OBJECTIVE: Newer medicine therapies have been proved efficacy in patients with intermittent claudication. With rapid advances of intervention devices and techniques for peripheral vessels in recent years, which has improved the therapy of peripheral artery disease (PAD). To review the clinical developments in treatment of PAD so as to provide references for optimal integrated therapy of medicine with proper interventional treatment, which enable PAD patients to achieve the greatest long-term prognosis. DATA SOURCES: A computer-based search for literatures related to PAD from 1991 to April 2006 was conducted in Medline databasewith the of "peripheral arterial disease, catheterization, peripheral, genetics", and the language was limited to English. Meanwhile, Chinese relevant literatures between 1994 and April 2006 were searched in Journal Full-text Database and Wanfang Database by computer with the keywords of "peripheral arterial disease, intermittent claudication, management". STUDY SELECTION: Primary selection was performed by following inclusive criteria: PDA and drug treatment, stent, angioplasty, genetic therapy, surgery, and articles related to PDA were selected. Scientific criteria of treatment for PDA were looked for in basic researches, clinical studies and those published in formal organizations. Exclusive criteria: Repetitive studies, reviews and Meta analytical literatures were excluded. DATA EXTRACTION: A total of 60 literatures about the treatment for PDA were collected, 30 enrolled articles in which were reviewed. Thirty repetitive studies, reviews and Meta analytical literatures were excluded. DATA SYNTHESIS: ①The prevalence of PAD depends on the diagnosis. Given the inaccuracy of physical examination, use of pulse examination as the sole criterion would grossly overestimate the prevalence. In contrast, a historical query for intermittent claudication would underestimate the prevalence of PAD. The ankle-brachial index (ABI) has been validated by angiography with the sensitivity of 95% and the specificity of 100%.②The risk factors of PAD were similar to those in patients with cardiovascular disease and cerebrovascular disease. The goals of therapy for patients with PAD are to prevent systemic atherosclerotic disease progression and clinical cardiovascular events as well as prevent limb loss and improve the functional status of patients with intermittent caludication.③Medical therapy of PAD should include manipulations of risk factors for atherosclerotic heart disease, including smoke-stopping, body mass reducing, blood glucose controlling, blood pressure controlling and hypercholestermia reducing etc. Instructive exercise therapy is the most effective way in non-interventional therapy, while medicine therapy mainly included antiplatelet therapy, angiotenic therapy and anticoagulation therapy. If the patients has obvious clinical ischemia symptoms and cannot be relieved by medical treatment, then interventional therapy or surgery is necessary. CONCLUSION: Patients with PAD can achieve the best long-term prognosis by an instructive exercise treatment integrated with optimal medicine therapy and proper interventional therapy.

To investigate the effects of Carvedilol on neurohormone and heart function in patients with congestive heart failure(CHF) by double blinded, randomized clinical trial. 35 congestive heart failure patients were double blinded and randomly divided into 2 groups, Carvedilol group and placebo group. 15 healthy persons constitute the normal control group. We measured the plasma concentration of norepinephrine(NE), angiotensin (Ang) and plasma renin activity (PRA) , meanwhile left ventricular ejection fraction (LVEF) , left ventricular dimension and volume were observed before and after treatment. The plasma concentrations of NE, Ang Ⅱ and PRA were found to be higher in patients with CHF than those of healthy control group ( P

As a multipotential stem cell, adipose-derived mesenchymal cell presents similar characters with bone marrow-derived menchymal stem cell in morphology and biology, and has the ability of directional differentiation to the all three germ layers. The adipose-derived mesenchymal stem cell could be harvested conveniently with slighter wound, and has a broad prospect in cell therapy and tissue engineering.

Objective To analyse the diagnosis characteristics of the aged and non-aged patients with dilated cardiomyopathy (DCM).Methods 192 inpatients suspected DCM from 2004 to 2006 were analysed retrospectively, as the groups of the aged (≥60 y) and non-aged (<60 y). Results The percentage of the aged group with idiopathic dilated cardiomyopathy (IDCM) or ischemic cardiomyopathy (ICM) was obviously higher than that of the non-aged group (P<0.01 and P<0.05, respectively). The percentage of the non-aged group with alcoholic cardiomyopathy (ACM) or viral cardiomyopathy (VCM) was higher than that of the aged group(P<0.01). Conclusion There are various diseases similar to DCM should be identified. The causes leading to DCM are different in the aged and non-aged patients.

Objective To evaluate the cardiac function changing before and after resection of pituitary tumor in patients with pituitary adenoma complicated with dilated cardiomyopathy with retrospective analysis method.Methods The clinical data of 14 cases of patients with pituitary adenoma complicated with dilated cardiomyopathy,treated with resection of pituitary tumor,in PLA General Hospital,from 2005 to 2011,were collected and analyzed.Comparative analysis of cardiac function were made in these patients before and after the surgery,also with the postoperative recovery status,using echocardiography and other noninvasive detection means to detect the growth hormone ( GH),left ventricular end-diastolic diameter (LVEDD),septal thickness (ST),left ventricular posterior wall thickness (LVPWT),left ventricular ejection fraction (LVEF) values.Results After the resection of pituitary tumor,the LVEDD,ST,LVPWT,LVEF levels were all significantly better than that before the surgery.Before the surgery the GH,ST,LVPWT,LVEF levels were 93.89 μg/L,11.13 mm,43.92％ and 10.53 mm,while those after the surgery were 5.16 μg/L,10.64 mm,49.28％ and 8.87 mm.The difference of the GH level before and after the surgery was correlated with the difference of ST,LVEDD and LVEF in a linear manner.Conclusions Recection of pituitary tumor can significantly improve the cardiac function in patients with pituitary adenoma complicated with dilated cardiomyopathy,and the cardiac function improving level is correlated with the difference of GH levels before and after the surgery.

