The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2015
The 4E-BP1/eIF4E ratio is a determinant for rapamycin response in esophageal cancer cells.
Rapamycin inhibits products of molecular pathways in esophageal squamous cell carcinoma and limits tumor cell growth by targeting 4E-BP1- and eIF4E-dependent gene translation. In this study, we investigate the influence of 4E-BP1-to-eIF4E ratio on rapamycin response in esophageal squamous cell carcinoma cells, and the underlying mechanism is discussed. ⋯ The 4E-BP1/eIF4E ratio is a determinant of the response of rapamycin treatment in esophageal cancer cells. Egr-1 can reduce 4E-BP1 gene expression and render esophageal squamous cell carcinoma cells resistant to rapamycin with a relatively low 4E-BP1/eIF4E ratio. Thus, the 4E-BP1/eIF4E ratio may represent a therapeutic index for the prediction of clinical outcome of rapamycin treatment in patients with esophageal squamous cell carcinoma.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Aborted sternotomy due to unexpected porcelain aorta: does transcatheter aortic valve replacement offer an alternative choice?
Surgical aortic valve replacement is challenging in patients with severe aortic calcification. Some patients undergo sternotomy and have the operation aborted because of intraoperative discovery of severe calcification. Hypothermic circulatory arrest and transcatheter aortic valve replacement offer clampless treatment options for aortic stenosis. The study objectives are to characterize patients who are referred after sternotomy was aborted for porcelain aorta and to describe the treatment outcomes. ⋯ Both surgical aortic valve replacement and transcatheter aortic valve replacement are safe and effective options after aborted sternotomy in patients with porcelain aorta who are referred to a high-risk valve center. Procedure selection may be tailored to individual patients on the basis of aortic morphology and comorbidities. Patients with aortic stenosis at risk for calcific aortic disease should be screened with cross-sectional imaging preoperatively.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Aortic root surgery in the United States: a report from the Society of Thoracic Surgeons database.
The purpose of the present study was to evaluate the early clinical outcomes of aortic root surgery in the United States. ⋯ Most cardiac centers performed aortic root surgery in small volumes. The unadjusted operative mortality was greater for patients >80 years old and those with aortic stenosis, regardless of age. Valve sparing root surgery was associated with the lowest mortality. A trend was seen toward an increased use of stented tissue valves from 2004 to 2009.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Pathologic von Willebrand factor degradation with a left ventricular assist device occurs via two distinct mechanisms: mechanical demolition and enzymatic cleavage.
Bleeding is an important source of morbidity in patients with a left ventricular assist device. Evidence suggests a major role for von Willebrand factor. However, limited data exist to explain the mechanism(s) of von Willebrand factor degradation during left ventricular assist device support. We investigated whether left ventricular assist device-related shear stress and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13, the von Willebrand factor protease) altered von Willebrand factor metabolism. ⋯ Supraphysiologic shear stress alone causes physical demolition of large von Willebrand factor multimers into smaller von Willebrand factor multimers. In the setting of supraphysiologic shear stress, ADAMTS-13 cleaves large von Willebrand factor multimers into von Willebrand factor degradation fragments. ADAMTS-13 may be a therapeutic target to reduce von Willebrand factor degradation and bleeding complications in patients with a left ventricular assist device.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Characteristics and outcomes of secondary nodules identified on initial computed tomography scan for patients undergoing resection for primary non-small cell lung cancer.
We sought to define the prevalence, malignancy rate, and outcome of secondary nodules (SNs) detected on computed tomography (CT) scan for patients undergoing resection for primary non-small cell lung cancer (NSCLC). ⋯ The prevalence of SNs on CT scan in patients undergoing resection for primary NSCLC is high. Only a low proportion of SNs are ever found to be malignant, predominantly those on the ipsilateral side as the dominant tumor. The presence of SNs has no effect on survival. Patients with SNs, if otherwise appropriately staged, should not be denied surgical therapy.