Membrane fixation enhances guided bone regeneration in standardized calvarial defects: A pre-clinical study.

AIM: To determine whether collagen membrane (CM) fixation enhances guided bone regeneration in standardized defects. MATERIALS AND METHODS: Four 8-mm-diameter defects were surgically made in eight rabbit calvaria, and randomly allocated into four groups: control (empty), unfixed-CM, fixed-CM, and unfixed-CM with bone graft (BG + CM) (positive control). After 1- and 4-week healing periods, the animals were sacrificed and quantitative reverse transcription polymerase chain reaction, micro-computed tomography, and histological outcomes were assessed. RESULTS: At week 1, the expression levels of BMP-2, FGF-2, VEGF, and osteocalcin were significantly higher in the fixed-CM group than in the unfixed-CM and control groups (p < .05). Conversely, cathepsin-K was significantly expressed in the unfixed-CM group. No significant differences in expression markers were observed between the fixed-CM and BG + CM groups (p > .05). At week 4, new bone formation was significantly higher in the fixed-CM group than the unfixed-CM and control groups (p < .05), but similar to the BG + CM group (p > .05). CONCLUSIONS: CM fixation enhances the expression of osteogenic factors similar to BG + CM, leading to significantly more new bone formation. This suggests that the osteogenic potential is greater when membranes are fixed, thereby limiting the necessity of membrane-supporting materials to enhance bone formation.

A Study of the Efficacy and Safety of Aerobic Exercise Training in Pulmonary Arterial Hypertension (the Saturday Study): Protocol for a Prospective, Randomized, and Controlled Trial.

Background: Patients with pulmonary arterial hypertension (PAH) have reduced exercise capacity and poor quality of life. Exercise-based rehabilitation in PAH results in clinically relevant improvements in exercise capacity and hemodynamics. To clarify the mechanism, we will evaluate the effect of aerobic exercise training rehabilitation on right ventricular (RV) remodeling and function as determined measured by cardiac magnetic resonance imaging (CMR). Methods: We will conduct a 26-week multicenter randomized controlled trial. Patients on stable and unchanged PAH-targeted medication are randomly assigned (1:1) to the control and training groups. The primary endpoint is the RV stroke volume (RVSV) change from baseline to Week 26, determined by CMR. Comprehensive RV function is also performed using CMR. Other characteristics of the RV and left ventricle, World Health Organization functional class, 6-min walk distance, and N-terminal pro-B-type natriuretic peptide are included in secondary endpoints. We also investigate the proteomic, metabolomic, and transcriptomic changes after exercise training as exploratory endpoints. Ethics and Dissemination: The study and protocol were approved by the Ethics Committee of Shanghai Pulmonary Hospital (Approved No. of ethics committee: L20-17). The results will be disseminated at medical conferences and in journal publications. All participants will sign written informed consent. Trial Registration Number: ChiCTR2000031650.

[Effects of aerobic exercise on exercise tolerance in patients with chronic heart failure].

OBJECTIVE: To explore the effects of aerobic exercise on exercise tolerance in patients with chronic heart failure (CHF). METHODS: A total of 50 CHF patients with left ventricular ejection fraction (LVEF) < 49% by echocardiography were enrolled. And they were randomly divided into exercise group (n = 25) and non-exercise group (n = 25). Cardiopulmonary exercise testing (CPET) was performed. The patients of exercise group underwent an aerobic exercise program in which exercise intensity was decided by anaerobic threshold (AT) before 10 J/s while those of non-exercise group performed daily activities. After 6 sessions of supervised aerobic exercise, the home-based aerobic exercise training began. CPET was re-examined 3 months later. RESULTS: The VO(2) AT, VO(2) peak, Load AT, Load peak, peak VO(2)/HR and VE/VCO(2) slope at baseline were similar between exercise group and non-exercise group (P > 0.05). The VO(2) AT, VO(2) peak, Load AT, Load peak and peak VO(2)/HR in patients of exercise group were increased compared with baseline, The differences between baseline and 3 months later expressed as ΔVO(2) AT, ΔVO(2) peak, ΔLoad AT, ΔLoad peak, Δpeak VO(2)/HR and ΔVE/VCO(2) slope, The differences of ΔVO(2) AT, ΔVO(2) peak, ΔLoad AT, ΔLoad peak and Δpeak VO(2)/HR between two groups were statistically significant [ΔVO(2) AT: 2.8 (1.2 - 3.5) ml×kg(-1)×min(-1) vs -0.3 (-2.8 - 0.1) ml×kg(-1)×min(-1), P < 0.01; ΔVO(2) peak: 3.4 (1.8 - 4.6) ml×kg(-1)×min(-1) vs -0.5 (-1.4 - 0.3) ml×kg(-1)×min(-1), P < 0.01; ΔLoad AT:15.0 (2.5 - 22.5) J/s vs 0.5(-4.2 - 3.8) J/s, P < 0.01; ΔLoad peak: 15.0 (1.3 - 25.0) J/s vs 0.0 (-8.8 - 15.0) J/s, P < 0.05; Δpeak VO(2)/HR: 2.3 (0.0 - 4.0) ml×kg(-1)×beat(-1) vs -0.1 (-0.7 - 1.2) ml×kg(-1)×beat(-1), P < 0.01]. The difference of ΔVE/VCO(2) slope was not statistically significant [-2.3 (-12.2 - 1.8) vs 1.0 (-0.4 - 2.6), P > 0.05]. CONCLUSION: After 3 months of aerobic exercise, exercise capacity may improve in the CHF patients.

