Role of Subordination in Nephritis of Socially Stressed Mice

A behavioral etiology of interstitial nephritis of male CBA mice chronically exposed to psychosocial stress is suspected. The blood urea nitrogen of these animals is inversely proportional to social status as measured by behavior and the appearance of fur. Blood pressure measurement tends toward an opposite relationship. Since subordinates have difficulty urinating in the presence of dominants and suffer from overfilled bladders, their fatal tubulointerstitial involvement may originate with repeated episodes of urinary reflux.     

Surgical device closure a new technique of ASD closure

Background Conventional approach of atrial septal defect (ASD) closure with cardio pulmonary bypass using mid sternotomy, minimally invasive or endoscopic technique is time tested. We decided to use custom made device with direct minimally invasive approach without cardio pulmonary bypass. Percutaneous transfemoral route using custom made device is a well established procedure performed by interventional cardiologist with occasional trauma and vessels. Method We performed the procedure in 3 patients of secundum ASD deemed adequate for device closure. We used a mini Right anterior thoracotomy approach using a double umbrella device which was implanted through direct Right Atrial puncture. Results In two patients we were successful in deploying the device. The proedure lasted 30 minutes with small infra Mammary scar and the post operative period was uneventful. In the third case where our attempt at surgical device closure failed the inferior margin was only one mm. The optimal size device kept slipping into the right atrium when the guide-wire was tugged after final deployment. The placement of an oversize device distorted the mitral valve, may causing regurgitation. Conclusion We think that this is a simple and safe technique of secundum ASD closure without cardio pulmonary bypass.     

Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis

OBJECTIVE: To compare the effectiveness of aspirin, warfarin, and ximelagatran as thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF). METHODS: Systematic review of randomised controlled trials in patients with NVAF treated with adjusted-dose warfarin and aspirin, fixed low-dose (FLD) warfarin, ximelagatran or placebo. Outcome measures studied were ischaemic stroke, systemic embolism, mortality and haemorrhage. Meta-analysis was performed using a fixed effects model. RESULTS: We identified 13 trials (n=14,423 participants) of sufficient quality to be included in the analysis. Adjusted-dose warfarin significantly reduced the risk of ischaemic stroke or systemic embolism compared with aspirin (relative risk [RR] 0.59; 95% confidence interval [CI]: 0.40 to 0.86), FLD warfarin (RR 0.36; 95% CI: 0.23 to 0.58), or placebo (RR 0.33; 95% CI: 0.24 to 0.45). However, aspirin and placebo had a lower risk of major bleeding compared to warfarin (RR 0.58; 95% CI: 0.35 to 0.97 and RR 0.45; 95% CI: 0.25 to 0.82, respectively). The oral direct thrombin inhibitor, ximelagatran was as effective as adjusted-dose warfarin in the prevention of ischaemic strokes or systemic emboli (RR 1.04; 95% CI: 0.77 to 1.40) with less risk of major bleeding (RR 0.74; 95% CI: 0.56 to 0.96). Adjusted-dose warfarin significantly reduced mortality compared to placebo (RR 0.69; 95% CI: 0.53 to 0.89), but not for any of the other comparisons (aspirin: RR 0.87; 95% CI: 0.67 to 1.13; FLD warfarin: RR 1.11; 95% CI: 0.81 to 1.52; ximelagatran: RR 1.04; 95% CI: 0.86 to 1.26). CONCLUSIONS: We have extended previous analyses, making this the largest systematic review and meta-analysis of thromboprophylaxis trial data in AF--and have included recent trials with the new oral direct thrombin inhibitor, ximelagatran. This systematic review confirms the superiority of anticoagulation therapy over aspirin as thromboprophylaxis in patients with NVAF. The new oral direct thrombin inhibitor, ximelagatran, appears as effective as adjusted-dose warfarin for the prevention of thromboembolic events in NVAF, with a lower risk of bleeding.     

