Preliminary application of combined auditory monitoring technique in resection of vestibular neurinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the value of electrically evoked auditory brainstem response (EABR) monitoring combined with brainstem auditory evoked potential (BAEP) and compound action potential (CAP) monitoring during vestibular schwannoma resection for the protection of the cochlear nerve. Methods: Clinical data from 12 patients with vestibular schwannomas who had useful hearing prior to surgery were analyzed at the PLA General Hospital from January to December 2021. Among them, there were 7 males and 5 females, ranging in age from 25 to 59 years. Before surgery, patients underwent audiology assessments (including pure tone audiometry, speech recognition rate, etc.), facial nerve function evaluation, and cranial MRI. They then underwent vestibular schwannoma resection via the retrosigmoid approach. EABR, BAEP, and CAP were simultaneously monitored during surgery, and patients' hearing preservation was observed and analyzed after surgery. Results: Prior to surgery, the average PTA threshold of the 12 patients ranged from11 to 49 dBHL, with a SDS of 80% to 100%. Six patients had grade A hearing, and six patients had grade B hearing. All 12 patients had House-Brackman grade I facial nerve function prior to surgery. The MRI indicated tumor diameters between 1.1 and 2.4 cm. Complete removal was achieved in 10/12 patients, while near-total removal was achieved in 2/12 patients. There were no serious complications at the one-month follow-up after surgery. At the three-month follow-up, all 12 patients had House-Brackman grade I or II facial nerve function. Under EABR with CAP and BAEP monitoring, successful preservation of the cochlear nerve was achieved in six of ten patients (2 with grade B hearing, 3 with grade C hearing, and 1 with grade D hearing). Successful preservation of the cochlear nerve was not achieved in another four patients (all with grade D hearing). In two patients, EABR monitoring was unsuccessful due to interference signals; however, Grade C or higher hearing was successfully preserved under BAEP and CAP monitoring. Conclusion: The application of EABR monitoring combined with BAEP and CAP monitoring during vestibular schwannoma resection can help improve postoperative preservation of the cochlear nerve and hearing.

Research progress on dietary and lifestyle inflammatory scores and their relationship with metabolic diseases / 公共卫生与预防医学

Objective To analyze the relationship between dietary and lifestyle inflammatory scores and metabolic syndrome, diabetes mellitus, cardiovascular disease, non-alcoholic fatty liver disease, tumor and other common metabolic diseases, and to explore the impact of dietary and lifestyle inflammatory potential on metabolic diseases, so as to provide new ideas for the diagnosis, treatment and prevention of metabolic diseases. Methods Databases such as CNKI, Wanfang , and PubMed were searched, and literatures related to the dietary and lifestyle inflammatory scores (DLIS) and metabolic diseases were reviewed . Results Seven articles showed that dietary and lifestyle inflammation scores had a positive correlation with metabolic diseases, and two articles showed that only lifestyle inflammatory scores had a positive correlation with metabolic diseases. Conclusion Dietary and lifestyle inflammatory scores may be positively correlated with metabolic diseases, but some results are still controversial. Further studies are needed to prove the correlation between DLIS and metabolic diseases.

Research progress on the relationship between serum uric acid and sarcopenia / 公共卫生与预防医学

Objective With the deepening of population aging, sarcopenia has become an important public health problem affecting the health and quality of life of the elderly population. As the end-product of purine metabolism in human body, uric acid has dual effects of anti-oxidation, pro-oxidation and pro-inflammatory reaction , which affects the occurrence and development of sarcopenia to a certain extent. This paper reviews the research progress of serum uric acid and sarcopenia. Methods PubMed database, Web of Science core collection database, Embase database, China National Knowledge Infrastructure (CNKI) and Wanfang database were searched for literatures on the relationship between serum uric acid (SUA) level and sarcopenia up to February 7, 2022, and then reviewed. Results A total of 4 epidemiological studies were found on serum uric acid levels and the risk of sarcopenia. Among them, 3 studies found that SUA within a certain level range was a protective factor for sarcopenia, and 1 study suggested that the risk of sarcopenia increased with the increase of SUA levels. There was a gender difference between serum uric acid level and sarcopenia risk. Conclusion At present, the results of studies on the relationship between serum uric acid levels and the risk of sarcopenia are still controversial, which may be caused by the different effects of uric acid in human body. In the future , more extensive and in-depth studies are needed to investigate the relationship between the two.

