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To investigate the alterations of topological organization of the whole brain functional networks in hypertension patients with cognitive impairment (HTN-CI) and characterize its relationship with cognitive scores.Fifty-seven hypertension patients with cognitive impairment and 59 hypertension patients with normal cognition (HTN-NC), and 49 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. Graph theoretical analysis was used to investigate the altered topological organization of the functional brain networks. The global topological properties and nodal metrics were compared among the three groups. Network-based statistic (NBS) analysis was used to determine the connected subnetwork. The relationships between network metrics and cognitive scores were also characterized.HTN-CI patients exhibited significantly decreased global efficiency, lambda, and increased shortest path length when compared with HCs. In addition, both HTN-CI and HTN-NC groups exhibited altered nodal degree centrality and nodal efficiency in the right precentral gyrus. The disruptions of global network metrics (lambda, Lp) and the nodal metrics (degree centrality and nodal efficiency) in the right precentral gyrus were positively correlated with the MoCA scores in HTN-CI. NBS analysis demonstrated that decreased subnetwork connectivity was present both in the HTN-CI and HTN-NC groups, which were mainly involved in the default mode network, frontoparietal network, and cingulo-opercular network.This study demonstrated the alterations of topographical organization and subnetwork connectivity of functional brain networks in HTN-CI. In addition, the global and nodal network properties were correlated with cognitive scores, which may provide useful insights for the understanding of neuropsychological mechanisms underlying HTN-CI.

Music and instruction-guided relaxation (MIGR) is a complementary therapeutic tool used in the treatment of the major depressive disorder (MDD). However, the neural mechanism that underlies the effect of MIGR on MDD patients is not known. Twenty-three right-handed MDD patients and 23 age-, sex-, handedness-, and educational level-matched healthy controls were enrolled. Resting-state functional MRI data were acquired from patients before and after MIGR and from healthy controls. The relationships between insular subregion-based functional connectivity and Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale (HAM-A), Automatic Thoughts Questionnaire, and Ruminative Responses Scale scores were examined. One-way analysis of variance exhibited significant differences among the three groups in functional connectivity between the left dorsal anterior insula (dAI) and left superior medial frontal gyrus (SMFG), left dAI and left precuneus, left posterior insula and left gyrus rectus, right ventral anterior insula (vAI) and left posterior cingulate cortex (PCC), right vAI and right inferior frontal gyrus (R-IFG). Further comparisons in regions of interest showed that MDD patients before MIGR showed decreased functional connectivity between the left dAI and left SMFG, left dAI and left precuneus, left posterior insula, and left gyrus rectus, right vAI and left PCC, right vAI and R-IFG relative to those in healthy controls. The strength of functional connectivity between the right dAI and left putamen also exhibited a negative correlation with the HAM-A score in MDD cases before MIGR. MIGR may result in enhanced functional connectivity in insular subregions, thereby potentially increasing the regulatory influence of cognitive reappraisal.

Purpose In pancreatic cancer (PC), CA 19-9, CEA and CA 125 are the most widely used tumor markers. The aim of this study was to explore the prognostic significance of baseline levels of serum CA 19-9, CEA, and CA 125, and to evaluate the clinical significance of these markers in PC patients. Patients and Methods A total of 278 patients with advanced PC that had received first-line chemotherapy treatments were examined. Correlation analysis between the tumor markers and clinical characteristics was performed using a Pearson's Chi-squared test or Fisher's exact test. A Pearson's correlation test was utilized to investigate the relationship between tumor markers and peripheral blood parameters. Univariate analysis was estimated using a Kaplan-Meier analysis and compared using a Log rank test. Multivariate analysis was performed using a Cox proportional hazards regression model. Results Both individually and collectively, the baseline CA 19-9, CEA and CA 125 levels were positively associated with the primary tumor site (p < 0.01), liver metastasis (p < 0.05), and number of organ metastases (p < 0.05). Furthermore, CA 19-9, CEA and CA 125 were correlated to baseline WBC (p < 0.001) and LDH (p < 0.01) levels. Additionally, CA 19-9 was correlated with years of smoking (p = 0.024); diabetes and years of diabetes (p = 0.012); baseline glycemic levels (p = 0.004); and neutrophil counts (p < 0.001). Moreover, CA 125 levels were associated with the baseline neutrophil counts (p < 0.001) and peritoneal metastasis (p = 0.008). When examining neutrophil, LDH, CA 19-9 and CA 125 levels were found to be associated with overall survival (OS) and shown to be independent prognostic factors. Conclusion CA 19-9, CEA and CA 125 are correlated with multiple clinical factors. Baseline neutrophil, LDH, CA 19-9 and CA 125 levels are associated with OS and may potentially serve as prognostic factors.

