Elevated high sensitive C-reactive protein and apelin levels after percutaneous coronary intervention and drug-eluting stent implantation

Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.     

Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI), who were treated with emergency percutaneous coronary intervention (PCI). Methods: 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate (eGFR) was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01). CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032, odds ratio (OR) 4.159, 95% confidence interval (CI) 1.127-15.346). Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.     

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.     

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。     

AMI患者PCI术对血浆BNP水平变化的初步临床观察

目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义.     

AMI患者PCI术后BNP相关分析及应用研究

目的:观察PCI术对AMI患者血浆中BNP的水平变化,探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对50例AMI患者PCI治疗前、治疗后7d内每日同一时间取静脉血进行BNP的测定和50例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在行PCI术后与对照组比较有显著性差异(P<0.05),PCI治疗后呈明显下降趋势.结论:AMI患者经PCI治疗血浆BNP水平变化说明PCI术对改善AMI患者的预后有重要意义.     

Current status of percutaneous coronary intervention of chronic total occlusion

This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%–20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient’s angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.     

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.     

Human bone marrow-derived mesenchymal stem cells transplanted into damaged rabbit heart to improve heart function

INTRODUCTION Congestive heart failure is the end stage of manycardiovascular diseases. Myocardial infarction (MI)is a life-threatening event that may cause suddencardiac death and heart failure. Despite considerableadvances in diagnosis and treatment of heart disease,cardiac dysfunction after MI is still the majorworldwide cardiovascular disorder. Damaged myo-cardium after acute MI is gradually replaced by fi-brotic noncontractile cells to form scar tissue. Thedeveloping ventricul…     

Endoscopic vein harvest in elective off-pump coronary artery bypass grafting

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hema-toma, pain scale, and superlicial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preopera-tive risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complica-tions and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.     

A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients – A naturalistic study

BackgroundBorderline personality disorder (BPD) is associated with high rates of suicidal and self-injurious behaviors and a substantial proportion of BPD patients have a history of trauma, particularly childhood sexual abuse (CSA).ObjectiveTo compare the clinical presentation severity in female adolescent inpatients with BPD with and without history of prolonged CSA.Participants and settingFemale adolescent BPD patients admitted to a psychiatric inpatient unit.MethodsA retrospective analysis of records of the inpatients, divided into two groups: with (n = 38) and without (n = 40) a history of prolonged CSA. Prolonged CSA was defined as sexual abuse continuing for at least 3 months. Demographic and clinical data, including number and duration of psychiatric hospitalizations until the age 19, non-suicidal self-injury (NSSI), suicide attempts, cigarette smoking, alcohol and drug use, and sexual impulsivity were compared between the two groups.ResultsThe BPD + prolonged CSA group had a larger duration of the first psychiatric hospitalization, number of hospitalizations and cumulative length of hospitalizations compared with the control group. Furthermore, the BPD + prolonged CSA group had a higher number of suicidal attempts, and higher rates of severe NSSI events, cigarette smoking, alcohol use, and sexual impulsivity.ConclusionsThis study demonstrated for the first time that adolescent female BPD inpatients with a history of prolonged CSA, manifest more severe clinical presentation compared to those without prolonged CSA. Hence, it appears essential to encourage therapists to inquire about history of CSA and refer adolescent female BPD inpatients with prolonged CSA to appropriate intensive therapy.     

PBL和传统教学在“循证医学”教学中的比较

目的:探讨PBL教学与传统教学在"循证医学"教学中教学效果差异。方法:对临床医学专业298名大三学生整群随机分为PBL和传统教学组,课程结束进行教学效果数据收集,用SPSS23.0进行统计分析。结果:PBL教学组176人(59.1%),传统教学组122人(40.9%),两组的性别(χ²=1.649,P=0.199)和其他课程中教学方式的使用(χ²=0.983,P=0.912)分布方面无统计学差异。PBL组在"循证医学"课堂上小组讨论频率与参与度、知识掌握情况均高于传统教学组(P<0.05),PBL组期末考试平均分高于传统教学组(t=5.268,P<0.000)。结论:PBL教学在"循证医学"中的教学效果优于传统教学。     

组织工程的一个初步研究混合多尿烷血管移植(英文)

本文的目的是研究半多孔内皮细胞的包膜(SPEUs)的效应 以PTMEG1000为基础的SPEU的多孔性为51.58%(±5.86%) 与天然脉管相比较,例如与一头6个月小牛胸部的上部下来的主动脉大血管相比较,SPEU的拉伸强度是足够强的 脉管的典型脉动压力服从静脉管压力(1.5～2%Δd/d),此压力小于动脉管压力(9～15%Δd/d) 在种植EC之前,观察了在SPEUs上培育的人皮的成纤维细胞(HDF) SPEU的DNA数量与HDF在一天之内种植;有71.9%(±11.01%)细胞被种植在SPEUs上 LDH试验表明:在有控制的和实验群数据之间没有显著的差别,说明没有细胞毒素 因此,EC在SPRUs上具有良好的粘附性,这是所期望的,而应用胶原实现了将EC种植在半微孔的SPEUs上的表面改善     

A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention

Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18–24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24–48 h and 48–72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 599th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26–8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88–6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.     

Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center： A randomized controlled trial

Objective To compare the efficacy of a short messaging service (SMS) text messaging and phone reminder to improve attendance rates at a health promotion center. Methods A total of 1 859 participants who had scheduled appointments in the health promotion center of our hospital from April 2007 to May 2007 were enrolled in the study and randomly assigned into 3 groups control (no reminder) group, SMS text messaging reminder group and telephone reminder group. Attendance rates and costs of interventions were collected. Results A total of 1848 participants were eligible for analysis. Attendance rates of control,SMS and telephone groups were 80.5%, 87.5% and 88.3%, respectively. The attendance rates were significantly higher in SMS and telephone groups than that in the control group, with odds ratio 1.698, 95% confidence interval 1.224 to 2.316, P=0.001 in the SMS group, and odds ratio 1.829, 95% confidence interval 1.333 to 2.509, P＜0.001 in the telephone group. However, there was no difference between the SMS group and the telephone group (P=0.670). The cost effectiveness analysis showed that the cost per attendance for the SMS group (0.31 Yuan) was significantly lower than that for the telephone group (0.48 Yuan). ConclusionSMS and telephone are effective reminders for improving attendance rate at a health promotion center. SMS reminder may be more cost-effective compared with the telephone reminder.     

Cardioprotective effects of anesthetic preconditioning in rats with ischemia-reperfusion injury: propofol versus isoflurane

Objective: We compare the cardioprotective effects of anesthetic preconditioning by propofol and/or isoflurane in rats with ischemia-reperfusion injury. Methods: Male adult Wistar rats were subjected to 60 min of anterior descending coronary artery occlusion followed by 120 min of reperfusion. Before the long ischemia, anesthetics were administered twice for 10 min followed by 5 min washout. Isoflurane was inhaled at I MAC (0.016) in I group, whereas propofol was inhaled intravenously at 37.5 mg/(kg.h) in P group. A combination ofisoflurane and propofol was administered simultaneously in I+P group. Results: In control (without anesthetic preconditioning, C group), remarkable myocardial infarction and apoptosis accompanied by an increased level of cardiac troponin T were noted 120 rain after ischemia-reperfusion. As compared to those of control group, I and P groups had comparable cardioprotection. In addition, I+P group shares with I and P groups the comparable cardioprotective effects in terms of myocardial infarction and cardiac troponin T elevation. Conclusion: A combination of isoflurane and propofol produced no ad-ditional cardioprotection.     

个体化护理在经尿道前列腺电切术全程的应用研究

目的：探讨个体化护理对经尿道前列腺电切术患者临床疗效的影响.方法：122例前列腺电切患者随机分为对照组和观察组,每组61例,对照组给予常规护理,观察组给予个体化护理.观察比较两组患者的并发症、舒适度和护理满意度和住院时间.结果：观察组患者的术后并发症较对照组减少,患者的治疗舒适度和护理满意度明显高于对照组（P＜0.05）,住院时间缩短（7.2±0.8 d VS9.9 ±1.2 d,P＜0.05）.结论：个体化护理应用于前列腺电切患者能提高护理满意度,减少术后并发症和促进术后康复,该模式值得推广.     

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.     

重组人脑利钠肽治疗急性心力衰竭的疗效观察

目的：探讨在监测血清脑钠肽水平下,短期使用注射用重组人脑利钠肽治疗急性心力衰竭或慢性心力衰竭急性发作的临床效果。方法：48例急性心力衰竭患者根据是否使用注射用重组人脑利钠肽分为常规组和注射用重组人脑利钠肽组,对比两组治疗的临床效果和超声心动图情况,并监测BNP水平。结果：治疗7d后,注射用重组人脑利钠肽组临床有效率明显好于常规组（81．7％vs61．6％,P〈0．05）,左室射血分数明显高于常规组（51±6）％vs（46±5）％,（P〈0．01）,且血清脑钠肽水平明显降低（498±209）pg／mL vs（642±318）pg／mL,（P〈0．01）,血清脑钠肽下降水平和左室射血分数提高水平差异有统计学意义（P〈0．05）,有效者治疗后左室射血分数提高及血清脑钠肽下降均强于无效者（P〈0．01）。结论：在血清脑钠肽指导下短期应用注射用重组人脑利钠肽有助于改善急性心力衰竭患者的临床症状和心功能。