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To investigate the feasibility of measuring pulmonary blood volume (PBV) by ultrasound microbubble angiography, which may provide a feasible method for further detection of PBV changes.Ultrasound microbubble angiography was used to calculate the PBV by detecting pulmonary transit time (PTT) and heart rate-normalized pulmonary transit time (nPTT). To evaluate the consensus degree based on the intra-, inter-observer and within-day variation in order to determine the repeatability. The method was used for acute left ventricular dysfunction models to determine the feasibility as well.The Bland-Atlman plots showed good intra-observer, within-day, and inter-observer consistency of measurement results. Application in acute left ventricular dysfunction models showed that, compared with the control, left heart failure models had higher PTT, nPTT and PBV (Detection of PTT/nPTT to calculate PBV by ultrasound microbubble angiography is simple and feasible, it is not easy to produce miscarriage of justice, with good intra- and inter-observer consistency of repeatability test results. The method has certain feasibility.

To investigate the influence of continuous low-volume ventilation in cardiopulmonary bypass (CPB) on the expression of krebs von den lungen-6 (KL-6) and perioperative pulmonary function in adults undergoing valve surgery.From 2017 Sept. to 2018 Jan., 60 patients who received valve replacement surgery were prospectively comprised in this study. We randomly allocated these patients into control group (The expression of serum KL-6 and BALF KL-6 in the two groups were both statistically significant（Continuing low-volume ventilation during CPB could decrease the expression level of KL-6, while it has no significant influence on perioperative outcomes.

To assess morphological changes of distal aorta and the risk factors for adverse aortic remodeling inpost-TEVAR（thoracic endovascular aortic repair） patients with acute Stanford B aortic dissection.We retrospectively investigated the patients who underwent TEVAR for a type B dissection between October 2005 and December 2015. CT angiogram (CTA) was obtained for each patients preoperatively, postoperatively and during the post-operational follow-up. Based on Criadol partition principle, we divided the aorta into descending thoracic aorta area, suprarenal abdominal aorta area, infrarenal abdominal aorta area and iliac artery area, and evaluated the distribution of aortic tears and the form of true and false lumen in different aortic partition. Univariate and multivariate logistic regression analyses were used to analyze the risk factors affecting distal aortic remodeling.Of 216 patients (mean follow-up (3.9±2.1) years) who were regularly followed up in our center, 47 patients (21.8%) occurred adverse remodeling in distal aorta. Univariate logistic regression indicated that abnormal aortic wall structure (Marfan's syndrome) and patent false lumen (existence of distal tears, decreased complete false lumen thrombosis) were associated with distal aortic adverse remodeling. Multivariate logistic regression showed that more tears in descending thoracic aorta area (Aortic wall structure abnormalities, a patent false lumen, more tears in descending thoracic aorta area, less tears in infrarenal abdominal aorta area are independent risk factors for adverse aortic remodeling in post-TEVAR patients with acute Stanford B aortic dissection.

To investigate effects of restrictive transfusion on the outcome of mitral valve replacement.We selected 120 continuous patients of mitral valve replacement from June 2011 to June 2016. Based on the different blood transfusion strategy,the patients were divided into two groups: liberal blood transfusion group and restrictive blood transfusion strategy group. The blood routine test,liver and kidney function,coagulation function,full examination before blood transfusion,blood types,echocardiography and so on were examined when the patients were admitted to hospital,also the clinical data of perioperative patients were recorded,and blood transfusion volume,major complication and mortality were compared between the two groups.The transfusion volume of red blood cells decreased from (3.2±1.1) to (1.8±1.5) U with restrictive transfusion,the difference was statistically significant (Restrictive transfusion strategy reduces the incidence of major complications in patients of mitral valve replacement with less cost.

To evaluate the outcomes of valve replacement of endocarditis using bioprothetic and mechanical valves.This study comprised 52 patients [mean age (47±18) yr.,mean follow-up time (6.2±3.8) years] underwent valve endocarditis with bioprotheses,The control group were matched (3∶1) with 156 patients of endocarditis underwent mechanical valves replacement using the following variables: age±5 yr.,body mass index (BMI)±20%,time of operation±1 year,replacement position and sex ratio. And evaluate the effects of using bioprothetic and mechanical valves on perioperative and long-term outcomes of valve replacement of endocarditis.The perioperative mortality of the patients receiving bioprothetic and mechanical valves were 17.3%±2.2% and 19.9%±1.8%,respectively,which was independent of valve type (Perioperative mortality and long-term survival are independent to valve types in patients with endocarditis. Mechanical valve shows potential advantage compared with bioprothetic valve in the patients younger than 60-year-old.

