The efficacy and safety of a novel domestic pulmonary artery thromoectomy system in the treatment of acute pulmonary embolization / 中华放射学杂志

Objective:To evaluate the efficacy and safety of a novel domestic pulmonary thromoboectomy system Tendvia TM in the treatment for high-risk patients complicated with acute pulmonary embolization (APE). Methods:The study was designed as a prospective single-center clinical trial. Twenty-four high-risk patients with APE were recruited and underwent percutaneous mechanical thromoectomy (PMT) with the Tendvia TM pulmonary thromoboectomy system. The primary efficacy endpoint was the reduction of RV/LV ratio at the post-operative 48 h. The secondary efficacy endpoints included technical success rate, mean pulmonary arterial pressure (mPAP), arterial PaO 2 and the instant post-operative thrombus clearance rate. The evaluation of the safety included the intraoperative complications and related complications during the follow-up period associated with the PMT operation and the major adverse event (MAE) rate within the post-operative 48 h. The pre-and post-operative data were compared with paired sample t-test or Wilcoxon rank sum test to evaluate the efficacy and safety of Tendvia TM pulmonary thromoboectomy system. Results:The technical success rate of PMT with Tendvia TM pulmonary thromoboectomy system was 100% (24/24). The 48 h pre-operative RV/LV ratio was 1.19±0.25 and the post-operative RV/LV ratio was 0.82±0.16. The mean RV/LV ratio of the patients was decreased by 0.37±0.25 at post-operative 48 h with significant statistical difference ( t=7.03, P<0.001). The 48 h pre-operative mPAP was (31.09±6.09) mmHg and the post-operative mPAP was (25.91±4.36) mmHg. The mPAP of the patients was reduced by 5.18 mmHg at post-operative 48 h with significant statistical difference ( t=6.73, P<0.001). The pre-operative PaO 2 was (74.66±11.28) mmHg and the post-operative PaO 2 was (88.01±10.57) mmHg. The pressure of oxygen in artery was increased by 13.36 mmHg. The differences were statistically significant( t=-4.08, P<0.001). The rate of thrombus removal was 68.17%±22.66%. 87.5% (21 cases) of patients achieved a thrombus removal greater than grade Ⅱ. One patient underwent catheter directed thrombolysis (CDT) after PMT based on the evaluation of operator. The patient′s thrombus removal achieved grade Ⅲ after 48 h and the CDT was ceased. Hemoptysis occurred intra-operatively in one case underwent PMT and the symptom of the patient was alleviated with conservative medication. The MAE incidence within the post-operative 48 h was 4.17% (1/24). No device-related mortality or all-cause mortality occurred in the trial. Conclusions:The Tendvia TM pulmonary thromoboectomy system is a safe and effective device to remove the pulmonary arterial thrombus for the treatment of patients with APE. The Tendvia TM pulmonary thromoboectomy system can be a new choice in the treatment for the patients with APE.

Risk factors and prognosis of new on-set postoperative atrial fibrillation undergoing isolated coronary artery bypass grafting surgery / 中华胸心血管外科杂志

Objective To analyse the risk factors and prognosis of new on-set postoperative atrial fibrillation in different age and gender groups.Methods The study is a retrospective analysis in 516 patients from a single center.All cases were divided into 5 groups by ages as:＜ 40 years (n =61),40-49 years (n =97),50-59 years (n =115),60-75 years (n =140),and ＞ 75 years(n =103).We retrospectively analysed the difference in the occurrence-and recurrence-rate of POAF,risk factors,feature of coronary artery in different age and gender groups.Results There were no statistics differences in the same age group.The major risk factors were smoking,family history of coronary artery disease and hyperlipaemia in age ＜40 years group and 40 ～ 49 years group.while the major risk factors were hypertension and diabetes in the 60-75 years group and age ＞ 75 years group.The percentage of smoking patients decreased along with adding age.There was obviously statistical difference in the recurrence-rate of POAF across all groups during 24 follow-up months (P ＜ 0.05).The number of coronary lesion was increased with age.There were more ostial lesions in the 60-75 years group and age ＞ 75 years group.Conclusion There are different risk factors and characteristics among POAF patients in different age and gender groups.It is of great significance for us that comprehensive clinical intervention measures are taken to prevent recurrence of AF.

