试论“心主血脉”

中医教材对"心主血脉"的解释是根据西医解剖和生理学的概念推导产生,不符合传统中医理论。中医的"心"并不是一个单纯解剖学的形态器官,而是一个以整体性原则确定的功能概念,是一系列有密切联系的生理病理功能的综合概括。"心"与"血"、"脉"之间的关系是藏象学说中的应象关系,《内经》中并没有所谓血液由心产生,心气维持心的搏动,从而推动血液运行的说法,营气才是推动血液在经脉内运行的动力。

温阳利水、健脾活血法治疗慢性充血性心力衰竭的疗效观察

心力衰竭（CHF）是一种复杂的临床症状群，是各种心脏病的严重阶段，其发病率高，5年存活期与恶性肿瘤相仿。中医学自古以来对本病未设专篇论述，但已有心衰之名。程杏轩《医述脏腑》又说“心主脉，爪甲色不华，则心衰矣”，说明心衰主要与心主脉的功能有关。目前充血性心力衰竭的治疗已取得较大的进展，但有时疗效仍不能令人满意。笔者近年来在常规西药强心、利尿、

Surgical Significance of the Aortic Root and its Neighbouring Structure Relationships

Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).

中和医派杨建宇教授经方治疗强直性脊柱炎的学验传承

中医中和理论是传统医学的精华,以中和医学为中医定义。随着西医疗法的不断发展创新,中和医学的地位逐渐升高,且中和医学的临床应用价值不断升高。中和医派应运而生,其思想在强直性脊柱炎的诊疗方面提供难能可贵的指导,中和医派独特的辨证思维,为治疗强直性脊柱炎提供了新的诊疗思路,且在强直性脊柱炎患者的诊疗中更具学术启迪及临床指导意义。

夏饮生脉饮

生脉饮出自《内外伤辨惑论》,由古方＂生脉散＂衍生而来,由人参5分（1.5克）、麦冬5分（1.5克）、五味子7粒组成。＂人参甘温,大补肺气而泻热,为君;麦冬甘寒,补水源而清燥金,为臣;五味酸温,敛肺生津,收耗散之气,为佐。盖心主脉,而百脉皆朝于肺,补肺清心,则气充而脉复,故曰生脉。

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.

Calcific degeneration and rupture of the aortic valve and ascending aorta： from cardiac auscultation to multimodality imaging

A 76-year-old Caucasian woman was admitted to the emergency room and referred for cardiac evaluation for dyspnea and abrupt onset of cough three weeks ago. She had a history of well-controlled arterial hypertension and was on adequate oral anticoagulant therapy for permanent atrial fibrillation. Previous thoracic injuries, connective tis- sue disorders or recent infections were excluded. No chest pain or syncope was reported. mmHg in both arms, heart rate Blood pressure was 150/50 was 90 beats/min.

Effect of transcatheter aortic valve replacement on P-wave duration, P-wave dispersion and left atrial size

Background P-wave dispersion （PWD）, a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis （AS）, P-wave duration and PWD were shown to be increased, indicating atrial electrical remodeling. However, the effect of transcatheter aortic valve replacement （TAVR） on P-wave morphology has not been established yet. The aim of this study is to assess the short and long-term effects of TAVR with two types of bioprosthetic valves on P-wave duration and PWD in association with left atrial （LA） size. Methods Fifty-two （36 female） eligible patients in sinus rhythm who underwent transfemoral TAVR between June 01, 2012 and July 31, 2014 with either a Medtronic CoreValve （MCV） （n = 32） or an Edwards SAPIEN XT Valve （n = 20） were enrolled. Standard 12-lead electrocardiogram and echocardiographic evaluations were per- formed pre-procedurally, post-TAVR day one and 6 months post-TAVR. P-wave duration and PWD were measured and correlation analyses with echocardiographic variables were performed. Results P-wave duration and PWD were significantly decreased on post-TAVR day one （P 〈 0.05）. They continued to decrease during the six month follow-up period, but were not significantly different from short-term values （P 〉 0.05）. The decrease of LA diameter was found significant at the sixth-months of follow-up （P 〈 0.05）. These changes were independent from the types of bioprosthetic valves implanted （P 〉 0.05）. A positive correlation was detected between minimum P-wave duration and maximum aortic valve gradients at post-TAVR day one （r = 0.297, P = 0.032）. Conclusions P-wave duration and PWD were significantly reduced early after TAVR indicating early reverse atrial electrical remodeling. Moreover, structural reverse remodeling of atrium was detected at the 6-months of follow-up. The effects of two types of bioprosthetic valves on atrial remodeling were similar.

Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation （TAVI） is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction （LVEF） on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system （92.8%） or the Edwards SAPIEN valve system （7.2%）. Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF 〈 30% on mortality was assessed by Cox regression. Results Patients with LVEF 〈 30% （n = 63）, as compared to those with LVEF 〉 30% （n = 586）, had a higher prevalence of NHYA class 〉 2 （P 〈 0.001） and presented with a higher Euroscore （P 〈 0.001）. Procedural success was similar in both groups （98.4% vs. 97.2%, P = 1）. After a median follow-up of 436 days （25^-75th percentile, 357-737 days）, all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios （HR）： 0.96, 95% confidence intervals （CI）： 0.56-1.63] and cardiac mortality （19.1% vs. 17.6%, P = 0.89, HR： 1.04, 95% CI： 0.57-1.90） were similar in patients with LVEF 〈 30% as compared to those with LVEF 〉 30%. Thirty-day all-cause mortality was not significantly different between the two groups （11.1% vs. 6.3%, P = 0.14, HR： 1.81, 95% CI： 0.814.06）. Patients with LVEF 〈 30% had a trend toward higher risk of 30-day cardiac mortality （11.1% vs. 5.3%; P = 0.06, HR： 2.16, 95% CI： 0.95-4.90）, which disappeared after multivariable adjustment （P = 0.22）. Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

Concomitant acute myocardial infarction and descending thoracic aorta penetrating ulcer

Acute coronary syndrome （ACS） refers to a spectrum of clinical presentations ranging from unstable angina to non-ST-segment elevation myocardial infarction （NSTEMI） to ST-segment elevation myocardial infarction （STEMI）. Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer （PAU） are three major acute aortic syndromes （AAS）.

Osteoporosis as A Source of Tissue Mineralization Research on Osteoporosis Therapy and Dissolution of Arterial Mineralization

Based on research conducted by the author in the last thirty-five years, this article presents the physicochemical mechanisms of the osteoporosis process, transport of substances created as its result, and the phenomena of tissue mineralization resulting from osteoporosis. Examination of bones, joint cartilage, arteries, veins, parts of heart, thyroid, salivary glands, various tumors and others was conducted with the use of biological and polarizing microscopy, SEM, EDS, ASA, IR, Raman spectroscopy, and X-ray diffraction. Several devices of the same kind, e.g. different types of SEM, were used. Specimens used for examination were obtained from post-surgery and post rnortem materials. Examination of human bones focused on their mineralization and demineralization （osteoporosis）. Examination of the mineralization of other tissues was conducted in terms of the ageing of human body. Obtained results show that the process of osteoporosis leads not just to mechanical degradation of bones, but through the transport of ions （mainly Ca and P）, it also causes mineralization of soft tissue. Such mineralization occurs in mineralization centers that have been classified in regard to genetics. Tissue mineralization in its first stage is latent and consists of including atoms, mainly Ca and P, into the biological structures of compounds that build the tissues. Latent mineralization may evolve into the next stage--apparent mineralization. Both types of mineralization cause many health issues and may lead to death. This article also presents initial results of research on dissolution of aortic mineralization.

Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis： a new paradigm for the heart team decision making

Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replace- ment （AVR） or transcatheter aortic valve implantation （TAVI）, in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty （BAV） as a bridge-to-decision （BTD） in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade 〉 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation （EuroSCORE） was 23.5%±15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% （0.5% major; 3.5% minor）. Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment （25.4% for AVR; 47.2% for TAVI）： 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to- decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.

Atrial electromechanical coupling parameters after transcatheter aortic valve replacement

The article entitled Effect of transcatheter aortic valve replacement on P-wave duration, P-wave dispersion and left atrial size by Dursun, et al. has contributed to our knowledge regarding the positive effects of transcatheter aortic valve replacement （TAVR） procedure on atrial electrical remodeling. In this study, TAVR procedure led to a decrease on P-wave duration and P-wave dinner,inn

