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Objective:To explore the application effect of the "combination of virtuality and actuality" practical teaching on Medical Imaging Equipment. Methods:The 2018 medical imaging technology students of Qiqihar Medical University were taken as the observation group, and the study adopted teaching method of "combination of virtuality and reality" in the practical teaching of Medical Imaging Equipment, including in-kind visit teaching (8 learning hours), experimental box circuit measurement teaching (20 learning hours) and virtual simulation teaching (16 learning hours). Besides, the 2017 medical imaging major students (control group) did not conduct virtual simulation teaching. The teaching effect and student achievement were compared between the two groups, and SPSS 17.0 was used to conduct t test and chi-square test. Results:There was significantly improvement in the practical performance of the students in the observation group compared with the control group ( t=6.44, P=0.007); the teaching satisfaction of the two groups was significantly improved ( χ2=5.25, P=0.022), and the teaching satisfaction degree was 100%. Conclusion:The teaching method of "combination of virtuality and reality" can effectively improve students' hands-on ability, strengthens their cognition of abstract principles, and solves the problems of equipment failure analysis, disassembly and installation of large-scale equipment that cannot be completed in physical teaching.
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Objective:To analysis the clinical features of patients with acute myocardial infarction (AMI) presenting de Winter pattern on electrocardiogram.Methods:A total of 1 287 patients with AMI admitted to Beijing Luhe Hospital between June 2017 and January 2019 were enrolled in the study. Electrocardiogram and clinical features of 13 patients with AMI presenting de Winter pattern on electrocardiogram were analyzed and compared with anterior wall ST-segment elevation myocardial infarction(STEMI, n=206). Results:Among the 13 patients, 12 were males, aged (52.23±12.55) years old. Compared to patients with anterior wall STEMI, the age in the de Winter group was younger [(52.23±12.55)years vs. (59.79±12.46)years; t=-2.12, P=0.03], and the time from onset to appearing a typical ECG was shorter [109.0 (71.5, 152.0)min vs. 200.5 (120.0, 397.5)min; Z=-3.38, P<0.01]. Three cases showed a shifting between de Winter pattern and typical STEMI ECG: the de Winter ECG pattern progressed to STEMI in 2 cases, 1 case changed from STEMI to de Winter,then converted to STEMI again. The emergency angiography was performed in all 13 patients, angiography showed that proximal left anterior descending branch (LAD) was involved in 11 cases, mid LAD was involved in 1 case, and diffuse spasm occurred in all vessels in 1 case. The de Winter ECG pattern vanished in all patients after primary percutaneous coronary intervention or emergency angiography. Conclusions:The de Winter ECG pattern suggests an acute proximal or mid LAD artery occlusion, and the de Winter ECG pattern can be alternated with STEMI. The de Winter pattern should be recognized and revascularization should be given early.
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Objective To investigate the impact of optical coherence tomography(OCT) imaging on physician decision-making during primary percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods From January 2016 to May 2017, OCT was performed in 100 cases pre- and post- primary PCI. The pathogenesis of myocardial infarction was determined and immediate effect of PCI evaluated by OCT. Clinical outcome during a 12-months follow up was analyzed. Results The data from 17 patients were excluded for further study due to poor OCT images quality. The rates of plaque rupture, plaque erosion, calcification nodules, stent malapposition and coronary spasm were 65.1％(54/83), 26.5％(22/83), 3.6％(3/83), 2.4％(2/83) respectively among the remaining 83 patients with sufficient OCT quality images. of the overall rate of stent malposition, tissue prolapse and incomplete stent expansion was 21.7％(18/83). The incidence of edge dissection was 19.3％(16/83), and among them 2 patients required treatment with stent implantation. Among the 17 patients without stenting:coronary spasm were found in 2 cases, thrombus overload in 1 case after thrombus aspiration, plaque rupture in 7 cases , plaque erosion in 4 cases and stent malposition in 3 cases. One patient died in hospital for cardiogenic shock and one patient had subacute stent thrombosis . There were no major adverse cardiac events occurred in the remaining patients during the (11.0±4.0) months of follow-up. Conclusions OCT can identify nonoptimal stent deployment in approximately one-fourth of STEMI patients undergoing primary PCI, thus providing preliminary guidance to the physician for further mangement.
