Abstract:With the development of science and technology, there are many new developments in the field of cardiovascular surgery. The section of cardiovascular surgery in this issue focuses on the new methods of cardiovascular surgery, factors affecting cardiovascular surgery outcome, perioperative cardiovascular protection and changes in lipoproteins’ function of cardiovascular diseases.

Abstract:Aim To investigate the risk factors and prognosis of decreased left ventricular ejection fraction (LVEF) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) in left anterior descending artery (LAD) myocardial infarction group (LAD MI group) (LAD or left main artery as culprit vessel) and non-LAD myocardial infarction group (non-LAD MI group) (circumflex or right coronary artery as culprit vessel). Methods 1246 STEMI patients who received emergency PCI in intensive care unit of the Second Affiliated Hospital of Harbin Medical University from January 2017 to December 2018 were selected. Baseline data, past history, laboratory results, coronary angiography results, major adverse cardiac and cerebrovascular event (MACCE) and LVEF measured within 3 days after PCI were recorded. According to the results of angiography, the patients were divided into LAD MI group and non-LAD MI group, and the two groups were separately divided into two subgroups:low LVEF (LVEF＜50%) group and normal LVEF (LVEF≥50%) group. The risk factors and short-term clinical prognosis of LAD MI group and non-LAD MI group were analyzed. Results Multivariate Logistic regression analysis showed that age (OR＝1.024), chest pain time (OR＝1.122), troponin peak (OR＝1.001), high-sensitivity C-reactive protein (hs-CRP) (OR＝1.048), prior myocardial infarction (OR＝2.404), proximal lesion (OR＝1.564) and application of intra-aortic balloon pump (OR＝3.638) were risk factors for reduced LVEF after PCI in LAD MI group. However, in non-LAD MI group, admission heart rate (OR＝1.017), troponin peak (OR＝1.004), uric acid (OR＝1.003), hs-CRP (OR＝1.101), number of disease vessels (OR＝1.786), prior myocardial infarction (OR＝3.025) and preoperative TIMI flow grade 0/1 (OR＝3.237) were risk factors for reduced LVEF after PCI. In the LAD MI group, the incidences of heart failure and cardiogenic shock during hospitalization in patients with reduced LVEF were significantly higher than those in patients with normal LVEF. In the non-LAD MI group, the incidences of heart failure, cardiogenic shock, malignant arrhythmia and mortality rate during hospitalization in patients with reduced LVEF were significantly higher than those in patients with normal LVEF. Conclusions The risk factors of low LVEF after PCI in patients with LAD MI are significantly different from those in patients with non-LAD MI. Patients with low LVEF have worse short-term clinical prognosis and higher incidence of MACCE in hospital after PCI.

Abstract:Aim To investigate the feasibility and effectiveness of 3D printing and extracorporeal membrane oxygenation assistant in transcatheter aortic valve replacement (TAVR) of severe aortic stenosis patients. Methods From November 2018 to May 9,0 patients with severe aortic stenosis underwent transcatheter aortic valve replacement assisted by ECMO in Xijing Hospital of Air Force Military Medical University. The preoperative left ventricular ejection fraction (LVEF) was (30.3%±10.5%). The preoperative cardiac function grade of all patients was Ⅳ grade(NYHA). Before operation, CT data of all patients were collected and reconstructed. Their cardiovascular models were made by using 3D printing technology. All preoperative evaluation, operation scheme determination and preoperative conversation were done with 3D printing models. Results All the 10 patients received TAVR successfully. The hemodynamic indexes were stable in the perioperative period. The operation time was (192.5±30.3) min, and the DSA irradiation time was (40.5±3.2) min. The ECMO assistant time was (60.5±23.9) min. The echocardiography showed the heart function was improved. The LVEF was (48.5%±4.3%). Conclusion It is very difficult for patients with very high-risk aortic stenosis to be treated with TAVR. 3D printing technology can provide doctors and nurses an intuitive model, assist doctors-patient communication and preoperative evaluation. ECMO can ensure the perioperative hemodynamic stability of patients and provide effective cardiopulmonary function support, thus to improve the success rate of TAVR.

