Publications by authors named "Chen-Han Zhang"

11 Publications

  • Page 1 of 1

Blood Transfusion and Acute Kidney Injury After Total Aortic Arch Replacement for Acute Stanford Type A Aortic Dissection.

Heart Lung Circ 2021 Jun 10. Epub 2021 Jun 10.

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China. Electronic address:

Aim: To evaluate the effect of packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelet concentrate (PC) transfusions on acute kidney injury (AKI) in patients with acute Stanford type A aortic dissection (ATAAD) with total arch replacement (TAR).

Method: From December 2015 to October 2017, 421 consecutive patients with ATAAD undergoing TAR were included in the study. The clinical data of the patients and the amount of pRBCs, FFP, and PC were collected. Acute kidney injury was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Logistic regression was used to identify whether pRBCs, FFP, and platelet transfusions were risk factors for KDIGO AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT).

Results: The mean ± standard deviation age of the patients was 47.67±10.82 years; 77.7% were men; and the median time from aortic dissection onset to operation was 1 day (range, 0-2 days). The median transfusion amount was 8 units (range, 4-14 units) for pRBCs, 400 mL (range, 0-800 mL) for FFP, and no units (range, 0-2 units) for PC. Forty-one (41; 9.7%) patients did not receive any blood products. The rates of pRBC, PC, and FFP transfusions were 86.9%, 49.2%, and 72.9%, respectively. The incidence of AKI was 54.2%. Considering AKI as the endpoint, multivariate logistic regression showed that pRBCs (odds ratio [OR], 1.11; p<0.001) and PC transfusions (OR, 1.28; p=0.007) were independent risk factors. Considering KDIGO stage 3 AKI as the endpoint, multivariate logistic regression showed that pRBC transfusion (OR, 1.15; p<0.001), PC transfusion (OR, 1.28; p<0.001), a duration of cardiopulmonary bypass (CPB) ≥293 minutes (OR, 2.95; p=0.04), and a creatinine clearance rate of ≤85 mL/minute (OR, 2.12; p=0.01) were independent risk factors. Considering RRT as the endpoint, multivariate logistic regression showed that pRBC transfusion (OR, 1.12; p<0.001), PC transfusion (OR, 1.33; p=0.001), a duration of CPB ≥293 minutes (OR, 3.79; p=0.02), and a creatinine clearance rate of ≤85 mL/minute (OR, 3.34; p<0.001) were independent risk factors.

Conclusions: Kidney Disease: Improving Global Outcomes-defined stage AKI was common after TAR for ATAAD. Transfusions of pRBCs and PC increased the incidence of AKI, stage 3 AKI, and RRT. Fresh frozen plasma transfusion was not a risk factor for AKI.
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http://dx.doi.org/10.1016/j.hlc.2021.05.087DOI Listing
June 2021

Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen.

J Card Surg 2021 May 16;36(5):1659-1664. Epub 2020 Sep 16.

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.

Objectives: We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19).

Methods: From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery.

Results: Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period.

Conclusions: The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.
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http://dx.doi.org/10.1111/jocs.15041DOI Listing
May 2021

uc.38 induces breast cancer cell apoptosis via PBX1.

Am J Cancer Res 2017 1;7(12):2438-2451. Epub 2017 Dec 1.

Breast Disease Division, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu Province, China.

