BACKGROUND: Vascular complications usually occur in diseases related to obesity such as primary hypertension or diabetes. Treating obesity with the method of promoting blood circulation to remove blood stasis gains a curative effect, so we presume that obesity may be correlated to blood stasis syndrome.OBJECTIVE: Analyzing the relationship between leptin(Lep) and insulinmetabolism of sugar and fat,endothelin(ET),blood pressure,body mass index(BMI), etc. Comparison of the differences in Lep and BMI between the blood stasis syndrome group and the non-blood stasis syndrome group was conducted to explore the correlation between obesity and the blood stasis syndrome.DESIGN: An observatory and controlled study based on patients with hypertension or diabetes.SETTING: Wards of the department of dardiovascular dedicine and the department of dndocrinology of a university of traditional Chinese medicine.PARTICIPANTS: All the patients in the present study were hospitalized at the Department of Internal Medicine of the Second Affiliated Hospital(Jinan City, Shangdong Province) of Shandong University of Traditional Chinese Medicine from September 2000 to January 2001.Among them, 126 cases with hypertension were at the Department of Cardiovascular Medicine, and 133 cases with type 2 diabetes were at the Department of Endocrinology. Inclusion criteria: ① The diagnosis of diabetes followed the diagnostic criteria for diabetes that was formulated by the WHO in 1980; ② The diagnosis of hypertension followed the diagnostic criteria in"China' s Guidebook for Hypertension Prevention and Treatment." The patients were aged between 45-76 years. Exclusion criteria: ① Secondary hypertension,diabetics; ②Complicated with severe diseases; ③ Complicated with severe disfunction of the heart,lung,liver, kidney or severe primary diseases in hematopoietic system; ④ Patients with mental disorder or pregnant women or in the state of lactation; ⑤ Patients aged <45'years old or>76 years old; ⑥ Patients who refused to participant in the study. Eighty-four cases with primary hypertension and 85 diabetics met the inclusion criteria, with a total of 169 cases including 73 male cases and 96 female cases. The cases were divided into blood stasis syndrome group and non-blood stasis syndrome group according to the clinical symptoms. There were 23 male cases and 37 female cases in the blood stasis syndrome group.METHODS: Drawing vein blood at the state of empty stomach for making plasma and serum. ET was detected with the radioimmuoassay(RIA) kit of ET by the method of RIA(the Arithmometer of Amma5500γ) . Lep and Ins were detected with the radioimmuoassay(RIA) kit of Lep and the radioimmuoassay(RIA) kit of Isu. The fasting blood sugar, total cholesterol(TC),triamid-glycerin(TG), high dense lipoprotein-cholesterol(HDL) and low dense lipoprrotein-cholesterol(LDL) were detected by the full-automatic bio-chemical analytical instrument of AMS-SaBa/8.MAIN OUTCOME MEASURES: Comparing the difference of Lep,Ins,ET between different diseases,syndromes; analyzing the relationship between Lep and Ins,BMI,blood sugar,blood lipid,blood pressure,etc.RESULTS: The detectable rate of the blood stasis syndrome in the diabetes group was higher than that in the hypertension group (P<0.05) . The ET density,Lep density,BMI,the percentage of fat of the blood stasis syndrome group were higher than those of the non- blood stasis syndrome group (P<0.05 ). The Ins density of the blood stasis syndrome group was lower than that of the non-blood stasis syndrome group(P<0.01 ). There was a positive correlation between Lep and BMI,the percentage of fat,ET,systolic pressure (SP),pulse pressure(PP) (P<0.05 or P<0. 01).CONCLUSION: There was a positive correlation between obesity and the blood stasis syndrome. Lep of patients with type 2 diabetes or hypertension was positively correlated to BMI,the percentage of fat and the level of ET.