Abstract:Aim This study analyzed the relationship between the concentration of circulating microparticles (MPs) with different diameters and the application of positive inotropic drugs in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). It aims to find out the effects of MPs on the postoperative cardiac function. Methods 103 patients undergoing cardiac surgery with CPB were enrolled. Age and gender matched 56 healthy subjects were recruited as control group. The blood was collected from healthy subjects and patients before (pre-op) and after operation 12 h (post-op 12 h) and 72 h (post-op 72 h). The MPs were isolated by differential centrifugation. The concentration and size distribution of MPs were detected by nanoparticle tracking analysis system. MPs were divided into different subgroups according to the size of MPs. The clinical data were collected and the correlation analysis was performed between the MPs and the clinical data. Results The level of MPs was increased in patients before and after surgery compared with healthy subjects (P＜0.05). There was no significant difference of the concentration of MPs in the surgery group among the different time points (pre-op, post-op 12 h and post-op 72 h). The MPs were divided into four groups according to the diameter (0~100 nm, 100~200 nm, 200~300 nm and 300~400 nm). The levels of “100~200 nm” MPs were decreased in post-op 12 h and post-op 72 h groups compared with pre-op group, but the levels of “200~300 nm” MPs were increased after operation(P＜0.05). In post-op 12 h group, the concentration of “0~100 nm” MPs was negatively correlated with N terminal pro B type natriuretic peptide (NT-proBNP), dopamine, norepinephrine and milrinone and the level of “200~300 nm” MPs was positively correlated with NT-proBNP (P＜0.05). In post-op 72 h group, the level of “0~100 nm” MPs was negatively correlated with NT-proBNP (P＜0.05) and the concentration of “200~300 nm” MPs was negatively correlated with dobutamine (P＜0.05). Conclusions After CPB assisted cardiac surgery, MPs with different particle size range was correlated with postoperative positive inotropic drug dosage, suggesting that there was a certain relationship between MPs and postoperative cardiac function. The concentration of MPs in different size may be used to reflect the cardiac function after CPB.

Abstract:Aim To analyze the related factors affecting the short-term prognosis of coronary artery bypass grafting (CABG) in patients with coronary heart disease, in order to provide some basis for improving the effect of CABG.Methods The clinical data of 65 patients who underwent the first CABG operation in the department of cardiac surgery of Guangdong Provincial People's Hospital were collected from June to December 2019. The preoperative, intraoperative and postoperative clinical indicators and surgical effects of the included patients were compared, and the related factors that may affect the result of CABG were screened out. Results 55 patients underwent extracorporeal circulation CABG and 10 patients underwent off-pump CABG (OPCABG). High age led to the increase of abnormal (death and automatic) discharge rate after CABG (P＝0.024); OPCABG (P＝0.009) and high professional doctor (P＝0.027) could reduce postoperative hospital stay; Simultaneous treatment of heart valves might increase the incidence of postoperative complications (P＝0.012); Smoking could slow down the recovery of cardiac function (P＝0.017). The time of cardiopulmonary bypass was positively correlated with the time of intensive care unit (r＝0.621, P＜0.001). Among the 65 patients, 1 died in hospital, with a mortality rate of 1.54%. Conclusion Age, OPCABG, simultaneous valve management, smoking, operation by senior doctor, preoperative high density lipoprotein level and cardiopulmonary bypass time are the factors influencing the short-term prognosis of CABG in patients with coronary heart disease.

Abstract:The composition of high density lipoprotein (HDL) is complex and its function is prone to change. Normal HDL is a protective lipoprotein, which can protect cardiovascular function. However, recent studies have found that HDL composition and function change not only in coronary heart disease, heart valve disease, aneurysm, heart failure, heart transplantation and other cardiovascular diseases, but also in the cardiovascular perioperative period. The HDL proinflammatory index in normal people is very low, but it becomes very high under the condition of cardiovascular disease, which impairs vascular endothelial function and affects the stability of hemodynamics after cardiac surgery. Apolipoprotein A-Ⅰ mimetic peptide and simvastatin can partially improve HDL function. Therefore, how to improve the function of HDL, and restore its protective cardiovascular effect to prevent cardiovascular diseases and enhance cardiovascular protection in perioperative period need to be studied in the future.

