Objective:To assess the predictive value for the risk of cardiogenic stroke (CS) in patients with paroxysmal atrial fibrillation (PAF) using quantification of left atrial appendage early blood stasis (LAA-BS) signs derived from left atrium-pulmonary vein CT examination.Methods:A retrospective analysis of 187 patients with PAF, who were confirmed to have LAA-BS by left atrium-pulmonary vein CT examinations, was conducted at Second Affiliated Hospital of Nantong University from January 2019 to December 2021. The ratio of LAA-BS CT values to ascending aorta (AA) CT values (HU BS/HU AA) and the ratio of LAA-BS volume to LAA volume (V BS/V LAA) were measured at the peak time of AA enhancement, which were used as characteristic quantitative indicators of LAA-BS. Using the median values of HU BS/HU AA and V BS/V LAA as cut-off points for grouping, the differences between the high-ratio and low-ratio groups were compared in terms of general information, clinical characteristics, and imaging characteristics. All enrolled patients were followed up with the primary outcome event of CS occurrence. The differences in the proportion of CS occurrence between the high-ratio and low-ratio groups were compared. The risk stratification analysis of the occurrence of CS in PAF patients was performed using Kaplan-Meier curves. Additionally, the predictive value of HU BS/HU AA, V BS/V LAA and other imaging indices for the risk of CS occurrence was assessed using Cox proportional risk regression models. Results:The incidence of hypertension and the proportion of patients with atrial fibrillation-stroke risk score (CHA 2DS 2-VASc)≥3 in the high V BS/V LAA group were higher than that in the low V BS/V LAA group, and the difference was statistically significant ( P=0.041, P=0.011). The left atrial volume (LAV) in patients in the low HU BS/HU AA group was greater than in the high HU BS/HU AA group, and the difference was statistically significant ( P=0.040). Kaplan-Meier analysis showed a higher incidence of CS in the low HU BS/HU AA group than in the high HU BS/HU AA group ( P=0.012). Similarly, the high V BS/V LAA group had a higher incidence of CS compared with the low V BS/V LAA group ( P=0.019). Subgroup analysis revealed a significantly higher incidence of CS in the subgroup with low HU BS/HU AA and high V BS/V LAA compared to other subgroups (all P<0.05). The Cox proportional hazards regression model, adjusting for confounding factors, identified low HU BS/HU AA and high V BS/V LAA as independent risk factors for CS occurrence in PAF patients ( P=0.005 and P=0.029). Conclusion:The HU BS/HU AA and V BS/V LAA quantified using left atrium-pulmonary vein CT imaging are predictive factors for CS occurrence in patients with PAF. These ratios synergistically contribute to the risk assessment of CS.

Objective:To assess the predictive value for the risk of cardiogenic stroke (CS) in patients with paroxysmal atrial fibrillation (PAF) using quantification of left atrial appendage early blood stasis (LAA-BS) signs derived from left atrium-pulmonary vein CT examination.Methods:A retrospective analysis of 187 patients with PAF, who were confirmed to have LAA-BS by left atrium-pulmonary vein CT examinations, was conducted at Second Affiliated Hospital of Nantong University from January 2019 to December 2021. The ratio of LAA-BS CT values to ascending aorta (AA) CT values (HU BS/HU AA) and the ratio of LAA-BS volume to LAA volume (V BS/V LAA) were measured at the peak time of AA enhancement, which were used as characteristic quantitative indicators of LAA-BS. Using the median values of HU BS/HU AA and V BS/V LAA as cut-off points for grouping, the differences between the high-ratio and low-ratio groups were compared in terms of general information, clinical characteristics, and imaging characteristics. All enrolled patients were followed up with the primary outcome event of CS occurrence. The differences in the proportion of CS occurrence between the high-ratio and low-ratio groups were compared. The risk stratification analysis of the occurrence of CS in PAF patients was performed using Kaplan-Meier curves. Additionally, the predictive value of HU BS/HU AA, V BS/V LAA and other imaging indices for the risk of CS occurrence was assessed using Cox proportional risk regression models. Results:The incidence of hypertension and the proportion of patients with atrial fibrillation-stroke risk score (CHA 2DS 2-VASc)≥3 in the high V BS/V LAA group were higher than that in the low V BS/V LAA group, and the difference was statistically significant ( P=0.041, P=0.011). The left atrial volume (LAV) in patients in the low HU BS/HU AA group was greater than in the high HU BS/HU AA group, and the difference was statistically significant ( P=0.040). Kaplan-Meier analysis showed a higher incidence of CS in the low HU BS/HU AA group than in the high HU BS/HU AA group ( P=0.012). Similarly, the high V BS/V LAA group had a higher incidence of CS compared with the low V BS/V LAA group ( P=0.019). Subgroup analysis revealed a significantly higher incidence of CS in the subgroup with low HU BS/HU AA and high V BS/V LAA compared to other subgroups (all P<0.05). The Cox proportional hazards regression model, adjusting for confounding factors, identified low HU BS/HU AA and high V BS/V LAA as independent risk factors for CS occurrence in PAF patients ( P=0.005 and P=0.029). Conclusion:The HU BS/HU AA and V BS/V LAA quantified using left atrium-pulmonary vein CT imaging are predictive factors for CS occurrence in patients with PAF. These ratios synergistically contribute to the risk assessment of CS.

