Distal thrombolysis versus thrombus aspiration during percutaneous coronary intervention in the treatment of acute ST segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To investigate the effects of distal thrombolysis versus thrombus aspiration on myocardial perf usion and prognosis in patients with acute ST segment elevation myocardial infarction(AMI)during emergency percutaneous coronary intervention(PCI). Methods 96 patients with acute ST segment elevation myocardial infarction(onset<6 hours)were randomly divided into thrombolysis group and distal thrombus aspiration group. Patients in the distal thrombolysis group(n=46)received transcatheter urokinase injection to the occlusive segment followed by balloon dilatation or stenting. Patients in the thrombus aspiration group(n=50)were given thrombus aspiration after balloon angioplasty or stenting. Patients were followed up for 30 days after operation. The coronary blood flow and myocardial perfusion were compared between the 2 groups. The incidence of major adverse cardiac events(MACE)and left ventricular systolic function after 30 days were compared. Results There was 1 case in the distal thrombolysis group (0.2%)and 6 case in the thrombus aspiration group(12%)presented with TIMI fl ow≤grade Ⅱ(P=0.008). A 65.2% of patients in the distal thrombolysis and 42.0% of patients in the thrombus aspiration group achieved > 50% of ST segment resolution in 2 hours(P=0.019). At 30-day follow up,the LVEF was found higher in the thrombolysis group compared with the aspiration group(54.1±8.6)% vs.(50.8±7.3)%,P=0.047 but the LVEDD(44.3±7.2)mm vs.(46.5±6.8)mm,P=0.038 and NT-proBNP levels(117.8±71.8)μg/L vs.(161.2±72.3)μg/L,P=0.025 were found significantly lower in the thrombolysis group. Conclusions For the ST segment elevation myocardial infarction,distal thrombolysis,when compared with thrombus aspiration,may reduce the incidence of slow flow and no reflow,and may improve the left ventricular systolic function.

Short-term treatment outcome of the trabecular monoblock metal tibial components versus conventional cemented tibial components in total knee arthroplasty / 中国组织工程研究

BACKGROUND: Porous tantalum metal has been recognized for its effective initial stability and superior bone consolidation in artificial hip/knee reversions. However, the application of the trabecular monoblock metal tibial components in the primary total knee arthroplasty (TKA) still remains controversial. Some scholars think that the non-bone cement fixation of TKA affects the life of prosthesis, and even the soft tissue is easy to be adhered with the porous metal, which results in the stiffness or pain of the knee joint after surgery. OBJECTIVE: To compare the short-term clinical efficacy of the trabecular monoblock metal and conventional cemented tibial components in TKA. METHODS: Fourteen patients undergoing unilateral TKA with trabecular monoblock metal tibial components non-bone cement porous tantalum tibial platform, and 14 patients with TKA using conventional cemented tibial components were enrolled. All patients suffered from advanced knee osteoarthritis, and were followed up for 1-3 years to correct the clinical and radiological data. RESULTS AND CONCLUSION: (1) No case underwent secondary surgery. (2) The clinical and function American Knee Society Score scales, the range of motion of the knee during flexion and extension, and femorotibial angle at last follow-up did not differ significantly between two groups (P > 0.05). (3) Radiological results revealed no aseptic loosening of the prosthesis, or subsidence and displacement of the tibial platform during follow-up. (4) These findings suggest that the application of trabecular monoblock metal tibial components in TKA can obtain similar clinical and radiological outcomes with the conventional cemented tibial components, but the long-term survival rate of the prosthesis still needs to be further explored.

Correlation of restenosis after rabbit carotid endarterectomy and inflammatory cytokines

OBJECTIVE@#To establish rabbit model of restenosis after carotid endarterectomy surgery, and to study tissue inflammatory cytokines (TNF-α, IL-6) involved in restenosis.@*METHODS@#A total of 32 rabbits were randomly divided into two groups: model group and control group. The right common carotid artery in rabbits was damaged by carotid endar terectomy in model group. The tissues were harvested at different time points respectively, the pathological changes of the vascular wall after operation were observed at different time points. The changes of expression of tissue vascular wall inflammatory cytokines (TNF-α, IL-6) at different time points after the surgery was observed by RT-PCR, and the changes of serum inflammatory cytokines (TNF-α, IL -6) were detected by ELISA.@*RESULTS@#The new intima appeared after 7 days of the injury and reached the peak on 28 d which is uneven and significantly thicker than the control group (P<0.01). The tissue inflammatory cytokines (TNF-α, IL-6) were significantly increased after the rabbit common carotid artery injury, which was significant difference compared with normal control group (P<0.05).@*CONCLUSIONS@#The tissue inflammatory factors significantly increase after the rabbit carotid artery injury, which suggests the mutual concurrent effects of inflammatory cytokines can result in the proliferation of vascular restenosis.

