Comparison of Bypass Surgery with Drug-Eluting Stents in Diabetic Patients with Left Main Coronary Stenosis

PURPOSE: Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients. MATERIALS AND METHODS: We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization). RESULTS: In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018). CONCLUSION: In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.

Outcomes of radiofrequency ablation in atrial tachyarrhythmia patients following circumferential pulmonary vein isolation / 第二军医大学学报

Objective: To observe the outcomes of radiofrequency ablation in patients with atrial tachyarrhythmia (ATa) after circumferential pulmonary vein isolation (CPVI), so as to discuss the related mechanism. Methods: A total of 64 patients underwent mapping and ablation using an electroanatomic mapping system (CARTO) at a mean of (3.7±2.4) months after the first CPVA procedure. Results: A total of 78 types of ATa were mapped, including 30 (38.5%) with re-entry mechanism and 48 (61.5%) with focal mechanism. Among reentrant ATa 12 had common atrial flutter and 18 had left atrial re-entry; the reentrant circuits were related to the mitral isthmus, the anterior wall of the left atrium, and the gaps on previous encircling lines. The tachycardias were unstable in 2 patients and were not mapped. Catheter ablation was successful in 56 of the 64 patients (87.5%), and cardioversion was needed in 8 patients to achieve sinus rhythm. During a mean follow-up of 13-21(16.5±2.9) months, 60 (93.8%) cases no longer had ATa. Conclusion: ATa after CPVA can have macro-reentrant and focal mechanisms. These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.

Cathepsin S in pathogenesis of neurological diseases / 浙江大学学报·医学版

Cathepsin S, one of the lysosomal proteinases, has many important physiological functions in the nervous system, especially in process of extracellular matrix degradation and endocellular antigen presentation. Those functions are closely associated with the pathogenesis of various neurological diseases. It would be beneficial to elucidate the role of Cathepsin S in the pathogenesis of various neurological diseases.