To observe the effect of hypotension induced by metoprolol and nitroglycerin (NTG) on the blood gas and hemodynamics. Method: 36 patients were randomly assigned to two groups. Group Ⅰ with intravenous metoprolol and nitroglycerin infusion (n=18), group Ⅱ with intravenous nitroglycerin infusion (n=18), Result: As compared with those in group Ⅱ, in group Ⅰ NTG dosage decreased by 55.7%. The reflex heart rate augmentation was suppressed, after the discontinuance of drug, the blood pressure increased steadily, rate-pressure prod uct value dereased and hemodynamics was stable. The changes in PaO_2 and BE was significantly lower in group Ⅰ than those in group Ⅱ (P

Objective To compare the diagnostic efficacy of the V/Q scan and CT pulmonary angiography (CTPA) for the detection of acute pulmonary embolism (PE) in elderly patients.Methods Fortyfour patients (age ≥60 years old) with suspected acute PE underwent V/Q scan and CTPA.The diagnosis of PE by V/Q scan was based on the criteria of prospective investigation of PE diagnosis (PIOPED) Ⅱ and the prospective investigative study of acute PE diagnosis (PISA-PED).The final diagnosis was made clinically.The sensitivities,specificities and accuracies of PIOPED Ⅱ,PISA-PED,CTPA and Wills score were calculated and compared using x2 and Fisher's exact tests.Kappa analysis was used to analyze the diagnostic accordance rate of PIOPED Ⅱ and PISA-PED.Results The sensitivities of PIOPED Ⅱ,PISA-PED and CTPA in the diagnosis of PE were 70.00％ (14/20),84.62％ (22/26) and 65.22％ (15/23),respectively (x2 =0.069-1.545,all P＞0.05).The sensitivity of Wills score was significantly lower (23.08％,3/13).The specificity of CTPA (93.75％,15/16) was significantly higher than those of PIOPED lⅡ and PISAPED (80.00％,12/15 and 61.11％,11/18,both P＜0.05).The accuracies of PIOPED Ⅱ,PISA-PED and CTPA were 74.29％ (26/35),75.00％ (33/44) and 76.92％ (30/39),respectively (x2 =0.005-0.070,all P＞0.05).The accuracy of Wills score was significantly lower (52.17％,12/23).The diagnostic accordance rate of PIOPED Ⅱ and PISA-PED criteria was 77.14％(27/35),Kappa=0.547,P＜0.05.Conclusion V/Q scan and CTPA have no significant difference for the diagnosis of PE in the elderly patients.

Objective To study the FDG SUVmax cutoff values in detection of metastases in mediastinal lymph nodes (MLN) and hilar/intralobar lymph nodes (HILN) in pre-operative patients with N0-2 stage NSCLC.Methods A total of 69 patients with stage N0-2 NSCLC (40 males,29 females,age 36-87 years) were included in this retrospective study.18F-FDG PET/CT was performed and followed by lung cancer resection with lymph node dissection in 1 month.The excised lymph nodes were compared one by one between their SUVmax and histopathology.The SUVmax cutoff value in detection of lymph node metastases was determined by the ROC curve.Mann-Whitney u test,x2 test,and Fisher exact test were used for data analysis.Results Metastatic MLN and (or) HILN were found in 21 of 69 NSCLC patients.The histopathologic results demonstrated metastases in 61 of 339 lymph nodes.The SUVmax of metastatic lymph nodes (4.95(3.46,7.19)) was significantly higher than that of benign lymph nodes (2.10(1.59,3.22);z=-7.576,P＜0.05).The SUVmax of metastatic HILN (6.32 (4.28,8.27)) was significantly higher than that of metastatic MLN (3.90(2.12,6.41);z=-2.921,P＜0.05).With cutoff of SUVmax ≥2.5,the sensitivity,specificity and accuracy in detection of all metastatic lymph nodes were 83.6％ (51/61),61.9％ (172/278)and 65.8％ (223/339) respectively,and the parameters were 74.2％ (23/31),79.6％ (160/201) and 78.9％ (183/232) for metastatic MLN,and 93.3％ (28/30),15.6％ (12/77) and 37.4％ (40/107) for metastatic HILN.The diagnostic sensitivities for metastatic MLN and for metastatic HILN were not significantly different (Fisher exact test,P＞0.05),while the specificities and accuracies between the two groups were significantly different (x2 values:96.7 and 56.1,both P＜0.05).According to ROC curves,cutoff values of SUVmax in detecting metastatic MLN and metastatic HILN were 2.78 and 4.93.With the specific cutoff value,the sensitivity,specificity and accuracy in detection of metastatic MLN were 71.0％ (22/31),87.1％ (175/201)and 84.9％(197/232),respectively.The corresponding data in detection of metastatic HILN were 73.3％ (22/30),77.9％(60/77) and 76.6％(82/107).Conclusion Different cutoff values of SUVmax in detecting metastatic MLN and metastatic HILN should be considered for more accurate lymph nodes staging in patients with NSCLC.

