Objective To evaluate the safety and possibility of coronary intervention in uremic patients on dialysis. Methods Three uremic patients with unstable angina pectoris were treated successfully with percutaneous transluminal coronary angioplasty and stenting. In order to minimize the adverse effect on kidney due to contrast, non-ionic and low osmolar contrast medium was used and coronary angiography and intervention therapy were performed separately. Further protection of the renal function was effected by more frequent dialysis and increasing fluid administration. Results Coronary contrary shows the stenosis of multiple vessels in one patient, unique vessel lesion in two patients. One to four stents were placed. Clinical follow-up period of 12-18 months after procedure, angina pectoris disappeared in all three patients and no deterioration of renal function was noted. Conclusion It is possible to perform coronary angiography and stenting in uremic patients on hemodialysis successfully and safely, provided due attention was paid to the choice of contrast medium and protective measures for renal function.

Objective To investigate the radiation doses in different areas around the operation table during intervention procedure and to study the effect of X-ray protection equipments.Methods A total of 37 procedures(12 diagnostic cardiac angiographies and 25 percutaneous coronary intervention therapy) were investigated.The detection of X-ray was carried out in 2 separate groups.The first group included the operators,assistants and nurses.There were 6 detecting points on each person resulting in a total of 18 detecting points.The second group consisted of 10 detecting points on different areas of the patients and the protecting lead shields around.The measurement of X-ray doses was performed by the specialist from the radiation protection agency.Results The doses of X-ray was directly proportional to the duration of exposure.The X-ray doses varied among the 28 detecting points.The highest amount of radiation were detected on the left arm of the operator and on the left axilla and the back of the patients.Above 90% of radiation could be protected by lead shields and lead clothes.Conclusion Lead protective products available at precent are efficient in protecting radiation exposure during cardiovascular intervention procedures.More attention still need to be paid to certain highly exposed areas.

BACKGROUND: Degenerated cervical intervertebral discs can release many kinds of cytokines and inflammatory mediums, which plays an important role in onset and development of cervical syndrome.OBJECTIVE: To observe the effect of anti-cytokine Chinese herb combined with western drug (anti-hyperosteogeny capsule combined with glucosamine hydrochloride capsule) and gene therapy, on the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) of degenerated cervical intervertebral discs in rabbits.DESIGN: Randomized controlled observation.SETTING: Department of Orthopaedics and Central Laboratory of Hebei People's Hospital.MATERIALS: The experiment was carried out in the Central Laboratory of Hebei People's Hospital from March 2003 to January 2004. A total of 35 New Zealand rabbits of both genders were selected and divided into 7groups according to randomly digital table: normal control group, shallowlayer model group, whole-layer model group, shallow-layer medicine group,whole-layer medicine group, shallow-layer gene group and whole-layer gene group. There were 5 rabbits in each group.METHODS: Except normal control group, rabbits in other 6 groups were used to establish models of dynamic dysequilibrium of cervical vertebra through cutting muscles of cervical back to induce degeneration of cervical intervertebral discs. Superficial group of muscle in cervical region was resected in shallow-layer groups, and both superficial and deep group of muscle was resected in whole-layer groups. ① Seven months after operation, rabbits in medicine groups were respectively treated with 1.1 g/kg anti-hyperosteogeny capsule (consisting of gouji, gusuibu, jixueteng, laifuzi,niuxi, nvzhenzi, roucongrong, shudihuang and yinyanghuo, etc.; Jiangsu Kangyuan Pharmaceutical Company Limited) and 0.06 g/kg glucosamine (Shanxi Zhongyuanwei Pharmaceutical Company Limited), which was dissolved into 20 mL distilled water. The medicine was administrated twice a day for 1 month. ② After anesthetization of rabbits in gene groups, recombinant plasmid DNA combined with transforming growth factor-β1 (TGF-β1) was injected to C2-3, C3-4 and C4-5 intervertebral disc (20μL per intervetebral disk). Eight months after modeling, rabbits in each group were sacrificed and C3-4 and C4-5 intervertebral disc was used as samples. In addition, contents of IL-1β and TNF-α were measured with double-antibodies-sandwich-ELISA method.MAIN OUTCOME MEASURES: Contents of IL-1β and TNF-α in cervical intervertebral discs of rabbits at 8 months after modeling.RESULTS: All 35 rabbits were involved in the final analysis. Eight months after modeling, for contents of IL-1β and TNF-α, shallow-layer model group was higher than normal control group (P ＜ 0.05-0.01); shallow-layer medicine group and shallow-layer gene group were obviously low er than shallow-layer model group (P ＜ 0.05); whole-layer medicine group and whole-layer gene group were lower than whole-layer model group (P＜ 0.05-0.01).CONCLUSION: The degenerated intervertebral discs can release many kinds of cytokine and inflammatory mediators which can enhance the degeneration of cervical intervertebral discs. Antihyperosteogeny capsule combined with glucosamine hydrochloride capsule and gene therapy can obviously reduce the contents of IL-1β and TNF-o in degenerated cervical intervertebral discs.