[The effects of aerobic exercise on cardiac output during exercise in patients with chronic heart failure].

OBJECTIVE: To observe the effects of aerobic exercise on cardiac output during exercise in patients with chronic heart failure (CHF). METHODS: A total of 50 CHF patients (echocardiography measured left ventricular ejection fraction < 0.49) were enrolled in the study and randomly divided into aerobic exercise group (n = 25) and control group (n = 25). Cardiopulmonary exercise testing (CPET) was performed. Patients of aerobic exercise group underwent aerobic exercise according to aerobic exercise prescription and exercise intensity is decided by anaerobic threshold before 10 J/s (1 minute before) of the oxygen consumption. After 6 supervised aerobic exercise training sessions in the hospital, patients were asked to perform the home-based aerobic exercise training. Patients in control group were required to maintain daily physical activities. CPET were reviewed 3 months later. RESULTS: Cardiac output (CO), peak CO, peak cardiac power output (peak CPO), resting heart rate (HR), heart rate at AT (HRAT), HR peak, resting mean arterial pressure (MAP), peak MAP at baseline were similar between aerobic exercise group and control [(4.2 ± 2.0) L/min vs. (3.3 ± 1.0) L/min, (6.2 ± 2.7) L/min vs. (5.2 ± 1.8) L/min, (1.8 ± 2.9) L/min vs. (2.0 ± 1.8) L/min, (1.3 ± 0.5) J/s vs. (1.2 ± 0.5) J/s, (76.8 ± 13.5) beats/min vs. (73.4 ± 11.9) beats/min, (91.5 ± 11.3) beats/min vs. (92.6 ± 12.4) beats/min, (106.0 ± 12.9) beats/min vs. (108.3 ± 17.4) beats/min, (80.8 ± 9.9) mm Hg (1 mm Hg = 0.133 kPa) vs. (87.6 ± 13.3) mm Hg, (98.8 ± 12.4) mm Hg vs. (102.7 ± 13.9) mm Hg, all P > 0.05]. Compared to baseline, CO, peak CO, peak CPO, HR, HRAT, HR peak, MAP, peak MAP after 3 months were similar between aerobic exercise group and control (all P > 0.05). The differences between baseline and 3 months later expressed as ΔCO, Δpeak CO, Δpeak CPO, ΔHR, ΔHRAT, ΔHR peak, ΔMAP, Δpeak MAP were also similar between aerobic exercise group and control group [(-0.7 ± 2.4) L/min vs. (0.7 ± 2.0) L/min, (1.1 ± 2.6) L/min vs. (1.4 ± 2.1) L/min, (0.1 ± 3.7) L/min vs. (-0.2 ± 2.5) L/min, (0.2 ± 1.0) J/s vs. (0.2 ± 0.5) J/s, (-0.4 ± 7.6) beats/min vs. (1.9 ± 9.9) beats/min, (3.4 ± 11.3) beats/min vs. (-2.8 ± 7.6) beats/min, (8.9 ± 14.5) beats/min vs. (3.7 ± 14.4) beats/min, (1.5 ± 12.8) mm Hg vs. (-1.3 ± 11.1) mm Hg, (6.4 ± 18.9) mm Hg vs. (1.3 ± 12.3) mm Hg, all P > 0.05]. CONCLUSION: Three months aerobic exercise training did not improve cardiac output and related parameters during exercise in this cohort patients with CHF.

[Reduced cardiopulmonary exercise capacity in patients with chronic heart failure: impact of left ventricular systolic dysfunction].

OBJECTIVE: To evaluate the cardiopulmonary exercise capacity in patients with chronic heart failure (CHF). METHODS: Cardiopulmonary exercise testing on bicycle ergometer was performed in 74 age, gender and BMI-matched patients. There were 37 patients with LVEF < 0.45 in CHF group and another 37 patients with LVEF > 0.50 in control group. VO(2)AT, VO(2)Peak, Load AT, Load peak and VE/VCO(2) slope were measured and compared. RESULTS: (1) VO(2)AT, VO(2)Peak, Load AT and Load peak were all significantly reduced in patients with CHF as compared with controls [VO(2)AT: (11.3 +/- 2.3) ml x kg(-1) x min(-1) vs (12.8 +/- 2.5) ml x kg(-1) x min(-1), P < 0.05; VO(2)peak: (15.2 +/- 4.3) ml x kg(-1) x min(-1) vs (17.3 +/- 3.9) ml x kg(-1) x min(-1), P < 0.05; Load AT: (25.2 +/- 18.8) J x s(-1) vs (45.6 +/- 18.7) J x s(-1), P < 0.01; Load peak: (54.9 +/- 22.5) J x s(-1) vs (80.3 +/- 21.6) J x s(-1), P < 0.01]; (2) VE/VCO(2) slope increased in patients with CHF as compared with controls [(36.7 +/- 6.7) vs (30.3 +/- 4.3), P < 0.01]; (3) None of VO(2)AT, VO(2), Peak Load AT, Load peak or VE/VCO(2) slope was correlated with LVEF [(r = 0.054, P > 0.05); (r = 0.03, P > 0.05); (r = 0.310, P > 0.05); (r = 0.174, P > 0.05); (r = -0.203, P > 0.05)]; VO(2)AT, VO(2)Peak, Load AT and Load peak were all correlated negatively with a higher NYHA grade [(r = -0.477, P < 0.01); (r = -0.591, P < 0.01); (r = -0.640, P < 0.01); (r = -0.672, P < 0.01)]; VE/VCO(2) slope correlated positively with a higher NYHA grade (r = 0.652, P < 0.01); None of VO(2)AT, VO(2)Peak, Load AT, Load peak or VE/VCO(2) slope was correlated with LVMI [r = 0.045, P > 0.05); (r = -0.017, P > 0.05); (r = -0.214, P > 0.05); (r = -0.123, P > 0.05); (r = 0.106, P > 0.05)]. CONCLUSION: (1) Cardiopulmonary exercise capacity is reduced in CHF patients. (2) None of VO(2)AT, VO(2)Peak, Load AT, Load peak and VE/VCO(2) slope is correlated with LVEF; VO(2)AT, VO(2)Peak, Load AT and Load peak all correlate negatively with the higher NYHA grade; VE/VCO(2) slope correlates positively with a higher NYHA grade; None of VO(2)AT, VO(2)Peak, Load AT, Load peak or VE/VCO(2) slope correlates with LVMI. An analysis of gas metabolism is a safe, accurate and scientific testing method of exercise tolerance.

[The expression and significance of immunity associated genes mRNA in patients with pulmonary embolism].

OBJECTIVE: To investigate the molecular alteration of immunity associated genes in patients with pulmonary embolism (PE) so as to preliminarily elucidate its pathogenetic mechanism. METHODS: Human cDNA microarray analysis was employed in this study, random variance model (RVM) corrected t-test was used for the statistical data analysis of differential gene expression. RESULTS: In comparison with control, mRNA expression of functional genes of neutrophils, monophagocytes, IFN regulating factors, TNF, adhesion molecules and T cells were significantly different in PE patients. However, gene expressions of B cell immune function and complement activation associated factors were not significantly different between two groups. CONCLUSION: Unbalance expression of immune function associated genes, especially down-regulated expression of T cell mediated function genes, in patients with PE indicates that the etiology of PE might be related to viral infection.

[Expression of COX-1 and COX-2 in the Platelet of Iron Deficiency Anemia Women at Childbearing Age and Its Clinical Significance].

OBJECTIVE: To detect the expression level of cyclooxygenase-1（COX-1） and cyclooxygenase-2（COX-2） in the platelet of iron deficiency anemia（IDA）women at childbearing age and to explore its correlation with the different indexes of anemia and platelets. METHODS: Forty female IDA patients at childbearing age and 35 healthy controls were enrolled in this study. The Flow cytometry was used to detect the expression of platelet COX-1 and COX-2，the platelet aggregation function as examined by turbidimetric method，and the levels of serum ferritin were analyzed by electrochemical luminescence method，the leval of serum iron was determined by ELISA，and the correlation of different indexes was analyzed. RESULTS: Compared with healthy controls，the levels of platelet COX-1 and COX-2 were significantly lower in female IDA patients at Childbearing age（P<0.05），but platelet count（Plt），mean platelet volume（MPV） and platelet aggregation rate（PAgT）were not statistically different between the 2 groups（P > 0.05）. The expression level of platelet COX-1 positively correlated with those of Hb（r =0.623，P<0.01），serum iron（r =0.321，P<0.05） and HCT（r=0.305，P<0.05）. but the platelet COX-2 expression did not corelate with these indexs. CONCLUSION: The expression of platelet COX-1 and COX-2 in female IDA patients at Childbearing age markedly decrease，and the expression level of platelet COX-1 closely relates with the severity of anemia，that possesses reference value for clinical diagnosis of female IDA patients at Childbearing age..

