Yiming Ni

Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases

Intracardiac leiomyomatosis is rare but has been increasingly reported in recent years. Owing to its rarity, intracardiac leiomyomatosis has been reported only as isolated case reports and case series. This disorder is thought to be underestimated and easily overlooked in the clinic, while it is dangerous owing to the risk of sudden death caused by total outflow tract obstruction. We performed an electronic literature search for intracardiac leiomyomatosis and identified 194 cases that were reported in English from 1974 (the first reported case) to September 2012. Our aim is to provide a detailed and comprehensive review of the clinical presentation, diagnosis, histopathological characterization, treatment and prognosis of this disorder. According to our analysis, intracardiac leiomyomatosis is most common in the fifth decade, and the mean age of detection is ~50 years. Most patients had undergone previous hysterectomy/myomectomy or had a coexisting uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, syncope, oedema of the lower extremities and palpitation. Transoesophageal echocardiography, computed tomography and magnetic resonance imaging are helpful in the preoperative diagnosis and to guide the surgical management. Complete removal guarantees an excellent outcome, with no recurrence or postoperative death, while incomplete removal leads to recurrence in one-third of patients. Anti-oestrogen therapy is not imperative after incomplete removal owing to its inability to prevent recurrence.

Optimization of venous return tubing diameter for cardiopulmonary bypass

OBJECTIVE To determine the optimal venous tubing diameter for adult cardiopulmonary bypass (CPB) to improve gravity drainage and to reduce priming volume. METHODS (A) Maximum bovine blood flow rates by gravity drainage were assessed in vitro for four different tubing diameters (1/2, 3/8, 5/16,1/4 inch) with three different lengths and various pre- and afterloads. Based on the results of (A) and multiple regression analyses, we developed equations to predict tubing sizes as a function of target flows

Cardiac hypertrophy and dysfunction induced by overexpression of miR-214 in vivo.

BACKGROUND An increasing number of studies have demonstrated the critical role of microRNAs in the pathogenesis of cardiac hypertrophy and dysfunction. This study evaluated whether miR-214 plays a pivotal role in the development of cardiac hypertrophy and heart failure. METHODS In human tissues, miR-214 overexpression was determined to promote cardiac hypertrophy. We predicted miR-214 direct target by bioinformatics database and verifed it using luciferase dual reporting system. We silenced miR-214 using a specific antagomir in a pressure-overload mouse model of heart failure. RESULTS Analysis of transgenic mice with cardiomyocyte-specific overexpression of miR-214 indicated that their hearts were 21% heavier than wild-type hearts and expressed several biochemical and functional markers consistent with dilated cardiomyopathy. These findings include enlarged left ventricular internal diameters, wall thinning, reduced ejection fraction, fractional shortening, and an increased fetal gene expression. The enhancer of zeste homolog 2 (EZH2) was confirmed as a direct target of miR-214 in cardiomyocytes. In vivo silencing of miR-214 using a specific antagomir rescued cardiac EZH2 expression and prevented cardiac hypertrophy and dysfunction. CONCLUSIONS Taken together, these results suggest that miR-214 may induce pathologic cardiac hypertrophy in part by reducing EZH2 messenger RNA levels. MiR-214 may therefore be a potential therapeutic target for treating certain cardiac disease states.

Complete excision of a giant thyroid goiter in posterior mediastinum

Intrathoracic goiter is commonly located in the anterior mediastinum. Here we report a case of a 58-year-old Chinese male in whom we successfully removed the intrathoracic goiter and eased his dyspnea by a right posterolateral thoracotomy approach. Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication of surgery.

Cardiac Hemangioma: A Comprehensive Analysis of 200 Cases

Cardiac hemangioma is a rare clinical entity. An increasing number of cases have been reported in recent years. Most of them were found incidentally at autopsy or during clinical practice, and reported as isolated cases. Our study is the most comprehensive review of cardiac hemangioma to date. The clinical demographics, clinical features, histopathologic features, treatment, and prognosis of 200 cases are reported. Logistic regression analysis was performed to identify the independent predictors of hemangioma-related death and long-term adverse events. We provide a few recommendations for diagnosis and treatment of this uncommon and sometimes lethal disorder.

