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Objective:To evaluate the outcomes of aortic root repair in acute type A aortic dissection (ATAAD) with aortic sinus involvement.Methods:The clinical data of patients with ATAAD involving the aortic sinus and an aortic root diameter of ≤45 mm who were treated from January 1, 2015, to December 31, 2016, were collected. Patients were divided into group A (involvement of one aortic sinus or part of one aortic sinus) and group B (involvement of more than one aortic sinus). The effectiveness of aortic root repair in ATAAD with sinus involvement was analyzed by comparing the preoperative imaging characteristics and postoperative results between the two groups.Results:The study cohort comprised 155 patients, including 100 patients in group A and 55 in group B. There were no differences between the two groups in baseline characteristics, aortic root diameter, 30-day mortality, and complication rates. During an average follow-up of(49.1±14.6) months, there was no difference between the two groups in the survival rate (92.0% vs. 89.5%, P=0.61). The aortic root diameter at follow-up showed no progressive expansion compared with preoperatively in either of the two groups[(38.1±3.6) mm vs. (37.9±3.5)mm, P=0.92, A; (38.4±4.1) mm vs. (38.3±3.6) mm, P=0.74, B]; furthermore, there was no difference between the two groups in aggravation of aortic regurgitation. Conclusion:Aortic root repair achieves satisfactory medium-term outcomes in ATAAD with more than one aortic sinus involved, but the long-term outcomes need to be evaluated.
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Objective:To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.Methods:From January 2005 to December 2018, a total of 12 patients with acute Stanford type A aortic dissection were treated in Zhongshan Hospital affiliated to Fudan University. Two patients died of sudden aortic dissection rupture during emergency CTA examination. The other 10 patients underwent surgical treatment, the age was 22-40 years[mean(30.7±5.8) years], the pregnancy was 15-39 weeks[mean(28.8±6.5) weeks], two cases in the second trimester of pregnancy, seven cases in the third trimester of pregnancy and one case in puerperium. Among them, seven cases were Marfan syndrome, one case was bicuspid aortic valve malformation, two cases were complicated with pregnancy hypertension.Results:One case died during perioperative period and died of rupture of abdominal aortic dissection in twelfth day after operation. One fetus was diagnosed as stillborn before operation. Before December 2013, six patients underwent surgeries, the mean cardiopulmonary bypass time was(96.8±16.5)min, aortic occlusion time was(70.8±19.3)min, intensive care unit time was(3.4±2.3) days, ventilator-assisted mechanical ventilation time was(21.6±15.6)h. After January 2014, four patients underwent surgeries, the mean cardiopulmonary bypass time was(202.3±6.4)min, the aortic cross-blocking time was(137.5±10.3)min, circulatory arrest time was(27.3±8.8)min, intensive care unit time was(12.0±5.7) days, and the ventilator-assisted mechanical ventilation time was(40.3±24.4)h. The postoperative complications included tracheotomy in two cases, hemodialysis in one case, poor wound healing in one case. One patient who had been treated with Bentall was followed up to sixth year and died of progressive rupture of descending arch dissection. One patient was followed up to seventh year after Bentall surgery, redo Bentall and Sun’s procedure were performed because of artificial valve infection, and was discharged uneventful. No adverse cardiovascular events occurred in other patients.Conclusion:Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety and effect of operation.
