Asprosin contributes to vascular remodeling in hypertensive rats via superoxide signaling.

OBJECTIVE: Proliferation and migration of vascular smooth muscle cells (VSMCs) contribute to vascular remodeling. Asprosin, a newly discovered protein hormone, is involved in metabolic diseases. Little is known about the roles of asprosin in cardiovascular diseases. This study focused on the role and mechanism of asprosin on VSMC proliferation and migration, and vascular remodeling in a rat model of hypertension. METHODS AND RESULTS: VSMCs were obtained from the aortic media of 8-week-old male Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). Asprosin was upregulated in the VSMCs of SHR. For in vitro studies, asprosin promoted VSMC proliferation and migration of WKY and SHR, and increased Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) activity, NOX1/2/4 protein expressions and superoxide production. Knockdown of asprosin inhibited the proliferation, migration, NOX activity, NOX1/2 expressions and superoxide production in the VSMCs of SHR. The roles of asprosin in promoting VSMC proliferation and migration were not affected by hydrogen peroxide scavenger, but attenuated by superoxide scavenger, selective NOX1 or NOX2 inhibitor. Toll-like receptor 4 (TLR4) was upregulated in SHR, TLR4 knockdown inhibited asprosin overexpression-induced proliferation, migration and oxidative stress in VSMCs of WKY and SHR. Asprosin was upregulated in arteries of SHR, and knockdown of asprosin in vivo not only attenuated oxidative stress and vascular remodeling in aorta and mesentery artery, but also caused a subsequent persistent antihypertensive effect in SHR. CONCLUSIONS: Asprosin promotes VSMC proliferation and migration via NOX-mediated superoxide production. Inhibition of endogenous asprosin expression attenuates VSMC proliferation and migration, and vascular remodeling of SHR.

Comparison of Carotid Blood Flow Measured by Ultrasound and Cardiac Output in Patients Undergoing Cardiac Surgery.

BACKGROUND: In general, cerebral blood flow accounts for 10-15% of cardiac output (CO), of which about 75% is delivered through the carotid arteries. Hence, if carotid blood flow (CBF) is constantly proportional to CO with high reproducibility and reliability, it would be of great value to measure CBF as an alternative to CO. The aim of this study was to investigate the direct correlation between CBF and CO. We hypothesized that measurement of CBF could be a good substitute for CO, even under more extreme hemodynamic conditions, for a wider range of critically ill patients. METHODS: Patients aged 65-80 years, undergoing elective cardiac surgery were included in this study. CBF in different cardiac cycles were measured by ultrasound: systolic carotid blood flow (SCF), diastolic carotid blood flow (DCF), and total (systolic and diastolic) carotid blood flow (TCF). CO simultaneously was measured by transesophageal echocardiography. RESULTS: For all patients, the correlation coefficients between SCF and CO, TCF and CO were 0.45 and 0.30, respectively, which were statistically significant, but not between DCF and CO. There was no significant correlation between either SCF, TCF or DCF and CO, when CO was <3.5 L/min. CONCLUSIONS: Systolic carotid blood flow may be used as a better index to replace CO. However, the method of direct measurement of CO is essential when the patient's heart function is poor.

Meplazumab in hospitalized adults with severe COVID-19 (DEFLECT): a multicenter, seamless phase 2/3, randomized, third-party double-blind clinical trial.

Meplazumab, a humanized CD147 antibody, has shown favourable safety and efficacy in our previous clinical studies. In DEFLECT (NCT04586153), 167 patients with severe COVID-19 were enroled and randomized to receive three dosages of meplazumab and a placebo. Meplazumab at 0.12 mg/kg, compared to the placebo group, showed clinical benefits in significantly reducing mortality by 83.6% (2.4% vs. 14.6%, p = 0.0150), increasing the proportion of patients alive and discharged without supplemental oxygen (82.9% vs. 70.7%, p = 0.0337) and increasing the proportion of patients who achieved sustained clinical improvement (41.5% vs. 31.7%). The response rate in the 0.2 mg/kg group was relatively increased by 16.0% compared with the placebo group (53.7% vs. 46.3%). Meplazumab also reduced the viral loads and multiple cytokine levels. Compare with the placebo group, the 0.3 mg/kg significantly increased the virus negative rate by 40.6% (p = 0.0363) and reduced IL-8 level (p = 0.0460); the 0.2 mg/kg increased the negative conversion rate by 36.9%, and reduced IL-4 (p = 0.0365) and IL-8 levels (p = 0.0484). In this study, the adverse events occurred at a comparable rate across the four groups, with no unexpected safety findings observed. In conclusion, meplazumab promoted COVID-19 convalescence and reduced mortality, viral load, and cytokine levels in severe COVID-19 population with good safety profile.

