Objective:To evaluate the interaction between remimazolam and propofol for sedation during hysteroscopy.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 20-45 yr, with body mass index of 18-28 kg/m 2, scheduled for elective hysteroscopy, were included. The test was conducted in two steps. Up-and-down sequential allocation was used to determine the median effective dose (ED 50) of remimazolam (group A) and propofol (group B). The ED 50 obtained in A and B groups were then used as the standard to determine the combination regimen in group C (0.25×ED 50 of remimazolam+ 0.75×ED 50 of propofol as the initial dose), in group D (0.5×ED 50 of remimazolam+ 0.5×ED 50 of propofol as the initial dose), and in group E (0.75×ED 50 of remimazolam+ 0.25×ED 50 of propofol as the initial dose). Up-and-down sequential allocation was used to determine the ED 50 of propofol when propofol and remimazolam were combined in C, D and E groups. The interaction between the sedative effects of two drugs was analyzed using the isobolographic analysis method, and the interaction coefficient and synergistic dose ratio of two drugs were calculated. Results:The ED 50 of remimazolam was 0.180 mg/kg in group A, and the ED 50 of propofol was 1.167 mg/kg in group B. The results of isobolographic analysis showed that remimazolam and propofol had a synergistic effect. When remimazolam 0.045, 0.090 and 0.135 mg/kg were combined with propofol 0.546, 0.288 and 0.160 mg/kg, the interaction coefficients were 1.393, 1.339 and 1.127 respectively. The synergistic dosage ratio of remimazolam and propofol was 1.0∶(3.2 to 12.0). Conclusions:Remimazolam and propofol have a synergistic effect on sedation when used for hysteroscopy, and the dose ratio is 1.0∶(3.2-12.0).

Background::Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods::Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.Results::A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43–0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04–13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65–3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38–1.53; P <0.001). Conclusions::In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration::ClinicalTrials.gov, NCT02309398.

This study aimed to observe the protective effect of momordicine I, a triterpenoid compound extracted from momordica charantia L., on isoproterenol (ISO)-induced hypertrophy in rat H9c2 cardiomyocytes and investigate its potential mechanism. Treatment with 10 μM ISO induced cardiomyocyte hypertrophy as evidenced by increased cell surface area and protein content as well as pronounced upregulation of fetal genes including atrial natriuretic peptide, β-myosin heavy chain, and α-skeletal actin; however, those responses were markedly attenuated by treatment with 12.5 μg/ml momordicine I. Transcriptome experiment results showed that there were 381 and 447 differentially expressed genes expressed in comparisons of model/control and momordicine I intervention/model, respectively. GO enrichment analysis suggested that the anti-cardiomyocyte hypertrophic effect of momordicine I may be mainly associated with the regulation of metabolic processes. Based on our transcriptome experiment results as well as literature reports, we selected glycerophospholipid metabolizing enzymes group VI phospholipase A 2 (PLA2G6) and diacylglycerol kinase ζ (DGK-ζ) as targets to further explore the potential mechanism through which momordicine I inhibited ISO-induced cardiomyocyte hypertrophy.Our results demonstrated that momordicine I inhibited ISO-induced upregulations of mRNA levels and protein expressions of PLA2G6 and DGK-ζ. Collectively, momordicine I alleviated ISO-induced cardiomyocyte hypertrophy, which may be related to its inhibition of the expression of glycerophospholipid metabolizing enzymes PLA2G6 and DGK-ζ.