Objective To determine the value of 18F-FDG PET/CT in the detection of subsolid pulmonary nodules.Methods The 18F-FDG PET/CT imaging data of 44 patients (35 males,9 females,mean age (68.05±9.89) years) with 49 subsolid pulmonary nodules were retrospectively analyzed.There were 28 pure ground-glass nodules (pGGN) and 21 part-solid nodules (PSN),which were all confirmed by postsurgical pathology or imaging results during follow-up.The lesion size (dmax),ground-glass opacity (GGO) percentage,SUV retention index (RI),and the positive rates on PET images were accessed.The correlation between SUVmax and lesion size and GGO percentage was analyzed by Pearson correlation analysis.The SUVmax between benign and malignant pGGN,and that between malignant pGGN and PSN,were compared using two-sample t test.The diagnostic accuracy was compared using x2 test.Results (1) Six pGGN were benign while 43 nodules (including 22 pGGN and 21 PSN) were malignant among the 49 nodules.(2) SUVmax was positively correlated with lesion size (r=0.500,P＜0.05) and was negatively correlated with GGO percentage (r=-0.605,P＜0.05) for PSN,while SUVmax was positively correlated with lesion size (r=0.375,P＜0.05) for pGGN.(3) SUVmax was not significantly different (t =-0.813,P＞0.05) between 6 benign pGGN (0.78±0.25,range:0.50-1.20) and 22 malignant pGGN (0.91±0.34,range:0.40-1.70);SUVmax of 21 malignant PSN (2.10±1.16,range:0.60-5.60) was higher than that of 22 malignant pGGN (t=-4.645,P＜0.05).(4) When a nodule's activity being equal to or greater than that of mediastinal blood-pool was defined as malignancy,the accuracy rate of PSN (66.7％,14/21) was significantly higher than that of pGGN (9.1％,2/22; x2 =15.244,P ＜0.05).Based on the criteria for malignancy of RI＞10％,the accuracy rates for PSN and pGGN were 65.0％ (13/20) and 45.8％ (11/24),respectively (x2 =1.616,P＞0.05).Conclusion 18F-FDG PET/CT shows no clear advantage for diagnosis of pGGN,but is helpful for PSN.

Objective To investigate the left ventricular synchrony under different ischemic statuses using phase analysis of 99Tem-MIBI gated SPECT MPI (GSMPI).Methods The data of 129 patients (65 males,64 females,age:48-88 (68.6±10.2) years) who underwent 2-d stress-rest GSMPI were retrospectively analyzed.Perfusion images were scored by a 5-grade criteria (0-4) based on 17 coronary artery segments.Patients were divided into normal perfusion group (G1) and abnormal perfusion group (G2) according to the summed stress scores.G2 was divided into reversible perfusion defect subgroup (G2a) and irreversible perfusion defect subgroup (G2b) by the summed difference scores.The difference of PSD and PHB between groups and the difference between stress and rest GSMPI within each subgroup were compared using two-sample t test and paired t test,respectively.Results The numbers of patients in G1,G2,G2a and G2b were 66,63,39 and 24,respectively.The PSD (18.3±7.8) and PHB (68.6±30.9) of G2 were significantly higher than those (14.3±6.6 and 50.2±20.0) of G1 (t =-3.110,-3.989,both P＜0.05).The PSD and PHB of G2b were higher than those of G2a,but the difference was not statistically significant (t:-1.554 to-0.408,all P＞0.05),and the differences of PSD and PHB between rest and stress MPI within each subgroup were not significantly different (t:-0.961 to-0.114,all P＞0.05).The PSD (20.4±8.1 and 20.8±6.4) and PHB (77.8±53.5 and 78.4±26.7) of rest and stress GSMPI in patients with LVEF ≤60％were significantly higher than those in patients with LVEF＞60％(15.0±6.8 and 15.3±7.0,53.5±23.0 and 55.9±24.5;t:3.642 to 4.567,all P＜0.05).Conclusions 99Tcm-MIBI GSMPI phase analysis can show damage effect of abnormal myocardial perfusion on left ventricular synchrony,which influencing global left ventricular function,and it can show different left ventricular synchrony due to different degrees of myocardial ischemia.There is nearly same value of stress GSMPI and rest GSMPI in assessment of left ventricular synchrony.

