Therapeutic Efficacy of a Staged Hybrid Technique vs. Coronary Artery Bypass Surgery Grafting in The Treatment of Multi-Vessel Coronary Artery Disease.

OBJECTIVE: Hybrid coronary revascularization (HCR) integrates the advantages of coronary artery bypass surgery grafting (CABG) and percutaneous coronary intervention (PCI) and provides another effective treatment for multi-vessel coronary artery disease (CAD). This study aimed to investigate the short- and intermediate-term efficacies of a staged hybrid technique vs. CABG in treating older patients with multi-vessel CAD. METHODS: Patients, who received elective revascularization for multi-vessel CAD between May 2016 and May 2018, were recruited. They were divided into the CABG group (N = 38) and HCR group (N = 38). The major adverse cardiovascular and cerebrovascular events (MACCE), including myocardial infarction and stroke, were recorded. The results of death and second revascularization also were recorded. RESULTS: In this study, 90.1% of patients received follow up for a median time of 24 months. At 60 days after surgery, the cumulative mortality in the CABG group was significantly higher than in the HCR group, but the incidence of second revascularization in the CABG group was markedly lower than in the HCR group. The incidence of MACCE was comparable between the two groups. CONCLUSION: In older patients with multi-vessel CAD, the mortality after CABG is higher than after HCR, but the incidence of second revascularization after CABG is lower than after HCR.

Clinical value of combined detection of thrombus precursor protein and P-selectin in the diagnosis of acute coronary syndrome / Valor clínico de la detección combinada de proteína precursora de trombo y selectina P en el diagnóstico del síndrome coronario agudo

Abstract Acute coronary syndrome (ACS), including acute myocardial infarction (AMI) and unstable angina (UA), is the most threatening and lethal form of coronary heart disease. ACS has an abrupt onset and rapid development, which may lead to fatal conditions at any time. Thus, it is never too early to detect and diagnose patients with ACS. The objective of this work was to explore the significance of the combined detection of plasma thrombus precursor protein (TpP) and serum P-selectin (Ps), in the detection and diagnosis of patients with early ACS. A total of 126 subjects were included in the study, 64 ACS patients, 30 individuals with stable angina (SA) and 32 healthy persons who were selected as the control groups. There were no differences in gender, age, ethnicity, or blood glucolipid levels among the groups. Enzyme linked immunosorbent assay (Elisa) was used to quantitatively determine the plasma levels of TpP and Ps. The levels of the two biomarkers in the case group were significantly higher than those in the control groups. Among the ACS patients, the levels of TpP and Ps were higher in AMI patients than in the UA patients. In addition, there was no significant differences in the levels of Ps between SA patients and healthy persons. In conclusion, plasma TpP and serum Ps are remarkably increased in patients with ACS. Therefore, TpP and Ps may serve as ACS indicators, and their measurement may provide a support for an early clinical identification of ACS.

Resumen El síndrome coronario agudo (SCA), que incluye el infarto agudo de miocardio (IAM) y la angina inestable (AI), es la forma más amenazante y letal de enfermedad coronaria. El SCA tiene un inicio abrupto y un desarrollo rápido, lo que puede conducir a condiciones fatales en cualquier momento. Por lo tanto, nunca es demasiado pronto para detectar y diagnosticar pacientes con SCA. El objetivo de este trabajo fue explorar la importancia de la detección combinada de la proteína precursora de trombos plasmáticos (TpP) y la selectina P sérica (Ps), en la detección y diagnóstico de pacientes con SCA precoz. Se incluyeron en el estudio un total de 126 sujetos, 64 pacientes con SCA, 30 individuos con angina estable (AE) y 32 personas sanas que fueron seleccionadas como grupos de control. No hubo diferencias en el género, la edad, el origen étnico o los niveles de glucolípidos en sangre entre los grupos. Se usó el ensayo inmunoabsorbente ligado a enzimas (Elisa) para determinar cuantitativamente los niveles plasmáticos de TpP y Ps. Los niveles de los dos biomarcadores en el grupo de casos (SCA) fueron significativamente más altos que los de los grupos de control. Entre los pacientes con SCA, los niveles de TpP y Ps fueron más altos en los pacientes con IAM que en los pacientes con AI. Además, no hubo diferencias significativas en los niveles de Ps entre pacientes con SA y personas sanas. En conclusión, la TpP plasmática y la Ps sérica están notablemente aumentadas en pacientes con SCA. Por lo tanto, TpP y Ps pueden servir como indicadores de SCA y su medición puede proporcionar un apoyo para una identificación clínica temprana de SCA.

