Polystyrene microplastics (PSMPs) are some of the most common microplastic components, and the resulting pollution has become a global problem. Extensive studies have been conducted on the toxic effects of PSMPs on the heart, lungs, liver, kidneys, nerves, intestines and other tissues. However, the impact of PSMPs on vascular toxicity is poorly understood at present. The aim of this study was to reveal the vascular toxicity of microplastics (MPs). Patients were assigned to a calcification group (25 patients) or a non-calcification group (22 patients) based on the presence or absence of calcification in the thoracic aorta wall. We detected 7 polymer types in human feces. Patients with vascular calcification (VC) had higher levels of total MPs, polypropylene (PP) and polystyrene (PS) in feces than patients without VC. The thoracic aortic calcification score was significantly positively correlated with the total MP abundance (Spearman r = 0.8109, p < 0.0001), PP (Spearman r = 0.7211, p = 0.0160) and PS (Spearman r = 0.6523, p = 0.0471) in feces. We then explored the effects of PSMP exposure on normal and vitamin D3 + nicotine (VDN)-treated rats. PSMP exposure induced mild VC in normal rats and aggravated VC in VDN-treated rats. PSMP exposure disturbed the gut microbiota, causing Proteobacteria and Escherichia_Shigella to be the dominant phylum and genus, respectively. It also induced intestinal inflammatory responses in normal rats, aggravated intestinal inflammation in VDN-treated rats, impaired the intestinal mucosal barrier, and increased intestinal permeability. This study provides a theoretical basis for the risk assessment of MP-induced cardiovascular disease.

目的 分析偏头痛患者采用经颅多普勒(TCD)发泡试验筛查卵圆孔未闭(PFO)的价值以及封堵PFO后的疗效.方法 选取100例偏头痛患者作为观察组,另选同期100例体检健康者作为对照组,两组均给予TCD发泡试验,观察组行食道超声心电图(TEE)检查、头部CT检查确诊,对确诊为PFO且愿意接受封堵治疗的患者行经皮穿刺介入封堵治疗.比较两组TCD发泡试验结果;分析观察组确诊PFO合伴偏头痛患者封堵PFO的治疗结果;比较行封堵PFO患者手术前后视觉模拟评分法(VAS)评分.结果 观察组中,49例(49.00％)TCD发泡试验显示心脏存在右向左分流,经TEE检查证实存在PFO;对照组中,6例(6.00％)存在PFO,均为小量分流.观察组PFO发生率高于对照组,差异具有统计学意义(P<0.05).观察组确诊的49例PFO合伴偏头痛患者中,30例接受了介入封堵治疗,包括19例先兆偏头痛(MA)、11例非先兆偏头痛(MO),手术均成功.其中20例患者术后偏头痛症状消失;8例明显改善;术后随访3个月,2例患者行TCD发泡试验仍伴有右向左分流,临床症状有所减轻,其中1例只是在Valsalva动作后出现症状,1例患者术前后均为Ⅳ级,所有患者行头部CT复查,未见梗死病灶.行封堵PFO的30例患者术后VAS评分显著低于术前,差异具有统计学意义(P<0.05).结论 TCD发泡试验在偏头痛患者PFO的筛查中有非常重要的诊断价值,对PFO合并偏头痛患者的治疗中选择PFO封堵治疗,可明显改善患者的临床症状.

目的 观察磷酸肌酸钠联合尼可地尔治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效.方法 选择医院2014年5月至2017年5月收治的STEMI患者91例,随机分为对照组(45例)和治疗组(46例).两组患者均于行经皮冠状动脉介入(PCI)手术后给予常规治疗,对照组患者给予尼可地尔治疗,治疗组患者给予磷酸肌酸钠联合尼可地尔治疗,两组均连续治疗14 d.结果 治疗组总有效率为95.65%,明显高于对照组的82.22%(χ2=4.194,P=0.041);治疗后,两组患者心脏指数(CI)、左心室射血分数(LVEF)均增大,室壁运动积分指数(WMSI)均减小,且治疗组变化均明显优于对照组(P<0.05);治疗后,两组患者血清肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(cTnI)、基质金属蛋白酶-9(MMP-9)、脑钠肽(BNP)水平均降低,超氧化物歧化酶(SOD)水平均升高,且治疗组变化均明显优于对照组(P<0.05).结论 磷酸肌酸钠联合尼可地尔治疗STEMI的临床疗效显著,能明显减轻心功能损伤,促进心功能恢复,且安全性较好,值得临床推广.