风湿性二尖瓣狭窄左心房血栓形成的危险因素分析

目的 探讨风湿性二尖瓣狭窄左心房血栓形成的危险因素.方法 2001年1月至2008年12月,2277例风湿性二尖瓣狭窄病人接受手术治疗,男737例,女1540例;年龄19～84岁,平均(50.9±10.2)岁.按左心房有无血栓分为血栓组(554例)和无血栓组(1723例).回顾性分析入选病例的一般资料、心电图、超声心动图及实验室检查资料.对单因素分析中有统计学意义的指标行多因素回归分析.结果 单因素分析发现年龄、二尖瓣瓣口面积、左心房内径、左室舒张末径、C反应蛋白、性别、二尖瓣狭窄程度、二尖瓣反流程度、三尖瓣反流程度、肺动脉高压程度、房颤和心功能分级共12个因素组间差异有统计学意义.多因素回归分析发现年龄、二尖瓣瓣口面积、左心房内径、二尖瓣反流程度、房颤是风湿性二尖瓣狭窄病人左心房血栓形成的主要影响因素.结论 风湿性二尖瓣狭窄病人年龄、二尖瓣瓣口面积、左心房内径、房颤是并发左心房血栓的主要危险因素.二尖瓣反流可以降低左心房血栓形成的风险,是左心房血栓形成的保护性因素.

Abstract：

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.     

全机器人心脏不停跳下房间隔缺损修补术

目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5～3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.

Abstract：

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After "da Vinci S" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.     

改良线路心房直视迷宫式射频消融治疗心房颤动

目的：探讨风湿性心脏病合并心房颤动（房颤）病人,在瓣膜置换同时采用改良线路经心房直视迷品式射频消融治疗房颤的可行性及疗效。方法：66例风湿性心脏病二尖瓣病变合并房颤病人,在体外循环心内直视下经心房行迷宫式射频消融,同时行二尖瓣置换术,结果：无手术死亡,57例房颤消失,其中术后窦性心律54例（81．8％）,结性心律1例（1．5％）,心房扑动2例（3％）,9例（13．6％）仍为房颤,随访2－60个月,总随访率89．6％,窦性心律稳定,无远期死亡,结论：经心房内视改良线路迷宫式射频消融治疗房颤,方法简捷,安全有效,远期疗效稳定,值得进一步研究,推广。     

Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers

Introduction

Congenital heart defects treatment shows progressive reduction in morbidity and mortality, however, the scar, resulting from ventricular (VSD) and atrial septal defect (ASD) repair, may cause discomfort. Right axillary minithoracotomy approach, by avoiding the breast growth region, is an option for correction of these defects that may provide better aesthetic results at low cost. Since October 2011, we have been using this technique for repairing VSD and ASD defects as well as associated defects.

Objectives

To evaluate the efficacy of this method in children undergoing correction of VSD and ASD, to compare perioperative clinical outcomes with those repaired by median sternotomy, and to evaluate the aesthetic result.

Methods

Perioperative clinical data of 25 patients submitted to axillary thoracotomy were compared with data from a paired group of 25 patients with similar heart defects repaired by median sternotomy, from October 2011 to August 2012.

Results

Axillary approach was possible even in infants. There was no mortality and the main perioperative variables were similar in both groups, except for lower use of blood products in the axillary group (6/25) vs. control (13/25), with statistical difference (P =0.04). The VSD size varied from 7 to 15 mm in axillary group. Cannulation of the aorta and vena cavae was performed through the main incision, whose size ranged from 3 to 5 cm in the axillary group, with excellent aesthetic results.

Conclusion

The axillary thoracotomy was effective, allowing for a heart defect repair similar to the median sternotomy, with more satisfactory aesthetic results and reduced blood transfusion, and it can be safely used in infants.     