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Objective:To investigate the effectiveness and safety of transcatheter closure of atrial septum defect(ASD) in adults using echocardiography as the only imaging tool.Methods:From April 2017 to August 2019, 118 patients with congenital atrial septum defect were treated by cardiac surgery in Zhongshan Hospital affiliated to Fudan University. There were 31 males and 87 females, aged 15-72 years old[mean(40.3±15.3) years old]. 117 cases of atrial septum defect were secondary foramen and 1 case was residual shunt after repair of atrial septum defect by transthoracic echocardiography. The patients with tricuspid insufficiency and pulmonary hypertension were followed up by transesophageal echocardiography.Results:The transcatheter closure of atrial septum defect(ASD) was successfully performed in 114 patients. 3 patients were successfully treated with right fourth intercostal small incision atrial defect occlusion due to the coaxial problem of occlusive device and atrial defect. One patient underwent repair of atrial septum defect during the correction of right ventricular injury. The selected size of occluder ranged from 12 mm to 38 mm. One case of ethmoidal orifice was successfully blocked with double occlusive device. There was no occlusive device displacement, no obvious residual shunt, peripheral vascular injury and other complications occurred in successful occlusive patients. 110 patients were directly transferred back to the general ward after extubation. The postoperative hospital stay was(2.3±1.1) days and the total hospitalization time was(4.5±1.7) days. There were 7 patients with tricuspid regurgitation above mild to moderate before operation, and 6 patients with tricuspid regurgitation decreased to mild regurgitation after occlusion. One month after operation, the pulmonary artery pressure of 51 patients with moderate and severe pulmonary hypertension decreased from(50.4±11.4)mmHg to(38.9±12.9) mmHg( P<0.05). The occlusive device was well fixed and no residual shunt was found. Conclusion:Transesophageal echocardiography guided transcatheter closure of atrial septum defect is not only safe and effective in adult cardiac surgery, but also can avoid radiation and contrast agent injury.
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Objective@#To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less.@*Methods@#A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ2 test or Fisher′s exact test, when appropriate.@*Results@#No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity.@*Conclusion@#The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.
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Objective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.Methods From January 2003 to December 2015,clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively.There were 1 312 males (68.9 ％) and 591 females (31.1％) the mean age was (54.2 ± 13.1) years.Early and long-term outcomes were summarized and risk factors for adverse events were assessed.Results There were 35 in-hospital deaths(1.8％) and in-hospital mortality for isolated mitral valve repair was 0.9％ (10/1 163).Perioperative complications included central nerve system complications(0.7％),respiratory failure requiring tracheotomy(1.8％),acute renal injury requiring hemodialysis(1.2％) and reoperation for bleeding(0.7 ％).NYHA function class Ⅲ-Ⅳ (OR =3.65),atrial fibrillation (OR =2.85) and ejection fraction ＜0.6(OR =2.34) were identified as independent risk factors for in-hospital mortality.12 years over follow-up,overall survival,freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85％ 、91％ and 75％,respectively.Age ＞ 60 years(HR =7.43),preoperative stroke(HR =6.51),ejection fraction ＜ 0.6 (HR =3.87),left ventricular end-systolic dimension ＞ 40 mm (HR =3.98) and pulmonary systolic pressure ＞ 50 mmHg (1 mmHg =0.133 kPa) (HR =2.85) were independent predictive factors for late death.Ejection fraction ＜ 0.6 (HR =4.01),left ventricular end-diastolic dimension ＞ 60 mm(HR =1.88),leaflet lesion involving anterior leaflet (HR =2.40) and residue mild regurgitation(HR =4.17) were independent predictors for late recurrent regurgitation.Leaflet lesion involving anterior leaflet(HR =2.40) and residue mild regurgitation (HR =3.35) were independent predictor for late reoperation for mitral valve.Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation.Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes.Early surgical intervention should be restricted in experienced high-volume centers.
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Objective The aim of the study was to compare the early and mid-term outcomes of isolate mitral valve repair through minimal invasive and median sternotomy approach .Methods From July 2009 to December 2015, 329 patients under-went minimal invasive isolated mitral valve repair through right thoracic approach at our institution .The mean age was(48 ±14) years(15-78 years), 202 patients(61.4％) were male and 137 patients(41.6％) were in NYHA class Ⅲ-Ⅳ.570 patients underwent isolate mitral valve repair through median sternotomy in the same period .Propensity score matching identify 248 pa-tient pairs with similar preoperative characteristics .Early and mid-term outcomes were compared between propensity-matched groups.Results After propensity matching, the mean cardiopulmonary bypass time[(91 ±27)min vs.(76 ±27)min, P<0.05] and aorta cross clamp time[(52 ±18)min vs.(43 ±15)min, P<0.05] were significantly longer in minimal invasive group.24 hours drainage volume was significantly less[(353 ±329)ml vs.(446 ±356)ml, P <0.05] and patients need transfusion was significantly fewer(22.2％ vs 31.5％, P<0.05) in minimal invasive group.Incidence of stroke, poor wound healing, renal failure requiring hemodialysis and tracheotomy were similar between the two groups(P>0.05).There were two in-hospital death in minimal invasive group(respiratory failure) and median sternotomy group(low cardiac output syndrome), respectively.Follow-up was 91％ complete and the mean follow-up time was(28 ±21) months(3-89 months).At 7 year after surgery, overall survival were 99％and 100％(P>0.05) in minimal invasive group and median sternotomy group, respective-ly.Freedom from reoperation were 100％ and 95％(P>0.05) and freedom from recurrent mitral regurgitation were 95％ and 90％(P>0.05).Conclusion Minimal invasive mitral valve repair was safe, effective and provide equivalent mid-term out-comes compared to median sternotomy approach .Minimal invasive surgery provided cosmetic benefits , decreased postoperative trauma.As the accumulation of clinical experience, complex repair is feasible through minimal invasive surgery.Adoption of minimal invasive surgery will increase the acceptance of early intervention strategy among asymptomatic MR patients and thus improve late outcomes and life quality .
