ObjectiveTo investigate the effects of granuloeyte colony stimulating factor (G-CSF) on myocardial apoptosis and left ventricular function following coronary mieroembolization (CME).MethodsA total of 68 male Sprague Dawley rats were randomized into control group(n=24), G-CSF-treated group(n= 24) and sham-operated group(n= 20). The control group and G-CSF -treated group underwent injection of homologous microthrombotic particle suspension into left ventricle when clamping the ascending aorta. The sham-operated group were treated with saline.rhG-CSF(100 yg · kg<'-1> · d<'-1>) were injected subcutaneously for 5 days since 2 h after operation in C-CSF group, meanwhile, the control group and sham-operated group were treated with saline respectively. The rats were sacrificed at day 3,7,14 and 28 after operation. The mRNA expressions of Bcl-2, Bax, Fas, FasL and glyceraldehyde phosphate dehydrogenase (GAPDH) were evaluated by real time PCR. The ratio of Bcl-2/Bax was calculated. The protein expressions of easpase-3 and cleaved poly ADP-ribose polymerase (PARP) were detected by Western blot. Myocardial apoptosis and leftventricular function were checked byterminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL)staining and hemodynamics respectively. ResultsCompared with sham-operated group,the mRNA expression of Bcl-2, Bax, Fas and FasL were increased whereas the ratio of Bcl-2/Bax markedly decreased in control group(0.28±0.04 vs. 2.98±0.49), P<0.05.Simultaneously, the protein expressions of caspase-3 and cleaved PARP enhanced (0.762±0.129 vs. 0.133±0.027;0.992±0.146 vs. 0.386+0.074) ,all P<0.05. The myocardial apoptosis index was elevated(17.2±1.9 vs. 1.2±0.6)and the left ventricular function decreased significantly (P<0.05). Compared with control group, the mRNA expression of Bct-2 increased and that of Bax, Fas and FasL decreased in G-CSF-treated group. Meanwhile, the ratio of Bcl-2/Bax markedly increased(2.07±0.29 vs. 0.28±0.04)and the protein expression of caspase-3 and cleaved PARP decreased(0.371±0.041 vs. 0.762±0.129;0.548±0.093 vs. 0.992±0.146, all P<0.05). The myocardial apoptosis index was reduced (6.1±1.0 vs. 17.2±1.9)and the left ventricular function increased significantly (P<0.05).ConclusionsG-CSF could lighten the myocardial apoptosis and improve the left ventrieular functionafter CME.

Objective This study was aimed to discuss the safety, feasibility and availability of perimembranous ventricular septal defects(PmVSD) closure via super minimal intercostal incision under transesophageal echocardiography(TEE) guidance in children.Methods There were 81 cases of PmVSD via super minimally invasive transintercostal device closure operation(length of incision ≤ 1cm) from August 2014 to August 2016.TEE was used to guide and monitor the entire procedure.Assessed the effectiveness of device closure by postoperative regular follow-up.Results 80 patients were successfully operated by super minimally invasive transintercostal device closure in all 81 cases.Operation success rate reached 98.77%.The average diameter of ventricular septal defects was(3.72±0.96)mm.The average diameter of amplatzer occluder was(4.88±0.95)mm.Postoperative follow-up time was from 6 months to 24 months.One of 16 cases that with aneurysm of membranous septum had more than two shunts, remained a mild residual shunt beside of the amplatzer occluder but self cured during follow-up.Mild pericardial effusion was found in one patients after the operation and disappeared during follow-up.There were no cases of perioperative death, device deformation or displacement, residual shunt, complete atrioventricular block and valve involvement in the patients whom were successfully operated.One patient transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass, because ventricular fibrillation happened when guide wire passed the ventricular septal.Conclusion Super minimally invasive transintercostal device closure of PmVSD in children guided by TEE was safety and availability, that could avoid x-ray radiation and sternotomy, and operate simply, with small incision and low complication.

