OBJECTIVETo evaluate the accuracy of optical coherence tomography (OCT) in evaluating neointimal proliferation in canine coronary artery following stenting.

METHODSIn 15 domestic dogs, a single bare-metal stent was implanted in the anterior descending or the circumflex branch of the left coronary artery. Ninety days after stenting, the dogs underwent coronary angiography and OCT, followed by quantitative histological assessment of neointimal proliferation in the target arterial segments. The parameters of OCT and the histological findings were analyzed comparatively.

RESULTSA total of 15 OCT-histology matched frames acquired at the point with the most severe stenosis in every stent, and 60 pathological sections from all the stents were analyzed. The difference of the stent area assessed by OCT was comparable to that defined histologically (5.01∓0.79 mm(2) vs 4.99∓0.81 mm(2), P>0.05). Neointimal thickness and area were smaller with OCT assessment than with histological assessment (0.19∓0.08 mm vs 0.22∓0.10 mm, and 1.52∓0.49 mm(2) vs 1.85∓0.78 mm(2), respectively, P<0.05). The lumen area was larger by OCT assessment than by histological assessment (3.50∓0.66 mm(2) vs 3.15 ∓ 0.43 mm(2), P<0.05). Close correlations were found between OCT and histological evaluations of the neointimal thickness (R(2)=0.5280.767), neointimal area (R(2)=0.5280.537) and stent area (R(2)=0.528), but the correlation was poor for lumen area (R(2)=0.5280.307). All the stents showed full endothelialization without thrombus or aneurysm in the stents.

CONCLUSIONOCT allows precise and reproducible assessment of neointimal proliferation in the coronary artery following stenting, but for measurement of the lumen area, OCT shows a poor correlation to histological evaluation.

Angioplasty, Balloon ; adverse effects ; instrumentation ; Animals ; Coronary Angiography ; Coronary Vessels ; diagnostic imaging ; pathology ; Dogs ; Male ; Models, Animal ; Neointima ; pathology ; Stents ; adverse effects ; Tomography, Optical Coherence ; Tunica Intima ; pathology

OBJECTIVEThis study was performed to evaluate the relationship between the stent fracture and restenosis after drug-eluting stent implantation.

METHODSThe study enrolled 536 patients with angiographies during stenting procedure and follow-up, the patients were divided into DES group (n=397) and BMS group (n=139). The coronary angiography images were analyzed to detect restenosis and stent fracture.

RESULTSRestenosis rate was significantly lower in DES group (31/397, 7.8%) compared that in BMS group (30/139, 21.6%, P<0.05). Stent fracture (n=5) was found only in DES group and not in BMS group (P<0.05). Restenosis were found in all stent fracture segments. The stent fracture developed at the angulated tortuosity lesions.

CONCLUSIONStent fracture is one of the causes of restenosis after drug-eluting stents implantation and related to implantation of long DES stent at the location of angulated tortuosity lesions.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis ; diagnostic imaging ; etiology ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Radiography ; Retrospective Studies ; Ultrasonography

OBJECTIVETo evaluate the safety and efficiency of local paclitaxel delivery using the double-balloon perfusion catheter to prevent restenosis in the canine coronary artery.

METHODSTwenty domestic canines underwent bare-mental stent implantation after balloon injure of the left coronary artery. A novel double-balloon perfusion catheter was used to deliver the drug locally in the canine coronary artery. In the treatment group (n = 15), paclitaxel (10 ml, 20 micromol/L) was delivered using the double-balloon perfusion catheter before stent implantation. In the control group (n = 5), 10 ml saline was delivered using the double-balloon perfusion catheter before stent implantation. The perfusion time in both groups was (26.45 +/- 5.18) s. Animals underwent coronary angiography and optical coherence tomography (OCT) 90 days after stent implantation and were sacrificed. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques.

