Publications by authors named "Zhiyun Xu"

117 Publications

Aspirin plus ticagrelor or clopidogrel on graft patency one year after coronary bypass grafting: a single-center, randomized, controlled trial.

J Thorac Dis 2021 Mar;13(3):1697-1705

Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.

Background: Dual antiplatelet therapy (DAPT) improves early post-operative graft patency, but the optimal DAPT strategy for the patients after coronary artery bypass grafting (CABG) has not been confirmed. We sought to evaluate the effect of aspirin plus ticagrelor versus aspirin plus clopidogrel on saphenous vein graft (SVG) patency within 1 year after CABG.

Methods: Between October 2017 and December 2018, 147 consecutive patients undergoing elective CABG at Changhai Hospital were randomized into two groups: group AT, receiving aspirin 100 mg/d plus ticagrelor 2×90 mg/d; group AC, receiving aspirin 100 mg/d plus clopidogrel 75 mg/d. Both DAPTs should be administered within 24 h when clinical stability was ensured. 64-multislice computed tomography angiography (MSCTA) was used to assess the graft patency at 12 months after CABG.CYP2C19 gene variants were measured to assess the clopidogrel efficacy on graft patency.

Results: Among the 147 participants who completed the study, one (0.7%) patient from the AC group died at 5 weeks after surgery due to severe infection. All other patients were treated with DAPT for 12 months and underwent 64-MSCTA according to schedule. There were no significant differences in pre-operative characteristics and intraoperative transit-time flow measurement findings between the two groups. Besides, no significant differences in the incidence of major adverse cardiac events (MACEs) and major bleeding were observed. A 64-MSCTA showed that SVG patency was 91.0% (141 of 155) in the AT group and 89.9% (161 of 179) in the AC group (P=0.751). No significant associations were found between different CYP2C19 genotypes and SVG patency (P>0.05).

Conclusions: Either aspirin plus ticagrelor or aspirin plus clopidogrel can maintain a fairly high graft patency rate in the early phase after CABG, regardless of CYP2C19 genotypes.
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http://dx.doi.org/10.21037/jtd-20-3407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024791PMC
March 2021

A bibliometric analysis of segmentectomy versus lobectomy for non-small cell lung cancer research (1992-2019).

Medicine (Baltimore) 2021 Apr;100(13):e25055

Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital.

Background: This study intends to create a series of scientific maps to quantitatively estimate hot spots and emerging trends in segmentectomy versus lobectomy for non-small cell lung cancer (NSCLC) research with bibliometric methods.

Methods: Articles published on segmentectomy versus lobectomy for NSCLC were extracted from the Web of Science Core Collection (WoSCC). Extracted information was analyzed quantitatively using bibliometric analysis by CiteSpace to find hot spots and frontiers in this research area.

Results: A total of 362 scientific articles on segmentectomy versus lobectomy for NSCLC were collected, and the annual publication rate increased over time from 1992 to 2019. The leading country and the leading institution were the United States and University of Pittsburgh, respectively. Furthermore, the most prolific researchers were, namely, James D. Luketich, Rodney J. Landreneau, Matthew J. Schuchert, Morihito Okada, and David O. Wilson. The analysis of keywords pointed out that carcinoma, bronchogenic carcinoma, limited resection, segmental resection, and morbidity are hot spots and lymph node dissection, minimally invasive surgery, impact, epidemiology, and high risk are research frontiers in this field.

Conclusion: Publications related to segmentectomy versus lobectomy for NSCLC have made great achievements based on bibliometric analysis in recent years. However, further research and global collaboration are still required. Finally, we find that segmentectomy for the treatment of NSCLC is receiving much more attention from researchers globally compared with lobectomy in this research area.
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http://dx.doi.org/10.1097/MD.0000000000025055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021308PMC
April 2021

Clinical Outcome of Reoperation for Mechanical Prosthesis at Aortic Position.

Heart Lung Circ 2021 Feb 12. Epub 2021 Feb 12.

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address:

Aim: Redo aortic valve surgery is usually associated with a high risk of mortality and complications. The aim of this study was to investigate the perioperative and long-term outcomes of reoperation after prior mechanical prosthesis implantation at the aortic position.

Method: The clinical data of 146 consecutive patients who underwent reoperation at the aortic position between 2003 and 2019 were analysed.

Results: Mean age was 51.5±12.7 years and 69 (47.3%) were female. The median interval from prior surgery to redo aortic valve surgery was 6 years. The aetiologies were pannus formation with prosthetic aortic stenosis in 62 cases (42.5%), prosthetic valve endocarditis (PVE) in five (3.4%), PVE with perivalvular leakage (PVL) in 16 (11.0%), PVL in 45 (30.8%), thrombosis in seven (4.8%), and aortic disease in 11 (7.5%). As for surgical procedure, aortic valve replacement was performed in 81 cases (55.5%), Bentall in 34 (23.3%), PVL repair in six (4.1%), and pannus debridement in 25 (17.1%). Fourteen (14) (9.6%) patients expired perioperatively. Prolonged ventilation time and postoperative renal failure were proved to be significant independent predictors of mortality according to multivariate analysis. Overall survival was 87.8%±7.4% and 76.4%±15.1% at 5 and 10 years, respectively. Survival was 87.7%±13.7% and 84.2%±15.6% in the pannus group, and 84.5%±12.6% and 74.6%±19.4% in the non-pannus group at 5 and 10 years, respectively (p=0.951). Survival was 87.5%±14.2% and 75.8%±22.7% in the PVL group and 84.7%±11.9% and 81.6%±13.5% in the non-PVL group at 5 and 10 years, respectively (p=0.365).

Conclusions: Pannus formation and PVL are two major indications for reoperation of mechanical prosthesis at the aortic position. Redo aortic valve surgery has a satisfactory outcome but with a high risk of complications. Long-term survival of patients seems not to be related to the aetiology. Final decision-making of redo aortic valve surgery should be based on aetiology.
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http://dx.doi.org/10.1016/j.hlc.2021.01.002DOI Listing
February 2021

[Analysis of Clinical Characteristics of Lung Cancer Combined with 
Multiple Primary Malignancies in Other Organs].

Zhongguo Fei Ai Za Zhi 2021 Jan;24(1):7-12

Department of Thoracic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing 210009, China.

Background: With the popularization of chest computed tomography (CT) early screening for lung cancer, the detection rate of lung cancer combined with multiple primary malignancies (MPM) in other organs has been increasing. In this paper, the incidence, pathological characteristics, diagnosis and treatment characteristics and prognosis were discussed and analyzed to provide research basis for improving the clinical diagnosis and treatment of this disease.

