Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databa...Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.展开更多
Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the ...Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the convenience sampling method,patients with heart failure and their main caregivers in the Department of Cardiology of a tertiary hospital in Suzhou from May to November 2023 were selected as the research subjects.The HFSS scale was used for data collection.The paired t-test or paired Wilcoxon test was used to evaluate the differences in the binary symptom assessment scores of heart failure.The intraclass correlation coefficient was used to assess the consistency level of the binary symptom assessment.The Pearson correlation test was used to examine the correlation of the binary symptom assessment.Regression analysis was employed to explore the factors related to the consistency assessment.Results:A total of 103 pairs of valid questionnaires were collected.The consistency levels of symptom evaluations in patients with heart failure and their primary caregivers were statistically significant(P<0.05).The most frequently reported and severe symptom by patients with heart failure and their primary caregivers is shortness of breath during activity.Both have a high consensus on the severity and urgency of most heart failure symptoms.The patient’s gender,body mass index,number of children,history of diabetes,number of comorbidities,mean arterial pressure,LVEF,number of stents,whether a defibrillator was implanted,as well as the gender,marital status,education level,relationship with the patient,care time,whether they lived together,and communication and interaction situation of the main caregiver were the influencing factors for the consistency of binary symptom assessment of heart failure(P<0.05).Conclusion:The degree of consistency in binary symptom assessment between patients with heart failure and their primary caregivers was moderate or higher,which emphasizes the importance of including binary groups in clinical assessment.展开更多
Background:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to in...Background:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to investigate the associations of perioperative anxiety and depression with postoperative complications,sociodemographic and clinical characteristics.Methods:This observational,analytical,longitudinal study included 42 pediatric participants aged 8 to 16 years old.Preoperative psychological assessments were completed by 36 children,the remaining 6 were unable to participate due to invasive ventilation,extracorporeal membrane oxygenation(ECMO),and physical debilitation.Postoperatively,all 42 subjects completed the psychosocial evaluations.Data on recipients characteristics,family characteristics and clinical parameters were collected.Anxiety and depression were assessed using the Screen for Child Anxiety Related Emotional Disorders(SCARED)and the Depression Self-Rating Scale for Children(DSRSC).The Short Form-36 Health Survey(SF-36)was applied to assess the health-related QoL.Results:Before transplantation,91.7%(33/36)of the children exhibited symptoms of anxiety,and an identical proportion(91.7%,33/36)showed signs of depression.After transplantation,the rates of anxiety and depression decreased to 35.7%(15/42)and 11.9%(5/42),respectively.Longer disease course(p=0.042),preoperative hypoalbuminemia(p=0.032),older age(p=0.024),postoperative hypertension(p=0.011),and postoperative CRRT(p=0.015)result in depression symptoms.Preoperative hypoalbuminemia(p=0.032)was also more common in the anxiety group.Additionally,children with psychosocial risks had significantly lower QoL scores in general health(p=0.008)and mental health(p=0.015).Conclusions:Perioperative anxiety and depression are highly prevalent among pediatric heart transplant recipients.Although significant improvements in psychosocial risks were observed at posttransplantation,approximately 40%children continued to experience psychosocial challenges.展开更多
Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive va...Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital （Beijing, China）. HF in these patients was caused by three diseases; coronary heart disease （CHD）, dilated cardiomyopathy （DCM） and valvular heart disease （VHD）. Patients were followed-up for 21 ~ 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan-Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD （P 〈 0.001, HR 1.315, 95% CI 1.122-1.543）. The group with higher N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.展开更多
Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai gr...Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai groups. The ischemic heart failure model was established in New Zealand white rabbits, which were intraperitoneally injected with YiQiFuMai injection and 0.9% sodium chloride after the operation. After six weeks, cardiac function was examined by ultrasound;serum BNP levels were measured by ELISA;p-AKT, eNOS, ICAM-1 and VEGF levels were evaluated by real-time PCR and Western-Blot;pathological changes of the myocardial tissue were observed by H&E staining;CD31 expression in tissue samples was analyzed by immunohistochemistry. The ultrastructure and microcirculation of myocardial tissue specimens from the three groups were assessed by transmission electron microscopy. Results: YiQiFuMai decreased serum BNP levels, and increased LVEF and reduced LVEDD at 6 weeks postoperatively. In addition, YiQiFuMai can improve myocardial damage and microcirculation structure, as assessed by histology and transmission electron microscope. At the molecular level, treatment with YiQiFuMai resulted in increased eNOS, VEGF and p-AKT levels but reduced ICAM-1 amounts compared with the heart failure group. Conclusion: Ischemic heart failure damages the microvascular structure and functions of the myocardium. Treatment with YiQiFuMai potentially ameliorates microcirculatory damage and alleviates cardiac failure by improving endothelial function and angiogenesis, and inhibiting inflammatory cell adhesion.展开更多
AIM To assess the association of resting heart rate with allcause and cardiovascular disease(CVD)mortality in the Diabetes Heart Study(DHS).METHODS Out of a total of 1443 participants recruited into the DHS,1315 parti...AIM To assess the association of resting heart rate with allcause and cardiovascular disease(CVD)mortality in the Diabetes Heart Study(DHS).METHODS Out of a total of 1443 participants recruited into the DHS,1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis.Heart rate was collected from baseline resting electrocardiogram and mortality(all-cause and CVD)was obtained from state and national death registry.Kaplan-Meier(K-M)and Cox proportional hazard analyses were used to assess the association.RESULTS The mean age,body mass index(BMI)and systolic blood pressure(SBP)of the cohort were 61.4±9.2 years,32.0±6.6 kg/m2,and 139.4±19.4 mmHg respectively.Fiftysix percent were females,85%were whites,15%were blacks,18%were smokers.The mean±SD heart rate was 69.8(11.9)beats per minute(bpm).After a median follow-up time of 8.5 years(maximum follow-up time is 14.0 years),258 participants were deceased.In K-M analysis,participants with heart rate above the median had a significantly higher event rate compared with those below the median(log-rank P=0.0223).A one standard deviation increase in heart rate was associated with allcause mortality in unadjusted(hazard ratio 1.16,95%CI:1.03-1.31)and adjusted(hazard ratio 1.20,95%CI:1.05-1.37)models.Similar results were obtained with CVD mortality as the outcome of interest.CONCLUSION Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes.In this study,a 1-SD increase in heart rate was associated with a 20%increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.展开更多
Objectives:This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019(COVID-19).Methods:The strategies...Objectives:This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019(COVID-19).Methods:The strategies of the Nursing Department included an early warning for prevention and control,taking functions of vertically commanding and horizontally coordinating,and reasonably allocating nursing workforce,to facilitate centralized treatment work in the in-hospital fever clinic,isolation wards and ICU,and referral and admission of critical patients.Five special groups were established in charge of training and examination,management and supervision,psychological support,logistical support,and reporting and publicity,respectively.Results:It was achieved that no deaths from critical patients and no medical staff,no other patients were infected.Conclusion:Through the implementation of these strategies,safe and efficient centralized treatment was ensured timely,orderly and sustainably.展开更多
In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the ma...In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.展开更多
Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how ...Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients’ needs at the last stage of the palliative phase are essential for the nurses’ approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses’ experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.展开更多
Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythm...Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.展开更多
Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,...Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.展开更多
Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were includ...Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.展开更多
