The relationship between circulating microRNA-21 and unstable plague in patients with coronary artery disease / 中华急诊医学杂志

Objective To investigate the relationship between circulating microRNA-21 (miR-21 ) and unstable plague in patients with coronary artery disease (CAD).Methods A total of 100 consecutive patients with CAD admitted in the department of cardiology in Guangzhou first people’s hospital from January 2012 to December 2014 were enrolled.All patients were checked with coronary angiograph and intravascular ultrasound (IVUS)and were divided into two groups according to the presence of unstable plague detected by IVUS:stable plague group (n =45)and unstable plague group (n =55).Another 50 healthy people asking for routine physical examination during the same periods were enrolled as control group.Plasma miRNA-21 of patients were measured by the methods of quantitative realtime fluorescent Polymerase Chain Reaction (qRT-PCR).Results The levels of plasma miRNA-21 in patients of unstable plague group were significant higher than that in patients of stable plague group and control group (0.87 ±0.10)vs.(0.78 ±0.11)vs.(0.67 ±0.08),P <0.05.The receiver operation curve (ROC)showed that plasma miRNA-21 had great significance in assessing the CAD patients with unstable plague evidenced by the areas under the ROC curve to be 0.869 (95%CI:0.797 -0.940,P <0.05).Multivariate logistic regression analysis showed that plasma miRNA-21 was one strong independent predicative factor for unstable plague in patients with CAD (P <0.05 ).Conclusions The increasing levels of plasma miRNA-21 had the capabilitiy to predicate the unstable coronary plague in CAD patients.That miRNA-21 may be one valuable biomarker for predicating unstable plague in patients with CAD.

The effect and safety of ischemic postconditioning in patients with acute myocardial infarction having underwent percutaneous coronary intervention / 中国医师进修杂志

Objective To investigate the effect and mechanism of ischemic postconditioning (IPC) on myocardial perfusion levels of acute ST-segment elevation myocardial infarction (STEMI) patients having underwent primary percutaneous coronary intervention (PCI), and the safety of IPC. Methods One hundred and sixty patients with STEMI were enrolled, and they accepted the primary PCI therapy within the onset of 12 h. The patients were divided into 2 groups according the treatment method:control group (routine PCI group, 82 cases) and IPC group (78 cases). The ST-segment resolution, TIMI myocardial perfusion grade (TMPG), before and after PCI levels of nitrogen monoxidum (NO), endothelin (ET)-1, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI)-1, rate of intraoperative complication were observed. The patients were followed up for 6 months, the rate of major adverse cardiac event (MACE) was recorded. Results The rates of ST-segment resolution and TMPG well in IPC group were significantly higher than those in control group:84.62%(66/78) vs. 67.07%(55/82) and 80.77%(63/78) vs. 64.63%(53/82), and the rate of ischemia-reperfusion injury in IPC group was significantly lower than that in control group: 7.69%(6/78) vs. 24.39%(20/82), and there were statistical differences ( P0.05). The rate of MACE in IPC group was significantly lower than that in control group:3.85% (3/78) vs. 14.63% (12/82), and there was statistical difference (P<0.05). Conclusions Applying IPC in patients with STEMI having underwent primary PCI is safe and can improve myocardial perfusion levels. The improvement of vessel endothelial function and fibrinolysis activity attained from IPC may be the major mechanism.

