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BackgroundInformation regarding the impact of cardiovascular disease (CVD) on disease progression among patients with mild coronavirus disease 2019 (COVID-19) is limited.MethodsThis study evaluated the association of underlying CVD with disease progression in patients with mild COVID-19. The primary outcome was the need to be transferred to intensive care due to disease progression. The patients were divided with and without CVD as well as stable and intensive care groups.ResultsOf 332 patients with mild COVID-19, median age was 51 years (IQR, 40-59 years), and 200 (61.2%) were female. Of 48 (14.5%) patients with CVD, 23 (47.9%) progressed to severe disease status and required intensive care. Compared with patients without CVD, patients with CVD were older, and more likely to have fatigue, chest tightness, and myalgia. The rate of requiring intensive care was significantly higher among patients with CVD than in patients without CVD (47.92% vs. 12.4%; PConclusionsPatients with mild COVID-19 complicating CVD in are susceptible to develop severe disease status and requirement for intensive care.Key PointsQuestionWhat is the impact of coexisting cardiovascular diseases (CVD) on disease progression in patients with mild COVID-19?FindingsAlthough most patients with mild COVID-19 were discharged alive from hospital, approximately 47.9% patients with coexisting CVD developed severe disease status and required intensive care. CVD is an independent risk factor of intensive care among patients with mild COVID-19.MeaningCoexisting CVD is associated with unfavorable outcomes among patients with mild COVID-19. Special monitoring is required for these patients to improve their outcome.

Background: Previous studies reported the prognostic value of the triglyceride-glucose (TyG) index in the course of cardiovascular (CV) diseases. Still, it remains unclear whether baseline and trajectories of TyG index are prospectively associated with incident CV events among patients with type 2 diabetes mellitus (T2DM).Methods: We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was the first occurrence of adverse CV events including nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes, and the TyG index was measured at 11 visits. Cox proportional hazards regression analysis was used to observe the association between baseline and trajectories of TyG index and adverse CV outcomes.Results: During a median follow-up period of 8.8 years, 1,815 (17.8%) developed at least one primary endpoint event. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in the TyG index was associated with a 19.00% higher risk of adverse CV events, similar in individuals categorized by TyG index quartiles. Four distinct trajectories of TyG indexes were identified- low (16.17%), moderate (40.01%), high (34.60%), and very high (9.30%). Among these, moderate, high, and very high TyG index trajectories had a greater risk of future incident adverse CV events than low TyG index trajectories after multivariate adjustments for traditional risk factors. Particularly, a similar association was noticed in the TyG index and the occurrence of coronary heart disease.Conclusions: The findings of this study suggest that both baseline and trajectories of TyG index have a significant association with the occurrence of adverse CV events in patients with T2DM. (Trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620)

Sinus of Valsalva aneurysm, a rare cardiac anomaly, can be life-threatening if it ruptures. Transcatheter closure has emerged as an effective alternative to surgical management; however, it has rarely been reported in patients with previous mechanical aortic valve replacements. We describe the case of a 45-year-old man who presented with a ruptured aneurysm of the noncoronary sinus of Valsalva 14 years after the implantation of a mechanical aortic valve. The ruptured aneurysm was closed by transcatheter means with use of a double-disc perimembranous ventricular septal defect occluder. The patient remained asymptomatic one year after the procedure. Our case suggests that transcatheter closure with use of this type of occluder is a viable method for successfully repairing ruptured sinus of Valsalva aneurysms in patients who have mechanical aortic valves.

