Yijie Hu

Relation Between Bone Mineral Density, Bone Loss and the Risk of Cardiovascular Disease in a Chinese Cohort

Cardiovascular disease (CVD) and osteoporosis share some common risk factors such as old age, smoking, alcoholic drinking, hypertension, diabetes mellitus, and hyperlipidemia. Although previous studies have investigated the association of bone mineral density (BMD) with CVD, the results were conflicting. There are limited studies on the association of BMD loss rate with CVD. We therefore conducted a 5-year prospective study to examine the relation among BMD, bone loss, and risk of CVD in a Chinese cohort. Of 9,657 community residents 30 to 75 years old, 6,092 were enrolled in the study and followed annually for 5 years. At baseline demographic data, BMD, smoking and drinking statuses, medical history, and blood samples were collected. Cox proportional hazards analysis was used to evaluate the association of BMD and incidence of CVD. Over the 5-year follow-up period, CVD developed in 118 subjects. Baseline BMD, bone loss rate, current smoking, daily alcoholic ingestion, and higher osteoprotegerin and leptin levels were independently associated with increased risk of CVD, whereas higher baseline adiponectin level was associated with decreased risk of CVD in women and men. In conclusion, uncovering the relation linking osteoporosis and CVD is important for understanding the pathogenesis of these 2 common disorders.

High basal level of autophagy in high-altitude residents attenuates myocardial ischemia-reperfusion injury.

OBJECTIVE Hypoxia can induce autophagy, which plays an important role in cardioprotection. The present study tested the hypothesis that patients with congenital heart disease living at a high altitude could resist ischemia-reperfusion injury better than those at a low altitude, through elevated basal autophagy by chronic hypoxia. METHODS Twelve Tibetan patients residing at a high altitude of >3000 m and 12 Han patients residing at a low altitude of <500 m with simple atrial or ventricular septal defects were prospectively recruited. All patients underwent cardiopulmonary bypass, maintaining a flow rate of approximately 2.4 to 2.8 L/min/m2 and mean arterial pressure of ≥40 to 60 mm Hg. Myocardial ischemia-reperfusion injury between the 2 groups was compared using cardiac troponin I, brain natriuretic peptide, hematoxylin eosin staining, and the terminal deoxynucleotidyl transferase dUTP nick end labeling test. Autophagy-related proteins microtubule-associated protein 1 light chain 3 II (LC3II), Beclin1, and lysosomal-associated membrane protein 2 (LAMP2) and their upstream protein BCL2/adenovirus E1B 19-kDa protein-interacting protein 3 (Bnip3) were evaluated with Western blotting. RESULTS The maximal cardiac troponin I concentration and increasing x-fold of brain natriuretic peptide in the high-altitude group were obviously lower than those in the low-altitude group (3.10±0.77 vs 7.10±2.28 ng/mL and 2.51±0.94 vs 14.66±6.83, respectively). The preoperative and postoperative levels of LC3II, LAMP2, and upstream Bnip3 in the high-altitude group were obviously greater. No difference was found in the Beclin1 level between the 2 groups at baseline or ischemia-reperfusion. CONCLUSIONS Patients living at a high altitude with congenital heart disease resisted ischemia-reperfusion injury during cardiac surgery better than those at a low altitude, possibly through elevated basal autophagy induced by chronic hypoxia.

Association between the polymorphism of estrogen receptor α and coronary artery disease in a Chinese population

BACKGROUND The role of estrogen receptor α (ERα) polymorphism in coronary artery disease (CAD) was investigated previously in several populations. There are few data on relation between ERa polymorphism and CAD in Chinese population. Our study was to investigate the possible association between ERα polymorphism and CAD in Chinese population. METHODS A total of 539 patients with CAD and 539 age and sex matched controls were examined for ERa polymorphism. DNA was obtained and ERa polymorphism was analyzed by the polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). RESULTS The frequencies of the PvuII C allele were significantly higher in CAD patients than in control individuals (P<0.05). Using T allele as a reference, the odds ratio for CAD patients with C allele was 1.24 (95%CI=1.03-1.48). Using TT genotype as a reference, the odds ratio for TC genotype was 1.17 (95%CI=0.90-1.50), and for CC genotype was 1.58 (95%CI=1.05-2.38). The odds ratio for CC genotype was 1.42 (95%CI=0.94-2.15) in women and 1.72 (95%CI=1.41-2.10) in men. There were no significant differences in XbaI allele and genotype between CAD patients and control individuals. CONCLUSIONS The ERa PvuII polymorphism is associated with the increased risk of CAD in men of a Chinese population. Further research is needed to investigate the mechanism underlying the association between ERα polymorphism and CAD.

