Abstract:Objective To investigate the correlation of left atrial low-voltage zones (LVZs) with atrial fibrillation (AF) recurrence after pulmonary vein (PV) antrum isolation (PVAI) in paroxysmal AF patients. Methods A total of 168 consecutive patients [92 males and 76 females, with age of (62±11) years] who underwent PVAI for treating AF in our department were enrolled in this study. High density (≥100 points) left atrial voltage maps were reconstructed during sinus rhythm using CARTO 3 system. LVZs were defined as areas with bipolar peak-to-peak voltage amplitudes ＜0.5mV. In 20min after PVAI, all patients were given intravenous injection of isoproterenol and adenosine triphosphate (ATP, 0.2 mg/kg) in an attempt to unmask PV reconnection and AF triggered by non-PV foci. If PV reconnection and non-PV foci were elicited, additional ablation was carried out till provocative test became negative. Results Voltage maps revealed LVZs in 42 patients (25%) but not in the other 126 patients (75%). The LVZs were distributed on the anterior wall in 22 patients (22/42, 52.4%), and correlated with female and larger left atrial diameter. PVAI was completed in all these patients. During (23±12) months of follow-up, 14 patients (14/42, 33.3%) with LVZs and 21 (21/126, 16.7%) without LVZs had AF recurrences (P＝0.028). Conclusion LVZs in paroxysmal AF patients increase the recurrence after PVAI, which might be correlated with gender and left artial diameter.

Abstract:

Abstract:

Abstract:Objective To determine the impact of age on the sinus node function in the patients with prolonged sinus pauses after termination of paroxysmal atrial fibrillation (PAF). Methods A total of 358 consecutive PAF patients with age of (63±11) years (220 males and 138 females) who received radiofrequeney ablation in our department from May 2011 to May 2013 were enrolled in this study. They were divided into 2 groups: older group (n＝181, ≥65 years old) and non-older group (n＝177, ＜65 years old). The prevalence of prolonged sinus pauses before the ablation and the rate of sinus node functional restoration after procedure were compared between the 2 groups. Results The older patients tended to have higher prevalence of prolonged sinus pauses after termination of PAF (indicating sinus node dysfunction) than non-older patients (14.4% vs 5.6%, P＜0.01). After the follow-up of (15.0±8.7) months, the prevalence of sinus node dysfunction was significantly lower than before catheter ablation in non-older group (1.1% vs 5.6%, P＜0.05). But there was only a decreasing trend in older patients (9.4% vs 14.4%, P＞0.05). The rate of sinus node functional restoration was significantly lower in older patients than in non-older ones, (34.6% vs 80.0%, P＜0.05). Conclusion Age plays an important role in the evaluation of sinus node function in patients with prolonged sinus pauses after termination of PAF. For the elderly patients with PAF, radiofrequency ablation exerts no obvious effect on sinus node function, and permanent pacemaker implantation is recommended in this situation.

Abstract:Objective To determine the value of cardiac failure, hypertension, age, diabetes and stroke 2 (CHADS2) and modified CHADS score to predict the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation. Methods A total of 93 consecutive patients with nonvalvular AF who received catheter ablation in our department from July 2010 to March 2012 were enrolled in this study. They were all followed up for at least 12 months. Electrocardiography or 24-hour Holter monitoring was conducted in these patients in 1, 3, 6, 9, and 12 months after ablation. They were divided into AF recurrence group (n＝40) and AF recurrence-free group (n＝53) according to clinical manifestations and electrocardiographic results. Univariate and multivariate analyses were conducted to find which variable was related with the risk of AF recurrence. Results There were 35 cases (37.65%) of persistent AF out of 93 AF patients, and 40 of them (43.01%) had AF recurrence in 12 months after ablation. Univariate analysis revealed that average age (P＜0.01), age＞70 years (P＜0.05), medical history (P＜0.05), type of AF (P＜0.01), left atrial diameter (LAD, P＜0.001), left ventricular ejection fraction (P＜0.05), hematocrit (P＜0.05), accompanied with congestive heart failure (P＜0.05), hypertension (P＜0.01), diabetes (P＜0.05), prior stroke or transient cerebral ischemic attack (P＜0.05), post-operative administration of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker (ACEI/ARB, P＜0.01) or class Ⅲ antiarrhythmic drugs (P＜0.05),` and CHADS2 score ≥1 (P＜0.001) were significantly related with the outcome of nonvalvular AF after ablation. Logistic analysis showed that medical history (OR＝1.16, P＝0.020), LAD (OR＝1.17, P＝0.025), type of AF (OR＝3.34, P＝0.050), and CHADS2 score≥1 (OR＝5.93, P＝0.019) were independent predictors of AF recurrence after ablation. CHADS2 score ≥2 (OR＝5.42, P＝0.028), modified CHADS score ≥1 (OR＝6.64, P＝0.015) and modified CHADS score ≥2 (OR＝7.32, P＝0.002) were also the independent risk factors of recurrence. Cut-off analysis showed that both CHADS2 score and modified CHADS score ≥1 showed the highest predictive value for AF recurrence. There was no significant difference in the sensitivity, speci?city, area under the receiver’s operating characteristic (AUC) curve for the 2 scores both ≥1 [0.775 vs 0.800, 0.358 vs 0.377, 0.708(95%CI 0.601-0.806) vs 0.711(95%CI 0.605-0.818), all P＞0.05]. Conclusion Medical history, LAD, type of AF, CHADS2 score ≥1, CHADS2 score ≥2, modified CHADS score ≥1, and modified CHADS score ≥2 are independent predictors of the recurrence of AF after ablation. And the modified CHADS score has similar value as CHADS2 score in the predicton.

Abstract:Objective To determine the safety and availability of anticoagulation of low-intensity warfarin therapy in atrial fibrillation (AF) patients with high risk of stroke and bleeding applying stroke risk score (CHA2DS2-VASc) and bleeding risk score (HAS-BLED) (CHA2DS2-VASc≥1 and HAS-BLED≥3) proposed by 2010 European Society of Cardiology Guideline. Methods A total of 99 AF patients who had the stroke risk scoring CHA2DS2-VASc≥1 and HAS-BLED score≥3 admitted in our hospital from January 2011 to January 2012 were selected randomly, and then divided into 2 groups. One group was treated by a standard intensity warfarin therapy of 2.0＜International Normalized Ratio (INR)≤3.0, and the other group was given a low-intensity warfarin therapy (1.6≤INR≤2.0). The incidence of stroke and bleeding events of the two groups were compared. Results Chi-square test indicated that there was no statistical difference in the incidence of stroke and bleeding between these 2 groups (P＞0.05). The incidence of bleeding was significantly higher in standard-intensity Warfarin group than in low-intensity Warfarin group (P＜0.05). Conclusion AF patients with high bleeding risk (CHA2DS2-VASc≥1 and HAS-BLED score≥3) should be treated by low-intensity warfarin anticoagulation. The therapy is safe and reliable, with advantages of suppressing thrombosis and embolism events and not increasing serious hemorrhage.

Abstract:The cardiac autonomic nervous system (ANS) which consists of sympathetic and vagal (parasympathetic) nerves plays an important role in the initiation and maintenance of atrial fibrillation (AF). Catheter ablation focusing on atrial ganglionated plexus (GP) has become the first-line or adjuvant therapeutic strategy for AF. However, there is of growing concern about the nervous and atrial remodeling induced by GP ablation.

Abstract:Objective To investigate the feature of age-of-onset of maternally inherited essential hypertension (MIEH) and the relative risk factors. Methods Two hypertensive pedigrees with the characteristics of MIEH [pedigree A (n＝104) and pedigree B (n＝19)] and individual hypertensive cases (n＝154) were subjected in this study. Their demographic information and clinical data were collected. The age-of-onset, hypertension-associated environment, clinical risk factors and biochemical indices of MIEH (n＝36), non-MIEH (n＝118) patients and normal controls (n＝36) were compared. Results Among the 14 MIEH patients from the pedigree A, the age-of-onset was (62.0±6.2) years in generation Ⅱ (n＝4), (46.3±5.8) years in generation Ⅲ (n＝6), and (23.3±2.9) years in generation Ⅳ (n＝4). Among the 6 MIEH patients from the pedigree B, the age-of-onset was (58.0±0.0) years in generation Ⅰ (n＝1), (48.3±7.6) years in generation Ⅱ (n＝3), and (37.5±0.7) years in generation Ⅲ (n＝2). Among the individual hypertensive cases, the average age-of-onset of hypertension was lower in MIEH patients than in non-MIEH ones (P＜0.01). There were significant differences in body mass index (P＜0.05), waist to hip ratio (P＜0.05), alcohol intaking (P＜0.05) and creatinine level (P＜0.01) between MIEH and healthy volunteers. Conclusion A progressively early age-of-onset by generation is observed as the characteristics of MIEH. Hereditary factors, probably combining with the clinical risk factors, participate in the early onset of and progress in MIEH.

Abstract:Objective To investigate the event-related potentials (ERP), P300, mismatch negativity (MMN), and contingent negative variation (CNV) in the elderly patients with cognitive impairment, including Alzheimer’s disease (AD) and mild cognitive impairment (MCI), to evaluate the diagnostic value of the 3 ERP in patients with MCI. Methods A total of 80 cognitive impairment in- and out-patients with age over 60 years in our department from February 2011 to March 2013 were enrolled in this study, and they were divided into mild AD group (n＝40) and MCI group (n＝40). Another 40 individuals with normal cognition served as normal control. Peak latencies (PL) and amplitudes (Amp) of the ERP, including P300, MMN, CNVM1, and CNVM2 were measured. Results Compared with the NC group, the PL of ERP were significantly delayed in the AD group (P＜0.05). The PL of P300 [(380.94±37.55)ms] and MMN [(188.63±31.63)ms] in the MCI group were longer than those of the NC group [(342.88±41.72) vs (137.48±28.69)ms; P＜0.05]. However, significant difference was not found in PL of CNVM1 and CNVM2 between MCI group and NC group (P＞0.05). Compared with the NC group, the Amp of the three ERP in the AD group were significantly shorter (P＜0.05). The Amp of MMN and CNVM2 in the MCI group were shorter than those in the NC group (P＜0.05). There was no significant difference in the Amp of the 3 ERP between the AD and MCI groups (P＞0.05). Conclusion P300, MMN and CNV (CNVM1 and CNVM2) are of value in the diagnosis of MCI. P300 and MMN are superior to CNV in distinguishing MCI from normal cognitive function.

Abstract:Objective To investigate the changes of serum adiponectin (APN) level in the elderly patients with pulmonary infection and its relationship with C-reactive protein (CRP), in order to provide basis for clinical diagnosis and disease monitoring for these elderly patients. Methods A total of 70 elderly patients with pulmonary infection admitted in our hospital from January 2012 to June 2013 were enrolled in this study. They were divided into severe pulmonary infection group (n=30) and mild pulmonary infection group (n＝40). Another 40 elderly receiving physical examination in the same period served as controls. ELISA and immune turbidimetry were used to detect the serum levels of APN and CRP respectively. Results The serum levels of APN were significantly lower in the mild and severe pulmonary infection groups than in the controls [(6.79±1.87) and (4.89±1.13) vs (8.89±1.93)mg/L; P＜0.05], but that of CRP was significantly increased [(13.87±2.72) and (25.73±5.77) vs (1.69±1.12)mg/L; P＜0.05]. A negative correlation was found between the serum levels of CRP and APN in the elderly patients with pulmonary infection (r＝-0.350; P＜0.05). Logistic regression analysis showed that APN (OR＝0.350, 95% CI 0.225?0.544; P＜0.05), fasting blood glucose (OR＝3.939, 95% CI 1.066?14.552; P＜0.05), and age (OR＝0.870, 95% CI 0.781?0.969; P＜0.05) were correlated with pulmonary infection in the elderly. Conclusion Serum level of APN is decreased significantly in the elderly patients with pulmonary infection. It may be a new anti-inflammatory factor, and can be used as a new marker for diagnosis and disease monitoring of pulmonary infection in the elderly.

Abstract:Objective To investigate the ultrasound image features of ischemic bowel disease(IBD) in the elderly and evaluate their significance in clinical practice. Methods Transabdominal ultrasonography was performed in 23 elderly out- and in-patients who were admitted to our hospital due to acute abdominal pain and hematochezia from October 2007 to October 2012. The ultrasound images were analyzed along with clinical manifestations and endoscopic findings. Results Diagnosis of IBD was confirmed in all cases by endoscopy and clinical manifestations. While, transabdominal ultrasonography established the diagnosis with an accuracy of 82.6% (19/23). Ischemic lesions were identified in the left side of colon in 12 patients (52.2%), on the descending colon in 5 patients (21.7%), on the sigmoid colon in 3 patients (13.0%), and on the splenic flexure colon in 3 patients (13.0%). The thickness of colon wall was increased to 0.61 to 1.91cm. The length of involvement part ranged form 10 to 19cm. The involved colon was symmetrically and circumferentially thickened, and the normal structure of colon wall became unclear or disappeared, as irregular hypoechoic areas in the ultrasound images. The involved colon became slightly narrow in cavity, resulting in slowed or disappeared peristalsis. There was a little fluid sonolucent area in 8 patients, and swelled lymph nodes (＞0.6cm) in the retroperitoneal area in 9 patients. There were 12 patients without obvious blood flow signals, and 11 patients with only sparsely dotty or short strip-like blood flow signals. Conclusion Transabdominal ultrasonography is beneficial to the early diagnosis of IBD. It clarifies the nature, location, and area of the lesions when combined with endoscopy, and has instructive value for clinical treatment.

Abstract:Objective To evaluate the efficacy and safety of 140W greenlight laser high performance system (HPS) for photoselective vaporization of prostate (PVP) procedure in the treatment of lower urinary tract obstruction secondary to prostate cancer. Methods A total of 65 senile prostate cancer patients suffering from lower urinary tract obstruction who were admitted in our department and treated with greenlight laser HPS from August 2009 to February 2012 were enrolled in this study. Their operation manipulation time, peri-operative bleeding, post-operative catheterization time, complications, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and the change in prostate volume before and after treatment were recorded. Results All procedures were completed successfully in the cohort. The operation time ranged from 50 to 110 (68.9±23.9)min, the peri-operative bleeding amount from 50 to 140 (74.9±22.4)ml, and hospitalization time from 5 to 7d. No permanent urinary incontinence was found. Qmax was increased from (4.98±2.15)ml/s to (15.31±3.36)ml/s at 1 month after operation, the volume of the prostate was decreased from (72.3±13.9)g to (35.4±6.8)g, and the IPSS score was decreased from (22.15±3.41) to (6.02±2.01). Significant difference was found in all above indices before and after surgery (P＜0.01). Conclusion Greenlight laser HPS PVP procedure is a better approach for lower urinary tract obstruction secondary to prostate cancer because of its small amount of blood loss, rapid postoperative recovery and lower incidence of complications.

Abstract:Objective To determine the prognostic factors in patients with heart failure (HF). Methods Clinical data of 556 HF patients admitted in our department from January 2007 to December 2010 were collected and retrospectively analyzed. All patients were followed up through telephone calls to know their final outcome. Then, they were classified into 2 groups: survival group (n＝282) and death group (n＝231). The 2 groups were compared in their clinical indices. Cox proportional hazards model was used to evaluate the mortality hazard ratio of different factors. Results A total of 513 HF patients were finally enrolled, and the other 35 were lost of follow-up. The mortality rate was 45%(231/513) in this group. Fasting blood glucose, total bilirubin, direct bilirubin, and creatinine at hospital admission were significantly higher in the dead group than in the survival group (P＜0.05). While, hemoglobin, sodium ion concentration, calcium ion concentration, total cholesterol, left ventricular ejection fraction (LVEF), and fractional shortening at the admission were significantly lower in the dead group than in the survival group (P＜0.05). In multivariable analysis, age (RR＝1.030), hospital stay (RR＝1.014), LVEF (RR＝0.988), complications (RR＝1.102), fasting blood glucose (RR＝1.060), and total bilirubin (RR＝1.004) were determined as the independent risk factors of mortality (P＜0.05). Conclusion Heart failure is of poor prognosis and high mortality rate. Abnormalities in LVEF, fasting blood glucose and total bilirubin are main factors influencing the prognosis of HF.

Abstract:Objective To investigate the in-hospital mortality and risk factors among the elderly acute myocardial infarction (AMI) patients at different ages. Methods The clinical data of 883 elderly AMI patients hospitalized in our department from December 2006 to January 2012 were collected and retrospectively analyzed. They were assigned into 2 groups based on their age: old group (60 to 74 years old, n＝473), and very old group (75 to 89 years old, n＝410). Their general condition, medical history and family history, admission examination, clinical diagnosis, complications, treatment and in-hospital mortality were compared and analyzed. Results The old group had significantly lower in-hospital mortality than very old group (5.9% vs 14.6%, P＝0.000). There were significantly more patients undergoing percutaneous coronary intervention (PCI) in old group than in very old group(92.6% vs 69.8%, P＝0.000). The in-hospital mortality was positively correlated with the increased levels of blood urea nitrogen, blood glucose, white blood cells and brain natriuretic peptide (BNP). Complications with arrhythmia (sinus arrest, ventricular and atrial fibrillation), cardiogenic shock and Killip3-4 group, placement of intra-aortic balloon counterpulsation (IABP), and no surgical treatment were also positively correlated with in-hospital mortality. And it was negatively correlated with receiving drugs [angiotensin converting enzyme inhibitors (ACEI)/angiotensinⅡreceptor blockers (ARB), β-blockers and statins]. High level of blood urea nitrogen, complications with sinus arrest and cardiogenic shock, and no surgical treatment were independent risk factors for in-hospital mortality in both groups. Conclusion Application of PCI improves prognosis of the elderly patients with AMI. More attention should be paid to blood urea nitrogen and complications such as sinus arrest and cardiogenic shock.

Abstract:Objective To investigate the anti-inflammatory effect and mechanism of docosahexaenoic acid (DHA) in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 40 COPD outpatients in our department from December 2011 to December 2012 were recruited in this study. Twenty cases of them in stable period were assigned as group A, and the left 20 cases in exacerbation period were assigned into group B. Their peripheral blood neutrophils were isolated and cultivated. Then the cells were treated with DHA at different concentrations (10, 50 and 100μmol/L) for 0, 24, 48 and 72h, respectively. The levels of the inflammatory cytokines IL-6, IL-8, and TNF-α in culture supernatants were measured. The expression level of NF-κB p65 protein was detected with Western blotting. Results Before DHA treatment, the levels of inflammatory factors were significantly higher in group B than in group A. After DHA treatment, the levels dropped directly in a concentration- and time-dependent manner in both groups, but the downtrend was stronger in group B than in group A. After treated with high dosed DHA for 72h, the inflammatory cytokines levels in group A were not significantly different with those in group B. NF-κB p65 protein expression was decreased in a dose- and time-dependent manner (P＜0.05). Conclusions DHA significantly reduces the levels of inflammatory cytokines IL-6, IL-8, and TNF-α through inhibiting NF-κB p65 protein expression in neutrophils, providing the theoretical basis for DHA in clinical treatment of COPD.

