Objective To evaluate the clinical value of cardiovascular dual-phase scan of 256-slice spiral CT in diagnosis of left atrial appendage (LAA) thrombus before radiofrequency ablation in patients with atrial fibrillation. Methods A prospective study was conducted. Thirty-six patients with atrial fibrillation being prepared to undergo radiofrequency ablation admitted to the Fifth Central Hospital of Tianjin from October 2015 toJuly 2016 were enrolled, they were scanned using dual-phase cardiovascular protocol of 256-slice spiral CT, and then trans-esophageal echocardiography (TEE) was performed for the definite diagnose of thrombus. In the first phase of cardiac CT, the intelligent tracking method was used to determine the delayed time; in the second phase cardiac CT scan, 85 seconds was confirmed as the delayed time; TEE as the golden standard was used to evaluate the value of dual-phase CT in definite diagnosis of LAA thrombus.Results LAA low density filling defect was discovered in 5 patients in the first phase CT scan, the CT scan in the second phase, the filling defect still existed, and the diagnosis of LAA thrombus in 3 patients was made (of them 2 cases after TEE examination were diagnosed definitely as LAA thrombus, and the echo in 1 case was smoke-like on TEE, being at pre-thrombus status), 2 cases were confirmed as pseudo-filling defects (afterwards, their diagnosis was confirmed as pre-thrombus status because the echo shown on TEE was smoke-like). Two patients were confirmed as true thrombi on TEE, and there were 3 patients diagnosed as pre-thrombus state by TEE because of their echo smoke-like. TEE was used as the golden standard for diagnosis of thrombus, the following indexes could be calculated: in the first phase, the sensitivity of using CT scan to diagnose LAA thrombus was 100.0%, the specificity 91.2%, positive predictive value (PPV) 40.0%, and negative predictive value (NPV) 100.0%; while in the second phase of using CT scan for diagnosis of LAA thrombus, the above indexes were 100.0%, 97.1%, 66.7%, 100.0% respectively; the CT Kappa coefficient of the second-phase was larger than that of the first-phase CT (0.898 vs. 0.739), the difference being statistically significant (P < 0.05).Conclusions Dual-phase cardiovascular protocol of CT can detecte of LAA thrombus/pre-thrombus state, the PPV is significantly elevated after the second phase of CT scan for diagnosis of thrombus, and the consistency between the second phase CT diagnosis of thrombus and TEE diagnosis is higher than that between the first phase CT and TEE, therefore, using dual-phase cardiovascular protocol of 256-slice spiral CT in diagnosis of LAA thrombus in patients with atrial fibrillation before radiofrequency ablation has relatively high application value.

Thrombolytic agents for the treatment of acute ischemic stroke have some limitations. Balloon angioplasty and stenting have become the research hotspot in the treatment of acute ischemic stroke. 1his article reviews the effectiveness and safety of balloon angioplasty and stenting in the treatment of acute ischemic stroke.

Approximately 20%-30% of the patients with acute ischemic stroke do not have an angiographically demonstrable arterial occlusion. This article reviews the possible explanations for the absence of angiographically documented occlusion, the risk and the occurrence rate of cerebral infarction, the prognosis, and the effectiveness as well as the safety of thrombolytic therapy.

Objective To observe the effects of the ethanol extract of thunberg fritillary leaf (EETFL) and the ethanol extract of thunberg fritillary flower (EETFF) on relieving cough, sputum elimination and relieving asthma. Methods The cough relieving effects of EETFL and EETFF were studied in mouse cough model caused by ammonia water and in guinea pig cough model caused by citric acid. The sputum elimination effects of EETFL and EETFF were researched by the observation of tracheal phenol red shedding in mice. The asthma relieving effects were tested by spraying method in guinea pigs. Results EETFL can obviously inhibit the incubation period and cough frequency of the model mice and guinea pigs induced by ammonia water and citric acid (P<0.05), and significantly improve the tracheal phenol red excretion volume in mice (P<0.05), and obviously prolong the incubation period of asthma (P<0.05). EETFF can obviously inhibit the incubation period and cough frequency of the model mice and guinea pigs induced by ammonia water and citric acid (P<0.05), and significantly improve the tracheal phenol red excretion volume in mice (P<0.05), but EETFF couldn’t prolong the incubation period of asthma evidently. Conclusion EETFL has obvious activity of relieving cough, eliminating phlegm and relieving asthma. EETFF has obvious activity of relieving cough and eliminating phlegm, but EETFF has no anti-asthmatic activity under the current dose.

[Objective]To explore the efficacy and results of tibial tubercle osteotomy used in exposure in complicated total knee arthroplasty.[Methods]During the period from Apr.2005 to Apr.2007,the tibial tubercle osteotomy were used in 16 cases of complicated total knee arthroplasty.The mean follow-up time were 20 months(6～26 months).Knee society score(KSS) and radiography were used to evaluate the clinical results.[Results]The mean KSS improved from 46 points preoperatively to 91 points postoperatively.The mean ROM improved to from 53?preoperatively 105?postoperatively.At 3 months after surgery the radiography examines showed all 16 cases had achieved satisfactory healing.The tubercle fragment slided toward proximal 0.7 cm occurred in one case,and finally healed at that position.[Conclusion]Exposure of the knee may be difficult in the total knee arthroplasty,but tibial tubercle osteotomy is a safe and reliable procedure which affords excellent exposure.

BACKGROUND:At present, a great quantity of research has shown the effectiveness of traditional Chinese medicine and bone marrow mesenchymal stem cel s for vascular restenosis. However, studies concerning their combined application to restenosis after percutaneous transluminal angioplasty with diabetes mel itus are presently lacking.
OBJECTIVE:To observe the effects of combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription on restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.
METHODS:A dog model of vascular restenosis with diabetes mel itus was established by bal oon injury of femoral artery and intravenous injection of al oxan. After successful model induction, 22 dog models were randomly divided into three groups:model group (n=6), treatment with Chinese medicine (n=8), and combined treatment with bone marrow mesenchymal stem cel s and Chinese medicine (n=8). Serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay preoperatively and at 1, 2, 4 and 8 weeks postoperation. Samples of vessels were taken to conduct pathomorphological observation and quantitative analysis of proliferation degree. Tissues, including heart, liver, kidney and pancreatic gland, were col ected to evaluate the safety of stem cel transplantation using hematoxylin-eosin staining at 8 weeks postoperation.
RESULTS AND CONCLUSION:Serum vascular endothelial growth factor levels began to increase at 1 week postoperation in the Chinese medicine group and combined treatment group, at 4 weeks postoperation in the model group compared with preoperation (P<0.05). At al time points, serum vascular endothelial growth factor levels were highest in the combined treatment group, but lowest in the model group (P<0.05). Quantitative analysis of vascular proliferation demonstrated that at 8 weeks postoperation, new intimal area, new intimal/medial areas and stenosis rate were highest in the model group, but lowest in the combined treatment group at 8 weeks postoperation (P<0.05). Safety assessment of stem cel transplantation showed morphological structures of the heart, liver, kidneys and pancreas were normal, no necrosis. In a word, the effects of the combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription were much pronounced in preventing restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus rather than single therapy of Chinese medicine. It is a safe and effective treatment to prevent vascular restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.

Objective To investigate the clinical efficacy and value of percutaneous transluminal angioplasty (PTA) in treating arteriosclerosis obliterans (ASO) of lower extremity that shows no visualization of its vascular outflow tract. Methods A total of 19 patients with ASO of lower extremities showing no outflow tract visualization were included in this study. The patients included 11 males and 8 females with a median age of 66 years (48-79 years. The main clinical symptom was rest pain of the leg in all patients; 10 cases had different degrees of foot ulcer and gangrene. Preoperative multi-slice CT angiography and DSA examination were performed in all patents. After PTA, the patients were followed up for 12 months, the changes of the clinical symptoms and signs were recorded. The claudication distance, toe skin temperature, ankle-brachial index (ABI), toe-brachial index (TBI), and CT angiography or color Doppler examination were separately performed before and one, 3, 6 and 12 months after PTA. Results In the 19 patients (38 diseased limbs in total), ASO with no visualization of vascular outflow tract was detected in 54 arteries, 3%), posterior tibial artery (n=18, 33.3%), peroneal artery (n=9, 16.7%) and popliteal artery (n=2, 3.7%). The technical success rate of limb PTA was 89.5%, while the technical success rate of single artery PTA was 85.2%. After PTA, the skin temperature of all the diseased limbs that had been successfully treated was obviously improved, the pain was significantly relieved or disappeared. One, 3, 6 and 12 months after PTA, the claudication distance, toe skin temperature, ABI and TBI were strikingly improved when compared with those determined before PTA (P<0.05). Twelve months after PTA the vascular restenosis rate was 39.5% (15/38), the limb vascular patency rate was 55.3% (21/38), and the limb salvage rate was 81.6%(31/38). Conclusion For the treatment of lower extremities arterial obliterans with obstructed outflow tract, PTA is safe and effective in short-term period. Although its long-term restenosis rate is higher, this technique can effectively control the progress of the disease, relieve the clinical symptoms, and help improve the limb salvage rate of ischemic limbs.

