Clinical study of serum NGAL and CysC levels in patients with morning hypertension / 心血管康复医学杂志

Objective: To measure serum levels of neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (CysC) in patients with morning hypertension (MH) and explore their clinical value. Methods: A total of 120 outpatients or inpatients with essential hypertension (EH) were selected from our department of cardiology. According to MH definition, they were divided into MH group (n=62) and non-MH group (n=58). Levels of serum NGAL and CysC, blood lipids and blood glucose were measured and compared between two groups. Results: There were no significant difference in levels of blood lipids, blood glucose etc. between two groups, P＞0. 05 all; compared with non-MH group, there were significant rise in serum levels of NGAL [(47. 50±3. 15) μg/L vs. (156. 87±18. 56) μg/L]and CysC [(0. 68±0. 16) mg/L vs. (1. 26±0. 86) mg/L]in MH group, P=0. 001 both. Conclusion: Serum levels of NGAL and CysC in MH patients are significantly higher than those of non-MH patients, which is of great significance for diagnosing early renal dysfunction in MH patients. Therefore, management of morning blood pressure should be strengthened in clinic.

Cadmium Activates Reactive Oxygen Species-dependent AKT/mTOR and Mitochondrial Apoptotic Pathways in Neuronal Cells / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To examine the role of Cd-induced reactive oxygen species (ROS) generation in the apoptosis of neuronal cells.</p><p><b>METHODS</b>Neuronal cells (primary rat cerebral cortical neurons and PC12 cells) were incubated with or without Cd post-pretreatment with rapamycin (Rap) or N-acetyl-L-cysteine (NAC). Cell viability was determined by MTT assay, apoptosis was examined using flow cytometry and fluorescence microscopy, and the activation of phosphoinositide 3'-kinase/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) and mitochondrial apoptotic pathways were measured by western blotting or immunofluorescence assays.</p><p><b>RESULTS</b>Cd-induced activation of Akt/mTOR signaling, including Akt, mTOR, p70 S6 kinase (p70 S6K), and eukaryotic initiation factor 4E binding protein 1 (4E-BP1). Rap, an mTOR inhibitor and NAC, a ROS scavenger, blocked Cd-induced activation of Akt/mTOR signaling and apoptosis of neuronal cells. Furthermore, NAC blocked the decrease of B-cell lymphoma 2/Bcl-2 associated X protein (Bcl-2/Bax) ratio, release of cytochrome c, cleavage of caspase-3 and poly(ADP-ribose) polymerase (PARP), and nuclear translocation of apoptosis-inducing factor (AIF) and endonuclease G (Endo G).</p><p><b>CONCLUSION</b>Cd-induced ROS generation activates Akt/mTOR and mitochondrial pathways, leading to apoptosis of neuronal cells. Our findings suggest that mTOR inhibitors or antioxidants have potential for preventing Cd-induced neurodegenerative diseases.</p>

Mechanism and re-ablation strategy for postablation atrial tachyarrhythmia in atrial fibrillation patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the mechanism and re-ablation strategy of recurrent atrial tachyarrhythmia (ATA) following circumferential ablation of pulmonary veins (PV) in patients with atrial fibrillation (AF).</p><p><b>METHODS</b>Fifteen patients with recurrent ATA following first AF ablation procedure were included in this study. Under CARTO guidance, PVs were remapped and ablated subsequently for relapse of left atrium to PV conduction. The whole atrium was then remapped and individualized ablation was made to eliminate inducible ATA.</p><p><b>RESULTS</b>Left atrium to PV conduction relapses were evidenced in 14 patients. After re-ablation, there were no inducible ATA in 9 patients, inducible left atrial macro-reentry tachycardia in 3 patients and all were terminated by further linear ablation on the roof and left atrial isthmus, inducible atrial focal tachycardia from left atrial isthmus in 1 patient and was eliminated after additional focal ablation, inducible right atrial macro-reentry tachycardia in 2 patients and were eliminated by right isthmus linear ablation. During 1 - 16 (5.5 +/- 4.4) months follow-up, ATA was disappeared in 13 patients and reduced in another 2 patients.</p><p><b>CONCLUSIONS</b>Relapse of left atrium to PV conduction is one of the main mechanisms for postablation ATA in patients with AF. Atrial macro-reentry tachycardia and focal atrial tachycardia were less common mechanisms for postablation ATA. Re-ablation focused on closing the PV gaps and additional individualized focal and lineal ablation strategies were helpful for treating postablation ATA in AF patients.</p>

