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MicroRNA expression in the hippocampal CA1 region under deep hypothermic circulatory arrest

Neural Regeneration Research 2019年第11期14卷 2003-2010页

作者： Xiao-Hua Wang Dong-Xu Yao Xiu-Shu Luan Yu Wang Hai-Xia Liu Bei Liu Yang Liu Lei Zhao Xun-Ming Ji Tian-Long Wang Department of Anesthesiology Xuanwu HospitalCapital Medical UniversityBeijingChina Institute of Geriatrics BeijingChina National Clinical Research Center for Geriatric Disorders BeijingChina Department of Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijingChina Cerebrovascular Research Center Xuanwu HospitalCapital Medical UniversityBeijingChina

Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulatory arrest are unclear. After piglet models underwent 60 minutes of deep hypothermic circulatory arrest at 14°C, expression of microRNAs(miRNAs) was analyzed in the hippocampus by microarray. Subsequently, TargetScan 6.2, RNA22 v2.0, miRWalk 2.0, and miRanda were used to predict potential targets, and gene ontology enrichment analysis was carried out to identify functional pathways involved. Quantitative reverse transcription-polymerase chain reaction was conducted to verify miRNA changes. Deep hypothermic circulatory arrest altered the expression of 35 miRNAs. Twenty-two miRNAs were significantly downregulated and thirteen miRNAs were significantly upregulated in the hippocampus after deep hypothermic circulatory arrest. Six out of eight targets among the differentially expressed miRNAs were enriched for neuronal projection(cyclin dependent kinase, CDK16 and SLC1 A2), central nervous system development(FOXO3, TYRO3, and SLC1 A2), ion transmembrane transporter activity(ATP2 B2 and SLC1 A2), and interleukin-6 receptor binding(IL6 R)– these are the key functional pathways involved in cerebral protection during deep hypothermic circulatory arrest. Quantitative reverse transcription-polymerase chain reaction confirmed the results of microarray analysis. Our experimental results illustrate a new role for transcriptional regulation in deep hypothermic circulatory arrest, and provide significant insight for the development of miRNAs to treat brain injuries. All procedures were approved by the Animal Care Committee of Xuanwu Hospital, Capital Medical University, China on March 1, 2017(approval No. XW-INI-AD2017-0112).

关键词： nerve regeneration cerebral protection deep hypothermic circulatory arrest gene ontology enrichment analysis microRNA hippocampus post-transcriptional expression microarray bioinformatics neural regeneration

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Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

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Chinese Medical Journal 2019年第10期132卷 1218-1227页

作者： Huai-Wu He Yun Long Da-Wei Liu Can Ince Department of Critical Care Medicine Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Science Beijing 100730 China Department of Intensive Care Erasmus MC University Hospital Rotterdam Rotterdam 3015 CE the Netherlands

Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell;Type 2: Macro-Micro incoherence + normal cell;Type 3: Micro-Cell incoherence + normal Micro;and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.

关键词： circulatory shock Shock Tissue perfusion Microcirculation Hemodynamic coherence Resuscitation incoherence

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Mechanical circulatory Support for the Failing Heart:Which Device to Choose

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Cardiovascular Innovations and Applications 2015年第B10期1卷 119-127页

作者： Mustafa Ahmed Rene Alvarez Division of Cardiovascular Medicine University of Florida College of MedicineGainesvilleFLUSA Division of Cardiology Temple UniversityPhiladelphiaPAUSA

Critical cardiogenic shock remains a problem with staggering mortality,with the best hope of survival depending on timely and aggressive *** often requires the use of extracorporeal mechanical support in addition to vasoactive medications to manage patients through their initial *** decision to use such support must be made early in the clinical presentation,and is best done in a multidisciplinary *** this article,we review the literature and provide an algorithm for the treatment of cardiogenic shock.

关键词： cardiogenic shock extracorporeal support temporary mechanical circulatory assist

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Investigating the circulatory-respiratory response of elderly people during Tai Chi Yuttari-exercise

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Health 2013年第12期5卷 58-63页

作者： Takuo Nomura Yoshiteru Akezaki Kohei Mori Emi Nakamata Fuminari Asada Yoshiaki Mori Satoru Kai Masahito Watanabe Department of Rehabilitation Sciences Kansai University of Welfare Sciences Osaka Japan Department of Rehabilitation Sciences Kansai University of Welfare Sciences Osaka Japan Theraputic Exercise Research Laboratory Kansai University of Welfare Sciences Osaka Japan Osaka Rosai Hospital Center for Preventive Medicine Osaka Japan