BACKGROUND Chronic hepatitis B is a highly heterogeneous disease that can be divided into four phases: Immune tolerant(IT), immune active(IA), inactive carrier(IC) and hepatitis B envelope antigen(HBeAg)-negative hepa...BACKGROUND Chronic hepatitis B is a highly heterogeneous disease that can be divided into four phases: Immune tolerant(IT), immune active(IA), inactive carrier(IC) and hepatitis B envelope antigen(HBeAg)-negative hepatitis(ENEG).AIM To investigate the immune status of natural killer(NK) and T cells in different phases of chronic hepatitis B.METHODS The frequency, phenotype and function of circulating NK cells, as well as nonantigen-specific and hepatitis B virus(HBV)-specific T cell responses were detected by flow cytometry in healthy and HBV-infected subjects.RESULTS The ability of NK cells to produce IFN-γ was markedly attenuated in HBVinfected patients overall but was less compromised in IC patients. Patients in the IT and IA phases also displayed significantly lower TNF-α production compared to healthy subjects. NK cells were phenotypically activated in the IA and ENEGphases, as evidenced by the upregulation of NKp44 in CD56^(bright) NK cells and CD69 in CD56^(dim) NK cells. Furthermore, global T-cells from the ENEG phase displayed a proinflammatory cytokine profile with upregulated IFN-γ and TNF-αexpression, while this profile was suppressed in IT and IA patients. Finally, core and S antigen-specific T cell responses were significantly stronger after in vitro expansion in the IC phase compared to other phases.CONCLUSION Our findings demonstrate the changes in immune response pattern during the natural history of HBV infection. Both NK and T cells are functionally impaired in the IT and IA phases. With the spontaneous clearance of HBeAg and hepatitis B surface antigen decline, NK cell cytokine production and HBV-specific T responses are partially restored in IC phase, and the ENEG phase is dominated by nonantigen-specific T cell responses.展开更多
Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pre...Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.展开更多
Atrial fibrillation is the most common arrhythmia and in symptomatic patients with a drug-refractory form,catheter ablation aimed at electrically disconnecting the pulmonary veins(PVs) has proved more effective than u...Atrial fibrillation is the most common arrhythmia and in symptomatic patients with a drug-refractory form,catheter ablation aimed at electrically disconnecting the pulmonary veins(PVs) has proved more effective than use of antiarrhythmic drugs in maintaining sinus rhythm during follow-up.On the other hand,this ablation procedure is complex,requires specific training and adequate clinical experience.A main challenge is represented by the need for accurate sequential positioning of the ablation catheter around each veno-atrial junction to deliver point-by-point radiofrequency energy applications in order to achieve complete and persistent electrical disconnection of the PVs.Imaging integration is a new technology that enables guidance during this procedure by showing a three-dimensional,pre-acquired computed tomography or magnetic resonance image and the relative real-time position of the ablation catheter on the screen of the electroanatomic system.Reports in the literature suggest that imaging integration provides accurate visual information with improvement in the procedure parameters and/or clinical outcomes of the procedure.展开更多
Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deteriora...Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.展开更多
BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting ...BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.展开更多
Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febu...Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing(RAP)and the mechanisms by which it acts.Methods Twenty-four rabbits were randomly divided into four groups:sham-operated group(Group S),RAP group(Group P),RAP with 5 mg/kg per day febuxostat group(Group LFP),and RAP with 10 mg/kg per day febuxostat group(Group HFP).All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks.The effects of febuxostat on atrial electrical and structural remodeling,markers of inflammation and oxidative stress,and signaling pathways involved in the left atrium were examined.Results Shortened atrial effective refractory period(AERP),increased AF inducibility,decreased mRNA levels of Cav1.2 and Kv4.3,and left atrial enlargement and dysfunction were observed in Group P,and these changes were suppressed in the groups treated with febuxostat.Prominent atrial fibrosis was observed in Group P,as were increased levels of TGF-β1,Collagen I,andα-SMA and decreased levels of Smad7 and eNOS.Treatment with febuxostat attenuated these differences.Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat.Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.展开更多
Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-...Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.展开更多
Extrarenal fibromuscular dysplasia causing gastro- intestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic ap...Extrarenal fibromuscular dysplasia causing gastro- intestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic appearance and the treatment is controversial. To our knowledge only seven cases of visceral fibromuscular dysplasia as a primary manifestation of the disease have been described, symptoms range from abdominal pain to gangrene. This is the first case of visceral fibromuscular dysplasia presenting with otherwise asymptomatic gastrointestinal bleeding, without bowel necrosis or ischemic changes. We provide a review of the literature.展开更多
基金funded by the Young Clinical Research Special Fund Project of Peking University First Hospital(No.2024YC05)。
文摘Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.
