口行 OPCAB,每例移植血管1～5支,平均移植血管2.42支.应用左乳内动脉38支,大隐静脉54支. 结果 全组无手术死亡,36例顺利完成手术,2例转为心肺转流术下冠状动脉旁路移植术.38例均在手术后2～12小时,平均4.9±2.6小时顺利拔除气管内插管.全组均顺利康复,15例手术后1个月内恢复了原工作. 结论对有适应证的患者,OPCAB是一项安全有效的术式.

Effect of Coronary Artery Bypass Grafting on Patients with Coronary Heart Disease and Giant Left Ventricular Dimension but without Aneurysm

Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.

153例非体外循环冠状动脉旁路移植术

目的　总结 15 3例非体外循环冠状动脉旁路移植术患者无手术死亡的治疗经验。　方法　回顾性分析近4年来 15 3例非体外循环冠状动脉旁路移植术的临床资料、手术方法、手术结果。　结果　全组无手术死亡。每例平均移植旁路血管 3.1支 ,全组无围手术期心肌梗死、呼吸衰竭、肝肾功能衰竭等并发症 ,14 1例患者术后 4～ 6小时拔除气管内插管 ,86例患者未输库血 ,术后心绞痛均消失。所有患者均获随访 ,随访时间 2～ 4 2个月 ,无晚期死亡。1例患者于术后 1年 6个月出现活动后胸闷、心绞痛 ,其余患者症状均消失 ,活动量明显增加 ,心功能改善。　结论　非体外循环冠状动脉旁路移植术安全、有效 ,术后并发症少 ,正确掌握其手术适应证、手术技巧和围术期处理 ,是确保手术疗效的关键。

Combined Cardiac Valve Surgery and Coronary Artery Bypass Grafting： Report of 81 Cases

Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting （CABG）. Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.

电视胸腔镜双侧肺减容术21例

目的　总结电视胸腔镜双侧肺减容术（BLVRS）治疗慢性阻塞性肺气肿（COPE）的临床经验，并观察其疗效。　方法　2009年9月至2010年9月，南京医科大学附属南京医院对21例COPE患者行电视胸腔镜 BLVRS，均为男性，年龄（65.71±9.05）岁。采用电视胸腔镜专用切缝器（Endo-GIA）切除过度充气的肺大泡组织，常规用4-0 Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离（6-MWD）的变化，并与术前进行比较，评价手术疗效。　结果　无围术期死亡，术后住院时间（13.20±4.60） d，胸腔引流时间（5.33±3.67） d。术后持续肺漏气 （5.91±3.52） d 12例，出现急性呼吸衰竭1例，广泛皮下气肿2例，合并肺部感染5例，均经相应的处理治愈。随访21例，随访时间6个月，术后6个月第1秒用力呼气容积［（1.63±0.23） L vs. （1.21±0.17） L］、动脉血氧分压［（77.62±6.98） mm Hg vs. （67.54±8.12） mm Hg］和6-MWD ［（430.55±80.49） m vs. （283.48±108.12） m］较术前增加，动脉血二氧化碳分压（PaCO2）、、残气量（RV） 较术前降低（P＜0.05）。　结论　电视胸腔镜BLVRS安全、有效，特别对非均质性肺气肿，可明显改善患者的生活质量，近期效果显著。

Modified Bentall Procedure for the Treatment of Stanford Type A3 Aortic Dissection

ObjectiveTo summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A3 aortic dissection (AD). MethodsFifty-four patients with Stanford type A3 AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. ConclusionModified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.

Analysis of the Risk Factors of Graft Stenosis Following Coronary Artery Bypass Grafting

Objective To investigate the risk factors of grafts stenosis following coronary artery bypass grafting (CABG), in an effort to benefit the prevention and treatment of graft stenosis after CABG. Methods The clinic data of 197 patients who underwent CABG and received selective angiography between January 1999 and December 2007 were retrospectively analyzed and all patients were subdivided into stenosis group (n=87) and normal group(n=110). Statistic analysis of χ2 test, ttest and multiple logistic regressions were used to find out the risk factor. Results It was demonstrated by angiography that there was graft stenosis after CABG in 87 patients involved 321 stomas (305 in the distal and 16 in the proximal). Univariate analysis revealed that diabetes mellitus，dyslipidemia, distal anastomoses in right coronary artery (RCA) territory, ＜70% stenosis in target coronary artery, ＜1.5 mm in diameter in target artery, saphenous vein grafts(SVG) and offpump CABG were significantly related to stenosis of grafts following CABG, and logistic multivariate regression analysis showed that diabetes mellitus(OR=3.654)， dyslipidemia(OR=2.625), distal anastomoses in RCA(OR=1.694), ＜70% stenosis in target coronary artery(OR=1.763), ＜1.5 mm in diameter in target artery (OR=1.337)and utilization of SVG (OR=1.652) were independent risk factors of graft stenosis. Conclusion Diabetes mellitus，dyslipidemia, distal anastomoses in RCA, ＜70% stenosis in target coronary artery, ＜1.5 mm in diameter in target artery and utilization of SVG are the risk factors of graft stenosis following CABG.

急性Stanford A型主动脉夹层的外科治疗

Objective To investigate the surgical experience, best timing of operative intervention, technique and clinical effects of surgical treatment for acute Stanford type A aortic dissection. Methods The clinical material, method of operation and follow-up results were retrospectively reviewed for 29 patients with acute Stanford type A aortic dissection in latest 8 years. The main principle of surgical therapy in Stanford type A aortic dissection was resecting the partial aorta of intimal tear to prevent aortic rupture, repairing the intimal tear and replacing or reconstructing the aorta by composite graft, and simultaneously dealing with the heart valve and myocardial ischemia disease. Results Emergency surgery was performed in 13 cases, and sub-emergency surgery for 16 cases. There were 2 cases (69%) early postoperative death. One patient died of severe arrhythmia after emergency surgery, and another case died of multiorgan failure after operation. After operation 6 cases needed to be re-operated for bleeding, 3 cases developed lung infection and respiratory failure, 4 cases delayed waking, 2 cases occurred acute renal failure and one case occurred gastrorrhagia, they all were treated appropriately and recovered. Twenty-four cases? (889%) were followed up for 23.6±101 months. One case died after 16 months postoperatively due to endocarditis and cerebral hemorrhage. One case was recorded of sudden death in 26 months. Currently other patients were still healthy as the normal person. Conclusion Early-time surgical treatment is the key factor for acute Stanford type A aortic dissection to reduce the mortality. Procedures chosen must depend on the location of intimal tear, involved extension, and the condition of aortic valve and aortic root. It is principle as simplifying operation and good effects of treatment.