Cloning and expression analysis of 2-oxoglutarate-dependent dioxygenase from Schisandra chinensis / 药学学报

The 2-oxoglutarate-dependent dioxygenase (2-ODD) gene is regarded as the key enzyme gene involved with aryl naphthalene lignan-podophyllotoxin synthesis. To study the expression pattern and function of the Sc2-ODD gene, a full-length cDNA of the gene was cloned. Bioinformatic analysis, the expression pattern, and prokaryotic expression and purification were implemented. The open reading frame of Sc2-ODD gene was 1 077 bp and encoded 358 amino acids with a molecular weight of 40.16 kD. The Sc2-ODD protein contained the conserved 2OG-FeII-oxy sequence of the 2-ODD protein. The results of phylogenetic analysis revealed that Sc2-ODD is most closely related to Corchorus olitorius 2-ODD. qRT-PCR results showed that Sc2-ODD expression displayed obvious up-regulation at the fruit-swelling stage, then down-regulation in the fruit-coloring period. The Sc2-ODD gene was cloned into the bacterial expression vector pGS21T, the recombinant Sc2-ODD protein was expressed in Escherichia coli Rosetta (DE3) cells and the fusion protein was obtained and purified by GST fusion protein purification technology. This study will lay a foundation for further research on the function and expressional regulation of the Sc2-ODD gene in the aryl naphthalene lignans biosynthesis pathway, and also provides a scientific basis for improving the lignan content and the medicinal quality of Schisandra chinensis using plant genetic engineering.

Screening Quorum-sensing-associated sRNA and construction of its overexpression and deletion mutant in Pseudomonas aeruginosa / 医学研究生学报

ObjectiveQuorum-sensing (QS) and small regulatory RNA (sRNA) play key regulatory roles in many signaling cascades of Pseudomonas aeruginosa. To investigate whether sRNA is involved in P. aeruginosa QS system, screening QS system-related sRNA, and to construct sRNA overexpression and deletion strains of Pseudomonas aeruginosa for further study of sRNA function.MethodsSRNA associated with the QS system was screened by qPCR and RNA-sequencing (RNA-seq). The target gene were amplified by PCR and inserted into the overexpression vector pROp200 or the homologous recombination vector pGSM-MR, respectively. The connection reaction solution of pROp200-sRNA and pGSM-ΔsRNA was transformed into Escherichia coli DH5a and SM10lp, respectively. The recombinant vectors were identified by PCR. The pROp200-sRNA was transformed into PAO1 by heat shock method, and the pGSM-ΔsRNA was transferred from SM10lp to PAO1 by conjugation. SRNA overexpression and deletion strains were identified by PCR, DNA sequencing and qPCR, the determination of the growth curves and the pyocyanin levels of strains.ResultsFive QS -associated sRNA P26, P5316.1, P30, P34 and AmiL were successfully screened by RNA-seq and qPCR. PCR, DNA sequencing and qPCR showed that sRNA of AmiL, P30 and P34 overexpression and knockout were successful. Compared with wild-type strain, sRNA overexpression and knockout had no significant effect on bacterial growth curve. It were notably that overexpression of AmiL and P30 inhibited and increase the production of pyocyanin, respectively (P0.05).ConclusionThe sRNA overexpression and deletion strains have been successfully constructed and can be used to study the regulatory relationship between sRNA and QS systems, and to further functional study.