RESULTSCoronary angiography results showed restenosis rate in control group was significantly higher than that in treatment group (60% vs. 33.33%, P < 0.05). The parameters of OCT showed in treatment group and control group: the neointimal thickness was (0.19 +/- 0.08) mm and (0.38 +/- 0.03) mm, the neointimal area was (1.52 +/- 0.49) mm2 and (2.51 +/- 0.47) mm2, the lumen area was (3.50 +/- 0.66) mm2 and (2.78 +/- 0.57) mm2, the extent of stenosis was (30.13 +/- 8.56)% and (47.40 +/- 4.50)%, and all the variances above were significantly different between the two groups (P < 0.05). The histologic parameters showed in treatment group and control group: the neointimal thickness was (0.22 +/- 0.10) mm and (0.47 +/- 0.05) mm, the neointimal area was (1.85 +/- 0.78) mm2 and (3.43 +/- 0.25) mm2, the lumen area was (3.15 +/- 0.43) mm2 and (1.85 +/- 0.55) mm2, the extent of stenosis was (36.00 +/- 10.97)% and (65.40 +/- 8.23)%, and all the variances above were also significantly different between the two groups (P < 0.05). The stents of both the groups were fully endothelialized. No thrombus or aneurysm was found in stents.

CONCLUSIONLocal delivery of paclitaxel with the double-balloon perfusion catheter to prevent restenosis in coronary stents is safe and efficient.

Angioplasty, Balloon, Coronary ; Animals ; Catheters ; Coronary Restenosis ; prevention & control ; Disease Models, Animal ; Dogs ; Injections ; Paclitaxel ; administration & dosage ; therapeutic use ; Stents

OBJECTIVETo analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI.

METHODSA total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed.

RESULTSLVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow.

CONCLUSIONEarly ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.

Aged ; Angioplasty, Balloon, Coronary ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; physiopathology ; therapy ; Treatment Outcome ; Ventricular Function, Left

OBJECTIVENeonatal hypoxic-ischemic brain damage (HIBD) causes acute death and chronic nervous system sequelae in newborn infants and children. Whereas there have been no specific treatment towards it up to now. Studies have shown that bone marrow mesenchymal stem cells (MSCs) have the therapeutic potential in many nervous system diseases and the authors previously found that retinoid acid (RA), which plays an important role in brain development, could enhance the neural differentiation of rat MSCs (rMSCs) in vitro. This study aimed to examine effects of rMSCs and RA-preinduced rMSC on learning and memory functional recovery after HIBD in neonatal rats in order to explore a new treatment strategy for clinical application, and explore the mechanism of action of rMSCs.

METHODSRat MSCs were isolated and purified from the whole bone marrow of juvenile Wistar rats by removing the non-adherent cells in primary and passage cultures. Neonatal hypoxic-ischemic brain damage rat models were built according to the methods described by Rice: the right carotid artery of 7-day-postnatal Wistar rats was ligated under anesthesia, and then the rats were exposed to 8% - 9% O2 in a container. At 5 days after hypoxia-ischemia, the HIBD neonatal rats were randomly divided into 3 groups and respectively transplanted with saline, BrdU marked rMSCs (1 - 2 x 10(5)) or RA-preinduced rMSCs (1 - 2 x 10(5)) into their lateral cerebral ventricle. Immunohistochemistry for nestin, neuron-specific enolase (NSE), neurofilament protein-heavy chain (NF-H) and glial fibrillary acidic protein (GFAP) were used to identify cells derived from rMSCs at 14 days and 42 days after transplantation. Shuttle box test was performed to evaluate the condition of learning and memory functional recovery when animals were 7 weeks old. Neurotrophin and receptors cDNA microarray were also employed at 14 days after transplantation to investigate the underlying action mechanisms of rMSCs treatment. Real-time PCR was used to confirm some of the remarkably changed genes.

RESULTS(1) The neonatal rat model of HIBD was successfully established. (2) Immunohistochemistry showed rMSCs-derived cells survived, migrated into the hypoxic-ischemic brain tissue and a few of them expressed protein characteristic of neurons and astrocytes (NF-H and GFAP) in RA-preinduced group 14 days and 42 days after transplantation, while no positive expression of nestin and NSE were detected. (3) The shuttle box test showed that the average learning times in rats transplanted with saline, rMSC and RA-preinduced rMSCs were (94.10 +/- 38.18), (74.60 +/- 29.21) and (47.90 +/- 21.13), respectively. The difference between the former two was not significant (P > 0.05), while the latter one exhibited significant improvement (P < 0.05). (4) The cDNA microarray analysis showed that compared with normal control group, IL-6, Fas and BDNF genes of the saline control group significantly up-regulated (the ratios of the three genes were 11.4, 2.4 and 6.6 respectively). Compared with saline group, the three genes in rMSC group were down-regulated (the ratios were all 0.1), while the levels of IL-6 and Fas genes (the ratios were 0.3 and 0.4 respectively) in RA-preinduced rMSCs group were higher than rMSCs group after down-regulating, but the level of BDNF remained at the saline group level. Real-time PCR analysis suggested that the results of IL-6 and Fas genes were at equal level with microarray results on the whole, while the level of BDNF gene in RA-preinduced rMSC group was significantly down-regulated (with ratio of 0.34), but higher than rMSCs group (the ratio was 0.25) as well.

