Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention / 中华医学杂志(英文版)

BACKGROUND@#The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap.@*METHODS@#A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR).@*RESULTS@#Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs. 5.5%; P < 0.001) and TLR (37.5% vs. 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984-35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145-34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months.@*CONCLUSIONS@#Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention / 中华医学杂志(英文版)

Background@#Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).@*Methods@#Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.@*Results@#A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min·1.73 m), 26.0% (118/454) in Group 2 (120 ml·min·1.73 m> eGFR ≥90 ml·min·1.73m), 18.3% (86/469) in Group 3 (90 ml·min·1.73 m> eGFR ≥60 ml·min·1.73 m), 21.8% (26/119) in Group 4 (60 ml·min·1.73 m> eGFR ≥30 ml·min·1.73 m), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min·1.73 m), with statistical significance (χ = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min·1.73 m). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ = 16.26, P = 0.009 at 6-month follow-up, and χ = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.@*Conclusions@#High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Effects of Prevention and Treatment by Integrated Traditional Chinese and Western Medicine on TCM Constitutions of Community Diabetic Patients / 中国中医药信息杂志

Objective To analyze the improved the effects of prevention and treatment by integrated tradition Chinese and Western medicine on TCM constitutions and relevant indexes of community diabetic patients; To provide a reference for the comprehensive prevention and treatment of community diabetes.Methods By using cluster sampling method, 700 patients with diabetes aged 45 to 65 in healthcare service center in Minhang District in Shanghai were chosen randomly and divided into intervention group and control group, with 350 cases in each group. The control group used information platform, and was treated with standardized management and treatment of diabetes. On the basis of the treatment of the control group, the intervention group was identified TCM constitutions once a month, developed personalized community diabetes prevention and treatment of TCM norms, and gave guidance and intervention for health preserving and disease prevention for a year. The TCM constitution improvement was observed. Diabetic symptoms grading scale and anxiety self-rating scale, depression self-rating scale were assessed, and the complications were observed.Results Before intervention: TCM constitution of yin-yang harmony (51.43％) > yin asthenia (18.29％) > qi asthenia (11.71％) > yang asthenia (9.71％) > damp-heat (1.57％). After intervention: TCM constitution of yin-yang harmony (63.71％) > yin asthenia (8.71％) > qi asthenia (6.57％), yang asthenia (6.29％) > damp-heat (1.71％). There was difference in constitutions of yin-yang harmony, yang asthenia, and damp-heat before and after and through intervention and group interaction (P<0.05). There was statistical significance in diabetes symptoms curative effect index between the two groups (P=0.021). There was statistical significance in ophthalmoscopy results before and after and through intervention and group interaction (P=0.002).Conclusion The prevention and treatment by intervention of integrated traditional Chinese and Western medicine can improve the TCM constitutions of diabetic patients in community and influence the symptoms of diabetes.

Correlation Study Between Serum Level of Cardiac M2-muscarinic Receptor Autoantibody and Hypertrophic Cardiomyopathy / 中国循环杂志

Objectives: To study serum level of M2-muscarinic receptor autoantibody (M2-AAb) in hypertrophic cardiomyopathy (HCM) patients with its relationship to relevant clinical parameters. Methods: Our research included in 2 groups: HCM group, 133 patients and they were divided into 3 subgroups:Obstructive hypertrophic cardiomyopathy (HOCM) subgroup, 72, Latent obstructive hypertrophic cardiomyopathy (LHOCM) subgroup, 22 and Non-obstructive hypertrophic cardiomyopathy (NOCM) subgroup, 39; since there was no obstruction of left ventricular outflow tract (LVOT) in LHOCM and NOCM patients at resting, LHOCM and NOCM patients were combined as LHOCM+NOCM subgroup, 61 in comparison with HOCM subgroup. And Control group, 40 subjects had no organic heart disease and autoimmune diseases which were confirmed by 12 lead ECG, transthoracic echocardiography and routine hematological tests, they were not using β-blockers, glucocorticoids and immune-suppressants. Serum levels of M2-AAb were examined by ELISA, the relationship between M2-AAb and relevant clinical parameters were studied. Results: Compared with Control group, HCM group had increased serum level of M2-AAb [22.91 (17.21, 29.64) ng/ml] vs (17.14±5.66) ng/ml, P<0.01; M2-AAb was similar among HOCM, LHOCM and NOCM subgroups; M2-AAb in female patients were higher than male, P=0.001. Further investigation presented that the patients with family history of sudden death had the higher M2-AAb, P<0.05; patients with atrial fibrillation (AF) or left atrial diameter (LAD)≥50 mm or moderate to severe mitral regurgitation (MR) had the higher M2-AAb than those without such problems, all P<0.05. In HCM group, log M2-AAb was positively related to resting LVOT gradient (r=0.178, P=0.040); in HOCM subgroup, log M2-AAb was marginal positively related to resting LVOT gradient (r=0.224, P=0.058). Conclusions: Serum M2-AAb was elevated in HCM patients; gender, family history of sudden death may affect M2-AAb level; patients combining AF or LAD≥50 mm or moderate-severe MR had the higher M2-AAb and it was related to resting LVOT gradient.

