Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

Case Report: Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

黄淮白山羊心脏冠状动脉形态特征研究

目的:观察黄淮白山羊心脏冠状动脉的形态学特征,为其研究提供基础资料.方法:选择成年健康黄淮白山羊10头,采用颈静脉放血方式处死,其中6只心脏取不同管径大小的冠状动脉,多聚甲醛溶液固定,经水洗、脱水、二甲苯透明,石蜡包埋以HE、Masson三色及Verhoeff VG染色等步骤,观察冠状动脉的基本组织结构特点;另4只心脏标本经左、右冠状动脉口分别加压注入丁腈苯乙烯(ABS)丙酮溶液,经凝固成型后于70%浓盐酸溶液中腐蚀,观察冠状动脉的分支与分布.结果:黄淮白山羊的心脏左、右冠状动脉均起自于主动脉窦,行走于肺动脉与左心耳之间的左冠状动脉较粗大.黄淮白山羊弹性冠状动脉中弹性纤维含量丰富,外膜层有散在分布的块状平滑肌;肌性冠状动脉内外弹性膜结构清晰,中膜层主要由发达的平滑肌构成,含少量弹性纤维;微冠状动脉由一层内皮细胞构成.结论:黄淮白山羊冠状动脉属于左优势型,可分为弹性冠状动脉、肌性冠状动脉和微动脉三种类型.     

经桡动脉行冠状动脉介入治疗的循证护理

冠心病是严重危害人类健康的主要疾病,经皮冠状动脉介入法已经在国内广泛应用于临床治疗冠状动脉粥样硬化,成为目前治疗冠心病的主要方法之一。经桡动脉介入治疗应运而生,因其损伤小、局部并发症少,手术前后对抗凝、抗血小板药物限制小,术后立即拔管,患者即可随意下地活动而越来越受到患者和介入医生的欢迎。虽然大多数文献报道经桡动脉介入治疗的并发症明显低于经股动脉介入治疗。但由于桡动脉途径自身的生理特点及局限性,并发症也并不少见,如处理不当,有时会导致严重的后果,因此,在经桡动脉行冠状动脉介入手术时应注意观察及护理。     

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

Objective: Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods: Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results: Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1−P)=exp(−2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions: The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.     

实时三维超声心动图评价冠脉介入术后左室收缩功能变化

应用实时三维超声心动图评价冠心病患者经皮冠状动脉介入术(PCI)后左室收缩功能的变化。研究对象分为两组,正常组14例为冠脉造影无异常发现者,冠心病组49例行冠脉内支架治疗。所有患者均于术前及术后14天行实时三维超声检查,测得左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)及左室射血分数(LVEF)。结果,正常组术前与术后LVESV、LVEDV及LVEF差异无统计学意义;冠心病组术后LVESV、LVEDV显著小于术前(P<0.001),LVEF显著高于术前(P<0.001)。结果表明,实时三维超声心动图能准确评价左室收缩功能,冠心病患者PCI后左室收缩功能明显改善。     

动态心电图ST-T变化与冠状动脉造影对比分析

目的：探讨动态心电图ST-T变化在冠心病诊断中的价值,为提高该病的诊断率提供参考。方法：对2008年1月至2009年8月在我院心血管内一科进行诊治的可疑冠心病患者共计128例,首先进行动态心电图检测,然后对其进行冠状动脉造影,对检测结果进行比较分析。结果：应用动态心电图共检出ST段呈水平型或下斜型压低患者52例,阳性率为40.63%。而冠状动脉造影结果显示,共有49例患者为冠心病,单支病变24例,双支病变18例,三支病变7例。动态心电图灵敏度为89.80%（44/49）;特异度为89.87%（71/79）,准确指数为79.67%。结论：动态心电图在检测可疑冠心病患者心肌缺血方面具有很好的灵敏度、特异度和准确度,可以作为诊断冠心病患者的可靠指标。     

Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

Objective: Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined. The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results: The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r = 0.920, P < 0.0001), left ventricular ejection fraction (r = (0.868, P < 0.0001) and left ventricular end diastolic pressure (r = 0.835, P < 0.0004). Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r = (0.913, P < 0.0001) and left ventricular end diastolic pressure (r = 0.893, P < 0.0001). Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.     

