Objective To evaluate the feasibility, and clinical efficacy of combined interventional procedure (CIP) in composite cardiovascular diseases (CCD). Methods Twenty one consecutive patients were diagnosed as CCD before the procedures. The algorithm of CIP were individualized by the operators and physicians. The criteria for a successful procedure were defined before the operation. The counterplan for predictable complications was also established beforehand. The successful rate, short and long term efficacy, the incidence of complications and adverse reaction associated with contrast medium and X-ray were observed. All the patients were followed up through special out-patient clinic, telephone, or letters. Results Seven cases accepted electrophysiological testing(EPT) + radiofrequency catheter ablation (RFCA)+coronary angiogram (CAG)+percutaneous transluminal coronary angioplasty (PTCA)+stent implantation (SI). Four cases accepted CAG+PTCA+SI+EPT. Three cases accepted EPT+RFCA+CAG. Six cases accepted CAG+PTCA+SI+peripheral artery angiogram (PAG). One cases accepted pacemaker implantation (PI)+CAG+PTCA+SI+percutaneous transluminal septal myocardial ablation (PTSMA). The symptoms of arrhythmia disappeared or alleviater in 19 cases during hospiatalization. Arrhythmia recurred in 2 cases 12 hours after the procedure and accepted RFCA again. No severe complications and adverse reaction occured. The successful rate was 90.5 percent. Two cases suffered from recurrent angina during the follow-up period and one of them had in-stent restenosis proved by CAG and accepted PTCA+SI again. The other patient received medicine therapy. Conclusion Combined interventional procedure operated by experienced interventional cardiologist in a conditioned catheterization laboratory is safe and feasible. The short-term outcomes are satisfied. The long-term outcomes will be proved by accumulating more cases' data. Individualized approaches, counterplans for complications and cautious operation are important to a successful procedure.

Objective To explore the relationship of personality and coping style between parents and male inpatients with internet addiction disorder. Methods 51 male inpatients with internet addiction disorder and their parents were investigated with Cattell 16PF and Coping Style Questionnaire to evaluate their personality and coping style. All data were analyzed by partial correlate analysis. Results Multi-factors of 16PF( warmth, reasoning, emotional stability, dominance, vigilance, sensitivity, abstractedness, privateness, openness to change, perfectionism, apprehension, tension ) of male inpatients were significantly correlated with father' s ( r = 0.72 ～ 0. 85 or - 0. 71 ～ - 0.93 ) or mother' s 16PF( r = 0.73 ～ 0.92 or - 0. 72 ～ - 0.81 ), bu+ non of those factors corrected with the same factor of parental. Male inpatients' coping style did not corrected with father' s, but their problem sloving, rationalization and self-accusation corrected with mother's seeking support, rationalization and avoidance respectively. Conclusion The personality of male inpatients with internet addiction disorder is affected by parental personality, but under the impact of internet addiction disorder, this kind of influence is weakened. In coping style, the father' s influence is far weaker than the mother' s, suggesting that there is father function flaw during the process of those inpatients growing up.

ObjectiveTo investigate current situation of creativity among inpatient high school students with internet game addiction disorder (IGAD) and its influential factors.MethodsThe participants comprised the patients in the General Hospital of Beijing Military Region meeting the diagnostic criteria for Internet Addiction( including 70 cases of high school (HSIGAD) and junior high school 65 cases (JHSIGAD) and 70 cases of high school in the school (HSIS) ).Questionnaire plus clinical interview method was used in the process of investigation,and the research tools include diagnostic criteria for Internet Addiction,Creativity Assessment Packet (CAP).And further Family environment questionnaire,Egna Minnen av Barndoms Uppfostran (EMBU) and 16PF were used for HSIGAD.ResultsThe creativity's total and each factor's score of HSIGAD( creativity's total ( 109.60 ±11.12 ),risk ( 23.77 ± 2.97 ),curiosity ( 31.51 ± 4.29 ),imagination ( 26.06 ± 3.57 ) and challenge ( 28.26 ±2.87) ) were lower than that of HSIGAD( ( 111.35 ± 12.00) (24.14 ±3.20) (32.25 ±4.26) (26.35 ±4.25)and (28.62 ±2.79) respectively),but there was no significant difference.The creativity's total and each factor's score of HSIGAD were significantly lower than that of HSIS( ( 121.27 ± 7.68 ) ( 26.17 ± 2.30) ( 35.80 ± 3.11 )(29.66 ±3.28) and (29.64 ±2.34) respectively) (P＜0.01).Multiple stepwise regression analysis found that extroversion in personality and knowledge in family environment entered the regression equation,and all had positive prediction for creativity tendency.ConclusionThe internet game addiction may slow the development of high school student's creativity.While the personality of extroversion and the family environment with esteem to knowledge were beneficial to the development of adolescent creativity tendency.

Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.

Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography (MSCT) angiography using a new 64-slice scanner. Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age- and sex-matched non-CHF controls. Compared with controls, CHF patients showed significant greater diameters of left superior pulmonary vein (LSPV) and right inferior pulmonary vein (RIPV) in both anteriorposterior(AP) and superior-inferior (SI) directions (P＜0.01), significant dilation of right superior pulmonary vein (RSPV) in AP direction (P＜0.05), as well as significant increase of LA transverse, AP, and SI diameters (P＜0.01). Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients. This anatomic and geometric changes may participate in the perpetuation of AF.