Long non-coding RNAs (lncRNAs) are transcripts longer than 200 bp with no protein-coding capacity. Transcribed ultraconserved regions (T-UCRs) are a type of lncRNA and are conserved among human, chick, dog, mouse and rat genomes. These sequences are involved in cancer biology and tumourigenesis. Nevertheless, the clinical significance and biological mechanism of T-UCRs in breast cancer remain largely unknown. The expression of uc.38, a T-UCR, was down-regulated in both breast cancer tissues and breast cancer cell lines. However, uc.38 was expressed at significantly lower levels in larger tumours and tumours of more advanced stages. Based on the results of in vitro and in vivo experiments, up-regulation of uc.38 expression inhibited cell proliferation and induced cell apoptosis. Thus, uc.38 suppressed breast cancer. Additional experiments revealed that uc.38 negatively regulated the expression of the pre-B-cell leukaemia homeobox 1 (PBX1) protein and subsequently affected the expression of Bcl-2 family members, ultimately inducing breast cancer cell apoptosis. Describing the uc.38/PBX1 axis has improved our understanding of the molecular mechanisms involved in breast cancer apoptosis and has suggested that this axis is a potential therapeutic target for breast cancer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752685PMC
December 2017

Shikonin reduces tamoxifen resistance through long non-coding RNA uc.57.

Oncotarget 2017 Oct 11;8(51):88658-88669. Epub 2017 Sep 11.

Breast disease division, First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.

Tamoxifen resistance is a serious problem in the endocrine therapy of breast cancer. Long non-coding RNAs play important roles in tumor development. In this study, we revealed the involvement of lncRNA uc.57 and its downstream gene BCL11A in TAM resistance. Tamoxifen-resistant MCF-7R cells showed lower expression of uc.57 and higher expression of BCL11A mRNA and protein than the parental MCF-7 cells. Moreover, levels of uc.57 mRNA were lower and BCL11A mRNA were higher in breast cancer tissues than in precancerous breast tissues. Shikonin treatment reduced tamoxifen resistance in MCF-7R cells both and , targeting uc.57/BCL11A. Fluorescence hybridization and RNA immunoprecipitation analyses showed that uc.57 binds to BCL11A. Uc.57 overexpression downregulated BCL11A and reduced tamoxifen resistance in MCF-7R cells both and . BCL11A knockdown also reduced tamoxifen resistance by inhibiting PI3K/AKT and MAPK signaling pathways. It thus appears shikonin reduces tamoxifen resistance of MCF-7R breast cancer cells by inducing uc.57, which downregulates BCL11A to inhibit PI3K/AKT and MAPK signaling pathways.
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http://dx.doi.org/10.18632/oncotarget.20809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687635PMC
October 2017

[Value of endobronchial ultrasound-transbronchial needle aspiration biopsy for diagnosis of PET-CT positive mediastinal lymph nodes].

Zhonghua Zhong Liu Za Zhi 2012 Aug;34(8):613-5

The First Affiliated Hospital of Guangzhou Medical College, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China.

Objective: To evaluate the clinical value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) biopsy for diagnosis of PET-CT positive mediastinal lymph nodes.

Methods: One hundred and twenty-six patients with lung cancer undergoing both PET-CT scanning and EBUS-TBNA biopsy in the First Affiliated Hospital of Guanzhou Medical College from July 2008 to August 2010 were included in this study. There were 89 male and 37 female patients with a mean age of 56.3 years (range 34 to 81 years). (18)FDG-PET was considered positive in mediastinal nodes if the PET-CT reported hypermetabolic activity consistent with malignant disease (standardized uptake value > 2.5). All of the patients were clinically followed up.

Results: Among the 126 patients, 185 stations of lymph nodes were punctured. The mean diameter of the nodes was 13.6 mm and the range was 6 - 23 mm. There were no procedural complications. The diagnostic accuracy, sensitivity, and specificity of EBUS-TBNA were 95.7%, 95.7%, and 100%, respectively.

Conclusions: EBUS-TBNA is a minimally invasive, highly effective and accurate, practical and safe procedure for diagnosis of PET-CT positive mediastinal lymph nodes.
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http://dx.doi.org/10.3760/cma.j.issn.0253-3766.2012.08.012DOI Listing
August 2012

[The analysis on the misdiagnosis of solitary fibrous tumor of the pleura].

Zhonghua Jie He He Hu Xi Za Zhi 2010 Jun;33(6):432-5

Department of Thoracic Surgery, Guangzhou Institute of Respiratory, Guangzhou 510120, China.