Abstract:Aim To extract and purify Cordyceps militaris polysaccharides (CMPS), analyze its molecular weight distribution and preliminarily explore its mechanism of cholesterol lowering. Methods CMPS was separated by hot water extraction and alcohol precipitation, and purified by sevage reagent and AB-8 macroporous adsorption resin. The molecular weight distribution of CMPS was determined by high-performance gel permeation chromatography. Then, the ability of CMPS to bind cholic acid salt was measured in a simulated gastrointestinal environment. Meanwhile, HepG2 cells were cultured and the effect of CMPS on proliferation rate and total cholesterol (TC) level was observed in HepG2 cells. The protein expressions of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA-R) and sterol regulatory element binding protein-2 (SREBP-2) in hepatocytes were analyzed by Western blot. Results The content of polysaccharides with molecular weight of 3 119 kDa in CMPS was the most, followed by 649 kDa and 20 kDa. The binding ability of CMPS to cholic acid salt was strong, and the binding rates of CMPS to sodium cholate, sodium taurocholate and sodium glycine cholate were respectively 63%, 62% and 50%. Cell culture showed CMPS concentration lower than 200 mg/L did not inhibit the growth of HepG2 cells after treatment for 24 hours. CMPS significantly down-regulated the protein expressions of HMG-CoA-R and SREBP-2 and decreased TC level in hepatocytes. Conclusion CMPS has the potential to lower cholesterol level.

Abstract:Aim To identify functional gene modules related to atherosclerosis (As) with diabetes by weighted gene co-expression network analysis (WGCNA). Methods GSE23304 data set containing 101 samples of atherosclerotic peripheral plaques (25 of them had diabetes) was downloaded from the gene expression omnibus (GEO), then the gene expression profile was correlated with phenotypic data and analyzed by WGCNA. According to the correlation coefficient size, the study identified the module which phenotype is the most highly associated with atherosclerosis, with functional annotation (GO) of the genes in the module, and then used STRING for protein interaction network analysis. Results 33 modules were obtained by WGCNA analysis, of which the Darkturquoise module identified by atherosclerosis is the most relevant to diabetes, and Darkturquoise is considered to be a key gene module for diabetes in atherosclerosis. Conclusion The atherosclerosis key gene module identified by WGCNA analysis may play an important role in diabetes.

Abstract:Aim To investigate the effect and mechanism of miR-376b-3p on proliferation and apoptosis of hypoxia reoxygenation (H/R) cardiomyocytes. Methods Cultured cardiomyocyte H9c2, hypoxia-reoxygenation method was used to simulate hypoxia reoxygenation injury in vitro, and a model of myocardial cell injury was established. Flow cytometry, Western blot, enzyme-linked immunosorbent assay(ELISA) were used to detect the apoptosis rate, apoptosis-related B lymphoblastoma-2 gene(Bcl-2), Bcl-2 related X gene (Bax) protein expression and inflammatory factors secreted tumor necrosis factor α(TNF-α), interleukin-6 (IL-6) and interleukin-17 (IL-17) in normal control group, H/R group, anti-miR-NC group, anti-miR-376b-3p group, anti-miR-376b-3p+si-NC group, anti-miR-376b-3p+si-fibroblast growth factor 21(FGF21) group. The dual luciferase reporter gene assay was used to detect the fluorescence activity. Results A cell model of hypoxia reoxygenation injury was successfully established. miR-376b-3p mRNA expression was significantly increased, FGF21 mRNA and protein expression were significantly decreased in the model group. The cell apoptosis and inflammatory factor levels of TNF-α, IL-6, IL-17 were all inhibited, as well as up-regulation of Bcl-2 protein expression, down-regulation of Bax protein expression in inhibiting miR-376b-3p group. In addition, miR-376b-3p can also target FGF21 mRNA. After inhibiting FGF21,the protective effect of inhibiting miR-376b-3p on H9c2 cells damaged by hypoxia reoxygenation was weakened. Conclusion miR-376b-3p can promote the apoptosis and inflammatory response of hypoxia reoxygenation myocardial cells, and its mechanism may be related to targeting FGF21 mRNA.

