60 strains which have antimicrobial activity had been isolated from nutritious soil in China in the study.We have further selected 1 strain which product broad-spectrum antibiotics using agar well-diffusion method.The strain was identified Brevibacillus laterosporus after physiological biochemical characteristic experiments,sequencing of 16S rDNA and cluster analysis,named S62-9.

OBJECTIVETo assess the efficacy of intracoronary nitroglycerin and verapamil for patients with the coronary slow flow phenomenon (CSFP).

METHODSSixty-four patients with CSFP without stenotic lesions during diagnostic coronary angiography were enrolled and divided into the nitroglycerin group (n = 35) and verapamil group (n = 29), 29 patients with normal coronary flow served as normal control. CSFP was defined when 4 or more heart beats were needed for contrast media to opacify the distal vasculature. Intracoronary injection of 100 - 400 microg nitroglycerin or verapamil through the diagnostic catheter was applied to patients with CSFP to improve coronary flow. The coronary blood flow was evaluated by thrombolysis in myocardial infarction (TIMI) frame count (TFC) method.

RESULTSClinical characteristics were similar among the three groups. The basic TFCs of left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were 78.3 +/- 19.4, 57.2 +/- 14.6, 56.9 +/- 12.5 in the verapamil group, and were 70.8 +/- 21.7, 55.3 +/- 12.5, 51.1 +/- 15.4 in the nitroglycerin group, respectively, which were significantly higher than those in the normal controls (LAD 29.2 +/- 4.4, LCX 23.1 +/- 3.5 and RCA 19.7 +/- 1.8, respectively). After the administration of drugs, the TFCs of LAD, LCX and RCA were 42.3 +/- 8.9, 36.7 +/- 6.8, 30.3 +/- 5.9 respectively (all P < 0.01 vs. baseline) in the nitroglycerin group and 37.7 +/- 9.3, 31.5 +/- 11.3, 24.6 +/- 4.4 respectively (all P < 0.01 vs. baseline) in the verapamil group. The TFCs after drug administration in both therapy groups were significantly higher than that in normal controls (all P < 0.05). The TFCs decrease in the verapamil group were more significant than that in the nitroglycerin group (all P < 0.05).

CONCLUSIONIntracoronary administration of verapamil could result in more coronary flow improvement in patients with CSFP than nitroglycerin, although the post therapy coronary flow was still slower than normal.

Adult ; Aged ; Coronary Circulation ; Female ; Humans ; Male ; Middle Aged ; Nitroglycerin ; therapeutic use ; No-Reflow Phenomenon ; drug therapy ; Treatment Outcome ; Verapamil ; therapeutic use

BACKGROUNDThere are few reports of quantitative and qualitative measuring of left main coronary artery (LMCA) plaques by multislice computed tomography coronary angiography (MSCTA), especially when compared with intravascular ultrasound (IVUS) as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.

METHODSA total of 91 patients (53 men, 38 women, mean age (64.78 +/- 9.19) years) were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index (kappa) for the agreement between MSCTA and IVUS was calculated. Minimal lumen area (MLA), external elastic membrane cross-sectional area (EEM-CSA) and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.

RESULTSThe sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index (kappa = 0.744, P < 0.001) indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 (P < 0.01). The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively (both P < 0.01). The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were (52.52 +/- 15.71) HU, (108.32 +/- 43.44) HU and (604.16 +/- 377.67) HU (P < 0.001). Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%.

CONCLUSIONSSixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.

Adult ; Aged ; Coronary Artery Disease ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods ; Ultrasonography

BACKGROUNDThe retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach.

METHODSEighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated.

RESULTSMean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P < 0.01). Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P < 0.01). There were 17 (20.2%) patients failure of recanalize the CTO lesions, among which 13 (15.5%) were due to the failure of retrograde wire crossing the collaterals.

CONCLUSIONSThe retrograde approach is an effective technique to recanalize CTO lesions, the septal collateral was preferable. When the epicardial collateral is selected, careful manipulation of devices and wires is essential due to the potential risk of perforation of collateral channels.

Adult ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; physiology ; Coronary Angiography ; Coronary Occlusion ; diagnostic imaging ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDLarge discrepancy of the incidence of myocardial bridging (MB) has been reported either among the postmortem studies or among the studies with coronary angiogram. This study was to investigate the prevalence of MB in large number of coronary angiograms and the angiographic characteristics of MB.

