Objective To explore the effect of remote ischemic preconditioning (RIPC) on preoperative heart rate variability in patients with heart valves. Methods Patients scheduled to undergo on-pump cardiac valve surgery in the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, between January and July 2022 were initially enrolled. Eligible patients were randomly assigned at a 1 : 1 ratio to either the RIPC group or the control group. Relevant indicators of heart rate variability [standard deviation of NN interval (SDNN), standard deviation of mean value of NN interval in every five minutes (SDANN), mean square root of difference between consecutive NN intervals (RMSSD), percentage of adjacent RR interval>50 ms (PNN50), low frequency (LF) component, high frequency (HF) component and LF/HF] at 8 hours in the morning on the surgical day between two groups were compared. Results A total of 118 patients were initially assessed. After screening, 58 patients were excluded, and 60 patients provided written informed consent and were enrolled in the trial, with 30 allocated to the RIPC group and 30 to the control group. Seven patients in the control group and 5 patients in the RIPC group were subsequently excluded due to missing heart rate variability data resulting from cancelled operations. Finally, 23 patients in the control group and 25 patients in the RIPC group were included in the analysis. There was no statistical difference in baseline characteristics between the two groups, and there was no significant difference in heart rate variability 24 hours before intervention (P>0.05). After the intervention measures were taken, the comparison of the results of heart rate variability at 8 hours on the day of operation showed that SDNN and SDANN of patients in the RIPC group were higher than those in the control group, with statistical differences (P<0.05). Conclusion RIPC can stabilize the preoperative heart rate variability of patients undergoing cardiac valve surgery.

Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

Objective To observe the efficacy of positive pressure oxygen therapy combined with drugs to improve pulmonary circulation in the treatment of severe viral pneumonia in high-altitude areas.Methods A two-way cohort study was conducted.Patients with severe viral pneumonia and those with common viral pneumonia complicated with underlying heart and lung diseases admitted to department of intensive care unit of Xizang Autonomous Region People's Hospital were selected as the research subjects.Patients who received conventional treatment in the early stage were assigned to the control group,while those who received conventional treatment plus active positive pressure oxygen therapy combined with drugs to improve pulmonary circulation in the later stage were assigned to the study group.The treatment effective rates of the two groups were observed(including the time for viral nucleic acid to turn negative,hospital stay,and 28-day follow-up mortality)and changes in cardiopulmonary function indicators[pulmonary artery pressure,tricuspid annular plane systolic excursion(TAPSE),left ventricular stroke volume(SV),and lung ultrasounol score(LUS)]before and after treatment were also observed,and the Kaplan-Meier curve was drawn to analyze the 28-day cumulative survival rate of the two groups.Results There was no statistically significant difference in the time for viral nucleic acid to turn negative and hospital stay between the two groups.Compared with the control group,the 28-day mortality in the study group was significantly lower[6.5%(2/31)vs.25.0%(13/52),P<0.05].Compared with before treatment,pulmonary artery pressure gradually decreased,TAPSE significantly increased,and left ventricular SV significantly increased after treatment in the study group,and the differences were statistically significant compared with 10 days after treatment[pulmonary artery pressure(mmHg,1 mmHg≈0.133 kPa):28.84±8.71 vs.34.68±10.76,TAPSE(cm):2.37±0.11 vs.2.03±0.41,SV(mL):68.68±7.17 vs.59.61±6.73,all P<0.01].Pulmonary lesions,especially bilateral pulmonary exudative lesions,significantly improved compared with before treatment,atelectasis improved significantly,and LUS significantly decreased(14.77±5.33 vs.20.32±5.63,P<0.01).Kaplan-Meier curve analysis showed that the 28-day cumulative survival rate in the study group was significantly higher than that in the control group(Log-Rank test:χ2=4.510,P=0.034).Conclusion Active use of positive pressure ventilation and early administration of drugs to improve pulmonary circulation in patients in high-altitude areas can significantly reduce pulmonary artery pressure and significantly improve left and right heart function and pulmonary exudative lesions.These improvements may reduce the mortality rate of viral pneumonia and viral infections complicated with underlying heart and lung diseases in high-altitude areas.