The purpose of this study was to examine the circulatory-respiratory dynamics in elderly people during Tai Chi Yuttari-exercise. The subjects were females with an average age of 74 years who had been continuously practicing Tai Chi Yuttari-exercise for at least six months. The heart rate and blood pressure were measured before and after the subjects performed four different versions of Tai Chi Yuttari-exercise. The perceived exertion was evaluated using the Borg scale. The respiratory rate, oxygen uptake and respiratory quotient (RQ) were measured using an expired gas analyzer. The results showed an increase in heart rate during exercise, but confirmed that the rise in HR was below the safety limit. The blood pressure tended to be low post-exercise. Regarding perceived exertion, the maximum heart-lungs Borg scale response was 9 (very light). A slight increase in the respiratory rate was observed while exercising, but no abnormal breathing patterns were observed. The average metabolic equivalents (METs) of the exercise ranged from 1.34 to 1.87, and the average RQ ranged from 0.82 to 0.90. The circulatory-respiratory dynamics observed in this study verified that elderly females with an average age of 70 years could safely perform the Tai Chi Yuttari-exercise. This study helped obtain basic data for expanding the indications for this exercise.

关键词： Tai Chi Chuan Exercise Therapy Aged circulatory and Respiratory Physiological Phenomena Rehabilitation

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PSYCHOLOGICAL DEVELOPMENT OF CHILDREN AFTER CARDIAC SURGERY WITH PROFOUND HYPOTHERMIA AND circulatory ARREST

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Medical Bulletin of Shanghai Jiaotong University 1994年第1期17卷 24-28页

作者：黄惠民陶素蝶苏肇伉丁文祥曹鼎方

Fifty-three patients with congenital heart disease were follwed up 14 to 57months after cardiac surgery with profound hypothermia and circulatory *** quotient(IQ)was 88.6±16.1The incidence of psychological underdevelopedwas 13.2(7/53),higher than normal children population,The high incidence may be attri-buted to poor preoperative intellecutual *** circulatory arrest time weremore than 60 minutes in 9 cases,41-60 minutes in 32 cases and less than 40 minutes inanother 12 *** IQ of these three groups were 84.8±11.9,86.2±15.7and 95.3±19.2respctively and incidence of psychological underdeveloped were 11.1%,15.6% and 8.5%respectively,No significant difference existed between *** time of circulatory ar-rest also had no obvious correlation with IQ.

关键词： profound hypothermia and circulatory arrest congenital heart diseaseintelligence quotient

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1400W reduces ischemia reperfusion injury in an ex-vivo porcine model of the donation after circulatory death kidney donor

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World Journal of Transplantation 2014年第4期4卷 299-305页

作者： Sarah A Hosgood Phillip J Yates Michael L Nicholson Department of Infection Immunity and Inflammation Transplant Group University of Leicester LE5 4PW Leicester United Kingdom Leicester General Hospital University Hospitals of Leicester LE5 4PW Leicester United Kingdom

AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase(iN OS) inhibitor in a model of donation after circulatory death(DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min warm ischemia. They were then stored on ice for 18 h before being reperfused ex vivo with oxygenated autologous blood on an isolated organ perfusion system. The selective i NOS inhibitor 1400W(10 mg/kg) was administered before reperfusion(n = 6) vs control group(n = 7). Creatinine(1000 μmol/L) was added to the system, renal and tubular cell function and the level of ischemia reperfusion injury were assessed over 3 h of reperfusion using plasma, urine and tissue samples. RESULTS: Kidneys treated with 1400 W had a higher level of creatinine clearance(CrC l) [area under the curve(AUC) CrC l: 2.37 ± 0.97 mL /min per 100 g vs 0.96 ± 0.32 mL /min per 100 g, P = 0.004] and urine output [Total: 320 ± 96 mL vs 156 ± 82 mL, P = 0.008]. There was no significant difference in levels of fractional excretion of sodium(AUC, Fr ex Na+: Control, 186.3% ± 81.7%.h vs 1400 W, 153.4% ± 12.1%.h, P = 0.429). Levels of total protein creatinine ratio were significantly lower in the 1400 W group after 1 h of reperfusion(1h Pr/Cr: 1400 W 9068 ± 6910 mg/L/mmol/L vs Control 21586 ± 5464 mg/L/mmol/L, P = 0.026). Levels of 8-isoprostane were significantly lower in the 1400 W group [8-iso/creatinine ratio: Control 239 ± 136 pg/L/mmol/L vs 1400 W 139 ± 47 pg/L/mmol/L, P = 0.041].CONCLUSION: This study demonstrated that 1400 W reduced ischaemia reperfusion injury in this porcine kidney model of DCD donor. Kidneys had improved renal function and reduced oxidative stress.

关键词： Kidney Transplantation Ischemia Donation after circulatory death Inducible nitric oxide

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Application of cerebral-myocardial perfusion combined with lower body circulatory arrest in pediatric complex aortic arch surgery

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中国循环杂志 2018年第S1期33卷 171-171页

作者： Yuanyuan Tong Jinping Liu Ruoning Lv Yu Jin Department of Cardiopulmonary Bypass National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Background Adjunct RCP to DHCA ensures some extent uninterrupted cerebral perfusion and that promotes one-stage repair of complex aortic arch ***-stage repair may induce longer myocardial ischemic *** there evolved cerebral-myocardial perfusion to reduce myocardial ischemic *** We reviewed 78 patients from January 2010 to July 2017 in our center.

