Objective To summarize the clinical features,treatment and follow-up of patients with severe coronary artery spasm.Methods Twenty-one patients with confirmed coronary artery spasm were selected.The study reviewed the patients' general conditions including age,gender,complication,smoking and drug situations.The clinical features,electrocardiogram and coronary angiography data were analyzed.Their diagnosis,treatment and prognosis were evaluated.Results Male (86％,18/21) had higher incidence in severe coronary artery spasm.Smoking (62％,13/21) was a major risk factor.Coronary artery spasm often happened on the base of a fixed narrow (57％,12/21),and the clinical process was treacherous.Coronary angiography was very important for early diagnosis.Calcium antagonist was the core of the treatments and should be sustained at full dose.Interventional therapy was not efficacious.Although patients in acute phase had higher risk,long-term prognosis was good.Conclusions Coronary artery spasm is a common problem,but it is often overlooked.Timely diagnosis is the key to prevent fatal events.Calcium antagonist is the core of the coronary artery spasm drugs.The long-term prognosis of coronary artery spasm is good.

Objective To investigate the effects of early estrogen replacement therapy(ERT) with different doses on aortic endothelial senescence and its possible mechanism. Methods Twenty- eight healthy New Zealand white female rabbits were randomized into four groups: group A(n=7), in sham operation;group B(n=7), ovariectomized;group C(n=7), ovariectomized and in low-dose ERT(estradiol benzoate 200 μg,im, QOD) ;and group D(n=7), ovariectomized and in high-dose ERT (estradiol benzoate 1000 μg,im,QOD). All rabbits were fed with high fat diet and the rabbits in group C and group D were given ERT from the 7th day after the operation. Blood samples taken via ear central artery before the operation and after the high fat diet for 4 and 12 weeks were used to determine the concentrations of serum estradiol(E2), total cholesterol(TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), trigtyceride (TG) and asymmetric dimethylarginine(ADMA). After 12 weeks, the aorta was separated for histopathologic analysis and the areas of senescent endothelium and atherosclerotic plaque were calculated.Results (1)After ovariectomized, the concentration of serum estradiol(E2) was significantly lower in group B than in other groups (all P<0.05). Twelve weeks later, the level of E2in was higher group D than in group A and C(both P<0. 05), but there was no significant difference between group C and group A (P< 0. 05). (2)After the high-fat diet for 4 and 12 weeks, there was a notable increase of TC, LDL-C, TG and HDL-C levels in rabbits of each group(all P<0. 01). After 12 weeks, the levels of TC and LDL- C were remarkably higher in group B than in other groups(all P<0. 01), however, the levels of TG and HDL-C were lower in group B than in other groups(all P<0. 01). The concentrations of TC and LDL-C in group C and group D were lower than those in group A (all P<0.01), but the differences of the levels of TG and HDL-C in group C and group D were not significant in comparison with group A (all P>0. 05). There were no significant differences in the lipid levels between group C and D (all P> 0. 05). (3)After 12-week high fat diet, there were a striking increases of serum ADMA level in all four groups (all P>0. 05). The level of ADMA was higher in group B than in other groups (P< 0. 05) andlower in group C and D than that in group A (both P<0. 05). There was no significant difference between group C and D (P<0. 05). (4)12 weeks later, the areas of senescent endothelium and atherosclerotic plaque in group B were significantly larger than those in other groups (all P< 0. 01), and the areas were smaller in group C and D than those in group A (all P<0. 01), there was no significant difference between group C and group D(both P>0.05). (5)Linear correlation analysis showed that there was an obvious positive correlation between the areas of senescent endothelium and atherosclerotic plaque(r=0. 962, P<0. 01), and both of them were positively correlated with the levels of serum AMDA (r=0. 812,0. 824,0. 755,0. 797,0. 749,0. 727), TC (r=0. 812,0. 824) and LDL-C(r=0. 755,0. 797) (all P<0. 01) and negatively correlated with the concentration of serum E2 (r=-0. 762,-0. 743, both P<0. 01).Conclusions Early ERT can improve serum lipid metabolism, reduce ADMA level, inhibit vascular endothelial senescence and attenuate atherogenesis. The delaying effect of estrogen on endothelial senescence may be due to its improving lipid metabolism and lowering ADMA level.