This study investigated the change of oxidative stress, activator protein-1 (AP-1), inflammatory, total antioxidant status (TAS) and artery stiffness, and explored the relationship between these characteristics and the efficacy of olmesartan intervention in elderly patients with mild-to-moderate essential hypertension (EH). In total, 386 elderly patients with EH and 353 normotensive controls were recruited. All study subjects had oxidative stress markers, AP-1, inflammatory factors, TAS and brancial-ankle artery pulse wave velocity (ba-PWV) measured. In total, 193 elderly patients with EH were randomized to olmesartan and were matched with 193 normotensive controls to observe the change of index above mentioned before and after the treatment. Compared with the controls, superoxide dismutase (SOD) and TAS were significantly reduced in patients with EH, and malondialdehyde (MDA), AP-1, high-sensitivity C-reactive protein (Hs-CRP), Monocyte Chemoattractant Protein-1 (MCP-1), heart rate， endothelin-1 (ET-1), TAS and ba-PWV were significantly increased (P < 0.01 for all). Pearson's correlation analysis showed that SOD and TAS were negatively related to AP-1 (P < 0.05 for all), and that blood pressure (BP), age, MDA, Hs-CRP, MCP-1, ET-1 were positively related to AP-1 (P < 0.01 for all). Multivariate linear regression analysis showed that BP, SOD, MDA, AP-1, Hs-CRP, MCP-1, ET-1, TAS, heart rate and age were independent risk factors for ba-PWV. After treatment with olmesartan, SOD and TAS were increased, while BP, heart rate, AP-1 and inflammatory factors were reduced with significant improvement in ba-PWV (P < 0.05 for all). More increase of arterial stiffness was reported in elderly hypertensive patients with greater oxidative stress, inflammatory, AP-1, heart rate, and lower TAS. Higher oxidative stress, AP-1 and inflammatory may predict higher arterial stiffness. Olmesartan may increase TAS, yet inhibit oxidative stress, AP-1, inflammatory, and heart rate with improved artery stiffness in elderly hypertensive patients.

The hydroperfluoroalkylation of electron-deficient olefins with perfluoroalkyl iodides promoted by a zinc/viologen system is described. Interestingly, no iodoperfluoroalkylation product was observed without the presence of a radical H-donor.

Background Our previous work showed that miR-10b was overexpressed in hepatocellular carcinoma (HCC) and promoted HCC cell migration and invasion. Epithelial–mesenchymal transition (EMT) is involved in HCC metastasis. So, we suspected that miR-10b might participate in the HCC EMT. Methods We performed morphological analysis and immunofluorescence to observe the roles of miR-10b in HCC EMT. The expression of KLF11 and EMT markers were detected by real-time RT-PCR and western blot. The regulation roles of miR-10b on KLF11 and KLF4 were determined by luciferase reporter assay. The chromatin immunoprecipitation revealed the binding relationship between KLF4 and KLF11. Results We found that overexpression of miR-10b could promote HCC EMT. miR-10b could upregulated KLF11 expression. The upregulation of KLF11 reduced the downstream molecular Smad7 expression, which upregulated the Smad3 expression to promote EMT development. Furthermore, the induction role of miR-10b in HCC EMT could be blocked by KLF11 siRNA. But our results showed that there was no direct regulation of miR-10b in KLF11 expression. Specifically, miR-10b could bind to the 3′UTR of KLF4 and inhibit KLF4 expression. KLF4 could directly bind to KLF11 promoter and downregulate KLF11 transcription. Conclusion Our results reveal that miR-10b downregulates KLF4, the inhibitory transcriptional factor of KLF11, which induces Smads signaling activity to promote HCC EMT. Our study presents the regulation mechanism of miR-10b in EMT through the KLF4/KLF11/Smads pathway for the first time and implicates miR-10b as a potential target for HCC therapies.

Objective Coronary artery embolism resulting in acute myocardial infarction (AMI) is an infrequent but potentially life-threatening occurrence. To date, there is still no consensus in the literature regarding the optimal therapeutic algorithm for embolic myocardial infarction. Patients We present our experience with three patients who had mechanical valve prosthesis and suffered from AMI due to coronary artery embolism in the setting of sub-therapeutic or interrupted anti-coagulation therapy. Those patients were treated with intracoronary thrombolysis, thrombus aspiration followed by balloon angioplasty and thrombus aspiration alone, respectively. Results In our case 1, the coronary angiogram demonstrated extensive thrombus within the left circumflex coronary artery and extending into the left anterior descending (LAD). We performed intracoronary thrombolytic therapy, which results in completed thrombus resolution and favourable clinical outcome. In our case 3, coronary angiography revealed massive thrombus within the middle-LAD with a TIMI grade 3 distal flow. The patient underwent a successful thrombus aspiration procedure without stent implantation. In our case 2, the coronary angiography revealed total occlusion of the middle LAD, and thrombus aspiration was initially performed because of the large thrombus burden. However, this approach was unsuccessful and so the patient was then treated with balloon angioplasty, resulting in TIMI 2 flow. Conclusion Embolic myocardial infarction, although uncommon, can occur in predisposed groups such as those with prosthetic mechanical valves with sub-therapeutic anticoagulation. The treatment for this specific group of patients needs to be tailored individually.

