Feasibility and safety of paclitaxel-eluting balloon for the treatment of de novo coronary lesions / 中华心血管病杂志

Objective@#To evaluate the safety and feasibility of treating de novo coronary lesions with paclitaxel-eluting balloon.@*Methods@#This is a retrospective study, which enrolled 76 patients with 80 de novo coronary lesions treated with paclitaxel-eluting balloons(<30% residual stenosis and there was no blood flow limited dissection after pretreatment) from April 2015 to November 2016 in Guangdong general hospital. The data of basic characteristics,procedures,devices and follow-up information were retrieved and analyzed. The primary endpoint was the composite of cardiac death, recurrent myocardial infarction and target lesion revascularization.@*Results@#(1)The age was (63.3±10.3) years. There were 68.4%(52/76) acute coronary syndrome patients, prevalence of type 2 diabetes was 36.8%(28/76), and 64.5%(49/76)patients with at least one high bleeding risk. (2)The lesion length was (17.4±7.6)mm, and the stenosis was (88.1±8.2)%.The reference vessel diameter≥2.75 mm accounted for 51.2% (41/80), and bifurcation stenosis accounted for 67.5%(54/80). (3)53.7%(43/80) lesions were pretreated with scoring balloon to optimize plaque modification. The paclitaxel-eluting balloon length and diameter were (22.3±5.5)mm and (2.74±0.52)mm.The residual stenosis was (12.3±10.3)%. Procedural success was 88.8%(71/80).Bail-out stenting rate was 5.0%(4/80). (4)The median follow-up duration was 12(6, 25) months. Primary endpoint occurred in 3 cases (3.9%), including 2 cardiac deaths(1 patient died of recurrent myocardial infarction, and 1 patient died of acute heart failure induced by severe mitral insufficiency), and one patient receivedtarget lesion revascularization.@*Conclusion@#In case of no more than 30% residual stenosis and no blood flow limited dissection after lesion pretreatment,it is safe and feasible to treat de novo coronary lesionsusing paclitaxel-eluting balloon.

Clinical characteristics of recent death in patients with acute myocardial infarction complicated with cardiac rupture / 中国中西医结合急救杂志

Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.

Clinical characteristics of recent death in patients with acute myocardial infarction complicated with cardiac rupture / 中国中西医结合急救杂志

Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.

Multicenter clinical study of the predictive value of neutrophil gelatinase-associated lipocalin for contrast-induced acute kidney injury after emergency percutaneous coronary intervention in patients with relative normal renal function / 实用医学杂志

Objective To explore the predictive value of neutrophil gelatinase associated lipocalin (NGAL) for contrast-induced acute kidney injury (CI-AKI) after emergency percutaneous coronary interventions (PCI) in patients with relative normal renal function.Methods A total of 73 patients with relative normal renal function undergoing PCI were enrolled in this prospective multicenter clinical study.Serum NGAL was measured by point-of-care test.Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of NGAL for CI-AKI.Results CI-AKI occurred in 5 patients (6.85％).The concentration of NGAL was higher in the CI-AKI group than in the non-CI-AKI group.ROC curve indicated that the area under the receiver operating characteristic was 0.755,0.761 and 0.809,respectively.Conclusions Serum NGAL at baseline,4 h and 8 h after procedure are served as a good biomarker for early diagnosis of CI-AKI after PCI.Therefore,NGAL might become an early and quick marker for CI-AKI in the future.

Accuracy Assessment of Type III Portable Monitor of Sleep Apnea for In-hospital Patients With Cardiovascular Disease / 中国循环杂志

Objective: To assess the accuracy and application value of type III portable monitor (III PM) of sleep apnea (SA) for in-hospital patients with cardiovascular disease (CVD). Methods: A total of 101 CVD patients received sleep apnea monitoring by both type II polysomnography ( II PSG) and III PM were enrolled to compare the apnea-hypopnea index (AHI) measured by 2 instruments. AHI was assigned into 4 grades: Normal (AHI0.05. Kendall correlation coefficient for 4 AHI grades was 0.701, P<0.01 which assumed strong correlation; Kappa value of consistency was 0.493, P<0.01 which assumed medium strong correlation. Using AHI≥15 as cut-off point, Kappa coefficient for the consistency between II PSG and III PM was 0.679, P<0.05, which meant high consistency. Taking II PSG as standard and AHI≥15 as cut-off point, the AUC of III PM measured AHI was 0.918 with the specificity at 80.4% and sensitivity at 87.3%. The best diagnosing cut-off value of III PM was AHI=15.70, at this point, the maximum Youden's index was obtained as 0.695. Conclusion: Using AHI≥15 as standard, III PM and II PSG had the favorable consistency and accuracy for monitoring the severity of SA for in-hospital patients with cardiovascular disease. AHI=15.7 was the best cut-off point of III PM in diagnosing moderate and severe SA in relevant patients.