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Objective To investigate the first medical contact to balloon ( FMC2B) time in our center and to identify the influencing factors .Methods This is a retrospective study conducted in the heart center of Beijing Luhe Hospital . A total of 140 patients undergoing primary percutaneous coronary intervention ( PCI) were enrolled between July 2013 to September 2014.Demographic data , clinical risk factors and the emergency process were evaluated .All the patients were categorized into 2 groups including:the conformed group ( patients with FMC2B<120 min for non-PCI-capable hospital and <90 min for direct arrival at Luhe hospital, n=59) and the unconformed group (n=81).Multivariant regression aralysis was done to analyse factors influencing FMC 2B time.Results Among the enrolled 140 patients, 58 patients were initially seen in a non-PCI-capable hospital , 31 patients were directly sent to Luhe hospital by ambulance and 51 patients arrived by themselves.The median FMC2B time was 106.16 min (interquartile range [ IQR ]: 77.37 -165.52 min ) and 42.1% ( 59/140 ) of the patients achieved the current recommended FMC2B time.In a multivariate logistic analysis , FMC to electrocardiographic ( ECG) within 10 min ( OR=5.61 , 95% CI 1.91-16.88 ) , admission during normal working hours ( OR=5.11 , 95%CI 1.88-13.85 ) , patient′s education level of high school or above ( OR=4.16 , 95%CI 1.53-11.34 ) , awareness of heart diseases ( OR =2.58, 95% CI 1.13 -5.91 ) were predictors of improving FMC2B. Transfer for primary PCI (OR=0.37, 95% CI 0.15-0.92) increased FMC2B.Conclusions Less than half of the patients with primary PCI achieved the goal of guidelines′recommended FMC2B time.Initial ECG, admission during normal working hours , patient′s education level and awareness of heart diseases and transfer for primary PCI are the independent predictors of FMC 2B time.
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Objective To investigate the therapeutic effect of self made balloon with side hole on no reflow ( NR) after emergency percutaneous coronary intervention ( PCI ) .Methods 48 patients with NR after PCI in our hospital were randomized into two groups , which were group A ( n=24 , patients received self made perfusion balloons with holes ) and group B ( n=24 , patients using direct guiding catheter ) and through respective devices intravascular tirofiban and verapamil were given .TIMI flow grade, recovery of myocardial enzymes and ST-segment elevation , LVEF and the incidence of MACE were compared between the 2 groups.Results Among patients in group A , the percentage of immediate postoperative TIMI Ⅲflow (79.2%vs.45.8%,P=0.032), ST segment resolution of more than 50% (83.3% vs.54.2%,P =0.029 ) and LVEF after 1 months [ ( 54.92 ±12.32 )% vs. ( 47.67 ±12.15 )%, P =0.046 ] were significantly higher than patients in group B .The CK peak value of patients in group A [ ( 1018.62 ± 732.34)mmol/L vs.(1497.75 ±858.63)mmol/L, P =0.043], CK-MB peak values [(113.84 ± 76.53 ) mmol/L vs.( 172.74 ±93.56 ) mmol/L, P=0.021 ] and MACE rates ( 0 vs.16.7%, P=0.037 ) were lower than those of patients in group B .Conclusions The use of self-made perfusion balloon with side hole for the treatment of NR patients after emergency PCI is convenient , easy and effective.
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Objective:To explore the impact of domestic bivalirudin on platelet function during emergency percutane-ous coronary intervention (PCI) .Methods :A total of 100 patients with acute ST segment elevation myocardial in-farction who recieved emergency PCI were randomly divided into unfractionated heparin group (UFH group ,n=53) and bivalirudin group (n=47) .Adenyl diphosphoric acid (ADP)-induced platelet aggregation rate was meas-ured and statistically compared between two groups before and after PCI .Results:Before emergency PCI ,there was no significant difference in ADP-induced platelet aggregation rate between two groups (P=0.99) .After emergency PCI ,ADP-induced platelet aggregation rate in bivalirudin group was significantly lower than that of UFH group [ (16.46 ± 10.23)% vs .(25.21 ± 15.91) % , P<0.01] .Conclusion:During percutaneous coronary intervention , compared with routine heparin anticoagulation , bivalirudin , as an anticoagulant , can more significantly inhibit platelet aggregation and possess antiplatelet effect .
