Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement. Methods    The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared. Results    There were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05). Conclusion    The aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.  

Relationship Between Prevalence of Atrial Fibrillation, Ischemia Stoke and CHA2DS2-VASc Score in Elderly Patients / 中国循环杂志

Objective: To explore the relationship between prevalence of atrial fibrillation (AF), iskhemia stoke and CHA2DS2-VASc score in patients≥65 years in order to provide prevention and treatment basis in clinical practice. Methods: A total of 5016 patients admitted in our hospital from 2013-10 to 2015-10 were enrolled. The patients were divided into 2 groups: AF group, n=437 and Non-AF patients, n=4579; according to age, the patients were further assigned into 4 subgroups as <65 years subgroup, (65-74) years subgroup, (75-84) years subgroup and ≥85 years subgroup. The risk factors for AF occurrence were retrospectively studied. Results: Compared with the Non-AF group, the patients in AF group had the elder age and more male gender, both P<0.001; more patients combining with hypertension, coronary artery disease (CAD), diabetes, sick sinus syndrome and rheumatic heart disease, all P<0.001. Age, male gender, CAD, sick sinus syndrome and rheumatic heart disease were the independent risk factors for AF occurrence. Compared with Non-AF group, AF group showed the higher prevalence rate of ischemic stroke and the elder onset age, both P<0.01. For non-valvular AF, the ratio of patients with CHA2DS2-VASc score≥2 was higher than those with CHA2DS2-VASc score<2 and the rate of anticoagulant therapy was decreasing by age increasing, all P<0.001. Conclusion: Age, male gender, CAD, sick sinus syndrome and rheumatic heart disease were independently related to AF occurrence. Non-valvular AF patients had the higher risk for ischemic stroke than non-AF patients, anticoagulation therapy should be conducted at the early stage.

Correlation Study Between Atrial Fibrillation and High-sensitivity Cardiac Troponin T Level in Patients With Stable Coronary Artery Disease / 中国循环杂志

Objective: To explore the relationship between serum level of high-sensitivity cardiac troponin T (hs-cTnT) and atrial ifbrillation (AF) occurrence in patients with stable coronary artery disease (CAD). Methods: A total of 1011 patients with stable CAD treated in our hospital from 2013-01 to 2015-09 were retrospectively studied. According to quartiles of hs-cTnT, the patients were divided into 4 groups: Group① the patients with hs-cTnT≤7ng/L, n=283, Group② hs-cTnT 7-10ng/L,n=238, Group③ hs-cTnT 10-15ng/L,n=272 and Group④ hs-cTnT>15ng/L,n=218. The relationship between hs-cTnT level and AF occurrence rate was studied; the risk factors for AF occurrence were explored by multi stepwise Logistic regression analysis. Results: There were 127/1011 (12.6%) patients combining AF and 884 (87.4%) with simple type stable CAD. AF patients had the higher serum level of hs-cTnT than non-AF patients 17.0 (12.0, 25.0) ng/L vs 10.0 (7.0, 13.0) ng/L,P Conclusion: Increased serum level of hs-cTnT was closely related to AF occurrence in patients with stable CAD.

Relationship Between Lower Extremity Atherosclerosis and Cardiovascular Risk Factors in Elder People / 中国循环杂志

Objective: To explore the relationship between lower extremity atherosclerosis disease (LEAD) and cardiovascular risk factors in elder people. Methods: A total of 700 consecutive patients receive lower extremity Color Doppler ultrasound in our hospital from 2013-05 to 2014-11 were investigated. The patients were divided into 3 age groups: Young and middle group, n=83, Elder group, n=377 and Senile group, n=240. Based on ultrasound scoring system, the patients were divided into 4 groups: Normal group, n=112, Mild atherosclerosis (Mild) group, n=81, Moderate group, n=466 and Severe group, n=41. The cardiovascular risk factors among different groups were compared. Results: Multivariate unconditional logistic regression analysis showed that age, smoking, history of diabetes, uric acid (UA), ankle-brachial index (ABI) were the independent risk factors for LEAD (B=0.144, 1.496, 0.963, 0.004, -2.510; 95% CI: 1.120-1.190, 2.257-8.824, 1.456-4.716, 1.001-1.007, 0.012-0.534;P=0.000, 0.000, 0.001, 0.006, 0.009 respectively. Ordinal logistic regression analysis indicated that age, male gender, smoking, ABI, UA, history of hypertension were related to the severity of atherosclerosis (B=0.130, 0.737, 0.592, -3.365, 0.003, 0.735; 95% CI: 0.097-0.162, 0.222-1.252, 0.052-1.132, -4.674 to -2.055, 0.001-0.005, 0.313-1.157;P=0.000, 0.005, 0.032, 0.000, 0.005, 0.001 respectively. Compared with Young and Middle groups, Elder and Senile groups had increased rates of moderate and severe arteriosclerotic lesions; compared with Elder group, Senile group presented the higher incidence of moderate and severe lesions, allP Conclusion: Lower extremity atherosclerosis lesions were more severe in elder patient, and it was particularly severe in senile patients.

