Objective To explore the hypothesis that postconditioning during percutaneous transluminal coronary angioplasty (PTCA) would improve cardiac function and reduce infarct size after prolonged reperfusion. Methods Forty-one patients undergoing primary PTCA with acute myocardial infarction were randomized into the control group (n=16) or the postconditioning (n=23) group within 90 minutes after admission. In the control group, no intervention was given at the onset of reperfusion, while in the postconditioning group, three cycles of repetitive angioplasty balloon inflation and deflation was performed within 1 minute after reperfusion. ST segment regression, TIMI flow and blush grade were analyzed for all patients after the procedure. Ejection fraction and infarct size assessed by nuclear imaging were quantified respectively at 7 days after restoration of reperfusion. Results ST segment resolution, TIMI flow and blush grade between the two groups were compatible. Area under the curve of serum CK release during the first 72 hours of reperfusion was significantly reduced in the postconditioning group than that in the control group (58?002 vs 79?787, P=0.04). There was a tendency towards amelioration in ejection fraction in the postconditioning compared with the control group (52.1%?12.9% vs 44.5%?16.7%, P=0.29). Conclusion Postconditioning during PTCA protects the heart against acute myocardial ischemic-reperfusion injury. More importantly, the study indicates that protection with postconditioning is still preserved after an extended reperfusion, suggesting a permanent protection.

[Abstrct] In 2008, Beijing Chaoyang Hospital of Capital Medical University was certified as cardiovascular interventional therapy tralning base of National Health and Family Planning Commission (former Ministry of Health). In accordance with the requirements of the measures for the management of tralning base, and according to the characteristics of tralning students in combination with the clinical teaching experience, skills of teaching for tralning base were summed up as the following: in strict accordance with the syllabus requirements , systematic and standardized tralning were emphasized . Emphasis on theoretical study which combined closely with actual operation was also established. After the tralning, all students who received tralning can do coronary angiography and PCI for simple lesion in accordance with the requirements of the syllabus. All tralnees passed unified national exam organized by the Ministry of Health and got the qualification for interventional therapy.

Objective To evaluate the benefits and the risk of pulmonary embolism between walking exercises and bed rest in the acute stage of deep venous thrombosis (DVT). Methods From February 2008 to March 2009,40 acute primary DVT patients were arbitrarily randomized into controlled group and experimental group,with 20 cases in each group,who were hospitalized within seven days of onset.Patients in controlled group underwent bed rest for 7-10 days,wearing elastic stockings.While patients in experimental group were early (1-2 days after admission) off bed walking about 600-1200 m every day with elastic stockings for 7-10 days.During the process patients in both group received regular anticoagulation treatment,and continued warfarin anticoagulation therapy after out of hospital for at least 6 months.The clinical characteristics of the two groups were comparable.Primary end points were the reduction of pain assessed daily with the Visual Analogue Scale (VAS),the reduction of leg circumference at thigh,and cumulative pulmonary embolism incidences of two groups in three months. Results Symptoms in all patients of the two groups were improved,but the pain level showed a statistically significant reduction starting after the third day(58 ±8) mm in the experiment group and after the fifth day (58 ± 13) mm in the controlled group.The leg circumferences of the two groups after 7 days were statistically significantly different (P ＜ 0.05),the cumulative pulmonary embolism incidences of the two groups for 3 months were not statistically significantly different. Conclusion Mobile patients with acute DVT should be encouraged to walk with medical compression stockings.The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression.The quality of life significantly improved.The risk of pulmonary embolism does not significantly increase by this approach.