A rare case report of giant epicardial lipoma compressing the right atrium with septal enhancement

BackgroundCardiac Lipoma is a rare entity constituting approximately 10-19 % of primary tumors of the heart and pericardium. To our best knowledge, such a large cardiac lipoma with septal enhancement in our case has never been reported before.Case presentationHere we present a rare case of a 65-year-old symptomatic female with an unusual giant cardiac lipoma. Due to the enhancement of the tumor septa, it was first diagnosed as liposarcoma and thought to be unresectable. Debulking surgery was performed to release patient’s symptoms.ConclusionsThe patient ultimately underwent complete tumor resection with uneventful postoperative evolution. The postoperative pathological diagnosis is cardiac lipoma.

Aortic valve tear with severe aortic regurgitation following blunt chest trauma

An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a 55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a mechanical prosthesis.

Nrf2 plays a pivotal role in protection against burn trauma-induced intestinal injury and death

Nuclear factor (erythroid-derived 2)–like 2 (NRF2) is a basic leucine zipper transcription factor that principally defends against oxidative stress and also plays a unique role in severe sepsis. However, its contribution to intestinal injury and death after burn trauma is unclear.In this study, wild-type (Nrf2+/+) and Nrf2-deficient (Nrf2−/−) mice were subjected to 15% or 30% total body surface area burn or sham injury. Survival, systemic inflammation, and gut injury were determined. Nrf2−/− mice were more susceptible to burn-induced intestinal injury, as characterized by increases in damage to the gut structure and in intestinal permeability. This exacerbation was associated with an increase in the intestinal mRNA expression of inflammatory cytokines (interleukin [IL]–6, IL-1B, monocyte chemotactic protein 1, intercellular adhesion molecule, and vascular cell adhesion molecule) and a decrease in the intestinal mRNA expression of Nrf2-regulated genes (NAD(P)H dehydrogenasequinine-1 and glutamate-cysteine ligase modifier subunit). Nrf2-deficient mice also showed a lower survival rate and higher levels of systemic cytokines (IL-6 and IL-1B) and high-mobility group protein B1 than wild-type mice. This study demonstrates for the first time that mice that lack Nrf2 are more susceptible to burn-induced intestinal injury and have more systemic inflammation and a lower survival rate.

Early Aggressive Medical Treatment Associated with Selective Prophylactic Aortic Stent-Grafting for Aortic Intramural Hematoma

BACKGROUND Although recent studies suggest that medical treatment is appropriate for patients with aortic intramural hematoma (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit patients with IMH. METHODS Nineteen patients with IMH were prospectively studied; after initial clinical and radiological evaluation, 13 underwent early aggressive medical therapy (group 1), and 6 underwent early aggressive medical therapy and prophylactic endovascular stent-grafting (group 2). RESULTS In group 1, one patient with type A IMH died prior to surgical consultation because of cardiac tamponade; another patient with type A IMH underwent replacement of the ascending aorta at the 6-month follow-up. The condition of the other 11 patients stabilized during hospitalization and after discharge. The disease spontaneously regressed in 10 patients, and the intramural hematoma completely resolved in 5 patients. In group 2, follow-up imaging revealed complete coverage of the penetrating aortic ulcers and regression of the intramural hematoma; endovascular leaks have not yet occurred. CONCLUSIONS Our protocol may be used as an alternative approach for patients with IMH. After initial clinical and radiological evaluation, the condition of patients without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH patients with penetrating aortic ulcers in the descending aorta.

Study of telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer and its clinical significance

OBJECTIVE To detect telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer (NSCLC) and to evaluate its clinical value. METHODS From July 2005 to May 2007, 167 pleural lavage fluid specimens were obtained from 135 patients with NSCLC and 32 patients with benign lung tumour during operation. Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in these specimens. Pleural lavage cytology (PLC) analysis of the pleural lavage fluid specimens was used for comparison. All the above specimens were examined within 3h. RESULTS The positive rate of telomerase activity and PLC in pleural lavage fluid from patients with NSCLC was 25.2% (34/135) and 8.1% (11/135), respectively, with a significant difference (P<0.05). Telomerase activity was detected in all 11 specimens with positive cytological examination. Telomerase activity was negative in all 32 patients with benign lung tumour. There was a significant relationship between telomerase activity and pleural extension, T level, N level as well as the clinical TNM (tumour, node, metastasis) stage of lung cancer. A significant association was found between positive telomerase activity and overall survival rate, even stage I survival rate. Multivariate Cox regression analysis demonstrated that telomerase activity, as well as PLC and the TNM stage were independent predictors of prognosis. CONCLUSION Telomerase activity is a useful adjunct for cytological method in the diagnosis of pleural micro-metastasis and was related to prognosis in a patient with NSCLC.