Aortic Coarctation Associated With Hypertrophic Cardiomyopathy in a Woman With Hypertension and Syncope: A Case Report With 8-Year Follow-Up.

BACKGROUND: Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation with aortic narrowing in the region of the ligamentum arteriosum. Hypertrophic cardiomyopathy (HCM) is a primary cardiomyopathy that is characterized by left ventricular wall thickening and likely left ventricular outflow tract (LVOT) obstruction. They are two irrelevant diseases, and their coexistence has not been reported before. Here, we described a young female patient who concurrently has CoA and HCM. CASE PRESENTATION: The patient has had hypertension since 18-years old and complained of chest discomfort on effort and fatigue thereafter. Initially, she was diagnosed as having hypertrophic cardiomyopathy and primary hypertension. The presence of CoA was not found until she was 35 years old when she had an onset of paroxysmal supraventricular tachycardia (PSVT) and presented with syncope. Failure of the ablation procedure via the femoral artery revealed the possibility of CoA and PDA that was confirmed by aortic CTA and angiography. CoA was then treated successfully with a covered stent, and the symptoms of the patient improved remarkably. Additionally, the patient had typical imaging features of HCM, and two novel HCM-causing heterozygous mutations were identified by genetic testing, DSP-encoding desmoplakin, and MYBPC3-encoding myosin-binding protein C. The HCM was suspected to be contributing to the clinical presentations of the patient and challenged the timely diagnosis of CoA. The 8-year follow-up on aortic CTA and angiography revealed no stent graft-related complications. Moreover, no changes in HCM-related imaging features were found in the follow-up echocardiography 8 years after the correction of aortic coarctation, which strengthened the diagnosis of HCM. CONCLUSION: Here, we reported the diagnostic challenges, management, and 8-yeasr follow-up findings in a rare case of CoA combined with HCM. The case highlighted the importance for physicians to exclude CoA in young hypertensive patients, and proved the efficacy of stent repair in treating CoA in older patients.

Diagnostic value of neutrophil gelatinase-associated lipocalin for renal injury in asphyxiated preterm infants.

The aim of the present study was to analyze the diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) in renal injury in asphyxiated preterm infants. In total, 48 cases of asphyxiated preterm infants, 45 cases of premature infants and 45 cases of normal newborn infants were included in the study. Using ELISA we evaluated the level of urine NGAL, kidney injury molecule-1 (KIM-1), cystatin C (Cys-C) and serum creatinine (Scr). We also calculated the estimated glomerular filtration rate (eGFR). Our results showed that NGAL, KIM-1 and Cys-C levels in the group of asphyxiant renal injury within 24 and 48 h were markedly higher than the other two groups (P<0.05), while changes in Scr and eGFR within 24 h were not significant (P>0.05). Scr level in renal injury group within 48 h was markedly elevated while the eGFR level was visibly reduced (P<0.05). According to analysis of receiver operating characteristic curve, area under curve for NGAL in the group of asphyxiant renal injury within 24 and 48 h was significantly higher than KIM-1 and Cys-C. Susceptibility and specificity were improved. In conclusion, diagnosis of renal injury in asphyxia neonates using NGAL was more efficient compared to other methods.

[Epidemiological survey of childhood asthma in 2010 in urban Baotou, China].

