With improvement in stent designs, the practice of direct stenting (DS) without balloon predilation has become more widespread. DS may allow partial retention of endothelium within treated arteries, and associate with decreased utilization of contrast agent, number of catheter, exposure of X-ray,and expense. This paper evaluate the experiment base, principle, indication, contraindication, skills, complications as well as the result of acute and chronic follow up of DS.

Objective To compare the efficacy of different does of remifenanil combined with propofol for colonoscopy.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 35-63 yr,weighing 45-72 kg,scheduled for elective painless outpatient colonoscopy,were randomly divided into 3 groups (n =30 each):remifentanil 0.2 μg/kg group (group Ⅰ),remifentanil 0.5 μg/kg group (group lⅡ) and remifentanil 1.0 μg/kg group (group Ⅲ).In groups Ⅰ-Ⅲ,remifentanil 0.2,0.5 and 1.0μg/kg were injected over 60 s,respectively,and then propofol 1.0 mg/kg was injected intravenously for induction.The colonoscope was inserted after loss of eyelash reflex.When body movement appeared during examination,remifentanil 0.1 μg/kg + propofol 0.5 mg/kg,remifentanil 0.25 μg/kg + propofol 0.5 mg/kg,and remifentanil 0.5μg/kg+ propofol 0.5 mg/kg were added in groups Ⅰ,Ⅱ and Ⅲ,respectively.The operation time,induction time,emergence time,examination room discharge time,and body movement,hypotension,bradycardia,hypoxemia and respiratory depression during operation were recorded.Results There was no significant difference in the operation time,induction time,emergence time,and examination room discharge time between the three groups (P ＞ 0.05).Compared with group Ⅰ,the incidence of body movement was significantly decreased,and the incidences of hypotension and respiratory depression were increased in group Ⅱ,and the incidence of body movement was significantly decreased,and the incidences of hypotension,hypoxemia,bradycardia and respiratory depression were increased in group Ⅲ (P ＜ 0.05).The incidences of hypoxemia,bradycardia and respiratory depression were significantly higher in group Ⅲ than in group Ⅱ (P ＜0.05).Conclusion The optimum dose of remifentanil is 0.5 μg/kg when combined with propofol for colonoscopy.

Objective To study the expression of hypoxia inducible factor-lalpha (HIF-1α) and eyclooxygenase-2 (COX-2) in gastric carcinoma and its correlation with lymph node metastasis and microvascular density (MVD). -Methods HIF-1α and COX-2 expression were detected by immunohistochemistry in 64 cases of gastric carcinoma and 15 cases of normal gastric mucosa tissues, MVD of the section marked with CD34 antibody was calculated. Results The positive rates of HIF-1α and COX-2 in 64 cases of gastric carcinoma were 67.19% and 78.13% respectively. The expressions of HIF-1α and COX-2 were significantly higher in gastric carcinoma than in normal gastric mucosa tissue(P < 0.05). The expressions of HIF-1α and COX-2 in gastric carcinoma were significantly associated with TNM stage, invasive depth and lymph node metastasis (P< 0.05) except for patient's age, sex and tumor grade.There were positive correlation between HIF-1α expression with COX-2 (rs=0.584, P<0.01). The MVD of cases with positive HIF-1α expression(36.78±10.46) was significantly higher than those without HIF-1α expression(17.92±3.71), the MVD of cases with positive COX-2 expression(37.59±10.75) was also higher than those without COX-2 expression (18.43±4.15). The expression of HIF-1α and COX-2 was associated with MVD(rs=0.624, 0.697, P<0.01). Conclusion HIF-1α and COX-2 play important roles in the pathway of carcinogenesis and progression of gastric carcinoma, and they may contribute to tumor angiogenesis through the same way, thus combined detection of HIF-1α and COX-2 may be recommended for diagnosis of gastric cancer and estimation of prognosis.

Objective To evaluate the feasibility and safety of ultrasound-localized percutaneous thrombin injection (ULTI) for the treatment of iatrogenic femoral pseudoaneurysm. Methods From January 2000 through October 2001, 5 patients (3 males, 2 females, age range 38～72 years) were found to have a pseudoaneurysm confirmed by ultrasound between 1 and 3 days following femoral arterial puncture. Two patients were associated with diagnostic arteriography and 3 with stent implantation. ULTI was our first choice for the treatment of ablating femoral pseudoaneurysm. All patients following ULTI were restudied within 24 hours. Results All 5 patients were initially treated with ULTI. Thrombin was injected directly into the pseudoaneurysm with a dose of 500 units over several seconds, successful ablation was visualized immediately in 4 patients, the remaining 1 patient needed ultrasound-guided compression treatment of five minutes. Follow-up at the 24th hour showed no recurrent pseudoaneurysm after initial successful ablation in any case. No distal embolization or allergic reaction occurred. Conclusion ULTI is a safe, rapid, well-tolerated, inexpensive and effective noninvasive method for the treatment of iatrogenic femoral pseudoaneurysm and should be considered as first-line therapy.