To observe the efficacy and safety of biological heart valves (BHV) and mechanical heart valves (MHV) in childbearing age women (CAW) during the perinatal and short-moderate term postoperative (SMTP) periods.There were 33 patients [(25.2±7.1) yr.] undergoing BHV replacement from September 2009 to December 2014 had completely followed-up,whose data were retrospectively collected. A 1∶4 matching study was conducted,therefore there were 132 patients undergoing MHV were included. The collected date included the clinical outcomes in the perioperative, perinatal,and SMTP period event-free survival (EFS) was determined using the Kaplan-Meier method and compared using the log-rank test.The average follow-up time was (5.8±3.6) years,and the two groups had similar baseline . The clinical outcomes difference of perinatal and SMTP between the two groups were not significant. There were 17 patients in BHV group and 60 in MHV group with pregnancy and birth experiences (PBE),which also showed no significant difference for adverse events both in the maternity and in the fetus. The rates of valve-related adverse events of BHV replacement patients with and without PBE were 5.9% and 0% at 3 years after the operation, and 11.8% and 5.9% after 5 years. PBE was not identified as an adverse prognostic factor for EFS (Either artificial BHV or MHV replacement can achieve ideal SMTP effect in CAW. BHV seems not superior to MHV. Pregnancy and birth experience will not increase the risk of BHV relevant adverse events.

This study was designed to assess the vessel wall characteristics and the expression levels of bone morphogenic protein4(BMP4) and proliferating cell antigen Ki67 in vein grafts harvested from diabetic rats,and to investigate the role of BMP4 in progression of vein graft hyperplastic remodeling under hyperglycemic condition.48 male SpragueDawky rats [body mass (194±16) g] aged 8 weeks were randomly divided into diabetes mellitus (DM) group (In the progression of rats vein grafts hyperplastic remodeling,the venous wall thickness of rats thickened with time increasing,and the intimal and medial thickness of the vein grafts harvested from DM rats were significantly higher than those from NDM rats at the same time postoperatively (The morphological and pathological changes within the venous wall were significantly correlated with the high expression levels of BMP4 in vein grafts harvested from diabetic rats,implying a potential role of BMP4 in the progression of accelerated vein graft failure under hyperglycemic condition.

To explore whether the serum concentration of adrenaline (AD) and noradrenaline (NA) elevate and its correlation with oxygenation index (OI) in the patients of acute aortic dissection (AAD).From April 2013 to December 2013, clinical data were collected from three groups of patients (38 cases of AAD in Group A, 28 cases of ascending aortic aneurysm in Group B, and 22 cases of angina in Group C). All patients received the measurement of serum concentrations of AD, NA and endotoxin (ET). Linear correlation was used to analyze the relationships between catecholamines (including AD and NA), ET and OI.The baseline of the three groups showed no significant difference. The serum concentrations of AD, NA and ET in Group A were higher than those in Group B and Group C (Higher serum concentrations of AD and NA correlated with more severe acute lung injury in AAD patients.

This study was designed to assess the expression levels of bone morphogenic protein-4 (BMP4) in saphenous veins harvested from diabetic patients undergoing coronary artery bypass grafting (CABG), and to investigate its association withFrom January 2013 to December 2014, forty patients with type 2 diabetes mellitus (DM) and risk factors matched non-DM controls (The intimal and medial thickness of the saphenous veins harvested from DM patients were higher than those from non-DM controls. Compared with non-DM patients, the expression level of BMP4 was significantly elevated in diabetic veins (The pre-existing intimal and medial hyperplasia were significantly correlated with the high expression levels of BMP4 in saphenous veins harvested from diabetic patients, implying a potential role of BMP4 in the progression of vein graft stenotic diseases in this cohort of post-CABG patients. Future studies were warranted in investigating novel therapeutic strategy targeting at BMP4 for improving long-term vein graft patency.

Introduction: The polymorphisms of the angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) genes have been demonstrated to be involved in some cardiovascular diseases. We hypothesised that the polymorphisms of ACE and ACE2 relate to the formation of thoracic aortic diseases and coronary heart disease. Methods: A total of 86 patients (four groups: thoracic aortic dissection; thoracic aortic aneurysm; coronary heart disease; and control group) were recruited. The ACE I/D polymorphism and the ACE2 (A8790G) polymorphism were measured in all patient samples. Results: There were no significant differences in groups with regard to either the ACE I/D polymorphism or the ACE2 (A8790G) polymorphism. Conclusion: The polymorphisms of the ACE and ACE2 genes are not associated with thoracic aortic dissection, thoracic aortic aneurysm and coronary heart disease.