OBJECTIVE: To investigate the prevalence rate of childhood asthma in 2010 in urban Baotou, China, as well as the characteristics of attacks and the status of diagnosis and treatment of childhood asthma. METHODS: More than 10 000 children (0-14 years) were selected from 3 secondary schools, 3 primary schools, 6 kindergartens, and 4 community vaccination sites in urban Baotou by cluster random sampling between September 2009 and August 2010. A standardized preliminary questionnaire was used for screening out suspected cases, which were then confirmed or excluded by a clinician; the confirmed cases underwent further questionnaire survey. Double entry and validation was adopted for all data using Epi-Info software, and analysis was performed using SPSS 13.0. RESULTS: A total of 11 323 children were surveyed. Asthma was diagnosed in 127 cases (including 121 children with typical asthma and 6 children with cough variant asthma), with a prevalence rate of 1.12%. The prevalence rate of asthma in male children was significantly higher than that in female children (1.51% vs 0.72%; P<0.01). The prevalence rate of asthma in 2010 was significantly increased compared with that in 1990 (0.55%) and 2000 (0.88%) (P<0.05). Systemic glucocorticoid use decreased significantly from 60.2% in 2000 to 25.9% in 2010 (P<0.01); inhaled corticosteroid use increased significantly from 13.6% in 2000 to 85.8% in 2010 (P<0.01); antibiotic use decreased from 98.1% in 2000 to 66.9% in 2010 (P<0.01). The multivariate logistic regression analysis showed that family history of allergy, allergic rhinitis, chronic cough, and recurrent respiratory tract infection were independent risk factors for childhood asthma. CONCLUSIONS: The prevalence rate of childhood asthma in urban Baotou shows an increasing trend. Inhaled corticosteroids have been widely used.

Increased leukocyte Rho-kinase activity in a population with acute coronary syndrome.

Accumulating evidence suggests that Rho-associated kinase (ROCK) may be important in the pathogenesis of atherosclerosis and coronary vasospasm. In the present study, we investigated whether ROCK activity is increased in acute coronary syndrome (ACS) patients. Twenty-one patients with ACS (12 males, mean age 58.0±8.0 years) and 20 control subjects (10 males, mean age 55.0±6.0 years) were enrolled. Blood samples were obtained and demographics were recorded. Peripheral leukocyte ROCK activity was determined by the ratio of phospho-myosin­binding subunit (P-MBS) on myosin light-chain phosphatase to total MBS. Compared with the control subjects, ROCK activity was significantly increased in ACS patients (0.69±0.07 vs. 0.45±0.04, P<0.001). There was no apparent correlation between the lipid levels (total cholesterol and low-density lipoprotein) and ROCK activity (r=0.17, P>0.05; r=0.08, P>0.05; respectively). However, ROCK activity correlated with mean arterial pressure (r=0.58; P<0.01). ROCK activity is increased in ACS patients indicating that this may be a novel serological marker of ACS.

Effect of fluoride exposure on bone metabolism indicators ALP, BALP, and BGP.

OBJECTIVE: To analyze the changes in serum alkaline phosphatase (ALP) and bone alkaline phosphatase (BALP) activity and changes in osteocalcin (BGP) content following fluoride exposure and, thereby, determine the reference indications of fluoride-induced changes in bone metabolism. METHODS: In the animal study, rats were allowed free access to drinking water containing different concentrations (10, 150, or 400 mg/L) of sodium fluoride. Serum ALP and BALP activity and serum BGP content were assessed at three exposure time-points. In the spot study, serum ALP and BALP activity and serum BGP content were assessed in workers exposed to fluoride in their working environment for different periods of time. RESULTS: Compared with the control group, on days 15 and 30, the activity of serum ALP in the low- and medium-dose group was significantly higher (p < 0.05), while in the high-dose group it was significantly lower (p < 0.05). Only on day 30 was the activity of serum BALP in the medium-dose group significantly higher than that of the control group (p < 0.05). BGP content was lower in the high-dose group than in the control group (p < 0.05) on days 30 and 90, but it was higher in the medium-dose group on day 90. Compared with the control group, BGP content in the fluoride-exposed group was higher (p < 0.05). In the spot study, serum ALP activity and serum BGP content in the medium working-age group were higher than that in the short working-age group (p < 0.05). However, serum ALP activity and serum BGP content were lower in the long working-age group than in the medium working-age group (p < 0.05). CONCLUSIONS: Our results suggest that serum fluoride and urinary fluoride can be used as reference indications to provide an overall reflection of the body's fluoride-load and fluoride exposure level. Serum ALP activity and serum BGP content can be used as important reference indications for diagnosing bone metabolism changes resulting from fluoride exposure.

