Effect of azitromycin on Th17/Treg balance in bronchiolitis obliterans mice after lung transplantation / 器官移植

Objective To evaluate the effect of azitromycin upon the bronchiolitis obliterans and T helper (Th)17/regulatory T cell (Treg) balance after lung transplantation. Methods Twenty-four specific pathogen free(SPF) C57BL/6 mice were used as the donors and 48 Balb/c mice were utilized as the recipients. The Balb/c mice were randomly divided into the control (C group), azitromycin control (Cazm group), transplantation (T group) and transplantation + azitromycin groups (Tazm group), 12 mice in each group. In the T and Tazm groups, heterotopic tracheal transplantation models were established to simulate bronchiolitis obliterans after lung transplantation. From 1 d post-transplantation, intragastric administration of azitromycin was given at a dose of 30 mg/kg three times per week in the Cazm and Tazm groups. At 14 and 28 d after transplantation, the transplanted trachea was removed and peripheral blood was collected. The tracheal sample was prepared for hematoxylin-eosin (HE) staining for pathological observation. The expression levels of ROR-γt and Foxp3 messenger ribonucleic acid (mRNA) in the peripheral blood were quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). The variation in the related cytokines levels of Th17 cells and Treg in the plasma was detected by enzyme linked immunosorbent assay (ELISA). Results After heterotopic tracheal transplantation, compared with the C group, thetracheal occlusion accompanied with inflammatory infiltration was observed in the T and Tazm groups. The severity of relevant symptoms in the Tazm group was slighter than that in the T group. Compared with the T group, the expression level of ROR-γt mRNA in the Tazm group was significantly down-regulated (P<0.05). No statistical significance was identified in the expression of Foxp3 mRNA between two groups (P>0.05). Compared with the T group, the levels of interleukin (IL)-6 and IL-17 cytokines in the Tazm group were significantly down-regulated (all P<0.05). Conclusions Persistent therapy of azitromycin can delay the progression of bronchiolitis obliterans after transplantation, which is probably associated with inhibiting Th17 cell differentiation and inflammation.

The role of raffinose-low potassium dextran lung preservation solution with blood in pulmonary graft preservation / 中华器官移植杂志

Objective To investigate the potential of a novel preservation solution,raffinose-low potassium dextran lung preservation solution with blood (BR-LPDS) in the preservation of the isolated lungs in rats,when compared to low-potassium dextran solution (LPDS).Methods Fifty donor lungs of Sprague-Dawley rats were randomly flushed with either R-LPDS (R-LPDS group,n =25) or RLPDS modified by the addition of blood (BR-LPDS group,n =25).After reperfusion,the double lungs were kept half inflate and then the pulmonary artery and bronchus were clamped.Then the grafts were flushed with and submerged in cold preservation solution at 4 C for 24 h.And they were excised for measurement of wet-to-dry ratio,as well as histologic examination to evaluate pulmonary edema,inflammation and cleaved caspase-3 expression at 0,2,4,5,6,8,10,12,14,16,24 h.Results As compared with the R-LPDS group,the mean wet-to-dry ratio of lungs in the BR-LPDS group was significantly reduced from 4 to 10 h after reperfusion.Upon histologic examination,less inflammatory cell aggregates and lower caspase-3 activity were seen in the lungs of the BR-LPDS group from 10 to 12 h and 10 to 14 h after reperfusion,respectively.Conclusion The addition of blood to the R-LPDS solution was shown to be more effective in reducing swelling,inflammation and caspase-3 expression of donor lungs than the R-LPDS solution.Further investigation is needed to evaluate lung preservation in BR-LPD solution as a viable option for transplant.

