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 c...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.展开更多
Objective To characterize early afterdepolarizations （EADs） caused triggered activity （TA） among calsequestrin-2 （CASQ2） knock-in （CASQ2 KI） mice and its relationship with aging. Methods Electrophysiological p...Objective To characterize early afterdepolarizations （EADs） caused triggered activity （TA） among calsequestrin-2 （CASQ2） knock-in （CASQ2 KI） mice and its relationship with aging. Methods Electrophysiological properties of ventricular myocytes from 3- month （mo, young）, 9-mo （adult-l） and 12-too （adult-2） in wild-type （WT） and CASQ2 KI mice were investigated with patch-clamp technique. Results The incidences of EADs and TA in CASQ2 KI cardiomyocytes increased with increasing age. In contrast, WT mice cardiomyocytes showed no significant change in matched-age groups. Compared with that in 3-mo CASQ2 KI mice, the 50% repolarization of action potential （APD50） showed prolongation in both 9-mo and 12-mo ones （9.2±0.9 ms of 9-mo and 10.3 ± 1.2 ms of 12- mo vs. 5.6± 0.3 ms of 3-mo）, while the 90 % repolarization of action potential （APD90） was similar among 3 age groups. Compared with 3-mo mice, the 9-mo and 12-mo CASQ2 KI mice showed markedly reduced transient outward potassium current （Ito） densities but increased L-type calcium current （ICa-L） densities. Conlcusion This study suggested that events of EADs and TA in CASQ2 KI mice increased with increasing age, It might be associated partly with the augment of cellular calcium concentration and the prolongation of APD50 induced by decrease of Ito and increase of ICa-L in adult CASQ2 KI mice展开更多
In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factor...In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient's clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS' acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?展开更多
The objective of this research was to identify levels of heat shock protein 70 （Hsp 70）, total immunoglobulin E （IgE） and matrix metalloproteinase-9 （MMP-9） before and after coronary artery bypass grafting （CAB...The objective of this research was to identify levels of heat shock protein 70 （Hsp 70）, total immunoglobulin E （IgE） and matrix metalloproteinase-9 （MMP-9） before and after coronary artery bypass grafting （CABG） surgery. Hsp 70, IgE, MMP-9, creatine phosphokinase-MB （CPK-MB）, and lactate dehydrogenase （LDH） levels were measured in normal subjects （n = 20）, and in patients with chronic stable angina pectoris who were referred for elective CABG, before and after performing CABG-surgery （n = 20）. Compared with normal subjects, increased Hsp 70 and IgE levels, unchanged MMP-9 level, and activities of CPK-MB and LDH were found in the pre-operative patient group. Hsp 70 and IgE levels in the post-operative period were significantly reduced when compared to pre-operative period. Hsp 70 and IgE might be used as markers for detection of early minor myocardial damage, and coronary insufficiency with less overt damage than myocardial infarction, as significant changes in their levels appear before occurrence of in any changes in the levels of MMP-9, CPK-MB and LDH. Besides, Hsp 70, and IgE returning to the normal levels after CABG surgery, suggest that they could be helpful to evaluate the effect of CABG surgery.展开更多
Right ventricular failure(RVF)is a complicated syndrome with multiple etiologies.RVF relates to pulmonary hypertension,left ventricle failure,and congenital heart diseases.The origin of its pathway is based on patholo...Right ventricular failure(RVF)is a complicated syndrome with multiple etiologies.RVF relates to pulmonary hypertension,left ventricle failure,and congenital heart diseases.The origin of its pathway is based on pathological gene expression and concomitant diseases.Diagnosis of RVF is a serious problem for clinicians,but none of the criteria in current clinical practice provides uncontaminated information on either systolic or diastolic function.Perioperative assessment and bedside monitoring of right ventricle function have to be revised and widely used.Right ventricle function in transplant patients demands different evaluation using biomarkers or/and autopsy.Treatment of RVF has surgical and non-surgical approaches;both are still in development and need further clarification.展开更多
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 endocardi...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.展开更多
Transient performance of fluid machinery during transient operating periods, such as startup and stopping, has been drawn more attentions recently due to the growing engineering needs. In this paper, the transient beh...Transient performance of fluid machinery during transient operating periods, such as startup and stopping, has been drawn more attentions recently due to the growing engineering needs. In this paper, the transient behavior of a prototype centrifugal pump with an open impeller during rapid startup period is studied experimentally. The variations of the rotational speed, flow rate, head, and shaft power during rapid startup period are recorded in ex- periments at different discharge valve openings. In addition, the non-dimensional flow rate and head are also used to analyze the transient behavior. The research result shows that the rise characteristic of the rotational speed is not basically changed by working points, while mainly depends on the startnp characteristics of the driving motor. Compared with the rapid rise of the rotational speed, the flow rate rises slowly in the initial stage of startup. Moreover, the flow rate lags behind the rotational speed to rise to final stable value, and the delay becomes more severe with the increase of the discharge valve opening. The shaft power impact phenomenon generally exists in the process of startup. The non-dimensional analysis shows that the non-dimensional head is very high at the very beginning of startup, and quickly falls to the minimum, then gradually rises to final stable value, while the non-dimensional flow rate always shows the rise tendency during whole startup period. In conclusion, it is found from the non-dimensional results that the quasi-steady analysis is unable to accurately assess the transient flow during startup period.展开更多