Objective To assess the association between admission plasma glucose (APG) and noreflow during primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI). Methods A total of 1413 patients with STEMI successfully treated with PCI were divided into no-reflow group and normal reflow group. Results The no-reflow was found in 297 patients (21.0%) of 1413 patients; their APG level was significantly higher than that of the normal reflow group [( 13.80 ±7.47) vs (9.67 ±5.79) mmol/L, P＜0.0001]. Multivariate logistic regression analysis revealed that current smoking ( OR 1.146, 95% CI 1.026-1. 839,P = 0.031), hyperlipidemia ( OR 1. 082,95% CI 1. 007-1. 162, P = 0. 032), long reperfusion ( ＞ 6 h, OR 1. 271, 95% CI 1. 158-1. 403, P =0. 001 ) , admission creatinine clearance ( ＜ 90 ml/min, OR 1.046, 95% CI 1. 007-1.086, P = 0.020 ) ,IABP use before PCI (OR 9.346, 95%CI 1.314-67. 199, P=0.026), and APG ( ＞ 13.0 mmol/L, OR1.269, 95% CI 1.156-1.402, P = 0.027) were the independent no-reflow predictors. The no-reflow incidence was increased as APG increased ( 14. 6% in patients with APG ＜ 7. 8 mmol/L and 36. 7% in patients with APG ＞ 13.0 mmol/L, P = 0.009 ). Conclusion APG ＞ 13.0 mmol/L is an independent noreflow predictor in patients with STEMI and PPCI.

Objective:To study the protective effects of Danhong injection ( DH) on myocardial damage induced by doxorubicin ( DOX) in Lewis tumor bearing mice. Methods:The model of Lewis lung cancer in mice was established by underarm injecting tumor cells, and then randomly divided into four groups:the model control group, DOX group, DH group and DH+DOX group. After the experiment, myocardial and tumor tissue were separated from Lewis tumor bearing mice, and the excised tumors were weighted. The activities of lactate dehydrogenase ( LDH) , creatine kinase ( CK) , manganese superoxide dismutase ( SOD) , catalase ( CAT) and glu-tathione peroxidase ( GPx) , and the content of malondialdehyde ( MDA) were determined by a colorimetric method. Flow cytometry was used to determine the levels of apoptosis, reactive oxygen species (ROS) and mitochondrial membrane potential (△Ψm). Re-sults:Compared with that in the model control group, a significant decrease of tumor weight was shown in both DOX group and DH+DOX group (P<0. 01). DH had no significant influence on the anticancer function of DOX. The activity of LDH and CK, and the ap-optosis in myocardium cells significantly increased (P<0. 01). Compared with DOX group, the activities of LDH and CK, and the ap-optosis significantly decreased in DH+DOX group (P<0. 01). The activities of △Ψm, SOD, CAT and GPx significantly increased (P<0.05orP<0.01). ThecontentofMDAandROSgenerationbothdecreased(P<0.01).Conclusion:DHhasnosignificantin-fluence on the antitumor effect of DOX. The combination of DH and DOX shows cadioprotective effect on the myocardial damage through improving mitochondrial antioxidant defense capacity, ameliorating oxidative stress and maintaining △Ψm homeostasis.

Objective To identify independent predictors of no-reflow after primary percutaneous coronary intervention (PPCI)in aged patients with ST-elevation acute myocardial infarction (STEMI), and thus construct a no-reflow predicting model.MethodsTotal of 668 aged patients with STEMI and successfully treated with PPCI were divided into the no-reflow group and the normal flow group. All clinical, angiographic and procedural data were collected. Multiple logistic regression analysis was used to identify independent no-reflow predictors.ResultsThe no-reflow was found in 181 of 668 (27.1％) patients.Multiple stepwise logistic regression analysis identified that admission systolic blood pressure (SBP)＜100 mm Hg, collateral circulation 0-1 grade, pre-PCI thrombus score ≥ 4, and intra-aortic balloon pump (IABP) use before PCI were independent noreflow predictors.The no-reflow incidence significantly enhanced as the numbers of independent predictors increased [10.0％ (2/20), 13.7％ (32/233), 30.8％ (85/276), 38.1％ (37/97), and 59.5％ (25/42) in patients with 0, 1, 2, 3, and 4 independent predictors, respectively,x2 =25.796,P＜0.01) ]. ConclusionsThe no-reflow predictors are admission SBP ＜ 100 mm Hg, collateral circulation 0-1grade, pre-PCI thrombus score≥4, and IABP use before PCI in patients with STEMI and treated with PPCI. The prediction model may provide basis for therapeutic decision.