The role of raffinose-low potassium dextran lung preservation solution with blood in pulmonary graft preservation / 中华器官移植杂志

Objective To investigate the potential of a novel preservation solution,raffinose-low potassium dextran lung preservation solution with blood (BR-LPDS) in the preservation of the isolated lungs in rats,when compared to low-potassium dextran solution (LPDS).Methods Fifty donor lungs of Sprague-Dawley rats were randomly flushed with either R-LPDS (R-LPDS group,n =25) or RLPDS modified by the addition of blood (BR-LPDS group,n =25).After reperfusion,the double lungs were kept half inflate and then the pulmonary artery and bronchus were clamped.Then the grafts were flushed with and submerged in cold preservation solution at 4 C for 24 h.And they were excised for measurement of wet-to-dry ratio,as well as histologic examination to evaluate pulmonary edema,inflammation and cleaved caspase-3 expression at 0,2,4,5,6,8,10,12,14,16,24 h.Results As compared with the R-LPDS group,the mean wet-to-dry ratio of lungs in the BR-LPDS group was significantly reduced from 4 to 10 h after reperfusion.Upon histologic examination,less inflammatory cell aggregates and lower caspase-3 activity were seen in the lungs of the BR-LPDS group from 10 to 12 h and 10 to 14 h after reperfusion,respectively.Conclusion The addition of blood to the R-LPDS solution was shown to be more effective in reducing swelling,inflammation and caspase-3 expression of donor lungs than the R-LPDS solution.Further investigation is needed to evaluate lung preservation in BR-LPD solution as a viable option for transplant.

Clinical relevance of angiographic coronary collaterals during primary coronary intervention for acute ST-elevation myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Collaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI). We sought to investigate the impact of early coronary collateralization, as evidenced by angiography, on myocardial reperfusion and outcomes after primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Acute procedural results, ST-segment resolution (STR), enzymatic infarct size, echocardiographic left ventricular function, and major adverse cardiac events (MACE) at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA (TIMI flow grade 0 or 1) within 12 hours of symptom-onset. Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.</p><p><b>RESULTS</b>Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralization was detected in 329 and 60 patients, respectively. Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion, but less often had left anterior descending artery occlusion. At baseline, these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band (CK-MB) and cardiac troponin I (cTnI). Procedural success rate, STR, corrected TIMI flame count, and area under the curve of CK-MB and cTnI measurements after the procedure were similar between patients with high collateralization and those with low collateralization (for all comparisons P > 0.05). There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.</p><p><b>CONCLUSIONS</b>In patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset, coronary collateralization to the occluded IRA was influenced by clinical and angiographic features. Early recruitment of collaterals limits infarct size at baseline, but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes.</p>

Surveillance and forecast system of schistosomiasis in Jiangsu Province ⅥDetection technology of water infectivity based on enrichment of Schistosoma japonicum cercariae on water surface / 中国血吸虫病防治杂志

Objective To explore the enrichment technique of Schistosoma japonicum cercariae on the water surface,so as to establish a new method combined with the existing technology to detect the cercarial infested water body quickly and sensitive-ly. Methods Soybean oil,gasoline,kerosene and isophorone were screened as expanding agents. The cercariae were enriched by the thrust of the expanding agents when diffusing on the water surface,and PE adsorption film and C-6 film were applied to seize them so as to determine the infectivity of the water quickly. The relationship between the dose of expanding agents and dif-fusion radius were explored. Results Gasoline,kerosene and isophorone were suitable expanding agents,and the diffusion ef-fect of isophorone was the best. After the enrichment by the expanding agents,the detection rate of cercariae of the method seiz-ing cercariae with the film significantly improved in the water. Conclusion This new method could effectively improve the de-tection rate of the cercarial infested water and is suitable for the low-degree infested water.

Efficacy and safety of intra-coronary bolus injection of tirofiban during primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To analyse and compare the effects and safety of early use (in emergency room, intravenous loading followed by infusion) with bolus injection during primary PCI of tirofiban, on post-procedural TIMI flow and 30d clinical outcomes. Methods Seven hundred and seven patients with acute STEMI treated by primary PCI in Ruijin hospital were retrospectively and enrolled screened. Among them, 86 patients with single bolus intra-coronary injection of tirofiban (25 μg/kg) during the procedure were served as observation group. Baseline, angiographic, PCI features and rate of major adverse cardiac events (MACE) at 30 d follow-up were compared with those received early intravenous infusion of tirofiban (10ug/kg bolus followed by 0.15μg/(kg·min) intravenous infusion)(control group, n=239). Results Compared with control group, patients in observation group were older[(63.8±11.4) vs. (57.9±8.8), P=0.01], had higher prevalence of hypertension (58.6%vs. 51.0%, P=0.005), multivessel disease (57.0%vs. 34.3%, P<0.001), and female in gender (40.7%vs. 25.1%, P=0.006). Post-procedural TIMI flow in culprit vessel and TMP grade were comparable between the two groups (P=0.66 and P=0.48, respectively). Reduction in TIMI minimal bleeding events were found in the observation group (2.3%vs. 9.6%, P=0.03). MACE free survival rate at 30d clinical follow-up was similar between the two groups (P=0.48). Conclusions Single bolus intra-coronary injection of tirofiban exerts similar effects in post-procedural TIMI flow, TMP grade in culprit vessel and 30d clinical outcomes compared with early use in emergency room with intra-venous loading and infusion, nevertheless, intra-coronary injection resulted in significantly reduced TIMI minimal bleeding events. Prospective, randomized clinical study is mandatory to prove our current results.