The functional alteration of dendritic cells in severe septic old patients / 中华急诊医学杂志

Objective To investigate the functional changes of dendritic cells (DC) in elderly patients with sepsis. Method Elderly patients (n = 20), ages 75 to 86 years, treated in the department of internal medicine for cadres and the medical intensive care unit (MICU), were selected to participate in the study. Patients with ma-ligoant tumors, hematological diseases, immune diseases, or a history of receiving drugs known to interfere with immune functions were excluded. Using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definition of sepsis, the patients were categorized into four groups: non-sepsis (group A) (n = 5) ; sepsis (group B) (n = 5) ; severe sepsis (group C) (n = 5) ; and septic shock (group D) (n = 5). The peripheral blood mononuclear cells (PBMCs) of each patient were isolated and cultured with human re-combinant granuloceyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) in vitro for 10 days. The cells were examined under an inverted microscope, scanning electron microscopy, and flow cytometry. The MTT colorimetric assay was used to observe the abilities of the dendritic cells to stimulale an allogeneic T lym-phocyte response in vitro. Paired t -test was used to compare changes in the surface markers among the different groups, Results The PBMCs in the four groups of patients differentiated into cells with typical dendritic configura-tions after in vitro cuhure with combined cytokines. The CD40, CD80, CD86, and HLA-DR expressions on the cell surfaces increased after culture,with (43.2±12.5)%/(27.3±9.3)%, (31.4 ± 10.1)%/(22.5 ± 8.7)%, (39.3±15.7)%/(21.9±7.7)%, and (75.4±25.6)%/(58.7±16.7)%, respectively. The stimulation index (the abilities of the dendritic cells to stimulale the allogeneic T lymphocyte response in vitro) in the four groups of patients after culture were (23.3±7.9) in group A, (18.9±8.3) in group B,(11.4±5.1) in Group C,and (5.5 ± 3.7) in Group D. Conclusions The immune functions of the dendritic cells of elderly patients with sepsis decrease in a linear manner with the severity of their septic state.

Comparison of anticoagulant effects on vein grafts between human TFPI gene transfection and aspirin oral administration / 华中科技大学学报（医学）（英德文版）

To develop a more efficient antithrombotic way after coronary artery bypass grafting (CABG), the anticoagulant effects were compared of human tissue factor pathway inhibitor (TFPI) gene transfection and aspirin oral administration (traditional method) on vein grafts. An eukaryotic expression plasmid pCMV-(Kozak) TFPI was prepared. Animal model of carotid artery bypass grafting was constructed. In operation, endothelial cells of vein grafts in TFPI group and empty plasmid control group were transfected with pCMV-(Kozak) TFPI and empty plasmid pCMV respectively, while no transfection was conducted in aspirin control group. After operation, aspirin (2 mg.kg(-1).(-1)) was administered (i.g.) in aspirin control group. Three days later, grafts (n=10) were harvested for RT-PCR, Western blotting and immunohistochemical analyses of exogenous gene expression and for pathological, scanning electron microscopic observation of thrombus. Thirty days later, the patency rates of remnant grafts (n=10) were recorded by vessel Doppler ultrasonography. Human TFPI gene products were detected in gene transferred vein grafts. Three days later, thrombi were found in 7 animals of aspirin control group and in 8 animals of empty plasmid control group, but in only 1 of TFPI group (P<0.01). Thirty days later, 5 grafts were occluded in empty plasmid control group, but none of grafts was occluded in the other groups (P<0.05). The endothelial surfaces of grafts in both of the control groups were covered with aggregated erythrocytes and platelets, and it were not seen in TFPI group. It was suggested that the anticoagulant effects on vein grafts of human TFPI gene transfection are better than those of aspirin.

CT classification of subcortical arterioselerotic encephalopathy in relation to intellectual and neuropsychological disturbance in the elderly / 中国组织工程研究

BACKGROUND: It is now know that the clinical presentations of subcortical arterioselerotic encephalopathy(SAE) could be mainly manifested by hypertension,stroke and chronic developed dementia,but there are very a few explorations on its definite pathogenesis and earlier assessment.OBJECTIVE: To investigate the correlation of CT classification of SAE with intellectual and neuropsycholohical disturbance,so as to explore the significance of CT classification of SAE to the assessment of SAE.DESIGN: Clinical case analysis based on patients.SETTING: A department of internal medicine in a military general hospital of Chinese PLA.PARTICIPANTS: From January 1999 to December 2002,totally 68 elders Guangzhou Military Area Command of Chinese PLA,included 65 males and 3 females,aged from 64 to 93 years old with the average age of(75. 8 ± 8. 1 )years old took part in the study.METHODS: Low-density focus around ventricle were observed with skull CT scanning and classified according to GOTO classification. Meanwhile the intellectual test and neuropsycholohical test were carried out,and the correlative analysis was conducted.MAIN OUTCOME MEASURES: Intellectual test,neuropsycholohical test,skull CT scanning,and analysis of correlation of CT classification with scores of intellectual test and neuropsycholohical test.RESULTS: Of 68 patients,91% (62/68) was proved to have different degree intellectual obstacle,100% was found to be vascular dementia; and low-density focus around ventricle were proved to be existed in all patients with skull CT scanning,GOTO classification indicated that type Ⅰ was found in 22 patients,type Ⅱ in 32 patients and type Ⅲ in 14 patients; skull CT classification was negatively correlated with the scores of intellectual test and positively correlated with scores of neuropsychiological test,with the correlative coefficient of -0. 83 and 0.75 respectively( P ＜ 0.01 ).CONCLUSION: GOTO classification of skull CT of SAE is related to intellectual obstacle and neuropsychiological disturbance in elder SAE.