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Objective:To explore the safety and efficiency of percutaneous coronary intervention (PCI) in maintenance hemodialysis patients combined with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods:The clinical data of 52 maintenance hemodialysis patients combined with NSTE-ACS from January 2010 to January 2015 in Dalian Central Hospital were retrospectively analyzed. Among of them, 25 patients were treated with common drugs (control group), and 27 patients were treated with common drugs combined with PCI (PCI group). The major adverse cardiac events (MACE) duration of hospital stay were record, including hemorrhage, malignant arrhythmia, new heart failure or aggravation, stroke and all-cause death. The dialysis complications within 1 month after treatment were recorded, including hypotension, arrhythmia, heart failure and angina pectoris. The patients were followed up for 12 months, the MACE 1, 6 and 12 months after treatment were recorded, including angina pectoris, heart failure and cardiac death.Results:Duration of hospital stay, the incidences of malignant arrhythmia and new heart failure or aggravation in PCI group were significantly lower than those in control group: 18.5% (5/27) vs. 44.0% (11/25) and 7.4% (2/27) vs. 32.0% (8/25), and there were statistical differences ( P<0.05); there were no statistical difference in the incidences of hemorrhage, stroke and all-cause death between the two groups ( P>0.05). The incidences of dialysis complications such as hypotension, arrhythmia, heart failure and angina pectoris within 1 month after treatment in PCI group were significantly lower than those in control group: 24.0% (6/25) vs. 56.5% (13/23), 16.0% (4/25) vs. 43.5% (10/23), 12.0% (3/25) vs. 47.8% (11/23) and 24.0% (6/25) vs. 52.2% (12/23), and there were statistical differences ( P<0.05 or <0.01). The follow-up results showed that the incidences of angina pectoris and heart failure 1, 6 and 12 months after treatment in PCI group were significantly lower than those in control group, angina pectoris: 28.0% (7/25) vs. 65.2% (15/23), 29.2% (7/24) vs. 76.2% (16/21) and 43.5% (10/23) vs. 17/17, heart failure: 16.0% (4/25) vs. 43.5% (10/23), 8.3% (2/24) vs. 33.3% (7/21) and 21.7% (5/23) vs. 10/17, and there were statistical differences ( P<0.05 or <0.01); there was no statistical difference in the incidence of cardiac death 1 and 6 months after treatment between two groups ( P>0.05), the incidence of cardiogenic death 12 months after treatment in PCI group was significantly lower than that in control group: 8.6% (2/23) vs. 9/17, and there was statistical difference ( P<0.01). Conclusions:PCI is safe and effective for maintenance hemodialysis patients combined with NSTE-ACS.
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Objective:To study the effect of left atrioventricular interphase (LAVI) via esophageal electrocardiogram on cardiac function after dual-chamber pacemaker implantation in patients with high-degree atrioventricular block.Methods:Using a prospective approach, 40 patients with high-degree atrioventricular block who would undergo dual-chamber pacemaker implantation from January 2017 to March 2018 in Department of Cardiovascular Medicine, Dalian Municipal Central Hospital Affiliated of Dalian Medical University were enrolled. All patients accepted esophageal electrocardiogram tests at 3 months after the implantation, to exam the interatrial conduction time (IACT) of sinus rhythm and pacing rhythm, and interventricular conduction time (IVCT). Then based on the outcome of the echocardiography test, the optimal atrioventricular delay (AVD) of the pacemaker of each patient was determined while the LAVI differed from 100 ms to 150 ms. The left ventricular ejection fraction (LVEF), peak speed of blood flow velocity in early mitral orifice diastole (E), E peak deceleration time (EDT), peak speed of early mitral annular diastolic movement (e′), isovolumic relaxation time (IVRT) and left atrial volume (LAV) were tested by echocardiogram before implantation, before AVD adjustment at 3 months after implantation, after AVD adjustment at 3 months after implantation, and 6, 12, and 18 months after implantation. Then, the left atrial volume index (LAV/body surface area) and E/e′ were calculated.Results:Among the 40 patients, the IACT of sinus rhythm was (55.55 ± 10.33) ms, the IACT of pacing rhythm was (93.95 ± 12.77) ms, and the mean IVCT was (63.20 ± 17.84) ms; the optimal LAVI was 110 to 150 (132.00 ± 10.43) ms, and notably, the optimal LAVI between 120 and 140 ms was 82.5% (33/40). The LVEF, EDT, IVRT, left atrial volume index and E/e′ from before AVD adjustment of 3 months after implantation to follow-up endpoint (18 months after implantation) were significantly improved compared with those before implantation, and there were statistical differences ( P<0.01); the EDT and IVRT after AVD adjustment at 3 months after implantation were significantly improved than those before AVD adjustment at 3 months after implantation: (142.15 ± 35.58) ms vs. (125.94 ± 31.13) ms and (119.52 ± 22.15) ms vs. (133.92 ± 23.87) ms, and there were statistical differences ( P<0.05); the IVRT and left atrial volume index 18 months after implantation were significantly improved compared with those before AVD adjustment at 3 months after implantation: (122.07 ± 16.99) ms vs. (133.92 ± 23.87) and 32.94 ± 3.22 vs. 35.43 ± 5.76, and there were statistical differences ( P<0.05). Conclusions:Optimizing the LAVI after dual-chamber pacemaker implantation via esophageal electrocardiogram can improve the long-term prognosis of patients with high-degree atrioventricular block.