The influence of diabetes on left ventricular remodeling after primary percutaneous coronary intervention for patients with acute myocardial infarction / 中国介入心脏病学杂志

Objective To investigate the influence of diabetes mellitus (DM) on left ventricular(LV) remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Methods Four hundred and fifty-one consecutive patients with acute STEMI treated by primary PCI were prospectively enrolled in the current study. Baseline, angiographic and PCI features and prevalence of LV remodeling at one-week during hospitalization and 6-month clinical follow-up by two-dimensional echocardiography were compared between 93 diabetic and 358 non-diabetic patients. Results Despite similar baseline clinical and angiographic characteristics, symptom-to-door time was longer (399±106 min vs. 321±116 min, P=0.006) and prevalence of multivessel disease was higher (65.6%vs. 51.7%, P=0.02) in diabetic patients. More patients in diabetic group had LV remodeling at 6-month clinical follow-up (29.0%vs. 17.3%, P=0.01), and DM was an independent predictor of LV remodeling (RR 2.1, 95%CI 1.31-4.79, P=0.02). The rate of rehospitalization due to heart failure did not differ between diabetic and non-diabetic patients (12.9%vs. 8.1%, P=0.15), however, more adverse events occurred in patients with LV remodeling comparing to those without LV remodeling (25.8% vs. 6.6%, P < 0.001). Conclusions Diabetic patients with STEMI often have an increased risk of LV remodeling after treated by primary PCI. Thus, comprehensive therapeutic strategy for diabetic patients presented with STEMI is required considering the poor prognosis of these patients with LV remodeling.

Clinical outcomes of patients with major bleeding after primary coronary intervention for acute ST-segment elevation myocardial infarction / 介入放射学杂志

Objective To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods During the period of January 2004-January 2008, primary PC1 was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P = 0.04), mainly the females (51.9% vs 23.1%, P = 0.001) and treated more often with glycoprotein (GP) Ⅱb/Ⅲa receptor inhibitor (88.9% vs 69.4%, P = 0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P = 0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively, which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P = 0.008 and P = 0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP Ⅱb/Ⅲa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P < 0.001). Conclusion In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment. Feminine gender, aged patient and use of GP Ⅱb/Ⅲa receptor inhibitor are independent predictors to increase the danger of major bleeding.

Effect of Rapamycin Eluting Stent for Inhibition of Neointimal Hyperplasia in Diabetic Porcine Model / 中国循环杂志

Objective:To investigate the effect of rapamycin eluting coronary stent for inhibition of neointimal hyperplasia in diabetic porcine model.Methods:There were two groups in this study. Diabetic group, n=12, diabetic porcine model was established by a single dose of streptozotocin, and rapamycin eluting coronary stents were randomly implanted into 2 of the major epicardial coronary arteries. Control group, n=12, with non-diabetic porcine. The degree of neointimal hyperplasia evaluated by coronary angiography, intravascular ultrasound (IVUS) and histopathology were compared between two groups respectively at 6 months of the event. Results:The distribution of vessels received stents, reference vessel diameters and post-procedural minimal luminal diameter were comparable between two groups. All animals received angiographic follow-up at 6 months of time. In Diabetic group, the degree of stent stenosis (35.6%±9.2% vs. 7.9%±3.1%,P<0.001), late lumen loss (0.32±0.09 mm vs. 0.09±0.04 mm,P<0.001), the thickness of neointima by IVUS examination (0.35±0.12 mm vs. 0.11±0.08 mm,P<0.05) and area stenosis by IVUS (1.29±0.51 mm~2 vs. 0.26±0.11 mm~2, P<0.001); and histopathological examination (1.24±0.76 mm~2 vs. 0.19±0.08mm~2, P<0.05) were significantly higher than those in Control group. Conclusion: The neointimal hyperplasia after rapamycin eluting stent implantation was significantly severe in the diabetic porcine models than those in non-diabetic ones.