IntroductionAfter the first episode, patients with remitted major depressive disorder (MDD) have a 60% chance of experiencing a second episode. There are currently no accepted, effective methods to prevent the recurrence of MDD in remission. Transcutaneous vagus nerve stimulation (taVNS) is a non-invasive, safe and economical approach based on the efficacy of VNS in improving clinical depression symptoms. This clinical trial will study the efficacy of taVNS in preventing MDD relapse and investigate the underlying mechanisms of this.Methods and analysisWe will conduct a multicentre, randomised, patient-blinded and evaluators double-blinded trial. We will randomise 90 eligible participants with recurrent MDD in remission in a 1:1 ratio into a real or sham taVNS group. All participants will be given six biopsychosocial assessments: proinflammatory cytokines, serum monoamine neurotransmitters, cognition, affective neuropsychology, multimodal neuroimaging and endocrinology. After the baseline measurements, all participants will be given corresponding interference for 6 months and then complete a 1-year follow-up. The assessments will be performed three times: at baseline, post-treatment and at the end of 1-year follow-up (except for multimodal MRI scanning, which will be conducted at the first two assessments only). Change in 17-item Hamilton Depression Rating Scale scores for MDD is the primary outcome parameter.Ethics and disseminationThe study protocol was approved by the Medical Ethical Committee of Beijing Hospital of Traditional Chinese Medicine on 18 January 2019 (2018BL-076). The trial results will be published in peer-reviewed journals and at conferences.Trial registration numberChiCTR1900022618.

Rumination is a common symptom of major depressive disorder (MDD) and has been characterized as a vulnerability factor for the onset or recurrence of MDD. However, the neurobiological mechanisms underlying rumination and appropriate treatment strategies remain unclear. In the current study, we used resting-state functional magnetic resonance imaging to investigate the effects of body-mind relaxation meditation induction (BMRMI) intervention in MDD with rumination. To this aim, we have recruited 25 MDD and 24 healthy controls (HCs). Changes in functional connectivity (FC) of the anterior cingulate cortex (ACC) subregion and the scores of clinical measurements were examined using correlation analysis. At baseline, MDD showed stronger FC between the right dorsal ACC (dACC) and right superior frontal gyrus than did the HC group. Compared to baseline, the HC group showed a significantly enhanced FC between the right dACC and right superior frontal gyrus, and the MDD group demonstrated a significantly weaker FC between the left dACC and right middle frontal gyrus (MFG) after the intervention. Furthermore, the FC between the right dACC and right superior frontal gyrus was positively associated with rumination scores across all participants at baseline. The above results indicate that BMRMI may regulate self-referential processing and cognitive function through modulating FC of the dACC in MDD with rumination.

Major depressive disorder (MDD) is a highly prevalent mood disorder, characterized by depressed mood, reduced capabilities to concentrate, impaired cognition, as well as a high risk of relapse. Unaffected siblings who have high risks for MDD development and yet without clinical symptoms may be helpful for understanding the neural mechanisms of MDD traits.We investigated both regional fluctuation and inter-regional synchronization in 31 fully remitted MDD patients, 29 unaffected siblings and 43 age, gender, and educational level matched helathy controls (HCs) using resting-state functional magnetic resonance imaging (rs-fMRI). The 17-item HAMD and neurocognitive scales were performed. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) strength were investigated.Compared with healthy control group, patients with remitted MDD and unaffected siblings showed increased fALFF in the left dorsomedial prefrontal cortex (dmPFC) and increased FC between the left dmPFC and the right ventromedial prefrontal cortex (vmPFC). In addition, a negative correlation was observed between the fALFF value in the left dmPFC and the speed of Trail Making Test in the remitted MDD patients. Higher vmPFC-dmPFC FC was positively correlated with Wisconsin Card Sorting Test (WCST) total correct, and negatively correlated with WCST random errors.In the absence of clinical symptoms, individuals with remitted MDD and unaffected siblings showed increased fALFF in left dmPFC as well as the vmPFC-dmPFC connectivity. These results suggest a specific trait abnormality in the default mode network associated with vulnerability to MDD, which may have implications for developing effective therapies using this network as a target.

