Objective To explore the effect of an in-hospital cardiac rehabilitation program on exercise capacity after cardiac surgery.Methods Forty-two patients with valvular heart disease or coronary heart disease were recruited and randomly divided into a rehabilitation group (n=22) and a control group (n=20).Both groups were given preoperative education and breathing guidance on the basis of conventional clinical treatment,but the rehabilitation group was also provided with in-hospital cardiac rehabilitation after the operation.The two-minute stepping test (2-MST) and the left ventricular ejection fraction test (LVEF) were performed before and after the intervention for both groups.Their hospital stays were also compared.One month after discharge,the exercise capacity of both groups was followed-up by telephone using the Veterans-specific Activity Questionnaire (VSAQ).Results After the intervention,there was no significant difference in average LVEF between the two groups (53.73±9.29％ and 56.25± 11.01％ respectively).The average 2-MST stepping frequency of the rehabilitation group was significantly greater than the control group (79.41± 10.99 times and 71.25± 14.21 times respectively,P＜0.05).One month after discharge,the exercise capacity of the rehabilitation group was also significantly higher than the control group for (5.77± 1.46 METs versus 4.75± 1.34 METs,P＜0.05).Stepping frequency at discharge and exercise capacity at one month after discharge were both positively correlated to 2-MST stepping frequency at admission(r =0.869,P＜0.01;r=0.752,P＜O.01).The average hospital stay of the rehabilitation group was significantly shorter (by about 3 days) than the control group (15.59±3.08 days versus 18.45±3.63 days,P＜0.01).Conclusions In-hospital cardiac rehabilitation can significantly improve exercise capacity after cardiac surgery and reduce the length of hospital stays.The 2-minute step test is a simple and practical way to assess the exercise capacity of patients early after cardiac surgery.

ObjectiveTo explore the effect of aerobic exercise on serum leptin,interleukin-18 (IL-18),soluble intercellular adhesion molecule-1 (sICAM-1),C reaction protein (CRP) concentration,and homeostasis model assessment insulin resistance (HOMA-IR) of patients with metabolic syndrome ( MS),and to explore its mechanism.MethodsForty sedentary patients with MS were randomly divided into exercise group and fenofibrate group.Patients in exercise group were trained at anaerobic threshold intensity (30 min/times) for 12 weeks (5 times/wk).Patients in fenofibrate group were treated with fenofibrate 200 mg every night.Serum leptin,IL-18,CRP,and sICAM-1 concentration were measured by enzyme linked immunosorbent assay (ELISA).Twenty healthy subjects were selected as the control group.ResultsSerum concentration of leptin [ ( 26.04 ± 9.07 ) ng/ml vs ( 8.32 ± 2.94 ) ng/ml,t =12.72,P ＜0.01 ],IL-18[ (308.27 ±50.39)pg/ml vs (230.60 ±29.15)pg/ml,t =6.41,P ＜0.01 ],CRP[ (2.65±0.57)ng/ml vs ( 1.26 ±0.23) ng/ml,t =9.69,P ＜0.01 ],sICAM-1 [ (331.89 ±60.08) ng/ml vs (246.43±39.32)ng/ml,t =5.98,P ＜0.01],and HOMA-IR(4.38 ±2.06 vs 2.12 ± 0.50,t =4.81,P ＜ 0.01 ) of patients with MS were significantly increased compared to the control.Serum concentration of leptin[(26.38±10.85)ng/ml vs (19.63 ±6.27)ng/ml,t =2.22,P ＜0.05],IL-18[(309.40 ±49.77)pg/ml vs (291.80 ±39.21)pg/ml,t =2.33,P ＜0.05],CRP[ (2.73 ±0.72)ng/ml vs (2.28 ±0.38)ng/ml,t =3.41,P ＜0.01 ],sICAM-1 [ (333.85 ±55.97) ng/ml vs (306.24 ±50.55) ng/ml,t =3.16,P ＜0.01],and HOMA-IR(4.53 ±2.39 vs 2.89 ±0.69,t =2.87,P ＜0.01 ) were significantly decreased after training for 12 weeks.ConclusionsAerobic exercise is one of the effective treatments of patients with MS.Its underlying mechanism may be associated with reduction of serum inflammatory adipokine concentration,and improvement of vascular endothelial function and insulin resistance.

