Nonalcoholic fatty liver disease(NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic(nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifes...Nonalcoholic fatty liver disease(NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic(nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications(cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment(diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.展开更多
Objective： The purpose of this study is to evaluate the safety and efficacy of transcatheter aortic valve implantation （TAVI） in patients with a severe stenotic bicuspid aortic valve （BAV） in a Chinese population...Objective： The purpose of this study is to evaluate the safety and efficacy of transcatheter aortic valve implantation （TAVI） in patients with a severe stenotic bicuspid aortic valve （BAV） in a Chinese population. While several groups have reported the feasibility, efficacy, and safety of TAVI for patients with a BAV, worldwide experience of the technique is still limited, especially in China. Methods： From March 2013 to November 2014, high surgical risk or inoperable patients with symptomatic severe aortic stenosis （AS） who had undergone TAVI at our institution were selected for inclusion in our study. Results were compared between a BAV group and a tricuspid aortic valve （TAV） group. Results： Forty patients were included in this study, 15 （37.5%） of whom were identified as having a BAV. In the BAV group, the aortic valve area was smaller （（0.47±0.13） vs. （0.59±0.14） cm2）, the ascending aortic diameter was larger （（40.4±4.4） vs. （36.4±4.3） mm）, and the concomitant aortic regurgitation was lower. No significant differences were found between the groups in the other baseline characteristics. No differences were observed either in the choice of access or valve size. The procedural success achieved in this study was 100%. There were no differences between groups in device success （86.7% vs. 88.0%）, 30-d mortality （6.7% vs. 8.0%）, or 30-d combined end point （13.3% vs. 12.0%）. The incidences of new pacemaker implantation, paravalvular regurgitation and other complications, recovery of left ventricle ejection fraction and heart function were similar in both groups. Conclusions： Patients with a severely stenotic BAV can be treated with TAVI, and their condition after treatment should be similar to that of people with a TAV.展开更多
目的研究猪主动脉瓣(猪瓣)去细胞方法,观察埋藏前后猪瓣内源性逆转录病毒(PERV)和瓣膜支架变化.方法①采用去垢剂、核酸酶和改变溶液渗透压方法制备去细胞猪瓣支架.②应用聚合酶链式反应(PCR)和逆转录-聚合酶链式反应(RT-PCR)等方法检...目的研究猪主动脉瓣(猪瓣)去细胞方法,观察埋藏前后猪瓣内源性逆转录病毒(PERV)和瓣膜支架变化.方法①采用去垢剂、核酸酶和改变溶液渗透压方法制备去细胞猪瓣支架.②应用聚合酶链式反应(PCR)和逆转录-聚合酶链式反应(RT-PCR)等方法检测去细胞前后新鲜猪瓣和去细胞猪瓣以及供体和受体外周血PERV.③去细胞瓣叶埋藏家兔皮下4、6、8、10周后分别取材,应用苏木素-伊红和免疫组织化学染色,Instron 1122型万能强力仪、分光光度计、光镜和电镜进行检查.结果①经去细胞处理后猪瓣内细胞成分完全去除,可溶性蛋白明显丢失[(0.24±0.04)% vs (0.48±0.12)%],瓣叶含水量增加[(92.16±1.48)% vs (89.20±1.55)%],P均＜0.01,但去细胞猪瓣仍保持了良好纤维支架结构,热皱缩温度[(72.0±0.7)℃ vs (71.2±0.8)℃]和断裂强度[(449±19)g/mm2 vs (541±19)g/mm2]均无明显变化.②新鲜猪瓣和猪外周血标本经PCR和RT-PCR检测,于琼脂糖凝胶电泳内均出现219 bp扩增带,经测序这一产物与Medline公布的PERV-C型病毒有90%～97%同源性;去细胞猪瓣,及其移植于犬体内一个月后,抽取犬的外周血标本检测,219 bp扩增带均消失.③埋藏于兔皮下的去细胞猪主动脉瓣有轻微组织反应,4周时可见中性粒细胞、淋巴细胞和浆细胞浸润;6周后上述炎性细胞明显减少,去细胞瓣叶周边部分开始吸收,10周后完全吸收,埋藏部位未见结缔组织增生或疤痕形成.结论①猪瓣内细胞成分可以完全去除,并保持良好的纤维支架结构和机械强度,抗原性轻微,是一种生物可降解性材料.②猪瓣存在C型PERV,当瓣叶细胞完全去除后PERV-C转为阴性,受体外周血标本PERV-C反应为阴性.展开更多
Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. How...Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.展开更多
BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Pote...BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho展开更多
文摘Nonalcoholic fatty liver disease(NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic(nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications(cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment(diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.
