Launched：February 1989
Editor-in-Chief：PEI Jian-ming
ISSN：1009-7236
CN：61-1268/R
Supervisor: Air Force Medical University
Sponsor: Medical Informatics Association Shaanxi Provincial Association for Physiological Sciences
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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doi: 10.12125/j.chj.202212052
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AIM To investigate the effects of pattern recognition receptor NLRX1 on cardiomyocytes upon hypoxia injury and the underlying molecular mechanisms. METHODS Primary neonatal rat ventricular myocytes (NRVMs) of SD rats were isolated and cultured. NRVMs were transfected with NLRX1-siRNA for 48 hours and then subjected to hypoxia and glucose deprivation for different times to simulate myocardial ischemia. Cell viability was determined by CCK-8 kit and cell apoptosis was analyzed with flow cytometry. Protein expression levels of NLRX1 and mitochondrial fusion related proteins (Opa1, Mfn1, Mfn2) were determined by western blotting and mitochondrial morphology was analyzed with laser scanning confocal microscopy. RESULTS NLRX1 was highly expressed in cardiomyocytes. Although total protein level of NLRX1 was not altered, cytoplasmic NLRX1 was up-regulated in NRVMs upon hypoxia and glucose deprivation. Compared with those in control group, NLRX1-siRNA up-regulated expression levels of mitochondrial fusion protein Mfn2 and Opa1, promoted mitochondrial fusion of hypoxic cardiomyocytes and reduced hypoxia induced cardiomyocyte death (P<0.05). CONCLUSION NLRX1 modulates the expression of mitochondrial fusion proteins Mfn2 and Opa1, and the inhibition of NLRX1 up-regulates the protein levels of Mfn2 and Opa1, which contributes to reduced cardiomyocytes injury upon hypoxia.
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doi: 10.12125/j.chj.202303068
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The important task of the military medical colleges is to cultivate high-quality medical professionals. The present study deeply analyzed the problems existing in the teaching incentive system in China's higher education institutions. Taking the teacher incentive strategy of the Air Force Medical University as an example, this paper discussed how to optimize the teaching incentive strategy by strengthening the school's understanding of the importance of undergraduate education, reasonably setting the proportion of teaching and scientific research achievements in teacher grade evaluation, establishing a reasonable teaching effectiveness evaluation system, increasing teaching supervision, promoting the professional development of teachers, establishing a teaching honor system, and a teaching reward system. The results of 194 questionnaires showed that teachers were generally satisfied with the setting of teaching and research indicators in the current professional title evaluation, while young teachers had a stronger and clearer belief in engaging in national defense and health education, and their ability and motivation to engage in education had improved. This article plays a positive role in promoting the establishment and improvement of the teaching incentive system in aerospace military medical colleges.
The important task of the military medical colleges is to cultivate high-quality medical professionals. The present study deeply analyzed the problems existing in the teaching incentive system in China's higher education institutions. Taking the teacher incentive strategy of the Air Force Medical University as an example, this paper discussed how to optimize the teaching incentive strategy by strengthening the school's understanding of the importance of undergraduate education, reasonably setting the proportion of teaching and scientific research achievements in teacher grade evaluation, establishing a reasonable teaching effectiveness evaluation system, increasing teaching supervision, promoting the professional development of teachers, establishing a teaching honor system, and a teaching reward system. The results of 194 questionnaires showed that teachers were generally satisfied with the setting of teaching and research indicators in the current professional title evaluation, while young teachers had a stronger and clearer belief in engaging in national defense and health education, and their ability and motivation to engage in education had improved. This article plays a positive role in promoting the establishment and improvement of the teaching incentive system in aerospace military medical colleges.
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doi: 10.12125/j.chj.202303039
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AIM To explore the construction and application of standardized nursing intervention in the diagnosis of patent foramen ovale (PFO) by transesophageal echocardiography (TEE) combined with right cardiac contrast echocardiography. METHODS From November 2020 to August 2022, 180 patients suspected of PFO underwent TEE combined with right heart sonography in the Second Affiliated Hospital of the Air Force Military Medical University were included in the study. The nursing staff participated in the whole process and provided standardized nursing, including personnel education, material preparation, guidance of Valsalva's actions, synchronous cooperation measures related to examination, observation and recording after examination, so as to ensure the smooth completion of the examination. RESULTS None of the 180 patients gave up TEE combined with right heart sonography because of fear and tension. 179 patients successfully completed TEE combined with right heart sonography under two states of calm breathing and Valsalva action. One patient was unable to complete the Valsalva action due to the sequelae of cerebral infarction, and only underwent right heart contrast echocardiography under calm breathing state. Two patients complained of dizziness and palpitation after the examination, which were relieved without special treatment. CONCLUSION During the whole process of TEE combined with right heart contrast echocardiography, scientific, effective and standardized nursing intervention is the key guarantee to better carry out relevant examinations.
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2023, 35(2): 125-129, 140.
doi: 10.12125/j.chj.202209001
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AIM To investigate the role and mechanism of branched-chain amino acid aminotransferase 1 (BCAT1) in regulating cardiomyocyte ferroptosis and hypoxia/reoxygenation injury. METHODS Neonatal rat ventricular myocytes (NRVMs) were routinely isolated from neonatal Sprague-Dawley rats and were in vitro cultured. NRVMs were transfected with adenovirus vectors over-expressing or silencing BCAT1 and then were subjected to hypoxia/reoxygenation (H/R) or the ferroptosis inducer, Erastin. ML385, a specific inhibitor of nuclear factor E2-related factor-2 (NRF2), was administered into NRVMs to explore the involvement of NRF2 in cardiomyocyte ferroptosis regulated by BCAT1. RESULTS BCAT1 silencing exacerbated H/R-induced NRVM death, a phenomenon basically eliminated by the ferroptosis inhibitor Ferr-1. Over-expression of BCAT1 significantly ameliorated H/R-induced cell death and Erastin-induced ferroptosis. BCAT1 over-expression significantly increased the protein abundance of NRF2 and up-regulated the mRNA levels of NRF2 downstream gene Ho-1, Nqo-1 and Trx-1. Inhibition of NRF2 by ML385 blocked the protective effect of BCAT1 over-expression against H/R injury and ferroptosis (all P<0.05). CONCLUSION BCAT1 regulates cardiomyocyte ferroptosis via a NRF2-dependent manner, which might be a key mechanism of BCAT1’s effect on H/R-induced cardiomyocyte injury.
