Chest Pain ; diagnosis ; Goals ; Humans ; Pain Clinics

Objective This study was aimed to evaluate the remote real-time transmission 12-lead electrocardiogram system on door-to-balloon time in patients with ST-segment elevation myocardial infarction.Methods We retrospectively analyzed the consecutive patients with STEM I who had accepted primary percutaneous coronary intervention (PCI) in the chest pain center of our hospital from February 2012 to July 2012.The study group consisted of patients with pre-hospital ECG,while the control group included patients without pre-hospital ECG,Their door-to-balloon time and door-to-catheter room time,mortality w ere compared.Results Totally 60 consecutive patients who had received primary PC I for STEMI were evaluated.Among them,35 patients were hospitalized with pre-hospital ECG while the other 25 patients without ECG.The Pre-hospital ECG was associated with a significautly shorter median door-to-balloon time (38 min vs.94min;P ＜0.01),The proportion of patients received balloon dilation within the guidelinerecommended 90 min timeframes Was significantly higher in pre-hospital ECG group than in non pre-hospital ECG group (94.6％ vs.60％;P =0.001).No difference was observed in mortality between the two groups (5.7％vs.4％;P ＞ 0.05),Significant difference was seen in the median hospital time in study group (5 compared with control group (7day) (5 day vs.7 day;P ＜ 0.01).Conclusions The remote real-time transmission 12-lead electrocardiogram system is associated with a significantly shorter door-to-balloon time in STEMI patients.The remote real-time transmission 12-lead electrocardiogram system is recommended in patients suspected STEMI.

The basic principles of piezoelectric quartz crystal immunosensor are reviewed. Its characteristics and applications in biomedicine are summarized. The feasibility of its application in detecting cardiac troponin I (cTnI) is briefly analyzed. There's no need of any signs and segregation steps in the technique, so the instrument is simple and easily-operated. Besides, it has a bright application future for its merits of rapid detection and precise quantification.

To investigate the effect and mechanism of intravascular brachytherapy with 192 Ir on expression of type I collagen after angioplasty. Restenosis model of domestic miniswine was employed.After angioplasty, the iliac arteries were randomized to brachytherapy group ( n =6) , which were treated with 20 25Gy of 192 Ir, and control group ( n =18). The target vessels were harvested at the 12 th week and the 24 th week after angioplasty. Immunohistochemistry and in situ hybridization were used to detect proteins of type I collagen, metalloproteinase 1 (MMP 1) and its tissue inhibitor (TIMP 1), and mRNA expression of type I collagen. The results showed that the protein and mRNA of type I collagen, and the ratios of TIMP 1/MMP 1 were lower in brachytherapy group than in control group. The peak of mRNA expression of type I collagen was at the 24 th week in control group and at the 12 th week in brachytherapy group, respectively. It suggested that intravascular brachytherapy with 192 Ir affects the metabolism of extracellular matrix by inhibiting the synthesis of type I collagen and regulating the activities of MMP 1 and TIMP 1.

Objective To investigate the changes and significances of the level of serum Fibulin-3 and correlation between Fibulin-3 and branchial-ankle Pulse Wave Velocity (baPWV) in patients with hypertension. Methods A total of 50 patients with hypertension and 38 healthy people were enrolled finally, whose fasting blood were collected. The levels of Fibulin-3、MMP-9 were detected by enzyme-linked immunosorbent assay. The baPWV was detected by pulse wave velocity automatic analyzer. Results The level of serum Fibulin-3 in hypertension was lower than the control group significantly (P < 0.001). There was no significance of serum MMP-9 in the two groups. The baPWV in hypertension was higher than the control group.Correlations between the level of Fibulin-3 and baPWV were significant (r = -0.324,P = 0.006). While correlations between the level of MMP-9 and baPWV had no significance (r=0.003,P=0.968). Conclusion The level of serum Fibulin-3 and baPWV can be used as index of functional changes in the early stage of hypertensive vascular remodeling, and may be applied for forecasting the organ damage in hypertension.

