Abstract Tumor necrosis factor–related apoptosis-inducing ligand (TRAIL) has been shown to induce apoptosis of cancer cells. Sensitization of cancer cells to TRAIL, particularly TRAIL-resistant cancer cells, could improve the effectiveness of TRAIL as an anticancer agent. The adenovirus type 5 E1A that associates with anticancer activities including sensitization to apoptosis induced by tumor necrosis factor is currently being tested in clinical trials. In this study, we investigated the sensitivity to TRAIL in the E1A transfectants ip1-E1A2 and 231-E1A cells and the parental TRAIL-resistant human ovarian cancer SKOV3.ip1 and TRAIL-sensitive human breast cancer MDA-MB-231 cells. The results indicated that the percentage of TRAIL-induced apoptotic cells was significantly higher in the E1A transfectants of both cell lines than it was in the parental cell lines. To further investigate the cellular mechanism of this effect, we found that E1A enhances TRAIL-induced activation of caspase-8, caspase-9, and caspase-3. Inhibition of caspase-3 activity by a specific inhibitor, Z-DEVD-fmk, abolished TRAIL-induced apoptosis. In addition, E1A enhanced TRAIL expression in ip1-E1A2 cells, but not in 231-E1A cells, and the anti-TRAIL neutralizing antibody N2B2 blocked the E1A-mediated bystander effect in vitro. Taken together, these results suggest that E1A sensitizes both TRAIL-sensitive and TRAIL-resistant cancer cells to TRAIL-induced apoptosis, which occurs through the enhancement of caspase activation; activation of caspase-3 is required for TRAIL-induced apoptosis; and E1A-induced TRAIL expression is involved in the E1A-mediated bystander effect. Combination of E1A and TRAIL could be an effective treatment for cancer.
To the Editor: A 47-year-old male patient was admitted because of chest discomfort for 2 weeks. He had no obvious incentive precordial discomfort 2 weeks ago, accompanied by palpitation. He immediately went to the town hospital. Electrocardiogram (ECG) showed myocardial infarction. Coronary angiography showed coronary artery disease accompanied by a ventricular aneurysm. The patient was transferred to Beijing Anzhen Hospital. ECG showed sinus rhythm, heart axis deviation + 111°, anterior septal, anterior lateral, anterior myocardial infarction, and complete right bundle branch block. Chest X-ray showed no obvious abnormalities in heart and lung. Echocardiography showed abnormal motion of segmental ventricular wall; formation of a ventricular aneurysm in apex area of the heart, the diameter of the ventricular aneurysm was 2 cm, the diastolic function of left ventricular was reduced. Coronary angiography showed left anterior descending artery filling slowly and its intima was not smooth; the stenosis rate was 90%. The stenosis rate of the circumflex artery was 90% [Figure 1a and b]. He was diagnosed with acute anterior myocardial infarction, left ventricular aneurysm, and hypertension.Figure 1: Coronary angiography right anterior oblique 30° display. (a) The circumflex artery was filled and stenosis. Left anterior descending artery was not completely filled; (b) After the circumflex artery was filled, left anterior descending artery was filled and stenosis.The patient received treatment of dilation of a coronary artery, anticoagulation, nourishing myocardium, and other symptomatic and supportive treatment. He underwent off-pump coronary artery bypass surgery with median incision of the sternum. Take the left internal mammary artery and the right saphenous vein in reserve. Activating clotting time (ACT) value was 391 s after intravenous injection of 75 mg heparin. Left internal mammary artery - left anterior descending artery; aorta - saphenous vein - obtuse marginal branch vascular anastomosis were performed using external fixator. Anastomotic stoma was unobstructed and nonhemorrhage. Flow meter displayed satisfactory flow in grafts. Heparin was neutralized followed by routine chest shut surgery. The patient broke out in the sudden reduction of blood pressure and ventricular fibrillation. Defibrillation (200 Ws) and emergency chest compressions were performed followed by exploratory thoracotomy surgery. Intra-aortic balloon counterpulsation (IABP) was used as an assistive device. Extracorporeal circulation was established. Heparin (250 mg) was intravenously injected. ACT value after heparin injection was 486 s, intraoperative ACT value was 610 s. Flow meter displayed no flow in grafts. A redo coronary artery bypass grafting surgery was performed. Thrombosis was found in the left internal mammary artery distal anastomosis and the left anterior descending artery, saphenous vein proximal and distal anastomosis, and the circumflex artery. The thrombus in anastomosis and grafts was carefully removed and the proximal and the distal grafts was spied. The distal circumflex artery was not satisfying. The distal left anterior descending artery was satisfying. Aorta - saphenous vein - anterior descending artery, aorta - saphenous vein - obtuse marginal branch vascular anastomosis were performed again. Anastomotic stoma was unobstructed. Extracorporeal circulation device could not stop so as to install extracorporeal membrane oxygenation (ECMO) assist device. Stop extracorporeal circulation device followed by routine chest shut surgery. The patient's vital signs were closely surveilled in Intensive Care Unit (ICU). The patient accepted cardiotonic agents, anti-infection, nourishing myocardium, and other symptomatic treatment. The patient condition gradually improved, ECMO device was removed on the fourth postoperative day. Trachea cannula was removed on the fifth postoperative day. IABP device was removed on the seventh postoperative day. The patient went back to the ward on the eighth postoperative day. Heart rhythm was regular. Cardiac murmur did not exist. Chest X-ray, echocardiography, and ECG showed no abnormalities. The patient was discharged 15 days after the operation. Thrombosis is a common complication of coronary artery bypass graft surgery. The thrombosis is classified as arterial thrombosis and venous thrombosis. Venous thrombosis is common, arterial thrombosis is rare. The main causes of venous thrombosis are vascular intimal injury and blood clotting disorders. The intimal injury may activate platelet function and make platelets release thromboxane A and other clotting factors to promote thrombosis. Coagulation abnormalities may lead to increased activity of clotting factor which could cause thrombosis. Arterial thrombosis is rare and its mechanism is unknown. Currently, it is known that heparin resistance is one of the reasons for arterial thrombosis. Heparin is an acidic mucopolysaccharide composed of glucosamine L-iduronic glucoside, N-acetyl glucosamine, and D-glucuronic acid. It is mainly produced by mast cells and basophils. Despite its little content in plasma under normal physiological conditions, it has rich content in the lung, liver, and other tissues. The anticoagulant effect of heparin is strong. It enhances the affinity of antithrombin III and thrombin, accelerates thrombin inactivation, inhibits clotting factor activation, inhibits platelet adhesion and aggregation, increases protein C activation, and stimulates vascular endothelial cells to release anticoagulant and fibrinolytic substances. Heparin is widely used in cardiovascular surgery. Studies have shown that patients undergoing coronary artery bypass surgery shows heparin resistance. The incidence of this phenomenon is rising.[1] Heparin resistance refers to the phenomena that ACT value is <400 s under the use of a standard dose of heparin.[2] If ACT value is <400 s, it is not sufficient for the patient to have plasma anticoagulant capacity in vivo. Meanwhile, the use of extracorporeal circulation system will lead to excessive activation of the coagulation system.[3] Lower activity of antithrombin III may be the cause of heparin resistance.[4] However, some reports showed that there is no direct relationship between antithrombin III and heparin.[5] Patients show symptoms of heparin resistance with the high levels of platelet in the blood. The mechanism is that platelets can release platelet factor 4 which could inhibit the function of heparin. The patients with the high levels of platelet in the blood will be able to inhibit the effect of heparin to a certain extent. The reason for heparin resistance is very complex. ACT value is not a specific indicator for the anticoagulant capacity of heparin. ACT value is affected by many variables in cardiac surgery. However, clinicians still use ACT value as the detection indicator of heparin anticoagulant capabilities. Heparin resistance can lead to a variety of serious complications such as bleeding, cardiac arrhythmia, ventricular fibrillation, prolonged intubation time, and prolonged residence time in ICU. This patient who had coronary artery bypass grafting surgery may have heparin resistance which lead to thrombosis in a coronary artery, artery, and vein grafts. The mechanism of heparin resistance is unclear. It is hoped that medical workers gain experience in future clinical work. Hence, heparin resistance phenomenon can be reduced. Financial support and sponsorship This work was supported by grants from 2014 Chaoyang District, Beijing Science and Technology Program (No. SF1417); 2015 Capital Medical University Student Technological Innovation Program (No. XSKY2015192). Conflicts of interest There are no conflicts of interest.
Fibulin-3 (FBLN3) levels vary among different types of cancers.We found that fibulin-3 was downregulated in colorectal cancer (CRC) cells, particularly in the SW480 cell line.However, transfecting SW480 cells with a lentivirus overexpressing fibulin-3 RNA inhibited proliferation, induced G1/S arrest, and promoted apoptosis.Fibulin-3 overexpression also suppressed CRC invasion and metastasis.These effects were regulated through the AKT/mTOR signaling pathway.