文摘Background:To investigate the consistency level of binary symptom assessment in patients with heart failure and their primary caregivers,and to analyze the related factors influencing consistency.Methods:By using the convenience sampling method,patients with heart failure and their main caregivers in the Department of Cardiology of a tertiary hospital in Suzhou from May to November 2023 were selected as the research subjects.The HFSS scale was used for data collection.The paired t-test or paired Wilcoxon test was used to evaluate the differences in the binary symptom assessment scores of heart failure.The intraclass correlation coefficient was used to assess the consistency level of the binary symptom assessment.The Pearson correlation test was used to examine the correlation of the binary symptom assessment.Regression analysis was employed to explore the factors related to the consistency assessment.Results:A total of 103 pairs of valid questionnaires were collected.The consistency levels of symptom evaluations in patients with heart failure and their primary caregivers were statistically significant(P<0.05).The most frequently reported and severe symptom by patients with heart failure and their primary caregivers is shortness of breath during activity.Both have a high consensus on the severity and urgency of most heart failure symptoms.The patient’s gender,body mass index,number of children,history of diabetes,number of comorbidities,mean arterial pressure,LVEF,number of stents,whether a defibrillator was implanted,as well as the gender,marital status,education level,relationship with the patient,care time,whether they lived together,and communication and interaction situation of the main caregiver were the influencing factors for the consistency of binary symptom assessment of heart failure(P<0.05).Conclusion:The degree of consistency in binary symptom assessment between patients with heart failure and their primary caregivers was moderate or higher,which emphasizes the importance of including binary groups in clinical assessment.
文摘Background:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to investigate the associations of perioperative anxiety and depression with postoperative complications,sociodemographic and clinical characteristics.Methods:This observational,analytical,longitudinal study included 42 pediatric participants aged 8 to 16 years old.Preoperative psychological assessments were completed by 36 children,the remaining 6 were unable to participate due to invasive ventilation,extracorporeal membrane oxygenation(ECMO),and physical debilitation.Postoperatively,all 42 subjects completed the psychosocial evaluations.Data on recipients characteristics,family characteristics and clinical parameters were collected.Anxiety and depression were assessed using the Screen for Child Anxiety Related Emotional Disorders(SCARED)and the Depression Self-Rating Scale for Children(DSRSC).The Short Form-36 Health Survey(SF-36)was applied to assess the health-related QoL.Results:Before transplantation,91.7%(33/36)of the children exhibited symptoms of anxiety,and an identical proportion(91.7%,33/36)showed signs of depression.After transplantation,the rates of anxiety and depression decreased to 35.7%(15/42)and 11.9%(5/42),respectively.Longer disease course(p=0.042),preoperative hypoalbuminemia(p=0.032),older age(p=0.024),postoperative hypertension(p=0.011),and postoperative CRRT(p=0.015)result in depression symptoms.Preoperative hypoalbuminemia(p=0.032)was also more common in the anxiety group.Additionally,children with psychosocial risks had significantly lower QoL scores in general health(p=0.008)and mental health(p=0.015).Conclusions:Perioperative anxiety and depression are highly prevalent among pediatric heart transplant recipients.Although significant improvements in psychosocial risks were observed at posttransplantation,approximately 40%children continued to experience psychosocial challenges.
文摘Background Increased red blood cell distribution width （RDW） is associated with adverse outcomes in patients with heart failure （HF）. The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital （Beijing, China）. HF in these patients was caused by three diseases; coronary heart disease （CHD）, dilated cardiomyopathy （DCM） and valvular heart disease （VHD）. Patients were followed-up for 21 ~ 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan-Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD （P 〈 0.001, HR 1.315, 95% CI 1.122-1.543）. The group with higher N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.