Optimal time for mesenchymal stem cell transplantation in rats with myocardial infarction / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>BACKGROUND</b>Bone marrow mesenchymal stem cell (MSC) transplantation is a promising strategy in the treatment of myocardial infarction (MI). However, the time for transplanting cells remains controversial. The aim of this study was to find an optimal time point for cell transplantation.</p><p><b>METHODS</b>MSCs were isolated and cultured from Sprague-Dawley (SD) rats. MI model was set up in SD rats by permanent ligation of left anterior descending coronary artery. MSCs were directly injected into the infarct border zone at 1 h, 1 week and 2 weeks after MI, respectively. Sham-operated and MI control groups received equal volume of phosphate buffered saline (PBS). At 4 weeks after MI, cardiac function was assessed by echocardiography; vessel density was analyzed on hematoxylin-eosin stained slides by light microscopy; the apoptosis of cardiomyocytes was evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay; the expressions of proteins were analyzed by Western blot.</p><p><b>RESULTS</b>MSC transplantation improved cardiac function, reduced the apoptosis of cardiomyocytes and increased vessel density. These benefits were more obvious in 1-week group than in 1-h and 2-week groups. There are more obvious increases in the ratio of bcl-2/bax and the expression of vascular endothelial growth factor (VEGF) and more obvious decreases in the expression of cleaved-caspase-3 in 1-week group than those in other two groups.</p><p><b>CONCLUSION</b>MSC transplantation was beneficial for the recovery of cardiac function. MSC transplantation at 1 week post-MI exerted the best effects on increases of cardiac function, anti-apoptosis and angiogenesis.</p>

Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To compare a new device (Innocor) for non-invasive measurement of cardiac output (CO) by foreign gas rebreathing method with conventional techniques used in the measurements of cardiac function.</p><p><b>METHODS</b>Cardiac outputs measured by Innocor (CO(RB)) were compared with CO obtained by echocardiography (CO(EC)), Swan-Ganz thermodilution (CO(TD)), and left ventricle radiography (CO(LVR)) in 34 patients subjected to cardiac catheterization. Values obtained from the four methods were analyzed by linear regression and paired values were compared by the method of Bland and Altman in SPSS.</p><p><b>RESULTS</b>There was strong positive correlation (r=0.94) between Innocor cardiac output values and the corresponding values obtained by thermodilution and between CO(EC) and CO(LVR) values. Thermodilution appears to overestimate cardiac output when compared to the values obtained with Innocor by (0.66+/-0.22) L/min (P<0.0001). There was no correlation between data obtained by Innocor and the corresponding CO(EC) and CO(LVR) values.</p><p><b>CONCLUSION</b>Innocor CO(RB) is an easy, safe and well established method for non-invasive measurement of cardiac output with good prospects for clinical application in heart disease patients.</p>

Segmental radiofrequency ablation of pulmonary vein ostia for patients with refractory paroxysmal atrial fibrillation using multi-slice spiral computed tomography guidance / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein (PV) ostia for patients with refractory paroxysmal atrial fibrillation (AF) under multi-slice spiral computed tomography (MSCT) guidance before the procedure.</p><p><b>METHODS</b>A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation of PV ostia. The 36 male and 22 female patients with mean age of (57.4+/-9.5) (32-79) years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimensional image of the left atrium (LA) and proximal PVs. Patients then underwent segmental radiofrequency ablation of PV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA.</p><p><b>RESULTS</b>No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was (17.1+/-9.3) months. Forty-one patients (95%) experienced improved quality of life one month after the procedure. Thirty-six patients (83%) showed stable sinus rhythm, while 10 patients (23%) required additional anti-arrhythmic drugs. AF returned> or =1 time in 6 (14%) patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter.</p><p><b>CONCLUSION</b>It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.</p>

