简介：BackgroundDataarelimitedregardingtheriskofcontrast-inducednephropathy(CIN)forpatientsafterthesecondcontrastexposure.ObjectiveToexaminetheriskofCINafterthesecondcontrastexposureinpatientsofacutecoronarysyndrome(ACS)withchronickidneydisease(CKD).MethodsPatientsofACSscheduledforasecondelectivePCI.Patientswererequiredtohaveanestimatedcreatinineclearance(CrCl)between15and60ml/min.Thevalueofserumcreatinin(sCr)priortothesecondcontrastexposuremustnotbe≥25%or≥88.4μmol/Lcomparedtobaseline.CINwasdefinedasanincreaseofsCr≥25%frombaselinewithin48-72hafterthesecondcontrastexposure.Theprimaryend-pointwasriskofdevelopingCIN.ResultsThirty-ninepatientscompletedthestudy.Theaverageofintervalbetweencontrastexposureswas116±64h,contrastvolumewas266±100mLandlengthofhospitalizationwas8.3±4.7days.TheincidenceofCINintheoverallstudypopulationwas10.3%.TherewasnotchangesignificantlyinaveragesCrandCrClafterthesecondcontrastexposure(sCr1.52±0.62vs.1.54±0.60mg/dLbaseline,P=0.75;CrCl(40.68±14.46vs.39.16±12.10mL/minbaseline,P=0.26).Noneofthepatientwasdeathin30days.One(2.6%)ofthepatientswhodevelopedCINrequireddialysisin-hospital.ConclusionOurfindingssuggestthatpatientswithpriorrenaldysfunctionarenotincreasedriskofdevelopingCINafterthesecondcontrastexposure.Thiscohortmaybebenefitfromsufficientprophylaxis.

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简介：Pheochromocytomaisatumorarisingfromneuroectodermalchromaffintissuesintheadrenalglandorextra-adrenalparaganglia(paragangliomas).Theprevalenceofthetumoris0.1%-0.6%inthehypertensivepopulation,ofwhich10%-20%aremalignant.Pheochromocytomaproduces,stores,andsecretescatecholamines,aswellasleadstohypertensivecrisis,arrhythmia,angina,andacutemyocardialinfarctionwithoutcoronaryarterydiseases.Wereportacaseofacutecoronarysyndrome(ACS)withafinaldiagnosisofmultipleendocrineneoplasiawithpheochromocytomaandmedullarythyroidcarcinoma(MTC).

简介：BackgroundThiazolidinediones(TZDs)notonlyimproveinsulinresistance,loweringbloodsugar,alsohasanti-atheroscleroticeffect.However,whethertheprotectiveeffectoncardiovascularpioglitazoneisstillcontroversial.MethodsTotally98patientswithcoronarydiseaseanddiabetesmellituswererandomlydividedintopioglitazonegroup(n=48)receivingconventionaltherapyandpioglitazone(15mg/day),andcontrolgroup(n=50)merelyreceivingconventionaltherapy.Thepatientswerefollowedupfor12months.TheplasmalevelofPlasminogenactivatorInhibitor1(PAI-1)andP-selectinweredetectedatbaselineandaftertreatmentfor12monthsbyELISA,andmajoradversecardiacevents(MACE)werestudied.ResultsPioglitazonetherapyfor12monthswasassociatedwithasignificantdecreaseofPAI-1[(7.9±1.4vs4.2±0.5)ng/mL,P<0.05]andP-selectin[(16.6±6.8vs12.4±3.6)ng/mL,P<0.05],MACEwassignificantlylowerinthepioglitazonegroupthaninthecontrolgroup[acutecoronarysyndrome(ACS):32.0%vs10.4%,P<0.05;targetvesselrevascularization:22.0%vs6.3%,P<0.05].ConclusionsPioglitazonecaneffectivelyreducetheplasmalevelofPAI-1,P-selectinandtheoccurrenceofMACEinpatientswithcoronaryheartdiseaseanddiabetesmellitus.

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简介：Bodysurfacepotentialmapping(BSPM)isarecentlydevelopednoninvisivecar-dioelectrophysiologicdiagnostictechnique.Thepurposeofthepresentstudyistoe-valuatetheefficacyandsignificanceofpercutaneoustransluminalcoronaryangioplas-ty(PTCA)usingaBSPM-Ⅲmodelcomputersystem.7patientswitheoronaryheartdiseasewerestudiedpriortoandfollowingPTCAusing98leadsBSPMwithspecial

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简介：ObjectivesToevaluatetheeffectivenessoffirebirdstentforthetreatmentofcoronarydenovolesioncomparedwithcypherstent.MethodsNinety-oneconsecutivepatientswith156lesionswhounderwentcoronarycypher(n=68lesions)andfirebird(n=88lesions)implantation,quantitativecoronaryangiography(QCA)wasperformedatthetimeofstentimplantationandsubsequentlyat8monthspost-stenting.Smallvesseldiseasewasdefinedas≤2.5mmofreferencevesseldiametermeasuredbyQCA.Majoradversecardiacevents(MACE)includingdeath,thrombosis,nonfatalmyocardialinfarctionandtargetlesionrevascularization(TLR)werecomparedbetweenthetwogroups.ResultsBaselineclinicalcharacteristicsandangiographicparametersweresimilarbetweenthetwogroups.Seven-monthangiographicfollow-up,thelatelosswasnotdifferentbetweenthetwogroups(0.14±0.38mmvs0.13±0.17mm,P>0.05).Similarly,overallthrombosisrateweresimilarinbothgroups(1.5%vs1.1%,P>0.05).However,in-stentrestenosisaswellasin-segmentrestenosisrateweresignificantlyhigherincyphergroupthanthatinfirebirdgroup(4.4%vs0%and19.1%vs3.4%,P=0.047andP=0.001respectively).TLRwasalsohigherinthecyphergroup(10.3%vs2.3%,P=0.033)comparedwithfirebirdgroup.ConclusionsInthissmallsamplesize,non-randomizedstudy,thedataindicatedthatimplantationoffirebirdstentforthetreatmentofsmallcoronarylesionshowedmorefavorableresultsinrespectiveofrestenosiscomparedwithcypherstentimplantation.Amulti-center,large-samplesize,randomizedstudy,therefore,maybewarranted.

简介：BackgroundTheclinicalcharacteristicsofstrokepatientstreatedwithdoubleanti-platelettherapy(DAPT)afterpercutaneouscoronaryintervention(PCI)isnotclear.MethodsIntotal,2675patientsunderwentPCIandDAPTinGuangdongGeneralHospital,and68outofthemwerehospitalizedduetosuspectedstroke,ofwhom23werediagnosedashavingstroke.Dataofthe23strokepatientswerecollectedandtraditionalriskfactorsassociatedwithstrokewereanalyzedretrospectively.ResultsThemeanageofthesepatientswas75.6±8.7years,and20(87.0%)weremales.Notably,19patientswerecomplicatedwithhypertension,7withdiabetesmellitus,7withprevioushistoryofstroke,nonewithatrialfibrillation(AF)orpatentforamenovale(PFO).Specifically,22patientswerediagnosedwithischemicstroke,and1patientwithhemorrhagicstroke.ConclusionStrokeinpatientstreatedwithDAPTafterPCIwascorrelatedwithadvancedage,gender,hypertension,diabetesmellitus,strokehistory.Longtermelectrocardiography(ECG)maybeneededforthediagnosisofAF,whiletrans-esophagealechocardiography(TEE)maybeneededforPFO.

简介：ObjectivesTostudythestatusoffibrinolyticinhibitioninpatientsofacutecoronarysyndrome(ACS)complicatedwithtypeⅡdiabetesmellitus(NIDDM)andtoevaluatetheeffectoffibrinolyticinhibitiontotheclinicalprognosis.MethodsTypeⅡdiabetesmellituswasdefinedbyADA1997/WH01998criteria.Thesubjectsweredividedintotreatmentgroupsthatincluded39patientsofACSwith20casesofacutemyocardiacinfarction(AMI),36patientsofACS+NIDOMwith20casesofAMI.Twentycasesofhealthypeoplewererandomizedtocontrolgroup.Theplasmaleveloftissuetypeplasminogenactivator(t-PA),plasminogenactivatorin-hibitortype-1(PAI-1)andplasmaD-dimerweredetectedbyusingelisatechnique.TheindexofstatueinfibrinolysiswasdetectedwiththeplasmalevelofD-dimerandtherateofPAI-1/D-dimerinpercentage.ThisindexwasusedtoevaluatethefibrinolyticinhibitionandtheclinicaloutcomeinallthepatientswithAMIintreatmentgroups.TheclinicaloutcomeinpatientswithAMIconsistedoftherateofreperfusion,theincidencesofreinfarction,severi-ousarrhythmia,pumpfailureanddeathintheearlyperiodofAMI.ResultsTheplasmalevelofPAI-1andD-dimerwashigherinthetwotreatmentgroupsthanthatinthecontrolgroup(P<0.01).TheplasmalevelofPAI-1significantlyhigherinACS+NIDDMpatientsthanthatinACS(P<0.05),buttheplasmalevelofD-dimerraisedfrombasiclevelwassignificanflylowerinACS+NIDDMthanthatinACS(P<0.05).TherateofPAI-1/D-dimerinpercentagewassignificantlyhigherinACS+NIDDMthanthatinACSorincontrolgroup(P<0.01).ForAMIpatientsintwotreatmentgroups,therateofreperfusionafterthethrorabolytictherapywassignifi-candylowerinACS+NIDDMthanthatinACS(P<0.01).TherateofincidencesinpumpfailurewassignificantlyhigherinACS+NIDDMthanthatinACStoo(P<0.05).Themorbidityofseveriousarrhythmia,re-infarctionandthemortalitywerealsohigherinACS+NI

简介：Leftbundlebranchblock(LBBB),traditionallyviewedasanelectrophysiologicabnormality,isincreasinglyrecognizedforitseffectsonhemodynamicsandpatient’sprognosis[1].Exercisenuclearstudiesfrequentlyshowreversibleperfusiondefectsintheabsenceofobstructivecoronaryarterydisease[2]andsomepatientswithintermittentLBBBdevelopanginacoincidentwiththeonsetofLBBB[3].WereportacaseofintermittentLBBBwithabnormalstresstechnetium99mTcsingle-photonemissioncomputedtomography(SPECT)studyandnormalcoronaryarteryangiography.

简介：‘Stent对stent’研究是被设计与以前同意的相比显示出新stent图案的优势的一种使随机化的试用。这些研究被规章的机构通常使用，例如美国食物药品管理局(食物及药品管理局)，到表示同意到新stent图案。有这些临床的试用的问题是他们的高费用和困难。在这份报纸，为‘stent对stent’的一种数字选择复杂临床的研究被介绍。一个有限元素模型被开发在冠的stent放置以后在结果上调查stent设计的影响。二商业地可得到的stents(NIR和多连接stents)被建模，他们的行为以压力分发在推广期间被比较，光线的获得，外部直径变化并且节略。而且，狭窄率上的stent设计的效果被在动脉以内比较压力分发调查。在stented动脉的动脉的墙压力的分析显示多连接stent设计原因与slotted试管NIR设计相比与局部性的stenotic损害降低应力到一个动脉粥样硬化患者容器。有观察临床的狭窄的调查结果相互关联与多连接stent设计相比在NIR评估狭窄率，它更高报导了。

简介：AbstractIatrogenic femoral artery pseudoaneurysm is a common complication of the endovascular procedures. Manual compression and thrombin injection are the conventional techniques to occlude the pseudoaneurysms. However, there are still some failed cases that applied these treatment options. The aim of the study is to seek a potential and alternative method with ProGlide system to close the pseudoaneurysm. During April 2018 to February 2019, 2 patients with iatrogenic pseudoaneurysm of the superficial femoral were treated with the suture-base closure device-ProGlide. After punctured the pseudoaneurysm and placed a 6-F sheath, the guide wire was placed in the right femoral artery via the access of the pseudoaneurysm neck. Then the pseudoaneurysm neck was sutured by ProGlide to occlude the blood supply to the pseudoaneurysm. These 2 patients were cured with no complications and complaints, which revealed that percutaneous suture technique with ProGlide at the neck level of pseudoaneurysm provides a novel method for the management of vascular access pseudoaneurysm, especially in those with a wide and short neck.

简介：BackgroundThisstudytestedthehypothesisthatmoderatealcoholintakeexertsitscardioprotectiveeffectmainlythroughanincreaseintheserumlevelofhigh-densitylipoproteincholesterol.MethodsandResultsIntheCohortofNorway(CONOR)study,149729adultparticipants,recruitedfrom1994to2003,werefollowedbylinkagetotheCauseofDeathRegistryuntil2006.Atrecruitment,questionnairedataonalcoholintakewerecollected,andtheconcentrationofhigh-densitylipoproteincholesterolinserumwasmeasured.UsingCoxregression,wefoundthattheadjustedhazardratioformenfordyingfromcoronaryheartdiseasewas0.52(95%confidenceinterval,0.39-0.69)whenconsumingalcoholmorethanonceaweekcomparedwithneverorrarely.Theratiochangedonlyslightly,to0.55(0.41-0.73),aftertheregressionmodelincludedtheserumlevelofhigh-densitycholesterol.Forwomen,thecorrespondinghazardratioswere0.62(0.32-1.23)and0.68(0.34-1.34),respectively.ConclusionsAlcoholintakeisrelatedtoareducedriskofdeathfromcoronaryheartdiseaseinthefollow-upofalarge,population-basedNorwegiancohortstudywithextensivecontrolforconfoundingfactors.Ourfindingssuggestthattheserumlevelofhigh-densitycholesterolisnotanimportantintermediatevariableinthepossiblecausalpathwaybetweenmoderatealcoholintakeandcoronaryheartdisease.

简介：BackgroundAnomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery(ALCAPA)isararecongenitalanomaly.Itdemonstratedthecombinedeffectsoftheabsenceofanormalcoronaryflowwithacoronarystealandtheprofoundischemiathatcanproduceleftventriculardysfunctionandmitralregurgitation.Wehereintroducethepostoperativemanagementofpatientswithrepairofanomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery,withanemphasisonitsoutcome.MethodsRecordsof31patientswithanomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryreceivingsurgeryfrom1998to2010werereviewedretrospectively,10ofwhichweretreatedwiththemitralvalvesurgicallyatthesametime.Theageofpatientswas4monthsto16years(median,1year)andweightofthosewas5to53kilograms(median,7.8kilograms),allofwhichwerediagnosedofanomalousoriginoftheleftcoronaryarteryfromthepulmonarybyechocardiographyandcardiaccatheterization.Aftersurgery,electrocardiogram,echocardiography,arterialbloodpressure,transcutaneousoxygensaturationandcentralvenouspressureweremonitored.Commonpostoperativecomplicationsinourgroupwereanalysed.Andpreoperativeandpostoperativedataincludingareaofmitralregurgitation,leftventricularsystolicdiameterandleftventriculardistolicdiameterwereobtained.Cardiopulmonarybypasstimeandmechanicalventilationtimeofpostoperativepatientswithnopneumoniawerecomparedwiththosewithpneumonia.Binarylogisticregressionwasappliedfortheanalysisoftheriskfactorsofpostoperativepneumonia.ResultsOf31patients,30survivedaftersurgerywithearlymortalityof3.23%.Onepatientdiedofseverelowcardiacoutputsyndrome.Mechanicalventilationtimewas4hoursto168hourshours(mean,39.68±50.52hours;median,18hours).ICUstaywas16hoursto425hours(mean,111.65±127.03hours;median,44hours).Inourgroup,commonpostoperativecomplicationsweremyocardialischemia(n=12,36.4%),infection(n=

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简介：AbstractBackground:Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT; however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography.Method:Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15-20 mg or atorvastatin 30-40 mg) and combination therapy group (rosuvastatin 5-10 mg or atorvastatin 10-20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student’s t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis.Result:Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = -9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = -9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up (B = -0.203, t = -2.701, P = 0.010), ΔTC% (B = -0.573, t = -2.048, P = 0.046), and Δhs-CRP% (B = -0.302, t = -2.963, P = 0.005) showed an independent association with ΔFCT%.Conclusions:Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.

简介：Objective:TostudythecharacteristicsofpulsetracingsinCHD,andobjectivelyevaluatethesignificanceofpulsesignalindiagnosisandappreciationoftherapeuticeffectinpatientswithcoronaryheartdisease(CHD),andaccordinglyprovidewiththeoreticproofsfordevelopingnon-invasivetechniqueofpulsediagnosis.Methods:Byusingthepulsedetectionsystem,pulsegraphsinCHDpatients,patientswithoutCHDand"health"adultswerecollectedandcompared.ThencharactersofthepulsesignalwereanalyzedwithHilbert-Huangtransformationroutine(HHT)andtime-domainmethodrespectively.Results:ThereexistedcharacteristicchangeinpulsegraphinCHD.①h1,h3,h4,h3/h1,t,t5/t4intimedomainparametersofpulsegraphincreasedandw1waswidened.②44%ofC2waveinHHTdisplayshowedchaoticanddisorderlywaveandirregularlywaveamplitudeinCHD.And72%ofC5Waveexhibitedinirregularwavewithaveragewaveamplitudeover10gram-forces.Thesechangesweresignificantlydifferentfromhealthadults.Conclusion:CharacteristicwaveofpulsegraphextractedwithmethodsoftimedomainorHHTroutinemightbeconsideredasproofsfordiagnosisanddifferentiationinCHD.OurresearchesprognosticatethatpulsediagnosiscanbeusedasanancillarydeterminationinoccurrenceofCHDforreasonsoftheadvantageofconvenientoperationandnon-invasion.

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