Comparison of the effective orifice area of prosthetic mitral valves using two-dimensional versus three-dimensional transesophageal echocardiography.

OBJECTIVE: This study compared the continuity equation-based effective orifice area (EOA) of prosthetic mitral valves between two-dimensional (2D) and 3D transesophageal echocardiography (TEE). METHODS: Thirty-four patients without major aortic valve abnormalities underwent mitral valve replacement surgery. The EOAs of prosthetic mitral valves were calculated using the continuity equation with 2D and 3D TEE. For 18/34 patients using a biological valve prosthesis, the EOA of the prosthesis was obtained from commercial records. RESULTS: The EOA of prosthetic mitral valves significantly varied between the 2D and 3D methods (2.22 ± 0.71 vs 2.35 ± 0.70 cm2, n = 34). The area of the diameter of the left ventricular outflow tract as determined by the 3D method was significantly higher than that by the 2D method (mean difference: -0.14 ± 0.20 cm2), with 95% coherence boundaries of -0.53 and 0.25 cm2. The regression equation for the EOA by 3D and 2D TEE was y = 0.27 + 0.94x, with a good correlation. CONCLUSIONS: The EOA of prosthetic mitral valves is underestimated using the 2D TEE method compared with the 3D TEE method. The 3D-TEE method has the advantage of higher precision over the 2D TEE method, and it may be helpful for better assessment of prosthetic mitral valves intraoperatively.

[Treatment Effect and Ecological Risk Assessment of Typical Antibiotics in Wastewater from Large-scale Dairy Farms in Tianjin].

To obtain the content level and treatment efficiency of typical antibiotics in wastewater treatment in large-scale dairy farms in Tianjin, the SPE-UPLC-MS/MS (ultra-high performance liquid chromatography tandem triple quadruple mass spectrometry combined with solid-phase extraction for pretreatment) technology was utilized to investigate and monitor seven typical antibiotics in wastewater from 12 large-scale dairy farms in Tianjin. Antibiotic residues were detected in 12 large-scale dairy farms before and after wastewater treatment. In the wastewater before treatment, the detection rates of tilmicosin (TIL), oxytetracycline hydrochloride (OTC), sparfloxacin (SPA), sulfathiazloe (STZ), ofloxacin (OFL), and sarafloxacin hydrochloride (SAR) were all 100%, whereas the detection rate of sulfadiazine (SDZ) was 83.33%. Among them, TIL and OTC were the main antibiotic components in untreated wastewater, the concentrations were 25.21 µg·L-1 and 9.87 µg·L-1, respectively. The detection rates of SDZ and OFL in the treated wastewater dropped to 25.00% and 41.66%, respectively. The main components were TIL and OTC and the concentrations were 11.30 µg·L-1 and 3.71 µg·L-1, respectively. There were significant decreases in the concentrations. The treatment effect on antibiotics from different farms ranged from 24.95% to 81.05%. The comprehensive treatment effect of the anaerobic-anoxic-oxic (AAO) treatment process was better than that of the anoxic-oxic (AO) treatment process. OFL, SAR, and OTC were the main high-risk pollutants in treated wastewater. Each large-scale dairy farm contained one or more antibiotic with RQs>1, and their emissions pose an ecological risk to the environment.

[Efficacy and safety of low-intensity extracorporeal shock wave therapy in the treatment of ED: A meta-analysis of randomized controlled trials].

