Yongxin Zhou

Risk factors for ventilator dependency following coronary artery bypass grafting.

Background: Ventilator dependency following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG). Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD). Results: The incidence of PVD was 13.8% (81/588). The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092). Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879), preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232), preoperative arterial oxygen partial pressure (PO2) (OR=0.462, 95%CI 0.235-0.783) and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783). Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO2 and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.

PI3K/AKT Mediated P53 Down-Regulation Participates in CpG DNA Inhibition of Spontaneous B Cell Apoptosis

The unmethylated CpG DNA can prevent spontaneous apoptosis of B cells. However, the precise mechanisms by which CpG DNA blocks apoptosis remain unclear. In this study, we showed B cell apoptosis was significantly inhibited by addition of CpG DNA. Treatment of CpG DNA could reduce the expression of caspase 3, increase IAP and Bcl-xL expressions, and inhibit p53 protein expression which level was increased in B cell spontaneous apoptosis at 24 h. AKT kinase activity was increased with the incubation of CpG DNA. The wortmannin and Ly294002 could abrogate the protection of B cell from apoptosis by CpG DNA. The up-regulations of Bcl-xL and IAP by CpG DNA were not inhibited when blocking PI3K by specific inhibitor Ly294002, while the inhibition of p53 by CpG DNA could be blocked by Ly294002. These results demonstrated that the inhibition of spontaneous B cell apoptosis by CpG DNA was correlated to up-regulation of Bcl-xL, IAP and down-regulation of p53 and caspase 3. CpG DNA inhibition of p53 is mediated through PI3K/AKT signaling.

Transcatheter Closure of Adult Patent Ductus Arteriosus with Severe Pulmonary Hypertension

The purpose of this study was to investigate the application of trial balloon occlusion for permanent closure of patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) in adults, and to assess its immediate and short-term results. From September 1999 to September 2005, a total of ten adults (two males, ages ranging from 20 to 54 years) with PDA who met the criterion for severe PH (basal pulmonary vascular resistance > 8 Wood units) received trial balloon occlusion via an embolectomy balloon catheter. Post-occlusion hemodynamics, along with an overall clinical and hemodynamic assessment, was used to consider the indication of closure of PDA. Nine of the patients underwent successful transcatheter closure of PDA and subsequently used Amplatzer occluder devices. Chest X-ray, cardiography and echocardiography were used for follow-up evaluation of the treatment within 6 months after successful closure of PDA. No patient had a detectable residual shunt by color flow mapping or any other complications (device migration, hemolysis, endocarditis, etc.) at follow-up. In conclusion, trial balloon occlusion helps to determine anticipated hemodynamics after closure of PDA, so it is conducive to indicating permanent closure of adult PDA with reversible but severe PH. Furthermore, satisfactory immediate and short-term outcomes have proven this method to be safe and valid.

Results of radiofrequency ablation for permanent atrial fibrillation in patients undergoing mitral valve surgery.

Objectives — The study aim was to evaluate the safety and feasibility of radiofrequency ablation for the surgical treatment of permanent atrial fibrillation in patients with degenerative mitral valve disease. Design — From August 2000 to August 2003, 40 consecutive patients (mean age 69.0 ± 9.3 years) with permanent atrial fibrillation and degenerative mitral valve disease underwent surgical radiofrequency ablation in conjunction with 22 mitral valve repairs and 18 mitral valve replacements. The mean duration of chronic AF was 5.1 ± 3.4 years.The completeness of follow-up was 100%.The mean follow-up time was 4.6 ± 2.0 years (range 0 to 7.8 years). Results — Thirty-day mortality was 2.5% (1 patient), the cause of death was cardiac failure. Cardiac failure and temporary A-V block were the most common postoperative complications. Both occurred in 10% (4 patients). No complication was related to the ablation procedure.At discharge, 65% (26/40) of the patients were in sinus rhythm. Overall incidence of sinus rhythm at the end of the follow-up was 56.4% (22/39). The 1-, 3- and 5-year survival was 97.5%, 91.8% and 85.9%, respectively. Conclusion — Mitral valve surgery combined with radiofrequency ablation is a safe and effective procedure in patients with permanent atrial fibrillation and degenerative mitral valve disease.The result is encouraging in restoring sinus rhythm, and an excellent postoperative survival rate can be achieved.

Identification of mutant genes with high‐frequency, high‐risk, and high‐expression in lung adenocarcinoma

To identify mutant genes with high‐frequency‐risk‐expression between lung adenocarcinoma and normal samples.

Oesophageal perforation for oesophageal stone

The diagnosis of oesophageal perforation secondary to an oesophageal stone was made and confirmed by thoracic computed tomography (CT; Fig. 1) and left thoracotomy (Fig. 2) in a 38-year-old male patient, who presented with acute left hypochondriac pain preceded by vomiting. Fig. 2. Round oesophageal stone measuring 4 cm in diameter, came from the chronic persimmon consumption by the patient, removed during left thora-cotomy. Fig. 1. Thoracic CT-scan showing hydropneumothorax and a round shadow next to the distal segment of the oesophagus.