METHODSA total of 5525 consecutive patients who underwent first diagnostic coronary angiography from January 2003 to March 2006 in Zhongshan Hospital were enrolled in this study. MB was diagnosed when the angiographical "milking effect", defined as the systolic compression and complete or partly release of the compression in diastole, was seen in the epicardial coronary arteries. Angiography was routinely repeated after intracoronary injection of 200 microg nitroglycerin. The systolic compression and length of MB were compared before and after the administration of nitroglycerin and also before and after stent implantation in patients with significant stenosis in segment proximal to the MB.

RESULTSAmong 5525 patients, MBs were found in a total of 888 patients angiographically with the prevalence of 16.1%. Atherosclerotic lesions were found more often in the segment proximal to the MB with 344/854 (40.3%) patients than in the segment distal to the MB with 47/854 (5.5%) (P < 0.01). The systolic compression ((43.3 +/- 13.7)% at baseline vs (54.2 +/- 14.0)% after nitroglycerine) and the average length ((20.9 +/- 7.5) mm at baseline vs (22.7 +/- 8.0) mm after nitroglycerine) of the MB segment were increased after intracoronary injection of nitroglycerin (both P < 0.01). Stent implantation was performed in 88 patients with significant stenosis in the segment proximal to the MB. The systolic compression and the length of the MB segment were increased after stenting compared with those before stenting (systolic compression, (49.4 +/- 14.6)% at baseline vs (57.3 +/- 12.3)% after stenting, and length of MB, (19.5 +/- 6.1) mm at baseline vs (21.8 +/- 6.3) mm after stenting, P < 0.01).

CONCLUSIONSMB was a frequent finding in coronary angiogram with an incidence of 16.1%. Intracoronary administration of nitroglycerin and stent implantation in the segment proximal to the MB could enhance the systolic compression and the length of the MB angiographically.

Aged ; Coronary Angiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; diagnosis ; pathology ; Retrospective Studies

BACKGROUNDFirst generation drug-eluting stents (DESs) were based on 316L stainless steel and coated with a permanent polymer. The vessel wall of these DESs was inflammatory and late in-stent thrombosis was reported. Hence, cobalt chromium based DES coated with a bioabsorbable polymer was an alternate choice.

METHODSCobalt chromium based DES with bioabsorbable polymer (Simrex stent) as well as control stents (Polymer stent and EXCEL(TM) stent) were implanted into porcine arteries. At a designated time, angiography, quantitative coronary angiography (QCA) analysis, histomorphometry, and electron-microscopical follow-up were performed.

RESULTSA total of 98 stents of all the three groups were harvested. At week 24, percent diameter stenosis (%DS), late loss (LL), and percent area stenosis (%AS) of Simrex was (12.9 ± 0.4)%, (0.35 ± 0.02) mm, and (24.5 ± 4.2)%, respectively, without significant difference in comparison to commercialized EXCEL(TM) stent. Slight inflammatory reaction was seen around the stent strut of Simrex, just as in the other two groups. Electron-microscopical follow-up suggested that it might take 4 - 12 weeks for Simrex to complete its re-endothelialization process.

CONCLUSIONSCobalt chromium based, bioabsorbable polymer coated sirolimus-eluting stent showed excellent biocompatibility. During 24 weeks observation in porcine model, it was proved that this novel DES system successfully inhibited neointima hyperplasia and decreased in-stent stenosis. It is feasible to launch a clinical evaluation to improve the current prognosis of DES implantation.

Angioplasty, Balloon, Coronary ; Animals ; Chromium Alloys ; administration & dosage ; Coronary Angiography ; Drug-Eluting Stents ; adverse effects ; Polymers ; administration & dosage ; Sirolimus ; administration & dosage ; Swine ; Swine, Miniature

OBJECTIVETo investigate the relationship between endothelin-1 (ET-1) and tumor necrosis factor-alpha and myocardial microcircular dysfunction during coronary microembolization (CME).

METHODSCME was induced in 10 miniswine by selective infusion of microspheres (45 microm) into left anterior descending artery (LAD). We measured (1) coronary sinus level of ET-1, TNF-alpha using radioimmunoassay; (2) CFR, a measure of microvascular integrity, using Doppler flow wire in LAD at baseline and different doses of microspheres.

RESULTSCFR decrease significantly with different doses of microspheres (vs. baseline, P < 0.05). Level of ET-1, TNF-alpha increased significantly with doses of 5 x 10(4) and peaked with 10 x 10(4). Interestingly, ET-1 progressively decrease while TNF-alpha persistently elevated from doses of 12 x 10(4) to 15 x 10(4). There are reverse correlations between ET-1 and CFR (r = -0.31, P < 0.05).

CONCLUSIONSThe extent of microvascular injury wasn't linearly related to the extent of ME, where, it closely associated with myocardial ET-1.