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Objective To observe the relationship between CYP2C19 gene polymorphisms and major adverse cardiovascular events in the patients of acute coronary syndrome (ACS) who accepted percutaneous coronary intervention (PCI) in Han population from Dalian. Methods A total 809 cases with ACS who had undergone PCI in the cardiology department of Dalian Municipal Central Hospital from Janurary 2012 to Janurary 2014 were selected,Among 809 cases of ACS,there were 178 cases of acute ST segment elevation myocardial infarction (STEMI),105 cases of acute non ST segment elevation myocardial infarction (NSTEMI) and 526 cases of unstable angina. The patients were divided into three groups according to their CYP2C19 genotype.CYP2C19 genotype (*1/*1) were classified as extensive metabolizers (EM group), CYP2C19 genotype (*1/*2、*1/*3) were classified as intermediate metabolizers (IM group) and CYP2C19 genotype (*2/*2、*3/*3、*2/*3) were classified as poor metabolizers (PM group). The occurrence of major adverse cardiovascular events at least 24 months was observed. Results Seven hundred and ninety patients finished the follow-up at least 24 months, 19 patients lost in follow-up, 350 cases (43.2%) were CYP2C19 (*1/*1),318 cases (39.3%) were CYP2C19(*1/*2), 42 cases(5.2%) were CYP2C19 (*1/*3),77 cases (9.5%) were CYP2C19 (*2/*2), 21 case(2.2%)were CYP2C19 (*2/*3), and 1 case (0.1%) was CYP2C19(*3/*3), 350 cases (43.2%) were classified as EM group, 360 cases (44.5%) were classified as IM group, and 99 cases(12.2%)were classified as PM group. No significant difference in age, gender, hypertention, diabetes mellitus, smoking was shown among three groups (P > 0.05). The rate of MACE were 3.3% , 8 cases had target lesion revascularization(EM group 3 cases, IM group 3 cases, PM group 2 cases), 2 cases had non-fatal myocardial infarction (IM group 1 case, PM group 1 case), 15 cases were died(EM group 6 cases, IM group 7 cases, PM group 2 cases), 1 case had subacute stent thrombosis in IM group. The rates of MACE were higher in PM group (5.1%) than those in EM group(2.65%) and IM group (3.41%) , but there was no significant difference in three groups (P>0.05). There was no significant difference in the rate of target lesion revascularization , thrombus in stent, non- fatal myocardial infarction and death among three groups(P > 0.05). Conclusions There is no significant correlation between CYP2C19 gene polymorphism and long-term prognosis in patients with ACS who accepte PCI treatment in Han population from Dalian.
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[ABSTRACT]OBJECTIVETo investigate the cytomegalovirus infection in neonates, characteristics of gap junction protein Connexin26 gene mutation and the hearing follow-up results, and to analyze their correlations. METHODS60 CMV-DNA positive and 40 CMV-DNA negative neonatal newborn from The Second Affiliated Hospital of Wenzhou Medical University and The first people's Hospital of Yongkang were screened, the blood biochemistry was analyzed, and the umbilical cord blood was reserved to detect the Connexin26 gene expression of mRNA with RT-PCR.PCR results was sequenced to track the newborn hearing, and analyze the correlations between neonatal cytomegalovirus types, the mutation of Connexin26 gene and hearing test results.RESULTS 26 cases from 60 CMV-DNA positive newborns were found with blood biochemical abnormalities. In all of the newborns, a total of 41 cases had 235delC mutation, 11 cases in the mutations for the development of hearing impairment. The results of correlation analysis showed that there were correlations between cytomegalovirus infection, gene mutation and hearing impairment.CONCLUSION Cytomegalovirus infection in neonates can lead to mutations in the Connexin26 gene, and may further lead to hearing impairment, and the probability of the mutation of Connexin26 gene and sensorineural hearing loss were higher in symptomatic cytomegalovirus infection neonates.
