Effects of pregnancy on long-term outcomes of pulmonary arterial hypertension associated with congenital heart disease: a preliminary study / 中华全科医师杂志

Objective To investigate the effects of pregnancy on long-term outcomes of pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD).Methods Women with PAH-CHD who had undergone pregnancy under the care of Beijing Anzhen Hospital from 2004 to 2013 were retrospectively identified and 1∶1 matched to nulliparous PAH-CHD females (controls).Functional status and other clinical data were recorded for each group at baseline and follow-up.Results We successfully matched 40 pairs of pregnant and non-pregnant women with PAH-CHD.The patients were followed up for a mean of (6.5 ± 1.9) years,the outcomes of patients were documented during April 2016 to October 2016.No deaths occurred in either group during the study period.There were no statistically significant differences in long-term cardiac function between the two groups (Z =-1.41,P =0.16).After adjusting age,timing of follow-up,specific drug therapy and Eisenmenger's syndrome,pregnancy didn't have significant effect on the long-term deterioration of cardiac function in PAH-CHD patients (OR =1.32,95％ CI:0.33-5.37,P =0.70).Conclusion Pregnancy may not have significant effect on long-term cardiac function in PAH-CHD patients,but this conclusion needs to be confirmed by further studies.

The temporal profile of astrocytes and Jak-STAT signal pathway after spinal ischemia and reperfusion injury in rabbits / 中华胸心血管外科杂志

Objective To observe the evolution of astrocytes,GDNF,BDNF and Jak-STAT signal pathway after spinal cord ischemia-reperfusion injury in rabbits.Methods Spinal cord ischemia was induced by means of balloon occlusion of the infrarenal aorta for 22 minutes in 54 male New Zealand white rabbits.We assigned rabbits to 9 groups (n =6),one sham group,eight operation groups.The operation process in the sham group was the same as the operation group except the ischemia reperfusion of the spinal cord.At 0 h,1 h,2 h,3 h,8 h,24 h,48 h and 72 h after reperfusion,animals were sarcrificed and the spinal cord was removed for histologic,immunohistochemical study and western blotting.Results Normal neurons were decreased with the extension of reperfusion time.Levels of GFAP increased at 3 h and reached a peak at 48 h after reperfusion.GDNF was increased reaching two peaks after injury,the first peak was at 3 h,the second was at 72 h.BDNF level was increased and peaked at 24 h after reperfusion.The expression of p-STAT3 showed a biphasic pattern which peaked at 1h and 48 h.GFAP,GDNF,BDNF were rare and the level of p-STAT3 could be neglected in sham group.Conclusion Spinal cord ischemia-reperfusion injury could induce the activation of astrocytes,the expression of GDNF,BDNF and the activation of JakSTAT signal pathway.They showed different expression rules in this study.

Investigation of Microglia Activation and Inflammatory Cytokine Changes in Experimental Rabbits After Spinal Cord Ischemia Reperfusion / 中国循环杂志

Objective: To observe the activation of microglia and the changing rule of inflammatory cytokine as IL-6, IL-10 and nuclear factor-κB (NF-κB) in experimental rabbits after spinal cord ischemia reperfusion (SCIR) injury in order to provide theoretical basis for post-conditioning time. Methods: Rabbit SCIR injury model was established by thoracic aorta balloon occlusion. 54 New Zealand male adult white rabbits were divided into 9 groups: Sham group (the animals received balloon implantation without occlusion), SCIR-0h group (reperfusion was conducted at 0 hour of spinal cord ischemia), SCIR-1h, -2h, -3h, -8h, -24h,-48h and -72h groups. n=6 in each group. The number of normal and apoptosis neurons, the levels of Iba-1, IL-6, IL-10 and NF-κB in spinal tissue were examined and compared among different groups respectively. Results: The number of normal neuron was decreasing with the extended reperfusion time, TUNEL-positive neuron began to increasing in SCIR-8h group and the peak was reached in SCIR-24h group. The expression of Iba-1 began to elevating in SCIR-2h group and the peak was obtained in SCIR-8h group; NF-κB began to rising in SCIR-3h group and the peak was observed in SCIR-8h group; both IL-6 and IL-10 arrived the peak in SCIR-24h group. The expressions of NF-κB, IL-6 and IL-10 were positively related to Iba-1 level. Conclusion: Microglia activation had dynamic changes in experimental SCIR rabbits and the expression levels of NF-κB, IL-6 and IL-10 were positively to microglia activation; post-conditioning time at front and back to microglia activation may reduce neuron injury.