The relationship of the gene polymorphisms of matrix metalloproteinase-1, -2, -3 and -9 to the progression of coronary atherosclerotic plaque / 介入放射学杂志

Objective To evaluate the influence of the gene polymorphisms of matrix metalloproteinase(mmp)-1 ,-2,-3 and -9 on coronary atherosclerotic plaque progression. Methods During the period of January 2005-December 2008, 80 patients with coronary heart disease underwent two times coronary angiography at authors' hospital. Based on the angiographic findings, the patients were classified into plaque progression group (n = 31 ) and plaque non-progression group (n = 49). Coronary atheroselerotic plaque progression was arbitrarily defined as that the minimal lumen diameter (MLD) of coronary artery showed a decrease ≥ 0.4 mm on the second coronary angiography. The detailed history and clinical examination results were collected, including serum concentrations of lipid profiling, fasting glucose and hs-CRP. Genotypings for polymorphic variances of MMP-1 (-1607 G/GG), MMP-2 (-955 A/C), MMP-3 (-1612 5A/6A ) and MMP-9 (-1562 C/T) were performed by polymerase chain reaction (PCR) and sequencing analysis in two groups.Comparison of the clinical characteristics and polymorphisms between two groups was made to assess their effects on coronary atherosclerotic plaque progression. Results More female patients and patients with acute coronary syndrome (ACS) were noted in patients with plaque progression compare to those with no progression (41.9% vs. 18.4%, P < 0.05 and 77.4% vs. 46.3%, P < 0.01, respectively).The serum hs-CRP level also significantly increased in group with plaque progression (0.26 ± 0.44 mg/L vs.0.02 ± 0.14 mg/L, P < 0.01). Multivariable logistic regression analysis revealed that serum hs-CRP concentration and ACS were independent risk factors of coronary atherosclerotic plaque progression (OR:12.63,95% CI:1.45-110.29, P < 0.05 and OR:2.99,95% CI:1.04-8.63, P < 0.05, respectively). The frequencies of 6A/6A genotype and 6A allele of MMP-3 promoter at location -1612 were significantly higher in group with plaque progression than that in group with no progression (87.1% vs. 53.1%, P < 0.01 and 93.5% vs. 75.5%, P < 0.01, respectively). However, no significant differences in the distribution of MMP-1,-2 and -9 polymorphisms existed between two groups. Conclusion ACS, feminine gender, high serum hs-CRP concentration and 5A/6A polymorphism in the MMP-3 gene promoter are closely associated with coronary atherosclerotic plaque progression. In addition, 5A/6A polymorphism of MMP-3 can be used as a marker for plaque progression.

Long-term outcomes in elderly patients after percutaneous coronary intervention / 中国实用内科杂志

0.05)compared to bare metal stents.Conclusion Age is an important clinical factor influencing mortality rate after PCI in patients with coronary artery disease,and the use of drug-eluting stents should be the preferred for the improvement of long-term outcomes in the elderly.

Relationship between coronary arterial remodeling and clinical presentation / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To examine the relationship between coronary arterial remodeling and clinical presentation.</p><p><b>METHODS</b>A total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI > 1.05 and negative remodeling as RI < 0.95.</p><p><b>RESULTS</b>Soft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P = 0.03). The EEM CSA (15.11 +/- 2.89 mm(2) vs 13.25 +/- 3.10 mm(2), P = 0.019) and plaque CSA (10.83 +/- 2.62 mm(2) vs 9.30 +/- 2.84 mm(2), P = 0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08 +/- 0.16 vs 0.95 +/- 0.14, P = 0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P = 0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P = 0.007).</p><p><b>CONCLUSIONS</b>The study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.</p>