The endothelial cell-specific microRNA (miRNA), miR-126, is considered a master regulator of physiological angiogenesis. Transplanted mesenchymal stem cells (MSCs) release soluble factors contributing to neoangiogenesis and cardiac repair. Therefore, we hypothesized that the over-expression of miR-126 may prolong MSC survival and enhance the cell secretome, thereby improving post-infarction angiogenesis and cardiac function. In this study, MSCs harvested from male C57BL/6 mouse bone marrow were infected in vitro with miR-126 (MSC(miR-126)) by using recombinant lentiviral vectors; the control cells were either non-transfected or transduced with mock vectors (MSC(null)). The results showed an increased secretion of angiogenic factors and a higher resistance against hypoxia in MSC(miR-126) compared with the control cells. The expression of the Notch ligand Delta-like (Dll)-4 in the MSC(miR-126) group was also increased. For in vivo experiments, MSC(miR-126) cultures were intramyocardially injected into the infarct region of the hearts of female C57BL/6 mice (an acute myocardial infarction model) who had undergone ligation of the left anterior descending coronary artery. The survival of MSC(miR-126) cultures, determined by Sry expression, was increased at 7 days after transplantation. MSC(miR-126)-treated animals showed significantly improved cardiac function as assessed by echocardiography 2 weeks later. The expression levels of angiogenic factors and Dll-4 in the infarcted myocardium were further increased by MSC(miR-126) compared with MSCs or MSC(null) cultures. Furthermore, fluorescent microsphere and histological studies revealed that myocardial blood flow and microvessel density were significantly increased in the MSC(miR-126)-transplanted animals. In addition, we found increased immature vessel proliferation following the transplantation of MSC(miR-126) cultures in which the expression of Dll-4 had been knocked down. However, blood vessels with lumen were barely detected, which indicated that Dll-4 plays a key role in tubulogenesis. We conclude that the transplantation of MSCs overexpressing miR-126 can further enhance functional angiogenesis in the ischemic myocardium possibly by the secretion of angiogenic factors and the activation of Dll-4, thus increasing MSC survival. Therefore, MSCs modified with miR-126 may represent a novel and efficient therapeutic approach for ischemic angiogenesis and the improvement of cardiac function.

The hydroperfluoroalkylation of electron-deficient olefins with perfluoroalkyl iodides promoted by a zinc/viologen system is described. Interestingly, no iodoperfluoroalkylation product was observed without the presence of radical H-donor.

Background: Following successful guidewire passage, inability to cross the occluded lesion with a balloon is the most common cause of procedural failure for percutaneous recanalization of chronic total occlusions (CTOs). We sought to evaluate the efficacy of “wire-cutting” technique for facilitating the balloon passage through the lesion during CTO-percutaneous coronary intervention. Methods: Sixteen consecutive patients with CTOs were treated by “wire-cutting” technique when a lubricious balloon could not be passed through the lesion after successful guidewire crossing. The main process of the “wire-cutting” technique involved: inserting 2 percutaneous transluminal coronary angioplasty (PTCA) guidewires (A and B) into the distal true lumen; advancing a balloon over guidewire A to the site of the occlusion abutting the proximal cap, the balloon was then inflated and guidewire B was pressed between the balloon and the proximal cap; rapidly withdrawing guidewire B produced a cutting power that crushed the proximal cap thus facilitating balloon crossing. Technique success was defined as balloon having crossed CTO lesions successfully after performing wire-cutting procedure. Results: Both technical success and procedural success were obtained in 10 (62.5%) cases. Technique failure occurred in 6 (37.5%) cases, of which 2 were due to the inability to place a second guidewire into the distal true lumen and the other 4 were due to severe coronary calcification. Of these 4 failures, 2 have final procedure success with the use of Rotablator and the remaining 2 patients were referred for bypass surgery. Major complication included severe coronary dissection that occurred in 1 (6.3%) patient, which was successfully treated by stenting. No other complications were observed. Conclusion: The wire-cutting technique may be considered as a simple and effective approach for facilitating balloon crossing resistant CTO lesions. (J Interven Cardiol 2012;25:297–303)