Coronary magnetic resonance angiography(MRA)is a technique that allows visualization of the coronary arteries by noninvasive means.This review summarizes results from several studies comparing the difference of coronary MRA with conventional coronary angiography,and finds it to be a diagnosis tool of coronary artery stenoses with a high degree of accuracy,especially with sites at the proximal and middle segments.Current limitations of two-dimensional and three-dimensional coronary MIRA are discussed,which prevents it to be sensitive enough as a screening tool.The development trends of coronary MRA are also been evaluated.(J Intervent Radiol,2007,16:139-142)

Background and objectives To investigate the effect of hepatocyte growth factor (HGF) on left ventricular (LV) remodeling after acute myocardial infarction (AMI). Methods AMI was produced by ligation of proximal left anterior descending coronary artery(LAD) in 12 mongrel canines. These animals were randomized into 2 groups. In HGF group (n=6), canines were injected with pcDNA3-HGF lml (about 300ug) at the margin of infarcted myocardium; in control group (n=6) canines were injected with equal volume of normal saline. Cardiac function and left ventricular remodeling were evaluated with echocardiography at 1, 4, 8 weeks after MI. LV myocardium specimens were obtained at 8 weeks and stained with hematoxylin and eosin for histological examination or with sirius red to assess the collagen content. Results Compared with control group, LVEF in HGF group was significantly higher at 4 weeks (49.61+6.66 vs 39.84+6.39; P＜0.05) and at 8 weeks (51.57+8.53 vs 40.61+7.67; P＜0.05) after AMI, while LVESV was significantly lower in HGF group than that in control group at 8 weeks after AMI (18.98+3.47 vs 25.66+5.86; P＜0.05). Posterior left ventricular wall thickness decreased significantly from 1 wk to 8 wks after AMI in control group, while remained unchanged in HGF group. Compared with control group, histological examination showed more neovascularization and less scar, and sirius red staining indicated higher volume of type Ⅲ collagen (7.10±4.06% vs 3.77±1.09%; P＜0.05) and lower collagen Ⅰ/Ⅲ ratio value (1.11±0.52 vs 2.94±2.48; P＜0.05)in HGF group. Conclusion HGF gene transfer might improve cardiac function and LV remodeling after acute myocardial infarction by stimulating angiogenesis, reducing fibrosis, and reducing myocardial scarring.

12 months in 31.3% (15/48). The graft lesions were found in 72.9% (35/48) of the patients, the worsened native lesions in 8.3% (4/48) and incomplete revascularization in 12.5% (6/48). Total occlusion was found in 33.3% (45/135) of the grafts and stenosis in 5.9% (8/135). LIMA total occlusion was 46.4% (13/28), stenosis was 8.6% (3/35) and competitive flow was 8.6% (3/35). Stenosis was found in 5.2% (5/97) of the SVG and total occlusion in 35.1% (34/97). Two of the five radial arteries were stenotic. Except for the chronic total occlusions, PCI treated the above problems with a high success rate. Conclusion Reoccurrence of angina is not uncommon after CABG. The causes are mainly due to the graft problem, and secondly due to worsened native lesion and incomplete revascularization. PCI can be used to treat the above problems except for the chronic total occlusions of the native vessels and graft.

Objective To evaluate the angiographic effectiveness of stenting for non-protected left main coronary leisions. Methods The follow-up angiograms of 18 patients who had received stent implantation for non-protected left main disease during 1997-2004 were assessed. Results (1) There were totally 9 patients implanted with two stents in distal left main bifurcation lesion. Among the 6 patients who had implanted two drug eluting stents using V technique, 4 of them had ostial restenosis of the branches and had TLR. Another 2 patients with bare metal stents implanted using T-stest technique also experienced restenosis and had TLR. (2) In the 9 patients with single stent implanted, 5 patients implanted the stents crossing-over the LCX and only 1 of them had restenosis. Among the 3 patients who had received left main body stenting, one patient had diffuse restenosis and performed TLR. Conclusion (1) Implantation of 2 stents in distal left main lesion showed a high restenosis rate. On the other hand, crossing over the LCX can be applied safely in left main bifurcation lesions and show a better prognosis.

Objective To analyze the effect on side branch with diameter ≥2.0 mm after stenting with cross-over technique in non-left main coronary bifurcation by using IVUS and QCA.Methods Comparative analysis was made on the IVUS and QCA results of the side branches in 35 non-left main bifurcation lesions which were intervened by cross-over technique.Results The diameter and area stenosis rates of the side branches examined by IVUS compared with QCA before intervention were 18.67%?16.29% vs 29.06%?23.16% and 31.17%?25.54% vs 42.22%?31.81% respectively.After cross-over interventional therapy,acute occlusion of the side branches detected by both IVUS and QCA was 2.86%.The rates of aggravated stenosis and newly developed stenosis in the side branches shown by IVUS and QCA were 14.29% vs 48.57%(P=0.012) and 11.43% vs 14.29%(P=0.294).Post-intervention morphology of the side branches detected by IVUS included plaque shift,vessel wall shrink,spasm and deformation.By using logistic analyzing,existence of soft plaque in the main branches was an independant factor affecting the fate of the side branches.Conclusion Comparing with IVUS results,QCA may over-estimate the degree of stenosis of the side branches after cross-over technique.The possible mechanism of side branch complications shown by IVUS included plaque shift,vessel wall shrink,spasm and deformation.Soft plaque in the main branch is an independant influencing factor of the result in the side branches.