2023, 35(2): 130-135, 140.
doi: 10.12125/j.chj.202207070
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AIM To investigate whether interfering with LncRNA STX18-AS1 can up-regulate the expression of miR-204 to affect the myocardial cell hypoxia injury. METHODS The cardiomyocytes H9C2 were cultured in vitro and the cardiomyocytes were treated with CoCl2 to establish a model of cell hypoxia injury. The expression levels of STX18-AS1 and miR-204 at different time points of CoCl2 treatment were detected by qRT-PCR. The experiment set up control group, model group, si-NC group, si-STX18-AS1 group, miR-NC group and miR-204 group. MTT was used to detect cell proliferation activity and flow cytometry and TUNEL were used to detect the apoptosis rate. The LDH activity, MDA level, SOD activity and CAT activity were detected using a biochemical kit and the targeting relationship of STX18-AS1 and miR-204 was verified by the dual luciferase report experiment. RESULTS Compared with those in control group, the expression level of STX18-AS1 in model group and si-NC group was increased (P<0.01) and the expression level of miR-204 was decreased (P<0.01) at 6 h, 12 h, 18 h and 24 h treated with CoCl2. Compared with those in si-NC group and si-NC group, the expression level of STX18-AS1 in si-STX18-AS1 group decreased (P<0.01) and the expression level of miR-204 increased (P<0.01) at 6 h, 12 h, 18 h and 24 h treated with CoCl2. Compared with those in control group, the cell proliferation activity in model group and si-NC group decreased (P<0.01), apoptosis rate, LDH activity and MDA level were significantly increased (P<0.01) and the activity of SOD and CAT were significantly decreased (P<0.01). Compared with those in model group and si-NC group, the cell proliferation activity was significantly increased (P<0.01), cell apoptosis rate and the LDH activity and MDA level were notably reduced (P<0.01) and the activity of SOD and CAT were significantly increased (P<0.01). The effect of transfection of miR-204 mimics on the proliferation activity, apoptosis and oxidative stress of cardiomyocytes was the same as the effect of transfection of si-STX18-AS1. The dual luciferase report experiment confirmed that STX18-AS1 could target miR-204. CONCLUSION Interfering with STX18-AS1 expression could up-regulate miR-204, inhibit cell apoptosis, promote proliferation and alleviate the oxidative damage of cardiomyocytes induced by CoCl2.
2023, 35(2): 136-140.
doi: 10.12125/j.chj.202205063
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AIM To establish an accurate and effective technique and method of isolating and culturing mouse skeletal muscle microvascular endothelial cells (MMECs) in vitro. METHODS Mouse MMECs were isolated and purified by collagenase I digesting and differential adhesion combined with magnetic beads and were adherently cultured in vitro. The cell morphology and ultrastructure were observed by microscopes, the growth curve of the cultured MMECs was measured by MTT, its phenotype was identified by CD31 related antigen immunofluorescence staining, and the purity of the MMECs was detected by flow cytometry. RESULTS Mouse skeletal muscle microvascular endothelial cells were obtained successfully and the primary cultured endothelial cells quickly adhered to the wall after 24 hours of culture, grew actively in monolayer with the characteristics of endothelial cell shape at (3~6) days of culture and fully covered the bottom in a “cobblestone” arrangement after (6~8) days of culture. MTT assay showed that cell growth curves of 2 generations of MMECs presented the inverted “S” shape. The results of flow cytometry indicated that the positive rate of CD31+ labelled MMECs purified with differential adhesion plus magnetic beads was over 97%. CONCLUSION A simple, reproducible and well tested method is established for isolating microvascular cells of murine skeletal muscle, which can provide the material basis and experimental model for further research on microvascular-related myopathy and molecular biology in related fields.
2023, 35(2): 141-145, 155.
doi: 10.12125/j.chj.202206084
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AIM To find out the relationship between early change of left ventricular ejection fraction (ΔLVEF) and long-term prognosis after initial percutaneous coronary intervention (PCI) intervention in patients with acute coronary syndrome (ACS) with impaired left ventricular ejection fraction (LVEF ≤50%) at admission. METHODS Patients with ACS and impaired LVEF who were admitted to the Cardiology Department of Xijing Hospital for the first time and successfully underwent PCI from January 2010 to December 2015 were enrolled. LVEF value was collected before, 3 months, 6 months and 12 months after PCI. The early change of LVEF (ΔLVEF) was defined as the difference between 3-month LVEF and the baseline LVEF and the patients were stratified into three categories: nonrecovery group (ΔLVEF≤0), slightly increase group (0<ΔLVEF≤14) and significantly increase group (ΔLVEF>14). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and the relationship between early change of LVEF and MACCE was assessed in Cox multivariable models. RESULTS There were significant differences in LVEF at baseline and 3 months among the three groups (all P<0.01). There was no statistical difference among the three groups in the all-cause mortality rate. The all-cause readmission rate in the nonrecovery group and the slightly increased group was higher than that in the significantly increased group. Compared with the non recovery group, the risk of MACCE in the slightly elevated group and the significantly elevated group decreased by 33% (HR=0.67, 95% CI: 0.51～0.88, P<0.01) and 57% (HR=0.43, 95% CI: 0.29～0.64, P<0.01), respectively. After multifactorial adjustment, age, cardiac function grade (3-4), hypertension, previous stroke history, low-density lipoprotein cholesterol, γ-Glutamyltransferase (GGT) and right coronal lesion are risk factors for predicting major adverse cardiovascular and cerebrovascular events, while early cardiac function changes (ΔLVEF) is a protective factor. CONCLUSION The extent of early LVEF change has important prognostic value in ACS patients with impaired LVEF (≤50%) after primary PCI. Therefore, health education and early follow-up are important for these patients and so is the control of LDL and blood pressure and the monitoring of GGT.