Objective: To compare the efficacy of off-pump minimally invasive cardiac surgery (MICS) via a single left intercostal space incision with median sternotomy multi-vesselcoronary artery bypass grafting (CABG). Methods: Patients who were diagnosed with multi-artery coronary artery disease (CAD) in the Ward 10 of the Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University and underwent CABG from July 2019 to January 2022 were retrospectively collected. All the patients were divided into MICS group and conventional CABG group according to the surgical methods. The perioperative outcomes were compared between thetwo groups, including intraoperative blood loss, postoperative 24 h thoracic drainage volume, ventilation duration, length of stay (LOS) in intensive care unit (ICU) and total LOS in hospital. Intraoperative blood flow of graft vesselswas measured by transit-time flow measurement (TTFM) after vascular anastomosis, and mean flow (MF) and pulsatile index (PI) were compared between the two groups. Results: A total of 444 patients were in the final analysis, with 351 males and 93 females, and the mean age of (62.0±8.9) years. There were 179 patients in MICS group and 265 cases in conventional CABG group, respectively. There were no statistically significant differences in the preoperative profiles between the two groups (all P>0.05) except that younger age [(60.7±9.3) years vs (62.8±8.5) years, P=0.017] and lower proportion of female [10.1% (18/179) vs 28.3% (75/265), P<0.001] were detected in MICS group. Likewise, there was no significant difference in the number of graft vessels between MICS group (3.18±0.74) and conventional CABG group (3.28±0.86) (P=0.234). Compared with those in conventional CABG group, patients in MICS group showed longer operation duration [ (5.10±1.09) h vs (4.33±0.86) h], fewer intraoperative blood loss [500 (200, 700) ml vs 700 (600, 900) ml], fewer postoperative 24 h thoracic drainage volume [300 (200, 400) ml vs 400 (250, 500) ml], shorter postoperative ventilation duration [15.0 (12.0, 17.0) h vs 16.5 (12.5, 19.0) h, P<0.001], LOS in ICU [18.0 (15.0, 20.0) h vs 20.0 (16.0, 23.0) h, P<0.001] and total LOS in hospital [(12.6±2.7) d vs (14.5±3.9) d, P<0.001]. MI and PI of graft vessels were similar between the two groups (both P>0.05). Moreover, there were no significant differences in major perioperative complications (i.e., repeat thoracotomy, incision infection, stroke) and mortality between the two groups (all P>0.05). Conclusion: MICS is an alternative treatment for patients with multi-vessel CAD with better perioperative outcomes compared with conventional CABG.目的： 比较非体外循环左侧肋间小切口微创与胸骨正中切口冠状动脉旁路移植术（CABG）（传统CABG）对多支冠状动脉病变的疗效。 方法： 回顾性分析2019年7月至2022年1月于首都医科大学附属北京安贞医院心脏外科十病区住院诊断为多支病变冠心病行CABG的患者临床资料，根据手术方式分为左侧肋间小切口微创CABG（MICS）组和传统CABG组。比较两组患者的围手术期结果，包括术中出血、术后24 h胸腔引流量、术后机械通气时间、重症监护病房（ICU）停留时间及总住院时间。术中应用即时血流测量技术对旁路血管进行血流测量，比较两组患者旁路血管的平均血流量（MI）和搏动指数（PI）。 结果： 共纳入444例患者，男351例，女93例，年龄（62.0±8.9）岁。MICS组179例，传统CABG组265例。与传统CABG组比较，MICS组女性比例较低［10.1%（18/179）比28.3%（75/265），P<0.001］，年龄较小［（60.7±9.3）岁比（62.8±8.5）岁，P=0.017），其他临床特征两组比较差异均无统计学意义（均P>0.05）。MICS组与传统CABG组患者旁路血管数量差异无统计学意义［（3.18±0.74）支比（3.28±0.86）支，P=0.234］，但MICS组患者手术时间较传统CABG组长［（5.10±1.09）h比（4.33±0.86）h，P<0.001］。与CABG组比较，MICS组患者术中出血量［500（200，700）ml比700（600，900）ml，P<0.001］、术后24 h胸腔引流量［300（200，400）ml比400（250，500）ml，P<0.001］均较少，术后机械通气时间［15.0（12.0，17.0）h比16.5（12.5，19.0）h，P<0.001］、术后ICU停留时间［18.0（15.0，20.0）h比20.0（16.0，23.0）h，P<0.001］、总住院时间［（12.6±2.7）d比（14.5±3.9）d，P<0.001］均较短。两组患者术后各旁路血管MI和PI差异均无统计学意义（均P>0.05）。两组患者围手术期主要并发症（包括再次开胸、切口感染、脑卒中）及病死率差异均无统计学意义（均P>0.05）。 结论： 与传统CABG比较，MICS是多支病变冠心病患者的一种有益的治疗选择，围手术期结局良好。.
