Investigation of factors related to the occurrence of in-stent restenosis after percutaneous coronary intervention / 介入放射学杂志

Objective To investigate the factors related to the occurrence of in-stent restenosis (ISR) after percutaneous coronary drug-eluting stent (DES) implantation. Methods A total of 258 consecutive patients with coronary angiography confirmed ISR that occurred at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the Affiliated Ruijin Hospital of Shanghai Jiaotong University during the period from September 2010 to September 2014 , were collected as ISR group; and other 260 age-and sex-matched patients with no ISR at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the same hospital and during the same period, were collected as the control group. The clinical characteristics, biochemical measurements, postoperative medications, left ventricular ejection fraction (LVEF), and coronary interventional features were determined;using multivariate logistic regression analysis the independent factors related to the occurrence of ISR were evaluated. Results Compared to the control group, in ISR group the history of previous myocardial infarction , presence of diabetes mellitus and cigarette smokers were more often seen; serum levels of high-sensitivity C-reactive protein(hs-CRP), glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C)and apoliprotein B in ISR group were significantly increased (P<0.05), while LVEF was decreased (P<0.05). Although the number of coronary lesions and the site of stent implantation were quite similar in both groups , the stents used in ISR group were smaller and longer (P<0.05), and bifurcation stenting procedure was more employed in ISR group (P<0.05). Multivariate Logistic regression analysis revealed that the history of previous myocardial infarction, diabetes, cigarette smoking, elevated serum hs-CRP and LDL-C levels, and longer stent length were independent risk factors for the occurrence of ISR, whereas stent diameter and LVEF bore a negative correlation with ISR. Conclusion The occurrence of ISR after coronary sirolimus-eluting stent implantation is related to multiple clinical and coronary angiographic and interventional factors. Effective control of risk factors of coronary heart disease and improvement of left ventricular function play an important role in preventing ISR, especially for the patients who has small vessel disease, and in whom longer stents are employed and bifurcation stenting procedure is carried out.

Research approaches to mass casualty incidents response: development from routine perspectives to complexity science / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the research methods of mass casualty incident (MCI) systematically and introduce the concept and characteristics of complexity science and artificial system, computational experiments and parallel execution (ACP) method.</p><p><b>DATA SOURCES</b>We searched PubMed, Web of Knowledge, China Wanfang and China Biology Medicine (CBM) databases for relevant studies. Searches were performed without year or language restrictions and used the combinations of the following key words: "mass casualty incident", "MCI", "research method", "complexity science", "ACP", "approach", "science", "model", "system" and "response".</p><p><b>STUDY SELECTION</b>Articles were searched using the above keywords and only those involving the research methods of mass casualty incident (MCI) were enrolled.</p><p><b>RESULTS</b>Research methods of MCI have increased markedly over the past few decades. For now, dominating research methods of MCI are theory-based approach, empirical approach, evidence-based science, mathematical modeling and computer simulation, simulation experiment, experimental methods, scenario approach and complexity science.</p><p><b>CONCLUSIONS</b>This article provides an overview of the development of research methodology for MCI. The progresses of routine research approaches and complexity science are briefly presented in this paper. Furthermore, the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems. And the only feasible alternative is complexity science. Finally, this summary is followed by a review that ACP method combining artificial systems, computational experiments and parallel execution provides a new idea to address researches for complex MCI.</p>

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.

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.

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>

Effect of trauma emergency care related factors on length of ICU stay / 中华创伤杂志

ObjectiveTo investigate the effect of factors correlated with trauma emergency care system on the length of ICU stay and figure out independent risk factors of prolonged ICU stay. Methods A total of 1 361 trauma patients admitted to the ICU of five tertiary hospitals in Zhejiang province in 2009 were retrospectively studied.Demographic data,time of ICU stay and variables related to trauma care were collected.Logistic regression was performed to determine the independent risk factors of prolonged ICU stay ( ≥ 15 days). ResultsOverall,192 trauma patients ( 14.1％ ) had a prolonged ICU stay ( ≥15 days).Single factor analysis indicated that ISS≥ 16 points,GCS≤7 points,blunt trauma,prehospital emergency care,length of emergency department stay ≥4 hours,mechanical ventilation and central venous pressure monitoring were associated with the prolonged ICU stay.Multivariate analysis showed that pre-hospital emergency care was a protective factor for the prolonged ICU stay( ≥ 15 days) and that mechanical ventilation,length of emergency room stay≥4 hours and ISS≥ 16 points were the independent risk factors for the prolonged ICU stay ( ≥ 15 days).Conclusions Pre-hospital emergency care and ICU care show significant influence on the length of ICU stay.Furthermore,shortened length of emergency department stay is also contributive to reduced length of ICU stay.