Effects Analysis of Special Rectification of Antibiotics for Prophylactic Use in Perioperative Period of Per-manent Cardiac Pacemaker Implantation in Our Hospital / 中国药房

OBJECTIVE:To provide reference for rational prophylactic application of antibiotics in perioperative period of per-manent cardiac pacemaker implantation. METHODS:600 cases performed permanent cardiac pacemaker implantation in 2010(be-fore rectification),2012(during rectification)and 2014(after rectification)were randomly sampled from our hospital,and divided into control group,intervention group one and intervention group two. The prophylactic application of antibiotics was investigated and analyzed in 3 groups. RESULTS:For control group,intervention group one and intervention group two,the rates of rational type selection of antibiotics for prophylactic use were 7.25%,31.00% and 91.96%,respectively. The rates of rational medication timing of antibiotics for prophylactic use were 0,100% and 100%;average duration of prophylactic use decreased from (3.6 ± 1.2)d before intervention to(1.1±0.5)d and(1.0±0.2)d. There was no statistical significance in the incidence of postoperative infection(P>0.05). Compared with control group,average drug cost,antibiotics cost and drug ratio decreased significantly in in-tervention group,with statistical significane (P<0.05). CONCLUSIONS:Antibiotics special rectification is effective and improve the rational application of antibiotics in our hospital.

Clinical features of 17 cases of rhabdomyolysis / 中华心血管病杂志

<p><b>OBJECTIVE</b>We retrospectively analyzed the causes, diagnosis, clinical characteristics, treatment and prognosis of 17 patients with rhabdomyolysis.</p><p><b>METHODS</b>Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.</p><p><b>RESULTS</b>A total of 17 rhabdomyolysis patients (male 13, mean age (60.4 ± 15.7) years) were analyzed.Four cases had coronary heart disease combined with hypertension, hyperlipaemia, atrial fibrillation, 10 cases had dilated cardiomyopathy combined with coronary heart disease, hyperlipaemia, atrial fibrillation, 8 cases had atrial fibrillation combined with hypertension, coronary heart disease, hyperlipaemia, 1 patient had pulmonary embolism combined with hyperlipaemia, 1 patient had aortic dissection combined with hypertension, 10 hypertension patients were combined with coronary heart disease, hyperlipaemia, atrial fibrillation, aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction, reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases, relevant neurological signs in 5 cases. Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization. All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing. Post therapy, 10 cases improved but 7 cases died. All 17 patients had history of statin use.</p><p><b>CONCLUSION</b>Statin may be the major cause of rhabdomyolysis in these patients, and the mortality of rhabdomyolysis is high despite various therapy stratigies.</p>

Genome-wide Analysis of DNA Methylation in Coronary Heart Disease Patients with MeDIP-Seq / 中国药房

OBJECTIVE:To explore the genome-wide methylation differences between coronary heart disease (CHD) patients and healthy volunteers,and to investigate the relationsip of DNA methylation with CHD from epigenetics. METHODS:In case-control study,subjects were divided into CHD group(50 cases)and health control group(50 cases). DNA of 2 groups were sequenced with methylated DNA immunoprecipitation sequencing technology. The genome-wide methylation differences were analyzed and compared between 2 groups. RESULTS:The number of methylation peak in CHD group was higher than health group,with statistical signfi-cance(P<0.05). The methylation peak mainly distributed in 5'UTR,Intron functional elements. The number of reads in AQP1,SHB and other gene promoters in CHD group were lower than health group,and its methylation level decreased. The number of reads in GRK5 and serveal gene promoters on chrX in CHD group were higher than helath group,and its methylation level increased,with sta-tistical significance(P<0.01). CONCLUSIONS:The genome-wide methylation level of CHD patients are higher than those of healthy volunteers. The occurence of CHD is possibly associated with the change of methylation level of related gene promoters.

Case-control study of factors associated with aortic dissection DeBakey type Ⅲ / 实用医学杂志

Objectives To investigate the recurrence risk factors and the protective factors of aortic dissection (AD) DeBakey type Ⅲ. Methods 43 patients with AD DeBakey type Ⅲ who were in Guangdong General Hospital from May 2014 to September 2014, were enrolled as the case group, while 27 volunteers exclude AD as the control group. Blood chemistries and other information obtained immediately after admissions , χ2 test or T test was used for univariate analysis of independent samples. Multivariate Logistic regression analysis was used to screen patients with recurrence risk factors or protective factors. Results The prevalence of hypertension (93.02%vs. 18.52%, P = 0.000) and proportion of smokers (34.88% vs. 11.11%, P = 0.027) were significantly higher in case group than control group. Logistic regression analysis showed that hypertension (OR=5.148, 95%CI= [2.209~13.058], P=0.001) and albumin level (OR=0.709, 95%CI = [0.541~0.929], P=0.013) were significantly associated with recurrence of aortic dissection DeBakey type Ⅲ. Conclusion Hypertension is an independent risk factor for recurrence of aortic dissection DeBakey type Ⅲ, and albumin level is a protective factor.

Progress of phytochemicals, pharmacological effects and clinical applications onCotinus coggygriaScop / 国际中医中药杂志

Cotinus coggygria Scop. is theAnacardiaceae Cotinus L. plant and used for natural drugs in the treatment of acute icteric infectious hepatitis. The pharmacological research showed thatCotinus coggygria Scop. has the effects of reducing jaundice and enzyme, gallbladder Cholagogic and strengthen immune function. The current research onCotinus coggygria Scop. is still not deep enough, the pharmacological effects ofCotinus coggygria Scop. are mostly limited to the anticoagulant, hemolytic and anti liver chemical injury. In order to better study the scientific connotation of antitumor ofCotinus coggygria Scop., the active ingredient ofCotinus coggygria Scop., pharmacological action and clinical application were reviewed.

Association between apolipoprotein A1-75 bp gene polymorphisms and risk for dyslipidemia and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between the apolipoprotein ApoA1-75 bp polymorphism and risk for dyslipidemia and coronary artery disease (CAD).</p><p><b>METHODS</b>A total of 723 patients (mean age (62.4 ± 10.2) years old) admitted to Guangdong General Hospital from 2011 to 2013 were enrolled. They were subdivided into CAD group (n = 444) and non-CAD (n = 279) group according to the result of coronary angiography (CAG). Clinical data including the profiles of lipids, -75 bp gene polymorphisms and Gensini scores were analyzed to determine the correlation between -75 bp gene polymorphisms, lipid profile and CAD.</p><p><b>RESULT</b>Frequency of male gender, history of diabetes and smoking, TC, TG, LDL-C and ApoB level were significantly higher and HDL-C level was significantly lower in CAD group than in non-CAD group (all P < 0.05). Frequency of A allele was significantly lower in CAD group than in non-CAD group (43.7% (194/444) vs. 56.6% (158/279) , P = 0.003). The ApoA1-75 bp gene polymorphism was significantly correlated with CAD (P < 0.005). Multivariate logistic regression analysis showed that -75 bp gene polymorphism mutation (OR = 0.649, P = 0.021) is an independent protective factor for coronary heart disease.</p><p><b>CONCLUSION</b>ApoA1-75 bp gene polymorphism is linked with risk of dyslipidemia and CAD.</p>

Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in adult atrial septal defect patients with pulmonary arterial hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>While echocardiography has been a pivotal screening test in pulmonary arterial hypertension (PAH), the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures (PAPs). This study sought to evaluate the accuracy of Doppler echocardiography (DE) for estimating PAPs in adult atrial septal defect (ASD) patients with PAH.</p><p><b>METHODS</b>A prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization (RHC) in adult ASD patients with PAH who underwent simultaneous DE and RHC. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs.</p><p><b>RESULTS</b>Two hundred and fifty-seven patients were included in the study. A significant overestimation of the systolic pulmonary arterial pressure (sPAP) and mean pulmonary artery pressure (mPAP) was reported by echocardiography compared with those by catheterization ((81.8 ± 26.9) mmHg vs. (72.9 ± 26.9) mmHg, P < 0.01; (51.9 ± 16.4) mmHg vs. (41.4 ± 17.2) mmHg, P < 0.01, respectively). Twenty-one percent (55/257) of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test. Using Bland-Altman analytic methods, the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95% limits of agreement ranging from -24.4 to 42.6 mmHg. For mPAP measurement, the bias was 10.5 mmHg with 95% limits of agreement ranging from -12.4 to 33.4 mmHg. On multiple linear regression analysis, age, gender, body surface area, ASDs' diameter, PVR, diastolic blood pressure, and echocardiographic assessment of right atrial pressure (RAP) explained 68.8% of the total variability in the model (r(2) = 0.688, P < 0.01).</p><p><b>CONCLUSION</b>Inaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age, gender, body surface area, ASDs' diameter, pulmonary vascular resistance, diastolic blood pressure and echocardiographic estimation of RAP.</p>

