Journal of Cardiothoracic Surgery最新文献

Thymoma-related aplastic anemia is a rare entity. This article retrospectively analyzes the clinical features and treatment course of a patient who developed aplastic anemia (AA) post-thymectomy, complemented by a systematic review of relevant literature. A 47-year-old female was diagnosed with thymoma, myasthenia gravis (MG), and severe AA (SAA). SAA onset occurred two weeks after total thymectomy, and the patient ultimately succumbed to concurrent COVID-19 infection following allogeneic hematopoietic stem cell transplantation (allo-HSCT). We also reviewed the clinical characteristics, treatment strategies, and prognosis of 47 thymoma-related aplastic anemia patients reported in the literature. AA may present prior to thymoma diagnosis, concurrently with thymoma, or post-thymectomy. Some patients progress to pure red cell aplasia (PRCA) and/or megakaryocytic aplasia, often following prior chemotherapy or radiotherapy. Similar to Good syndrome and PRCA, thymectomy fails to alleviate AA, and spontaneous improvement is rare. Treatment options for thymoma-related aplastic anemia include cyclosporine A (CsA) monotherapy, CsA combined with glucocorticoids, thrombopoietin receptor agonists (TPO-RAs), and allo-HSCT. However, regimens of cyclophosphamide plus methylprednisolone and glucocorticoid monotherapy show limited efficacy. The overall one-year mortality rate is alarmingly high at 29.8%. For young thymoma-related aplastic anemia patients with SAA and suitable donors, allo-HSCT remains the preferred treatment.

Extensive research has investigated the therapeutic potential of mesenchymal stem cells (MSCs) in treating infectious diseases and mitigating tissue damage caused by these diseases. MSCs, along with their exosomes, present a promising avenue for combating infectious diseases, particularly HACEK endocarditis (HE). MSCs possess immunomodulatory properties and aid in tissue repair, while exosomes carry bioactive molecules. Antimicrobial peptides (AMPs) released by MSCs demonstrate efficacy against a broad spectrum of microorganisms, including bacteria, fungi, yeasts, and viruses. Key AMPs produced by MSCs include hepcidin, cathelicidin LL-37, and β-defensin-2. Furthermore, these AMPs have been found to interact with MSCs, influencing their proliferation, migration, and regeneration, indicating a broader biological impact than previously recognized. Preclinical studies have highlighted the potential of these AMPs to reduce inflammation, enhance cardiac function, and augment the efficacy of antibiotics against bacterial pathogens. This narrative review investigates the antimicrobial efficacy of MSCs, with specific emphasis on their therapeutic application against HACEK-associated infective endocarditis.

Background: Advances in medicine lead to an increase in the number of patients with concurrent heart disease and cancer. We investigated the effect of cardiac surgery under cardiopulmonary bypass (CPB) on the blood levels of growth factor cytokines, and assessed whether it might affect the proliferation of pancreatic cancer cells.

Methods: Ten consenting patients undergoing elective cardiac surgery with the use of CPB under general anesthesia. We obtained patients' serum at each of the following time points: between median sternotomy and before activating CPB (pre-CPB), and after activating CPB (post-CPB). Growth factor cytokines in plasma samples were analyzed using cytokine array. Proliferation assay was performed using pancreatic cancer cells (PANC-1 and PK-1) incubated in culture medium containing patients' serum at a concentration of 30%. The levels of cytokines and proliferation of cancer cells were compared between pre-CPB and post-CPB samples.

Results: Plasma and serum from eight patients were analyzed. PANC-1 and PK-1 cells proliferated significantly more following incubation with post-CPB (125%, P = 0.014 and 120%, P = 0.030, respectively) than pre-CPB samples. The following cytokines were significantly increased post-CPB compared to pre-CPB: amphiregulin (42 fold), basic fibroblast growth factor (5 fold), heparin binding-epidermal growth factor (9199 fold), hepatocyte growth factor (9 fold), insulin-like growth factor-binding protein (IGFBP)-1 (11 fold), IGFBP-4 (15 fold), insulin-like growth factor-2 (2 fold), macrophage colony-stimulating factor (2 fold), neurotrophin-4 (10 fold), transforming growth factor beta-3 (2 fold), vascular endothelial growth factor (VEGF)-A (3 fold), and VEGF receptor 2 (3 fold).

Conclusions: These results suggest that cardiac surgery with CPB increases the plasma levels of several growth factors, thus potentially promoting pancreatic cancer cell proliferation, as seen in the in vitro study using serum from non-cancer patients.

Trial registration: registration number UMIN000053046, date of registration December 12th, 2023.