Abstract:Aim To investigate the expression pattern of plasma exosome mRNA inAMI(acute myocardial infarction ) patients using NCCP(noncardiac chest pain)patients as control group, and determine the possible effects of differentially expressed mRNAs in AMI patitents. Methods Fifteen NCCP andAMI patients were enrolled from Beijing Chao-yang Hospital and Baotou Central Hospital. Exosomes and exosome RNA were extracted from the plasma of selected patients. High-throughput sequencing technology was used to detect the expression of mRNA(message RNA )profile in exosomes in the plasma of patients with AMI and NCCP. GO (gene ontology) and KEGG (kyoto encyclopedia of genes and genomes) were used to analyze differentially expressed mRNAs. Results The size of exosomes was between 30-200 nm. These exosomes express CD63(cluster of differentiation 63) and HSP70 (heat shock proteins 70), but not GAPDH (glyceraldehyde-3-phosphate dehydrogenase), conforming with the characteristics of exosomes. 64258 mRNAs were detected in the plasma exosomes of AMI patients and 64374 mRNAs were detected in the plasma exosomes of NCCP patients.Among these detected mRNAs, 1800 mRNAs were differentially expressed in AMI group (951 mRNAs were upregulated, and 849 mRNAs were down regulated). GO and KEGG analysis showed that these differentially expressed mRNA participated in the biological regulatory functions and pathways of AMI. Conclusion The mRNA expression pattern of plasma exosomes in patients with AMI was significantly different from that in the NCCP group. These differentially expressed exosome mRNAs may play important roles in the occurrence and development of AMI.

Abstract:Aim To investigate the changes of carotid intima media thickness (CIMT) in patients with sleep apnea hypopnea syndrome (OSAHS), and to explore the correlation between CIMT and 25(OH)D levels in OSAHS patients.Methods The portable sleep monitor (PM) was used to monitor the sleep condition of the people reference for the health examination. According to sleep apnea hypopnea index (AHI), they were divided into control group, mild OSAHS group, moderate OSAHS group and severe OSAHS group. CIMT and the levels of 25(OH)D in the four groups were compared to analyze the correlation between CIMT and 25(OH)D. Results CIMT in severe OSAHS group was higher than that in control group and mild OSAHS group ((0.88±0.15) mm vs (0.75±0.14) mm and (0.76±0.14) mm, all P＜0.05), the difference was statistically significant. The level of 25(OH)D in the moderate and severe OSAHS group was lower than that in the control group ((19.06±6.04) μg/L and (17.67±4.73) μg/L vs (22.78±7.40) μg/L, all P＜0.05), the difference was statistically significant. After adjusting the influences of various hybrid factors, multiple linear regression analysis demonstrated that CIMT in OSAHS patients was positively correlated with AHI (P＝0.006) and negatively correlated with 25(OH)D (P＝0.024). Conclusion CIMT in OSAHS patients increases with the increase of severity. 25(OH)D deficiency may be a risk factor for carotid intimal thickening in OSAHS patients.