Objective To investigate the associated protein markers in urine of patients with chronic renal failure (CRF) based on surface enhanced laser desorption and ionization time of flight mass spectrometry (SELDI-TOF MS)technique.Methods Urine samples were taken from 150 CRF patients and 50 healthy people,and investigated by proteomic techniques with H4 gene chip.Results Compared to healthy group,141 different protein peaks were identified within the range of 1000 to 20 000 M/Z in the protein map of CRF group,whose differences were all significant (all P＜0.01).The decision tree model for CRF urine was constructed after bioinformation analysis to significantly differentiate between CRF and healthy group.The accuracy rate,sensitivity and specificity of the decision tree model were 96.0％,100.0％ and 94.7％ respectively.In CRF group and healthy group,the different protein peaks in urine were identified to probably be 17 proteins with reference to SwissProt database.Conclusions Candidate protein markers in urine are screened and prediction model of CRF urine is established.The markers are identified with the database which provides a more accurate prediction and solid evidence for early diagnosis of CRF.

Objective To observe the clinical efficacy of L-carnitine combined with trimetazidine in the treatment of chronic heart failure.Methods The clinical data of 700 patients with chronic heart failure were retrospectively analyzed.According to different treatment methods,they were divided into four groups:A,B,C,D.181 cases of A group used L-camitine combined with trimetazidine treatment on the basis of routine treatment.177 cases of B group received L-carnitine treatment on the basis of routine treatment.175 cases of C group received trimetazidine treatment on the basis of routine treatment.167 cases of D group received conventional treatment.Then,the clinical efficacy of the four groups was compared.Results The total effective rates of A,B,C,D groups were 83.43％,76.84％,73.71％,62.28％,respectively.The total effective rate of A group was obviously higher than the other groups,the difference was statistically significant(x2 =22.40,P ＜0.05).There was no significant difference in total effective rate between B group and C group (x2 =0.46,P ＞ 0.05),but both B and C groups were obviously better than group D (x2=4.37,5.13,all P ＜ 0.05).The data before and after treatment in four groups were significantly improved,such as 6MWT,NT-proBNP,LVEF and FS(A group:t =33.856,37.474,17.722,31.250,B group:t =27.328,31.559,6.863,25.581,C group:t =23.430,32.640,9.524,16.923,D group:t =15.863,9.602,3.061,10.169,all P ＜ 0.01).In the above four indicators,those in A group were obviously better than B group,C group and D group (F =5.884,38.621,4.357,13.770,all P ＜ 0.01).Conclusion L-carnitine combined with trimetazidine can improve the abnormal metabolism of myocardium,optimize the energy metabolism pathway of myocardium,improve the short-term cardiac function of patients markedly.L-carnitine combined with trimetazidine is worthy of promoting joint use.

Objective: To observe the dynamic changes of plasma level thymosinβ4 (Tβ4) in acute myocardial infarction (AMI) patients with intervening therapy within 15 days of onset and to explore the relationship between Tβ4 and clinical prognosis in AMI patients.
Methods: Our research included 2 groups:AMI group, n=69 and Control group, the patients with suspected chest pain while CAG excluded coronary artery stenosis, n=32. Plasma levels of Tβ4 were examined in all AMI patients on admission day and every day until 15 days of onset;AMI patients were followed-up for 18 months and the endpoint was defined as major adverse cardiovascular event (MACE) occurrence.
Results: ①Compared with Control group, AMI group had increased plasma level of Tβ4 on admission day and on day-15 of onset, P<0.01. ② With intervening therapy, AMI group had elevated Tβ4 level upon immediate onset, it was decreased on day-1, reached low level on day-3 and elevated to peak on day-6, then reduced followed by slightly raising on day-11.③During follow-up period, the AMI patients without MACE had the higher mean in-hospital maximum Tβ4 value than those with MACE occurrence, P<0.01. Logistic regression analysis indicated that the mean in-hospital maximum Tβ4 value was related to MACE occurrence during follow-up period (OR=0.999, 95%CI 0.999-1.000).
Conclusion: AMI may induce up-regulated expression of plasma Tβ4;with intervening therapy, Tβ4 showed a trend of“elevation-reduction-elevation-reduction”at the early stage of AMI. High expression of Tβ4 was helpful for improving clinical prognosis in AMI patients which may provide a theoretical basis for exogenous use of Tβ4 in AMI treatment.