OBJECTIVE: To evaluate the clinical efficacy and safety of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of ED based on the available clinical evidence. METHODS: We searched PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, VIP, CBM and Wanfang Database up to June 2018 for published randomized controlled trials on the treatment of ED by LI-ESWT. We performed literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria, and conducted a meta-analysis of the data obtained using the RevMan 5.3 software. RESULTS: A total of 595 ED cases in 8 double-blind randomized controlled trials (RCT) were included in this study, 362 in the LI-ESWT and 233 in the control group. Compared with the controls, the patients treated by LI-ESWT showed significantly improved IIEF (WMD = 1.70, 95% CI: 0.44－2.96, P = 0.008) and erection hardness score (EHS) (RR = 11.72, 95% CI: 5.13－26.80, P < 0.01). The IIEF scores of the patients were markedly increased at 4 and 24 weeks after LI-ESWT (WMD = 1.43, 95% CI: 0.10－2.75, P = 0.03; WMD = 3.09, 95% CI: 1.49－4.68, P = 0.0002), as well as after the 10th to 12th treatment (WMD = 1.81, 95% CI: 0.31－3.31, P = 0.02) though not after the 5th to 6th (WMD = 1.88, 95% CI: －2.10 to 5.86, P = 0.35). LI-ESWT also significantly increased the IIEF scores in the patients with the baseline IIEF ≥12 (WMD = 2.13, 95% CI: 0.51－3.75, P = 0.01) but not in those with the baseline IIEF ≤11 (WMD = 1.04, 95% CI: －0.96 to 3.03, P = 0.31). No significant adverse events were reported in the 8 RCTs. CONCLUSIONS: As a non-invasive treatment, LI-ESWT is safe and effective and can significantly improve IIEF and EHS in ED patients.

Synthesis of the ABC Tricyclic System of Daphnicyclidin A.

A substrate-stereocontrolled synthesis of the ABC tricyclic system of daphnicyclidin A is developed. The key reactions include an efficient tandem N-allylation-SN2' reaction to assemble 2,3,4-cis trisubstituent pyrrolidine ring C and two intramolecular Horner-Wadsworth-Emmons reactions to construct cycloheptanone ring A and piperidine ring B.

[Effects of ulinastatin on cognitive function in patients with coronary artery bypass grafting].

OBJECTIVE: To investigate the effects of ulinastatin(UTI) on postoperative cognitive function in patients undergoing coronary artery bypass grafting. METHODS: One hundred and twenty-seven patients undergoing elective coronary artery bypass surgery were randomly divided into three groups:high-dose UTI group(16000 U/kg i.v.), low-dose UTI group(8000 U/kg i.v.) and control group(normal saline). The levels of plasma cortisol were measured before and one day after surgery. The level of IL-6, IL-10, TNF-α and S100ß were measured before operation(T0), at open chest(T1), end of operation(T2), 6 h(T3)and 24 h(T4) after operation. A neuropsychological test scale was to evaluate the cognitive function 1 day before operation, 1 week and 3 months after operation. RESULTS: Ninety-three patients completed the study. There was no significant difference in general information of patients among three groups(P>0.05). The level of plasma cortisol one day after operation was significantly higher than that before operation in control group(P<0.01). The levels of plasma cortisol in high-dose UTI group and low-dose UTI group were lower than that of control group(P<0.01). In all groups, the level of plasma IL-6, IL-10, TNF-α and S100B increased remarkably at T2, T3, T4 compared to those at T0(all P<0.05). The level of plasma IL-6, TNF-α(at T2, T3, T4)and S100ß(at T3)in high-dose UTI group and low-dose UTI group were all lower than those of control group(P<0.05),while there were no significant differences between high-dose UTI group and low-dose UTI group(P>0.05). The incidence of postoperative cognitive dysfunction in POCD 1 week after operation in high-dose UTI and low-dose UTI groups(25.8% and 23.3%)was lower than that in control group(50.0%), while there were no significant difference 1 month after operation between high-dose UTI group(12.9%) or low-dose UTI group(16.7%)and control group(28.1%). The level of plasma S100ß at T2 of POCD patients(n=31)was higher than that of non-POCD group(n=62)(P<0.05). CONCLUSION: Ulinastatin can reduce the incidence of postoperative cognitive dusfunction 1 week after coronary artery bypass surgery, which might be associated with inhibition of inflammation and S100ß expression.