Objective To investigate the value of neutrophil to lymphocyte ratio (NLR) in predicting in-stent restenosis (ISR) in patients with coronary heart disease. Methods We collected the data of 618 patients with coronary heart disease hospitalized in the Department of Cardiology in the First Affiliated Hospital of Kunming Medical University from January 2011 to June 2012. All selected patients underwent coronary angiography and stent implantation, and were divided into two groups according to the average size of NLR. The relationship between the neutrophil to lymphocyte ratio and coronary heart disease in-stent restenosis was investigated. Results There were statistically significant differences in the presence of diabetes, high density lipoprotein, low density lipoprotein, the percentage of neutrophils and lymphocytes in patients between two groups (P<0.05) . We found 13 patients (4.2%) and 32 patients (10.4%) with in-stent restenosis in the first group and the second group, respectively, and there was a statistically significant difference between two groups (P<0.01) . Conclusion Neutrophil to lymphocyte ratio is correlated with ISR,and has clinical value in predicting ISR.

Objective: To investigate the effect of nocturnal hypertension in essential hypertension (EH) patients with early renal dysfunction. Methods: A total of 182 EH patients were enrolled in this study. According to weather the average night blood pressure (BP) > 120/70 mmHg, the patients were divided into 2 groups: Nocturnal hypertension group,n=89 and Control group,n=93. The levels of urine micro albumin (mALB), podocalyxin (PCX) and serum Cyst-C were examined and compared between 2 groups. Results:① For BP: the average systolic and diastolic BP in Nocturnal hypertension group were higher than those in Control group as SBP (138.05 ± 6.33) mmHg vs (102.51 ± 8.76) mmHg, DBP (84.11 ± 6.32) mmHg vs (70.03 ± 4.56) mmHg, P<0.05. ② For renal dysfunction biomarkers: several biomarker levels were higher in Nocturnal hypertension group than those in Control group as mALB (13.60 ± 0.69) mg vs (10.04 ± 0.73) mg, PCX (5.35 ± 1.69) ng/ml vs (2.05 ± 0.88) ng/ml and serum Cyst-C (1.35 ± 0.69) mg/L vs (1.02 ± 0.44) mg/L, allP<0.05.③ For correlation study: In Nocturnal hypertension group, the PCX level was positively correlated to the levels of mALB (r=0.675,P<0.05), Cyst-C (r=0.734,P<0.05), night BP (r=0.830, P<0.05) and the duration EH (r=0.688,P<0.05). Conclusion: EH patients with nocturnal hypertension have more incidences to suffer from renal dysfunction, the examination of mALB, PCX and Cyst-C are beneifciary for the early diagnosis in relevant patients.

Objective To summarize the experience on the diagnosis and therapy of intravenous leiomyomatosis(IVL)of the inferior vena cava.Methods Eight IVL patients were treated in our hospital from March 1998 to April 2007. Results The diagnosis of IVL of the inferior vena cava was established histologically by biopsy during inferior vena eavagram before operation in 4 patients.Seven patients received open surgery.Except one patient dying of massive hemorrhage during operation and one IVL recurrence during follow-up,postoperative course was uneventful and an average follow-up of 29 months found no recurrence in the other five patients. Conclusion The final diagnosis of IVL of the inferior vena cava depends on venogram and biopsy,and it is an estrogen dependent tumor originating from uterus leiomyoma.Total surgical extirpation of the tumor is the only effective treatment for IVL.

Objective: To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction (STEMI).
Methods: A total of 105 STEMI patients with percutaneous coronary intervention (PCI) in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of (58.39 ± 10.37) years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events (MACE) at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups.
Results: The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial (TIMI) 3 lfow rate was higher in Group A than that in Group B (92.45% vs 55.77%), P=0.000. TIMI 2 and TIMI 0~1 lfow rates were lower in Group A than that in Group B (7.55%vs 26.92%), P=0.008 and (0%vs 17.31%), P=0.002. The adjusted TIMI frame was lower in Group A (27.26±5.50) vs (38.98±5.42), P<0.001. The echocardiography at 6 months after PCI indicated that Group A had higher LVEF than that in Group B (0.55±0.06) vs (0.47±0.06), P<0.001;lower left ventricular end diastolic diameter (50.77±5.45) vs (54.76±5.34), P<0.001;less angina and target vessel revascularization (16.98%vs 40.38%), P=0.008 and (9.43%vs 17.31%), P=0.008. The incidence of MI, acute heart failure, cardiac death and non-target vessel revascularization were similar between 2 groups, P>0.05.
Conclusion:Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI patients after PCI, it could reduce the incidence of no-relfow without increasing MACE.