Optimizing microcirculation in STEMI patients with thrombus-containing lesion undergoing percutaneous coronary intervention (PCI) remains challenging. Our objective was to compare the effects on myocardial perfusion and cardiac function of delayed vs immediate stent implantation after thrombus aspiration in STEMI patients undergoing PCI.Eighty-seven STEMI patients with thrombus-containing lesion undergoing PCI were enrolled. After thrombus aspiration was performed, subjects were divided into 2 groups according to residual thrombus score (TS): immediate stent implantation (ISI) group (n = 47, residual TS2; stenting was performed immediately), and delayed stent implantation (DSI) group (n = 40, residual TS ≥ 2; stenting was performed 7 days later). Corrected thrombolysis in myocardial infarction frame count and myocardial blush grade were analyzed immediately after PCI. The wall motion score index was assessed on admission and at 6-month follow-up.At the end of the PCI procedure, the corrected thrombolysis in myocardial infarction frame count was significantly shorter and the myocardial blush grade 3 was more frequent in the DSI group than in the ISI group. Compared with the ISI group, the DSI group had a lower incidence of thrombus-related angiographic events, including distal embolization and no reflow. A significantly greater improvement in wall motion score index from baseline to 6-month follow-up was observed in the DSI group compared with the ISI group.In STEMI patients presenting with thrombus containing lesion undergoing PCI, delayed stent implantation after thrombus aspiration leads to better myocardial perfusion and cardiac functional recovery in comparison with immediate stent implantation.

Retraction The following article from Clinical Cardiology, “The Effect of Early and Intensive Statin Therapy on Ventricular Premature Beat or Nonsustained Ventricular Tachycardia in Patients With Acute Coronary Syndrome,”1 by Xian-Zhi He, MD; Sheng-Hua Zhou, MD; Xin-Hong Wan, MD; Hai-Yu Wang, MD; Qing-Hua Zhong, MD; and Jian-Fang Xue, MD, published online on December 10, 2010 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Dr. A.J. Camm, and Wiley Periodicals, Inc. The retraction has been agreed due to significant overlap with a similar article2 previously published by the same authors in the Cardiology Journal. References 1. He X.-Z., Zhou S.-H., Wan X.-H., Wang H.-Y., Zhong Q.-H. and Xue J.-F. The effect of early and intensive statin therapy on ventricular premature beat or nonsustained ventricular tachycardia in patients with acute coronary syndrome. Clin Cardiol. 34(1):59–63. doi: 10.1002/clc.20818 2. He XZ, Zhou SH, Wan XH, Wang HY, Zhong QH, Xue JF. The effect of early and intensive statin therapy on ventricular premature beat or non-sustained ventricular tachycardia in patients with acute coronary syndrome. Cardiol J. 2010;17(4):381–385. The authors have no funding, financial relationships, or conflicts of interest to disclose.

Background Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center. Methods One hundred and sixty-eight PMVSD patients were accepted for transcatheter closure with Amplazter PMVSD occluder (AGA Medical, Plymouth, Minn., USA). The procedure was discontinued when a second- or third-degree AVB occurred. A steroid was administered to all patients who developed AVBs. Temporary pacemakers were inserted in patients who developed a complete AVB or Mobitz type II AVB during or after the procedure. Results During the follow-up period of 6–24 mo (mean 10.6 ± 3.9), the incidence of AVBs occurring during or after transcatheter closure of PMVSD was 3.5%. The AVB disappeared quickly after discontinuing the procedure in patients who developed AVBs during the procedure, whereas the AVBs disappeared between 2 and 21 d (mean 8.0 ± 8.8) in the patients who developed AVBs after the procedure. However, complete right bundle branch block (CRBBB) was observed, and a transient complete AVB emerged after 8 mo in 1 case, incomplete right bundle branch block (IRBBB) in 1 case, and CRBBB and left anterior hemiblock (LAH) in 1 case. Conclusions The AVB is a serious complication during and after transcathter closure of PMVSD. More attention should be paid to the complication, and multicentres are required to monitor the complication. Copyright © 2008 Wiley Periodicals, Inc.

Mesenchymal stem cells (MSC) have recently been shown to possess immunomodulatory properties in vitro and in vivo. The present study aimed to investigate the regulatory effect of MSC transplantation on the immuno-inflammatory response in myocardial infarction (MI). Methods MI was induced in SpragueDawley rats by left anterior descending coronary artery ligation, and the animals were randomly assigned into the following three groups: sham ( n8); phosphate-buffered saline (PBS) injected (MIPBS, n8); and MSC transplantation (MI MSC, n8). BrdU-labeled MSC or PBS was transplanted into periinfarct myocardium by direct myocardial injection. At 1 and 28 days post-transplantation, cardiac function was evaluated by echocardiography. Transplanted cells were investigated through immunohistochemistry. Lymphocyte cytotoxic activity was evaluated with the crystal violet method. The activity of NF-kB and protein expression of tumor necrosis factor-a (TNF-a), interleukin (IL)-6 and IL-10 in myocardium were assessed by immunohistochemistry and Western blot. Results Echocardiographic examination revealed that the MSC transplantation prevented left ventricular dilation and dysfunction at 28 days after the operation. BrdU-stained cells were found living in host heart 4 weeks after transplantation. MSC transplantation attenuated the cytotoxic activity of spleen lymphocytes. Transplantation of MSC inhibited the activity of NF-kB, attenuated the protein production of TNF-a and IL-6, and increased the expression of IL-10 in periinfarct myocardium. Discussion MSC transplantation modulated the immuno-inflammatory response in MI. The immuno-inflammatory regulatory effect of MSC transplantation might partly account for the cardiac protection in myocardial infarction.

