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Abstract:Anti-thrombotic therapy is beneficial to patients with coronary heart diseases. The risk of hemorrhage is apparently increased in elderly patients with coronary artery disease compared with non-elderly patients while they benefited from the anti-thrombotic drugs. It is very important to understand the mechanism of these anti-thrombotic drugs and carefully balance the efficacy and safety of the anti-thrombotic therapy for elderly patients with coronary artery disease. In order to not only obtain the expected efficacy but also avoid the bleeding adverse events, it should be emphasized to monitor the side effect of bleeding and enable individualized dosage and strategy of the drug therapy.

Abstract:Objective To explore the long-term clinical efficacy and safety of 6-month dual antiplatelet therapy (DAPT) after biodegradable polymer based drug eluting stent (DES) implantation. Methods In the multi-center prospective CREATE Study, a total of 2034 patients who received biodegradable polymer based sirolimus eluting stent (Excel stent) treatment and had no major adverse cardiac events (MACE) at 6-month were included. Among them, 1626 (79.9%) patients discontinued clopidogrel treatment within 6 months (DAPT≤6 months) and 408 (20.1%) prolonged clopidogrel treatment after 6 months (DAPT＞6 months). The incidences of MACE and stent thrombosis through 6 months to 4 years were compared between patients with different DAPT durations. Results There was no statistical difference between the two groups in the incidences of cardiac death (2.0% vs 2.2%, P=0.753), myocardial infarction (0.2% vs 0.4%, P=1.0), target lesion revascularization (1.7% vs 2.4%, P=0.407) and MACE (3.7% vs 3.4%, P=0.819). The overall incidence of stent thrombosis in patients with DAPT＞6 months and≤6 months was 1.5% and 0.7%, respectively (P=0.128). The incidences of definite or probably stent thrombosis were similar between the two groups (0.7% vs 0.5%, P=0.469). Multivariate analysis showed that prior myocardial infarction was an independent predictor of stent thrombosis (OR=15.313, 95% CI: 4.02?58.25, P＜0.001). However, DAPT duration of ≤6 months was neither associated with the risk of MACE (OR=0.987, 95%CI: 0.545?1.787, P=0.965) nor stent thrombosis (OR=0.847, 95%CI: 0.208?3.439, P=0.816). Conclusions DAPT for 6 months is safe and effective at four years after biodegradable polymer based DES implantation, which needs further confirmation by randomized controlled studies.

Abstract:Objective To evaluate the clinical efficacy, safety and prognosis of fondaparinux in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Methods A retrospective analysis was performed on 2448 NSTE-ACS patients [1696 males, aged 21～90 years, mean (68.4±12.1) years] who were administrated with fondaparinux after receiving either percutaneous coronary intervention (PCI) or merely drug therapy in our department between March 2010 and December 2011 and with intact follow up . We summarized the characteristics of the patients, recorded incidence of in-hospital major bleeding, platelet reduction and incidence of major adverse cardiac events (MACE) during hospitalization and 1 month after discharge. Then we compared our results with those of OASIS-5 trial. Results There was no significant difference between our study and OASIS-5 in baseline clinical characteristics (P＞0.05). The success rate of the invention operation was 97.1% (2043/2104). There was no death during the PCI procedure. Compared with OASIS-5 trial, which used enoxaparin to assist anticoagulation for patients with NSTE-ACS, our study showed identical incidence of death, myocardial infarction and refractory ischemia at day 9 and day 30, while fondaparinux group showed significantly lower incidence of major bleeding than enoxaparin group at day 9 (P＜0.05). The incidence of major bleeding in fondaparinux group was significantly lower than that in enoxaparin group in OASIS-5 at day 9 (1.6% vs 4.1%; HR: 0.38; 95% CI: 0.28?0.54; P＜0.05), and this difference continued during the 30 days follow-up (1.4% vs 5.0%; HR: 0.65; 95% CI: 0.45?0.93; P＜0.05). Incidence of bleeding complication was significantly higher in Tirofiban-used patients than in non-Tirofiban-used ones (25.6% vs 3.8%, P＜0.001). Patients with renal impairment mainly manifested with multivessel lesions identified by coronary angiography. They also showed lower rate of TIMI grade 3 after PCI procedure (21.0%), and higher rate of in-stent thrombosis (1.2%). The incidence of death, myocardial infarction and refractory ischemia of patients with impaired renal function at day 9 were significantly higher than those in patients with normal renal function (4.94% vs 1.04%; HR: 7.87; 95% CI: 3.41?18.16; P＜0.05), and this difference sustained during the 30 days follow-up (5.4% vs 2.4%, P＜0.05). Patients with renal impairment in fondaparinux group had significantly reduced incidence of major bleeding than those in enoxaparin group of OASIS-5 trial (2.2% vs 6.4%; P＜0.001). Conclusion Application of fondaparinux is safe in NSTE-ACS patients both receiving PCI and merely drug therapy. It also significantly improves coronary blood supply and coronary perfusion after PCI procedure as well as clinical prognosis without increasing bleeding risk.

Abstract:Objective To evaluate the efficacy and safety of subcutaneous injection of fondaparinux during perioperative period of radiofrequency catheter ablation of atrial aibrillation (AF), figure out whether it will affect the targeted time of INR after using warfarin, and compare with dalteparin and enoxaparin for ecchymosis effects at the injection sites. Methods Ninety-four AF patients undergoing catheter ablation were randomly divided into 3 groups, including 24 patients in enoxaparin group, 20 patients in dalteparin group, and 50 patients in fondaparinux group. Enoxaparin, dalteparin or fondaparinux was subcutaneously injected for 5?10 days before catheter ablation, and continued for at least 3?5 days after ablation before INR achieving the target of 1.8?2.0 under the use of oral warfarin. Results There was no statistical difference in baseline characteristics among three groups (P＞0.05). The thromboembolic events were 0/24 patients in enoxaparin group, 0/20 in dalteparin group and 1/50 in fondaparinux group, and there was no statistical difference in the incidence of thromboembolic events among three groups. There was no serious bleeding events in all three groups. The time for achieving the targeted INR after ablation had no statistical difference among three groups (P＞0.05). The incidence and the long diameter of ecchymosis in injection sites were significantly lower/less in fondaparinux group than in enoxaparin and dalteparin groups on the seventh day after injection of fondaparinux or LMWH (non-ecchymosis ratio: fondaparinux, 0.66; enoxaparin, 0.21; dalteparin, 0.15; P＜0.05; long diameter of ecchymosis: fondaparinux, 0.7cm; enoxaparin, 2.3cm; dalteparin, 3.3cm; P＜0.05). Conclusion Compared with enoxaparin and dalteparin, fondaparinux in perioperative anticoagulation therapy of catheter ablation of AF neither increases the major bleeding and thromboembolic events, nor affects the targeted time of INR after using warfarin. Fondaparinux could reduce the incidence and scope of ecchymosis in subcutaneous injection sites.

Abstract:Objective To compare the clinical safety and effectiveness of domestic clopidogrel (Talcom) and imported clopidogrel (Plavix) in the patients after percutaneous coronary intervention (PCI). Methods A total of 210 patients with coronary heart disease (CHD) were randomly divided into two groups, including Talcom group (n=103) and Plavix group (n=107). All patients were given 300 mg of aspirin (once per day), 300 mg of clopidogrel for the loading dosage and then 75 mg of clopidogrel (once per day) for one year. For patients with triple vessel disease, 300 mg of clopidogrel for the loading dosage, 150 mg of clopidogrel (once per day) for two weeks, and then 75 mg of clopidogrel (once per day) for one year were administrated. The primary endpoints included major adverse cardiac and cerebral events (including cardiac death, stent thrombosis, in-stent restenosis, non-fatal myocardial infarction, target vessel revascularization) and stroke for 6 months. The secondary endpoints were hemorrhage events and change of platelet aggregation rate. Results There was no significant difference in the incidence of major cardiovascular diseases between Talcom group and Plavix group (P＞0.05). As for the rate of platelet aggregation and general incidence of bleeding events at 6 months, no significantly difference was found between the two groups. Conclusion The domestic clopidogrel (Talcom), as an anti-platelet drug, is safe and effective for patients undergoing drug eluting stent in 6 months.

Abstract:Objective To investigate the association between serum γ-glutamyl transpeptidase (GGT) and metabolic syndrome(MS) in elderly people. Methods A total of 1444 elderly individuals who received routine physical examination were included. The serum GGT, body mass index(BMI), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FBG), triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), alanine transferase(ALT) and uric acid were determined in all subjects. Results Serum GGT levels, BMI, SBP, DBP, TG, ALT, and uric acid were significantly higher in MS group than in normal control group(P＜0.01). HDL-C was significantly lower in MS group than in normal control group(P＜0.01). The prevalence of MS and MS components(including obesity, abnormal blood pressure, abnormal blood glucose, and abnormal blood lipid) were all significantly increased with the increase of inter-quartile interval of GGT(P＜0.01). Multiple linear regression showed that GGT was positively associated with DBP,TG,ALT,uric acid and the number of MS components (P＜0.01), but negetively correlated with HDL-C (P＜0.05). Logistic regression analysis indicated that serum GGT was a risk factor of MS(OR = 1.008, 95%CI 1.000?1.024, P = 0.046). Conclusion In elderly individuals, serum GGT is closely related with MS. GGT may be a screening biomarker of MS after excluding liver diseases.

Abstract:Objective To investigate ATP-binding cassette transporter 1(ABCA1) M233V and R219K gene polymorphism in Mongolian nationality population in Inner Mongolia region and its correlationship with blood lipids and coronary heart disease(CHD). Methods The target fragments of ABCA1gene were amplified and analyzed by polymerase chain reaction-restriction fragments length polymorphism(PCR-RFLP) technique in 115 Mongolian control subjects without CHD and patients with CHD. Results The subjects presented ABCA1 gene M233V polymorphism, which had three genotypes: MM genotype, MV genotype and VV genotype. There was no significant difference in frequency of allele and genotype in M233V polymorphism between controls and CHD patients(P＞0.05). No significant difference was found in levels of total cholesterol(TC), triglyceride(TG), high density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol(LDL-C) between MM genotype and MV+VV genotype(P＞0.05).The frequency of KK genotype was significantly higher in controls than in CHD patients(P＜0.05). KK genotype had higher HDL-C level(P＜0.05) and lower TG level than RR genotype (P＜0.05).Conclusion In Mongolian population in Inner Mongolia region, M233V is a novel polymorphism in ABCAl gene. ABCAl gene R219K polymorphism is associated with CHD risk．The KK genotype results in a beneficial profile of blood lipids, which may be a novel genetic marker for low risk of CHD.

Abstract:Objective To compare the effect of erythromycin or metoclopramide on feed failure of mechanically ventilated patients in intensive care unit; to observe the effect of “rescue” combination therapy using both erythromycin and metoclopramide after monotherapy failure; to screen out the factors associated with a poor response to prokinetic therapy. Methods Seventy-two mechanically ventilated patients with feed failure in ICU from June 2007 to June 2010 were collected. Enteral nutrition was given at 10:00 on the first day after feed failure. The subjects were randomly divided into erythromycin group and metoclopramide group. The first erythromycin or metoclopramide injection was given at 8:00 on the first day. After 24 hours, gastric residual volume was aspirated and measured every day at 10:00, 16:00, 22:00 and 04:00 on next day. At the same time, we recorded the general condition and pretreatment 24-hour gastric residual volume of the subjects. The mean gastric residual volume and the successful feeding rate were compared every day. Six days later, the patients who failed the monotherapy received the rescue combination therapy directly for another 6 days. Twenty-four hours later, daily gastric residual volume and the successful feeding rate were recorded. Results For mechanically ventilated patients with feed failure, the daily gastric residual volume in erythromycin group was smaller than that in metoclopramide group[day 2:(75±19) vs (130±23) ml; day 3: (72±16) vs (120±21) ml; day 4: (71±22) vs (125±18) ml; P＜0.05]. The successful feeding rate in erythromycin group was higher than that in metoclopramide group(day 2:65.7% vs 37.8%; day 3: 51.4% vs 27.0%; day 4: 45.7% vs 18.9%; day 5:40.0% vs 16.2%; P＜0.05). In patients who failed monotherapy, the “rescue” combination therapy using erythromycin and metoclopramide had higher successful feeding rate(64.3% on day 5) than erythromycin(40%) or metoclopramide (16.2%). Factors that were associated with a poor response to prokinetic therapy included high pretreatment 24-hour gastric residual volume, high blood sugar, a high Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score on inclusion day and the existence of any kinds of shock. Conclusion For mechanically ventilated patients with feed failure in ICU, erythromycin is more effective than metoclopramide; in patients who failed monotherapy, “rescue” combination therapy using erythromycin and metoclopramide is highly effective. High pretreatment 24-hour gastric residual volume, high blood sugar, a high APACHEⅡ score on inclusion day and existence of any kinds of shock are independent risk factors of a poor response to prokinetic therapy.

Abstract:Objective To analyze the early outcome of juxtarenal abdominal aortic aneurysms(AAA) repair with fenestrated endovascular stent graft. Methods Four juxtarenal AAA patients with severe comorbidities who were not suitable for open surgery were included. Fenestrated endovascular stent graft was customized according to CT data. The stent graft was implanted together with two small stent grafts into the renal arteries under general anesthesia. Results After operation, digital subtraction angiograph(DSA) showed the patency of the visceral arteries and the renal arteries and favorable morphology of the stent graft. Minimal proximal typeⅠendoleak was found in 2 cases. The follow-up results at 3 months after the operation showed that the morphology of the stent graft was normal in all 4 patients; typeⅠendoleak found immediately after the operation in two patients disappeared; type Ⅱ endoleak was detected in another patient. Conclusion Fenestrated endovascular stent graft yields satisfactory short-term therapeutic effects on patients with juxtarenal AAA.

Abstract:Objective To determine the risk factors of atherosclerosis(AS) and arterial stiffness assessed non-invasively by the cardio-ankle vascular index(CAVI). Methods A total of 845 subjects aged from 35 to 85 years were subjected to CAVI measurement. Blood pressure(BP), lipids, glucose, renal function, chest X-ray radiographs, previous medical records were also obtained for all subjects. CAVI was measured using a VaSera VS-1000 and calculated by heart to ankle pulse wave velocity(haPWV, m/s). Results CAVI was high in 458 subjects(54.2%). CAVI was significantly positively correlated with age, BP, and pulse pressure. Detection rates of hypertension, diabetes, coronary artery disease(CHD), stroke and dyslipidemias, especially CHD and hyperlipidemias, increased with aging. Smoking was significantly correlated with CAVI. The smokers with other comorbidities displayed further higher CAVI. Conclusions CAVI, as a new parameter of arterial stiffness, is influenced by various cardiovascular risk factors. Smoking and the comorbidities are all involved in elevation of CAVI. A personalized comprehensive prevention and treatment strategy should be recommended for patients with AS.

Abstract:Objective　To investigate the value of non-invasive comprehensive method in diagnosis of primary lung cancer. Methods Medical data of 120 out-patients suspicious for primary lung cancer were analyzed retrospectively. The sensitivity and specificity of non-invasive comprehensive examination method (including chest X-ray, CT, tumor markers, cytology of sputum) for diagnosis of lung cancer were analyzed. Results　The sensitivity and specificity only based on clinical symptoms for diagnosis of lung cancer were 11.8% and 25.9% respectively, accuracy 15.0%, false positivity rate 74.1%, and false negativity rate 88.2%. The sensitivity and specificity based on clinical manifestations plus imaging data were 46.2% and 40.7% respectively, accuracy 45.0%, false positivity rate 59.3%, and false negativity rate 53.8%. The sensitivity, specificity and accuracy based on clinical manifestations plus imaging data plus tumor markers plus cytology of sputum reached up to 80.7%, 77.8%, and 80.0% respectively, and the false positivity rate and false negativity rate decreased to 22.2% and 19.3% respectively. Conclusions The non-invasive comprehensive method including clinical symptoms, radiological examinations, tumor markers and sputum cytology has a high sensitivity and specificity for diagnosis of primary lung cancer. The clinicians should give emphasis to the screening of lung cancer to increase its detection rate.

Abstract:Objective To investigate the drug resistance of pan-drug resistant Acinetobacter baumannii(PDR-AB) to common disinfectants. Methods K-B paper method was used in routine drug susceptibility test. Paper method and broth cultivation were used in disinfectants susceptibility test. Results The PDR-AB was sensitive to 0.5% povidone iodine (PVP-I) disinfectant,0.1% chlorhexidine acetate solution, 2000ppm trichlorosocynuric acid (freshly prepared), and 2% glutaraldehyde(soak), but resistant to 75% ethanol, 0.1% chlorine oxide, 0.1% PVP-I, and 2000ppm trichlorosocynuric acid(prepared 30 minutes later). Conclusion The 0.5% PVP-I disinfectant, 0.1% chlorhexidine acetate solution, 2000ppm trichlorosocynuric acid (freshly prepared), and 2% glutaraldehyde(soak) show excellent efficacy in killing clinically isolated PDR-AB, but low concentration of PVP-I and chlorine-containing disinfectants and 75% ethanol show poor efficacy.

Abstract:Objective To explore the roles of Salvia Miltiorrhiza Bge (SMB) in improving myocardial fibrosis in aged spontaneously hypertensive rats and the possible mechanisms —— cyclooxygenase pathway of arachidonic acid. Methods The 17-month-old SHR rats were given consecutive SMB injection or saline control for 12 weeks, while the age-matched WKY rats were selected as normal control. Meanwhile, celecoxib, the specified arachidonic acid cyclooxygenase-2 (COX-2) inhibitor, was administrated intragastrically before SMB injection. The blood pressure, hemodynamic index and left ventricular mass index were determined. HE staining and Masson staining were performed to analyze the size of myocardial cells or the level of myocardial fibrosis, as well as left ventricular myocardial expression and activity level of COX-2 protein. Results Compared with the elderly WKY rats, senescent SHR had higher blood pressure[systolic blood pressure: (171±12) vs (125±3)mmHg; diastolic blood pressure: (115±9) vs (87±3)mmHg; mean artery pressure: (139±10) vs (106±5)mmHg , P＜0.05], deterious heart function[LVEDP: (13.9±1.7) vs (7.6±1.3)mmHg; LVdP/dtmax: (2528±167) vs (3015±217)mmHg/s; ?LVdP/dtmax: (1957±134) vs (2501±175)mmHg/s, P＜0.05], increased left ventricular mass index[(3.45±0.07) vs (2.23±0.06)mg/g, P＜0.05], increased myocardial cells[diameter: (23.5±0.4) vs (14.3±0.4)μm, P＜0.05], severe fibrosis[myocardial interstitial fibrosis index: (1.66±0.05)% vs (0.64±0.05)%; myocardial perivascular fibrosis index: (139±9)% vs (68±7)%, P＜0.05], elevated expression[(125.8±7.2) vs (47.6±3.8), P＜0.05] and activity level of myocardial COX-2 protein[(73.9±5.6) vs (56.7±4.4)kU/g, P＜0.05]. Except the systolic blood pressure, other indicators in SMB-treated SHR were significantly reduced. The administration of celecoxib partially abolished the effect of SMB. Conclusion SMB therapy can reverse myocardial fibrosis in senescent spontaneously hypertensive rats, which may be through cyclooxygenase pathway.

Abstract:Objective To investigate the effects of emodin on inducible nitric oxide synthase (iNOS) expression of pancreatic tissue, serum leptin and intestinal permeability in rats with acute pancreatitis(AP) and the relative mechanism. Methods Sixty adult SD rats were randomly divided into three groups: sham operation group, AP group, and emodin treatment group, with 20 in each group. The expressions of iNOS and NO in pancreatic tissue were measured. Blood amylase(AMY) and serum content of leptin were detected. Intestinal permeability was measured by albumin clearance(AC) of 125I-labeled rat serum albumin. The histopathologic changes of pancreas and ileum were observed. Results The blood AMY, plasma content of leptin, cumulative 125I-labeled serum albumin index and the levels of iNOS and NO in pancreatic tissue were significantly higher in AP group and emodin treatment group than in sham operation group(P＜0.05). Compared with AP group, in emodin treatment group, the levels of iNOS and NO in pancreatic tissue, the blood AMY and cumulative 125I-labeled serum albumin index were significantly decreased(P＜0.05); the serum content of leptin was increased; the pathological changes of pancreas and ileum were significantly alleviated(P＜0.05). Conclusion The increase of intestinal permeability in rats with AP may be induced by overexpression of NO via action of iNOS. Emodin is effective in the increase of the serum leptin and the decrease of iNOS. Emodin has certain preventive and therapeutic effects on bowel wall permeability decrease in AP rats.

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Abstract:The cluster of hypertension, diabetes mellitus, dyslipidemia and body obesity, collectively referred to as the metabolic syndrome, is a common cause of atherosclerotic and cardiovascular diseases, and also one of the most serious threats to public health. Metabolic syndrome is closely related to micro-inflammation, which receives great attention in recent years. Besides the hemodynamic regulatory role, renin-angiotensin system (RAS) also plays an important role in micro-inflammation. Blockade of RAS could protect against the development of metabolic syndrome. It has been confirmed that RAS exerts its effects mainly through angiotensin converting enzyme(ACE)-angiotensinⅡ(AngⅡ)-angiotensin 1 receptor(AT1R) axis and ACE2-Ang(1-7)-Mas axis, and the two approaches have opposite biological activities. Angiotensin(Ang)Ⅱ could initiate inflammation through a variety of mechanisms by its receptors, but the Ang1-7, as the antagonists to AngⅡ, restrains the inflammation. In this paper, we reviewed the mechanism through which RAS is involved in micro-inflammation.

Abstract:With the development of medical sciences and intelligent software, the amount of data acquired electronically from patients in intensive care unit (ICU) has grown exponentially, therefore they were susceptible to analysis by artificial neural network (ANN). ANN has been used in ICU in a variety of fashions, but most extensively for outcome prediction. ANN can function as intelligent assistant to clinicians, constantly monitoring electronic data streams for important trends. The integration of ANN into the ICU can be expected to make significant use of health resources and improve outcome of the patients.

Abstract:Dizziness is the most frequent chief complaint in neurological clinic. Regarding the position of etiology, dizziness is divided into central dizziness and peripheral dizziness. Although it accounts for 25% only, the central dizziness draws great attention from clinicians because of its complex clinical condition and poor prognosis. In recent years, with the concept and coverage of the dizziness changing, those of central dizziness also change correspondingly. Most scholars hold that dizziness include vertigo, disequilibrium without vertigo, presyncope (near-faint), psychophysiologic dizziness. Correspondingly, central dizziness includes central vertigo, central dysequilibrium without vertigo, central presyncope, and central psychophysiologic dizziness. In this article, we introduced the concept, location, characteristics and common subtypes of central dizziness; we also reviewed its research progress.

Abstract:The sleep apnea-hypopnea syndrome (SAHS) in the elderly is not rare. The pathogenesis and clinical manifestations have the characteristics specific for the elderly. The diagnosis criteria are also different with those of the non-elderly. The complications are usually more serious. Continuous positive airway pressure is the first choice for the treatment. In this paper, we reviewed the prevalence, the pathogenesis, the clinical manifestations, the diagnosis criteria, the complications and outcomes, and the treatment of SAHS in the elderly by comparing with those in the non-eldelry.