Objective To investigate the roles of T GFβ1 and TGFβ1 typeⅠrecepter(TβRⅠ) in development of myocardial hypert rophy and myo cardial interstitium remodelling in renovascular hypertensive rat. 　Methods TGFβ1 and TβRⅠwere evaluated by qualitative and semi -qu antitative immunohistochemical staining to explore their distribution and ex peression in left ventricular tissue. Van Gieson staining were used in the stud y of total collagen in left ventricular interstitial tissue. 　Results Compared with sham-operated rat(SOR),the expression of T GFβ1 andTβRⅠ in left ventricular tissue were significantly increased in RHR(P <0.01 all). In RHR the antibody to TGFβ1 reacted primarily with cytoplasma a nd myo cardial interstitium while antibody to TβRⅠreacted mainly with myocyte membran es with weak labeling in myocardial interstitium. In SOR,very mild labeling for TGFβ1 and TβRⅠin myocardiun was found with no labeli ng in myocardial interstitium. Correlative analysis revealed that TGFβ1 or T βRⅠ was positively correlated with left ventricular mass index(LVMI),negativel y correlated with grey level of myocardial total collagen. Conclusions TGFβ1 and TβRⅠmay play important roles in develo pment of left ventricular hypertrophy and myocardial interstitial fibrosis.

Objective To analyze the risk factors impeding early extubation after off-pump coronary artery bypass grafting (OPCAB) in Chinese patients, so that to identify the applicable patients for "fast track recovery". Methods Clinical data of 680 consecutive patients who had received OPCAB were analyzed retrospectively. The patients were divided into two groups according to the time of extubation (group Ⅰ,n=333, extubation was performed within 12 h postoperation; group Ⅱ,n=347, extubation failed in 12 h). Univariate and multivariate analyses were used to determine risk factors prolonging mechanical ventilation. Results Univariate analyses showed significant difference between the two groups in the percentages of patients over 70 years [25% (84/333) vs 39% (136/347), ?2=15.148, P=0.000], with history of stroke [14% (46/333) vs 22% (75/347), ?2=7.068, P=0.008], with LVEF70 (OR=2.003), LVEF70, severe coronary artery lesion, emergency operation, and poor cardiac function are risk factors impeding early extubation. "Fast track recovery" protocol is applicable to young patients who have good cardiac function without left main lesion and do not need IABP during perioperative period.

Objective To investigate the effects of exercise training intervention on the expressions of TNF-α and adiponectin in circulation and tissues of high-fat/high-sucrose diet-induced insulin resistance rats. Methods 29 S-D rats were random divided into 2 groups: Control group (9 rats) and high-fat/high-sucrose diet group (20 rats). After fed for 6 weeks, 18 rats with insulin resistance were random divided into 2 groups: model group ( n = 9) and exercise group ( n = 9). After 6 weeks intervention, serum TNF-α and adiponectin concentration were measured by radioimmunity assay and ELISA respectively, while TNF-α and adiponectin mRNA expressions in liver and skeletal muscle were measured by RT-PCR. Results Fasting plasma glucose(FPG) and fasting serum insulin(FINS) levels increased significantly and insulin sensitivity index(ISI) decreased significantly in rats of model group than those in control group(7.49 ± 1.13 vs 5.06±0.38, 33.57 ±4.87 vs 13.61±2.94, -5.51±0.16 vs -4.21 ±0.22, all P <0.05). Serum TNF-α concentration was significantly higher than those in control group, while serum adiponectin concentration was significantly lower. (3.03 ± 0. 50 vs 2. 39 ± 0. 44, 0. 77 ± 0. 09 vs 0. 86 ± 0. 08, all P < 0. 05 ).Expressions of TNF-α mRNA in liver and skeletal muscle increased significantly and adiponectin mRNA expression significantly decreased in rats of model group compared to those in control group (0. 66 ± 0. 19 vs 0. 05 ± 0. 03, 1.15 ± 0. 20 vs 0. 25 ± 0. 10, 0. 25 ± 0. 10 vs 0. 85 ± 0. 13, all P < 0. 01 ). Fasting plasma glucose(FPG) and fasting serum insulin(FINS) levels decreased significantly and insulin sensitivity index (ISI) increased significantly in rats of exercise group than those in model group(5.77 ± 1.17 vs 7.49 ±1.13, 25.69 ±4.27 vs 33.57 ±4. 87, -5. 10 ±0.31 vs -5.51 ±0. 16, all P <0.05) ;Serum TNF-α concentration was significantly lower and serum adiponectin concentration was significantly higher in rats of exercise group than those in model group ( 2.40 ± 0. 59 vs 3.03 ± 0. 50, 0. 86 ± 0. 10 vs 0. 77 ± 0. 09, all P < 0. 05); Expressions of TNF-α mRNA in liver and skeletal muscle decreased significantly and adiponectin mRNA expression increased significantly in rats of exercise group compared to those in model group (0. 21±0. 10 vs 0.66±0. 19, 0.49 ±0. 17 vs 1.15 ±0.20, 0.97 ±0.20 vs 0. 25 ±0. 10, all P <0.01). Conclusion Exercise training can significantly improve insulin resistance, which may be through modulating the expressions of TNF-α and adiponectin.