2023, 35(2): 146-149.
doi: 10.12125/j.chj.202204021
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AIM To explore the application value of contrast transthoracic echocardiography (c-TTE) in screening patent foramen ovale with right to left shunt (PFO-RLS). METHODS A total of 103 patients with suspected PFO due to migraine or unexplained cerebral infarction in the Neurology Department of our hospital underwent c-TTE and contrast transesophageal echocardiography (c-TEE) examinations to observe the positive rate of PFO-RLS detected by c-TTE and c-TEE at rest and under Valsalva maneuver. The results of c-TEE were regarded as the “gold standard” for PFO-RLS diagnosis and the diagnostic efficiency of c-TTE was evaluated under Valsalva maneuver. RESULTS The positive rates of c-tte and c-tee were 38.83% and 40.78% respectively at rest. The positive rates of the two methods were significantly higher under Valsalva action (all P<0.05), 80.58% and 82.52% respectively. There was no significant difference between the positive rates of c-tte and c-tee between the two groups at rest and Valsalva action; Compared with the gold standard c-tee, the positive predictive value of resting c-tte for pfo-rls was 100%, the negative predictive value was 96.82%, the sensitivity was 95.23%, the specificity was 100%, the accuracy was 98.05%, and the consistency kappa value was 0.95. Under Valsalva action, the positive predictive value of c-tte for pfo-rls was 98.79%, the negative predictive value was 85.00%, the sensitivity was 96.47%, the specificity was 94.44%, the accuracy was 96.11%, and the consistency kappa value was 0.87. CONCLUSION c-TTE has high sensitivity, specificity and accuracy in the diagnosis of PFO-RLS patients. As c-TTE is minimally invasive, painless, convenient and easy to be popularized in clinical application, it can be used as an early screening method for PFO-RLS patients. c-TEE should be performed for accurate assessment of PFO morphologies when the closure is planned.
2023, 35(2): 150-155.
doi: 10.12125/j.chj.202205025
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AIM To determine the middle and long-term safety and efficacy of using the Amplatzer duct occluder Ⅱ (ADO Ⅱ) for perimembranous ventricular septal defect (pmVSD) closure in adults. METHODS From June 2013 to June 2021, adult pmVSD patients were selected and treated through transcatheter intervention using ADOⅡoccluders. The closure results and complications were evaluated immediately, 1 d, 1 m, 3 m, 6 m and annual follow-up after procedures using electrocardiography and transthoracic echocardiography (TTE). RESULTS A total of 44 patients with pmVSD, aged (38 ± 13) years, were enrolled, including 24 cases of membranous bulging tumor, 13 cases of tubular type, 4 cases of funnel type, and 3 cases of residual fistula after surgical repair of pmVSD. pmVSD occlusion was performed with ADO Ⅱ occluder. Under angiography, the average defect outlet size was (3.4 ± 1.1) mm, the average waist diameter of the occluder was (4.8 ± 1.5) mm, and the average length of the occluder was (4.3 ± 0.7) mm. The success rate of immediate occlusion was 100%, and the complete occlusion rate was 75.0%. The follow-up time of 23 patients was (38 ± 24) months, and the median follow-up time was 36 months. Compared with that before operation, at the 6-month follow-up after operation, the left ventricular EDV decreased from (97 ± 23) mL to (86 ± 22) mL (P<0.05), and the LVEDD decreased from (51 ± 5) mm to (46 ± 5) mm (P<0.05). There was no significant change in the EF value of the left ventricular ejection fraction. The incidence of serious complications was 2.3%. During the follow-up period, there were no deaths, infective endocarditis, cAVB, occluder embolism, valve regurgitation requiring surgical treatment and other serious complications. The overall incidence of arrhythmia was 6.8%, and the immediate residual shunt incidence after operation was 25.0%. The cardiac function of 43 patients during follow-up was NYHA grade I or II. CONCLUSION Transcatheter closure of pmVSD and post-surgery residual shunts using ADO Ⅱ occluders in adults are both safe and effective and yields excellent middle and long-term results in selected patients. The potential benefits of this intervention include remodeling of the heart and reduced incidence of infective endocarditis.
2023, 35(2): 156-161.
doi: 10.12125/j.chj.202203077
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AIM To conduct a cross-sectional study on prehypertension and anxiety/depression of patients in Outpatient Department of Cardiovascular Medicine and to analyze the risk factors of prehypertension from the aspects of social economy, biology and psychology. METHODS Patients≥ 18 years old who were treated in the Outpatient Department of Cardiovascular Medicine of Tangdu Hospital from December 2020 to December 2021 were randomly selected and they were divided into normal blood pressure group, pre-hypertension group and hypertension group. The characteristics of the subjects were recorded by questionnaire and the risk factors of prehypertension were determined by univariate and multivariate logistic regression analysis. RESULTS The detection rate of pre hypertension was 43.3% (male 46.9%, female 38.7%). Compared with the normal blood pressure group, the age of prehypertension group (group A) and hypertension group (group B) increased (all P<0.01), the proportion of men increased (all P<0.01), the heart rate increased (all P<0.01), the proportion of low BMI and normal body weight decreased (all P<0.01), and the proportion of overweight and obesity increased (all P<0.01). Primary school education/college education or higher education level is lower (group A P<0.05, group B P<0.01), junior high school/secondary school/vocational high proportion (B group P<0.01), primary school and below ratio is higher (B group P<0.01), diabetes ratio is high (B group P<0.01), smoking ratio is high (all P<0.01), exercise rate is lower than 3 times a week (all P<0.01), and no exercise proportion is high (P <0.01). The proportion of poor sleep quality was high (all P<0.01), the proportion of family income above 10000 yuan was low (group A P<0.05, group B P<0.01), the proportion of family income (5000～10000) yuan was low (group B P<0.01), the proportion of family income below 1000 yuan was high (group B P<0.01), the proportion of snoring was high (group B P<0.01), the proportion of light diet was low (group A P<0.05, group B P<0.01), the proportion of oil and salt was high (group A P<0.05, group B P<0.01) The proportion of eating meat and meat was low (group B P<0.05), and the proportion of mild anxiety/depression was high (group A P<0.05). Compared with the prehypertension group, the age of hypertension group increased (P<0.01), heart rate increased (P<0.01), BMI body weight ratio decreased (P<0.01), education level decreased in proportion of college/University and above, proportion of junior high school/secondary school/vocational high school decreased, primary school and below increased (P<0.01, P<0.05, P<0.01), proportion of diabetes increased (P<0.01), exercise situation 3 times a week, and proportion decreased. The proportion of non exercise increased (all P<0.01), the proportion of family income above 10000 yuan decreased, (5000～10000) yuan decreased, the proportion of less than 1000 yuan increased (all P<0.01), the proportion of snoring was high (P<0.01), the proportion of light food was low (P<0.05), the proportion of oil and salt was high (P<0.01), and the proportion of mild anxiety/depression increased. Univariate logistic regression analysis showed that age, gender, heart rate, overweight, obesity, education, smoking, exercise, sleep quality and anxiety/depression were the influencing factors of pre hypertension. The analysis showed that overweight and depression were independent risk factors. Conclusion the detection rate of pre hypertension is high, and overweight, obesity, anxiety or depression are important risk factors.