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Objective To investigate the expression of human epidermal growth factor receptor 2 (HER2)and its relationship with prognosis in breast cancer patients.Methods One hundred and ninety-eight patients with breast cancer treated with breast surgery in Jizhong Energy Fengfeng Group Hospital from January 2007 to October 2011 were selected as the research objects.The expression of HER2 in 198 cases of breast cancer and 108 cases of breast adenoma at the same time were compared.The 5 year disease-free survival and overall survival rate of breast cancer patients with HER2 positive and negative expression were analyzed and compared.Cox regression analysis was used to analyze the prognosis.Results The positive expression of HER2 in breast cancer tissues was showed in 93 cases,the negative expression was observed in 105 cases,the positive rate was 47.0%(93/198); the positive rate in the breast adenoma group was 0(0/108).The difference between the two groups in the positive rate was statistically significant(P=0.000).The 5 year disease-free survival rate and overall survival rate of the breast cancer patients in the HER2 positive group was 80.8% and 82.9%,respectively.The 5 year disease-free survival rate and overall survival rate was 94.6% and 97.2% in the HER2 negative group,respectively.The differences between the two groups was statistically significant(P=0.046,0.045).The tumor diameter,clinical stage,lymph node metastasis and HER2 positive expression were the independent risk factors for disease-free survival rate and overall survival rate of breast cancer patients(RR=1.59,1.51,5.45,1.72,95%CI=1.00 ~ 2.50,1.10 ~ 17.03,2.00 ~ 5.39,1.10~1.68,P<0.05).The tumor diameter,clinical stage,lymph node metastasis and HER2 positive expression were the independent risk factors for overall survival rate of breast cancer patients(RR=1.70,1.630,4.29,2.08,95%CI=1.02~2.80, 1.12~15.87,2.40~7.59,1.28~3.42,P<0.05).Conclusion Overexpression of HER2 in breast cancer can promote the occurrence,development and metastasis of breast cancer and that is an independent risk factor to predict the prognosis of breast cancer patients.
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Objective To investigate the expression and clinical significance of Survivin and human epidermal growth factor receptor-2 in breast cancer tissue.Methods Eighty-seven cases of patients with breast cancer treated in Jizhong Energy Fengfeng Group Hospital from October 2010 to December 2016 were analyzed.All of them were diagnosed as invasive ductal carcinoma of breast by pathological diagnosis.Normal tissue adjacent to the tumor(more than 5 cm)was collected as the control group.The expression of Survivin and human epidermal growth factor receptor -2 in breast lesions was detected by immunohistochemical SP method.The correlation between Survivin and human epidermal growth factor receptor -2 was analyzed through the comparison of their expression of different clinical pathological features in breast cancer patients.Results The positive rate of Survivin in the breast cancer group was 69.0%(60/87),and 4.6%(4/87)in the control group.The difference between the two groups was statistically significant(P=0.000).The positive rate of human epidermal growth factor receptor -2 in cancer tissues was 46%(40/87)in the breast cancer group,and 0(0/87)in the control group.The difference between the two groups was statistically significant(P=0.000).The expression of survivin was not related to the age,tumor diameter and histological grade of breast cancer patients, but was related to lymph node metastasis(P<0.05).The expression of human epidermal growth factor receptor-2 was not related to the age,tumor diameter of breast cancer patients,but was related to tissue grading and lymph node metastasis(P<0.05).Spearman correlation analysis showed that human epidermal growth factor receptor-2 was positively correlated with survivin(r=0.412,P<0.05).Conclusion Survivin and human epidermal growth factor receptor-2 are associated with the development and progression of breast cancer,both of which play a coordinating role in the development and progression of breast cancer.They play an important role in the process of tumor invasion and metastasis.