This comparative study investigates the method, efficiency, and anti-hypoxic ability of cardiomyocytes, directionally induced from human (h) and mouse (m) embryonic stem cells (ESCs). hESCs were induced into cardiomyocytes by suspension culture, without inducers, or adherent culture using the inducers activin A and BMP4. mESCs were induced into cardiomyocytes by hanging-drop method, without inducers or induced with vitamin C. All four methods successfully induced ESCs to differentiate into cardiomyocytes. There was a significant difference between groups with and without inducers. A significant difference was found between mESC and hESC groups with inducers. The average beating frequency of cardiomyocytes differentiated from hESC was lower than cardiomyocytes differentiated from mESC, while the average beating frequency of cardiomyocytes differentiated from the same cell line, despite different culture methods, did not differ. Beating cardiomyocytes of each group were positive for cTnT staining. Spontaneous action potentials of beating cardiomyocytes were detected by patch-clamp experiments in each group. Different apoptotic ratios were detected in beating cardiomyocytes in each group and the difference between cardiomyocytes induced from mESCs and hESCs was statistically significant. The differentiation efficiencies in the groups without inducers were significantly higher than those without inducers. The induction of mESCs was more simple and efficient compared with hESCs. Without the presence of other protective factors, the anti-hypoxic ability of cardiomyocytes induced from hESCs was stronger and the beating times were longer in vitro compared with mESCs.
Gaillardia pulchella Foug., belonging to the family Asteraceae, is an annual herb commonly seen in tropical America and China. It is often used as ornamental flowers because of its bright color, long flowering period and simple cultivation and management. In June 2021, leaf spot on G. pulchella with ∼40% disease incidence was observed in Laoshan scenic spot of Qingdao, Shandong Province, China. Initial symptoms on leaves appeared as light yellow to brown round or oval spots with dark brown borders, and the lesion area gradually expanded and the color deepened with the development of the disease. Small tissue samples collected from the infected lesions were surface-sterilized with 70% ethanol for 30 s, then rinsed with 2% sodium hypochlorite (NaClO) for 60 s, and finally rinsed with sterilized water three times. All the samples were transferred to potato dextrose agar (PDA) medium and incubated at 25℃ in the dark for 5 days (Zhu et al. 2013). A total of 9 isolates were obtained from the 11 selected tissues of symptomatic leaves. Afterward, all the single spore isolates were transferred onto potato carrot agar (PCA) plates (Mirkova 2003). After 7 to 10 days of incubation on PCA at 25℃ in the dark, colonies had a cottony mycelium with round margins, colored in white to gray. To test pathogenicity, six healthy G. pulchella plants were inoculated with mycelial plugs of the above pure cultures from a 7-day-old culture grown on PCA, while six germfree PCA plugs were served as negative controls. All the inoculated plants were set in greenhouse incubator at 25℃ and 80% relative humidity. Following 5 days incubation, brown spots began to appear on the sites of all inoculated leaves with mycelial plugs, while all the negative controls inoculated with sterile PCA plugs remained healthy. Infected lesions were separated and cultured as the same as those isolated in the field, and the same isolate was again microscopically identified, fulfilling Koch's postulates. 5 isolates were characterized, the colony margins of single spore isolate were round with gray or black aerial mycelia. Conidia were clustered and unbranched with 1 to 4 septa, colored in light or dark brown, shaped in obclavate or ellipsoid with short conical beak at the tip, dimensions varied from 14 to 51 μm (length) × 4.5 to 11 μm (width). The described morphological characteristics were consistent with Alternaria alternata (Simmons 2007). For further identification of molecular characterization, the genes of Chitin synthase (CHSD), RNA polymerase II second largest subunit (PRB2), Tsr1 ribosome biogenesis protein (Tsr1) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) were obtained by PCR amplification with the primer pairs CHSDF1/CHSDR1, PRB2DF/PRB2DR, Tsr1F/Tsr1R and GAPDHF1/GAPDHR1 (Damn et al. 2019; Lawrence et al. 2013), respectively. The sequenced genes (GenBank accession nos. ON660874, ON660875, ON660876 and ON660877) had more than 99% nucleotide identity with the corresponding genes (GenBank accession nos. KY996470.1, MN304718.1, KY996472.1 and MN158133.1) of the reference strains of A. alternata in GenBank, and the re-inoculated and re-isolated strains have the same results which were repeated three times. The causal agent occurred on G. pulchella was identified as A. alternata based on the morphological and molecular characteristics. To our knowledge, this is the first record causing leaf spot on G. pulchella by A. alternata in China.