Study on the safety and effectiveness of drug-coated balloons in patients with acute myocardial infarction.

BACKGROUND: Drug-coated balloon (DCB) is a new technology that has emerged in recent years and has been proven to be effective and safe in the treatment of in-stent restenosis. The purpose of this article is to observe the safety and effectiveness of drug-coated balloons in patients with acute myocardial infarction. METHOD: We selected 80 patients admitted to the hospital for STEMI from January 2018 to December 2019. The subjects were randomly divided into a Yinyi (Liaoning) Biotech Bingo Drug Coated Balloon treatment group (balloon group, n = 38) and a drug-eluting stent (DES) treatment group (stent group, n = 42). Patients were followed up to understand the incidence of major adverse cardiovascular events (MACE) at 1 month, 6 months and 1 year after surgery. Coronary angiography was rechecked 1 year after surgery to understand the late lumen loss (LLL) in the two groups. RESULT: During the one-year follow-up, the LLL of the target lesion in the balloon group was -0.12±0.46 mm, while the target lesion in the stent group was 0.14±0.37 mm ( P <0.05). Within 1 year, the incidence of MACE in the balloon group was 11%, while the incidence of MACE in the stent group was 12%. There was no significant difference between the two groups. IN CONCLUSION: When PCI is used for STEMI, only DCB therapy is safe and effective, and has shown good clinical effects during a one-year follow-up period.

Increased oxidative stress and plasma Hsp70 levels among gasoline filling station attendants.

OBJECTIVES: Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organic derivative of manganese (Mn) and is used as an antiknock agent and octane enhancer in gasoline. In this article, we tested the oxidative stress and heat stress protein (Hsp) 70 levels of gasoline station attendants to explore potential plasma biomarkers. Furthermore, the dose-response relationship was also identified. METHODS: A total of 144 workers, including 96 petrol fillers and 48 cashiers, participated in the study. Ambient concentrations of benzene, toluene, ethylbenzene, and xylene (BTEX) and Mn were monitored at nine filling stations. During the measuring process, the individual cumulative exposure index was calculated. Plasma oxidative stress and Hsp70 levels were also analysed using enzyme-linked immunosorbent assay. RESULTS: The BTEX time-weighted average in office areas was significantly lower than in refuelling areas ( p < 0.05). In refuelling areas, the content of Mn ranged from 6.44 µg/m3 to 127.34 µg/m3, which was much higher than that in office areas (3.16-7.22 µg/m3; p < 0.05). Exposed workers had significantly different plasma oxidative stress indicators compared with the control group, respectively: superoxide dismutase (SOD), 39.18 ± 6.05 U/mL versus 52.84 ± 3.87 U/mL; glutathione peroxidase (GSH-Px), 186.07 ± 15.63 U versus 194.38 ± 10.42 U; and malondialdehyde (MDA), 1.68 ± 0.52 nmol/L versus 1.43 ± 0.64 nmol/L (in all comparisons, p < 0.05). Plasma Hsp70 level in the exposed group (2.77 ± 0.64 ng/mL) was significantly higher than in the control group (2.32 ± 0.87 ng/mL; p < 0.05). Furthermore, Hsp70 levels were inversely correlated with the activities of SOD ( r = -0.305) and GSH-Px ( r = -0.302) in the exposed group ( p < 0.05). Moreover, a positive correlation ( r = 0.653) was found between plasma Hsp70 levels and plasma MDA levels ( p < 0.05). CONCLUSION: Exposure to MMT-containing gasoline may result in increasing reactive oxygen stress among filling station attendants. Plasma Hsp70 levels could be used as a sensitive responsive biomarker for exposed workers.

The risk of missed abortion associated with the levels of tobacco, heavy metals and phthalate in hair of pregnant woman: A case control study in Chinese women.

To assess the association between exposure to the tobacco, heavy metals and phthalate on early pregnancy and missed abortion.42 women with missed abortion and 57 matched controls (women with normal pregnancies) were recruited between March and May 2012, from the Department of Gynecology and Obstetrics, First Affiliated Hospital of Guangxi Medical University and the People Hospital of Guangxi Zhuang Autonomous Region. The questionnaire survey was carried on to learn about the basic conditions, as well as smoking history of all participants. The levels of tobacco, heavy metal, and phthalate exposure were compared between the 2 groups by measuring nicotine, cocaine, cadmium (Cd), manganese (Mn), plumbum (Pb) and dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), butyl benzyl phthalate (BBP), di-2-ethyl hexyl phthalate (DEHP) in the hair samples.Out results showed that significant differences in age (P = .042), premarital examination (P = .041), passive smoking (P = .021), and heavy metal exposure (P = .022) were found in the case group compared to the control. In addition, the concentration of nicotine (P = .037), cotinine (P = .018), Cd (P = .01), Pb (P = .038) and DEHP (P = .001) in the hair were significantly higher in the case group. Furthermore, logistic analysis revealed that age [Odds Ratio (OR) 1.172, 95% confidence interval (CI) 1.036-1.327], Cd (OR 8.931, 95% CI 2.003-39.811), Cotinine (OR 4.376, 95% CI 1.159-16.531), DEHP (OR 1.863, 95% CI 1.103-3.146) were important factors contributing to the missed abortion (P < .05).It was demonstrated that high gestational age, passive smoking, heavy metals, and the phthalate exposure were the risk factors for missed abortion, while the premarital health examination was a protective factor. Avoiding these harmful substances before getting pregnant and during the early stages of pregnancy, might help prevent missed abortions.

Elevated serum complement factors 3 and 4 are strong inflammatory markers of the metabolic syndrome development: a longitudinal cohort study.

An epidemiological design, consisting of cross-sectional (n = 2376) and cohort (n = 976) studies, was adopted to investigate the association between complement factors 3 (C3) and 4, and the metabolic syndrome (MetS) development. In the cross-sectional study, the C3 and C4 concentrations in the MetS group were higher than those in the non-MetS group (all P < 0.001), and the levels of immune globulin M (IgM), IgA, IgE, and IgG exhibited no significant differences between MetS and non-MetS (all P > 0.050). After multi-factor adjustment, the odds ratios (ORs) in the highest quartile of C3 and C4 concentrations were 7.047 (4.664, 10.648) and 1.961 (1.349, 2.849), respectively, both P trend < 0.050. After a 4 years follow-up, total 166 subjects were diagnosed with MetS, and the complement baseline levels from 2009 were used to predict the MetS risk in 2013. In the adjusted model, the relative risks (RRs) in the highest quartile of C3 and C4 levels were 4.779 (2.854, 8.003) and 2.590 (1.567, 4.280), respectively, both P trend < 0.001. Activation of complement factors may be an important part of inflammatory processes, and our results indicated that the elevated C3 and C4 levels were independent risk factors for MetS development.

Chronic exposure to manganese sulfate leads to adverse dose-dependent effects on the neurobehavioral ability of rats.

Manganese sulfate is the main combustion product of methylcyclopentadienyl manganese tricarbonyl (MMT). Currently, little is known about the neurobehavioral consequences of chronic manganese sulfate exposure. In this study, rats were treated with 0, 5.0, 10.0, and 20.0 mg/kg MnSO4 ·H2 O for 24 consecutive weeks via intraperitoneal injection. During the treatment period, spatial learning-memory ability was measured using the Morris water maze (MWM). At the end of the exposure period, spontaneous motor behavior and emotional status, hippocampal histologic changes, and Hsp70 mRNA levels were measured using the open-field test (OFT), hematoxylin-eosin staining and real-time quantitative PCR (RT-PCR), respectively. A dose-dependent decrease was noted in the spatial learning-memory ability and the spontaneous activities of rats (P < 0.05), and negative emotions differed significantly between the exposed groups and the control group (P < 0.05). Moreover, overt morphological changes in the hippocampuses of the exposed rats were detected. Cellular degeneration and death were also found. The Hsp70 mRNA levels of the hippocampal areas in the 20.0 mg/kg group (1.567 ± 0.236) were significantly increased compared with the control group (P < 0.05). These results suggest that chronic exposure to manganese sulfate can have adverse dose-dependent effects on rats' neurobehavioral ability, and the mechanism of abnormal hippocampal Hsp70 expression needs to be further explored. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1571-1579, 2016.

[Effects of chronic manganese sulfate toxicity test on myocardial ultrastructure and heart organ index of rats].

OBJECTIVE: To observe the effects of manganese sulfate on blood pressure, myocardial ultrastructure and heart organ index of rats. METHODS: Forty male SPF SD rats were randomly divided into 4 groups: control group (0 mg/kg), 5 mg/kg dose group, 15 mg/kg dose group and 25 mg/kg dose group, 10 rats each group. Intraperitoneal injection was performed for six months, by five times each week, the rat blood pressure was measured by tail cuff method, and the heart organ index of the rats was computed. Three rats were selected from each group randomly, and the myocardial ultrastructure of the rats was observed by using transmission electron microscopy (TEM). The BMD and BMDL between manganese sulfate injected dose and the rats heart organ index were evaluated by BMD (Benchmark Dose). RESULTS: There was no significant of blood pressure between the experimental group and the control group (P > 0.05).The heart organ indexes of the four groups were 0.24% ± 0.10%, 0.25% ± 0.02%, 0.26% ± 0.02%, and 0.24% ± 0.02%. Statistical significance of heart organ indexes was found between the 15 mg/kg dose group and the control group (P < 0.05). Observed by TEM, we found that-different degrees of mitochondrial crest fracture or disappear, mitochondria swelling, hydropic change and myocardial fibers degeneration happened in the rats of the three exposed groups, but not the control group. The BMD and BMDL were calculated as 9.33 mg/kg and 4.28 mg/kg in the study of manganese sulfate injected dose and the rats heart organ index. CONCLUSION: Chronic manganese poisoning can lead to myocardial mitochondria superfine lesions, myocardial fiber damage and heart organ index change in rats.

Association of atrial fibrillation with gene polymorphisms of connexin 40 and angiotensin II receptor type 1 in Chongming adults of Shanghai.

OBJECTIVE: To characterized the gene polymorphisms of connexin 40 (cx40) and angiotensin II receptor type 1 (AT1R) in Chongming adults with atrial fibrillation (AF) and to explore their relationships with AF. METHODS: 82 patients with AF, and 82 subjects without AF were enrolled. Polymorphisms of cx40 G-44A and AT1 A1166C were detected. Moreover, several samples were randomly selected to validate the gene polymorphisms of cx40 and AT1. RESULTS: Genotypes AA, AG and GG of cx40 G-44A were found in both AF patients and controls. The frequencies of genotypes AA, AG and GG were 39%, 29% and 32%, respectively, in AF patients and 31%, 35% and 34%, respectively in controls. The frequencies of alleles A and G were 54% and 46%, respectively in AF patients and 48% and 52%, respectively, in controls (P < 0.05). The risk for AF in patients with allele A increased 1.31 times (OR = 1.31, P < 0.05). The frequencies of genotypes AA, AC and CC were 88%, 8% and 4%, respectively in AF patients and 93%, 6% and 1%, respectively in controls. The frequencies of alleles A and C were 92% and 8%, respectively in AF patients and 96% and 4%, respectively in controls (P < 0.05). More AF patients had allele C as compared to controls. The risk for AF increased by 1.43 times in patients with allele C (OR = 1.43, P < 0.05). CONCLUSION: There were relationships between gene polymorphisms of cx40 and AT1 and AF in Chongming adults. Allele A of cx40 G-44A and allele C of AT1 A1166C significantly increase the risk for AF.

Expression profile analysis of circulating microRNAs and their effects on ion channels in Chinese atrial fibrillation patients.

OBJECTIVE: To investigate the changes in expression profile of circulating microRNAs (miRNAs) and the regulatory effect of atrial fibrilation (AF)-related miRNAs on ion channels. METHODS: 112 patients with AF were assigned into observation group, and another 112 non-AF people were assigned into control group. Total plasma RNAs were extracted from patients' blood samples. Differentially expressed miRNA-1s were transfected into primary-cultured neonatal rat cardiac myocytes. RESULTS: Compared with control group, significant differences were observed in 15 kinds of miRNAs in observation group. Down-regulation of the expression of miRNAs included hsa-miR-328, hsa-miR-145, hsa-miR-222, hsa-miR-1, hsa-miR-162, hsa-miR-432, and hsa-miR-493b; Up-regulation of the expression included hsa-miR634, hsa-miR-664, hsa-miR-9, hsa-miR-152, hsa-miR-19, hsa-miR-454, hsa-miR-146, and hsa-miR-374a. The expression level of CACNB2 protein in miRNA-1 group was significantly lower than that in blank control group, negative control group, MTmiRNA-1 group, AMO-1 group and miRNA-1+AMO-1 cotransfection group (P < 0.05), while in AMO-1 group, the expression level of CACNB2 protein was significantly higher than that in other groups (P < 0.05). These results indicated that transfected miRNA-1 could significantly inhibit the expression of CACNB2 protein. CONCLUSIONS: Circulating miRNAs can be used in studies concerning on the regulation mechanism of the occurrence and development of AF. MiRNA-1 can decrease the intracellular Ca(2+) concentration and prevent the AF.

Synergistic impaired effect between smoking and manganese dust exposure on pulmonary ventilation function in Guangxi manganese-exposed workers healthy cohort (GXMEWHC).

PURPOSE: The aims of this study were to investigate the effects of manganese (Mn) dust exposure on lung functions and evaluate the potential synergistic effect between smoking and Mn dust exposure among refinery workers. METHODS: A retrospective study including 1658 workers in a ferromanganese refinery was conducted, with subjects who were from the Guangxi manganese-exposed workers healthy cohort (GXMEWHC). Based on the Mn manganese cumulative exposure index (Mn-CEI), all subjects were divided into the low exposure group (n = 682) and the high exposure group (n = 976). A pulmonary function test was performed using an electronic spirometer, including the values and percentages of FVC, FEV1, FEV1/FVC, MMEF, PEFR, MVV, respectively. RESULTS: No significant effect of Mn dust exposure on the pulmonary function was found in the female workers (all p>0.05). However, there was an obvious decrease in the male workers in the high exposure group compared with those in the low exposure group (FVC -60 ml, FEV1 -120 ml, MMEF -260 ml/s, MVV -5.06 L, all p<0.05). In the high exposure group, the reduction in FVC% predicted, MMEF and MMEF% predicted was 1.0%, 210 mL/s, and 4.9%, respectively. In particular, among the exposed subjects smokers had a statistically significant decrease in lung function compared with non-smokers and the reduction in FVC% predicted, MMEF and MMEF% predicted was 1.0%, 210 mL/s, and 4.9%, respectively (p<0.05). Partial correlation analysis showed that there was also negative correlation between Mn-CEI and decreased changes in MMEF (r = -0.159, p = 0.018) and also MMEF% predicted (r = -0.163, p = 0.015). CONCLUSIONS: Mn dust can impair the pulmonary ventilation function of male workers but not females, and individual smoking habits and manganese exposure had a synergistic effect on the lung function decrease.

Rationale, design and baseline results of the Guangxi manganese-exposed workers healthy cohort (GXMEWHC) study.

OBJECTIVE: To determine the relationship between biomarkers of exposure, disease and susceptibility, and early health effects and long-term diseases related to occupational manganese (Mn) exposure. DESIGN: Baseline survey of a longitudinal cohort study of workers in a ferromanganese refinery. PARTICIPANTS: A total of 1888 individuals (1197 men, 691 women; average seniority 15.34 years) were enrolled in the Guangxi manganese-exposed workers healthy cohort (GXMEWHC) study. Participants were between 18 and 60 years of age (mean 40.31 years), had worked in the ferromanganese refinery for at least 1 year and lived in the local area. RESULTS: The GXMEWHC study included a baseline survey. Participants were divided into four groups according to manganese (Mn) cumulative exposure index (Mn-CEI) levels: an internal control group (Mn-CEI <1.0 mg/m(3) year), a low exposure group (1.0 mg/m(3) year≤Mn-CEI<2.0 mg/m(3) year), a medium exposure group (2.0 mg/m(3) year≤Mn-CEI<5.0 mg/m(3) year) and a high exposure group (Mn-CEI≥5.0 mg/m(3) year). Genome-wide association studies of quantitative trait loci and binary trait loci in 500 Mn-exposed workers were performed using Illumina Infinium HumanExome BeadChip arrays. Stored plasma, DNA, hair and urine are available for further study. Participants will be followed up every 3 years. CONCLUSIONS: The GXMEWHC study provides abundant data for exploring the systemic health effects of occupational Mn exposure using biomarkers of exposure, disease and susceptibility.

Relationship of osteopontin and renal function with severity of coronary artery lesions.

AIM: To explore the relationship of plasma osteopontin (OPN) level and renal function with severity of coronary artery lesions. METHODS: OPN level and renal function were detected and compared in 210 patients with coronary heart disease (CHD group) and 134 patients without coronary heart disease (control group) to analyze the relationship of osteopontin and renal function with severity of coronary artery lesions. RESULTS: Plasma OPN and creatinine level were significantly higher in CHD group than those in control group (P<0.01), and estimated glomerular filtration rate (eGFR) was lower in CHD group than that in control group (P<0.01). The proportions of multi-vessel lesion and moderate to severe decreased renal function were higher in patients with high osteopontin than those in patients with low osteopontin (P<0.05), and the proportion of multi-vessel lesion was higher in patients with moderate to severe decreased renal function than that in normal renal function (P<0.05). Osteopontin and renal failure were the independent risk factors for coronary heart disease. CONCLUSIONS: Plasma OPN level is associated with renal failure, both of which are correlated with the severity of coronary artery lesions.

Cognitive function and plasma BDNF levels among manganese-exposed smelters.

OBJECTIVES: To explore the potential dose-response relationship between manganese (Mn) exposure and cognitive function and also plasma brain-derived neurotrophic factor (BDNF) levels in occupational Mn exposure workers. METHODS: A total 819 workers were identified from our Mn-exposed workers, and 293 control workers were recruited in the same region. All exposed workers were divided into three groups based on Mn cumulative exposure index. The Montreal Cognitive Assessment (MoCA) test was applied to estimate cognitive function for all subjects. Plasma BDNF levels were determined by ELISA in 248 selected exposed workers and 100 controls. RESULTS: Mn-exposed workers had significantly lower MoCA scores than those in the control group (25.62 ± 0.25): those in high-exposure group had the lowest scores (21.33 ± 0.32), compared with the intermediate-exposure group (23.22 ± 0.30) and low-exposure group (23.57 ± 0.23). Mn exposure levels were inversely associated with MoCA total scores, all p<0.05. A positive correlation was found between plasma BDNF levels and MoCA total scores (r=0.278, p<0.01). Moreover, compared with the control group (288.7 ± 181.7 pg/mL), BDNF levels were lower in the high-exposure group (127.5 ± 99.8 pg/mL), and in the intermediate-exposure (178.2 ± 138.1 pg/mL) and low-exposure groups (223.4 ± 178.3 pg/mL). Additionally, plasma BDNF levels decreased significantly as Mn exposure levels increased (ptrend<0.01). CONCLUSIONS: Mn exposure may be associated with decreased plasma BDNF levels and cognition impairment in this large cross-sectional study.

Use of an artificial neural network to localize accessory pathways of Wolff-Parkinson-White syndrome with 12-lead electrocardiogram.

Today, radio-frequency ablation has been shown to be a safe and effective method to treat paroxysmal tachycardia with Wolff-Parkinson-White syndrome. The many criteria reported for localizing the sites of accessory pathways from a 12-lead electrocardiogram have not proven adequate to differentiate the correct sites of accessory pathways for all situations. This study trained an artificial neural network to differentiate the varied features needed to localize 10 sites of accessory pathways. One hundred fifty patients underwent successful catheter ablation, with manifest single and antegradely conducting accessory pathways. Using the two electrocardiogram features of polarity of delta wave and R wave's share of QRS complex, an artificial neural network learned the characteristics of electrocardiogram waves for each site of the 10 accessory pathways through 90 learning cases, and an applicable network model was developed for testing. In 58 of 60 test cases (96.7%), sites of accessory pathways were localized correctly by the network. Based on the method employed in the present study, it thus becomes possible to predict the sites of accessory pathways with Wolff-Parkinson-White syndrome in more detail by using an artificial neural network with a 12-lead electrocardiogram. In the future, when this method is incorporated into a conventional automatic electrocardiogram system which could analyze delta waves and ORS complex, it will become useful to automatically diagnose the locations of the accessory pathways with Wolff-Parkinson-White syndrome in clinical practice.

A telemedicine system for collaborative work on radiographic coronary video-images.

We designed a telemedicine system that supports collaborative work on video-images from coronary cine-angiograms and cine-ventriculograms. Two workstations were connected by ISDN at 128 kbit/s. Coronary cine-angiogram and cine-ventriculogram video-images were transmitted to an image examination workstation before the images were required for analysis (i.e. in a 'pre-fetch' operation). If one workstation changed even a single frame in a video-sequence, then the change was transmitted to the other workstation, rather than the entire video-sequence. To evaluate the performance of the system, the diagnoses made by five cardiology specialists were compared with those recorded in the original report. Coronary cine-angiogram and cine-ventriculogram video-images from 27 patients were used. The cardiologists, who were blinded to the patient information, regenerated the video-images on the workstation and assessed coronary arterial stenosis and wall motion. The kappa scores for clinician agreement with the original reports for ratings of stenosis were 0.54-0.66 and for wall motion were 0.41-0.69. The system performed reasonably reliably and it therefore appears likely to be useful in telemedicine work.