It has been well known that electric pulse can be utilized to enhance the plasticity of metals, which is attributed to the change of dislocation dynamics, e.g., localized planar slip to homogeneous wavy slip. Here, we show another effect of pulse current, which facilitates texture weakening through room-temperature dynamic recrystallization and additionally improve the plasticity of a polycrystalline Mg-3Al-1Sn-1Zn alloy. By conducting a tensile test under electrical pulse, we found that the peak flow stress and fracture strain depend strongly on current density. As peak current densities increases, the flow stress drops and the fracture strain increases. Our Electron Backscatter Diffraction results suggest that dynamic recrystallization occurs at room temperature, which develops a weakened texture. Our work provides a new insight into electroplasticity mechanism in Mg alloys.

Semi-solid aluminum slurries have globular grains, different from traditional dendritic solidification microstructures. The mechanism responsible for the formation of these globular grains is still in dispute. Some researchers suggest that the globular grains are formed by fractured dendrites, while others report it is due to copious nucleation. This study will model the growth of the α-Al phase during the production of semi-solid slurries using the swirled equilibrium enthalpy device (SEED) process, where liquid alloy with a low superheat is poured into a steel crucible and swirled within the semi-solid region. Experimental observations have shown that the final microstructure of the slurry produced by the SEED process is relatively non-uniform, with large dendrites at surface and fine spherical particles at the center. Open source code for the phase field method has been adopted to simulate the different microstructural evolution for semi-solid alloy 357.0. The effect of localized temperatures under isothermal condition on the morphology of the α-Al particles has been investigated according to the special conditions of the SEED process. In addition, suggestions for modifying the slurry production to achieve more uniform microstructure are discussed.

In this work, the tensile deformation behavior of an as-extruded AZ80 magnesium alloy under pulsed current (PC) was investigated based on microstructure observations. We found that compared with the tensile tests at room temperature (RT) and given temperature (GT), the flow stress is reduced due to both thermal and athermal effects of pulsed current. A quasi-in-situ electron backscatter diffraction (EBSD) analysis reveals that at the same strain, the geometrically necessary dislocation (GND) density of the RT sample is the highest, followed by the GT sample and the PC sample. This proves that the athermal effect can promote the annihilation of dislocations and slow down dislocation pileup, which reduces the flow stress. In addition, the twinning behavior under different deformation conditions was studied, the twins are {10&minus, 12} tension twins, which are activated with the assistance of local stress. We found that the twin fraction in the PC sample is lower than that in the RT and GT samples, due to the least accumulation of GNDs at grain boundaries, which decreases the nucleation of {10&minus, 12} tension twins.