2023, 35(2): 162-167.
doi: 10.12125/j.chj.202204064
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AIM To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2) and pentraxin 3(PTX3) for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease (CHD). METHODS A total of 379 CHD patients undergoing PCI for severe coronary artery stenosis were selected. According to the reexamination of ISR 6 months after the operation, 53 cases were divided into ISR group and 326 cases were non-ISR group. General clinical data of patients in both groups were collected. Lp-PLA2 and PTX3 levels in both groups were monitored 1d after surgery. Logistic stepwise regression was used to analyze the risk factors of ISR.The cross-sectional area of the elastic membrane (EEM-CSA), plaque area (PLA), minimum lumen area (MLA), intima proliferation area (IPA) and Gensini score were reviewed 6 months after the operation. The correlation of Lp-PLA2 and PTX3 with Gensini score, EEM-CSA, MLA, PLA, IPA was analyzed. The optimum cut-off value and AUC of Lp-PLA2 and PTX3 for predicting ISR were evaluated by ROC curve. RESULTS (1) STEMI (P<0.05), smoking history (P<0.01), diabetes (P<0.01), LDL-C (P<0.05), stent tandem (P<0.05), bifurcation operation (P<0.01), stent placement duration (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.01) were higher in ISR group than in non-ISR group, HDL-C, LVEF and medication compliance were lower in ISR group than in non-ISR group (ALL P<0.05). Smoking (P<0.01), LDL-C (P<0.01), bifurcation procedure (P<0.01), diabetes (P<0.01), medication compliance (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.05) were independent risk factors for ISR. (2) The Gensini score of ISR group was higher than that of non-ISR group (P<0.01). Compared with the non-ISR group, the ISR group had larger IPA, PLA (all P<0.05) and smaller EM-CSA and MLA (all P<0.01). Lp-PLA2 and PTX3 were positively correlated with Gensini score, IPA and PLA (all P<0.01), but negatively correlated with EEM-CSA (all P<0.05) and MLA (all P<0.01). (3) The optimal truncation values of Lp-PLA2 and PTX3 for predicting ISR were 310.65 ng/ mL and 3.87 ng/ mL, respectively, and AUC were 0.780 (95%CI: 0.739-0.861) and 0.751 (95%CI: 0.751), respectively.The AUC of ISR predicted by LP-PLA2 combined with PTX3 was 0.832 (95%CI: 0.817-0.933), which was significantly higher than that predicted by LP-PLA2 and PTX3 alone (Z=3.083, P=0.021; Z=3.697, P=0.017). CONCLUSION ISR patients have higher lP-PLA2 and PTX3 levels after PCI, and monitoring of lP-PLA2 and PTX3 levels after PCI is helpful to predict the risk of ISR occurrence, the combined detection enhances the predictive value of ISR.
2023, 35(2): 168-172.
doi: 10.12125/j.chj.202108078
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AIM To investigate the effect of left bundle branch area pacing (LBBAP) on the incidence of new onset atrial fibrillation (AF) and on cardiac functions in patients with medium or long-term high proportion of ventricular pacing. METHODS Patients with atrioventricular block and indication for pacing were recruited and randomly assigned to LBBAP high ventricular pacing group (LBBAP-high Group), right ventricular septal pacing (RVSP) high ventricular pacing group (RVSP-high group) or RVSP low ventricular pacing group (RVSP-low group). Patients were followed up at 3 months, 6 months and every 6 months after the operations. The atrial high rate events (AHREs) documented by pacemaker, with frequency greater than 180 beats per minute, duration greater than 1 minute and automatic mode conversion (AMS) occurrence were recorded and deemed as AF events. AHREs, AF events documented by Holter monitor, echocardiography parameters, and NT-proBNP levels at each follow-up point were recorded. Kaplan-meier method was applied to draw the time curve of AF in each group and COX proportional hazard model was applied to analyze the correlation of multiple factors with new-onset AF. RESULTS Compared with LBBAP high group, QRS width of pacing increased in RVSP low group (P<0.01) and RVSP high group (P<0.01). The incidence of new atrial fibrillation increased with time. A total of 59 cases (57%) of atrial fibrillation events were recorded in the three groups, including 15 cases (44%) in LBBAP high group, 11 cases (38%) in RVSP low group, and 33 cases (82%) in RVSP high group. The rate of new atrial fibrillation in RVSP high group was significantly higher than that in LBBAP high group and RVSP low group (P<0.01). The false discovery rate (FDR) method was used to compare two groups: the sinus rhythm retention rate between LBBAP high group and RVSP high group was statistically significant (P<0.01); There was significant difference in sinus rhythm retention rate between RVSP high group and RVSP low group (P<0.01). There was no significant difference in sinus rhythm retention between LBBAP high group and RVSP low group. COX single factor regression analysis showed that right ventricular septal pacing with high pacing ratio (HR=3.004; 95% CI: 1.615～5.586; P<0.01), low ejection fraction (HR=1.029; 95% CI: 1.004～1.054; P<0.05) and hypertension (HR=1.889; 95% CI: 1.05～3.40; P<0.05) were independent risk factors for new atrial fibrillation after surgery. Multivariate regression analysis showed that only a high proportion of right ventricular septal pacing (HR= 5.572; 95% CI: 2.444～12.701; P<0.01) and hypertension (HR=2.752; 95% CI: 1.342～5.642; P<0.05) were independent risk factors for postoperative new atrial fibrillation. Half a year after operation, compared with LBBAP high group (223 ± 63) pg/mL, the NT proBNP level in RVSP high group (752 ± 54) pg/mL increased (P<0.01); Compared with RVSP low group (405 ± 48.7) pg/mL group, the NT proBNP level in RVSP high group increased (P<0.01). CONDLUSION LBBAP, as a more physiological pacing mode, reduces the proportion of new-onset AF. In this group, LBBAP does not have adverse effects on medium or long-term cardiac functions.