Effect of PI3K-mediated autophagy in human osteosarcoma MG63 cells on sensitivity to chemotherapy with cisplatin

OBJECTIVE@#To investigate the influence of autophagy on sensitivity to the chemotherapy drug cisplatin (DDP) and the role of PI3K in autophagy.@*METHODS@#MTT methods and flow cytometer, with rapamycin up-regulating the autophagy and 3-MA down-regulating the autophagy, were employed to measure the proliferation inhibition rate on DDP-treated osteosarcoma cells and the change in cell cycle. The expression of intracellular protein was detected by Western blot. The autophagy of MG63 cell was observed using fluorescence microscope and transmission electron microscope.@*RESULTS@#Western blot showed that basic autophagy level of MG63 cell was significantly lower than that of hFOB cell. MTT test revealed that the cell proliferation inhibition rate in the group treated with rapamycin and DDP, group treated with 3-MA and DDP, and group only treated with DDP was significantly different. It was demonstrated by the flow cytometry that in group treated with DDP, inhibition on autophagy can increase the cell numbers in G1 phase and reduce the cell numbers in S phase of cell cycle. Increase of autophagosome in MG63 cytoplasm was observed under fluorescence microscope.@*CONCLUSIONS@#Up-regulating the autophagy significantly reduced the sensitivity of MG63 cell to chemotherapy with DDP. DDP induced autophagy of MG63 cell and blocked the cell cycle at G1 phase.

Effect of PI3K-mediated autophagy in human osteosarcoma MG63 cells on sensitivity to chemotherapy with cisplatin

Objective: To investigate the influence of autophagy on sensitivity to the chemotherapy drug cisplatin (DDP) and the role of PI3K in autophagy. Methods: MTT methods and flow cytometer, with rapamycin up-regulating the autophagy and 3-MA down-regulating the autophagy, were employed to measure the proliferation inhibition rate on DDP-treated osteosarcoma cells and the change in cell cycle. The expression of intracellular protein was detected by Western blot. The autophagy of MG63 cell was observed using fluorescence microscope and transmission electron microscope. Results: Western blot showed that basic autophagy level of MG63 cell was significantly lower than that of hFOB cell. MTT test revealed that the cell proliferation inhibition rate in the group treated with rapamycin and DDP, group treated with 3-MA and DDP, and group only treated with DDP was significantly different. It was demonstrated by the flow cytometry that in group treated with DDP, inhibition on autophagy can increase the cell numbers in G

Study of effect of tongsaimai tablets on experimental diabetic foot model rats / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Tongsaimai (TSM) tablets in treating foot trauma of diabetic foot (DF) model rats, and discuss its potential mechanism.</p><p><b>METHOD</b>Male SD rats were selected to duplicate the diabetic foot ulcer model and randomly divided into the blank control group, the model group, the metformin treatment group, and TSM 12.44, 6.22, 3.11 g x kg(-1) groups (n = 10). The healing of ulcer wounds were observed on day 1, 4, 8, 13 and 18. After 18 days, a histopathologic examination was conducted for ulcer tissues. The contents of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by hydroxylamine and TBA methods. The content of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were determined with the radioimmunoassay. The immunohistochemical method was used to observe the expression of vascular endothelial growth factor (VEGF) in ulcer tissues and the number of capillary vessels.</p><p><b>RESULT</b>TSM could alleviate the pathological changes of diabetic foot rats, accelerate the ulcer healing on 4, 8, 13, 18 d, reduce MDA, IL-6, TNF-alpha, VEGF content in rat serum at 18 d (after the rehabilitation period), and enhance the SOD content. Specifically, the TSM 12.44 g x kg(-1) group showed significant differences compared with the model group (P < 0.05, P < 0.01). At 18 d after the treatment (the late rehabilitation period), the VEGF expression of TSM 12.44, 6.22 g x kg(-1) groups and the number of blood capillaries of the TSM 12.44 g x kg(-1) group were significantly lower than that of the model group (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>TSM could promote the foot wound healing of DF model rats, reduce MDA, IL-6 and TNF-alpha levels in serum, increase the SOD content and decrease the VEGF expression and the number of blood capillaries in the late rehabilitation period. Its action mechanism may be related to the inhibition of oxidative stress injury and the inflammatory cell infiltration.</p>

