ABSTRACT
Objective To analyze the etiological or associated factors and the treatment of patients with atrial fi brillation in high altitude areas in Tibet. Methods The clinical data of atrial fi brillation patients hospitalized in our hospital during January 2012 to Jane 2016 were analyzed retrospectively. Results (1) A total of 442 patients (male:female,1.2:1) were included in the study with ages of 30-96(65.9±12.3) years. The percentages of paroxysmal, persistent and permanent atrial fi brillation were 14.9%, 69.2%, and 15.8% respectively. The associated factors of atrial fi brillation included hypertension (53.4%), rheumatic heart disease (7.5%),chronic mountain sickness (10.6%), coronary heart disease(5.7%), hyperthyroidism (6.1%) and diabetes (9.0%).(2)Only 42 patients (9.5%) had evaluation with CHADS2score during hospitalization and actually 74.6% patients scored≥2. Twenty-one patients were restored to sinus rhythm during hospitalization and no patients had radiofrequency ablation.Conclusions The associated factors of atrial fi brillation in high altitude areas are similar to other areas. Thrombosis risk evaluation and anticoagulation therapy was not sufficient. Rhythm control rate was low and development of radio frequency ablation therapy should be considered.
ABSTRACT
Background Most animal models of experimental autoimmune uveitis (EAU) are single attacked procedure,with a different feature from the natural course of human recurrent autoimmune uveitis.So establishing a recurrent EAU model is necessary for the clinical study on EAU.Objective This study was to establish the recurrent EAU model in rat and investigate the ocular inflammation and pathological manifestation and interleukin-17 (IL-17)expression in the eye.Methods T cells isolated from the spleen and draining lymph nodes of Lewis rats immunized with interphotoreceptor retinoid-binding protein (IRBP) 1177-1191 peptide fragments (R16) 10 days earlier were re-stimulated with R16 in vitro and injected into naive syngeneic rats to establish the recurrent EAU models,and the normal Lewis rats were used as controls.The eyes of model rats were then examined daily for clinical signs of uveitis by slit-lamp biomicroscopy and scored Caspi's criteria.The rats were sacrificed 1 month,2,3months after injection respectively,and the retinal sections were prepared for the pathological examination by hemotoxylin & eosin staining.Immunohistochemistry was performed to detect the expression of IL-17 in the retina.Results Adoptive transfer of R16-specific T cells to Lewis rats induced recurrent uveitis.The inflammatory scores on the fourth day,the sixth day,and the inflammatory response disappeared on the tenth day after injection.However,the inflammatory reaction occurred repeatedly 4 or 5 times in the 2-month duration after that,and the right and left eyes of a single recipient showed a different pattern of relapse,and the clinical manifestations of EAU was similar to the natural course to those of human autoimmune uveitis.In the retinal specimens of 1-,2-and 3-month group,the number of inflammatory cells was gradually decreased as the time lapse.Compared with the normal group,the thicknesses of the entire retina,outer nuclear layer and inner nuclear layer decreased with a significant difference among the 4 groups (F=20.46,288.40,4.43,all P=0.00).The number of RGCs in the normal group,1-,2-and 3-month group was 231.27 ± 15.36,225.36 ± 17.79,132.18 ±9.39 and 67.45 ± 11.90,respectively,showing a significant difference among them (F=68.94,P=0.00).Immunohistochemistry showed that the scores of the IL-17 expression in the rat retina were 0.64 ± 0.17,1.92 ± 0.19,1.17 ± 0.23 and 0.83 ± 0.23,showing statistically significant difference (F=64.10,P=0.00).Conclusions The stimulation of R16-specific T cells can induce recurrent EAU in Lewis rat.Th17 is involved in the disease course.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the cardiac structural and functional changes in high altitude heart disease (HAHD) patients with various grade of pulmonary artery hypertension (PAH).</p><p><b>METHODS</b>Pulmonary artery systolic pressure (PASP) was evaluated by Doppler echocardiography in 100 patients with HAHD and patients were divided into 3 groups: mild (PASP: 30-49 mm Hg), moderate (PASP: 50-69 mm Hg) and severe (PASP ≥ 70 mm Hg) PAH and 50 patients without organic heart disease served as control group. Data on heart structure and function, heart rhythm and whole blood NT-proBNP were compared among groups.</p><p><b>RESULTS</b>Right ventricular free wall was significantly thicker in moderate and severe PAH groups than in the control group [(5.10 ± 2.23) mm, (7.00 ± 2.29 ) mm vs.(3.70 ± 0.92)mm, P < 0.05], and in the severe PAH group than in mild and moderate PAH groups [ (7.00 ± 2.29) mm vs.(4.58 ± 1.80) mm, (5.10 ± 2.23) mm, all P < 0.05] and which was similar between the mild PAH group and the control group. Right ventricular inter diameter and right ventricular outflow tract inter diameter were significantly increased in all HAHD groups compared to the control group (all P < 0.01), and were also significantly increased in moderate and severe PAH groups than in the mild PAH group (P < 0.01). Thickness of interventricular septum was also significantly increased in HAHD patients than control group and in moderate and severe PAH groups than in moderate PAH group. Left atrium anterior-posterior diameter was significantly increased in HAHD patients than in control group and was similar among HAHD patients with various degree of PAH. Left ventricular ejection fraction (LVEF) was remarkably decreased in all HAHD groups than in the control group (P < 0.05) , moreover, LVEF was remarkably decreased in the moderate PAH group than in the mild PAH group (P < 0.05) . EF was similar between severe PAH group and moderate PAH group (P > 0.05) . There was no significant correlation between lgPASP and EF (R = -0.103, P = 0.298) . Compared with the control group, the incidences of decompensated heart failure and arrhythmia were remarkably increased in HAHD patients (P < 0.05) . The level of whole blood NT-proBNP increased in proportion to increasing PASP in HAHD patients (P < 0.05).</p><p><b>CONCLUSION</b>Increased PASP correlates with whole blood NT-proBNP and is an important determinant affecting the right ventricular structure and left and right ventricular function in HAHD patients.</p>