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Objective To investigate the diagnosis and surgical treatment of peripheral solitary pulmonary nodule (SPN).Methods From January 2007 to October 2012,the clinical data of 69 cases of SPN treated were analyzed prospectively.And postoperative pathologic examination results as the gold standard to determine spiral CT enhanced check the accuracy and consistency test (Kappa test).Results Twenty-eight cases were diagnosed as malignant SPN by preoperative CT,25 cases were diagnosed as malignant SPN by postoperative pathology.The accuracy of CT judgment SPN benign and malignancy was 89.3％ (25/28),the Kappa value was 0.503.All patients were followed up for 6-12 (9.6 ± 1.4) months.There was no recurrence or enlargement.Conclusions Enhanced spiral CT scan is more economical and practical way for identifying benign and malignant SPN.Malignant SPN diagnosed by CT should be considered having surgery and auxiliary thoracoscopy combined with intraoperative rapid freezing to determine the surgical approach.
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Objective To investigate the feasibility,advantage and clinical effect of video-assisted thoracoscopic in the treatment of sharp injury hemopneumothorax.Methods 53 cases in our hospital of sharp injury hemopneumothorax who need operation treatment were divided into the observation group (VATS group) and the control group(Open group),which were treated by Video-assisted thoracoscopic surgery and the traditional thoracotomy surgery respectively.The clinical effects,such as operative time,intraoperative blood loss,hospital stays,postoperative chest lead flow and so on were compared.Results The operation time,bleeding volume,length of hospital stay,postoperative chest lead flow and pleural drainage days have significant difference (all P ＜ 0.05).Conclusion VATS has shorter operative time,less intraoperative blood loss and quicker recovery after operation,which is a better and safer treatment of sharp injury hemopneumothorax and deserves further clinical application.
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Objective To discuss the clinical efficacy of video-assisted thoracoscopic surgery(VATS)for bilateral bullous lung disease operation.Methods VATS procedures were performed on 120 patients with bilateral ballous lung disease.56 patients were operated in one-stage with traditional incision surgery.Results 120 patients were cured.The mean duration of chest drainage after surgery was 4.7 days.Postoperative complications occurred in 14 cases,including pulmonary edema,pneumothorax again respiratory failure and so on.The mean postoperative hospital stay was 14.5 days.The patients were followed up 1 to 60 months.Conclusion VATS is an effective and preferred method for bilateral bullous lung disease.compared with conventional open techniques for bilateral bullous lung disease,the advantages of VATS include shorter hospital stays,less postoperative pain and earlier return to work.
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Objective To analyze the changes of heart rate turbulence (HRT) and heart rate variability (HRV) in coronary heart disease (CHD), and evaluate the relationship between CHD and coronary artery disease (CAD) and two parameters of HRT and HRV, and investigate the correlation between the 2 parameters.Methods We performed coronary angiography in all 103 patients with CHD (group A), who were classified into 3 subgroups: 35 patients of stable angina pectoris ( group A1 ), 28 patients of unstable angina pectoris ( group A2 ) and 40 patients of AMI ( group A3 ), and 30 structurally normal patients with ventricular premature contraction who were included in healthy control group ( group B).The 24-hour ambulatory electrocardiogram was performed in all the patients, and the parameters of HRT and HRV were obtained.Results The value of the TO onset of group A was significantly higher than that of group B( -4.17± 2.75, - 3.16 ± 3.18, - 0.96 ± 2.92; - 6.30 ± 3.47 ), the value of TS of group A was lower than that of groupB(6.81±3.18,5.12±3.31,3.20±1.71;9.52±3.85) (P ＜0.05 orP ＜0.01).The values of SDNN, PNN50, and HF of group A were significantly lower than those of group B (P＜ 0.05).TO was positively correlated with Gensinies score, while TS, SDNN, PNN50 and HF were negatively correlated with Gensinies score, and TS showed the strongest negative correlation with Gensini score (r=-0.45).TO was negatively correlated with SDNN, PNN50, and HF, while TS was positively correlated with SDNN, PNN50 and HF, and TS showed much stronger correlation with HF (r=0.47).Conclusions HRT was dramatically blunted and HRV in patients with CHD was significantly lower;.HRT and HRV of group A1 were significantly correlated with Gensini score, and TS had the strongest correlation with Gensini score.TO and TS were correlated with SDNN, PNN50 and HF, and TS had much stronger relationship with HF.
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OBJECTIVE@#To evaluate the efficacy and safety of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) avoiding defibrillation threshold (DFT) testing when treating ventricular tachycardia (VT) or ventricular fibrillation (VF).@*METHODS@#We analyzed a continuous database of the 21 patients who had avoided DFT during ICD implantation from Oct. 1999 to Aug. 2008. Follow-up data were completed and analyzed in the 21 patients with ICD implantation.@*RESULTS@#ICDs were implanted successfully in 17 patients with VT or VF, and CRT-D were implanted successfully in 4 myocardiopathy patients with severe heart failure who avoided DFT during ICD or CRT-D implantation. Eight patients accepted DFT 1 week later, VT or VF was not induced in 3 patients (37.5%). During the mean follow-up of 1 approximately 7 (4.2+/-1.9) years, malignant ventricular arrythmia was recorded in 16 patients. Among them, 89 episodes were successfully terminated by defbrillation (100%), 120 VT events were terminated by the first run of antitachycardia pacing (51.1%) and 22 by low energy cardioversion (59.2%). All patients took antiarrhycardia drugs after ICD or CRT-D implantation. No patient died from malignant ventricular arrythmia during the follow-up.@*CONCLUSION@#No application of routine DFT may avoid complications associated with DFT during ICD or CRT-D implantation. ICD or CRT-D implantation may effectively treat fatal ventricular tachyarrhythmias and prevent sudden cardiac death.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Arrhythmias, Cardiac , Therapeutics , Defibrillators, Implantable , Reference Standards , Electric Countershock , Reference Standards , Equipment Safety , Follow-Up Studies , Sensory Thresholds , Unnecessary Procedures , Ventricular FibrillationABSTRACT
Objective To investigate the effect of prostaglandin E1(PGE1) on the expression of monocyte chemoattractant protein-1(MCP-1)in human umbilical vein endothelial cells (HUVECs) and its possible mechanism. Methods Endothelial cells were incubated with oxidized low-density lipoprotein (ox-LDL group) in the presence or absence of prostaglandin E1. The level of MCP-1 in the supernatants was determined by enzyme linked immunosorbent assay (ELISA), the expression of MCP-1 mRNA in cultured endothelial cells was detected by in-situ hybridization and the protein expression of NF-κB was analyzed by Western blot. Results Compared with ox-LDL(100 μg/ml),PGE1 markedly lowered the levels of MCP-1[(0. 327±0. 051),(0. 214±0. 213),(0. 247±0. 228)pg/ml vs. (0. 655±0. 013)pg/ml], inhibiting the expression of MCP-1 mRNA [(0. 061±0. 008), (0. 033±0. 006),(0. 026±0. 004)A/μm2 vs. (0. 220±0. 032)A/μm2] in the cultured HUVECs in a dosedependent manner (0. 001, 0. 01, 0.1 mol/L). Western blot analysis demonstrated that the amount of NF-κB p65 was attenuated after treatment with prostaglandin E1 for 24 hours. Conclusions Prostaglandin E1 can downregulate the expressions of MCP-1 and NF-κB induced by ox-LDL in HUVECs, which may thereby defend the blood vessel endothelial cell function.
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BACKGROUND: 60% of the patients receiving implantable cardioverter defibrillator(ICD) believe their quality of life has been improved. However,about 30% to 50% of the patients suffer from postoperative depression and anxiety; especially those patients receive electroconvulsive therapy (ECT).OBJECTIVE: To probe into the modulatory effects of cognitive behavior therapy(CBT) on depression and anxiety in patients with ICD.DESIGN: A retrospective case analysis based on ICD patients SETTING: Room of Cardiac Catheterization, Department of Cardiology, Xiangya Second Hospital PARTICIPANTS: The study was conducted in the Room of Cardiac Catheterization of the Department of Cardiology, Xiangya Second Hospital,Central South University from October 2000 to August 2001. Inclusive criteria: ICD patients that had ineffective medicine therapy for paroxysmal ventricular tachycardia and/or ventricular fibrillation complicated with cardiac syncope. Exclusive criteria: incoorperative patients or patients who unable to receive periodical follow up. A total of 6 patients were involved including 4 male and 2 female patients aged from 45 to 71 years old with an average age of (57.3 ± 2.4) years old. All of the patients received Micro Jewell Ⅱ 7223 ICD made by Medtronic Company. Diagnoses of basic disease:2 cases of coronary heart disease, 2 cases of right ventricular myocardial disease, 1 case of paroxysmal ventricular tachycardia due to unknown reason,and 1 case of Brugada syndrome.METHODS: "Morita therapy" technique was used. Patients were asked to transfer their spirit energies into feasible objectives of their real life, which would be helpful to the rapid improvement of their symptoms. symptom checklist-90(SCL-90) scale was used to evaluate the psychological symptoms before and after the therapy.MAIN OUTCOME MEASURES: Comparison of the scores gained in SCL-90 between before and after CBT.RESULTS: There were significant differences in the items of somatization,compulsion, sensitive human relationship, depression, anxiety, phobia disorder, etc. between before and after CBT ( P ＜ 0.05 or 0.01 ).CONCLUSION: Psychotherapy shouldn't be neglected in the postoperative follow up of ICD, and CBT is helpful to relieve symptoms especially for those depression and anxiety patients with electroconvulsive experiences.
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Objective To investigate the clinical significance of vascular endothelial growth factor (VEGF) levels in the serum of patients with acute myocardial infarction (AMI),and also to explore the relationship between VEGF and creatine kinase (CK) levels in AMI.Methods 25 patients with AMI and 12 controls were used for this study. Serum was isolated from peripheral blood on day 1, 5, 10 and15 after the onset of AMI. VEGF levels were measured by enzyme-linked immunosorbant assay (ELISA).Results Serum VEGF levels elevated gradually after the onset of AMI and reached a peak on day 10, which was significantly higher than that of control group (178 9?48 9)pg/ml vs(64 9?16 7)pg/ml,P
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Objective To investigate the expression of nuclear factor kappa B(NF-?B) in carotid artery of hypercholesterolemic rabbits injured by balloon and its relationship with intimal hyperplasia.Methods Twenty-five New Zealand male rabbits were fed with atherogenic diet and balloon injury was conducted in right carotid artery 4 weeks later.The rabbits were killed at the 6th hour,24th hour,1th week,2th week and 4th week,respectively.Blood samples and right carotid artery were collected in time and intimal hyperplasia was studied by histological morphology method.The expression of NF-?B was measured by in-situ hypridization(ISH).Results Intimal hyperplasia was present at the 7th day after balloon injury in hypercholesterolemic rabbits and it became more obvious with the increasing of the time.The intimal hyperplasia was not detected in the media area.The intima/media ratio was increased as time went on.The expression of NF-?B mRNA was observed in the carotid atery of hypercholesterolemic rabbits at the 6th hour after balloon injury and the expression reached its peak at the 2th week.The expression of NF-?B was much higher in injury group than that of control group.Conclusion The expression of NF-?B is up-regulated in carotid artery of hypercholesterolemic rabbits injured by balloon,which is involved in the inflammatory reaction and restenosis caused by balloon injury.
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Objective To analyze the relationship between the concentration of plasma insulin during oral glucose tolerance test (OGTT) and stent restenosis in non-diabetic patients, and determine whether hyperinsulinemia during OGTT is a predictor of the development of stent restenosis. Methods 49 non-diabetic patients with coronary artery disease underwent stent implantation were enrolled in this study. All patients were subjected to 75g OGTT before or after stent implantation, and coronary angiography was performed to observe the stent restenosis about 6 months of post-operation. Results The concentrations of plasma insulin at 0 5, 1, 2 and 3 hours after glucose loading were significantly higher in patients with stent restenosis than those in patients without stent restenosis(P≤0 05). Insulin area(IA) and insulin area/glucose area(IA/GA) were also significantly higher in patients with stent restenosis than those in patients without stent restenosis(P≤0 05). Conclusion Non-diabetic patients with hyperinsulinemia during OGTT had a higher risk for stent restenosis after stent implantation, and OGTT before stent implantation may be useful to predict stent restenosis.
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Objective To observe the effect of anxiety and depression on cell adhesion molecules and fibrolytic activity in cardiac-pacing patients. Methods The levels of plasma P-selectin, E-selectin, sICAM-1, vWF and PAI-1 were measured in 39 cardiac-pacing patients with anxiety or depression as rersearch group, 32 cases cardiac-pacing patients without any psychological problems as observation control group and 20 healthy subjects as normal control group. Result The levels of plasma P-selectin, E-selectin, sICAM-1, vWF and PAI-1 in cardiac-pacing patients were significantly higher than those in normal control group, and their plasma levels in the patients with anxiety or depression were significantly higher than those in the patients without psychological problems. Conclusion There were significantly elevated cell adhesion molecules level and decreased fibrolytic activity in cardiac-pacing patients. The anxety and depression status could aggregate this condition.
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Objective To observe the dynamic change of the intimal proliferation in balloon-injured rabbit carotid arteries to explore the mechanism of restenosis. Methods 40 healthy male New Zealand white rabbits were randomly divided into experiment groupsⅠ、Ⅱ、Ⅲ and control group, each group containing 10 rabbits. Right carotid artery was injured with PTCA balloon in the experiment groups. 10 rabbits in each experiment group were killed on 1, 2 and 4 weeks after injury. Morphological change of injured intimae was examined by light microscope and analyzed using a computerized imaging analysis system. Results In experiment group, neointimal areas were significantly more than those in control group(P
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Objective To investigate mechanism and clinical effect of implantation of pacemaker with artial fibrillation(Af) preventive pacing algorithms (Vitatron 900E).Method 24 cases of patients with paroxysmal Af were observed in three phases (each phase two weeks):⑴Monitoring phase,in which onset mechanism of atrial arrtythmias was recorded, the device was programmed into DDD mode with 60 bpm;⑵Lower rate limit phase (LRL),DDDR mode with 85bpm LRL, and evaluating anti-Af effect by elevated rate;⑶Preventive pacing therapy phase,all preventive pacing therapies with programming to on or off, and this phase determined whether combined pacing therapies impacted on incidence of Af. Results 24 cases of patients were free of Af, in which 17 cases were done by using post-PAC-response or/and post-exercise-rate-control therapy only, and 7 cases of 17 casees were done by combining it with cordarone 0 1～0 2g/d also. The other 7 cases were done by DDDR 85 bpm only.Conclusions Af prevention pacing may be benefit for patients with paroxysmal Af,especially with complicated symptomatic bradycardia.
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AIM: To explore the effect of atorvastatin on cardiac remodeling in spontaneous hypertension rats(SHR).METHODS: Twelve spontaneous hypertension rats were divided randomly into two groups: group of atorvastatin(atorvastatin 50 mg?kg~(-1)?d~(-1)) and group of SHR(0.5% mucilage of arabic gum,10 mL?kg~(-1)?d~(-1)).Additionally,six male Wistar-Kyoto rats(0.5% mucilage of arabic gum,10 mL?kg~(-1)?d~(-1)) were selected as control group.Systolic blood pressure was assessed with the tail-cuff method.After six weeks,entire heart,and left ventricle were weighed.The left ventricular weight index was calculated and myocardial hydroxyproline and collagen protein concentration were measured.The serum high sensitivity CRP(hs-CRP) was measured by nephelometry.The localization of vascular cell adhesion molecule(VCAM) in myocardium was investigated by immunohistochemistry assays.The level of NF-?B mRNA expression was detected with in situ hybridization.Ultrastructure in cardiac muscle was also observed under transmission electron microscope.RESULTS: The expression of myocardial VCAM and NF-?B in SHR group was stronger than that in WHY group.Compared with SHR group,entire heart weight,left ventricular weight,left ventricular weight index,serum hs-CRP,myocardial hydroxyproline and collagen protein concentration was decreased,the expression of myocardial VCAM and NF-?B in SHR group was weaker than that in atorvastatin treatment group.The myocardial pathological change such as incomplete karyotheca in cardiac muscle cells,no clear of transverse striation and the mess in myofibril alignment,and hyperplasy in interstitial collagen fibre were observed in SHR group and these changes were improved in atorvastatin treatment group.CONCLUSION: The cardiac remodeling in SHR is improved by atorvastatin.The molecular mechanism may be related to its down-regulating the expression of VCAM protein and NF-?B and inhibiting myocardial chronic inflammation.
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Objective To study the effect of G-CSF and SCF on ventricular remodeling after acute myocardial infarction in rats. Methods Left anterior descending coronary artery ligation was performed on 78 rats and after 6 hours there were 60 rats survived. The 60 rats were randomly divided into 2 groups: 30 rats received the treatment of G-CSF and SCF while the other 30 rats served as the control. The treatment group was injected subcutaneously with G-CSF and SCF and the control group was given saline. The treatment and control groups were randomly divided into 3 subsections and were killed in the 1~(st), 2~(nd) and 4~(th) week respectively. Comparison between the two groups was made in terms of ratio of ventricular weight to body weight, percentage of the infarction area to the total surface area of the LV as well as HE and immunohistological staining of the myocardium. Results (1) In the 4~(th) week, the ratio of ventricular weight to body weight in the treatment group was smaller (P