Effects of iloprost combined with low dose tadalafil in adult congenital heart disease patients with severe pulmonary arterial hypertension: a single-center, open-label controlled study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the therapy efficacy of iloprost combined with low dose tadalafil in adult congenital heart disease (CHD) patients with severe pulmonary arterial hypertension (PAH).</p><p><b>METHODS</b>Adult CHD patients with severe PAH were included and divided into the sequential combination therapy group [iloprost: 10 µg/inhalation, 6 times per day for 6 months, and then add oral tadalafil (5 mg/d) till 12 months, n = 32] and upfront combination therapy group [iloprost: 10 µg/inhalation, 6 times per day combined with oral tadalafil (5 mg) for 12 months, n = 36]. Data on 6 min walking test (6MWT), Borg dyspnea score, oxygen saturation measurement, WHO classification, and cardiac catheterization were obtained at baseline, 6 and 12 months.</p><p><b>RESULTS</b>Seventy-two patients were enrolled in the study and 68 patients completed the study. Pulmonary vascular resistance (PVR) was significantly reduced in the sequential combination therapy group[ (12.96 ± 6.48 ) Wood U vs. (16.94 ± 8.11) Wood U, P < 0.05] and in the upfront combination therapy group [(12.45 ± 7.32) Wood U vs. (16.73 ± 9.28) Wood U, P < 0.05] while pulmonary blood flow [(6.77 ± 3.17) L/min vs. (5.08 ± 2.36) L/min, P < 0.05; (6.95 ± 3.32) L/min vs. (5.03 ± 2.32) L/min, P < 0.05], the 6 MWD were significantly increased [(458 ± 59) m vs. (427 ± 65) m, P < 0.05; (494 ± 59) m vs. (436 ± 62) m, P < 0.01], the Borg dyspnea score (2.04 ± 0.72 vs. 2.52 ± 0.79, P < 0.05; 1.72 ± 0.73 vs. 2.51 ± 0.77, P < 0.01) was significantly improved in both groups at 6 months compared to baseline levels. In the upfront combination therapy group, venous oxygen saturation [(68.4 ± 9.3)% vs. (62.9 ± 9.5)%, P < 0.05] and systemic oxygen saturation during exercise[ (87.2 ± 9.7)% vs. (83.1 ± 15.6)%, P < 0.05]at 6 months were also significantly improved compared to baseline. At month 12, significantly lowered pulmonary artery pressure, PVR, Rp/Rs and increased pulmonary blood flow and cardiac index were evidenced in both groups compared to baseline.</p><p><b>CONCLUSION</b>Iloprost combined with low dose tadalafil regimen can effectively reduce PVR, increase 6MWD, and improve cardiopulmonary function in adults CHD patients with severe PAH. Compared with the sequential therapy regimen, the upfront combination therapy regimen can more rapidly improve the clinical symptoms of patients.</p>

Relationship between carbon dioxide combining power and contrast- induced acute kidney injury in patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the relationship between carbon dioxide combining power(CO₂-CP) and contrast-induced acute kidney injury (CI-AKI) in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.</p><p><b>METHODS</b>We retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention. Patients were divided into three tertiles according to pre-operative CO₂-CP: T1 (CO₂-CP < 22.62 mmol/L), T2(CO₂-CP 22.62-24.30 mmol/L), T3(CO₂-CP > 24.30 mmol/L). Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups. An increase in serum creatinine of >26.4 µmol/L and/or >50% from baseline within 48 hours after contrast exposure was defined as CI-AKI. Univariate logistic regression analysis was used to identify the risk factors of CI-AKI. The relationship between CO₂-CP and CI-AKI was assessed by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify the optimal cutoff of the CO₂-CP for predicting CI-AKI.</p><p><b>RESULTS</b>CI-AKI occurred in 25 (14.4%) patients, and lower CO₂-CP was related to higher incidence of CI-AKI (27.6% (16/58) in group T1, 5.3% (3/57) in group T2, 1.7 % (1/59) in group T3, P = 0.002) and higher in-hospital mortality (10.3% (6/58) vs. 0 and 1.7% (1/59), P = 0.010). Dialysis rate was similar among 3 groups (5.2% (3/58) vs. 0 and 1.7% (1/59), P = 0.168). The incidence of CI-AKI was significantly associated with CO₂-CP < 22.00 mmol/L in univariate analyses (OR = 6.767, 95% CI 2.731-16.768, P < 0.001). After adjusting for potential confounding risk factors, CO₂-CP < 22.00 mmol/L remained significantly associated with the incidence of CI-AKI (OR = 5.835, 95%CI 1.800-18.914, P = 0.003) in multivariate logistic regression. ROC analysis revealed that the optimal cutoff of CO₂-CP to predict CI-AKI was 22.00 mmol/L (sensitivity 64.0%, specificity 79.1%, AUC = 0.714).</p><p><b>CONCLUSIONS</b>Pre-percutaneous coronary intervention CO₂-CP in patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention is related to CI-AKI. CO₂-CP < 22.00 mmol/L predicts higher risk of CI-AKI in this patient cohort.</p>

Procalcitonin could be a reliable marker in differential diagnosis of post-implantation syndrome and infection after percutaneous endovascular aortic repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.</p><p><b>METHODS</b>We conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.</p><p><b>RESULTS</b>Post endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.</p><p><b>CONCLUSIONS</b>PCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.</p>

Prevalence and impact of concomitant coronary artery disease in aged patients with Stanford type B aortic dissection / 中华胸心血管外科杂志

Objective To evaluate the prevalence and impact of coronary artery disease (CAD) in aged patients with Stanford type B aortic dissection(AD).Methods From January 2008 to December 2011,CAG was routinely performed before aortography and thoracic aortic repair(TEVAR) to determine the prevalence of concomitant CAD in 200 consecutive Stanford type B AD patients who were older than 50 years.All patients received 1 year follow-up.Adverse events were compared between patients with and without concomitant CAD.Data analysis by SPSS 17.0 statistical software,using Student t test,Chi-square test and Fisher exact test.Results CAG showed 53 patients (26.5％) had CAD.Multivariate logistic regression analysis showed that male gender(OR =4.415,95％ CI:1.131-17.237,P =0.033) and age (OR =1.061,95％ CI:1.017-1.108,P =0.006) were independent predictors of Stanford type BAD coexisted with CAD.Age was also independent predictor of multi-vessel disease(MVD) and/or left main disease(LMD) (OR =1.096,95％ CI:1.009-1.191,P =0.023).At 30-day follow-up,there was no difference in the incidence of adverse events between patients with and without concomitant CAD.Patients with concomitant CAD showed higher incidence of myocardial infarction[3 (5.66％) vs.0(0),P =0.018] and stroke [4 (7.55 ％) vs.1 (0.68 ％),P =0.018].Conclusion The prevalence of CAD in aged patients with Stanford type BAD is relatively high.Concomitant CAD is associated with higher risk of cardio-cerebrovascular ischemic events while dose not increase the risk of adverse aorta related events.

Clinical characteristics of 42 patients with cardiac amyloidosis / 中华内科杂志

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.

TIAM2 functional gene mutation has no effect of on bleeding events after clopidogrel antiplatelet therapy in patients with coronary heart disease / 实用医学杂志