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Objective To evaluate the effect of early intracoronary injection of tirofiban via aspiration catheter on myocardial no-reflow in elderly patients with acute ST-segment elevation myocardial infarction (STEMI).Methods 120 consecutive patients over 65 years old with AMI undergoing primary percutaneous coronary intervention (PCI) were randomized into two groups.In tirofiban group (n=60),thrombus aspiration and intracoronary tirofiban bolus (10 μg/kg prior to the first balloon inflation) via aspiration catheter were performed.In control group (n=60),thrombus aspiration was followed by primary PCI.The incidence of no-reflow and bleeding were assessed in the two groups.Results The moderate to severe bleeding (TIMI bleeding criteria) did not occur in the two groups,there's no significant difference between two groups in the incidence of minor bleeding [26.7％(16 cases) vs.21.7％ (13 cases),x2 =0.19,P=0.522].The incidence of myocardial noreflow was significantly lower in tirofiban group than in the control group [10.0％ (6/60) vs.25.0％ (15/60),x2 =4.68,P=0.031].Conclusions The intracoronary injection of tirofiban via aspiration catheter may significantly reduce the incidence of myocardial no-reflow in patients with STEMI without increasing bleeding complications.
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Objective To evaluate the current clinical application of domestic tirofiban in patients with acute coronary syndrome (ACS) and to explore its safety profile focused on the common causes and correlation factors for the hemorrhagic events.Methods The patients diagnosed as ST-elevation myocardial infarction (STEMI) and medium to high risk non-ST-elevation myocardial infarction (NSTEMI)/ unstable angina(UA) in 15 hospitals from September 2009 to December 2011 and given domestic tirofiban,were enrolled in this study.The following data were carefully collected:demographic data,comorbidities,concomitant medications,laboratory data,interventional treatment,application of tirofiban,hemorrhagic events and major adverse cardiac events(MACE) in hospital and at day 30 after discharge.Results (1) A total of 927 patients were enrolled in the study.The domestic tirofiban was given to 241 subjects (26.0％) before the intervention,567 subjects (61.2％) during the intervention and 89 subjects (9.6％) after the intervention.The standardized application was performed in 737 subjects (79.5％) with the loading dose of 10 μg/kg and the maintenance dose of 0.15 μg · kg-1 · min-1 In all the subjects,the average maintenance time was (30.4 ± 14.2) hours with the average dose of (339.3 ± 182.9)ml.(2)During hospitalization,major bleeding happened in 4 cases(0.4％) and major adverse cardiac events (MACE) in 37 cases (4.0％).(3)At day 30 after discharge,1 cases (0.1％)was reported with major bleeding and 9 cases (1.0％) with MACE.(3)The least MACE was showed in the preoperative tirofiban group (2.5％) and followed by the intraoperative group (4.1％) and the postopcrative group (9.0％).Compared with the non-standardized application group,MACE was significantly decreased in the standardized application group (2.44％ vs 10.00％,P ＜ 0.05).Conclusions The standardized application of the domestic tirofiban could decrease the incidence of MACE.Taken into account the combination therapy of clopidogrel and aspirin in the vast majority of patients,the domestic tirofiban exhibits a good safety profile with a relatively lower incidence of bleeding than the similar clinical studies.
