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Objective:To develop a self-made plasma quality control material for non-invasive prenatal testing (NIPT) and evaluate its performance.Methods:139 NIPT-negative maternal plasmas stored in the genetic department of Shaoxing maternal and child health hospital from January 1, 2019 to June 30, 2021 were divided into male groups (19 cases) and female groups (120 cases) according to the neonatal gender. 9360 cases from September 2020 to September 2021 were enrolled as clinical validation cases.First step, 200 μl plasma from a 47 years-old non-pregnant healthy women was used as a matrix. Different amounts (0.1, 0.2, 0.5, 2.5, and 5 μl) of positive DNA from fetal chromosome aneuploidy (T21, T18, T13) detection kit were added. The appropriate volume of positive DNA was 0.5 μl according to the test results. Second step,Plasma in male and female group was treated as matrix. 0.5 μl positive DNA was added per 205 μl. Plasma matrix from female group showed good repeatability and the sensitivity was 100%.Third step, evaluate the self-made plasma quality control material, including storage stability, matrix uniformity and repeatability, and the effect of different batch numbers of positive DNA, by calculating Z score and the CV of fetal DNA concentration (FF).Results:Plasma matrix from female group showed good repeatability and the sensitivity was 100%, while the sensitivity of male group was only 84%. The CV of FF in female matrix was 3.9% in the repetitive experiments. After adding 0.5 μl positive DNA, the mean FF of self-made positive plasma quality control was 5.63%±0.42%, Z values>6, and the CV was 7% after storage of three months. Considering the concentration variation of positive DNA in different lots, 1 μl of positive DNA should be added when the FF of positive DNA is lower than 10%.Used in 9360 clinical cases from September 2020 to September 2021, all positive plasma quality control materials showed positive results, and the positive predictive value of trisomy 21 was 100%.Conclusions:The NIPT self-made positive plasma quality control material has been successfully developed in this study. The preliminary experimental results show that it has good repeatability and stability, which is suitable for clinical application.
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Objective:To explore potential signaling pathways and genes related to vitiligo progression by using bioinformatics methods.Methods:A vitiligo genechip dataset GSE75819 was downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were screened between lesional and non-lesional skin tissues from 15 Indian patients with vitiligo with the dataset GSE75819 by using LMFit and eBayes functions in R LIMma package. The Kyoto Encyclopedia of Genes and Genomes (KEGG) -based pathway analysis, Gene Ontology (GO) analysis and Gene Set Enrichment Analysis (GSEA) were carried out to identify enriched pathways and functions of the DEGs. Protein-protein interaction networks were established to screen hub genes from the DEGs. In addition, lesional and non-lesional skin tissue specimens were obtained from 8 patients of Han nationality with vitiligo vulgaris in Hospital of Xinjiang Traditional Uyghur Medicine between January and June in 2019, and real-time quantitative PCR was performed to verify the expression of the top 10 up- or down-regulated DEGs.Results:Compared with the 15 non-lesional skin tissues, a total of 148 DEGs were identified in the 15 lesional skin tissues. Among these DEGs, KRT9, CXCL10, C8ORF59, TPSAB1 and RPL26 were the top 5 up-regulated genes, and SILV, RPPH1, TYRP1, MLANA and LOC401115 were the top 5 down-regulated genes, which were all verified by real-time quantitative PCR in the lesional and non-lesional skin tissues from the 8 patients of Han nationality with vitiligo. GO analysis showed that the DEGs were chiefly enriched in translational initiation, cellular response to lipopolysaccharide, ribosomes, ribosomal subunits and structural constituents of ribosomes. KEGG analysis showed that the DEGs were chiefly enriched in tyrosine metabolism, peroxisome proliferator-activated receptor signaling pathway, oxidative phosphorylation and Toll-like receptor signaling pathway. Four hub genes, including UPF3B, SNRPG, MRPL13 and RPL26L1, were screened out by protein-protein interaction analysis.Conclusion:KRT9, CXCL10, C8ORF59, TPSAB1, RPL26, SILV, RPPH1, TYRP1, MLANA and LOC401115 genes may serve as potential diagnostic molecular markers and therapeutic targets for vitiligo.