Animals ; Coronary Thrombosis ; physiopathology ; Disease Models, Animal ; Endothelin-1 ; blood ; Microcirculation ; physiopathology ; Swine ; Swine, Miniature ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND/AIMS: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients. METHODS: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients. RESULTS: The mean admission sodium level was 138 +/- 4.7 mmol/L, and 247 patients (16.8%) had hyponatremia defined as Na+ < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and beta-blocker. Underuse of optimal medical treatment was more pronounced in hyponatremic patients. CONCLUSIONS: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.
Aged ; Aged, 80 and over ; Asia/epidemiology ; *Asian Continental Ancestry Group ; Biomarkers/blood ; Cardiovascular Agents/therapeutic use ; Disease-Free Survival ; Female ; Guideline Adherence ; Healthcare Disparities ; Heart Failure/*diagnosis/drug therapy/ethnology/mortality/physiopathology ; *Hospitalization ; Humans ; Hyponatremia/blood/*diagnosis/drug therapy/ethnology/mortality ; Male ; Middle Aged ; Practice Guidelines as Topic ; Predictive Value of Tests ; Proportional Hazards Models ; Risk Factors ; Sodium/*blood ; Stroke Volume ; Time Factors ; Treatment Outcome

BACKGROUNDTumor necrosis factor-α (TNF-α) plays an important role in progressive contractile dysfunction in several cardiac diseases. The cytotoxic effects of TNF-α are suggested to be partly mediated by reactive oxygen species (ROS)- and mitochondria-dependent apoptosis. Glucagon-like peptide-1 (GLP-1) or its analogue exhibits protective effects on the cardiovascular system. The objective of the study was to assess the effects of exenatide, a GLP-1 analogue, on oxidative stress, and apoptosis in TNF-α-treated cardiomyocytes in vitro.

METHODSIsolated neonatal rat cardiomyocytes were divided into three groups: Control group, with cells cultured in normal conditions without intervention; TNF-α group, with cells incubated with TNF-α (40 ng/ml) for 6, 12, or 24 h without pretreatment with exenatide; and exenatide group, with cells pretreated with exenatide (100 nmol/L) 30 mins before TNF-α (40 ng/ml) stimulation. We evaluated apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay and flow cytometry, measured ROS production and mitochondrial membrane potential (MMP) by specific the fluorescent probes, and assessed the levels of proteins by Western blotting for all the groups.

RESULTSExenatide pretreatment significantly reduced cardiomyocyte apoptosis as measured by flow cytometry and TUNEL assay at 12 h and 24 h. Also, exenatide inhibited excessive ROS production and maintained MMP. Furthermore, declined cytochrome-c release and cleaved caspase-3 expression and increased bcl-2 expression with concomitantly decreased Bax activation were observed in exenatide-pretreated cultures.

CONCLUSIONThese results suggested that exenatide exerts a protective effect on cardiomyocytes, preventing TNF-α-induced apoptosis; the anti-apoptotic effects may be associated with protection of mitochondrial function.

Animals ; Apoptosis ; drug effects ; Cells, Cultured ; In Situ Nick-End Labeling ; Membrane Potential, Mitochondrial ; drug effects ; Mitochondria ; drug effects ; Myocytes, Cardiac ; cytology ; drug effects ; Oxidative Stress ; drug effects ; Peptides ; pharmacology ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Rats ; Tumor Necrosis Factor-alpha ; pharmacology ; Venoms ; pharmacology

OBJECTIVETo investigate the effect of coronary microemboliation (CME) on coronary microvascular injury and myocardial endothelin-1 (ET-1) level.

METHODSCME was induced in 10 miniswines by selective infusion of microspheres (45 microm) into left anterior descending artery (LAD). The ET-1 level in coronary sinus was measured with radioimmunoassay. The microvascular integrity indicator CFR was measured by Doppler flow wire in LAD at baseline and after infusion of microspheres.

RESULTCompared to the baseline, CFR decreased significantly with different doses of microspheres. ET-1 level increased significantly with doses of 5 x 10(4) and peaked with 10 x 10(4), and progressively decreased from doses of 12 x 10(4) to 15 x 10(4) microspheres. There was negative correlation between ET-1 and CFR (r=-0.31, P=0.02).

CONCLUSIONThe extent of microvascular injury is not linearly related to the extent of microembolization, but it is closely associated with myocardial ET-1 level.

Animals ; Coronary Vessels ; pathology ; Disease Models, Animal ; Embolism ; Endothelin-1 ; blood ; Female ; Male ; Myocardial Infarction ; blood ; pathology ; Swine ; Swine, Miniature