In this paper,the CFD simulation and new flow unsteadiness analysis for a single-blade centrifugal pump with whole flow passage were carried out.The periodic flow unsteadiness has been quantitatively investigated in d...In this paper,the CFD simulation and new flow unsteadiness analysis for a single-blade centrifugal pump with whole flow passage were carried out.The periodic flow unsteadiness has been quantitatively investigated in detail by defining unsteady intensity and turbulence intensity in both rotor and volute domains under design condition Q=33 L s 1.The results show that the distributions of flow unsteadiness are the functions of impeller rotating angle and have complex unsteady characteristics.The obvious T u fluctuations can be also observed for different impeller positions.In addition,time-averaged unsteady intensity and time-averaged turbulence intensity were calculated by averaging the results of each mesh node for entire impeller revolution period to evaluate the strength distributions of flow unsteadiness directly and comprehensively.The accumulative results of an impeller revolution can directly show the positions and strength of the flow unsteadiness and turbulence intensity in both rotor and stator domains which can be an important aspect to be considered in the single-blade pump optimum design procedure for obtaining more stable inner flow of the pump and decreasing flow-induced vibration and noise.The flow unsteadiness in the side chamber cannot be neglected for an accurate prediction of the inner flow of the pump,and the optimizing design procedure for a single-blade pump impeller will not be accurate using CFD tool if the unsteady flow phenomenon in the side chamber is not considered.展开更多
The hemodynamics of intracranial aneurysm(IA)comprises complex transient flow patterns that affect its growth and rupture.Owing to the combined effects of geometrical factors and pulsatile flow conditions,the transien...The hemodynamics of intracranial aneurysm(IA)comprises complex transient flow patterns that affect its growth and rupture.Owing to the combined effects of geometrical factors and pulsatile flow conditions,the transient flow patterns in the IA are still unclear.The purpose of this work is to reveal the effect of the aspect ratio(AR,sac height/neck width)on the evolution of the internal flow patterns and the hemodynamics of the IA.We proposed an easy method to fabricate three simplified elastic IA models and measured the transient flow characteristics by using particle image velocimetry(PIV).Transient vortex structures in the IA modes during a cardiac cycle were systemically measured and many new flow phenomena were found,including the vortex morphology(size,structure,and core location),a high-speed jet,wall compliance effects,and three flow modes during retrograde flow phase.The results show that the AR of the IA affects the transient flow patterns as well as the wall shear stress(WSS)in complex ways.The results could deepen our understanding of the transient flow behaviors in IA and guide related clinical studies.展开更多
文摘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.
文摘Objective To characterize early afterdepolarizations （EADs） caused triggered activity （TA） among calsequestrin-2 （CASQ2） knock-in （CASQ2 KI） mice and its relationship with aging. Methods Electrophysiological properties of ventricular myocytes from 3- month （mo, young）, 9-mo （adult-l） and 12-too （adult-2） in wild-type （WT） and CASQ2 KI mice were investigated with patch-clamp technique. Results The incidences of EADs and TA in CASQ2 KI cardiomyocytes increased with increasing age. In contrast, WT mice cardiomyocytes showed no significant change in matched-age groups. Compared with that in 3-mo CASQ2 KI mice, the 50% repolarization of action potential （APD50） showed prolongation in both 9-mo and 12-mo ones （9.2±0.9 ms of 9-mo and 10.3 ± 1.2 ms of 12- mo vs. 5.6± 0.3 ms of 3-mo）, while the 90 % repolarization of action potential （APD90） was similar among 3 age groups. Compared with 3-mo mice, the 9-mo and 12-mo CASQ2 KI mice showed markedly reduced transient outward potassium current （Ito） densities but increased L-type calcium current （ICa-L） densities. Conlcusion This study suggested that events of EADs and TA in CASQ2 KI mice increased with increasing age, It might be associated partly with the augment of cellular calcium concentration and the prolongation of APD50 induced by decrease of Ito and increase of ICa-L in adult CASQ2 KI mice
文摘In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient's clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS' acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?
文摘The objective of this research was to identify levels of heat shock protein 70 （Hsp 70）, total immunoglobulin E （IgE） and matrix metalloproteinase-9 （MMP-9） before and after coronary artery bypass grafting （CABG） surgery. Hsp 70, IgE, MMP-9, creatine phosphokinase-MB （CPK-MB）, and lactate dehydrogenase （LDH） levels were measured in normal subjects （n = 20）, and in patients with chronic stable angina pectoris who were referred for elective CABG, before and after performing CABG-surgery （n = 20）. Compared with normal subjects, increased Hsp 70 and IgE levels, unchanged MMP-9 level, and activities of CPK-MB and LDH were found in the pre-operative patient group. Hsp 70 and IgE levels in the post-operative period were significantly reduced when compared to pre-operative period. Hsp 70 and IgE might be used as markers for detection of early minor myocardial damage, and coronary insufficiency with less overt damage than myocardial infarction, as significant changes in their levels appear before occurrence of in any changes in the levels of MMP-9, CPK-MB and LDH. Besides, Hsp 70, and IgE returning to the normal levels after CABG surgery, suggest that they could be helpful to evaluate the effect of CABG surgery.
