Thrombolytic therapy has been proved to be effective in treating acute myocardial infarction (AMI),whereas the role of urgent percutaneous transluminal coronary angioplasty (PTCA) is disputed.Results of many clinical trials show that urgent PTCA,comparing with intravenous thrombolytic agents,has more advantages in increasing reperfusion rate,lowering mortality,the rate of reinfarct and bleeding.PTCA has gradually become a routine option in the treatment of AMI.This review focus mainly on PTCA intervention of AMI without thrombolysis,after thrombolytic success,and after thrombolytic failure.

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Objective To investigate the clinical features and the findings of coronary angiography,the treatment and prognosis of patients with myocardial bridge.To increase our knowledge on myocardial bridge.Methods Fifty two patients were diagnosed as myocardial bridge by coronary angiography in our hospital from January 2001 to December 2004. Angiographically,systolic compression of the arterial lumen that disappears during diastole was considered diagnostic of a myocardial bridge.Analyse the clinical features and therapy condition.Follow patients by telephone or clinical visits.Results Our study included fifty two patients.Male patients were more than female ones and the average age was 53?12 years old.Myocardial bridge was the most common in the middle segment of the left anterior descending artery.Majority of the patients took medication,and 2 of them were treated with intracoronary stent implantation.Forty patients were followed.During a mean 1.9?1.1 years follow-up period,there was no cardiac death.25 of the patients required medication,and 1 of 2 patients who underwent stent implantation had in-stent restenosis at 3.3 years.Conclusion Patients with myocardial bridge may present with atypical chest pain.Major patients with myocardial bridge are treated with medication,and stent implants may improve patients' symptoms.The prognosis of the patients with myocardial bridge is usually good.

Objective To investigate the clinical characteristics of hypertrophic cardiomyopathy (HCM) in the elderly. Methods The clinical characters of HCM in 70 elderly patients were retrospectively analysed. Results Among the 196 identified HCM patients, 70 were elders. Out of them, 7 patients(10.0%) were suspected as HCM according to the clinical symptoms, 29 patients (41.4%)were suspected as other cardiac diseases, 34 (48.3%) were diagnosed HCM due to other reasons. Among the 70 patients, 12 patients(17.1%) had history of cerebrovascular diseases, 54 (77.1%) manifested symptoms after 45 years of age and 4 (5.7%) showed no obvious symptoms. Among them, 18 patients were examined by UCG for two times and HCM was diagnosed at the second time. Conclusions HCM in the elderly is not an uncommon disease. The onset of cardiac symptoms is relatively late in the elderly HCM and frequently misdiagnosed; cerebrovascular diseases are commonly seen in elderly HCM patients.

Objective To investigate the involvement of mitogen-activated protein kinase(MAPK)and PI3K(phosphatidylinositol 3 kinase)/ Protein kinase B(Akt) signal transduction pathways in the mechanism of myocardium remodeling in patients with congestive heart failure(CHF).Methods Thirty nine patients of mitral valve disease with CHF were randomly selected and 30 cases of healthy persons were included as controls.Cardiac function parameters were measured by echocardiography.Concentration of AngⅡ in plasma and myocardial tissues was determined by radio immunoassay.Activity of PKC was determined by using competive prote in binding method,activity of MAPK was detected by the methods of immunoprecitipation.Immunoprecitipation was used to assay the protein expression and phosphorylation of PI3K and Akt(Protein kinase B),protein expression of C-FOS and ?-skeletal-actin in myocardial tissues.Results Pathological changes of myocardial tissues in CHF with valvular heart diseaseshowed typical myocardial remodeling.The hypertrophy was dominant at early stagy of CHF,while at end stage the characteristics include disordered alignament of the myocytes,the discontinuity and dissolving of cardiomyofibrills,destroyed subcellular organs,and the hyperplasia of interstitial tissue.AngⅡ concentration in plasm and myocardial tissues in patients with CHF was higher than those in the control group(P

Objective To study the efficacy of low dose of combined angiotensin Ⅱ type 1 receptor blockade(ARB)valsartan with angiotensin-converting enzyme inhibitor(ACEI)ramipril on the expression of the gene of angiotensin Ⅱ type 1 receptor(AT1R)and type 2 receptor(AT2R)in cardiovascular vessels and brain in SHR.Methods SHRs 7-8 weeks old were received valsartan 30 mg/(kg?d),or ramipril 1 mg/(kg?d),or valsartan 15 mg/(kg?d)combined with ramipril 0.5 mg/(kg?d)by gavage for three months.SBP,LV/BW ratio,plasma angiotensin Ⅱ,plasma and myocardial NO levels were determined.The severity of myocardial interstitial fibrosis was assessed by image analysis.ACE mRNA,AT1R mRNA and AT2R mRNA expression were detected in the LV myocardium,aorta and brain by the RT-PCR.Results Combined low dose of valsartan and ramipril was shown to reduce more significantly the expression of AT1R mRNA and ACE mRNA in myocardium,aorta and brain than valsartan or ramipril monotherapy(AT1R mRNA:P