Objective To investigate the correlations between the time of thoracic endovascular aortic repair (TEVAR) and prognosis in patients with type B acute aortic dissection (AADB). Methods The clinical data of 156 AADB patients with TEVAR was retrospectively analyzed and divided into 3 groups according to the time from onset of symptom to TEVAR:less than seven days was deifned as group 1 (G1, n=87), seven days to fourteen days group 2 (G2, n=48);more than fourteen days was group 3 (G3, n=21). The status of aortic reconstruction at three months TEVAR, in-hospital mortalities, mean hospital expense and length of stay were compared among three groups. Results Before TEVAR, there was no signiifcant differences in the ratio of smallest true lumen diameter and largest false lumen diameter amony the three groups (0.47±0.33, 0.42±0.18, 0.47±0.27, respectively, P>0.05). At three months after TEVAR, the ratio of largest true lumen diameter and largest false lumen diameter among the three groups was signiifcantly greater in group 1 (1.76±0.51) than group 2(1.42±0.30) and group 3(1.34±0.34, P < 0.05), when there was no signiifcant difference between the later two groups. Complete aortic reconstruction (8 from group 1 and 4 from group 2) was achieved in 12 patients at 3 months after TAVAR. Eight patients died during hospitalization, 5 from visceral ischemic, 2 from proximal aortic dissection, one patient from sudden death. Compared with G3, the hospital expense of group 1 and group 2 was cut down about ￥20000. Length of stay was signiifcant greater in group 3 than in group 1 and group 2 (P<0.05). Conclusions Early TEVAR for AADB was safe and beneifcial for aortic reconstruct and reducing the hospital expense and length of stay.

Objective To evaluate puncture technique in thoracic endovascular aortic repair with abdominal aortic aneurysm and assess the feasibility and safety of using a pre-close technique for puncture and closure of femoral access sites. Methods From May 2010 to August 2013, the pre-close technique which involved two 6 F per-close ProGlide devices deployed in the femoral artery before upsizing to a 18-25 F sheath and one or two deployed before upsizing to a 14-16 F sheath were applied to 42 patients with abdominal aortic aneurysm (group A). Forty-seven patients using surgical femoral cutdown from December 2006 to April 2010 were enrolled into group B. The rate of technical success, time from procedure to the aortic delivery, operation time, low limb braking time, local complication, time from procedure to discharge, local vascular diameter after 3 months was evaluated and compared between two groups. Results There was no significant difference in endograft external diameter between two groups ( P>0.05). The rate of technical success was 97.62%(41/42) in group A and 95.74%(45/47) in group B, and there had no significant difference (P>0.05). Time from procedure to the aortic delivery, operation time and time from procedure to discharge in group A were significantly shorter than those in group B: (21.79 ± 5.79) min vs. (41.37 ± 11.79) min, (127.66±37.83) min vs. (157.84±42.71) min, (6.59±1.89) d vs. (9.14±2.57) d, P<0.05. The incidence rate of local complications, low limb braking time, and local vascular diameter after 3 months had no significant difference between two groups:7.14%(3/42) vs. 8.51%(4/47), (8.51± 1.83) h vs. (8.38±1.79) h, (1.05 ±0.36) mm vs. (0.98 ±0.31) mm, P>0.05. Conclusion The puncture technique with per-close ProGlide is safe and effective in percutaneous endovascular aortic repair which can be adopted as an alternative technique of surgical femoral cutdown approach in patients with abdominal aortic aneurysm.

OBJECTIVETo investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm.

METHODSTwo hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test. Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram. Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group.

RESULTSCoronary artery spasm was detected in 103 out of 271 patients, a rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4.2 times and 2.3 times, respectively. There was a significantly negative relationship between diabetes mellitus and coronary artery spasm. Furthermore, there was no significant difference of left ventricular ejection fraction and end diastolic pressure between spasm group and non-spasm group.

CONCLUSIONSCoronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis. Smoking and hyperlipidemia were the main clinical risk factors for coronary artery spasm.

Acetylcholine ; pharmacology ; Adult ; Aged ; Coronary Vasospasm ; etiology ; Female ; Humans ; Hyperlipidemias ; complications ; Male ; Middle Aged ; Risk Factors ; Smoking ; adverse effects

Objective To explore the effect of general anesthesia on Wuzhishan miniature pigs induced by a mixture of ketamine, Sumianxin II and midazolam, and maintained by ketamine and propofol in surgery lasting up to 8 hours. Methods A total of 18 Wuzhishan miniature pigs (body weight (20. 3 ± 1. 9) kg, 14 male and 4 female) were used in this study. The induction of anesthesia was performed with intramuscular injection of ketamine (8 -10 mg/kg) Sumianxin II (1. 5 mL) and midazolam (10 mg) behind the ear, and the general anesthesia was maintained with a mixture containing 0. 9％ sodium chloride 8 mL, ketamine 100 mg/2 mL and propofol 200 mg/40 mL, continuously injected through the marginal ear vein through a syringe infusion pump. The time spent for anesthesia induction and the duration time of anesthesia were recorded. Physiological indexes including body temperature, blood pressure, heart rate and respiratory rate, the reflex activities, and the effects of analgesia, sedation and muscular relaxation of the miniature pigs under anesthesia at 0, 0. 5, 1, 1. 5, 2, 4, 6, 8 h were observed. Results All the 18 pigs were successfully anaesthetized, but 4 pigs died during surgery due to hypovolemic shock, anesthesia accident, left main coronary thrombosis and reperfusion arrhythmia, respectively. During anesthesia, the analgesia, sedation and muscular relaxation effects on the pigs were obvious. The average time spent for anesthesia induction was (4. 8 ± 1. 2) min and the duration time of anesthesia was (54. 1 ± 5. 8) min. The eyelid reflex, corneal reflex and anal reflex in the pigs were weak or disappeared during 1 -8 h after the anesthesia was induced. The body temperature of the pigs was decreased gradually, with a significant difference between 1 h and 0 h (P＜ 0. 05), reaching the lowest point at 4 h, and then maintained stable. The blood pressure was gradually decreased, reaching the lowest level at 2 h (P ＜ 0. 05), then somehow increased, and maintained at a stable level until the end of surgery. The respiratory rate fluctuated during the anesthesia, with no significant difference. Conclusions The anesthesia induced by a combination of ketamine, Sumianxin II and midazolam and maintained with a combination of ketamine and propofol is simple to operate, shows effects fast, and has good effects of analgesia, sedation and muscular relaxation, keeping the circulatory system and respiratory system relatively stable throughout the anesthesia. Thus it is suitable for general anesthesia for miniature pigs.

Objective To explore the success rate and the risk of establishment of the acute myocardial infarction model between the beagle dogs and the mini-pigs by interventional technique ,further to provid theoretical basis for choose a more suitable animal model .Methods 6 dogs and 6 mini-pigs were anaesthetized ,then underwent the coronary arteriography via femoral artery .After is-chemic preconditioning the coronary balloon was inflated to occlude the middle left anterior descending coronary for 180 minutes . The electrocardiogram was examined throughout the operation and the pathological sections were examined until the animals were executed one week later .Results All beagle dogs survived ,while 1 case of mini-pigs dead(1/6) .There was 1 cases(1/6) of beagle dogs had acute myocardial infarction ,while 5(5/6)cases in mini-pigs .All mini-pigs had malignant arrhythmia(6/6) but never seen in beagle dogs .The time needed for building a model was similar between the two groups ,the difference had no statistical signifi-cance(P>0 .05) .Conclusion The risk of establish myocardial infarction model in mini-pigs is higher than beagle dogs ,but the suc-cess rate is still high ,it might be the better choice .