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@#Objective To detect the expression of PITX2 and KCNQ1 in the left atrial appendage of patients with atrial fibrillation after modified mini-maze procedure, and to detect the clinical risk factors of different types of atrial fibrillation. Methods We collected left atrial appendage tissue of 59 atrial fibrillation patients who received modified mini-maze procedure and left atrial appendectomy from February 2017 to August 2018. The expression levels of PITX2 and KCNQ1 of left atrial appendage tissue were quantitatively analyzed by western blotting assay between paroxysmal attial fibrillation and persistent atrial fibrillation groups. The correlation between protein expression and prognosis after surgery was also analyzed based on clinical data. Results Binary-logistic regression analysis showed that KCNQ1 expression level was an independent risk factor for the progression from paroxysmal atrial fibrillation to persistent atrial fibrillation. Receiver operating characteristic (ROC) curve confirmed that KCNQ1 expression level (the ratio of KCNQ1 to actin in the analysis) was 0.60, which was the best cut-off point for the progression of paroxysmal atrial fibrillation to persistent atrial fibrillation. Conclusion High expression of KCNQ1 in left atrial appendage is a risk factor for progression from paroxysmal atrial fibrillation to persistent atrial fibrillation.
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Objective To summarize the treatment decision-making strategy and its long-term efficacy for advanced elderly patients with severe valvular heart disease and clear indications for surgery.Methods Clinical data of 196 patients aged 75 years and older firmly diagnosed as severe valvular heart diseases were retrospectively analyzed.The patients were divided into the surgical group (a mean age of 77.4±2.0 years,n=126)and the conservative group(a mean age of 80.5±5.0 years,n =70).Factors affecting therapeutic decision-making were analyzed,and the differences in a long-term survival were compared between the two groups.Results The most common reason for choosing conservative treatment was the recommendation of the doctor giving a preliminary diagnosis and worrying about the high-risk surgery for the patients(62.9％,44/70).Only 26(37.1％)patients in the conservative group were evaluated by cardiac surgeons,among whom 12 (17.1％)patients were considered to have surgical contraindications,and 14 (20.0％) patients themselves or their family members chose conservative treatment for the fear of surgical risks.Patients in the operation group were mainly from the outpatient department of cardiac surgery,and only 8 (6.3 ％)cases were referred from department of internal medicine.Logistic regression analysis showed that female,chronic renal insufficiency,advanced age,pneumonia and emergency hospital admissions were independent predictors for the conservative option(P ＜0.01),while patients with isolated aortic valve disease tended to receive surgical treatment.Overall 5-year survival was higher in the surgical group than in the conservative group (76.4％ vs.39.9％,P ＜ 0.01).Cox regression analysis disclosed that the conservative treatment option was the single risk factor for long-term survival in all series.Conclusions Many factors affect the process of therapeutic decision-making for patients with severe valvular heart diseases,and a multidisciplinary collaboration is the best way for the optimal treatment strategy for those patients.
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Objective To investigate whether Th17/Treg imbalance existed,and whether VEGF165 attenuated the imbalance in allogeneic skeletal myoblasts transplantation(allo-SMT) for acute myocardial infarction (AMI).Methods There were 60 C57BL/6 male mice,3 to 4 weeks old,weighting 0.016-0.020 kg.On the day 1,2,4,and 7 after allo-SMT,the percentages of Th17 and Treg cells,and the ratios of Th17/Treg cells were analyzed by FCM in AMI group,AMI-S group(alloSMT) and AMI-Ⅴ group(with VEGF165 treatment).Subsequently,related proinflammatory and regulatory cytokines and key transcription factors ROR-γt mRNA and Foxp3 mRNA expression were examined by Bio-plex and RT-PCR respectively.Results On the day 1,2,4,and 7 after allo-SMT,the percentage of Treg,related cytokines concentrations and transcript factor Foxp3 mRNA in AMI-S group were lower than those in AMI group,while the AMI-Ⅴ group were higher than those in AMI groups.However,the percentage of Th17 cells,related cytokines concentrations,and ROR-γt mRNA in AMI-S group were higher than those in AMI group; but the AMI-Ⅴ group were lower than those in AMI group.Apparently,compared with AMI group,the ratios of Th17/Treg significantly ascended in AMI-S group and decended in AMI-Ⅴ group.Conclusion Th17/Treg imbalance participated in the formation and development of inflammation and immune response after allo-SMT.However,transfected VEGF165 could relieve the severity of Th17/Treg imbalance.
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Objective We sought to evaluate the efficacy of bipolar radiofrequency ablation of atrial fibrillation (AF) in patients undergoing cardiac surgery,and to determine independent factors affecting the recurrence.Methods From June 2007 through February 2010,81 patients with atrial fibrillation underwent a modified Cox-Maze Ⅳ procedure using a biopolar radiofrequency device( Medtronic in 32 cases,Atricure in 49 cases).There were 45 males and 36 females,aged (48.2 ± 11.0)years,including 26 cases of permanent AF,44 cases of persistent AF and 11 cases of paroxysmal AF.The mean duration time of AF was (7.56 ± 7.47 ) years.The left atrial diameter were 36 ～ 72 mm.In conjunction with cardiac surgery including:mitral valve replacement (MVR) (or add tricuspid valve plasty (TVP) in 33 cases,mitral and aortic valve replacement (DVR)( or add TVP) in 18 cases,off-pump coronary artery bypass surgery (OPCAB) in 16 cases,aortic valve replacement (AVR) in 4 cases,MVR and coronary artery bypass grafting (CABG) in 1 case,mitral valve plasty (MVP) in 1 case,and others in 8 cases.Among them,22 patients were undergoing electrophysiological mapping by high-frequency bipolar stimulation from June 2009 to February 2010.A follow-up of 12 to 44 months was completed.Recurrences were evaluated by 12-lead ECG or 24 hour Holter recording every clinic visit-1,3,6,9,and 12 months after the procedure and yearly thereafter,or if symptoms developed.Multivariate regression analysis was performed to determine independent factors affecting the recurrence.Results Hospital mortality was 1.23％.The successful ablation of AF were 100％,82.5％,and 84.8％ immediately after operation,at discharge,and at 2(6.1 ± 13.6) months after operation respectively.Multinomial regression analysis showed small left atrium ( ＜ 60 mm),and electrophysiological mapping might contribute better sinus rhythm restoration ( P ＜ 0.05 ).Conclusion Bipolar radiofrequency ablation of atrial fibrillation in patients undergoing cardiac surgery is safe and effective.Small left atrium ( ＜ 60mm) and electrophysiological mapping should be considered to improve results in selected patients.