Purpose In pancreatic cancer (PC), CA 19–9, CEA and CA 125 are the most widely used tumor markers. The aim of this study was to explore the prognostic significance of baseline levels of serum CA 19–9, CEA, and CA 125, and to evaluate the clinical significance of these markers in PC patients. Patients and Methods A total of 278 patients with advanced PC that had received first-line chemotherapy treatments were examined. Correlation analysis between the tumor markers and clinical characteristics was performed using a Pearson’s Chi-squared test or Fisher’s exact test. A Pearson’s correlation test was utilized to investigate the relationship between tumor markers and peripheral blood parameters. Univariate analysis was estimated using a Kaplan–Meier analysis and compared using a Log rank test. Multivariate analysis was performed using a Cox proportional hazards regression model. Results Both individually and collectively, the baseline CA 19–9, CEA and CA 125 levels were positively associated with the primary tumor site (p < 0.01), liver metastasis (p < 0.05), and number of organ metastases (p < 0.05). Furthermore, CA 19–9, CEA and CA 125 were correlated to baseline WBC (p < 0.001) and LDH (p < 0.01) levels. Additionally, CA 19–9 was correlated with years of smoking (p = 0.024); diabetes and years of diabetes (p = 0.012); baseline glycemic levels (p = 0.004); and neutrophil counts (p < 0.001). Moreover, CA 125 levels were associated with the baseline neutrophil counts (p < 0.001) and peritoneal metastasis (p = 0.008). When examining neutrophil, LDH, CA 19–9 and CA 125 levels were found to be associated with overall survival (OS) and shown to be independent prognostic factors. Conclusion CA 19–9, CEA and CA 125 are correlated with multiple clinical factors. Baseline neutrophil, LDH, CA 19–9 and CA 125 levels are associated with OS and may potentially serve as prognostic factors.

Background:CA199, CEA and CA125 were the most widely used tumor markers in pancreatic cancer. However, the studies associated with the relationship between the three markers and pancreatic cancer were limited. This study aimed to explore the correlation between baseline serum CA199, CEA, CA125 levels and clinical characteristics in pancreatic cancer. Methods:278 patients with advanced pancreatic cancer received first-line chemotherapy treatments enrolled in this research. Correlated analysis between tumor markers and disease characteristics was performed by Pearson’s Chi-squared test or Fisher exact test. We used Pearson’s correlation test to investigate the relationship between tumor markers and peripheral blood parameters. Univariate analysis was estimated by Kaplan-Meier method and compared using the log-rank test. Multivariate analysis and HR calculation was determined by the Cox regression model. Results: Baseline CA199, CEA, and CA125 both positively associated with the primary tumor site (p=0.007; p=0.012; p=0.003, respectively);liver metastasis (p=0.001; p=0.001; p=0.028, respectively); number of organ metastasis (p=0.001; p=0.008;p=0.042, respectively); baseline WBC levels (p

Pulse current assisted treatment has gained more attention in metallic materials, which is efficient and energy-saving, as compared with traditional heat treatment. However, the microstructural evolution of magnesium alloys with varied pre-deformation under pulsed current is still unclear. In this work, AZ91 alloy is subjected to gradient rolling and pulse current treatment (∼40 s). After gradient rolling, a transition zone from the initial to deformed microstructure was obtained in the sample, and the evolution of phases and twins can be analyzed precisely and continuously. Due to the difference in the Joule heat distribution of pulse current, a large number of fine Mg17Al12 phase are precipitated and dispersed, the precipitation and dissolution process of Mg17Al12 phase occur simultaneously. The region with moderate deformation has the largest recrystallization fraction, and the { 10 1 ¯ 1 } − { 10 1 ¯ 2 } double twins and { 10 1 ¯ 1 } compression twins are the preferred nucleation sites in the early stage of pulse current treatment. The weaken of texture is due to the newly formed grains with non-basal orientations. This work provides a new insight into the microstructural control of pre-deformed magnesium alloys under pulse current assisted treatment.