Preliminary characterization of acute aortic dissection in the mainland of China / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the differences in the characteristics of acute aortic dissection (AAD) among less and more economically developed countries with various cultures and races.</p><p><b>DATA SOURCES</b>Reports from the International Registry of Acute Aortic Dissection (IRAD) and the mainland of China (MC) were collected by searching the PubMed Database and the Chinese Journal Full-text Database from January 2000 to March 2009.</p><p><b>STUDY SELECTION</b>Those reports from IRAD and MC containing larger numbers of cases and complete patients' information were selected, which focused on concrete issues of diagnosing or managing AAD were excluded if they were not able to reflect the overall characteristics of this condition. And the data from the article containing the largest number patients reported by the same medical center in MC were taken into statistics.</p><p><b>RESULTS</b>AAD patients from MC were significantly younger than IRAD countries and the percentage of male patients in the Chinese group was higher than IRAD countries (80.7% vs. 68.6%, P < 0.001). Patients in MC were less likely to present with typical symptoms and signs except for any focal neurological deficits. Different from the IRAD group, Chinese patients were prone to undergo magnetic resonance imaging (MRI) to make the diagnosis of AAD (45.5% vs. 11.6%, P < 0.001). The in-hospital mortality was similar between 2 groups but only smaller proportion of AAD patients in MC underwent surgical or medical treatment.</p><p><b>CONCLUSIONS</b>The general characteristics of AAD patients in MC were shown and differences in some clinical variables between MC and IRAD groups still existed.</p>

Value of preoperative barium contrast examination for the diagnosis and operative planning in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the value of preoperative barium contrast examination for the diagnosis and operative planning in gastric cancer.</p><p><b>METHODS</b>Clinical data of 229 gastric cancer patients were analyzed retrospectively. Lesions were divided into three parts: the cardiac, the body, and the antrum. The diagnostic accuracy of localization and the extent of tumor between gastroscopy alone and gastroscopy plus barium contrast were compared with the results of surgical findings.</p><p><b>RESULTS</b>The diagnostic accuracy of localization and the extent of tumor for gastroscopy in the cardiac, the body and the antrum cancers were 100% and 78.4%, 94.6% and 86.5%, 98.1% and 84.6%, respectively, while for gastroscopy plus barium contrast were 100% and 84.8%, 100% and 91.9%, 99.0% and 90.4%, respectively. The diagnostic accuracy of both the localization and the extent of tumor were not significantly different between gastroscopy alone and gastroscopy plus barium contrast (P>0.05). Diagnostic accuracy of the length of esophagus infiltrated by cardiac cancer in gastroscopy was 60.6%, while in gastroscopy plus barium contrast was 90.9%, which was significantly different (P<0.05). Gastroscopy plus barium contrast was more accurate in predicting the possibility of thoracotomy in cardiac cancer infiltrating the lower esophagus.</p><p><b>CONCLUSIONS</b>It is necessary to perform preoperative barium contrast examination in cardiac cancer patients, so as to identify whether the lower esophagus is infiltrated and to measure the length of lesion, which can provide evidences for making a decision of thoracotomy. For gastric body and antrum cancer, there is no indication for barium contrast examination if gastroscopy findings are satisfied.</p>

Assessment of early mortality risk factors undergoing coronary artery bypass graft surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze early mortality risk factors and clinical characteristics in our patients undergoing coronary artery bypass graft (CABG) surgery.</p><p><b>METHODS</b>Clinical data of 310 consecutive patients undergoing CABG from January 2005 to March 2007 were collected. Twenty-two risk factors were evaluated by univariate and multivariate Logistic stepwise regression analysis.</p><p><b>RESULTS</b>Univariate statistical analysis revealed that factors significantly correlated with early death were 12 variables including age, diabetes, neurological dysfunction, old myocardial infarction, acute myocardial infarction, ejection function, left main artery stenosis, emergency procedure, cardiopulmonary bypass time, aortic cross-calming time, and mechanical ventilation time. Logistic stepwise regression analysis showed that emergency procedure, ejection function, age, cardiopulmonary bypass time, and mechanical ventilation time were independent risk factor of early mortality after procedure.</p><p><b>CONCLUSION</b>Emergency procedure, ejection function, age, cardiopulmonary bypass time, and mechanical ventilation time are independent risk factors of early mortality after CABG procedure.</p>

The clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting via left anterior small thoracotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To estimate the clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting (MIDCAB) via left anterior small thoracotomy.</p><p><b>METHODS</b>MIDCAB via left anterior small thoracotomy approach was performed in 38 cases of coronary artery disease with single or multi-vessel involvement from January 2002 to October 2006. There were 25 males and 13 females with a mean age of (63.3 +/- 11.1) years old. The left internal mammary artery (LIMA) was harvested under direct vision or with the assistance of thoracoscopy. After heparinization the pericardium was directly opened to expose the target vessels. The coronary artery bypass grafting was completed on beating heart.</p><p><b>RESULTS</b>The procedure were smoothly completed in all the 38 cases. The LIMA was anastomosed to the left anterior descending artery (LAD) or the diagonal artery in 20 cases, while two bypass grafts were performed in 8 cases (including 3 cases of sequential grafting and 5 cases of LIMA-radial artery Y-shaped grafting). Hybrid procedure was performed on 10 patients. There were no serious postoperative complications and operative deaths found. All the 38 cases except one were followed for 26 to 82 (53.2 +/- 28.5) months and no myocardial infarction or death occurred. NYHA class were I in 26 cases and II in 12 cases. There were 3 recurrence of angina, 2 patients relieved their symptoms with medication while 1 patient received stent implantation because of anastomose stenosis confirmed by coronary angiography 2 years after surgery.</p><p><b>CONCLUSIONS</b>MIDCAB via left anterior small thoracotomy has low rate of mortality and adverse cardiac events. The long-term follow-up is good.</p>

The predictive values of EuroSCORE of early mortality in coronary artery bypass grafting patients / 中华外科杂志

<p><b>OBJECTIVE</b>To verify the predictive value of EuroSCORE of early mortality in coronary artery bypass grafting (CABG) patients.</p><p><b>METHOD</b>From January 2005 to March 2007, 310 consecutive patients were operated with CABG. Detailed data for the EuroSCORE risk factor were collected and all patients were scored according to the EuroSCORE additive model, retrospectively or prospectively. Expected or predicted mortality was calculated for individual patients using the EuroSCORE algorithms, arranged sequentially in order of predicted score. The population was divided into three clinically relevant risk categories according to the range of predicted mortality rate. Expected mortality was compared to observed or actual mortality for each risk category. Mortality was defined as death from any cause within 30 days of operation or within the same hospital admission.</p><p><b>RESULTS</b>Preoperative overall patients: low-risk group was 25.2% (78/310), middle-risk group was 48.4% (150/310), high-risk group was 26.4% (82/310). In the EuroSCORE model, predicted mortality was 1.4% for low-risk group, 2.7% for middle-risk group, 7.4% for high-risk group, and 3.6% for overall patients. Actual mortality was 0, 1.3% and 3.7% respectively, overall early mortality was 1.6%. Area under the ROC curve was 0.78.</p><p><b>CONCLUSION</b>The EuroSCORE yield good predictive value for hospital mortality of patients undergoing CABG, especially in off-pump CABG.</p>

Effects of bone marrow stromal cells on endothelial cells proliferation and microvessel formation in vitro / 中国康复理论与实践

@#ObjectiveTo observe the effects of bone marrow stromal cells (BMSCs) on vessel endothelial cells proliferation and microvessel formation in vitro.MethodsBMSCs and brain vessel endothelial cells were separated from adult and divided into co-culture group of BMSCs and endothelial cells, medium group of BMSCs, comparison group. Endothelial cells proliferation and microvessel formation were observed. ResultsEndothelial cells were promoted to proliferate and formate the microvessel in medium group and co-culture group. And the effect was prominence in co-culture group.ConclusionBMSCs can promote the proliferation and microvessel formation of endothelial cells.