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Chronic stress leads to many psychiatric disorders, including social and anxiety disorders that are associated with over-activation of neurons in the basolateral amygdala (BLA). However, not all individuals develop psychiatric diseases, many showing considerable resilience against stress exposure. Whether BLA neuronal activity is involved in regulating an individual's vulnerability to stress remains elusive. In this study, using a mouse model of chronic social defeat stress (CSDS), we divided the mice into susceptible and resilient subgroups based on their social interaction behavior. Using in vivo fiber photometry and in vitro patch-clamp recording, we showed that CSDS persistently (after 20 days of recovery from stress) increased BLA neuronal activity in all the mice regardless of their susceptible or resilient nature, although impaired social interaction behavior was only observed in susceptible mice. Increased anxiety-like behavior, on the other hand, was evident in both groups. Notably, the CSDS-induced increase of BLA neuronal activity correlated well with the heightened anxiety-like but not the social avoidance behavior in mice. These findings provide new insight to our understanding of the role of neuronal activity in the amygdala in mediating stress-related psychiatric disorders.
Subject(s)
Animals , Mice , Amygdala , Anxiety/etiology , Anxiety Disorders , Avoidance Learning , Mice, Inbred C57BL , Social Behavior , Stress, Psychological/complicationsABSTRACT
Five secondary metabolites, including a new isopimarane derivative xylaroisopimaranin A (1), were isolated from the endophytic fungus Xylaralyce sp. (HM-1), and their structures were elucidated by 1D, 2D NMR, MS and CD spectra. Their bioactivities were performed to antibacterial, Hep G2 cells cytotoxicity and brine shrimp inhibition. The biological evaluation results showed that the xylaroisopimaranin A (1), xylabisboein B (2), griseofulvin (3) , 5-methylmellein (4) and mellein-5-carboxlic acid (5) displayed no significant Hep G2 cells cytotoxicity and antibacterial acitivity, but they inhibited the brine shrimp with IC₅₀ from 0.5 to 25 µmol/mL.
Subject(s)
Artemia , Fungi , Griseofulvin , Hep G2 CellsABSTRACT
Objective: To compare the risk angle and safety angle of needling Yamen (GV 15) between the atlanto-axial dislocation (AAD) patients and healthy subjects. Methods: A total of 177 AAD patients diagnosed and treated at the Center of Upper Cervical Vertebra of Beijing China-Japan Friendship Hospital between January 2010 and January 2018 were included in the AAD group. Another 207 healthy subjects were included in the normal group. There were totally 191 males and 193 females. The MRI scan was performed for the cervical vertebrae to measure the risk angle and safety angle of acupuncture at Yamen (GV 15) on the sagittal image. Results: In the AAD group, the risk angle was (13.14±3.99)° and the relative safety angle was (10.31±3.23)° for the perpendicular needling, while the oblique needling risk angle was (9.09±3.09)° for the male; the risk angle was (12.12±2.74)° and the relative safety angle was (10.56±2.09)° for the perpendicular needling, while the oblique needling risk angle was (9.70±2.95)° for the female. In the normal group, the risk angle was (7.89±1.59)° and the relative safety angle was (10.21±3.55)° for the perpendicular needling, while the oblique needling risk angle was (16.07±1.77)° for the male; the risk angle was (6.93±1.45)° and the relative safety angle was (10.70±2.94)° for the perpendicular needling, while the oblique needling risk angle was (14.89±2.18)° for the female. The perpendicular needling risk angles for the males and females in the AAD group were larger than those in the normal group, and the differences were statistically significant (bothP<0.01); for the inner-group comparison, there was no significant difference in the perpendicular needling risk angle between the male and the female in the AAD group (P>0.05); however, the perpendicular needling risk angle for the male was larger than the female, and the difference was statistically significant in the normal group (P<0.01). There were no significant differences in the relative safety angle for both the male and the female between the AAD group and the normal group (bothP>0.05). For the inner-group comparison, there was no significant difference in the relative safety angle between the male and the female (P>0.05). The oblique needling risk angles for both the males and females were smaller in the AAD group than those in the normal group, and the differences were statistically significant (bothP<0.01); the oblique needling risk angle for the male was not significantly different from that for the female in the AAD group (P>0.05); in the normal group, the oblique needling risk angle for the male was larger than that for the female, and the difference was statistically significant (P<0.01). Conclusion: Under the AAD condition, the risk angle and safety angle of acupuncture at Yamen (GV 15) change significantly, perpendicular needling should be better if performed slightly lower than the horizontal direction, and the oblique needling should be safer across the occipital foramen toward the occipital bone.
