Predictive value of neutrophil-to-lymphocyte ratio in coronary chronic total occlusion patients

BACKGROUND The neutrophil to lymphocyte ratio(NLR)has been reported as a novel predictor for atherosclerosis and car-diovascular outcomes.This study aimed to determine the effects of NLR on long-term clinical outcomes of chronic total occlusion(CTO)patients.METHODS A total of 670 patients with CTO who met the inclusion criteria were included at the end of the follow-up period.Patients were divided into tertiles according to their baseline NLR levels at admission:low(n=223),intermediate(n=223),and high(n=224).The incidence of major adverse cardiac events(MACEs)during the follow-up period,including all-cause death,nonfatal myocardial infarction(MI),or ischemia-driven revascularization,were compared among the three groups.RESULTS Major adverse cardiac events were observed in 27 patients(12.1%)in the low tertile,40(17.9%)in the intermediate tertile,and 61(27.2%)in the high NLR tertile(P<0.001).Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE,ischemia-driven coronary revascularization,non-fatal MI,and mortality in patients within the high tertile than those in the low and intermediate groups(all P<0.001).Multivariable COX regression analysis showed that the high tertile of baseline NLR level showed a strong association with the risk of MACE(hazard ratio[HR]=2.21;95%confidence interval[CI]:1.21-4.03;P=0.009),ischemia-driven coronary revascularization(HR=3.19;95%CI:1.56-6.52;P=0.001),MI(HR=2.61;95%CI:1.35-5.03;P=0.043)and mortality(HR=3.78;95%CI:1.65-8.77;P=0.001).CONCLUSION Our findings suggest that NLR is an inexpensive and readily available biomarker that can independently pre-dict cardiovascular risk in patients with CTO.

Meta analysis of the efficacy of western medicine combined with Qiliqiangxin capsule versus western medicine alone in the treatment of chronic heart failure

Objective: To compare the clinical efficacy of conventional Western medicine combined with Qiliqiangxin capsule and western medicine alone in the treatment of chronic heart failure, and to prove that Qiliqiangxin capsule combined treatment has more advantages, providing reference for clinical decision-making in the treatment of chronic heart failure. Methods: Randomized controlled trials (RCTs) of conventional Western medicine treatment and Western medicine combined with Qiliqiangxin capsule in the treatment of chronic heart failure were searched in databases such as PubMed, Embase, Webofscience, CNKI, WanFang, VIP, and CBM. The bias risk assessment was conducted using the RCT tool recommended by Cochrane, and then the meta-analysis was performed using RevMan5.4 and Stata17 software. Compare the efficacy evaluation of cardiac function, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), cardiac stroke output (SV), 6-minute walking test (6MWT), and N-terminal proBNP in the conventional western medicine combined with Qiliqiangxin capsule group (hereinafter referred to as the treatment group) and the conventional western medicine group (hereinafter referred to as the control group). Results: A total of 20 RCTs meeting the criteria were included, including 2953 patients, including 1508 in the treatment group and 1445 in the control group. The results of meta-analysis showed that the treatment group had significantly better cardiac function evaluation, LVEF, LVEDD, SV, 6MWT, and NT-proBNP improvement than the control group. Its central functional efficacy evaluation (OR=2.09,95% CI: 1.71-2.55, P<0.001), LVEF (WMD=7.05,95% CI: 5.30-8.79, P<0.00001), LVEDD (WMD=6.73, 95% CI: 3.18-10.29, P=0.0002), SV (WMD=6.73, 95% CI: 3.18-10.29, P=0.0002), 6MWT (SMD=0.70,95% CI: 0.54-0.87, P<0.00001), NT-proBNP (SMD=-1.95,95% CI: -2.5 2 to 1.38 (P<0.0001), with statistically significant differences. Conclusion: Conventional western medicine combined with Qiliqiangxin capsule can significantly improve the clinical efficacy of heart failure, improve LVEF, LVEDD, SV, and NT-proBNP index, and improve exercise tolerance. It is worth using for reference in the treatment.