Value of trauma and injury severity score in predicting mortality of trauma patients in different rank hospitals / 中华创伤杂志

ObjectiveTo evaluate the trauma care effect and the value of trauma and injury severity score (TRISS) in prediction of the mortality by using TRISS to calculate the survival probability of trauma patients in five hospitals from Zhejiang province in 2009.MethodsA retrospective study was done on trauma patients (study group) firstly admitted to Emergency Department of five hospitals from Zhejiang province in 2009.The relevant information was collected,including demographic data,trauma types and injury causes.The TRISS score was obtained through calculating injury severity score (ISS) and revised trauma score (RTS) on admission into emergency department.With the major trauma outcome study (MTOS) as control group,M value,standardized Ws value and 95％ confidence interval (CI) were calculated to compare actual survival rate and anticipation survival rate.ResultsA total of 2 193 patients at mean age of 44.39 years were enrolled in the study,including 1 661 male patients (75.74％).Traffic accident injury was the most common,followed by fall injury.The mortality rate according to TRISS was 13.22％,but the actual mortality rate was 9.75％.For all the patients,M =0.80 indicated that the injury severity of the study group was significantly different from that of the control group.At the same time,Ws =2.15,95％ CI for Ws:1.54-2.77 showed that the actual survival rate of the study group was significantly higher than that of the control group.Besides,the survival rate of trauma patients in the affiliated hospitals and three hospitals at class A grade was significantly higher fian that of the control group,but there was no significant difference between three hospitals at class B grade and control group. ConclusionsTRISS overestimates the mortality of the study group,which is probably associated with the rapid development of traumatology and the old coefficients of TRISS.Setting up local trauma database and renewing coefficients of TRISS may improve the ability of TRISS in predicting mortality of the trauma patients.

Recurrence prevention by embedding 5-FU microparticles on the cutting surface after hepatectomy for HCC / 中华普通外科杂志

Objective To evaluate embedding 5-FU microparticles during operation after hepatectomy for small hepatocellular carcinoma to prevent recurrence. Methods A retrospective analysis on 184 patients was done.All patients received liver resection for HCC from 2007 Mar.to 2008 Mar.In 90 cases,5-FU releasing microparticles were embeded on liver cutting surface after the tumor was resected (group A).94 cases in which no micropaticles were given served as controls (group B).All patients had a single tumor( ≤5 cm) without visible vessel invasion. Results The postoperative disease-free survival ( DFS),and median period of DFS of group A vs.group B was 43 months vs 35 months.Postoperative DFS rates of 1-,2-and 3-year were 86％,76％ ％ and 64％ respectively in A group,while they were 77％,61％and 49％ respectively in B group ( x2 =4.77,P ＜ 0.05 ).In two groups the liver and kidney main function index( TB,ALB,ALT,BUN,Scr)on day 7 and postoperative complications were not statistically different (P ＞ 0.05 ). Conclusions Embeding 5-FU microparticle after hepatectomy for HCC could increase the postoperative DFS rates,and patients do not suffer from significant liver and kidney malfunctions.

Right hepatectomy with total hemihepatic vascular exclusion in hepatocellular carcinoma / 中华肝胆外科杂志

Objective To explore the clinical value of total hemihepatic vascular exclusion (THHVE) in right hepatectomy for hepatocellular carcinoma (HCC). Methods One hundred and twenty-three consecutive patients who underwent right hepatectomy for HCC between February 2006 and December 2008 were studied retrospectively. THHVE was used in 58 patients (group A) and Pringle maneuver in 65 patients (group B). The patient's demographics,surgical procedure and outcome were collected and compared between the two groups.ResultsThe tumor size was significantly bigger in group A than group B (7.69±3.70 cm vs.6.08±4.07 cm,P＜0.05).The vascular occlusion time in group A was significantly longer than groupB (28.55±8.67 min vs.19.85±6.71 min,P＜0.05). However, intraoperative blood loss in group A was significantly less than group B (304.31±270.36 ml vs.542.62±876.84 ml,P＜0.05),and the elevation of serum alanine aminotransferase (ALT) on day- 1,-3 and- 7 after operation in group A were significantly lower than group B (P＜0.05).The postoperative complication rate in group A was lower than group B (18.97％ vs.38.46％,P＜0.05).ConclusionTHHVE was a safe and efficacious technique in right hepatectomy for HCC.It significantly decreased blood loss,alleviated liver injury and reduced postoperative morbidity and mortality.

