Publications by authors named "Jinfu Yang"

61 Publications

Case Report: Congenital Coronary Artery Ring With Single Left Coronary Ostium and Fistula: A Previously Unreported Anatomy.

Front Cardiovasc Med 2021 27;8:699529. Epub 2021 Aug 27.

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Single coronary ostium concomitant with coronary artery fistula is a very rare congenital anomaly. Apart from that, the combination of a closed loop of the coronary artery has never been reported. Herein, we present a 7-year-old girl diagnosed as single left coronary ostium with a giant coronary trunk, coronary artery to right ventricle fistula, and coronary artery ring. The coronary fistula was surgically ligated with off-pump strategy and the patient discharged on postoperative day 5 and free of symptoms during the 3 years of follow-up. To our knowledge, the presented congenital coronary anomaly is the first to be reported in the literature with the name of congenital coronary artery ring with single left coronary ostium and fistula.
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http://dx.doi.org/10.3389/fcvm.2021.699529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430395PMC
August 2021

Exosomes in atrial fibrillation: therapeutic potential and role as clinical biomarkers.

Heart Fail Rev 2021 Jul 12. Epub 2021 Jul 12.

Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China.

Atrial fibrillation (AF), the most common cardiac arrhythmia, is a global epidemic. AF can cause heart failure and myocardial infarction and increase the risk of stroke, disability, and thromboembolic events. AF is becoming increasingly ubiquitous and is associated with increased morbidity and mortality at higher ages, resulting in an increasing threat to human health as well as substantial medical and social costs. Currently, treatment strategies for AF focus on controlling heart rate and rhythm with medications to restore and maintain sinus rhythm, but this approach has limitations. Catheter ablation is not entirely satisfactory and does not address the issues underlying AF. Research exploring the mechanisms causing AF is urgently needed for improved prevention, diagnosis, and treatment of AF. Exosomes are small vesicles (30-150 nm) released by cells that transmit information between cells. MicroRNAs in exosomes play an important role in the pathogenesis of AF and are established as a biomarker for AF. In this review, a summary of the role of exosomes in AF is presented. The role of exosomes and microRNAs in AF occurrence, their therapeutic potential, and their potential role as clinical biomarkers is considered. A better understanding of exosomes has the potential to improve the prognosis of AF patients worldwide, reducing the global medical burden of this disease.
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http://dx.doi.org/10.1007/s10741-021-10142-5DOI Listing
July 2021

Cell Death and Exosomes Regulation After Myocardial Infarction and Ischemia-Reperfusion.

Front Cell Dev Biol 2021 9;9:673677. Epub 2021 Jun 9.

Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Cardiovascular disease (CVD) is the leading cause of death in the global population, accounting for about one-third of all deaths each year. Notably, with CVDs, myocardial damages result from myocardial infarction (MI) or cardiac arrhythmias caused by interrupted blood flow. Significantly, in the process of MI or myocardial ischemic-reperfusion (I/R) injury, both regulated and non-regulated cell death methods are involved. The critical factor for patients' prognosis is the infarct area's size, which determines the myocardial cells' survival. Cell therapy for MI has been a research hotspot in recent years; however, exosomes secreted by cells have attracted much attention following shortcomings concerning immunogens. Exosomes are extracellular vesicles containing several biologically active substances such as lipids, nucleic acids, and proteins. New evidence suggests that exosomes play a crucial role in regulating cell death after MI as exosomes of various stem cells can participate in the cell damage process after MI. Hence, in the review herein, we focused on introducing various cell-derived exosomes to reduce cell death after MI by regulating the cell death pathway to understand myocardial repair mechanisms better and provide a reference for clinical treatment.
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http://dx.doi.org/10.3389/fcell.2021.673677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220218PMC
June 2021

TMSB4 Overexpression Enhances the Potency of Marrow Mesenchymal Stromal Cells for Myocardial Repair.

Front Cell Dev Biol 2021 9;9:670913. Epub 2021 Jun 9.

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Objective: The actin-sequestering proteins, thymosin beta-4 (Tβ4) and hypoxia-inducible factor (HIF)-1α, are known to be associated with angiogenesis after myocardial infarction (MI). Herein, we aimed to identify the mechanism of HIF-1α induction by Tβ4 and investigate the effects of bone marrow mesenchymal stromal cells (BMMSCs) transfected with the Tβ4 gene () in a rat model of MI.

Methods: Rat BMMSCs were isolated, cultured, and transfected with the gene by using the lentivirus-mediated method. Rats with surgically induced MI were randomly divided into three groups ( = 9/group); after 1 week, the rats were injected at the heart infarcted border zone with TMSB4-overexpressed BMMSCs (BMMSC-TMSB4 ), wild-type BMMSCs that expressed normal levels of TMSB4 (BMMSC-TMSB4 ), or medium (MI). The fourth group of animals ( = 9) underwent all surgical procedures necessary for MI induction except for the ligation step (Sham). Four weeks after the injection, heart function was measured using transthoracic echocardiography. Infarct size was calculated by TTC staining, and collagen volume was measured by Masson staining. Angiogenesis in the infarcted heart area was evaluated by CD31 immunofluorescence histochemistry. experiments were carried out to observe the effect of exogenous Tβ4 on HIF-1α and explore the various possible mechanism(s).