Establishment of the craniofacial three-dimensional finite element models with the sutures defined alone / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To develop a child craniofacial three-dimensional (3D) finite element model (FEM) with sutures defined alone.</p><p><b>METHODS</b>The CT data for this study was developed from sequential computed tomography scan images taken at 0.625 mm intervals of an 8 years children skull. Data set was imported into Mimics 10.0 and processed with Geomagic 9.0, and exported as initial graphics exchange specification(IGES) files. The IGES files were then imported into Ansys 13.0 to set up two FEM with or without the median palatine suture being opened. The FEM contained nine craniofacial sutures and eight teeth which were defined alone.For simulating orthopedic maxillary protraction, three forces (F1-F2) were loaded on FEM.F1(1 N) was loaded at 1 cm above the geison. F2(1 N) was loaded at articular fossa of temporal bone. F3(2 N) was directed anteriorly and paralleled with occlusal plane near the canine. The stress distribution and the values distributed in each point gained in the two models were compared.</p><p><b>RESULTS</b>Two craniofacial 3D FEM of the child were developed with the median palatine suture opened or not .With median palatine suture being opened or not, the two models showed the similar von Mises stresses (VMS). The distribution of the VMS was in the bridge of the nose and dextro-ala nasi.When the median palatine suture was opened, the max VMS value was 18916.00×10(-4) MPa which appeared in the nose point and the min VMS value was 1.61×10(-4) MPa which appeared in the maxillary central incisor point. At the same time, the max stress value at the direction Y was -3985.30×10(-4) MPa and appeared in the frontomaxillary suture point, and the min Y value was 0.08×10(-4) MPa which appeared in the maxillary central incisor point. When the median palatine suture was not opened, the max VMS value was 19 244.00×10(-4) MPa and appeared in the nose point. The min VMS value was 1.62×10(-4) MPa and appeared in the maxillary central incisor point. At the same time, the max stress value at the direction Y was -4258.20×10(-4) MPa and appeared in the frontomaxillary suture point, and the min Y value was 0.08×10(-4) MPa which appeared in the maxillary central incisor point.</p><p><b>CONCLUSIONS</b>To define the sutures as entities alone contributed to develop child craniofacial 3D FEM which consist nine sutures. There was tiny difference in stress distribution in both the VMS and in Y direction with the median palatine suture being opened or not.</p>

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>To overcome the drawbacks of permanent stents, biodegradable stents have been studied in recent years. The bioabsorbable polymer vascular scaffold (BVS) was the first bioabsorbable stent to undergo clinical trials, demonstrating safety and feasibility in the ABSORB studies. Iron can potentially serve as the biomaterial for biodegradable stents. This study aimed to assess the short-term safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries.</p><p><b>METHODS</b>Eight iron stents and eight cobalt chromium alloy (VISION) control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed.</p><p><b>RESULTS</b>Histomorphometric measurements showed that mean neointimal thickness ((0.46 ± 0.17) mm vs. (0.45 ± 0.18) mm, P = 0.878), neointimal area ((2.55 ± 0.91) mm(2) vs. (3.04 ± 1.15) mm(2), P = 0.360) and percentage of area stenosis ((44.50 ± 11.40)% vs. (46.00 ± 17.95)%, P = 0.845) were not significantly different between the iron stents and VISION stents. There was no inflammation, thrombosis or necrosis in either group. The scanning electron microscopy (SEM) intimal injury scores (0.75 ± 1.04 vs. 0.88 ± 0.99, P = 0.809) and number of proliferating cell nuclear antigen (PCNA) positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents ((84.38 ± 14.50)% vs. (65.00 ± 22.04)%, P = 0.057), but the difference was not statistically significant. Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries or major organs.</p><p><b>CONCLUSIONS</b>The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the miniswine coronary artery. Corrosion of iron stents is observed at four weeks and no signs of organ toxicity related to iron degradation were noted.</p>

Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the short-term prognosis and risk factors of ventricular septal rupture (VSR) following acute myocardial infarction (AMI).</p><p><b>METHODS</b>A total of 70 consecutive VSR patients following AMI hospitalized in our hospital from January 2002 to October 2010 were enrolled in this study. We compared the clinical characteristics of patients with VSR who survived ≤ 30 days (n = 39) and survived > 30 days (n = 31) post AMI. A short-term prognosis index of VSR (SPIV) was established based on the logistic regression analysis.</p><p><b>RESULTS</b>The single factor analysis showed that the risk factors of death within 30 days of VSR patients were female, anterior AMI, Killip class 3 or 4, apical VSR and non-aneurysm (all P < 0.05). Logistic regression analysis revealed that female (P = 0.013), anterior AMI (P = 0.023), non-aneurysm (P = 0.023), non-diabetes (P = 0.009), Killip class 3 or 4 (P = 0.022) and time from AMI to VSR less than 4 days (P = 0.027) were independent risk determinants for death within 30 days post VSR. Patients with SPIV ≥ 9 were associated with high risk [77.4% (24/31)] of dying within 30 days post AMI. SPIV ≤ 8 were associated with low risk as the 30 days mortality is 28.6% (8/28).</p><p><b>CONCLUSION</b>Female gender, anterior AMI, non-aneurysm, non-diabetes, Killip class 3 or 4 and time from AMI to VSR less than 4 days are independent risk factors of short-term mortality of VSR.</p>

Clinical analysis and risk stratification of ventricular septal rupture following acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ventricular septal rupture (VSR) remains an infrequent but devastating complication of acute myocardial infarction (AMI). The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment. The purpose of this study was to review the clinical outcomes of 70 patients with VSR, to analyze the short-term prognosis factors of VSR following AMI, and to make a risk stratification for patients with VSR.</p><p><b>METHODS</b>A total of 70 consecutive VSR patients following AMI treated in our hospital from January 2002 to October 2010 were enrolled in this study retrospectively. The difference of clinical characteristics were observed between patients with VSR who survived ≤30 days and survived >30 days. We analyzed the short-term prognosis factors of VSR and established the short-term prognosis index of VSR (SPIV) based on the Logistic regression analysis to stratify patients with VSR.</p><p><b>RESULTS</b>Among 12 354 patients with acute ST-segment elevation myocardial infarction, 70 (0.57%) patients (33 males and 37 females) were found to have VSR. The average age was (68.1±8.5) years. Fifty-four (77.1%) patients were diagnosed with an acute anterior infarction. Patients with VSR selected for surgical repair had better outcomes than patients treated conservatively; 1-year mortality 9.5% versus 87.8%, P < 0.005. Logistic regression analysis revealed that female (P = 0.013), anterior AMI (P = 0.023), non-ventricular aneurysm (P = 0.023), non-diabetes (P = 0.009), Killip class 3 or 4 (P = 0.022) and time from AMI to VSR less than 4 days (P = 0.027) were independent risk determinants for shortterm mortality. SPIV ≥9 indicates a high risk as the 30-day mortality is 77.4%; SPIV <8 indicates a low risk as the 30-day mortality is 28.6%; SPIV between 8 and 9 indicates a moderate risk.</p><p><b>CONCLUSIONS</b>VSR remains a rare but devastating complication of AMI. The independent risk determinants for short-term mortality of VSR were female gender, anterior AMI, non-ventricular aneurysm, non-diabetes, Killip class 3 or 4, and the time from AMI to VSR less than 4 days. It is reasonable to take more active treatments for the patients at high risk to save more lives.</p>

Effect of maxillary protraction with or without rapid palatal expansion in treating early skeletal Class III malocclusion / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of treatment with maxillary protraction with or without rapid palatal expansion (RPE) for skeletal Class III malocclusion in mixed dentition.</p><p><b>METHODS</b>A total of 31 children with Class III malocclusion in mixed dentition were selected, and 15 (group A) received maxillary protraction treatment with RPE, the other 16 (group B) received maxillary protraction without RPE. Cephalometric films were taken before and after treatment, and traditional and Pancherz analysis were used.</p><p><b>RESULTS</b>The average duration of treatment was 10.14 months in group A and 9.77 months in group B respectively (P>0.05). According to Pancherz analysis, maxillary basal bone moved forwards by 2.99 mm in group A and 3.33 mm in group B respectively (P>0.05), mandibular basal bone moved backwards by 0.07 mm in group A, while forwards by 0.80 mm in group B (P>0.05), the overjet increased by 4.51 mm in group A and 6.37 mm in group B respectively (P<0.05), and the molar relationship improved by 4.97 mm in group A and 4.73 mm in group B respectively (P>0.05). The effects were clinically satisfactory in the both groups. Lower molar moved forwards by 1.18 mm in basal bone in group A, while backwards by 1.20 mm in group B (P<0.05). Traditional cephalometric analysis showed no statistic differences between the two groups except that upper incisior showed greater procline in group B than in group A (P<0.05).</p><p><b>CONCLUSION</b>The study shows that maxillary protraction treatment, with or without RPE, is clinically satisfactory to correct early skeletal Class III malocclusion.</p>