Objective To study the application effect of Suhexiang after PCI in the patients with mild cognitive impairment(MCI) complicating acute ST-elevation myocardial infarction.Methods A total of 100 inpatients with MCI complicating acute ST-elevation myocardial infarction in Shijiazhuang People's Hospital were selected and divided into the control group and Suhexiang group according to the random number table method,50 cases in each group.The control group was given the clinical routine treatment of coronary heart disease PCI,and the Suhexiang group was added with Suhexiang 1 g once daily on the basis of the control group,and the course of treatment was 1 month.Each patient conducted the coronary arterial SYNTAXⅡ sco-ring.Resting D-SPECT+regadenoson loaded D-SPECT was used to evaluate the number of myocardial ische-mia total segments,left ventricular ejection fraction,total myocardial perfusion score on 7 d and in 3 months after PCI,MMSE and MoCA were used to evaluate the cognitive impairment on 7 d and in 3 months after PCI,and the adverse drug reactions occurrence in 3 months after PCI was recorded.Results There was no statistically significant difference in MMSE,MoCA,left ventricular ejection fraction,number of myocardial is-chemia segments,and myocardial perfusion total score on 7 d after PCI between the two groups (P>0.05). The MMSE,MoCA,left ventricular ejection fraction,number of myocardial ischemia segments and total myo-cardial perfusion score in 3 months after PCI in the Suhexiang group were significantly better than those in the control group,and the difference was statistically significant (P<0.05).There was no statistically significant difference in adverse reactions between the two groups (P>0.05).Conclusion Suhexiang could significantly improve the myocardial perfusion,cardiac function and cognitive function after PCI in the patients with MCI complicating acute ST-elevation myocardial infarction,but does not increase adverse reactions.

Objective To survey the awareness and knowledge of Helicobacter pylori (Hp) infection among medical staff in Shanghai.Methods A questionnaire survey was conducted among 316 medical staff in Shanghai,including 74 gastroenterologists (GI),158 general practitioners (GP),and 68 gastroenterology nurses(GN),from October 2014 to September 2015.The questionnaire was designed according to the Fourth Helicobacter Pylori Infection Treatment Consensus Report of China (the Consensus).There were 4 parts and 29 questions in the questionnaire,including the knowledge and performance of the Consensus (8 questions),the indications of Hp eradication (8 questions),detection methods of Hp infection (7 questions)and the therapy of Hp eradication (6 questions).Results Total 300 valid questionnaires were received with a response rate of 94.9％ (300/316).The awareness rate of the Consensus in GI,GP and GN groups was 81.1％ (60/74),57.6％ (91/158) and 26.4％ (18/68),respectively (χ2 =43.67,P=0.001).GI had higher awareness rate than GP and GN in indications of Hp eradications (for peptic ulcer,mucosa-associated lymphoid malignancies,post-resection patients of early gastric cancer,and family history of gastric cancer,the χ2 values were 16.68,35.60,33.46 and 39.22,respectively;all P ＜0.05).In part of Hp infection detection methods,the responses of GI,GP and GN groups in C14 or C13 urea breathing test were 97.3％ (72/74),47.5％ (75/158) and 82.1％ (55/68),respectively (χ2 =72.38,P =0.001);in gastric mucosa tissue rapid urease test were 70.3％ (52/74),13.9％ (22/158) and 25.4％ (17/68),respectively (χ2 =78.22,P =0.001);in serological test were 58.1％ (43/74),20.9％ (33/158)and 44.8％ (30/68),respectively (χ2 =40.30,P =0.001);in gastric mucosa tissue section staining were 56.8％ (42/74),13.3％ (21/158) and 22.4％ (15/68),respectively (χ2 =50.35,P =0.00).In part of Hp eradication therapy the responses of GI,GP and GN groups in recommended bismuth quadruple therapy were 71.6％ (53/74),47.5％ (75/158) and 40.3％ (25/62),respectively (χ2 =15.93,P =0.001);in triple therapy were 27.0％ (20/74),51.6％ (81/158) and 42.0％ (26/62),respectively (χ2 =12.42,P =0.002);in 10 or 14 d for treatment duration were 78.4％ (58/74),78.5％ (124/158)and 67.6％ (46/68),respectively (χ2 =3.36,P =0.186).Conclusion Gastroenterologists are more likely to adhere with the Consensus than general practitioners and gastroenterological nurses in the management of Hp infection.The survey suggests that more attention should be paid for popularization and implementation of Hp infection guidelines and consensus among Shanghai medical staff,especially for GP and nurses.