2023, 35(2): 173-176, 190.
doi: 10.12125/j.chj.202108103
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AIM To investigate the efficacy of detecting epicardial fat (EAT) combined with left atrial appendage ejection fraction (LAAEF) based on multi-slice spiral CT (MSCT) in predicting coronary heart disease patients with atrial fibrillation. METHODS One hundred and eighty-nine patients with coronary heart disease admitted to our hospital from April 2019 to December 2020 were selected and divided into atrial fibrillation group (n=47) and no atrial fibrillation group (n=142) according to whether atrial fibrillation occurred within 6 months. The baseline data, EAT volume and LAAEF of the two groups were compared. Multivariate logistic regression equation was used to analyze the relevant influencing factors of coronary heart disease complicated by atrial fibrillation and receiver operating characteristic curve (ROC) and the area under the ROC (AUC) were used to analyze the EAT volume, the value of LAAEF and their combined use in prediction of atrial fibrillation. RESULTS There were significant differences in hypertension, Gensini scores and coronary heart disease types between the atrial fibrillation group and the non-atrial fibrillation group (P<0.05 or P<0.01). The atrial fibrillation group had higher EAT volume and lower LAAEF than the non-atrial fibrillation group (all P<0.01). After controlling for hypertension, Gensini score and coronary heart disease type, EAT volume and LAAEF were still related factors influencing the occurrence of atrial fibrillation (P<0.01). EAT volume in predicting the AUC of atrial fibrillation was 0.726, LAAEF was 0.777, but EAT volume combined with LAAEF in predicting the AUC of atrial fibrillation was 0.867. The EAT volume of patients with persistent atrial fibrillation was higher than that of patients with paroxysmal atrial fibrillation, and their LAAEF was lower than that of patients with paroxysmal atrial fibrillation (P<0.01). CONCLUSION The use of MSCT to detect coronary heart disease EAT volume and LAAEF predicts the risk of patients with atrial fibrillation, help distinguish different types of atrial fibrillation and provides an objective basis for clinical diagnosis, treatment and intervention.
2023, 35(2): 177-182.
doi: 10.12125/j.chj.202201071
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AIM To explore the relationship between fibrinogen (FIB) level and premature coronary artery disease (CAD) and phlegm-dampness syndrome of premature CAD. METHODS A total of 239 patients (male <55 years of age, female <65 years of age) admitted to the Department of Cardiology of Integrated Traditional Chinese and Western Medicine of China-Japan Friendship Hospital for coronary angiography from November 2019 to November 2021 were divided into premature CAD group (n=111) and non-CAD group (n=128). The patients in premature CAD group were further divided into phlegm-dampness syndrome group (n=56) and non-phlegm-dampness syndrome group (n=55). Clinical data of the above groups were compared. The relationship between FIB and premature CAD and phlegm-dampness syndrome of premature CAD were analyzed by logistic regression analysis and the value of FIB for predicting phlegm-dampness syndrome of premature CAD was analyzed by ROC curve analysis. RESULTS The FIB level of the premature CAD group was higher than that of the non-CAD group (P<0.01). The FIB level of the phlegm-dampness syndrome group was higher than that of the non-phlegm-dampness syndrome group (P<0.05). Logistic regression analysis showed that FIB was associated with the prevalence of premature CAD (OR=1.85, 95% CI: 1.06～3.23, P<0.05), and the results of subgroup analysis were relatively stable. FIB was associated with phlegm-dampness syndrome of premature CAD (OR=1.73, 95% CI: 1.02～2.93, P<0.05). The area under the ROC curve of FIB in predicting phlegm-dampness syndrome of premature CAD was 0.63 (95% CI: 0.52～0.73, P<0.05). CONCLUSION FIB is associated with premature CAD and with phlegm-dampness syndrome of premature CAD.
2023, 35(2): 183-190.
doi: 10.12125/j.chj.202202050
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AIM To analyze the potential mechanism of Kushen in the treatment of viral myocarditis (VMC) by network pharmacology method to provide reference for further study of Kushen and drug development for VMC. METHODS The main active components of Kushen were collated by TCMSP, TCMIP and BATMAN-TCM databases and corresponding targets were generalized. The targets related to VMC were retrieved by GeneCards, OMIM, TTD and PharmGKB databases. Venny2.1.0 platform was imported to draw Venn diagram and Cytoscape was used to construct disease-component-target network diagram and core genes. Then, GO functional enrichment and KEGG pathway enrichment analyses were performed. RESULTS A total of 11 main active components were screened out from Kushen, corresponding to 662 potential targets. After mapping and information screening with 1161 VMC disease targets, 27 drug-disease interaction targets were obtained. The top 10 core targets were obtained by topological analysis, including IL-6, TNF, VEGFA, STAT3, MYC, EGFR, CCND1, CASP3, MMP9 and IL-2. The results of enrichment analyses involved three biological processes and 151 signaling pathways. CONCLUSION The treatment of VMC by Kushen is characterized by multi-components, multi-targets and multi-pathways. However, it mainly regulates core gene targets such as IL-6, TNF, VEGFA, STAT3, MYC and EGFR and participates in mediating signal pathways such as PI3K-Akt, TNF and HIF-1 that contribute to VMC. This study provides a potential mechanism of Kushen in the treatment of VMC and provides guidance for subsequent pharmacological research and clinical application.