Methods: From September 2011 to September 2015, a total of 5,570 patients with lung cancer were treated in Jiangsu Cancer Hospital. The clinicopathological characteristics of 61 patients with lung cancer combined with MPM in other organs were retrospectively analyzed.

Results: The incidence rate of lung cancer combined with MPM in other organs in this group was 1.1%, of which 15 cases were synchronous MPM (SMPM), 46 cases were metachronous MPM (MMPM). Colorectal cancer, breast cancer and thyroid cancer accounted for the top three of lung cancer combined with MPM in other organs. The overall 5-year survival rate was 39.3% and 71.4% of patients died from metastasis or recurrence of lung cancer. Multivariate analysis showed that the clinical stage of lung cancer patients, the order of occurrence of lung cancer and other tumors, the treatment status of patients with other organ tumors and the presence of epidermal growth factor receptor (EGFR) gene mutation were important factors for the survival of the patients.

Conclusions: The incidence rate of lung cancer combined with MPM in other organs is not uncommon. Lung cancer is the main cause of death compared with other organs tumors. Patients with advanced lung cancer, SMPM, lung cancer first, combined with tumor only receiving palliative treatment and without EGFR gene mutation had a poor prognosis.
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http://dx.doi.org/10.3779/j.issn.1009-3419.2021.101.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849037PMC
January 2021

Efficacy of cardiovascular surgery for Marfan syndrome patients: a single-center 15-year follow-up study.

J Thorac Dis 2020 Dec;12(12):7106-7116

Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.

Background: Most Marfan syndrome (MFS) patients have thoracic aortic diseases which is the major cause of death. The aim of the study is to analyze the impact of different surgical procedures on prognosis of MFS patients.

Methods: We retrospectively analyzed the results of hospitalization and long-term follow-up of MFS patients who underwent surgical intervention in our center.

Results: Of the 135 MFS patients, 11 died during hospitalization (8.1%). There were no statistical differences in in-hospital mortality between the proximal surgery group and the distal surgery group (P=0.11). Compared to patients who underwent proximal aortic surgery, patients who underwent arch and distal surgery were more likely to have postoperative respiratory dysfunction (P=0.008). The type of surgical procedure was not associated with the incidence of complications during hospitalization. Pre-surgical New York Heart Association (NYHA) Functional Classification IV (P=0.047), EF <50% (P=0.047), pre-surgical atrial fibrillation (P=0.042), and the injury of dissection propagating onto coronary arteries (P=0.02) were independent risk factors for post-surgical mortality. After 15 years of follow-up, there were no deaths in the David group, while the 15-year survival rate for patients in the Bentall group was 73%±13.5%, and 71%±13.9% for patients in the arch surgery group (P=0.42). The probability of patients in the David group not requiring re-surgery after 15 years was 58.9%±20%, while it was 58.7%±12.1% for patients in the Bentall group, 71.5%±10.5% for patients in the Bentall + Arch group, and 12.5%±11.7% for patients in the Arch + Stent group (P=0.007).

Conclusions: The David procedure was the most beneficial and had the highest long-term patient survival rates.
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http://dx.doi.org/10.21037/jtd-20-2109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797851PMC
December 2020

miR-214 Attenuates Aortic Valve Calcification by Regulating Osteogenic Differentiation of Valvular Interstitial Cells.

Mol Ther Nucleic Acids 2020 Dec 15;22:971-980. Epub 2020 Oct 15.

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.

Calcific aortic valve disease (CAVD) is a common heart valve disease in aging populations, and aberrant osteogenic differentiation of valvular interstitial cells (VICs) plays a critical role in the pathogenesis of ectopic ossification of the aortic valve. miR-214 has been validated to be involved in the osteogenesis process. Here, we aim to investigate the role and mechanism of miR-214 in CAVD progression. miR-214 expression was significantly downregulated in CAVD aortic valve leaflets, accompanied by upregulation of osteogenic markers. Overexpression of miR-214 suppressed osteogenic differentiation of VICs, while silencing the expression of miR-214 promoted this function. miR-214 directly targeted ATF4 and Sp7 to modulate osteoblastic differentiation of VICs, which was proved by dual luciferase reporter assay and rescue experiment. miR-214 knockout rats exhibited higher mean transvalvular velocity and gradient. The expression of osteogenic markers in aortic valve leaflets of miR-214 knockout rats was upregulated compared to that of the wild-type group. Taken together, our study showed that miR-214 inhibited aortic valve calcification via regulating osteogenic differentiation of VICs by directly targeting ATF4 and Sp7, indicating that miR-214 may act as a profound candidate of targeting therapy for CAVD.
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http://dx.doi.org/10.1016/j.omtn.2020.10.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679242PMC
December 2020

Lymphatic Metastasis of NSCLC Involves Chemotaxis Effects of Lymphatic Endothelial Cells through the CCR7-CCL21 Axis Modulated by TNF-α.

Genes (Basel) 2020 Nov 4;11(11). Epub 2020 Nov 4.

Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.

Metastasis and recurrence are the main causes of lung adenocarcinoma patients' death. Lymphatic metastasis is the main way of non-small cell lung cancer (NSCLC) metastasis. C-C chemokine receptor type 7 (CCR7) overexpression has been demonstrated to mediate occurrence and progression of NSCLC. Moreover, Chemokine ligand 21 (CCL21) was used to activate CCR7. The CCR7-CCL21 axis is one of the most common "chemokine-receptor" modes of action in the development and metastasis of multiple tumors. However, the role of the CCR7-CCL21 axis in lymphatic metastasis of NSCLC is poorly understood. The study was conducted to investigate the molecular mechanism underlying CCR7-CCL21 axis-mediated lymphatic metastasis of NSCLC A549 cells. Tumor necrosis factor α (TNF-α) could regulate the tumor microenvironment balance by promoting chemokine secretion. Our study demonstrated that TNF-α promoted CCL21 production in human lymphatic endothelial cells (HLEC). Results further showed that TNF-α significantly activated the NF-κB pathway in HLEC. NF-κB pathway inhibition with ammonium pyrrolidinedithiocarbamate (PDTC) caused a significant decrease in CCL21 secretion, suggesting that TNF-α-induced CCL21 secretion in HLEC was through NF-κB pathway. Co-culture of A549 cells and TNF-α-treated HLEC confirmed that the metastasis of A549 cells was enhanced, meanwhile, apoptosis-related proteins were hardly affected. The data proved that a co-culture system prevented cell apoptosis while inducing the lymphatic metastasis of A549 cells. However, the situation was reversed after neutralizing CCL21 expression, suggesting that TNF-α-induced CCL21 secretion in HLEC is involved in A549 cells metastasis. Collectively, our finding demonstrated that NF-κB pathway-controlled CCL21 secretion of HLEC contributing to the lymphatic metastasis of A549 cells via the CCR7-CCL21 axis, validating the CCR7-CCL21 axis as a potential target to inhibit metastasis of NSCLC.
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http://dx.doi.org/10.3390/genes11111309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694274PMC
November 2020

Risk factors of chronic left ventricular dysfunction after cardiac valve surgery.

