Abstract:Cardiorenal syndrome(CRS) has been defined as a state in which therapy to relieve heart failure(HF) symptoms is limited by further worsening renal function. Currently, there is no widely accepted standard for the diagnosis of CRS syndrome. But some researchers have suggested that CRS can be diagnosed when renal function worsens with creatinine elevation＞3-5 mg/L or glomerular filtration rate decrement＞9-15 ml/min. Nowadays, the exact prevalence of CRS remains unclear. Some studies revealed that the incidence of CRS in case of HF reached as high as 30%. The mechanisms behind CRS are complex. Central venous congestion, neuroendocrine hyperactivity, anemia, oxidative stress and renal sympathetic nerve hyperactivity have been demonstrated to be important reasons causing cardiorenal syndrome. The treatment for CRS remains a big challenge. The first principle of the treatment is to correct the reversible risk factors. Stable renal perfusion is also needed by sustaining systolic blood pressure over 80 mmHg or mean blood pressure over 60 mmHg. For those with low cardiac output, nitrates might be helpful. Further, medications with renal toxicity should be withdrawn timely. Diuretics, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, hemofiltration, recombinant human B-type natriuretic peptide can be used as appropriate choice.

Abstract:

Abstract:

Abstract:The cardiorenal syndrome (CRS) is defined as a complex pathophysiological disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other. A new classification of CRS has been proposed with five subtypes that reflect the pathophysiology, the bidirectional nature of heart and kidney interaction and the time-frame. The pathophysiology of the CRS involves interrelated hemodynamic and neurohormonal mechanisms, including the renin-angiotensin- aldosterone system, the sympathetic nervous system, the imbalance between nitric oxide and reactive oxygen species, anemia, inflammation and others such as endothelin and arginine vasopressin system activation. CRS remains a challenge in treatment options. Traditional agents, including diuretics, angiotensin converting enzyme inhibitors/angiotensin receptor blocker, β-blockers and erythropoietin, are chosen to alleviate symptoms. Novel agents, such as adenosine A1 antagonists and vasopressin receptor antagonists, have been evaluated in randomized controlled trials. Renal replacement therapy should be used early if diuretic resistance exists.

Abstract:Hypertension, a major public health problem, is an independent risk factor for heart failure and end stage renal disease. Chronic kidney disease, also a global health problem, brings huge economic burden to society because of its high morbidity and mortality. A large number of studies have indicated that hypertension is the cause, as well as a consequence of kidney disease. Microalbuminuria has been proved to be a marker of hypertensive renal disease in early stage. Tight blood pressure control can reduce proteinuria and delay the progression of renal disease. In this paper, we reviewed the morbidity, risk factors, interaction, and therapy of these two diseases.

Abstract:Objective To observe the relationship between ambulatory arterial stiffness index(AASI) and estimated glomerular filtration rate(eGFR) in elderly patients with essential hypertension, and to explore the roles of arterial stiffness expressed by AASI in evaluating renal function decline in elderly patients with essential hypertension. Methods Totally 218 elderly hypertensive patients with normal serum creatinine level who underwent 24 hours ambulatory blood pressure monitoring were divided into two groups according to AASI (≤0.55 or ＞0.55). The eGFR values were compared between the two groups. The correlations of eGFR with AASI, age, average systolic blood pressure, average diastolic blood pressure and serum creatinine were determined by Pearson correlation and multiple linear regression analysis. Results Compared with AASI≤0.55 group, the eGFR level was significantly decreased in AASI＞0.55 group( P＜0.001). Pearson correlation analysis showed that eGFR was negatively correlated with AASI（r=－0.624, P＜0.001）. After adjustment for age, average systolic blood pressure, average diastolic blood pressure, serum creatinine, there was still correlation between eGFR and AASI (r=－0.343, P＜0.001). Stepwise multiple regression analysis showed that eGFR values were independently associated with serum creatinine levels and AASI (standard partial regression coefficient: －0.770,－0.240, P＜0.001). Conclusion The eGFR is negatively correlated with AASI and the increase of AASI is one independent risk factor of renal function decline in elderly patients with essential hypertension.