Objective To explore the effect of a self-developed augmented multi-task sensory exer-cise intervention on perceptual-motor skills and motor coordination in children with developmental coor-dination disorder(DCD).Methods Twenty-four DCD children aged 6～7 years were included and ran-domly divided into a control group(n=12)and an experimental group(n=12).Both groups maintained their daily physical activities and took P.E.classes in school,while the experimental group additional-ly underwent a multi-task somatosensory motor intervention consisting of 3 stages.Each stage lasted for 4 weeks,3 sessions per week,with progressively increased difficulty.A self-designed data process-ing module of the somatosensory intervention system was used to collect the scores of each task(i.e.,sensory-motor evaluation),and the changes in scores of each task at each stage were analyzed.More-over,before and after the intervention,the motor coordination ability was assessed using the Move-ment Assessment Battery for Children-Second Edition(MABC-2),and the intra-and inter-group dif-ferences in MABC-2 scores were analyzed.Two weeks after the intervention,the experimental group conducted 3 sessions of motor relearning at the difficulty level of the 3rd stage to examine the effects of motor retention and relearning.Results 1)The experimental group showed a significant increase in their scores on all tasks from T1 to T5 during the enhanced multi-task somatosensory training of all the three stages(P<0.001,P<0.05).2)After the kinesthetic exercises,the experimental group had sig-nificantly higher abilities in fine motor skills,positioning&grasping and body balance compared to the control group(P<0.05),with relatively greater effect on threading beads,drawing traces,tossing and catching bags,single-leg balance,tiptoe walking and two-legged hopping(η2≥0.114).3)In the assessment of motor skill retention and relearning,the T1～T4 scores in the first retest were lower than the previous final ones(P<0.05),with no significant difference from those at the end of the second stage,but showing significantly higher T1 and T5 scores.Moreover,all the T1～T5 scores reached the level measured at the previous end of stage three after three sessions of relearning.Conclusion The augmented multi-task somatosensory practice based on perception-motor skills theory can enhance the perception-motor skills and motor coordination ability of the DCD children,with good motor skill reten-tion and recovery effectiveness after such intervention.

Objective To determine the effect of Tai Chi practice on balance control ability of the individuals with functional ankle instability(FAI)in single-leg stance(SLS),and further observe the augmented effect from attention focus on ankle.Methods A total of 46 individuals with FAI were randomly divided into ankle focus group,free focus group and control group.The ankle focus group and free focus group performed Tai Chi practice for 10 weeks;the ankle focus group focused their attention on the ankle joint,while the free focus group didn't require attention focus;the control group maintained the origin lifestyle and didn't engage in special physical activities.The three-dimensional force plate and Y balance test(YBT)were used to evaluate the static(with eyes open and closed)and dynamic(instant and continuous)balance ability of individuals with FAI.Results For ankle focus group and free focus group,the anterior-posterior(AP)and medial-lateral(ML)sway distances of center of pressure(COP)in SLS with eyes open and closed were significantly reduced,and the reach distance in YBT in three directions were increased.For the ankle focus group,the ML stability index and the dynamic postural stability index were significantly reduced during single-leg drop landing.The ankle focus group and free focus group had a significantly smaller ML COP sway distance than control group in SLS with eyes open;the ankle focus group had a significantly smaller ML COP sway distance than free focus group and control group in SLS with eyes closed;and the reach distance of ankle focus group in posterior-medial&posterior-lateral direction in YBT was longer than that of free focus group and control group.Conclusions Tai Chi practice can comprehensively improve static and dynamic balance control ability of the individuals with FAI in SLS,and ankle attention-focused Tai Chi practice is more effective,especially for the enhancement of their ML control ability in static state with eyes closed and in continuous dynamic SLS.

Objective To determine the effect of Tai Chi practice on balance control ability of the individuals with functional ankle instability(FAI)in single-leg stance(SLS),and further observe the augmented effect from attention focus on ankle.Methods A total of 46 individuals with FAI were randomly divided into ankle focus group,free focus group and control group.The ankle focus group and free focus group performed Tai Chi practice for 10 weeks;the ankle focus group focused their attention on the ankle joint,while the free focus group didn't require attention focus;the control group maintained the origin lifestyle and didn't engage in special physical activities.The three-dimensional force plate and Y balance test(YBT)were used to evaluate the static(with eyes open and closed)and dynamic(instant and continuous)balance ability of individuals with FAI.Results For ankle focus group and free focus group,the anterior-posterior(AP)and medial-lateral(ML)sway distances of center of pressure(COP)in SLS with eyes open and closed were significantly reduced,and the reach distance in YBT in three directions were increased.For the ankle focus group,the ML stability index and the dynamic postural stability index were significantly reduced during single-leg drop landing.The ankle focus group and free focus group had a significantly smaller ML COP sway distance than control group in SLS with eyes open;the ankle focus group had a significantly smaller ML COP sway distance than free focus group and control group in SLS with eyes closed;and the reach distance of ankle focus group in posterior-medial&posterior-lateral direction in YBT was longer than that of free focus group and control group.Conclusions Tai Chi practice can comprehensively improve static and dynamic balance control ability of the individuals with FAI in SLS,and ankle attention-focused Tai Chi practice is more effective,especially for the enhancement of their ML control ability in static state with eyes closed and in continuous dynamic SLS.