Abstract:Objective To investigate the change in chloride ion (Cl-) concentration in high glucose-induced cardiomyocyte injury and the role of 4,4’-diisothiocyanostilbene-2,2’-disulfonic acid (DIDS), a chloride channel blocker, in the injury. Methods Primarily cultured neonatal rat cardiomyocytes were exposed to glucose (33mmol/L) for 72h to establish the cell model of high glucose-induced injury. The cardiomyocytes were randomly divided into 4 groups: control group, high glucose group, high glucose+DIDS group and DIDS group. MTT assay was applied to detect cell viability, and flow cytometry was used to measure cell viability and apoptosis. N-(Ethoxycarbonylmethyl)-6-methoxyquinolinium bromide (MQAE) was used to examine the intracellular chloride concentration. Results High glucose decreased the cardiomyocyte viability in a dose- and time-dependent manner (P＜0.05). Cardiomyocyte injury was mainly in the form of apoptosis. Compared to control group, high glucose resulted in a significant decrease in intracellular Cl- in the cardiomyocytes (P＜0.05). There was no significant difference in cardiomyocyte viability and intracellular Cl- between the DIDS treated cells and control cells (P＞0.05). While, DIDS treatment improved the cardiomyocyte viability and attenuated the decrease in intracellular Cl- in cardiomyocytes after high glucose induction (P＜0.05). Conclusion Cl- is involved in the high glucose-induced cardiomyocyte injury. DIDS attenuates the injury which mainly presents as apoptosis.

Abstract:

Abstract:We reported a successful diagnosis of a 76-year-old male patient with systemic sclerosis. His main manifestation was edema, and the diagnosis was indefinite at the early stage. Symptomatic and supportive treatments were merely useful for temporary remission of the symptoms. Testing for serum related auto-antibodies showed that anti-nuclear antibody was positive after the aggravation of edema. Ultimately, the diagnosis of systemic sclerosis was established after skin biopsy. According to literature and our clinical experience, the clinical manifestations of systemic sclerosis were complicated and lack of specificity, so it was hard to diagnose at its early stage. We should take systemic sclerosis into consideration when we meet intractable cases with edema. More attention should be paid to skin lesion and serum related auto-antibodies testing in order to make the correct diagnosis of this disease as early as possible.

Abstract:Myocardial infarction is the main cause of heart failure, causing the loss of myocardial cells, and then declining the cardiac function. Bone marrow derived mesenchymal stem cells (BM-MSCs) are stem cells with capacity for self-renewal and potential to differentiate into a broad tissue distribution. BM-MSCs after transplantation can survive in the myocardium and then improve cardiac function through paracrine and other mechanisms. The cell transplantation provides a new approach for treatment of myocardial infarction and has great application potential. In this paper, we reviewed the current understanding of BM-MSCs isolation, induction, transplantation and recent clinical research on the therapy for cardiac diseases.

Abstract:Large conductance Ca2+-activated K+ channels (BKCa channel) are found to be abundantly expressed in the membrane of coronary vascular smooth muscle cells, and play an important role in the maintenance of cellular physiological functions. Evidence shows that cell membrane depolarization and/or increase in intra-cellular Ca2+ activates BKCa channels, then the opening of the channels enables K+ efflux, thus finally, membrane hyperpolarization and vasodilation take place. However, the functions of BKCa channels are altered under some pathophysiological conditions, such as hypertension, diabetes mellitus, hypoxia, heart failure, aging and so on. This alteration exerts dramatic impacts on vascular functions. The paper mainly reviewed the recent research progress in BKCa channel in cardiovascular diseases.