ABSTRACT
@#Coronary heart disease is the second leading cause of death worldwide. As a preventable and treatable chronic disease, early screening is of great importance for disease control. However, previous screening tools relied on physician assistance, thus cannot be used on a large scale. Many facial features have been reported to be associated with coronary heart disease and may be useful for screening. However, these facial features have limitations such as fewer types, irregular definitions and poor repeatability of manual judgment, so they can not be routinely applied in clinical practice. With the development of artificial intelligence, it is possible to integrate facial features to predict diseases. A recent study published in the European Heart Journal showed that coronary heart disease can be predicted using artificial intelligence based on facial photos. Although this work still has some limitations, this novel technology will be promise for improving disease screening and diagnosis in the future.
ABSTRACT
Hypoplastic right heart syndrome(HRHS) is characterized by hypoplastic right ventricle (RV); Numerous transcriptional cascades in the second heart field (SHF) regulateRVdevelopment. The relationship of SHF gene variants with humanHRHS remains unknown. The whole lengths of 17 SHF genes were sequenced in 16 HRHS, and the selected single-nucleotide variants (SNVs) were then genotyped in HRHS, other congenital heart disease (CHD) and healthy control. Luciferase assay was performed to verify the effect of FOXC2: rs34221221A>GandTBX20: rs59854940C>Gat the transcription level. There were 151 (12.86%) novel SNVs after sequence analysis, of which three were in exons (one was synonymous SNV and two were nonsynonymous SNVs), two in promoter, and most SNVs (89.95%) were in intronic regions. Genotype analyses revealed that the minor alleles of FOXC2: rs34221221 A>G and TBX20: rs59854940 C>G could increase HRHS risk (P<0.05), but not in other CHD or healthy control. Luciferase assay showed that the minor G allele in rs34221221 significantly increased FOXC2 transcription while in rs59854940 it decreased TBX20 transcription significantly. Novel variants of SHF gene associated with HRHS were identified. Minor alleles in two variants from FOXC2 and TBX20 could increase the risk of HRHS.
ABSTRACT
SUMMARY OBJECTIVE To investigate the clinical efficacy and the possible mechanisms of saxagliptin in the treatment of type 2 diabetes mellitus (T2DM) combined with non-alcoholic fatty liver disease (NAFLD). METHODS A total of 95 T2DM and NAFLD patients were randomly divided into group A (saxagliptin group), group B (glimepiride group), and group C (glimepiride combined with polyene phosphatidylcholine group). RESULTS After intervention treatment for 24 w, body mass index (BMI), waist-to-hip ratio (WHR), glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), fasting insulin (FINS), homeostatic model assessment of insulin resistance (HOMA-IR), interleukin-6 (IL-6), triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (γ-GT), and quantitative detection of liver steatosis of study subjects were observed, the action of liver steatosis in subjects of groups A and C were significantly different from those of group B; however, there were no differences between groups A and C. The FINS, HOMA-IR, and IL-6 of subjects in group A was lower than those in groups B and C; however, there were no significant differences between the latter two groups. CONCLUSION For T2DM combined with NAFLD patients, the saxagliptin treatment could not only effectively control blood glucose but also attenuate insulin resistance and inflammatory injury of the liver to improve fatty liver further.
RESUMO OBJETIVO Investigar a eficácia clínica e os possíveis mecanismos da saxagliptina no tratamento do diabetes mellitus tipo 2 (DM2) associado à doença hepática gordurosa não alcoólica (DHGNA). MÉTODOS Um total de 95 DM2 combinados com pacientes com DHGNA foram aleatoriamente divididos em grupo A (grupo saxagliptina), grupo B (grupo glimepirida) e grupo C (glimepirida combinado com grupo fosfatidilcolina polienizada). RESULTADOS Após a intervenção tratamento por 24 w, índice de massa corporal (IMC), relação cintura-quadril (RCQ), hemoglobina glicada (HbA1c), glicemia de jejum (FPG), insulina de jejum (Fins), avaliação do modelo homeostático de insulina resistência (Homa-IR), interleucina-6 (IL-6), triglicérides (TG), colesterol total (CT), alanina aminotransferase (ALT), aspartato aminotransferase (AST), γ-glutamiltransferase (γ-GT) e detecção de esteatose hepática dos sujeitos do estudo foram observados. Ação de esteatose hepática de indivíduos nos grupos A e C foram significativamente diferentes do grupo B; no entanto, não houve diferenças entre os grupos A e C. Os grupos Fins, Homa-IR e IL-6 dos participantes do grupo A foram menores que os dos grupos B e C; no entanto, não houve diferenças significativas entre os dois últimos grupos. CONCLUSÃO Para o DM2 combinado com pacientes com DHGNA, o tratamento com saxagliptina pode não apenas controlar efetivamente a glicemia, mas também atenuar a resistência à insulina e a lesão inflamatória do fígado para melhorar ainda mais o fígado gorduroso.