Cox regression analysis of 6246 critically ill patients with prolonged stay in emergency room / 中华急诊医学杂志

Objective To explore factors associated with prolonged emergency room (ER) stay of critically ill patients admitted so as to accelerate throughput of emergency patients.Methods Data of critically ill patients admitted into the emergency room of a tertiary teaching hospital in 2010 were retrospectively studied.Stepwise Cox regression analysis was used to determine factors likely associated with prolonged stay in ER.Results ( 1 ) A total of 6246 critical illnesses were admitted into emergency room,the ER length of stay [M (Qr)] was 11 h (3 ～23 h).Of them,56.6％ patients stayed in ER more than 6 h and 21.6％ over 24 h.(2) Univariate analysis showed the major factors contributing to prolonged stay in ER were insufficient inpatient bed capacity,followed by poor family finances,complicated diseases needed care from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of critical care,age,gender and arrival time to ER.(3) Multivariate analysis showed that the main factors contributing to prolonged stay were insufficient inpatient beds,poor family finances,complicated diseases needed treatment from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of treatment,gender and arrival time to ER.Age was not an independent factor.Conclusions Plenty of critically ill patients admitted to this hospital had prolonged stay in emergency room with variety of factors.The possible factors contributing to this were insufficient inpatient bed capacity,poor family finances and complicated diseases needed care from multiple departments,and this investigation deserves a further study.

Analysis on the characteristics and associated factors of shunt of critically ill patients in emergency room / 中华急诊医学杂志

Objective To investigate the characteristics of patient throughput in emergency room (ER),and the factors causing increase in ER length of stay in order to improve the quality of emergency service.Methods Data of critically ill patients presented to an emergency room in a tertiary teaching hospital in 2010 were retrospectively studied,and the characteristics of patient throughput including patients referred to different departments with different outcomes,and variation in number of patients round the clock in workdays and weekends were analyzed.Results ( 1 ) The median length of stay (LOS) of 7966 critical patients in emergency room (ER) was 11 h,and of them,56.6％ stayed in ER for more than 6 h,and 21.6％ over 24 h.(2) There were significant differences in LOS in ER among patients treated by different departments leading to no shorter length of time consumed for treatment by many departments other than the following specialties of emergency department,neurosurgery,neurology and general medicine department in sequence from less time required to the longest length of time consumed.( 3 ) There were significant differences in LOS in ER among patients with different courses after disposition leading to the longest length of time consumed by those discharged by patients 'own decision and admitted into the hospital,and the shortest time required in patients after emergency operation.(4) There were also significant differences in specialty,outcomes and time needed for throughput between workdays and weekends,and during different time intervals round the clock.Conclusions The situation of patient throughput of critical illness in emergency room in this hospital was not ideal.The factors associated with prolonged stay in ER included different specialties in charge of patients,different courses and outcomes after disposition,severity of illness,different time intervals round the clock,and this investigation deserves a further study.

The relationship between amount of cigarette smoked and insulin resistance in male patients with coronary artery disease / 中华内科杂志

Objective To investigate the relationship between smoking and insulin resistance in non-obese male patients with CAD. Methods 414 consecutive non-obese male patients with angiographically-documented CAD(luminal diameter narrowing>50%)were recruited,including 113 nonsmokers and 301 smokers.With 99 miht smokers(<400 packs/year),95 medium smokers(400-799 packs/year)and 107 heavy smokers(≥800 packs/year).Insulin resistance index(IRI)was expressed by homeostasis model assessment for insulin resistance(HOMA-IR)calculated by the formula of[fasting serum glucose(mmol/L)×fasting plasma insulin(mU/L)]/22.5.IRI≥2.69 was defined as insulin resistance,while IRI<2.69 was insulin sensitive.Fasting glucose,fasting insulin and IRI were recorded and odds ratio for the incidence of insulin resistance was calculated.Results Fasting glucose was higher in heavy smokers (5.86 mmol/L)than that in nonsmokers(5.51 mmol/L,P=0.037)and mild smokers(5.33 mmol/L,P=0.014).Fasting insulin and IRI were also significantly higher in heavy smokers(10.25 mU/L)than those in non-smokers(8.72 mU/L,P=0.0231,respectively)and mild smokers(8.67 mU/L,P=0.023 1).Compared with nonsmokers,the odds ratio for the incidence of insulin resistance was 1.53(95%CI 0.55-2.94;P=0.027)in medium smokers and 1.89(95%CI 0.49-3.14;P=0.018)in heavy smokers.Conclusions The relationship between smoking and insulin resistance is highly dose dependent in non-obese male patients with CAD.

