Objective To investigate the safety and efficacy of percutaneous left atrial appendage closure(LAAC)in the prevention of stroke in elderly patients with non-valvular atrial fibrillation(NVAF)complicated with heart failure(HF).Methods A total of 125 NVAF patients aged ≥65 years undergoing percutaneous LAAC in Northern Jiangsu People's Hospital from January 2019 to October 2022 were recruited,and were divided into HF group(35 patients)and non-HF(90 patients)according to whether being complicated with HF.Their clinical features,characteristics of left atrial appendage,operation procedure and follow-up results were analyzed and compared between the two groups.Results The non-HF group had significant smaller proportions of smok-ing,drinking and previous stroke,lower left ventricular ejection fraction(LVEF),and higher ratio of one-stop surgery,but lower renal dysfunction ratio and B-type natriuretic peptide(BNP)lever when compared with the HF group(P＜0.05,P＜0.01).There were no statistical differences in the type of occluder,shape and depth of LAA and long diameter of LAA opening,residual shunt,pericardial effusion,incidence of newly stroke onset and death ratio between the two groups dur-ing perioperative period(P＞0.05).The HF group had an obviously shorter follow-up time(12.10±1.30 months vs 12.72±1.10 months,P=0.025)and higher incidence of recurrent HF(8.57％vs 0％,P=0.005)than the non-HF group.Conclusion LAAO is safe and feasible for elderly NVAF patients complicated with HF,and it is safe and effective in preventing ischemic stroke.

BACKGROUNDCardiovascular diseases, including dilated cardiomyopathy (DCM) and hypertension, are the leading cause of death worldwide. The role of mitochondrial DNA (mtDNA) in the pathogenesis of these diseases has not been completely clarified. In this study, we evaluate whether A8701G mutation is associated with maternally inherited hypertension and DCM in a Chinese pedigree of a consanguineous marriage.

METHODSFourteen subjects in a three-generation Han Chinese family with hypertension and DCM, in which consanguineous marriage was present in the parental generation, were interviewed. We divided all the family members into case (7 maternal members) and control group (7 nonmaternal members) for comparison. Clinical evaluations and sequence analysis of mtDNA were obtained from all participants. Frequency differences between maternal and nonmaternal members were tested to locate the disease-associated mutations.

RESULTSThe majority of the family members presented with a maternal inheritance of hypertension and DCM. Sequence analysis of mtDNA in this pedigree identified eight mtDNA mutations. Among the mutations identified, there was only one significant mutation: A8701G (P = 0.005), which is a homoplasmic mitochondrial missense mutation in all the matrilineal relatives. There was no clear evidence for any synergistic effects between A8701G and other mutations.

CONCLUSIONSA8701G mutation may act as an inherited risk factor for the matrilineal transmission of hypertension and DCM in conjunction with genetic disorders caused by consanguineous marriage.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cardiomyopathy, Dilated ; genetics ; DNA, Mitochondrial ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Hypertension ; genetics ; Male ; Middle Aged ; Mitochondrial Proton-Translocating ATPases ; genetics ; Mutation ; genetics ; Pedigree ; Risk Factors

Objective: To explore associations between physical activity, screen time and anxiety, sleep quality among college students in Shanghai, and to provide a reference for relevant prevention and control. Methods: By using cluster random sampling method, a total of 4 964 students from grade 1 to grade 2 in 3 universities from 3 districts of Shanghai were enrolled. Self-Rating Anxiety Scale, Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire were used to assess the level of anxiety, sleep quality and physical activity. Results: The reporting rate of anxiety symptoms among students was 9.7%(8.7% for males and 11.4% for females) and the prevalence of poor sleep quality was 55.0%(51.8% for males and 60.4% for females), there was significant gender differences in anxiety symptoms and poor sleep quality rate(χ2=9.92, 34.81, P<0.01). Among male students, with adjustment of age, BMI and lifestyle, those who met neither physical activity nor screen time recommendations had 2.23(95%CI=1.31-3.79) and 1.48(95%CI=1.13-1.94) times risks for anxiety and poor sleep quality than those meeting both recommendations. Among girls, there was a significant association between screen time and anxiety(aOR=1.61, 95%CI=1.18-2.21). However, physical activity was not associated with anxiety and sleep quality. Conclusion High screen time and physical inactivity may increase the risk of anxiety and poor sleep quality among male college students, and screen time may also increase the risk of anxiety among female college students.

Objective To investigate the efficacy of dronedarone combined with low dose metoprol-ol in the treatment of atrial tachycardia.Methods A total of 175 elderly patients with atrial tachy-cardia admitted in Northern Jiangsu People's Hospital during January 2020 to January 2022 were enrolled and then randomly divided into dronedarone group(n=57),metoprolol group(n=55)and combined group(dronedarone+metoprolol,n=48).The frequency,duration and symptom changes of arrhythmia were compared before and after treatment.Results After 3 and 6 months of administration,the total effective rate was significantly higher in the combination group than the dronedarone group and the metoprolol group(P＜0.05).The frequency of atrial fibrillation(AF)attacks[(2.31±1.78)/48 h vs(11.56±18.68)/48 h],AF duration[(4.86±6.73)h/48 h vs(10.92±9.61)h/48 h],atrial flutter(AFL)attacks[(2.33±1.53)/48 h vs(4.33±1.53)/48 h]and AFL duration[(5.15±4.87)h/48 h vs(21.54±20.08)h/48 h]in the combined group,and AFL duration[(2.75±1.94)h/48 h vs(10.29±8.04)h/48 h]in the dronedarone group were reduced after 6 months of treatment(P＜0.05).Conclusion In the treatment of atrial tachycardia,dronedarone combined with low dose metoprolol can not only obviously improve symptoms,but also significantly reduce the atrial premature and atrial tachycardia attacks,decrease the number and duration of AF and AFL attacks,and control heart rate effectively.

Objective To evaluate the clinical value of left bundle branch pacing(LBBP)in HF pa-tients requiring cardiac resynchronization therapy(CRT).Methods A total of 128 HF patients who met the indicatons for CRT Class Ⅰ and Ⅱ and admitted in Department of Cardiology of Northern Jiangsu People's Hospital from January 2018 to January 2023 were consecutively recrui-ted,and 32 patients of them having left bundle branch electrode implantation due to failure of cor-onary sinus electrode implantation were assigned into the LBBP group,and the rest 96 patients getting conventional biventricular pacing(BVP)into the BVP group.The pacing parameters and other indicators were observed in the two groups at the time of implantation.Follow-up visits were made to the Special Clinic of"Arrhythmia and Cardiac Pacemaker"in Northern Jiangsu People's Hospital at 1,3,6,and 12 months after surgery,and then,the visits were conducted every 3 to 4 months thereafter.Clinical evaluation,12-lead electrocardiography,echocardiography,detections for programmable controller and pacemaker function and other tests were completed at each follow-up.Readmission or death events due to HF were recorded.Results Compared with the preoperative results,both groups obtained shorter QRS duration,better NYHA class,smaller LVEDD and increased LVEF at the last follow-up(P＜0.05).At the time point,shorter QRS du-ration,better NYHA class and higher LVEF were observed in the LBBP group than the BVP group(P＜0.05).There were no significant differences in pacing parameters between the two groups at the time of implantation and the last follow-up(P＞0.05).No statistical difference was found in readmission rate between the LBBP group and the BVP group(18.75％vs 16.67％,P＞0.05).Conclusion LBBP is safe and effective,and can improve the cardiac function of HF pa-tients.LBBP may provide a new option for patients who have failed traditional CRT.

Objective To explore the predictive value of the fractional flow reserve derived from coronary computed tomography(FFRCT)in CAD.Methods Clinical data of 136 patients(309 ma-jor coronary vessels)with suspected CAD consecutively attending to Northern Jiangsu People's Hospital from January 2020 to February 2022 were collected and retrospectively analyzed.Coro-nary computed tomography angiography(CCTA)and coronary angiography(CAG)data and FFRCT were collected.The accuracy,positive predictive value,negative predictive value,sensitivity and specificity of CCTA and FFRCT for the diagnosis of stenosis in 309 major coronary arteries were compared;the correlation between FFRCT and CAG was analyzed using the consistency test.Imaging parameters of 156 vessels were analyzed by senior radiologists for smallest luminal diam-eter,stenotic plaque length,stenotic diameter rate,stenotic area rate,stenotic lumen area and plaque properties.The 98 vessels with ≥50％coronary stenosis were assigned into the coronary group,and the 58 vessels with＜50％ischaemic stenosis were into the non-coronary group.Logistic regression was used to analyze the relationship between the vessel parameters of 156 ves-sels and coronary heart disease(CHD);ROC curve was plotted to analyze the value of each pa-rameter and their combination for the diagnosis of CHD.Results The diagnostic efficacy of FFRCT was more accurate than that of CCTA for CAD(P＜0.01),and the Kappa agreement anal-ysis showed that the Kappa value of the diagnostic results of FFRCT and CAG was 0.620,indica-ting high agreement(P＜0.01).Lower smallest luminal diameter,lower FFRCT,longer stenotic plaque length,and higher diameter stenosis rate and area stenosis rate were observed in the coro-nary group than the non-coronary group(P＜0.01).Multivariate logistic regression analysis showed that smallest luminal diameter(OR=0.536,95％CI:0.335-0.858),stenotic plaque length(OR=1.109,95％CI:1.054-1.166),and FFRCT≤0.80(OR=0.204,95％CI:0.078-0.532)were independent influencing factors in predicting CAD(P＜0.01).ROC curve analysis revealed that the AUC value of combined smallest luminal diameter,stenotic plaque length,and FFRCT 0.80 together in diagnosis of CAD was 0.853(0.795-0.918).Conclusion FFRCT has a higher di-agnostic value for CAD than CCTA,and the combined diagnosis of FFRCT≤0.80,smallest luminal diameter,and stenotic plaque length can further improve the accuracy of the diagnosis of CAD.

Objective To explore the therapeutic value of metoprolol combined with Wenxin Keli(a Chinese patent drug)on atrial tachycardia(AT)after catheter ablation in patients with atrial fibrillation(AF).Methods A total of 290 patients who were diagnosed with AF and underwent catheter ablation successfully in the Department of Cardiovascular Medicine of Northern Jiangsu People's Hospital from May 2018 to January 2022 were enrolled,and were randomly divided into Wenxin Granule group(Group W),metoprolol group(Group M),combined group(Group MW)and blank control group(Group C).The times of AT,heart beats during the longest AT episode,average heart rate and adverse reactions were compared among the 4 groups.Results The mean heart rate,episodes of AT,heart beats during the longest AT episode,and numbers of premature atrial contractions(PAC)of class Ⅰ,Ⅱ and Ⅲ in Group C in 1 year after operation were all sig-nificantly higher than the baseline levels(P＜0.01),so were in the Group W,Group M and Group MW(P＜0.01).Group MW had obviously lower mean heart rate,episodes of AT,heart beats dur-ing the longest AT episode,and numbers of PAC of class Ⅰ,Ⅱ and Ⅲ when compared with Group W and Group M(P＜0.05).There was no significant difference in the total incidence of ad-verse reactions in Group W,Group M and Group MW(7.1％vs 13.9％vs 8.9％,P=0.301).Con-clusion Metoprolol combined with Wenxin Keli can be used to treat AT after AF catheter abla-tion.The combination can effectively reduce the average heart rate,episodes of AT,numbers of PAC and heart beats during the longest AT episode,and thus decrease the recurrence of postopera-tive AF with high safety.

Objective To investigate the effect of precision management on improving the symp-toms and response rate of patients after cardiac resynchronization therapy(CRT).Methods A to-tal of 97 patients with heart failure(HF)who received CRT for the first time in Department of Cardiology,Northern Jiangsu People's Hospital from January 1,2020 to December 31,2021 were enrolled in this study.They were divided into control group(53 cases)and precision management group(44 cases).CRT response rate and incidence of HF readmission or death were compared be-tween the two groups.Results The precision management group had significantly larger propor-tion of total response in 12 months after CRT than the control group(P＜0.05).Kaplan-Meier survival analysis showed that the survival rate without clinical concern was obviously higher in the precision management group than the control group(P=0.018).Multivariate Cox regression analysis indicated that no precision management after surgery(HR=0.21,95％CI:0.09-0.47,P=0.005)and hospitalization for HF within 1 year before surgery(HR=3.94,95％CI:1.70-9.14,P=0.005)were the main predictors of clinical events of concern after CRT.Conclusion Postoperative precision management of CRT can increase the CRT response rate,reduce the risk of readmission or death due to HF,and improve the prognosis effectively.

Objective To sulnmarize the perioperative nursing experience of CT-guided radiofrequency ablation of fight tibia osteoid osteoma in children.Methods One case of CT-guided radiofrequency ablation was clinically observed and nursed.Results The patient underwent a successful surgery without complications,healing well.Condusions Good psychological care,safety care before the operation and improved preoperative preparation are the key to make sure that the operation goes smoothly.Strengthening the observation and care after surgery could effectively reduce complications and improve cure rate.