Subject(s)
Humans , Male , Female , Phosphatidylcholines/administration & dosage , Sulfonylurea Compounds/administration & dosage , Adamantane/analogs & derivatives , Diabetes Mellitus, Type 2/drug therapy , Non-alcoholic Fatty Liver Disease/drug therapy , Hypoglycemic Agents/administration & dosage , Blood Glucose , Insulin Resistance , Adamantane/administration & dosage , Body Mass Index , Treatment Outcome , Diabetes Mellitus, Type 2/complications , Dipeptides/administration & dosage , Non-alcoholic Fatty Liver Disease/complications , Middle AgedABSTRACT
@#The cardiovascular surgery in China has reached a stable platform, with notable progress been achieved in the past several decades. However, significant divergency regarding the healthcare quality was also observed, which requiring effective intervention to start the transition from the focus on "quantity" to the pursuit of "quality". Quality improvement program, including the establishment of a national cardiovascular surgery database, the conformation of a standard key quality evaluation indicator system, and the conduction of quality intervention and improvement initiatives, are promising to consolidate and expand the advantages of cardiac surgery and lead to better patient outcomes.
ABSTRACT
@#Facing the increasing cardiovascular disease burden and prevailing population risk factors, the cardiovascular surgery in China was also encountering challenges including imbalances in discipline development, significant divergencies in healthcare quality, lacking of clinical guidelines and domestic critical evidence. The concept of quality control and improvement has been practiced and tested in many disease specialties. Quality improvement programs are urgently needed in China to promote the universal cardiovascular surgery healthcare quality.
ABSTRACT
@#Ischemic mitral regurgitation represents a common complication after myocardial infarction, the severity of the mitral regurgitation increases the risk of mortality. There is continuing debate regarding the management of moderate ischemic mitral regurgitation in patients undergoing surgical management. The debates lie in whether adding mitral valve surgery to coronary artery bypass grafting. So the review is about the analysis of existing evidence and expectation about it.
ABSTRACT
@#Objective To analyze the risk factors of new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Methods From September 2011 to October 2013, 1 614 consecutive patients underwent elective coronary artery bypass grafting in Fuwai Hospital. There were 1 281 males and 333 females at average age of 60.3±8.4 years. Holter data recorded for 5 days after operation were collected and analyzed. The risk factors associated with POAF were assessed according to the baseline and intraoperative data, and the positive variables were stratified. Results A total of 314 patients (19.5%) developed new-onset POAF. The rate of POAF was elevating with the increase of age (P<0.001). Conclusion Age was an independent risk factor for POAF in patients undergoing elective CABG alone.
ABSTRACT
@#Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.
ABSTRACT
@#Objective To evaluate the safety and efficacy of skeletonized and pedicled harvesting of bilateral internal mammary artery (BIMA) in coronary artery bypass graft (CABG) surgery. Methods From December 2015 to May 2017, 152 patients (128 males, 24 females, age of 56.5±6.8 years) underwent CABG using either skeletonized BIMA (s-BIMA group, n=73) or pedicled BIMA(p-BIMA group, n=79). The operative data and post-operative outcomes were analyzed in the s-BIMA group (61 males, 12 females, age of 56.6±7.0 years) and the p-BIMA group (67 males, 12 females, age of 56.3±6.7 years). Results There was no peri-operative mortality. There was no statistical difference in operative time, cardiopulmonary bypass time, aortic cross-clamp time or internal mammary artery graft flow between the two groups. One patient(1.4%) in the s-BIMA group suffered from severe sternal wound complication, which was major sternal wound complication. Five patients (6.3%) in the p-BIMA group suffered from sternal wound complications, including 1(1.3%) with severe complication and 4(5.1%) with minor complication. One(1.4%) patient in the s-BIMA group and 7 (8.9%) patients in the p-BIMA group suffered from chylothorax. The chest tube drainage significantly reduced in the s-BIMA group, both in postoperative day 1(P=0.000) and postoperative day 1-3 (P=0.001). CT angiography showed no stenosis of BIMA in both groups. Conclusion The use of skeletonized BIMA for CABG is safe and efficacious, with less sternal wound complications, chylothorax and chest tube drainage. Skeletonization should be suggested if BIMA is harvested in CABG.
ABSTRACT
@#Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group. Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs. 23.4% vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD, OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
ABSTRACT
@#Objective To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure. Methods We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed. Results Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found. Conclusion Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.
ABSTRACT
@#Objective To verify whether hybrid surgical and interventional ablation(HA) for the treatment of persistent atrial fibrillation (AF) is superior to video-assisted thoracoscopic surgical radiofrequency ablation (VATS-RA). Methods From September 2010 to December 2017, 79 consecutive patients with persistent AF underwent VATS-RA or HA in Fuwai Hospital. VATS-RA was performed in sixty patients (a stand-alone surgical group, 48 males and 12 females, at average age of 56.0±7.6 years, and HA was performed in nineteen patients (a hybrid group, 14 males and 5 females, at average age of 58.0±7.3 years). Follow-up was completed at 3 months, 6 months, 1 year and annually thereafter. Postoperative sinus rhythm was defined as sinus rhythm recorded in 24-hour or 7-day Holter during follow-up, without exhibited rapid atrial tachyarrhythmia≥30 s including AF, atrial flutter, or atrial tachycardia. Results Seventy-eight patients (98.7%) completed the follow-up. Although the preoperative left atrial diameter (49.1±5.3 mm) in the hybrid group was significantly greater than that in the stand-alone surgical group (41.7±6.2 mm, P<0.001). Overall sinus rhythm maintenance rate in the hybrid group was significantly greater than that in the stand-alone surgical group (94.7% versus 64.4%, P=0.011). And sinus rhythm maintenance rate free from anti-arrhythmic drugs (AADs) and catheter ablation in the hybrid group was significantly greater than that in the stand-alone surgical group (84.2% versus 50.8%, P=0.010). Conclusion HA is superior to VATS-RA in the treatment of persistent AF, but a larger sample size is needed for further validation in prospective randomized studies.
ABSTRACT
Background: Molluscs can accumulate carotenoids in their body tissues by predominantly feeding on aquatic plant sources. Carotenoid transport and absorption are determined by the regulation of various proteins such as Scavenger receptor class B(SR-BI). We report the identification and characterisation of pearl oyster Pinctada fuctada martensii SR-BI (PmSR-BI). The correlation between total carotenoid content (TCC) and gene expression was also estimated. Results: The full-length cDNA of PmSR-BI was 1828 bp, including an open-reading frame encoding of 1518 bp with a pI value of 5.83. PmSR-BI protein contains a hydrophobic CD36 domain and four centrally clustered cysteine residues for the arrangement of disulphide bridges. The deduced amino acid sequence had an identity of 30% to 60% with the SR-B of other organisms. Reverse transcription polymerase chain reaction analysis showed that mRNA transcripts were expressed in multiple tissues of adult pearl oyster. A higher expression of PmSR-BI gene was observed in the hepatopancreas than in the adductor muscle, gill and mantle. The TCC and gene expression of PmSR-BI were significantly correlated (P b 0.05), with a correlation coefficient of 0.978. Conclusions: The results suggested that PmSR-BI is involved in the absorption of carotenoids in the pearl oyster P. fuctada martensii.
Subject(s)
Carotenoids/metabolism , Pinctada , Receptors, Scavenger/genetics , Receptors, Scavenger/metabolism , Terpenes , Vitamin A/metabolism , RNA, Messenger/genetics , Gene Expression , Cloning, Molecular , Sequence Analysis , Abscisic Acid , DNA, Complementary/genetics , Hydrophobic and Hydrophilic Interactions , Real-Time Polymerase Chain ReactionABSTRACT
Background: C4ST-1 catalyzes the transfer of sulfate groups in the sulfonation of chondroitin during chondroitin sulfate synthesis. Chondroitin sulfate consists of numerous copies of negatively charged sulfonic acid groups that participate in the nucleation process of biomineralization. In the present study, we obtained two CHST11 genes (PmCHST11a and PmCHST11b) which encoded the C4ST-1 and explored the functions of these genes in the synthesis of chondroitin sulfate and in the formation of the nacreous layer of shells. Results: Both PmCHST11a and PmCHST11b had a sulfotransferase-2 domain, a signal peptide and a transmembrane domain. These properties indicated that these genes localize in the Golgi apparatus. Real-time PCR revealed that both PmCHST11a and PmCHST11b were highly expressed in the central zone of the mantle tissue. Inhibiting PmCHST11a and PmCHST11b via RNA interference significantly decreased the expression levels of these genes in the central zone of the mantle tissue and the concentration of chondroitin sulfate in extrapallial fluid. Moreover, shell nacre crystallized irregularly with a rough surface after RNA interference. Conclusions: This study indicated that PmCHST11a and PmCHST11b are involved in the nacre formation of Pinctada fucata martensii through participating in the synthesis of chondroitin sulfate.
