OBJECTIVETo develop the chromatographic fingerprints of composite Folii Isatidis injection by HPLC.

METHODThe separation was performed on a Diamonsil C18 column with a mobile phase consisting of methanol-water-phosphoric acid as gradient eluent at the flow rate of 1.0 mL x min(-1). The UV detection was set at 254 nm.

RESULTA standard HPLC fingerprint procedure was developed for composite Folii Isatidis injection, with 20 common peaks and a similarity threshold of 9.0 established.

CONCLUSIONThis method was accurate, repeatable and useful for the quality control of composite Folii Isatidis injection.

Chromatography, High Pressure Liquid ; methods ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; isolation & purification ; Ginkgo biloba ; chemistry ; Injections ; Isatis ; chemistry ; Plant Leaves ; chemistry ; Plants, Medicinal ; chemistry ; Quality Control ; Reproducibility of Results ; Uridine ; analysis

The concept of anaerobic ammonium oxidation (ANAMMOX) is presently of great interest. The functional bacteria belonging to the Planctomycete phylum and their metabolism are investigated by microbiologists. Meanwhile, the ANAMMOX is equally valuable in treatment of ammonium-rich wastewaters. Related processes including partial nitritation-ANAMMOX and completely autotrophic nitrogen removal over nitrite (CANON) have been developed, and lab-scale experiments proved that both processes were quite feasible in engineering with appropriate control. Successful full-scale practice in the Netherlands will accelerate application of the process in future. This review introduces the microbiology and more focuses on application of the ANAMMOX process.
Bacteria, Anaerobic ; metabolism ; Bioreactors ; Nitrites ; metabolism ; Nitrogen ; metabolism ; Oxidation-Reduction ; Quaternary Ammonium Compounds ; metabolism ; Waste Disposal, Fluid ; Water Purification ; methods

OBJECTIVETo analysis the risk factors predicting intracardial thrombus after prosthetic valve replacement.

METHODSThe clinical data of 29 cases from January 2005 to April 2009 with intracardial thrombus after prosthetic valve replacement during a 1-year follow-up was retrospectively analyzed. There were 11 male and 18 female, aged from 12 to 70 years with a mean of 48 years. The risk factors of intracardial thrombus were examined by univariate and multivariate analysis.

RESULTSUnivariate analysis found that bioprosthetic valve replacement, anticoagulation using aspirin, valve replacement at mitral position, atrial fibrillation, preoperative and postoperative internal diameter of left atrium, postoperative fibrinogen were predict factors of intracardial thrombus after prosthetic valve replacement (P < 0.05). Logistic regression analysis showed valve replacement at mitral position (OR = 9.815, P < 0.05), atrial fibrillation (OR = 5.267, P < 0.05), preoperative internal diameter of left atrium (OR = 4.529, P < 0.05) were significant risk factors of intracardial thrombus after prosthetic valve replacement.

CONCLUSIONSValve replacement at mitral position, atrial fibrillation, and preoperative internal diameter of left atrium are the correlated risk factors of intracardial thrombus after prosthetic valve replacement. Anticoagulation after prosthetic valve (especially bioprosthetic valve) replacement should be standardized to prevent intracardial thrombus formation.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Heart Diseases ; etiology ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Risk Factors ; Thrombosis ; etiology ; Young Adult

OBJECTIVETo analysis the causes of valve prosthesis-patient mismatch (PPM) after mitral valve replacement in Chinese patients.

METHODSConsecutive 100 patients for elective mitral valve replacement from January 2009 to June 2009 were enrolled and followed for this study. There were 37 males and 63 females. The mean age at operation was (52 ± 9) years (ranging 32 to 76 years). The predominant mitral valve lesion was stenosis in 60 patients, regurgitation in 14 patients and mixed in 26 patients. Among them, 63 patients were combined tricuspid valve regurgitation. Mitral valve effective orifice area was measured by Doppler echocardiography in 100 patients who received mitral valve replacement and indexed for body surface area (EOAI). PPM was defined as not clinically significant if the EOAI was above 1.2 cm(2)/m(2), as moderate if it was >0.9 and ≤ 1.2 cm(2)/m(2), and as severe if it was ≤ 0.9 cm(2)/m(2). By using the criteria, all 100 patients were classified to two groups: PPM group and no PPM group. The clinical characteristic of the patients between the two groups was compared to determine the causes of PPM and the predictors of outcomes after mitral valve replacement, such as the gender, age, valve prosthesis type, size, body surface area, and mitral valve lesion, et al.

RESULTSOf the 100 patients after MVR, 52 (52.0%) had significant PPM, 51 (51.0%) had moderate PPM, and 1 (1.0%) had severe PPM. In comparison to patients in no PPM group, patients in PPM group had a significantly larger body surface area [(1.76 ± 0.17) m(2) vs. (1.59 ± 0.13) m(2), P < 0.01] and higher prevalence of male gender (55.8% vs. 16.6%, P < 0.01). The other preoperative and operative data were similar in both groups, such as the valve prosthesis type, size, and mitral valve lesion, et al. There were no significant differences in postoperative Doppler-echocardiographic data of cardiac structure and heart function between the two groups (P > 0.05).