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Objective To investigate the expression and clinical significance of Survivin and human epidermal growth factor receptor-2 in breast cancer tissue.Methods Eighty-seven cases of patients with breast cancer treated in Jizhong Energy Fengfeng Group Hospital from October 2010 to December 2016 were analyzed.All of them were diagnosed as invasive ductal carcinoma of breast by pathological diagnosis.Normal tissue adjacent to the tumor(more than 5 cm)was collected as the control group.The expression of Survivin and human epidermal growth factor receptor -2 in breast lesions was detected by immunohistochemical SP method.The correlation between Survivin and human epidermal growth factor receptor -2 was analyzed through the comparison of their expression of different clinical pathological features in breast cancer patients.Results The positive rate of Survivin in the breast cancer group was 69.0%(60/87),and 4.6%(4/87)in the control group.The difference between the two groups was statistically significant(P=0.000).The positive rate of human epidermal growth factor receptor -2 in cancer tissues was 46%(40/87)in the breast cancer group,and 0(0/87)in the control group.The difference between the two groups was statistically significant(P=0.000).The expression of survivin was not related to the age,tumor diameter and histological grade of breast cancer patients, but was related to lymph node metastasis(P<0.05).The expression of human epidermal growth factor receptor-2 was not related to the age,tumor diameter of breast cancer patients,but was related to tissue grading and lymph node metastasis(P<0.05).Spearman correlation analysis showed that human epidermal growth factor receptor-2 was positively correlated with survivin(r=0.412,P<0.05).Conclusion Survivin and human epidermal growth factor receptor-2 are associated with the development and progression of breast cancer,both of which play a coordinating role in the development and progression of breast cancer.They play an important role in the process of tumor invasion and metastasis.
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Objective The aim of the study was to compare the mid-and long-term results between mitral valve repair and mitral valve replacement in mitral regurgitation due to infective endocarditis.Methods From January 2005 to December 2014, 225 patients with mitral regurgitation due to infective endocarditis underwent surgical treatment at our institution.159 patients(70.7%) were male, and the mean age was(42±15) years(13-76 years).Among them, mitral valve repair was performed in 89 patients(repair group) and mitral valve replacement in 136 patients(replacement group).Preoperative clinical profiles, perioperative details and follow-up data were reviewed retrospectively.Results There was no operative death in both groups.Compared to replacement group, patients undergoing mitral valve repair suffered significantly less embolism events(9.0% vs.22.8%, P0.05] and aorta clamp time[(52±21) min vs.(51±23) min, P>0.05]were similar between repair group and replacement group.Intensive care stay was significantly shorter in repair group[(1.4±0.7)days vs.(1.9±1.3)days, P0.05).Conclusion Mitral valve repair was safe and feasible in mitral regurgitation due to infective endocarditis, with good mid-and long-term outcomes.Thorough excision of infective tissue and vegetation was necessary to perform mitral valve repair.Yet mitral valve replacement was a viable option in patients for whom repair was infeasible due to severe damage of valve.
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Objective To observe the efficacy of using a semiconductor laser combined with short-wave ultraviolet rays(UV)to treat patients with herpes zoster. Methods Forty-two patients with herpes zoster in the Department of Dermatology of our hospital were randomly divided into two groups,with 21 patients per group. Patients in the control group were treated with conventional dermatology drugs and short-wave UV,whereas patients in the observation group were treated with conventional dermatology drugs and a semiconductor laser combined with short-wave UV. Re-sults After treatment for 7 days,the efficacy rate in the control group was 80.95%,whereas that in the observation group was 95.24%. The analge-sia time,scab time,and scab removal time were significantly shorter in the observation group than in the control group(P<0.05). The results of the pain assessment(visual analog scale )showed that the score of the observation group after treatment was significantly lower than that of the con-trol group(P<0.05). Conclusion Therapy involving a semiconductor laser combined with short-wave UV for patients with herpes zoster can be more effective than therapy with only a short-wave UV laser in promoting herpes healing,relieving neuralgia,and improving quality of life.