Objective To explore the effect and mechanism of stent implantation on the quality of sexual activity in middle and old age male patients with exertional angina pectoris.Methods One hundred and seventy-two male patients with exertional angina pectoris were enrolled in this study,and they were divided into control group (94 patients) and percutaneous coronary intervention group (78 patients).The patients in control group were given routine pharmacotherapy and the patients in percutaneous coronary intervention group were given drug-eluting stent implantation and routine pharmacotherapy.The sexual activity function was evaluated by international index of erectile function (IIEF)-5 scale before treatment and 3 months after treatment.The times of sexual intercourse was added up.The evaluation of angina pectoris was performed by the grade of Canadian cardiovascular society (CCS).At the same time,the walking distance and heart rate were measured through 6-minute walking test.The left ventricular ejection fraction(LVEF) was detected by echocardiogram.Results After treatment for 3 months,the scores of IIEF-5,the degree of sexual satisfaction,the times of sexual intercourse and the grade of CCS in percutaneous coronary intervention group were significantly improved compared with those in control group [(20.58 ± 7.36) scores vs.(16.38 ± 6.35) scores,(4.32 ± 1.38) scores vs.(2.51 ± 1.89) scores,(6.3 ± 3.2) times/month vs.(3.5 ± 1.6) times/month,(1.10 ± 0.43) grades vs.(2.50 ± 1.1 0) grades] (P ＜ 0.05).The walking distance and heart rate after 6-minute walking test and LVEF in percutaneous coronary intervention group were significant improved compared with those in control group [(386 ± 82) m vs.(281 ± 86) m,(95 ± 18) times/minute vs.(122 ± 25) times/minute,(65.2 ± 11.2)％ vs.(55.6 ± 13.8)％] (P ＜ 0.05).Conclusions Stent implantation can significandy improve the quality of sexual activity in middle and old age male patients with exertional angina pectoris.The mechanisms are associated with the exercise capacity increasing and the frequency of angina pectoris attacks decreasing during sexual intercourse.

Objective To investigate the influence of proton pump inhibitors (lansoprazole and rabeprazole) on dual-antiplatelet therapy (DAPT) in patients with coronary heart disease.Methods One hundred and eighty-one cases of coronary heart disease with DAPT were selected,and they were divided into control group (66 cases,no proton pump inhibitors administered),lansoprazole group (65 cases,lansoprazole administered) and rabeprazole group (50 cases,rabeprazole administered).100 mg/day of aspirin and 75 mg/day of clopidogrel were concomitantly used in all patients.Platelet aggregation rate,platelet aggregation threshold index (PATI) and adenosine diphosphate (ADP) was measured.Results The ADP-PATI in control group was (3.47 ± 0.96) μ mol/L,lansoprazole group was (3.28 ± 1.05) μ mol/L,rabeprazole group was (3.32 ±0.83) μ mol/L,and there was no statistically significant difference among three groups (P＞0.05).There was also no statistically significant difference in platelet aggregation rate and collagen-PATI among three groups (P ＞ 0.05).Conclusion In patients with coronary artery disease,the concomitant use of lansoprazole or rabeprazole does not affect antiplatelet action during DAPT.

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.

As an emerging tumor therapy, high intensity focused ultrasound (HIFU) therapy has difficulty in controlling its dosage due to the complex human tissues. The dosage is related to the tumor such as its depth, size, characteristics and the tissue performances of its growth site. The existing cases are applied to establishing a repository with the above-mentioned parameters of the tumor analyzed. Then reasoning and self-learning are performed. So, the therapeutic dosage can be provided to the clinician when a new case occurs.

Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction(AMI) patients with gastrointestinal bleeding (GIB) in the elderly.Methods Total 325 elderly patients with AMI were divided into AMI control group (n=304,patients without gastrointestinal bleeding around the period of AMI),GIB-post-AMI (n=14,patients developing gastrointestinal bleeding after AMI) group and AMI-post-GIB (n=7,patients with gastrointestinal bleeding subsequently suffered an AMI) group.The clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal AMI,heart failure and stroke were analysed.Results (1) Estimated glomerular filtration rate (eGFR) became lower in the patients with GIB-post-MI (61.9+27.3) ml · min-1 · 1.73 m2 compared with AMI control patients (77.3+27.9) ml · min-1 · 1.73 m2,P＜0.05.Multivariate regression analysis revealed that the relative risk from a decreased eGFR for developing gastrointestinal bleeding after AMI in elderly patients was 0.980 (95％CI:0.960-0.999,P＜0.05).(2) There were significantly less patients adopting anti-platelet and anti-coagulant medications in AMI-post-GIB group and less patients applying aspirin in GIB-post-AMI group as compared with AMI control group,respectively (P＜0.05).AMIpost-GIB patients had significantly lower hemoglobin (74 + 14) g/L than GIB-post-AMI patients (111±25) g/L,P＜0.01.More MI-post-GIB patients (6 cases,85.7％) versus GIB-post-AMI patients (4 cases,28.6％)underwent blood transfusion( P＜0.05).There were significantly less patients adopting PCI and thrombolytic therapy in AMI-post-GIB group as compared to AMI control patients (P＜0.01).(3) The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal MI,heart failure and stroke in GIB-post-MI group were significantly higher than in AMI control group[42.9％ (6/14) vs.17.8％ (54/304),P＜0.05].Conclusions Reduced eGFR is an important predictor for elderly AMI patients developing gastrointestinal bleeding which makes it difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment,usually with worse prognosis.

ObjectiveTo study the effect of different renal functions on the prognosis of elderly patients with coronary neart disease (CHD). MethodsAll 383 patients with CHD were divided into elderly group and non-elderly group. Then patients in the elderly group were assigned to 4 groups according to the quartile of the estimated glomerular filtration rate (eGFR): GFR1 group (eGFR:1.73 m-2). All patients were followed up for 2 years, and the cumulative death rate of cardiovascular diseases and the relative risk for cardiovascular death were analyzed. Results(1)The cumulative death rate of cardiovascular diseases in elderly group was higher than that in non-elderly group (9.4vs. 1.3%, P=0. 019). (2)The cumulative death rate of cardiovascular diseases in GFR1,GFR2,GFR3 group were 6.8% ,6.3% ,4.6%, respectively, and there were no statistical differences among the three groups (P>0. 05). The cumulative death rate of cardiovascular diseases was 19.4% in GFR4 group, which was higher than that in other three groups (19.4% vs. 6.8%, P=0.038;19.4% vs. 6.3%, P=0.025 ;19.4% vs. 4.6%, P=0.009) . (3)Multivariate regression analysis revealed that eGFR was an independent prognosis factor for elderly patients with CHD, and the hazard ratio for cardiovascular death was 0. 965(95% CI: 0. 946～0. 985, P=0. 001). ConclusionseGFR is an important predictor for cardiovascular death in elderly patients with CHD.

ObjectiveTo observe the in-hospital and long-term results in patients with drugeluting stenting age≥70 years with unprotected left main (UML) coronary artery disease.MethodsIn this retrospective study, 100 patients with UML disease were enrolled. Death, myocardial infarction, repeated revascularization and composite end points during follow-up were compared between groups aged ≥70 years and control aged ＜70 years.ResultsThere was no remarkable distinction between the two groups in cardiovascular risk factors, anatomic findings of coronary artery disease and stent variables. No significant differences were found between the two groups in procedure success rate[96.2％ (50 cases) vs. 97.9％ (47 cases) ,x2 = 1.75, P＞0.05] and in-hospital mortality [3.8％ (2 cases) vs. 2.1％ ( 1 case), x2 = 0.27, P ＞0.05]. Patients were clinically followed for an average time of 22.0 months in the elderly group and 23.0 months in the control group (t= -0.78, P＞0.05). There were no significant differences in death[3.9％(2 cases) vs. 2.1％(1 case) ,x2 =2.51,P＞0.05], myocardial infarction[7.7 ％ (4 cases) vs. 4.2 ％ (2 cases), x2 = 0.55, P＞0.05], repeated revascularization [13.5％ (7 cases) vs. 12.5％(6 cases) ,x2 =0.02, P＞0.05]and composite endpoints of death, myocardial infarction and repeated revascularization[30.7％ (16 cases)vs. 18.8％ (9 cases),x2 = 1.92, P＞0.05] between the elderly group and the control group.ConclusionsThe procedure success rate and in-hospital mortality of drug-eluting stent implantation in elderly patients aged≥70 years old with unprotected left main coronary artery are comparable to group aged＜70 years. The main endpoints including death, myocardial infarction and repeated revascularization are favorable at about 2 years clinical follow up. It is safe and efficacious to implant drug-eluting stent in patients aged ≥70 years old with unprotected left main coronary artery.