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Objective To study the functional connectivity (FC) pattern of anterior cingulated cortex in patients with vascular cognitive impairment with no dementia (VCIND) after subcortical ischemic vascular disease,and to analyze the relationship between FC and cognitive function.Methods Resting state functional magnetic resonance imaging (MRI) data were acquired from 14 patients with VCIND and 16 healthy volunteers with normal cognition.The altered functional connectivity pattern in VCIND was valuated by comparing to normal control.Then a correlation analysis was performed between the strength of FC and the Montreal Cognitive Assessment (MoCA) scores in patients with VCICD.Results (1) The visual space or executive function (3.14 ± 0.29),attention or computing power (3.79 ± 0.37),language (1.14 ± 0.21),directional power (4.14 ± 0.53) items,and the total points of MoCA (17.29 ± 1.53) in VCIND were significantly lower than that in the normal control group (4.93 ± 0.07,5.93 ± 0.07,2.93 ± 0.26,5.93 ± 0.07,27.57 ± 0.33 ; t =31.62,32.50,28.51,12.00,39.71,all P ＜ 0.05).While the abstract ability or memory (4.36 ± 0.74),the naming (2.79 ± 0.11) items in VCIND were not significantly different with that in the control group (4.79 ± 0.80,2.93 ± 0.07 ; t =1.76,1.00,both P ＞ 0.05).(2) Compared with the control group,the patients showed FC decrease between the anterior cingulated cortex and several brain regions,including the left middle temporal gyrus/left superior temporal gyrus,the left superior frontal gyrus/left middle frontal gyrus/left inferior frontal gyrus,the left posterior cingulated cortex/left precuneus,the left inferior parietal lobule/left angular gyrus,the right middle temporal gyrus/right superior temporal gyrus,the right orbit frontal cortex/right inferior frontal gyrus,the right inferior parietal lobule/right angular gyrums,and the right superior frontal gyrus/right middle frontal gyrus.There were also some regions that showed increased FC,which included the right posterior lobe of the cerebellum,the calcarine fissure,the left middle frontal gyrus,and the left precentral gyrus.(3) In the VCIND patients,the brain regions which positively correlated with the MoCA scores were the left inferior parietal lobule,the right middle temporal gyrus,the right superior frontal gyrus,and the left superior temporal gyrus.The negativerelated brain regions were the right posterior limb of internal capsule,the left middle temporal gyrus,the left precuneus,and the right anterior limb of internal capsule.Conclusions VCIND patients show abnormal FC pattern of anterior cingulated cortex,which could be the pathological basis of VCIND,and have certain predictive value for VCIND.
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Objective To evaluate the efficacy of intravenous immunoglobulin (IVIG) in the treatment of severe EV71 infection in children.Methods The clinical data of children with severe EV71 infection,who admitted in our hospital from January 2010 to November 2012 were retrospectively analyzed.According to the time of admission and treatment principles,the patients were divided into the 2010 group and the 2012 group.The patients of the 2010 group routinely received IVIG treatment,but patients in the 2012 group received IVIG treatment in serious condition.The obvious effective rate,effective rate,ineffective rate,the incidence rate of critically ill and mortality of the two groups were compared.Results There were no significant differences in the obvious effective rate (86.0％ and 85.2％),effective rate (9.6％ and 11.8％),ineffective rate (4.4％ and 3.0％),the incidence rate of critically ill (4.0％ and 2.2％) between the two groups (x2 =0.011,1.269,1.657,3.304,all P ＞ 0.05).The mortality of the 2010 group (2.8％) was higher than that of the 2012 group (0.6％)(x2 =8.213,P ＜0.05).Conclusion IVIG has no effect on patients with severe EV71 infection,and is not recommended.