Objective To investigate the changes in serum matrix metalloproteinase(MMP)-2 and MMP-9 and their relationship with serum B-type brain natriuretic peptide(BNP)in patients with chronic heart failure.Methods MMP-2,MMP-9 and serum BNP levels were measured in 184 patients with chronic heart failure and 61 healthy controls.The relationship between changes in MMP-2 and-9 and serum BNP was analyzed.Results Chronic heart failure was categorized into grade Ⅱ,Ⅲ and Ⅳ according to NYHA.In grade Ⅱ,Ⅲ and Ⅳ and the control group,the levels of MMP-2 were(309.1±60.1)nmol/L,(422.6±89.6)nmol/L,(694.8±126.2)nmol/L and(217.2±26.3)nmol/L respectively,and the levels of MMP-9 were (321.2±63.2)nmol/L,(454.4±96.3)nmol/L,(634.1±51.2)nmol/L and(210.8±23.6)nmol/L respectively.The levels of MMP-2 and MMP-9 were significantly higher in chronic heart failure subgroups than in the control group(F=3.65,12.52;P=0.000,0.000).According to the pairwise comparison among the chronic heart failure subgroups,the levels of serum MMP-2 and MMP-9 were significantly higher in NYHA Ⅳ grade than in NYHA Ⅲ grade,and higher in NYHA Ⅲ grade than in NYHA Ⅱ grade(all P<0.05).In patients with chronic heart failure groups,MMP-2 was positively correlated with serum BNP(r=0.866,P=0.000),and with MMP-9(r=0.516,P=0.001).Conclusions MMP-2 and MMP-9 levels might be closely correlated with chronic heart failure and show an upward trend with the progression of chronic heart failure.The levels of MMP-2 and MMP-9 are associated with BNP,which indicates that clinical monitoring of the serum level changes can provide a certain reference for diagnosis,treatment and prognosis in patients with chronic heart failure.

Objective To evaluate the value of mean platelet volume (MPV) in identifying the location of infarct at left circumflex artery (LCX) in patients with non-ST-elevation myocardial infarction (NSTEMI).Methods In this retrospective study,184 consecutive patients with NSTEMI were eligible to be enrolled from January 1,2009 to June 30,2011 and laboratory examinations including platelet count,B-type natriuretic peptide (BNP),troponins test (TnI),C-reactive protein and serum creatinine (SCr) were done.The demographics and detailed history of patients were documented.In addition,left ventricular ejection fraction (LVEF) test and coronary angiography to determine the culprit vessel implicating in infarction were carried out in all enrolled patients.The patients were categorized into LCX group and N-LCX group according to culprit vessel.Results Of 184 patients,68 patients were in LCX group and 116 patients had left anterior descending artery (LAD) lesion or right coronary artery (RCA) lesion.High percent of LCX infarction were found in patients with high MPV level and low BNP level,and in smokers.And lower proportion of those patients had previous percutaneous coronary artery intervention.The results showed that MPV was larger in patients with LCX infarction than that in patients with LAD or RCA.Receiver operating characteristic curve showed the area under curve was 0.75 (95％ CI:0.675-0.826).An optimized cut off point at 9.15 fL of MPV showed 83.8％ sensitivity and 63.8％ specificity for prediction of LCX infarction.Multivariate analysis also showed that MPV was the only independent predictor of a LCX infarction in patients with NSTEMI [OR=1.32,(95％ CI:1.031-1.688),P＜0.05].Conclusions MPV was the only independent factor associated with LCX infarction in patients with NSTEMI.