OBJECTIVE:To observe the efficacy and safety of prednisone combined with human immunoglobulin(pH4)for intra-venous injection in the treatment of idiopathic thrombocytopenic purpura. METHODS:85 patients with idiopathic thrombocytopenic purpura were divided into control group(42 cases)and observation group(43 cases). Control group received 1.6 mg/(kg·d)Predni-sone tablet,orally,for continuous 4 weeks;observation group received 400 mg/(kg·d)human immunoglobulin(pH4)for intravenous injection,intravenous injection,for continuous 5 d,then 1.6 mg/(kg·d)Prednisone tablet,orally,for continuous 4 weeks. All pa-tients were given Adrenal color hydrazone tablet,Vitamin C tablet and other conventional treatment. Clinical efficacy,platelet number, T lymphocyte subsets(CD3+,CD3+CD4+,CD3+CD8+,CD19+),TNF-α,IL-6 before and after treatment,time of platelet number reached normal and reached peak value,peak value of platelet number and the incidence of adverse reactions in 2 groups were ob-served. RESULTS:The total effective rate and peak value of platelet number in observation group were significantly higher than control group,time of platelet number reached normal and reached peak value were significantly shorter than control group,the differences were statistically significant(P<0.05). Before treatment,there were no significant differences in platelet number,T lymphocyte sub-sets,IL-6 and TNF-αlevel in 2 groups(P>0.05);after treatment,platelet number,CD3+and CD3+CD4+in 2 groups were significant-ly higher than before,and observation group was higher than control group,IL-6,TNF-αlevel,CD3+CD8+and CD19+were signifi-cantly lower than before,and observation group was lower than control group,the differences were statistically significant(P<0.05). And there was no significant difference in the incidence of adverse reactions in 2 groups(P>0.05). CONCLUSIONS:Prednisone com-bined with human immunoglobulin(pH4) for intravenous injection shows better efficacy than prednisone alone in the treatment of idio-pathic thrombocytopenic purpura,it can increase platelet number,adjust immune function,and do not increase the incidence of ad-verse reactions.

Objective:To explore the teaching evaluation of online open course of hematology based on small private online course (SPOC) platform by means of quantitative method.Methods:The fourth-year undergraduates of clinical medicine major were selected to receive online course learning of hematology, including video viewing, rich text browsing, in-class quizzes, and seminars. The teaching contents covered the basis of hematological diseases, anemic diseases, hematological tumors, bleeding and coagulation disorders. Teaching evaluation was conducted through teaching behavior assessment, unit test, course examination and SPOC scoring. Linear regression analysis was used to analyze the correlation between the duration of the teaching video and student learning behavior. The correlation between video learning quantity and viewing time and course test scores and SPOC scores was analyzed. Kruskal-Wallis test was used to compare the differences in curriculum learning behavior (participation rate). T-test was used to compare the differences between the two results of two unit tests and to calculate the alternative-form reliability. Chi-square test was used to compare the differences in scores of different sub-specialty questions in hematology, and the differences of participation rate of different examination points of hematological tumors. Results:The teaching video viewing rate was significantly higher than the participation rate of rich text browsing and in-class quizzes ( P < 0.001; P < 0.001). There was no obvious correlation between video duration and video viewing, rich text browsing, in-class quizzes ( R = 0.168, F = 0.81, P = 0.376; R = 0.057, F = 0.07, P=0.802; R=0.124, F=0.37, P=0.546). There was a significant positive correlation between the participation rate of video viewing and rich text browsing and in-class quizzes ( R =0.890, F=76.41, P<0.001; R=0.934, F=163.67, P < 0.001). The participation rate of anemic disease unit test was significantly higher than that of hematological tumors ( χ2 = 49.08, P<0.001), bleeding and coagulation disorders ( χ2= 25.97, P< 0.001), and the second results were significantly improved ( t=-2.09, P=0.040), and the alternative-form reliability was 0.750. There was no significant difference in the participation rate of different sub-specialty courses ( χ2=5.20, P=0.074); the number of video watching was significantly positively correlated with SPOC scores ( R=0.523, F=196.22, P<0.001); the participation rate of molecular genetics and molecular biology tests of blood tumor was significantly lower than that of general clinical information questions ( P < 0.05). Conclusion:Teaching videos are the foundation of online courses. Increasing the number of video viewing and improving video viewing rate can effectively mobilize the enthusiasm of extensive learning, such as rich text browsing and in-class quizzes, and improve learning participation. It is conducive to the improvement of students' academic performance. Simple behavior factors such as video viewing time are not recommended as performance evaluation indicators. Unit test takes two times to get the highest score, which is conducive to improving professional learning level through learning behavior, without affecting the reliability of the performance evaluation. The online open course based on the SPOC platform is conducive to the balanced development of the course teaching of Hematology.