Objective To explore the correlation of the TIAM2 functional gene mutations with the bleeding events in patients with coronary heart disease who undergone PCI and postoperative taken anti-platelet drug clopi-dogrel. Methods One hundred and twenty Chinese Han patients who had undergone PCI and postoperative taken anti-platelet drug clopidogrel were orderly enrolled from Guangdong General Hospital. Followed for 6 months after PCI, PCR sequencing was applied to test TIAM2 promoter region genotyping assay. Results After follow-up six months , 113 cases were remained lost of 7 cases , , including 19 cases with bleeding and 94 cases without bleed-ing; Bleeding risk in patients with diabetes mellitus (OR=3.115) or taking statins (OR=11.539), may be high, but there was no significant difference (P > 0.05); TIAM2 promoter region had three variants (c.3168+3116C>T, c.3168+3261A>G,c.3168+3596A>C), including wild-type, heterozygous, and homozygous. The probability of pa-tients with bleeding were 36.84%, 52.63%and 10.53%, and there is a certain chain of state , but the genotype was not significantly correlated with bleeding events of clopidogrel antiplatelet therapy (P>0.05). Conclusion Clopi-dogrel antiplatelet therapy bleeding events were not significantly correlated with TIAM2 functional gene mutation.

Influence of acute hyperglycemia on the assessment of cardiac function with N-terminal pro-brain natriuretic peptide / 中华急诊医学杂志

Objective To investigate the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) derived cardiac function index (Tei index) in patients with acute coronary syndrome under different plasma glucose levels and to evaluate the influence of hyperglycemia on the preciseness of cardiac function assessment with NT-proBNP.Methods Consecutive patients with acute coronary syndrome admitted to the department of cardiology in Guangdong General Hospital were prospectively enrolled.Based on their plasma fasting glucose level,patients were divided into hyperglycemia group (fasting plasma glucose ≥ 6.1 mmol/L) and euglycemia group (fasting plasma glucose ＜ 6.1 mmol/L).All the patients underwent transthoracic echocardiagraphy and tissue Doppler imaging (TDI) investigations.Blood samples were obtained within 24 hours of hospitalization for measurment of NT-proBNP level.Relationship between TDI-Tei index and the level of NT-proBNP in the two groups were analyzed respectively.Results The TDI-Tei index,the systolic index and the diastolic index were all significant higher in the hyperglycemia group (n =27) than those in the euglycemia group (n =35)(0.68±0.14) vs.(0.61 ±0.10),P =0.03; (0.29±0.07) vs.(0.26±0.05),P =0.045; (0.38±0.08) vs.(0.35 ±0.050,P =0.03,respectively.In both groups,TDI-Tei and In NT-proBNP showed significant linear regression.In the hyperglycemia group,TDI-Tei =0.175 + 0.068 In NT-proBNP,R2 =0.702,P ＜ 0.01.In the euglycemia group,TDI-Tei =0.185 + 0.060 In NT-proBNP,R2 =0.405,P ＜ 0.01.Conclusions (1) Compared with patients suffering from an acute coronary syndrome with euglycemia,the global cardiac function of patients with hyperglycemia is poorer; (2) NT-proBNP correlates significantly with TDI-Tei in both hyperglycemia and euglycemia patients with acute heart syndrome.It is appropriate to assess global cardiac function with NT-proBNP in patients suffering from ACS complicated with hyperglycemia.

Application of retrograde intervention in chronic total occlusion with calcification / 中国基层医药

Objective To evaluate the efficacy and safety of retrograde wire in chronic total occlusion with calcification.Methods 4 patients with chronic total occlusion with calcification were selected.3 RCA and 1 LAD as CTO target vessel.Side branches proximal to the occlusion waspresent in all patients,2 of 4 with extreme tortuosity,1 of 4 with ostial occlusion in LAD.At the support of 150cm Finecross microcatheter,all patients were treated with the retrograde technique,with 3 of 4 as primary strategy,1 of 4 as immediately after antegrade failure.Results Retrograde wire crossed the collaterals and successfully delivered distal to the occlusion in all patients.Epicardial collateral from LCX to RCA was accessed in 1 patient,and septal in 3 of 4 patients.Reverse CART technique was applied in 2 of 4 patients,and subsequent exteriorization of the retrograde wire via the antegrade guide was completed.Kissing of antegrade and retrograde microcatheters inside antegrade guide was completed and antegrade wire crossed the CTO lesion via retrograde microcatheter in 1 patient.Both retrograde and antegrade wires could not cross the CTO lesion in 1 patient with extreme tortuosity and severe calcification,and the RCA CTO lesion was not opened in this patient.Overall successful rate was 75％.Drug eluting stents were implanted in 3 successfully recanalized vessels.All patients had no complications during procedure and subsequent hospitalization.Conclusion The retrograde approach was used with high degree of success and safety in chronic total occlusion with calcification.