Assessment of cardiac output and volume load by transpulmonary thermodilution technique in immature pigs / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the accuracy of cardiac output (CO) measured by transpulmonary thermodilution technique (TPTD)and explore the validity of intrathoracic blood volume index (ITBVI) for assessment of circulatory volume status.</p><p><b>METHODS</b>Ten immature pigs with a mean weight of (20.6±1.9)kg were studied during the conditions including normovolemia, hypervolemia, and hypovolemia. Simultaneous CO was measured in each condition using pulmonary artery thermodilution (PATD) method and TPTD. More specifically, CO (COPA) was determined with PATD, while CO (COTP) and ITBVI were determined with TPTD. All measurements were repeated 3 times. Central venous pressure (CVP) and heart rate were measured at the same time. The potential correlations of CVP and ITBVI with cardiac index (CI) and stroke volume index (SVI) in each blood volume status were analyzed.</p><p><b>RESULTS</b>A total of 90 simultaneous measurements of COPA and COTP in 3 different blood volume conditions were made. The correlation coefficient between the two measurements was 0.977 (P<0.001) and the mean difference was (0.25±0.26)L/min (95%CI:0.20-0.30 L/min, P<0.001). The coefficient of variation of COTP was 3.7%, while COPA was 5.4%. Compared with those in normovolemia, CVP and ITBVI in hypervolemia significantly increased (P=0.002, 0.019), ITBVI in hypovolemia decreased significantly (P<0.001), and CVP in hypovolemia decreased insignificantly (P=0.05). Correlation analysis revealed a significant correlation between ITBVI with CI and SVI in normovolemia (r=0.741, P=0.014; r=0.885, P=0.001). In contrast, correlations between CVP with CI and SVI were poor.</p><p><b>CONCLUSIONS</b>TPTD can accurately and precisely measure CO in different blood volume conditions. ITBVI measured by TPTD has better validity for the assessment of circulatory volume status than CVP.</p>

Long-term outcome of native artery versus bypass graft intervention in prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with prior coronary artery bypass graft (CABG) have a poor outcome after acute myocardial infarction (AMI). Little is known about the treatment strategy and outcome of percutaneous coronary intervention (PCI) in these patients. The purpose of this study was to investigate the impact of graft versus native artery PCI on the outcomes of prior CABG patients with AMI.</p><p><b>METHODS</b>Between September 2005 and October 2011, a total of 140 consecutive patients with previous CABG undergoing PCI for the treatment of AMI were included. Clinical/procedural characteristics and long-term clinical outcomes were compared between graft and native artery PCI patients.</p><p><b>RESULTS</b>The mean time interval to prior CABG was (5.6 ± 4.2) years. Thirty patients received graft PCI, success rate being 90%. One hundred and ten patients received native artery PCI, success rate being 90.7% (P > 0.05). There were no significant differences in the basic characteristics between the two groups. All patients received drug eluting stents (DESs). Three patients died during hospitalization in the graft-PCI group (10% vs. native PCI 0, P < 0.05). After a median follow- up of two years, major adverse cardiac events (MACE) (myocardial infarction, target vessel revascularization, total death) were 20% with no significant difference between the two groups. Cox regression analysis showed that both diabetes mellitus (DM, HR 3.57, 95%CI 1.03 - 5.75, P < 0.05) and primary PCI (HR 5.932, 95%CI 1.91 - 18.4, P < 0.05) were independent predictors of MACE.</p><p><b>CONCLUSIONS</b>More patients with prior CABG underwent native artery PCI for AMI. PCI to culprit graft vessels had higher in-hospital mortality. DM and primary PCI, but not graft PCI, were predictors for adverse long-term outcome.</p>

