Objective: To explore the effect and safety of pre-operative loading ticagrelor on myocardium reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI). Methods: A total of 105 acute STEMI patients received PCI within 12-hour of onset were studied and they were divided into 2 groups: Ticagrelor group, the patients received pre-operative oral chewing ticagrelor 180 mg,n=58 and Clopidogrel group, the patients received pre-operative oral chewing clopidogrel 600 mg,n=47. The baseline feathers, operative TIMI and corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG), no-relfow/slow lfow conditions were compared between 2 groups. Results: The baseline feathers and pre-operative TIMI were similar between 2 groups, bothP>0.05. Compared with Clopidogrel group, Ticagrelor group showed increased ratios of TIMI 3 lfow (94.8% vs 80.9%) and TMPG (89.7% vs 72.3%), bothP<0.05, improved CTFC (20.0 ± 4.9) vs (31.8 ± 3.9),P<0.001; decreased rates of no-relfow/slow lfow,P=0.016 and less MACE occurrence,P<0.05; while the post-operative bleeding events were similar between 2 groups,P>0.05. Conclusion: Prior PCI loading ticagrelor may reduce no-relfow/slow lfow incidence, improve myocardium reperfusion safely and therefore, decrease MACE occurrence in acute STEMI patients.

Objective: To investigate thoracic endovascular aortic repair (TEVAR) and “Chimney” technique for treating the involved left common carotid artery (LCCA) or left subclavian artery (LSA) in Standford B patients with aortic lesion and in-sufficient proximal anchoring area. Meanwhile, to explore the relationship between endoleaking condition and the location of lesion with the prognosis. Methods: A total of 32 relevant patients treated by TEVAR + “Chimney” technique in our hospital from 2011-09 to 2015-07 were retrospectively analyzed. Immediate post-operative image development of LCCA or LSA was observed; cerebral complications, severe upper limb ischemic symptoms and endoleaking conditions were recorded. The patients were followed-up for (3-46) months. Results: Thoracic aortic stent-graft placement was successfully carried out in all 32 patients. Immediate post-operative image development of LCCAor LSAwas favorable, no cerebral complications and no severe upper limb ischemic symptoms were observed. There were 7 patients suffered from endoleak at aortic arch including 6 with the lesion located at the greater curvature side and 1 at the small curvature side. During follow-up period, aortic stent-graft remained in a stable condition and the blood flow in “Chimney” stent was unobstructed. Endoleking condition was gradually reduced and disappeared in 5 patients, it was persisted in 2 patients. Conclusion: “Chimney” technique may prolong anchoring area and keep LCCA or LSA unobstructed, therefore expand the indication of TEVAR in a mini-invasive, safe and effective way. When aortic lesion located at the greater curvature side, the endoleaking probability could be increased.

BACKGROUND:Restenosis after angioplasty severely limited the application and long-period therapeutic effects of percutaneous coronary intervention. Changes in smooth muscle cel phenotype and their proliferation are important mechanisms of restenosis after angioplasty.
OBJECTIVE:To use bal oon in vivo transduction of osteopontin short hairpin RNA (OPN-shRNA), to inhibit osteopontin expression at the injured blood vessels of a rabbit model of experimental atherosclerosis, and to prevent restenosis after angioplasty.
METHODS:A total of 20 rabbit models of atherosclerosis were established and randomly equal y assigned to empty plasmid group and OPN-shRNA plasmid group. The plasmid recombinant OPN-shRNA and empty plasmid were transferred to the ventral aorta by bal oon.
RESULTS AND CONCLUSION:After bal oon dilatation, specific green fluorescence was detected in the layer of vascular smooth muscle in the two groups. Moreover, with prolonged time of transfection, fluorescence intensity gradual y decreased. Compared with the empty plasmid group, the expanded artery lumen area obviously increased in the OPN-shRNA plasmid group, and plaque burden evidently reduced. Results indicated that bal oon catheter used in regional blood vessels in rabbit models of atherosclerosis could successful y transduce OPN-shRNA plasmid. The restenosis of the expanded blood vessels lessened, and thrombus burden relieved. It is of great importance to prevent the occurrence of restenosis after angioplasty in rabbit models.

Objective:To develop a national secondary reference material of Urea and Creatinine in frozen human serum as a standard for metrological traceability.Methods:According to JJF1343-2012 "General and Statistical Principles for Characterization of Reference Materials" and JJF 1006-1994 " Technical Norm of Primary Reference Material ", the homogeneity, stability, and commutability were evaluated;Using the JCTLM recommended methods, the value of the reference materials was assigned through collaboration with 6 accredited reference laboratories from Guangdong Provincial Hospital of Chinese Medicine, Beijing Aerospace General Hospital, Shenzhen Mindray Bio-Medical Electronics, Maccura Biotechnology, Beijing Leadman Biochemistry, and Zhejiang MedicalSystem Biotechnology. Uncertainty components including inhomogeneity, stability and value assignment were evaluated.Results:The results of one-way analysis of variance of homogeneity for the reference materials showed P>0.05, and the stability evaluation was less than the critical value of the t-test. The measured values were in the 95% confidence interval in the four conventional detection systems for commutability, and the certified values and expanded uncertainties were urea:(14.7±0.3) mmol/L ( k=2),Cr:(313.9±14.5) μmol/L ( k=2). Conclusion:The prepared secondary reference materials of urea and creatinine had promising homogeneity, stability, and commutable, the values of urea and creatinine concentration in reference materials were accurate and reliable.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.