Abstract:Objective Resting heart rate(RHR) symbolizes the sympathetic nerve activity and is correlated with target organ damage in hypertensive subjects. This study aimed to investigate the relation between RHR and the parameters of renal function and other risk factors in elderly hypertensive patients. Methods Totally 419 in-hospital patients from September, 2006 to February, 2011 were enrolled, including 289 males and 130 females, with age ranging from 80～94 years, averaged (80.8±6.1) years. The subjects were divided into three groups according to RHR: group A, RHR＜70 beats/min; group B, RHR 70～80 beats/min; group C, RHR＞80 beats/min. The blood pressure, body mass index(BMI), smoking index(SI) and glycosylated hemoglobin A(HbAc1) were determined. Renal function were evaluated by glomerular filtration rate(GFR) which was determined by Single Photon Emission Computed Tomography(SPECT) , serum creatinine (SCr), creatinine clearance(CCr) and micro albumin uria (MAU) respectively. The relation between RHR and these parameters was identified by simple correlation analysis. Results The RHR was significantly different between the three groups [(63.4±7.2), (74.1±4.0), and (84.3±8.8) beats/min in group A, B and C respectively, P＜0.05], as well as SI [(321±73), (378±99), and (463±79) (cigarettes?year)in group A, B and C respectively, P＜0.05] and SBP [(140.2±10.1), (146.3±8.1) and (149.8±9.6)mmHg in group A, B and C respectively, P＜0.05]. No significant difference was found in age, hypertension course, diabetes and HbAc1 level among the three groups. BMI and DBP were higher in group C than in group A and B[BMI:(23.7±3.0), (23.1±5.4), (25.9±5.9)kg/m2; DBP: (64.6±9.5), (65.2±9.1), (71.3±12.4)mmHg in group A, B, C respectively, P＜0.05]. Significant difference in GFR[(84.5±11.0), (78.2±10.6) and (67.6±10.1)ml/min in group A, B and C respectively, P＜0.05], SCr[(87.3±23.1), (90.0±22.3) and (104.0±19.7)μmol/L in group A, B and C respectively, P＜0.05], CCr[(73.9±16.8), (68.0±18.3) and (62.5±20.1)ml/min in group A, B and C respectively, P＜0.05] and MAU[(51.4±11.3), (56.0±17.3) and (90.9±22.8)mg/L in group A, B and C respectively, P＜0.05] was found among the three groups. RHR was correlated with SBP(r=0.264, P=0.002),GFR(r= ?0.330, P=0.011), CCr (r= ?0.463, P＜0.01) and MAU(r=0.208, P=0.029). Conclusion For elderly hypertensive patients, RHR is correlated with impaired renal function, suggesting that RHR could be regarded as the predictor in renal dysfunction of elderly hypertensive patients.

Abstract:Objective To explore the safety and efficacy of hemodialysis treatment during percutaneous interventional(PCI) therapy for coronary artery disease patients complicated by chronic renal insufficiency. Methods Patients with coronary heart disease combined with chronic renal dysfunction were selected. For all patients, hydration and alkalization were performed by giving continuous oral administration of sodium bicarbonate tablets 1g(three times daily, for 3 days) and intravenous infusion of sodium chloride 1000～1500ml within 3-12 hours before PCI operation, 3～10ml/(kg?h). After PCI treatment, indwelling of femoral artery puncture sheath tube was kept and patients were transferred to the dialysis room immediately and underwent 4 hours of dialysis treatment to protect renal function. Changes in renal function were analyzed. Results All patients underwent PCI treatment successfully. No obvious complication or stent thrombosis was detected within one month after PCI. Among 58 cases, 56 showed no significant increase in plasma creatinine levels compared with those before operation; one patient showed increased plasma creatinine level; one patient required permanent dialysis. Conclusion Interventional therapy is not an absolute contraindication for patients with coronary heart disease combined with renal dysfunction. Interventional treatment can be performed safely when the renal function of patients are protected adequately.

Abstract:Objective To investigate the cardiorenal protective effects of statins, and the pathophysiologic mechanism between cardiac insufficiency and renal insufficiency was also discussed. Methods Twenty-four Wistar rats were divided into three groups: blank control group (n=4), statins group(n=10), and isoproterenal(ISO) group(n=10). Rats in blank control group and ISO group received normal saline (2ml/d) by intragastric administration. Rats in statins group received rosuvastatin [4mg/(kg?d)] by intragastric administration. Two weeks later, rats in ISO group and statins group received isoproterenol injection twice [85 mg/(kg?d)] intraperitoneally, while rats in blank control group received normal saline (2ml/d). After 15 weeks, the heart function of the rats was evaluated by cardiac ultrasound; a series of blood detections on renin angiotensin aldosterone system (RAAS), antioxidase, and inflammation factors were performed; additionally, heart and kidney tissues were also examined histopathologically to analyze the organ damage. Results Compared with ISO group, rats in statins group exhibited a signi?cant improvement in heart function [LVEF: (73.18±7.89)% vs (58.58±6.41)%, P＜0.05] and reduction in serum AngⅡ level [(928.50±536.87) vs (1886.80±718.89) pg/ml, P＜0.05]. In addition, rats in statins group showed a decrease in serum malondialdehyde [(10.10±0.74) vs (12.36±2.11) nmol/ml, P=0.073], and interleukin-6 [(44.46±24.57) vs (76.31±20.79) ng/ml, P=0.058] levels compared with rats in ISO group, but not reaching statistical significance. Histopathological examination showed significant protective effect of rosuvastatin on heart and kidney. Conclusion Rosuvastatin could protect cardiac and renal structure and function in ISO-induced cardiac insufficiency rats, possibly through RAAS inhibition and anti-oxidation or anti-inflammation.

Abstract:Objective To explore the correlative factors for anemia and the correlation of kidney function with anemia in the elderly through investigating the influence of glomerular filtration rate(GFR) and erythropoietin(EPO) on anemia incidence. Methods A total of 200 elderly patients(≥60 years) were enrolled and divided into three groups according to estimated GFR(eGFR) with Cockcroft-Gault equation: group A(62 cases), eGFR＞50 ml/(min?1.73m2); group B(114 cases), 30 ml/(min?1.73m2)≤eGFR≤50 ml/(min?1.73m2); group C(24 cases), eGFR＜30 ml/(min?1.73m2). Besides, 30 healthy adults were selected as control group. In addition, 66 elderly patients with anemia were divided into group AA, AB and AC according to eGFR (the same as above standard). Hemoglobin(Hb), serum creatinine(Scr) and serum EPO were measured. Results Anemia incidence of the elderly increased with decline of renal function(P＜0.05). Log EPO was negatively correlated with Hb in control group(r2 = 0.219, P = 0.009) and group A(r2 = 0.065, P = 0.045), but positively correlated with Hb in group C(r2 = 0.294, P = 0.006). There was no correlation between LogEPO and Hb in group B. In the elderly with anemia, EPO level decreased with decline of renal function. Compared with group AA, LogEPO was significantly reduced in group AC(P = 0.042). Conclusion In the elderly with moderate decline of renal function, prevalence of anemia increases significantly. EPO shows compensatory increase with age, which is weakened with decrease of eGFR, and low EPO may be a main reason for anemia in the elderly with severe reduced renal function.

Abstract:

Abstract:Objective To analyze the possible factors influencing serum albumin in the elderly. Methods A total of 267 elderly individuals (≥60 years) without serious disease were offered a clinical evaluation with physical examination. General data, such as weight, past medical history, residential area(urban or rural), vocation, diet, daily intake, marriage, sleep and mental state were recorded. Meanwhile, serum albumin, total protein, alanine aminotransferase, and serum creatinine were assessed. The subjects were grouped into categories according to different factors. Results Serum albumin was significantly lower in the oldest old group than in normal elderly group[(35.6±3.4) vs (38.2±3.2)g/L, P＜0.01], in male group than in female group[(36.4±3.5 ) vs (38.2±3.2)g/L, P＜0.01], in vegetarian diet group than in meat-based diet group[(34.8±2.1) vs (37.6±3.5)g/L, P＜0.01], in low intake group than in normal intake group[(35.4±3.6) vs (37.7±3.3)g/L, P＜0.01], in individuals who live alone than in those who live together with a partner[(35.6±3.4 )g/L vs (37.9±3.3 )g/L, P＜0.01], in insomnia group than in good sleep group[(36.0±3.4) vs (38.2±3.2)g/L, P＜0.01], in anxiety or depression group than in good mental state group[(35.7±3.8) vs (37.4±3.4)g/L, P＜0.01]. No significant difference was found between urban group and rural group, as well as between mental workers and physical workers. Linear regression analysis showed that serum albumin was negatively correlated with age(r =－0.196, P＜0.01), positively correlated with weight(r = 0.133, P＜0.01) and total protein (r =0.282, P＜0.01), but not correlated with alanine aminotransferase and serum creatinine. Conclusion Many factors, including sex, age, diet, daily intake, marriage state, sleep and mental state, may influence serum albumin in the elderly, which decreases with age and changes in parallel with weight and total protein.

Abstract:Objective To compare the different characteristics of adaptive support ventilation(ASV) and synchronized intermittent mandatory ventilation-pressure support ventilation(SIMV-PSV) mode in weaning patients after coronary artery bypass grafting and seek a more suitable weaning mode. Methods Prospective study enrolling 50 patients who received coronary artery bypass grafting from January 2007 to June 2010 was performed. After cardiac surgery, the patients were transferred to ICU and divided into ASV group and SIMV-PSV group randomly. Respiratory weaning progressed through 3 phases following the standard procedure and the patients were extubated if 3 phases all accorded with weaning condition. Duration of intubation, duration of mechanical ventilation, success rate of fast-track extubation, condition of breathing mechanics and hemodynamics, ventilator alarms, and ventilator settings manipulations before extubation were compared between the two groups. Results Forty-five patients including 22 patients in ASV group and 23 patients in SIMV-PSV group completed the study. Compared with SIMV-PSV group, parameters in ASV group, such as duration of mechanical ventilation[(213.9±65.4) vs (309.2±71.2)min], duration of intubation[(244.5±72.9) vs (338.3±85.6)min], success rate of fast-track extubation(90.9% vs 60.9%), ventilator alarms[(2.2±1.8) vs (4.2±2.1)times/min], ventilator settings manipulations[(4.6±2.0) vs (9.3±4.3)times/min] were significantly different(P＜0.05). As for condition of breathing mechanics, mean airway pressure in ASV group was significantly lower than that in SIMV-PSV group[(7.5±1.1) vs (11.6±1.4)cmH2O, P＜0.05] and pulmonary dynamic compliance in ASV group was better than that in SIMV-PSV group[(65.3±12.3) vs (50.4±11.8)ml/cmH2O, P＜0.05]. There was no significant difference in hemodynamics and blood gas analysis between the two groups (P＞0.05). Conclusion ASV weaning mode is safe and effective, which could accelerate the extubation and simplify the manipulation.

Abstract:Objective To determine the role of plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) in evaluating the therapeutic effects on acutely decompensated heart failure by analyzing the correlation of non-invasive function parameters, including NT-proBNP, left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDd), with invasive hemodynamic parameters. Methods Totally 32 acutely decompensated chronic heart failure patients with NYHA Ⅲ～Ⅳ, LVEF＜40%, and pulmonary capillary wedge pressure(PCWP)≥13 mmHg, were enrolled. NT-proBNP, LVEF and LVEDd were detected within 8 hours before implanting Swan-Ganz catheter. Mean pulmonary arterial pressure(MPAP), PCWP, systemic vascular resistance index(SVRI) and cardiac index(CI) were recorded repeatedly for three times in the process of Swan-Ganz catheter performance. And the mean values were obtained. Linear correlation analysis was performed to determine the association of NT-proBNP, LVEF and LVEDd with invasive hemodynamic parameters. Results LVEF and LVEDd were not correlated with invasive hemodynamic parameters(CI and PCWP). NT-proBNP was correlated with CI significantly(r = ?0.356, P＜0.05) instead of PCWP. The invasive hemodynamic parameters, including MPAP, PCWP, and SVRI were all correlated with CI(r = ?0.358, ?0.309 and ?0.576 respectively, P＜0.05). MPAP was correlated with PCWP(r = ?0.822, P＜0.05). No correlation was found between the other invasive heart function parameters(P＞0.05). Conclusions For the acutely decompensated heart failure patients, NT-proBNP is correlated with CI closely. NT-proBNP could play an important role in monitoring the hemodynamics.

Abstract:Objective To analyze the clinical features and diagnosis methods of 75 cases of bronchioloalveolar carcinoma (BAC) confirmed pathologically. Methods A total of 75 BAC cases from January, 2001 to June, 2010 were retrospectively analyzed. Results Among all 75 cases, the ratio of male and female was 1:1.34; the mean age was 56.5 years; the smoking patients accounted for 12%. All 75 patients had chest CT scanning. Among which, 58 patients displayed solitary tubercle, 8 patients widespread tubercles, and 9 patients infiltrating inflammation. Transthoracic biopsy guided by CT or ultrasound were performed in 26 patients, and 22 patients got definite diagnosis of BAC. Nine patients underwent bronchofibroscopy and only one got definite diagnosis. Postoperative biopsy was performed in 52 cases to get the definite diagnosis of BAC. Conclusion The clinical features of BAC are different from other lung cancers. CT scan may be beneficial in diagnosis of this disease. Transthoracic biopsy can elevate diagnosis accuracy of BAC.