Objective To assess independent no-reflow predictors in patients with STEMI after primary drug-eluted stenting.Method A prospective study was carried out in 1413 patients with STEMI treated with primary drug-eluted stenting within 12 hours after onset of AMI from January 2007 through March 2010.The patients were divided into the no-reflow group and the normal reflow group.Univariate and multivariate logistic regression were applied to identification of no-reflow predictors.Results The no-reflow was found in 297(21.0％)of 1413 patients.Univariate and multivariate logistic regression identified that age ＞65 years,long time from onset to reperfusion ＞6 hours,admission plasma glucose(APG)＞ 13.0mmol/L,collateral circulation ≤ 1,pre-percutaneous coronary intervention(PCI)thrombus score ≥ 4,and intra-aortic balloon pump(IABP)used before PCI(P ＜0.05)were independent no-reflow predictors.The no-reflow rate significantly increased as the number of predictors increased(P ＜ 0.01).Conclusions There are 6 factors associated with coronary no-reflow used for prediction in patients with STEMI after primary drug-eluted stenting.

Objective To investigate the effects of cholinergic pathway on acute renal tubular cell injury induced by acute oxygen and glucose deprivation. Methods Rat kidney macrophages were isolated and cultured for constructing macrophages and renal epithelial cells co-cultivating model of oxygen-glucose deprivation (OGD), and the model cells were divided into three groups: OGD alone group, acetylcholine (ACh 100μmol/L)+OGD group and ACh + galantamine (Gal 10μmol/L)+OGD group. The cells underwent OGD treatment for 1 hour, and normally cultured for 24 hours. The expressions of TNF alpha, IL-1 beta, and IL-10 in supernatant fluid were detected by ELISA, the renal tubular cell viability was determined by MTT assay, the expression of acetylcholine esterase (AChE) mRNA and protein were determined by RT-qPCR and Western blotting. The activity of AChE was determined by colorimetric method. Results The expressions of TNF alpha (pg/ml) in OGD, Ach+OGD group, Ach+Gal+OGD groups were 140.2±44.81, 119.46±4.42 and 103.31±1.62 respectively (P<0.05), those of IL-1β (pg/ml) were 172.26±13.51,144.34±5.53 and 119.37±11.42 respectively (P<0.05), and those of IL-10 (pg/ml) were 181.47±16.01, 173.62±10.12 and 188.36±8.73 respectively (P>0.05); The values of renal tubular cell proliferation were 55.02%±6.28%, 66.65%±6.47%, and 79.75%±4.22% respectively (P<0.01); the expressions of AChE mRNA in macrophages were 4.07±0.03, 4.22±0.15 and 3.98±0.29 respectively in the three groups (P>0.05); those of AchE protein were 0.66±0.07, 0.74±0.04 and 0.67±0.06 respectively (P>0.05); The activity of AChE (kU/L) was 0.51±0.02, 0.35±0.05 and 0.32±0.04 respectively (P=0.001, 0.001 and 0.368). Conclusions ACh and Gal could inhibit the secretion of inflammatory mediators and cholinesterase activity and can reduce the acute hypoxic renal tubular cell injury. The modulation of the cholinergic pathway in macrophages may be the important treatment method for acute renal injury in the future.