文摘Objective: To assess the effects of traditional Chinese medicine YiQiFuMai on cardiac function during the progression of ischemic heart failure. Methods: Rabbits were divided into sham, heart failure, and YiQiFuMai groups. The ischemic heart failure model was established in New Zealand white rabbits, which were intraperitoneally injected with YiQiFuMai injection and 0.9% sodium chloride after the operation. After six weeks, cardiac function was examined by ultrasound;serum BNP levels were measured by ELISA;p-AKT, eNOS, ICAM-1 and VEGF levels were evaluated by real-time PCR and Western-Blot;pathological changes of the myocardial tissue were observed by H&E staining;CD31 expression in tissue samples was analyzed by immunohistochemistry. The ultrastructure and microcirculation of myocardial tissue specimens from the three groups were assessed by transmission electron microscopy. Results: YiQiFuMai decreased serum BNP levels, and increased LVEF and reduced LVEDD at 6 weeks postoperatively. In addition, YiQiFuMai can improve myocardial damage and microcirculation structure, as assessed by histology and transmission electron microscope. At the molecular level, treatment with YiQiFuMai resulted in increased eNOS, VEGF and p-AKT levels but reduced ICAM-1 amounts compared with the heart failure group. Conclusion: Ischemic heart failure damages the microvascular structure and functions of the myocardium. Treatment with YiQiFuMai potentially ameliorates microcirculatory damage and alleviates cardiac failure by improving endothelial function and angiogenesis, and inhibiting inflammatory cell adhesion.
文摘AIM To assess the association of resting heart rate with allcause and cardiovascular disease(CVD)mortality in the Diabetes Heart Study(DHS).METHODS Out of a total of 1443 participants recruited into the DHS,1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis.Heart rate was collected from baseline resting electrocardiogram and mortality(all-cause and CVD)was obtained from state and national death registry.Kaplan-Meier(K-M)and Cox proportional hazard analyses were used to assess the association.RESULTS The mean age,body mass index(BMI)and systolic blood pressure(SBP)of the cohort were 61.4±9.2 years,32.0±6.6 kg/m2,and 139.4±19.4 mmHg respectively.Fiftysix percent were females,85%were whites,15%were blacks,18%were smokers.The mean±SD heart rate was 69.8(11.9)beats per minute(bpm).After a median follow-up time of 8.5 years(maximum follow-up time is 14.0 years),258 participants were deceased.In K-M analysis,participants with heart rate above the median had a significantly higher event rate compared with those below the median(log-rank P=0.0223).A one standard deviation increase in heart rate was associated with allcause mortality in unadjusted(hazard ratio 1.16,95%CI:1.03-1.31)and adjusted(hazard ratio 1.20,95%CI:1.05-1.37)models.Similar results were obtained with CVD mortality as the outcome of interest.CONCLUSION Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes.In this study,a 1-SD increase in heart rate was associated with a 20%increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.
基金Zhejiang Medical Science and Technology Plan Project(2019RC167).
文摘Objectives:This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019(COVID-19).Methods:The strategies of the Nursing Department included an early warning for prevention and control,taking functions of vertically commanding and horizontally coordinating,and reasonably allocating nursing workforce,to facilitate centralized treatment work in the in-hospital fever clinic,isolation wards and ICU,and referral and admission of critical patients.Five special groups were established in charge of training and examination,management and supervision,psychological support,logistical support,and reporting and publicity,respectively.Results:It was achieved that no deaths from critical patients and no medical staff,no other patients were infected.Conclusion:Through the implementation of these strategies,safe and efficient centralized treatment was ensured timely,orderly and sustainably.
文摘In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.
文摘Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients’ needs at the last stage of the palliative phase are essential for the nurses’ approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses’ experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.
文摘Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.
文摘Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.
基金This work was financially supported by National Natural Science Foundation of China(Nos.82000325,82100325,82070349)Young Elite Scientists Sponsorship Program by Beijing Association for Science and Technology(No.BYESS2023392)+2 种基金The Beijing Gold-bridge project(No.ZZ21055)The Peking University First Hospital Seed Foundation(No.2020SF19)High-level hospital clinical research funding of Fuwai Hospital,Chinese Academy of Medical Sciences(No.2022-GSP-GG-11).
文摘Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.
基金Supported by National Science Fund of China(NSFC)No.30771911National Science and Technology Major Project No.2012ZX10002007-003
文摘BACKGROUND Chronic hepatitis B is a highly heterogeneous disease that can be divided into four phases: Immune tolerant(IT), immune active(IA), inactive carrier(IC) and hepatitis B envelope antigen(HBeAg)-negative hepatitis(ENEG).AIM To investigate the immune status of natural killer(NK) and T cells in different phases of chronic hepatitis B.METHODS The frequency, phenotype and function of circulating NK cells, as well as nonantigen-specific and hepatitis B virus(HBV)-specific T cell responses were detected by flow cytometry in healthy and HBV-infected subjects.RESULTS The ability of NK cells to produce IFN-γ was markedly attenuated in HBVinfected patients overall but was less compromised in IC patients. Patients in the IT and IA phases also displayed significantly lower TNF-α production compared to healthy subjects. NK cells were phenotypically activated in the IA and ENEGphases, as evidenced by the upregulation of NKp44 in CD56^(bright) NK cells and CD69 in CD56^(dim) NK cells. Furthermore, global T-cells from the ENEG phase displayed a proinflammatory cytokine profile with upregulated IFN-γ and TNF-αexpression, while this profile was suppressed in IT and IA patients. Finally, core and S antigen-specific T cell responses were significantly stronger after in vitro expansion in the IC phase compared to other phases.CONCLUSION Our findings demonstrate the changes in immune response pattern during the natural history of HBV infection. Both NK and T cells are functionally impaired in the IT and IA phases. With the spontaneous clearance of HBeAg and hepatitis B surface antigen decline, NK cell cytokine production and HBV-specific T responses are partially restored in IC phase, and the ENEG phase is dominated by nonantigen-specific T cell responses.
文摘Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.
文摘Atrial fibrillation is the most common arrhythmia and in symptomatic patients with a drug-refractory form,catheter ablation aimed at electrically disconnecting the pulmonary veins(PVs) has proved more effective than use of antiarrhythmic drugs in maintaining sinus rhythm during follow-up.On the other hand,this ablation procedure is complex,requires specific training and adequate clinical experience.A main challenge is represented by the need for accurate sequential positioning of the ablation catheter around each veno-atrial junction to deliver point-by-point radiofrequency energy applications in order to achieve complete and persistent electrical disconnection of the PVs.Imaging integration is a new technology that enables guidance during this procedure by showing a three-dimensional,pre-acquired computed tomography or magnetic resonance image and the relative real-time position of the ablation catheter on the screen of the electroanatomic system.Reports in the literature suggest that imaging integration provides accurate visual information with improvement in the procedure parameters and/or clinical outcomes of the procedure.
文摘Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.
文摘BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.
基金supported by the Beijing Natural Science Foundation(Z141100002114050)
文摘Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing(RAP)and the mechanisms by which it acts.Methods Twenty-four rabbits were randomly divided into four groups:sham-operated group(Group S),RAP group(Group P),RAP with 5 mg/kg per day febuxostat group(Group LFP),and RAP with 10 mg/kg per day febuxostat group(Group HFP).All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks.The effects of febuxostat on atrial electrical and structural remodeling,markers of inflammation and oxidative stress,and signaling pathways involved in the left atrium were examined.Results Shortened atrial effective refractory period(AERP),increased AF inducibility,decreased mRNA levels of Cav1.2 and Kv4.3,and left atrial enlargement and dysfunction were observed in Group P,and these changes were suppressed in the groups treated with febuxostat.Prominent atrial fibrosis was observed in Group P,as were increased levels of TGF-β1,Collagen I,andα-SMA and decreased levels of Smad7 and eNOS.Treatment with febuxostat attenuated these differences.Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat.Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.
文摘Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.
文摘Extrarenal fibromuscular dysplasia causing gastro- intestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic appearance and the treatment is controversial. To our knowledge only seven cases of visceral fibromuscular dysplasia as a primary manifestation of the disease have been described, symptoms range from abdominal pain to gangrene. This is the first case of visceral fibromuscular dysplasia presenting with otherwise asymptomatic gastrointestinal bleeding, without bowel necrosis or ischemic changes. We provide a review of the literature.
