Objective To observe the effect of numerical simulation technique for predicting effect of self-expanding prosthetic valve(SEV)stents for treating type 0 bicuspid aortic valve(BAV)stenosis with different implantation strategies.Methods Based on CT angiography data from a patient with type 0 BAV stenosis and asymmetric calcification,three-dimensional models of aortic root wall,aortic valve calcification,native valve and SEV were reconstructed.ABAQUS/Explicit dynamic analysis module was used to observe the interaction between SEV stents and aortic root including root stress and stent deformation under different implantation strategies(implantation depths of high,medium or low,and implantation centers of central or eccentric position).Results When SEV was implanted centrally at low depth and central position,the Von Mises stress on aortic root wall was the highest,with mean and peak value of 2.28 and 45.30 kPa,respectively.When SEV was implanted at medium depth and central position,the average eccentricity of stent across all planes was the highest(0.254),while when implanted at high depth and eccentric position,the average ellipticity in planes S1-S3 was the minimal(0.124).Conclusion Different SEV implantation strategies resulted in varying interactions between stent and aortic root.Numerical simulation technique could be used to determine the implantation center and depth based on the size and location of type 0 BAV calcification,which was helpful to reducing rupture risk of aortic annulus,increasing durability and improving prognosis of SEV stent.

Objective To observe the effect of numerical simulation technique for predicting effect of self-expanding prosthetic valve(SEV)stents for treating type 0 bicuspid aortic valve(BAV)stenosis with different implantation strategies.Methods Based on CT angiography data from a patient with type 0 BAV stenosis and asymmetric calcification,three-dimensional models of aortic root wall,aortic valve calcification,native valve and SEV were reconstructed.ABAQUS/Explicit dynamic analysis module was used to observe the interaction between SEV stents and aortic root including root stress and stent deformation under different implantation strategies(implantation depths of high,medium or low,and implantation centers of central or eccentric position).Results When SEV was implanted centrally at low depth and central position,the Von Mises stress on aortic root wall was the highest,with mean and peak value of 2.28 and 45.30 kPa,respectively.When SEV was implanted at medium depth and central position,the average eccentricity of stent across all planes was the highest(0.254),while when implanted at high depth and eccentric position,the average ellipticity in planes S1-S3 was the minimal(0.124).Conclusion Different SEV implantation strategies resulted in varying interactions between stent and aortic root.Numerical simulation technique could be used to determine the implantation center and depth based on the size and location of type 0 BAV calcification,which was helpful to reducing rupture risk of aortic annulus,increasing durability and improving prognosis of SEV stent.

Objective:To improve the understanding of indolent mantle cell lymphoma (MCL).Methods:The data of a patient with indolent leukemic MCL in the Second Affiliated Hospital of Nanjing Medical University in May 2013 were collected. The cell morphology was analyzed by using cell smear, the flow cytometry was used to make immunophenotype analysis, the karyotype analysis was performed by usig cytogenetic technique, and polymerase chain reaction (PCR) was used to make the immunoglobulin gene analysis. At the same time, lymph node pathology and immunohistochemistry were also analyzed. The related articles published were reviewed to sum up the characteristics and the treatment of indolent MCL.Results:The male patient aged 60 years was obviously asymptomatic accompanied with slow disease progression, leukemic manifestation and without lymphadenopathy. He received pathological biopsy because of located lymphadenopathy in 2008. Small cell morphology, Kappa light chain immunophenotype, t(11;14) translocation showed after the cytogenetic examination, clonal immune globulin gene rearrangement and low Ki-67 positive index were identified. In situ MCL was diagnosed by retrospective pathology.Conclusions:Indolent MCL is extremely rare. It is typically asymptomatic with none or minimal nodal involvement, indolent disease course, leukemic phase with mild lymphocytosis, Kappa light chain expression, simple karyotype, classical or small cell morphology of tumor cells and the positive index of Ki-67 <10%. In situ MCL can be seen in pathology examination. IgVH gene mutation positive and SOX11 negative expression are notable in indolent MCL. International prognostic index of MCL is probably not appropriate in the prognostic analysis of leukemic indolent MCL. It is emphasized that initial observation and having therapies only after the disease progression can be suited for indolent MCL.

Objective: To discuss and evaluate the safty and outcome of the second order chordal-cutting. Methods: From Aug 2015 to Mar 2017, 9 chronic IMR patients underwent chordal-cutting procedure, in addition to myocardial revascularization and undersized mitral annuloplasty. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA)<145° and the coaptation depth (CD) less than 10 mm. Pre- and post-procedure clinical data including left ventricular ejection fraction(LVEF), mitral regurgitation grade, New York Heart Association (NYHA) class and dimension of the left ventricle were compared. Results: There was no perioperative death. No patient was lost to follow-up. MR grade decreased from 2.89 ± 0.60 preoperatively to 0.56 ± 0.70 postoperatively. The New York Heart Association class decreased from 2.78 ± 0.70 preoperatively to 1.33 ± 0.50 postoperatively. The BA increased from (136.22 ± 4.55)°preoperatively to (174.22 ± 3.15)°postoperatively. The coaptation depth decreased from (8.59 ± 0.46) mm preoperatively to (1.54 ± 0.68) mm postoperatively. LVEF increased from 0.49±0.07 preoperatively to 0.57±0.05 postoperatively. The diastolic and systolic diameters of left ventricle decreased from (62.78 ± 5.24 )mm to (53.67 ± 2.99)mm and( 44.11 ± 4.62)mm to( 37.22 ± 3.27)mm, respectively. Conclusion In selected chronic IMR patients with a BA<145° and coaptation depth less than 10 mm, second order chordal-cutting can be a good surgical option, and is related to less MR return or persistence, improved LVEF, and lower New York Heart Association class.

