Objective To investigate the effect of PPARγ in acute coronary syndrome (ACS) patients with type 2 diabetes (T2DM) for the severity of coronary atherosclerosis and plaque stability. Methods We selected 102 patients with ACS, including 52 patients with type 2 diabetes mellitus (ACS+T2DM group) and 50 patients with simply ACS (ACS group). Meanwhile, we selected 30 patients without coronary heart disease and T2DM as the control group. All basic clinic data, CAG and the Gensini score were compared among all groups. To all patients, blood was drew when they were enrolled to detect the level of PPARγ and MMP-9. Results Gensini points in the ACS+T2DM group was much higher than that of the ACS group (P < 0.05). The levels of PPARγ of the ACS group and the ACS+T2DM group, when compared with the control group, were decreased significantly, but the level of MMP-9 were increased (all P < 0.05). The level of PPARγ in the ACS+T2DM group was much lower than the ACS group, and the level of MMP-9 was much higher (P<0.05). Gensini scores (r=-0.416, P<0.05), the level of MMP-9(r= - 0.503, P < 0.05) were correlated negatively with the level of PPARγ. Conclusions Complicating with T2DM can aggravate coronary artery disease and plaque instability degree in ACS patients, and PPARγpossibly make an protective effect.

Objective To study the suitable dose of intracoronary adenosine (AD) on fractional flow reserve (FFR) measurement in Chinese patients with angiographic coronary artery disease. Methods FFR was measured in 32 patients with 40 moderate coronary stenosis. Boluses of intracoronary AD at increasing doses of 60μg (A1), 80μg (A2), 100μg (A3) and 120μg (A4) were randomly administered. FFR values, symptoms, systemic effects and development of atrioventricular block were recorded. Results FFR value decreased significantly by 8.99%(A1), 11.24%(A2), 13.48%(A3) and 13.48%(A4) compared with the baseline distal coronary pressure/aortic pressure (0.891±0.044, all P<0.001). A3 and A4 showed significantly lower FFR values than A1 (t=6.331、6.343, all P < 0.001),A2 (t=2.974、3.058, P=0.005、0.004). Positive rates of an FFR of<0.75 were 30.0%(n=12), 32.5%(n=13), 35.0%(n=14) and 35.0%(n=14) in A1, A2, A3 and A4. A total of 13 patients(40.6%) reported at least one side effects. Conclusions This study suggests a dose-response relationship for intracoronary AD on the measurement of FFR in Chinese patients with angiographic coronary artery disease. The suitable dose of bolus of intracoronary AD is 100μg.

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.

Objective To study the changes in and correlations between the partial pressure of end-tidal carbon dioxide (PETCO2) and the coronary perfusion pressure during cardio-pulmonary resuscitation (CPR) based on the cardiac arrest dog models of ventricular fibrillation by electric shock. Methods 36 healthy dogs were evenly randomized into 3 groups including 4 minutes close-chest CPR(CCCPR) group, 4 minutes open-chest CPR(OCCPR) group, and 8 minutes OCCPR group. There were 12 dogs in each group, half male and half female. In the process of CPR, all parameters about PETCO2 and CPP were recorded. Results In the 4 minutes CCCPR group, the correlation coefficient between the CPP and the PETCO2 was 0.992 (P<0.05), which was in positive linear correlation. In the 4 minutes OCCPR group, the correlation coefficient between the CPP and the PETCO2 was 0.937 (P < 0.05), which also showed positive linear correlation. In the 8 minutes OCCPR group, the correlation coefficient between the CPP and the PETCO2 was 0.952 (P<0.05), and was also in positive linear correlation. The percentage of ROSC was 66.7(8/12) in the 4 minutes CCOPR group, 100%(12/12) in the 4 minutes OCCPR group and 58.3%(7/12) in the 8 minutes OCCPR group. There were statistical differences in CPP, PETCO2 between models with ROSC and without ROSC at 1, 2, 5, 10, 15 and 20 mins of CPR (all P<0.05). Conclusions This research shows that there is a close positive linear relationship between the coronary perfusion pressure and the PETCO2, and PETCO2 could be used to evaluate the prognosis of the CPR.

Objective To explore possible role of cellular repressor of E1A-stimulated genes(CREG) in the process of phenotypic switching of adventitial fibroblasts(AFs). Methods Immunofluorescent staining was performed with tissue sections from mouse carotid arteries to evaluate the relationship between the expression of CREG and smooth muscle actin-α(α-SMA) in injured arteries, especially in the adventitia. Tissue block pasted culture method was used to isolate and culture AFs. RT-PCR and Western-blot were used to detect the change of CREG andα-SMA mRNA and protein expression in AFs in the presence of different concentrations of AngⅡfor 12 h/24 h or in the presence of 100 nmol/L Ang Ⅱ for different times. Results Normal mouse carotid arteries had little α-SMA expression throughout the tunica adventitia. Arteries at day 1 and day 3 post-injury exhibited significantly higher immunofluorescence of α-SMA compared with non-injured arteries. Alpha-SMA expression began to decrease on day 7 and progressively declined on day 14. In contrast, immunofluorescent staining revealed that CREG was expressed in the adventitia of normal arteries. Expression of CREG in the adventitia of injured arteries was decreased on the 1st day, reached its lowest value on the 3rd day, and increased gradually from the 7th day, and was higher compared with that in non-injured arteries on the 14th day after injury. Similarly, the expression of CREG in AFs was very high, and AngⅡremarkably decreased mRNA and protein expression levels of CREG in a dose-dependent and time-dependent manner. Conclusions The changes in CREG expression correlate with AF phenotypic modulation, and CREG down-regulation may facilitate AF phenotypic switching into myofibroblasts (MFs).

Objective To explore the Influence of different health education approaches to standard anticoagulation of non-valvular atrial fibrillation. Methods 400 patients with NVAF were randomly divided into the research group (n=200) and the control group (n=200). Baseline clinical information was recorded. Both groups were given regular education and treatment. The control group was randomly divided into two subgroups. One subgroup (patients or/and family members) was given knowledge lectures of atrial fibrillation, atrial fibrillation anticoagulant, and application of warfarin. The other was given the knowledge through booklets. Standard anticoagulation fulfillment rate, ischemic stroke, other events of artery embolism, major bleeding, minor bleeding and death in the two groups were observed after 1 year. The cost for different education approaches was also compared between the 2 subgroups. Results (1)In the research group, standard anticoagulation fullfillment rate (40.53%) was higher than that of the control group(15.96%) (P<0.01). The rate of ischemic stroke (2.63%) was also lower than the control group (4.49%) (χ2=4.49, P<0.05). The death rate was lower in the research group than those in the control group, but minor bleeding rate was higher, without statistically significance (P>0.05).Other artery embolism rate , major bleeding, minor bleeding, death rate had no statistical difference. (2)Knowledge lecture group (10.8±1.0 min) spend more time than the booklet group (1.0±0.5 min) (P<0.01). The booklet group (5.1±1.1 yuan) costed more in terms of money than the knowledge lecture group (1.8±0.5 yuan) (P<0.01). (3)The knowledge lecture group showed higher standard anticoagulation fulfillment rate (47.96%) than that of booklet group (32.60%) (χ2=7.33, P<0.01). There was no statistical difference in ischemic stroke rate, other artery embolism rate, major bleeding rate, minor bleeding rate and the death rate. Conclusions Detailed, correct anticoagulant education and guidance can improve NVAF patients with standard anticoagulation, and reduce the risk of ischemic stroke. Knowledge lecture consumes more time but can improve the standard anticoagulation fulfillment rate.

Objective This study was conducted to investigate the clinical outcomes and safety of percutaneous coronary intervention (PCI) to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction. Methods Twenty-seven patients with severe left ventricular systolic dysfunction (ejection fraction≤35%) undergoing PCI were included. All the patients received PCI only to the single-opened vessel lesion under the conditions of: (1) There were limitations to open chronic total occlusion (CTO);(2) Single-opened vessel lesion was not calcified and tortuous. Clinical outcomes, including success rate of PCI, changes of symptoms in-hospital, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) pre-and one week post-PCI, the major adverse cardiac events (MACE, including death, myocardial infarction and target vessel revascularization) at 30-days after discharged were observed. Results The success rate of PCI was obtained in all 27 patients(100%), and all the patients received drug eluting stent implantation. The symptoms improvement occurred in all patients and the NYHA class improved from grade Ⅳto grade Ⅲin 22 patients(81.5%) in-hospital. Significant differences were noted in the mean BNP and LVEF between pre-PCI and one week post-PCI, BNP[(2699.6±1104.7) pg/ml vs. (737.0 ± 261.7) pg/ml, P<0.05],LVEF[(26.9±5.7)%vs. (36.0±3.41)%, P<0.05)]. No MACE happened in-hospital and at 30-days follow up. Conclusions PCI only to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction under the condition of limitations to open CTO is safe and can significantly improve clinical outcomes in-hospital and at 30-days follow up, but it must be emphasized that single-opened vessel lesion not with obvious calcification and tortuosity.

Objective To evaluate the effectiveness of combination technique in treating descending thoracic aortic dissection with coronary heart disease by endovascular graft exclusion (EVGE) and percutaneous coronary intervention(PCI). Methods From April, 2002 to October, 2013, a total of 40 in-hospital patients with descending thoracic aortic dissection and coronary heart disease who underwent EVGE and PCI were analyzed for outcomes. All patients were performed EVGE before they underwent PCI in 3~7days of time. Long-term treatment were observed. Results For dissection tears, 40 trunk tectorial membrane stents were used. The rate of success of EVGE implantation was 100%. No paraplegia, death and other complications. 59 stents were placed to 54 target vessels of 40 patients. The success rate of PCI procedure was 100%and no severe complication occurred. All patients were followed up for average 56±31 months. The rate of followed up was 92.5%(37/40). During follow-up, 3 patients died including two patients died of cerebral hemorrhage and one case of malignant tumor. The major adverse cardiac events (MACE) rate was 6.9% in the 29 cases of patients who underwent EVGE and PCI during the clinical follow-up. Conclusions It is safe and feasible that treating descending thoracic aortic dissection with coronary heart disease by combination technique of EVGE and PCI.

Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.

Objective To study the effects of endothelial nitric oxide synthase (eNOS) gene transfection on endothelial progenitor cells (EPCs) transplantation in the process of injured vascular endothelium repair. Methods EPCs were cultured and expanded in vitro. EPCs were transduced with pseudotyped retroviral vectors expressing eNOS gene (pMCV-eNOS-EPCs) or green fluorescent protein gene (pMCV-GFP-EPCs). EPCs with expressing eNOS, GFP or saline were injected respectively into rat injured artery model by tail vein injection after balloon injury and again 24 hours. 14 days after transplantation. eNOS expression in injured artery was detected by RT-PCR, western blot and immunohistochemical methods. The morphology of arterial intima and media was studied by optical microscopy and image analysis system. Results Compared with GFP-EPCs group and control group, the mRNA and protein of eNOS were obviously high expressed in eNOS-EPCs group. EPCs transplantation reduce lumen stenosis and inhibit neointimalhyperplasia (eNOS-EPCs group vs.control group, 0.58±0.05 vs. 1.56±0.21, P < 0.01;GFP-EPCs group vs. control group, 0.84±0.09 vs.1.56±0.21, P < 0.05). eNOS gene transfection could further enhance this anti-proliferative effects (eNOS-EPCs group vs. GFP-EPCsgroup,0.58±0.05 vs. 0.84±0.09, P < 0.05). Furthermore, eNOS modified EPCs could improve the endothelial function of injured vascular endothelium. Conclusions eNOS gene transfection could increase the anti-proliferative effect of EPCs transplantation on injured artery and obviously ameliorate endothelial function.