关键词： lower body circulatory arrest pediatric complex aortic arch surgery DHCA

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Chinese expert consensus statement on the diagnosis and treatment of fulminant myocarditis

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Science China(Life Sciences) 2019年第2期62卷 187-202页

作者： Daowen Wang Sheng Li Jiangang Jiang Jiangtao Yan Chunxia Zhao Yan Wang Yexin Ma Hesong Zeng Xiaomei Guo Hong Wang Jiarong Tang Houjuan Zuo Li Lin Guanglin Cui Section of Precision Medicine Group of Chinese Society of Cardiology,Editorial Board of Chinese Journal of Cardiology &Working Group of Adult Fulminant Myocarditis 1Division of Cardiology Department of Internal Medicine Tongji Hospital Tongji Medical College Huazhong University of Science &Technology Wuhan 430030 China 不详

Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock,with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial(NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time,we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes(i) mechanical life support(applications of mechanical respirators and circulatory support systems,including intraaortic balloon pump and extracorporeal membrane oxygenation),(ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and(iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.

关键词： adult fulminant myocarditis diagnosis and treatment expert consensus life support-based comprehensive treatment regimen cardiogenic shock mechanical circulatory support

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Successful repair of acute type A aortic dissection during pregnancy at 16th gestational week with maternal and fetal survival: A case report and review of the literature

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World Journal of Clinical Cases 2019年第18期7卷 2843-2850页

作者： Su-Wei Chen Yong-Liang Zhong Yi-Peng Ge Zhi-Yu Qiao Cheng-Nan Li Jun-Ming Zhu Li-Zhong Sun Department of Cardiovascular Surgery Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Beijing Aortic Disease Center Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Beijing Institute of Heart Lungand Blood Vessel DiseasesBeijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Beijing Engineering Research Center of Vascular Prostheses Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

BACKGROUND Aortic dissection during pregnancy is a rare but life-threatening event for mothers and fetuses. It often occurs in the third trimester of pregnancy and the postpartum period. Most patients have connective tissue diseases such as Marfan syndrome. Thus, the successful repair of a sporadic aortic dissection with maternal and fetal survival in the early second trimester is extremely rare. CASE SUMMARY A 28-year-old woman without Marfan syndrome presented with chest pain at the 16th gestational week. Aortic computed tomographic angiography confirmed an acute type A aortic dissection (TAAD) with aortic arch and descending aorta involvement. Preoperative fetal ultrasound confirmed that the fetus was stable in the uterus. The patient underwent total arch replacement with a frozen elephant trunk using moderate hypothermic circulatory arrest with the fetus in situ. The patient recovered uneventfully and continued to be pregnant after discharge. At the 38^th gestational week, she delivered a healthy female infant by cesarean section. After 2.5 years of follow-up, the patient is uneventful and the child’s development is normal. CONCLUSION A fetus in the second trimester may have a high possibility of survival and healthy growth after aortic arch surgery.

关键词： Aortic dissection Pregnancy Cardiopulmonary bypass Hypothermia circulatory arrest Case report

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Challenging rescue of a 4 years old boy with H1N1 infection by extracorporeal membrane oxygenator: A case report

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World Journal of Clinical Cases 2014年第10期2卷 578-580页

作者： Nestoras Papadopoulos Sven Martens Harald Keller Ali El-Sayed Ahmad Anton Moritz Andreas Zierer Division of Thoracic and Cardiovascular Surgery Johann-Wolfgang-Goethe University Division of Thoracic and Cardiovascular Surgery University Hospital Muenster

Introduction: World Health Organization announced on April 2009 a public health emergency of international concern caused by swine-origin influenza A(H1N1) virus. Acute respiratory distress syndrome(ARDS) has been reported to be the most devastating complications of this pathogen. Extracorporeal membrane oxygenator(ECMO) therapy for patients with H1N1 related ARDS has been described once all other therapeutic options have been exhausted. Here, we report the case of a child(German, male) with H1N1-associated fulminate respiratory and secondary hemodynamic deterioration who was rescued by initial emergent ECMO established through a dialysis catheter and subsequent switch to central cannulation following median sternotomy. This report highlights several important issues. First, it describes a successful use of a dialysis catheter for the establishment of a veno-venous ECMO in an emergency case by child. Second, it highlights the importance of a closely monitoring of clotting parameters during ECMOtherapy and third, if severe respiratory failure is complicated by cardiogenic shock, veno-atrial ECMO support via median sternotomy should be considered as a viable treatment option without further delay.

关键词： Airway circulatory temporary support Coagulants Extracorporeal membrane oxygenation Infection

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