CONCLUSIONTransplantation of rMSC and RA-preinduced rMSCs into lateral cerebral ventricle can improve learning and memory functional recovery after HIBD in neonatal rats, especially RA-preinduced rMSCs. Regulating the levels of IL-6, Fas and BDNF in the brain to maintain at reasonable levels may be the mechanism.

Animals ; Animals, Newborn ; Cell Differentiation ; Cells, Cultured ; Hypoxia-Ischemia, Brain ; psychology ; therapy ; Memory ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; cytology ; Neurons ; cytology ; Rats ; Rats, Wistar

OBJECTIVETo evaluate the characteristic of late stent malposition after drug-eluting stent implantation by optical coherence tomography (OCT).

METHODSThe study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year ago [average (14.8 +/- 5.2) months]. OCT images of the stent were analyzed at interval of 0.5 mm. The stent malposition was detected, the thickness of intima and gap between the stent strut and vessel wall were measured.

RESULTSStent malposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n = 4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others [(0.06 +/- 0.05) mm vs. (0.05 +/- 0.03) mm, P > 0.05].

CONCLUSIONThe causes of late stent malposition include the primary malposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the ostium of side branch. Thinner intima coverage was also observed on the stent struts with malposition.

Aged ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Tomography, Optical Coherence ; Treatment Failure

BACKGROUNDReports on mood regulating circuit (MRC) indicated different activities between depressed patients and healthy controls. The functional networks based on MRC have not been described in major depression disorder (MDD). Both the anterior cingulate cortex (ACC) and thalamus are all the key regions of MRC. This study was to investigate the two functional networks related to ACC and thalamus in MDD.

METHODSSixteen patients with MDD on first episode which never got any medication and sixteen matched health controls were scanned by 3.0 T functional magnetic resonance imaging (fMRI) during resting-state. The pregenual anterior cingulate cortex (pgACC) was used as seed region to construct the functional network by cortex section. The thalamus was used as seed region to construct the functional network by limbic section. Paired-t tests between-groups were performed for the seed-target correlations based on the individual fisher z-transformed correlation maps by SPM2.

RESULTSDepressed subjects exhibited significantly great functional connectivity (FC) between pgACC and the parahippocampus gyrus in one cluster (size 923) including left parahippocampus gyrus (-21, -49, 7), left parietal lobe (-3, -46, 52) and left frontal lobe (-27, -46, 28). The one cluster (size 962) of increased FC on thalamus network overlapped the precuneus near to right parietal lobe (9, -52, 46) and right cingulate gyrus (15, -43, 43) in health controls.

CONCLUSIONSAbnormal functional networks exist in earlier manifestation of MDD related to MRC by both cortex and limbic sections. The increased functional connectivity of pgACC and decreased functional connectivity of thalamus is mainly involved in bias mood processing and cognition.

Adult ; Depressive Disorder, Major ; physiopathology ; Female ; Gyrus Cinguli ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Thalamus ; physiopathology

OBJECTIVETo study the resistance phenotype and homology of Klebsiella pneumoniae (KPN) in burn patients with infection.

METHODSFifty-four strains of KPN were isolated from wound excretion, blood, sputum, venous catheter, feces, and oral cavity of patients hospitalized in Institute of Burn Research of Southwest Hospital (briefly called our institute) from January 2007 to June 2011. Drug resistance of the 54 strains of KPN to 18 antibiotics commonly used in clinic, including ampicillin, ticarcillin, etc, was tested by K-B paper disk diffusion method after being identified. Extended-spectrum β-lactamase (ESBL)-producing KPN was screened based on the drug resistance result. The positive rates of drug-resistant genes SHV, TEM, and CTX-M of the ESBL-producing KPN were detected by polymerase chain reaction. The homology of the ESBL-producing KPN was analyzed by pulse field gel electrophoresis and clustering methodology. The homology of ESBL-producing KPN isolated in each year was analyzed too.

