Objective To verify the safety and efficacy of percutaneous coronary intervention of Type Ⅳ bifurcation lesion of left main by using a left main bifurcation strategy and crush stenting technique with domestic drug-eluting stents(DES).Methods The study population consisted of patients with isolated unprotected ostial stenosis of the left anterior descending(LAD)or circumflex(LCX)artery.Sequential steps of crush stent deployment and post-dilation were undertaken followed by a modified crush stenting technique with domestic DES.Clinical and angiographic follow up was obtained to assess the primary endpoint of death,non-fatal myocardial infarction(MI)or target lesion revascularization(TLR).Results Twenty-nine patients(21 males,8 females)with a mean age of 62.57?14.21 years were evaluated.All patients were successfully treated using crush stenting technique with which final kissing balloon inflations were performed.The radial approach was utilized in 44.8% of the procedures.The mean procedural time was 36.2?9.4 minutes while the mean fluoroscopic time was 18.3?3.5 minutes.LAD ostial lesion was found in 58.6% of the patients.Predilatation with balloon angioplasty was performed in 44.8% of the patients.Partner stents and Excel stents were used in 79.3% and 20.7% of the patients respectively.The average stent diameter was 3.76 mm and the average stent length was 18.19 mm of main branch.GP IIb/IIIa inhibitors were used in 6(20.7%)patients.Angiographic results from Quantitative coronary angiographic(QCA)data showed mean target lesion length was of 13.20?4.71 mm and the baseline ostial stenosis was 78.4%.Follow-up angiography at a mean interval of 11.5?2.7 months revealed late lumen loss of 0.06?0.10 mm and 0.21?0.12 mm in the main branch and in the side branch,respectively.Binary restenosis did not occur within the main branch and side branch stents.Clinical follow up was available in all patients with mean duration of 14.2?5.2 months.No cardiac death,non-fatal MI occurred and no TLR needed during the followup of all patients.Conclusion The application of modified crush stenting technique and final kissing balloon inflations with domestic DES may be a reasonable option for the treatment of Type Ⅳ bifurcation lesion of left main.

Objective: To observe influence of different risk factors on prognosis of patients with coronary heart disease (CHD) and normal myocardial perfusion imaging outcome.Methods: A total of 99 CHD patients with normal myocardial perfusion imaging outcome were selected.Left ventricular function indexes were measured by gated resting myocardial imaging in resting and stress state.All patients received telephone follow-up until natural death (died of other causes) or fatal or non-fatal heart attacks, or the termination of the experiment after 45 months.Cox proportion risk regression model was used to analyze risk factors of fatal and non-fatal heart attacks.Results: A total of 15 cases died during the 45-month follow-up.Mean all-cause mortality per year was 5.05%.Fatal heart attacks occurred in nine cases (9.09%), and non-fatal heart attacks occurred in 21 cases (21.21%).Cox proportion risk regression analysis indicated that smoking and left ventricular ejection fraction (LVEF) <50% were risk factors for fatal heart attacks (HR=4.887, 3.365, P=0.043, 0.002), while diabetes mellitus, dyslipidemia, smoking and LVEF<50% were risk factors for non-fatal heart attacks (HR=2.215~4.544, P<0.05 all).Conclusion: Incidence rate of cardiovascular events is higher in CHD patients with normal myocardial perfusion imaging.Smoking and impaired heart function suggest poor prognosis in these patients.