[Qualitative analysis of platelet rich plasma prepared by acute plateletpheresis in patients undergoing heart surgery].

This study was aimed to evaluate the efficiency and effectiveness of platelet-rich plasma(PRP) prepared by acute plateletpheresis in patients undergoing open heart surgery, and to analyze the quality of prepared platelet-rich plasma. Whole blood from 20 patients with ASAII-III was collected and PRP was harvested by machine after induction of anesthesia. Platelet count (Plt), mean platelet volume (MPV), platelet distribution width (PDW), plasma pH, plasma lactic acid (LA) concentration, and lactic dehydrogenase (LDH) concentration, germiculture result, CD62p and PAC-1 positive rate of inactivated and activated platelets by ADP in the whole blood before plateletpheresis (T1) , in the PRP after plateletpheresis (T2) and PRP before back-transfusion (T3) were determinated. The results showed that as compared with whole blood the platelet count in the PRP at T2 was (783 ± 184) ×10(9)/L, MPV, PDW and pH significantly decreased (P < 0.01) , while the plasma LDH, LA concentration, CD62p and PAC-1 positive rate of inactivated platelets were not significantly different from the whole blood at T1. In the PRP at T3, the platelet count, MPV, PDW and pH significantly decreased (P < 0.01) , while plasma LDH concentration, CD62p and PAC-1 positive rate of inactivated platelet significantly increased (P < 0.05 or P < 0.01) compared with the whole blood at T1. There were no significant difference among the CD62p and PAC-1 positive rate of activated platelets in the whole blood and PRP. It is concluded that PRP can be efficiently obtained from the patients undergoing open heart surgery by acute plateletpheresis, and the platelets in PRP are not activated during the preparing process. Some platelets in PRP are activated during the preserving process, but the whole activating function of platelets keeps normal.

Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients. A meta-analysis.

OBJECTIVE: To evaluate the prognostic value of late gadolinium enhancement (LGE) in dilated cardiomyopathy (DCM) patients. METHODS: We searched PubMed, MEDLINE, the Cochrane library and EMBASE databases from September to December 2012 in the Renmin Hospital of Wuhan University, Wuhan, China for studies of LGE in DCM patients. We extracted the clinical outcomes (all-cause mortality, cardiovascular mortality, sudden cardiac death [SCD], aborted SCD, heart failure hospitalization) after carefully reviewed. A meta-analysis was performed to calculate pooled odds ratios (OR) with 95% confidence intervals (CIs) for prognostic outcomes in LGE positive versus LGE negative patients with DCM. RESULTS: Five studies for 545 DCM patients were contained in this meta-analysis. The results showed LGE positive patients was significantly associated with higher cardiovascular mortality (pooled OR: 2.67; 95% CI: 1.12-6.35; p=0.03), aborted SCD (pooled OR: 5.26; 95% CI: 1.57-17.55; p=0.007), and heart failure hospitalization (pooled OR: 3.91; 95% CI: 1.99-7.69; p<0.001). CONCLUSION: Late gadolinium enhancement during cardiac MRI is significantly associated with cardiovascular mortality, aborted SCD and heart failure hospitalization in DCM patients. The LGE can be a potential stratification tool to predict the risk of cardiac events among patients with DCM.

Use of hypophysin in hypotensive patients with low systemic vascular resistance following cardiopulmonary bypass.