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Two new polyketides, chinoketides A and B (1 – 2) with a known compound xylarphthalide A (3), were isolated from the solid medium of the endophytes from the leaves of the relic plant Distylium chinense with the “black-box” co-culture method, and the structures of two new compounds were elucidated by NMR, MS and CD spectra. And the absolute configurations of chinoketides A (1) and B (2) were determined as 2R,3R,8S and 5R,6S by calculating their ECD spectra to compare with the experimental CD spectra. Finally, the antimicrobial activities were evaluated to Erwinia carotovora sub sp. Carotovora (Jones) Bersey et al, and the results showed that compounds 1 – 3 displayed the antimicrobial activities with MIC value at 20.5, 30.4 and 10.2 µg/mL.
Subject(s)
Coculture Techniques , Endophytes , Methods , Pectobacterium carotovorum , Plants , PolyketidesABSTRACT
Objective To observe the influence of necrostatin-1 (Nec-1) on necroptosis and retinal ganglion cells (RGC) in mice with retinal ischemia reperfusion injury (RIRI).Methods Together 60 wild-type C57 mice were randomly divided into three groups (n =20),and they were control group,experimental group and blank group.Firstly,as for investigation the effect of Nec-I on necroptosis,15 mice in the blank group left untreated,15 mice in the experimental group were injected with 2 μL Nec-1 (2 mol · L-1) intravitreally,and 15 in the control group without pretreatment.After 4 h,the RIRI model was established by anterior chamber perfusion in the latter two groups.Then retinas in 5 mice in each group were harvested 3 days after ischemia reperfusion injury for Western blot,immunofluorescence quantitative PCR and immunofluorescence staining to detect the expression of mRNA and protein of IL-1β,IL-6,TNF-α,RIP3,RIP1 and Caspase-8.Secondly,the rest of 5 mice in 20 of each group were collected and retrogradely labeled with fluoro-gold (FG) to explored the influence of Nec-1 on RGC.Mice in the blank group left untreated.Mice in the experimental group were injected with 2 μL Nec-1 (2 mol · L-1) intravitreally,while the control group was not treated anything 7 days after fluorescence labeling;after 4 h,the RIRI model was established by anterior chamber perfusion in the two groups.The retinal tissue was harvested and RGC counting was performed 3 days after ischemia reperfusion injury.Results When compared with control group,mRNA expression levels of IL-1β,IL-6,TNF-α,RIP3 and RIP1 in the experimental group were decreased significantly (all P ＜ 0.001),but Caspase-8 mRNA did not change obviously (P =0.654 8).Western blot and immunofluorescence staining showed that RIP3 expression decreased dramatically in the experimental group when compared with the control group.FG labeled RGC counting presented that RGC number of each field in experimental group was significantly larger than that in the control group (P ＜ 0.001).Couclusion Nec-1 can block necroptosis and significantly increase RGC number in mice model of experimental RIRI.
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Objective To observe the influence of necrostatin-1 (Nec-1) on necroptosis and retinal ganglion cells (RGC) in mice with retinal ischemia reperfusion injury (RIRI).Methods Together 60 wild-type C57 mice were randomly divided into three groups (n =20),and they were control group,experimental group and blank group.Firstly,as for investigation the effect of Nec-I on necroptosis,15 mice in the blank group left untreated,15 mice in the experimental group were injected with 2 μL Nec-1 (2 mol · L-1) intravitreally,and 15 in the control group without pretreatment.After 4 h,the RIRI model was established by anterior chamber perfusion in the latter two groups.Then retinas in 5 mice in each group were harvested 3 days after ischemia reperfusion injury for Western blot,immunofluorescence quantitative PCR and immunofluorescence staining to detect the expression of mRNA and protein of IL-1β,IL-6,TNF-α,RIP3,RIP1 and Caspase-8.Secondly,the rest of 5 mice in 20 of each group were collected and retrogradely labeled with fluoro-gold (FG) to explored the influence of Nec-1 on RGC.Mice in the blank group left untreated.Mice in the experimental group were injected with 2 μL Nec-1 (2 mol · L-1) intravitreally,while the control group was not treated anything 7 days after fluorescence labeling;after 4 h,the RIRI model was established by anterior chamber perfusion in the two groups.The retinal tissue was harvested and RGC counting was performed 3 days after ischemia reperfusion injury.Results When compared with control group,mRNA expression levels of IL-1β,IL-6,TNF-α,RIP3 and RIP1 in the experimental group were decreased significantly (all P ＜ 0.001),but Caspase-8 mRNA did not change obviously (P =0.654 8).Western blot and immunofluorescence staining showed that RIP3 expression decreased dramatically in the experimental group when compared with the control group.FG labeled RGC counting presented that RGC number of each field in experimental group was significantly larger than that in the control group (P ＜ 0.001).Couclusion Nec-1 can block necroptosis and significantly increase RGC number in mice model of experimental RIRI.