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Objective To study the effects of chronic exposure to inorganic arsenic (iAs) in drinking water on bone mineral density (BMD) in mice and its underlying mechanisms.Methods Five-month-old female C57BL/6 mice were randomly divided into sham groups and ovarectomy (OVX) groups (n =19 mice each group),which were further randomly assigned into control group (distilled water) and iAs exposure groups [5 mg/L and 20 mg/L,inorganic arsenite (iAsⅢ):inorganic arsenate (iAsv) =1 ∶ 1].Following 3 months of exposure to iAs,BMD of the mice were determined by the dual energy X-ray detector.RAW 264.7 cell line and bone marrow hematopoietic stem cells (BMHSC) primarily isolated from C57BL/6 mice were used to study the in vitro effects of iAs on osteoclast differentiation and underlying mechanisms.During differentiation induced by receptor activator of nuclear factor-κ B ligand (RANKL,50 μg/L) and macrophage colony-stimulating factor (M-CSF,30 μg/L),RAW 264.7 cell line were treated with 0.00,0.25,0.50,0.75,1.00,1.50 μmol/L iAsⅢ,while BMHSC with 0.0,0.2,0.4,0.6,0.8,1.0 μmol/L iAsⅢ for 6 days.Based on the effect of iAsⅢ on the differentiation of RAW cells,RAW 264.7 cell line were treated by 0.6 μmol/L iAsⅢ combined with 0,5,10 mmol/L of N-acetyl-cysteine (NAC).Tartrate resistant acid phosphatase (TRAP)-positive red-colored cells with 3 or more nuclei were considered mature osteoclast.Results The femoral BMD of the mice [(80.04 ± 4.06) mg/cm2] that had been exposed to 20 mg/L of iAs for 3 months was substantially decreased compared to that of sham control mice [(84.44 ± 4.40) mg/cm2].As expected,the BMD of the OVX group [(76.36 ± 3.36) mg/cm2] was significant decreased compared to that of the sham control group (P ＜ 0.05).However,the BMD among the OVX groups showed no significant difference [5 mg/L:(77.74 ± 4.91) mg/cm2;20 mg/L:(75.56 ± 3.71) mg/cm2,P ＞ 0.05].In vitro studies,the iAsⅢ evidently affected the osteoclast differentiation in a concentration-dependent fashion.Low concentrations of iAs Ⅲ exposure significantly augmented osteoclast differentiation in the two cell models while high concentrations showed inhibitory effect.In RAW 264.7 cells,the number of osteoclasts in different groups was significantly different (F =1 522,P ＜ 0.05),in the 0.50 μmol/L iAs Ⅲ group the number of osteoclasts reached the peak.In the BMHSC,the nmnber of osteoclasts in different groups was also significantly different (F =1 781,P ＜ 0.05),in the 0.6 μmol/L iAsⅢ group the number of osteoclasts reached the peak.NAC pretreatment significantly abolished low-level iAsⅢ(0.6 μmol/L)-induced augmentation of osteoclast differentiation in a concentration-dependent fashion (0 mmol/L:109.33 ± 3.06;5 mmol/L:56.00 ± 2.65;10 mmol/L:22.67 ± 0.58,F =1 940,P ＜ 0.05).Conclusions The inhibitory effect of iAs on bone metabolism is dependent on the availability of ovary function,suggesting that iAs may interfere with estrogen metabolism and/or function to disturb bone metabolism.Oxidative stress induced by iAs exposure stimulates osteoclast differentiation,and the increased osteoclast differentiation may be involved in the reduction of BMD caused by chronic iAs exposure.These preliminary findings suggest that antioxidant intervention may be an effective approach to prevent osteoporosis induced by chronic iAs exposure.