Interactive effect of fluoride burden with calcitonin receptor gene polymorphisms on the risk of F bone injury.

PURPOSE: This study aims to examine the interactive effect of fluoride burden with calcitonin receptor (CTR) gene polymorphisms on the risk of fluoride (F) bone injury and provide the basis for determination of F bone injury risk factors. METHODS: In this case-control study, a total of 119 cases and 126 controls were enrolled from 2 aluminum plants in Hubei province. F burden (UF) was measured by F ion-selective electrode method. The CTR gene polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios, 95% confidence intervals (CI). RESULTS: The odds of developing F bone injury for participants in the moderate F burden group versus the mild F burden group were 4.1 (95% CI: 1.9, 8.7); the heavy F burden group versus the mild F burden group were 14.1 (95% CI: 6.5, 30.6). The odds of developing F bone injury for participants with the TC & TT genotypes versus the CC genotype were 2.6 (95% CI: 1.4, 4.7). The interactions between TC & TT genotypes and moderate, heavy F burden were significant (OR = 14.4; OR = 40.3). CONCLUSION: The interactive effect of F burden and CTR genotype was significant, which increased the F bone injury risk.

Evaluation on the safety and efficacy of tirofiban in the treatment of acute coronary syndrome.

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein llb/llla receptor, in the treatment of unstable angina and myocardial infarction without persistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban+heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or refractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban+heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban+heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in patients with ACS receiving tirofiban+heparin was lower when compared with that of patients who received only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.

Impact of left ventricular epicardial and biventricular pacing on ventricular repolarization in normal-heart individuals and patients with congestive heart failure.

AIMS: Malignant ventricular arrhythmias can arise in a subset of congestive heart failure (CHF) patients after they undergo cardiac resynchronization therapy (CRT), thus counteracting the haemodynamic benefits typically associated with biventricular pacing. This study seeks to assess whether alteration of the ventricular transmural repolarization and conduction due to reversal of the depolarization sequence during epicardial or biventricular pacing facilitate the development of ventricular arrhythmias. METHODS AND RESULTS: ECGs and monophasic action potential (MAP) were recorded during programmed stimulation from right ventricle (RV) endocardium (RV-Endo), left ventricle (LV) epicardium (LV-Epi), or both (biventricular, Bi-V) in 15 individuals without structural heart diseases. In patients with severe CHF and CRT (n=21), ECGs were collected during RV-Endo, LV-Epi, and Bi-V pacing. MAP duration on intracardiac electrogram, the QT, JT, and T(peak)-T(end) intervals on ECGs at different pacing sites were measured and compared. In subjects with or without structural heart disease, compared with RV-Endo pacing, LV-Epi and Bi-V pacing resulted in a longer JT (341.78+/-61.97 ms with LV-Epi, 325.86+/-59.69 ms with Bi-V vs. 286.14+/-38.68 ms with RV-Endo in CHF individuals, P<0.0001) or T(peak)-T(end) interval (121.55+/-19.88 ms with LV-Epi, 117.71+/-42.63 ms with Bi-V vs. 102.28+/-12.62 ms with RV-Endo in normal-heart subjects, P<0.0001; 199.70+/-62.44 ms with LV-Epi, 184.89+/-74.08 ms with Bi-V vs. 146.41+/-31.06 ms with RV-Endo in CHF patients, P<0.0001), in addition to prolonged myocardial repolarization time and delayed endocardial activation. During follow-up, sudden death and arrhythmia storm occurred in two CHF patients after CRT. CONCLUSION: Epicardial and biventricular pacing prolong the time and increase the dispersion of myocardial repolarization and delay the transmural conduction. All of these should be considered as potential arrhythmogenic factors in CHF patients who receive CRT.