2023, 35(2): 191-195.
doi: 10.12125/j.chj.202203073
Abstract:
AIM To explore the value of non-invasive left ventricular pressure-strain loop (LVPSL) in evaluating myocardial work in patients with coronary atherosclerotic heart disease (CAD) of different degrees of coronary stenosis. METHODS One hundred and thirty patients who were clinically diagnosed with suspected CAD and underwent coronary angiography from December 2019 to October 2021 in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Hunan Traditional Chinese Medicine College were selected prospectively for routine echocardiography and LVPSL examination. According to the results of coronary angiography, the patients were divided into group without coronary artery stenosis (n=33) and group with coronary artery stenosis (n=97) according to the coronary artery Gensini score. The group with coronary artery stenosis was further divided into three subgroups: mild stenosis group (Gensini score <25, n=37), moderate stenosis group [Gensini score (25~50), n=32] and severe stenosis group (Gensini score >50, n=28). Simultaneous cardiac conductance was connected to collect conventional echocardiography parameters and three cardiac cycles were taken from the left ventricular apical four-chamber heart, three-chamber heart and two-chamber heart section to obtain the overall longitudinal strain (GLS) of the left ventricle in the mode of two-dimensional speckle tracking imaging. Left ventricular global work index (GWI), global effective work (GCW), global ineffective work (GWW) and global work efficiency (GWE) were evaluated by LVPSL, and the effects of different degrees of coronary artery stenosis on the left ventricular systolic function and myocardial work were compared. RESULTS Compared with the group without coronary artery stenosis, the GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01) in the group with mild coronary artery stenosis; In the group of moderate coronary artery stenosis, GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01); In severe coronary artery stenosis group, GLS, GWI, GCW, GWE decreased and GWW increased (all P<0.01). Compared with mild coronary artery stenosis, GLS,GWI, GCW, GWE decreased and GWW increased in moderate coronary artery stenosis group (all P<0.01); In severe coronary artery stenosis group, GLS decreased, GWI decreased, GCW decreased, GWE decreased and GWW increased (all P<0.01); Compared with moderate coronary artery stenosis, GLS, GWI, GCW, GWE decreased and GWW increased in severe coronary artery stenosis group (all P<0.01). The Gensini score of coronary artery stenosis group was negatively correlated with the absolute value of GLS, GWI, GCW, GWE (r=−0.554, −0.661, −0.619, −0.829), and positively correlated with GWW (r=0.718), of which the correlation with GWE was the highest. CONCLUSION GWI, GCW, GWE and GWW measured by LVPSL technique can quantitatively analyze the myocardial work of CAD patients with different degrees of coronary artery stenosis and the correlation between GWE and Gensini score is superior to that of GLS.
2023, 35(2): 196-199.
doi: 10.12125/j.chj.202208101
Abstract:
Fighter pilots often experience positive acceleration (+ Gz) in the air, which can result in increased hydrostatic pressure of blood column and redistribution of blood, thus making the cardiovascular system bear great pressure. G-induced loss of consciousness (G-LOC) or almost loss of consciousness (A-LOC) may occur when the decrease of cerebral blood flow caused by + Gz load leads to cerebral hypoxia-ischemia. Cerebral hypoxia-ischemia is the root cause of G-LOC/A-LOC, but there are many factors affecting cerebral hypoxia-ischemia and the relationship between cerebral hypoxia-ischemia and G-tolerance remains to be fully elucidated. This paper further sorts out the relationship between cardiopulmonary reserve and G-tolerance by reviewing reported effects, in recent years, of heart rate variability, blood pressure, cardiac systolic function, ECG index, pulmonary function, pulmonary gas diffusion and blood flow on G-endurance.
Fighter pilots often experience positive acceleration (+ Gz) in the air, which can result in increased hydrostatic pressure of blood column and redistribution of blood, thus making the cardiovascular system bear great pressure. G-induced loss of consciousness (G-LOC) or almost loss of consciousness (A-LOC) may occur when the decrease of cerebral blood flow caused by + Gz load leads to cerebral hypoxia-ischemia. Cerebral hypoxia-ischemia is the root cause of G-LOC/A-LOC, but there are many factors affecting cerebral hypoxia-ischemia and the relationship between cerebral hypoxia-ischemia and G-tolerance remains to be fully elucidated. This paper further sorts out the relationship between cardiopulmonary reserve and G-tolerance by reviewing reported effects, in recent years, of heart rate variability, blood pressure, cardiac systolic function, ECG index, pulmonary function, pulmonary gas diffusion and blood flow on G-endurance.
2023, 35(2): 200-203.
doi: 10.12125/j.chj.202209070
Abstract:
Morality and talent cultivation is the central link and fundamental task in higher education. To foster virtue through education, ideological and political education must persist throughout the whole process of professional courses. This paper discusses the characteristics and implementation path of ideological and political education in aerospace cardiovascular physiological training courses, proposes four entry points and summarizes our practice of part of the ideological elements of this training course. This paper provides reference for the ideological and political education in aerospace medical courses and military training courses.
Morality and talent cultivation is the central link and fundamental task in higher education. To foster virtue through education, ideological and political education must persist throughout the whole process of professional courses. This paper discusses the characteristics and implementation path of ideological and political education in aerospace cardiovascular physiological training courses, proposes four entry points and summarizes our practice of part of the ideological elements of this training course. This paper provides reference for the ideological and political education in aerospace medical courses and military training courses.
2023, 35(2): 204-207, 212.
doi: 10.12125/j.chj.202110069
Abstract:
Cardiovascular disease is a common disease that threatens the health of human and is also one of the main causes of death. Cytokines play an important role in the pathogenesis of cardiovascular diseases. As a member of the interleukin-12 (IL-12) family, IL-35 is an inhibitory cytokine produced mainly by regulatory T cells. Recent studies have shown that IL-35 is involved in the development of cardiovascular diseases. This paper reviews the structure, signaling pathway and biological function of IL-35 and summarizes the research progress of the regulatory role and mechanism of IL-35 in the pathogenesis of cardiovascular diseases, aiming to provide new ideas and directions for the prevention and treatment of cardiovascular diseases.
Cardiovascular disease is a common disease that threatens the health of human and is also one of the main causes of death. Cytokines play an important role in the pathogenesis of cardiovascular diseases. As a member of the interleukin-12 (IL-12) family, IL-35 is an inhibitory cytokine produced mainly by regulatory T cells. Recent studies have shown that IL-35 is involved in the development of cardiovascular diseases. This paper reviews the structure, signaling pathway and biological function of IL-35 and summarizes the research progress of the regulatory role and mechanism of IL-35 in the pathogenesis of cardiovascular diseases, aiming to provide new ideas and directions for the prevention and treatment of cardiovascular diseases.
