OBJECTIVE:This study was aimed to assess mechanisms underlying continuous training induced atrial fibrillation (AF) in an animal model.METHODS:Healthy New Zealand rabbits were divided into three groups ( n=12 each): control group (C), moderate intensity group (M), and high intensity group (H). The intensity of continuous training was adjusted according to the treadmill speed. After 12 weeks of training, with a Langendorff perfusion system, AF was induced by S1S2 stimulation and the incidence was recorded. Changes in atrial kir2.1, kir2.2, type Ⅰ and Ⅲ collagen protein mRNA expressions were assessed by quantitative real-time PCR. Masson staining was used to assess the extracellular collagen volume fraction (CVF) .RESULTS:After 12 weeks, comparing with group C, groups M and H had greater ( P<0.05): CVF, incidence of AF ( P<0.05, also between Groups H and M), and atrial inward rectifier potassium current/channel (IK 1) . In Group H, kir2.1, kir2.2, type Ⅰ and Ⅲ collagen protein mRNA expressions in the left atrium were increased ( P<0.05, compared with Groups C and M).CONCLUSION:Long-term and high-intensity treadmill running could increase AF incidence in rabbits.

目的 阐明持续训练相关性心房颤动(AF)的机制,可能为制定新的治疗方法和选择训练方法提供信息.本研究旨在评估兔动物模型中持续训练诱发房颤的机制.方法 33只新西兰大耳兔随机分为三组(每组11只):对照组(Group C)、中强度耐力运动训练组(Group M)及高强度耐力运动训练组(Group H),于训练前、训练后8周、12周分别检测各组兔固有心率(IHR);全部训练结束后,各组随机各取6只,共18只兔采用离体心脏Langendorff系统进行1μm/L乙酰胆碱(Ach)+不同浓度阿托品溶液(0 mg/ml～0.002 mg/ml)灌注冠脉,在左心耳置入的电极分别记录相应的心房有效不应期(AERP)及90％动作电位时程(APD90);给予心房早搏程序刺激(S1S2)诱发房颤.灌流完后剪取兔左心房,经PT-PCR技术检测心房肌组织IKAch通道Kir3.1、Kir3.4的mRNA表达.取剩余各组5只实验兔,共15只运用全细胞膜片钳技术,记录心房肌细胞IKAch电流密度.结果 长期高强度的耐力运动训练16周后,Group H兔IHR明显低于其他两组;1μm/L Ach背景下,相同剂量阿托品作用下,随着运动强度的增加APD90、AERP相应缩短有统计学差异(Group H vs.Group C and M,P<0.001);同一组内,随着阿托品剂量的增加APD90、AERP相应延长,房颤发生率降低有统计学差异(P<0.05);Group H心房肌细胞IKAch电流密度高于其他两组(Group H vs.Group C、M,P<0.05),Group H心房组织Kir3.1、Kir3.4的mRNA表达量高于其他两组(Group H vs.Group C、M,P<0.05).结论长期的高强度耐力运动训练促进运动试验兔房颤发生.

BACKGROUND Few data were known on surgical management of intracardiac-extending in patients with intravenous leiomyomatosis (IVL). METHODS From June 2007 to December 2014, six women (mean age, 39.3 ± 7.5 years; range, 24-55 years) with intracardiac-extending IVL were treated surgically at our hospital. Data were obtained from medical and pathological records, including characteristics of patients, surgical management, and follow-up. RESULTS Surgery was performed successfully in all patients. Of 6 patients, 4 underwent one-stage operation and 2 underwent two-stage procedures. Circulatory arrest with hypothermia was used for a cardiotomy combined with venotomy in 5 patients. Complete resection was done in 5 patients. There were no perioperative deaths or complications in any of the patients. Hospital stay was 11.2 ± 2.9 days (range 7-15 days). All patients were followed-up for a mean of 41.0 ± 19.1 months (range, 17-69 months) after surgery. A recurrence of pelvic mass was found in 1 patient, but no symptoms or intravenous mass were reported. No obstruction occurred in any patient with a venotomy. CONCLUSION Surgery is a better therapy for IVL and complete removal has favorable outcomes.

