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Objective Recently, the effect of long non-coding RNAs (lncRNAs) in hypertension (HTN) has been identified. This study aims to explore the expression of lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in HTN and its role in vascular lesion and remodeling of HTN rats. Results LncRNA MALAT1 expression was up-regulated in HTN patients, and lncRNA MALAT1 could be an effective index of HTN diagnosis. Down-regulated MALAT1 and inhibited Notch-1 could reduce relative factor expression, including inflammation-related factors, endothelial function-related factors and oxidative stress-related factors, and inhibit apoptosis of aortic endothelial cells of HTN rats. Methods LncRNA MALAT1 expression in HTN patients and healthy controls was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Angiotensin II (Ang II)-induced HTN rat models were injected with MALAT1-siRNA, empty lentivirus vector, Notch pathway inhibitor (DAPT) and dimethyl sulphoxide (DMSO) via caudal vein. After three-week treatment, changes of blood pressure, inflammatory factor levels, endothelial function-related factors, oxidative stress indices and apoptosis of vascular endothelial cells were determined by a series of assays. Conclusion This study revealed that down-regulated lncRNA MALAT1 could alleviate the vascular lesion and remodeling of HTN rats, the mechanism may be related to the inhibited activation of Notch signaling pathway.

Background Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting. Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion. Trial design DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided vs angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary end point is the rate of 12-month target vessel failure, including cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. The secondary end points consist of the individual component of primary end point, all-cause death, myocardial infarction, and in-stent restenosis. The safety end point is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure. Conclusions DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.

Background Cell based therapy has been heralded as a novel, promising therapeutic strategy for cardiovascular diseases including pulmonary arterial hypertension (PAH). However, the low survival rate after transplantation due to cell death via anoikis is a major obstacle in stem cell therapy. Cells adhesion via Integrin alpha5beta1 (ITGA5B1) has a tendency to exert higher maximum forces. The present study aimed to evaluate the potential protective effect of ITGA5B1 on rat bone marrow mesenchymal stem cells (rBMSCs) from anoikis. Methods Mononuclear cells were isolated by density gradient centrifugation with Ficoll, and rBMSCs cell surface markers were evaluated by flow cytometry. Osteogenic and adipocyte differentiation was determined by Alizarin Red S and Oil Red O staining respectively. The expression of Integrin A5 (ITGA5), Integrin B1 (ITGB1), eNOS and actived-caspase-3 mRNA or protein was confirmed by qPCR and western-blot. Cell adhesion, cell viability, anoikis and the migration of rBMSCs were also evaluated. Nitric oxide (NO) production was detected by the greiss assay. Results Co-infected with Integrin A5 and B1 lentivirus to rBMSCs increased ITGA5 and ITGB1 mRNA and protein expression. ITGA5B1 enhanced the cell adhesion, cell viability, cell migration and NO production but reduced the cell anoikis in rBMSCs/ITGA5B1 groups. Conclusion Transduction of rat rBMSCs with ITGA5B1 lentivirus could prevent cell anoikis and increase NO production.

Objective Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality (Chastre and Fagon, 2002; Klompas, 2007) among mechanically ventilated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27%; crude mortality ranges from 25% to 50% (Rello, Ollendorf, Oster, et al., 2002; Tablan, Anderson, Besser, Bridges, Hajjeh, 2003). A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results Ten RCTs with 2314 patients were identified. SSD significantly reduced the incidence of VAP (relative risk [RR] = 0.52, 95% confidence interval [CI]: 0.42–0.64, p

Cardiac allograft vasculopathy is the leading cause of death after the first year of heart transplantation. The optimal treatment for unprotected left main coronary artery disease in orthotopic heart transplantation (OHT) patients is unknown. Two OHT patients with left main disease following heart transplantation underwent percutaneous coronary intervention (PCI). Technical success was achieved in the patients with drug-eluting stents inserted to cover the lesions in the left main coronary artery. After 16 months follow-up, one patient died of multiorgan failure, the other was alive and free from myocardial infarction or target vessel revascularization. We conclude that the unprotected PCI for the left main coronary artery stenosis in transplanted heart is feasible.

Atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence of up to 10% in patients who are 80 years and older. There has been some significant progress in the understanding and management of AF in recent years. Large-scale clinical trials have provided solid evidence in supporting the role of anti-thrombotic therapies in the prevention of stroke in moderate to high risk patients. Appropriate control of the ventricular rate or the maintenance of sinus rhythm offers long-term benefits in specific groups of patients. Catheter ablation or "Maze" surgery has proven to be curative to some patients. However, the implementation of the evidence-based therapeutic strategies in the day-to-day care of the AF patients have been found to vary greatly from one institution to another, some of which are hindering the achievement of optimal long-term outcomes. In this brief review, some of the key strategies in the evidence-based management of AF are discussed, with particular emphasis on anti-thrombotic therapy, rhythm or rate control, as well as catheter ablation.