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BACKGROUND:Drug eluting stents(DESs)has been applied in treatment of saphenous vein grafts,but few reports are present.OBJECTIVE:To retrospectively compare the late loss and major adverse cardiac events(MACE)between DES and bare mental stents(BMS)in patients with diseased saphenous vein grafts.DESIGN,TIME AND SETTING:The experiment,a grouping control study and follow-up observation,was performed from January 2002 to February 2007 in Beijing Luhe Hospitat and Beijing Anzhen Hospital.PARTICIPANTS:Ninety-seven consecutive patients with saphenous vein graft lesions were treated with DESs (DESgroup.n=50)or BMSs(BMS group,n=47).METHODS:All patients underwent percutaneous coronary implantation and received clinical follow-ups immediately.They were scheduled to undergo 12-month coronary angiography.MAIN OUTCOME MEASURES:The cardiac events including death,myocardial infarction,target lesion and/or target vessel revascularization.Late lumen loss was recorded and compared between the two groups.RESULTS:There were no significant differences on the gender,age,history of bridge vessels and complication between the two groups(P>0.05).A total of 97 patients with 118 lesions localized in 105 diseased saphenous vein grafts were included:50 patients received 71 DESs for 59 lesions,whereas 47 patients received 62 BMSs for 59 lesions.Procedural success was achieved in 94.0%of patients in the DES group and 93.6%in BMS group(P=0.43).At 12 months,the cumulative incidence of MACE was significantly lower in DES group than in BMS group(1 2.0%vs.29.8%.P=0.03).Angiographic follow-up was available for 54 patients,26 patients in DES group and 28 in BMS group.Late lumen loss was significantly reduced in DES group[(0.32±0.65)mm vs.(0.79±1.23)mm,P=0.01].The DES group had a significantly lower incidence of target lesion revascularization compared with BMS group(6.0%vs.19.1%.P=0.05).By Cox regression analysis,independent predictors for MACE at 12-month follow-ups were diabetes (OR:2.37;CI:0.95 to 5.88;P=0.064),BMS(OR:2.86;CI:0.98 to 8.34;P=0.05),and stent per lesion(OR:2.92;CI:1.25 to 6.82;P=0.01).CONCLUSION:DES is superior to BMS in diseased saphenous vein grafts,and it can significantly reduce late lumen loss and MACE.
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With improvement in stent designs, the practice of direct stenting (DS) without balloon predilation has become more widespread. DS may allow partial retention of endothelium within treated arteries, and associate with decreased utilization of contrast agent, number of catheter, exposure of X-ray,and expense. This paper evaluate the experiment base, principle, indication, contraindication, skills, complications as well as the result of acute and chronic follow up of DS.
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Objective To evaluate the feasibility and safety of ultrasound-localized percutaneous thrombin injection (ULTI) for the treatment of iatrogenic femoral pseudoaneurysm. Methods From January 2000 through October 2001, 5 patients (3 males, 2 females, age range 38～72 years) were found to have a pseudoaneurysm confirmed by ultrasound between 1 and 3 days following femoral arterial puncture. Two patients were associated with diagnostic arteriography and 3 with stent implantation. ULTI was our first choice for the treatment of ablating femoral pseudoaneurysm. All patients following ULTI were restudied within 24 hours. Results All 5 patients were initially treated with ULTI. Thrombin was injected directly into the pseudoaneurysm with a dose of 500 units over several seconds, successful ablation was visualized immediately in 4 patients, the remaining 1 patient needed ultrasound-guided compression treatment of five minutes. Follow-up at the 24th hour showed no recurrent pseudoaneurysm after initial successful ablation in any case. No distal embolization or allergic reaction occurred. Conclusion ULTI is a safe, rapid, well-tolerated, inexpensive and effective noninvasive method for the treatment of iatrogenic femoral pseudoaneurysm and should be considered as first-line therapy.
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Objective To evaluate the outcome of percutaneous intervention for the diseased bypass grafts in patients with previous coronary artery bypass graft surgery (CABG).Methods Sixty-six patients with diseased grafts after CABG underwent percutaneous intervention between July 2003 and July 2004.Angiographic follow up was suggested to all patients and major adverse cardiac events(MACE,including death,acute myocardial infarction and target lesion revascularization)were recorded within 6 months of follow up.Results Sixty-six patients with 74 diseased grafts(83 lesions) underwent percutaneous intervention.The angiographic success rate was 96.97%((64/66)) and the procedural success rate was 95.45%(63/66).No reflow phenomenon occurred in 2 cases,1 case restored TIMI 3 flow after administering verpamil but the other patient failed to restore the blood flow. Distal embolization occurred in 1 case.Abrupt closure in 1 case because of Dtype dissection not treated during the procedure but TIMI 3 flow was obtained after repairment with another stent.No MACE(death,acute myocardial infarction and acute emergency revascularization) occurred during hospitalization and the incidence of MACE was 31.3%(20/64) at 6 months follow up.In-segment restenosis rate was 32.5%(13/40) in 37 patients with angiographic follow-up.Conclusion Percutaneous intervention for diseased bypass grafts is feasible,safe and effective.