Objective To study the therapeutic effects of prostaglandin E1 on the neonates with transposition of the great vessels with intact ventricular septum (TGV/IVS) retrospectively. Method From January 2004 to June 2009, 34 neonates with TGV/IVS were enrolled in this study. The pulse rate and oxygen saturation (SpO2) of patients were measured percutaneouly at admission. Lipo-prostaglandin E1 (Lipo-PGE1) was administered via peripheral vein with pumping infusion continuously after diagnosis by echocardiography in order to keep the ductus arteriosus (DA) patent. The dose and the time required for the Lipo-PGEl to produce effect were recorded. The changes of SpO2 before and after administration of Lipo-PGE1 were observed. The changes of DA's diameter detected by using echocardiography before and during the operation. Results In all patients the initial dose of Lipo-PGEl was 5 ng/( kg·min) except 3 patients whom larger dosed were required to give guided by the change of SpO2 with 10 ng/(kg·min) in two patients and 15 ng/(kg·min) in one patient. The time required for Lipo-PGE to produce the effect was 5-15 minutes in most infants with mean of (12 ± 3) minutes. The mean SpO2 of the patients measured at admission was (80.05±7.64)%, and it was (86.41±4.83)% two hours before operation (P < 0.05). The average diameter of DA was (0.37±0.08) cm at the time diagnosis and it was (0.51 ±0.15) cm during the operation. The adverse effects occurred in two patients and one of them had apnea and was treated mechanical ventilation. Conclusions Lipo-PGE1 given by continuous pumping infusion via peripheral vein in dose of 5 ng per kilogram per minute can maintainthe DA patency and promote the systemic oxygenation and perfusion, improving the circulation and oxygenation and correcting the acidosis until the plastic surgery performed. Most of the adverse effects of PGE1 are dose related.

Objective To compare the procedural difficulty index (PDI) and immediate outcome (IM) of percutaneous coronary intervention (PCI) in patients with various stages of myocardial infarction.Methods Ninety-four patients with myocardial infarction were divided into three groups, direct PCI(n=38), delayed PCI(n=22) and late PCI(n=34). The characteristics of infarct-related coronary artery, PDI and IM of PCI were evaluated angiographically, and severe procedural complications (SPC) and major adverse cardiac events (MACE) during hospitalstay were documented. Results In the three groups, PDI was 1.47 ?1.79, 1.82 ?1.72 and 2.85 ?2.83, respectively (P

Objective: To explore the impact of PI3K-Akt-eNOS signaling on atrial fibrillation inducibility in diabetic rats. Method: Eight-week-old male diabetic rats were randomized assigned into GK group, IGF group and L-NAME group (n=8 each) which respectively received normal saline (NS), insulin like growth factor (IGF-1) or L-NAME+IGF-1 through tail vein daily for 4 weeks. Eight 8-week-old male homologous Wister-Kyoto(WKY) rats treated with intravenous NS served as control group (WKY group). Blood glucose was measured once per week. The left atrial diameter (LAD) was measured by echocardiography, the atrial electrical parameters, including the P-wave duration, the atrial effective refractory period (AERP) and its dispersion (AERP-d), the incidence and the duration of atrial fibrillation induced by atrial burst pacing, were evaluated by electro-physiological instrument at 4 weeks post various treatments. Rats were then sacrificed, left atrial (LA) cell morphology was determined on HE stained sections, LA interstitial collagen was determined on Masson stained sections. The protein expression of phosphatidylinositol 3-kinase (PI3K) and phosphate endothelial nitric oxide synthase (p-eNOS) were detected by Western blot. Results: (1) At the beginning of the study, the random blood glucose (GLU) level was significantly higher and LAD was large in GK, IGF and L-NAME groups than in WKY group;after 4 weeks, GLU level and LAD dimension of IGF group were lower than GK and L-NAME groups (P<0.01 or 0.05). (2) One rat in L-NAME group died during operation. Four weeks later, the incidence of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 7/8, 2/8, 6/7 and 3/8. The median duration of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 11.9(9.3, 13.1), 0(0, 1.8), 11.5(4.4, 12.0), and 0(0, 3.0) s. Compare with WKY group, the P-wave duration and PR interval were significantly longer, AERP-d, incidence, and duration of atrial fibrillation were significantly higher in GK group (P<0.01), these changed were significantly reversed in IGF group compared to GK and L-NAME groups (all P<0.01). Heart rate and AERP were similar among the 4 groups on (P>0.05). (3) Four weeks later, the CSA and CVF of LA were significantly larger in GK group than in WKY group (P<0.01), which were significantly reversed in IGF group (P<0.01 vs. GK group), and the beneficial effects of IGF disappeared by co-treatment with L-NAME (P<0.01 vs. IGF group). (4) Four weeks later, compare with WKY group, the protein expression of PI3K (P<0.01) and p-eNOS (P<0.05) of LA were significantly downregulated in GK group, which could be significantly upregulated by IGF (P<0.01 and 0.05 vs. GK group), these effects diminished by co-treatment with L-NAME (P<0.01 or 0.05 vs. IGF group). Conclusion Increased atrial fibrillation susceptibility in diabetic rat is linked with structural and electrical remodeling in LA, possibly mediated through downregulated PI3K-Akt-eNOS signaling.

Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique (the mono-ring culotte) stenting was done in which the side branch (SB) stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch (MB) wire. Secondly, the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015, 15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was (34. 3 ± 9. 6) min, fluoroscopic time was (18. 1 ± 3. 8) min, and contrast volume was (112. 0 ± 24. 5) ml, respectively. Post-procedurally, the residual stenosis of the main and the side branch were (10. 0 ± 2. 5)% and (10. 2 ± 5. 3)% , respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions, and may be superior to the conventional culotte stenting.

OBJECTIVETo summarize the features of clinical manifestations, laboratory tests and imaging findings of patients with cardiac amyloidosis (CA).

METHODSA total of 60 CA patients (including 41 male and 19 female patients) from 4 centers admitted between May, 2012 and November, 2013 were included in the study. The demographic data, medical history, clinical manifestations, laboratory test data, ECG, cardiac ultrasound, and cardiac magnetic resonance (CMR) imaging of the patients were analyzed.

RESULTSTwo-thirds of the 60 CA patients, were middle-aged or elderly men, and 47% of the patients had AL-CA. The clinical manifestations included exertional dyspnea (73%), pedal edema (47%), hypotension (47%), and hypertrophy of the tongue (22%); abnormal laboratory test results included albuminuria (53%) and liver (15%) and kidney (28%) dysfunction; blood routine, urine and serum immunoglobulin quantification and immunofixation electrophoresis could help the screening of AL-CA. Kidney (53%) and liver (15%) involvement was common, and 86% of AL-CA patients had kidney involvement. Typical ECG characteristics included poor R wave progression (35%), low voltage in limb leads (33%), and a pseudo infarct Q wave (30%); the latter two were more frequent in AL-CA. The characteristics of ultrasound findings included left ventricle thickening (100%), left atrial enlargement (87%) and enhanced echo of the myocardial granules(92%), and diastolic dysfunction was obvious in all the CA patients regardless of the systolic function. The DT and E/e' of the mitral annulus could be used as an index to evaluate diastolic dysfunction in early stage of the disease. Left ventricular (LV) global subendocardial late gadolinium enhancement (LGE, 81%) accompanied by right ventricular (RV) and atrial LGE was the typical characteristic of CMR, and the range of LGE in the RV and the two atria was wider in AL-CA than in non-AL-CA. NT-proBNP (97%) and cardiac troponin (53%) in CA patients were both elevated, which helped in diagnosing and assessing the severity of cardiac involvement, according to which 50% of the patients were found to be at a high risk, 43% at an intermediate risk, and 7% at a low risk.