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Objective To investigate the expression of S-phase kinase associated protein 2 (Skp2) in rats with acute liver failure (ALF) and its significance. Methods There were 256 male SD rats used in this study, among which 240 were injected with D-galactosamine (D-GaIN) to set up ALF model. The rats were divided into 3 groups: ALF model group, free hepatocellular transplantation group, microencapsulated hepatocyte transplantation group, which were intraperitoneally injected with 2 mL of RPMI 1640 culture medium, free hepatocellular suspension and microencapsulated hepatocyte suspension, respectively. The other 6 rats were in control group and the rest 10 rats were used for hepatocyte isolation. Expressions of Skp2 protein in hepatocytes of rats at different time points were detected by immunohistochemical technique. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were detected by automatic biochemistry analyzer. The survival rate in each group was observed. Comparisons among groups were done using one-factor analysis of variance. Results Levels of ALT, AST and TBil decreased more significantly by intraperitoneal transplantation of microencapsulated hepatocytes than those by intraperitoneal transplantation of free hepatocytes (P<0. 05). Skp2 labeling indices after 36 h of injection in ALF model group, free hepatocellular transplantation group and microencapsulated hepatocyte transolantation grouo were (28. 2±6.1) %, (41.4± 10. 5) % and (68. 0±10.8) %, respectively (F=29. 08 , P<0. 05). There were 4, 6 and 11 out of 15 rats survived in the 3 groups, respectively. Conclusion The dynamic observation of Skp2 expression could be used to judge the regeneration of hepatocytes.
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Objective To investigate Smac/DIABLO and cytochrome c(cyt-c)mRNA levels in liver tissue of rats with acute hepatic failure treated by microencapsulated hepatocyte.Methods Acute hepatic failure were induced by intraperitoneal injection of D-galactosamine in rats.and the rats were treated with microencapsulated hepatocytes,free hepatocytes and physical saline(contr01),respectively.Smac/DIABLO and cyt-c mRNA in liver tissue was detected by RT-PCR and the mRNA expression levels among three groups were compared.Results Smac/DIABLO and cyt-c mRNA levels in liver tissues of rats with acute hepatic failure were higher than those of normal rata(F=4.345,14.821,47.565,42.178 and 62.961,P<0.05).The peak values of Smac/DIABLO and cyt-C mRNA expressions in free hepatocytes and control groups were at 48 h.while that in microencapsulated hepatoeytes group was at 24 h.Conclusion Smac/DIABLO and cyt-c mRNA expression is an indicator of apoptosis of hepatocytes.
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Objective To investigate the changes of fractalkine (FKN) in rat model of acute liver failure (ALF) and the role of FKN in liver inflammatory injury.Methods SD rats were divided into tWO groups:6 in normal group and 36 in model group.D-galactosamine(D-Gal) was used to induce ALF in model group.The sera and hepatic tissue samples were collected at 12,24,48,72,120 andl68 h.After D-Gal injection.FKN mRNA and nuclear factor(NF)-kB mRNA in hepatic tissue samples were detected by reverse transcription-polymerase chain reaction (RT-PCR).Results The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at 12 h were(208.3±43.5)U/L and (375.2±117.3)lJ/L,respectively,which were both significantly higher than those in normal group[(31.8±2.9)U/L and (90.8±3.1)U/L](t=-9.912 and-5.935,respectively,both P<0.01);the levels of ALT and AST peaked at 72 h after D-Gal injection.The levels of FKN mRNA(O.086±0.009)in model group at 12 h were significantly higher than those (O.044±0.009) in normal group(t=-7.999.P<0.01),and peaked at 72 h (O.333±0.033),then decreased obviously at 120 h. The levels of NF-KB mRNA in the liver of normal rats were very little;and the levels in model group were increased gradually over time,then peaked at 72 h (O.583±0.i01,t=-12.607,P<0.01).FKN mRNA and NF0kB mRNA were positively correlated (r=0.760,P<0.01).Conclusion The FKN expression may play all important role in liver inflammatory injury in rat model of acute liver failure, which could provide a new approach for ALF therapy.
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Objective To evaluate the treatment effect of acute liver failure(ALF) by xeno-transplantation of co-microencapsulated Sertoli cells and hepatocytes and the intraperitoneal immune privilege effects of Sertoli cells on hepatocytes. Methods ALF rats were induced by intraperitoneal injection of D-galactosamine and, thereafter, were treated with physical saline, free hepatocytes, microencapsulated hepatocytes, or co-microencapsulated Sertoli cells and hepatocytes (CMSH), respectively. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were detected in rats' blood samples from various groups. Expression of Smac/Diablo and caspase-3 were determined by reverse transcription-polymerase chain reaction (RT-PCR). Fifteen rats in each group were used for survival rate analysis. The intraperitoneal microencapsules were observed and lymphocytes in ascites were counted. The data were analyzed by multi-factor or single factor analysis of variance and the comparison between groups was done by t test. Results In CMSH treatment group, ALT level decreased to (533.7 ± 76.5) U/L, AST level decreased to (381.2 5± 46.7) U/L after 48 h. TBil level reduced to (7.36 ± 2.18) μmol/L after 72 h. Albumin level increased to (28.4±2.5) g/L after 48 h. All these values were significantly different from those in other groups (F=10.7,6.5,12.2,8.4;P＜0.05). The expression levels of Smae/Diablo and caspase-3 mRNA at 48 h and 72 h were lower in CMSH group than in other groups (F=3.7,4.8,3.6,4.2; P＜0.05). Survival rates in microencapsulated hepatocytes group and CMSH group were similar while both of them were higher than other groups. Microencapsules neither in microencapsulated hepatocytes group nor in CMSH group were adhered to intraperitoneal mucosa. Lymphocyte counts in ascites of CMSH group were lower than those in microencapsulated hepatocytes group (t= 4.21, P＜0. 05). Conclusions Intraperitoneal transplantation with CMSH is a promising approach for ALF treatment. Furthermore, Sertoli cells can help reduce lymphocytes' aggregation caused by encapsulated hepatocytes in ascites.