CONCLUSIONSThe higher incidence of PPM in mitral valve position was in male or large body surface area patients. At the time of operation, surgeons should consider the related factors, such as the patient's gender and body surface area, et al. A larger prosthesis size might be implanted to avoid PPM in mitral valve position.

Adult ; Aged ; Female ; Heart Valve Prosthesis ; adverse effects ; Heart Valve Prosthesis Implantation ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery

OBJECTIVETo evaluate intraventricular mechanical synchrony in systole by real-time tri-plane tissue synchronization imaging (TSI).

METHODSReal-time tri-plane TSI was performed in 20 normal subjects, and the apical 4-chamber, 2-chamber and long-axis views of the left ventricular (LV) were obtained simultaneously. The data were post-processed offline, and a TSI surface map of LV colorized according to the time-to-positive peak systolic velocity (TTP) was generated to reflect the segment TTP semi-quantitatively. The segmental TTP of the six-basal and six-mid segments of LV was measured and compared.

RESULTSThe myocardium was color-coded mainly by well-distributed green, and only a small portion displayed yellow or red color in the apical area; the TTP showed no significant differences between the segments measured (P>0.05).

CONCLUSIONSIn normal subjects, the long-axis systolic motions of the LV are highly synchronized. TSI allows immediate visual identification of intraventricular mechanical synchrony and quantitative measurement of regional TTP.

Adult ; Aged ; Echocardiography, Doppler, Color ; Female ; Heart Ventricles ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; physiology ; Systole ; physiology ; Ventricular Function, Left ; Young Adult

OBJECTIVETo investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure.

METHODSClinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed. The follow-up data of the patients were also analyzed including all-cause mortality rate and major adverse cardiac and cerebral events (MACCE, including myocardial infarction, cerebrovascular event, and repeated revascularization).

RESULTSThe perioperative mortality rate was 3.09% (3/97) in these patients. Of the 97 patients analyzed, 91 (93%) were available for follow-up for 29-192 months (with a median of 95.61∓34.07 months). The 10-year survival rate of the patients was 62% with a 10-year MACCE-free survival rate of 47.4%. During the follow-up, 6 (6.8%) patients underwent repeated revascularization procedures, 12 (12.37%) had cerebrovascular accidents and 5 (5.15%) had myocardial infarction. Logistic regression analysis showed that hypertension (OR=1.388, P=0.043) and diabetes (OR=1.692, P=0.017) were independent predictors of MACCE, and incomplete revascularization did not increase the risk of postoperative MACCE.

CONCLUSIONOPCAB is safe and effective in elderly patients with good long-term outcomes. Hypertension and diabetes are independent risk factors of MACCE, and adequate control of blood pressure and blood glucose can reduce the incidence of postoperative MACCE. Incomplete revascularization is not detrimental to the long-term outcomes of OPCAB in elderly patients.

OBJECTIVETo summarize the experience of ventricular septal myectomy (modified Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODSFrom June 2003 to March 2011, 38 patients (26 male and 12 female) with HOCM underwent modified Morrow procedure. The mean age was 36.3 years (ranging from 18 to 64 years). The diagnosis was made by echocardiography and spiral CT. The mean systolic gradient between the left ventricle and the aorta from transthoracic echocardiography (TTE) was (89±31) mmHg (ranging from 50 to 184 mmHg, 1 mmHg=0.133 kPa) before operation. There was moderate or severe systolic anterior motion (SAM) in 38 cases and mitral regurgitation in 29 cases. Ventricular septal myectomy with modified Morrow procedure was performed in all 38 cases. TEE was used intraoperatively to evaluate the results of the surgical procedures. After 1 to 2 weeks of operation, TTE was performed to evaluate the effect of operation. All patients were followed up with TTE after operation.

RESULTSAll patients were discharged without complications. Intraoperative TEE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (95±36) mmHg before procedures to (14±11) mmHg after operation (t=13.265, P=0.000), and the thickness of ventricular septum was decreased from (28±8) mm to (12±3) mm (t=11.656, P=0.000). TTE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (89±31) mmHg preoperatively to (18±13) mmHg (t=12.729, P=0.000) in 1 to 2 weeks after operation. Mitral regurgitation and SAM were significantly improved or disappeared (t=7.930, t=5.213, both P=0.000). During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only and syncope was abolished, and TTE showed that the pressure gradient was kept on the postoperative level or slightly decreased (P=0.494).

CONCLUSIONSVentricular septal myectomy with modified Morrow procedure is a mostly effective method for patients with HOCM. Good surgical exposure and the hypertrophied septum thoroughly excised are paramount for successful surgery.

Adolescent ; Adult ; Cardiomyopathy, Hypertrophic ; surgery ; Cardiomyoplasty ; methods ; Female ; Follow-Up Studies ; Heart Septum ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo analyze the surgical treatment and outcomes of isolated right-sided infective endocarditis.

