Objective To determine the effect and feasibility of kissing dilating with cutting balloon and conventional balloon for bifurcated lesions Methods We divided 34 patients with true bifurcated stenosis into cutting ballon group (13 patients) and stenting group (21 patients) Intravascular ultrasound (IVUS) was performed before and immediately after the interventional procedure Several indexes including minimal lumen diameter, external vessel crossectional area, lumen crossectional area, plaque crossectional area, vessel/lumen diameter and %diameter stenosis were calculated, respectively Results In cutting balloon group, more common lesions were found in left anterior descending artery and first diagonal (43 5% vs 28 9%, P

Objective To determine the lesion characteristics and effect of intervention on diseased grafts in older patients. Methods Thirty-eight patients with angina after coronary artery bypass grafts (CABG) were enrolled into Nanjing First Hospital. Interventions were performed after multiple-view angiogram and formal consent from relatives received. Angiographic follow-up was conducted within 6 months. Cardiac events were recorded during the 6-month clinical follow-up. Results Of the 38 patients (36 males and 2 females), the average age was 63.2 years. Angina occurred 11.5 months after CABG. Angipgrams were performed 4.8 years after CABG. Diabetes was complicated in 10 cases and old myocardial infarction in 8, respectively. Left ventricular ejection fraction was increased from 52%?10% to 58%?14% (P

Objective To investigate the efficacy and safety of glycoprotein Ⅱb/Ⅲa inhibitor (tirofiban) for elderly high-risk patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventional therapy (PCI). Methods Ninety four high-risk ACS patients admitted between Dec 2004 and Jul 2006 were randomly divided into the tirofiban group (n=46, mean age 68.5?11.4 years old) whom received tirofiban and half-dose of heparin, and the conventional interventional group (n=48, mean age 66.8?9.9 years old) whom were treated by full dose heparin before PCI. The coronary reperfusion flow (TIMI grades) of culprit vessel (CV) after PCI, cardiac enzyme changed 6 hrs and 12 hrs afterwards, major adverse cardiac events (MACE) rates within 30 days, bleeding and transfusion rates were analyzed and compared between the two groups. Results The average TIMI reperfusion grades (by frames) and CK-MB levels at 6 hrs and 12 hrs after PCI were better in the tirofiban group than in the conventional group (35.6?6.1, 16.2?3.9 mmol/L, 13.4?3.9 mmol/L vs 38.7?8.2, 18.4?4.8 mmol/L, 15.5?5.1 mmol/L, P

Objective To investigate the ability of myocardial fractional flow resever (FFRmyo) in predicting the incidence of major cardiac events (death, myocardial infarction, revascularization and recurrance of angina) 3 months after stent inplantation and also try to find out the cutoff point. Methods Coronary pressure was measured in 79 patients with stable angina immediately after stent implantation. The values of poststenting FFRmyo was calculated and found to be related to the presence of major adverse cardiac events during first 3 months. Results In 14 patients (18.4%), at least one adverse event occurred. Two out of 12 patients experienced recurrance of angina and underwent revascularization. By Logistic Regress analysis, FFRmyo immediately after stenting was the most significant independent variable for predicting major cardiac events. By receiver-operating characteristic (ROC) analysis, the cutoff point of FFRmyo was 0.92. Conclusion FFRmyo immediately after stenting is an independent predictor of clinical events at first 3 months.

Clostridium difficile( C. difficile)is a major nosocomial infection pathogen and the principal causative agent of antibiotic-associated diarrhea. The toxigenic C. difficile strains cause colonic injury and inflammation mainly by secreting enterotoxin A( TcdA)and cytotoxin B( TcdB). The severity of C. difficile associated disease( CDAD)is correlated to the toxin level during host infection. However,the toxigenic capacity of C. difficile varies widely among strains,which correlates with the gene regulation involved during toxin production. This article reviewed the regulatory mechanism of C. difficile toxin-associated pathogenic gene and anti-toxin treatment.

Objective To investigate the relationship between the infarction area and the changes of serum fibrotic indexes in acute myocardial infarction (AMI) patients.Medthods Serum procollagen type Ⅲ (PCⅢ),collagen IV(IV?C) and laminin (LN) were measured in 42 AMI patients with successful recanalization,22 AMI patients with unsuccessful recanalization and 37 healthy controls.Michelle's method was used to calculate infarction area and correlative analysis was made between indexes and infarction area.Results Serum PCⅢ,IV.C and LN were significantly increased in AMI patients with unsuccessful recanalization as compared with the other two groups,which were positively correlated with the infarction area.However,there was no statistical significance between the indexes in the other two groups and infarction area.Conclusion Serum PCⅢ,IV.C and LN can be serum fibrotic indexes in AMI patients,which can reflect the infarction area indirectly.