Inflammation serves an important role in the pathogenesis of myocardial ischemia/reperfusion (I/R) injury. Fragments of endogenous damaged‑associated molecular patterns, recently identified as mitochondrial DNA (mtDNA), have been proven to be a potent pro‑inflammatory mediator. Epigallocatechin‑3‑gallate (EGCG) is able to regulate the expression levels of a series of inflammatory cytokines. However, the involvement of endogenous mtDNA in EGCG‑regulated inflammatory activities in the context of myocardial I/R injury remains to be elucidated. The present study was designed to investigate the role of mtDNA in EGCG‑mediated myocardial protection in a rat I/R model. Significant positive correlations between elevated plasma mtDNA copy numbers and the expression levels of tumor necrosis factor (TNF) and interleukins (IL)‑6 and ‑8 were observed in the myocardial tissue following an I/R injury (P

The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale.Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case.Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients).Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.

Dramatic changes of pressure in the local circulation flow field would lead to alterations in biorheological characteristics of Endothelial cells(ECs), and futher resulted in the apoptosis induced by loss of anchorage, a form of cell death known as anoikis. In this study, we set levels of pressure(negative and positive pres- sure) loaded ECs groups and non-activated cultured ECs ,single shear stress loaded ECs as control group to demonstrate the effects of pressure shift on cell morphogenesis and adhesion. Furthermore, we in- vestigate the effects of pressure shift on ECs proli- feration and apoptosis to elucidate the influences of pressure shift on vitality of ECs. We present these data here to suggest that the negative pressure might be another important factor beyond velocity and shear stress in biomechanical impairment on ECs, then to trigger the apoptosis with the extracellular matrix (ECM) detachment (anoikis). As the negative pressure is thought to play a role in the anoikis process, these results have implications for both the path- ogenesis and therapeutics investigations of stenostic vessel dis- eases and the future vascular tissue engineering.

To evaluate the early and mid-outcomes of proximal aorta reconstruction for type A aortic dissection (AAD) patients without intimal tear in aortic arch, and assess the safety and efficacy of this surgical strategy.From January 2010 to February 2013, there were 23 AAD patients without intimal tear in the aortic arch received proximal aorta reconstruction surgery. Clinical data of these patients were analyzed retrospectively, the mean age was (48.04 ± 12.37) years old (21-73 yr.). Twelve cases were acute aortic dissection, the others were chronic dissection. Bentall surgery was performed for 13 cases, Cabrol surgery for 2 cases, Wheat surgery for 1 case, ascending aorta replacement and aortic valve repair was employed for 1 patient, simple ascending aorta replacement for 6 cases. The patients received follow-up every 3 to 6 months after the surgery.The duration of CPB time was (182.83 ± 36.98) min, cardiac arrest time was (111.87 ± 18.82) min, circulatory arrest time was (24.22 ± 6.38) min. The complications were lung infection (4 cases, 17.4%), tracheotomy (2 cases), peritoneal dialysis (1 case), 2 cases suffered transient neurological dysfunction. None stroke, paralysis, and permanent neurological dysfunction occurred. All the patients were discharged. Mean time of follow-up was (38.35 ± 11.95) months (18-56 months). All patients were alive and return to normal life, the proportion of false lumen closure was 65.22% (15 cases). None patients need secondary surgery.Proximal aorta reconstruction is safe and effective for AAD patient without intimal tear in aortic arch, the operation strategy can be used individually.

To investigate the clinical significances of plasma IL-6, CRP and TNF-alpha concentration changes in aortic dissection.Plasma concentrations of IL-6, TNF-alpha and CRP were determined in 68 aortic dissection patients,50 patients with essential hypertensionand 50 healthy volunteers. The changes of plasma IL-6, CRP and TNF-alpha concentration were analyzed in aortic group along with the progression of the disease which was divided into 9 differenttime courses.Compared with essential hypertension and healthy control group, significantly elevated CRP, IL-6 and TNF-alpha concentrations were detected in aortic dissection patients (P0.05, respectively). All the concentrations of CRP, IL-6 and TNF-alpha reached the peak in acute phase of aortic dissection and then gradually declined in subacute and chronic phase.Increased plasma inflammatory factors were significantly associated with aortic dissection.