MicroRNA-146a Promotes Embryonic Stem Cell Differentiation towards Vascular Smooth Muscle Cells through Regulation of Kruppel-like Factor 4

Objective Vascular smooth muscle cell(VSMC)differentiation from stem cells is one source of the increasing number of VSMCs that are involved in vascular remodeling-related diseases such as hypertension,atherosclerosis,and restenosis.MicroRNA-146a(miR-146a)has been proven to be involved in cell proliferation,migration,and tumor metabolism.However,little is known about the functional role of miR-146a in VSMC differentiation from embryonic stem cells(ESCs).This study aimed to determine the role of miR-146a in VSMC differentiation from ESCs.Methods Mouse ESCs were differentiated into VSMCs,and the cell extracts were analyzed by Western blotting and RT-qPCR.In addition,luciferase reporter assays using ESCs transfected with miR-146a/mimic and plasmids were performed.Finally,C57BL/6J female mice were injected with mimic or miR-146a-overexpressing ESCs,and immunohistochemistry,Western blotting,and RT-qPCR assays were carried out on tissue samples from these mice.Results miR-146a was significantly upregulated during VSMC differentiation,accompanied with the VSMC-specific marker genes smooth muscle-alpha-actin(SMαA),smooth muscle 22(SM22),smooth muscle myosin heavy chain(SMMHC),and h1-calponin.Furthermore,overexpression of miR-146a enhanced the differentiation process in vitro and in vivo.Concurrently,the expression of Kruppel-like factor 4(KLF4),predicted as one of the top targets of miR-146a,was sharply decreased in miR-146a-overexpressing ESCs.Importantly,inhibiting KLF4 expression enhanced the VSMC-specific gene expression induced by miR-146a overexpression in differentiating ESCs.In addition,miR-146a upregulated the mRNA expression levels and transcriptional activity of VSMC differentiation-related transcription factors,including serum response factor(SRF)and myocyte enhancer factor 2c(MEF-2c).Conclusion Our data support that miR-146a promotes ESC-VSMC differentiation through regulating KLF4 and modulating the transcription factor activity of VSMCs.

Brugada syndrome associated with out-of-hospital cardiac arrest: A case report

BACKGROUND Brugada syndrome(BrS)is an inherited disease characterized by an electrocardiogram(ECG)with a coved-type ST-segment elevation in the right precordial leads(V1-V3),which predisposes to sudden cardiac death(SCD)due to polymorphic ventricular tachycardia or ventricular fibrillation in the absence of structural heart disease.We report the case of a 29-year-old man with out-ofhospital cardiac arrest.BrS is associated with a high incidence of SCD in adults,and increasing the awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.CASE SUMMARY A 29-year-old man suffered from out-of-hospital cardiac arrest,and after defibrillation,his ECG demonstrated a coved-type elevated ST segment in V1 and V2.These findings were compatible with type 1 Brugada pattern,and ECG of his brother showed a type 2 Brugada pattern.The diagnosis was BrS,NYHF IV,multiple organ dysfunction syndrome,sepsis,and hypoxic ischemic encephalopathy.The patient had no arrhythmia episodes after discharge throughout a follow-up period of 36 mo.CONCLUSION Increasing awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.

Influencing factors of fatigue in young and middle-aged patients with coronary heart disease:a cross-sectional study

Objective:To examine the present state of fatigue in young and middle-aged patients with coronary heart disease(CHD)and to identify the elements that may be affecting it.Methods:From December 2020 to June 2021,240 young and middle-aged patients with CHD who were being treated in the cardiology department of a tertiary care hospital in Suzhou were chosen using a convenience sampling method in order to gather data on the patients’sociodemographic status,fatigue,social support,and stress.Results:Of the 240 disseminated questionnaires,220 valid responses were returned,resulting in an effective recovery rate of 91.67%.The frequency of exhaustion was 51.8%,and the fatigue score was(5.27±2.77).The stress score was(11.15±3.36),while the overall social support score was(39.13±4.72).Binary logistic regression analysis indicated that age,exercise,staying up late,stress,social support,high-sensitivity troponin T,high-density lipoprotein,and ejection fraction were independent risk factors for fatigue in young and middle-aged patients with CHD(P<0.05).Conclusions:Fatigue is more prevalent in young and middle-aged patients with CHD.Clinical nurses can create a unique management plan for patients based on their lifestyle and behavioral patterns,stress levels,social support,and clinical signs to reduce fatigue.

Association of fatigue with short-term prognosis in young and middle-aged patients with coronary heart disease

Background:To investigate the effect of fatigue on the short-term prognosis of young and middle-aged patients with coronary heart disease(CHD).Methods:A cross-sectional,observational survey was distributed at a tertiary hospital in Suzhou,China.Patients were assessed for fatigue and their prognosis was assessed at 3 and 6 months after discharge.General Information Questionnaire,Fatigue Scale and Seattle Angina Questionnaire(SAQ)were used for the survey.The Cox proportional hazard model was used to analyze the impact of fatigue on the occurrence of major adverse cardiac events(MACEs)at 3 and 6 months after discharge.Multiple linear regression models were used to analyze the effect of fatigue on health-related quality of life(HRQoL)at 3 and 6 months after discharge.Results:199 patients were followed up with in the end.43 patients(21.6%)with MACE three months after discharge had a total SAQ score of(399.76±39.61).The overall SAQ score was(425.14±22.66)and 52 patients(26.1%)experienced MACE six months after discharge.Fatigue was identified as a risk factor for MACE 6 months after discharge by the Cox proportional hazard model(HR=2.939,95%CI:0.177~0.655,P=0.001)and as an independent risk factor for quality of life 3 and 6 months after discharge by multiple linear regression(P<0.001).Conclusions:In individuals who are young or middle-aged and have coronary heart disease,fatigue is a risk factor for the short-term prognosis.It is advised that clinical professionals prioritize patient fatigue assessment and improve management of fatigue symptoms.

Comparative study of the chitooligosaccharides effect on the proliferation inhibition and radiosensitization of three types of human gastric cancer cell line

Objective:To observe the chitooligosaccharides(COS) effect on the proliferation inhibition and radiosensitivity of three types of human gastric cancer cell line.Mothods:CCK-8 assay was employed to obtain the inhibition ratio of COS on BGC823 cells,MKN45 cells and SGC7901 cells at 48 h after treatment and the proliferation-inhibition curve was drawn with the inhibition ratio of COS on three types of cells.The clonogenic assay was used to detect the cell viability of 0,1,2,4,6 and 8 Gy(6 dose grades) in RAY group and RAY+COS group after X-ray,and the cell survival curve was used to analyze the sensitization enhancement ratio of COS.Flow cytometry was employed to detect cell cycle and apoptosis rate in control group,RAY group and RAY+COS group after 48 h treatment.Results:COS inhibited the proliferation of three types of cells.The inhibition rate was positively correlated with the concentration of COS,and the susceptibility of MKN45 cells,SGC7901 cells and BGC823 cells to COS decreased in turn.The cell viability decreased gradually with the increasing radiation dose in RAY group and RAY+COS group(P<0.01).The cell viabilities of RAY+COS group were lower than those of RAY group at all the dose grades under X-ray exposure(P<0.01),and the sensitization enhancement ratios of COS on BGC823 cells,MKN45 cells and SGC7901 cells were 1.06,1.28 and 1.15 respectively.In controlled trials,apoptosis rate and percentage in the G_2/M phase of three types of cells in RAY+COS group were higher than those in control group and RAY group,and percentage in the S phase and the G_0/G_1 phase in RAY+COS group were lower than those in the other two groups(P<0.01).Conclusions:COS can inhibit the proliferation of three types of human gastric cancer cells and enhance the radiosensitivity by inducing apoptosis and G_2/M phase arrest.

Effect of metoprolol on myocardial apoptosis after coronary microembolization in rats

BACKGROUND:Coronary microembolization(CME) is a serious complication following percutaneous coronary intervention(PCI) in patients with acute coronary syndromes.The use of metoprolol before PCI can significantly protect ischemic myocardium from myocardial damage,but the function of metoprolol in the treatment of CME is not entirely clear.This study was to explore the effect and significance of metoprolol on myocardial apoptosis and caspase-3 activation after CME in rats.METHODS:Thirty rats were randomly divided into three groups including sham-operation(control group),CME plus saline(CME group),CME plus metoprolol(metoprolol group),10 rats for each group.The CME group was induced by injecting 3 000 polyethylene microspheres(42 urn)into the left ventricle during a 10-second occlusion of the ascending aorta;the control group was injected with physiological saline instead of microembolization ball;the metoprolol or saline group was given three intravenous bolus injections before CME.Echocardiography,TUNEL staining,and Western blotting were used to evaluate cardiac function,proportion of apoptotic cells and activation of caspase-3 respectively at 6 hours after operation.RESULTS:Echocardiography parameters displayed that the metoprolol group improved cardiac function significantly compared with the CME group(PO.05).The myocardial apoptotic rate of the CME group as well as the contents of activated caspase-3 increased significantly(P<0.05),both of which were ameliorated significantly by metoprolol treatment(P<0.05).CONCLUSIONS:This study demonstrates that metoprolol can protect the myocardium during CME in rats by inhibiting apoptosis and improving cardiac function.These results suggest that the inhibition of apoptosis can be a potential therapeutic strategy for the treatment of CME.

Clinical evaluation of Technetium-99m sestamibi myocardial perfusion SPECT in diabetes with suspected coronary artery diseases

Objective:To study the clinical value of Technetium-99m sestamibi myocardial perfusion single photon emission computed tomography(SPECT) in diabetes with suspected coronary artery diseases.Methods:Seventy-eight diabetic patients complicated with cardiac symptoms or electrocardiogram(ECG) abnormalities and suspected coronary heart disease hospitalized in the department of endocrinology from January,2008 to December,2008 were investigated.Technetium-99m sestamibi myocardial perfusion SPECT was performed in all patients.Exercise stress test was done in 35 cases(group A).Adenosine stress test was done in 43 cases(group B).Results:The positive rates in the two groups were 54.29%(19/35) and 53.48%(23/43),respectively.There was no statistic difference between the 2 groups(P>0.05).The abnormality rates in male and female groups were 63.04% and 28.13%,respectively(P<0.01).Eighty-six segments of perfusion abnormality were detected in 38 positive patients.Four segments of fixed defect were found in 4 cases.Conclusion:As non-invasive method,myocardial perfusion SPECT can play an important role in the treatment of diabetes with suspected coronary artery disease.

Albuterol in the treatment of acute respiratory distress syndrome: A meta-analysis of randomized controlled trials

BACKGROUND: This meta-analysis of randomized controlled trials aimed to systematically evaluate the value of albuterol in the treatment of patients with acute respiratory distress syndrome(ARDS).DATA SOURCES: Randomized controlled trials on albuterol treatment of ARDS from its inception to October 2014 were searched systematically. The databases searched included: Pub Med, Ovid EMBASE, Ovid Cochrane, CNKI, WANFANG and VIP. The trials were screened according to the pre-designed inclusion and exclusion criteria. We performed a systematic review and meta-analysis of the randomized controlled trials(RCTs) on albuterol treatment, attempting to improve outcomes, i.e. lowering the 28-day mortality and ventilator-free days.RESULTS: Three RCTs involving 646 patients met the inclusion criteria. There was no significant decrease in the 28-day mortality(risk difference=0.09; P=0.07, P for heterogeneity=0.22, I2=33%). The ventilator-free days and organ failure-free days were significantly lower in the patients who received albuterol(mean difference=–2.20; P<0.001, P for heterogeneity=0.49, I2=0% and mean difference=–1.71, P<0.001, P for heterogeneity=0.60, I2=0%).CONCLUSIONS: Current evidences indicate that treatment with albuterol in the early course of ARDS was not effective in increasing the survival, but significantly decreasing the ventilator-free days and organ failure-free days. Owing to the limited number of included trails, strong recommendations cannot be made.

Patient-Specific Echo-Based Fluid-Structure Interaction Modeling Study of Blood Flow in the Left Ventricle with Infarction and Hypertension

Understanding cardiac blood flow behaviors is of importance for cardiovascular research and clinical assessment of ventricle functions.Patient-specific Echo-based left ventricle(LV)fluid-structure interaction(FSI)models were introduced to perform ventricle mechanical analysis,investigate flow behaviors,and evaluate the impact of myocardial infarction(MI)and hypertension on blood flow in the LV.Echo image data were acquired from 3 patients with consent obtained:one healthy volunteer(P1),one hypertension patient(P2),and one patient who had an inferior and posterior myocardial infarction(P3).The nonlinear Mooney-Rivlin model was used for ventricle tissue with material parameter values chosen to match echo-measure LV volume data.Using the healthy case as baseline,LV with MI had lower peak flow velocity(30%lower at beginejection)and hypertension LV had higher peak flow velocity(16%higher at begin-filling).The vortex area(defined as the area with vorticity>0)for P3 was 19%smaller than that of P1.The vortex area for P2 was 12%smaller than that of P1.At peak of filling,the maximum flow shear stress(FSS)for P2 and P3 were 390%higher and 63%lower than that of P1,respectively.Meanwhile,LV stress and strain of P2 were 41%and 15%higher than those of P1,respectively.LV stress and strain of P3 were 36%and 42%lower than those of P1,respectively.In conclusion,FSI models could provide both flow and structural stress/strain information which would serve as the base for further cardiovascular investigations related to disease initiation,progression,and treatment strategy selections.Large-scale studies are needed to validate our findings.

Heart rate-adjusted PR as a prognostic marker of long-term ventricular arrhythmias and cardiac death in ICD/CRT-D recipients

Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D).Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring.Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph,and the PR/RR was calculated.The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs),and the secondary endpoint was cardiac death.Results During a mean follow-up period of 38.8 ± 10.6 months,197 patients (46%) experienced VAs,and 47 patients (11%) experienced cardiac death.The overall PR interval was 160 ± 40 ms,and the RR interval was 866 ± 124 ms.Based on the receiver operating characteristic curve,a cut-off value of 18.5% for the PR/RR was identified to predict VAs.A PR/RR ≥ 18.5% was associated with an increased risk of VAs [hazard ratio (HR)= 2.243,95% confidence interval (CI)= 1.665–3.022,P < 0.001) and cardiac death (HR = 2.358,95%CI = 1.240–4.483,P = 0.009) in an unadjusted analysis.After adjustment in a multivariate Cox model,the relationship remained significant among PR/RR ≥ 18.5%,VAs (HR = 2.230,95%CI = 1.555–2.825,P < 0.001) and cardiac death (HR = 2.105,95%CI = 1.101–4.025,P = 0.024.Conclusions A PR/RR ≥ 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.

Influence of hydrogen sulfide on zymogen activation of homocysteineinduced matix metalloproteinase-2 in H9C2 cardiocytes

Objective: To observe the influence of different concentrations of homocysteine(Hcy) and hydrogen sulfide(H2S) on the secretion and activation of matix metalloproteinase-2(MMP-2) in cardiocytes so as to search for new ways to fight against myocardial tissue fibrosis. Methods: Cardiocytes H9C2 was cultured in vitro and different concentrations of Hcy and H2 S were added for 6-h and 24-h cultivation. MTT cell proliferation assay was applied to test the activation change of cardiocytes H9C2 after affecting by different concentrations of Hcy and H2 S. ELISA and MTT were employed to detect the expression and enzymatic activity of MMP-2. Results: The H9C2 cell inhibition of activity was more significant with 1 000 μmol/L of Hcy as compared with other concentrations(P<0.001). With 2.5-100.0 μmol/L Hcy and 0.1, 1.0 and 10.0 mmol/L H2 S, the activity of H9C2 did not change significantly(P>0.05). Hcy with concentrations of 10, 50 and 100 μmol/L could increase the quantity of MMP-2 secreted by cardiocytes H9C2, and the interaction strength was concentration-dependent(P<0.05). After interacting with 100 μmol/L of Hcy for 6 h, the zymogen activation effect of MMP-2 was stronger than that of the 2.5-25 μmol/L group(P<0.05). After interacting with Hcy and H2S(1.0 mmol/L) for 6 h and 24 h, the activation effect of MMP-2 was stronger than those interacted with 10, 25, 50 and 100 μmol/L of Hcy(P<0.05). Conclusions: Hcy can increase the production of MMP-2 secreted by H9C2 cell and improve its zymogen activation. Besides, the interaction strength is concentration-dependent; while H2 S can up-regulate the activation of MMP-2 and co-promote the activation of MMP-2 with Hcy as well.

The gender difference of utilization of cardiac implantable electronic device in China： data from Arrhythmia Interventional Therapy Data Registry

BackgroundCardiac 可植入的电子设备(CIED ) 极大地改进病人的幸存和生活质量。然而，关于这些设备的利用和利益有性差别。在这张未来的 CIED 注册表，我们试图在中国从 14 个省在 China.MethodsTwenty 中心在 CIED 利用估价性差别在我们的登记学习被包括。在在 2015 年 1 月和 2016 年 12 月之间的这二十个中心经历了 CIED 培植的所有病人是 8570 个病人全部的 included.ResultsA 在基线队被注册，包括 7203 心律调整器， 664 个可植入的心脏的使用高压脉冲来消减心脏(ICD ) 植入并且 703 心脏的再同步治疗设备(CRT/D ) 。完全， 4117 (48.0%) CIED 病人是女性的，并且超过 59% 心律调整器病人是女性的，但是女人们仅仅说明在这张注册表的三分之一 ICD 或 CRT/D 培植。在心律调整器和 ICD 指示的性之间有重要差别。女性是更可能的由于病了的湾穴症候群(SSS ) 收到了一个心律调整器(63.9% 对 51.0% ， P < 0.001 ) 。收到 ICD 的女病人由于心脏的离子隧道疾病是更可能的(29.2% 对 4.2% ， P < 0.001 ) 。在女病人的双房间的心律调整器的利用的百分比比男性显著地高(85.3% 对 81.1% ， P < 0.001 ) 。但是男病人更多半被接待心脏的再同步治疗有使用高压脉冲来消减心脏的设备比女性(56.5% 对 41.9% ， P = 0.001 ) 。在心律调整器病人，男性是更可能的有结构心疾病(31.3% 对 28.0% ， P = 0.002 ) 。在 ICD 病人，男病人是更可能的有 ischemic 心疾病(48.2% 对 29.2% ， P < 0.001 ) 。女人的吝啬的年龄在 CRT/D 培植的时候比男人旧(P = 0.014 ) 。 Nonischemic 心肌症(70.9%)是在经历了 CRT/D 的治疗的病人的最普通的病原学，不管男性或 female.ConclusionsIn 真实世界的背景，女性确实有不同传染病学， pathophysiology 和许多心脏的节奏混乱的临床的表示什么时候与相比男性，并且所有这些因素可以影响 CIED 培植的利用。但是它另外文化、社会经济的特征可以在这明显的辨别起一个作用的可能性。

Correlation between betatrophin/angiogenin-likeprotein3/lipoprotein lipase pathway and severity of coronary artery disease in Kazakh patients with coronary heart disease

BACKGROUND The results of previous animal experiments and clinical studies have shown that there is a correlation between expression of betatrophin and blood lipid levels.However,there are still differences studies on the correlation and interaction mechanism between betatrophin,angiogenin-likeprotein3(ANGPTL3)and lipoprotein lipase(LPL).In our previous studies,we found an increase in serum ANGPTL3 Levels in Chinese patients with coronary heart disease(CHD).Therefore,we retrospectively studied Kazakh CHD patients.AIM To explore the correlation between the betatrophin/ANGPTL3/LPL pathway and severity of coronary artery disease(CAD)in patients with CHD.METHODS Nondiabetic patients diagnosed with CHD were selected as the case group;79 were of Kazakh descent and 72 were of Han descent.The control groups comprised of 61 Kazakh and 65 Han individuals.The serum levels of betatrophin and LPL were detected by enzyme-linked immunosorbent assay(ELISA),and the double antibody sandwich ELISA was used to detect serum level of ANGPTL3.The levels of triglycerides,total cholesterol,and fasting blood glucose in each group were determined by an automatic biochemical analyzer.At the same time,the clinical baseline data of patients in each group were included.RESULTS Betatrophin,ANGPTL3 and LPL levels of Kazakh patients were significantly higher than those of Han patients(P=0.031,0.038,0.021 respectively).There was a positive correlation between the Gensini score and total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),betatrophin,and LPL in Kazakh patients(r=0.204,0.453,0.352,0.471,and 0.382 respectively),(P=0.043,0.009,0.048,0.001,and P<0.001 respectively).A positive correlation was found between the Gensini score and body mass index(BMI),TC,TG,LDL-C,LPL,betatrophin in Han patients(r=0.438,0.195,0.296,0.357,0.328,and 0.446 respectively),(P=0.044,0.026,0.003,0.20,0.004,and P<0.001).TG and betatrophin were the risk factors of coronary artery disease in Kazakh patients,while BMI and betatrophin were the risk factors in Han patients.CONCLUSION There was a correlation between the betatrophin/ANGPTL3/LPL pathway and severity of CAD in patients with CHD.