Aims: To evaluate the safety and efficacy of a new approach for transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). Methods: One hundred and two patients with rheumatic mitral stenosis were randomized into two groups. In the study group (RA approach), an imaginary horizontal line was drawn from the top end of the tricuspid valve under anteroposterior fluoroscopic view. The intersection of the horizontal line and the right edge of the corresponding thoracic vertebra was defined as the upper border of the Fossa ovalis. The atrial septum was punctured from a point 0.5 cm below the upper border of the Fossa ovalis. In the control group (LA approach), an imaginary horizontal line was drawn between the upper and middle third of the left atrium, and the intersection of this horizontal line and the right edge of the corresponding thoracic vertebra was used as an atrial septum puncture point. Results: Atrial septum puncture succeeded in all patients in the study group and in 72.6% of the patients in the control group (p < 0.01). The average fluoroscopy times for transseptal catheterization in the study and the control groups were 2.0 ± 0.5 and 3.0 ± 1.0 min, respectively (p < 0.01). Transseptal catheterization was subsequently achieved using the RA approach in the 14 patients from the control group in whom the LA approach failed. Conclusions: The RA approach is a safe and effective means for transseptal catheterization in patients undergoing PBMV.

Absract Chronic heart failure is one of the most common heart diseases and is a leading cause of morbidity and mortality. There has been a rapid growth in knowledge and understanding of the pathogenesis of chronic heart failure in recent years. Tumor necrosis factor (TNF-α), a pro-inflammatory cytokine, is found to play an important role on the development and progression of heart failure. Recent evidence suggests that testosterone improves cardiac function and clinical symptoms in patients with chronic heart failure. Recent experimental studies show that testosterone suppresses the biosynthesis of TNF-α while increasing the levels of anti-inflammatory faction, interleukin-10. Therefore, we hypothesize that testosterone may also suppress the biosynthesis of TNF-α and re-balancing the pro- and anti-inflammatory mechanisms in human hearts, leading to significant improvement in cardiac function and symptoms in patients with chronic heart failure.

Background As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. Objective To investigate the clinicopathologic features of senile meningiomas. Design A retrospective analysis. Setting Affiliated Hospital of Hebei University. Participants Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60–74 years of age, and they were all diagnosed by CT and MRI. Methods The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. Main outcome measures Sites and pathological types of the tumor; Postoperative outcomes and complications. Results All the 49 patients were involved in the analysis of results. The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 (4.1%) died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. Conclusion Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.

To evaluate the effects of l-carnitine as an adjunct therapy to percutanenous coronary intervention (PCI) for non-ST elevation acute coronary syndrome (NSTEMI). Ninety-six consecutive patients with NSTEMI were randomized into treatment group (l-carnitine 5 g IV bolus followed by 10 g/day IV infusion for 3 days), and control group. All patients also underwent PCI within 24 h from the onset of chest pain. The peak values of creatine kinase-MB and troponin-I before and after PCI were observed. In the treatment group, the peak values of creatine kinase-MB were significantly lower than the control group at 12 h and 24 h after PCI (P

Purpose: To investigate the effect of adrenomedullin on the cell numbers and apoptosis of endothelial progenitor cells (EPCs). Methods: Mononuclear cells were isolated from peripheral blood by Ficoll density gradient centrifugation. The cells were stimulated with adrenomedullin, before and after the treatment of adrenomedullin-receptor antagonist, adrenomedullin 22-52, or a PI3K inhibitor LY294002. Results: Adrenomedullin dose-dependently increased the number of EPCs (P < 0.05). Adrenomedullin also significantly decreased apoptosis rate of EPCs in a concentration-dependent manner (P < 0.05). In the isolated human mononuclear cells pretreated with adrenomedullin 22-52 or LY294002, adrenomedullin failed to increase the number of EPCs or to reduce the level of apoptosis. Conclusions: Adrenomedullin increases the number of EPCs and decreases their apoptosis. These actions are likely mediated by PI3K signaling pathways. The clinical importance of these favourable effects on EPCs remains to be determined.

Congenital hydrocephalus (CH), characterized by enlarged brain ventricles, is considered a disease of excessive cerebrospinal fluid (CSF) accumulation and thereby treated with neurosurgical CSF diversion with high morbidity and failure rates. The poor neurodevelopmental outcomes and persistence of ventriculomegaly in some post-surgical patients highlight our limited knowledge of disease mechanisms. Through whole-exome sequencing of 381 patients (232 trios) with sporadic, neurosurgically treated CH, we found that damaging de novo mutations account for >17% of cases, with five different genes exhibiting a significant de novo mutation burden. In all, rare, damaging mutations with large effect contributed to similar to 22% of sporadic CH cases. Multiple CH genes are key regulators of neural stem cell biology and converge in human transcriptional networks and cell types pertinent for fetal neuro-gliogenesis. These data implicate genetic disruption of early brain development, not impaired CSF dynamics, as the primary pathomechanism of a significant number of patients with sporadic CH.