[Determination of lead in water samples by graphite furnace atomic absorption spectrometry after cloud point extraction with dithizone].

Cloud point extraction was used for the preconcentration of lead after the formation of a complex with dithizone in the presence of surfactant Triton X-114, and then the lead was determined by graphite furnace atomic absorption spectrometry. The conditions affecting the separation and detection process were optimized. Separation of the two phases was accomplished by centrifugation for 15 min at 4 000 rpm. Upon cooling in an ice-bath, the surfactant-rich phase became viscous. The aqueous phase could then be separated by inverting the tubes. Later, a solution of methanol containing 0.1 mol x L(-1) of HNO3 was added to the surfactant-rich phase up to 0.5 mL. The samples were determined by graphite furnace atomic absorption spectrometry with NH4H2PO4 and Mg(NO3)2 as a chemical modifier. At pH 8.0, the preconcentration of only 10 mL sample in the presence of 0.05% Triton X-114 and 20 micromol x L(-1) dithizone permitted the detection of 0.089 microg x L(-1) lead. The enhancement factors were 19.1 times for lead. The calibration graph using the preconcentration system for lead was linear with a correlation coefficient of 0.998 from levels near the detection limits up to at least 30 microg x L(-1). The regression equation was A = 0.026 1c (microg x L(-1)) + 0.010 6. The proposed method has been applied to the determination of lead in water samples.

Quantitative evaluation of cardiopulmonary functional reserve in treated patients with pulmonary embolism.

BACKGROUND: There is no research, either at home or abroad, focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE), but the benefits of early exercise are well recognized. The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET), and to compare it with traditional methods. METHODS: CPET on the bicycle ergometer were performed in 40 patients with age, gender, body mass index, systolic blood pressure, and pulmonary function matched. The first group was the PE group composed of 16 PE patients (5 male, 11 female) who were given the standard antithrombotic therapy for two weeks. The second group was composed of 24 normal individuals (10 male, 14 female). Both groups were evaluated by cardiac ultrasound examination, 6-minute walking test (6MWT), and CPET. RESULTS: (1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group, (34.81 ± 8.15) mmHg to (19.75 ± 3.47) mmHg (P < 0.01). But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls. The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects, (447.81 ± 79.20) m vs. (513.75 ± 31.45) m (P < 0.01). Both anaerobic threshold oxygen consumption (VO(2)AT) and peak oxygen consumption (VO(2)peak) were significantly lower in patients with PE, while CO(2) equivalent ventilation (VE/VCO(2) slope) was higher; VO(2)AT (9.44 ± 3.82) ml×kg(-1)×min(-1) vs. (14.62 ± 2.93) ml×kg(-1)×min(-1) (P < 0.01) and VO2peak (12.26 ± 4.06) ml×kg(-1)×min(-1) vs. (23.46 ± 6.15) ml×kg(-1)×min(-1) (P < 0.01) and VE/VCO(2) slope 35.47 ± 6.66 vs. 26.94 ± 3.16 (P < 0.01). There was no significant difference in resting cardiac output (CO) between the PE and normal groups, whereas peak cardiac output (peak CO) and the difference between exercise and resting cardiac output (ΔCO) were both significantly reduced in the PE group; peak CO (5.97 ± 2.25) L/min to (8.50 ± 3.13) L/min (P < 0.01), ΔCO (1.29 ± 1.59) L/min to (3.97 ± 2.02) L/min (P < 0.01). (2) The 6-minute walk distance did not correlated with CPET except for the VO2 peak in patients with PE, r = 0.675 (P < 0.01). CONCLUSIONS: The cardiopulmonary functional reserve was reduced in patients with PE. CPET is an accurate, quantitative evaluation of cardiopulmonary functional reserve for PE patients.

Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure.

BACKGROUND: Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity. METHODS: A total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) < 0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF > 0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities. RESULTS: The study showed that left ventricular end diastolic/systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P < 0.01). The VO(2)AT, Peak VO(2), Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P < 0.05), VE/VCO(2) slope was increased in patients with chronic heart failure (P < 0.01). Multivariate linear regression analysis indicated that the patients' exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P = 0.012), while Load AT correlated positively with LVEDD in control patients (P = 0.006). VE/VCO(2) slope correlated positively with LAD (B = 0.477, P < 0.0001) in chronic heart failure patients, while the VE/VCO(2) slope correlated negatively with LAD in control patients (P = 0.009). CONCLUSION: The study indicates that the size of LVEDD and LAD are important determinants of exercise capacity in patients with CHF, which may be helpful to identify exercise tolerance for routine monitoring of systolic heart failure.