Assessment of early radial injury after transradial coronary intervention by high-resolution ultrasound biomicroscopy: innovative technology application / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial coronary procedure and the quality as a bypass conduit. We sought to compare the early radial injury after TRI between first-TRI and repeat-TRI by ultrasound biomicroscopy (UBM).</p><p><b>METHODS</b>A total of 1116 patients who underwent the transradial coronary procedures were enrolled. The patients depending on whether for the first time to accept transradial coronary procedure were divided into first-TRI group and repeat-TRI group. The RA was examined by UBM before and one day after the procedure.</p><p><b>RESULTS</b>Compared with first-TRI group, the mean RA diameter of repeat-TRI one day after the procedure decreased significantly (P < 0.05). In first-TRI group, the mean RA diameter was (2.32 ± 0.53) and (1.93 ± 0.57) mm before procedure and one day after the procedure respectively (P < 0.05). In repeat-TRI group, the mean RA diameter was (2.37 ± 0.51) and (1.79 ± 0.54) mm before procedure and one day after the procedure, respectively (P < 0.01). Compared with first-TRI group, the mean RA diameter was reduced significantly in repeat-TRI group one day after the procedure (P < 0.05). The early radial injuries and intimal thickening were compared between first-TRI and repeat-TRI. The mean intima-media thickness of RA was (0.24 ± 0.13) mm and (0.59 ± 0.28) mm before procedure and one day after the procedure in first-TRI group. The mean intima-media thickness of RA was (0.29 ± 0.16) mm and (0.68 ± 0.32) mm before procedure and one day after the procedure in repeat-TRI group. Compared with first-TRI group, the mean intimal thickening was increased significantly in repeat-TRI group one day after the procedure (P < 0.05). Intimal dissection, stenosis and occlusion were all significantly greater in repeat-TRI RAs (P < 0.05). Linear regression analysis revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.</p><p><b>CONCLUSIONS</b>RA early injuries were greater in repeat-TRI patients than in first-TRI patients. We first use high-resolution UBM imaging to demonstrate the rate of radial injury and revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.</p>

Impact of CYP2C19 polymorphism and smoking on response to clopidogrel in patients with stable coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Dual anti-platelet treatment with aspirin and clopidogrel is established foundation for patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic events. The present study was conducted to examine whether the CYP2C19 681G > A polymorphism and cigarette smoking had independent or interactive effect on response to clopidogrel.</p><p><b>METHODS</b>Among 722 Chinese Han patients undergoing elective coronary stent placement due to stable angina pectoris, a loading dose of 300 mg clopidogrel was given to all patients and a daily maintenance dose of 75 mg for a minimum of 12 months. CYP2C19 681G > A polymorphism was genotyped. The platelet reactivity was measured by light transmittance aggregometry (LTA) with 5 µmol/L adenosine diphosphate (ADP) induced. The poor response was defined as 10% or less absolute difference between aggregation at baseline and 24 hours after loading dose of clopidogrel.</p><p><b>RESULTS</b>The results showed that the poor-response to clopidogrel was presented in 105 patients (14.5%). Overall, the genotype GA/AA carriers were likely to be poor-responsive cases (19.6% vs. 11.0%, P = 0.001) with odds ratio (OR) of 1.971 (95%CI: 1.296 - 2.998, P = 0.002), compared with the GG homozygotes. Meanwhile, compared with nonsmokers, the smokers showed lower rate of poor-response (10.9% vs. 17.3%, P = 0.015) with OR of 0.582 (95%CI: 0.374 - 0.904, P = 0.016). The smokers with GG genotype had the lowest risk with OR of 0.487 (95%CI: 0.246 - 0.961, P = 0.038) while nonsmokers with GA/AA genotype had the highest risk of poor-response with OR of 1.823 (95%CI: 1.083 - 3.068, P = 0.024), compared with nonsmokers with GG genotype. However, there was no significant interaction between genotype and smoking.</p><p><b>CONCLUSION</b>Our study indicated that both CYP2C19 polymorphism and smoking independently affected response to clopidogrel.</p>

Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Radial artery spasm (RAS) is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up.</p><p><b>METHODS</b>Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.</p><p><b>RESULTS</b>The incidence of RAS was 7.8% (112/1427) in all the patients received transradial procedure. Univariate analysis indicates that young (P = 0.038), female (P = 0.026), small diameter of radial artery (P < 0.001), diabetes (P = 0.026), smoking (P = 0.019), moderate or severe pain during radial artery cannulation (P < 0.001), unsuccessful access at first attempt (P = 0.002), big sheath (P = 0.004), number of catheters (> 3) (P = 0.048), rapid baseline heart rate (P = 0.032) and long operation time (P = 0.021) were associated with RAS. Logistic regression showed that female (OR = 1.745, 95%CI: 1.148 - 3.846, P = 0.024), small radial artery diameter (OR = 4.028, 95%CI: 1.264 - 12.196, P = 0.008), diabetes (OR = 2.148, 95%CI: 1.579 - 7.458, P = 0.019) and unsuccessful access at first attempt (OR = 1.468, 95%CI: 1.212 - 2.591, P = 0.032) were independent predictors of RAS. Follow-up at (28 +/- 7) days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain (11.8% vs. 6.2%, P = 0.043). The occurrences of hematoma (7.3% vs. 5.6%, P = 0.518) and radial artery occlusion (3.6% vs. 2.6%, P = 0.534) were similar.</p><p><b>CONCLUSIONS</b>The incidence of RAS during transradial coronary procedure was 7.8%. Logistic regression analysis showed that female, small radial artery diameter, diabetes and unsuccessful access at first attempt were the independent predictors of RAS.</p>

Safety and efficacy of transulnar approach for coronary angiography and intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention.</p><p><b>METHODS</b>Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar (TUA) or transradial approach (TRA). Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events (MACE) as secondary end point was recorded till 30 days follow-up.</p><p><b>RESULTS</b>Successful puncture was achieved in 98.3% (118/120) of patients in the TUA group, and in 100% (120/120) of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively (P = 0.949). No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients.</p><p><b>CONCLUSIONS</b>The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.</p>

Comparison between drug eluting stent and coronary artery bypass grafting surgery for the treatment of unprotected left main coronary artery disease in elderly patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the 2 years outcome of elderly patients with ULMCA stenosis undergoing coronary artery bypass grafting (CABG) or drug eluting stent (DES).</p><p><b>METHODS</b>From January 2004 to June 2006, 295 patients with ULMCA stenosis and age > or = 70 years undergoing coronary revascularization with either CABG (n = 206) or DES (n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up.</p><p><b>RESULTS</b>The cumulative rate of 2-year mortality were 10.2% (n = 21) in CABG-treated patients and 13.3% (n = 12) in DES-treated patients (P = 0.428). The survival rate during 2-year follow-up was 89.2% for CABG-treated patients and 86.4% for DES-treated patients (P = 0.668). The incidence of 2-year myocardial infarction was 7.8% (n = 16) in CABG-treated patients and 10.1% (n = 9) in DES-treated patients (P = 0.501). The incidence of target lesion revascularization (TLR) was 4.9% (n = 10) in CABG-treated patients and 13.5% (n = 12) in DES-treated patients (P = 0.015). In the multivariable analysis, age (HR: 1.04, 95% CI: 1.01-1.09, P = 0.024), left ventricular dysfunction (ejection fraction < 30%, HR: 4.97, 95% CI: 1.22-24.85, P = 0.018) and type 2 diabetes (HR: 2.22, 95% CI: 1.31-4.86, P = 0.001) were independent predictors of 2-year mortality.</p><p><b>CONCLUSION</b>In this study, 2-year mortality was comparable in elderly patients with ULMCA stenosis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.</p>