Results: experiments showed that vascular density 4 weeks after treatment was about twofold higher in BMMSC-TMSB4 -treated animals than in BMMSC-TMSB4 -treated animals ( < 0.05). The cardiac function and infarct size significantly improved in both cell-treatment groups compared to controls. Notably, the cardiac function and infarct size were most prominent in BMMSC-TMSB4 -treated animals (both < 0.05). HIF-1α and phosphorylated HIF-1α (p-HIF-1α) were significantly enhanced by exogenous Tβ4, which was nonetheless blocked by the factor-inhibiting HIF (FIH) promoter (YC-1). The expression of prolyl hydroxylase domain proteins (PHD) was decreased upon treatment with Tβ4 and further decreased with the combined treatment of Tβ4 and FG-4497 (a specific PHD inhibitor).

Conclusion: TMSB4-transfected BMMSCs might significantly improve recovery from myocardial ischemia and promote the generation of HIF-1α and p-HIF-1α the AKT pathway, and inhibit the degradation of HIF-1α the PHD and FIH pathways.
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http://dx.doi.org/10.3389/fcell.2021.670913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221609PMC
June 2021

A large congenital atrial septal defect in an adult with delayed therapy.

J Int Med Res 2021 Mar;49(3):300060521997700

Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Patients with a large congenital atrial septal defect (ASD) traditionally have the ASD repaired at the preschool age. Unfortunately, insufficient education of patients regarding medical science and clinical recommendations can lead to delayed therapy, resulting in complications during adulthood. We report a rare case of a large congenital ASD in a 20-year-old man. Echocardiography showed a 67-mm ostium secundum defect and moderate mitral and tricuspid regurgitation. The patient underwent transthoracic ASD repair along with mitral and tricuspid valvuloplasty. This report emphasizes the importance of educating patients about congenital malformations and potential interventions in developing countries, particularly in rural communities.
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http://dx.doi.org/10.1177/0300060521997700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952845PMC
March 2021

Individualized Surgical Reconstruction of the Right Ventricle Outflow Tract in Double Outlet Right Ventricle With Mirror Image-Dextrocardia.

Front Pediatr 2021 19;9:611007. Epub 2021 Feb 19.

Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.

The purpose of this study was to report our experience in the surgical reconstruction of the right ventricular outflow tract in double outlet right ventricle with a major coronary artery crossing the right ventricular outflow tract in the presence of mirror image-dextrocardia. From January 2005 to December 2019, 19 double outlet right ventricle patients (median age 4 years) with mirror image-dextrocardia and a major coronary artery crossing the right ventricular outflow tract received surgical repair. An autologous pericardial patch was used to enlarge the right ventricular outflow tract in four patients without pulmonary stenosis and three patients with mild pulmonary stenosis. A valved bovine jugular venous conduit was added to a hypoplastic native pathway in nine patients, among which six patients with moderate pulmonary stenosis received small-sized bovine jugular venous conduit implantation (diameter ≤ 16 mm). In comparison, a large-sized bovine jugular venous conduit (diameter >16 mm) was adopted in a total of three patients with severe pulmonary stenosis. Finally, three patients with preoperative pulmonary hypertension (mean pulmonary artery pressure ≥40 mmHg) did not undergo further intervention of right ventricular outflow tract due to the adequate outflow tract blood flow. There was no hospital mortality. One patient with sub-pulmonary ventricular septal defect and concomitant severe pulmonary hypertension died from respiratory failure 11 months after the operation. Kaplan-Meier survival was 94% at 5, 10 years. Within a mean echocardiographic follow-up of 6.9 ± 3.6 years, a total of two patients received reintervention due to valvular stenosis of the bovine jugular venous conduit (pressure gradient > 50 mmHg at 4 and 9 years) after surgical operation. Actuarial freedom from reoperation was 90 and 72% at 5 and 10 years, respectively. During the last echocardiographic follow-up phase, all the survivors were in NYHA class I. Double outlet right ventricle with mirror image-dextrocardia is a rare and complicated congenital cardiac malformation. Surgical reconstruction of the right ventricular outflow tract should be individualized based on the degree of pulmonary stenosis and the specific anatomical features of each patient. Reconstructing the pulmonary artery using the various sizes of valved bovine jugular venous conduit is a safe and effective surgical method.
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http://dx.doi.org/10.3389/fped.2021.611007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933223PMC
February 2021

RIP1/RIP3/MLKL-mediated necroptosis contributes to vinblastine-induced myocardial damage.

Mol Cell Biochem 2021 Feb 28;476(2):1233-1243. Epub 2020 Nov 28.

Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.

