Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.

Objective This study is to evaluate the advantages between percutaneous and peratrial device closure of secundum atrial septal defects(ASD) under single transesophageal echocardiographic (TEE) guidance.Methods From December 2010 to December 2012,53 patients with the ASD of≤25 mm in diameter underwent percutaneous device closure under simple TEE guidance(the percutaneous group).The device was implanted through the femoral vascular access.Fifty patients with similar age and similar-sized ASD to the percutaneous group,were selected from 350 consecutive patients who underwent peratrial device closure of ASD and assigned to the peratrial group.The ASDs were occluded through a right minithoracotomy approach.The success rate,intracardiac manipulation time,procedural time,postoperative stay and the follow-up results were recorded.Results When the maximum diameter of ASD was ＜ 20 mm,the success rate of both groups was 100％.When the ASD diameter was 20 mm but 25 mm,the success rate was 84％ in the percutaneous group and 100％ in the peratrial group.Three patients failed in the percutaneous group with the ASD diameter of 20 mm and the aortic rim of 3 mm.They were successfully converted to peratrial device closure.The average intrcardiac manipulation time was(20±7) minutes in the percutaneous group and (5 ± 6) minutes in the peratrial group(P ＜ 0.05).The average procedure time was(24 ± 7) minutes in the percutaneous group and (39 ± 6) minutes in the peratrial group(P ＜ 0.05).The postoperative hospital stay was (3.0 ± 0.8) days in the percutaneous group and(4.7 ± 1.5) days in the peratrial group(P ＜ 0.05).Conclusion The percutaneous device closure of ASD under simple TEE guidance is feasible,safe,and efficacious in patients with the ASD diameter of ≤25 mm.It has the advantages of less trauma,less procedural time,shorter hospital stay and better cosmetic results.However,when the ASD diameter was 20 mm and the aortic rim was 3 mm,the peratrial approach may be a better choice.

Objective To explore the significance of nuclear factor-?B(NF-?B)activation in peripheral blood mononuclear cells(PBMC)during acute Kawasaki disease(KD).Methods Peripheral blood was collected from children with acute KD(n=30)and healthy age-matched children(n=20).PBMC were cultured in vitro and divided into 3 groups:naturally cultured blank control group,protein kinase C(PKC)activator stimulated phorbol 12-myristate 13-acetate(PMA)group and PMA plus NF-?B inhibitor treated PMA plus pyrrolidine dithiocarbamate(PDTC)group.Percentages of NF-?B activation were detected by immunohistochemistry.Results Under natural culturing,the percentage of cells with activated NF-?B was significantly higher in acute KD blank control group than that in healthy blank control group.The percentage of cells with activated NF-?B was significantly higher in acute KD PMA group than that in acute KD blank group and that in normal control PMA group,respectively(Pa0.05).Conclusions NF-?B activation in PBMC during acute KD is markedly increased,which suggests that NF-?B activation plays an important role in the formation of vasulitis and CAL in this disease.NF-?B activation in PBMCs in children with KD is regulated by the PKC signaling pathway and PDTC obviously inhibits the activation of NF-?B.J Appl Clin Pediatr,2009,24(1):35-37

Calbindin 2 ; metabolism ; Heart Neoplasms ; metabolism ; pathology ; surgery ; Humans ; Male ; Middle Aged ; MyoD Protein ; metabolism ; Myogenin ; metabolism ; Rhabdomyosarcoma, Embryonal ; metabolism ; pathology ; surgery

Objective:To detect the effect of pulse radiofrequency (PRF) treatment on the neuropathic pain established by L5-spinal nerve ligation (SNL) on rats,and to investigate if PRF treatment would affect the expression of autophagy related protein LC3 and autophagy related receptor P62 at the dorsal horn.Methods:A total of 36 male Sprague-Dawley rats were randomly divided into 3 groups:a Sham group,a SNL group,and a SNL+PRF group.The 50％ paw withdrawal mechanical threshold (PWMT) was detected at 1 day before and 1,3,7,14 and 28 days post-operation by using Von-Frey filaments.The autophagy related protein LC3 and autophagy related receptor P62 were investigated by Western blot.Results:Compared with the Sham group,the PWMT significantly decreased in the SNL group at each time points (P＜0.05);in SNL+PRF group,PRF treatment could elevate the PWMT at the 1st day post-operation and lasted for 28 days (P＜0.05).What's more,SNL could elevate the LC3-Ⅱ and P62 levels at the 7th day post-operation (P＜0.05),which were decreased by the PRF treatment (P＜0.05).Conclusion:PRF treatment could improve SNL-induced the neuropathic pain,which might be partly due to the regulatory effects on the autophagy levels at the spinal dorsal horn.

Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.

OBJECTIVETo study the effect of blood activating water relieving method (BAWRM) on heart functions and serum levels of NT-proBNP in patients with heart failure with normal ejection fraction (HFNEF).

METHODSSixty-four HFNEF patients were admitted to our hospital during January 2011 to June 2012. They were randomly assigned to the treatment group (32 cases) and the control group (32 cases). Patients in the control group received routine Western medical treatment, while those in the treatment group additionally took Chinese medical recipes for activating blood circulation and relieving water retention. Changes of Chinese medical syndromes, E/E', serum NT-proBNP contents were observed between the two groups.

RESULTSCompared with before treatment, their Chinese medical syndromes and E/E' were significantly improved, and serum NT-proBNP contents decreased in the two groups (P < 0.05). Compared with the control group, Chinese medical syndromes, E/E', serum NT-proBNP contents obviously decreased in the treatment group, showing statistical difference (P < 0.05).

CONCLUSIONBAWRM was an effective way to improve the diastolic function of HFNEF patients and lower the serum level of NT-proBNP with confirmative efficacy.

Aged ; Female ; Heart Failure ; blood ; drug therapy ; physiopathology ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Stroke Volume

This study was aimed to observe renoprotective effect and possible mechanism on Y i-Shui Sheng-Xin Yin in spontaneously hypertensive rats. Sixty 12-week male SHR rats were randomly divided into six groups , which were the Y i-Shui She ng-X in Y in low-dose group , middle-dose group , high-dose group , Benazepril group , model group and blank control group , and ten rats for each group . The SHR rats were sacrificed after eight weeks . The urine microalbumin , blood urea nitrogen and cystatin were tested in each rat . The HE and Masson staining method were used to observe changes of renal pathology . Changes of expression of transforming growth factor-β1 ( TGF-β1 ) , connective tissue growth factor ( CTGF ) , FN were detected by immunohistochemistry . The results showed that compared with the blank control group , blood pressure in model group was associated with a significant rise after 8 weeks. Compared with the model group, blood pressure in the Yi-Shui Sheng-Xin Yin middle-dose group, high-dose group and Benazepril group significantly decreased. Compared with the blank control group , urine microalbumin , blood urea nitrogen and cystatin in model group were associated with a significant rise . Compared with the model group , urine microalbumin , blood urea nitrogen and cystatin in the Y i-Shui She ng-X in Y in middle-dose group , high-dose group and Benazepril group significantly decreased . Pathological examinations showed that pathological changes in model group were faster than all drug-groups , appeared pathological changes of glomerular hypertrophy , glomerular basement membrane thickening of heterogeneity and extensive vacuoles degeneration . Immunohistochemical staining showed that compared with the blank control group , expressions of TGF-β1 , CTGF and FN of rat kidney tissue in model group were obviously up-regulated ( P < 0 . 05 ) . Compared with the model group , expressions of TGF-β1 , CTGF and FN in the Y i-Shui She ng-X in Y in , middle-dose group , high-dose group and Benazepril group were down-regulated ( P < 0 . 05 ) . It was concluded that Y i-Shui She ng-X in Y in can reduce SHR rats' early renal glomerulosclerosis and renal interstitial fibrosis , which play roles of delaying the progress of hypertension and protecting kidney . Its mechanism of action may be related to TGF-β1 , CTGF , FN signal pathways .