J Thorac Dis 2020 Sep;12(9):4854-4859

Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.

Background: To analyze the risk factors of chronic left ventricular dysfunction (LVD) after cardiac valve surgery.

Methods: A retrospective analysis of 860 patients who underwent heart valve surgery in our center from January 2017 to December 2018, including 650 males and 210 females, aged 58±5.8 years. Inclusion criteria: (I) the patient was clinically diagnosed with heart valve disease and met the surgical indications for mitral valve replacement (MVR), mitral valve repair (MVP), aortic valve replacement (AVR) and double valve replacement (DVR); (II) if atrial fibrillation, coronary artery disease, and tricuspid regurgitation are combined before surgery, radiofrequency ablation, coronary bypass and tricuspid angioplasty were performed contemporarily. Exclusion criteria: (I) preoperative LVEF <50%; (II) aortic dissection underwent Bentall and right heart valve replacement procedures; (III) cardiopulmonary resuscitation and death during perioperative period and 6 months after operation; (IV) postoperative CRRT, IABP, or ECMO assistance; (V) postoperative cardiac dysfunction due to valvular dysfunction, perivalvular leak, or infective endocarditis. Patients were divided into LVD group (LVEF <40%) and control group (LVEF ≥40%) based on cardiac LVEF at 6 months after surgery. Logistic regression was used to analyze the risk factors of postoperative LVD.

Results: There were 126 cases in LVD group and 734 cases in control group. There were significant differences in preoperative coronary artery disease, atrial fibrillation, pulmonary hypertension, NYHA classification, left ventricular end diastolic diameter (LVEDD), and left ventricular end systolic diameter (LVESD) between the two groups (P<0.05). The differences in the changes of LVEDD and LVESD before and after operation between the two groups were statistically significant (P<0.05). Logistic regression analysis showed that preoperative LVEDD >55 mm, preoperative LVESD >40 mm, preoperative combined atrial fibrillation, preoperative combined pulmonary hypertension, preoperative NYHA III-IV, and preoperative combined coronary artery disease were the risks of postoperative chronic LVD.

Conclusions: The left ventricular diameter, preoperative coronary artery disease, NYHA III-IV, preoperative atrial fibrillation, and preoperative pulmonary hypertension are risk factors for chronic LVD after heart valve surgery.
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http://dx.doi.org/10.21037/jtd-20-1010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578501PMC
September 2020

All-Trans Retinoic Acid Prevented Vein Grafts Stenosis by Inhibiting Rb-E2F Mediated Cell Cycle Progression and KLF5-RARα Interaction in Human Vein Smooth Muscle Cells.

Cardiovasc Drugs Ther 2021 Feb 12;35(1):103-111. Epub 2020 Oct 12.

Institute of Cardiac Surgery, Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.

Purpose: Vein graft failure (VGF) is an important limitation for coronary artery bypass graft (CABG) surgery. Inhibition of the excessive proliferation and migration of venous smooth muscle cells (SMCs) is an effective strategy to alleviate VGF during the CABG perioperative period. In the present study, we aimed to explore the role and potential mechanism of all-trans retinoic acid (ATRA) on preventing vein grafts stenosis.

Methods: The autogenous vein grafts model was established in the right jugular artery of rabbits. Immunohistochemistry staining and western blot assays were used to detected the protein expression, while real-time PCR assay was applied for mRNAs expression detection. The interaction between proteins was identified by co-immunoprecipitation assay. The Cell Counting Kit-8 and wound-healing assays were used to investigate the role of ATRA on human umbilical vein smooth muscle cells (HUVSMCs) function. Cell cycle progression was identified by flow cytometry assay.

Results: Vein graft stenosis and SMCs hyperproliferation were confirmed in vein grafts by histological and Ki-67 immunohistochemistry assays. Treatment of ATRA (10 mg/kg/day) significantly mitigated the stenosis extent of vein grafts, demonstrated by the decreased thickness of intima-media, and decreased Ki-67 expression. ATRA could repress the PDGF-bb-induced excessive proliferation and migration of HUVSMCs, which was mediated by Rb-E2F dependent cell cycle inhibition. Meanwhile, ATRA could reduce the interaction between KLF5 and RARα, thereby inhibiting the function of cis-elements of KLF5. KLF5-induced inducible nitric oxide synthase (iNOS) expression activation could be significantly inhibited by ATRA.

Conclusions: These results suggested that ATRA treatment may represent an effective prevention and therapy avenue for VGF.
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http://dx.doi.org/10.1007/s10557-020-07089-4DOI Listing
February 2021

Staged repair of chronic type A aortic dissection with small true lumen at the descending aorta.

J Thorac Dis 2020 Aug;12(8):4126-4131

Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.

Background: Surgical strategy for treating chronic type A dissection with small true lumen at the descending aorta has not been reported. In this retrospective study, we reviewed our experience of applying a two-stage procedure for treating chronic type A dissection with small true lumen at the descending aorta.

Methods: Between February 2016 and December 2019, seven patients suffering from chronic type A dissection with small true lumen at the descending aorta underwent this procedure. Preoperative computed tomographic angiography (CTA) was performed to carefully assess the diameter of the descending aorta, tear site, and visceral arteries. The interval between the two procedures is determined by the condition of the patients' recovery and illustration of postoperative CTA after the first stage procedure.

Results: All patients underwent first- and second-stage procedures. No mortality was observed among the seven patients. One patient who had a transient neurological deficit after the first stage recovered completely before hospital discharge. In two patients, the diameter of the descending aorta was enlarged postoperatively after the first-stage procedure. The interval between the two procedures was 2-3 months. However, no adverse events, such as stroke, paraparesis, visceral malperfusion, and lower extremity malfunction, were observed.

Conclusions: The two-staged procedure for the repair of chronic type A dissection with small true lumen at the descending aorta is adaptable with low prevalence of mortality and complication.
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http://dx.doi.org/10.21037/jtd-20-1048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475528PMC
August 2020

Measuring Genome-Wide Nascent Nucleosome Assembly Using ReIN-Map.

Methods Mol Biol 2021 ;2196:117-141

State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences and Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.

The successful assembly of nucleosomes following DNA replication is critically important for both the inheritance of epigenetic information and the maintenance of genome integrity. This process, termed DNA replication-coupled (RC) nucleosome assembly, requires that DNA replication and nucleosome assembly function in a highly coordinated fashion to transmit both genetic and epigenetic information. In this chapter, we describe a genome-wide method for measuring nucleosome occupancy patterns on nascent strands, which we have termed Replication-Intermediate Nucleosome Mapping (ReIN-Map), to monitor the RC nucleosome assembly level genome-wide in vivo. This method takes advantage of next-generation sequencing and in vivo labeling of newly synthesized DNA using a thymidine analogue, 5-bromo-2'-deoxyuridine (BrdU), and involves parallel analyses of the nucleosome formation using micrococcal nuclease (MNase) digestion of chromatin (MNase-seq) and of the newly synthesized DNA levels using sonication shearing of chromatin s (Sonication-seq). Replicated chromatin was enriched by immunoprecipitation using antibodies against BrdU (BrdU-IP), which is incorporated into DNA during DNA synthesis; the DNA is then subjected to strand-specific sequencing.
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http://dx.doi.org/10.1007/978-1-0716-0868-5_10DOI Listing
March 2021

3D-to-2D Dimensional Reduction for Exploiting a Multilayered Perovskite Ferroelectric toward Polarized-Light Detection in the Solar-Blind Ultraviolet Region.

Angew Chem Int Ed Engl 2020 Nov 17;59(48):21693-21697. Epub 2020 Sep 17.

State Key Laboratory of Structure Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, Fujian, 350002, P. R. China.

Polarized-light detection in solar-blind ultraviolet region is indispensable for optoelectronic applications, whereas new 2D candidates targeted at solar-blind UV range remain extremely scarce. 2D hybrid perovskite ferroelectrics that combine polarization and semiconducting properties are of increasing interest. Here, using the 3D-to-2D dimensional reduction of CH NH PbCl , we designed a multilayered hybrid perovskite ferroelectric, (CH CH NH ) (CH NH ) Pb Cl , which shows spontaneous polarization and a high Curie temperature (390 K) comparable with that of BaTiO (393 K). The wide band gap (ca. 3.35 eV) and anisotropic absorbance stemming from its intrinsic 2D motif, greatly favor its polarization-sensitive activity in UV region. The device displays excellent polarization-sensitive behavior under 266 nm, along with a large dichroic ratio (ca. 1.38) and high on/off current ratio (ca. 2.3×10 ).
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http://dx.doi.org/10.1002/anie.202009329DOI Listing
November 2020

Giant and Broadband Multiphoton Absorption Nonlinearities of a 2D Organometallic Perovskite Ferroelectric.

Adv Mater 2020 Sep 23;32(36):e2002972. Epub 2020 Jul 23.

State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, Fujian, 350002, P. R. China.

Multiphoton absorption (MPA) has been utilized for important technological applications. High-order multiphoton harvesting (e.g., five-photon absorption, 5PA) exhibits unique properties that could benefit biophotonics. Within this field, perovskite oxide ferroelectrics (e.g., BaTiO ) enable low-order optical nonlinearities of 2PA/3PA processes. However, it is challenging to obtain efficient, high-order 5PA effects. Herein, for the first time, giant and broadband MPA properties are presented in the 2D hybrid perovskite ferroelectric (IA) (MA) Pb Br (1; IA = isoamylammonium and MA = methylammonium), where multiphoton-excited optical nonlinearities related to different MPA mechanisms over a broadband range of 550-2400 nm are observed. Strikingly, its 5PA absorption cross-section (σ ) reaches up to 1.2 × 10 cm s photon (at 2400 nm), almost 10 orders larger than some state-of-the-art organic molecules and a record-high value among all known ferroelectrics. This unprecedented 5PA effect results from the quantum-confined motif of inorganic trilayer sheets (wells) and organic cations (barriers) in 1. Moreover, its large ferroelectric polarization of 5 µC cm could promote modulation of MPA effects under external electric fields. As far as it is known, this is the first report on giant, broadband high-order MPA properties in ferroelectrics, which provides potential, novel electric-ordered materials for next-generation biophotonic applications.
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http://dx.doi.org/10.1002/adma.202002972DOI Listing
September 2020

Dysregulated long non-coding RNAs involved in regulation of matrix degradation during type-B aortic dissection pathogenesis.

Gen Thorac Cardiovasc Surg 2021 Feb 14;69(2):238-245. Epub 2020 Jul 14.

Institute of Cardiac Surgery, Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.

Thoracic aortic dissection (TAD) is a catastrophic disease with the rupture of aortic media resulted mainly from the degradation of extracellular matrix. With the deep study of long non-coding RNAs (lncRNAs) in cardiovascular diseases, the correlation between lncRNAs and the TAD pathogenesis is under revealed. In this study, we aimed to screen the differentially expressed lncRNAs involved in the regulation of matrix degradation during type-B aortic dissection (TBAD), whose pathogenesis is more similar to atherosclerosis. A total of 393 aberrantly expressed lncRNAs and 432 aberrantly expressed mRNAs were identified in the descending aortic samples from TBAD patients. Then, co-expression analysis was applied to analyze the correlation between the top five differentially expressed lncRNAs and aberrantly expressed mRNAs, so as to screen the lncRNAs involved in the regulation of matrix degradation. The results showed that two transcripts from lnc-TNFSF14 (lnc-TNFSF14-2, and lnc-TNFSF14-3) were negatively interacted with MMP14 and MMP19. Subsequently, quantitative real-time PCR assay confirmed that lnc-TNFSF14-2 were negatively correlated with MMP14 (r = - 0.8180) and MMP19 (r = - 0.8449), and lnc-TNFSF14-3 was also negatively correlated with MMP14 (r = - 0.7098) and MMP19 (r = - 0.7728) in descending aorta from TBAD patients (n = 20). Overall, our study found the aberrant lncRNAs expression profiles in TBAD, and identified lnc-TNFSF14 as a potential target regulating matrix degradation. The results also provided crucial clues for lncRNAs function research on TBAD development.
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http://dx.doi.org/10.1007/s11748-020-01441-zDOI Listing
February 2021

A radial force-independent bioprosthesis for transcatheter tricuspid valve implantation in a preclinical model.

