Objective:To investigate the incidence of coronary artery tortuosity and its correlation with poor prognosis in patients with septal hypertrophic cardiomyopathy (HCM).Methods:This was a retrospective cohort study. Patients with septal HCM who were hospitalized in Fuwai Central China Cardiovascular Hospital and Zhengzhou University People′s Hospital between December 1, 2017 and June 10, 2021 were selected. Non-HCM patients were matched by gender, age, and hypertension as control group. Septal HCM was divided into two groups based on the presence or absence of coronary artery tortuosity. Clinical baseline data and coronary angiography findings were compared using a multifactorial logistic analysis of the risk factors for coronary artery tortuosity. Patients were followed up until July 1, 2022, with the primary outcome being the composite endpoint of malignant arrhythmia, ischemic stroke and all-cause death. Incidence densities were compared between the coronary artery tortuosity and non-coronary artery tortuosity groups of septal HCM patients. The Cox risk-ratio model was used to analyze risk factors for primary outcomes in septal HCM patients.Results:There were 156 patients in the septal HCM group and 156 patients in the control group, both aged (57.0±11.4) years, and 75 (48.1%) were female. The incidence of coronary artery tortuosity was significantly higher in the septal HCM group than in the control group (63.5% vs. 36.5%, P<0.01), and the coronary artery tortuosity score was also higher in the septal HCM group than in the control group ( P<0.01). Multiple logistic regression analysis showed that septal HCM was a risk factor for coronary artery tortuosity ( OR=3.27, 95% CI: 2.02-5.29, P<0.01). In the septal HCM patients, after (2.5±1.2) years of follow-up, the incidence density of primary outcome was significantly higher in the coronary artery tortuosity group than in the non-coronary artery tortuosity group ( P=0.02), while each on-point in coronary artery tortuosity score increased the risk of primary outcome by 53% for septal HCM patients ( HR=1.53, 95% CI: 1.26-1.86, P<0.01). Conclusions:Patients with septal HCM are more prone to suffer coronary artery tortuosity and suffer from it to a greater extent. Coronary artery tortuosity is an important risk factor for adverse events in patients with septal HCM.

BACKGROUND: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. METHODS: We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment. CONCLUSIONS Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
Humans ; Female ; Middle Aged ; ST Elevation Myocardial Infarction/drug therapy* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Cross-Sectional Studies ; Aspirin/therapeutic use* ; Platelet Aggregation Inhibitors/therapeutic use* ; Adrenergic beta-Antagonists/therapeutic use* ; Hospital Mortality ; Registries ; Treatment Outcome ; Percutaneous Coronary Intervention

Objective To evaluate the clinical effect of umbilical cord mesenchymal stem cells (MSCs) for treatment of chronic dilated cardiomyopathy complicated with systolic heart failure.Methods Fifty-nine patients with chronic dilated cardiomyopathy and systolic heart failure in Henan Provincial People's Hospital from December 2013 and December 2014 were selected and divided into treatment group (n =30)and control group (n =29).All patients were given routine drug treatment.Based on this,the patients in treatment group were given umbilical cord MSCs 20mL by intracoronary transplantation;the patients in control group were given the same volume of saline.The changes of cardiac function,left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter(LVEDD),6 minutes walking distance,the amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels,the re-hospitalization rate,mortality rate of patients in the two groups were observed and compared at 1 month and 6 months after treatment.Results The cardiac function grading of the New York Heart Association (NYHA)of patients in the two groups were improved at 1 month and 6 months after treatment (P ＜ 0.05);the NYHA cardiac function grading of patients in the treatment group was significantly better than that in the control group at 1 month and 6 months after treatment (x2 =12.64,16.75;P ＜ 0.05).There was no statistic difference in LVEDD,LVEF,serum level of NT-proBNP and 6-min walking distance of patients between the two groups before treatment (P ＞ 0.05).There was statistic difference in LVEDD,LVEF,serum level of NT-proBNP and 6-min walking distance of patients in the two groups before treatment and 1 month,6 months after treatment(P ＞ 0.05).There was no statistic difference in LVEDD of patients between the two groups at 1 month after treatment (P ＞ 0.05);the LVEF,6-min walking distance of patients in the treatment group were significantly higher than those in the control group,but the serum level of NT-proBNP of patients in the treatment group was significantly lower than that in the control group at 1 month after treatment (P ＜ 0.05).At 6 months after treatment,the LVEDD,serum level of NT-proBNP of patients in the treatment group were significantly lower than those in the control group,but the LVEF and 6-min walking distance of patients in the treatment group were significantly higher than those in the control group (P ＜ 0.05).The mortality rate of patients in the treatment group (6.67％,2/30) was significantly lower than that in the control group (24.14％,7/29) (x2 =4.99,P ＜ 0.05).The re-hospitalization rate of patients in the treatment group and control group was 16.67％ (5/30) and 31.031.(9/29) respectively;there was no statistic difference in the re-hospitalization rate of patients between the two groups (x2 =1.68,P ＞ 0.05).Conclusion Umbilical cord MSCs can improve the cardiac function and cardiac remodeling,reduce the mortality rate of patients with chronic dilated cardiomyopathy complicated with systolic heart failure.