Long-term outcome and prognostic factors in pregnant women with pulmonary arterial hypertension associated with congenital heart disease / 中华内科杂志

Objective To investigate the perinatal outcome , risk factors and long-term outcome of pregnancy complicated with pulmonary arterial hypertension (PAH) and congenital heart diseases (CHD). Methods Clinical data of 110 pregnant women who were diagnosed as PAH-CHD were retrospectively analyzed in the Department of Obstetrics and Gynecology and Surgical Intensive Care Unit at Beijing Anzhen Hospital from 2004 to 2013.The survival and treatment status were followed up .Results 110 subjects consisted of 11 mild PAH, 33 moderate and 66 severe ones .The incidences of deterioration in New York Heart Association ( NYHA ) classes (≥2 ) during pregnancy , respiratory failure , pulmonary hypertension crisis and arrhythmia were 25.5% (28/110),7.3% (8/110),10.0% (11/110),10.0% (11/110) respectively.Among them, the difference of deterioration in NYHA classes (≥2) during pregnancy among the three groups was statistically significant .A total of 8 ( 7.3%) maternal deaths occurred during hospitalization , all of whom were severe PAH cases .Multivariate analysis showed that pulmonary artery systolic pressure was a risk factor of perioperative death (OR=1.042, P=0.005).There were 55 cases (50.0%) of term delivery, and 35 cases (31.8%) of iatrogenic abortion.The proportion of term delivery in the severe PAH group was significantly lower . The proportion of iatrogenic abortion and small for gestational age infant ( SGA ) were higher in severe group .The incidence of neonatal malformations was 8.0%(6/75).The follow-up rate was 61.8%(63/102).Sudden death was reported in a parturient a few days after discharge .The remaining 62 patients survived during follow-up, while 53 patients (85.5%) were functional class ( FC ) Ⅰ -Ⅱ, 9 ( 14.5%) were FC Ⅲ -Ⅳ at follow-up.The cardiac function deterioration during pregnancy was not significantly correlated with long-term deterioration (P =0.767). Conclusions Perinatal mortality and the incidence of maternal and fetal adverse events were high in pregnancy with PAH-CHD.Pulmonary artery systolic pressure is a major risk factor for perioperative mortality in pregnant women .PAH-CHD woman had good overall outcome after puerperium .

Matrix metalloproteinase-8 inhibitors mitigate sepsis-induced myocardial injury in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sepsis-induced myocardial injury (SIMI) is caused by a variety of mechanisms. The aim of the study is to investigate the effects of metalloproteinase-8 (MMP-8) on SIMI and its mechanisms in rats.</p><p><b>METHODS</b>Forty male Sprague Dawley rats were randomly divided into four groups: MMP-8 inhibitor (M8I), dexamethasone (DEX), sepsis, and sham groups. The sepsis model was established by cecal ligation and puncture (CLP). Rats in the M8I group immediately received an intraperitoneal injection of M8I (0.1 mg/kg) after CLP. Rats in the DEX group immediately received an intraperitoneal (IP) injection of DEX (2 mg/kg). Rats in the sepsis and sham groups received intraperitoneal injections of normal saline. Rats were sacrificed 12 hours after CLP. Paraffin sections were stained with hematoxylin and eosin to observe the myocardium. The myocardial ultrastructure was observed with transmission electron microscopy. MMP-8, tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) were detected by immunohistochemistry. The expression of MMP-8 was measured by Western blotting. TNF-α and IL-1β levels in serum and myocardial tissue were determined by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Compared with the sham group, the myocardium in the sepsis group was seriously injured. MMP-8, TNF-α and IL-1β expression was higher in the sepsis group than in the sham group. Treatment with M8I or DEX, however, attenuated sepsis induced histopathological changes in the heart, and was associated with significant reductions in serum and myocardial levels of TNF-α and IL-1β (P < 0.05). M8I significantly inhibited MMP-8 expression in myocardial tissue (P < 0.05). In addition, treatment with DEX was not associated with a change in myocardial levels of MMP-8 (P > 0.05).</p><p><b>CONCLUSION</b>MMP-8 inhibitor attenuated myocardial injury in septic rats, which might be related to reduced expression of TNF-α and IL-1β.</p>

Effect of prostaglandin E1 lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect and severe pulmonary artery hypertension / 中华实用儿科临床杂志