Objective To prepare arginine-glycine-aspartic acid (RGD)-and ribonuclease A (RNase A)-conjugated CdTe quantum dot (QD) nanoprobes,and to observe their capability to target human A375 malignant melanoma cells.Methods RNase A-modified CdTe quantum dots (CdTe RQDs) were obtained by using a microwave-based heating method,and then chemically conjugated to the RGD peptide to prepare RGD-CdTe RQD nanoprobes,which were then physically and chemically characterized by transmission electron microscopy,powder crystal diffraction,fluorescence spectrophotometry,and ultraviolet absorption spectrophotometry.A375 cells were cultured in vitro and incubated with various concentrations (20,40,80 nmol/L) of RGD-CdTe RQD nanoprobes for different durations (12,24,36,72 hours).Then,methyl thiazolyl tetrazolium (MTT) assay was conducted to estimate the proliferative activity of A375 cells.To observe the targeting capability of RGD-CdTe RQD nanoprobes,A375 cells were treated with RGD-CdTe RQD nanoprobes at the concentration determined by MTT assay for one hour followed by laser confocal microscopy.Results CdTe RQDs with good dispersion and biocompatibility were obtained by using a microwave-based heating method,and then successfully conjugated to the RGD peptide to form RGD-CdTe RQD nanoprobes.The treatment with RGD-CdTe RQDs of 20 nmol/L for 12 hours exhibited the weakest effect on the proliferative activity of A375 cells,and hence,20 nmol/L was selected for the fluorescence imaging assay.Laser confocal microscopy revealed that RGD-CdTe RQD nanoprobes were able to actively target A375 cells.Conclusion RGD-CdTe RQD nanoprobes with a favorable capability to actively target A375 cells are successfully prepared in this study.

Objective To compare the efficacy of and adverse reactions to a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser in the treatment of atrophic acne scars.Methods Twenty-one patients with atrophic acne scars were enrolled in this study.Half of each subject's face was treated with micro-plasma,and the other half with fractional ultrapulsed CO2 laser,for one session.Treatments were randomly administered in a split-face manner.The efficacy and adverse effects were evaluated 6 months after the treatment by using the following outcome parameters:ECCA grading scale (échelle d' évaluation clinique des cicatrices d'acné),degrees of post-treatment pain and edema,time taken for crusting and durations of inflammatory erythema,patients' subjective rating of improvement in scar by using a quartile grading scale.A non-parametric rank test was conducted to compare the efficacy and adverse effects between the two treatments.A scar model was established on both ears of a New Zealand big ear rabbit,and treated with the CO2 laser and micro-plasma respectively,immediately followed by the resection of scar tissue for the observation of histological changes.Results A decrease of ECCAscore was observed in 90.5％ (19/21) of the patients after micro-plasma treatment,and in 86.7％ (18/21) after CO2 laser treatment; no significant difference was observed in the response rate (P ＞ 0.05).In detail,ECCA score decreased by 31.5％ (from 50.71 to 34.76 ) after micro-plasma treatment,compared to 29.9％ (from 53.57 to 38.10) after CO2 laser treatmet.Mild edema was observed after micro-plasma treatment,with the duration of erythema and crusting being 13.95 days and 6.95 days,respectively,compared to 45.81 days and 10.10 days respectively,after CO2 laser treatment.Pigmentation occurred in none of the patients after micro-plasma treatment,but in 19％ after CO2 laser treatment.Animal experiment showed that microscopic ablation zones were broad and shallow after micro-plasma treatment,but narrow and deep after CO2 laser treatment.Conclusions Fractional micro-plasma and CO2 laser are both effective for the treatment of atrophic acne scars,but the former seems to have less side effects with a lower incidence of pigmentation.