Objective: To observe influence of exercise on expressions of peroxisome proliferators-activated receptor-γ (PPAR-γ) and glucose transporter-4 (Glut-4) in skeletal muscle tissue of mice with insulin resistance (IR) induced by high fat diet, and preliminarily investigate mechanism of swimming training improves IR. Methods: A total of 30 eight-week-old healthy male C57BL /6J mice were randomly divided into normal diet group (n=10), high fat diet group (n=10) and high fat diet + exercise group (HE group, n=10, mice received 12-week swimming training). Body weight and fasting blood glucose (FBG) of mice were measured every week. After 12-week swimming training, fasting insulin (FINS) was measured by radioimmunoassay and IR index (IRI) was calculated; expressions of PPAR-γ and Glut-4 mRNA in skeletal muscle tissue were detected by reverse transcription polymerase chain reaction (RT-PCR). Results: Compared with normal diet group, body weight significantly increased in high fat diet group; body weight of HE group was significantly lower than that of high fat diet group (P<0.05). Compared with normal diet group, there were significant increase in FINS, FBG and IRI in high fat diet group and HE group (P<0.01). Compared with high fat diet group, there were significant decrease in FINS [(14.00±7.12) mmol/L vs. (10.17±3.88) mmol/L], FBG [(9.49±1.28) mmol/L vs. (8.03±1.67) mmol/L] and IRI [(1.47±0.38) vs. (1.06±0.27), P<0.05 all], and significant increase in expressions of PPAR-γ [(0.95±0.17) vs. (2.37±0.41)] and Glut-4 mRNA [(0.68±0.24) vs. (1.54±0.28), P<0.01 both] in HE group. Conclusions: Exercise may significantly improve insulin resistance, and the mechanism may be related with upregulation of expressions of PPAR-γ and Glut-4 mRNA in skeletal muscle, regulation of glucose metabolism and promotion of transduction of insulin signal.

Objective: To study the relationship of the mood and behavior types in patients with coronary heart disease, to supply the foundation of psychotherapy in patients with coronary heart disease. Methods: 81 patients with coronary heart disease and 59 normal healthy people were evaluated by Type A Behavior Scale, Hospital anxiety and depression scales. To analyse the relationship between the behavior type and mood disorder. Results: The rates of Type A behavior and anxious mood disorder were significantly higher in the study group than the contrast group (P

Objective To observe the influence of exercises on the mRNA expression of peroxisome proliferator-activated receptor (PPAR-α) and its target genes of acyl-CoA oxidase (ACO),Enoyl-CoA-hydratase and 3-hydroxyacyl-CoA-dehydrogenase (EHHADH) in the skeletal muscles in insulin-resistance mice to develop a way to improve the lipid metabolism.Methods Twenty male ApoE knockout mice were randomly divided into two groups,the high-fat diet group (group HFD) and the exercise training group (group Ex).The HFD group were fed with highfat diet,while the Ex group were fed in the same way,with additionally swimming training.And ten healthy male C57BL/6j mice were chosen as the control group(group ND).After 12 weeks of intervention,the serum lipid,blood glucose and insulin levels were determined,and homeostasis model assessment insulin resistance index (Homa-IRI) was calculated.The bilateral gastrocnemiuses were cut to be observed under a transmission electron microscope,and the mRNA expression of PPAR-α,ACO and EHHADH in skeletal muscle were measured using reverse transcription polymerase chain reaction(RT-PCR).Results The transmission electron microscope showed that the sarcolemma edema,mitochondrial swelling,as well as focal myocytolysis and edema within myofibrils were observed in the HFD group.The total cholesterol,low-density lipoprotein cholesterol,free fatty acid,fasting glucose,insulin and HomaIRI of the HFD group were significantly higher than the control group (P ＜ 0.05),while the mRNA expression of PPAR-α,ACO and EHHADH was significantly deceased than the latter(P ＜ 0.05).After swimming,the abovementioned pathological changes disappeared.The serum lipid of the Ex group were significantly lower (P ＜ 0.05),while HDL was significantly higher (P ＜ 0.05).And fasting insulin,glucose and HOMA-IR of the Ex group were significantly lower (P ＜ 0.05),while the mRNA expression of the above in the Ex group were significantly increased (P ＜0.05).Conclusion Swimming training could improve insulin resistance and metabolic disorder of lipid of ApoE knockout mice.The possible mechanisms may be through up-regulating the expression of PPAR-α,which in turn stimulates the expression of ACO and EHHADH mRNA to strengthen fatty acid β-oxidation.

Objective: To observe the autonomic nerve functional changing and the impact of comprehensive exercise in patients with cardiovascular neurosis (CN). Methods: Our research included in 2 groups: CN group, n=48 and Control group, n=30 normal subjects. Resting heart rate (RHR) and heart rate at the first recovery minute (HRR1) were measured by cardiopulmonary exercise testing (CPET) for comparison between 2 groups. In CN group, 30 patients were chosen and randomly assigned into 2 subgroups: Medication subgroup, patients received β-receptor blocker, n=14 and Comprehensive exercise subgroup, patients received the same medication plus aerobic and Thera-band resistance training, n=16; both subgroups were intervened for 3 months. Symptom checklist 90 (SCL-90) was used to evaluate relevant parameters before and after intervention, the changes of RHR and HRR1 were also compared between 2 subgroups. Results: ① Compared with Control group, CN group had the higher RHR and lower HRR1, all P<0.01. ② Compared with pre-intervention, both subgroups had improved RHR, HRR1 and SCL-90 scores at post-intervention, all P<0.05; compared with Medication subgroup, Comprehensive exercise subgroup showed improved SCL-90 scores and HRR1, all P<0.05. Conclusion: Comprehensive exercise including aerobic and Thera-band resistance training could effectively improve the clinical symptoms in CN patients, which might be related to changing the autonomic nerve function in relevant patients.

Objective To investigate the serum leptin, leptin receptor of tissue in rats with insulin resistance (IR), and the effect of exercise on them. Methods 9 male Sprague-Dawley rats were fed with normal diet as control group. 34 rats were randomly assigned into 4 groups: model group (n=9), fed with high-fat/high-sucrose diet without any other intervention; metformin group (n=8), fed with high-fat/high-sucrose diet and metformin 300 mg/kg·d; exercise group (n=9), fed with high-fat/high-sucrose diet and trained with swimming; integrated group (n=8), fed with high-fat/high-sucrose diet and metformin 300 mg/kg·d, and trained with swimming. After 6 weeks of intervention,the serum leptin was measured with the enzyme-linked immunoabsorbent assay; the expression of leptin receptor protein in liver, skeletal muscle and adipose were measured with immunohistochemistry, and the expression of leptin receptor mRNA in the same tissues was measured with reverse transcriptase-polymerase chain reaction. Results Compared with the model group, the levels of fasting blood glucose and fasting insulin decreased in the exercise, metformin and integrated group (P<0.05), while the IR index increased (P<0.05). Compared with the control group, the serum leptin increased in the model group (P<0.01), while the expression of leptin receptor protein and mRNA in liver, skeletal muscle and adipose decreased (P<0.01). Compared with the model group, the serum leptin decreased in the exercise, metformin and integrated groups (P<0.05), while the expression of leptin receptor protein and mRNA increased (P<0.05). Compared with the metformin group, the expression of leptin receptor protein and mRNA increased in the exercise and integrated groups (P<0.05). Conclusion High level of serum leptin and low expression of leptin receptor can be found in rats with insulin resistance. Exercise can improve the insulin resistance, which may associate with the decrease of the serum leptin and increases of the leptin receptor.