2023, 35(2): 208-212.
doi: 10.12125/j.chj.202202033
Abstract:
Atherosclerosis (AS) is a chronic inflammatory disease of the cardiovascular system and one of the main causes of ischemic heart disease, stroke and peripheral vascular disease. More and more evidences indicate that inflammatory response is an important factor of plaque instability and plaque rupture, which runs through the whole process of the occurrence, development and rupture of unstable plaques. Interleukin-18 is a new type of proinflammatory cytokine, which can promote inflammatory response and is an important factor involved in the inflammatory process of atherosclerosis. This paper reviews the role of interleukin-18 in the pathogenesis of atherosclerosis and its current research status in AS-related diseases to provide new detection indicators and therapeutic targets for atherosclerosis.
Atherosclerosis (AS) is a chronic inflammatory disease of the cardiovascular system and one of the main causes of ischemic heart disease, stroke and peripheral vascular disease. More and more evidences indicate that inflammatory response is an important factor of plaque instability and plaque rupture, which runs through the whole process of the occurrence, development and rupture of unstable plaques. Interleukin-18 is a new type of proinflammatory cytokine, which can promote inflammatory response and is an important factor involved in the inflammatory process of atherosclerosis. This paper reviews the role of interleukin-18 in the pathogenesis of atherosclerosis and its current research status in AS-related diseases to provide new detection indicators and therapeutic targets for atherosclerosis.
2023, 35(2): 213-217.
doi: 10.12125/j.chj.202110077
Abstract:
Branched-chain amino acid (BCAA) is the body’s nutrient essential amino acid. They are not only the basic units of proteins, but also play an important physiological role as signaling molecules regulating glucose and lipid metabolism, apoptosis and autophagy. In addition to anabolism, catabolism also plays an important role in branched-chain amino acid metabolism. Metabolic abnormalities in branched-chain amino acid are associated with the progression of diseases such as insulin resistance, diabetes, arteriosclerosis, and cancers. However, the metabolic mechanism of BCAA is not very clear. This article reviews the branched-chain amino acid metabolic pathway and metabolism of various organs.
Branched-chain amino acid (BCAA) is the body’s nutrient essential amino acid. They are not only the basic units of proteins, but also play an important physiological role as signaling molecules regulating glucose and lipid metabolism, apoptosis and autophagy. In addition to anabolism, catabolism also plays an important role in branched-chain amino acid metabolism. Metabolic abnormalities in branched-chain amino acid are associated with the progression of diseases such as insulin resistance, diabetes, arteriosclerosis, and cancers. However, the metabolic mechanism of BCAA is not very clear. This article reviews the branched-chain amino acid metabolic pathway and metabolism of various organs.
2023, 35(2): 218-223, 228.
doi: 10.12125/j.chj.202111121
Abstract:
Acute ST-segment elevation myocardial infarction (STEMI) is a catastrophic cardiovascular disease that threatens human health and life, with dangerous onset and high mortality. With the development of percutaneous coronary intervention (PCI), the revascularization of occluded arteries and the restoration of distal myocardial perfusion in short term can significantly reduce the mortality of STEMI patients and improve their clinical outcomes. However, a considerable number of STEMI patients may suffer from coronary no-reflow (CNR) phenomenon after revascularization, which greatly hinders the improvement of clinical therapy and long-term prognosis. Currently, the pathological mechanism of CNR is still unclear and there is a lack of reliable clinical predictors or treatment measures. Some medications and surgical procedures have shown certain efficacy in preventing and improving CNR after PCI, but the long-term cardiovascular benefits remain unknown. In this review, we focus on the definition and diagnosis, risk factors and predictors, and prevention and treatment measures, thus to improve clinical attention to CNR after PCI in STEMI patients and also to forecast future research directions.
Acute ST-segment elevation myocardial infarction (STEMI) is a catastrophic cardiovascular disease that threatens human health and life, with dangerous onset and high mortality. With the development of percutaneous coronary intervention (PCI), the revascularization of occluded arteries and the restoration of distal myocardial perfusion in short term can significantly reduce the mortality of STEMI patients and improve their clinical outcomes. However, a considerable number of STEMI patients may suffer from coronary no-reflow (CNR) phenomenon after revascularization, which greatly hinders the improvement of clinical therapy and long-term prognosis. Currently, the pathological mechanism of CNR is still unclear and there is a lack of reliable clinical predictors or treatment measures. Some medications and surgical procedures have shown certain efficacy in preventing and improving CNR after PCI, but the long-term cardiovascular benefits remain unknown. In this review, we focus on the definition and diagnosis, risk factors and predictors, and prevention and treatment measures, thus to improve clinical attention to CNR after PCI in STEMI patients and also to forecast future research directions.
2023, 35(2): 224-228.
doi: 10.12125/j.chj.202206041
Abstract:
Catheter ablation (CA) has become one of the main methods for treating patients with medically refractory AF at home and abroad and pulmonary vein isolation (PVI) is the most important cornerstone of CA. There are still irreversible safety problems such as phrenic nerve injury, atrial esophageal fistula and pericardial tamponade, both in impedance thermal injury of catheter and cryoablation of balloon. Pulsed field ablation (PFA), as a new type of electrical impulse energy, is a hotspot in the treatment of arrhythmia. Its principle is that short-duration and high-voltage electrical impulse energy is released to irreversible electroporation of cells, resulting in cell apoptosis and causing irreversible damage to the heart muscle, thereby isolating the pulmonary veins. It can protect coronary artery, esophagus, pulmonary vein, phrenic nerve and other surrounding tissues from injury, and is more effective and safe than conventional ablation in the process of pulmonary vein isolation in atrial fibrillation. In this paper, the characteristics of pulsed electric field ablation are reviewed and its advantages in the treatment of atrial fibrillation are explained.
Catheter ablation (CA) has become one of the main methods for treating patients with medically refractory AF at home and abroad and pulmonary vein isolation (PVI) is the most important cornerstone of CA. There are still irreversible safety problems such as phrenic nerve injury, atrial esophageal fistula and pericardial tamponade, both in impedance thermal injury of catheter and cryoablation of balloon. Pulsed field ablation (PFA), as a new type of electrical impulse energy, is a hotspot in the treatment of arrhythmia. Its principle is that short-duration and high-voltage electrical impulse energy is released to irreversible electroporation of cells, resulting in cell apoptosis and causing irreversible damage to the heart muscle, thereby isolating the pulmonary veins. It can protect coronary artery, esophagus, pulmonary vein, phrenic nerve and other surrounding tissues from injury, and is more effective and safe than conventional ablation in the process of pulmonary vein isolation in atrial fibrillation. In this paper, the characteristics of pulsed electric field ablation are reviewed and its advantages in the treatment of atrial fibrillation are explained.
