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Objective: To investigate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in the treatment of severe aortic stenosis. Methods: The clinical data of patients with severe aortic stenosis who underwent TAVR at the People's Hospital of Xinjiang Uygur Autonomous Region between September 2016 and September 2022 were retrospectively analyzed. Changes in aortic transvalvular pressure gradients, valve orifice area, and activity tolerance of patients before and after the surgery were compared. Moreover, postoperative complications and follow-up results from 30 days to 6 years after the surgery were recorded. Results: A total of 76 patients were included in the study (50 males and 26 females), with an average age of (71.3±7.6) years, including 16 rheumatic valvular diseases, 60 senile degenerative diseases, 46 bicuspid valves and 30 tricuspid valves. The success rate of the operation was 96.1% (73/76). Compared with that before the operation, the mean aortic transvalvular pressure gradients decreased [(8.5±2.8) mmHg vs (68.5±19.2) mmHg (1 mmHg=0.133 kPa), P <0.001], but the valve orifice area increased [(1.91±0.31) cm 2 vs (0.65±0.21) cm 2 , P <0.001]. Likewise, six-minute walking test (6MWT) showed that walking distance was longer after the surgery [(430±13) m vs (201±28) m, P <0.001]. There were 1 case of retroperitoneal hematoma, 1 case of stricture balloon dilatation after femoral artery suture concomitant with postoperative puncture site infection, 1 case of femoral artery surgical incision, 2 cases of valve-in-valve (ViV) and 5 cases of perivalvular leakage (4 cases were mild and 1 case was moderate) after the surgery, respectively. Moreover, acute left main artery occlusion during operation occurred in 1 case, ventricular rupture during operation occurred in 1 case and the patient was transferred to valve replacement surgery and finally dead, delayed coronary artery occlusion and death happened in 1 case, and all of the above-mentioned 3 cases were due to surgical failure. Postoperative pacemaker implantation due to third-degree atrioventricular block was performed in 5 cases. There were 1 case of pulmonary embolism, 1 case of transient right limb disorder, 1 case of gastrointestinal bleeding and 1 case of urethral bleeding after the surgery, respectively. The patients were followed up for (1.0±0.1) years (30 days to 6 years), and the results showed that 2 cases died, including 1 case died suddenly at home (the cause of death was unknown) and 1 case died of acute heart failure 8 months after the surgery. Chronic heart failure occurred repeatedly in 6 cases. The quality of life of other patients improved significantly. Conclusion: TAVR is effective and safe for patients with severe aortic stenosis.

Objective: To analyze the distribution of gene mutations in newly diagnosed acute myeloid leukemia (AML) patients, based on next generation sequencing technology (NGS) and to evaluate their value in AML risk stratification. Methods: The study analyzed 453 newly diagnosed AML(excluded acute promyelocytic leukemia, APL) patients from seven hospitals in Shanghai, from January 1st 2014 to December 31th 2017. RNA and DNA were extracted from pretreatment bone marrow mononuclear cells and targeted sequencing of AML genes were performed. The data of different groups was compared. Results: A total of 453 newly diagnosed AML patients were enrolled in the study, including 247 males and 206 females with a median age of 49.5 (range,11-85) years. A total of 540 mutations/fusion genes were detected in 289 patients, 29.1% (132/259) of whom with two or more mutations/fusion genes. In all patients, NPM1 was the most common mutation(12.8%), followed by ETO and TET2 mutation (11.92% and 11.04%, respectively) . And WT1 over-expression accounted for 10.6%. Patients over the age of 50 were with a higher frequency of mutations associated with epigenetic modification, 11.93% for ASXL1, 13.99% for DMNT3A, 6.58% for IDH1/IDH2, and 13.17% for TET2. The frequency of DMNT3A mutations was three times higher than that of patients under 50 years of age ( P= 0.017). In this study, a relatively low proportion of genetic mutations was observed in low-risk karyotype group. In the medium-risk karyotype group, the relatively high mutation frequencies were observed in NPM1, TET2, FLT3-ITD, DNMT3A, ASXL1, and CEBPA genes. In the poor-risk karyotype group, the mutation frequencies of ASXL1, TET2, DNMT3A and PHF6 genes were more than 10%, especially ASXL1 and PHF6 mutation frequencies were significantly higher than other molecular risk stratification groups ( P< 0.05). Of the 254 patients (56%) with normal karyotype AML (NK-AML), 56 patients were detected to have gene mutations about epigenetic modification. The median OS of this group was worse than that of patients without related mutations, while the median LFS had no significant difference. In patients with NK-AML older than 50 years, the OS and LFS of patients with epigenetic modification related gene mutations was 12 months and 10 months, versus 18 months and 12 months of patients without mutations. Conclusions: The gene mutations frequencies in AML patients with different age and molecular risk stratification groups are different. Epigenetics gene mutation frequencies, such as DNMT3A, ASXL1, IDH1/IDH2 and TET2,are higher in patients older than 50 years. A shorter OS can be observed in older patients(>50 years) with epigenetics gene mutation.