Objective To evaluate the efficacy of recombinant human TNK tissue-type plasminogen activator and adenosine injection through guiding in treating acute ST-segment elevation myocardial infarction(ASTEMI)in emergency primary percutaneous coronary intervention(PPCI).Methods Patients with ASTEMI who chose to receive emergency PPCI were randomly divided into control group and treatment group according to a digital random table method.The control group received conventional treatment of PPCI.If the infarct-related artery(IRA)reached TIMI flow grade 3 after PPCI,the operation was terminated.If TIMI flow was ≤2,then a guide catheter to inject sodium nitroprusside,nitroglycerin,and tirofiban into the coronary artery to improve coronary microcirculation dysfunction(CMD)was applied until the IRA reached TIMI flow grade 3.The treatment group received the conventional treatment of PPCI,and after opening of the IRA during the operation,a guide catheter to inject recombinant human TNK tissue-type plasminogen activator(8 mg)and adenosine(200 pg)into the coronary artery was applied.If the IRA reached TIMI flow grade 3,the operation was terminated.If TIMI flow was ≤2,then adenosine injection was re-applied to improve CMD until the IRA reached TIMI flow grade 3.Observation indicators were as follows:① myocardial injury indicators:cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),and N-Terminal pro-brain natriuretic peptide(NT-pro BNP)levels before and 12 h,24 h,36 h,and 48 h after surgery;② myocardial perfusion indicators:corrected TIMI frame count(CTFC)after surgery and ST segment regression value(STR)at 90 min after surgery;③ degree of myocardial ischemia:rest D-SPECT+adenosine stress D-SPECT examination at day 3 after surgery,observation of myocardial perfusion total score under 17 segment distribution and myocardial ischemia total segment number;@adverse drug reactions at day 30 after surgery:subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary bleeding,hemoglobin decline,and cerebral hemorrhage;⑤ major adverse cardiovascular events(MACE)at day 30 after surgery:cardiac death,myocardial infarction,heart failure,and target vessel revascularization.Results ① Myocardial injury indicators:There was no significant difference in the levels of cTnⅠ,CK-MB,or NT-pro BNP before surgery between the two groups(all P＞0.05).The myocardial injury indicators were significantly lower in the treatment group than in the control group at 12 hours after surgery(all P＜0.05),and then showed a downward trend.There was no significant difference between the two groups at 48 hours after surgery(all P＞0.05).② Myocardial perfusion indicators:CTFC in the treatment group was significantly better than that in the control group after surgery(P＜0.05).Using the rank sum test,the STR was significantly better in the treatment group than in the control group at 90 minutes after surgery(Z=2.437,P=0.014).③ myocardial ischemia:Both groups underwent rest D-SPECT+adenosine stress D-SPECT examination at 3 days after surgery.Under the distribution of 17 myocardial segments,the total score of myocardial perfusion and the total number of myocardial ischemia segments in the treatment group were significantly better than those in the control group(all P＜0.05).④ Adverse drug reactions 30 days after surgery:There was no significant difference in subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary system bleeding,hemoglobin decline,or cerebral hemorrhage between the two groups(P＞0.05).⑤ MACE 30 days after surgery:There was no significant difference in cardiac death,myocardial infarction,heart failure,target vessel revascularization,or total MACE between the two groups(P＞0.05).Conclusion The intra-coronary injection of recombinant human TNK tissue-type plasminogen activator and adenosine injection through a guiding catheter in emergency PPCI is safe and effective for the treatment of ASTEMI.It can improve myocardial injury,myocardial perfusion,and myocardial ischemia.

Objective To study the correlation between the abnormal perfusion area detected by resting+regadenoson stress D-SPECT and the severity of coronary arterial lesions.Methods One hundred patients needing coronary angiography and PCI admitted in the cardiology department of First Hospital of He-bei Medical University from April 1,2022 to April 1,2023 were selected as the study subjects.The resting+regadenoson loading examination was performed by using the special cardiac machine D-SPECT.The patients were divided into the mild ischemia group(range＜10％),moderate ischemia group(range 10％-20％)and severe ischemia group(range＞20％)according to the proportion of sparse or defect appearance in myocardi-al segmental radionuclide distribution during regadenoson stress D-SPECT in comparison with resting exami-nation.The coronary arterial angiography was performed.The Gensini score was calculated.Results The Gensini score in the severe ischemia group was(55.70±20.60)points,which was higher than(41.88±28.07)points in the moderate ischemia group and(39.71±21.40)points in the mild ischemia group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the Gensini score between the mild ischemia group and moderate ischemia group(P＞0.05).The mean stent length in the severe ischemia group was(30.50±7.47)mm,which was significantly higher than(20.90±4.72)mm in the mild ischemia group and(23.50±3.87)mm in the moderate ischemia group,and the differ-ences were statistically significant(P＜0.05).There was no statistically significant difference in the mean stent length between the mild ischemia group and moderate ischemia group(P＞0.05).Conclusion The abnormal perfusion area detected by resting+regadenoson stress D-SPECT is conducive to evaluate the severity of coro-nary arterial lesions and the length of needing implantation stent.