Objective: To report the characteristics of solitary fibrous tumor of the pleura (SFTP), and to analyze the factors associated with the misdiagnosis of this disease.

Methods: A retrospective review of the clinical records of 21 cases of SFTP in our hospital from June 2000 to September 2008 was conducted. The follow-up data were also reviewed.

Results: The preoperative diagnosis was pleural mesothelioma in 7 cases, neurogenic tumor in 6, lung cancer in 4, SFTP in 2, hilar lymph node tuberculosis in 1 and inflammatory granuloma in 1 case. All the cases underwent radical resection, and postoperative pathology and immunohistochemical study were performed, and the diagnosis of benign solitary fibrous tumor of the pleura was confirmed. Follow-up periods ranged from 3 months to 8 years (median, 43 months). Two cases were lost, and the remaining 19 cases reported no recurrence or metastasis.

Conclusion: The recognition of the clinical characteristics of pleural solitary fibrous tumor is essential for improving the diagnosis of this uncommon disease.
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June 2010

[Single lung transplantation for emphysema: analysis of 6 cases].

Nan Fang Yi Ke Da Xue Xue Bao 2008 Oct;28(10):1802-5

Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.

Objective: To review the experience with the management of single lung transplantation for emphysema.

Methods: Between January 2003 and August 2006, single lung transplantation was performed in 6 patients for emphysema with cold low potassium solution flushing. A triple-drug regimen was adopted using steroids, mycophenolate mofetil and tacrolimus as the maintenance immunosuppressants. Chest radiograph score, oxygenation index, and pulmonary arterial pressure of the patients in early after the transplantation were reviewed.

Results: All the 6 patients survived for over 30 days after the operation, and 4 of them remained alive with good quality-of-life. Four patients recovered from acute rejection successfully after methylprednisolone pulse therapy for 3 days. One patient underwent reoperation for hemorrhage in the thoracic cavity and finally recovered; spontaneous pneumothorax of the autologous lungs occurred in two patients, who underwent reoperation but finally died 74 days and 77 days after the transplantation, respectively.

Conclusion: Single lung transplantation is effective for end-stage emphysema. Carefully selected recipients and comprehensive design of the surgical procedures are critical to successful lung transplantation.
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October 2008

[Injection of activated carbon nanoparticles for guiding lymphadenectomy during minimal invasive surgery in lung cancer].

Zhonghua Zhong Liu Za Zhi 2008 Mar;30(3):228-30

Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China.

Objective: To evaluate the clinical value of activated carbon nanoparticles for guiding lymphadenectomy in lung cancer.

Methods: Fourty-two lung cancer patients were divided into two groups: the control group (22 cases) and experiment group (20 cases) who received activated carbon nanoparticles injection around the tumor either by endoscopic injection or intraoperative subserosal injection. The number of dissected lymph node, black-stained lymph node, positive lymph node and the side effect of the procedure were analyzed, respectively.

Results: No severe complication was observed in the experiment group. The operative time was not prolonged significantly in the experiment group either. However, the number of average lymph nodes dissected in the experiment group (25.5) was significantly more than that in the control group (14.6) (P <0.01).

Conclusion: Local injection of activated carbon nanoparticles around the tumor during surgical exploration is effective, safe and easy to do for guiding lymphadenectomy in lung cancer patient.
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March 2008

[Bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for central lung cancer: a report of 139 cases].

Zhonghua Wai Ke Za Zhi 2007 Nov;45(22):1530-2

Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical College, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China.

Objective: To evaluate the efficacy and practicability between bronchial sleeve resection or reconstruction of the pulmonary artery by video-assisted thoracic small incision and routine posterolateral incision for lung cancer.

Methods: The clinic data was analyzed retrospectively, including 139 cases in our hospital underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung cancer from January 1995 to July 2007 and 99 cases in the HUAXI Hospital of SICHUAN University underwent routine posterolateral incision from April 2000 to December 2005. All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve resection or reconstruction of the pulmonary artery.