Recent findings demonstrate the vital role of endothelial progenitor cells in the homeostasis of the vessel wall and the development of atherosclerosis. Endothelial progenitor cells (EPCs) play important roles in repair-to-injury of arteries. Many evidences have shown Cardiovascular risk factors closely correlated with EPCs numbers and function. Levels of circulating EPCs represented a better predictor of endothelial function than conventional risk factors. Depletion of bone marrow and Cardiovascular risk factors are the two prerequisits of atherosclerosis. All conditions of manifest atherosclerotic disease are accompanied by reduced EPC numbers and migratory capacity. Therefore, based on response-to-injury hypothesis and these findings, we build up EPCs-mediated repair-to-injury hypothesis, which may have important therapeutic implications in the prevention and therapy of atherosclerosis. The use of EPCs for vascular repair may be important therapy strategies with a maximized benefit for the patient in the future.

Background Bone morphogenetic protein-2 (BMP-2) plays a key role both in vascular development and pathophysiological processes. However, the effects of oxidized low-density lipoprotein (ox-LDL) combined with atorvastatin on BMP-2 expression are entirely unknown in human umbilical vein endothelial cells (HUVECs). The present study investigates the effects of ox-LDL on BMP-2 expression. Furthermore, the influence of atorvastatin on ox-LDL-induced BMP-2 expression is also examined. Methods and Results The HUVECs were treated by ox-LDL or combined with pyrrolidine dithiocarbamate (PDTC) or atorvastatin. The expression level of BMP-2 mRNA was examined by real-time PCR and RT-PCR analysis. The expression of BMP-2 protein was assayed by enzyme-linked immunosorbent assay. The malondialdehyde (MDA) and activities of total superoxide dismutase (SOD) were detected by routine methods. The activation of nuclear factor κB (NF-κB) in HUVECs was determined using an assay kit from active motif and western blot analysis. Ox-LDL treatment significantly increased BMP-2 expression, which is associated with NF-κB activation, but BMP-2 expression was suppressed by treatment with PDTC or atorvastatin. Furthermore, the increase in MDA levels and decrease in activities of total SOD caused by ox-LDL treatment were reversed by the treatment of PDTC or atorvastatin. Conclusions Ox-LDL-induced BMP-2 expression was suppressed by PDTC or atorvastatin treatment. The effects of atorvastatin might contribute to the mechanisms by inhibiting NF-κB activation. (Circ J 2008; 72: 807 - 812)

Background:Transcatheter closure (TCC) of ruptured sinus of Valsalva aneurysm (RSVA) is an alternative strategy to surgery, but there is a lack of long-term outcome data.Methods and Results:From 2004 to 2012, 17 patients (8 males, 9 females) were treated with patent ductus arteriosus (PDA) occluders by antegrade venous approach and were followed for 18–102 months. Of the 17 patients, transthoracic echocardiography revealed rupture of the right coronary sinus into the right ventricle in 9 and into the right atrium in 4, and noncoronary sinus rupture into the right ventricle in 3 and into the right atrium in 1. Most (10/17) were in New York Heart Association (NYHA) functional class III or IV. Aortography showed that the size of the defect was 7.71±2.84 mm (4–15 mm). TCC was attempted using PDA occluders 2–5 mm larger than the aortic end of the defects. The device sizes ranged from 8/6 to 18/16 mm (median, 10/8 mm). The procedure was successful in 16 (94.1%), and all of them had complete occlusion at discharge. On a median follow-up of 42 months, 14 patients were in NYHA class I and 2 were in class II, and there was no residual shunt, device embolization, infective endocarditis, or aortic regurgitation.Conclusions:TCC of RSVA is a safe and effective alternative to surgery with favorable long-term follow-up results. (Circ J2014;78:2197–2202)