Effects of upstream tirofiban versus downstream tirofiban on myocardial damage and 180-day clinical outcomes in high-risk acute coronary syndromes patients undergoing percutaneous coronary interventions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For patients with moderate to high-risk acute coronary syndromes (ACS) who undergo early, invasive treatment strategies, current guidelines recommend the usage of glycoprotein (GP) IIb/IIIa inhibitors as an upstream treatment for a coronary care unit or as an downstream provisional treatment for selected patients who are undergoing percutaneous coronary intervention (PCI). The relative advantage of either strategy is unknown. The purpose of this study was to evaluate the effects of upstream tirofiban versus the effects of downstream tirofiban on myocardial damage and 180-day major adverse cardiovascular events (MACE) after PCI in high-risk non-ST-segment elevation ACS (NSTE-ACS) undergoing PCI.</p><p><b>METHODS</b>From July 2006 to July 2007, 160 high-risk NSTE-ACS undergoing PCI were randomized to receive upstream (within 4 - 6 hours before coronary angiography) tirofiban or downstream (the guidewire crossing the lesion) tirofiban, to evaluate the extent of myocardial damage after PCI by quantitatively and qualitatively analyzing the value of cardiac troponin I (cTnI) as well as MB isoenzyme of creatine kinase (CK-MB) before and after PCI. The incidences of 24-hour, 3-day, 7-day, 30-day and 180-day MACE after PCI were followed up and the rates of bleeding complications and thrombocytopenia during tirofiban administration were recorded.</p><p><b>RESULTS</b>The peak release and cumulative release of cTnI levels within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban (0.45 vs 0.63 and 0.32 vs 0.43, respectively; P < 0.05). Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received the upstream tirofiban than those who received the downstream tirofiban (66.3% vs 87.5%, P < 0.05). The peak and cumulative release of CK-MB levels as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups (16 vs 14 , 5 vs 3 and 26.3% vs 36.3%, respectively; P > 0.05). The incidences of 24-hour, 3-day, and 7-day MACE after PCI were the same between the two groups (0 vs 0, 0 vs 0 and 1.25% vs 1.25%, respectively). Although the incidences of 30-day and 180-day MACE after PCI were not statistically different between the two groups, the incidences were consistently lower with upstream tirofiban (3.75% vs 6.25% and 12.99% vs 16.67%; P > 0.05). Aging (OR = 1.164, P < 0.001), hypertension (OR = 4.165, P = 0.037) and type 2 diabetes (OR = 13.628, P < 0.001) were independent risk factors of MACE. The timing of administrating the tirofiban (OR = 2.416, P = 0.153) plays an extensive role in the incidence of MACE. The incidences of major and minor bleeding complications as well as mild thrombocytopenia during the administration of tirofiban were similar between the two groups (2.50% vs 1.25%, 1.25% vs 1.25% and 1.25% vs 1.25%, respectively; P > 0.05).</p><p><b>CONCLUSIONS</b>Based on the pretreatment with aspirin and clopidogrel, upstream tirofiban was associated with attenuated minor myocardial damage and the tendency of reducing incidences of 180-day MACE after PCI among high-risk NSTE-ACS patients undergoing PCI. Aging, hypertension and type 2 diabetes were independent risk factors of MACE in high-risk NSTE-ACS patients undergoing PCI associated with tirofiban.</p>

Effects of upstream tirofiban versus downstream tirofiban on platelet aggregation and clinical outcomes in patients with high-risk acute coronary syndromes undergoing percutaneous coronary interventions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effects of upstream versus downstream application of tirofiban on platelet aggregation and clinical outcomes (major adverse cardiovascular event, MACE) in patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>From July 2006 to July 2007, 160 high-risk NSTE-ACS patients undergoing PCI were randomized to receive upstream (4-6 h prior PCI) tirofiban and downstream (immediately prior to PCI) tirofiban. Platelet aggregation inhibition was determined at admission, before coronary angiography and after PCI. Incidences of MACE at 1, 3, 7, 30 and 180 days after PCI were compared. The incidences of bleeding complications and thrombocytopenia during tirofiban treatments were recorded.</p><p><b>RESULTS</b>The extent of platelet aggregation inhibition post tirofiban was significantly greater in upstream tirofiban than that in downstream tirofiban group (8% vs. 42%, P<0.05). The incidences of MACE at various time points were similar between the two groups (all P>0.05). Aging, hypertension and type-2 diabetes were independent risk factors of MACE. The incidences of major and minor bleeding complications as well as mild thrombocytopenia during tirofiban treatments were similar between the two groups (2.5% vs. 1.3%, 1.3% vs. 1.3% and 1.3% vs. 1.3%, respectively; all P>0.05).</p><p><b>CONCLUSION</b>On top of aspirin and clopidogrel, upstream application of tirofiban is associated with increased platelet aggregation inhibition but the incidences of MACE up to 180 days post tirofiban are similar in the upstream and downstream tirofiban treated patients with high-risk NSTE-ACS after PCI. Aging, hypertension and type-2 diabetes were independent risk factors of MACE in these patients.</p>