不同国家、地区和组织，对老年的定义不同[1,2]，WHO定义年龄大于65岁即为老年。随着国家经济的发展，人们的寿命不断延长，心血管疾病的发病率也随之增加，而老年是心脏疾病的多发人群[3]，且手术治疗者日益增多。老年心脏疾病患者常合并高血压、高血脂、糖尿病等，手术风险和死亡率增高，术后并发症较多[4]。老年心脏疾病以冠状动脉病变居多，其次是主动脉瓣退行性病变，部分为两种病变同时存在。

Background: The study is inclined to investigate the antagonistic effects of endostatin-vascular endothelial growth inhibitor chimeric recombinant adenovirus (Ad-hENDO-VEGI) on homocysteine (Hcy)-induced vascular endothelial cells (VECs) injury in vitro and in vivo.Methods: Human VECs cell line ECV304 was selected and infected with Ad-hENDO-VEGI. The LDH leakage, SOD activity, and MDA levels were measured by the automatic biochemical analyzer. Cell survival rate was counted by Trypanblau dying. The TNF-alpha and MCP-1 protein expressions were detected by ELISA assay. The protein expressions of fusion protein of Ad-hENDO-VEGI, nuclear factor kappa B p65 (NF-kappa B p65), and NF-kappa B inhibitor alpha (I-kappa B-alpha) were detected by Western blotting. A rat model of hyper-homocysteinemia was constructed. Thirty-six Wistar rats were randomly divided into 3 groups: the control group, the model group, and the Ad-hENDO-VEGI group. Serum Hcy levels in rats were measured with enzymatic cycling method. Endothelial vasodilation function was evaluated with the treatment of sodium nitroprusside and acetylcholine.Results: After Ad-hENDO-VEGI infection, high expressions (41 kD) of fusion proteins in ECV304 cells were observed. The injury severity of Hcy on ECV304 cells had a dose-dependent manner, and the injury reached a steady stage at 1.0mmol/L. Thus, 1.0 mmol/L Hcy was selected for further experiments. With an increase of Ad-hENDO-VEGI in ECV304 cells after Hcy treatment, LDH leakage, MDA, TNF-alpha, MCP-1, and nuclear NF-kappa B p65 protein expression were gradually decreased, and cell survival rate, SOD activity, and I-kappa B-alpha protein expression were gradually increased. Compared with the control group, the model group had a higher Hcy level and attenuated vasodilator response. The Ad-hENDO-VEGI group exhibited a lower Hcy level and enhanced vasodilator response than the model group.Conclusion: These results indicated that Ad-hENDO-VEGI could down-regulate NF-kappa B p65 expression and suppress inflammatory response, thereby alleviating Hcy-induced VECs injury.

Objective To investigate the safety of early cardiac surgery under cardiopulmonary bypass (CPB) in patients with cardiogenic ischemic stroke.Methods The patients with non-coma cardiogenic ischemic stroke (n=26) were chosen from Jul. 2000 to Aug. 2015, and given cardiac valve replacement, ventricular aneurysmectomy or resection of cardiac myxoma under CPB within 1 m due to some early surgical indications such as malignant arrhythmia, uncontrolled heart failure by drugs, uncontrolled infection and repeated embolism. The types of primary cardiac diseases, surgical modes, surgical effects and follow-up results were recorded.Results Of 26 cases, 19 (73.1%) were male and aged from 32 to 67 (48.6±11.3). There were 14 patients with rheumatic heart disease, 7 with infective endocarditis, 3 with coronary heart disease complicating left ventricular aneurysm and 2 with left atrial myxoma. There were 14 cases undergone mitral valve replacement, 6 undergone aortic valve replacement, 1 undergone mitral valve and aortic double valve replacement, 3 undergone coronary artery bypass grafting and left ventricular aneurysmectomy and 2 undergone resection of left atrial myxoma. There were 26 cases cured and no one died. There were 3 cases with delayed analepsia, 4 with delayed extubation and 1 with second chest opening for stanching. During the follow up period from 3 m to 60 m (28.0±5.6), 1 case died of cerebral hemorrhage due to improper anticoagulation 2 m after cardiac valve replacement, and there was no one with relapse of stroke.Conclusion Cardiac surgery under CPB within 1 m is safe for patients with cardiogenic ischemic stroke complicating malignant arrhythmia, uncontrolled heart failure by drugs, uncontrolled infection and repeated embolism.

Coronary atherosclerotic heart disease (CHD) is the most common type of cardiovascular disease with increased incidence and serious damage to human life and health. Left main coronary artery lesions lead to severe ischemic symptoms, including ventricular fibrillation, cardiac shock, cardiac arrest, and even death. At present, two kinds of intervention such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) could be used for treatment. Comparison of their effects is still under investigation. 462 cases of patients who were diagnosed as left main coronary artery disease and received blood reconstruction surgery in our hospital between Jan 2009 and Dec 2012 were retrospectively analyzed. 270 cases were treated by PCI combined drug-coated stents, and 192 cases received CABG therapy. Parsonnet score and Karnofsky score were compared. Target lesion revascularization rate, incidence of myocardial infarction, adverse cerebrovascular events (MACCE), mortality, and curative effect were evaluated. No statistical difference was observed in Parsonnet score (P > 0.05). Follow-up analysis found PCI group has higher rate of target lesion revascularization, incidence of angina pectoris, incidence of MACCE than CABG group, whereas lower Karnofsky score (P < 0.05). Myocardial infarction and fatality rate were similar between two groups. In conclusion, our study showed that PCI and CABG showed similar curative effect for the treatment of left main coronary artery lesions, while CABG presented better long-term curative effect.

Objective To investigate the surgical method and curative effect of treating chronic sternum osteomyelitis after cardiac surgery with repairing transfer of pectoralis major muscle flap. Methods The patients with chronic sternum osteomyelitis after cardiac surgery (n=56) were chosen from Jan. 2008 to Aug. 2014, and among them 36 with simple sternum osteomyelitis, 11 with sternum osteomyelitis accompanied by costal chondritis and 9 with sternum osteomyelitis accompanied by suppurative infection in mediastinum. During the cardiac surgery, complete debridement and removing source of infection were carried out, and enough pectoralis major muscle flap was transferred to fill sternum defect. Negative pressure drainage was applied continuously and sensitive antibiotics were administered for preventing infection after cardiac surgery. The clinical efficacy was observed and followed up. Results All patients were followed up for 4 m to 12 m (averagely 8 m). There were 51 patients (91.1%) with phase I healing of incision, 3 (5.3%) with a few secretion at drainage outlet and healed after dressing changes for 1 w, and 2 (3.6%) with poor incision healing and cured after cardiac surgery again. There were no patients with incision re-infection, formation of chronic sinus tract and recrudescence of sternum osteomyelitis. All patients had normal functions of upper limbs. Conclusion The curative effect of repairing transfer of pectoralis major muscle flap is reliable in treatment of sternum osteomyelitis after cardiac surgery without more incisions, which is suitable for clinical application.

Objective To explore clinical outcomes of coronary artery bypass grafting ( CABG) using the radial artery grafts in patients over 70 years of age. Methods We retrospectively analyzed the data collected from 69 patients aged 70 years or older,who underwent primary isolated no emergent CABG between February 2010 and February 2015. Results The harvest time of radial artery was (24 ± 3. 8) minutes. No wound complication related to radial artery harvesting was observed. An average of (3. 06 ± 0. 67) grafts were performed per patient. The thoracic drainage within the first 24 hours after surgery was (596. 1 ± 213. 8)ml. The ventilation time was (6. 3 ± 3. 8) hours, ICU stay was (68. 6 ± 16. 9) hours and postoperative stay in hospital was (10. 8 ± 6. 3) days. The perioperative mortality was 1. 4%, and incidences of complications were atrial fi-brillation (26. 1%), cardiac insufficiency (14. 5%), renal insufficiency (7. 2%), and cerebrovascular accident (2. 9%) perioperative myocardial infarction (1. 4%). Follow-up period was 3-42 months, 2 patients died of stroke and lung tumor, 3 patients still suffered from angina pectoris,and turned for better after medication and interventional treatment. Conclusion The use of radial artery grafts for CABG in patients aged 70 years or older may produce satisfactory outcomes. It is of clinical value.

