Objective To discuss the relationships of the genotype of cytochrome P450 2C19 (CYP2C19) gene and and clopidogrel responsiveness.Methods The study enrolled 110 patients with acute myocardial infarction who were treated with clopidogrel in Tiantan Hospital of Beijing from November 2012 to May 2014.Patients were treated by aspirin and clopidogrel.CYP2C19 polymorphisms were detected by genotype testing kits.Platelet inhibition rates were measured by thrombelastography to represent the antiplatelet effect of clopidogrel.The platelet inhibition rates of clopidogrel were compared among different genotypes.Results Compared with carriers of CYP2C19 * 2 or * 3 reduced-function allele,CYP2C19 * 1 wild type had higher platelet inhibition rate of clopidogrel ((35.73 ± 19.29)％ vs.(48.30± 20.84)％),and the difference was significant(t =3.264,P＜0.05).There was no difference between intermediate metabolizer((35.72± 19.27)％) and poor metabolizer((35.75±19.89)％;P＞0.05).The frequency of wild-type homozygotes CYP2C19 * 1/* 1 was higher in responders than in low responders(frequency of low reaction group CYP2C19 * 1/* 1 14 cases (40.0％),* 1/.2 10 cases(28.6％),* 1/* 3 4 cases(11.4％),* 2/* 2 5 cases(14.3％),* 2/* 3 2 cases (5.7％),frequency of reaction group were 45 cases (60.0％),15 cases (20.0％),4 cases (5.3 ％),7 cases (9.3％),4 cases(5.3％);x2 =3.838,P =0.05).Conclusion Polymorphism of gene CYP2C19 is associated with different responses to clopidogrel.CYP2C19 * 2/ * 3 reduced-function allele is associated with low response to clopidogrel.

Anticoagulants ; therapeutic use ; Humans ; Venous Thrombosis ; drug therapy

Humans ; Noise, Occupational ; adverse effects ; Occupational Exposure ; standards

Objective To summarize the experience of surgical treatment of venous drug-induced infective endocarditis(IE). Methods The 17 cases of drug-induced IE were found to have valvular vegetations,16 patients had involvement of tricuspid valve, 1 mitral valve associated with ventrieular septal defect. Preoperative blood culture was positive in 8 patients. The operations included tricuspid valve repair (6 cases),tricuspid valve replacement(8 cases), mitral valve replacement and VSD closure(1 cases). Results All patients were alive and discharges. After follow-up of 6 months to 6 years, 1 case had severd tricuspid alve regurgitation, 1 had haemoptysis because of incorrect anticoagulation. Conclusions This study indicated surgical intervention is effective treatment of venous drug-induced infective endocarditis.

Objective To develop a lower limbs rehabilitative apparatus and explore its effects. Methods From January to September, 2016, 28 children with spastic cerebral palsy were divided into control group (n=14) and observation group (n=14) randomly. The control group received routine rehabilitation, while the observation group received self-made lower limbs rehabilitative apparatus training addition-ally. They were assessed with Gross Motor Function Measure (GMFM)-88 and Berg Balance Scale (BBS) before and three months after treatment. Results There was no significant difference in the scores of GMFM-88 and BBS between two groups before treatment (P>0.05), while they increased after treatment (t>6.124, P<0.001), and were higher in the observation group than in the control group (t>2.329, P<0.05). Conclusion Self-made lower limbs rehabilitative apparatus could help to improve the gross motor function and balance function in children with spastic cerebral palsy.

Objective To evaluate retrospectively the image quality and detection of nodules with low-dose chest computed tomography (LDCT)by photon detector and iterative reconstruction (IR).Methods Sixty-six patients with lung nodules underwent routine LDCT with image reconstruction using filtered back projection (FBP).These patients were followed up by LDCT with photon detector 6 months later with image reconstruction using FBP and SAFIRE.Image quality and detection rate of the nodules were compared among groups including routine LDCT,photon decector+FBP and photon Decector+IR groups.Results Noise was decreased and SNR was increased in turn for routine LDCT,photon detector+FBP and photon detector +IR,exhibiting statistical differences (all P<0.001).The CT image quality score among routine LDCT,photon decector+ FBP and photon decector+ IR groups were increased in turn with statistical differences (χ2 =32.65,P<0.001).132 lung solid nodules (SN)were all identified in three groups with average diameter of (5.13±1.49)mm, (5.1 1±1.57)mm and (5.08±1.54)mm,respectively,and the difference was not statistically significant (P >0.05).14 ground glass nodules (GGN )in routine LDCT group and 15 in other two groups were identified with the average diameter of (6.44±1.86)mm, (7.23±1.74)mm and (7.31±1.68)mm,respectively.The ability of routine LDCT to detect the GGNs was lower than that of the others.Conclusion Photon detector and IR are able to decrease image noise,improve image quality,and increase detection rate and measurement accuracy of GGN.

Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.

Objective To evaluate aneurysm sac pressure monitoring during endovascular repair (EVAR)of abdominal aortic aneurysm. Methods From April 2006 to May 2007,12 patients with abdominal aorta aneurysm underwent endovascular aneurysm repair.The average max-diameter of the aneurysm WR8(5.83±0.95)cm.The sac pressure was monitored during the whole process of the operation.The correlation between the pressure and endoleaks and long-term outcomes was observed during follow-up.Results Before the stentgraft was delivered.sac pressure was equal to the systemic blood pressure in all the 12 cases.After the EVAR wag finished,the sac systolic pressure dropped by＞40% in 11 cases,among which sac blood pressure bropped by ≥50% in 7 cases.sac pressure did not change in 1 case.In all the 12 cases,pulse pressure diminished by＞30%,and＞75%in 6 cages.During the follow-up,there were no endoleaks and death.In 5 Cases.with sac systolic pressure drop＞50%,the max-diameter of the aneurysm decreased by 1.6～3.1 mm,while in one c88e,in which sac pressure had no change the postoperative maxdiameter of the aneurysm has increased by 3.2 nma. Conclusion Abdominal aorta aneurysm sac pressure monitoring during EVAR helps to predict the change of the sac pressure after EVAR,and to detect the endoleaks.

Objective To study the anatomical characteristics of ascending aortic and aortic arch in adult Chinese. Methods From Sep 2006 to Sep 2007, we retrospectivly reviewed 388 volunteers undergoing thoracic aorta CTA in our institution. We measured the diameter of ascending aorta, aortic arch, and branch vessels of aortic arch respectively in AW4.2 work station. CHESS statistical software was used to analyze data. Results The aortic diameter above coronary artery (CA) (D1), the level at origin of brachiocephalie trunk (BCT) ( D3 ), the halfway of the AA( D2 ), the level at origin of LCCA( D4 ) , the level at origin of LSA ( D5 ) and the level at distal origin of LSA ( D6 ) respectively are: ( 34 ± 5 ) mm; ( 33 ± 4) mm; ( 34 ± 5 ) mm; ( 30 ± 4) mm; ( 28 ± 3 ) mm; ( 26 ± 3 ) mm. The diameters of two level between the origin of BCT and RSA are ( 13. 1 ± 1.9) mm, ( 12. 8±2. 3) mm, respectively. The diameter of two level at LCCA is ( 8. 7 ± 1.5 )mm and ( 7. 9 ± 1. 0) mm respectively. The diameter of two level between the origin of LSA and L-vertebral arteryis (10.7±1.7) mm,(9.3±1.3) mm, respectively. Conclusion The data of the diameter and length of ascending aort and vasculature arising from the arch abtained by CT topography in Chinese volunteers are very useful for clinical practice.

Objective To probe into the reasons for and results of remedial surgical therapy in thoracic aortic dissection patients after first endovascalar repair.Methods From July 2000 to December 2012,12 cases received second interventional surgery.The average time from second therapy to first surgery was ( 14 ± 11 ) months.Main reasons for second endovascular therapy were sustained type Ⅰ endoleak at proximal landing zone and type A dissection caused by retrograde tear.Therapies included hybrid operations in 8 cases and absnlute endovascular therapy in 4 cases.Results The 30 day mortality after the second intervention was 5.6％ ( 1/12),total mortality rate was 16.7％ (2/12).In 7 cases with endoleak,small endoleak remained after remedial therapy (57.1％ ) in 4 cases.Among 4 cases with secondary type A aortic dissection,successful staged hybrid operation with mid-sternal thoracotomy was adopted in 3 cases,one died of pulmonary emtbolism during follow-up period,1 case with Bebcet disease still had proximal type Ⅰ endoleak after second hybrid operation,and died from tear of aorta.Conclusions Endoleak and secondary type A aortic dissection are the main cause necessitating second intervention after primary endovascular therapy for thoracic aortic dissection.Hybrid operation remains the best choice to treat postoperative complications after endovascular therapy for thoracic aortic dissection.