CONCLUSIONThe combination of the features of clinical, laboratory tests and imaging findings of CA have important diagnostic and prognostic value for CA.

Adult ; Aged ; Amyloidosis ; diagnosis ; pathology ; physiopathology ; Cardiomyopathies ; diagnosis ; pathology ; physiopathology ; Electrocardiography ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Magnetic Resonance Imaging ; Male ; Middle Aged

Objective To explore the value of transesophageal echocardiography ( T EE ) in high ventricular septal defect ( VSD) occlusion via a left parasternal ultra‐minimal intercostal incision ( ≤1 cm ) with eccentric occluder in children . Methods Forty‐eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder . T he w hole operation , including preoperative evaluation ,intraoperative localization and guidance and postoperation evaluation were performed under the guidance of T EE . Results Forty‐six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95 .8% . T he average size of high VSD was 2 .2－6 .0 ( 3 .70 ± 0 .90) mm and the average size of eccentric occluder was 4－8 ( 5 .48 ± 1 .12) mm . T he average operation duration was 18－98 ( 49 .80 ± 16 .71) min . T here were 2 cases of peri‐membranous high VSD and 44 cases of outlet‐typle VSD ,of w hich 10 cases of mild aortic valve prolapses ( AVOP) ,including 5 cases of aortic valve regurgitation ( AR ) . In addition ,there was 1 case of replacement of device ,1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect . T he 46 cases were followed up for 6 to 42 months ,and the pericardial effusion occured in 3 cases and disappeared during follow‐up . No other abnormal conditions were found . Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder ,T EE has an important value in defect assessment ,intraoperative localization and guidance ,and immediate evaluation of efficacy ,and can effectively guide the device occlusion of high VSD .

Acylcarnitines are metabolic intermediates of fatty acids and branched-chain amino acids having vital biofunctions and pathophysiological significances.Here,we developed a high-throughput method for quantifying hundreds of acylcarnitines in one run using ultrahigh performance liquid chromatography and tandem mass spectrometry(UPLC-MS/MS).This enabled simultaneous quantification of 1136 acyl-carnitines(C0-C26)within 10-min with good sensitivity(limit of detection＜0.7 fmol),linearity(cor-relation coefficient＞0.992),accuracy(relative error＜20％),precision(coefficient of variation(CV),CV＜15％),stability(CV＜15％),and inter-technician consistency(CV＜20％,n=6).We also established a quantitative structure-retention relationship(goodness of fit＞0.998)for predicting retention time(tR)of acylcarnitines with no standards and built a database of their multiple reaction monitoring parameters(tR,ion-pairs,and collision energy).Furthermore,we quantified 514 acylcarnitines in human plasma and urine,mouse kidney,liver,heart,lung,and muscle.This provides a rapid method for quantifying acyl-carnitines in multiple biological matrices.

Objective:Combined with the actual clinical situation, to introduce the application of invasive trans super minimal intercostal device closure in doubly committed ventricular septal defect(DCVSD).Methods:Between January 2017 and July 2020, 82 DCVSD children were recruited. Relevant data such as operation time, length of hospital stay, postoperative complications, etc. were analyzed, and the follow-up of the postoperative period was used to evaluate the effect of the operation.Results:Among them, 2 children’s puncture points were bleeding. Chest closure time was obviously extended. The total operation time of the remaining children was 24-72(47.54±12.06)min, among which the umbrella release time was 5-37(16.16±8.01)min, and the chest opening and closing time was 14-59(31.56±9.58) min. Pericardial effusion occurred in 2 patients after operation, and the discharge time was more than 2 weeks. The remaining children were hospitalized for 3-9(5.79±1.45)days after surgery.Conclusion:Closing DCVSDs through a super minimal intercostal incision under TEE guidance was safe, effective and less trauma.