Objective:To evaluate the reliability of cardiac late iodine enhancement dual-energy CT (LIE-DECT) multiparameter post-processing technique for evaluating the presence, location, and extent of cardiac scars in patients with heart failure (HF), using cardiac MR (CMR) late gadolinium enhancement (LGE) as a reference standard.Methods:Thirty-nine HF patients who underwent cardiac LIE-DECT and LGE-CMR examinations in the Second Affiliated Hospital of Nantong University from November 2019 to November 2021 were prospectively collected, all enrolled HF patients underwent LIE-DECT post-processing to reconstruct monoenergetic plus (Mono+) map (40 keV), iodine map and Rho/Z map, to evaluate the enhancement degree, location and extent of left ventricular myocardial LIE on the left ventricular short-axis map, respectively, and compared with LGE-CMR. Cohen′s Kappa test was used to assess the intra-and inter-observer consistency of LIE by DECT multiparameter technique and the consistency of LIE presence and location by DECT multiparameter technique and by CMR. The diagnostic efficacy of DECT multiparameter technique in diagnosing myocardial scar was calculated.Results:Of the 39 patients included, 32 patients were detected by CMR with LGE in 147 segments, including 37 subendocardial patterns, 19 transmural patterns, 74 mid-wall patterns, and 17 epicardial patterns. The intra-observer consistency Kappa values of 40 keV Mono+map, iodine map and Rho/Z map were 0.878, 0.930 and 0.835 ( P all<0.001), respectively. The inter-observer consistency Kappa values were 0.838, 0.892 and 0.808 ( P all<0.001), respectively. The LIE of 40 keV Mono+map, iodine map and Rho/Z map were in good agreement with CMR, Kappa values were 0.903, 0.883 and 0.810 ( P all<0.001), respectively. For the per-patient analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map were 92.3% (36/39), 92.3% (36/39) and 82.1% (32/39), respectively. For the segment-based analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map accuracy were 96.1% (492/512), 95.3% (488/512) and 92.6% (474/512), respectively. In Bland-Altman analysis, the consistency bias between scar extent measured by 40 keV Mono+map, iodine map, Rho/Z map and that measured by LGE-CMR were -2.03%, -2.21%, -2.65%, and the 95% limit of agreement were -12.20%-8.14%, -12.69%-8.28% and -14.85%-9.58%, respectively. Conclusion:LIE-DECT multiparameter technique can detect myocardial scar in HF patients well, which is consistent with LGE-CMR.

OBJECTIVETo observe the impacts of acupoint catgut embedding therapy on postpartum weight retention.

METHODSSeventy-one women of postpartum weight retention were divided into an observation group (35 cases) and a control group (36 cases) according to their own wishes when re-examination in 42 days after delivery. In the control group, the nutrition consultation was provided and the calories intake was controlled continuously for 20 weeks. In the observation group, on the basis of the treatment as the control group, the acupoint embedding therapy was applied to Zhongwan (CV 12), Zhongji (CV 3), Qihai (CV 6), Guanyuan (CV 4), Tianshu (ST 25), Guilai (ST 29), Shuifen (CV 9), Shousanli (LI 10), Zusanli (ST 36), Fenglong (ST 40) and Yinlingquan (SP 9). The sutures, No. 4-0 were cut as 2 to 4 mm in length and put into the embedding needle. Afterarrival, the sutures were pushed into the acupoints with the needle core and the needle was removed quickly. The treatment was given once every two weeks, continuously for 20 weeks. Totally, 10 times of acupoint catgut embedding therapy were required. Before and after treatment, the body mass, weight retention, body mass index (BMI), percentage of body fat (PBF), waist circumference (WC), waist-hip ratio (WHR) and health promoting lifestyle profile (HPLP-Ⅱ) were observed in the participants of the two groups.

RESULTSAfter treatment, body mass, weight retention, BMI, PBF, WC and WHR were all reduced as compared with those before treatment in the participants of the two groups, indicating the significant differences (all<0.05). After treatment, the body mass, weight retention, BMI, PBF, WC and WHR in the participants of the observation group were lower than those in the control group, indicating the significant differences (all<0.05). The score of every dimension of HPLP-Ⅱ after treatment was higher than that before treatment in the participants of the observation group, indicating the significant differences (all<0.05); and the scores of health responsibility, sports and spiritual growth in the observation group were higher than those in the control group, indicating the significant differences (all<0.05).

CONCLUSIONSThe acupoint catgut embedding therapy improves in the postpartum weight retention and achieves the satisfactory clinical therapeutic effects.

OBJECTIVE:To explore the difference of genotypes in patients with coronary artery disease(CAD)and different responses to clopidogrel. METHODS:Totally 159 CAD patients were selected from cardiology department of our hospital during Mar. 2013-Nov. 2015. They were given clopidogrel+aspirin for dual antiplatelet therapy for at least 1 year. Turbidimetry method was used to detect the percentage of platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid (AA) before and after treatment. The polymorphism of cytochrome P450(CYP)2C19,CYP3A5,wild type leucine 33 allele(PLA1)/proline 33 al-lele(PLA2)were detected by PCR-RFLP. RESULTS:There were 3 kinds of CYP2C19 genotypes(2/2,2/1,1/1),3 kinds of CYP3A5 genotypes (3/3,3/1,1/1) and 3 kinds of PLA1/PLA2 genotypes (A1/A2,A2/A2,A1/A1);the frequency of each genotype was in line with Hardy-Weinberg balance(P>0.05). Among 159 cases,there were 81 cases of clopidogrelsemi-re-sponse,accounting for 50.9%;78 cases of clopidogrelresponse,accounting for 49.1%. The frequencies of CYP2C19 gene dele-tion(2/2 or 2/1 genotype)and 2 allele in clopidogrelsemi-responsepatients were significantly higher than clopidogrelre-sponsepatients,with statistical significance(P<0.05). The frequencies of PLA1/PLA2 gene deletion(A2/A2 or A1/A2 genotype) and A2 allele in clopidogrelsemi-responsepatients were significantly higher than clopidogrelresponsepatients,with statistical significance(P<0.05). The frequencies of CYP3A5 gene deletion(3/3 or 3/1 genotype)and 3 allele in clopidogrelsemi-re-sponsepatients were slightly higher than clopidogrelresponsepatients,without statistical significance (P>0.05). After treat-ment,the percentage of ADP or AA-induced platelet aggregation in different genotypes patients were significantly lowered,com-pared to before treatment;but the percentage of platelet aggregation in CYP2C19 gene deletion and CYP3A5 gene deletion patients were significantly higher than gene expression patients(1/1 genotype),with statistical significance(P<0.05). There was no sta-tistical significance in the percentage of platelet aggregation between PLA1/PLA2 gene deletion patients and gene expression patients (P>0.05). CONCLUSIONS:The incidence of clopidogrelsemi-responsein CAD patients is high. CYP2C19 and PLA1/PLA2 gene polymorphism may be related to clopidogrelsemi-re-sponse,while CYP3A5 gene polymorphism has no relation-ship with it. CYP2C19 and CYP3A5 gene deletion may weaken inhibitory effects of clopidogrel on platelet aggregation of CAD patients.

OBJECTIVE:To observe the effect of rosuvastatin on prognostic of patients with paroxysmal atrial fibrillation (AF) after circumferential pulmonary vein ablation. METHODS:75 patients with paroxysmal AF were divided into observa-tion group(n=39)and control group(n=36)according to the admission single. All patients underwent circumferential pulmo-nary vein ablation antiarrhythmic treatment. Control group orally received warfarin sodium,amiodarone,metoprolol,and sub-cutaneous injected low molecular weight heparin. Observation group additionally received 10 mg Rosuvastatin tablet,qd on the basic of contol group. Changes of cardiac function,inflammatory factors,lipid levels in 2 groups before and after treat-ment were observed,and follow-up results were compared. RESULTS:There was no significant difference in left atrial diame-ter and left ventricular ejection fraction in 2 groups before and after treatment (P>0.05);atrial effective refractory periods (AERP)in 2 groups significantly prolorged,and observation group prolorged more significantly than control group,the differ-ence was statistically significant(P<0.05). Serum high sensitivity C-reactive protein,interleukin-6 48 h and 1 month after op-eration in 2 groups significantly increased,and control group was significantly higher than observation group,the difference was statistically significant (P<0.05);before operation and after 3 months of operation,there was no significant difference in inflammatory cytokine levels(P>0.05). Triglyceride and low density lipoprotein cholesterol in observation group 1 month after operation significantly decreased, HDL-C significantly increased, there were significant differences (P<0.05). Fol-low-up time was (23.91 ± 5.28) months,AF recurrence was 7.8%,which was significantly lower than control group (13.9%),the difference was statistically significant (P<0.05);and there were no significant differences in ablation-related atrial tachycardia (ATa) and the incidence of adverse reactions between 2 groups (P>0.05). CONCLUSIONS:Rosuvastatin can effectively inhibit the inflammatory reaction and prolong the AERP,thereby reducing the recurrence rate of AF,with good efficacy and safety.

Objective To observe the effects of electro-acupuncture on the E-selectin and resistin protein expression in the hippocampus of rats of chronic stress depression;To explore the role and mechanism of electro-acupuncture in the micro-environment of brain with depression. Methods 40 Fourty rats were randomly divided into four groups:blank group, model group, model+EA group, and model+fluoxetine group by using chronic stress combined with solitary raising methods, 10 rats in each group. Electro-acupuncture intervention was used 1 hour before the modeling. Electro-acupuncture was given at points Baihui (Du 20) and Yintang (Extra) for twenty minutes (2 Hz, 0.6 mA) every day. Fluoxetine was given at the volume of 5 mL/kg, dosage of 10 mg/kg. E-selectin and resistin protein expression in hippocampus were determined by biotin label-based antibody array. Results Compared with the blank group, the protein expression of E-selectin and resistin in the model group increased (fold change=1.23, 1.22). Compared with the model group, E-selectin and resistin expression decreased (fold change=0.65, 0.62;fold change=0.76, 0.65). Conclusion Electro-acupuncture intervention could down-regulate E-selectin and resistin expression in the hippocampus of chronic stress depression model.

OBJECTIVETo evaluate the potential role of insulin-like growth factor-1 receptor mRNA (IGF-IR mRNA) in the onset and development of retinopathy in diabetic rats.

METHODSA diabetic model was duplicated in Wistar rats. The early changes in the retina were examined using light and transmission electron microscopy. Expression of IGF-IR mRNA was analyzed using in situ hybridization.

RESULTSWeak expression of IGF-IR mRNA (5%) was found in retinas of normal rats, but was significantly increased (15% and 18%) in the retinas of diabetic rats after 3 and 6 months of diabetes (P < 0.01). In situ hybridization and morphological study demonstrated that there was a positive correlation between IGF-IR mRNA expression and retinal changes at various stages.

CONCLUSIONIncreased IGF-IR mRNA might play an important role in the onset and development of diabetic retinopathy.

Animals ; Blood Glucose ; analysis ; Diabetic Retinopathy ; etiology ; Glycated Hemoglobin A ; analysis ; Insulin-Like Growth Factor I ; physiology ; Male ; RNA, Messenger ; analysis ; Rats ; Rats, Wistar ; Receptor, IGF Type 1 ; genetics ; Retina ; metabolism ; pathology