2023, 35(2): 229-232.
doi: 10.12125/j.chj.202201074
Abstract:
With the global epidemic of high hypertension and obesity, the number of patients with obese hypertension will continue to soar. However, the pathogenesis of obesity-induced hypertension is not completely clear, and there is a lack of targeted drug in clinical treatment. Angiotensin receptor-neprilysin inhibitor (ARNI) is a new cardiovascular drug that acts on both renin-angiotensin system (RAS) and natriuretic peptide system (NPs). As the first agent of ARNI to be marketed in the world, sacubitril/valsartan has been widely used in patients with heart failure with reduced ejection fraction (HFrEF). With the approval of essential hypertension indications, more and more evidence has shown that sacubitril/valsartan is superior to traditional RAS blockers in blood pressure control. Sacubitril/valsartan also has additional benefits such as improving glucose and lipid metabolism and delaying renal deterioration, which may make sacubitril/valsartan the “best choice” for obese hypertension. Through systematic literature review, we discuss the comprehensive therapeutic effect and possible mechanism of sacubitril/valsartan in the control of obese hypertension and provide more theoretical basis for the treatment of hypertension and its complications.
With the global epidemic of high hypertension and obesity, the number of patients with obese hypertension will continue to soar. However, the pathogenesis of obesity-induced hypertension is not completely clear, and there is a lack of targeted drug in clinical treatment. Angiotensin receptor-neprilysin inhibitor (ARNI) is a new cardiovascular drug that acts on both renin-angiotensin system (RAS) and natriuretic peptide system (NPs). As the first agent of ARNI to be marketed in the world, sacubitril/valsartan has been widely used in patients with heart failure with reduced ejection fraction (HFrEF). With the approval of essential hypertension indications, more and more evidence has shown that sacubitril/valsartan is superior to traditional RAS blockers in blood pressure control. Sacubitril/valsartan also has additional benefits such as improving glucose and lipid metabolism and delaying renal deterioration, which may make sacubitril/valsartan the “best choice” for obese hypertension. Through systematic literature review, we discuss the comprehensive therapeutic effect and possible mechanism of sacubitril/valsartan in the control of obese hypertension and provide more theoretical basis for the treatment of hypertension and its complications.
2023, 35(2): 233-236.
doi: 10.12125/j.chj.202109081
Abstract:
Obstructive sleep apnea (OSA) often affects sleep quality and causes cardiovascular diseases, with the highest incidence of hypertension. At present, the relationship between OSA and hypertension and its mechanism are still being explored, and the antihypertensive effect of continuous positive airway pressure, an effective treatment for obstructive sleep apnea, on blood pressure remains controversial. Better understanding of the relationship between obstructive sleep apnea and hypertension and the therapeutic effect of continuous positive airway pressure will be conducive to clinical practice.
Obstructive sleep apnea (OSA) often affects sleep quality and causes cardiovascular diseases, with the highest incidence of hypertension. At present, the relationship between OSA and hypertension and its mechanism are still being explored, and the antihypertensive effect of continuous positive airway pressure, an effective treatment for obstructive sleep apnea, on blood pressure remains controversial. Better understanding of the relationship between obstructive sleep apnea and hypertension and the therapeutic effect of continuous positive airway pressure will be conducive to clinical practice.
2023, 35(2): 237-239, 244.
doi: 10.12125/j.chj.202207098
Abstract:
AIM To compare the difference between problem based learning (PBL) combined with multi-disciplinary team (MDT) teaching method and lecture based learning (LBL) teaching method among medical students in cardiovascular clinical practice. METHODS A total of 80 clinical medical students in fifth grade in Shanghai Jiao Tong university school of medicine between January 2018 and January 2020 were selected and randomly divided into study group and control group. The study group adopted MDT combined with PBL teaching method, while the control group adopted LBL teaching method. After the end of internship, the two groups of students were tested. Questionnaires were given to the students to survey the satisfaction of teaching. RESULTS The scores of theoretical knowledge and clinical case analysis were higher in study group than those in the control group (P<0.05). The questionnaire survey showed that the MDT combined with PBL teaching method could increase the interest of learning, cultivate students’ clinical thinking, increases students’ humanities and with higher teaching novelty and satisfaction when compared with LBL teaching. CONCLUSION MDT combined with PBL teaching method is better than LBL teaching method in improving theoretical scores and clinical thinking, and the overall satisfaction of students is higher.
2023, 35(2): 240-244.
doi: 10.12125/j.chj.202207075
Abstract:
AIM To evaluate the application effect of “big data platform combined with flipped class model” in instruction of acute myocardial infarction. METHODS A total of 80 five-year-program undergraduates of clinical medicine in Grade 2019 in Air Force Medical University were randomly divided into two groups: experimental group (n=40) and control group (n=40). The experimental group was taught in the mode of “big data platform combined with flipped class” and the control group was taught in the traditional mode. After the course, the teaching effect of “big data platform combined with flipped class model” and traditional teaching method was evaluated by satisfaction questionnaire, time of learning and examination scores. RESULTS The test scores of the experimental group were (88 ± 4) points and that of the control group were (80 ± 2) points. The theoretical knowledge test scores of the experimental group were significantly higher than those of the control group (P<0.05). The input time of pre class preview, post class review and autonomous learning in the experimental group was (71 ± 15) min, (74 ± 17）min and (89 ± 9) min were significantly higher than those in the control group (33 ± 9) min, (62 ± 18) min and (35 ± 11) min (all P<0.05).. The satisfaction questionnaire survey showed that the experimental group was superior to the control group in five aspects, namely, improving the mastery of theoretical knowledge, cultivating learning interest, enhancing the ability of independent learning, cultivating clinical thinking ability, and approving the teaching mode (all P<0.05). CONCLUSION The application of big data platform combined with flipped class model in instruction of acute myocardial infarction can significantly improve the students’ learning effect of acute myocardial infarction, autonomous learning ability and satisfaction with instruction in undergraduates.
2023, 35(2): 249-250.
doi: 10.12125/j.chj.202111029
Abstract:
