Application Value of Plasma vWF and ADAMTS-13 in Evaluating Postoprative Vascular Endothelial Injury and Prognosis in Children with VSD / 中国实验血液学杂志

OBJECTIVE@#To dynamically observe the levels and activities of von Willebrand factor (vWF) and ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) in plasma of children with congenital ventricular septal defect (VSD) during perioperative period, and explore the value of plasma vWF antigen (vWF:Ag) and ADAMTS-13 activity (ADAMTS-13: AC) in evaluating vascular endothelial injury and prognosis in children with VSD.@*METHODS@#In this cross-sectional study, a total of 74 children with VSD who underwent surgical treatment in TEDA International Cardiovascular Hospital from September 2018 to March 2019 were enrolled in the observation group. Among them, there were 28 cases of pure VSD, 32 cases of VSD combined with pulmonary hypertension, and 14 cases of VSD combined with valvular heart disease. 31 healthy children who underwent physical examination in Tianjin Children's Hospital during the same period were collected as the control group. The biochemical indexes of the children at admission were recorded. Peripheral plasma was collected at admission, postsurgery day 0 and day 1, respectively, and the levels of vWF activity (vWF:AC), vWF:Ag, ADAMTS-13 antigen (ADAMTS-13:Ag) and ADAMTS-13:AC were detected.@*RESULTS@#The level of plasma vWF:Ag and vWF:AC in the observation group before surgery were significantly lower than those in the control group (P<0.001), and increased continuously, on postsurgery day 0 and day 1 (P<0.001). The level of ADAMTS-13:Ag in the observation group before surgery was significantly higher than that in the control group (P<0.001), which decreased significantly on postsurgery day 0 (P<0.001), and increased significantly on postsurgery day 1 compared with postsurgery day 0 (P=0.033). The level of ADAMTS-13:AC in the observation group before surgery was significantly lower than that in the control group (P=0.015), which decreased significantly on postsurgery day 0 (P=0.037), and increased on postsurgery day 1, but the difference was not statistically significant (P=0.051). The changes of vWF and ADAMTS-13 in the three subgroups were basically similar to the observation group. vWF: Ag/ADAMTS-13: AC ratio on postsurgery day 0 and day 1 had high diagnostic value in vascular endothelial injury (AUC=0.80, P<0.001; AUC=0.93, P<0.001). Preoperative vWF and ADAMTS-13 levels, and related baseline indicators were not correlated with postoperative infection, bleeding, thrombosis,etc.@*CONCLUSION@#Preoperative vWF: Ag, vWF: AC and ADAMTS-13: AC levels in children with VSD are low, while the level of ADAMTS-13: Ag is high. After surgery, the levels of vWF: Ag and vWF: AC are increased and the level of ADAMTS-13: Ag is decreased. The postoperative vWF: Ag/ADAMTS-13: AC ratio shows high diagnostic value in evaluating vascular endothelial injury. There is no correlation between preoperative vWF and ADAMTS-13 levels with perioperative clinical events.

CT manifestations of liver involvement in children with Langerhans cell histiocytosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the computed tomography (CT) manifestations of liver involvement in children with Langerhans cell histiocytosis (LCH).</p><p><b>METHODS</b>Retrospective analysis was performed on 9 LCH children with liver involvement confirmed by clinical, laboratory and pathological examinations to investigate the CT manifestations of this condition. These children, including 6 males and 3 females, had undergone both plain CT scan and dual-phase (the arterial and portal venous phases) contrast-enhanced CT scan.</p><p><b>RESULTS</b>The main CT manifestations included hepatomegaly (8 cases); periportal dendritic hypodense lesions or "periportal halo sign" (7 cases) which were mildly or moderately enhanced in the arterial phase; intrahepatic bile duct dilatation (5 cases); lymphadenopathy in the hepatic hilar or retroperitoneal region (4 cases); and diffuse small hypodense nodules (3 cases), which showed annular enhancement on the contrast-enhanced CT scan.</p><p><b>CONCLUSIONS</b>CT findings may be helpful in the early diagnosis and treatment of LCH in children.</p>

Comparison of safety and efficacy between fondaparinux and nadroparin in non-ST elevation acute coronary syndromes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) guidelines gave fondaparinux a class I recommendation for use in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) undergoing invasive or conservative strategy. Nadroparin is one of the common anticoagulants used in NSTE-ACS in China. Accordingly, this study compared the safety and efficacy between fondaparinux and nadroparin in patients with NSTE-ACS.</p><p><b>METHODS</b>In this prospective, randomized, open-label, and single center study, a total of 300 patients with NSTE-ACS were randomized to receive either fondaparinux (group F, n = 150, 2.5 mg/d) or nadroparin (group N, n = 150, 0.1 ml/10 kg q12 h) for a mean of 4 days. The primary safety endpoint was the incidence of major or minor bleeding at 9 days that was not related to coronary artery bypass grafting (CABG). The primary efficacy endpoints included death, myocardial infarction, or recurrent ischemia at 9 days. All patients underwent a 180-day follow-up.</p><p><b>RESULTS</b>Baseline characteristics were well matched between the two groups. There was a non-significant 28% relative risk reduction in the primary safety endpoint in group F compared with group N (4.7% vs. 6.7%, HR 0.72, 95%CI 0.42-1.65, P = 0.38). The primary efficacy endpoint was 8.0% in group F and 10.0% in group N (HR, 0.82, 95%CI 0.54-1.71, P = 0.49). The composite of the safety and efficacy endpoints at 9 days (10.0% vs. 16.0%, HR 0.61, 95%CI 0.31-1.10, P = 0.10), 30 days (14.0% vs. 17.9%, HR 0.72, 95%CI 0.47-1.16, P = 0.21), or 180 days (18.7% vs. 27.3%, HR 0.65, 95%CI 0.38-1.11, P = 0.11) showed a non-significant trend toward a lower value in group F.</p><p><b>CONCLUSION</b>Fondaparinux resulted in a nonsignificant risk reduction in patients with NSTE-ACS in both bleeding and ischaemic events during short- and long-term follow-up compared with nadroparin.</p>

Clinical implication and association between local and systemic levels of interleukin-1β and interleukin-10 in patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the systemic and local near atherosclerosis lesion levels of pro-inflammatory factor interleukin-1β (IL-1β) and anti-inflammatory factor IL-10 in patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Plasma samples were collected from 30 individuals without angiographical coronary artery stenosis (control group), 90 patients with CAD (stable angina pectoris, SA, n = 30, unstable angina pectoris/non-ST-segment elevation myocardial infarction, UA/NSTEMI, n = 30 and ST-segment elevation myocardial infarction, STEMI, n = 30). During diagnostic coronary angiography or interventional procedures, systemic samples were obtained from aorta root in all patients (n = 120), local samples from distal of the coronary lesion in patients with CAD (n = 90), and samples from coronary sinus of 14 patients with STEMI. IL-1β and IL-10 were determined by ELISA method.</p><p><b>RESULTS</b>The result showed systemic levels of IL-1β were lg(-1) (0.97 ± 0.42), lg(-1) (0.98 ± 0.43), lg(-1) (1.21 ± 0.42), lg(-1) (1.30 ± 0.43) ng/L in the control, SA, UA/NSTEMI and STEMI groups, were significantly higher in UA/NSTEMI and STEMI groups compared with the control group (P < 0.05, P < 0.01); systemic IL-10 levels were lg(-1) (0.77 ± 0.29), lg(-1) (0.73 ± 0.45), lg(-1) (0.75 ± 0.35), lg(-1) (1.14 ± 0.36) ng/L in the four groups and was significantly higher in STEMI group than the control group (P < 0.01). The local concentration of IL-1β and IL-10 were similar as the systemic levels in SA group [lg(-1) (0.98 ± 0.41), lg(-1) (0.67 ± 0.47) ng/L], local IL-1β [lg(-1) (1.22 ± 0.48) ng/L] was similar while local IL-10 [lg(-1) (0.89 ± 0.46) ng/L] was significantly higher than the systemic levels in UA/NSTEMI group. The local levels of IL-1β and IL-10 [lg(-1) (1.45 ± 0.45), lg(-1) (1.35 ± 0.31) ng/L] were both significantly higher than the systemic levels in STEMI group (all P < 0.01). The IL-1β levels of systemic, local and coronary sinus in STEMI patients with acute totally occluded left coronary artery [lg(-1) (1.47 ± 0.37), lg(-1) (1.65 ± 0.34), lg(-1) (1.53 ± 0.35)ng/L] and the IL-10 levels [lg(-1) (1.06 ± 0.48), lg(-1) (1.34 ± 0.39), lg(-1) (1.34 ± 0.23) ng/L] were similar. The level of IL-1β in coronary sinus was significantly lower than in culprit lesion (P < 0.05) while IL-10 levels were similar at these two sites (P > 0.05).</p><p><b>CONCLUSION</b>The systemic level of pro-inflammatory marker IL-1β and anti-inflammatory marker IL-10 could not reliably reflect the local inflammatory status near the atherosclerosis plaque locations.</p>

Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery (IRA) bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction (STEMI). This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.</p><p><b>METHODS</b>This single center study included 108 matched control patients with STEMI, angioplasty after thrombus aspiration, and 108 study patients with STEMI plus intra-IRA administration of 500 microg of tirofiban. Both groups had subsequent 12-hour intravenous infusion of 0.1 microg x kg(-1) x min(-1) of tirofiban after angioplasty. The primary end points were Thrombolysis in Myocardial Infarction (TIMI) flow immediately after angioplasty, ST-segment elevation resolution (STR) (> 70%) at 90 minutes after angioplasty, and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at nine months follow-up, cardiac death, target vessel revascularization (TVR), re-infarction and the combination of these three as major adverse cardiac events (MACE) within nine months and any bleeding events.</p><p><b>RESULTS</b>Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group (97.22% vs. 87.04%, chi(2) = 7.863, P = 0.049). The peak of CK-MB (83.9 (68.9 - 310.5) U/L vs. 126.1 (74.7 - 356.7) U/L, P = 0.034) and TnI (42.7 (14.7 - 113.9) ng/ml vs. 72.5 (59.8 - 135.3) ng/ml, P = 0.029) were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, (45.7 +/- 8.3)% to (42.9 +/- 12.1)%, t = 1.98, P = 0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference (Log-rank chi(2) = 2.865, P = 0.09). There was no statistical difference in any bleeding events between the two groups.</p><p><b>CONCLUSIONS</b>Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.</p>

Efficiency and safety of thrombus aspiration plus intra-infarct-related artery administration of tirofiban during primary angioplasty / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.</p><p><b>METHODS</b>In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 µg tirofiban administration, with subsequent 12-hour intravenous infusion of 0.1 µg×kg(-1)×min(-1) after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspiration group). The primary end points included thrombolysis in myocardial infarction (TIMI) flow immediately after angioplasty, complete ST-segment elevation resolution (> 70%) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events (MACE: cardiac death, target vessel revascularization, re-infarction) at 9 months and any bleeding events.</p><p><b>RESULTS</b>Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87.04%, P = 0.011) and the complete ST-segment resolution rate (66.67% vs. 50.91%, χ(2) = 6.129, P = 0.047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126.1 U/L, P = 0.034) and TnI (42.7 ng/ml vs. 72.5 ng/ml, P = 0.029) were significantly lower in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiration + tirofiban the group (45.7% ± 10.8%, 42.9% ± 9.9%, t = 1.99, P = 0.049). There was a tendency to decreased MACE rate at 9-month follow-up, which favored thrombus aspiration + tirofiban the group (logrank χ(2) = 2.865, P = 0.09). Bleeding events were similar between the two groups.</p><p><b>CONCLUSION</b>Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.</p>

Pathological analysis of aspirated materials from the culprit lesion in patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the components of retrieved materials from the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients by manual aspiration during primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Visible retrieved materials were collected, fixed in formalin and processed for paraffin embedding, sectioned and stained with hematoxylin and eosin (HE). The retrieved materials were microscopically divided into erythrocyte-rich thrombi, platelet/fibrin-rich thrombi, combined thrombi (similar proportions of erythrocytes and platelet/fibrin components), atherosclerotic plaque materials and edematous components. Based on pathological findings, thrombus materials were classified into fresh (< 1 d), lytic (1-5 d), fresh/lytic and organized thrombi (> 5 d) after formation. All patients were further classified into plaque positive and plaque negative groups. Clinical and angiographic data were also obtained for analyzing possible association between pathological findings and surrogates of myocardial reperfusion, including myocardial blush grade (MBG), enzymatic estimated infarction size (peak CK and CK-MB levels), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) which were assessed 16 h after procedure.</p><p><b>RESULTS</b>Visible samples were collected from 49 patients by manual catheter aspiration (thrombus components in 46 patients, atherosclerotic plaque only in 3 patients). Frequency of erythrocyte-rich thrombi, platelet/fibrin-rich thrombi and combined thrombi were 41.3% (19/46), 30.4% (14/46) and 28.2% (13/46), respectively. The incidence of fresh, lytic, fresh/lytic and organized thrombi were 47.8% (22/46), 32.6% (15/46), 10.9% (5/46) and 8.7% (4/46), respectively. Plaque materials were found in 57.1% (28/49) patients, including ruptured plaque accompanied by thrombus formation [8.2% (4/49)], fibrous plaque [6.1% (3/49)] and thickened intima [2.0% (1/49)]. Baseline characteristics did not differ between plaque positive (n = 28) and plaque negative (n = 21) groups. Ratios of MBG 3 were higher in plaque positive group than in plaque negative group [82.1% (23/28) vs. 52.4% (11/21), P = 0.025]. Peak CK and CK-MB levels were lower in the former than in the later [(1705 +/- 1647) U/L vs. (2629 +/- 2013) U/L, P = 0.042; (146 +/- 136) microg/L vs. (258 +/- 215) microg/L, P = 0.016; respectively]. Furthermore, LVEF were higher in plaque positive group than in plaque negative group (0.59 +/- 0.10 vs. 0.52 +/- 0.08, P = 0.012).</p><p><b>CONCLUSION</b>Manual catheter aspiration during primary PCI in STEMI patients is an effective way for removing thrombus and plaque materials, and plaque debulking before stenting or pre-dilation and this procedure might probably improve myocardial reperfusion, limit infarction size and improve cardiac function.</p>

Oral ferric ammonium citrate solution in MRCP for diagnosing low-level obstructive jaundice / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the value of oral ferric ammonium citrate solution as a gastrointestinal contrast agent in diagnosing low-level obstructive jaundice.@*METHODS@#Thirty-six patients who were suspected of low-level obstructive jaundice were performed with magnetic resonance cholangiopancreatography (MRCP) and conventional MRI before and after the administration of oral ferric ammonium citrate solution. The diagnostic accuracy for evaluating the site and the cause of obstruction was compared with other diagnostic modalities.@*RESULTS@#The image qualities of single-slice and multi-slice MRCP were improved markedly. The accuracy of MRCP for evaluating the site of obstruction was 97.22%, which was superior to US (P<0.05). There were no significant differences among the MRCP, CT, and ERCP.@*CONCLUSION@#Oral ferric ammonium citrate solution can significantly improve the image quality of MRCP. FAC-MRCP is a simple, safe, and noninvasive technique with excellent accuracy in the diagnosis of low-level obstructive jaundice.

Expression of Ang2 and Tie2 and their relation with the angiogenesis of hepatocellular carcinoma in rats / 中南大学学报(医学版)

OBJECTIVE@#To investigate the relationship between the expression of Ang2, Tie2 and the angiogenesis of hepatocellular carcinoma in rats.@*METHODS@#Thirty-eight healthy male rats were randomly divided into 3 groups: 5 rats in the control group; 25 rats in the experimental group were equally divided into 5-day, 10-day, 15-day, 20-day, and 25-day groups; the other 8 rats were used as the supplement of the experimental group. An allogenic transplanted rat model of CBRH-7919 hepatocellular carcinoma in situ was established by immunosuppression. The expressions of Ang2 and Tie2 were detected by immunohistochemical staining in cancerous tissues of different developmental stages and liver tissues of the control group. At the same time, microvessel density was determined by anti-CD31 immunohistochemical staining.@*RESULTS@#CBRH-7919 hepatocellular carcinoma models were successfully set up in 24 rats. The expression level of Ang2 and Tie2 in cancerous tissues was much higher than that of liver tissues of the control group (P <0.05). The overexpression of Ang2 was pristine and continuous in different developmental stages. The expressions of Ang2 and Tie2 positively correlated with microvessal density in hepatocellular carcinoma (P<0.05).@*CONCLUSION@#The up-regulation of Ang2 and Tie2 may play important roles in the angiogenesis of hepatocellular carcinoma. Ang2 may participate in the start of angiogenesis of hepatocellular carcinoma.