Effect of Shexiang Tongxin Dropping Pills () on the Immediate Blood Flow of Patients with Coronary Slow Flow / 中国结合医学杂志

OBJECTIVE@#To observe the immediate effect and safety of Shexiang Tongxin dropping pills (, STDP) on patients with coronary slow flow (CSF), and furthermore, to explore new evidence for the use of Chinese medicine in treating ischemic chest pain.@*METHODS@#Coronary angiography (CAG) with corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) was applied (collected at 30 frames/s). The treatment group included 22 CSF patients, while the control group included 22 individuals with normal coronary flow. CSF patients were given 4 STDP through sublingual administration, and CAG was performed 5 min after the medication. The immediate blood flow frame count, blood pressure, and heart rate of patients before and after the use of STDP were compared. The liver and kidney functions of patients were examined before and after treatments.@*RESULTS@#There was a significant difference in CTFC between groups (P0.05).@*CONCLUSIONS@#The immediate effect of STDP in treating CSF patients was apparent. This medication could significantly improve coronary flow without affecting blood pressure or heart rate. Our findings support the potential of Chinese medicine to treat ischemic chest pain.

Evaluation of myocardial perfusion in patients with coronary slow flow by myocardial contrast echocardiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore myocardial perfusion of patients with coronary slow flow (CSF) using myocardial contrast echocardiography.</p><p><b>METHODS</b>Myocardial contrast echocardiography was performed in coronary artery angiography diagnosed CSF patients (n = 20) and control patients (n = 20). The images at baseline and after low dose dobutamine stress test were analyzed by automatic tracking software and the maximal amplitude score A, the mean ascending slope of the curve β and the product of A×β were measured. The reserve of A×β was also calculated. Electrocardiogram at rest and at each stage of dobutamine stress test was obtained simultaneously.</p><p><b>RESULTS</b>At baseline, the A [(6.85 ± 2.99) dB vs. (7.01 ± 3.49) dB], β[(0.59 ± 0.33)/s vs. (0.61 ± 0.38)/s] and A×β [(3.48 ± 1.46) dB/s vs. (3.31 ± 0.96) dB/s] values were similar between CSF group and control group (all P > 0.05). After dobutamine stress test, both β and A×β were significantly increased in two groups. The β [(0.89 ± 0.42)/s vs. (1.31 ± 0.54)/s, P < 0.01] and A×β [(5.82 ± 2.69) dB/s vs. (8.07 ± 2.76)dB/s, P < 0.05] in CSF group were significantly lower than in control group. Electrocardiogram of all the subjects was normal at rest, but the electrocardiogram positive rate was significantly higher in CSF group than in control group after dobutamine stress test (12% vs. 2%, 60% vs. 10%, P < 0.01).</p><p><b>CONCLUSIONS</b>Dobutamine stress test could induce myocardial perfusion abnormalities in patients with coronary slow flow phenomenon.</p>

Clinical application of VerifyNow-P2Y12 assay in evaluation of platelet inhibition efficacy of clopidogrel / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the platelet inhibition efficacy in patients under regular maintenance dose of clopidogrel by VerifyNow-P2Y12 assay and explore the clinical characteristics of clopidogrel non-responders and related predicting factors.</p><p><b>METHODS</b>A total of 99 patients underwent percutaneous coronary intervention procedure and receiving clopidogrel in regular maintenance dose for at least 1 week were enrolled. Platelet reactivity, including baseline, P2Y12 reaction unit (PRU), and platelet inhibition rate were measured with VeifyNow-P2Y12 assay. The dosage of anti-platelet drugs, combination with any other drugs, clinical characters in baseline of all enrolled patients were analyzed. PRU ≤ 240 was used as cut-off to identify clopidogrel responder and clopidogrel non-responder. In the non-responder group, patients were further separated into 3 sub-groups (types) according to the baseline and platelet inhibition rate: type I with high baseline, high inhibition rate, representing false non-responder; type II with low inhibition rate, representing true non-responder and type III mixed type.</p><p><b>RESULTS</b>In this study, 48 of 99 patients were found to be clopidogrel non-responder (48.5%). The ratio of type I, type II and type III in the non-responder group was 9.1% (n = 9), 27.3% (n = 27), and 12.1% (n = 12), respectively. Baseline platelet value in female patients was significantly higher than in males (P < 0.01), number of females with high PRU also is higher than males (P < 0.01), female gender was a predict factor for type I non-responder (OR = 6.5, 95%CI 2.295 - 18.407, P < 0.01). BMI > 24 kg/m(2) was a risk factor for clopidogrel non-responder (P < 0.05), and may be regarded as a predict factor for type II non-responder (OR = 3.207, 95%CI 1.375 - 7.485, P < 0.01). Age, hypertension, diabetics, smoking, hyperlipidemia, CRP and pantoprazole use do not show significant correlation with baseline and platelet inhibition rate.</p><p><b>CONCLUSIONS</b>Clopidogrel responses could be reliably detected by VerifyNow-P2Y12 assay. Female gender and high body weight are independent risk factors for clopidogrel non-responses.</p>