Objective To explore the effect of a self-developed augmented multi-task sensory exer-cise intervention on perceptual-motor skills and motor coordination in children with developmental coor-dination disorder(DCD).Methods Twenty-four DCD children aged 6～7 years were included and ran-domly divided into a control group(n=12)and an experimental group(n=12).Both groups maintained their daily physical activities and took P.E.classes in school,while the experimental group additional-ly underwent a multi-task somatosensory motor intervention consisting of 3 stages.Each stage lasted for 4 weeks,3 sessions per week,with progressively increased difficulty.A self-designed data process-ing module of the somatosensory intervention system was used to collect the scores of each task(i.e.,sensory-motor evaluation),and the changes in scores of each task at each stage were analyzed.More-over,before and after the intervention,the motor coordination ability was assessed using the Move-ment Assessment Battery for Children-Second Edition(MABC-2),and the intra-and inter-group dif-ferences in MABC-2 scores were analyzed.Two weeks after the intervention,the experimental group conducted 3 sessions of motor relearning at the difficulty level of the 3rd stage to examine the effects of motor retention and relearning.Results 1)The experimental group showed a significant increase in their scores on all tasks from T1 to T5 during the enhanced multi-task somatosensory training of all the three stages(P<0.001,P<0.05).2)After the kinesthetic exercises,the experimental group had sig-nificantly higher abilities in fine motor skills,positioning&grasping and body balance compared to the control group(P<0.05),with relatively greater effect on threading beads,drawing traces,tossing and catching bags,single-leg balance,tiptoe walking and two-legged hopping(η2≥0.114).3)In the assessment of motor skill retention and relearning,the T1～T4 scores in the first retest were lower than the previous final ones(P<0.05),with no significant difference from those at the end of the second stage,but showing significantly higher T1 and T5 scores.Moreover,all the T1～T5 scores reached the level measured at the previous end of stage three after three sessions of relearning.Conclusion The augmented multi-task somatosensory practice based on perception-motor skills theory can enhance the perception-motor skills and motor coordination ability of the DCD children,with good motor skill reten-tion and recovery effectiveness after such intervention.

Objective To observe the efficacy of positive pressure oxygen therapy combined with drugs to improve pulmonary circulation in the treatment of severe viral pneumonia in high-altitude areas.Methods A two-way cohort study was conducted.Patients with severe viral pneumonia and those with common viral pneumonia complicated with underlying heart and lung diseases admitted to department of intensive care unit of Xizang Autonomous Region People's Hospital were selected as the research subjects.Patients who received conventional treatment in the early stage were assigned to the control group,while those who received conventional treatment plus active positive pressure oxygen therapy combined with drugs to improve pulmonary circulation in the later stage were assigned to the study group.The treatment effective rates of the two groups were observed(including the time for viral nucleic acid to turn negative,hospital stay,and 28-day follow-up mortality)and changes in cardiopulmonary function indicators[pulmonary artery pressure,tricuspid annular plane systolic excursion(TAPSE),left ventricular stroke volume(SV),and lung ultrasounol score(LUS)]before and after treatment were also observed,and the Kaplan-Meier curve was drawn to analyze the 28-day cumulative survival rate of the two groups.Results There was no statistically significant difference in the time for viral nucleic acid to turn negative and hospital stay between the two groups.Compared with the control group,the 28-day mortality in the study group was significantly lower[6.5%(2/31)vs.25.0%(13/52),P<0.05].Compared with before treatment,pulmonary artery pressure gradually decreased,TAPSE significantly increased,and left ventricular SV significantly increased after treatment in the study group,and the differences were statistically significant compared with 10 days after treatment[pulmonary artery pressure(mmHg,1 mmHg≈0.133 kPa):28.84±8.71 vs.34.68±10.76,TAPSE(cm):2.37±0.11 vs.2.03±0.41,SV(mL):68.68±7.17 vs.59.61±6.73,all P<0.01].Pulmonary lesions,especially bilateral pulmonary exudative lesions,significantly improved compared with before treatment,atelectasis improved significantly,and LUS significantly decreased(14.77±5.33 vs.20.32±5.63,P<0.01).Kaplan-Meier curve analysis showed that the 28-day cumulative survival rate in the study group was significantly higher than that in the control group(Log-Rank test:χ2=4.510,P=0.034).Conclusion Active use of positive pressure ventilation and early administration of drugs to improve pulmonary circulation in patients in high-altitude areas can significantly reduce pulmonary artery pressure and significantly improve left and right heart function and pulmonary exudative lesions.These improvements may reduce the mortality rate of viral pneumonia and viral infections complicated with underlying heart and lung diseases in high-altitude areas.