文摘Right ventricular failure(RVF)is a complicated syndrome with multiple etiologies.RVF relates to pulmonary hypertension,left ventricle failure,and congenital heart diseases.The origin of its pathway is based on pathological gene expression and concomitant diseases.Diagnosis of RVF is a serious problem for clinicians,but none of the criteria in current clinical practice provides uncontaminated information on either systolic or diastolic function.Perioperative assessment and bedside monitoring of right ventricle function have to be revised and widely used.Right ventricle function in transplant patients demands different evaluation using biomarkers or/and autopsy.Treatment of RVF has surgical and non-surgical approaches;both are still in development and need further clarification.
文摘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.
基金supported by the National Natural Science Foundation of China(No.21076198,51249003)the National Basic Research Program ("973" Program,No.2009CB724303)
文摘Transient performance of fluid machinery during transient operating periods, such as startup and stopping, has been drawn more attentions recently due to the growing engineering needs. In this paper, the transient behavior of a prototype centrifugal pump with an open impeller during rapid startup period is studied experimentally. The variations of the rotational speed, flow rate, head, and shaft power during rapid startup period are recorded in ex- periments at different discharge valve openings. In addition, the non-dimensional flow rate and head are also used to analyze the transient behavior. The research result shows that the rise characteristic of the rotational speed is not basically changed by working points, while mainly depends on the startnp characteristics of the driving motor. Compared with the rapid rise of the rotational speed, the flow rate rises slowly in the initial stage of startup. Moreover, the flow rate lags behind the rotational speed to rise to final stable value, and the delay becomes more severe with the increase of the discharge valve opening. The shaft power impact phenomenon generally exists in the process of startup. The non-dimensional analysis shows that the non-dimensional head is very high at the very beginning of startup, and quickly falls to the minimum, then gradually rises to final stable value, while the non-dimensional flow rate always shows the rise tendency during whole startup period. In conclusion, it is found from the non-dimensional results that the quasi-steady analysis is unable to accurately assess the transient flow during startup period.
基金supported by the National Outstanding Young Scientists Founds of China (Grant No. 50825902)Jiangsu Provincial Project for Innovative Postgraduates of China (Grant No.CX10B_262Z)
文摘In this paper,the CFD simulation and new flow unsteadiness analysis for a single-blade centrifugal pump with whole flow passage were carried out.The periodic flow unsteadiness has been quantitatively investigated in detail by defining unsteady intensity and turbulence intensity in both rotor and volute domains under design condition Q=33 L s 1.The results show that the distributions of flow unsteadiness are the functions of impeller rotating angle and have complex unsteady characteristics.The obvious T u fluctuations can be also observed for different impeller positions.In addition,time-averaged unsteady intensity and time-averaged turbulence intensity were calculated by averaging the results of each mesh node for entire impeller revolution period to evaluate the strength distributions of flow unsteadiness directly and comprehensively.The accumulative results of an impeller revolution can directly show the positions and strength of the flow unsteadiness and turbulence intensity in both rotor and stator domains which can be an important aspect to be considered in the single-blade pump optimum design procedure for obtaining more stable inner flow of the pump and decreasing flow-induced vibration and noise.The flow unsteadiness in the side chamber cannot be neglected for an accurate prediction of the inner flow of the pump,and the optimizing design procedure for a single-blade pump impeller will not be accurate using CFD tool if the unsteady flow phenomenon in the side chamber is not considered.
基金supported by the National Natural Science Foundation of China(Grant Nos:12172017 and 11872083)Project of Beijing Municipal Education Commission(Grant Nos.KZ202210005006 and KZ202110005007).
文摘The hemodynamics of intracranial aneurysm(IA)comprises complex transient flow patterns that affect its growth and rupture.Owing to the combined effects of geometrical factors and pulsatile flow conditions,the transient flow patterns in the IA are still unclear.The purpose of this work is to reveal the effect of the aspect ratio(AR,sac height/neck width)on the evolution of the internal flow patterns and the hemodynamics of the IA.We proposed an easy method to fabricate three simplified elastic IA models and measured the transient flow characteristics by using particle image velocimetry(PIV).Transient vortex structures in the IA modes during a cardiac cycle were systemically measured and many new flow phenomena were found,including the vortex morphology(size,structure,and core location),a high-speed jet,wall compliance effects,and three flow modes during retrograde flow phase.The results show that the AR of the IA affects the transient flow patterns as well as the wall shear stress(WSS)in complex ways.The results could deepen our understanding of the transient flow behaviors in IA and guide related clinical studies.