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<p><b>BACKGROUND</b>There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.</p><p><b>METHODS</b>All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.</p><p><b>RESULTS</b>Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.</p><p><b>CONCLUSIONS</b>During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Artery Disease , Therapeutics , Drug-Eluting Stents , Percutaneous Coronary Intervention , Stroke VolumeABSTRACT
Ten isoflavonoids were isolated from the heartwoods of Caragana changduensis Lion f. by means of various column chromatographic techniques. Based on the detailed spectral data analysis (MS and NMR), as well as comparison with the literatures, their chemical structures were determined as 7,2'-dihydroxy-8,4'-dimethoxyisoflavone (1), 4'-hydroxy-7,3'-dimethoxyisoflavone (2), 5, 7, 4'-trihydroxy-2',5'-dimethoxyisoflavone (3), prunetin (4), afrormosin (5), odoratin (6), genistein (7), texasin (8), pratensein (9), and 6,7,3'-trihydroxy-4'-methoxyisoflavone (10). Among them, compounds 1-3 and 9-10 were isolated from the Caragana genus for the first time. All the compounds were obtained from this species for the first time. In the preliminary assays, compounds 1, 2, 6, and 7 possessed significant inhibitory effects on NO production, with IC50 values of 48.12, 25.32, 62.71, 43.59 μmol x L(-1), respectively.
Subject(s)
Animals , Mice , Caragana , Chemistry , Drugs, Chinese Herbal , Chemistry , Pharmacology , Isoflavones , Chemistry , Pharmacology , Macrophages , Metabolism , Molecular Structure , Nitric Oxide , MetabolismABSTRACT
<p><b>BACKGROUND</b>The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.</p><p><b>METHODS</b>From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.</p><p><b>RESULTS</b>Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0).</p><p><b>CONCLUSIONS</b>The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures , Methods , Coronary Artery Bypass , Echocardiography , Heart Aneurysm , General Surgery , Myocardial Infarction , General Surgery , Retrospective Studies , Risk FactorsABSTRACT
<p><b>BACKGROUND</b>Left ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB).</p><p><b>METHODS</b>From June 2009 to April 2011, 31 patients with LVA had angina symptoms and ventricular arrhythmia. In all patients, circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms, followed by a linear placation of ventricular aneurysms on beating heart.</p><p><b>RESULTS</b>All the patients showed complete recovery. The average number of grafted vessels was 2.7 ± 1.3. Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation. All cases had been followed up for one year. Holter monitoring revealed a significant reduction in ventricular arrhythmias (P < 0.05). Echocardiography showed significant increase in left ventricular ejection fraction (P < 0.05) and decrease in left ventricular end-diastolic diameter (P < 0.05).</p><p><b>CONCLUSIONS</b>For patients with ventricular aneurysm and preoperative malignant arrhythmia, aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique. However, medium- to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac , General Surgery , Catheter Ablation , Coronary Artery Bypass, Off-Pump , Heart Aneurysm , Heart Ventricles , General Surgery , Pericardium , General SurgeryABSTRACT
<p><b>BACKGROUND</b>Left main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG). This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG), compared with non-left main coronary artery stenosis (non-mainstem disease).</p><p><b>METHODS</b>From January 1, 2009 to December 31, 2010, 4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital. According to the pathology of LMCA lesions, they were retrospectively classified as a non-mainstem disease group (n = 3933) or a LMCA group (n = 936). Propensity scores were used to match the two groups, patients from the non-mainstem disease group (n = 831) were also randomly selected to match patients from the LMCA group (n = 831). Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.</p><p><b>RESULTS</b>The difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P = 0.429, P = 0.127 respectively). With a mean follow-up of (12.8 ± 7.5) months and a cumulative follow-up of 1769.6 patient-years, the difference in the freedom from MACCEs between the two groups, calculated through Kaplan-Meier method, did not reach statistical significance (P = 0.831).</p><p><b>CONCLUSION</b>Analysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG. Therefore, a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass, Off-Pump , Mortality , Coronary Artery Disease , General Surgery , Follow-Up Studies , Kaplan-Meier Estimate , Retrospective StudiesABSTRACT
<p><b>BACKGROUND</b>The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.</p><p><b>METHODS</b>From July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥ 50%) underwent PCI (n = 350) or CABG (n = 570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days.</p><p><b>RESULTS</b>In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P = 0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P = 0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P < 0.001), mainly due to higher rate of repeat revascularization (adjusted P < 0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion.</p><p><b>CONCLUSION</b>Among patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Mortality , Coronary Artery Bypass , Mortality , Heart Failure , Therapeutics , Hospital Mortality , StentsABSTRACT
<p><b>BACKGROUND</b>Left ventricular (LV) dyssynchrony has been described to occur in patients with myocardial infarction. Dyssynchrony of left ventricular mechanical contraction produces adverse hemodynamic consequences. This study aimed to test the capacity of geometric rebuilding by aneurysm plication to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention.</p><p><b>METHODS</b>A total of sixty patients with anterior myocardial infarction, QRS duration < 120 ms, electively undergoing operation between January 2008 and January 2010 were included for analysis. Real-time 3-dimensional echocardiography was performed to assess LV function, LV systolic and diastolic dyssynchrony by measuring ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR) and LV dyssynchrony. LV dyssynchrony was defined as the systolic dyssynchrony of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle, systolic dyssynchrony index (SDI). We compared changes of LV dyssynchrony at different interval times.</p><p><b>RESULTS</b>LV contraction was significantly asynchronous because preoperative SDI was higher, EF, PER and PFR were lowered. Compared with function after operation, LV mechanical intraventricular resynchronization was improved with decreased SDI ((8.7 ± 0.5)% vs. (14.3 ± 1.6)%, P = 0.01); LV function was improved with EF increasing ((43 ± 9)% vs. (37 ± 7)%, P = 0.001), and LV systolic and diastolic dyssynchrony was improved with more rapid PFR (199.4 ± 15.6 vs. 148.4 ± 21.2, P = 0.002) and PER (212.4 ± 14.5 vs. 156.3 ± 26.2, P = 0.001).</p><p><b>CONCLUSIONS</b>Systolic and diastolic dyssynchrony was highly prevalent in patients with aneurysm, irrespective of QRS duration. Aneurysm plication produces a mechanical intraventricular resynchronization.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Aneurysm , General Surgery , Echocardiography, Three-Dimensional , Myocardial Infarction , Diagnostic Imaging , General Surgery , RadiographyABSTRACT
<p><b>BACKGROUND</b>In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.</p><p><b>METHODS</b>From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.</p><p><b>RESULTS</b>At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.</p><p><b>CONCLUSIONS</b>Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.</p>
Subject(s)
Humans , Angioplasty, Balloon, Coronary , Methods , Chronic Disease , Coronary Angiography , Coronary Artery Bypass , Methods , Coronary Artery Disease , General Surgery , Therapeutics , Coronary Occlusion , General Surgery , Therapeutics , Drug-Eluting Stents , Prospective StudiesABSTRACT
<p><b>BACKGROUND</b>Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB.</p><p><b>METHODS</b>From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out.</p><p><b>RESULTS</b>Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P < 0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P < 0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P < 0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein.</p><p><b>CONCLUSIONS</b>Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Coronary Angiography , Coronary Artery Bypass, Off-Pump , Methods , Coronary Vessels , General Surgery , Mammary Arteries , Transplantation , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the early and medium-term curative effect of water sac blocking used in the proximal anastomosis during off-pump coronary artery bypass (OPCAB) in the patients with serious calcified ascending aorta.</p><p><b>METHODS</b>Thirty-one patients with serious calcified ascending aorta who underwent OPCAB were enrolled in this study from January 2005 to May 2009 as experimental group in which the water sac blocking was used in the proximal anastomosis during OPCAB. There were 23 male and 8 female patients with the age of (69±8) years. Sixty-three patients without calcified ascending aorta who underwent OPCAB at the corresponding period were selected randomly as control group in which lateral-mural clamp on ascending aorta was used in the proximal anastomosis during OPCAB. There were 39 male and 24 female patients with the age of (60±9) years. Preoperative and postoperative heart functional indexes were compared in 3 months and the short and the mid-term outcomes were followed up.</p><p><b>RESULTS</b>No deaths happened in the two groups. Postoperative incidence rate of cerebral stroke in control group was relatively higher than experimental group, but there was no significant difference between the two groups (P<0.05). All the patients had no symptoms 3 months after operation. Heart function and ejection fraction were increased significantly (P<0.05), meanwhile left ventricular end-diastolic diameter were decreased notably (P<0.05). The follow-up rate was 91.5% and the survival rate was 96.0% and left ventricular function decreased slightly (P<0.05) up to the end of November 2009. Seven patients more than two years after operation received coronary angiography which showed proximal anastomotic stoma was patent.</p><p><b>CONCLUSION</b>For patients with serious calcified ascending aorta, the short and medium-term result of water sac blocking used in proximal anastomosis was simple, effective and safe.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Methods , Aorta , General Surgery , Coronary Artery Bypass, Off-Pump , Coronary Artery Disease , General Surgery , Follow-Up Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To identify the gene mutation for two Chinese families with autosomal dominant non-syndromic hearing impairment(NSHI).</p><p><b>METHODS</b>Two NSHI pedigrees with common ancestor were identified by clinical examination and family investigation. Linkage analysis was performed for all known NSHI loci, and all exons and exon-intron boundaries of the non-muscle myosin heavy chain 14 (MYH14) gene were amplified by PCR and sequenced.</p><p><b>RESULTS</b>The disease-causing gene of these 2 pedigrees was fine mapped to the DFNA4 locus on 19q13.33. A heterozygous transition of c. 359T>C (p.S120L) in MYH14 gene was identified. The mutation was detected in all patients but not in normal members in the two families.</p><p><b>CONCLUSION</b>It is the first report that mutation in MYH14 gene can cause dominant non-syndromic hearing impairment in Asian population, suggesting that MYH14 gene can be a disease-causing gene of Chinese patients with hearing impairment.</p>
Subject(s)
Female , Humans , Male , Hearing Loss , Genetics , Microsatellite Repeats , Genetics , Mutation , Myosin Heavy Chains , Genetics , Myosin Type II , Genetics , Pedigree , Polymerase Chain ReactionABSTRACT
<p><b>OBJECTIVE</b>To investigate the changes of thyroxin and monocyte human leukocyte antigen-DR expression in senior patients with sepsis and explore their clinical significance.</p><p><b>METHODS</b>According to the 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions, 125 senior patients with sepsis free of thyroid conditions were divided into non-severe sepsis group (n=86) and severe sepsis group (n=39), with another 30 healthy subjects as the control. Thyroid function was assayed by chemoluminescence method in these patients and monocyte HLA-DR expression was determined by flow cytometry.</p><p><b>RESULTS</b>Compared with the control group and non-severe sepsis cases, the levels of free T3 (FT3), free T4 (FT4), T3, T4 and monocyte HLA-DR expression were significantly lower in severe sepsis cases (P<0.05), but the levels of thyroid stimulating hormone (TSH) were comparable between the 3 groups (P>0.05). The non-severe sepsis cases showed significantly lower levels of FT3, FT4, T3, T4, TSH and monocyte HLA-DR expression than the control group (P<0.05). In severe sepsis group, the levels of FT3, FT4, T3, T4 and monocyte HLA-DR expression showed significant differences between the fatal cases and surviving cases (P<0.05).</p><p><b>CONCLUSION</b>The levels of thyroxin and monocyte human leukocyte antigen-DR expression are obviously lower in senior patients with severe sepsis, and their detection may well indicate the severity of the condition and help make prognostic judgment.</p>