Int J Cardiol 2020 11 4;319:120-126. Epub 2020 Jul 4.

Department of Cardiovascular Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China. Electronic address:

Background: Interventional treatments of tricuspid regurgitation have been emerging as minimally invasive alternatives. Among those reported transcatheter tricuspid devices, the radial force between the device and native tricuspid annulus is the common principle to be employed for device immobilization. However, this immobilization mechanism may potentially lead to adverse consequences. We developed a radial force-independent stent valve device for implantation at native tricuspid annular site without inducing stress on either myocardial tissue or the bioprosthesis.

Methods: We designed a radial force-independent LuX-Valve as a transcatheter bioprosthesis, comprising a stent valve and a delivery system. The device employs a combination of a right ventricle anchoring component, two leaflet-grasping clips, and an atrial disc as a mechanical integrity to immobilize the stent valve device in secure at the native tricuspid annulus. We evaluated the feasibility and safety of implantation of this device in a goat model.

Results: We successfully implanted LuX-Valves at the tricuspid position through the right atrium in 17 goats. Procedures in 16 cases were safe. Time for the operator to implant the device until immobilization in secure ranged from 3.5 to 10 min. No significant paravalvular leakage was detected by echocardiography during follow-up, up to 180 days. Histopathology showed no evidence of stent fracture and myocardial injury.

Conclusion: The results indicated that radial force-independent LuX-Valve was safe and practicable for tricuspid valve implantation with satisfactory prosthetic function.
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http://dx.doi.org/10.1016/j.ijcard.2020.06.070DOI Listing
November 2020

Esophageal cancer patients of heavier weight have more nutritional risk of inadequate calorie intake immediately after esophagectomy: a retrospective study.

Support Care Cancer 2021 Mar 3;29(3):1265-1274. Epub 2020 Jul 3.

Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China.

Background: Perioperative malnutrition is common in patients undergoing esophagectomy, and nutritional support is critical for postoperative recovery in these patients. But few studies reported which characteristics of these patients were associated with post-esophagectomy inadequate calorie intake. This study aimed to explore which patients were more likely to have inadequate calories immediately after esophagectomy and the impact on clinical outcomes.

Methods: From January 2018 to June 2019, patients undergoing esophagectomy were retrospectively divided into the "adequate calorie group" and the "inadequate calorie group" according to whether they met daily calorie requirements in a week after esophagectomy. Caloric requirements met rate and clinical outcomes were compared between patients with and without complications, and with weight > 70 kg or ≤ 70 kg.

Results: Patients in the inadequate calorie group (n = 104) had significantly higher weight (p < 0.001), lean body mass (p = 0.028), and BMI (p = 0.001) than the adequate calorie group (n = 46). Weight loss after esophagectomy was reduced (p = 0.043) in the adequate calorie group. Patients with complications had lower rate of adequate calorie intake (72.8% vs. 63.8%). The caloric requirements met rate in patients with weigh ≤ 70 kg was significantly higher than those weight > 70 kg (80.2% vs. 43.2%, p < 0.001).

Conclusion: The weights of patients having inadequate calories in a week after esophagectomy were significantly heavier than those having adequate calories. Heavier patients after esophagectomy should attract more attention to their nutrition support.

Trial Registration: This trial was registered ( ChiCTR1900025557 ).
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http://dx.doi.org/10.1007/s00520-020-05538-2DOI Listing
March 2021

The Effects of High-Salt Gastric Intake on the Composition of the Intestinal Microbiota in Wistar Rats.

Med Sci Monit 2020 Jun 6;26:e922160. Epub 2020 Jun 6.

Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).

BACKGROUND A high-salt diet may result in chronic disease and changes in the intestinal microbiota. This pilot study aimed to investigate the microbial composition of the intestine in Wistar rats given intragastric high-salt infusions for four weeks. MATERIAL AND METHODS Six 4-week-old male Wistar rats were fed standard chow and divided into the high-salt group (n=3) and the control study group (n=3). Rats in the high-salt group were given 1 ml of 10% NaCl solution intragastrically three times per week for four weeks. The fecal pellets were collected, and the microbiota was characterized using 16S rRNA gene sequencing that targeted the V4 region. The relative abundance of microbial populations was compared using linear discriminant analysis effect size (LEfSe) statistical analysis for the identification of biomarkers between two or more groups, principal component analysis (PCA), and linear discriminant analysis (LDA). Microbial genome prediction was performed using the phylogenetic investigation of communities by reconstructing the unobserved states (PICRUSt) bioinformatics software. RESULTS There was no significant difference in the alpha diversity of the fecal microbiota between the high-salt group and the control group. However, PCA showed structural segregation between the two groups. Further analysis using LEfSe showed that the intestinal contents in the high-salt group had significantly reduced populations of Lactobacillus and Prevotella NK3B31, and a significant increase in Alloprevotella and Prevotella 9, without physiological or pathological changes. CONCLUSIONS A pilot study in Wistar rats showed that high-salt intake was associated with a change in the composition of the intestinal microbiota.
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http://dx.doi.org/10.12659/MSM.922160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297027PMC
June 2020

Room-Temperature Ferroelectric Material Composed of a Two-Dimensional Metal Halide Double Perovskite for X-ray Detection.

Angew Chem Int Ed Engl 2020 Aug 4;59(33):13879-13884. Epub 2020 Jun 4.

State Key Laboratory of Structure Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, 350002, P. R. China.

Although two-dimensional (2D) metal-halide double perovskites display versatile physical properties due to their huge structural compatibility, room-temperature ferroelectric behavior has not yet been reported for this fascinating family. Here, we designed a room-temperature ferroelectric material composed of 2D halide double perovskites, (chloropropylammonium) AgBiBr , using an organic asymmetric dipolar ligand. It exhibits concrete ferroelectricity, including a Curie temperature of 305 K and a notable spontaneous polarization of ≈3.2 μC cm , triggered by dynamic ordering of the organic cation and the tilting motion of heterometallic AgBr /BiBr octahedra. Besides, the alternating array of inorganic perovskite sheets and organic cations endows large mobility-lifetime product (μτ=1.0×10  cm  V ) for detecting X-ray photons, which is almost tenfold higher than that of CH NH PbI wafers. As far as we know, this is the first study on an X-ray-sensitive ferroelectric material composed of 2D halide double perovskites. Our findings afford a promising platform for exploring new ferroelectric materials toward further device applications.
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http://dx.doi.org/10.1002/anie.202004235DOI Listing
August 2020

Long-term outcomes of surgical procedures for Marfan syndrome: aortic dissection versus aneurysm.