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Objective To evaluate the nourishment and immune privilege effects of Sertoli cells on co-encapsulated hepatocytes. Methods The hepatocytes and Sertoli cells were encapsulated or co-encapsulated in various ratio of 100∶1、50∶1、20∶1、10∶1, and co-cultured for 21 days in vitro. The secretion of albumin and urea was analyzed, and the morphology of encapsulated cells was observed by microscopy, then to determine the best mixed ratio of hepatocytes to Sertoli cells. Splenocyte proliferation response was assessed to evaluate Sertoli cell’s immune privilege function to hepatocytes by CCK-8.Results Sertoli cells could elevate hepatocyte’s secretion of albumin and urea when they were co-encapsulated with each in appropriate ratio (P
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@#ObjectiveTo investigate the clinical characteristics and the way of discovery in early stage.Methods68 cases with asymptomatic pulmonary carcinoma living in Chongqing City who were discovered within health checkup were retrospectively analyzesed. ResultsThere were 62 males and 6 females,ages ranging from 28 to 78 years with an average of 52 years. In all patients,there were 56 cases (82.4%) with cigarette using history, 42 cases (61.8%) with family history of pulmonary carcinoma and 38 cases(55.9%) with cigarette using history and family history of pulmonary carcinoma. 65 cases (95.6%) were with peripheral type of lung cancer, 3 cases(4.4%) were with central type. Among these patients, 38 cases with adenocarcinoma ,18 cases with squamous carcinoma. There were 27 cases (39%) in Stage I, 38 cases(55.9%) in Stage II and 3 cases(4.4%) in Stage III. There were 43 cases (63.2%) without symptom while 25 cases(36.8%) with symptom of pulmonary carcinoma.ConclusionMost of patients with asymptomatic pulmonary carcinoma were middle-aged male and were adenocarcinoma or squamous carcinoma in cell type and had closed relationship with cigarette using history and family history.
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Objective To evaluate the rationality, safety and efficiency of the time-limited rescue angioplasty following thrombolytic therapy in acute myocardial infarction (AMI).Methods Among the patients within 6 hours from the onset of symptoms of AMI, forty-four cases (group A) underwent primary coronary angioplasty and fifty-eight cases (group B) underwent firstly intravenous thrombolytic therapy. According to clinical early reperfusion indication within 90 minutes following thrombolytic therapy, group B was divided into two subgroups, the patients with early reperfusion (subgroup C) underwent delayed interventional examination 7～10 days after AMI and that with non-reperfusion (subgroup D) underwent rescue angioplasty. The reperfusion rates and complications in different groups were analyzed and compared. Cardiac function (left ventricular ejection fraction, LVEF) was evaluated by echocardiograph 4 weeks after AMI. Results The results showed that the rate of reperfusion, in group A, was 95.45% (42/44),that of subgroup C was 32.76 % (19/58) within 90 minutes following thrombolytic therapy (16 of subgroup C underwent delayed interventional examination and 12 of them underwent PTCA+stent) and that of subgroup D was 97.43% (38/39); There were no serious complications that occurred in subgroups C and D. The LVEFs in group A, subgroups C and D were not significantly different, but there was a significant difference between reperfusion within 6 hours and beyond after AMI (62.7% vs 56.8%, P
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Plasma A Ⅱ_2 was measured dynamicly by radioimmunoassay in rats after myocardial infarction, and its responses to captopril were studied too. The results showed that after myocardial infarction the concentraction of A Ⅱ rose markedly at first day, but it was sustained briefly and at third day , fell to the level before infarction. Plasma A Ⅱ decreased and was sustained at the almost unchanged level during Long—term captopril administra—tion in rats with infarction.