Objective To evaluate the outcome of percutaneous intervention for the diseased bypass grafts in patients with previous coronary artery bypass graft surgery (CABG).Methods Sixty-six patients with diseased grafts after CABG underwent percutaneous intervention between July 2003 and July 2004.Angiographic follow up was suggested to all patients and major adverse cardiac events(MACE,including death,acute myocardial infarction and target lesion revascularization)were recorded within 6 months of follow up.Results Sixty-six patients with 74 diseased grafts(83 lesions) underwent percutaneous intervention.The angiographic success rate was 96.97%((64/66)) and the procedural success rate was 95.45%(63/66).No reflow phenomenon occurred in 2 cases,1 case restored TIMI 3 flow after administering verpamil but the other patient failed to restore the blood flow. Distal embolization occurred in 1 case.Abrupt closure in 1 case because of Dtype dissection not treated during the procedure but TIMI 3 flow was obtained after repairment with another stent.No MACE(death,acute myocardial infarction and acute emergency revascularization) occurred during hospitalization and the incidence of MACE was 31.3%(20/64) at 6 months follow up.In-segment restenosis rate was 32.5%(13/40) in 37 patients with angiographic follow-up.Conclusion Percutaneous intervention for diseased bypass grafts is feasible,safe and effective.

Objective To evaluate the ischemic postconditioning on endoplasmic reticulum stress during cerebral ischemia/reperfusion (I/R) in rats.Methods Ninety adult male Sprague-Dawley rats,aged 350-450 g,were randomly divided into 3 groups (n =30 each) using a random number table:sham operation group (S group),I/R group,and ischemic postconditioning group (group P).Focal cerebral I/R was induced by electrocoagulation of left middle cerebral artery and 30 min occlusion of bilateral common carotid arteries followed by reperfusion.In group P,bilateral common carotid arteries were subjected to 3 cycles of 30 s reperfusion and 10 s ischemia at the beginning of reperfusion.At 24 h of reperfusion,neurological deficit was scored,and cerebral infarct size was detected by TTC staining.At 6,12 and 24 h of reperfusion,the expression of glucose-regulated protein 78 (GRP78),C/EBP homologous protein (CHOP) and caspase-12 in the ischemic area were measured (using immunohistochemistry).The neuronal apoptosis in the ischemic area was detected by TUNEL.Results Compared with S group,the neurological deficit score was significantly increased,cerebral infarct size was enlarged,the neuronal apoptosis was increased,and the expression of GRP78,CHOP and caspase-12 was up-regulated in I/R and P groups.The neurological deficit score was significantly lower,cerebral infarct size was smaller,the expression of GRP78 was higher at 12 and 24 h of reperfusion,the neuronal apoptosis was lower at 24 h of reperfusion,and the expression of CHOP and caspase-12 was lower in group P than in group I/R.Concluion Ischemic postconditioning can inhibit neuronal apoptosis mediated by endoplasmic reticulum stress during cerebral I/R,which dose not play a leading role in cerebral protection in rats.

AIM:To investigate the influencing factors of abnormal telangiectasia secondary to diabetic retinopathy(DR).METHODS: Prospective studies. A total of 153 cases(240 eyes)with DR treated in our hospital from January 2021 to January 2023 were selected to analyze the risk factors of abnormal telangiectasia secondary to DR and its predictive efficacy.RESULTS: The patients were divided into dilated group(77 eyes of 40 cases)and non-dilated group(163 eyes of 113 cases)according to whether they had secondary abnormal telangiectasia. There were significant differences in diabetic macular edema, hard exudates grade and fasting blood glucose level between the two groups(P<0.05). Logistic regression analysis showed that diabetic macular edema, high hard exudates grade and high blood glucose level were the risk factors for abnormal telangiectasia secondary to DR(P<0.05).CONCLUSION: The occurrence of telangiectasia secondary to DR may be related to diabetic macular edema, grade 3 hard exudates and high blood glucose level.

