Objective To determine the related facuors of side branch occlusion after stent implantion in the main branch of biburcation lesions.Methods We retrospectively analyzed 121 bifurcation lesions in 92 patients who accepted percutaneous coronary interventional therapy in our hospital from 2005 September to 2006 January.We employed quantitive coronary angiography analysis after stenting in the main branch and then evaluated the factors related to side branch stenosis.Results After stenting in the main branch of bifurcation lesions,four factors were found to be involved in causing side branch stenosis,which included:the plaque burden of both branches,the angle of bifurcation and the diameter of the side branch.The plaque burden of both branches was positively correlated but the biburcation angle and the diameter of the side branch were correlated to the formation of side branch stenosis.The severity of side branch stenosis after PCI could be represented by the regression equation:Y=0.48A-11.4B-0.23C+0.22D(Y:the degree of side branch stenosis after main branch stenting,unit:%;A:degree of pre-procedural side branch stenosis;B:diameter of the side brance;C:biburcation angle;D:the degree of pre-procedural main branch stenosis).Conclusion In bifurcation lesions,side branch stenosis after stenting in the main branch is related to plaque burden of both branches,diameter of the side branch and the bifurcational angle.Serious plaque burden in both branches,small side branch and sharper biburcation angle are more likely to cause side branch occlusion after main branch stenting.

Objective:To assess the clinical value of ultrasonic imaging in combination with McGill thyroid nodules score (MTNS) system in differential diagnosis of nodule size and benign and malignant tumors.Methods: The clinical data of a total of 112 patients with thyroid nodules were analyzed retrospectively. The nidus of the patients was identified by ultrasound-guided fine needle aspiration biopsy, and then the MTNS, nodule size and false negative rate of the patients were calculated, respectively.Results: The MTNS of the 112 cases of patients with thyroid nodules was within the range of 1 to 18, with an average score of (6.83±2.31). 16 cases with malignant nodules(the percent was 14.29%) were finally diagnosed by pathology, and 96 cases were diagnosed with benign nodules(the percent was 85.71%). The MTNS of patients with malignant nodules was significantly higher than that of those with benign nodules. Ultrasonic imaging showed that the nodule diameter was within the range of 1 to 8.9cm, with an average diameter of (4.13±4.13)cm. MTNS was positively correlation with nodule diameter (r=0.146,P<0.05). Besides, the average diameter of benign nodules was (3.67±1.60)cm, and that of malignant nodules was (4.23±1.51)cm. The missed diagnosed malignant nodules mainly were large diameter nodules.Conclusion: Ultrasound imaging in combination with MTNS can better predict the benign or malignant risk of thyroid nodules.

[Objective]On the origin and development of stroke research and interpretation. [Methods]Reading from pre-Qin period to the Ming and Qing dynasties in the ancient literature related to stroke the literature, according to the treatment of disease, etiology, pathogenesis, therapeutic principle, prevention and curing of Chinese medical induction, summary, combining the origin of stroke, analysis of pathogenesis and therapeutic principle of stroke, and it is filtered and classified the ancient literature and research, summarizes the extraction.[Methods]Reading and analyzing ancient documents related to the stroke.[Results]The termstrokeand theoretical source inNei Jing, the treatment based on syndrome differentiation is initiated Treatise on Febrile and Miscellaneous Diseases.Jin and Yuan dynasties developed stroke theory;modern perfect stroke syndrome differentiation system. Previously, during the Tang and Song dynasties, it is mainly based on the theories of vital Qi deficiency,pathogenic wind into the argument, treatment of strengthening the body and removal of scattered wind. After the Jin Yuan dynasties, they are internal injury based, wind from the endogenous theories. the treatment is mainly focused on internal injuries. [Conclusion]That ancient physicians paid attention to the etiology and treatment of stroke more, keeping in good health and prevention mentioned less, so we should pay attention to the prevention and recovery.

Objective To study the anticoagulant activity of hirulog. Methods Rabbits blood samples were collected before and after injecting hirulog. Thrombin clot time (TT), prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured to investigate the dose-effect and time-effect relationship of hirulog and compared the efficacy with heparin. Results TT, PT and APTT of rabbits blood samples were prolonged remarkably by hirulog, and the action duration was about 60 min, that was similar to heparin. Conclusion Hirulog showed obvious anticoagulant effects with clear dose-effect relationship.

Objective To assess the relationship between coronary plaques and risk factor of coronary heart disease in a asymptomatic population.Methods A total of 604 in-patients who received coronary computerized tomography angiography (CCTA) during January 1 th,2010 and April 1 th,2011 were enrolled in this study and assigned to the non-lesion group (0),mild lesion group (0 ＜ score ≤ 5) andmoderate-severe lesion group (＞ 5) according to the third quartile of CCTA score.Clinical data including physical examination,laboratory test,ultrasound sonogram and discharge diagnoses were collected and compared between the groups.Multivariable linear regression and bivariate logistic regression were performed to find out the main risk factors of coronary heart disease.ROC curve was drawn to estimate the diagnostic value of coronary lesions.Results There were 240 individuals in the non-lesion group,271 in the mild lesion group,93 in the moderate-severe lesion group.Multivariable linear regression indicated Y =-6.56 +3.22 × mean carotid intima-media thickness (cIMT) + 1.106 × male + 0.597 × low-density lipoprotein cholesterol (LDL-C) + 0.116 × age-1.596 × high-density lipoprotein cholesterol (HDL-C).Bivariate logistic regression and ROC curve showed that mean cIMT was the main risk factor of coronary heart disease (odds ratio (OR) =7.19,ROC =0.730,P=0.00,95％ confidence interval (CI):0.68 to 0.78).Furthermore,major coronary lesions were located in the LAD (20.8％) and was soft plaque (42.5％).Conclusion In this investigation,60.2％ of the asymptomatic patients showed plaques in CCTA.Age,cIMT,LDL-C and HDL-C may be predictive to moderate to severe coronary artery lesions.