OBJECTIVE: This study aimed to test the effects of hypophysin on hemodynamics and coronary artery caliber of patients with hypotension and decreased systemic vascular resistance (SVR) following cardiopulmonary bypass (CPB). METHODS: Twenty-four patients with mean arterial pressure (MAP) < 60 mmHg, mean aorta pressure < 70 mmHg, SVR < 800 dynes.sec.cm-5, cardiac index (CI) > 2.5 l.min-1.m-2, central venous pressure > 8 mmHg and refractory to dopamine, norepinephrine, and fluid resuscitation were treated with hypophysin at an initial dose of 0.6 IU and a continuous infusion rate of 1 - 4 IU/h till the end of operation. The hemodynamics and the diameter of proximal left main coronary artery were evaluated before incision, before hypophysin administration, 5 min after hypophysin administration, and at the end of operation. RESULTS: MAP, SVR, and the diameter of proximal left main coronary artery increased whereas heart rate, CI, stroke volume index, and mean pulmonary artery pressure had no significant changes after hypophysin administration compared with before hypophysin administration. All hypophysin-treated patients successfully recovered. CONCLUSION: Hypophysin may improve the hemodynamics and dilate the proximal left main coronary artery in hypotensive patients with low SVR following CPB.

Baicalein, a natural product, selectively activating AMPKα(2) and ameliorates metabolic disorder in diet-induced mice.

The aim of the present study was to determine the effect of baicalein on metabolic syndrome induced by a high-fat diet in mice. The mice developed obesity, dyslipidemia, fatty liver, diabetes and insulin resistance. These disorders were effectively normalized in baicalein-treated mice. Further investigation revealed that the inhibitory effect on inflammation and insulin resistance was mediated by inhibition of the MAPKs pathway and activation of the IRS1/PI3K/Akt pathway. The lipid-lowering effect was attributed to the blocking of synthesis way mediated by SERBP-1c, PPARγ and the increased fatty acid oxidation. All of these effects depended on AMPKα activation. These results were confirmed in the primary hepatocytes from wild type and AMPKα(2)(-/-) mice. However, the IRS-1/PI3K/AKT pathway showed no change, which may be due to the time of stimulation and concentration. Thus, these data suggested that baicalein protects mice from metabolic syndrome through an AMPKα(2)-dependent mechanism involving multiple intracellular signaling pathways.

[The protective effects of insulin on cardiocyte apoptosis challenged by burn serum].

OBJECTIVE: To investigate the protective effects of insulin on burn serum-challenged cardiocyte apoptosis and its mechanism. METHODS: Burn-serum challenged cardiocytes were pretreated with insulin and inhibitors to pathway SB203580 and LY294002. The expression of cardiac myofilament proteins cleaved-caspase-3, Bax and phosphorylation nuclear factor-ΚB inhibitive factor α (p-IΚBα) were examined by Western blotting. The mRNA expression of tumor necrosis factor-α (TNF-α) was determined by real-time reverse transcription-polymerase chain reaction (RT-PCR). Apoptosis of cardiocyte was observed after Hoechst 33258 staining. Further blocking experiments were used to investigate the cytoprotective pathway of insulin. RESULTS: Insulin could significantly decrease the expression of cleaved-caspase-3 (2.22 ± 0.30 vs. 4.84 ± 0.74, P < 0.01), Bax (1.33 ± 0.35 vs. 3.74 ± 0.65, P < 0.01), p-IΚBα (1.43 ± 0.62 vs. 3.62 ± 0.74, P < 0.01), TNF-α (0.72 ± 0.27 vs. 2.02 ± 0.63, P < 0.01) and the cardiocyte apoptosis rate [(9.4 ± 3.4)% vs. (19.1 ± 5.6)%, P < 0.01] in cardiocytes challenged by burn serum. Further blocking experiments showed that LY294002, phosphatidylinositol-3-kinase (PI3K)/Akt activation inhibitor, could mitigate the protective effects of insulin. Meanwhile, SB203580, an inhibitor of p38 mitogen-activated protein kinase (p38MAPK) pathway, was able to inhibit cardiocyte injury challenged by burn serum, and it was as effective as insulin. CONCLUSION: For cardiocytes challenged by burn serum, insulin may decrease inflammatory cytokine expression and apoptosis via regulating PI3K/Akt and p38MAPK pathway.

[Intensive insulin treatment protected the cardiac myocytes against apoptosis in severely scalded rats].