Analysis of C.3925_3929 deletional mutations of APC gene in pedigrees with familial adenomatous polyposis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of germline mutations of adenomatous polyposis coli (APC) gene in pedigrees affected with familial adenomatous polyposis (FAP).</p><p><b>METHODS</b>Genomic DNA was extracted from peripheral blood samples from members of the 13 FAP pedigrees. Multiplex ligation-dependent probe amplification (MLPA) was used to detect large fragment deletions of the APC gene. Subsequently, potential mutation was screened from all exons of the APC gene with PCR amplification and direct sequencing.</p><p><b>RESULTS</b>Germline mutations have been identified in 5 FAP pedigrees, which included c.3184_3187delCAAA, c.5432C>T, c.3925_3928delAAAA and c.3925_3929del AAAAG(in two pedigrees). Small deletional mutations were found primarily in the area of AAAAG tandem repeat sequences.</p><p><b>CONCLUSION</b>C.3925_3929 located in AAAAG tandem repeats is probably the hot spot for APC gene mutations, which are mostly deletional mutations, especially the 5 bp base deletion at codon 1309.</p>

Effects and mechanisms of ghrelin on plaque neovascularization in rabbits with atherosclerosis / 中华内分泌代谢杂志

Objective The aim of our study was to investigate the effects and mechanisms of ghrelin on neovascularization in atherosclerosis plaque. Methods 30 male New Zealand rabbits were randomly divided into normal control group ( CON group) , atherosclerosis model group ( AS group) , and ghrelin treatment group ( ghrelin group) , and each group of 10 rabbits. The AS group and ghrelin group underwent balloon-induced arterial wall injury and then fed with high fat diet, the CON group was fed only on a regular diet. They were all fed for 3 months. Then the ghrelin group was given ghrelin 25μg·kg-1 ·d-1 , the other two groups received the same amount of sterile normal saline only. Four weeks later, body weight and blood lipids were detected. The thickness ratio of the intima to media was measured by HE staining. Degree of intra-plaque angiogenesis was evaluated by CD31+ cells immunohisto-chemistry. The vascular endothelial growth factor ( VEGF ) and vascular endothelial growth factor receptor 2 ( VEGFR2) were detected by quantitative realtime PCR and Western blot. The expressions of matrix metalloproteinase ( MMP)-2 and MMP-9 were detected by immunohistochemistry and Western blot. Results ( 1 ) No significant differences in body weight and blood lipids were found between the AS group and the ghrelin group(P>0. 05), but both items were significantly higher than those of the CON group(P<0. 05). (2)The thickness ratio of the intima to media in the ghrelin treated group was distinctly less than that in the AS group(P<0. 05). (3)Compared with the AS group, the ghrelin group showed significantly decreased microvascular density and the expressions of VEGF and VEGFR2 (P<0. 05). (4)Compared with the AS group, ghrelin dramatically inhibited the plaque contents of MMP-2 and MMP-9 ( P<0. 05 ). Conclusions Ghrelin is able to inhibit the growth of neovascularizationin in the atherosclerotic plaque and the development of plaque. And these beneficial effects derive from downregulation of VEGF, VEGFR2, MMP-2, and MMP-9 at the advanced stage of atherosclerosis in rabbits.

