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.

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.

BACKGROUND:Studies regarding atherosclerosis models preparation commonly established by feeding high-fat diet or arterial intimal injury to healthy or hyperlipoidemia animals.OBJECTIVE:To establish atherosclerosis models induced by feeding high-fat diet combined with arterial intimal injury of ventral aorta with balloon.DESIGN,TIME AND SETTING:A comparative observation experiment was performed at the Animal Experimental Center of Chinese PLA General Hospital from January to March 2007.MATERIALS:Twenty New Zealand rabbits were randomly divided into high-fat diet,and high-fat diet combined with arterial intimal injury groups,with 10 animals in each group.High-fat diet was composed of common forage,4% cholesterol,10% pork fat and 10% egg yolk powder.METHODS:Rabbits in the high-fat diet group were fed with high-fat diet.Animals in the high-fat diet combined with arterial intimal injury group were underwent operation of sacculus injury after fed with high-fat diet for 4 weeks.MAIN OUTCOME MEASURES:Arteriae aorta was harvested after 12 weeks of operation and received pathological examination,thickness ratio of fatty streak and plaque,intima,and tunica media was calculated.Serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL) and low density lipoprotein cholesterol(LDL) was measured.RESULTS:After 12 weeks,the levels of TC,TG,HDL and LDL were increased,which was more obviously in the high-fat diet combined with arterial intimal injury group(P

Objective To evaluate the safety and efficacy of stenting in unprotected left main coronary artery lesions.Methods From December 2001 to April 2006,43 patients with mean ages of 62.79?11.26(45-86)years underwent unprotected left main coronary artery stenting.There were 4 cases(9.3%)with previous history of myocardial infarction,30 cases(69.8%)with hypertension and 5 cases(11.6%)with diabetes mellitus.Results Altogether 56 coronary stents were deployed in 43 patients.Isolated LMCA stenosis was found in 4 cases(9.3%),and in 39 patients(90.7%)there was multivessel disease in combination.There was ostial lesion in 11 cases(25.6%),and with mid shaftlesion in 6 cases(13.9%).Bifurcation lesion was found in remaining patients.Stents were successfully implanted into LMCA in 43 cases without complication during the procedure.In-hospital MACE developed in 2 cases(4.7%),including 1case of TLR(2.3%)and 1 death(2.3%).The patients were followed up for 2-53 months.MACE developed in 4 cases(9.5%),all were TLR.There were no significant difference in the rate of in-hospital and follow-up MACE,as well as recurring symptom among sites of the lesion.The cardiac event-free survival was 93.3% 6 months after PCI,89.4% 9 months after PCI,and 84.5% one year after PCI.Conclusion With the improvement of PCI strategies and intervention devices,coronary stenting can be safely applied for the treatment of LMCA lesions with satisfactory in-hospital and long-term outcomes in the experienced center.

ObjectiveTo observe the effects of anti-neurohormone drugs on ventricular remodelling and the plasma concentrations of neurohormone of patients with different grade heart function after myocardial infarction.MethodsAccording to ejection fraction of patients,103 consective patients with myocardial infarction were divided into two groups:normal heart function group:ejection fraction ranged from 50% to 70%.Abnormal heart function group:ejection fraction was less than 50%.All patients were given the same beta-receptor blocking agent and angiotensin-converting enzyme inhibitor and then were followed up 6 months.Heart function and the plasma concentrations of neurohormone were compared before and after anti-neurohormone drugs were given;at the same time,changes of heart function and the plasma concentrations of neurohormone were compared in statistical aspect between two groups.ResultsThe improvement of heart function and change of the plasma concentrations of neurohormone were significantly different in statistics before and after drugs were used.Besides,the patients with different grade heart function had significantly different changes of heart function and plasma concentrations of neurohormone.ConclusionAnti-neurohormone drugs can significantly reduce the level of the plasma neurohormone,improve heart function and inhibit heart remodeling.What’s more,there are better treatment effects in patients with heart failure.

Objective To investigate the differences of coronary artery lesion between myocardial infarction patients with or without ST segment elevation. Methods This study included 126 confirmed myocardial infarction patients with acute ST segment elevation (STEMI) and 96 confirmed myocardial infarction patients with acute non-ST segment elevation (NSTEMI). All patients received coronary angiography and the results were compared between two groups. Results More myocardial patients were with single vessel disease in STEMI group as compared with NSTEMI group (44% vs 14%, P