Vinblastine (VBL) has been considered as a first-line anti-tumor drug for many years. However, vinblastine-caused myocardial damage has been continually reported. The underlying molecular mechanism of the myocardial damage remains unknown. Here, we show that vinblastine induces myocardial damage and necroptosis is involved in the vinblastine-induced myocardial damage both in vitro and in vivo. The results of WST-8 and flow cytometry analysis show that vinblastine causes damage to H9c2 cells, and the results of animal experiments show that vinblastine causes myocardial cell damage. The necrosome components, receptor-interacting protein 1 (RIP1) receptor-interacting protein 3 (RIP3), are significantly increased in vinblastine-treated H9c2 cells, primary neonatal rat ventricular myocytes and rat heart tissues. And the downstream substrate of RIP3, mixed lineage kinase domain like protein (MLKL) was also increased. Pre-treatment with necroptosis inhibitors partially inhibits the necrosome components and MLKL levels and alleviates vinblastine-induced myocardial injury both in vitro and in vivo. This study indicates that necroptosis participated in vinblastine-evoked myocardial cell death partially, which would be a potential target for relieving the chemotherapy-related myocardial damage.
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http://dx.doi.org/10.1007/s11010-020-03985-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873015PMC
February 2021

Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation.

Cardiovasc Diagn Ther 2020 Oct;10(5):1200-1215

Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.

Background: The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up.

Methods: Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL.

Results: A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%.

Conclusions: AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.
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http://dx.doi.org/10.21037/cdt-20-574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666964PMC
October 2020

Downregulation of Long Non-coding RNA Nuclear Paraspeckle Assembly Transcript 1 Inhibits MEG-01 Differentiation and Platelet-Like Particles Activity.

Front Genet 2020 16;11:571467. Epub 2020 Oct 16.

School of Pharmacy, Binzhou Medical University, Yantai, China.

Platelets are derived from megakaryocytes and play an important role in blood coagulation. By using high throughput sequencing, we have found that the long non-coding RNA (lncRNA) nuclear paraspeckle assembly transcript 1 (NEAT1) is abundant in platelets (GEO ID: 200097348). However, little is known about its role in regulating megakaryocyte differentiation and platelet activity. This study aims to clarify the effect of NEAT1 on MEG-01 differentiation and platelet-like particle (PLP) activity. NEAT1 in MEG-01 cells was knocked down by siRNA transfection. The adhesion of MEG-01 and PLP to collagen-coated coverslips was observed under a fluorescence microscope. Flow cytometry was used to investigate cell apoptosis, cell cycle, the levels of D41/CD42b on MEG-01 cells and CD62P on PLPs. Quantitative real-time polymerase chain reaction was used to detect NEAT1 and IL-8 expression levels. Western blot was used to measure the protein levels of Bcl-2, Bax, cleaved caspase-3, and IL-8. RNA-binding protein immunoprecipitation was used to detect the interaction of NEAT1 and splicing factor proline/glutamine-rich (SFPQ). Results showed that NEAT1 knockdown decreased the adhesion ability of thrombin-stimulated MEG-01 and PLP. The expression of CD62P on PLPs and CD41/CD42b on MEG-01 cells was inhibited by NEAT1 knockdown. In addition, NEAT1 knockdown inhibited cell apoptosis with increased Bcl2/Bax ratio and decreased cleaved caspase-3, and reduced the percentage of cells in the G0/G1 phase. Meanwhile, NEAT1 knockdown inhibited the expression of IL-8. A strong interaction of NEAT1 and SFPQ, a transcriptional repressor of IL-8, was identified. NEAT1 knockdown reduced the interaction between SFPQ and NEAT1.The results suggest that lncRNA NEAT1 knockdown decreases MEG-01 differentiation, PLP activity, and IL-8 level. The results also indicate that the regulation of NEAT1 on IL-8 may be realized a direct interaction between NEAT1 and SFPQ.
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http://dx.doi.org/10.3389/fgene.2020.571467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596361PMC
October 2020

Nanoparticle-Mediated Drug Delivery for Treatment of Ischemic Heart Disease.

Front Bioeng Biotechnol 2020 24;8:687. Epub 2020 Jun 24.

Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States.

The regenerative capacity of an adult cardiac tissue is insufficient to repair the massive loss of heart tissue, particularly cardiomyocytes (CMs), following ischemia or other catastrophic myocardial injuries. The delivery methods of therapeutics agents, such as small molecules, growth factors, exosomes, cells, and engineered tissues have significantly advanced in medical science. Furthermore, with the controlled release characteristics, nanoparticle (NP) systems carrying drugs are promising in enhancing the cardioprotective potential of drugs in patients with cardiac ischemic events. NPs can provide sustained exposure precisely to the infarcted heart via direct intramyocardial injection or intravenous injection with active targets. In this review, we present the recent advances and challenges of different types of NPs loaded with agents for the repair of myocardial infarcted heart tissue.
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http://dx.doi.org/10.3389/fbioe.2020.00687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326780PMC
June 2020

Application of Modified Sliding Anastomosis in the Repair of Aortic Coarctation.

Biomed Res Int 2020 14;2020:3805385. Epub 2020 May 14.

Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Middle Renmin Road 139, Changsha 410000, China.

Objectives: To evaluate the early and midterm results of a modified sliding anastomosis technique in patients with aortic coarctation.