CD151 promotes neovascularization and improves blood perfusion in a rat hind-limb ischemia model.

PURPOSE: To evaluate the efficiency of recombinant adeno-associated virus (rAAV)-mediated CD151 gene delivery in promoting neovascularization and improving blood perfusion in the skeletal muscle of the rat hind-limb ischemia model. METHODS: CD151 was constructed into the rAAV vector. Twelve Wistar rats were randomly divided into 2 groups of 6 rats each and then intramuscularly injected with rAAV-CD151 or rAAV-GFP, respectively, in one hind limb. Two weeks after gene delivery, the femoral arteries in the treated limbs were excised to establish the model of hind-limb ischemia. Expression of the transgene product CD151 was confirmed by Western blot and the reverse transcription polymerase chain reaction. The skin temperature, angiographic score, and capillary density of the hind limb were measured to assess blood perfusion and neovascularization 6 weeks after transfection. RESULTS: Compared to the group transfected with GFP, the CD151 group showed a 63% higher angiographic score (p<0.05) and an 18% increase in capillary density (p<0.05). In addition, the mean skin temperature of the AAV-CD151-transfected hind limbs was equivalent to the level of the contralateral nonischemic limb, whereas the limb temperature in the GFP-transfected rats was significantly lower than the nonischemic control. The expression of CD151 in the ischemic hind limb injected with rAAV-CD151 was significantly higher than limbs injected with rAAV-GFP. The CD151 mRNA and protein expression was persistently observed in the injected muscle for at least 6 weeks after injection, while no human CD151 mRNA could be detected in remote organs or rAAV-GFP-injected muscles. CONCLUSIONS: This study demonstrates that the rAAV-mediated CD151 gene transfer into rat skeletal muscles is efficient, stable, and has no ectopic expression. Moreover, rAAV-mediated CD151 gene transfer stimulates neovascularization, especially arteriogenesis, and thereby improves blood perfusion in a rat hind-limb ischemia model. These findings suggest that CD151 could be a new target for neovascularization therapy in ischemic disease, and rAAV-mediated CD151 gene transfer may be useful for treatment of ischemic disease.

[Effects of CD151 on migration of human tongue squamous carcinoma cell line Tca8113].

BACKGROUND & OBJECTIVE: Over-expression of CD151 gene in tumor tissues may be associated with metastasis and poor prognosis of cancer, but the mechanism is unknown. This study was designed to determine the effects of CD151 gene on migration of human tongue squamous carcinoma cell line Tca8113. METHODS: Functional fragment of CD151 gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR), and inserted into plasmid adeno-associated virus (pAAV) vector in sense direction and antisense direction to construct rAAV-CD151 and rAAV-antiCD151, the virus titers were determined by dot blot. Two weeks after transfection, protein level of CD151 in Tca8113 cells was detected by Western blot, the effect of CD151 on migration of Tca8113 cells was detected by Transwell chambers. RESULTS: Titer of rAAV-CD151 was 2x10(11) pfu/ml, titer of rAAV-antiCD151 was 1x10(11) pfu/ml. Transfection of rAAV-CD151 increased expression of CD151 in Tca8113 cells by 108% of control cells, while transfection of rAAV-antiCD151 decreased expression of CD151 in Tca8113 cells by 79% of control cells. Migrated cells count was significantly higher in rAAV-CD151-transfected cells (93.6+/-11.6), and lower in rAAV-antiCD151-transfected cells (24.0+/-4.4) than in untransfected and rAAV-GFP-transfected cells (53.0+/-6.6 and 46.0+/-7.0, P<0.05). CONCLUSIONS: It is an important molecular mechanism of tumor metastasis that over-expression of CD151 promotes migration of tumor cells. rAAV-antiCD151, a novel therapeutic tool, can specifically reduce the expression of CD151, and inhibit migration of tumor cells.