J Thorac Dis 2020 Mar;12(3):249-257

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.

Background: Multiple of subsequent procedures may necessary in Marfan syndrome (MFS) patients after initial surgery. The aim of this study was to investigate the full spectrum of secondary distal vascular or valvular interventions encountered after initial surgery.

Methods: Retrospective analysis of 201 consecutive MFS patients between January 2000 and March 2019 who underwent 274 distal aortic reinterventions and 5 mitral valve replacements.

Results: Of the enrolled 201 MFS patients (73 female, mean age 37.0±12.8 years), the surgical indication for 93 patients was aortic root aneurysm, and for another 108 patients was dissection. The mean follow-up interval was 8.4±5.5 years. Total arch replacement (TAR) was performed in 68.5% of MFS patients presenting with type A aortic dissection (TAAD) and in 2.2% of patients with aneurysm. Secondary TAR became necessary for 3.4% of patients who failed to receive TAR at initial surgery in aneurysm group during follow-up, while for 33.3% of patients in dissection group (P<0.001). Freedom from distal aortic reoperation in dissection group were 65.4%±5.2%, 49.6%±6.4%, and 38.3%±7.7% and in aneurysm group were 90.5%±3.5%, 84.2%±4.8%, and 84.2%±4.8% at 5, 10, and 15 years, respectively (P<0.001). Survival in dissection group were 94.4%±2.4%, 83.4%±5.7%, 68.4%±10.8% and in aneurysm group were 100%, 97.7%±2.3%, 97.7%±2.3% at 5, 10, and 15 years, respectively (P=0.001). Freedom from mitral valve reoperation in dissection group were 98.8%±1.2%, 98.8%±1.2%, 88.9%±9.4% at 5, 10, and 15 years, respectively. Freedom from mitral valve reoperation in aneurysm group were 97.2%±1.9%, 94.6%±3.2%, 94.6%±3.2% at 5, 10, and 15 years, respectively (P=0.775).

Conclusions: TAAD at initial surgery was an independent predictor of distal aortic reoperation. Limited repair was feasible for MFS patients presenting with aneurysm at initial surgery, extended repair might be better for TAAD for its higher risk of distal reintervention. Concomitant mitral valve procedures may depend on mitral regurgitation grades.
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http://dx.doi.org/10.21037/jtd.2020.01.72DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139013PMC
March 2020

Impact of a Higher Body Mass Index on Prolonged Intubation in Patients Undergoing Surgery for Acute Thoracic Aortic Dissection.

Heart Lung Circ 2020 Nov 19;29(11):1725-1732. Epub 2020 Mar 19.

Department of Cardiovascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China. Electronic address:

Background: In recent years, obese patients presenting with acute thoracic aortic dissection have not been uncommon and there are often pulmonary complications among them. Whether a higher body mass index (BMI) is associated with more pulmonary complications or even a higher mortality rate has yet to be determined. This study aimed to evaluate the effects of higher BMI on pulmonary complications and other surgical outcomes.

Methods: A total of 404 patients who underwent acute thoracic aortic dissection surgery were retrospectively studied. They were divided into three groups based on their BMI: normal weight (BMI 18.5 to <25 kg/m, n=173), overweight (BMI 25 to <30 kg/m, n=145) and obese (BMI ≥30 kg/m, n=86). Clinical data were collected and analysed among groups.

Results: No statistical significance was detected among the groups for postoperative complications, in-hospital mortality and hospital or ICU stay, except for prolonged intubation, the proportion of which was highest in the obese group followed by the overweight and normal groups (40.7% vs 29% vs 11%, respectively; p<0.001). Furthermore, logistic regression analysis showed that postoperative renal failure (OR=16.984) and cardiopulmonary bypass time (OR=1.013) were independent risk factors for in-hospital mortality, while higher BMI (OR=7.148 for BMI ≥25 and 18.967 for BMI ≥30), transfused red blood cells (OR=1.004), and postoperative renal failure (OR=7.386) were independent risk factors for prolonged ventilation (p<0.05).

Conclusion: Body mass index had no effect on in-hospital mortality but may be closely correlated with prolonged intubation for patients undergoing aortic dissection surgery. This finding suggests that these patients should receive more aggressive pulmonary management.
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http://dx.doi.org/10.1016/j.hlc.2020.02.008DOI Listing
November 2020

Highly-Anisotropic Dion-Jacobson Hybrid Perovskite by Tailoring Diamine into CsPbBr for Polarization-Sensitive Photodetection.

Small 2020 Apr 12;16(14):e1907020. Epub 2020 Mar 12.

State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences Fuzhou, Fujian, 350002, P. R. China.

2D materials with inherent attributes of structural anisotropy have been well applied in the field of polarization-sensitive photodetection. However, to explore new 2D members with strong polarized-light responses still remains a challenge. Herein, by alloying diamine molecule into the 3D prototype of CsPbBr , a new Dion-Jacobson (DJ) type 2D perovskite of (HDA)CsPb Br (1, where HDA is 1,6-hexamethylenediammonium), containing both inorganic Cs metal and organic cations is designed. The natural anisotropy characteristics of 1 are solidly elucidated by analyzing crystal structure, electric conductivity, and optical properties. Strikingly, distinct polarization-sensitive responses are observed in 1, owing to its strong anisotropy of optical absorption (the ratio of α /α ≈ 2.2). Consequently, crystal-based detectors of 1 exhibit fascinating photo-activities to polarized-light, including high detectivity (1.5 × 10 Jones), large dichroism ratio (I /I ≈ 1.6) and fast responding rate (200 µs). All these polarization-sensitive performances along with intriguing phase stability make 1 a potential candidate for polarized-light detection. This work paves a pathway toward new functionalities of DJ-type 2D hybrid perovskites for their future optoelectronic device applications.
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http://dx.doi.org/10.1002/smll.201907020DOI Listing
April 2020

Decision-making at initial surgery for type A aortic dissection in patients with Marfan syndrome: proximal or extensive repair.

J Thorac Dis 2019 Dec;11(12):4951-4959

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.

Background: Data on outcome of Stanford type A aortic dissection (TAAD) in Marfan syndrome (MFS) patients are limited. We investigated the full spectrum of reoperation and survival after initial surgery in MFS patients who suffered TAAD.

Methods: Retrospective analysis of 85 consecutive MFS patients in one-single center during the past 15 years.

Results: Overall, 85 MFS patients with TAAD underwent surgical repair [74% acute dissections; 80% DeBakey type I; 91% composite valved graft; 70% total arch replacement (TAR); 68% frozen elephant trunk (FET); 7% in-hospital mortality] at Changhai hospital affiliated to the Second Military Medical University over the past 15 years. Five (20.8%) patients in non-TAR group need aortic arch reintervention with resternotomy during follow-up, which is significantly higher than that in TAR group (P=0.001). Freedom from aortic arch reoperation in non-TAR group was all 78.7%±8.5% at 5, 10, and 15 years. No patient required aortic arch reoperation in TAR group (P=0.001). On the other hand, the FET was inserted into false lumen intentionally at initial surgery in 2 cases of chronic TAAD with narrowed true lumen. Scheduled thoracoabdominal aortic replacement was performed 6 months later. Both 2 patients are with well clinical outcomes. At last, we found that Debakey type and TAR at initial surgery were irrelevant to survival and reoperation for descending aorta.

Conclusions: TAR combined with FET is recommended in MFS patients when the aortic arch is dissected or enlarged. The FET could be inserted into the false lumen intentionally in selective case for scheduled 2-staged descending aortic repair.
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http://dx.doi.org/10.21037/jtd.2019.12.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988001PMC
December 2019

Extra-anatomical bypass to treat aortic endograft infection after thoracic endovascular aortic repair.

Interact Cardiovasc Thorac Surg 2020 04;30(4):620-622

Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.

This study aimed to report the case of 7 consecutive patients who underwent surgical treatment for aortic endograft infection after thoracic endovascular aortic repair (TEVAR). The management included the reconstruction of aorta using extra-anatomic prosthetic graft bypass (between the ascending aorta and the abdominal aorta), removal of the infected endograft with debridement of the infected tissue and sac drainage, followed by prolonged antibiotic therapy. This brief communication highlights that the reconstruction of aorta using extra-anatomic prosthetic graft bypass during surgical treatment for aortic endograft infection after TEVAR was reliable and effective.
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http://dx.doi.org/10.1093/icvts/ivz318DOI Listing
April 2020

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study.

J Cardiothorac Surg 2020 Jan 22;15(1):25. Epub 2020 Jan 22.

Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.

Background: Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5-10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery.

Methods: In this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis.

Results: Among 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3-47.8) vs. 69.0 h (47.8-110.3), p < 0.001) and ICU stay (122.0 h (80.8-155.0) vs 179.5 h (114.0-258.0), p < 0.001). There were no significant between-group differences in mortality, complications, or length of hospital stay.

Conclusions: In this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.
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http://dx.doi.org/10.1186/s13019-020-1069-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977331PMC
January 2020

Multilayered 2D Cesium-Based Hybrid Perovskite with Strong Polarization Sensitivity: Dimensional Reduction of CsPbBr.

Chemistry 2020 Mar 27;26(16):3494-3498. Epub 2020 Feb 27.

State Key Laboratory of Structure Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, Fujian, 350002, P. R. China.

3D perovskite CsPbBr has recently taken a blooming position for optoelectronic applications. However, due to the lack of natural anisotropy of optical attributes, it is a great challenge to fulfil polarization-sensitive photodetection. Here, for the first time, we exploited dimensionality reduction of CsPbBr to tailor a 2D-multilayered hybrid perovskite, (TRA) CsPb Br (1, in which TRA is (carboxy)cyclohexylmethylammonium), serving as a potential polarized-light detecting candidate. Its unique quantum-confined 2D structure results in intrinsic anisotropy of electrical conductivity, optical absorbance, and polarization-dependent responses. Particularly, it exhibits remarkable dichroism with the photocurrent ratio (I /I ) of ≈2.1, being much higher than that of the isotropic CsPbBr crystal and reported CH NH PbI nanowire (≈1.3), which reveals its great potentials for polarization-sensitive photodetection. Further, crystal-based detectors of 1 show fascinating responses to the polarized light, including high detectivity (>10 Jones), fast responding time (≈300 μs), and sizeable on/off current ratios (>10 ). To our best knowledge, this is the first study on 2D Cs-based hybrid perovskite exhibiting strong polarization-sensitivity. The work highlights an effective pathway to explore new polarization sensitive candidates for hybrid perovskites and promotes their future electronic applications.
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http://dx.doi.org/10.1002/chem.201905531DOI Listing
March 2020

Dimensional Reduction of Cs AgBiBr : A 2D Hybrid Double Perovskite with Strong Polarization Sensitivity.

Angew Chem Int Ed Engl 2020 Feb 24;59(9):3429-3433. Epub 2020 Jan 24.

State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, Fujian, 350002, China.

By dimensional reduction of the 3D motif of Cs AgBiBr , a lead-free 2D hybrid double perovskite, (i-PA) CsAgBiBr (1, i-PA=isopentylammonium), was successfully designed. It adopts a quantum-confined bilayered structure with alternating organic and inorganic sheets. Strikingly, the unique 2D architecture endows it highly anisotropic nature of physical properties, including electric conductivity and optical absorption (the ratio α /α =1.9 at 405 nm). Such anisotropy attributes result in the strong polarization-sensitive responses with large dichroic ratios up to 1.35, being comparable to some 2D inorganic materials. This is the first study on the hybrid double perovskites with strong polarization sensitivity. A crystal device of 1 also exhibits rapid response speed (ca. 200 μs) and excellent stabilities. The family of 2D hybrid double perovskites are promising optoelectronic candidates, and this work paves a new pathway for exploring new green polarization-sensitive materials.
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http://dx.doi.org/10.1002/anie.201911551DOI Listing
February 2020

Fabrication of porous bovine pericardium scaffolds incorporated with bFGF for tissue engineering applications.

Xenotransplantation 2020 01 6;27(1):e12568. Epub 2019 Nov 6.

Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Background: The design and fabrication of porous scaffolds are important issues for tissue engineering applications. In this study, we attempted to fabricate porous scaffolds using bovine pericardium (BP) and examined whether these scaffolds were beneficial for cell ingrowth and bioactive factors delivery.

Methods: A vacuum-freeze-thawing-Triton X-100 (VFTT) protocol was used to fabricate porous BP scaffolds. The porous and mechanical properties were assessed using histology, scanning electron microscopy, and mechanical assay. The fabricated scaffolds were seeded with mesenchymal stem cells (MSCs), and cell ingrowth was evaluated. Basic fibroblast growth factor (bFGF) was subsequently incorporated into the fabricated scaffolds. The bioactive factor delivery capacity was evaluated using loading and release studies. The bioactivity of released bFGF was assessed using a rat subcutaneous model.

Results: The BP scaffolds fabricated by the VFTT protocol displayed interconnected porous structures with porosity of 6.82 ± 1.36%.There were no significant differences in thickness, ultimate load, Young's modulus, and ultimate tensile strength between the fabricated porous BP scaffolds and native BPs (all P > .05). However, the water content of BPs was slightly reduced after VFTT treatment (P < .05). Cell ingrowth analysis showed that the seeded MSCs penetrated into the porous BP scaffolds with time of culture, while MSCs were limited to the surface layers of native BPs. Furthermore, bFGF was observed to be effectively loaded onto and released from the porous BP scaffolds. The released bFGF increased the phosphorylation levels of Akt, ERK 1/2, and MEK1/2, promoted host MSC recruitment, and inhibited myofibroblast differentiation in vivo.

Conclusions: The porous BP scaffolds fabricated using a VFTT protocol were promising natural scaffolds for tissue engineering applications, since they had considerable mechanical properties as native BPs, supplied porous channels for cell ingrowth, and possessed bioactive factors delivery capability.
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http://dx.doi.org/10.1111/xen.12568DOI Listing
January 2020

Outcomes and risk factors of postoperative hepatic dysfunction in patients undergoing acute type A aortic dissection surgery.

J Thorac Dis 2019 Aug;11(8):3225-3233

Department of Cardiovascular Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.

Background: Postoperative hepatic dysfunction (HD) increases the morbidity and mortality risk after cardiac surgery; however, only a few studies have specifically focused on acute type A aortic dissection (AAAD) surgery. We explored the possible risk factors and outcomes of early postoperative HD in patients with AAAD undergoing surgery.

Methods: All patients who underwent AAAD surgery at our institution from April 2015 to April 2017 were retrospectively evaluated. Postoperative model for end-stage liver disease (MELD) score was used to define HD. Independent risk factors for HD were determined by multivariate logistic analysis.

Results: Two hundred fifteen patients with AAAD met the inclusion criteria. The incidence rate of early postoperative HD was 60.9%, and the rate of in-hospital mortality was 16.8%. Patients with a high postoperative MELD score had longer mechanical ventilation time, longer durations of intensive care unit (ICU) stay, and higher in-hospital mortality. During the postoperative period, patients with AAAD complicated by HD needed continuous renal replacement therapy (CRRT), reintubation, tracheostomy, and blood transfusion more frequently. Aortic cross clamp (ACC) time [per 10 min higher; odds ratio (OR): 1.216, 95% confidence interval (CI): 1.017-1.454, P=0.032], postoperative leucocytes (per 2×10/L higher; OR: 1.161, 95% CI: 1.018-1.324, P=0.026), postoperative respiratory dysfunction (OR: 3.176, 95% CI: 1.293-7.803, P=0.012), and postoperative low cardiac output syndrome (LCOS) (OR: 12.663, 95% CI: 1.432-111.998, P=0.022) were independent risk factors associated with HD in patients undergoing AAAD surgery.

Conclusions: Postoperative HD prolongs mechanical ventilation time and ICU stay, and is associated with increased in-hospital mortality among patients who undergo AAAD surgery. Several factors are associated with a high postoperative MELD score.
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http://dx.doi.org/10.21037/jtd.2019.08.72DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753406PMC
August 2019

IgG4-Related Tumefactive Lesions at the Pulmonary Artery Causing Stenosis of Bilateral Primary Branches and Resultant Pulmonary Hypertension.

Cardiology 2019;143(3-4):136-144. Epub 2019 Sep 2.

Department of Cardiothoracic Surgery, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China,

IgG4-related disease (IgG4-RD) is a newly recognized but rare entity involving multiple organs, with autoimmune pancreatitis, retroperitoneal mass, and the inflammation of glands being typical in most cases. IgG4-related perivascular lesions, although uncommon, have been increasingly reported in recent years. Diagnosis of IgG4-RD relies on comprehensive consideration of characteristic histopathological and immunostaining results, clinical and imaging findings, and serological results according to several widely recognized diagnostic criteria. This benign disorder frequently presenting tumefactive lesions should be distinguished from malignancy and other inflammatory mimics. Here we report a case of tumefactive mass at the bifurcation of the pulmonary trunk causing stenosis of the proximal left and right pulmonary artery (PA) and resultant pulmonary hypertension (PH). Bypass from the PA trunk to the right branch distal to stenosis was performed to resolve the obstructive hemodynamic disturbance and PH. Glucocorticoid monotherapy was performed after a diagnosis of definite IgG4-RD. Longitudinal disease activity assessment via imaging modalities, serological parameters, and IgG4-RD responder index verified no relapse during follow-up and the validity of the treatment strategy.
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http://dx.doi.org/10.1159/000501741DOI Listing
February 2020

Exploring Lead-Free Hybrid Double Perovskite Crystals of (BA) CsAgBiBr with Large Mobility-Lifetime Product toward X-Ray Detection.

Angew Chem Int Ed Engl 2019 Oct 17;58(44):15757-15761. Epub 2019 Sep 17.

State Key Laboratory of Structure Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, Fujian, 350002, P. R. China.

Halide double perovskites have recently bloomed as the green candidates for optoelectronic applications, such as X-ray detection. Despite great efforts, the exploration of promising organic-inorganic hybrid double perovskites toward X-ray detection remains unsuccessful. Now, single crystals of the lead-free hybrid double perovskite, (BA) CsAgBiBr (BA is n-butylammonium), featuring the unique 2D multilayered quantum-confined motif, enable quite large μτ (mobility-lifetime) product up to 1.21×10  cm  V . This figure-of-merit realized in 2D hybrid double perovskites is unprecedented and comparable with that of CH NH PbI wafers. (BA) CsAgBiBr crystals also exhibit other intriguing attributes for X-ray detection, including high bulk resistivity, low density of defects and traps, and large X-ray attenuation coefficient. Consequently, a vertical-structure crystal device under X-ray source yields a superior sensitivity of 4.2 μC Gy  cm .
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http://dx.doi.org/10.1002/anie.201909815DOI Listing
October 2019