Objective:To investigate the difference in left ventricular dysfunction between type 2 diabetes mellitus (T2DM) patients with hyperlipidemia and those without hyperlipidemia, and analyze the application value of three-dimensional speckle tracking technology.Methods:The clinical data of 70 patients with T2DM admitted to Heji Hospital Affiliated to Changzhi Medical College from January 2020 to June 2021 were retrospectively analyzed. Among these patients, 35 patients had hyperlipidemia and 35 patients had no hyperlipidemia. At the same time, 40 healthy subjects who concurrently underwent health checkups in the same hospital were included as healthy controls. All subjects underwent routine cardiac ultrasound and 3D-STE examinations. General clinical information and left ventricular function-related parameters, including global longitudinal strain, global circumferential strain, global area strain, and global radial strain were compared between healthy controls and T2DM patients with hyperlipidemia and those without hyperlipidemia.Results:The proportion of left ventricular remodeling increased in T2DM patients without hyperlipidemia, and the proportion of left ventricular hypertrophy was the highest in T2DM patients with hyperlipidemia. Global longitudinal strain and global circumferential strain in T2DM patients without hyperlipidemia were (-16.97 ± 2.59)% and (-17.41 ± 2.50)%, respectively, which were significantly higher than (-18.86 ± 2.46)% and (-18.71 ± 2.92)% in healthy controls ( t = 0.95, 0.57, both P < 0.05). Global longitudinal strain, global circumferential strain, and global area strain in T2DM patients with hyperlipidemia were (-14.98 ± 3.15)%, (-15.80 ± 3.16)%, (-27.17 ± 4.54)%, respectively, which were significantly higher than (-18.86 ± 2.46)%, (-18.71 ± 2.92)%, (-30.62 ± 4.02)% in healthy controls ( t = 0.46, 1.37, 0.98, all P < 0.05) and (-16.97 ± 2.59)%, (-17.41 ± 2.50)%, (-30.06 ± 3.59)% in T2DM patients without hyperlipidemia ( t = 0.37, 1.02, 0.77, all P < 0.05). Global radial strain in T2DM patients with hyperlipidemia was significantly higher than [(51.49 ± 8.94)%, t = 1.35, P < 0.05] in healthy controls and [(47.71± 8.46)%, t = 0.98, P < 0.05] in T2DM patients without hyperlipidemia. In patients with T2DM, fasting blood glucose and hyperlipidemia were independently correlated with all strain-related parameters. Conclusion:Hyperlipidemia can aggravate left ventricular remodeling and dysfunction in patients with T2DM and 3D-STE is one of the examination methods for subclinical left ventricular remodeling and dysfunction in T2DM patients with or without hyperlipidemia.

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

The ischemic mitral regurgitation( IMR) is present in 20% to 30% of patients with old myocardial infarction. In patients with heart failure after myocardial infarction , the incidence of IMR is even as high as 50%.IMR has adverse effects on the prognosis of patients and is positively correlated with the degree of reflux , including increased risk of heart failure and mortality of cardiovascular disease.Patients with severe hemodynamic abnormalities, and in the case of have accepted the best drug treatment is still difficult to alleviate symptoms of heart failure , surgical treatment should be implemented.However, the surgical treatment strategy of IMR is still controversial, that is, for the moderate IMR, only the blood transport reconstruction is sufficient to restore the natural form of the valve, whether the valve operation needs to be performed simultaneously ; In the case of severe IMR, simultaneous valvular surgery has been agreed upon.The controversy is that the mitral valve repair(MVP) and mitral valve replacement(MVR) are both superior and inferior.The purpose of this paper is to review the literature on IMR sur-gery in order to help us understand this important question.

Systolic anterior motion of mitral valve ( SAM) is a relatively uncommon complication , but it can result in se-vere left ventricular outflow tract(LVOT) obstruction and/or mitral regurgitation(MR), even can be life-threating.Echocardio-graphy is still the first-line method of SAM diagnosis.Due to LVOT obstruction and MR reducing the long-term prognosis of pa-tients with SAM, it is necessary to carry out surgical treatment for patients with SAM for whom conservative treatment are not ef-fective.Then mitral valve repair(MVREP) is the first choice.Besides, surgical techniques for treatment and prevention of SAM have made great progress which have promoted the popularization of MVREP , and the rate of MVREP in mitral valve oper-ation has been greatly improved .

Objective: To evaluate the efifcacy of modiifed extended Morrow procedure on hypertrophic obstructive cardiomyopathy (HOCM) in adolescent patients. Methods: We retrospectively studied 29 consecutive HOCM patients at the age≤21 years who received modiifed extended Morrow procedure in our hospital from 2011 to 2015 for their clinical conditions to assess surgical efifcacy. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outlfow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Moreover, pre-operative and post-operative plasma NT-proBNP levels were determined. Cardiac function was evaluated by New York Heart Association functional class. Results: There were 17 (58.6%) patients received isolated modiifed extended Morrow procedure and 12 patients had concomitant operation including 8 (27.6%) with coronary artery bypass grafting. Compared with pre-operation, the post-operative thickness of ventricular septum decreased from (24.6 ± 6.8) mm to (16.9 ± 7.1) mm, left ventricular outlfow tract gradient decreased from (68.8 ± 15.7) mmHg to (10.7 ± 4.2) mmHg, bothP<0.001; mitral regurgitation degree reduced from (1.7 ± 1.3) to (0.2 ± 0.4),P<0.01; NYHA classification improved from (3.4 ± 0.8) to (1.4 ± 0.5),P<0.01; plasma level of NT-proBNP reduced from (1957.6 ± 392.5) ng/ml to (458.7 ± 161.0) ng/ml,P<0.01. There was no peri-operative death, the survival rates at 12, 24 and 36 months post-operation were 100%, 86.7% and 86.7% respectively. Conclusion: Modiifed extended Morrow procedure has been a safe and effective method for treating adolescent HOCM patients, adequate exposure is the key point to assure surgical efifcacy.