Objective: To investigate the expression levels of S100A6, Notch1 in multiple myeloma (MM) patients and its clinical significance. Mathods: The expression levels of S100A6, Notch1 in 28 MM cases and 20 healthy controls were determined by real time quantitative PCR (RQ-PCR) , and their relationships with clinical features and outcomes were analyzed. Immunohistochemical was used to analysis the levels of S100A6 and Notch1 in bone marrow biopsy samples and intramedullary metastases soft tissues. RQ-PCR and Western blot were used to test the changes of Notch1 mRNA and Notch1 protein in U266 MM cells after S100A6 silenced by siRNA. Results: ①The expression levels of S100A6, Notch1 in primary MM patients was 2.19±1.25, 2.98±0.64, significantly higher than those in controls (0.71±0.20, 0.58±0.39, P<0.05) and patients in platform status (0.85±0.26, 0.72±0.40, P<0.05) . 8 cases with intramedullary metastasis had significantly higher levels of S100A6 (3.36±1.23) and Notch1 (5.71±3.96) , as compared to those without extra medullary metastases. ②S100A6 expression was positive correlation with Notch1 (r=0.505, P=0.007) . ③S100A6 and Notch1 proteins were positive in plasma cells of bone marrow biopsy samples and intramedullary metastases soft tissues. ④The Notch1 mRNA and Notch1 expression decreased significantly after 48 hours treatment by S100A6 siRNA in U266 cells. Conclusion S100A6 and Notch1 were closely associated with MM progress and intramedullary metastasis. They have significant correlation and might be as two prognostic molecular markers in MM.

Objective To observe the effect of exercise preconditioning (EP) on pressure overload-induced pathological cardiac hypertrophy and explore related mechanisms.Methods Ten-week-old male Sprague-Dawley rats (n =80) were randomly divided into four groups via random number table method: sham, TAC,EP + sham and EP + TAC.Two EP groups were subjected to 4 weeks of treadmill training, and followed by sham and TAC operations.Eight weeks after the surgery, mean arterial pressure (MAP), cardiac morphology, mRNA expressions of the B-type natriuretic peptide (BNP) and heat shock protein (HSP) 70 and protein expression of the BNP, heat shock transcription factor 1 (HSF1), HSP70, nuclear factor κB (NF-κB) p65, and interleukin-2 (IL-2) were examined.Results (1) Pathological cardiac hypertrophy index: eight weeks after TAC, MAP, heart size, HW/BW, cross-sectional area of the cardiomyocytes (CSA) and mRNA and protein expressions of BNP in the LV were all significantly higher in the TAC and EP + TAC groups than respective sham groups (all P ＜ 0.05).HW/BW, CSA, and mRNA and protein expressions of BNP in the LV were significantly lower in EP + TAC group than in TAC group (all P ＜0.05).(2) mRNA and protein expressions of HSF1 and HSP70 and nuclear HSF1 levels were significantly downregulated post TAC, however, EP treatment significantly increased the expression of HSFl and nuclear HSF1 levels in TAC rats (all P ＜ 0.05).(3) mRNA and protein expressions of NF-κB p65 and IL-2 were significantly increased in the TAC and EP + TAC groups compared with the respective sham groups (all P ＜ 0.05), which were significantly downregulated in EP + TAC group compared to TAC group (all P ＜ 0.05).Conclusions EP could effectively reduce the cardiac hypertrophic responses induced by TAC possibly through upregulating the expressions of HSF1 and HSP70 and inhibiting the expression of NF-κB p65 and its nuclear translocation.

Objective: To explore the effect of exercise preconditioning (EP) on pathological cardiac hypertrophy and heart failure (HF) in pressure over-loaded experimental rats.
Methods:A total of 60 SD rats at the age of 6 weeks were randomly divided into 3 groups, n=20 in each group. Sham-operation group, Transverse aortic constriction (TAC) group and EP + TAC group. The cardiac function and structure were evaluated by echocardiography, patholgical changes and HF biomarkers were examined for EP effect at 4 and 8 weeks after TAC.
Results:Compared with Sham-operation group, the cardiac function and structure had obvious changes in the other 2 groups. Compared with TAC group, the ejection fraction in EP+ TAC group increased 15%, the heart weight index and left ventricular weight index decrease 15.7%and 20%respectively at 8 weeks after TAC, all P<0.05. Compared with Sham-operation group, the mRNA and protein expressions of ANP and BNP increased in TAC group at 4 and 8 weeks after TAC, increased in EP+TAC group at 8 week after TAC. Compared with TAC group, the mRNA expressions of ANP and BNP in EP+TAC group decreased 47%and 62%at 4 weeks after TAC, decreased 44%and 28.1%at 8 weeks after TAC, all P<0.05;the protein expression of ANP and BNP in EP+TAC group decreased 22.3%and 48%at 4 weeks after TAC, decreased 21.5%and 38.3%at 8 weeks after TAC, all P<0.01.
Conclusion: EP may improve cardiac pathological hypertrophy in pressure over-loaded rats at the early stage, and delay the heart failure process.