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Objective:To observe therapeutic effect of aerobic exercise on blood pressure and vasoactive mediators in patients with isolated diastolic hypertension (IDH).Methods:A total of 93 recently diagnosed IDH patients were se- lected and randomly divided into exercise intervention group (n=47,received aerobic exercise,twice/d,50~80 min/time for six months)and control group (n=46,didn't receive aerobic exercise).Office blood pressure (OBP), ambulatory blood pressure monitoring (ABPM)and levels of vasoactive mediators were measured and compared be- tween two groups before and six months after intervention.Results:There were no significant difference in levels of OBP,ABPM indexes and related vasoactive mediators between two groups before intervention (P>0.05 all).Com- pared with before intervention,after six-month intervention,there were significant reductions in levels of office di-astolic blood pressure (ODBP),mean DBP (mDBP),daytime DBP (dDBP)and nighttime DBP (nDBP)in both groups (P<0.05 or <0.01);compared with control group,there were significant reductions in levels of ODBP [(89.23±14.70)mmHg vs.(79.26±13.18)mmHg],mDBP [(86.51±14.30)mmHg vs.(77.20±12.45)mm- Hg],dDBP [(87.93±12.16)mmHg vs.(78.02±11.27)mmHg]and nDBP [(83.18±12.57)mmHg vs.(74.22 ±11.36)mmHg]in exercise intervention group,P<0.05 all.Compared with control group,after six-month inter- vention,there were significant rise in levels of adrenomedulin (AM)[(36.75±5.13)ng/L vs.(47.59±6.82)ng/L]and prostaglandinI2 (PGI2)[(89.55±16.31)ng/L vs.(99.24±18.20)ng/L],and significant reductions in levels of angiotensin Ⅱ (AngⅡ)[(98.30± 15.65)ng/L vs.(91.28±17.40)ng/L]and thromboxane A2 (TXA2 )[(93.61±15.27)ng/L vs.(80.24±12.31)ng/L]in exercise intervention group,P<0.05 all.Conclusion:Aer- obic exercise can significantly lower blood pressure and correct vasoactive mediator level disorder in IDH patients.
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Objective To investigate the role of nuclear factor(erythroid?derived 2)?like 2(Nrf2)in load?driven bone metabolism in Nrf2 knock?out(KO)mice. Methods The hybridized mice in the same brood were selected through PCR detection and were divided into two groups,i.e.,the Nrf2 knockout(KO)group and the wild?type(WT)group. Ulna of mice was loaded with 4 000 peak microstrains at 2 Hz for 3 consecutive days (120 cycles/day)as scheduled,the relative mineralizing surface(rMS/BS)and the relative bone formation rate(rBFR/BS)of ulna were measured for the two groups. Results Load?induced bone formation was suppressed in KO mice. Compared to the WT control,the relative bone formation rate was roughly 84%lower in KO mice(P<0.01). Conclusion The loss?of?function mutation of Nrf2 in bone diminishes load?driven bone formation.
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Objective To evaluate the safety and efficacy of the valve sparing aortic reimplantation in selected patients with acute type A aortic dissection(AAAD).Methods From October 2012 to March 2014, 65 AAAD patients with entry tear located in the sinus of Valsalva and/or genetic: syndrome underwent emergent operation.Of them, 34 patients had valve sparing aortic reimplantation(David Ⅰ group) , and 31 patients underwent aortic composite replacement(Bentall group).Results No operative mortality was observed in this study.In-hospital mortality(8.8％ vs.9.7％ , P ＞ 0.05) and morbidity (25.4％ vs.27.9％, P ＞0.05) were comparable between two groups.All the patients underwent arch replacement and stented elephant trunk implantation concomitantly.Mean cross-clamp time [(149 ± 23) min v s.(124 ± 21) min, P ＜ 0.05] was longer for David Ⅰ group, while mean cardiopulmonary bypass time[(186 ± 77) min vs.(193 ± 89) min, P ＞0.05] and mean operation time [(341 ± 137) min vs.(378 ± 174) min, P ＞ 0.05] had no significant difference between two groups.The blood transfusion was significantly reduced in David Ⅰ group than that in Bentall group[(1 180 ±490) ml vs.(1 790 ±560) ml, P ＜0.05].The mean follow-up was(17.6 ± 5.4) months(range, 8-26 months).In David Ⅰ group, one patient with genetic syndrome died of ruptured abdominal aortic aneurysm 18 months postoperatively.Two late deaths occurred in Bentall group due to intracranial hemorrhage after 9 months and ruptured infective pseudoaneurysm after 13 months respectively.In David Ⅰ group, average grade of aortic regurgitation 6 months postoperatively was 0.6 ± 0.4.At the latest visit, no pseudoaneurysm on anastomosis was observed.Besides two patients from Bentall group were in NYHA class Ⅱ , all the other patients presented in NYHA class Ⅰ.Conclusion David Ⅰ aortic root reimplantation can be performed safely and obtain excellent short-term results in selected patients with AAAD.Long-term results need continuing follow-up.
