Microvascular perfusion and cardiac function after revascularization assessed by myocardial contrast echocardiography in patients with acute ST-segment elevation myocardial infarction / 中华心血管病杂志

Objectives: To evaluate microvascular perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction after revascularization using myocardial contrast echocardiography (MCE), and to explore clinical influencing factors of abnormal microvascular perfusion in these patients. Methods: This is a cross-sectional study. The analysis was performed among patients admitted to Peking University People's Hospital for acute ST-segment elevation myocardial infarction (STEMI) from June 2018 to July 2021. All patients underwent percutaneous coronary intervention (PCI) and completed MCE within 48 hours after PCI. Patients were divided into normal myocardial perfusion group and abnormal perfusion group according to the myocardial perfusion score. The echocardiographic indexes within 48 hours after PCI, including peak mitral valve flow velocity (E), mean value of early diastolic velocity of left ventricular septum and lateral mitral annulus (Em), left ventricular global longitudinal strain (GLS) and so on, were analyzed and compared between the two groups. Multivariate logistic regression analysis was used to evaluate the influencing factors of myocardial perfusion abnormalities. Results: A total of 123 STEMI patients, aged 59±13 years with 93 (75.6%) males, were enrolled. There were 50 cases in the normal myocardial perfusion group, and 73 cases in the abnormal myocardial perfusion group. The incidence of abnormal myocardial perfusion was 59.3% (73/123). The left ventricular volume index ((62.3±18.4)ml/m2 vs. (55.1±15.2)ml/m2, P=0.018), wall motion score index (WMSI) (1.59 (1.44, 2.00) vs. 1.24(1.00, 1.47), P<0.001) and mitral E/Em (17.8(12.0, 24.3) vs. 12.2(9.2, 15.7), P<0.001) were significantly higher whereas left ventricular global longitudinal strain (GLS) ((-10.8±3.4)% vs. (-13.8±3.5)%, P<0.001) was significantly lower in the abnormal myocardial perfusion group than those in the normal myocardial perfusion group. Multivariate logistic regression analysis showed that left anterior descending (LAD) as culprit vessel (OR=3.733, 95%CI 1.282-10.873, P=0.016), intraoperative no/low-reflow (OR=6.125, 95%CI 1.299-28.872, P=0.022), and peak troponin I (TnI) (OR=1.018, 95%CI 1.008-1.029, P=0.001) were independent risk factors of abnormal myocardial perfusion. As for ultrasonic indexes, deceleration time of mitral E wave (OR=0.979, 95%CI 0.965-0.993, P=0.003), mitral E/Em (OR=1.100, 95%CI 1.014-1.194, P=0.022) and WMSI (OR=7.470, 95%CI 2.630-21.222, P<0.001) were independently related to abnormal myocardial perfusion. Conclusions: The incidence of abnormal myocardial perfusion after PCI is high in patients with acute STEMI. Abnormal myocardial perfusion is related to worse left ventricular systolic and diastolic function. LAD as culprit vessel, intraoperative no/low-reflow and peak TnI are independent risk factors of abnormal myocardial perfusion.

Short-term outcome of complex coronary lesions treated by excimer laser coronary atherectomy / 中国介入心脏病学杂志

Objective To investigate the feasibility, safety and efficacy of excimer laser coronary atherectomy used in complex lesions, including in-stent restenosis, non-crossable or nonexpandable lesions, heavily calcified lesions without successful wire-exchange and saphenous vein grafts lesions. Methods From Jul 24, 2017 to Aug 24, 2018, 22 cases with 24 lesions were treated with excimer laser coronary atherectomy in Peking University People's Hospital, combined with or without IVUS/OCT, rotational atherectomy or other percutaneous coronary intervention instrument, and with or without stent implantation. Results The procedural success rate was 23/24. There was no complications in all cases. Drug-eluting stents were implanted in 19/24 of lesions. There were no major advent cardiovascular events, including death, acute ST-segment-elevation myocardia and pericardial tamponade recorded. Conclusions Excimer laser coronary atherectomy used in complex lesions is feasible, safe and efficient with satisfactory in-hospital short-term outcome.