ObjectiveTo prepare paclitaxel-loaded nanoparticles (NPs),and to observe drug biodistribution after intravascular infusion of the NPs using a DispatchTM catheter into New Zealand rabbit abdominal aorta models.Methods Paclitaxel-loaded NPs were prepared by ultrasonication/emulsificcation/solvent evaporation technique using biodegradable poly (lactic-co-glycolic acid)(PLGA) as drug carrier.NP size and morphology was assessed by submicro-laser defractometer and scanning electron microscopy.In vitro release of paclitaxel from the NPs was performed by shaking in PBS at 37℃.The NPs was delivered into New Zealand rabbit abdominal aorta using a DispatchTM catheter.ResultsThe diameter of paclitaxel NPs was around 246 nm with very narrow size distribution.The NPs showed good spherical shape with smooth uniform surface.Paclitaxel loading in the NPs was about 19.06％ with encapsulation efficiency about 93.25％.The NPs maintained a sustained in vitro drug release for 30 days in PBS.After in vivo NP infusion,paclitaxel was detected in the vascular tissue around the infusion site and it retained in the site for 21 days.ConclusionPLGA nanoparticles as local drug delivery carrier showed great potential to maintain a high local drug concentration and prolonged drug resident time in animal model in vivo.

Objective To investigate the value of double-balloon endoscopy (DBE) and multi-slice CT enteroclysis (MSCTE) in diagnosis of Crohn's disease (CD) in small intestine. Methods DBE and MSCTE were performed in 71 patients with suspected Crohn's disease in small intestine. The two methods were compared in terms of diagnosis, extents of disease, existance of complications and activity of the disease according to the pathologic findings and the outcome of follow-up. Results The diagnostic yields of DBE and MSCTE were comparable with no significant difference (χ2=2.29, P> 0.05). The positive and negative likelihood ratios were 22.5 and 0. 022 in DBE respectively, and were 1.6 and 0. 240 in MSCTE respectively. The results of DBE was consistent with MSCTE in diagnosis of mild bowel stenosis, but was inconsistent with MSCTE in diagnosis of moderate-severe bowel stenosis (χ2=11.298, P=0.001). The concordance of two methods in diagnosis of disease activity was 95.8%. Conclusions The first choice in diagnosis of small bowel CD is DBE. The combination of two methods will be helpful in diagnosis and evaluation of CD severity.

Objective:To observe the relationship between dynamic blood pressure variability (BPV) and left ventric‐ular diastolic function in patients with essential hypertension (EH) .Methods :A total of 140 newly diagnosed EH pa‐tients were selected .According to total coefficient of variation (CV) of 24h systolic blood pressure BPV ,they were divided into high CV group (n=70 ,CV>12.16% ) and low CV group (n=70 ,CV≤12.16% ) .Another 70 healthy subjects with corresponding gender and age were enrolled as healthy control group simultaneously .Echocardiography was used to measure mitral early diastolic peak flow velocity (E) ,late diastolic peak flow velocity (A) and decelera‐tion time of E peak (DT);meanwhile ,tissue Doppler mode was used to record early diastolic peak velocity (Em) and late diastolic peak velocity (Am) .All above indexes were compared among all groups .Results:Compared with healthy control group ,BPV significantly rose in EH patients (P<0.05 or < 0.01) .All BPV indexes in high CV group were significantly higher than those of low CV group except daytime mean diastolic blood pressure variability (dDBP‐BPV) and nighttime mean diastolic blood pressure variability (nDBP‐BPV) , P<0.05 all .Compared with healthy control group ,there were significant reductions in E and Em/Am ,and significant rise in DT and E/Em in EH patients ,P<0.05 or <0.01 ;compared with low CV group ,there was significant rise in E/Em [(10.32 ± 3.20) vs .(14.22 ± 2.20) ,P=0.033] in high CV group .Conclusion:Left ventricular diastolic dysfunction is more severe in hypertensive patients with higher dynamic blood pressure variability .

ObjectiveTo investigate the clinical features of patients with Caroli disease. MethodsThe clinical data were collected from 41 patients who were diagnosed with Caroli disease in The Fifth Medical Center of Chinese PLA General Hospital from April 2015 to January 2020, and the patients were divided into type I group with 16 patients and type Ⅱ group with 25 patients. A retrospective analysis was performed for general information, laboratory markers, and clinical features. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data; a Spearman correlation analysis was also performed. ResultsThe type Ⅰ group had a significantly higher level of albumin (Alb) than the type Ⅱ group (t=0.976, P=0.048), and the type Ⅱ group had a significantly higher prothrombin time (PT) than the type I group (Z=3.115, P=0.001). Compared with the type I group, the type Ⅱ group had significantly higher incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (χ2=6.077, 5.468, and 2.403, P=0.002, 0.019, and 0.028). In the patients with type Ⅱ Caroli disease, the level of cholinesterase was negatively correlated with the incidence rates of esophageal and gastric varices and portal hypertension (r=-0.468 and -0.436, P=0.018 and 0.029); Alb level was negatively correlated with the incidence rate of esophageal and gastric varices (r=-0.561, P=0.004); red blood cell count was negatively correlated with the incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (r=-0.662, -0.566, and -0.436, P＜0.001, P=0.003, and P=0.029); hemoglobin count was negatively correlated with the incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (r=-0.605, -0.590, and -0.510, P=0.001, 0.002, and 0.009); PT was positively correlated with the incidence rates of esophageal varices and portal hypertension (r=0.488 and 0.520, P=0.013 and 0.008). ConclusionCompared with the patients with type I Caroli disease, the patients with type Ⅱ Caroli disease have a higher incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension, with the changes in clinical indicators such as the decrease of Alb level and the increase of PT level, and they tend to have poor prognosis.

ObjectiveTo investigate the features and changing trend of drug-induced liver injury (DILI) in the elderly from 2009 to 2019, and to provide a reference for clinical prevention and treatment of DILI in the elderly. MethodsA retrospective analysis was performed for the clinical data of 2107 elderly patients, aged ≥60 years, who were diagnosed with DILI in The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2019, and they were divided into groups according to age. Related clinical data were analyzed, including age, sex, clinical features, prognosis, and regional distribution. The Chi-square test was used for comparison of categorical data between groups. ResultsAmong the 2107 patients with DILI, there were 802 male patients and 1305 female patients, with a male/female ratio of 1∶1.63. Cholestasis type was the most common clinical type and was observed in 1439 patients (68.3%). There was the highest number of patients in the 60-64 years group (942 patients, 44.7%), among whom 618(65.6%) were female, 589(62.5%) had cholestasis type, 471(50.0%) had chronic DILI, 421(44.7%) had drug-induced liver cirrhosis, and 25(2.7%) had drug-induced liver failure. There were 187 patients in the 75-79 years group, among whom 110 (58.8%) patients were male, 137(73.3%) had cholestasis type, 114(60.9%) had liver cirrhosis, 4(2.1%) had drug-induced liver failure. The results showed that chronic DILI was more common in the 60-64 years group, and liver cirrhosis was more common in the 75-79 years group. As for prognosis, in the 60-64 years group, 27 patients (2.9%) were cured, 885 (93.9%) were improved, 30(32%) had no response or died; in the 65-69 years group, 16 (2.8%) were cured, 528 (92.0%) were improved, and 30(5.2%) had no response or died; in the 70-74 years group, 9(2.8%) were cured, 305(94.1%) were improved, and 10 (3.6%) had no response or died. The results showed that there was no significant difference in mortality rate between the different age groups (P＞0.05). The proportion of elderly DILI patients among hospitalized DILI patients increased from 15.90% in 2009 to 22.05% in 2013 and 27.51% in 2019, with a 1.73-fold increase in 11 years. As for regional distribution, the patients in North China accounted for the highest proportion of 47.08% (the patients from Hebei, Shanxi, and Inner Mongolia accounted for 24.92%, 10.96%, and 10.25%, respectively), followed by those in Northeast China who accounted for 17.85%. The patients in Beijing accounted for 11.53%. ConclusionThe proportion of elderly DILI patients among hospitalized DILI patients tends to increase in these years. Cholestasis type is the most common clinical type, and most of the patients with this clinical type progress to chronic DILI and drug-induced liver cirrhosis. Early diagnosis, early intervention, and standardized treatment of elderly DILI should be taken seriously.