Objective: To assess the status of the cardiovascular disease associated risk levels among hypertensive population of Han, Uygur and Kazakh ethnicities, in Xinjiang Uygur Autonornous Region, to guide hypertension prevention and treatment in different ethnicities., Methods: Four stages random cluster sampling method was used, and all the data was collected from Xinjiang local residents aged over 18 between October 2007 and March 2010., Results: A total of 14 618 subjects completed this survey, in which 2 654 Han, 1 612 Uygur and 2034 Kazakh people diagnosed with hypertension was included in this research. Most of them were"grade 1 hypertension", and the percentage of grade 3 hypertension was Han (19.1%), Uygur (17.3%) and Kazakh (32.3%), respectively. Majority hypertensive people accompanied with 1 risk factor. The risk proportions of low, medium, high and very high in hypertension population of different ethnicities were Han (19.4%, 34.6%, 46.1%), Uygur (17.7%, 37.6%, 44.7%), Kazakh (12.5%, 38.0%, 49.4%) respectively. In Han, Uygur and Kazakh ethnicities, the percentage of high risk and very high risk was highest in hypertensive men aged over 60 years old.The percentages of hypertension awareness were 42.0%, 45.6%, 46.5% and percentages of medicine therapy were 29.6%, 23.4%, 25.2% for Han, Uygur and Kazakh ethnicities, respectively., Conclusions: Hypertensive people among Han, Uygur and Kazakh ethnicities in Xinjiang are mainly under high risk and very high risk situation of cardiovascular disease, especially in men aged ≥60. The percentage of hypertension awareness and medicine therapy in high risk and very high risk population is the highest, while percentage of awareness in medium risk population is low.

Objective: To evaluate the early diagnostic value of matrix metalloproteinase-9 (MMP-9) level on admission for ST-segment elevation myocardial infarction (STEMI), explore the relationship between MMP-9 and global registry of acute coronary events (GRACE) scores and determine the values of MMP-9 in short-term prognosis of STEMI., Methods: A total of 55 STEMI patients admitted into our hospital between September 2011 and February 2012 were recruited. There were early STEMI (≤ 4h of onset, n = 22) and late STEMI (> 4 h after onset, n = 33). Fifty subjects of coronary artery without significant stenosis after angiography were enrolled into a control group. The plasma levels of MMP-9 in venous blood were detected with enzyme-linked immunosorbent assay (ELISA). And the GRACE risk score was used for risk assessment. The incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure (MACE) was recorded during a follow-up period of 6 months., Results: The MMP-9 levels were significantly higher in patients with STEMI (P < 0.001), early STEMI (P < 0.001) and late STEMI (P < 0.001) than the control group. And no statistical differences existed between early STEMI and late STEMI (P > 0.05). The level of MMP-9 was positively correlated with the GRACE risk score. MACE occurred in 8 [14.5% (8/55)] patients during hospitalization and 17 [30.9% (17/55)] patients during follow-up. Receiver operating characteristic (ROC) curve analysis showed area under the curve (AUC) of on admission GRACE risk score and MMP-9 levels were 0.848 (95%CI 0.706 - 0.991, P = 0.002) and 0.766 (95%CI 0.575 - 0.957, P = 0.017) respectively. ROC curve analysis showed AUC of hospital discharge GRACE risk score and MMP-9 levels were 0.737 (95%CI 0.601 - 0.873, P = 0.005) and 0.711 (95%CI 0.565 - 0.856, P = 0.013) respectively. No statistical differences existed between GRACE risk score and MMP-9 levels for predicting the short-term risk of MACE (P > 0.05)., Conclusion: The plasma level of MMP-9 has a higher diagnostic value for early STEMI. Positively correlated with the GRACE risk score, it is a predicator of short-term risk of MACE.