Apigenin is a naturally occurring plant flavonoid that possesses antioxidant, anti-cancer and anti-inflammatory properties. However, there are few reports has been done on the ability of apigenin to induce apoptosis in macrophages. In this study, mouse macrophage ANA-1 cells were incubated with different concentrations of apigenin. The cell viability was determined by an MTT assay. The cell apoptosis were analyzed by flow cytometric analysis. Apoptosis were also analyzed using a TUNEL assay and a DNA ladder. The level of intracellular ROS was detected using a dichlorofluorescein -diacetate probe. The expression levels of apoptosis-related proteins were detected by western blot analysis. The results showed that apigenin decreased the viability of ANA-1 cells and induced apoptosis in a dose- and time-dependent manner. Apigenin increased the level of intracellular ROS, downregulated the expression of Bcl-2 and upregulated the expression of caspase-3 and caspase-8 in ANA-1 cells. Furthermore, apigenin downregulated the expression of phospho-ERK and phospho-JNK, upregulated the expression of phospho-p38 and had no significant effect on the expression of Bax, ERK, JNK and p38. The results suggested that apigenin induced cell apoptosis in mouse macrophage ANA-1 cells may via increasing intracellular ROS, regulating the MAPK pathway, and then inhibiting Bcl-2 expression.
Several studies reported the impact of cardiac surgical operation on morbidity and mortality in renal transplant recipients as well as on renal graft function and safety and effect of immunosuppressant medication.1-3 However, few data are available about the risk and immunosuppressant medication in patients who undergo cardiac surgical operation after successful renal transplantation, especially in patients who underwent off pump coronary artery bypass grafting (CABG) with previous renal transplantation. This research provides important insights into the immunosuppressive management of a patient requiring valve replacement or CABG after renal transplantation during the perioperative period. METHODS Six patients (4 male, 2 female) were identified who had undergone a cardiac surgical operation after renal transplantation. Charts were reviewed for factors related to the patients’ date of renal transplantation and immunosuppression therapy. Perioperative data included indication for operation, type of procedure, date of procedure, postoperative course, and complications. The severity of coronary artery disease or heart valve disease was assessed. Coronary heart disease was assessed in 2 and heart valve disease in 4 patients. Coronary arteriography revealed marked (≥75% luminal stenosis) triple-vessel disease in one patient, double-vessel disease in one patient. Aortic valve disease was found in three patients, mitral valve insufficiency in one patient. The interval between renal transplantation and cardiac operation was (8.5±1.7) years (range, 6-10 years). The mean age of the patients at cardiac operation was (42±14) years (range, 27-66 years). The mean body weight of the patients was (58±15) kg (range 44-78 kg). The mean body area of the patients was (1.5±0.1) m2 (range 1.4-1.7 m2). All patients had functioning renal allografts with preoperative serum creatinine levels (103.7±15.1) μmol/L. The preoperative New York Heart Association functional classification was III in three patients, II in three patients. All patients continued to take immunosuppressant medication of cyclosporine 50 mg twice daily and mycophenolate mofetil 0.25 g twice daily. All patients were given oral cyclosporine 50 mg and mycophenolate mofetil 0.25 g on the morning of surgery. Four valve diseases patients were operated on using moderate systemic hypothermia (32°C) for myocardial protection. Cold potassium cardioplegia was applied. Two coronary artery diseases patients were operated without pump. Particular attention was directed intraoperatively to adequate urine output. Intravenous methylprednisolone 500 mg during surgery procedure and intravenous methylprednisolone 150 mg/d for three days starting on the day of surgery were used. All patients continued to take immunosuppressant medication of cyclosporine 50 mg twice daily and mycophenolate mofetil 0.25 g twice daily when the patients were able to take oral medications. All patients’ renal function was monitored daily. All experiments were performed at least three times, and data were expressed as mean ± standard deviation (SD) and analyzed by Student’s t test. A value of P < 0.05 was considered statistically significant. RESULTS All patients survived the operation. No patient died in the post-operative course. The cure rate was 100%. In all patients, the function of the renal allograft was not impaired by