Percutaneous closure of patent arterial ducts with the Amplatzer Ductal Occluder has become an effective and widely accepted alternative to surgical management. Although rarely, the occluder can be dislodged after an initially successful deployment, and with catastrophic consequences. We describe such a case in a 12-month-old girl who underwent transcatheter closure of a patent arterial duct. After device deployment, the occluder embolized in the patient's descending thoracic aorta, and severe spinal cord ischemic injury resulted. To our knowledge, ours is the first report of this complication after the deployment of an Amplatzer Ductal Occluder. We discuss pathophysiologic mechanisms that could expose patients to the risk of device dislodgment, and we review the relevant medical literature.

A 69-year-old male patient with prolonged PR interval presented with narrow QRS complex tachycardia for electrophysiological study. A discussion on different possibilities is made During tachycardia, diagnosis was made as atrioventricular nodal reentrant tachycardia, trial to ablate the slow pathway was not successful to cure the tachycardia along with a high degree atrioventricular block occurs made it more challenging for diagnosis, by studying the sequence of atrial, His and ventricular potentials diagnosis was supposed to be an accessory pathway connecting the atria with ventricle.

Background: The aim of this research was to study whether transplantation of mesenchymal stem cells (MSCs) overexpressing microRNA-1 into mouse infarcted myocardium can enhance cardiac myocyte differentiation and improve cardiac function efficiently. Methods: Eight-week-old female C57BL/6 mice underwent ligation of the left coronary artery to produce models of myocardial infarction. The ligated animals were randomly divided into 4 groups (20 in each). One week later, they were intramyocardially injected at the heart infarcted zone with microRNA-1-transduced MSCs (MSCmiR-1 group), mock-vector-transduced MSCs (MSCnull group), MSCs (MSC group) or medium (PBS group). At 4 weeks post-transplantation, transthoracic echocardiographic assessment, histological evaluation and Western blot were performed. Results: The transplanted MSCs were able to differentiate into cardiomyocytes in the infarcted zone. Cardiac function in the MSC, MSCnull and MSCmiR-1 groups was significantly improved compared to the PBS group (p < 0.01 or p < 0.001). However, treatment of MSCs expressing microRNA-1 was more effective for cardiac repair and improved cardiac function more efficiently by enhancing cell survival and cardiac myocyte differentiation compared to the MSC group or the MSCnull groups (p < 0.05 or p < 0.01, respectively). Conclusions: Transplantation of microRNA-1-transfected MSCs was more conducive to repair of infarct injury and improved heart function by enhancing transplanted cells survival and cardiomyogenic differentiation.

This article is to investigate the role of outpatient informationization and the SAFE-CARE system in raising the level of outpatient high-quality medical service. It summarizes combination application experiences of outpatient informationization and the SAFE-CARE system to improve the level of outpatient medical service during the past year. Outpatient informationization has provided an efficient operational tool to improve the treatment efficiency; the SAFE-CARE system has guaranteed medical safety and quality, and enhanced the level of hospital management. Therefore, the combination application of outpatient informationization and the SAFE-CARE system is one of important measures to alleviate the difficulties of the masses medical treatment.

Oxidized low density lipoprotein (ox-LDL), a risk factor of atherosclerosis, facilitates the formation and vulnerability of atherosclerotic plaque, thus contributing to several clinical complications. Stem cells participate in vascular repair after damage and atherosclerosis is a process of inflammation accompanied with vascular injury. Researchers have proposed that stem cells participate in the formation of atherosclerotic plaque. Also, because ox-LDL is capable of inducing toxic effects on stem cells, it is reasonable to postulate that ox-LDL promotes the progress of atherosclerosis via acting on stem cells. In the present article, we review the relationship between ox-LDL, stem cells, and atherosclerosis and a portion of the associated mechanisms.