Aortic root replacement

Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques、Methods Between January 1994 and August 1999, a group of 231 consecutive patients underwent aortic root replacement at our hospital, with 13 being treated on an emergency basis、 There were 189 men and 42 women, ranging in age from 14 to 69 years、 The diameter of the aneurysm varied from 4、5 to 11?cm、 Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dissection, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection、 Aortic valve regurgitation occurred in all cases、 Aortic root replacement was performed with composite valved graft in 229 patients, and in 2 patients the aortic valve was preserved、Results The hospital mortality rate was 3、03% (7 patients)、 Early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each、 One hundred and seventy-five patients (78、12%) were followed up, with a mean follow-up time of 15、7±13、1 months (range, 2 weeks to 65 months)、 One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively、 Three patients died from postoperative anticoagulation accidents、 The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68、1±9、4?mm, range 54 to 112?mm; vs 54、8±8、2?mm, range 38 to 88?mm; P<0、001)、Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general conditions permit、 Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5?cm

Mineral metabolism disturbances are associated with the presence and severity of calcific aortic valve disease

Objective：We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease （CAVD） in patients with normal or mildly impaired renal function. Methods：We measured serum levels of calcium, phosphate, alkaline phosphatase （AKP）, intact parathyroid hormone （iPTH）, 25-hydroxyvitamin D （25-OHD）, and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis （AVSc） （n=164） or stenosis （AVS） （n=96） and in 164 age- and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results：Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels （al P〈0.001）. Similarly, osteocalcin, procol agen I N-terminal peptide, andβ-isomerized type I col agen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS （al P〈0.001）. In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding varia-bles, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were in-dependently associated with the presence and severity of CAVD. Conclusions： This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism.

Aorta-to-right atrium fistula,an unusual complication of endocarditis

Infective endocarditis(IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious complication of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis,vegetation,perforation of noncoronary sinus,and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardiography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis,aggressive antibacterial therapy,and surgical treatment may improve the prognosis.

A disintegrin and metalloproteinase with thrombospondin motif 1(ADAMTS1) expression increases in acute aortic dissection

Acute aortic dissection(AAD) is a life-threatening cardiovascular disease caused by progressive medial degeneration of the aortic wall. A disintegrin and metalloproteinase with thrombospondin motifs 1(ADAMTS1) is a recently identified extracellular metalloproteinase participating in the development of vascular disease, such as atherosclerosis. In the present study, we found that ADAMTS1 was significantly elevated in blood samples from AAD patients compared with patients with acute myocardial infarction and healthy volunteers. Based on these findings, we established an AAD model by infusing angiotensin II in older mice. AAD was successfully developed in aorta tissues, with an incidence of 42% after 14 days in the angiotensin II group. Macrophage and neutrophil infiltration was observed in the media of the aorta, and ADAMTS1 overexpression was found in the aorta by Western blot and immunohistochemistry. Double immunofluorescence staining showed the expression of ADAMTS1 in macrophages and neutrophils. Consistent with the upregulation of ADAMTS1 in aortic dissection tissues, versican(a proteoglycan substrate of ADAMTS1) was degraded significantly more in these tissues than in control aortic tissues. These data suggest that the increased expression of ADAMTS1 protein in macrophages and neutrophils that infiltrated aortic tissues may promote the progression of AAD by degrading versican.

Berry syndrome： a rare cardiac malformation with extra-cardiac findings

Dear Editor,Berry syndrome is a rare combination of congenital cardiac malformations characterized by four abnormal features;namely,an aortopulmonary window(APW),aortic origin of the right pulmonary artery,hypoplasia or interruption of the aortic arch,with an intact ventricular septum.The disease was first reported by Berry in 1982,who estimated the incidence within the population with congenital cardiac malformations to be 0.046%(Berry et al.,1982).Until recently,

Effect of pulsatile perfusion during cardiopulmonary bypass in terms of radial artery sphygmogram

OBJECTIVE: To investigate a quantitative method for using radial artery pulse waveforms to assess the effect of pulsatile flow during cardiopulmonary bypass(CPB).METHODS: A total of 34 adults with heart disease who underwent open-heart surgery between April2010 and January 2011 were randomized into a pulsatile perfusion group(n=17) and a non-pulsatile perfusion group(n=17). Radial arterial pulse waveforms of pulsatile and non-pulsatile perfusion patients were observed and compared before and during CPB.RESULTS: No pulse waveform could be detected at patients' radial artery in both groups when the aorta was cross-clamped. Pulse waveforms could be detected at pulsatile perfusion patients' radial artery, but could not be detected at non-pulsatile perfusion patients' radial artery during CPB. Additionally, patients' pulse waveforms during pulsatile perfusion were lower than those before the operation.CONCLUSION: Our findings indicate that radial artery sphygmogram can be used as a valid indicator to evaluate the effectiveness of pulsatile perfusion during CPB.