Objective To investigate the expression serum type B natriuretic peptide(BNP),vascular endotheli-al growth factor (VEGF) and transforming growth factor-β 1(TGF-β 1) levels in patients with congenital heart disease complicated with pulmonary hypertension and its clinical significance.Methods A total of 86 patients with left to right shunt congenital heart disease,who were treated in Shenzhen People's Hospital from January 2014 to June 2017,were se-lected as the study group and according to the pulmonary artery systolic pressure(PASP)divided into the group A(PASP<30 mmHg,n=20),group B(30 mmHg≤PASP<50 mmHg,n=42),group C(PASP≥50 mmHg,n=24).Another 80 healthy people in the same period were selected as the control group.The levels of serum BNP,VEGF and TGF-β1between the study group and the control group and different PASP groups were compared,and the correlation between them and PASP was analyzed.Results The serum levels of BNP,VEGF and TGF-β1in the study group were(236.76±75.43)pg/mL, (403.32 ± 89.87) pg/mL, (837.53 ± 102.25) pg/mL, respectively, which were significantly higher than corresponding (88.36±26.73)pg/mL,(86.73±22.45)pg/mL,(128.81±32.13)pg/mL in the control group(P<0.05).With the increase of PASP,the serum levels of BNP,VEGF and TGF-β1increased,and the levels of serum BNP,VEGF and TGF-β1in pa-tients with different PASP groups were statistically different(P<0.05).Pearson correlation analysis showed that the lev-els of serum BNP, VEGF and TGF-β 1were positively correlated with PASP in patients with congenital heart disease complicated with pulmonary hypertension(r=0.684,0.572,0.521,all P<0.05),and the serum BNP,VEGF were positive-ly correlated with TGF-β1in patients with congenital heart disease complicated with pulmonary hypertension(r=0.512, 0.554,all P<0.05).Conclusion The serum levels of BNP,VEGF and TGF-β1are increased in left to right shunt con-genital heart disease,and the three of them are positively correlated with PASP.

Objective To investigate the correlation between left atrial diameter (LAD), serum uric acid (UA) level and atrial fibrillation (AF). Methods 239 patients with AF (case group) and 60 patients without AF (control group) were recruited from Jan 2016 to Jun 2016 in department of cardiology, Shenzhen People's Hospital. The medical records and laboratory results were collected. The left ventricular end systolic LAD, left ventricular end diastolic diameter (LVDD) and left ventricular ejection fraction (LVEF) were measured by using an ultrasonic diagnostic instrument. Logistic regression was used to analyze the risk factors of atrial fibrillation. Results The TC, TG and LEVF of the patients in the case group were significantly lower than those in the control group (all P<0.05). The UA and LAD in the case group were significantly higher than those in the control group (all P<0.05). Logistic regression analysis showed that age, UA and LAD were risk factors of atrial fibrillation. The levels of UA and LAD in patients with paroxysmal AF and persistent AF were significantly higher than those in control group (all P<0.05), and the levels of UA and LAD in patients with persistent AF were higher than those with paroxysmal AF (all P<0.05). Conclusion Left atrial diameter and serum uric acid level are independent risk factors of atrial fibrillation, and may be related to the progress of atrial fibrillation, the mechanism needs to be further studied and confirmed.