Subject(s)
Sulfotransferases/metabolism , Pinctada , Nacre/biosynthesis , Chondroitin Sulfate Proteoglycans/biosynthesis , Sulfotransferases/genetics , Nucleic Acid Amplification Techniques/methods , RNA Interference , Real-Time Polymerase Chain Reaction , BiomineralizationABSTRACT
<p><b>OBJECTIVE</b>To assess the predict value of European system for cardiac operative risk evaluation (EuroSCORE) II on early death in patients with severe coronary artery disease undergoing active treatment.</p><p><b>METHODS</b>Consecutive 2 240 patients with three-vessel disease ( with or without left main disease) diagnosed by elevtive coronary angiogram between July 2011 and September 2012 were screened for this study, data from 1 892 patients who underwent active treatments (percutaneous coronary intervention or coronary artery bypass grafting) were analyzed retrospectivly. The predicted 30 days operative mortality calculated with EuroSCORE II was compared with the actual one. The calibration and discrimination of EuroSCORE II were tested with Hosmer-Lemeshow χ2 test and area under receiver operating characteristic (ROC) curve respectively.</p><p><b>RESULTS</b>Age was 61.0 (54.0-68.0) years old and 75.8% (1,435/1,892) were male in this cohort, 58.0% (1,097/1,892) patients received percutaneous coronary intervention and 42.0% (795/1,892) patients received coronary artery bypass grafting. The overall 30 days operative mortality was 0.53% (10/1,892), 30 days operative mortality predicted by EuroSCORE II was 0.85% (95% CI:0. 44%-1.26%). The calibration (χ2 = 3.47 and P > 0.10) and discrimination (area under ROC curve was 0.75) of EuroSCORE II were satisfactory.</p><p><b>CONCLUSION</b>EuroSCORE II could precisely predict 30 days operative mortality for three-vessel disease patients with or without left main disease undergoing active treatments.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Artery Disease , Mortality , Heart , ROC Curve , Risk AssessmentABSTRACT
BACKGROUND AND OBJECTIVES: The effects of artificial obstacles on the dynamics of ventricular fibrillation have been extensively investigated with an electrical mapping system. This study was performed to assess the influence of transmural obstacles on the dynamics of wavefronts, and determine whether these can convert ventricular fibrillation to ventricular tachycardia by stabilizing the wavefronts in the fibrillating right ventricular tissues of pigs, using an optical mapping system. MATERIALS AND METHODS: The right ventricles of pigs (n=15) were excised and placed in a tissue perfusion system, with the epicardium facing up. Holes, with increasing sizes, from 2 to 8 mm in diameter, were created using a skin biopsy punch. Another 8 mm sized hole was then made adjacent to the first, and the changes in the wavefront dynamics and cycle length of the optical action potential waves investigated. RESULTS: In 14 of the 20 obstacles, in ten tissues, transient attachment of electrical activities along the rim of obstacles and transient rotation of the wavefronts were observed. During baseline ventricular fibrillation, the fibrillation cycle length was 118.5+/-24.7 msec, which was increased to 135.4+/-30.2 msec after creation of the first hole, and to 159.4+/-47.7 msec after the second (p=0.01). There was a positive correlation between the obstacle size and cycle length (r=0.43, p=0.007). In three tissues, conversion to ventricular tachycardia from ventricular fibrillation was observed after creation of the two holes. CONCLUSION: Obstacles of an appropriate size had anti-fibrillatory effects in tissues with ventricular fibrillation, which was partly explained by the temporary attachment of wavefronts to the obstacles.