METHODSFrom January 1994 to February 2009, 28 patients with isolated right-sided infective endocarditis underwent operation whose clinical data was retrospectively reviewed. There were 18 male and 10 female, age ranged from 10 to 72 years with a mean of 38 years. All of the patients presented intermittent fever, 14 patients presented heart failure (NYHA class III or IV), 25 patients had a history of pulmonary embolism or pneumonia, 18 patients had positive culture; 27 patients had intra-cardiac vegetations confirmed by echocardiogram. All the operations were performed under cardiopulmonary bypass. Antibiotic therapy continued for another 2 to 3 weeks after surgery.

RESULTSOne patient had underwent re-operation due to mediastinal bleeding, 2 patients needed mechanical ventilation for more than 1 week after surgery, renal dysfunction occurred in 3 patients. After surgery, 11 patients presented with mild or moderate tricuspid regurgitation before discharge. One patient (3.6%) died in hospital after surgery due to severe infection and multi-organ failure, the other 27 patients were cured and discharged. Patients were followed up for 6 months to 15 years.NYHA class decreased in all patients, and the symptoms of heart failure improved significantly after surgery. No recurrent case was found.

CONCLUSIONSSurgery is an effective treatment for isolated right-sided infective endocarditis with congenital heart disease or right heart implants. Good outcomes are observed in these settings.

Adolescent ; Adult ; Aged ; Child ; Endocarditis, Bacterial ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the diagnostic accuracy in the assessment of coronary artery bypass grafts using 64 multi-slice computed tomography angiography (64-MSCTA) technology.

METHODSThere were 228 patients post coronary artery bypass grafting (CABG) underwent 64-MSCTA from July 2005 to April 2007. Thirty-one patients with 82 bypass grafts performed coronary angiography (CAG) because of angina or grafts lesion showed by 64-MSCTA.

RESULTSAll bypass grafts could be visualized by 64-MSCTA. Thirteen bypass graft occlusions and fourteen significant stenosis were detected by 64-MSCTA and confirmed by CAG. One venous grafts distal anastomosis was missed and another one was miss diagnosed as stenosis. One false negative and one false positive CT-finding resulted in a sensitivity of 93.3%, a specificity of 98.1%, a positive predictive value of 93.3%, a negative predictive value of 98.1% and an accuracy of 97.1% for grafts stenosis. As to the grafts lesion, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for grafts occlusion were 96.4%, 98.1%, 96.4%, 98.1% and 97.6%, respectively.

CONCLUSION64-MSCTA demonstrates high diagnostic accuracy in the assessment of graft patency and suitable for the follow-up of patients post CABG.

Aged ; Coronary Angiography ; methods ; Coronary Artery Bypass ; Female ; Graft Occlusion, Vascular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; Sensitivity and Specificity ; Tomography, Spiral Computed

OBJECTIVETo explore the perioperative features of surgical treatment in valvular patients with small left ventricle, and investigate the postoperative early structural changes of left ventricle and its correlation with cardiac function.

METHODSA total of 51 patients with small left ventricle underwent mitral valve replacement from January 2003 to August 2008. There were 7 males and 44 females with mean age of (48 +/- 5) years old. The mean pathologic course was (18 +/- 9) years old. The concomitant procedures included aortic valve replacement in 6 cases, coronary artery bypass grafting in 1 case, tricuspid valvular plasty in 48 cases, left atrial thrombi scavenging in 36 cases, and left atrium folding in 42 cases.

RESULTSThe perioperative mortality was 3.9% (2/51). Fourteen patients (27.5%) suffered from severe low-output syndrome in the earlier period postoperatively. Among them, 5 patients needed secondary cardiopulmonary bypass (CPB) to assist circulation, with the result of 1 patient died of weaning off CPB unsuccessfully, 1 patient revived with intra-aortic balloon pump assisted for another 2 d after termination of CPB and another 1 patient died of multiple organ failure (MOF) 10 d later. Eleven cases complicated with MOF. Five patients complicated with ventricular arrhythmia. The echocardiographic examinations showed that the left ventricular dimensions didn't expand significantly postoperatively at 7 to 14 d postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (36.5 +/- 3.2) mm preoperatively and (38.6 +/- 5.3) mm postoperatively (P > 0.05). Preoperative LVEDD index (LVEDDI) was (45.9 +/- 3.8) ml/m(2) and postoperative LVEDDI was (48.2 +/- 7.4) ml/m(2) (P > 0.05). The contract function of left ventricle was improved postoperatively but with no statistical significance. Ejection fraction was 48.6% +/- 6.7% preoperatively and 52.8% +/- 8.3% postoperatively. Left ventricular fraction shortness was 25.5% +/- 3.3% preoperatively and 27.1% +/- 1.3% postoperatively.

CONCLUSIONSFor the patients with small left ventricle usually, the postoperative emphases should be put on the management of low output syndrome. The decreased dimension of left ventricle doesn't expand in the early period after valvular operation.

Adult ; Aged ; Female ; Heart ; physiopathology ; Heart Valve Prosthesis Implantation ; Heart Ventricles ; abnormalities ; Humans ; Male ; Middle Aged ; Myocardium ; pathology ; Postoperative Period ; Retrospective Studies