Objective To investigate the effects of left atrial appendage occlusion on cardiac function and neuroendocrine function in patients with nonvalvular atrial fibrillation. Methods Thirty patients with nonvalvular atrial fibrillation,who were treated by left atrial appendage occlusion in the Department of Cardiology,Renmin Hospital of Wuhan University and Department of Cardiology,Shenzhen Municipal People's Hospital between September 2015 and April 2016,were included in the study. The operation and complications were recorded. The transthoracic echocardiography (TTE) was performed at baseline and at 1 d,1 month and 6 months after the operation. The left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD),left ventricular end diastolic volume (LVEDV),and left ventricular ejection fraction(LVEF)at different time points were compared. The levels of plasma endothelin 1(ET-1),tumor necrosis factor α(TNF-α)and N-terminal pro-brain nitric peptide(NT-proBNP)were examined at baseline and at 1 d,1 month and 6 months after the operation. Results Thirty patients successfully underwent the left atrial appendage occlusion,and no serious complications occurred. There were left atrial appendage and left atrial residual shunt in 12 cases,and no residual shunt in 18 cases at the end of operation. There were no statistically significant differences in the levels of LAD,LVEDD,LVEDV and LVEF at baseline and at 1 d,1 month and 6 months after the operation(all P>0.05). The levels of plasma ET-1,TNF-αand NT-proBNP at 1 d,1 month and 6 months after the operation were significantly decreased as compared with those at baseline (all P<0.05). Conclusion The success rate of left atrial appendage occlusion is high in the treatment of nonvalvular atrial fibrillation,which shows no significant effect on cardiac function,and can significantly reduce the related plasma indicators of neuroendocrine.

目的:探讨细小型成年动脉导管未闭(PDA)患者的造影、介入治疗特点,观察应用室间隔缺损(VSD)封堵器关闭此类动脉导管未闭的疗效、安全性和意义.方法:选择成年PDA患者25例,造影观察PDA的形态、大小,将其分为长管型10例(A组),迂曲不规则型9例(B组),动脉瘤型6例(C组).UCG显示直径1.2～2.8 mm,造影显示最小直径1.2 mm,最大直径4.3 mm.PDA长度7.9～11.9 mm,平均(9.9±1.3)mm.结果:选择对称型室间隔封堵器和肌部室间隔封堵器进行介入封堵治疗,治疗前后肺动脉压力无明显差异,但造影与TTE测量最窄处直径差异有统计学意义(P＜0.05).总体成功率100％.随访无明显降主动脉缩窄、左肺动脉狭窄及其他并发症.结论:室间隔封堵器关闭细小型PDA疗效肯定、安全.

目的对比急性心肌梗死患者静脉溶栓后介入治疗与直接介入治疗的临床疗效。方法选取2011年1月至2012年12月期间因为急性心肌梗死来我院接受治疗的48例患者为研究对象,将其随机分为两组,观察组24例采用静脉溶栓后介入治疗,对照组24例直接介人治疗,分析两组患者的临床治疗效果。结果对照组心电图检测ST段下移率为87.5%,胸痛明显缓解率为41.7%;观察组心电图检测ST段下移率为79.2%,胸痛明显缓解率为45.8%,两组患者治疗效果差异明显,P<0.05,有统计学意义。结论静脉溶栓介入治疗比直接介入治疗疗效明显,且安全性高,值得临床推广研究。

Objectives To evaluate the efficacy and safety of using 3-dimensional electroanatomical mapping system(Carto mapping system and Ensite mapping system)in radiofrequency catheter ablation(RFCA)in children with arrhythmia.Methods Twenty-two children with arrhythmia,including 9 cases of atrial tachyarrhythmia(AT),4 cases of atriobentricular reentrant tachycardia(AVRT),5 cases of premature ventricular contraction(PVC),and 4 cases of idiopathic ventricular tachycardia(IVT),underwent RFCA,which were guided by Carto mapping system or Ensite mapping system(Ensite Array and Ensite NavX).Results Under the guidance of 3-dimensional electroanato-mical mapping system,the ablation site were accurately identified in all cases.There were no serious complications during and after operation.After RFCA,no cases can be irritated again.All cases were followed up for 6 to 24 months.Only one case of AT in Ensite Array had a recurrence,which can be controlled by antiarrhythic drugs.Conclusions RFCA guided by Carto mapping system or Ensite mapping system in children with arrhythmia is efficacious and safe,especially suitable for complicated,untolerated,nonsustained arrhythmias.