Materials And Methods: In this study, we reported a new repair method and compared the early and midterm outcome(s) with a conventional surgical approach for the management of patients with aortic coarctation. Forty-eight aortic coarctation patients with a narrowed segment length longer than 2 cm were operated at our department's pediatric surgical division. Excision of the coarctation and end-to-end anastomosis was carried out in twenty-five patients (control group). In contrast, a modified sliding technique was used for twenty-three cases in the observation group. Other accompanying cardiac anomalies simultaneously repaired included ventricular septal defect and patent ductus arteriosus. All patients received 1.5-10 years of postoperative echocardiographic follow-up.

Results: This is a retrospective study carried out between January 2005 and June 2018. The study population consisted of forty-eight patients, which included twenty-six male and twenty-two female patients, with an average age of 5.2 ± 1.9 months (range, 28 days to 1 year). There was no mortality. The operative time, the number of intercostal artery disconnection, the drainage volume, and arm-leg systolic pressure gradient postoperation were less in the observation group as compared to the control group ( < 0.05). Also, cases with an anastomotic pressure gradient exceeding 10 mmHg during follow-up were less in the observation group as compared to the control group ( < 0.05). The postoperative complications encountered were chylothorax (control group 2 cases vs. observation group 0) and pulmonary atelectasis (control group 4 cases vs. observation group 1). They all, however, recovered after conservative treatment. Three patients in the control group underwent balloon angioplasty (reintervention) postoperative 2-4 years due to an increase in the anastomotic pressure gradient (>20 mmHg). After reintervention, the anastomotic pressure gradient reduced to 14 mmHg, 15 mmHg, and 17 mmHg, respectively.

Conclusions: For long segment aortic coarctation patients (longer than 2 cm), the use of the modified sliding anastomotic technique effectively helps to retain more autologous tissues, enlarge the diameter of the anastomosis, and decrease anastomotic tension and vascular injury. Therefore, this technique provides a new idea for the surgical treatment of aortic coarctations.
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http://dx.doi.org/10.1155/2020/3805385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245663PMC
March 2021

Myocardial protection by nanomaterials formulated with CHIR99021 and FGF1.

JCI Insight 2020 06 18;5(12). Epub 2020 Jun 18.

Department of Biomedical Engineering, School of Medicine, and School of Engineering, the University of Alabama at Birmingham, Birmingham, Alabama, USA.

The mortality of patients suffering from acute myocardial infarction is linearly related to the infarct size. As regeneration of cardiomyocytes from cardiac progenitor cells is minimal in the mammalian adult heart, we have explored a new therapeutic approach, which leverages the capacity of nanomaterials to release chemicals over time to promote myocardial protection and infarct size reduction. Initial screening identified 2 chemicals, FGF1 and CHIR99021 (a Wnt1 agonist/GSK-3β antagonist), which synergistically enhance cardiomyocyte cell cycle in vitro. Poly-lactic-co-glycolic acid nanoparticles (NPs) formulated with CHIR99021 and FGF1 (CHIR + FGF1-NPs) provided an effective slow-release system for up to 4 weeks. Intramyocardial injection of CHIR + FGF1-NPs enabled myocardial protection via reducing infarct size by 20%-30% in mouse or pig models of postinfarction left ventricular (LV) remodeling. This LV structural improvement was accompanied by preservation of cardiac contractile function. Further investigation revealed that CHIR + FGF1-NPs resulted in a reduction of cardiomyocyte apoptosis and increase of angiogenesis. Thus, using a combination of chemicals and an NP-based prolonged-release system that works synergistically, this study demonstrates a potentially novel therapy for LV infarct size reduction in hearts with acute myocardial infarction.
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http://dx.doi.org/10.1172/jci.insight.132796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406256PMC
June 2020

Endomyocardial fibrosis.

Cardiovasc Diagn Ther 2020 Apr;10(2):208-222

Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.

Background: Endomyocardial fibrosis (EMF) is a neglected cardiovascular disease of poverty which carries a poor prognosis with no specific treatment affecting mainly children and young adults. Here, we report our 10-year experience in the therapeutic management and surgical treatment for EMF.

Methods: From February 2009 to 2019 March, 55 patients diagnosed with EMF from our cardiology unit underwent surgical repair at our department's pediatric surgical division. There were 35 male, and 20 female patients whose ages varied from 1 year 2 months to 12 years mean age 5.7 (±3.2). We designed the study aimed at assessing the cardio-structural abnormalities and coronary vascular changes faced with EMF patients using echocardiography, and coronary angiography with a detailed and thorough surgical examination of each case.

Results: Of the 55 operated patients, 1 had mild lesions, 26 had moderate lesions, and 28 had severe heart disease. All but one patient was in NYHA functional class III or IV at the time of surgery. All but one female patient with mild ventricular lesions and no valvular involvement had severe atrioventricular valve regurgitation with valves considered suitable for both replacements; 45 patients mean age 6.0 (±3.1) and repair nine patients mean age 3.8 (±2.9). The mean endocardial thickness was 3,000 (±1519) µm.