Objective To investigate the safety and efficacy of mitral valve replacement combined with cryoablation Maze surgery in patients with atrial functional mitral regurgitation (AFMR). Methods From January 2014 to June 2020, patients with AFMR who underwent mitral valve replacement in our department were enrolled. They were divided into two groups, a cryoablation Maze group who received cryoablation Maze surgery during mitral valve replacement, and a non-cryoablation Maze group who did not receive cryoablation Maze surgery. The baseline data, surgical data, efficacy, and prognosis between the two groups were compared. Results Finally 85 patients were enrolled. There were 16 males and 24 females with an average age of 58.65±6.86 years in the cryoablation Maze group, and 24 males and 21 females with an average age of 61.29±8.30 years in the non-cryoablation Maze group. There was no statistical difference in baseline data between the two groups (P＞0.05). The aortic occlusion time and extracorporeal circulation time of the cryoablation Maze group were longer than those of the non-cryoablation Maze group with statistical differences (P＜0.01). There was no statistical difference in postoperative ICU retention time, ventilator assistance time, length of hospital stay, intraoperative blood loss, drainage volume on the first day or occurrence rate of complications (temporary pacemaker application, electrical cardioversion, thoracic puncture drainage, hospitalization death) between the two groups (P＞0.05). At the time of discharge, postoperative 3-month, 6-month, 12-month, and 24-month, the maintenance rates of sinus rhythm in the non-cryoablation Maze group were statistically different from those of the cryoablation Maze group (P＜0.001). Compared with the non-cryoablation Maze group, the decrease values of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and pulmonary artery systolic pressure were statistically different (P＜0.05). Postoperative cardiac function grading of both groups was grade Ⅰ or Ⅱ, which was significantly improved compared with preoperative level, but there was no statistical significance between the two groups (P＞0.05). There was no statistical difference in the incidence of adverse events during follow-up (P＞0.05). Conclusion Cryoablation Maze surgery combined with mitral valve replacement is safe and effective in the treatment of AFMR patients, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle, the reduction of pulmonary systolic blood pressure, and the improvement of life quality of the patients.

AIM: To explore the mechanism of osthole on elderly spontaneously hypertensive rats. METHODS: 20-month-old spontaneously hypertensive rats (SHRs) and healthy Wistar-Kyoto (WKY) rats were purchased. SHRs were treated with osthole (i.g.) for 8 weeks. The systolic blood pressure and diastolic blood pressure of rats were monitored. Hematoxylin-eosin staining (H&E), periodic acid-schiff staining (PAS) and Masson staining were used to observe the pathological changes of rat kidney tissues. The activity of superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione (GSH) in rat kidney was detected by ELISA kit. PI3K/Akt/mTOR signaling pathway related proteins were detected by western blot. RESULTS: Osthole reduced the systolic and diastolic blood pressure of SHRs, improved the histopathological changes of SHRs kidney, reduced the activity of MDA in SHRs kidney, and increased the activity of SOD and GSH. Osthole reduced the levels of p-PI3K, p-Akt and p-mTOR. CONCLUSION: Osthole reduces the activity of PI3K/Akt/mTOR signaling pathway and exerts a protective effect on renal oxidative stress injury in aged spontaneously hypertensive rats.