Abstract:Objective To observe the effects of exogenous testosterone replacement and androgen receptor block agent administration on the expression of senescence-associated-β-galactosidase(SA-β-Gal), and to determine the relationship between androgen and myocardial senescence. Methods Forty male Wistar rats were randomly divided into castrated group, testosterone group (castrated＋physiological dose of testosterone), flutamide group (castrated＋physiological dose of testosterone+flutamide) and sham group, with 10 in each group. After 8 weeks, blood testosterone concentration was measured; myocardium tissues were examined for histomorphology by HE staining; activity of SA-β-Gal was determined immunohistochemically. Results Compared with sham operation group, testosterone concentration was almost three times higher than that in flutamide group (P＜0.01). The activity of SA-β-Gal was obviously enhanced in castrated group than in sham group[(2.00±0.86) vs (1.15±0.67), P＜0.01]. Compared with castrated group, the activity of SA-β-Gal was significantly weakened in testosterone group[(0.90±0.79), P＜0.01]. Compared with testosterone group, the activity of SA-β-Gal was enhanced in flutamide group[(2.05±0.76), P＜0.01]. There was no statistical difference in the activity of SA-β-Gal between testosterone group and sham group（P=0.309）. Conclusions Androgen deficiency may influence the activity of SA-β-Gal in the heart of male rats. It suggests that myocardial senescence is possibly associated with androgen levels.

Abstract:Objective To investigate the role of matrix metalloproteinase-9(MMP-9) in the formation of isolated systolic hypertension so as to provide a new model of isolated systolic hypertension. Methods Twenty 8-week old male Wistar rats were randomly divided into the model group (n=10) and control group(n=10). To induce large artery calcification, rats were treated with warfarin and vitamin K1. Eight weeks later, blood pressure and left ventricular pressure were measured by right carotid arterial cannulation. The segments from each aorta were processed for histological analysis by Von Kossa methed. Aortic calcium contents were calculated in each group with atom-spectrum. Elastic fiber structure in aorta was analyzed by elastic fiber staining. MMP-9 expression was determined by immunohistochemistry and Western blot. Results Compared with control group, blood pressures were significantly higher in model group[systolic blood pressure: (151±9) vs (113±7)mmHg, P＜0.01; diastolic blood pressure: (122±10) vs (98±8)mmHg, P＜0.05]. The mean left ventricular pressure was not significantly different between the two groups. In model group, the blood pressure fluctuation was associated with morphological change of the aorta, such as extensive arterial medial elastocalcinosis. Compared with control group, calcium content in aorta was significantly higher in model group [(17.9±1.8) vs (5.8±0.6)mg/g, P＜0.01]; the elastic lamellae was flatten and lost natural waviness. Western blot analysis showed that MMP-9 protein expression level was significantly higher in model group than in control group. Conclusion Chronic treatment with warfarin and vitamin K1 produce a satisfactory model of isolated systolic hypertension which is identical to the disorder in humans. The elevated expression of MMP-9 enhances the elastin degeneration and calcification of the aortic elastic fibers and plays a role in the formation of isolated systolic hypertension.

Abstract:

Abstract:Left heart disease (LHD) is one of the most common causes of heart failure. Pulmonary hypertension (PH) is a common hemodynamic finding in patients with LHD and is usually associated with increased morbidity and mortality. LHD-assoicated PH is one of the most common types. Doppler echocardiography remains the most useful noninvasive tool for assessing the presence of PH in patients with LHD, and for diagnosis and assessment of LHD. Typical hemodynamic finding in LHD-associated PH is pre-capillary PH. Hemodynamic parameters, including pulmonary capillary wedge pressure, pulmonary artery pressure, pulmonary vascular resistance and transpulmonary pressure gradient (for example mPAP–mPCWP), are all valuable in diagnosis, differential diagnosis, assessment, and effective treatment of LHD-associated PH. Most importantly, the underlying cause of LHD should be treated firstly. Drugs with proven efficacy in pulmonary arterial hypertension are being increasingly used in LHD-associated PH, despite the virtual absence of supporting evidence from clinical trials. LHD-associated PH may be the hot and difficult point in the future researches on PH, as well as heart failure.

Abstract:Establishment of aging animal model is an effective way to study the aging process of human being. It has been a focus to establish different aging models for research of aging and anti-aging agents according to the physiological characteristics and natural attributes of various animals. Compared with other aging models, including naturally aging model, ozone induced aging model, thymus removed aging model, and aging SAMP model, D-galactosis induced aging model has been widely used because of its easy feasibility, low lost, and stable performance. In this paper, regarding its application and development, we reviewed the D-galactosis induced aging models from the following aspects: the mechanism and the dosage of the D-galactose to induce aging, the specific protocols, and the evaluation for successful establishment. In addition, we summarized some indexes to assess aging, such as behavioral, biochemical, morphological and molecular biological indices. In summary, subcutaneous injection of 120～125mg/(kg?d) of D-galactose once per day for 6 to 8 weeks is a reliable and stable way to establish the aging model.

Abstract: