BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

Interarterial subtype of coronary artery with anomalous aortic origin is a rare and congenital cardiovascular malformation,manifested by chest pain and syncope after exertion or activity,which can lead to decreased cardiac contractility,myocardial infarction,and even sudden death.Here we report a case of an adolescent patient,who presented with chest pain during activity accompanied by syncope and lost consciousness.Initially diagnosed with acute myocardial infarction,the patient was subsequently diagnosed as interarterial subtype of a coronary artery originating from anomalous aorta after echocardiography,coronary angiography,coronary CT angiography examinations.After anomalous coronary artery correction and coronary angioplasty,the paitent recovered well.

Humans ; COVID-19 ; HIV Infections/drug therapy* ; Risk Factors

Objective:To search, evaluate and integrate the best evidence for lactation maintenance of very low birth weight infant(VLBWI) mothers, and to provide evidence for lactation maintenance.Methods:Up to Date, BMJ best practice, Newborn Services Clinical Guidelines, ABM, NICE, OVID evidence-based database, NGC, Joanna Briggs Institute Library, Cochrane Library, Web of Science, PubMed, CNKI, CBM and Wanfang Data were retrieved by computer on the Maintenance of Mother′s Lactation in VLBWI: Guidelines, Systematic Evaluation, Expert Consensus/Opinions, Evidence Summary Literature screening, quality evaluation, evidence extraction and integration of documents which met the requirements.Results:A total of 10 articles were included, including 3 guidelines, 4 systematic reviews, 1 expert consensus and 2 expert opinions. A total of 41 evidences were summarized from 9 aspects, including lactation support, lactation initiation, lactation monitoring and the application of lactating agents.Conclusion:The evidence of lactation maintenance of VLBWI mothers is sufficient, which can provide a basis for medical staff to make clinical decisions.

Objective:To investigate the effect of Shentai Tea Polyphenols on memory and its underlying mechanism in healthy elderly adults.Methods:According to the randomized, double blind and placebo-controlled prospective experimental design, 240 healthy middle-aged or elderly subjects with normal objective cognition were recruited in our hospital from April to December 2019 through advertising, and they were randomly divided into an experimental group ( n=120) and a control group ( n=120). Oral administration of Shentai Tea Polyphenols or placebo capsules (lasting for 90 d, 2 times/d, 2 capsules/time) was given to subjects in the two groups. The neuropsychological scale scores and near-infrared brain imaging data of all subjects were collected before and after intervention, and the mean time from baseline data collection before intervention to follow-up data collection after medication was controlled within 6 months. Results:In patients from the experimental group, as compared with those before intervention, scores of delayed recall and recognition memory in the auditory verbal learning test (Huashan version) and Boston naming test, scores of Montreal cognitive assessment scale (basis version) were significantly higher, and scores of Hamilton anxiety scale, shape trails test A and rapid-eye-movement sleep behavior disorder screening questionnaire were significantly lower after intervention ( P<0.05); however, only scores of delayed recall in the auditory verbal learning test (Huashan version) were significantly increased in the control group ( P<0.05). A total of 23 pairs of differences of brain function connection before and after intervention in the experimental group were significantly higher than those in the control group ( P<0.05), mainly involving the function connection of forehead peak network (FPN), and function connection of FPN-default network, function connection of FPN-somatosensory movement network, function connection of FPN-dorsal attention network and function connection of FPN-visual network, as well as the function connection of default network and somatosensory movement network. Conclusion:Shentai Tea Polyphenols can improve cognitive performances including memory, language and executive function, anxiety mood and sleep quality in healthy middle aged or elderly subjects by affecting the functional connections of the networks in the brain.

Objective To investigate the inhibitory effect of Allicin on the apoptosis of hippocampal neurons induced by lead in rats.Methods Sixty male Sprague-Dawley rats aged 3 weeks were randomly divided into 6 groups,10 rats in each group,which were low dose group(A-L),medium-dose group(A-M) and high dose (A-H) Allicin group and lead exposure group (Pb group),dimercaptosuccinic acid (DMSA) group and blank control group.The blank control group animals were treated with ultrapure water,and the other 5 groups received 1.0 g/L lead acetate aqueous solution instead of ultrapure water after 20 days and they were treated them with compounds by oral gavage.The doses of Allicin in group A-L,A-M group and A-H group were 2.7 mg/kg and 5.4 mg/kg,and 10.8 mg/kg,respectively.The DMSA dose was 10.8 mg/kg,and the Pb group was given 9 g/L saline.After the model was established,the rats were sacrificed to collect whole blood and hippocampus.Blood lead and tissue lead concentrations were measured,and the level of apoptosis in hippocampus was observed by TUNEL staining.The levels of cysteine-containing aspartate-specific proteases (caspase)-3,caspase-9,poly adenosine diphosphate-ribose polymerase (PARP) mRNA and caspase-3,caspase-9,PARP activated protein and cytochromes C distribution in the hippocampus cells were detected by using real-time quantitative PCR (qPCR),Western blot,and immunofluorescence staining.Results (1) Lead levels in the blood lead and hippocampus of rats in A-L group,A-M group and A-H group [(190.54±11.33) μg/L,(0.28 ±0.03) μg/L;(159.55 ±16.94) μg/L,(0.22 ±0.06) μg/L;(l16.62 ±8.85) μg/L,(0.19 ±0.01) μg/L] were lower than those in Pb group [(271.34 ±21.23) μg/L,(0.31 ±0.04) μg/L],and there were significant differences (all P ＜ 0.05).The blood lead and hippocampal lead levels in the DMSA group [(50.12 ± 7.44) μg/L,(0.15 ± 0.03) μg/L] were lower than those in the A-L group,A-M group and A-H group.(2) The results of TUNEL staining showed that the apoptosis levels of hippocampus in A-L group,A-M group and A-H group were lower than that in Pb group [(2.81 ±0.17)％,(2.08 ±0.28)％,(1.33 ±0.08)％ vs.(4.23 ±0.17)％],and there were significant differences (all P ＜ 0.05);the apoptosis level of hippocampus in the DMSA group [(2.63 ± 0.32) ％] was higher than that in the A-M group and the A-H group,which was lower than that in the Pb group.(3) qPCR results showed that the levels of caspase-3,caspase-9 and PARP mRNA in A-H group were down-regulated compared with Pb group (1.07 ± 0.05,1.02 ± 0.02,1.11 ± 0.02 vs.1.34 ± 0.02,1.26 ±0.05,1.93 ± 0.07).The differences were statistically significant (P ＜ 0.05).The expression levels of caspase-3 and PARP mRNA in A-L group and A-M group were down-regulated (1.21 ± 0.05,1.43 ± 0.12,1.16 ± 0.02,1.20 ± 0.06 vs.1.34 ± 0.02,1.93 ± 0.07),and there were significant differences (all P ＜ 0.05),and there was no significant change in caspase-9 mRNA;the mRNA levels of caspase-3,caspase-9 and PARP in A-H group (1.07 ± 0.05,1.02 ± 0.02,1.11 ± 0.02) were lower than those in DMSA group (1.14 ± 0.02,1.15 ± 0.08,1.32 ±0.05).(4) Western blot results:compared with Pb group,the expression levels of activated caspase-3,caspase-9 and PARP protein in A-H group were down-regulated (A-H group:0.44 ± 0.15,0.58 ± 0.25 and 0.31 ±0.19,0.23 ±0.07 vs.Pb group:0.69 ±0.13,0.72 ±0.22 and 0.55 ±0.21,0.43 ±0.10),the expression of activated caspase-9 protein in A-M group was lower than that in Pb group (A-M group:0.59 ±0.18 vs.Pb group:0.72 ± 0.22),and there were significant differences (all P ＜ 0.05);the expression of activated caspase-3 and RARP protein in A-H group was lower than that in DMSA group.(5) Fluorescence staining showed that the expression of cytochrome C in cytoplasm of A-L group,A-M group and A-H group were significantly lower than that of Pb group and DMSA group.Conclusion Allicin can inhibit the apoptosis of hippocampus cells in rats with lead poisoning through mitochondrial pathway.The effect of Allicin on apoptosis inhibition may be better than DMSA.

Objective: To evaluate the effect of catheter ablation (CA) by endpoint of left atrium (AF)- pulmonary vein (PV) with bi-directional electrical isolation in treating the patients with paroxysmal atrial fibrillation (PAF) with remote electro-cardio graphic monitoring.
Methods: A total of 82 AF patients received radio frequency catheter ablation (RFCA) in our hospital and 76 PAF patients were observed. Based on circumferential pulmonary vein isolation (CPVI) judgment, the PAF patients were divided into 2 groups: Bi-directional block (BDB) group,n=20 and Entrance block (EB) group,n=56. The post-operative rhythm was followed-up by remote electro-cardio graphic monitoring and the clinical efifcacy of CA was prospectively observed.
Results:①All 76 patients finished CA, 1 patient died in EB group at 4 days after operation for pulmonary embolism, the rest 75 patients were followed-up for (31±19) months. The overall success rates of single ablation procedure at 3 months and 6 months after operation were 85.33% and 77.33%; in BDB group were 95.00% and 85.00%, in EB group were 81.82% and 74.55% respectively, the result was similar between 2 groups,P>0.05.②The overall occurrence rates of arrhythmia at 1 week and 3 months after operation were 35.53% and 17.33%; in BDB group were 15.00% and 5.00%, in EB group were 42.86% and 21.82% respectively, the differences between 2 groups were at P=0.049 andP>0.05.③Remote electro-cardio graphic monitoring recorded the patients with asymptomatic atrial arrhythmia at 1 week and 3 months after operation were at 22.22% and 23.08% respectively.
Conclusion:①Compared with EB group, BDB group had obviously lower occurrence rate of arrhythmia at short term after CA.②The overall success rate of single ablation procedure was similar between 2 groups which might be because less patients were studied.③Remote electro-cardio graphic monitoring has certain advantage for evaluating the occurrence of atrial arrhythmia after operation.

Objective To establish a stable and feasible animal model of acute cerebral infarction,and to evaluate it with functional magnetic resonance imaging and pathology.Methods Twenty-five S-D rats were randomly divided into five groups,and there were 5 rats in each group.Rats in group A were sham-operated for control study.Unilateral middle cerebral artery occlusion(MCAO) was performed with improved thread in group B,C,D,E and were enrolled for MRI and MRS study at 3,6,12,24 hours after MCAO.All rats were examined by 1-hydrogen magnetic resonance spectroscopy(~1H MRS).Two or three rats in each group were sacrificed for 2,3,5-triphenyltetrazolium chloride(TTC) staining of the brain and two rats for pathological examination after MRS.Results Rats in group A showed no change in brain on ~1 H MRS or pathological study.~1H MRS of the rat brains after right MCAO showed a decrease of N-acetyl-aspartate(NAA),an increase of Lactate(Lac) in all groups.There was no significant change of Choline(Cho) and Creatine(Cr) peaks onrats in group B,C,D.The peaks of Cho and Cr were slightly dropped in group E.Conclusion The acute regional cerebral ischemic model in rats made by our approach is stable and reproducible,and it is suitable for evaluation and study with functional magnetic resonancespectroscopy accurately and sensitively.