Abstract:Aim To investigate the risk factors of depression in patients with hypertension. Methods 110 patients with hypertension combined with depression and 110 patients with hypertension alone were enrolled in this study,and the general data and serum factor levels of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed on the variables with statistical significance in univariate analysis. Results Univariate analysis showed that cortisol(Cor)and renin precursor(Rep)levels were significantly increased and heme oxygenase-1(HO-1)levels were significantly decreased in patients with hypertension combined with depression (P＜0.05), but there was no significant differences in other indicators between the two groups. Multivariate Logistic regression analysis was used to analyze the three variables selected by univariate analysis. It was found that HO-1 (OR=0.2,5%CI:0.001~0.251, P＜0.01) and Rep(OR=5.9,5%CI:3.054~11.706, P＜0.001) were the important risk factors of depression for patients with hypertension. Conclusion Low HO-1 level and high Rep level are the important risk factors of depression for patients with hypertension.

Abstract:Aim To investigate the relationship between baseline monocyte to high density lipoprotein cholesterol ratio (MHR) and acute heart failure (AHF) in postmenopausal women with coronary heart disease (CHD). Methods A cohort of 180 postmenopausal women was enrolled, who were diagnosed as CHD by coronary angiography in Shantou Central Hospital (Shantou, China) from December 2014 to July 2016. The patients were categorized into two groups:fifty-five patients with AHF in hospital as AHF group, one hundred and twenty-five patients without AHF as control group. The relationship between MHR and AHF was assessed by Logistic regression analysis. Results MHR in AHF group (0.48(0.1,0.61))was higher than that in control group(0.35 (0.3,0.44)) (P＝0.005). MHR was negatively correlated with left ventricular ejection fraction (LVEF) by Spearman rank correlation analysis (r＝－0.304, P＝0.001) and partial correlation analysis by controlling for age(r＝－0.215, P＝0.005). The optimal MHR cut-off level for predicting AHF in postmenopausal women with CHD was 0.367 7 (specificity 70.6%, sensitivity 59.8%, area under the ROC curve 0.646, standard error 0.048, P＝0.3,5%CI 0.551~0.740). Multivariate Logistic regression analysis showed that the independent risk factors of AHF included MHR(OR 2.0,5%CI 1.141~5.743, P＝0.023), diabetes mellitus (DM) (OR 2.5,5%CI 1.012~4.977, P＝0.047), brain natriuretic peptide (BNP) (OR 5.8,5%CI 2.140~14.226, P＜0.001) and serum creatinine (OR 1.4,5%CI 1.001~1.026, P＝0.032). Conclusion MHR is an independent predictor of AHF during hospitalization in postmenopausal women with CHD.

Abstract:Physiological angiogenesis plays an important role in tissue repair and body balance, but abnormal angiogenesis can induce a variety of diseases, such as cancer, ischemic heart disease and stroke. Regulation of angiogenesis is of great significance for the treatment of many diseases. Anti-angiogenic therapy has shown therapeutic significance in certain diseases, but pro-angiogenic therapy remains a difficult problem. In recent years, a large number of studies have shown that long noncoding RNA (lncRNA) plays an important role in angiogenesis. By regulating abnormal lncRNA, angiogenesis can be inhibited or promoted, which opens up a new field for the treatment of diseases related to abnormal angiogenesis.

Abstract:High density lipoprotein (HDL) is mainly composed of apolipoprotein A1 (ApoA1), lipid and related regulatory factors. Its structural and functional abnormalities are closely related to the occurrence and development of cardiovascular diseases. HDL mainly transports cholesterol from the macrophages under the endothelium of blood vessels to the liver and expels it through the reverse cholesterol transport pathway, regulating the lipid balance in the body. It is found that the structure and metabolism of HDL have changed in patients with cardiovascular disease, including the abnormal modification of ApoA1, serum amyloid A instead of ApoA1 and the change of miRNA content carried by HDL. This article reviews the structure, metabolism and function of HDL, which provides a new way for the diagnosis and treatment of lipid metabolism related diseases.

Abstract:Recent related studies suggest that osteopontin is related to the severity of cardiac insufficiency, and its mechanism is related to mediating the expression of extracellular matrix and the regulation of the renin angiotensin aldosterone system, which is expected to be a new biochemical indicator for clinical evaluation of patients with heart failure. This article reviews the structure and function of osteopontin and its mechanism and significance related to heart failure.