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Vascular dementia is one of the common causes of cognitive impairment.Occlusion of bilateral common carotid arteries, middle cerebral artery occlusion, as well as induced hypertension are major methods to make rat model for vascular dementia.The present review will summarize research progress in medical and non-medical treatment of vascular dementia rat models in order to provide theoretical direction for clinical practice.
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Objective Functional mitral regurgitation (FMR) refers to the systolic regurgitation of mitral valve secondary to compromised cardiac function or geometry abnormity with non-organic change of leaflets and ancillary parts of the valve.Severe aortic insufficiency (AI) with left ventricular dilation and dysfunction is clinically a complex heart disease and its postoperative complications and mortality are higher than usual valvular surgery.And such patients are often accompanied by FMR.It is generally acknowledged that FMR may improve after aortic valve replacement(AVR).This study follow up AI patients with left ventricular dilation and dysfunction and preoperative 2 + ＜ FMR≤3 + to evaluate the outcome of FMR after AVR.Preoperative clinical data is assessed by regression analysis.Methods From January 2000 to April 2011 our hospital treated 74 cases of patients with severe aortic regurgitation combined with left ventricular dilation (LVEDds ≥70 mm) and dysfunction (left ventricle ejection fraction,LVEF≤0.35) accompanied by 2 + ＜ FMR≤3 +.Postoperative follow-up was performed.Results The perioperative mortality rate was 8.1％.Average follow-up time was (14.9 ± 7.7) months and follow-up rate of 83.6％.5 patients died during follow-up.6 months after surgery,the average of FMR was (2.64 ± 1.17) (+),compared with preoperative data.LVEDd,LAD,CPMA,all P ＞ 0.05 compared with the preoperative data.LVEF,PAH,both P ＜ 0.05 compared with preoperative data.3.Multiple regression analysis:FMR pre/FMR post ratio is not correlated with age,gender,weight,LVEDd ≥ 75 mm,LVEF≤0.30,hypertension,ventricular arrhythmia and FMR postoperative improvement.However,PAH ≥ 50 mm Hg(1 mm Hg =0.133 kPa),LAD ≥ 50 mm,PAH≥50 mm Hg,CPMA ≥ 15mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Conclusion Severe AI with left ventricular dilation and dysfunction is a critical clinical heart disease and its postoperative complications and mortality are high.PAH ≥ 50 mm Hg,LAD ≥ 50 mm,PAH ≥ 50 nun Hg,CPMA ≥ 15mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Since patients with 2 + ＜ FMR ≤3 + usually do not improve or even worsen after AVR,those who have these above conditions preoperatively,should be treated on FMR during AVR.