Conclusions: The echocardiographic changes corresponded well to the findings on surgery and histopathology. The coronary changes seen included a spectrum of fibrin deposition, medial sclerosis and degeneration, and the formation of plexiform lesions. Surgically evaluating the resected cardiac tissue might help improve disease management.
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http://dx.doi.org/10.21037/cdt.2020.02.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225420PMC
April 2020

Utilization of Human Induced Pluripotent Stem Cells for Cardiac Repair.

Front Cell Dev Biol 2020 31;8:36. Epub 2020 Jan 31.

Department of Cardiovascular Medicine, Physiology and Biomedical Engineering, Mayo Clinic, Scottsdale, AZ, United States.

The paracrine effect, mediated by chemical signals that induce a physiological response on neighboring cells in the same tissue, is an important regenerative mechanism for stem cell-based therapy. Exosomes are cell-secreted nanovesicles (50-120 nm) of endosomal origin, and have been demonstrated to be a major contributor to the observed stem cell-mediated paracrine effect in the cardiac repair process. Following cardiac injury, exosomes deriving from exogenous stem cells have been shown to regulate cell apoptosis, proliferation, angiogenesis, and fibrosis in the infarcted heart. Exosomes also play a crucial role in the intercellular communication between donor and recipient cells. Human induced pluripotent stem cells (hiPSCs) are promising cell sources for autologous cell therapy in regenerative medicine. Here, we review recent advances in the field of progenitor-cell derived, exosome-based cardiac repair, with special emphasis on exosomes derived from hiPSCs.
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http://dx.doi.org/10.3389/fcell.2020.00036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025514PMC
January 2020

Cardiomyocytes from CCND2-overexpressing human induced-pluripotent stem cells repopulate the myocardial scar in mice: A 6-month study.

J Mol Cell Cardiol 2019 12 17;137:25-33. Epub 2019 Oct 17.

Department of Biomedical Engineering, School of Medicine, School of Engineering, University of Alabama at Birmingham, USA. Electronic address:

Background: Cardiomyocytes that have been differentiated from CCND2-overexpressing human induced-pluripotent stem cells (hiPSC-CCND2 CMs) can proliferate when transplanted into mouse hearts after myocardial infarction (MI). However, it is unknown whether remuscularization can replace the thin LV scar and if the large muscle graft can electrophysiologically synchronize to the recipient myocardium. Our objectives are to evaluate the structural and functional potential of hiPSC-CCND2 CMs in replacing the LV thin scar.

Methods: NOD/SCID mice were treated with hiPSC-CCND2 CMs (i.e., the CCND2 group), hiPSC-CCND2 CMs (the CCND2 group), or an equal volume of PBS immediately after experimentally-induced myocardial infarction. The treatments were administered to one site in the infarcted zone (IZ), two sites in the border zone (BZ), and a fourth group of animals underwent Sham surgery.

Results: Six months later, engrafted cells occupied >50% of the scarred region in CCND2 animals, and exceeded the number of engrafted cells in CCND2 animals by ~8-fold. Engrafted cells were also more common in the IZ than in the BZ for both cell-treatment groups. Measurements of cardiac function, infarct size, wall thickness, and cardiomyocyte hypertrophy were significantly improved in CCND2 animals compared to animals from the CCND2 or PBS-treatment groups. Measurements in the CCND2 and PBS groups were similar, and markers for cell cycle activation and proliferation were significantly higher in hiPSC-CCND2 CMs than in hiPSC-CCND2 CMs. Optical mapping of action potential propagation indicated that the engrafted hiPSC-CCND2 CMs were electrically coupled to each other and to the cells of the native myocardium. No evidence of tumor formation was observed in any animals.

Conclusions: Six months after the transplantation, CCND2-overexpressing hiPSC-CMs proliferated and replaced >50% of the myocardial scar tissue. The large graft hiPSC-CCND2 CMs also electrically integrated with the host myocardium, which was accompanied by a significant improvement in LV function.
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http://dx.doi.org/10.1016/j.yjmcc.2019.09.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346870PMC
December 2019

Reabsorbable Pins can Reinforce an Early Sternal Stability After Median Sternotomy in Young Children with Congenital Heart Disease.

Pediatr Cardiol 2019 Dec 23;40(8):1728-1734. Epub 2019 Sep 23.

Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China.

We evaluated the efficacy of bioresorbable sternal reinforcement device (poly-L-lactide sternal pins) on sternal healing after median sternotomy in young children (with body weight less than 10 kg) with congenital heart disease (CHD). Data from 85 patients, who underwent CHD surgery through median sternotomy from October 2016 to May 2018, were collected and analyzed. Sternal pins were utilized in 85 patients (10 mm × 1 mm × 1 mm for patients with body weights less than 5 kg and 15 mm × 2 mm × 2 mm for those weighing between 5 and 10 kg) in addition to sternum closure with Ethicon PDSII running sutures (Group A), while 84 patients received the Ethicon sternal closure (Group B) with no pins. The occurrence of sternal dehiscence, anterior-posterior displacement, and high-low displacement was evaluated by physical examination and three-dimensional computed tomography at one month postoperatively. No anterior-posterior sternal displacement (0%) was observed in Group A, while 10 anterior-posterior displacements (11.9%) were observed in Group B (P < 0.01). The number of sternal caudal-cranial displacements in Groups A and B was 4 (4.71%) and 5 (5.35%), respectively (P = 0.870). While no sternal dehiscence (0%) was observed in Group A, 7 out of 84 patients (8.33%) in Group B exhibited obvious sternal dehiscence (P < 0.01). The bioresorbable poly-L-lactide sternal pins reduced an anterior-posterior sternal displacement and sternal dehiscence, which was accompanied by a significant improvement of an early sternal fixation.
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http://dx.doi.org/10.1007/s00246-019-02212-1DOI Listing
December 2019

Clinical Study to Individual Treatment for Major Aortopulmonary Collaterals of Tetralogy of Fallot.

