Cardiac biomarkers of sensitive and specific are very important to the early diagnosis of cardiovascular diseases,such as cardiac troponin (high sensitivity),myoglobin,heart-fatty acid-binding protein,ischemia modified albumin,B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide.They also play an important role in risk stratification and prognosis evaluation,but improvement is still needed.Biomarker of high sensitivity and specificity,convenient detection control is still required in clinical application.

During the last fifty-year medical treatments have made great advances in the treatment of heart failure(HF).The current applicatin of treatment improves the life quality of patients with HF,and reduces their clinical envents and mortality.But the patients with refractory heart failure(RHF) have poor prognosis.This article reviews and analyzes the advances in the therapies for patients with RHF.

Objective To investigate the clinical values of dexmedetomidine in general anesthetic for laparo-scopic cholecystectomy.Methods One hundred patients admitted to our center with cholelithes were prospectively studied.According to the principle of completely random digital table,all patients were randomly signed to dexmedeto-midine group or control group.The primary outcomes were hemodynamic changes and postoperative complications. Results There was no significant differences at t0,t1,t2,t3,t4 and t5 in mean arterial pressure (P >0.05).There was no significant difference in heart rate at t0 (P =0.503),however,compared with the control group,patients in the dexmedetomidine group got a significant reduction in t1,t2,t3,t4 and t5 in heart rate(all P <0.05).Compared with the control group,the operation time of the dexmedetomidine group was significantly shorten[(1 18.52 ±15.42)min vs.(127.24 ±19.14)min,t = -5.673,P =0.021 ],the rate of movement of the center of the operation was significantly decreased (36% vs.64%,χ2 =7.840,P <0.001),the incidence rate decreased significantly (0% vs. 10%,χ2 =5.263,P =0.022).There was no difference between the two groups in intra -operative bleeding volume, hypertension,hypotension,tachycardia,postoperative drainage volume,postoperative bleeding,infection and vomiting (all P >0.05 ).Conclusion Dexmedetomidine contributed to maintaining the hemodynamic stable in general anesthetic for laparoscopic cholecystectomy,and reducing the rate of shivering.

Ostial lesions present many challenges for percutaneous coronary intervention (PCI). Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wire technique and focused-force angioplasty.

0.05).However,major vascular complications occurred only in the femoral group(3.9%).Conclusion Transradial LM PCI is as fast and successful as the femoral approach and results in fewer vascular complications.

Objective To evaluate the efficacy and safety of facilitated PCI(low-dose rt-PA combined with percutaneous coronary intervention)in acute myocardial infarction(AMI).Methods One hundred and sixteen patients with AMI were divided into low-dose facilitated PCI group(n=69)and direct PCI group(n=47).69 patients in low-dose facilitated PCI group were treated with an intravenous drip of 50 mg rt-PA and PCI,while 47 patients in direct PCI group were treated with PCI.The rates of recanalization before and after PCI,and the left ventricular ejection fraction(LVEF)and major hemorrhage and major adverse cardiac events(MACE)in hospital were compared in two groups.Results There was no significant difference in the interval from hospitalization to the PCI between low-dose facilitated PCI group and direct PCI group.Compared with direct PCI group,the rates of recanalization and TIMI grade 3 before PCI were significantly higher in low-dose facilitated PCI group(44.7% vs 21.7%,P

Objective We sought to determine the incidence,clinical features,and risk factors for retroperitoneal hematoma(RPH)after percutaneous coronary intervention(PCI).Methods A retrospective analysis yielded 21 cases of RPH out of 3,729 consecutive patients undergoing PCI between January 2000 and September 2005 in Anzhen hospital.Cases were compared with a randomly selected sample of 30 control subjects without RPH.Predictors were studied using univariate and multivariate analysis.Results The incidence of RPH was 0.6%.Anemia(100%)was a most universal feature.Features of RPH included hypotension(95%),diaphoresis(57%),groin pain(48%),abdominal pain(38%)and back pain(38%).The following variables were found to be independent predictors of RPH:female gender(odds ratio OR=5.23,P

Objective To assess the efficacy and safety of two kinds of arterial suture-mediated closure devices (Angioseal and Perclose) in patients after coronary arteriography(CAG) and percutaneous coronary intervention (PCI). Methods 1?020 patients (672 male, 348 female, mean age 57.8?2.4 yr) undergoing CAG or PCI were randomized into either the Angioseal group (CAG 380, PCI 120) or the Perclose group (CAG 392, PCI 128). The procedural success rate and occurance of local complications were compared between the two groups. Results Both kinds of devices had a high success rate (Angioseal 94% vs Perclose 96%) and there was no statistical difference between them. There were five cases of hematoma and no pseudoaneurysm in the Angioseal group. On the other hand, there were four cases of hematoma and three cases of pseudoaneurysm in preclose group. There was no statistal difference in terms of local complications between the 2 groups. Conclusion Both kinds of arterial suture-mediated closure devices (Angioseal and Perclose) are feasible and safe for patients undergoing CAG and PCI.

Objective To evaluate the short-term effect of early treatment with clopidogrel before elective coronary stenting in patients with NSTE-ACS,compared with treatment with clopidogrel at the time of the procedure. Methods Patients with NSTE-ACS undergoing elective coronary stenting were randomly divided into two groups: early treatment group (n=272) and control group (n=265). Patients in the early treatment group were given clopidogrel immediately since hospitalization (300 mg loading dose, then 75 mg once daily); while in the control group, patients were given clopidogrel (300 mg) after coronary angiography followed by 75 mg per day after PCI. The composite endpoints were death, recurrent angina pectoris, instent thrombosis, myocardial infarction and urgent target vessel revascularization within 30 days after coronary stenting. Results Differences in baseline characteristics among patients between the two groups were negligible. There were no significant difference in the target vessel lesions requiring stenting between the 2 groups. Compared with the control group, early administration of clopidogrel showed a lower rate of death, myocardial infarction, refractory ischaemia, instent thrombosis and revascularization within 30 days of PCI. Conclusion Compared with administration of clopidogrel at the time of coronary stenting, pre-treatment with clopidogrel in patients with NSTE-ACS could significantly reduce the odds of adverse cardiovascular event and improve clinical outcomes within 30 days of PCI.

Objective To investigate the character and differentiation diagnosis of coronary artery fistula in aged.Methods Clinical symptom, sign and laboratory examination were analyzed in 8 aged patients with coronary artery fistula. Results Myocardial ischemia is the main manifestation of agedness coronary artery fistula, and should be discriminated with coronary artery disease. Conclusion If myocardial ischemia symptom aggravates with age in patient with long-term angina, coronary angiogram is the most dependable method.