This study was designed to examine whether transplantation of mesenchymal stem cells (MSCs) overexpressing miR-126 enhances angiogenesis in the infarcted myocardium of mice.MSCs were harvested from mice using density gradient centrifugation and adherent culture. MSCs were transfected with lentiviral vectors carrying mature miR-126. Mice models of myocardial infarction were established by ligation of coronary artery. The ligated animals were randomly divided into three groups (15 in each) and after two weeks, were intramyocardially injected at the heart infarct zone with miR-126-transfected MSCs (the miR-126-MSCs group), MSCs (the MSCs group), or medium (the PBS group). Six weeks later, histological study and echocardiographic assessment were performed.Capillary density of the infarcted region was significantly improved in the miR-126- MSCs group compared to the MSC group and the PBS group (both p0.01). Western blot showed that ERK(1), pERK(1), AKT and pAKT gene were dramatically enhanced in the miR-126-MSC group compared to the MSC group and the PBS group (both p0.05). Echocardiography showed MiR-126 led to a sustained improvement in cardiac function for at least six weeks at the injected area, as assessed by left ventricular ejection fraction and fraction of shortening.Transplantation of MSCs transfected with miR-126 can improve angiogenesis and cardiac function in the infarcted area of the hearts of mice, which may be due to stimulation of the AKT/ERK-related pathway.

Transcatheter device closure of atrial septal defect (ASD) has become a well-accepted alternative to surgical repair. Serious complications of transcatheter ASD closure are rare, but when they occur, devastating consequences may result. Herein, we present the case of a 4-year-old girl who had an ischemic stroke caused by a presumptive paradoxical embolism after an unsuccessful transcatheter ASD procedure and in whom subsequent venous color Doppler showed deep venous thrombosis (DVT) of the right lower extremity. The risk factors that predisposed to paradoxical cerebral embolism and DVT in this patient are discussed, and the literature is reviewed.

Background We previously found that remnant-like lipoproteins (RLPs), lipolytic products of triglyceride-rich lipoproteins including very low-density lipoprotein and chylomicron, can accelerate endothelial progenitor cell (EPC) senescence, which involves telomerase activity. The aim of this study was to investigate the effects of RLPs on telomerase activity and the catalytic subunit telomerase reverse transcriptase (TERT) in EPCs and the associated signal pathway. Methods RLPs were prepared from plasma samples by the immunoaffinity method. EPCs at day 8 were incubated with RLPs at 10-, 50-, 100-, and 200-μg/mL for 24 hours. Telomerase activity was measured with telomeric repeat amplification protocol assay, and optimum concentration of RLPs was determined. Human TERT (hTERT) and phosphorylated Akt protein kinase were detected by Western blot analysis in RLP-incubated EPCs with or without pretreatment of either superoxide dismutase or atorvastatin for 3 hours. Phosphorylated hTERT was measured by immunoprecipitation and Western blot assay. Nitrotyrosine was evaluated by immunofluorescence assay, and senescent EPCs were determined by senescence-associated β-galactosidase staining. Results Dose dependently, RLPs resulted in a decrease in telomerase activity, with a maximal effect at 200 μg protein/mL. The optimum concentration of RLPs was determined as 100 μg protein/mL. This dosage resulted in significant increases in senescence-associated β-galactosidase–positive cell and nitrotyrosine staining. In addition, RLPs decreased the expression of hTERT and repressed the phosphorylation of Akt and hTERT. Pretreatment of either superoxide dismutase or atorvastatin remarkably reversed these effects. Conclusions RLPs may suppress telomerase activity and accelerate EPC senescence through downregulating hTERT expression via the reactive oxygen species–dependent pathway.

Bone morphogenetic protein-2 (BMP-2), a transforming growth factor-β superfamily member cytokine, plays a key role both in vascular development and in pathophysiological processes. However, the effects and mechanisms of angiotensin II (Ang II) on BMP-2 expression remain unknown in human umbilical vein endothelial cells (HUVECs). Here we show that Ang II treatment significantly increased BMP-2 expression, associated with NF-κB activation, which was suppressed by treatment with pyrrolidine dithiocarbamate (PDTC) or irbesartan. Furthermore, the increased levels of MDA (malondialdehyde) in conditioned media and the decrease in activities of total superoxide dismutases (SOD) caused by Ang II were reversed by irbesartan or PDTC treatment. Our findings indicate that Ang II-induced BMP-2 expression might contribute to NF-κB activation. BMP-2 expression induced by Ang II might involve excessive oxidative stress.

Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage. Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization. Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4 - 46 days (mean (15 +/- 10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6 - 24 months (mean (11.8 +/- 3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed. Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

Bone morphogenetic protein-2 (BMP-2) plays a key role in both vascular development and pathophysiological processes. However, the effect of high glucose on BMP-2 expression remains unclear. Here we show in human umbilical vein endothelial cells that high glucose increased BMP-2 expression, associated with NF-ĸB activation, whereas pioglitazone suppressed BMP-2 expression and NF-ĸB65 activation induced by high glucose. Furthermore, the increase in MDA levels and decrease in activities of total superoxide dismutase of cell culture stimulated by high glucose were reversed by pioglitazone treatment. Our findings indicate that BMP-2 expression induced by high glucose might be closely related to NF-ĸB activation, and both effects can be suppressed by pioglitazone.