Biomed Res Int 2019 15;2019:1603712. Epub 2019 May 15.

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, 410011 Changsha, China.

Objectives: To build a guideline for the individual treatment of Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) and tentatively establish the occlusion index of MAPCAs.

Methods: According to the diameter of the aortopulmonary collaterals (R: mm) and the bodyweight of the children (weight: kg), K= ((∑ )/) was set as the occlusion index of TOF with MAPCAs. A retrospective study was initially performed in 171 patients who suffered from TOF with MAPCAs and underwent cardiac malformation repair to investigate the intervals of the K value: K≥2, 1
Result: The proportion of the patients treated with occlusion and the postoperative ICU resident time (p<0.05) in patients with 1
Conclusion: Due to restrictions on medical conditions in China with a large population base, a standard individual treatment of TOF with MAPCAs should be established based on the Aortopulmonary Collaterals Occlusion Index K= ((∑ )/), which can effectively avoid unnecessary collateral occlusion, minimize trauma, and shorten the length of ICU and hospital stay. When K≥2, the collateral occlusion and surgical correction are recommended to be performed simultaneously. When 1
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http://dx.doi.org/10.1155/2019/1603712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541992PMC
December 2019

An Improved Refined Composite Multivariate Multiscale Fuzzy Entropy Method for MI-EEG Feature Extraction.

Comput Intell Neurosci 2019 28;2019:7529572. Epub 2019 Mar 28.

Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China.

Feature extraction of motor imagery electroencephalogram (MI-EEG) has shown good application prospects in the field of medical health. Also, multivariate entropy-based feature extraction methods have been gradually applied to analyze complex multichannel biomedical signals, such as EEG and electromyography. Compared with traditional multivariate entropies, refined composite multivariate multiscale fuzzy entropy (RCmvMFE) overcomes the defect of unstable entropy values caused by the scale factor increase and is beneficial towards obtaining richer feature information. However, the coarse-grained process of RCmvMFE is mean filtered, which weakens Gaussian noise and is powerless against random impulse noise interference. This yields poor quality feature information and low accuracy classification. In this paper, RCmvMFE is improved (IRCmvMFE) by using composite filters in the coarse-grained procedure to enhance filter performance. Median filters are employed to remove the impulse noise interference from multichannel MI-EEG signals, and these filtered MI-EEGs are further smoothed by the mean filters. The multiscale IRCmvMFEs are calculated for all channels of composite filtered MI-EEGs, forming a feature vector, and a support vector machine is used for pattern classification. Based on two public datasets with different motor imagery tasks, the recognition results of 10 × 10-fold cross-validation achieved 99.43% and 99.86%, respectively, and the statistical analysis of experimental results was completed, showing the effectiveness of IRCmvMFE, as well. The proposed IRCmvMFE-based feature extraction method is superior compared to entropy-based and traditional methods.
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http://dx.doi.org/10.1155/2019/7529572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458931PMC
August 2019

Aortic annulus malformation: triple aortic arch.

Eur Heart J 2019 04;40(13):1091

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, China.

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http://dx.doi.org/10.1093/eurheartj/ehy671DOI Listing
April 2019

[Application of the index system for clinical evaluation of implementation effect: An example of vaginal delivery].

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2018 Jan;43(1):22-27

Department of Neurosurgery, Third Xiangya Hospital, Central South University, Changsha 410013, China.

Objective: In order to apply the index system for clinical evaluation of implementation effect in hospitals.
 Methods: A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366). The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment. The index system was used for clinical evaluation of implementation effect.
 Results: There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P<0.05). The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital. The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033). The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052). As for clinical implementation effect, the secondary hospitals were better than the tertiary hospital, and the general hospitals were better than the specialized hospitals.
 Conclusion: The index system for clinical evaluation could quantify the implementation effect, and compare the implementation effect in different hospitals, which provides reference for the management of clinical pathway.
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http://dx.doi.org/10.11817/j.issn.1672-7347.2018.01.004DOI Listing
January 2018

A rare, giant coronary artery ectasia coexisting with a coronary artery fistula in an older infant.

Cardiol Young 2017 Sep 27;27(7):1387-1389. Epub 2017 Jun 27.

Department of Cardiovascular Surgery,The Second Xiangya Hospital,Central South University,Changsha,China.