Diagnostic value of 320-slice computed tomography coronary angiography to assess in-stent restenosis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic accuracy of 320-slice CT coronary angiography (CTA) in the evaluation of in-stent restenosis (ISR, ≥50% luminal narrowing) in comparison with quantitative coronary angiography (CAG).</p><p><b>METHODS</b>A total of 69 patients with previous stent implantation who underwent both CTA and CAG were prospectively included. We assessed diagnostic valve for ISR with CTA in comparison with CAG.</p><p><b>RESULTS</b>A total of 110 stents were implanted in these patients.CAG identified 14 ISR. CTA correctly identified 13 ISR and misdiagnosed 5 ISR in stents without ISR. Besides, 6 stents could not be evaluated by CTA due to unsatisfied image quality. Accordingly, sensitivity, specificity, positive and negative predictive value of CTA for diagnosing ISR were 93%, 89%, 54% and 99%, respectively. The image quality of CTA was significantly better in larger stents (percentages of good and moderate stent image of ≥3.0 mm and <3.0 mm: 56% vs. 27%, 25% vs. 49%) and which was linked with better diagnostic coincidence rate (95% vs. 78%) for larger stents. The image quality of CTA was significantly better in stents with thinner stent strut thickness (percentages of poor CTA stent image quality of stent strut thickness<140 µm and ≥140 µm: 12% vs. 45%, P<0.01) and which was associated with better diagnostic coincidence rate for stents with thinner stent strut thickness (94% vs. 76%, P<0.05). The image quality of CTA was also significantly better in single stent (percentages of poor CTA stent image quality of single stent vs. overlap and dedicated stent: 17% vs. 36%, P<0.05). However, heart rate (≥65 beats/min vs. <65 beats/min) during CTA acquisition was not associated with image quality and the diagnostic coincidence rate (all P>0.05).</p><p><b>CONCLUSIONS</b>Our results indicate that 320-slice CTA allows accurate noninvasive assessment of significant in-stent restenosis in selected patients. Stents with a large diameter and thin struts are associated with better image quality and higher diagnostic accuracy.</p>

Urea Combine with Glucocorticoid Treatment of Infancy Hemangioma Associated with Thrombopenia Syndrome / 实用儿科临床杂志

Objective To explore the treatment of hemangioma associated with thrombopenia(Kasabach-Merritte syndrome,KMS) in infant.Methods The clinical manifestation and the therapy of 14 cases patients with KMS in hospital from 2003 to 2006 were collected ang analyzed,the 400 g/L urea(manufactured by ourself)combined with methylprednisolone local injection were used and followed 0.5 to 1.0 year.Results Two in 14 cases were emergency exairesis,7 cases were recurred for several times,12 cases were cured,1 case was improved,1 case was loss the connection.Conclusions It is an ideal therapy method to use the urea combined with glucocorticoid to treat infancy KMS,little trauma,definite effective,low side effect,high cure rate.