Objective To observe the expression and location of TF and TFPI in femoral artery atherosclerotic plaque.Methods We detected the expressions and locations of TF and TFPI in femoral artery atherosclerotic plaque by immunohistochemical and double-stain immunohistochemical method.We detected TF mRNA and TFPI mRNA expressions in atherosclerotic plaque by RT-PCR,with the normal umbilical artery as a control.ResultsThe normal umbilical artery contained little TF,TFPI and their mRNA in the adventitia.A great deal of TF,TFPI and their mRNA were found in the tunica intima of the femoral artery atherosclerotic plaque.Conclusion Expression of TF,TFPI and their mRNA of all types of cells and stroma in the proliferative tunica intima.

Objective To observe the dynamic changes in plasma levels of neuropeptide Y (NPY) in patients with acute cerebral infarction (ACI) and the serum nitric oxide synthase (NOS) in order to find out the relationship between each other as well as their clinical significance. Method A prospective and control study was done in 30 patients with ACI including 21 male and 9 female with average age of (58.07 ± 12. 1S) years admitted from May 2008 to March 2009. These patients hit the diagnostic criteria for cerebral infarction (CI) set by the Chinese Society for Neruoscience and the Chinese Association of Neurosurgery in 1996 for their first attack of CI was treated within 48 hours. Patients with acute myocardial infarction, peripheral vascular disease, infection, tumor,or severe organic functional impairment, etc within six months were excluded. Another 27 healthy subjects asking for routine physical examination including 15 male and 12 female with average age of (55.00± 11.03) years were included as control group at the same period. The two groups were comparable. The blood samples of fasted subjects of control group and CI patients 48 hours after and within 10 days after attack were taken to examine the level of NPY by using radioimmunoassay and the level of serum NOS by using chemical colorimetry. The size of responsible focus of CI was calculated, and the degree of neurological deficits were estimated with Stroke Scales set by the American National Institutes Of Health (NIHSS). The chi-square test was used for constituent ratios within samples, while t -test was applied to analysis of differences between two groups, and linear was used for bivariate simple correlation analysis. Results (1) There was no significant difference in NPY between two groups. (2) The level of constructional NOS (cNOS) within 48 hours after attack in CI group was significantly lower than that in control group, and it was significantly and negatively correlated with the size of infarction and the NIHSS scores at the same period, whereas it significantly and positively correlated with difference in NIHSS scores, while it increased more significantly 10 days after attack than it did within 48 hours after attack. (3) The level of inducible NOS (iNOS) within 48 hours after attack in CI group was significantly higher than that in control group, and it was significantly and positively correlated with the size of infarctionand NIHSS scores at the same period, and it significantly and negatively crrelated with the difference in NIHSS scores, while it decreased more significantly 10 days after attack than it did within 48 hours after attack. (4) The level of NPY was not correlated with both cNOS and iNOS in CI group. The difference in levels of NPY was negatively and significantly correlated with the difference in levels of cNOS. Conclusions There was no significant change in plasma NPY level in ACI patients, and it was not correlated significantly with the disease itself. The serum cNOS was negatively correlated with the disease itself significantly within 48 hours after attack. The iNOS level was positively correlated with the disease itself significantly, and it reflected the severity of CI within 48 hours after attack. The changes of NPY level in plasma were significantly and negatively correlated with the changes of cNOS level in serum within 48 hours and 10 days after attack.

Objective To investigate the manifestations of cardiac involvement in the patients with mucopolysacharidosis Ⅰ (MPS Ⅰ).Methods The clinical data of 10 MPS Ⅰ patients were collected.Electrocardiography (ECG) and echocardiography (Echo) were performed in all patients and then analyzed.Results Among the ten patients,seven were men.The onset age of MPS was (0.5 ～ 8.0) years old and the age of diagnosis was (1.8 ～ 20.0) years old.Two patients had grade 2 precordial systolic murmur.ECG was abnormal in three patients with right ventricular hypertrophy in two and right axis deviation in another one.Echo showed valvular thickening and insufficiency in nine patients,enlarged left atrium and ventricle in one patient,hapulmonary hypertension and right ventricular hypertrophy in two patients and abnormal left ventricular configuration in five patients.Conclusions Cardiac involvement is common in MPS Ⅰ patients and may present as valvular thickening with regurgitation,abnormal left ventricular configuration and pulmonary hypertension.The cardiac involvement progresses with age.ECG and Echo should be done regularly during follow-up of MPS Ⅰ patients.

Clinical characteristics were retrospectively analyzed in a patient with parathyroid crisis as the main symptoms of parathyroid adenoma and asymptomatic pheochromocytoma.This analysis was aimed to implement specific diagnosis and treatment and to accumulate experience in managing these diseases.