BACKGROUND:Percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures has achieved very good results.
OBJECTIVE:To discuss and resolve some problems related to thoracic and lumbar vertebroplasty.
METHODS:225 patients (78 males and 147 females) aged 53 to 92 years old were included in this study. They al accepted percutaneous vertebrolplasty and we observed and made a record about some questions related this surgery during perioperative period.
RESULTS AND CONCLUSION:Six cases (2.7%) missed diagnosis. More than two-third of the compression degree were found in sixteen cases (7.1%). Forty-five (12.8%) vertebrae suffered from bone cement leakage in twenty-nine cases (12.9%). Recurrent fractures appeared in ten cases (4.4%). Multiple vertebrae fractures appeared in seventy-nine cases (35.1%). (1) Strategies for missed diagnosis:conduct preoperative physical examination careful y;avoid missing the point of pain;increase MRI scanning when necessary. (2) Coping strategies for severe vertebral fractures:place the needle into the paral el endplates as far as possibly;puncture along the lumbar spine pedicle base and the lateral thoracic pedicle. (3) Coping strategies for cement leakage:when cement leakage over the lower edge of the end plate occurred in operation, we should immediately put the C-arm X-ray machine into anteroposterior position to determine the orientation of the leakage and stop injecting;we should continue to inject the bone cement into the no leak-side to ensure the fil ing amount of vertebral bone cement. (4) Coping strategies for recurrent fractures:reoperation. (5) Coping strategies for multiple fractures:patients with multiple fractures often have a feature of poor constitution and more complications. So, it is necessary to shorten the operation time, and determine unilateral or bilateral puncture ways depending on the degree of vertebral compression to save operation time.

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement.The vertebral height is restored and the decreased loading ability of the fractured vertebral body is re-strengthened with pain relief.The effect of the method is widely demonstrated in those conditions.At the same time, the relative problems, such as the complications are being lucubrated and discussed.The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more.By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various.The mechanisms and correlative factors are still not clear-cut either.The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0％ to 63％.The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification,failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on.Great controversy still exists on the correlation between those possible factors and the re-fractures.More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Objective: To investigate the compliance of smoking cessation and the effect of smoking status on long-term clinical prognosis in male patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) therapy. Methods: A total of 656 ACS patients after DES therapy were studied, according to the post-operative smoking status, the patients were divided into 3 groups: Non-smoking group,n=226, Quit smoking group,n=283 and Persistent smoking group, n=147. The patients were followed-up for the average of 27 months, the major adverse cardio-/cerebral-vascular events (MACCE) were recorded in detail, and the effect of smoking status for MACCE occurrence were evaluated by multivariable Cox regression analysis. Results: The pre-operative smoking rate was 65.5% (430/656) of patients and post-operative smoking rate was 22.4% (147/656). Compared with Non-smoking group and Quit smoking group, the patients in Persistent smoking group had the younger age (P<0.001), more patients with abnormal blood lipids (P=0.005) and having lower level of education (P<0.001). The all cause death rates in Non-smoking group, Quit smoking group and Persistent smoking group were at 1.8%, 1.1% and 6.1% respectively,P=0.004; the MACCE occurrence rates were at 7.1%, 5.3% and 15.0% respectively,P=0.002. Multivariable Cox regression analysis showed that post-operative smoking was the independent risk factor for MACCE occurrence, HR =1.404, 95% CI (1.206-1.793),P=0.008. Conclusion: Smoking is the independent risk factor for MACCE occurrence in male ACS patients after DES therapy.