冠状动脉三支病变心电图特征

目的：通过冠状动脉造影术与常规心电图比较，分析冠状动脉三支病变的心电图特征。方法：选择68例冠状动脉造影冠状动脉三支病变的患者，进行常规12导联心电图特点分析，预测心电图对冠状动脉三支病变的临床意义。结果：心电图对冠状动脉三支病变的诊断缺乏特异性。结论：冠状动脉造影术是诊断冠状动脉三支病变的金标准。     

肺栓塞30例临床误诊分析

目的：探讨肺栓塞的诊断方法,分析常见误诊原因,提高对肺栓塞的认识,降低误诊、误治。方法：收集了30例肺栓塞患者的临床表现、实验室资料及误诊情况,对误诊原因进行分析。结果：肺栓塞临床表现缺乏特异性,临床医生,尤其是部分外科医生对该病认识不足,故误诊率高。30例病例误诊肺炎11例,肺结核4例,胸膜炎3例,慢性阻塞性肺病2例,肺心病2例,急性冠脉综合征5例,急性左心衰2例,腰椎间盘突出症1例。结论：肺栓塞早期临床诊断有一定困难,临床医生应提高对病症的认识,对有高危因素患者新近出现气促、胸痛、咯血、呼吸困难和新发肺部浸润影,经治疗症状无缓解,应考虑肺栓塞可能,尽早完善CT肺动脉造影检查,减少误诊、误治。     

The question of linguistic anomaly in developmental dyslexia

Recent research findings pointing to an anatomical anomaly in the left hemisphere of dyslexics supports the conjecture that dyslexia involves a central anomaly in structural linguistic capacity. Two preliminary studies were carried out to test this conjecture. One study employed the techniques of grammatical research and the other was a reaction time study. Each study provided distinct evidence of a linguistic anomaly. The grammatical study suggested an anomaly when the assignment of referential relations among nominal elements is restricted on the basis of sentence structure, and the reaction time study provided evidence of an anomaly in the exploitation of grammatical markers. Based on a presentation at the 33rd Annual Conference of The Orton Dyslexia Society, San Diego, California, November 1983. I wish to thank Albert Galaburda for many stimulating discussions which led to the preliminary research reported here and the elaboration of that work in continuing studies, he cannot, however, be held accountable for either.     

Case Report: Takayasu's arteritis associated with Crohn's disease

Takayasu's arteritis (TA), also known as the "pulseless disease," is a chronic vasculitis of the aorta and aortic branches. TA with Crohn's disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu's arteritis associated with concurrent Crohn's disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autolo-gous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn's disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn's disease may be associated with immune disorders, especially autoimmunity.     

Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery bypass grafting with radial arteries on long-term patency and mortality.     

心率及心电图在冠状动脉造影术时的变化

目的:探讨选择性冠状动脉术时心率和心电图的变化.方法:经常规两种人路途径行冠状动脉造影术,全过程中12导联心电图监测记录,记录选择性冠状动脉术时注射造影剂前后心率、R波、ST段及T波的变化.结果:注射造影剂后均出现心率减慢,R波幅降低(或S波加深),ST段降低或压低,T波幅度下降或倒置加深.结论:冠状动脉有严重病变者,造影剂的量要少于常规量,并且要准备好抢救药品和器械.     

Stranger responses: effects of familiarity, stranger's approach, and sex of infant

Most investigators examining contextual influences on infant responses to a stranger have limited their study to the initial responses of the infant. Few have considered infant reactions beyond the first minutes of the encounter or the enduring effects of contextual variables once mothers have left. The present study examines the effects of stranger's style of approach, familiarity with the stranger, and infant sex on infant response before and after maternal separation. Familiarity was operationalized in 2 ways: the length of time mothers stayed before leaving infants with the stranger and meeting the stranger a second time. Findings suggest that all these factors influence infant behavior. Ifants looked and smiled at the stranger significantly more when approached slowly. Contrary to expectations, infants (particularly girls) who met the familiar stranger after 1 week protested significantly more when left with her at that time. Trends indicate the length of time mothers stayed was least influential since most infants became extremely distressed once mothers departed.     