Objective To establish the animal model of exercise atrial fibrillation (AF) and review its results. Methods Healthy adult New Zealand rabbits (n=24) were divided into control group, mid-intensity group and high-intensity group (each n=8). The control group did not do any exercises and other groups did treadmill running with different intensity (for 1 h or one-time exhaustive exercise) for 5 d a week for 12 w. The size of atrium was detected by using echocardiogram before exercise and 8 w and 12 w after exercise. After exercise finished, Langendorff system is employed for isolated heart perfusion in all rabbits, and AF was induced by using S1S2 and induction rate of AF was recorded. Results Compared with control group, the left atrial anteroposterior diameter and right atrial anteroposterior diameter increased in mid-intensity group and high-intensity group after 8 w and after 12 w (all P<0.05). Compared with mid-intensity group, the left atrial anteroposterior diameter and right atrial anteroposterior diameter increased in high-intensity group after 8 w and after 12 w (all P<0.05). Compared with control group, the incidence of AF increased in mid-intensity group (45%vs. 60%) and high-intensity group (45%vs. 90%, all P<0.01). Conclusion Long-term and high-intensity treadmill running can enlarge atrial inner diameter and increase AF incidence in rabbits.

心源性缺血性卒中是指心脏内的脱落栓子（血栓、赘生物及肿瘤等）阻塞脑供血动脉，引起动脉管腔闭塞，导致相应供血区域脑组织发生缺血性坏死的脑血管疾病，是心脏疾病的严重并发症。在临床试验中，卒中的最新定义是要求症状持续24 h以上或在症状快速消失的患者中有急性临床相关脑损伤的影像表现[1]。

Objective To compare the effects of Kangsite Cardioplegic Solution (histidine-triptophan-ketoglutalate solution, HTK Solution) and Lenghanxue Cardioplegic Solution in myocardial protection during surgery in patients with severe valvular heart disease. Methods The patients (n=46) undergone open-heart surgery supported by cardiopulmonary bypass (CPB) and without active rheumatism and coagulation disorders were chosen from Mar. 2012 to Mar. 2014. All patients were divided into observation group and control group (each n=23), and observation group was given HTK Solution and control group, Lenghanxue Cardioplegic Solution. CPB time, aorta cross-clamping time, auto-rebeat rate, incidence of post-surgery arrhythmia, dosage of vasoactive drug, duration of mechanical ventilation time and ICU monitoring time were recorded in 2 groups. The levels of creatine kinase MB (CK-MB) and serum cardiac troponin T (cTnT) were detected respectively at different time points (before surgery, and 4 h, 12 h and 24 h after surgery). Results The difference in CPB time, aorta cross-clamping time, incidence of post-surgery arrhythmia, duration of mechanical ventilation time and ICU monitoring time had no statistical significance between 2 groups during surgery (all P>0.05). Compared with control group, auto-rebeat rate increased (54.17%vs. 79.17%) and dosage of dopamine decreased after surgery for 24 h [(6.6±2.3)μg/(kg·min) vs. (5.2±2.1)μg/(kg·min), all P<0.05] in observation group. Compared with control group, the level of CK-MB decreased after 4 h [(49.7±11.8) IU/L vs. (24.5±2.0) IU/L], 12 h [(83.9±18.3) IU/L vs. (31.1±2.6) IU/L] and 24 h [(62.4±12.5) IU/L vs. (32.4 ±3.3) IU/L, all P<0.05] in observation group. Compared with control group, the level of cTnT decreased after surgery for 4 h [(1.20±0.13)μg/L vs. (0.21±0.04)μg/L], 12 h [(2.35 ±0.64)μg/L vs. (1.22±0.59)μg/L] and 24 h [(1.75 ±0.24)μg/L vs. (0.76±0.41)μg/L, all P<0.05] in observation group. Conclusion The protective effect of HTK Solution on heart function is better than that of Lenghanxue Cardioplegic Solution during surgery in patients with severe valvular heart disease.