Safety and feasibility of transradial coronary angiography at the outpatient clinic / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic.</p><p><b>METHODS</b>From February 2007 to June 2007, 100 outpatients who received transradial coronary angiography in Anzhen hospital were included in this analysis, 100 inpatients underwent coronary angiography were selected as control group. Primary endpoints included success rate, percent of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.).</p><p><b>RESULTS</b>The success rate (100% vs. 100%), procedure duration time [(12.5 +/- 3.4) min vs.(10.8 +/- 3.6) min, P = 0.517] and exposition time [(4.3 +/- 1.0) min vs. (4.1 +/- 1.0) min, P = 0.629] were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. The total cost of the outpatient group was significantly lower than the inpatient control group [(4012 +/- 238) yuan vs. (5329 +/- 371) yuan, P < 0.001]. Expenditure including chemical tests, medicine, nursing care, room and board all decreased significantly.</p><p><b>CONCLUSION</b>Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.</p>

Safety and feasibility of transradial approach for primary percutaneous coronary intervention in elderly patients with acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral approach. This study aimed to investigate the safety and feasibility of transradial approach for primary percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>A total of 103 consecutive elderly patients (age = 65 years) who were diagnosed as having AMI were indicated for PCI. Among them, 57 patients received primary PCI via the transradial approach (transradial intervention, TRI group), and 46 underwent primary PCI via the transfemoral approach (transfemoral intervention, TFI group). The success rate of puncture, puncture time, cannulation time, reperfusion time, the total time for PCI, the success rate of PCI, the use rates of temporary pacemaker and intra-aortic balloon pump (IABP), and the total length of hospital stay of the patients in the two groups were compared. After the procedure, vascular access site complications and major adverse cardiovascular events (MACE) in the two groups in one month were observed.</p><p><b>RESULTS</b>The success rates of puncture (98.2% vs 100.0%) and PCI (96.5% vs 95.7%) for the patients in the TRI and TFI groups were not statistically significant (P > 0.05). The puncture time ((2.4 +/- 1.1) vs (2.0 +/- 0.9) minutes), cannulation time ((2.7 +/- 0.5) vs (2.6 +/- 0.5) minutes), reperfusion time ((16.2 +/- 4.5) vs (15.4 +/- 3.6) minutes), total time of the procedure ((44.1 +/- 6.8) vs (41.2 +/- 5.7) minutes), use rates of temporary pacemaker (1.8% vs 2.2%) and IABP (0 vs 2.2%) in the two groups were not statistically significant (P > 0.05), but the hospital stay of the TFI group was longer than that of the TRI group ((10.1 +/- 4.6) vs (7.2 +/- 2.6) days, P < 0.01). A radial occlusion was observed in the TRI group, but no ischemic syndrome in hand. In the TFI group, 4 patients had hematosis, 1 had pseudoaneurysm, and 1 had major bleeding. Statistical significance in vascular access site complications was seen in the two groups (1.8 % vs 13.1%, P < 0.05). Three patients died in the two groups respectively in one month, and there was no statistical significance in MACE in the two groups (5.3% vs 6.5%, P > 0.05).</p><p><b>CONCLUSION</b>The transradial approach for primary PCI is safe and feasible for elderly patients with AMI.</p>

Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients aged over 85 years have been under-represented in percutaneous coronary intervention (PCI) trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome (ACS) remain unclear. Moreover it is unknown whether there are differences between bare metal stent (BMS) and drug eluting stent (DES) in this special population.</p><p><b>METHODS</b>A total of 80 patients with ACS aged over 85 years undergoing stenting (BMS group n = 21 vs DES group n = 59) were retrospectively studied. In-hospital, one year and overall clinical follow-up (12 - 36 months) of major adverse cardiac events (MACEs) including cardiac deaths, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) as well as stroke and other major bleeding were compared between the two groups.</p><p><b>RESULTS</b>In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher (14.3% vs 6.8%, P = 0.30). The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12 - 36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower (5.3% vs 21.1%, P = 0.20). Multivariate regression analysis showed that the creatinine level (OR: 1.013; 95% CI: 1.006 - 1.020; P = 0.004) and hypertension (OR: 3.201; 95% CI: 1.000 - 10.663; P = 0.04) are two major factors affecting the long-term MACE.</p><p><b>CONCLUSIONS</b>Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and long-term efficacy. Patients with renal dysfunction and hypertension may have a relatively high incidence of MACE.</p>

Transradial approach for coronary angioplasty in Chinese elderly patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The radial artery is currently regarded as a useful vascular access site for coronary procedures. This study was conducted to investigate the feasibility and safety of the percutaneous radial artery approach for angioplasty in the elderly.</p><p><b>METHODS</b>Two thousand and fifty-eight consecutive patients (762 elderly, age = 65 years; and 1296 non-elderly, age < 65 years, respectively) who underwent transradial coronary angioplasty were recruited in this study. Study endpoints included procedure success rate, procedure time, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization.</p><p><b>RESULTS</b>Elderly patients were more likely to present with unstable angina and renal dysfunction. The incidence of radial and brachiocephalic trunk anatomical tortuosity was higher in elderly patients than that in non-elderly patients (11.5% vs 3.7%; 8.9% vs 2.6%, P < 0.01, respectively). However, procedural success rate (94.7% vs 95.6%) and total mean procedure time ((67.9 +/- 27.3) minutes vs (58.6 +/- 38.5) minutes) for transradial coronary angioplasty were not significantly different between the two groups. Clinical course during the hospitalization was slightly worse in the elderly patients because of more adverse cardiac and cerebrovascular events after the procedure. However, the incidence of vascular complications was not significantly different between the elderly and non-elderly patients.</p><p><b>CONCLUSION</b>Although the incidence of radial and brachiocephalic trunk anatomical tortuosity is higher in elderly patients, transradial coronary intervention can be performed with similar safety and procedural success in these patients as compared with non-elderly patients.</p>

Rosiglitazone could improve clinical outcomes after coronary stent implantation in nondiabetic patients with metabolic syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have shown that thiazolidinediones (TZDs) could reduce in-stent restenosis and improve clinical outcomes in patients with type 2 diabetes after coronary stent implantation. It remains unclear whether nondiabetic patients with metabolic syndrome after stenting could also benefit from the treatment with TZDs.</p><p><b>METHODS</b>Three hundred and sixty patients with metabolic syndrome who underwent coronary stent implantation were randomly assigned to a rosiglitazone group (n = 180) or a control group (n = 180). Patients in the rosiglitazone treatment group were treated with rosiglitazone 1 day before coronary stenting (4 mg once daily) and treatment was continued until the 9 months follow-up; while in the control group, patients were treated with placebo 1 day before the procedure and until the 9 months follow-up. Adverse events were death, myocardial infarction and urgent target vessel revascularization within 9 months after coronary stenting.</p><p><b>RESULTS</b>One hundred and fifty two patients in the rosiglitazone group and 145 patients in the control group survived during the follow-up. Baseline characteristics among patients in the two groups were well balanced. There was no significant difference in target vessels or the procedure of stent implantation. Compared with the control group, treatment with rosiglitazone was associated with a lower rate of death, myocardial infarction and urgent target vessel revascularization (7.2% vs 14.5%, P = 0.044).</p><p><b>CONCLUSION</b>Rosiglitazone could reduce the risk of the adverse cardiovascular event and improve clinical outcomes in nondiabetic patients with metabolic syndrome after coronary stent implantation.</p>