Objective To analyze the effect on side branch with diameter ≥2.0 mm after stenting with cross-over technique in non-left main coronary bifurcation by using IVUS and QCA.Methods Comparative analysis was made on the IVUS and QCA results of the side branches in 35 non-left main bifurcation lesions which were intervened by cross-over technique.Results The diameter and area stenosis rates of the side branches examined by IVUS compared with QCA before intervention were 18.67%?16.29% vs 29.06%?23.16% and 31.17%?25.54% vs 42.22%?31.81% respectively.After cross-over interventional therapy,acute occlusion of the side branches detected by both IVUS and QCA was 2.86%.The rates of aggravated stenosis and newly developed stenosis in the side branches shown by IVUS and QCA were 14.29% vs 48.57%(P=0.012) and 11.43% vs 14.29%(P=0.294).Post-intervention morphology of the side branches detected by IVUS included plaque shift,vessel wall shrink,spasm and deformation.By using logistic analyzing,existence of soft plaque in the main branches was an independant factor affecting the fate of the side branches.Conclusion Comparing with IVUS results,QCA may over-estimate the degree of stenosis of the side branches after cross-over technique.The possible mechanism of side branch complications shown by IVUS included plaque shift,vessel wall shrink,spasm and deformation.Soft plaque in the main branch is an independant influencing factor of the result in the side branches.

Objective To verify the application of intravascular ultrasound(IVUS)in the classification of coronary bifurcation lesions.Methods There were 62 coronary bifurcations verified by CAG.Additional to conventional CAG,all patients received IVUS exam.Observation and determination of the plaque position in the main vessel(MV)and the side branches(SB)was made as well as the plaque morphological characters in these bifurcations.Results A 93.55% of the MV and 98.39% of the SB plaque at the bifurcation were eccentric and 77.42% of the plaques located at the external side of the vessel wall of both the MV and SB.There were 6 types(Type A,B,C,D,E,F)of bifurcations elassified by IVUS in this study.Type A(90.32%)was eccentric plaque in the MV which located at the opposite site of SB with the plaque in SB located at the opposite site of carina.Type B(1.61%)was concentric plaque found only in MVwith no plaque in the SB.Type C(1.61%)was concentric plaque in MV with eccentric plaque in SB which sited at the opposite of the carina.Type D(3.23%)was concentric plaque in MV which involved both of the ostium and the carina of SB.Type E(1.61%)was eccentric plaque in MV which located at the opposite side of SB which has concentric plaque at ostium.Type F(1.61%)was eccentric plaque in MV located at its the internal wall and involved carina of MV.A total of 6.45% of the all the lesions involved carina of the bifurcation.Conclusion Classification of coronary bifurcation based on IVUS was different from conventional CAG classification.The main IVUS classification criteria include ubtact carina,eccentricity and distribution of plaque on the external side of the vessel wall.

Anterior cervical plating has been widely used to treat cervical spine trauma, degeneration, deformity and tumor due to the advantages such as augmentation of cervical stability and promotion of bone graft fusion. This paper introduced the classification and evolution of plate-screw internal fixation system, analyzed the biomechanics of anterior cervical plate, and discussed its clinical application. Although the therapeutic effect of anterior cervical plating is favorable, there are still various complications postoperatively. Therefore, it is necessary to improve the anterior cervical plate from different aspects to expand its clinical application.

Objective To investigate the diagnostic accuracy of 3-dimensional reconstruction(3DR) coronary angiography in the evaluation of coronary artery disease compared with conventional quantitative coronary angiography with IVUS result as the reference standard.Methods Twenty vessel segments in nineteen patients who underwent coronary angiography and IVUS were studied.With the IVUS result as the reference standard,the 3D reconstruction images and the single plane(2D) images of each angiograph were retrospectively studied and compared.Results In all the 20 segments,the minimal vessel diameter/area rate of the stenosed vessels and the reference vessels,and the minimal cross-sectional stenosis rate had no significant differences among the conventional 2D angiograph the 3DR angiograph and the IVUS results.According to the IVUS results,all the 20 vessel/segments were further divided into two groups which were:the eccentric stenosis group(n=7) and the centripetal stenosis group(n=13).In the centripetal stenosis group,all the angiographic parameters detected by the three methods had no statistical difference.In the eccentric stenosis group,the 3DR angiograph showed more consistent results as detected by IVUS compared with the 2D angiograph in terms of cross-sectional stenosis rate.Conclusion Three dimentional reconstruction of coronary angiography showed higher accuracy in the quantitative analysis of coronary artery stenosis compared with conventional coronary angiography,especially in eccentric stenosis.