The Relationships between Serum Concentration of IGF-I and Left Ventricular Function as well as Coronary Collateral Circulation in Patients with Coronary Artery Disease

Objective To investigate therelationships between serum concentration of insulin -like growth factor - I (IGF-I) and left ventricular function as well as coronary collateral circulation in patients with coronary artery disease (CAD) . Methods In 41 patients with CAD and 15 control subjects without CAD, the concentrations of serum IGF - I were measured using radioimmunoassay. The relationships between the concentration of serum IGF - I and Leaman coronary artery score, Rentrop grade of coronary collateral circulation, left ventricular ejection fraction (LVEF) as well as left ventricular wall motion Cortina score were assessed. Results 1. There was no significant difference in the mean level of serum IGF -I between the CAD group and the control group (107. 92±44.74 ng/ml vs 113.05 ±33. 65 ng/ml, P> 0. 05), but the IGF - I concentrations in the subgroup with collateral circulation were significantly greater than that in the control group (147. 33 ±29. 92 ng/ml vs 113. 05±33. 65 ng/ml, P < 0. 01) or in the subgroup without collateral circulation (147. 33 ±29. 92 ng/ml vs 80. 01±29. 75 ng/ml , P < 0. 01). 2. The serum concentration of IGF -I had no significant correlation to the Leaman coronary artery score. 3. The serum level of IGF -I had significantly positive correlation to both LVEF ( r = 0. 45, P < 0. 001) and the Rentrop grade of coronary collateral circulation ( r = 0. 74, P < 0. 001), and was negatively related to the left ventricular wall motion Cortina score (r = -0. 53, P < 0. 001). 4. The Leaman coronary artery score had no significant correlation to the Rentrop grade of coronary collateral circulation. 5. The Leaman coronary artery score was related to neither the LVEF nor the Cortina score in the whole CAD group. In the subgroup without coronary collateral circulation, however, the Leaman score had significantly negative correlation to LVEF ( r = - 0. 46, P < 0. 05) and positive correlation to the Cortina score (r = 0. 47, P < 0. 05) . Conclusions The serum concentration of IGF -I was associated with both left ventricular function and coronary collateral circulation in patients with CAD. IGF -I may play a role in promoting coronary collateral circulation and in protecting left ventricular function in patients with coronary artery disease.

Computational Modeling of Human Bicuspid Pulmonary Valve Dynamic Deformation in Patients with Tetralogy of Fallot

Pulmonary valve stenosis(PVS)is one common right ventricular outflow tract obstruction problem in patients with tetralogy of Fallot(TOF).Congenital bicuspid pulmonary valve(BPV)is a condition of valvular stenosis,and the occurrence of congenital BPV is often associated with TOF.Dynamic computational models of normal pulmonary root(PR)with tri-leaflet and PR with BPV in patients with TOF were developed to investigate the effect of geometric structure of BPV on valve stress and strain distributions.The pulmonary root geometry included valvular leaflets,sinuses,interleaflet triangles and annulus.Mechanical properties of pulmonary valve leaflet were obtained from biaxial testing of human PV leaflet,and characterized by an anisotropic Mooney-Rivlin model.The complete cardiac cycle was simulated to observe valve leaflet dynamic stress/strain behaviors.Our results indicated that stress/strain distribution patterns of normal tri-leaflet pulmonary valve(TPV)and the BPV were different on valve leaflets when the valve was fully open,but they were similar when valves were completely closed.When the valve was fully open,the BPV maximum stress value on the leaflets was 197.2 kPa,which was 94.3%higher than of the normal TPV value(101.5 kPa).During the valve was fully open,the stress distribution in the interleaflet triangles region of the PR was asymmetric in the BPV model compared with that in the TPV model.The geometric orifice area value in the completely opened position of BPV model was reduced 55.6%from that of the normal PV.Our initial results demonstrated that valve geometrical variations with BPV may be a potential risk factor linked to occurrence of PVS in patients with TOF.Computational models could be a useful tool in identifying possible linkage between valve disease development and biomechanical factors.Large-scale clinical studies are needed to validate these preliminary findings.