Objective To investigate the ultrasonic characteristics of angiographical normal left main (LM) branch of coronary artery observing with intravaseular ultrasound(IVUS). Methods Seventy-six patients whose coronary angiogram showed the lesions restricted only in left anterior descending (LAD) branch or left cireumflex(LCX) branch and no lesion was found in LM branch were enrolled and IVUS was performed. The plaque burden was measured and the quality of atherosclerosis was identified in lesion site of LAD or LCX by IVUS. Meanwhile,the absence or existence of lesions in LM was identified,and the quality of lesions was analyzed if it showing those existed lesions. The diameter and area of lumen in left main were measured and diameter and area of vessel were also measured. The plaque burden were measured for those who atheroselerosis existed in LM. Results IVUS showed 28 cases completely normal, 12 cases with intimal membrance hyperplesia,36 cases with plaque and 2 cases with intimal membrance flap in patients which LM was angiographically normal. Among those there were 30 eccentric plaques and 6 concentric plaques. For 36 patients whose lesions existed in LM observed by IVUS,there were 25 cases (69.4%) with soft plaque,4 eases (11.1%) with fibrous plaque,2 cases (5.6%) with calcific plaque,5 cases (13.9%)with mixed plaque. IVUS showed lumen diameter was (5.32±0.68)mm and lumen area was (23.34±5.27)mm2 for female patients; and lumen diameter was (5.90±0.50)mm and lumen area was (27.75±4.47)mm2 for male patients. The difference had significane when comparing lumen diameter and lumen area between male and female patients (P=0.042 and P=0.048, respectively). Vessel diameter was (5.90±0.47)mm and vessel area was (27.58±4.21)mm2 in patients with intimal membrance hyperplesia; lumen diameter was (4.39±0.54)mm and lumen area was (17.45±5.23)mm2,vessel diameter was (5.99±0.67)mm and vessel area was(26.61±6.27)mm2 n patients with atherosclerotic plaque.Diameter stenosis percentage was(26.17±7.87)%and plaque burden was(34.79±9.37)%in LM.Conclusions IVUS can find those lesions in LM which CAG cannot detect and identify the quality and severity of lesion precisely.

BACKGROUND: Stent under-expansion and procedurally related abnormal lesion morphologies (e.g. dissection, thrombus) are associated with stent restenosis and acute, subacute and chronic thrombosis.OBJECTIVE: To explore whether larger post-procedural final minimum stent area can be acquired and more procedurally related complications can be identified in stent implantation guided by intravascular ultrasound.DESIGN, TIME AND SETTING: Retrospective analysis was performed at the Heart Center of Beijing Chaoyang Hospital, Capital Medical University between January 2004 and February 2005.PARTICIPANTS: Fifty patients with coronary artery disease with 52 lesions were enrolled in the study and underwent stenting guided by intravascular ultrasound. The patients were characterized as non-diffused lesion with vessel diameter ≥ 2.5 mm. Patients with severe left main lesion were excluded.METHODS: Qualitative and quantitative analyses were carried out in 50 patients with 52 lesions before and after stent implantation. The stent diameter and the end-point of therapy were determined by intravascular ultrasound standard.MAIN OUTCOME MEASURES: The differences of end point for stent implantation and the enlargement of lumen area gained by stent implantation were compared between cardioangiography and by intravascular ultrasound.RESULTS: The average stent diameter guided by intravascular ultrasound was larger than by cardioangiography (P=0.011); the peak balloon pressure was higher in intravascular ultrasound group than cardioangiography group (P < 0.001), and area stenosis percentage measured by quantitative coronary angiogram was smaller in intravascular ultrasound group than cardioangiography group (P=0.044). ②Cardioangiography showed success rate was 96.2% and intravascular ultrasound showed the success rate was only 37.7% after first balloon high-pressure dilation. Intravascular ultrasound subgroup analysis showed higher peak balloon pressure (P < 0.001), larger lumen diameter (P < 0.001), larger lumen area (P < 0.001), and smaller area stenosis percentage (P < 0.001). No obvious stenosis was found at the proximal and distal segments of the stent observed by cardioangiography, while atherosclerotic lesions at proximal segment were found in 39 cases (75.0%) and at distal segment were in 23 cases (44.2%) observed by intravascular ultrasound. The lumen area was larger in non-fatty plaque than in fatty plaque after stent implantation (P < 0.001). Compared with non-fatty plaque, the enlargement of vessel area was 1.30 mm2 smaller, while plaque compression was 0.48 mm2 larger. CONCLUSION: Stent implantation guided by intravascular ultrasound can acquire larger final lumen area and identify more procedurally related complications.