Objective To evaluate the efficacy and safety of long pulsed Nd:YAG laser in the treatment of onychomycosis.Methods Thirty-five patients with onychomycosis were treated by long pulsed Nd:YAG laser with a wavelength of 1064 nm,power of 30-40 J/cm2,pulse width of 35 milliseconds,diameter of light spot of 4 mm.One treatment session included 4 times of irradiation at an interval of 2 minutes.Patients were treated once a week for 4 weeks followed by once a month for 6 months.Clinical and mycological efficacy was evaluated 9 months after the beginning of treatment.Side effects were recorded and analyzed.Nails were divided into various groups according to causative fungal species,clinical phenotypes,and distribution of affected nails.Data were processed by using SPSS 17.0 software.Chi-square test was performed to compare the response and recurrence rate between these groups.Results A total of 79 nails were treated by long pulsed Nd:YAG laser in this study.At 9 months after the first treatment,clinical response was observed in 67.1％ of these nails,mycological response in 73.4％,and recurrence in 19.0％.The Trichophyton rubrum group showed a better clinical (x2 =10.913,P ＜ 0.05) and mycological response (x2=13.532,P ＜ 0.05),but a lower recurrence/reinfection rate (x2 =10.980,P ＜ 0.05) compared with the other-species group.No significant difference was observed between the Trichophyton rubrum group and Candida albicans group in the clinical and mycological response rate or recurrence/reinfection rate.The clinical response in the distal lateral subungual onychomycosis (DLSO) group was significantly poorer than that in the white superficial onychomycosis (WSO) group (x2 =11.935,P ＜ 0.05),but better than that in the proximal subungual onychomycosis (PSO)/total dystrophic onychomycosis (TDO) group (x2 =17.515,P ＜ 0.05).Increased clinical response rate was observed in the second-fifth finger nail group compared with the thumb nail/second-fifth toe nail group (x2 =13.437,P ＜ 0.05)and hallux nail group (x2 =10.595,P＜ 0.05),while no statistical difference was observed in clinical response rate between the hallux nail group and thumb nail/second-fifth toe nail group (x2 =3.030,P＞ 0.05),or in mycological response rate or recurrence/reinfection rate among the second-fifth finger nail group,thumb nail/second-fifth toe nail group and hallux nail group.There was no obvious adverse reaction but pain during the treatment.Conclusions Long pulsed Nd:YAG laser appears to be an effective and safe approach to the treatment of onychomycosis,and the treatment outcome is affected by clinical types,location,and causative fungal species of onychomycosis.

Objective To investigate the clinical application of statins for secondary prevention and its efficacy in patients with ischemic stroke.Methods A total of 300 patients with ischemic stroke were divided into statins group (n=91) and control group (n=209) according to whether statins was received or not.Serum lipid parameters,liver and kidney function,carotid artery intimamedia thickness (IMT) and plaque area were compared between the two groups.Results In 209 patients not taking statins,68 cases (32.5％) were not advised by clinic doctor; 55 cases (27.8％)were reluctant to take statins in fear of adverse reactions; 77 cases (36.8％) discontinued stains when serum lipids were normal; 3 cases (1.4％) developed skin allergic reaction and the skin rash that disappeared after stains discontinuance; 3 cases (1.4％) had elevated liver enzyme levels and the enzyme levels were declined to normal after stains discontinuance.The levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were significantly lower in statin group than in control group [(4.93±0.45) mmol/L vs.(5.87±0.38) mmol/L,(1.68±0.61)mmol/L vs.(2.01±0.58) mmol/L,(2.49±0.57) mmol/L vs.(3.76±0.44) mmol/L,t=18.60,4.46,20.94,P=0.000,0.007,0.000,respectively].High density lipoprotein (HDL-C) level was significantly higher in stain group than in control group [(1.36±0.31) mmol/L vs.(1.03±0.25)mmol/L,t=9.75,P=0.001].There were no significant differences in liver and kidney function parameters such as alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,serum total bilirubin,direct bilirubin,indirect bilirubin,glutamyl transferase,blood urea nitrogen and serum creatinine between the two groups (all P＞0.05).The carotid IMT and carotid atherosclerotic plaque area were significantly lower in stain group than in control group [(1.62 ± 0.23) mm vs.(1.74±0.31) mm,(0.57±0.12) cm2 vs.(0.65±0.18) cm2,t=3.32,3.88,P=0.008,0.002,respectively].Conclusions Most patients with ischemic stroke are still not taking statin for secondary prevention.Statins can improve the blood lipid levels and carotid arteriosclerosis status,and no obvious adverse reactions are observed.