Gadobutrol at different injection rates for dynamic supra-aortic imaging by contrast-enhanced magnetic resonance angiography

The aim of this study was to compare differences in imaging quality at different injection rates of gadobutrol(Gadovist? 1.0M) for dynamic supra-aortic imaging by contrast-enhanced magnetic resonance angiography(CEM RA). In 6 healthy volunteers,dynamic CEM RA examinations were performed twice at a 7 d interval with a gadobutrol dose of 0.1 mmol given to 1 kg body mass. For the two examinations,the contrast medium was injected at rates of 1.5 mL/s and 2.0 mL/s,followed by 20 mL normal saline injected at the same rate. Using a GE Signa 3.0T M R apparatus and the time-resolved imaging of contrast kinetics(TRICKS) technique,scanning was performed continuously for 15 phases at a time resolution of about 2.4 s. Vascular reconstruction was undertaken by multiplane reconstruction and maximum intensity projection techniques. Two radiologists experienced in CEM RA diagnosis subjectively evaluated the contrast effect,vascular detail,and pseudo-shadow of all images,and graded them via a 5-point scale. With the two drug injection rates,the image quality,peak signal-to-noise ratio(SNR) and contrast-to-noise ratio(CNR) were compared for imaging of the infra-aortic arch,brachiocephalic trunk,subclavian artery(left/right),common carotid artery(left/right),internal carotid artery(left/right),and external carotid artery(left/right). Characteristics of the time-signal-intensity(T-S-I) curves were also analyzed at the two injection rates. All studies were performed successfully,without any complications. There was good image quality with both gadobutrol injection rates of 1.5 mL/s and 2.0 mL/s,and subjective scores for image quality,SNR and CNR were not significantly different between the two rates(P 0.05). The time-to-peak(TTP) from the hand dorsal vein injection site to the carotid artery ranged from 16.0 s to 27.1 s(mean 21.7 s ±3.4 s) in the 6 subjects,and was also not significantly different between the two drug injection rates(P 0.05). We conclude that dynamic CEM RA examination of the supra-aortic arch with gadobutrol injection at a rate of 1.5 mL/s was feasible,and satisfactorily reflected vascular shape and dynamic blood flow information.     

黄芪预处理对麻醉家兔心肌缺血再灌注损伤的保护作用

目的:观察黄芪预处理对家兔心肌缺血再灌注损伤的保护作用。方法:采用在体家兔冠状动脉阻断的缺血/复灌损伤模型,测定心肌梗死面积、血浆中乳酸脱氢酶(LDH)和肌酸激酶(CK)活性及各项心室力学指标。结果:与单纯缺血/复灌组相比,黄芪预处理明显降低心脏缺血/复灌后的梗死面积和血浆中LDH、CK含量,促进左室收缩压(LVSP)、最大左室收缩速率( dP/dtmax)和最大左室舒张速率(-dP/dtmax)的恢复。结论:黄芪预处理对麻醉家兔心肌缺血再灌注所致心肌损伤具有保护作用。     

Takayasu’s arteritis associated with Crohn’s disease

Takayasu’s arteritis (TA), also known as the “pulseless disease,” is a chronic vasculitis of the aorta and aortic branches. TA with Crohn’s disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu’s arteritis associated with concurrent Crohn’s disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autologous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn’s disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn’s disease may be associated with immune disorders, especially autoimmunity.      

冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床研究

目的：研究冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床意义。方法：采用高频超声测量冠心病组和对照组颈动脉斑块积分、斑块数、颈动脉内-中膜厚度（IMT）及血管内皮舒张功能（EDD％），并进行对比分析。结果：1．冠心病组颈动脉IMT、斑块积分及斑块数明显高于对照组，多支冠脉血管病变组明显高于单支病变组；2．冠心病组内皮舒张功能明显低于对照组，单支、双支病变组间无显著性差异。3．冠状动脉造影与颈动脉超声结果比较，以斑块存在为预测冠脉病变的阳性指标，敏感性为83％、特异性75％。结论：冠心病患者多合并血管舒张功能受损及颈动脉粥样硬化，高频超声探查颈动脉可预测冠状动脉病变的存在及严重程度。     

对大学生运动性猝死的原因及预防措施的研究

文章应用文献资料法,对大学生运动性猝死的原因进行了调查与分析,结果表明:由冠心病、主动脉畸型、先天性心脏病等引发的心源性猝死是大学生运动性猝死的主要原因.并探讨了运动性猝死的预防措施,对高校体育教学和管理中预防运动性猝死具有指导性意义.