Nuclear accumulation of CXCR4 and overexpressions of VEGF-C and CK19 are associated with a higher risk of lymph node metastasis in hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to evaluate the correlation of protein expressions of CXC chemokine receptor 4 (CXCR4), vascular endothelial growth factor-C (VEGF-C) and cytokeratin 19 (CK-19) with lymph node metastasis (LNM) in patients with hepatocellular carcinoma (HCC), and their survival.</p><p><b>METHODS</b>The expressions of CXCR4, VEGF-C and CK-19 in HCC patients with (n = 123) or without (n = 145) LNM were determined using tissue microarray and immunohistochemical staining. The relationship between clinicopathological features and CXCR4, VEGF-C and CK-19 were analyzed. Evaluation of immunostaining was performed semiquantitatively by visual assessment.</p><p><b>RESULTS</b>The UICC T stage, and expressions of nuclear CXCR4, VEGF-C and CK-19 were independent risk factors for LNM. Nuclear CXCR4, VEGF-C and CK-19 expression were predictive factors for LNM in HCC patients. In patients with LNM, the median survival time was 15.1 months for patients with high nuclear CXCR4 expression and 24.5 months for those with low nuclear CXCR4 expression. The median survival time was 15.1 months for patients with high tumor VEGF-C expression and 31.1 months for those with low tumor VEGF-C expression. The median survival time was 12.0 months for patients with positive CK-19 expression and 19.2 months for patients with negative CK-19 expression. Patients with high nuclear CXCR4, VEGF-C or CK-19 expression had significantly poorer prognosis than those with low expression (all P < 0.05). PVT, UICC T stage and expressions of nuclear CXCR4, VEGF-C, and CK-19 were independent prognostic factors.</p><p><b>CONCLUSION</b>Increased protein expressions of nuclear CXCR4, VEGF-C, and CK-19 are independent risk factors for developing lymph node metastasis, and they are significantly correlated with LNM and poor outcome in HCC patients.</p>

Effects of tirofiban administration to myocardial ischemical reperfusion injury during primary percutaneous coronary intervention / 中华急诊医学杂志

Objective To investigate the effects and the mechanism of tirofiban administration in myocardial ischemical reperfusion injury(MIRI) in patients with acute myocardial infarction(AMI) undergoing primary percutaneous coronary intervention(PCI). Method The study included 158 STEMI Patients who accepted primary PCI therapy and were randomly (random number) divided into two groups: tirofiban administration group and control group. Incidence of MIRI during PCI, Correct TIMI frame count(CTFC), ST segment resolution(STR), peak value and peak time of MB isoenzyme of creatine kinase( CK-MB), and incidence of major adverse cardiac events (MACE) during 30 days postoperation in both groups were measured. Results Tirofiban administration group was superior to control group in terms of incidence of MIRI, CTFC, STR, peak value and peak time of CK-MB, and incidence of MACE during 30 days postoperation (P < 0.05). Multiple factor logistic regression analysis indicated that intravenous tirofiban administration before primary PCI was the independently protective factor for MIRI. Conclusions Intravenous tirofiban administration in patients with STEMI before primary PCI can significantly decrease the incidence of MIRI,reduce myocardial damage and improve the prognosis.

The preliminary study of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma patients with portal vein tumor thrombus / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus.</p><p><b>METHODS</b>22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Comparison of stent patency rate curves and survival curves was analyzed by Log rank test.</p><p><b>RESULTS</b>The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying degrees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. I-II degree gastrointestinal tract reactions occurred in 3 cases, I-II degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25% , 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 12 months was 100%, 80% , 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05).</p><p><b>CONCLUSION</b>Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.</p>

Postoperative adjuvant radiotherapy for pancreatic carcinoma patients after radical resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To retrospectively investigate the difference in survival of pancreatic adenocarcinoma patients treated by radical surgery with or without adjuvant radiation therapy.</p><p><b>METHODS</b>Forty-four patients with pancreatic cancer underwent surgical resection with a curative intent, and were divided into two groups: surgery alone (n = 24) or surgery combined with postoperative external beam radiotherapy (EBRT) (n = 20). Survival as an endpoint was analyzed between the two groups.</p><p><b>RESULTS</b>All 44 patients completed their scheduled treatment. The median survival time of the patients treated with radical resection alone was 379 days versus 665 days for those treated with combined therapy. The 1-, 3-, 5-year survival rates of the patients treated with radical resection alone were 46.3%, 8.3%, 4.2% versus 65.2%, 20.2%, 14.1% for the patients treated with combined therapy, respectively, with a significant difference between the two groups (P = 0.017). The failures in local-regional relapse were significantly lower in the postoperative EBRT group than that in the surgery alone group (P < 0.05), while the additional postoperative radiation therapy did not increase the complication rate (P > 0.05).</p><p><b>CONCLUSION</b>Postoperative external beam radiation therapy can improve the survival in patients with pancreatic adenocarcinoma.</p>

Reperfusion arrhythmias in acute myocardial infarction do not enhance myocardial injury / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the clinical implications of reperfusion arrhythmias during primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>Data from 228 AMI patients in whom the infarct-related artery (IRA) were successfully recanalized by primary PCI were retrospectively analyzed. The 228 patients were divided into 2 groups: myocardial ischemia-reperfusion injury (MIRI) group (n=119) in whom MIRI events occurred within minutes after successful recanalization of IRA, and non-MIRI group (n=109). The 119 patients in MIRI group were further divided into 3 subgroups: severe bradycardia with hypotension (brady-arrhythmia subgroup), lethal ventricular arrhythmias requiring electrical cardioversion (tachy-arrhythmia subgroup), and IRA antegrade flow less than or equal to TIMI 2 grade without angiographic evidence of abrupt closure (no-reflow subgroup).</p><p><b>RESULTS</b>(1) Clinical and angiographic data: Compared with non-MIRI group, MIRI group was characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more diseased vessels, more often TIMI 0 grade of initial antegrade flow in IRA, less pre-infarction angina, more renal insufficiency, and higher in-hospital mortality (13.4% vs. 4.6%, P=0.021). (2) The peak CK level was remarkably lower in brady-arrhythmia subgroup than that in non-MIRI group (2010 IU/L vs. 2521 IU/L, P=0.039). The peak CK or CK-MB level was notably higher in no-reflow subgroup than in non-MIRI group (4573 IU/L, 338 IU/L, respectively, P=0.000). (3) Left ventricular ejection fraction in no-reflow subgroup was significantly lower than in non-MIRI group (38.7% +/- 8.3% vs. 51.2% +/- 8.1%, P=0.000), left ventricular end-diastolic volume in no-reflow subgroup was greater than that in tachy-arrhythmia subgroup [(135 +/- 32) ml vs. (105 +/- 19) ml, P=0.029].</p><p><b>CONCLUSION</b>Reperfusion arrhythmias may imply the existence of much survived myocardium and do not enhance myocardial damage, while no-reflow increases myocardial injury and induces permanent impairment of cardiac function.</p>

Analysis on correlative factors for occurrence of myocardial ischemia-reperfusion injury during primary percutaneous coronary intervention for acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the risk and protective factors for the occurrence of myocardial ischemia-reperfusion injury (MIRI) during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).</p><p><b>METHODS</b>Clinical and angiographic data of 228 AMI patients in whom the infarct-related arteries (IRA) were successfully revascularized by primary PCI were analyzed retrospectively. MIRI was defined if the following conditions existed after PCI: severe bradycardia with hypotension, or lethal ventricular arrhythmias requiring electrical cardioversion, or IRA antegrade flow < or = TIMI 2 grade flow without angiographic evidence of thrombus, emboli, dissection or spasm. Multivariate logistic regression was used to identify independent relative factors among 18 clinical and angiographic factors for occurrence of MIRI.</p><p><b>RESULTS</b>Multivariate logistic regression analysis showed that independent risk factors for MIRI were the time intervals from AMI onset to IRA reflow < or = 6 h (P = 0.014), inferior infarction localization (P = 0.006), IRA antegrade flow prior to PCI < or = TIMI 1 grade (P = 0.028), multivessel lesions (P = 0.063) and renal insufficiency (P = 0.067). Pre-infarction angina was found to be an independent protective factor (P = 0.005).</p><p><b>CONCLUSIONS</b>Short time intervals from AMI onset to IRA revascularization, inferior wall infarction location, low IRA antegrade flow prior to PCI, multivessel lesions and renal insufficiency may promote the occurrence of MIRI during primary PCI, whereas pre-infarction angina may be a cardioprotective factor attenuating MIRI.</p>

Research on the Course Reform of Management Majors in Colleges Of Chinese Traditional Medicine / 中华医学教育探索杂志

This article takes the society demand of talented persons' knowledge structure as the guidance,discusses how to construct the curriculum of management majors in colleges of Chinese Traditional Medicine,widens the students' knowledge in curriculum setting,trains the students to study independently and strengthens practical ability,effectively improves students' comprehensive quality,builds the reliable foundation for their employment and provides outstanding talents for the medical department and medicine enterprise.

Evaluation system research on cultural quality education of college students based on balanced scorecard / 中华医学教育探索杂志

From the connotation of the cultural quality and according to the characteristics of evaluation system in college students,the article analyzed the evaluation system of students' culture quality by using balanced scorecard to promote college students' cultural quality education.