Results: All patients were done operation successfully with no perioperative mortality and no occurrence of anastomosis stenosis as well as fistula. The median survival period of video-assisted thoracic small incision patients and the posterolateral incision patients were 63.17 months and 42.00 months, respectively (P > 0.05). There was no sign of reperfusion injury in the reconstruction of the pulmonary artery patients. The small incisions' length was from 8 to 13 cm and the mean length was 10 cm. The routine posterolateral incisions' mean length was 30 cm. Compared to the patients underwent the routine posterolateral incision, patients underwent the operation of video assisted thoracic small incision had less operation time, less chest tube time, less hospitalization time and less postoperative shoulder joint dysfunction.

Conclusions: The bronchial sleeve resection and reconstruction of the pulmonary artery by video-assisted thoracic small incision surgery for lung cancer can finish the same work as the traditional thoracic lateral incision with less trauma and recovery time.
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November 2007

[Treatment and timing of re-operation for postoperative recurrence of spontaneous pneumothorax].

Zhonghua Jie He He Hu Xi Za Zhi 2007 Mar;30(3):170-2

Division of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical College, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China.

Objective: To investigate the treatment for postoperative recurrence of spontaneous pneumothorax, the feasibility of re-operation, indications and the results.

Method: The clinical and follow-up data of 28 cases of postoperative recurrence from 485 patients who underwent operations for spontaneous pneumothorax from Jan, 1994 to Jan, 2005 were retrospectively reviewed.

Results: One case was observed without any invasive therapy, 12 cases underwent closed pleural drainage and 15 cases received reoperation. All of the patients had the lungs reexpanded sufficiently, with comorbidities in 2 cases, one of which was pleural effusion, the other was prolonged leakage after surgery. No death occurred. The operation time was 80 - 315 (115 +/- 43) min, and the bleeding volume was 50 - 350 (115 +/- 54) ml. The time of chest tube drainage was 1 - 7 (4 +/- 2) d, and the time of hospital stay was 7 - 18 (11 +/- 5) d. The follow-up of the 28 cases ranged from 1 to 107 months (median 55.4) without recurrence.

Conclusions: The findings on lung high rate CT (HRCT) are the most important factors in deciding treatments of postoperative recurrence of pneumothorax. If it is the first recurrence, and there is no evident bullae on HRCT, conservative therapy should be considered, especially for the recurrence within two years postoperation. If the first recurrence occurs after surgery, especially within 2 years, and the bullae is invisible on HRCT, adhesion is the choice without significant adverse effect. If the recurrence occurred twice and more, bullae is found on HRCT, adhesion hampered lung reexpansion, or pleural drainage alone could not work, re-operation should be performed.
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March 2007

[The management of the contralateral lungs in four cases with single allograft lung transplantation].

Zhonghua Jie He He Hu Xi Za Zhi 2006 May;29(5):317-9

Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.

Objective: To report the management of the contralateral lungs in 4 cases with single allograft lung transplantation.

Methods: Four cases receiving lung transplantation were analyzed respectively. One presented with bilateral multiple lung cysts and three with chronic obstructive pulmonary disease (COPD) with bilateral bullae. In the case with bilateral multiple cysts, the contralateral lung remained untreated after operation. For the contralateral lungs in the three cases with COPD, one remained untreated, one received lung volume reduction surgery (LVRS) immediately after lung transplantation, and one received LVRS 47 days after lung transplantation.

Results: Three patients recovered after operation, and 2 of them survived more than 18 months. One patient with delayed contralateral LVRS died 74 days after lung transplantation.

Conclusions: For advanced stage COPD with bilateral bullae, contralateral LVRS may be performed immediately after single lung transplantation. In patient with bilateral cysts only, the resection of the contralateral cysts may be avoided if there is no severe infection.
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May 2006
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