Objectives: To evaluate the predictor and risk factor of left ventricular (LV) free wall reverse remodeling in patients with obstructive hypertrophic cardiomyopathy (HCM) after modiifed Morrow procedure by three-layer speckle tracking of echocardiography.
Methods: Our investigation included 2 groups: HCM group, n=60 patients who had successful modified Morrow procedure in our hospital from 2014-06 to 2014-12, there were 41 (68.3%) male with the average age of (39.1 ± 15.2) years. Control group, n=40 healthy subjects. Three-layer speckle tracking echocardiography was conducted to analyze pre-and post-operative LV free wall three-layer myocardium (endocardial, mid, and epicardial layers) changes at longitudinal strain (LS) and circumferential strain (CS). Clinical and echocardiography information were collected at pre-and (6-24) months post-operation. The impact factors for LV free wall reverse remodeling was identiifed by liner regression analysis and the segment’s thickness≥15mm was deifned as the hypertrophic LV free segment.
Results: In HCM group, compared with pre-operative condition, the post-operative thickness of LV free wall including anterior, anterolateral and inferolateral were reduced;while both post-operative LS and CS elevated (-13.8 ± 4.8)%vs (-17.0 ± 5.2)%and (-23.7 ± 3.8)%vs (-25.4 ± 3.7)%, P<0.05. LV mass index by echocardiography was larger than LV mass index by surgical resection (13.5 ± 30.9) g/m2 vs (3.4 ± 2.0) g/m2, P<0.05. Liner regression analysis indicated that the number of pre-operative hypertrophic segments (r=-0.680, P<0.001) and age (r=0.638, P<0.001) were the independent impact factors for post-operative LS;△left ventricular outlfow tract (LVOT) gradient (r=0.386, P=0.005) was the independent impact factor for post-operative CS.
Conclusion:①After modiifed Morrow procedure, LVOT obstruction disappeared which leaded LV free wall reverse remodeling in HCM patients, ②three-layer myocardium of LV free wall all had reverse remodeling, ③better improved LVOT gradient were with less number of hypertrophic segments;the elder patients usually had the better post-operative reverse remodeling.

Objective To explore the clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study.Incidence rate and severity of PH were depicted.The study population was divided into two groups (PH group and control group),and the differences in clinical profile were elucidated.Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis.Results The incidence of PH was 12.3％ (37 cases),in which 48.6％ patients (18 cases) were mild PH,40.5％ patients (15 cases) were moderate PH,and patients with severe PH accounts for 10.8％ (4 cases).Multivariate logistic regression analysis indicated that female (OR =3.95,95％ CI 1.74-8.98,P =0.001),age ≥ 65 years (OR =3.87,95％ CI 1.16-12.97,P =0.030),history of atrial fibrillation (OR =2.76,95％ CI 1.01-7.57,P =0.049) and moderate or severe mitral regurgitation (OR =6.63,95％ CI 3.02-14.57,P =0.000) were independent risk factors of PH.Stratification according to sex showed that age ≥65 years(OR =7.79,95％ CI 1.35-47.26,P ＜ 0.05) and moderate or severe mitral regurgitation (OR =9.83,95 ％ CI 2.26-42.67,P ＜0.01)were independent risk factors of PH for male patients;while history of atrial fibrillation(OR =6.32,95％ CI 1.57-25.40,P =0.01) and moderate or severe mitral regurgitation (OR =5.23,95％ CI 1.92-14.26,P＜0.01)were independent risk factors of PH for female patients.Risk factors were similar between the mild PH group and moderate to severe PH groups.Conclusion Compared with patients without PH,HOCM patients complicated with PH were older and with higher percentage of female,and resting obstruction,history of atrial fibrillation and moderate or severe mitral regurgitation.Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female,advanced age,history of atrial fibrillation and moderate or severe mitral regurgitation.