Tissue Doppler imaging evaluate the effect of optimal biventricular resynchronization for congestive heart disease in left ventricular synchrony and function / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the immediate change of left ventricular systolic performance and asynchronization between simultaneous biventricular pacing and sequential biventricular pacing by tissue synchronization imaging (TSI) and tissue velocity imaging (TVI) in patients with congestive heart failure. The effect of sequential biventricular resynchronization therapy was also observed.</p><p><b>METHODS</b>Ten patients with dilated cardiomyopathy who received sequential biventricular resynchronization were enrolled. The TVI and TSI imagings were performed by GE vivid7 with M3S probe. The left ventricular ejection fraction (LVEF), stroke volume (SV), aortic velocity time integral (VTI), left ventricular end diastolic diameter (LVEDd), the standard deviation of the electro-mechanical delay (EMD-SD) of 6 segments and TSI index were measured before implanting of InSync 8042 and 1 month, 3 months, 6 months after implanting respectively.</p><p><b>RESULTS</b>After 6 months of implanting, the LVEF, SV and VTI were obviously increased from (22.0 +/- 8.8)% to (38.0 +/- 9.9)%; (36.0 +/- 14.9) ml to (57.0 +/- 15.7) ml; (20.22 +/- 5.72) cm to (26.20 +/- 5.98) cm, P < 0.05, respectively, compared with the before of implanting. The LVEDd was decreased from (6.6 +/- 0.6) cm, to (6.0 +/- 0.9) cm, P < 0.05. The EMD-SD and TSI-index were declined gradually after implanting, which was more evident in the 6 months after implanting, from (83.07 +/- 46.99) ms to (22.37 +/- 16.38) ms; (2.20 +/- 0.36) to (1.50 +/- 0.43), P < 0.05, respectively, but the immediate EMD-SD did not change obviously between simultaneous biventricular pacing and sequential biventricular pacing, whereas, the TSI index and VTI were significantly improved from (1.87 +/- 0.31) to (1.71 +/- 0.29); (22.44 +/- 5.43) cm to (25.44 +/- 5.36) cm, P < 0.05, respectively, in the sequential biventricular pacing.</p><p><b>CONCLUSION</b>Sequential biventricular resynchronization could improve the left ventricular systolic function and synchronism of wall motion in the patients with congestive heart failure, which is more effective than simultaneous biventricular pacing after implanting immediately.</p>

Use of B-type natriuretic peptide in evaluation of early percutaneous coronary intervention in patients with acute coronary syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies showed that blood B-type natriuretic peptide (BNP) level could predict the prognosis of acute coronary syndromes (ACS). This study investigated the evaluation value of circulating BNP for early percutaneous coronary intervention (PCI) in patients with ACS.</p><p><b>METHODS</b>Nine hundred and sixty consecutive patients with ACS were enrolled. Circulating BNP level was measured when each patient arrived at the emergency room. All patients underwent PCI in 90 minutes in spite of contraindication. Cardiac events (death from any cause, heart failure, and recurrence of acute myocardial infarction or ACS) were recorded during follow-up.</p><p><b>RESULTS</b>In patients with BNP > or = 80 pg/ml, mortality from all causes within 1 month and 6 months in those underwent delayed PCI (> or = 6 hours) was significantly higher than those received early PCI (< 6 hours) (9.53% vs 3.49%, P = 0.027; 13.61% vs 5.24%, P = 0.010, respectively). Similarly, the incidence rate of heart failure in delayed PCI patients was significantly higher than those received early PCI within 1 month and 6 months (12.93% vs 4.66%, P = 0.008; 14.97% vs 6.98%, P = 0.021, respectively). The recurrence rate of acute myocardial infarction or ACS, however, was not significantly different between early PCI and delayed PCI patients in group BNP > or = 80 pg/ml. In patients with BNP < 80 pg/ml, no significant difference was observed between early PCI and delayed PCI patients with any of the above cardiac events within 1 month or 6 months.</p><p><b>CONCLUSION</b>While early level of circulating BNP > or = 80 pg/ml, the incidence of mortality and heart failure, but not recurrence of acute myocardial infarction, is significantly reduced in patients with ACS provided by early PCI.</p>