Objective: To explore the distribution characteristics of apolipoprotein A5 (ApoA5) gene c.553G > T polymorphism and the relationship of serum lipid in Chinese Han and Uighur populations in Xinjiang, China., Methods: The genotypes of ApoA5 gene c.553G > T polymorphism were detected in 406 Uighur and 527 Han people by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP)., Results: The frequencies of GG, GT and TT genotypes of ApoA5 gene c.553G > T were 378 (93.1%), 27 (6.7%) and 1 (0.25%) patients in Uighurs versus 478 (90.7%) patients, 49 (9.3%) patients and 0% in Hans. There was no significant difference in the distribution of genotypes between two groups (P > 0.05). In both groups, individuals with T allele (TT + GT genotype) had a higher level of serum triglyceride than those with GG genotype. After adjusting for gender, age, smoking, alcoholism, body mass index, blood pressure and blood lipid, non-conditional logistic regression analyses revealed that individuals with T allele (TT + GT genotype) in both groups had an elevated risk of HTG versus the GG genotype (OR = 3.31, 95%CI: 1.31 - 8.36 in Uighurs vs OR = 3.98, 95%CI: 1.81 - 8.74 in Hans)., Conclusion: The mutation of c.553G > T polymorphism of ApoA5 gene is associated with the level of serum triglyceride in Uighur and Han populations of Xinjiang. And T allele may be a risk factor of hypertriglyceridemia.

Objective: To investigate the prevalence and risk factors of smoking and metabolic syndrome (MS) among male Uygur and Kazakh adults residing in Xinjiang., Methods: Four-stage selected random sampling was used to analyze the prevalence and the relationship between the risk factors of smoking and metabolic syndrome. The sampled adult populations over 35 years old were collected 6 localities (Urumqi, Kelamayi, Fukang, Turfan Basin locality, Hetian locality & Yili Kazakh Autonomous Prefecture) in Xinjiang, China. The subjects were 4019 males of Uygur and Kazakh. Each individual answered a questionnaire, received physical examinations and a biochemical indicator survey. The smoking patients were divided into two groups: one complicated with metabolic syndrome and the other not. A logistic regression analysis was also made to identify the possible risk factors and their powers on the prevalence of metabolic syndrome with smoking., Results: With regards to the habit of smoking, the smokers of Uygur and Kazakh were 869 and 1114 respectively. The prevalence of MS was 24.74% and 29.62% for Uygur and Kazakh smokers respectively. And 16.75% and 24.72% for Uygur and Kazakh non-smokers respectively. The comparison of baseline information showed that, in Uygur males, the mean values of diastolic blood pressure, waist circumference and triglyceride were higher in smoker group than those in non-smoker group (P < 0.05); in Kazakh males, the mean values of systolic blood pressure, diastolic blood pressure and waist circumference were higher than nonsmoker group (P < 0.05). Logistic regression analysis showed that the OR value of smoking was 1.698 (95%CI 1.129 - 2.553) in Uygur and 1.845 (95%CI 1.544 - 2.206) in Kazakh of MS patients., Conclusion: The prevalence of MS is higher in male smokers than that in non-smokers in Uygur and Kazakh. Perhaps smoking is one of the risk factors for MS.

Objective: To investigate the detection rate of carotid artery plaque in Han, Uygur and Kazakh adult populations of Xinjiang., Methods: During the period of October 2007 to March 2010, the present study was performed in 13896 Han, Uygur and Kazakh adults of Xinjiang aged 35 years old and over by a four-stage random sampling method. All subjects were investigated by a standardized questionnaire, physical, biochemical examination and ultrasonography of carotid arteries. Risk factors were analyzed by a logistic regression model., Results: The prevalence of carotid artery plaque was 10.2%. After standardization, the detection rate of Chinese Han, Uygur and Kazakh populations was 2.46%, 2.31% and 1.84% respectively. By the analysis of multivariate logistic regression, age (OR 1.032, 95%CI 1.026-1.037), smoking (OR 1.358, 95%CI 1.164-1.585), total cholesterol (OR 1.075, 95%CI 1.018-1.135), blood glucose (OR 1.050, 95%CI 1.020-1.081) and systolic blood pressure (OR 1.011, 95%CI 1.008-1.014) were independent risk factors in the occurrence of carotid artery plaque. Females (OR 0.653, 95%CI 0.545-0.738) and high-density lipoprotein (OR 0.864, 95%CI 0.751-0.994) were the protective factors in the occurrence of carotid artery plaque., Conclusion: The detection of carotid artery plaque in Xinjiang increases substantially with age and difference exists between nationalities. The associated risk factors of the formation of carotid artery plaque include gender, age, smoking, high-density lipoprotein, total cholesterol, blood glucose and systolic blood pressure. The effect of these factors is different between genders.