Objective To explore the relationship between platelet distribution width (PDW) and cardiac syndrome X.Methods Totally 58 patients with cardiac syndrome X and 70 normal controls were selected,and PDW level was detected in the blood samples of all the patients.Results The PDW level was (14.1± 2.9) in the cardiac syndrome X group,which was significantly higher than (12.6 ± 1.9) in the normal controls (P ＜ 0.01).The binary Logistic regression analysis showed that RDW could be used as an independent predictor for cardiac syndrome X.Conclusion High platelet distribution width is associated with attack of cardiac syndrome X.

Objective To explore the relationship between platelet distribution width (PDW) and cardiac syndrome X.Methods Totally 58 patients with cardiac syndrome X and 70 normal controls were selected,and PDW level was detected in the blood samples of all the patients.Results The PDW level was (14.1± 2.9) in the cardiac syndrome X group,which was significantly higher than (12.6 ± 1.9) in the normal controls (P ＜ 0.01).The binary Logistic regression analysis showed that RDW could be used as an independent predictor for cardiac syndrome X.Conclusion High platelet distribution width is associated with attack of cardiac syndrome X.

Objective To discuss the clinical effects and the major adverse cardiac events of intracoronary prostaglandin E1 injection prior to percutaneous coronary intervention (PCI) in early(within 24h of symptom onset) interventional treatment for patients with acute non -ST segment elevation myocardial infarction ( NSTEMI ) . Methods 122 patients with NSTEMI who underwent early interventional treatment were divided into three groups according to the digital table:41 cases in prostaglandin E 1 group,41 cases in nitroglycerin group ,40 cases in control group.The TIMI blood flow was compared among the three groups after PCI .All patients were followed up during 6 months about major adverse cardiac events ( MACE) and the cardiac structure and function by echocardiography . Results After primary PCI,the corrected TIMI frame count(CTFC) was significantly better in the prostaglandin E 1 group[(20.22 ±6.82)] than in the nitroglycerin group[(26.35 ±8.71)] and the control group[(27.02 ±9.65), t=6.451,6.763,all P<0.05].The TIMI myocardial perfusion grade (TMP) was significantly better in the prosta-glandin E1 group(7.3％) than in the nitroglycerin group(26.8％) and the control group(30.0％)(P<0.05). There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).All patients were followed up for 6 months,the LVDd in the prostaglandin E1 group[(46.8 ±3.7)mm] was significantly lower than that in the nitroglycerin group[(49.5 ±5.8) mm] and the control group [(50.2 ±4.9) mm,t=6.312, 5.893,all P<0.05].The LVEF in the prostaglandin E1 group [(55.8 ±8.2)％] was significantly higher than that in the nitroglycerin group [(49.3 ±7.9)％] and the control group [(50.5 ±6.8)％,t=7.011,5.981,all P<0.05].The incidence rate of MACE in the prostaglandin E 1 group(4.9％) was significantly lower than that in the nitroglycerin group(12.2％) and control group(12.5％)(χ2 =5.834,5.719,all P<0.05).There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).Conclusion Intracoronary administration of prostaglandin E 1 injection prior to balloon dilation can significantly improve the myocardial microcir-culation perfusion,and can decrease MACE in patients with NSTEMI who underwent early interventional treatment .

Objective To summarize the experience of applying transradial sheathless technique in treat-ment of bifurcation coronary lesions. Methods The clinical data on 39 patients with bifurcation coronary lesions who received transradial PCI using sheathless guide catheter produced by ASAHI or self-made sheathless guide catheter were retrospectively analyzed. Passing ability of sheathless guide catheter, success rate and complications of PCI were observed.Results There were 10 patients with left main bifurcation lesions, 29 left anterior descend-ing branch and diagonal branch bifurcation lesions. 33 patients were treated using sheathless of 7.5 Fr and 6 were treated by self-made sheathless guide catheter.PCI achieved expected goal.No catheter placement related complica-tions, cardiovascular or cerebrovascular events were observed in 39 patients in their hospital stay. Conclusions Transradial sheathless technique can be applied in of coronary lesions. Sheathless of 7.5 Fr is easy to use and has perfect passing ability.Sheathless guide catheter is effective,safe and highly practicable.Both procedures are worth of clinical application.

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.