MicroRNA-1、MicroRNA-133、MicroRNA-34a及其可能靶蛋白Ankyrin-B在心房颤动患者心房组织中的表达及意义

目的 通过检测心房颤动（房颤）与窦性心律患者右心耳组织中microRNA-1、microRNA-133及microRNA-34a的表达差异,及其可能靶蛋白锚蛋白-B （Ankyrin-B ）的表达变化,分析两者之间的关系,以从microRNAs调控水平研究房颤发生、发展的新机制。 方法 将第三军医大学新桥医院40例风湿性心瓣膜病行心瓣膜置换术患者分为房颤组［男8例,女12例;年龄（52.9±5.8）岁］和窦性心律组［男9例,女11例;年龄（52.4±6.2）岁］ 。采用逆转录-实时定量聚合酶链式反应（RTQ-PCR,Real-time quantitive PCR）法检测患者右心耳组织中microRNA-1、microRNA-133及microRNA-34a的表达,ΔΔCt法计算结果;石蜡切片免疫组织化学法检测组织中Ankyrin-B的表达;蛋白免疫印迹（Western Blotting）法检测组织中Ankyrin-B的表达变化。 结果 房颤组患者右心房组织中的microRNA-1表达较窦性心律组显著降低（0.559±0.252 vs. 3.997±1.251;t =-21.455,P=0.000）,microRNA-133的表达较窦性心律组显著降低（0.630±0.238 vs. 5.514±1.549;t =24.133,P=0.000）,而microRNA-34a的表达较窦性心律组增高（4.783±2.012 vs. 1.350±0.638,t =12.596,P=0.000）。免疫组织化学法及Western Blotting均显示房颤组心房组织Ankyrin-B表达较窦性心律组明显降低,且差异有统计学意义（0.66±0.45 vs. 1.09±0.42;t =-3.396,P=0.001）。结论 MicroRNA-34a可能通过调节Ankyrin-B蛋白的表达,从而参与心房颤动的发生、发展。     

急性心肌梗死冠状动脉介入术伴房颤患者的抗凝治疗

目的分析急性心肌梗死冠状动脉介入(PCI)术伴心房颤动(房颤)患者达比加群酯抗凝的疗效和安全性。方法回顾性分析我院2016年5月至2018年5月收治的70例急性心肌梗死PCI术伴房颤患者的抗凝疗效与安全性。患者分为华法林组和达比加群酯组两组,患者均给予阿司匹林、氯吡格雷抗栓治疗。比较两组患者治疗前和治疗3个月后活化的部分凝血活酶时间(aPTT)、凝血酶原时间国际化标准比值(PT-INR);治疗后的血栓事件及出血并发症。结果治疗前,两组患者的aPTT和PT-INR经比较差异无统计学意义(P>0.05)。治疗后3个月,达比加群酯组的aPTT显著高于华法林组,两组比较差异有统计学意义(P<0.05)。两组患者治疗后的心血管栓塞事件发生率,经比较差异无统计学意义(P>0.05)。治疗1、3个月后,达比加群酯组的总出血和严重出血的发生率均显著低于华法林组,两组比较差异有统计学意义(P<0.05)。结论与华法林联合双抗比较,达比加群酯联合双抗治疗急性心肌梗死PCI术伴房颤患者心血管血栓栓塞事件发生率相似,但出血并发症的发生率较低。     

心房颤动患者脑微出血的分布和相关危险因素分析

目的了解心房颤动患者脑微出血(CMBs)的比例和分布,分析房颤脑微出血患者的相关危险因素。方法选取2015年1月～2017年6月在我院住院且行头颅磁敏感加权成像检查的132例房颤患者。对所有患者采集一般临床资料,并对CMBs的数量和分布进行分析;采用Logistic回归分析房颤患者的相关危险因素。结果本研究中38例房颤患者(28.9%)合并有CMBs,其中9例患者(23.7%)CMBs病灶数为1个,17例患者(44.7%)病灶数为2～4个,12例患者(31.6%)病灶数≥5个。房颤CMBs患者总病灶数为183个,其中102个病灶(55.7%)位于脑叶,57个病灶(31.2%)位于深部,24个病灶(13.1%)位于幕下。回归分析提示年龄(OR=1.102,P=0.001,95%CI1.044～1.163)和抗凝治疗(OR=3.006,P=0.033,95%CI 1.091～8.281)是房颤患者CMBs的独立危险因素。结论房颤患者脑微出血病灶主要位于脑叶,对于年龄大且需要抗凝的房颤患者,建议行头颅磁敏感加权成像监测脑微出血。