Effects and related mechanisms of ghrelin on myocardial neovascularization in diabetic rats with experimental myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects and related mechanisms of ghrelin on myocardial neovascularization in diabetic rats with experimental myocardial infarction (MI).</p><p><b>METHODS</b>Adult male SD rats were divided into six groups (n = 20 each group): control, diabetes mellitus (DM), MI, DM+MI, DM+MI+ghrelin, DM+MI+ghrelin+D-Lys3-GHRP-6 (GHSR1a inhibitor). DM was induced by streptozotocin (STZ, 60 mg/kg), 3 months later, MI was induced by left anterior descending artery ligation in DM rats. DM+MI+ghrelin group received ghrelin 200 µg×kg(-1)×d(-1) and DM+MI+ghrelin+D-Lys3-GHRP-6 group received ghrelin 200 µg×kg(-1)×d(-1) and D-Lys3-GHRP-6 50 mg×kg(-1)×d(-1) for 4 weeks. Then, cardiac function was measured by echocardiography, microvascular density (MVD) was measured by CD34 immunohistochemistry, myocardial infarct size was determined by Masson staining, the mRNA and protein expressions of vascular endothelial growth factor (VEGF) and receptors Flk-1, Flt-1 were detected by real-time PCR and Western-blot, respectively.</p><p><b>RESULTS</b>Compared with MI group, MVD (15.3 ± 1.0 vs.20.7 ± 1.6, P < 0.05), left ventricular ejection fraction (LVEF) ((64.2 ± 3.4)% vs. (81.3 ± 3.8)%, P < 0.01), left ventricular fractional shortening (LVFS) ((31.7 ± 1.1)% vs. (48.8 ± 3.3)%, P < 0.01) and the mRNA and protein expression of VEGF, Flk-1 and Flt-1 (P < 0.01) were reduced, while myocardial infarct size ((55.8 ± 3.1)% vs. (35.7 ± 2.5)%, P < 0.01) was increased in DM+MI group. These effects were partly reversed in DM+MI+ghrelin group and the beneficial effects of ghrelin were partly abolished by D-Lys3-GHRP-6 (all P < 0.05).</p><p><b>CONCLUSIONS</b>Our results demonstrate that ghrelin could improve microvascular density, cardiac function, and reduce myocardial infarct size of diabetic rats with myocardial infarction via modulating GHSR1a-mediated expressions of VEGF, Flk-1 and Flt-1.</p>

Bone marrow mesenchymal stem cells with support of ultrasound-mediated microbubbles and bispecific antibody prevent myocardial fibrosis via HSP-70 / 中华超声影像学杂志

Objective To explore the effects of transplantated bone marrow mesenchymal stem cells (MSCs) on myocardial fibrosis with the aid of ultrasound-mediated microbubbles (MB) and bispecific antibody(BiAb) combination.Methods With the aid of MB,isolated MSCs from male mice and the BiAb were transfused into female mice with isoproterenol-induced myocardial fibrosis via tail vein (MSCs + BiAb + MB group).BiAb was producted with anti-CD29 which can recognize MSCs and anti-myosin light chain antibody (AMLCA) which can specifically bind to injured myocardium.There were six groups investigated:MSC + BiAb + MB,MSC,BiAb,MB,MSC + BiAb,untreated,and control groups.Five weeks after treatment administration,the expressions of sex-determining region of Y-chromosome (SRY) in myocardium were detected by fluorescent quantitative PCR.The distribution of collagen was observed by sirius red staining.Heat shock protein-70 (HSP-70) in myocardium was detected by immunohistochemistry.Results The highest homing number of MSCs was in the MSCs + BiAb + MB group,MSCs + BiAb group ranked the second,and lowest in MSCs group.Compared to the untreated group,the MSCs + BiAb + MB,MSCs + BiAb and MSCs groups had less collagen deposition (P ＜0.05),and decreased level of HSP-70.Compared to those of the MSCs group,the collagen deposition were decreased in MSCs + BiAb + MB group (P ＜0.05).Conclusions MB and BiAb can promote the homing number of MSCs in mice.MB can further the homing rate and the repairing efficacy of MSCs.The homing MSCs can prevent the process of myocardial fibrosis.And HSP-70 was involved in the internal mechanism.