A 22-year-old male patient was admitted to our institution because of repeated chest pain and syncope. Physical examination was unremarkable except for a systolic murmur on cardiac auscultation. Transesophageal echocardiogram showed a large, very mobile cystic mass (21×17 mm) attaching to the bicuspid aortic valve, which caused severe left ventricular outflow tract obstruction with normal ventricular size and function (Figure 1A and 1B and Movies I and II in the online-only Data Supplement). …

To investigate the mid-long-term clinical results of aortic valve replacement with 17 mm St. Jude medical regent valve with hemodynamic evaluation including the measurement of effective orifice area, the occurrence of prosthesis-patient mismatch (PPM) and its affect on heart function.There were 44 patients accepted aortic valve replacement with 17 mm St. Jude medical regent valve because of small aortic annulus. Before the operation and during the postoperative follow-up, color doppler echocardiography was used to measure the hemodynamic parameters, such as left ventricular mass (LVmass), effective orifice area (EOA) and effective orifice area index (EOAI), etc.Transthoracic echocardiographic data were obtained from 39 of 44 patients (88.6%) at 12-55 months after surgery. One (2.27%) died of heart failure in 1 year. According to the current standard of PPM (EOAIor = 0.85 cm2/m2), 33 cases (82.1%) had PPM, 13 cases (30.8%) had severe PPM with an EOAIor = 0.65 cm2/m2. After the operation, there were significant decreases in LVAo-PG (19 +/- 8) mmHg and left ventricular mass index (LVmass I) (86.6 +/- 23.3) g/m2 (P0.05). The assessment for physical capacity according to NYHA classification: 41 patients improved to class II or better and 2 patients improved to class III (P0.05).The patients with small aortic annulus may obtain satisfactory clinical results after AVR with 17 mm St. Jude medical regent valve, PPM seems not affect the mid-long-term results.

Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

The self-assembling peptide, RAD16-II (Ac-RARADADARARADADA-NH2), has been shown to have many great applications in nanotechnology and tissue engineering. But few studies have been carried out to study the application of self-assembling peptides as a drug carrier. We used hydrophobic drug pyrene as a model and liposome vesicles to mimic bilayer membranes to study the ability of RAD16-II in drug encapsulation and transfer to lipid vesicles. It was found that this designed self-assembling peptide was able to stabilize hydrophobic drug in aqueous solution and deliver it into lipophilic environment. Analysis of the fluorescence excitation spectra showed that pyrene was present in the crystalline form when stabilized by RAD16-II and was able to be dispersed in egg phosphatidylcholine vesicles. This suggested that pyrene was completely released from RAD-Py mixture into the bilayer membranes. Furthermore, the concentration of pyrene transferred into the vesicles was quantified and its transfer rate was determined. The scanning electron micrograph image showed that pyrene microcrystals and peptide were absorbed by each other and the size of the pyrene-peptide complexes was larger than 10 microm. These data further demonstrated that this type of ionic complementary oligopeptides was able to significantly encapsulate hydrophobic drug and provide a new type of nanomaterials for delivering drugs.

To investigate the expression of the transcriptive factors, GATA-4 and Nkx2.5 gene, in the course of induction of mesenchymal stem cells (MSCs) into cardiomyocytes, and analyze its molecular biological mechanism.Rattus Mesenchymal Stem Cells were cultured in vitro and 3rd generation cells were induced in 10 micromol/L 5-azacytidine, troponin I was checked with immunohistochemistry and Western blot, GATA-4 and NkX2.5 gene were analyzed by RT-PCR in 1, 2, 3 and 4 weeks respectively.Growth of MSCs stopped after being induced, trending to form colonies, troponin I positive expressed since 2nd week, GATA-4 and Nkx2.5 began to express in 1st week, increasing gradually, peak in 3rd week.GATA-4 and Nkx2. 5 gene expression increased gradually in the course of stem cells differentiation, which may control the rule of cardiomyocyte transcription.