Risk factors for nosocomial infection in trauma patients during intensive care unit stay / 中华急诊医学杂志

Objective To determine risk factors in nosocomial infection of trauma patients during intensive care unit stay. Methods A retrospective study was carried out. A total of 1103 trauma patients admitted to the intensive care unit of five tertiary hospitals in Zhejiang Province in 2009 were reviewed. Demographic data, injury severity score and other variables related to the trauma services were collected. Univariate and multivariate analysis were processed to identify the independent risk factors of nosocomial infection in trauma patients during stay in intensive care unit. Results Overall, 171 patients( 15.5% )developed nosocomial infection during ICU stay. Of 1103 patients, 157 patients (14.2% ) died, and the 59 fatal patients were from infection group. The mortality rate in infection group was 34.7% , which was significantly higher than that in non - infection group (10.5% ). The independent risk factors of nosocomial infection in all the patients determined by using multivariate analysis included central venous monitoring, mechanical ventilation, age ≥65, the length of ICU stay > 14 days and injury severity score ≥ 16. For the severe trauma patients, central venous monitoring, mechanical ventilation, the length of ICU stay > 14 days were independent risk factors of nonsocomial infection. Conclusions The severity of injury, age, the length of ICU stay and invasive procedures were related to the nosocomial infection. To standardize the invasive procedures and to reduce the length of ICU stay may decrease the infection rate of trauma patients.

An analysis of the risk factors in the mortality of casualties: data from eight hospitals in Zhejiang province / 中华急诊医学杂志

Objective To explore risk factors in the mortality of casualties and to find a way to improve trauma emergency service. Method The possible factors likely related to the mortality of casualties were taken into account based on each stage of trauma emergency so as to find the independent risk factors by using univariate and multivariate analyses. Results A total of 3 659 casualties were enrolled in this study.Of them, 226 casualties died and the mortality rate was 6.18%. Following factors were related to mortality after univariate analysis: age, cause of trauma, injury severity score, Glasgow come scale come on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU and mechanical ventilation in ICU. After multivariate analysis, six factors were independently related to the mortality of casualties as follows: Glasgow coma scale, injury severity score, mechanical ventilation, blood pressure at admission, age and professional emergency treatment on the scene. Conclusions It has a great significance to investigate the risk factors of mortality for casualties. Severity of trauma and age were independently associated with the outcomes of trauma. Besides, improving prehospital care and stabilizing the trauma patients in early phase can further decrease the mortality.

The estimation of traceability and uncertainty of measurement on the result of HBV DNA with different detecting system / 中华检验医学杂志

Objective To study the uncertainty and traceability of HBV DNA assays and discuss the comparability of results among different detection systems. Methods Different detecting systems were used to detect HBV DNA using the national standard substance as "quality control substance". The uncertainty of the results was evaluated referring "Guidelines for estimating and reporting measurement uncerTAinty of chemical test results" of NATA The results were traced back to the national standard substance. According to the CLSI document EP9-A2, the results were analyzed and subjected to bias estimation with the t(0.05sv) √u2b1+ u2b2 as the criterion clinically accepted to investigate the comparability of different detecting systems. Results The means (-y) measured by 3 HBV DNA assay systems were 6.15,5.88,and 6.31 lg(kIU/L) respectively. Except system A,both the biases of system B and C had statistical significance (all P ＜ 0. 05) and expanded uncertainty of three detection systems was varied, but the difference was within the maximum acceptable range (± 0. 5) of the external quality assessment by National Center for Clinical Laboratory. Being traceable to national standard substance, the results of HBV DNA of the three detecting systems were (5.45 ± 1.23), (5.55 ± 1.32) and (5.42 ± 1.25) lg(kIU/L), respectively.There was significant difference among three systems (F = 5.63, P ＜ 0. 05). Comparing system A and B,there was significant difference in statistic (q = 5. 12, P ＜ 0. 05) and the difference between system B and C also had statistically significant (q = 6. 85, P ＜ 0. 05), but the results between system A and C had no statistical difference (q = 1.85,P ＞ 0. 05). Among these three systems, the difference of any two detection systems had no statistical significance (all P ＞ 0. 05). It showed that system bias was acceptable in clinical application and the results between different systems were comparable. Conclusions It is necessary to estimate the uncertainty and traceability when comparing the HBV DNA assay among the different labs. It also needs to estimate the bias of different systems and evaluate the clinical acceptability to ensure the accuracy and comparability of the results.