Intravascular ultrasound-guided clinical decision-making for intermediate coronary stenosis / 中华超声影像学杂志

Objective To evaluate the role of intravasc ular ultrasound (IVUS) in determining strategy for coronary artery stenosis of intermediate severity.Methods The study population consisted of 75 patients who had de novo coronary lesions of intermediate severity (40% to 70% diameter stenosis) in coronary angiography. IVUS examination was performed in all patients using standard methodology. Minimal lumen cross-sectional area (MLA) ≤ 4.0- mm 2 or percent area stenosis≥60% were identified as an IVUS index of functionally severe coronary stenosis, and used as an indication of coronary stenting. Major adverse cardiac events (cardiac death, acute myocardial infarction and recurrent angina) and the use of nitrates were recorded during follow-up. Results There were 44 patients (59%) with functional coronary artery stenosis, and all underwent successful coronary stenting. Acute coronary syndromes, soft plaque and positive coronary arterial remodeling were more common compared with the remaining 31 patients (41%) only treated medically. During a mean of (14?7) months of follow-up, there was no cardiac death and acute myocardial infarction. Readmission occurred in 5 patients (11%) due to in-stent restenosis in patients with interventional therapy and 4 patients (13%) due to exacerbation of coronary artery stenosis in patients with medical therapy. The use of nitrates was discontinued in 18(41%) and 14(45%) patients treated with interventional therapy and medical therapy, respectively. Conclusions It is valuable to perform IVUS examination in clinical decision making for intermediate coronary artery stenosis. IVUS criteria of MLA≤ 4.0- mm 2 or area stenosis≥60% may be a reliable index of functional coronary stenosis, determining the therapeutic strategy in patients with intermediate coronary artery stenosis.

Clinical experience of coroflex intracoronary stent / 中国介入心脏病学杂志

Objective To evaluate the clinical efficacy of coroflex (BRAUN, Germany) intracoronary stent. Methods To retrospectively analyze the immediate angiographic and clinical follow-up outcomes of 81 patients (pts) receiving coroflex intracoronary stenting. Results 88 coroflex intracoronary stents were implanted in 81 pts. According to ACC/AHA classification, 38 lesions were type A-B 1, 50 lesions were type B 2-C. 52 lesions were de novo, 22 were suboptimal results after PTCA and 14 lesions were bailout for dissections. Stent deployment was successful in 82/88 (93.2%). High-pressure (16-18 atm) balloon was used for stent deployment in 3 lesions with severe calcification. Dissection was occurred at distal of stent in 2 lesions but no inducing flow reduction. Angiography showed TIMI 2 grade after intracoronary stenting in 1 diffused lesion. There were no adverse events occurred during hospital stay. Clinical follow-up of in 75 pts were conducted for 7.5?3.0 (3-13) months, there were no cardiac death or myocardial infarction reported. Complain of angina (CCS class Ⅰ) occurred in 17 pts (22.7%). Repeat angiography was performed in 7 pts, there were 2 in-stent restenosis with successful revascularization. Conclusion Coroflex intracoronary stenting appears to be safe and effective in the treatment of coronary lesions with favorable outcomes.

Cutting balloon angioplasty for treatment of lesions in small coronary arteries / 介入放射学杂志

Objective To evaluate the clinical efficacy of cutting balloon angioplasty (CBA) for treating lesions in small coronary arteries. Methods The diameter for reference of coronary artery is less than 2.7mm which is considered as “small vessel”. CBA procedures were performed on 25 lesions in 22 patients. Results The procedure was successfully obtained in 21 lesions(84%). Seven severe stenotic lesions (diameter of stenosis≥90%) underwent dilatation with small conventional balloon(1.5 mm diameter). Bail out stenting was performed in 2 lesions because of severe dissections. Failure of cutting balloon to pass through the stenosis in one lesion. During follow up, 5 patients had recurrence of coronary angina and 3 of them underwent coronary angiography for check up, In stent restenosis (ISR) occurred in one patient, which was successfully redilated using CBA. One patient had total occlusion of the diagonal branch with ISR of LAD. One patient developed new lesion in other coronary artery.Conclusions CBA is safe and effective, and provides a new therapeutic strategy for lesions in the small coronary arteries.