To evaluate the operative indication, the choice of valve prostheses, and the method of anticoagulation therapy of tricuspid valve replacement (TVR).From May 1998 to January 2008, 70 patients underwent TVR. There were 59 cases of rheumatic heart diseases. The operations included mitral and tricuspid valve replacement for 37 cases, triple valve replacement for 18 cases, isolated TVR for 13 cases, and tricuspid and aortic valve replacement for 2 cases. All the patients received oral anticoagulant therapy (warfarin) 2 d after the operations.There were 3 in-hospital deaths (4.3%) and 1 late death (0.4%). The follow-up rate was 88.1%, and the cumulative follow-up was 243.5 patient-years (pty). The anticoagulation-related event rate was 2.9% pty, and the mean INR value of 643 out-patient samples was 1.87 +/- 0.68. Post-operative heart function NYHA classification: 52 cases in class I to II, and 7 cases in class III.TVR should be indicated for severely damaged and deformed tricuspid valve of rheumatic heart diseases. Bileaflet mechanical valve is a suitable prosthesis for TVR. The optimal anticoagulation therapy intensity of TVR needs to be investigated.

It has been found that the self-assembling peptide RADA 16-I forms a beta-sheet structure and self-assembles into nanofibers and scaffolds in favor of cell growth, hemostasis and tissue-injury repair. But its biophysical and morphological properties, especially for its beta-sheet and self-assembling properties in heat- and pH-denatured conditions, remain largely unclear. In order to better understand and design nanobiomaterials, we studied the self-assembly behaviors of RADA16-I using CD and atomic force microscopy (AFM) measurements in various pH and heat-denatured conditions. Here, we report that the peptide, when exposed to pH 1.0 and 4.0, was still able to assume a typical beta-sheet structure and self-assemble into long nanofiber, although its beta-sheet content was dramatically decreased by 10% in a pH 1.0 solution. However, the peptide, when exposed to pH 13.0, drastically lost its beta-sheet structure and assembled into different small-sized globular aggregates. Similarly, the peptide, when heat-denatured from 25 to 70 degrees C, was still able to assume a typical beta-sheet structure with 46% content, but self-assembled into small-sized globular aggregates at much higher temperature. Titration experiments showed that the peptide RADA16-I exists in three types of ionic species: acidic (fully protonated peptide), zwitterionic (electrically neutral peptide carrying partial positive and negative charges) and basic (fully deprotonated peptide) species, called 'super ions'. The unordered structure and beta-turn of these 'super ions' via hydrogen or ionic bonds, and heat Brownian motion under the above denatured conditions would directly affect the stability of the beta-sheet and nanofibers. These results help us in the design of future nanobiomaterials, such as biosensors, based on beta-sheets and environmental changes. These results also help understand the pathogenesis of the beta-sheet-mediated neuronal diseases such as Alzheimer's disease and the mechanism of hemostasis.

Background Deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion has been historically preferred for organ protection during surgical repair of the acute aortic dissection type A. However, in the past decades, different perfusion-specific strategies with a growing trend to increase the body temperature at circulatory arrest emerged. In this study, we retrospectively analyzed the clinical results of our modified protocol for cardiopulmonary bypass and hypothermia management. Methods Between February 2007 and September 2012, 54 consecutive patients suffering from acute aortic dissection type A underwent emergent surgery. All patients received hypothermic circulatory arrest in combination with antegrade cerebral perfusion. The patients were divided into two subsets according to the degree of hypothermia and perfusion strategies: namely the DHCA group and the group of modified hypothermic circulatory arrest (MHCA). Results The overall 30-day mortality was 27.8% and was not significantly different between groups (DHCA, 33.3%, MHCA, 19%; p=0.253). The requirement for blood product transfusion in MHCA patients was significantly less as as compared with the patients in the DHCA group. No difference occurred in the incidence of temporary neurologic dysfunction, dialysis-dependent renal failure, or reexploration for bleeding between two groups of patients. The use of MHCA was identified as a protective factor against the postoperative composite complications (OR, 0.78; CI, 0.52 to 0.98; p=0.04) and the prolonged intensive care unit stay (OR, 0.8; 95% CI, 0.56 to 0.98; p=0.04). Conclusions Moderate hypothermia in combination with selective brain perfusion and systemic retrograde perfusion is associated with adequate cerebral and visceral protection, reduced postoperative complications and shortened intensive care unit stay in our series. This modified perfusion strategy may help in improving perioperative outcomes in this particular group of patients.

Studies on the anticancer mechanism of peptide P18 in human leukemia K562 cells revealed that P18 causes the death of most K562 cells by depolarizing plasma membrane potential and enhancing membrane permeability, rather than activating the classical apoptosis pathway. The mechanistic studies indicate that disrupting plasma membrane is an effective approach to kill cancer cells and help design more effective peptide analogues in future cancer therapies.