Objective To evaluate the value of adenosine injection in paclitaxel eluting PTCA balloon catheter.Methods A total of 200 patients undergoing drug-coated balloon angioplasty were randomly divided into control group receiving conventional treatment after the procedure,and observation group receiving adenosine injection for 3 hours continuously.All patients underwent coronary SYNTAX II scoring,and CK-MB,NT-proBNP,hs-CRP levels were recorded before and after PTCA for 6 hours,12 hours,18 hours,and 24 hours.A dedicated Israeli cardiac machine D-SPECT was used for rest+stress myocardial perfusion radionuclide imaging before and after the PTCA for 7 days.The total myocardial perfusion score under rest+stress myocardial perfusion in 17 segments was observed,as well as the adverse drug reactions after the PTCA.Results There were no significant differences in clinical characteristics,concomitant medication upon admission,coronary SYNTAX II score and PTCA treatment,mean target vessel stenosis,mean balloon diameter and length,CK-MB,NT-proBNP,hs-CRP before PTCA,and total myocardial perfusion score values under resting and stress myocardial perfusion distribution in 17 segments between the two groups(P>0.05).The CK-MB,NT-proBNP,and hs-CRP values in the experimental group were significantly lower than those in the control group at 6,12,18,and 24 hours after PTCA(P<0.05);The total myocardial perfusion score under resting and stress myocardial perfusion distribution in 17 segments was signifi-cantly lower in the experimental group than in the control group at 7 days after PTCA(P<0.05);There was no significant difference in adverse drug reactions between the two groups of patients after PTCA(P>0.05).Conclusions The application of adenosine injection in patients after drug-coated balloon therapy significantly reduced the CK-MB,NT-proBNP,and hs-CRP values 24 hours after PTCA,as well as the total myocardial perfusion score under resting and stress myocardial perfusion distribution in 17 segments 7 days after PTCA,without increasing significant adverse reactions.

[Objective] To explore the safety and effectiveness of provisional stenting (PS) applied in patients with unprotected simple left main bifurcation lesions, and to observe the impact of this procedure on cardiac function, myocardial injury, and myocardial perfusion. [Methods] A retrospective analysis was made on 82 patients with unprotected simple left main bifurcation lesions who underwent elective stenting and completed a 3-month follow-up in the Department of Cardiology, Hebei Medical University First Hospital. All the patients underwent preoperative examinations, including rest dynamic single-photon emission computed tomography (D-SPECT) and regadenoson stress D-SPECT before and 3 months after surgery. The safety evaluation indicators for the surgery included immediate success rate of stent implantation, acute stent thrombosis, coronary no-reflow, branch involvement, branch acute occlusion, acute left heart failure, heart block, cardiac tamponade, major bleeding, and mortality. The effectiveness evaluation indicators included the minimum lumen area (MLA) of the left main trunk of coronary artery measured by intravenous ultrasound (IVUS) before and after surgery, as well as cardiac function indicators [brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD)] and myocardial injury indicators [creatine kinase isoenzyme-MB (CK-MB), cardiac troponin Ⅰ (cTn Ⅰ)] at day 1, day 7, 1 month, and 3 months before and after surgery. The myocardial perfusion evaluation indicators included the total myocardial perfusion score and total ischemic segment number under the 17-segment distribution of myocardial perfusion using rest D-SPECT and regadenoson stress D-SPECT before and 3 months after surgery. [Results] Safety indicators: immediate success rate of stent implantation (100%), 19 cases (23.1%) of circumflex branch involvement that underwent balloon anastomosis dilation, 1 case of acute branch occlusion, followed by double stent surgery using provisional stenting-T stenting (PS-T) technique. There were no cases of acute stent thrombosis, coronary reflow, acute left heart failure, cardiac block, cardiac tamponade, major bleeding, or death. Effectiveness indicators: the MLA of the left main trunk measured by postoperative IVUS showed significant improvement compared to the preoperative. BNP, CK-MB, and cTnⅠ showed significant improvement from day 7 after surgery compared to before. Myocardial perfusion indicators: the total score of myocardial perfusion and the total number of ischemic segments in the 17-segment distribution of the myocardium after 3 months of surgery were significantly better than before. [Conclusion] PS can improve heart function, myocardial injury, and myocardial perfusion in patients with unprotected simple left main bifurcation lesions.