Objective To measure the effect of prostaglandin E1 (PGE1) lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect(VSD)and severe pulmonary artery hypertension (PAH).Methods Forty infants [(7.1 ± 3.3) years old] with VSD and severe PAH who underwent surgery under cardiopulmonary bypass were involved in the study.They were divided into 2 groups averagely:control group (20 cases) and experimental group (20 cases).All the patients were continuously intravenous pumping of nitroglycerin or PGE1 during the perioperative period.The effect of PGE1 on cardiac haemodynamics and oxygen metabolism between the 2 groups were measured during 72 hours postoperatively.Results The statistical analysis demonstrated that the values trend of mean arterial blood pressure (mABP),mean pulmonary arterial pressure (mPAP),mPAP/mABP,pulmonary vascular resistance index (PVRI),left ventricular stroke work index (LVSWI) were affected during 72 h postoperative period (P ＜0.05).The mABP at 48 h,LVSWI at 48 h,72 h in experimental group were significantly higher than those in control group (all P ＜0.05).The mPAP at 8 h,48 h,PVRI at 72 h and pulmonary arterial wedge pressure (PAWP)at 12-48 h in experimental group were significantly lower than that in control group (all P ＜ 0.05).Compared to postoperative period,mABP at 12 h,72 h,mPAP at 4-12 h,48 h were increased significantly in control group (P ＜ 0.05) ; mABP and LVSWI at 8-72 h,right ventricular stroke work index at 48 h,72 h and cardiac index at 72 h were significantly increased (P ＜0.05),while PVRI and PAWP at 72 h,mPAP/mABP at 24-72 h were significantly decreased in experimental group (P ＜ 0.05).There were no significant differences in the values of oxygen metabolism between both groups (P ＞0.05).Conclusions LipoPGE1 can significantly decrease the pulmonary arterial pressure,which can enhance cardiac function and decrease the duration of intubation after surgery.

Agreement between cardiac index measured with arterial pressure-based cardiac output and pulmonary artery catheter during cesarean section in parturients with congenital heart disease and severe pulmonary hypertension / 中华麻醉学杂志

Objective To determine if the cardiac index (CI) measured with arterial pressure-based cardiac output (APCO) agrees with that measured with pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease and severe pulmonary hypertension.Methods Thirty parturients with congenital heart disease and severe pulmonary hypertension,scheduled for elective cesarean section,were enrolled in the study.APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2-3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5-6).The correlation was tested by Pearsone correlation analysis.CI derived from APCO and PAC was compared by Bland-Altman analysis for agreement.Results CI measured with PAC was significantly higher than that measured with APCO (P ＜ 0.05).Compared with the baseline value at T1,no significant difference in CI measured with PAC and APCO was found at T11-T4 and T6 (P ＞ 0.05),and CI measured with PAC and APCO was significantly increased at T5 (P ＜ 0.05).Bland-Ahman analysis showed poor agreement between CI measured with the two methods.The correlation analysis showed that there was positive correlation between CI derived from the two methods at T1-6 (the correlation coefficient was 0.93,0.95,0.94,0.89,0.96 and 0.91 at T1-6,respectively,P ＜ 0.05).Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parturients with congenital heart disease and severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.

An analysis of risk factors for postpartum cardiac events in pregnant women with heart disease / 中华内科杂志

Objective To investigate the risk factors for postpartum cardiac events in pregnant women with heart diseases and to provide prenatal counseling for them.Methods A retrospective analysis was made in cases of pregnant women with heart diseases admitted to the surgical intensive care unit (SICU) of Anzhen Hospital from May 2004 to May 2012.Data were used to identify univariate and multivariate predictors for postpartum cardiac events.Results A total of 190 patients (≥ 20 weeks gestation) were enrolled in the study with 134 (70.5％) of congenital heart disease,30 (15.8％) of rheumatic heart disease,10 (5.3％) of cardiomyopathy,2 (1.1％) of peripartum cardiomyopathy and 14(7.4％) of hypertensive heart disease.Postpartum cardiac events were observed in 42 cases with the incidence of 22.1％.A total of 7 cases resulted in death with the mortality rate of 3.7％.Among them,5 cases were dead of circulatory collapse and pulmonary hypertensive crisis postpartum,while the other 2 cases with secondary pulmonary infection were died of respiratory and circulatory collapse.The baseline parameters of New York Heart Academy(NYHA) ＞ 1,left ventricular ejection fraction (LVEF) ＜ 50％,use of cardiac drugs and pulmonary artery hypertension(PAH) ＞ 80 mm Hg(1 mm Hg =0.133 kPa) were the independent predictors for postpartum cardiac events by univariate and multivariate logistic regression analysis.Conclusions The incidence of postpartum cardiac events is high in pregnant women with heart diseases.Pulmonary artery hypertension and heart failure are the main causes of death.

