SummaryAtrial fibrillation (AF) is the most common clinically relevant arrhythmia. AF is a strong independent risk factor for the subsequent development of heart failure (HF). HF and AF can interact to perpetuate and exacerbate each other. Soluble ST2 (sST2) is a biomarker of cardiomyocyte stretch that is useful in the diagnosis and prognosis of HF. Its role in the field of AF has not yet been well investigated. We studied the concentration of sST2 in a cohort of 174 subjects (62.1% men; mean age, 65.6 ± 10.3 years [± standard deviation (SD)]) with nonvalvular AF and 116 age-matched patients with sinus rhythm (SR). Subjects were subdivided into 3 groups: paroxysmal AF, persistent AF, and SR. Plasma sST2 concentrations were measured using an electrochemiluminescence-based immunoassay. The sST2 level was higher in persistent AF patients (P < 0.05) and paroxysmal AF patients (P < 0.05) than in SR patients. No significant difference was found between persistent AF and paroxysmal AF. sST2 was correlated with left atrial diameter (LAD) (r = 0.21; P < 0.01). During a median follow-up time of 6 months, 43 subjects with non-valvular AF in the study had HF. Cox proportional hazard analysis revealed both sST2 and LAD were independent predictors of HF. sST2 concentrations are higher in AF than SR. Plasma sST2 may be a useful biomarker in predicting HF in patients with AF.(Int Heart J 2018; 59: 58-63)

Scutellarin (SCU) is the major active component of breviscapine and has been reported to be capable of decreasing myocardial fibrosis. The aim of the present study is to investigate whether SCU treatment attenuates isoprenaline-induced myocardial fibrosis and the mechanisms of its action. Rats were injected subcutaneously with isoprenaline (Iso) to induce myocardial fibrosis and rats in the SCU treatment groups were intraperitoneally infused with SCU (10 mg·kg 15612(CD31), and the Notch signalling proteins (Notch1, Jagged1 and Hes1) were examined. The administration of SCU resulted in a significant improvement in cardiac function and decrease in the cardiac weight indices; reduced fibrous tissue proliferation; reduced levels of type I and III collagen; increased microvascular density; and decreased expression of α-smooth muscle actin and increased expression of CD31, Notch1, Jagged1 and Hes1 in isoprenaline-induced myocardial fibrosis in rats. Our results suggest that SCU prevents isoprenaline-induced myocardial fibrosis via inhibition of cardiac endothelial-mesenchymal transition potentially, which may be associated with the Notch pathway.

Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support during cardiopulmonary resuscitation unresponsive to conventional methods. Here, we analyzed the extracorporeal cardiopulmonary resuscitation (ECPR) results of children in a cardiac arrest setting after cardiac surgery. Of 3119 cases of pediatric open‐heart surgery, 31 required postoperative ECMO. Among the 31 patients, 11 experienced cardiac arrest and ECPR in the early postoperative period. These 11 patients’ median age is 1.5 [range, 0.1‐19] months and median weight is 3.9 [range, 2.9‐10.3] kg. The medical records of ECPR cases were analyzed. The median ECMO‐assisted time was 68 (range, 13‐456) hours and 4 cases (36.4%) survived. The ECMO‐assisted times were ≤2 days in 4 patients (all eventually died), ≥6 days in 3 patients (all also died), and all 4 cases supported for 2‐6 days were discharged successfully (P = 0.006). In the survivors and nonsurvivors, peak lactate levels were 10.8 ± 7.04 and 22.8 ± 6.98 mmol/L (P = 0.023) and peak creatinine levels were 47.50 ± 25.9 and 153.7 ± 73.9 mg/dL (P = 0.035), respectively. In these 11 ECPR cases, the most common complications were bleeding requiring re‐exploration (n = 6, 54.5%) and renal failure (n = 6, 54.5%). The incidence of renal failure was significantly correlated with hypoperfusion time (P = 0.015). ECPR is valuable in children with postoperative cardiac arrest. The higher peak lactate level, higher peak creatinine level, and prolonged ECMO duration were associated with higher mortality. Early diagnosis and intervention of residual anatomical problems could improve survival. Bleeding and renal failure were the most common complications and the incidence of renal failure may be correlated with longer hypoperfusion duration.

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National data show that in China mainland unsedated gastrointestinal (GI) endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own decisions: the unsedated group (n=1000) and the sedated group (n=800). After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unsedated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference (P<0.01). Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% between the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% patients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure (P<0.01). In China, unsedated GI endoscopy is now widely accepted by the majority of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people's living standard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually accepted by more patients.