Objective: To explore the clinical characteristics of ST elevation and non-ST elevation acute myocardial infarction (AMI) related with left circumflex artery (LCX) occlusion. Methods: Clinical data of 86 consecutively enrolled patients with LCX occlusion -related AMI undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. According to manifestations of electrocardiography, the patients were divided into ST elevation myocardial infarction (STEMI) group (n=32) and non STEMI (NSTEMI) group (n=54). Clinical features and prognosis were compared between two groups. Results: Compared with NSTEMI group, there were significant increase in serum level of creatinine [(80±23) μmmol/L vs. (100±30) μmmol/L], in rates of intra-aortic balloon counterpulsation （IABP）support (3.7% vs. 18.8%), usage of invasive respiratory machine (1.9% vs. 15.6%), ischemic mitral reflux (13.0% vs. 40.6%), complete atrioventricular block (0 vs. 9.4%), proportion of left coronary artery dominant type (7.4% vs. 28.1%) and left ventricular end-diastolic diameter [LVEDd,（46±4）mm vs.（48±5）mm?]; And significant decrease in percentage of triple-vessel coronary disease (72.2% vs. 46.9%) in STEMI group, P<0.05 or <0.01. There was no significant difference in mortality rate during admission (3.1% vs. 0, P>0.05) between STEMI group and NSTEMI group. Conclusions: Compared with patients with NSTEMI, patients with STEMI have poorer heart function in patients with left circumflex artery occlusion, which may be related to more left coronary dominance.

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.

Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty (PTA)for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007,35 patients with critical limb ischemia (CLI)were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA Was 83%.Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57%and 82%,respectively.Mean length of tibioperoneal arterial PTA was 9.5 cm(4.5～14 cm),concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting.There were three complications including arterial spasm and thrombosis in one, which Was relieved by thrombolysis and antispasmodics, and artery perforation in 2 cases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salrage rate,tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.

Aim To study the inhibitory activities of potential new anti-influenza virus agents,3-O-β-chaco-triosyl pentacyclic triterpenoids against the entry of H5N1influenza viruses.Methods Three target com-pounds were designed and synthesized structurally re-lated to the lead compound 3-O-β-chacotriosyl dioscin derivative (1 )with inhibitory activities against H5N1 influenza viruses.The inhibitory activities of these tar-get compounds were tested at a cellular level pseudo vi-rus system targeting H5N1 influenza viruse entry.Re-sults All the compounds 1 a,1 b and 1 c showed po-tent inhibitory activities against the entry of A/Thai-land/Kan353/2004 pseudo virus into the target cells, of which compound 1 b showed the best inhibitory activ-ity with an IC50 value of (1.25 ±0.22)μmol·L-1. Conclusion The SARs analysis of these compounds indicated that replacement of the aglycone moiety of compound 1 with pentacyclic triterpenoids could in-crease antiviral activity.Different types of pentacyclic triterpen as aglycone residue had the significant influ-ence on the inhibitory activity (1 b >1 c >1 a),sug-gesting ursane type of triterpenes was superior to the two other kinds of triterpenes as aglycone residue.

Objective To find the key miRNA that relative to peritoneal fibrosis associated with peritoneal dialysis (PD) by microarray technology,and verify its expression in vitro and in vivo.Methods The peritoneal fibrosis mouse model associated with PD were established by intraperitoneal injection of lipopolysaccharide (LPS)+ 4.25％ peritoneal dialysate.The expression of miRNA was detected by microarray in peritoneal tissues.The expression of miRNA profiles between fibrotic and normal peritoneal tissues was compared.The differentially expressed miRNA (miR-200a) was validated by real-time PCR in lager sample size cohorts.The expressions of miR-200a were also detected in the epithelial-mesenchymal transition (EMT) process of human peritoneal mesothelium cells.Results In mice model of PD,peritoneal tissue was markedly thickened and with a massive extracellular matrix accumulation.In contrast with control,the expression level of epithelial marker E-cadherin was significantly decreased,α-SMA,Col-Ⅰ and FN were remarkably increased (P ＜ 0.05).By miRNA microarray analysis,miR-200a was significantly down-regulated (3.31 folds change,P ＜ 0.05) in fibrotic peritoneal tissues.The down-regulated expression level of miR-200a was also validated by realtime PCR in larger cohorts (P ＜ 0.05).Then,the expression level of miR-200a was detected in the EMT process of human peritoneal mesothelium cells.During the process of TGF-β1 induced EMT,miR -200a was significantly down-regulated compared with the control (P ＜ 0.05).Conclusions Downregulated expression of miR-200a was observed both during peritoneal fibrosis and TGF-β 1 induced EMT in vivo and in vitro,suggesting that miR-200a may be involved in the peritoneum fibrosis by regulating the target genes of EMT.

Objective To observe the efficacy and safety of radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of complex regional pain syndrome(CRPS).Methods 26 patients with lower limb CRPS were selected and treated by the radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with oral pregabalin capsule.The visual analogue scale (VAS)and the quality of sleep(QS)were adopted to evaluate the pain change before treatment and on 1,7,14,28,56 d after treatment.The temperature change of lower limb skin and the occurrence situation of adverse reactions were recorded.Results Compared with before treatment,the scores of VAS and QS at different time points after treatment were decreased significantly (P <0.05),the skin temperature of affected lower limb after treatment was increased significantly (P <0.05).The total effective rates on 28,56 d after treatment were 88.46% and 96.15% respectively.The adverse reactions were mainly dizziness and somnolence.No severe complications such as vascular,neural and intra-abdominal organs injury were found in the treatment process.Conclusion The radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of CRPS can rapidly alleviate pain,improve the patients′quality of sleep and living.

Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.

OBJECTIVETo study the inhibitory activities of 3-O-β-chacotriosyl benzyl ursolate and its derivatives as potential new anti-influenza virus agents against the entry of H5N1 influenza viruses into the target cells.

METHODSFour target compounds were designed and synthesized, which were structurally related to the lead compound 3-O-β-chacotriosyl methyl ursolate (1). The inhibitory activities of these compounds were tested at a cellular level psuedovirus system targeting H5N1 influenza viruse entry.

RESULTS AND CONCLUSIONThe compounds 1b, 1c and 1d showed potent inhibitory activities against the entry of A/Thailand/Kan353/2004 pseudovirus into the target cells, and among them compound 1d showed the strongest inhibitory activity with an IC50 value of 0.96 ± 0.10 µmol/L. The structure-activity relationship analysis of these compounds indicated that when 17-COOH of ursolic acid was esterified, introduction of Me groups rather than aryl groups more strongly enhanced the inhibitory activity. Changing 17-COOH of ursolic acid into amide could increase the antiviral activity and decrease the cytotoxicity of the compounds in MDCK cells.

Animals ; Antiviral Agents ; chemistry ; Dogs ; Influenza A Virus, H5N1 Subtype ; drug effects ; physiology ; Madin Darby Canine Kidney Cells ; Structure-Activity Relationship ; Triterpenes ; chemistry ; Virus Internalization ; drug effects

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in middle-aged and older adult population in Shanghai Pudong New District.Methods Two thousand residents aged 45 years and above were randomly selected for questionnaire survey and health check-up in Shanghai Pudong New District from July 2006 to October 2010.The laboratory examinations were also performed including the urine routine,urinary protein to creatinine ratio,serum creatinine,blood glucose and lipids.The glomerular filtration rate (eGFR) was estimated by simplified Chinese MDRD (modification of Diet in Renal Disease) equation.SPSS 13.0 statistical software was used for statistical analysis.Results Among 1905 residents who completed survey and examinations,the adjusted prevalence of albuminuria was 12.0％ (95％ CI:0.105-0.135) and of eGFR less than 60 ml · min-1 · 1.73 m-2 was 1.9％ (95 ％ CI: 0.172-0.213).The prevalence of CKD was 12.6％ (95 ％ CI: 0.112-0.142).Logistic regression analysis revealed that age (OR =1.043),hypertension (OR =2.272),diabetes mellitus (OR =1.233)and hyperuricemia (OR =1.003)were independently associated with CKD.Conclusions The prevalence of CKD in adult residents (≥45 years) from Shanghai Pudong New District is high.It is necessary to carry out early screening and to intervene risk factors of CKD in middle-aged and older residents.

Objective To evaluate the clinical changes of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves in contralateral eyes of patients with unilateral infectious keratitis.Methods A prospective serial case observation study was conducted in patients with unilateral infectious keratitis from January to August 2018 in the First Affiliated Hospital of Harbin Medical University.The corneal epithelial cells density,dendritic cells density,endothelial cells density,total nerve density,total number of nerves and branch nerve density were analyzed with in vivo confocal microscopy (IVCM),slit lamp microscopy was performed on all subjects to observe the conjunctiva,cornea and anterior chamber.Corneal branch nerve density and total nerve density were compared with the control group by homogeneity test of variance.This study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No.IRB-AF/SC-04/01.0).Results Slit lamp microscopy showed no significant changes in anterior segment of the contralateral uninfected eyes in the 3 groups.The corneal epithelial cells density of uninfected eyes in viral keratitis group,bacterial keratitis group and fungal keratitis group was 1 834 (1 584,2 107),1 905 (1 651,2 332) and 1 859 (1 477,1 995)/mm2,respectively,which were significantly lower than 3 479 (3 080,3 910)/mm2 in the control group,the dendritic cells densities in viral keratitis group and bacterial keratitis group were 175 (139,214)/mm2 and 156 (118,190)/mm2,which were higher than 69(57,76)/mm2 in the control group,the differences were statistically significant (all at P＜0.05).The corneal endothelial cells density of uninfected eyes in viral keratitis group was 1 107(945,1 270)/mm2,which was less than 1 905(1 651,2 332)/mm2 in the bacterial keratitis group and 1 859(1 477,1 995)/mm2 in the fungal keratitis group (both at P＜0.05).The corneal nerve number and total nerve density of uninfected eyes in viral keratitis group were l0(7,11)/mm2 and (1 822.85±622.34) μm/mm2,which were lower than 11 (9,13)/mm2 and (2 340.91±:408.70)μm/mm2 in the bacterial keratitis group,with significant differences between them (P＜ 0.05,P＜ 0.008 3).The morphology of corneal epithelial cells and endothelial cells in each infectious keratitis group was larger than that in the control group,while the morphology and number of dendritic cells in the contralateral eye of patients with viral and bacterial keratitis increased.Conclusions In unilateral uninfected eyes of infectious keratitis,the density of corneal epithelial cells,dendritic cells,endothelial cells and corneal nerves changes correspondingly.There may be a close relationship of corneal immunity and nervous system between the two eyes.