Objective: To investigate the prevalence and distribution pattern of hypertension in Xinjiang adult population., Methods: A total of 15,061 adults at 35 years old or over were surveyed. Four-stage selected random sampling was employed to analyze the prevalence and distribution pattern of self-reported congestive hypertension in different groups of nationality, age and gender. The sampled adult population was collected from 7 localities (Urumqi, Ke lamayi, Fukang, Turfan Basin, Hetian, Altay, Yili Hazakh autonomous prefecture) in 23 municipalities and 5 autonomous counties in Xinjiang. The proportion of male to female was 50% each., Results: The prevalence of hypertension was 36.21% (male: 38.70% vs female: 34.22%). The Prevalence of hypertension was 33.42%, 28.50% and 48.69% in Han, Uygur and Hazakh populations respectively. The prevalence of hypertension was higher in Hazakh than Han people (χ2=29.36, P<0.01). The males had a higher frequency of hypertension than the females (χ2=20.01, P<0.01). The risk of hypertension increased substantially with age. The analysis of multiple logistic regression revealed that age (OR=1.06), alcohol consumption, obesity (OR=3.12) and levels of triglyceride (OR=1.30) and cholesterol (OR=1.32) and serum glucose (OR=1.41) were risk factors of hypertension. The corresponding relative hazards were age, alcohol consumption, obesity and levels of triglyceride and cholesterol and serum glucose for Han; the risk factors were similar in Uygur except serum glucose. Age, obesity and levels of triglyceride were only for Hazakh., Conclusion: There is still a higher prevalence of hypertension in Xinjiang. The prevalence of hypertension increases substantially with age and there is difference between different nationalities.

Objective: To investigate the prevalence of peripheral arterial disease (PAD) and its correlative risk factors in Xinjiang Uygur and Kazak adult populations., Methods: The subjects over the age of 35 years old in Urumqi, Karamay City, Fukang City, Turpan Region, Hotan Prefecture and Yili Kazak Autonomous Prefecture were selected by the four-stage random sampling method. The investigators collected the data of PAD prevalence in different nationalities, different age groups and different gender groups and analyzed its risk factors., Results: The prevalence of PAD in Uygur and Kazak adults was 6.46% (n = 542). The standardized prevalence was 6.51%. The prevalence of PAD was 7.05% (n = 315) in Uygur adults and 5.79% (n = 227) in Kazak adults. The standardized prevalence in the Uygur and Kazak adults was 7.08% and 5.83% respectively. The prevalence of PAD of different nationalities was different (χ(2) = 5.55, P < 0.05). And its prevalence was 4.49% (n = 170) in males and 8.08% (n = 372) in females. The standardized prevalence was 4.30% in males and 7.90% in females. The prevalence of PAD in males and females was significantly different (χ(2) = 44.26, P < 0.01). The multivariate logistic regression analysis was performed. Age (OR = 1.01, 95%CI 1.00 - 1.02), females (OR = 1.75, 95%CI 1.45 - 2.14), overweight or obesity (OR = 1.04, 95%CI 1.01 - 1.06), diabetes (OR = 1.59, 95%CI 1.01 - 2.36), elevated systolic blood pressure (OR = 1.02, 95%CI 1.01 - 1.03), elevated diastolic blood pressure (OR = 1.08, 95%CI 1.01 - 1.11) and history of coronary heart disease (OR = 1.69, 95%CI 1.14 - 2.50) were associated with an elevated prevalence of PAD., Conclusion: The prevalence of PAD is lower in Xinjiang Uygur and Kazak adult populations. Females, age, overweight or obesity, diabetes, elevated systolic blood pressure and a history of coronary heart disease are risk factors of PAD.

Objective: To explore the association of genetic polymorphism (rs12218) of serum amyloid protein A1 (SAA1) with serum high density lipoproteins cholesterol (HDL-C)., Methods: A total of 607 healthy subjects were recruited into the Cardiovascular Risk Survey between June 2007 and March 2009. Their genotypes of SAA1 were detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP)., Results: There was no significant difference between each genotype of SAA1 in triglyceride, total cholesterol and low density lipoprotein cholesterol (LDL-C). But marked significance existed between CC genotype and TT genotype in serum HDL-C level both before [(1.28 ± 0.38) mmol/L vs (1.44 ± 0.43) mmol/L, P = 0.017] and after adjusting for gender and age [(1.27 ± 0.07) mmol/L vs (1.41 ± 0.03) mmol/L, P = 0.048]., Conclusion: In Chinese Han people, the genetic polymorphism of SAA1 may reflect the serum concentration of HDL-C. The carriers with CC genotype have a lower HDL-C level.