// Zhi-Peng Guo 1,2 , Hai-Tao Hou 1 , Rui Jing 3 , Zhen-Guo Song 3 , Xiao-Cheng Liu 2 , Guo-Wei He 1,2,4,5,6 1 Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Shi, China 2 Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Shi, China 3 Department of Cardiology, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Shi, China 4 The Heart Center, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China 5 Medical College, Zhejiang University, Zhejiang, China 6 Department of Surgery, Oregon Health & Science University, Portland, OR, USA Correspondence to: Guo-Wei He, email: // Keywords : coronary artery disease, coronary artery bypass grafting, platelet factor 4, secreted frizzled-related protein 1 Received : November 30, 2016 Accepted : February 15, 2017 Published : March 18, 2017 Abstract This study was designed to identify the protein profiling in patients with triple vessel coronary artery disease (CAD) undergoing CABG, in order to detect CAD-related differential proteins in these patients. CABG patients with triple vessel disease with/without left main stenosis ( n =160) were compared to normal coronary angiographic subjects ( n =160). Plasma samples of 20 males and 20 females in each group were analyzed with iTRAQ technique. ELISA test was used to test the chosen proteins from iTRAQ results in plasma samples from a new cohort of the CABG group ( n =120, male/femal=61/59) and control ( n =120, male/female=60/60). iTRAQ detected 544 proteins with 35 up-regulated and 41 down-regulated (change fold > 1.2 or < 0.83, p < 0.05). Three proteins including platelet factor 4 (PF4), coagulation factor XIII B chain (F13B), and secreted frizzled-related protein 1 (sFRP1) were selected for validation by using ELISA that demonstrated significant up-regulation of PF4 and sFRP1 ( p < 0.05). There was a positive correlation between these proteins and CAD ( p < 0.05) and myocardial infarction history ( p < 0.05). Thus, we for the first time have found 76 proteins differentially expressed in plasma of CABG patients. The thrombotic disease/inflammation progress-related protein PF4 and sFRP1, a member of the Wnt/fz signal-transduction pathway and related to myocardial repair, are significantly up-regulated in triple-vessel disease with/without left main stenosis. PF4 may be developed as a biomarker for the diagnosis of the severity of CAD requiring CABG procedure.

A novel one-pot method for the synthesis of substituted μ-oxo-bis [tetraphenyl porphyrinatoiron] compounds ([TRPPFe]2O) from pyrrole and aromatic aldehydes was proposed and investigated in this paper. Four kinds of [TRPPFe]2O were designed and synthesized by one-pot reaction and characterized by elemental analysis, infrared spectra and ultraviolet-visible spectroscopy. Moreover, the [TRPPFe]2O yields of 18.7~22.4% could be obtained with this novel method under the optimum reaction conditions.

This work presents a 3D computation of fluid-structure interaction in a cyclone separator. The finite volume method was used to simulate the flow field in the cyclone separator. The fluid-structure interaction was conducted by transferring the computational pressure distribution to the corresponding surface of the cyclone shell. The stress and deformation distribution in the cyclone shell was computed by the finite element method. Results obtained show that the maximum equivalent stress and deformation is linearly increases with the increases of the inlet gas velocity.

Combining MS-based proteomic data with network and topological features of such network would identify more clinically relevant molecules and meaningfully expand the repertoire of proteins derived from MS analysis. The integrative topological indexes representing 95.96% information of seven individual topological measures of node proteins were calculated within a protein-protein interaction (PPI) network, built using 244 differentially expressed proteins (DEPs) identified by iTRAQ 2D-LC-MS/MS. Compared with DEPs, differentially expressed genes (DEGs) and comprehensive features (CFs), structurally dominant nodes (SDNs) based on integrative topological index distribution produced comparable classification performance in three different clinical settings using five independent gene expression data sets. The signature molecules of SDN-based classifier for distinction of early from late clinical TNM stages were enriched in biological traits of protein synthesis, intracellular localization and ribosome biogenesis, which suggests that ribosome biogenesis represents a promising therapeutic target for treating ESCC. In addition, ITGB1 expression selected exclusively by integrative topological measures correlated with clinical stages and prognosis, which was further validated with two independent cohorts of ESCC samples. Thus the integrative topological analysis of PPI networks proposed in this study provides an alternative approach to identify potential biomarkers and therapeutic targets from MS/MS data with functional insights in ESCC.