Objective To evaluate the efficacy and safety of cardiac shock wave therapy(CSWT) in coronary heart disease in elderly patients.Methods Eleven patients with refractory angina pectoris were enrolled.The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography,and treated with CSWT.The CSWT were performed during treatment of 3 months,with 9 times totally.The clinical evaluations included the clinical symptoms,Canadian Cardiovascular Society (CCS) class scores,New York Heart Association class (NYHA),Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin,left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).The amelioration of ischemic myocardial was analyzed by SPECT.The safety of CSWT was evaluated by changes in clinical symptoms,ECG monitoring,blood pressure and oxygen saturation,blood levels of creatine kinase,creatine kinase myocardial band isoenzymes (CK-MB),troponin T (TnT),alanine transfer enzyme (ALT),creatinine (CR),brain natriuretic peptide and high sensitive C reactive protein (hs CRP).Results The CCS class scores,NYHA,6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment.The steady state of angina pectoris and the frequency score in SAQ were significantly improved.The 21 cardio-vessel segments were treated,and the improvement rate of resting myocardial perfusion was 46.2％ (6/13),the effective rate was 38.5％ (5/13),and the obvious effective rate was 7.8％ (1/13) after treatment.The improvement rate of loaded myocardial perfusion was 57.1％ (12/21),the effective rate was 47.6％ (10/21),and the obvious effective rate after treatment was 9.5％ (2/21).There were no significant changes in levels of CK,CK-MB,TNT,ALT,Cr,BNP and hs CRP,heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment.Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly,and the curative effect could maintain at least one year.

Objective To investigate the relationship of glycated hemoglobin (HbA1c),fibrinogen (Fbg)and cystatin C (Cys C)with the severity of coronary artery lesions in non-diabetic patients.Methods We enrolled 358 patients who received coronary angiography (CAG)in this study.They were divided into coronary artery disease (CAD)group and non-CAD group according to CAG results.Moreover,according to different clinical types of CAD,all the CAD patients were further classified into stable angina pectoris (SAP)group and acute coronary syndrome (ACS)group.We calculated Gensini score and divided CAD group into A,B and C subgroups by Gensini score.HbA1 c,Fbg,Cys C and other clinical data were measured and compared between groups,and the correlation analysis was used to find the relationship of HbA1c,Fbg and Cys C with Gensini score.Results The levels of HbA1 c,Fbg and Cys C were significantly higher in groups A,B and C than in non-CAD group.When Gensini score increased,the three indexes were increased too (P<0.05).The levels of HbA1c,Fbg and Cys C were significantly higher in ACS group than in SAP and non-CAD group (P<0.05).After adjustment for the influencing factors, HbA1 c was still associated with Fbg (P<0 .0 5 ).The levels of HbA1 c and Fbg were closely related to Gensini score (P<0.05).Conclusion In non-diabetes patients,HbA1c and Fbg are significantly related to the severity of coronary artery stenosis,and Cys C may not be an independent risk factor of coronary artery stenosis.

Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P<0 .0 5 ),but there was no significant difference between NSTEMI and UAP groups (P>0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.

Objective To detect the levels of CD31+/CD42b- and CD144+ endothelial microparticles (EMPs)in plasma,and analyze the relationship with carotid intima-media thickness (CIMT)and the risk factors of atherosclerosis.Methods Totally 122 outpatients and inpatients in our hospital were selected,and carotid artery ultrasound examination was performed.The results were divided into a thickening group (62 cases)and a control group (60 cases).Flow cytometry was used to detect the levels of CD31+/CD42b- and CD144+ EMPs in the blood to analyze the relationship between the level of endothelial cells and CIMT,and to investigate the relationship between the level of plasma EMPs and the risk factors of atherosclerosis.Results Compared with the control group,the levels of EMPs of CD31+/CD42b- and CD144+ were significantly higher.In the correlation analysis, plasma CD31+/CD42b- and CD144+EMPs levels were positively correlated with CIMT;in multi-factor Logistic regression analysis,CD31+/CD42b- EMPs levels were correlated positively with age,TC and Cys C;plasma CD144+ EMPs levels were correlated with UA and BMI.Conclusion The levels of CD31+/CD42b-,CD144+EMPs in plasma were correlated with CIMT,guiding early prevention of cardiovascular diseases.

Objective To investigate the expression of serum angiopoietin-2 (Ang-2 ) and its clinical significance in patients with chronic heart failure (CHF).Methods The levels of serum Ang-2,N-terminal pro-B-type natriuretic peptide (NT-proBNP)and left ventricular ejection fraction (LVEF)were detected in 1 1 3 patients with CHF,who were divided into four groups according to New York Heart Association (NYHA:class Ⅰ,n=3 2;Ⅱ,n=30;Ⅲ,n=26;Ⅳ,n=25).Another 20 healthy volunteers for physical check-up were chosen as the control group.Results With the change of cardiac function (from Ⅰ to Ⅳ),the levels of plasma Ang-2 and NT-proBNP were increased significantly (P<0.05 ).The level of serum Ang-2 was positively correlated with NT-proBNP (r=0.774,P<0.001),but negatively correlated with left ventricular ejection fraction (r=-0.725,P<0.001).Conclusion The level of serum Ang-2 has a significant correlation with the severity of heart failure.Ang-2 is expected to be used to predict and evaluate the severity of CHF.