Objective To evaluate the intermedim effectiveness of interventional therapy using domestic occluder to perimembranous ventricular septal defect with pseudoaneurysm. Materials and Methods The ventricular septal defects with aneurysems were measured by left ventriculography among 68 patients. The diameter of the occluders ranged fron 4-14 mm. Transthroacic echocardiograohy (TTE),chest X-ray film and electrocardiogram (ECG) were performed 24h, 3,6,12 and 24 months later. Results Among the 68 pations, transcatheter closures were successfully conducted to 62 patients,the success rate was 91.2%. Residual shunt was found by transthroacic echocardiograohy (TTE) in 8 patients 24 hours later and disappeared in 12 months. Transient block in 9 patients disappeared 3 months later. No cases were found delayed arrthmia. Conclusion Domestic occluder for interventional therapy to perimembranous ventricular septal defect with pseudoaneurysm was safe, effective and has fewer complications. But we still should give follow-up studies.

Objective To investigate the cause of T-wave altemans in pediatric patients, and prevent malignant ventricular arrhythmia and sudden cardiac death. Methods We retrospectively analyzed the treating process of 6 pediatric patients with T-wave alternans. Case 1 was a child with acute serious myocarditis. Case 2 was a child with idiopathic left ventricular tachycardia, and had acquired long-QT syndrome after treated with large dose of amiodarone for a long time by unclear diagnosis. Case 3 had congenital long-QT syndrome. Case 4 was a child with myocardial infarction after correction of coarctation of aorta for 5 months. Case 5 and case 6 were children who hade increasing heart rate with severe congenital stenosis of aortic valve. Results All of 6 cases occurred T-wave altemans, and 5 of them occurred malignant ventricular arrhythmia instantly or after several hours. In 2 cases, T-wave altemans disappeared and malignant ventricular arrhythmia did not occurred through prevention and treatment. The other 4 cases died without active prevention for malignant ventricular arrhythmia. Conclusion T-wave alternans is presymptom of malignant ventricular arrhythmia and sudden cardiac death. We should take notice of occurrence of malignant ventricular arrhythmia in pediatric patients with T-wave altemans and diagnosing and treating correctly for primary disease. It is of great importance to prevent occurrence of T-wave altemans.

OBJECTIVETo explore safety, indications and advantages of mapping and ablation of arrhythmia in children guided by Carto and Ensite system.METHODSGuided by Carto system, radiofrequency catheter ablation (RFCA) was performed on 8 pediatric patients with tachycardia whose mean age was (6.2 + or - 1.7) years, mean weight was (18.0 + or - 2.0) kg. Guided by Ensite system, RFCA was performed on 10 pediatric patients with arrhythmia, 8 of them were ablated guided by Ensite Array system: 6 cases with premature ventricular contractions (PVCs), 2 cases with right atrial tachycardia, their mean age was (11.3 + or - 1.2) years, and mean weight (40.0 + or - 5.0) kg. The other two cases with W-P-W syndrome were ablated guided by Ensite Navx system.RESULTGuided by Carto system, 8 cases were successfully mapped and ablated: 6 cases had incision atrial tachycardia, 1 case had left atrial tachycardia and 1 case had right atrial tachycardia. In 1 case with incision atrial tachycardia the condition recurred after 3 months, and was ablated again successfully. Guided by Ensite Array system, 6 cases with PVCs (in 2 originating from the right ventricular inflow tract and in 4 originating from the right ventricular outflow tract) and 2 cases with right atrial tachycardia were successfully mapped and ablated, PVCs of the first 6 cases were reduced from (32 333 + or - 4509) 24 h to (0-4)/24 h after ablation. In 1 case with automatic atrial tachycardia, mapping could not be done by Ensite Array system, because P wave could not be identified from T wave. Single bolus of adenosine 20 mg was given within 30 s to let ventricles stop for 2 s (cardio-ventricular pacing standby) until T wave vanished, mapping and ablation were operated again successfully, but another atrial tachycardia occurred 1 day later. Guided by Ensite Navx system, 2 cases with W-P-W syndrome were successfully ablated, operation under X-rays lasted for 8 and 10 min. In none of the 9 patients the disease recurred after follow-up for 6 months.CONCLUSIONCarto system is suitable for mapping and ablation in pediatric patients with continuous tachycardia, especially with incision atrial tachycardia; Ensite Array system fits children older than 10 years with right heart discontinuous arrhythmia; and Ensite NavX system can set up model and display endocardial anatomic structure quickly. Compared with two-dimensional mapping system, the three-dimensional mapping system (Carto and Ensite) can display the origin of arrhythmia and activation sequence clearly, decrease difficulty of operation efficiently and diminish operation time under X-ray.