The monitoring and management for patients following lung transplatation surgery during early stage in intensive care unit: 9 cases report / 中华胸心血管外科杂志

Objective To summarize the experience during early stage of postoperative monitoring and treatment for the patients follwing lung transplantation in surgical intensive care unit,and to improve the patient's outcome of lung transplantation.Methods A retrospective analysis of 9 cases of orthotopic lung transplantation admitted to surgical intensive care unit (SICU) of Beijing Anzhen Hospital from May 2005 to May 2011 was made.Results There 5 male patients and 4 female patients with the age 21 -67 (46.1 ± 14.1 ) years old in present group,and among them 6 patients survived (survival rate:66.7％ ).The etiological indication of admission were idiopathic pulmonary fibrosis (n =4),pulmonary lymphangioleiomyomatosis ( n =3 ),and bronehiectasis ( n =2).Bilateral sequential lung transplantation ( n =5 ),single left lung transplantation ( n =1 ) and single rigbt lung transplantation ( n =3) were performed.The postoperative duration of mechanical ventilation,stay duration in SICU and in hospital were 2 -32 d,3 -42 d,and 3 -60 d respeetively.Postoperative complication taking place after surgery were acute rejection in 2 cases and pneumonia 4 cases (3 cases were treated with extracorporeal membrane oxygenator).Postoperative in hospital death was 3 cases of 9 resulting from severe intection (n =2) and cireulation failure ( n =1 ).Conclusion Well-planned postoperative management stroategy in SICU plays an important role in outcome control after lung transplantation,including monitor and respiratory and cardiacvascular management,reasonable implementation of vasoactive medications and diuretics,protective mechanical ventilation strategy,reducing the time of ventilation.

The risk factors associated with intraoperative acute cardiac decompensation in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective To identify the risk factors associated with intraoperative acute cardiac decompensation in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods From November 2007 to February 2009, 2379 OPCABGs were performed in our hospital. The possible risk factors associated with intraoperative cardiac decompensation were retrospectively analyzed. The preoperative patient demographics and intraoperative characteristics were correlated with intraoperative acute cardiac decompensation.The possible risk factors included sex, age, body weight, cardiac function (NYHA classification), the associated diseases (hypertension, diabetes mellitus, liver-kidney dysfunction), history of myocardial infarct, ventricular aneurysm, preoperative treatment with β-blocker and/or calcium channel blocking agent, ventricular extrasystole,atrial fibrillation, duration of operation, etc. Results Three hundred and sixty-eight patients developed acute cardiac decompensation during OPCABG (15.5%). No patient died during operation. Multivariate analysis indicated that the risk factors for acute cardiac decompensation during OPCABG included left ventricular aneurysm valvular dysfunction, left main disease, history of myocardial infarct, preoperative ventricular premature beat,preoperative ejection fraction (EF) ＜ 40%, intraoperative atrial fibrillation, intraoperative frequent ventricular premature beat, tachycardia before anesthesia and emergency OPCABG. Conclusion The risk factors for acute cardiac decompensation during OPCABG includ left ventricular aneurysm valvular dysfunction, left main disease,history of myocardial infarct, preoperative ventricular premature beat, preoperative EF ＜ 40%, intraoperative atrial fibrillation, intraoperative frequent ventricular premature beat, tachycardia before anesthesia and emergency OPCABG.

Analysis of risk factors for perioperative acute cerebral vascular accident in the elderly / 中华老年医学杂志

Objective To analyze the risk factors for perioperative acute cerebral vascular accident (PACVA) and put forward the corresponding preventive measures.Methods The clinical data of elderly patients in our hospital who suffered from PACVA in recent 5 years were retrospectively studied.The correlation between risk factors and the occurrence of PACVA was analyzed.Results One hundred and fifty cases were enrolled in the study.Seventy eight cases of them suffered from PACVA with the average age of 70 years ranging from 60 to 98 years.Fifty six cases(71.8%)were found PACVA in one week after operation.Multiple regression analysis showed that hypertension, history of cerebrovascular disease, unstable blood pressure and obesity were independent risk factors for PACVA.The newly diagnosed perioperative atrial fibrillation and carotid atheroselerosis were the high risk factors for PACVA.Conclusions PACVA is one of the common perioperative complications.Necessary check, monitor and treat measures should be taken in the perioperative period, especially for patients with risk factors.

Changes of lung microvascular permeability in blunt chest trauma, endotoxemia and their combined injury in rats / 第三军医大学学报

Objective　To observe the changes of the microvascular permeability after blunt chest trauma (BCT), endotoxemia and their combined injury in rats. Methods　After the establishment of the rat models of BCT, endotoxemia and their combined injury in the right lungs, the fluorescein sodium (FINa) content was measured with flurospectrophotometer in lungs 0.5, 1, 4 and 8 h after injury. Results　There was an early obvious increase of the microvascular permeability in the impact lateral (peak at half an hour after injury), and a delayed increase in the contralateral lung (peak at the 8th h) in the BCT group. The FINa content was higher in endotoxemia group than in the BCT group(P<0.05), and lower than that in the combined injury group(P<0.05) in the contralateral lung. Conclusion　Results indicate that there were different pathophysiologic processes among the 3 kinds of injury and the FINa content is a useful index to manifest the changes of microvascular permeability in tissues.