Effect of carotid artery stenting surgery combined with nimodipine on cerebral anterior circulation hemodynamics

Objective To evaluate the effect of carotid artery stenting combined with nimodipine on cerebral hemodynamics by comparing and analyzing the change of anterior cerebral blood flow before and after treatment through transcranial Doppler (TCD). Methods Twenty patients with ischemic cerebrovascular disease were detected in blood flow velocity of bilateral middle cerebral arteries (MCA) and anterior cerebral arteries (ACA) and artery pulsatility index with TCD before and two weeks after treatment. Results After treatment, TCD examination showed dynamic changes in blood flow significantly. Ipsilateral MCA flow velocity significantly increased; ipsilateral ACA flow velocity did not change significantly; there was no significant increase in the contralateral MCA flow velocity; flow rate decreased significantly in contralateral ACA. Conclusion Carotid artery stenting combined with nimodipine treatment can cause anterior cerebral hemodynamic changes in ipsilateral hemisphere and significantly improve blood flow.

Optimal programming management of ventricular tachycardia storm in ICD patients

Ventricular tachycardia storm （VTS） is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia （VT） leading to implantable cardioverter defibrillator （ICD） therapy within 24 hours. Patients with VTS have poor outcomes and require immediate medical attention. ICD shocks have been shown to be associated with increased mortality in several studies. Optimal programming in minimization of ICD shocks may decrease mortality. Large controlled trials showed that long detection time and high heart rate detection threshold reduced ICD shock burden without an increase in syncope or death. As a fundamental therapy of ICD, anti- tachycardia pacing （ATP） can terminate most slow VT with a low risk of acceleration. For fast VT, burst pacing is more effective and less likely to result in acceleration than ramp pacing. One algorithm of optimal programming management during a VTS is presented in the review.

Anisotropic Models of Human Pulmonary Root with Bicuspid Pulmonary Valve in Patients with Tetralogy of Fallot: Pulmonary Root Function Assessment and Mechanical Stress Analysis

Background Tetralogy of Fallot(TOF)is the most common cyanotic heart defect,accounting for 10%of all congenital defects.Pulmonary valve stenosis(PVS)is one common right ventricular outflow tract obstruction problem in patients with TOF.Congenital bicuspid pulmonary valve(BPV)is a condition of valvular stenosis,which morphologic feature is the presence of only two pulmonary leaflets instead of the normal tri-leaflet.Congenitally BPV are uncommon and the occurrence is often associated with TOF.Methods The three-dimensional geometric reconstruction of pulmonary root(PR)were based on well-accepted mathematical analytic models with physiological parameters obtained from a typical sample of the pulmonary root used in clinical surgery.The PR geometry included valvular leaflets,sinuses,interleaflet triangles and annulus.The dynamic computational models of normal PR with tri-leaflet and PR with BPV in patients with TOF were developed to investigate the effect of geometric structure of BPV on valve stress and strain distributions and the geometric orifice area.Mechanical properties of pulmonary valve leaflet were obtained from biaxial testing of human pulmonary valve left leaflet,and characterized by an anisotropic Mooney-Rivlin model.The complete cardiac cycle was simulated to observe valve leaflet dynamic stress and strain behaviors.Results Our results indicated that stress/strain distribution patterns of normal tri-leaflet pulmonary valve(TPV)and the BPV were different on valve leaflets when the valve was fully open,but they were similar when valves were completely closed.When the valve was fully open,the BPV maximum stress value on the leaflets was 218.1 kPa,which was 128.0%higher than of the normal TPV value(95.6 kPa),and BPV maximum strain value on the leaflets was 70.7%higher than of the normal TPV.The location of the maximum stress from TPV and BPV were also different,which were found at the bottom of the valve near the leaflet attachment for TPV and the vicinity of cusp of the fusion of two leaflets for BPV,respectively.During the valve was fully open,the stress distribution in the interleaflet triangles region of the PR was more asymmetric in the BPV model compared with that in the normal TPV model,and the largest change on the PR with the geometrical variations in the two models was 39.6%in maximum stress.This stress asymmetry indicates that BPV may be one of the causes of post-stenotic pulmonary artery dilatation and aneurysm in patients with TOF.The cusp of the BPV model showed significant eccentricity during peak systolic period,and its geometric orifice area value in the completely opened position of valve was reduced 57.5%from that of the normal TPV model.Conclusions Our initial results demonstrated that valve geometrical variations with BPV may be a potential risk factor linked to occurrence of PVS in patients with TOF.Computational models could be used as an effective tool to identifying possible linkage between pulmonary valve malformation disease development and biomechanical factors,better design of artificial valves and new surgical procedures without testing those on patients.Large-scale clinical studies are needed to validate these preliminary findings.