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Objective Functional mitral regurgitation (FMR) refers to the systolic regurgitation of mitral valve secondary to compromised cardiac function or geometry abnormity with non-organic change of leaflets and ancillary parts of the valve.Severe aortic insufficiency (AI) with left ventricular dilation and dysfunction is clinically a complex heart disease and its postoperative complications and mortality are higher than usual valvular surgery.And such patients are often accompanied by FMR.It is generally acknowledged that FMR may improve after aortic valve replacement (AVR).This study follow up AI patients with left ventricular dilation and dysfunction and preoperative 2 + ＜ FMR ≤3 + to evaluate the outcome of FMR after AVR.Preoperative clinical data is assessed by regression analysis.Methods From January 2000 to April 2011,74 cases of patients were treated,who with severe aortic regurgitation combined with left ventricular dilation (left ventricle,LVEDD ≥ 70 mm) and dysfunction (left ventricle ejection fraction,LVEF ≤ 0.35) accompanied by 2 + ＜ FMR ≤3 +.Postoperative follow-up was performed.Calculation FMR preoperative/FMR postoperative ratio,the age,sex,weight,high blood pressure,ventricular arrhythmia,atrium fibrillation,LVEDD,LVEF,left atrium diameter(LAD),pulmonary artery pressure (PAH),mitral leaflet coaptation point and the mitral annular(CPMA).All factors for logistic multiple faotors regression analysis.Results The perioperative mortality rate was 8.1％.Average follow-up time was (14.9 ± 7.7) months and follow-up rate of 83.6％.5 patients died during follow-up.6 months after surgery,the average of FMR was 2.64 ± 1.17 (+),P ＞0.05 compared with preoperative data.LVEDD,LAD,CPMA,P ＞0.05 compared with the preoperative data.LVEF,PAH,both P ＜0.05 compared with preoperative data.3.Multiple regression analysis:FMR preoperative/FMR postoperative ratio is not correlated with age,gender,weight,LVEDD ≥75 mm,LVEF≤0.30,hypertension,ventricular arrhythmia and FMR postoperative improvement.However,PAH ≥50 mm Hg,LAD ≥50 mm,PAH ≥50 mm Hg,CPMA ≥ 15 mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Conclusion Severe AI with left ventricular dilation and dysfunction is a critical clinical heart disease and its postoperative complications and mortality were high.PAH ≥50 mm Hg,LAD ≥50 mm,PAH ≥50 mm Hg,CPMA ≥15 mm,preoperative atrial fibrillation was negatively correlated with FMR postoperative improvement.Since patients with 2 + ＜ FMR≤3 + usually do not improve or even worsen after AVR,those who have these above conditions preoperatively,should be treated on FMR during AVR.
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Objective Analysis the clinical data of high-EuroSCORE 114 patients due to ronary surgery to elucidatethe surgical advantages between on-pump and off-pump CABG.Methods From September 2008 to March 2011,114 highEuroSCORE patients due to coronary surgery were randomly divided into off-pump group 48,and on-pump gronp 66 cases.Preoperative,intra-operative and peri-operative clinical data of all the patients were collected.All patients were followed up for 1 month postoperatively.Results The baseline of the two groups had no significant difference.Application of internal mammary artery,positive inotropic drugs and IABP assistance between the two groups were similar,P ＞0.05,Compared with the offpump group,patients in on-pump gnup had longer operation time,hut more graft counts and a higher rate of revascularization [ (3.71±0.55)gnifis vs.(2.82±0.39)grafts ],P ＜ 0.05.There were no significant differences of peri-operative mortality and post-operative complications between the two groups,P ＞0.05.The patients in on-pump group had more post-operative chest drainage in the first 24 hours[ (875.0±134.2)ml vs.(589.4±102.5)ml] and blood transfusion[ (656.3±84.4)ml vs.(433.3±62.9) ml ] compared with the off-pump group,P ＜ 0.05.The data of l-month follow up denonstrated that echocardiographic data,NYHA and symptoms of angina of the two groups had no significant difference,P ＞ 0.05.Conclusion Compared with OPCAB,CCAB did not increase postoperative renal failure,neurological complications and lung injury in highrisk patients,but had more complete revascularization.The disadvantage of CCAB was postoperative bleeding,blood productsuse.
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Objective To study the interaction between ?_1-antichymotrypsin (ACT) and amyloid peptide A?_~1-42 in vitro, and the effects of their complex on expression of transcription factors PPAR? and NF?B in human neuroblastoma (Kelly) cells. Methods A?_~1-42 and ACT were mixed at a 10∶1 molar ratio at room temperature, the complex formed in 2 hours and 24 hours were expressed as A?_~1-42 /ACT (2 hours), A?_~1-42 /ACT (24 hours), respectively. The complexes were studied by using agrose electrophoresis, and their effects on PPAR? and NF?B expressions were assessed by electrophoresis mobility shift assay (EMSA). Results At conditions used, ACT interacted with A?_~1-42 in vitro, the complexes formed and functioned differently according to their interaction period. Compared with unstimulated control cells, A?_~1-42 /ACT (2 hours) strongly increased PPAR? and NF?B expressions by Kelly cells by 158% (P