心房颤动（房颤）是临床上最常见、最难以治疗的心律失常，也是心血管疾病死亡的重要原因。随着我国老龄化社会的到来，心电监测水平的提高，房颤的患病率不断增加。目前有大量关于房颤病理改变的研究，而其机制尚不明确。房颤模型的建立，为房颤机制的研究奠定基础。

胸骨正中切口是心脏手术最常用的手术入路，因为暴露充分，容易操作而被广泛应用，但术后出现深部胸骨切口感染，治疗非常困难，虽然发生率不高，一旦发生死亡率极高，给患者生理上和心理上带来极大的痛苦，增加患者的经济负担，延长住院时间。根据大量的文献报道，心脏外科术后深部切口感染的发生率0.4%~5.0%，深部胸骨切口感染是心脏外科术后非常严重的并发症，可以引起胸骨哆开，体温升高，败血症，大出血等，死亡率可以达到19%~29%[1]。因此对深部胸骨切口感染应予以高度重视。本文对可能引起胸骨切口感染的原因，临床诊断及目前的治疗方法予以阐述。

1病例资料男,52岁,体重72 kg。主因发热原因待查收入院。因胸主动脉假性动脉瘤于一年前在当地医院行人工血管置换术,术中病理证实为感染性动脉瘤,术后1个月开始出现间断发热,为弛张热型,体温波动范围38.5~40.0℃,曾到多家医院救治未见明显好转,因发热原因待查入住我院。入院查体：体温39.5℃,血压135/78 mmHg,面部皮肤潮红,浅表淋巴结无增大,左下肺可闻及少量湿啰音,心脏听诊未见异常,腹软,肝肋下未触及,脾区有轻度压痛,肠鸣音3~5/ min,双下肢无浮肿。血常规及生化检查：白细胞22×109/ L,中性粒细胞百分比81℅,C-反应蛋白58 mg/ L,血沉69 mm/ h,谷丙转氨酶78 U/ L,尿素氮7.5 g/ L,肌酐56 g/ L,白蛋白35 g/ L。血培养结果为沙门菌和真菌感染。 CT 检查示胸主动脉人工血管周围有少量气体(图1)、右下肺叶感染及脾脓肿。在CT 引导下行脾穿刺(图2),引流出黄褐色黏稠脓液60 ml,有腥臭味,经穿刺部位放置引流管。食管造影检查提示食管瘘,瘘口位于食管中下段,少量造影剂渗入纵隔(图3)。在 X 线透视引导下放置空肠管至空肠,并经食管瘘口及瘘管放置引流管,行 CT 检查证实经食管瘘口引流管远端位于胸主动脉人工血管周围。同时给予禁食水,胃肠减压、空肠营养支持(肠内营养乳剂 TP,每日能量约1800 kcal)、强力抗感染(注射用头孢唑啉钠2.0 g 静脉滴注3/ d,氟康唑注射液400 mg 静脉滴注1/ d)及纠正水电解质紊乱。经食管瘘口引流管注入庆大霉素8 U 和甲硝唑注射液5 ml,2/ d。并根据病情输血、血浆及白蛋白,保证营养、增强自身抵抗力、促进瘘口愈合。治疗1周后体温恢复正常。1个月后,复查血培养结果阴性,抗生素改用口服(乳酸左氧氟沙星0.6 g,1/ d)。3个月后复查CT 胸主动脉人工血管周围腔隙消失,脾脓肿及左下叶肺炎明显好转。拔除经食管瘘口及脾穿刺引流管。5个月后复查食管造影提示食管内壁光滑,未见瘘口及瘘管(图4)。出院后3个月,复查食管造影及 CT检查未见异常。

Objective To observe the clinical efficacy of coronary artery bypass grafting (CABG) in aged patients over 80 with coronary heart disease (CHD).Methods The patients (n=60, male 53 and female 7, average age=82.65±2.27) with CABG were chosen from Oct. 2001 to Oct. 2013. Among them, there were 5 with emergency CABG, 6 with on-pump CABG, and 54 with off-pump CABG. The number of coronary bypass, respirator supporting time during perioperative period, hospitalization time, incidence of vital organs complications and short-term incidences of myocardial ischemia events were recorded.Results The average number of bypass was (3.13± 0.24), respirator supporting time after CABG was (10.11±4.37) h, average hospitalization time was (11.36±4.51) d. The perioperative mortality was 5%, and incidences of complications were, in a descending order, pleural effusion (48.3%), hyoxemia and hypercapnia (30.0%), atrial fibrillation (26.7%), renal insufficiency (23.3%) and low cardiac output syndrome (5.0%). All patients were followed up for 3 m after discharged from hospital and there were no myocardial ischemia events found.Conclusion With sufficient preoperative preparation, review and management, CABG will get good results in aged patients over 80.

<正>随着社会的老龄化,退行性病变二尖瓣返流(DMR)已经成为目前最常见的瓣膜性心脏疾病。有症状的严重DMR应当尽早接受外科手术,已经是大家的共识;但由于缺乏随机对照的临床试验,对于无症状严重DMR患者的最佳治疗措施争议还比较大,主张手术者建议早期进行预防

Objective To study the protective effect of histidine-tryptophan-ketoglutarate(HTK) solution on myocardium in the elderly patients during open-heart surgery.Methods The patients(n=40) having open-heart surgery of cardiac pulmonary bypass(CPB) were randomly divided into group A and group B(each n=20).After aortic clamping,group A was given HTK solution(4℃) and group B,cold crystalloid blood cardioplegia(4:1,4℃).The concentration of cTnI and CK-MB was detected in two groups respectively after aortic opening for 12 hours and 24 hours.The time of CPB and aortic clamping,mechanical time,rate of spontaneous cardiac rhythm,incidence of arrhythmia,dosage of positive inotropic drugs and ICU time were compared between two groups.Results There was no statistical difference in average CPB time,aortic clamping time,mechanical time and incidence of arrhythmia between two groups(P>0.05),but in rate of spontaneous cardiac rhythm,dosage of dopamine,ICU time and concentration of cTnI and CK-MB at two time points,group A was significantly superior to group B(P<0.05).Conclusion HTK solution is superior to cold crystalloid blood cardioplegia(4:1) in protecting myocardium in the elderly patients during open-heart surgery,especially in older ones with more complicated condition.

<正>随着人们生活方式的改变和人口的老龄化,主动脉瓣硬化、钙化与狭窄的发病率日益增高。研究显示,年龄大于65岁的人群中1/4存在主动脉瓣硬化[1],而其中约1/6主动脉瓣硬化将发展成主动脉瓣狭窄(aortic stenosis,AS)[2],而半数轻-中度AS患者将会发展为血流动力学异常的重度主动脉瓣狭窄(symptomatic severe aortic stenosis,SAS)[3]。有症状的AS患者预后比较差,易发生意外心脏事件,主动脉瓣置换术(aortic valve replacement,AVR)是公认的最有效

Objective To compare the short-term and mid-term curative effects between endoscopic saphenous vein harvesting(EVH) and direct-vision open saphenous vein harvesting(OVH) during coronary artery bypass grafting(CABG).Methods The CHD patients(n=268) with CABG and whole follow-up materials were chosen from Apr.2005 to Jan.2010,and then divided into EVH group(n=129) and OVH group(n=139).The patency rate of saphenous vein was compared and analyzed by using 64-MSCT respectively after the operation for three months,one year and three years.Results There was no statistical difference in patency rate of saphenous vein between two groups respectively after the operation for three months,one year and three years(88.0%vs.85.6%,78.9%vs.79.9% and 72.2%vs.71.8%,P<0.05),while the harvesting time was longer [(50.23±5.87) min vs.(38.65±7.96) min] and damaged veins were more [(1.51±0.19)vs.(0.84±0.04)] in EVH group(P<0.05).Conclusion EVH and OVH have similar short-term in mid-term patency rates of saphenous vein,but EVH has longer harvesting time and more damaged veins.