Effects of retroperfusion on the levels of serum soluble inetr cellular adhesion molecule-1,soluble P-selectin and cardiac troponin Ⅰin patients of cardiac operation under direct vision / 中国医师进修杂志

Objective To investigate the effects of retrograde cardioplegia on serum soluble inter cellular adhesion molecule (sICAM)-1,soluble P-selectin (sPs) and cardiac troponin Ⅰ(cTnI) in the process of heart valve replacement operation.Methods Fifty-six cases undergoing heart valve replacement with cardiopulmonary bypass (CPB) were divided into antegrade cardioplegia (AC) group and retrograde cardioplegia (RC) group.Serum levels of sICAM-1,sPs and cTnI were measured using enzyme-linked immunosorbent assayd (ELISA) at six times.Results After the CPB,the levels of sICAM-1,sPs and cTnI ascended quickly,at the time of 8-hour after operation achieved the peak value.The peak value of RC group were lower than those of AC group[sICAM-1 (817.9±133.2)μg/L vs(901.1±132.0)μg/L,sPs(83.46±16.24)μg/L vs(107.82±19.68) μg/L,cTnI(10.50±2.03) μg/L vs (14.45±2.26)μg/L],and the dedined degree of RC group were faster than those of AC group.Conclusion Retroperfusion has a better myocardial protection to the patients suffering heart valve replacement operation through active suppressed expression of sICAM-1,sPs and cTnI palliated inflammatory reaction.

Study of humanities courses joined with disease in gerontology on medical students' learning achievement / 中华医学教育探索杂志

Objective To investigate the effect of teaching achievement of humanities courses joined with disease in gerontology. Methods 95 medical students were randomly divided into two groups:experiment group(n=48) and control group(n=47). Students in experiment group accepted humanities courses joined with disease in gerontology,while control group accepted only traditional courses in gerontology without humanism. Both of the two groups were under the same teacher and study period,and the global minimum essential requirements of undergraduate medical education was adopted ao the final examination. The marks of two groups were tested by t-test. Results There are obvious differences of teaching achievement between the two groups(P

Survey of mental health of rural individuals with HIV/AIDS in a county of Henan Province / 第三军医大学学报

Objective To investigate the psychological condition of the rural residents with HIV/AIDS.Methods Totally 192 subjects with HIV/AIDS residing in countryside of Henan Province(China)were investigated with questionaire and Symptom Check list 90(SCL-90).Results SCL-90 total score,the number of positive items and the score of each factor for the 192 subjects with HIV/AIDS were higher than those of Chinese normal(P

Study on the growth hormone axis in aged patients with congestive heart failure / 中华老年医学杂志

Objective To observe the changes of growth hormone axis(GH axis) and to study the mechanism of acquired growth hormone resistance in aged patients with congestive heart failure (CHF). Methods Ninety-five patients with congestive heart failure were divided into three groups (Grade Ⅱ , n = 28; Grade Ⅲ , n = 36;and Grade Ⅳ , n = 31) according to New York Heart Association criterion. Another 30 healthy people were used as controls. The concentrations of plasma GH , insulin growth factor 1 (IGF-1) and insulin growth factor binding protein 3 (IGFBP-3) were measured by radioimmunoassay, and growth hormone sensitivity was assessed by log(IGF-1 /GH). Results Plasma concentration of GHC[(5. 83 ? 1. 41) mlU/L vs (1. 56 ? 0. 97) mlU/L were higher in grade Ⅳ group than those in normal subjects ( P

ACUTE MYOCARDIAL INFARCTION A TEN YEAR CLINICAL EXPERIENCE / 重庆医科大学学报

0.05). 29 patients died of AMI during hospitalization. The mortality rate of recurrent AMI was higher than that of the first attacked (p

ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH RHEUMATIC HEART DISEASE DURING LABOR AND DELIVERY / 重庆医科大学学报

Echocardiographic measuraments -were carried out in 53 patients with chronic rheumatic heart disease (RHD) during labor and delivery .Ten patients were delivered b-y cesarean section and tkree patients were delivered vaginally.Only mild alterations In maternal cardiovascular function were encountered undergoing cesarean section under epidural anesthesia,excepting a transient decline in blood pressure. A significant incre-, ase in blood pressure,heart rate and systemic vascular resistance were observed in t-he second stage of labor. A decrease in cardiac output was demonstrated at the same t-ime.Our results suggest that cesarean section as the mode of choice for delivery in pat- -, ients with, RHD is better than that of the vaginal delivery