Objective To observe the clinical results of bronchial artery infusion(BAI) combine with radiotherapy for non-small cell lung cancer(NSCLC)in inoperable.Methods There were 26 cases with NSCLE in this group,BAI chemotherapy was performed first followed by radiotherapy,after half of the radiotherapy quantity(40 Gry),BAI chemotherapy was given again at last,these patients were treated by the remainder radiotherapeutic quantity total radiotherapy quantity was 60 Gry.DDP 80～120 mg,ADM 40～80 mg,VP-16 200～400 mg and HCPT 20～40 mg were used for chemotherapy.Results Short-term results in this group were:complete response(CR) in 9 cases,partial response(PR)in 14 cases,total efficiency rate was 88.5%.Conclusion Bronchial artery infusion combine with radiotherapy is an effective method to treat non-small cell lung cancer in inoperable.

BACKGROUND:Drug eluting stents(DESs)has been applied in treatment of saphenous vein grafts,but few reports are present.OBJECTIVE:To retrospectively compare the late loss and major adverse cardiac events(MACE)between DES and bare mental stents(BMS)in patients with diseased saphenous vein grafts.DESIGN,TIME AND SETTING:The experiment,a grouping control study and follow-up observation,was performed from January 2002 to February 2007 in Beijing Luhe Hospitat and Beijing Anzhen Hospital.PARTICIPANTS:Ninety-seven consecutive patients with saphenous vein graft lesions were treated with DESs (DESgroup.n=50)or BMSs(BMS group,n=47).METHODS:All patients underwent percutaneous coronary implantation and received clinical follow-ups immediately.They were scheduled to undergo 12-month coronary angiography.MAIN OUTCOME MEASURES:The cardiac events including death,myocardial infarction,target lesion and/or target vessel revascularization.Late lumen loss was recorded and compared between the two groups.RESULTS:There were no significant differences on the gender,age,history of bridge vessels and complication between the two groups(P>0.05).A total of 97 patients with 118 lesions localized in 105 diseased saphenous vein grafts were included:50 patients received 71 DESs for 59 lesions,whereas 47 patients received 62 BMSs for 59 lesions.Procedural success was achieved in 94.0%of patients in the DES group and 93.6%in BMS group(P=0.43).At 12 months,the cumulative incidence of MACE was significantly lower in DES group than in BMS group(1 2.0%vs.29.8%.P=0.03).Angiographic follow-up was available for 54 patients,26 patients in DES group and 28 in BMS group.Late lumen loss was significantly reduced in DES group[(0.32±0.65)mm vs.(0.79±1.23)mm,P=0.01].The DES group had a significantly lower incidence of target lesion revascularization compared with BMS group(6.0%vs.19.1%.P=0.05).By Cox regression analysis,independent predictors for MACE at 12-month follow-ups were diabetes (OR:2.37;CI:0.95 to 5.88;P=0.064),BMS(OR:2.86;CI:0.98 to 8.34;P=0.05),and stent per lesion(OR:2.92;CI:1.25 to 6.82;P=0.01).CONCLUSION:DES is superior to BMS in diseased saphenous vein grafts,and it can significantly reduce late lumen loss and MACE.

Objective To evaluate the effect of early intracoronary injection of tirofiban via aspiration catheter on myocardial no-reflow in elderly patients with acute ST-segment elevation myocardial infarction (STEMI).Methods 120 consecutive patients over 65 years old with AMI undergoing primary percutaneous coronary intervention (PCI) were randomized into two groups.In tirofiban group (n=60),thrombus aspiration and intracoronary tirofiban bolus (10 μg/kg prior to the first balloon inflation) via aspiration catheter were performed.In control group (n=60),thrombus aspiration was followed by primary PCI.The incidence of no-reflow and bleeding were assessed in the two groups.Results The moderate to severe bleeding (TIMI bleeding criteria) did not occur in the two groups,there's no significant difference between two groups in the incidence of minor bleeding [26.7％(16 cases) vs.21.7％ (13 cases),x2 =0.19,P=0.522].The incidence of myocardial noreflow was significantly lower in tirofiban group than in the control group [10.0％ (6/60) vs.25.0％ (15/60),x2 =4.68,P=0.031].Conclusions The intracoronary injection of tirofiban via aspiration catheter may significantly reduce the incidence of myocardial no-reflow in patients with STEMI without increasing bleeding complications.