ObjectivesThe strategies of repair of tetralogy of Fallot change with the age of patients. In children older than 4 years and adults, the optimal strategy may be to use different method of reconstruction of the right ventricular outflow tract from those followed in younger children, so as to avoid, or reduce, the pulmonary insufficiency that is increasingly known to compromise right ventricular function.MethodsFrom April, 2001, through May, 2008, we undertook complete repair in 312 patients, 180 male and 132 female, with a mean age of 11.3 years ±0.4 years, and a range from 4 to 48 years, with typical clinical and morphological features of tetralogy of Fallot, including 42 patients with the ventriculo-arterial connection of double outlet right ventricle. The operation was performed under moderate hypothermia using blood cardioplegia. The ventricular septal defect was closed with a Dacron patch. When it was considered necessary to resect the musculature within the right ventricular outflow tract, or perform pulmonary valvotomy, we sought to preserve the function of the pulmonary valve by protecting as far as possible the native leaflets, or creating a folded monocusp of autologous pericardium.ResultsThe repair was achieved completely through right atrium in 192, through the right ventricular outflow tract in 83, and through the right atrium, the outflow tract, and the pulmonary trunk in 36 patients. A transjunctional patch was inserted in 169 patients, non-valved in all but 9. There were no differences regarding the periods of aortic cross-clamping or cardiopulmonary bypass. Of the patients, 5 died (1.6%), with no influence noted for the transjunctional patch. Of those having a non-valved patch inserted, three-tenths had pulmonary regurgitation of various degree, while those having a valved patch had minimal pulmonary insufficiency and good right ventricular function postoperatively, this being maintained after follow-up of 8 to 24-months.ConclusionsBased on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.

The heat transfer at the metal-die interface is believed to have great influence on the solidification process and cast structure of the high-pressure die-casting (HPDC) process. The present article focused on the effects of process parameters, casting thickness, and alloys on the metal-die interfacial heat-transfer coefficient (IHTC) in the HPDC process. Experiment was carried out on a cold-chamber die-casting machine with two casting alloys AM50 and ADC12. A special casting, namely, “step-shape” casting, was used and cast against a H13 steel die. The IHTC was determined using an inverse approach based on the temperature measurements inside the die. Results show that the IHTC is different at different steps and changes as the solidification of the casting proceeds. Process parameters only influence the IHTC in its peak value, and for both AM50 and ADC12 alloys, a greater fast shot velocity leads to a greater IHTC peak value at steps 1 and 2. The initial die surface temperature has a more prominent influence on the IHTC peak values at the thicker steps, especially step 5. Results also show that a closer contact between the casting and die could be achieved when the casting alloy is ADC12 instead of AM50, which consequently leads to a higher IHTC.

This paper focuses on the determination of the heat flow density (HFD) and interfacial heat transfer coefficient (IHTC) during the high pressure die casting (HPDC) process of AM50 alloy. A specially designed “step shape” casting is used during the die casting experiment. Based on the temperature measurements inside the die, HFD and IHTC are successfully determined. Calculation results indicate that HFD and IHTC at the metal-die interface increases sharply right after the fast injection process until approaching their maximum values, and after that their values decrease to a much lower level until the dies are opened. Casting thickness has a great influence on both of the HFD and IHTC. Process parameters, such as the intensification pressure, the piston velocity, have little influences on HFD while on the other hand the die temperature has a great influence on the HFD. The IHTC seems to be independent upon all those process parameters so the IHTC peak values maintain at a particular level when the casting thickness is fixed.

The effect of a Pulsed Electro Magnetic Field (PEMF) on the solidification of an Al-15 wt%Cu alloy was studied in situ by synchrotron X-ray radiography. Samples were solidified with and without the presence of the PEMF while recording radiographs, enabling observation and quantification of dendrite fragmentation by image analysis. Fragmentation increased with a PEMF and was attributed to induced inter-dendritic flow. © (2013) Trans Tech Publications, Switzerland.

Background Functional tricuspid regurgitation (TR) occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6%) had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc.) and 40 patients (88.9%) had atrial fibrillation. Twenty-six patients (57.8%) were in New York Heart Association (NYHA) functional class III, and 19 (42.2%) in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%), 4 for bioprosthetic mitral valve replacement (8.9%), and 7 for tricuspid annuloplasty (15.6%). Results The tricuspid valves were repaired with Kay's (7 cases, 15.6%) or De Vega technique (4 cases, 8.9%). Tricuspid valve replacement was performed in 34 cases (75.6%). One patient (2.2%) died. Postoperative low cardiac output (LCO) occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P < 0. 05). Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.