Platelet-rich-plasma for intervertebral disc degeneration: from bench to bedside / 中国组织工程研究

BACKGROUND: Intervertebral disc degeneration (IDD) is a common cause of low back pain. Microenvironmental and cytological changes of intervertebral disc are main factors inducing disc degeneration. However, the underlying mechanism still remains unclear.OBJECTIVE: To review the application of platelet rich plasma (PRP) in the treatment of IDD.METHODS: First, the article structure was designed, and then WanFang and CNKI databases were retrieved for related articles using Chinese and English keywords. After analyzing the abstract and main body, the eligible articles were enrolled according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION: Surgical treatment has achieved remarkable outcomes in the treatment of middle- and late-stage IDD. However, there is still no good conservative therapy for early degeneration. PRP has been extensively applied in the treatment of IDD due to its improvement in tissue healing and regeneration. PRP has been proved to be capable of effectively delaying and even reversing IDD through cytology tests and animal experiments. Some clinical trials have shown that PRP treatment can ease low back pain, while others have demonstrated that the combination of PRP and other biological treatments can significantly improve IDD. Nowadays, most of the experiments are limited in the study of cytology and zoology rather than clinical trials, and there is still no unified standard for extraction method, dose and optimal injection time of PRP. Moreover, there is little reported on its side effects. Consequently, the curative effect of PRP for IDD needs to be verified further.

Simultaneous quantitative determination of five alkaloids in Catharanthus roseus by HPLC-ESI-MS/MS / 中国天然药物

AIM@#To establish a method to simultaneously determine the main five alkaloids of Catharanthus roseus for trace samples, a high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS) analysis method was developed.@*METHOD@#The five Catharanthus alkaloids, vinblastine, vincristine, vinleurosine, vindoline, and catharanthine were chromatographically separated on a C18 HPLC column. The mobile phase was methanol-15 nmol·L(-1) ammonium acetate containing 0.02% formic acid (65 : 35, V/V). The quantification of these alkaloids was based on the Multiple Reaction Monitoring (MRM) mode.@*RESULTS@#This method was validated, and the results achieved the aims of the study. The intra- and inter-day precision and accuracy of the five alkaloids were within 1.2%-11.5% (RSD%) and -10.9%-10.5% (RE%). The recovery rates of the five alkaloids of samples were from 79.9% to 91.5%. The five analytes were stable at room temperature for 2 h, at 4 °C for 12 h, and at -20 °C for two weeks. The developed method was applied successfully to determine the content of the five alkaloids in three plant parts of three batches of C. roseus with a minute amount collected from three regions of China.@*CONCLUSION@#The HPLC-ESI-MS/MS method can be used for the simultaneous determination of five important alkaloids in trace C. roseus samples.

Safety and efficacy of rotational atherectomy followed by drug-eluting stenting for treating patients with heavily calcified coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of rotational atherectomy followed by drug-eluting stent implantation for treating patients with heavily calcified coronary lesions.</p><p><b>METHODS</b>From March 1, 2010 to September 1, 2012, 65 cases with 78 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stent implantation in Peking University People's Hospital were included, and 36 cases also underwent intravascular ultrasound to guide the rotational atherectomy procedure and drug-eluting stent implantation.All patients were followed up in hospital and post discharge. Procedure parameters, complications and major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention related myocardial infarction, target vessel revascularization, recurrent angina, intra-stent restenosis and stent thrombosis) were analyzed.</p><p><b>RESULTS</b>Direct rotational atherectomy was performed in 64.6%(42/65) patients, rescued rotational atherectomy in 35.4%(23/65) patients, drug-eluting stents implantation was applied to all cases after rotational atherectomy. The immediate procedural success rate was 100% (78/78). The average burr/artery ratio was 0.50 ± 0.04, the average number of burr used per case was 1.15 ± 0.36. The average burr/artery ratio was 0.52 ± 0.03 and the average number of burr used per cases was 1.19 ± 0.40 in 36 cases guided with intravascular ultrasound. Five cases (7.7%) developed complications and were treated accordingly during procedure with satisfactory results. The incidence of major adverse cardiovascular events was 13.8% (9/65) during (17.6 ± 8.5) months follow-up.</p><p><b>CONCLUSION</b>Rotational atherectomy followed by drug-eluting stent implantation is a safe and efficient technique for treating heavily calcified coronary lesions.</p>

Assessment of culprit lesions by intravascular ultrasound in patients with acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>We performed 18 intravascular ultrasound assessments preintervention during the primary PCI for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM >1.0. Culprit lesions were identified by a combination of electrocardiogram (ECG) and coronary angiography.</p><p><b>RESULTS</b>There was an average of 1.44 infarct-related artery (IRA) plaques per patient. The incidences of thrombus and plaque ruptures were 28% (5) and 33% (6), respectively. Hypoechoic plaque was observed in 72% (13) of AMI patients. Calcified lesions could be found in 33% (6) of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling.</p><p><b>CONCLUSIONS</b>Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling.</p>