Coronary artery fistula with giant coronary artery ectasia is a rare abnormal CHD. Multidetector CT is useful for the diagnosis. Early diagnosis and surgery are recommended.
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http://dx.doi.org/10.1017/S1047951117000269DOI Listing
September 2017

A Giant Cavernous Hemangioma of the Left Atrioventricular Groove.

Case Rep Pediatr 2017 20;2017:6898629. Epub 2017 Mar 20.

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha 410011, China.

A 10-year-old Chinese female diagnosed with an asymptomatic giant cardiac cavernous hemangioma was reported. The patient originally tended to observation because this unusual cardiac tumoral mass was discovered incidentally during routine health examination of transthoracic echocardiography. Over 5 years of follow-up, the mass had enlarged obviously, and the patient visited our outpatient clinic and was prone to excision. Subsequently, a total resection surgery of the tumor was performed, and the tumor was found to be located on the left atrioventricular groove with complete packing membrane. The patient was discharged on postoperative day 4 and remains asymptomatic on last follow-up.
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http://dx.doi.org/10.1155/2017/6898629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376948PMC
March 2017

Pulmonary Arteriovenous Malformation Detected by Three-dimensional Computed Tomographic Angiography.

Heart Lung Circ 2017 Aug 22;26(8):e59-e61. Epub 2017 Mar 22.

Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China. Electronic address:

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http://dx.doi.org/10.1016/j.hlc.2017.02.016DOI Listing
August 2017

Congenital enlargement of the right atrium in a child with progressive dyspnea.

J Card Surg 2017 May 4;32(5):313-315. Epub 2017 Apr 4.

Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.

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http://dx.doi.org/10.1111/jocs.13126DOI Listing
May 2017

Reconstruction of the pulmonary posterior wall using in situ autologous tissue for the treatment of pulmonary atresia with ventricular septal defect.

J Cardiothorac Surg 2017 Feb 23;12(1):12. Epub 2017 Feb 23.

Department of the cardiovascular surgery, the Second Xiangya Hospital, Central South University, Middle Renmin Road 139, 410011, Changsha, China.

Background: To evaluate the early and mid-term results of pulmonary trunk reconstruction using a technique in which autogenous tissue is preserved in situ in pulmonary atresia patients with a ventricular septal defect (PA-VSD).

Methods: The pulmonary artery was reconstructed using autogenous tissue that had been preserved in situ and a bovine jugular venous patch in 24 patients who were diagnosed with PA-VSD (the observation group). The traditional operation using a bovine jugular venous conduit was performed in 40 other cases of PA-VSD (the control group).

Results: In the observation group, all patients survived and recovered successfully without complications. Follow-up echocardiography 2-10 years after the procedure showed that the reconstructed right ventricular outflow tract (RVOT) and pulmonary artery were patent, showing no evidence of flow obstruction. Only mild regurgitation of the bovine jugular vein valve was observed. In the control group, early postoperative death occurred in two cases. Another two patients had obstruction of the anastomotic stoma and underwent conduit replacement surgery within 2 weeks of the initial procedure. During the 2-10 years of follow-up care, six patients presented with valvular stenosis of the BJVC, with a pressure gradient of more than 50 mmHg.

Conclusions: The technique for preserving autogenous tissue to reconstruct the pulmonary posterior wall is a satisfactory method for treating PA-VSD.
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http://dx.doi.org/10.1186/s13019-017-0578-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324245PMC
February 2017

Right Coronary Artery Fistula Into Left Ventricle: Blood Flow Steal Phenomenon.

Ann Thorac Surg 2017 03;103(3):e287

Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.

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http://dx.doi.org/10.1016/j.athoracsur.2016.09.079DOI Listing
March 2017

Isolated cardiac peripheral primitive neuroectodermal tumor: A case report.

Cancer Biol Ther 2017 01 1;18(1):4-7. Epub 2016 Dec 1.

a Department of The Cardiovascular Surgery , The Second Xiangya Hospital, Central South University , Changsha , China.

Background: Peripheral primitive neuroectodermal tumor isolated in the heart, presenting as a primary cardiac tumor is considered as extremely rare.

Methods: We present a 53-year-old Chinese female with a cardiac tumor which was discovered by CT.

Results: A hypo-intense tumorous mass was shown extending from the left ventricle by Cardiac CT, and fused FDG positron emission tomography demonstrated no other abnormal FDG active lesions in the body. We performed a total resection surgery of the tumor subsequently and the patient recovered well and discharged from hospital 6 d after surgery.

Conclusion: The pathological diagnosis was primary cardiac peripheral primitive neuroectodermal tumor. No tumor recurrence was shown by echocardiography during the 24 months follow-up visits.
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http://dx.doi.org/10.1080/15384047.2016.1264542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323009PMC
January 2017

[Hybrid procedure for infants/children treatment with pulmonary stenosis under transesophageal echocardiographic guidance].

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016 Jul;41(7):691-5

Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.

Objective: To investigate the outcomes of hybrid procedure in treating 10 infants/children with pulmonary stenosis under transesophageal echocardiographic guidance.


Methods: Between September, 2009 and December, 2015, 10 infants/children underwent hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis in the Second Xiangya Hospital, Central South University. The age, height and weight at the time of admission were 0.7-42 (14.8±15.8) months, 53-97 (74.8±16.3) cm, and 4-15.5 (9.3±4.1) kg, respectively. Atrial septal defect, patent foramen ovale, patent ductus arteriosus, muscular ventricular septal defect, persistent left superior vena cava and tricuspid regurgitation were found in 2, 6, 1, 2, 1 and 5 cases, respectively.


Results: After the operation, all patients were sent into ICU. The mean duration mechanical ventilation, ICU stay and hospitalization were 0.5-41(6.8±12.3) h, 2-85 (31.1±22.8) h, and 6-20 (11.4±5.1) d, respectively. Postoperative transvalvular pressure gradient reduced to 16-45 (31.1±9.8) mmHg, which was decreased significantly compared with that in preoperative (P<0.001). There was no death during hospitalization and follow-up.


Conclusion: Hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis under transesophageal echocardiographic guidance is a safe and effective treatment.
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http://dx.doi.org/10.11817/j.issn.1672-7347.2016.07.005DOI Listing
July 2016

Initial Research on Postoperative Management of Tetralogy of Fallot with Major Aortopulmonary Collaterals.

Cardiology 2016;134(4):406-10. Epub 2016 Apr 28.

Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Objectives: Tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCA) is a well-known but always severe congenital heart disease. This study was designed to explore proper management after radical correction of TOF with MAPCA based on a hierarchical approach.

Methods: The following data were collected from 39 patients planned to undergo radical correction of TOF: age, weight, number of aortopulmonary collaterals, total lumen diameter and collateral diameter-to-body weight ratio, transcatheter occlusion and cardiac catheterization findings, mechanical ventilation time, and ICU monitoring time. The patients were divided into 4 groups by collateral diameter-to-body weight ratio as follows: <0.200 mm/kg (group 1), 0.200-0.500 mm/kg (group 2), >0.500 mm/kg (group 3), and no MAPCA (group 4). Data analysis was performed using IBM SPSS Statistics software for Mac version 22.0 (SPSS Inc., Chicago, Ill., USA) with logistic regression and Fisher's exact test.

Results: Most of the patients recovered well after radical correction; postoperative complications occurred in 12 patients and included bloody sputum, low cardiac output syndrome, and severe pulmonary infection that led to tracheotomy. By prolonging the mechanical ventilation time of the patients with postoperative complications, the conditions in 3 patients were improved. However, in the remaining patients, the condition worsened until transcatheter occlusions were performed. Transcatheter occlusion was performed in all 7 patients in group 3 (100%). Only 2 of the 8 patients in group 2 required transcatheter occlusion (25%), and none of the 9 patients in group 1 required transcatheter occlusion (0%). Only 1 patient (group 3) died after radical correction. The transcatheter occlusion results showed a strong association with the total lumen diameter and the collateral diameter-to-body weight ratio (p < 0.05) but no obvious association with age, weight, or the number of aortopulmonary collaterals (p > 0.05).

Conclusions: Postoperative management of patients with TOF and MAPCA has great significance. To reduce the morbidity and mortality, transcatheter coil embolization or surgical ligation should be performed in patients with a collateral diameter-to-body weight ratio of at least 0.500 mm/kg. In patients with values between approximately 0.200 and 0.500 mm/kg, prolongation of mechanical ventilation should have priority over transcatheter occlusion, and for patients with values below 0.200 mm/kg no additional treatment is needed.
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http://dx.doi.org/10.1159/000445046DOI Listing
January 2018

An explanatory analysis of driver injury severity in rear-end crashes using a decision table/Naïve Bayes (DTNB) hybrid classifier.

Accid Anal Prev 2016 May 27;90:95-107. Epub 2016 Feb 27.

Geospatial and Population Studies Traffic Research Unit, University of New Mexico, Albuquerque, NM 87106, USA.

Rear-end crashes are a major type of traffic crashes in the U.S. Of practical necessity is a comprehensive examination of its mechanism that results in injuries and fatalities. Decision table (DT) and Naïve Bayes (NB) methods have both been used widely but separately for solving classification problems in multiple areas except for traffic safety research. Based on a two-year rear-end crash dataset, this paper applies a decision table/Naïve Bayes (DTNB) hybrid classifier to select the deterministic attributes and predict driver injury outcomes in rear-end crashes. The test results show that the hybrid classifier performs reasonably well, which was indicated by several performance evaluation measurements, such as accuracy, F-measure, ROC, and AUC. Fifteen significant attributes were found to be significant in predicting driver injury severities, including weather, lighting conditions, road geometry characteristics, driver behavior information, etc. The extracted decision rules demonstrate that heavy vehicle involvement, a comfortable traffic environment, inferior lighting conditions, two-lane rural roadways, vehicle disabled damage, and two-vehicle crashes would increase the likelihood of drivers sustaining fatal injuries. The research limitations on data size, data structure, and result presentation are also summarized. The applied methodology and estimation results provide insights for developing effective countermeasures to alleviate rear-end crash injury severities and improve traffic system safety performance.
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http://dx.doi.org/10.1016/j.aap.2016.02.002DOI Listing
May 2016
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