Association of insulin resistance with spontaneous recanalization of infarct-related arteries in patients with a-cute myocardial infarction / 中国综合临床

Objective To clarify the role of insulin resistance on spontaneous recanalization of infarct-relat-ed arteries in the early phase of acute ST-elevation myocardial infarction (STEMI) in patients with normal glucose tolerance. Methods 141 consecutive patients with normal glucose tolerance and acute STEMI were enrolled in our study. Subjects were divided into TIMI 0-1 group (n =91 ) and TIMI 2-3 group (n =50) by primary coronary angi-ngraphy (CAG). The Gemini score and 0-3-vessel disease score estimated the severity and extent of coronary artery disease (CAD). Metabolic parameters and homeostasis model assessment for insulin resistance (IRI) were deter-mined. Results Serum level of fasting insulin, IRI and Gemini score were higher in TIMI 0-1 group than in TIMI 2-3 group [ (11.52±6.22)mU/L vs (7.54±3.65)mU/l,(2.79±2.32) vs (1.73±1.26),(59.17±26.95) vs ( 38.46±22.74) ( P <0.01)]. IRI was positively associated with Gemini score (r=0.185,P <0.05 ). Multivariate Logistic regression analysis revealed that IRI was independent risk factor influencing spontaneous recanalization of in-farct-related urteries(OR=2.87,95% CI=1.09-7.57,P<0.05). Conclusion Insulin resistance is independent risk factor influencing spontaneous recanalizafion of infarct-related arteries in the early phase of acute STEMI in pa-tients with normal glucose tolerance.

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.

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.

Quantitative assessment of left ventricular torsion in normal subjects using vector velocity imaging / 中华超声影像学杂志

Objective To evaluate the left ventricular(LV) torsion and rotation in normal subjects using vector velocity imaging.Methods LV basal and apical short-axis images were captured in 10 healthy individuals to estimate LV torsion and rotation using routine 2-dimensional echocardiography and vector velocity imaging. Results As viewed from LV apex,the systolic basal rotation was clockwise (negative value),and apical rotation was counterclockwise (positive Value). The apical peak systolic rotational velocity was significantly higher than the basal [endo:(150±62)°/s vs (114±65)°/s;epi:(81±40)°/s vs (55±28)°s,respectively,P＜0.01]. The peak systolic endocardial rotational velocity and rotation was significantly higher than epicardial rotational velocity and rotation[basal:(-114±65)°/s vs (-55±28)°/s,(-12±6)°vs (-4±1)°;apical:(150±62)°s vs (81±40)°s,(10±4)°vs(6±2)°,respectivelv,P＜0.05]. There were no significant differences in the time to peak systolic rotational velocity/rotation between basal endocardium/epicardium and apical endocardium/epicardium. Conclusions Vector velocity imaging can assess LV torsion and rotation non-invasively,and normal LV has a kind of characteristic motion of torsion.

Left atrial function assessed by speckle tracking imaging in patients with chronic heart failure / 中华超声影像学杂志

Obiective To observe the value of speckle tracking imaging(STI)in assessing left atrial(LA) function in patients with chronic heart failure(CHF).Methods Twenty-two patients with CHF[LVEF(37.1± 10.5)%]and twenty normal controls[LVEF(61.94±10.68)%]were studied.CHF group was subdevided into patients with normal or abnormal LV filling pressure.Velocity vector imaging(Siemens Medical Solutions)was used to acquire 2-D images at parasternallong axis and apical 4-chamber views.The LA dimension and volume,LV volume and ejection fraction,ratio of mitral valve E wave and mitral annulus velocity e'E/e')were measured. LA tangential and radial velocity(Vt-As,Vr-As)and time to peak velocity(TVt-As,TVr-As)were analysed on Syngo Workplace offline.Results Vt-As and Vr-As of the CHF group were significantly smaller than those of the controls(P＜0.05),and Vr-As was even decreased in patient with elevated LV filling pressure(P＜0.05), however,TVt-AS and TVr-AS didn't show evident impairment in the CHF group(P＞0.05).Vt-As and Vr-AS were closely correlated with LVEF,EDV and ESV(P＜0.05).Vt-As was negtively correlated with LA volume (P＜0.05).Conclusions STI can quickly and accurately assess LA function,and help to recognize patients with elevated LV filling pressure,which is useful in the risk stratification,treatment evaluation and prognosis prediction of CHF patients.