OBJECTIVE: To investigate the effect of intensive insulin treatment, in the protection of myocardiocytes against apoptosis in severely scalded rats and its underlying mechanism. METHODS: Eighteen Sprague-Dawley (SD) rats were randomly divided into three groups (6/each) to receive: sham surgery, burn damage (on the back of the animals, degreeIII, to 30% of total body surface area), and burn damage+intensive insulin treatment. Tissue samples were collected from the left ventricle 6 hours after infliction of the burn damage for the examination of myocardial cell apoptosis [by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining] and the expression of apoptosis-related molecules caspase-3, Bax, and Bcl-2 (by immuno-histochemistry and Western blotting). RESULTS: In comparison with the animals in sham treated group, the myocardiocyte apoptosis rate in animals in burn damage only group increased significantly [(13.1 ± 3.4)% vs. (0.6 ± 0.4)%, P < 0.01]. The expression of caspase-3 and Bax both significantly increased while the level of Bcl-2 expression significantly decreased (immuno-histochemistry caspase-3: 13.72 ± 4.13 vs. 1.36 ± 0.95, Bax: 29.64 ± 5.42 vs. 2.24 ± 1.04, Bcl-2: 3.39 ± 1.52 vs. 8.01 ± 2.56; Western blotting caspase-3: 5.72 ± 2.13 vs. 1, Bax: 4.64 ± 1.42 vs. 1, Bcl-2: 0.69 ± 0.42 vs. 1, all P < 0.01). The animals received intensive insulin treatment showed significantly less myocardiocyte apoptosis [(6.7 ± 1.8)% vs. (13.1 ± 3.4)%, P < 0.01], significantly lower expression in caspase-3, Bax, and significantly higher level of Bcl-2 expression as compared to the animals in burn damage only group (immuno-histochemistry caspase-3: 8.88 ± 3.36 vs. 13.72 ± 4.13, Bax: 14.43 ± 3.69 vs. 29.64 ± 5.42, Bcl-2: 8.61 ± 3.72 vs. 3.39 ± 1.52; Western blotting caspase-3: 2.18 ± 0.86 vs. 5.72 ± 2.13, Bax: 2.87 ± 1.35 vs. 4.64 ± 1.42, Bcl-2: 3.57 ± 1.70 vs. 0.69 ± 0.42, P < 0.05 or P < 0.01). CONCLUSION: Intensive insulin therapy may protect myocardiocytes against apoptosis in severely burned animals through the regulation of the expression of apoptosis-related molecules caspase-3, Bax and Bcl-2.

Two-dimensional strain combined with adenosine stress echocardiography assessment of viable myocardium.

The objective of this study was to explore a new method for the identification of viable myocardium by means of two-dimensional (2D) strain imaging combined with adenosine stress echocardiography. A total of 15 anesthetized open-chest healthy mongrel dogs underwent left anterior descending coronary artery occlusion for 90 min followed by 120-min reperfusion. Adenosine was infused at 140 µg kg(-1) min(-1) over a period of 6 min. Images were acquired at baseline (when pericardial cradle was made), after reperfusion (when reperfusion finished) and after adenosine administration (while administration stopped). Measurements of the regional peak-systolic strain in radial, circumferential, and longitudinal motion on anterior wall and anterior septum were, respectively, performed under different conditions. The dogs were killed after the echocardiographic studies finished and then the area of infracted myocardium was defined by triphenyltetrazolium chloride histology. A segment with equal or less than 50% area of infracted myocardium was considered to be viable. As a result, 37 regions were viable whereas 53 were non-viable among 90 regions in 15 dogs. At baseline, there was no significant difference in peak-systolic radial strain (Rs), circumferential strain (Cs), and longitudinal strain (Ls) between the viable and non-viable groups. After reperfusion, Rs, Cs, and Ls in absolute value decreased compared to those at baseline in both groups, although there was no significant difference between these groups. Rs and Ls increased after adenosine administration compared to reperfusion (p < 0.01; p < 0.05) in viable group while there were no changes in non-viable group. Compared with non-viable group Rs, Cs and Ls in viable group increased significantly (p < 0.01; 0.05) after adenosine administration. There was a negative correlation between Rs and infarct size (r = -0.72). Cs and Ls correlated well with infarct size, respectively (r = 0.40; 0.67). A change of Rs more than 13.5% has a sensitivity of 83.8% and a specificity of 83.0% for viable whereas a change of Ls more than 11% allowed a sensitivity of 78.4% and a specificity of 88.7%. Combined with these two variables, the sensitivity and specificity could reach 91.9 and 79.2%. Two-dimensional strain imaging combined with adenosine stress echocardiography can provide a new way to distinguish viable myocardium from the non-viable.