Bacterial cell division is strictly regulated in the formation of equal daughter cells. This process is governed by a series of spatial and temporal regulators, and several new factors of interest to the field have recently been identified. Here, we report the requirement of gluconate 5-dehydrogenase (Ga5DH) in cell division of the zoonotic pathogen Streptococcus suis. Ga5DH catalyzes the reversible reduction of 5-ketogluconate to D-gluconate and was localized to the site of cell division. The deletion of Ga5DH in S. suis resulted in a plump morphology with aberrant septa joining the progeny. A significant increase was also observed in cell length. These defects were determined to be the consequence of Ga5DH deprivation in S. suis causing FtsZ delocalization. In addition, the interaction of FtsZ with Ga5DH in vitro was confirmed by protein interaction assays. These results indicate that Ga5DH may function to prevent the formation of ectopic Z rings during S. suis cell division.
Bacterial Proteins ; chemistry ; genetics ; metabolism ; Cell Division ; Cell Shape ; Cytoskeletal Proteins ; chemistry ; genetics ; metabolism ; Mutation ; Oxidoreductases ; deficiency ; genetics ; metabolism ; Protein Binding ; Streptococcus suis ; enzymology

Objective To explore the efficacy and safety of fondaparinux combined with tirofiban in patients with high risk unstable angina (UA) undergoing complex percutaneous coronary intervention (PCI).Methods A total of 389 patients were enrolled and randomized into two groups receiving either fondaparinux with tirofiban or enoxaparin with tirofiban.Bleeding,thrombosis and main adverse cardiovascular events (MACE) were compared between the two groups during hospitalization,at week 2 and week 4 after discharge.Results No severe bleeding was observed during hospitalization in the both groups,while lower rate of mild and minor bleeding was shown in the fondaparinux group (0 vs 1.5％ and 18.2％ vs 34.5％,P =0.04 and P ＜0.001 respectively).No difference was found between the two groups in the rate of MACE during hospitalization,at week 2 and week 4 weeks after discharge.The rates of death,recurrent myocardial infarction,refractory myocardial ischemia and target vessel revascularization were 0.5％ vs 1.0％,0.5％ vs 1.0％,1.6％ vs 1.0％ and 2.1％ vs 1.5％ during hospitalization;0 vs0,1.0％ vs 0.5％,1.0％ vs 1.5％,0.5％ vs 1.0％ at week2 after discharge; 0.5％ vs0.5％,0.5％ vs0.5％,2.6％ vs 2.0％,0 vs 0.5％ at week 4 after discharge (all P values ＞ 0.05).Conclusion The combination therapy of fondaparinux and tirofiban is of good safety and efficacy in high risk UA patients undergoing complex PCI.

Objective To summarize the clinical experience of successful intervention in single chronic coronary actery total ocdusion (CTO) lesions by the transradial.Methods A retrospective analysis was conducted in 103 patients with single CTO lesions who got intervention treatment by the radial artery.Results ( 1 ) Of the 103 cases,57 cases had unstable angina,12 cases had stable angina,and 34 cases chronic myocardial infarction.Lesions' block time was ≤ 6 months in 83 cases,and ＞ 6 months in 20 cases.(2)The path vessels of the 103 patients have no severe tortuosity and anatomical structure variation.Fifty-one cases occurred left anterior descending occlusion,25 cases occurred left circumflex branches occlusion,and 27 cases occurred right coronary artery occlusion.Furthermore,24 cases had chronic complete occlusion,and 79 cases had chronic functional block.The side branches did not block in 91 cases,no lesions(bridge) collateral formation occurred in 87 cases,lesions length was less than 15 mm in 67 cases,and tapered lesions was observed in 81 cases.( 3 ) Final intervention rate via Judkins,XB,EBU guide catheter was 37.86％,30.10％ and 29.13％ respectively.(4)the PILOT successfully through the lesions for the series wire guided was 64.08％.(5) 1.25 mm diameter series with a balloon through the first lesions and successful expanding was observed in 57 cases (55.34％),and 1.5 mm diameter series with a balloon occurred in 38 cases(36.89％ ).Conclusion Intervention treatment by the radial of single CTO lesions is feasible for experienced performers.The successful intervention depends on path vessels unimpeded,target vessels with characteristic pathological features and reasonable choice of instruments.

Objective To explore the effects of penile erectile dysfunction (ED) on the quality of life in male renal transplant recipients.Methods 150 cases of male married recipients undergoing renal transplantation were selected randomly.The recipients were divided into ED group (n =63) and non-ED group (n =87) through the IIEF-5 score.The Short Form-36 Health Status Survey (SF-36)and Hamilton Anxiety Scale were used to compare their living quality and the state of mental health between the two groups,respectively.Results The SF-36 scores in ED group in General Health,Vitality,Social Function,Role Limitation due to Emotional Problems,Mental Health were significantly lower than those in non-ED group (P＜0.05).There were 13 cases in ED group with anxiety disorders (20.6％),significantly more than in non-ED group (3.4％),P＜0.05.Conclusion ED is an important influencing factor for the quality of life in male kidney transplant recipients.