RESULTS(1) The sensitive rate of the 54 strains of KPN to imipenem, meropenem, and ertapenem was respectively 96.30%, 92.59%, and 81.48%, that of these strains to cefotetan and cefoxitin was respectively 70.37% and 64.81%, and that of these strains to ceftazidime was 57.41%. The sensitive rates of the 54 strains of KPN to the other antibiotics were all lower than 40.00%. (2) Twenty-six ESBL-producing KPN strains were screened and the positive rate of SHV, TEM, and CTX-M was 96.15% (25/26), 76.92% (20/26), and 57.69% (15/26), respectively. Detection rate of ESBL-producing KPN strains carrying three genes at the same time was 42.31% (11/26), that of these strains carrying both SHV and TEM was 34.62% (9/26), and those of these strains carrying only a single gene were all less than 10.00%. (3) The twenty-six ESBL-producing KPN were classified into 9 gene types, with 30.77% (8/26) in type A, 19.23% (5/26) in type B, 15.38% (4/26) in type C, 11.54% (3/26) in type D, 7.69% (2/26) in type E, and the rest four strains respectively in type F, G, H, I [3.85% (1/26)]. (4) The major gene type of ESBL-producing KPN in the year of 2007 and 2010 was type A, respectively accounting for 2/3 and 1/2, while that in the year of 2009 was type B, accounting for 1/2. The three strains in 2008 was respectively in type C, E, and F. The four strains in 2011 was respectively in type A, D, H, I.

CONCLUSIONSKPN in burn patients with infection in our institute are highly resistant to commonly used antibiotics in clinic, but carbapenems antibiotics can be used for the treatment. Most of the ESBL-producing KPN strains carry two or three drug-resistant genes, and the main gene type of them is type A.

Anti-Bacterial Agents ; pharmacology ; Burns ; microbiology ; Carbapenems ; pharmacology ; DNA, Bacterial ; analysis ; Drug Resistance, Bacterial ; genetics ; Genes, Bacterial ; Humans ; Klebsiella pneumoniae ; genetics ; isolation & purification ; Microbial Sensitivity Tests ; Sequence Homology

OBJECTIVETo observe the effect of chronic arsenic exposure on cerebral cortex and serum metabolics of mice and explore the mechanism of arsenic neurotoxicity.

METHODSTwelve 3-week-old male C57BL/6J mice were randomly assigned into exposure group and control group and exposed to sodium arsenite (50 mg/L) via drinking water and deionized water for 12 weeks, respectively. After the exposure, arsenic level in the cerebrum was determined by hydride generation-atomic fluorescence spectrometry. The metabolites in the cerebral cortex and serum were determined using gas chromatography-mass spectrometry (GC/MS) analysis. Principal component analysis (PCA) was used to analyze the difference of the metabolites between the exposure and the control groups. Online tools for analyzing metabolic pathways were used to identify the related metabolites pathways.

RESULTSArsenic content in the brain of exposure group was significantly higher than that in the control group (P<0.05). The mice exposed to arsenic had a higher level of citric acid, phenylalanine, tyrosine, histidine and lysine in the cerebral cortex (P<0.05). Serum levels of serine, glycine, proline, aspartate and glutamate were significantly higher while α-ketoglutaric acid level was significantly lower in the exposure group than in the control group (P<0.05). PCA analysis showed a significant difference in cerebral cortex and serum metabolites between the two groups.

CONCLUSIONChronic arsenic exposure may affect the function of the central nervous system by interfering with amino acid metabolism and tricarboxylic acid cycle, which may be one of the mechanisms of arsenic neurotoxicity.

BACKGROUNDThrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.

METHODSWe used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.

RESULTSThe fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).

CONCLUSIONSPlaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.

Acute Coronary Syndrome ; diagnostic imaging ; etiology ; Adult ; Aged ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; complications ; diagnostic imaging ; Rupture, Spontaneous ; complications ; Tomography, Optical Coherence ; methods