[Evaluation of viable myocardium by two-dimensional strain imaging combined with adenosine stress echocardiography in dogs underwent experimental ischemia/reperfusion injury].

OBJECTIVE: to explore the feasibility of evaluating viable myocardium with two-dimensional strain imaging combined with adenosine stress echocardiography. METHODS: acute myocardial infarction and reperfusion model was made by ligating anterior descending coronary artery for 90 minutes followed by 120-minute reperfusion in 15 healthy mongrel dogs. Images were acquired at baseline and after reperfusion. Adenosine was then infused and image acquisition repeated. Regional peak-systolic strain in radial, circumferential and longitudinal motion on anterior wall and anterior septum were measured. TTC staining served as a "gold standard" to define viable and nonviable myocardium. The ratio of infarct area (S(N)) to total area (S) was calculated and viable myocardium was defined with S(N)/S ≤ 50%. RESULTS: at baseline, RS(peak sys), CS(peak sys) and LS(peak sys) were similar between viable (n = 37) and nonviable myocardial segments (n = 53) and significantly decreased after reperfusion in both viable and nonviable myocardial segments. Compared with values obtained after reperfusion, LS(peak sys) and RS(peak sys) remained unchanged in nonviable myocardial segments and significantly increased in viable myocardial segments after adenosine (P < 0.05). Post adenosine RS(peak sys) was negatively correlated with S(N)/S and CS(peak sys) and LS(peak sys) were positively correlated with S(N)/S. With ΔRS(peak-sys) (before and after adenosine) ≥ 13.5%, the sensitivity was 83.8% and specificity was 83.0% for distinguishing viable from nonviable myocardial segment. With ΔLS(peak sys) ≥ 11% as cutoff value, the sensitivity was 78.4% and specificity was 88.7% for distinguishing viable from nonviable myocardial segment. Combining ΔRS(peak sys) and ΔLS(peak sys), the sensitivity and specificity for distinguishing viable from nonviable myocardial segment were 91.9% and 79.2%, respectively. CONCLUSIONS: two-dimensional strain imaging combined with adenosine stress echocardiography could quantitatively identify viable and nonviable myocardium.

[Surgical treatment of post-infarction left ventricular aneurysm: clinical analysis].

OBJECTIVE: To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. METHODS: The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54 cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. RESULTS: All patients underwent surgery with a mean cardiopulmonary bypass duration of (103 ± 35) min and aortic cross clamp duration of (62 ± 26) min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6 months versus pre-operation were significantly reduced (P < 0.05). End-systolic volume (LVESV) reduced from (129 ± 27) ml to (65 ± 8) ml and end-systolic volume index (LVESVI) decreased from (104 ± 14) ml/m(2) to (44 ± 6) ml/m(2) and the subgroup of LVEF < 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). CONCLUSIONS: For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease.

BACKGROUND: Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. METHODS: A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n = 150) or CABG with cardiopulmonary bypass (CCABG, n = 150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P < 0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group (P < 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups. RESULTS: No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P < 0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P < 0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (perioperative myocardial infarction, stroke, atrial fibrillation). CONCLUSIONS: OPCAB can be applied to patients with triple-vessel coronary artery disease and can achieve similar completeness of revascularization and similar early surgical results, with shorter respiratory support, reduced transfusion requirement, and fewer cases of pulmonary dysfunction and abnormal renal function.