Risk Factors for Acute Kidney Injury in Patients Undergoing Same Admission Coronary Angiography and Valve Replacement

We investigated risk factors for acute kidney injury (AKI) in patients undergoing same admission coronary angiography (CAG) and valve replacement.

Multiple Thrombosis Caused by Arrhythmogenic Right Ventricular Cardiomyopathy

A 68-year-old man was transferred emergently to our department because of multichamber intracardiac thrombosis. Enhanced computed tomography revealed multichamber thrombosis in the right atrial appendage, right ventricular outlet tract. and left atrial appendage, with localized aneurysm of a much enlarged right ventricle. He underwent thrombectomy and valve repair. Here we report a rare case of arrhythmogenic right ventricular cardiomyopathy with multichamber intracardiac thrombosis.

Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects

OBJECTIVES Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost. METHODS Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures. RESULTS Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01). CONCLUSIONS Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital.

An Occult Congenital Fistula Between the Descending Aorta and the Left Pulmonary Vein in an Adult Presenting With Recurrent Episodes of Hemoptysis

We report a case of recurrent hemoptysis due to an occult congenital fistula between the descending aorta and the left pulmonary vein in a 25-year-old female patient. The anomaly was confirmed by contrast-enhanced CT scan and angiography. No abnormality was noted in the bronchia and pulmonary arteries. The patient was successfully managed by simple ligation of the fistula. To our knowledge, this is the first reported case of adult-onset hemoptysis caused by an occult congenital fistula between the descending aorta and a pulmonary vein.

High Takeoff of the Right Coronary Artery Associated with Ventricular Septal Defect, Right Aortic Arch, and Bridging Bronchus

We report a case of a 14‐year‐old female with abnormally high takeoff of the right coronary artery (RCA) that was associated with a ventricular septal defect, right aortic arch, and bridging bronchus. During surgery, an exceptionally high takeoff of the RCA was discovered. Postoperative computed tomography confirmed the presence of the associated right aortic arch with anomalous branching pattern, and bridging bronchus. doi: 10.1111/jocs.12379 (J Card Surg 2014;29:829–831)

Mechanism of genistein regulating the differentiation of vascular smooth muscle cells into osteoblasts via the OPG/RANKL pathway

Objective The present study aimed to investigate the mechanism of genistein, a tyrosine kinase inhibitor, regulating the differentiation of vascular smooth muscle cells (VSMCs) into osteoblasts via the OPG/RANKL (Osteoprotegerin/Receptor Activator of Nuclear Factor-κB Ligand) pathway. Methods The mouse VSMCs were isolated, purified and cultured. We constructed the LV5-Tnfrsf11b overexpression lentiviral vector and LV3-OPG-309 interference lentiviral vector. The OPG overexpression was induced and the growth of VSMCs infected with the lentiviral vector was observed. The VSMC calcification and control group were treated with different doses of genistein. The mRNA and protein expression levels of OPG, α-SM-actin (smooth muscle actin), ALP (alkaline phosphatase) and OPN (osteopontin) were detected in VSMCs after treatment using RT-PCR and Western Blot. Result We induced OPG overexpression and performed lentiviral vector infection of the VSMCs to suppress OPG expression, respectively, which was followed by treatment with genistein. The results showed that the relative expression of OPG was the highest in the VSMC calcification +genistein +OPG overexpression-inducing treatment group. It was the lowest in the VSMC calcification +OPG expression-suppressing treatment group. The relative expression of ALP was the highest in the VSMC calcification +OPG expression-suppressing treatment group, and the lowest in the VSMCs+genistein treatment group. Conclusion OPG gene plays an important regulatory role in the growth of VSMCs, by suppressing the calcification of VSMCs. Genistein could regulate the differentiation of VSMCs into osteoblasts via the OPG/RANKL pathway in a dose-dependent manner.

Modified repair for huge unruptured aneurysm of the right sinus of valsalva.

Unruptured aneurysm of the sinus of Valsalva is a rare abnormality. In the present case, the huge aneurysm of the sinus of Valsalva was only involved in the right coronary sinus with the ostium far from its normal place. We designed a modified repair technique, with a scalloped Intergard woven vascular patch combined with aortic flap, to reconstruct the sinus of Valsalva and avoid the reimplantation of right coronary artery.