The rupture of coronary atherosclerotic plaque and subsequent thrombus formation are major events underlying acute coronary syndromes (ACS). Pregnancy associated plasma protein A (PAPP-A) is a member of the metzincin superfamily of metalloproteinases originally identified in the serum of pregnant women. Recent studies indicate that ACS is associated with elevated serum concentrations of PAPP-A. PAPP-A level is not only a marker of plaque instability favoring the progression to myocardial infarction, but is indicative of a poor prognosis even after the occurrence of an acute ischemic event caused by plaque instability. Why PAPP-A expression in unstable plaques is high is a puzzling problem. We hypothesized that PAPP-A is a possible cause of the instability of atherosclerotic plaque which plays a role in ACS. Studies found that PAPP-A was abundantly expressed in both eroded and ruptured plaques, but was only minimally expressed in stable plaques. Other studies have also demonstrated that patients with hyperechoic or isoechoic carotid plaques exhibit significantly higher PAPP-A levels than those with hypoechoic early carotid lesions. If the hypothesis is confirmed, administration of PAPP-A monoclonal antibodies may be used to eliminate the pathogen. It will be a new target point to treat ACS.

Objectives To analysis the application of retrograde coronary venography (RCV) in left ventricular lead implementation during cardiac resynchronisation therapy (CRT). Methods A total of 31 patients (21 men and 10 women,mean age 63.1 ± 8.0 years) with NYHA class III∼IV received CRT from March 2009 to December 2011. The etiologies of heart failure were idiopathic dilatedcardiomyopathy in 22, ischaemic heart disease in 7, alcoholic cardiomyopathyin 1 and valvular heart disease in 1. Indications were LVEF ≤ 0.35 andleft ventricular end-diastolic dimension > 55 mm. Vein trail andleft ventricular lead were selected according to different venous anatomy inorder to obtain ideal pacing position. Results RCV were performed by different positions. left ventricular lead were located in 12, posterior lateralvein in 12 and posterior vein in 5. Another 2 were failed to located in veins successfully because of abnormal coronary vein anatomy and were finally located in left lateral epicardium by thoracotomy. Dissection took palce in 2 patients but were not influenced procedure with stable haemodynamics. There were no myocardial perforation or vein stenosis. 25 in 29 patients needed a PTCA wire in the procedure. Conclusions Carefull manipulation and proper selection of cather and lead can decrease the rate of complication in CRT despite of the diversity of coronery vein anatomy..

Objectives Recently, the prognostic role of N-terminal pro-brain natriuretic peptide (NT-pro BNP) in heart failure and coronary diseases has been demonstrated in many studies. SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process in appropriately informing patients electing to undergo coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). However is not known if there is a relation between NT-pro BNP levels and SYNTAX score (SS). A present study came to investigate the relationship between plasma NT-pro BNP level and extent and complexity of coronary lesions assessed using SS in patients with stable angina pectoris candidate for coronary angiography. Methods The study population included 203 consecutive patients with stable angina and intend for selective coronary angiography. SS was calculated in all participants, According to SS value,all subjects were divided into three groups: low risk ( Results Regarding the role of N terminal pro BNP for assessing severity of coronary lesions based on SS, The NT pro BNP level increased significantly as risk classification of SS upgraded (P Conclusions NT-pro BNP can be a good parameter for predicting severity of coronary lesions. NT-pro BNP level was significantly associated with the extent and complexity of coronary artery disease.

A 49-year-old man presented with progressive exertional dyspnoea associated with palpitations for 4 months’ duration. Physical examination was notable for marked jugular venous distention and a to-and-fro murmur was heard at the apex. A chest x-ray showed significant cardiomegaly with a bulging contour over the right cardiac border (figure 1A). Transthoracic echocardiography revealed the right coronary artery (RCA) was obviously dilated with a huge aneurysm and a fistula draining into the LV, moreover, the right heart chamber was significantly …

A 4 year old girl was admitted with cyanosis after exercise. Physical examination found a continuous murmur which was loudest in the upper right parasternal region. The ECG was normal. Transthoracic echocardiography revealed mild right ventricular and atrial dilatation; it also revealed a fistula originating from the left main coronary artery (LMCA), rounding the ascending aorta and left atrium, …