基金supported by the Fundamental Research Funds from Zhejiang University(No.2012FZA7008),China
文摘Objective： The purpose of this study is to evaluate the safety and efficacy of transcatheter aortic valve implantation （TAVI） in patients with a severe stenotic bicuspid aortic valve （BAV） in a Chinese population. While several groups have reported the feasibility, efficacy, and safety of TAVI for patients with a BAV, worldwide experience of the technique is still limited, especially in China. Methods： From March 2013 to November 2014, high surgical risk or inoperable patients with symptomatic severe aortic stenosis （AS） who had undergone TAVI at our institution were selected for inclusion in our study. Results were compared between a BAV group and a tricuspid aortic valve （TAV） group. Results： Forty patients were included in this study, 15 （37.5%） of whom were identified as having a BAV. In the BAV group, the aortic valve area was smaller （（0.47±0.13） vs. （0.59±0.14） cm2）, the ascending aortic diameter was larger （（40.4±4.4） vs. （36.4±4.3） mm）, and the concomitant aortic regurgitation was lower. No significant differences were found between the groups in the other baseline characteristics. No differences were observed either in the choice of access or valve size. The procedural success achieved in this study was 100%. There were no differences between groups in device success （86.7% vs. 88.0%）, 30-d mortality （6.7% vs. 8.0%）, or 30-d combined end point （13.3% vs. 12.0%）. The incidences of new pacemaker implantation, paravalvular regurgitation and other complications, recovery of left ventricle ejection fraction and heart function were similar in both groups. Conclusions： Patients with a severely stenotic BAV can be treated with TAVI, and their condition after treatment should be similar to that of people with a TAV.
文摘目的研究猪主动脉瓣(猪瓣)去细胞方法,观察埋藏前后猪瓣内源性逆转录病毒(PERV)和瓣膜支架变化.方法①采用去垢剂、核酸酶和改变溶液渗透压方法制备去细胞猪瓣支架.②应用聚合酶链式反应(PCR)和逆转录-聚合酶链式反应(RT-PCR)等方法检测去细胞前后新鲜猪瓣和去细胞猪瓣以及供体和受体外周血PERV.③去细胞瓣叶埋藏家兔皮下4、6、8、10周后分别取材,应用苏木素-伊红和免疫组织化学染色,Instron 1122型万能强力仪、分光光度计、光镜和电镜进行检查.结果①经去细胞处理后猪瓣内细胞成分完全去除,可溶性蛋白明显丢失[(0.24±0.04)% vs (0.48±0.12)%],瓣叶含水量增加[(92.16±1.48)% vs (89.20±1.55)%],P均＜0.01,但去细胞猪瓣仍保持了良好纤维支架结构,热皱缩温度[(72.0±0.7)℃ vs (71.2±0.8)℃]和断裂强度[(449±19)g/mm2 vs (541±19)g/mm2]均无明显变化.②新鲜猪瓣和猪外周血标本经PCR和RT-PCR检测,于琼脂糖凝胶电泳内均出现219 bp扩增带,经测序这一产物与Medline公布的PERV-C型病毒有90%～97%同源性;去细胞猪瓣,及其移植于犬体内一个月后,抽取犬的外周血标本检测,219 bp扩增带均消失.③埋藏于兔皮下的去细胞猪主动脉瓣有轻微组织反应,4周时可见中性粒细胞、淋巴细胞和浆细胞浸润;6周后上述炎性细胞明显减少,去细胞瓣叶周边部分开始吸收,10周后完全吸收,埋藏部位未见结缔组织增生或疤痕形成.结论①猪瓣内细胞成分可以完全去除,并保持良好的纤维支架结构和机械强度,抗原性轻微,是一种生物可降解性材料.②猪瓣存在C型PERV,当瓣叶细胞完全去除后PERV-C转为阴性,受体外周血标本PERV-C反应为阴性.
文摘Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.
文摘BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho
