Objective:To study and compare coronary lesion by angiography between Chinese and Australian. Methods:3 021 Chinese patients from Nanjing and 3 230 Australian patients from Sydney,whom were suspected to have coronary heart disease(CHD),were included for coronary angiography.The coronary lesion was evaluated by the number and location of coronary lesion. Results:① 69.4% patients were diagnosed with CHD in Chinese,and 75.5% in Australian(P

Objective To evaluate the feasibility, safety and effectiveness of interventional occlusion with thin waist occluder for perimembranous ventricular septal defect with pseudoaneurysm. Methods During the period from March 2008 to March 2013 at Shanghai Yodak Cardiothoracic Hospital , interventional occlusion with thin waist occluder was carried out in a total of 96 patients with perimembranous ventricular septal defect (VSD) complicated by pseudoaneurysm. The patient’s age varied from 2 years to 36 years. Before the procedure, routine left ventricular angiography and ascending aortic angiography were carried out. Left ventricular angiography and ascending aortic angiography as well as the transthoracic ultrasonography were performed immediately after the procedure to observe the therapeutic results. Follow-up checkups with transthoracic ultrasonography, EKG and chest X-ray film were conducted at one week as well as at one, 3, 6 and 9 months after the surgery were conducted. Results Successful occlusion of VSD was obtained in 93 patients, with a success rate of 96.8% (93/96). After the surgery, small amount of shunt flow was detected in 8 patients, which disappeared within 48 hours in 7 patients, and in the other one the shunt flow disappeared one month later which was confirmed by follow-up examination. After the treatment, complete right bundle branch block occurred in 4 patients, complete left bundle branch block in 5 patients, and transientⅢdegree atrioventricular block in one patient. The conduction block disappeared at the time of discharge in all patients. The left ventricular end-diastolic diameter (LVEDD) decreased from preoperative (47.5 ± 5.2) mm to postoperative (45.2 ± 5.1) mm, the difference was statistically significant (t = 18.33, P < 0.01). During the follow-up period lasting for 9 months, no delayed cardiac arrhythmia, valve damage or sudden death occurred. Conclusion For the treatment of perimembranous ventricular septal defect with pseudoaneurysm, interventional occlusion with thin waist occluder is safe and effective with excellent mid-term effect. Based on the imaging findings, including the location, shape, ruptured orifice, number of the perimembranous pseudoaneurysm as well as the distance between the pseudoaneurysm and the aortic valve, to select suitable occluder and proper occlusion site is the key to ensure a successful surgery.

From August 2006 to June 2011 among consecutive 18 294 patients underwent thoracic surgery from Shanghai Chest Hospital,41 developed adverse events during peri-anesthesia period and the incidence was 0.224％,and the constituent ratios of the predictable and unpredictable events were 15％ and 85％,respectively.Cardiac arrest and massive hemorrhage were the main clinical manifestation of the adverse events and the constituent ratios were 37％ and 24％,respectively.Among the inducements for adverse events,patient's factor,surgical factor,anesthesia factor,patient-surgery factor,patient-anesthesia factor and patient-surgery-anesthesia factor accounted for 12.2％,48.8％,12.2％,7.3％,7.3％ and 12.2％,respectively.The ratio of death from adverse events was 17％ (7 cases),and among the inducements for adverse events causing death,surgical factor,patient-surgery factor and patient-surgery-anesthesia factor accounted for 43％,43％ and 14％,respectively.The incidence of adverse events was 1.093％ in the patients underwent operation on trachea,which was significantly higher than that in the patients underwent operation on lung (0.223％),mediastinum (0.236％) and esophagus (0.194％).In conclusion,although the adverse events which occurred during peri-anesthesia period in the patients underwent thoracic surgery were rare,they threatened the safety of patients.Surgical factor was not only the main inducement,but also the risk factor for death,and cardiac arrest and massive hemorrhage were the main clinical manifestation of the surgery-related adverse events.For cardiac arrest,as long as it was found in time and treated appropriately,the serious consequences could be avoided.For massive hemorrhage,more attention should be paid due to be the main reason of death,and the prevention depended on the surgeon's improvement of diagnosis and surgery.It was difficult to predict patient-related the adverse events and careful monitoring was required.For the anesthesia-related adverse events,they were mostly due to the poor airway management,so preoperative airway assessment should be strengthened.

Objective To explore the plasma expressions of monocyte chemotaxis proteins(MCPs) in patients with type A aortic dissection and their clinical significance.Methods 51 patients with type A aortic dissection were enrolled,in which 29 combined with hypertension.Fourteen hypertension patients and 1 1 hcalthy subjects were enrolled as control.Plasma samples were collected and we examined the levels of MCP-1,MCP-2 and MCP-4 by enzyme linked immunosorbent assay (ELISA).Results Plasma levels of MCP-1 and MCP-2 significantly decreased in patients with type A aortic dissection compared to healthy subjects(P ＜0.001),while MCP-4 had no change.Type A aortic dissection patients with or without hypertension both showed significant decreased plasma MCP-1 and MCP-2 levels compared to hypertension patients(P ＜0.001).There was no change of MCP-4 among different groups.Furthermore,Spearman correlation analysis showed that there was no correlation between serum CRP levels and plasma MCP-1,MCP-2 concentrations.Conclusion Plasma MCP-1 and MCP-2 may participate in the pathogenesis of type A aortic dissection,and their concentrations were not correlated with hypertension or serum CRP levels.The detailed mechanism needs further observations.

Objective To analyze the clinical significance of four kinds of microalbuminuria detection in early diagnosis of iodinated contrast agent damage to kidney by studying four elements in the patients' urine:microalbumin (mAlb),immunoglobulin G (IgG),α1-microglobulin (α1-MG) and β2-microglobulin (β2-MG).Methods 106 patients who have received percutaneous coronary interventional therapy were chosen and divided into group A(angiography dose ＜ 100ml,n =51) and group B (angiography dose ≥ 100ml,n =55) according to the amount of contrast agent used.Changes in the amount of mAlb,IgG,α1-MG and β2-MG levels,serum creatinine(Scr),endogenous creatinine clearance rate(eGFR) in the urine of the patients before and after the surgery were observed.Results Postoperative α1-MG and β2-MG levels in the urine of group A higher than before surgery (t =-6.748,-11.173,all P ＜0.0 5).2 4 hours after the surgery,mA1b,IgG,α1-MG and β2-MG levels in group B were elevated than before surgery,and the differences were significant(t =-6.223,-3.518,-11.532,-10.773,all P ＜ 0.05).Two groups had significant differences in terms of mAlb,IgG,α1-MG and β2-MG levels after the surgery (F =27.306,4.704,5.118,19.011,all P ＜ 0.05).Conclusion Four kinds of microalbuminuria detecting are conducive to early diagnosis of iodinated contrast agent damage to kidney and assessing the damage degree.The contrast agent damage to kidney first occurs as the renal tubular damage.When the contrast agent was used at a dosage of more than 100ml,glomerular damage occurred.

This study was aimed to investigate the blood-enriching effect of processed Radix Polygoni Multiflori on blood deficiency rats. A total of 140 SD rats were randomly divided into 14 groups, which were the blank control group, blood deficiency model group, positive control group and 11 test groups. The blank control group and model control group were treated with distilled water and the positive control group was given X ue b ao Buxue soluble granules. The test groups were treated with 11 different kinds of processed Radix Polygoni Multiflori sam-ples at a dosage of 2 g?kg-1 respectively. All rats were given drugs once a day. After 10 days, blood samples were collected and the amount of red blood cell (RBC), hemoglobin (Hb), haematocrit (HCT), whole blood viscos-ity and plasma viscosity, prothrombin time were estimated. The results showed that 9 processed Radix Polygoni Multiflori groups can increase the number of RBC and Hb significantly ( P < 0 . 05 or P < 0 . 01 ) in blood deficien-cy rat models. They were the sample processed with decoction of black soybean (DBS) for 24 h, with wine and DBS combination for 24 h , steamed for 4 h and 8 h under high pressure , with DBS for 6 h and 8 h , with wine for 6 h, with wine and DBS combination under high pressure, respectively. The samples processed with DBS un-der high pressure for 8 h increased RBC and Hb were more obviously ( P < 0 . 01 ) . The 8 groups can improve the situation of functional disorder of blood rheology significantly ( P < 0 . 05 or P < 0 . 01 ) . They were the unprocessed samples, processed with DBS and wine for 24 h respectively, with DBS and wine combination for 24 h, steamed for 4 h and 8 h or steamed with DBS for 6 h and 8 h or with wine for 6 h under high pressure respectively. It was concluded that the blood-enriching effect was improved while the R adix Polygoni Multiflori was processed with DBS or wine and under high pressure for 6-8 h .

Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

Objective: To estimate the prevalence and the risk factors of preoperative coronary angiography (CAG) confirmed coronary stenosis in patients with degenerative valvular heart disease. Methods: A total of 491 patients who underwent screening CAG before valvular surgery due to degenerative valvular heart disease were enrolled from January 2011 to September 2014 in our hospital, and clinical data were analyzed. According to CAG results, patients were divided into positive CAG result (PCAG) group or negative CAG (NCAG) group. Positive CAG result was defined as stenosis ≥50% of the diameter of the left main coronary artery or stenosis ≥70% of the diameter of left anterior descending, left circumflex artery, and right coronary artery.Risk factors of positive CAG result were analyzed by multivariable logistic regression analysis, and Bootstrap method was used to verify the results. Results: There were 47(9.57%)degenerative valvular heart disease patients with PCAG. Patients were older ((68.0±7.6)years vs.(62.6±7.1)years, P<0.001) and the prevalence of typical angina was significantly higher (14.89%(7/47)vs. 2.03%(9/444), P<0.001)in PCAG group than in NCAG group. Multivariable logistic regression analysis showed that age (OR=1.118, 95%CI 1.067-1.172, P<0.001), typical angina (OR=8.970, 95%CI 2.963-27.154, P<0.001), and serum concentration of apolipoprotein B (OR=20.311, 95%CI 4.774-86.416, P<0.001) were the independent risk factors of PCAG in degenerative valvular heart disease patients. Bootstrap method revealed satisfactory repeatability of multivariable logistic regression analysis results (age: OR=1.118, 95%CI 1.068-1.178, P=0.001; typical angina: OR=8.970, 95%CI 2.338-35.891, P=0.001; serum concentration of apolipoprotein B: OR=20.311, 95%CI 4.639-91.977, P=0.001). Conclusions A low prevalence of PCAG before valvular surgery is observed in degenerative valvular heart disease patients in this patient cohort. Age, typical angina, and serum concentration of apolipoprotein B are independent risk factors of PCAG in this patient cohort.

Objective: To explore the plasma chemokines expressions and related clinical implication in patients with Stanford type A aortic dissection (AD). Methods: We retrospectively analyzed the data of 65 patients with Stanford type A aortic dissection, hypertensive patients and 11 healthy subjects admitted in our department from October 2013 to December 2014, they were divided into four groups: NH-CON group (11 healthy subjects), H-AD group (29 AD patients with hypertension), NH-AD group (21 AD patients without hypertension), and H-CON group (14 hypertension patients). Four plasma samples from AD patients and 4 plasma samples from healthy subjects were collected randomly with random numbers table, and the levels of different chemokines were examined by protein array analysis. Then, plasma levels of chemokines including macrophage inflammatory protein 1β(MIP-1β), epithelial neutrophil activating peptide 78(ENA-78), interleukin 16(IL-16), interferon inducible protein 10(IP-10) and FMS-like tyrosine kinase 3(Flt-3) ligand were analyzed by luminex. Pearson analysis was used to determine the correlations between the chemokines and serum C reactive protein (CRP) levels. Results: Plasma levels of MIP-1β(34.0(29.3, 47.2) ng/L vs. 51.0(28.2, 80.7) ng/L, P<0.05) and ENA-78(110.5(59.1, 161.4) ng/L vs. 475.7(299.3, 837.3) ng/L, P<0.05) were significantly lower in H-AD group, while plasma IL-16 level was significantly higher in H-AD group(54.7(16.3, 187.8) ng/L vs. 17.5(11.9, 20.8) ng/L, P<0.05) than in H-CON group. Plasma levels of MIP-1β(48.3(26.4, 62.1) ng/L, P<0.05) were significantly lower in H-AD patients than in NH-AD patients. Plasma level of ENA-78 was significantly lower in NH-AD group than in NH-CON group (95.0(58.0, 155.0) ng/L vs. 257.7(85.2, 397.8) ng/L, P<0.05). The levels of IP-10 and Flt-3 ligand were similar among the 4 groups (all P>0.05). Pearson analysis showed that there were no correlation between MIP-1β(r²=0.01, P>0.05), ENA-78(r²=0.02, P>0.05), IL-16(r²=0.02, P>0.05), IP-10(r²=0.00, P>0.05), Flt-3 ligand(r²=0.02, P>0.05) and CRP levels in patients with Stanford type A aortic dissection. Conclusions Lower plasma levels of MIP-1β and ENA-78 and higher plasma levels of IL-16 may associate with the occurrence and development of type A aortic dissection, but their concentrations are not correlated with serum CRP levels. There is no significant change on plasma levels of IP-10 and Flt-3 in the Stanford type A aortic dissection patients.