cardiac surgical operation. Two patients underwent off pump CABG and four cases underwent valve replacement. For coronary revascularization, two patients received saphenous veins for all bypasses. At the mean time, the left internal mammary artery also was used. The valve operations included aortic valve replacement (AVR) in three patients, isolated mitral valve replacement (MVR) in one patient. Mechanical heart valves were used in 2 patients in the aortic position and one patient for MVR. Bioprosthetic valve was used in one patient in the aortic position. Cardiopulmonary bypass time (CPB) was (101.3±16.7) minutes, and the aortic cross-clamping time was (75.6±9.7) minutes. Patients were extubated after one day postoperatively. The left ventricle ejection fraction before operation and after operation was (56.5±5.8)% and (63.5±4.5)% respectively (P<0.05); left ventricular end-diastolic diameter before operation was (54.5±8.5) mm, while after operation was (43.7±6.8) mm (P<0.05). Serum creatinine levels before operation and after operation were (103.7±15.1) μmol/L and (106.6±34.7) μmol/L (P>0.05). Oral cyclosporine 50 mg twice daily and mycophenolate mofetil 0.25 g twice daily were continued from the day after surgery. All patients’ renal function was monitored daily and remained stable. All patients had an uneventful recovery with normal temperature, stable cardiac function, and no obvious renal transplant rejection. Routine laboratory investigations including renal function tests were within the normal range, echocardiography and chest X-ray did not show any abnormalities, and all patients were discharged from hospital. Hospitalization time was (17±6) days. The follow-up of the 6 patients was 4-15 months. All patients were free of cardiac symptoms and returned to New York Heart Association Classes I and II. DISCUSSION We administered intravenous methylprednisolone, 500 mg during surgery and 150 mg/d for 3 days after surgery, to prevent rejection and provide anti-inflammatory and anti-allergy effects. Obviously, the risk of rejection was not enhanced when immunosuppressive therapy was maintained throughout the perioperative period. With taking long-term immunosuppressive medication, infection was the most worrying operation complication for a renal transplant recipient.4 So controlling blood glucose well and rationally using antibiotics was essential. In order to prevent the damage of cardiopulmonary bypass on renal transplant, we tried to shorten the operation time and cross-clamping time in the condition of low temperature. At the same time, we remained high perfusion pressure during the bypass, ensuring that the patient maintained urine, and patient renal function was monitored daily after operation. We had used off-pump of coronary artery disease to avoid the cardiopulmonary bypass damage. In order to avoid the danger of immunosuppressive medication, we had performed operations carefully. A polyester sheet was placed around the aortic wall to achieve hemostasis. With careful use of immunosuppressive drugs, renal transplant rejection was avoided. We performed operations safely in all 6 patients. Patients undergoing CABG after successful renal transplantation had a good survival rate. In our research, the cure rate was 100%. We generally preferred mechanical heart valves over bioprosthetic valves because of the young age of the patients. Serum creatinine in renal transplant recipients showed normal level postoperatively. We saw no rejection episodes in our patients postoperatively. Obviously, the risk of rejection is not enhanced when immunosuppressive therapy is maintained throughout the perioperative period.5 Cardiac surgical operation has many risk factors for sepsis, including major tissue trauma, prolonged exposure to air, and physiologic aberrations induced by the mechanical circulatory assist system. Despite all of these risk factors and immunosuppressive therapy, the incidence of wound infection or septicemia was comparable with that in patients not having transplantation. Our study showed that renal transplant recipients can cope with the stress of cardiac surgical operation. The risk of rejection is efficiently controlled by continuing the immunosuppression protocol. This research provides important insights into the immunosuppressive management of a patient requiring cardiac surgery after renal transplantation during the perioperative period. Cardiac operations in renal transplant recipients are effective and safe. Function of the transplanted organ can be maintained at the preoperative level. Acknowledgement: The authors would like to thank Dr. Men Xu and Dr. Sun Lizhong for giving generous support and patient information.
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