Objective: To investigate the effects of ischemic postconditioning (IPost) in protecting hypertrophic myocardium subjected to ischemic-reperfusion (I/R) and to study the role of extracellular regulated protein kinase (ERK1/2) in mediating such protection., Methods: Transverse aortic constriction (TAC) operation was performed on 12-week-old C57/BL mice to establish left ventricular hypertrophy models. Sixty-four isolated TAC mouse hearts were mounted onto the Langendorff perfusion system and randomly divided into 4 equal group: (1) I/R group undergoing stable perfusion for 30 min, ischemia for 30 min, and re-perfusion for 120 min (an I/R cycle) to cause hypertrophic myocardium I/R injury, (2) IPost group undergoing ischemia for 10s and reperfusion for 10s, totally 3 cycles (60s) before reperfusion for 120 min, (3) I/R+ PD98059 (an ERK1/2 inhibitor) group undergoing perfusion of Krebs-Henseleit (KH) buffer with PD98059 10(-5)mol/L for 15 min and perfusion of KH buffer without PD98059 at the beginning of re-perfusion, and (4) IPost + PD98059 group undergoing 3 cycles of IPost and perfusion of KH buffer with PD98059 10(-5)mol/L for 15 min at the beginning of re-perfusion. Hemodynamic examination was conducted 120 min after re-perfusion to measure the left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), maximal uprising velocity of left ventricle pressure (dp/dt(max)), and minimal uprising velocity of left ventricle pressure (dp/dt(min)). After the I/R procedure the myocardium of the left ventricle was isolated to detect the infarction size (IS). Western blotting was used to detect the protein expression of extracellular signal-regulated kinase (ERK) 1/2, phosphorylated ERK1/2, Bcl-2, Bax, and mitochondrial and cytosolic cytochrome (Cyt). C. TUNEL was used to detect the apoptotic rate., Results: The LVSP and dp/dt(max) levels of the IPost group were (85 +/- 4) mm Hg and (3811 +/- 230) mm Hg/s, both significantly higher than those of the I/R group [(68 +/- 5) mm Hg and (2830 +/- 230) mm Hg/s respectively, both P < 0.05]. Compared with the I/R group, the protein levels of phosphorylated ERK1/2, Bcl-2, mitochondrial CytC of the IPost group were all significantly higher, the protein levels of Bax and cytosolic CytC, and apoptosis index were significantly lower (all P < 0.05), and the IS was smaller (P < 0.05). I/R + PD98059 showed no effects on the above-mentioned parameters. However, the results of the IPost + PD98059 group showed that in the first 15 min of reperfusion addition of PD98059 reversed all changes observed in the IPost group and eliminated the IPost protection by increasing IS to a level similar to that in the I/R group., Conclusion: IPost has protective effect in hypertrophic myocardium with I/R injury in vitro. ERK1/2 signaling pathway is involved in the protection of IPost by regulating the myocyte apoptosis.

Objective: To investigate the effect of cytokine tumor necrosis factor alpha(TNFalpha) on pancreatic beta cells apoptosis and the effect of transcription factor nuclear factor of kappa B (NF-kB) on TNFalpha-mediated apoptosis., Methods: INS-1 cells, a pancreatic beta cell line, were cultured,and recombinant DNA technique, transfection and reinfection technology were used to obtain INS-1/IkBDeltaN cells expressing inhibitor of kB (IkB)alphaDeltaN, mutant IkBalpha (inhibitor of NF-kB). DNA fragmentation assay and fluorescence analysis using a kB-luc reporter gene were applied to observe the NF-kB activity and beta cell apoptosis., Results: NF-kB activity induced by IL-Ibeta was detectable in INS-1 cells but not in INS-1/IkBDeltaN cells. After incubation of the cells with IL-1beta (10 micro g/L), TNFalpha (100 micro g/L) and interferon (IFN)gamma (100 000 U/L) for 48 hours, the combination of TNFalpha and IFNgamma induced apoptosis in INS-1 cells but not in INS-1/IkBDeltaN cells. No apoptosis was observed after incubation of INS-1 cells with IL-1beta or IFNgamma or IL-1beta plus IFNgamma., Conclusion: Apoptosis is one of the TNFalpha-induced beta-cell death forms. NF-kB may play an important role in the TNFalpha-mediated beta-cell apoptosis. Inhibition of NF-kB activation protects beta-cells from TNFalpha-induced apoptosis.