Objective: To explore the clinical response on cardiac resynchronization therapy (CRT) in patients of chronic heart failure (CHF) with different QRS wave morphology. Methods: A total of 52 CHF patients received CRT in our hospital and the Seventh People's Hospital of Zhengzhou City from 2010-03 to 2013-07 were retrospectively studied. The patients were divided into 3 groups: True-complete left bundle branch block (t-CLBBB) group,n=20, Classic LBBB (CLBBB) group,n=15 and IVCD group,n=17. The general clinical condition, the indexes of echocardiography at 6 months of follow-up study including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), NYHA classiifcation and 6-MWT were examined and compared among different groups. Results: In general clinical condition, the ratio of non-ischemic heart disease patients in t-CLBBB group was higher than those in CLBBB group and IVCD group, allP<0.05. By 6 months follow-up study, LVEDD in t-CLBBB group (62.6 ± 8.9) mm was lower than those in CLBBB group (70.0 ± 8.9) mm and IVCD group (72.8 ± 8.0) mm, LVEF was higher in t-CLBBB group (38.5 ± 6.2) % than those in CLBBB group (31.7 ± 6.7) % and IVCD group (30.1 ± 6.7) %. NYHA classiifcation in t-CLBBB group (2.00 ± 0.45) grade was lower than those in CLBBB group (2.73 ± 0.80) grade and IVCD group (3.12 ± 0.78) grade . 6-MWT in t-CLBBB group (302.0 ± 57.9) m was longer than those in CLBBB group (257.3 ± 59.0) m and IVCD group (220.2 ± 57.9) m, allP<0.05. Conclusion: CRT is an effective method for treating CHD patients, different QRS morphology may have different response, the patients with t-CLBBB would make better response.

Objective To investigate the relationship between the systolic/diastolic orthostatic hypotension(OH S/OH-D) and myocardial infarction (MI) in the elderly.Methods 200 subjects without myocardial infarction (MI) aged 60 years and over in our urban district were selected.The orthostatic and supine blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All eases were divided into systolic orthostatic hypotension(OH-S)or diastolic orthostatic hypotension(OH-D)groups based on the results of orthostatic hypotension,and followed up by telephone with mean period of 325 days.The primary endpoint was MI occurrence for analyzing the correlation between OH-S/OH-D and MI incidence.Results The prevalence rate of OH in this cohort was 38％,with OH-S 20％ and OH-D 18％.In the very elderly group(≥80 years)versus the elderly group,the occurrences of 0H and OH-S were(27％ vs.21 ％,P =0.036;22 ％ vs.15 ％,P =0.020),respectively,while no significant difference was found in OH-D between the two groups.After 325 day follow up,the prevalence of MI was significantly(P＜ 0.05)higher in the OH positive subjects than in the 0H negative subjects,which result was the same as the prevalence of MI in OH-S or and OH-D group.After adjusting for age,supine blood pressure,creatinine and cerebrovascular history,logistic regression analysis showed that MI was correlated with OH(HR 15.72,95％CI 3.29～74.23,P=0.002),OH-S(HR 8.552,95％CI 2.51～30.21,P=0.004)and OH-D(HR 3.80,95 ％CI 1.14～13.80,P=0.042).Compared with OH-D,OH-S had more significant correlation with MI.Conclusions Orthostatic hypotension,particularly systolic orthostatic hypotension,is common in elderly patients.The OH-S and OH-D have a significant correlation with MI.

Objective The localization of pulmonary nodules in surgery remains a clinical challenge .In this study we dis-cussed the diagnostic and treatment value of CT-guided coil localization followed by real-time digital subtraction angiography ( DSA)-guided accurate resection of solitary pulmonary nodules (SPN) with video-assisted thracoscopic surgery (VATS). Methods This study involved 82 cases of SPN treated in the Department of Cardiothoracic Surgery of Jinling Hospital from September 2011 to May 2014 .The SPNs were preoperatively positioned by placing a metal coil close to the lesion under CT guidance on the same day of surger -y.Then VATS wedge resection of the SPNs was performed under the guidance of real -time DSA and further procedures followed in ac-cordance with the results of intraoperative pathology . Results The success rate of coil localization was 100%, the mean time of po-sitioning was (15.3 ±3.2) min, and the mean time of VATS wedge resection was (24.2 ±12.1) min.Pathological results revealed 45 cases of malignancy and 37 cases of benign lesions . Conclusion Preoperative CT-guided coil localization of SPNs showed a high accuracy and no serious complications , and by real-time DSA-guided VATS that immediately followed , the nodules could be precisely removed with the cutting edge 2 cm above the lesion , which achieved both the purposes of diagnosis and treatment of SPNs .