ObjectiveTo investigate safety and efficacy of one-stage pedicle screw fixation plus 360° spinal canal decompression and reconstruction in treatment of severe thoracolumbar burst fractures.MethodsThe study reviewed 11 patients (8 males and 3 females, at age range of 19-59 years, mean 34.4 years) with severe thoracolumbar burst fracture, who underwent one-stage posterior pedicle screw fixation, 360° spinal canal decompression and reconstruction. The injury location was at T12 in one patient, at L1 in three, at L2 in two, at L3 in three and at L4 in two. According to AO classification, all patients were with type A 3.3 fractures. McCormack load score was 7-9 points ( average 8.2 points). Based on the Frankel' s scale, the spinal cord function was classified as grade A in one patient, grade B in one,grade C in five and grade D in four. ResultsAll the operations accomplished successfully, with operation duration for 3.5-4.5 hours ( mean 4.1 hours) , blood loss for 900-2 800 ml ( mean 1 750 ml) and allogeneic blood transfusion for 400-1 200 ml ( average 760 ml). There was no complication either during or after operation. The loss rate of the anterior vertebrae column height was 48％ -85％ ( average 64.2％ )before operation and recovered to 95％ -100％ (average 98.6％ ) of the normal. The kyphotic Cobb angle was at -12°-35 ° ( average 12.1 ° ) before operation and recovered to - 30°-7 ° ( average - 8.1 ° ) after operation. The spinal canal stenosis rate was improved remarkably. The patients were followed up for 10-18 months (average 14. 5 months), which showed solid bone fusion, with no implant failure. The spinal cord function was improved Ⅰ to Ⅲ degrees in all patients except for one patient at grade A. One patient had mild lower back pain.ConclusionsOne-stage pedicle screw fixation plus 360° spinal canal decompression and reconstruction is a good alternative for severe thoracolumbar burst fracture, but it is essential for choosing strictly the surgical indications.

ObjectiveTo compare the clinical results of pedicle screw fixation via the injured vertebra versus across the injured vertebra for thoracolumbar spine fracture.MethodsThe study reviewed 56 patients (41 males and 15 females,at age range of 21-66 years,mean 41.5 years) with thoracolumbar spine fractures managed with the two fixation methods from June 2005 to December 2008.The fracture segment included T12 in 13 patients,L1 in 27 and L2 in 16.According to the AO classification,there were six patients with type A1.2,29 with type A3.1,nine with type A3.2 and 12 with type A3.3.McCormack load score was 5-8 points (average 6.3 points). The spinal cord injury was classified as grade A in three patients,grade B in four,grade C in eight,grade D in 17 and grade E in 24 according to Frankel scale.The patients were divided into two groups,ie,across vertebral fixation group (27 patients) and via the vertebral fixation group (29 patients).All patients were selectively treated with monosegment bone graft simultaneously.The Cobb' s angle,restoration of the anterior height of the injured vertebra,improvement of spinal canal stenosis rate and Denis scale in local pain and work status were compared between the two groups.The bone graft fusion and spinal cord recovery of both groups were observed during follow-up.ResultsAll patients were followed up for 12-48 months (average 25.8 months).Implantation loosening occurred in one patient 1.5 month after operation in across vertebral fixation group.There were no significant differences in aspects of correction of Cobb' s angle,restoration of the anteriorheight of injured vertebra and improvement of spinal canal stenosis rate postoperatively as well as in aspects of restoration of anterior height of injured vertebra and improvement of spinal canal stenosis rate at the latest follow-up between the two groups ( P ＞ 0.05).The postoperative loss of correction rate of Cobb's angle of both groups existed,with significant difference (P ＜0.05). The differences of the Cobb's angle at the latest follow-up and after operation were significant in the across vertebral fixation group ( P ＜ 0.05) but insignificant in the via vertebral fixation group (P ＞ 0.05 ).Bone graft fusion occurred in 21 patients (78％) in the across vertebral fixation group and in 27 patients (93％) in the via vertebral fixation group ( P ＜ 0.05 ).Denis scale indicated a better recovery in the local pain of via vertebral fixation group compared with the across vertebral fixation group ( P ＜ 0.05 ),but showed no significant differenc e in work status between the two groups ( P ＞ 0.05 ).ConclusionsCompared with across vertebral fixation,the pedicle screw fixation via the vertebra has the advantages of higher fusion rate and better correction rate of Cobb' s angle and is a better choice for thoracolumbar spine fracture with posterior approach.

Simvastatin,a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor,is widely prescribed to patients with hypercholesteremia and its muscular toxicity has been widely reported.The metabolism of simvastatin depends on the enzymic activity of cytochrome P450 3A4 (CYP3A4) and inhibitors of CYP3A4 can result in clinical events by interacting with simvastatin.Diltiazem is a moderate inhibitor of CYP3A4,which is known to increase the serum concentration of simvastatin.Here we report a patient with unrecognized hypothyroidism who had been stable for more than one year on low-dose simvastatin therapy of hypercholesteremia and rhabdomyolysis occurred with the addition of diltiazem.This is one of scanty reports of rhabdomyolysis induced by simvastatindiltiazem drug interaction,especially in hypothyroid patient.This case reminds the clinicians that although diltiazem as a moderate CYP3A4 inhibitor can be used cautiously with small doses of CYP3A4-dependent statius (eg,simvastatin),these two commonly used drugs should be avoided in hypothyroid patient.

Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P＞0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P＞0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.

Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4％ and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 ％ of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17％ of the patients. This temporal association was seen in 21％ of the patients with nocturnal ST-segment depressions, more frequently in men (P＜0.05) and more frequently in those with severe disordered breathing (P＜0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73％ of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)