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.

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.

The effect of the selective debridement with the aid of the arthroscope performed under local anesthesia for osfeoarthritis of 296 knees in 260 patients was studied. The pathological changes of osteoarthritis under the arthroscopy include hyperplasia of synovial membrane, degeneration of cartilage or exposure of subchondral bone on the stress areas of the femur condyles and patella , wear and tear of meniscus, formation of osteophyte and loose body. The debridement included the removal of the loose body, hyperplasia of synovial membrane, degenerated cartilage, and the torn meniscus. Many factors,including age of the patients, selection of the indication, stress of the knee joint, and the degeneration of cartilage,may influence the curative effect. After selecfive debridement and lavage for osteoarthritis of the knee joint, the majority of patients were released from pain, with restoration of function and range of motion, and the development of pathological process was retarded. Good and excellent results constitute 74.7% of the patients.

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

As the indexes of reflecting whole blood coagulation and fibrinolytic capacity, thrombelas-tography are being increasingly used in the fields of guiding intraoperative blood transfusion, hypercoagulable state monitoring and correction, treatment of trauma patients, and clotting mechanism research. This article reviews the clinical application value and limitation of thrombelastography in patients with ischemic cerebrovascular disease.

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.

Objective To investigate the significance of three electrocardiographic indexes in predicting the myocardial infarct related artery (IRA) in inferior wall of acute myocardial infarction (IAMI) Methods One hundred and twenty patients with IAMI were studied Results (1) IRA was related to right coronary artery (RCA) in 98 (81 7%) case, left circumflex branch (LCX) in 22 (18 3%) cases (2) ST segment depression in lead Ⅰ identified RCA occlusion with a sensitivity of 77 6%, specificity of 90 9% in patient with IAMI, but isoelectric or elevated ST segment in lead Ⅰ identified LCX occlusion with a sensitivity of 90 9%, specificity of 77 6% (3) About QRS wave of lead aVL, S/R≥1/3 identified RCA occlusion with a higher sensitivity of 93 9% and a lower specificity of 63 6% (4) When IRA was RCA, ST segment elevated amplitude Ⅲ≥Ⅱ identified as a diagnostic index no matter the location of occlusion Conclusion Three electrocardiographic indexes have significant value in predicting the infarct related artery in inferior wall acute myocardial infarction

Objective To compare the effect of different dosage of verapamil and a cocktail therapy(verapamil 200 ?g plus nitroglycerin 200 ?g) in the prevention of radial artery spasm(RAS) during transradial PCI.Methods It is a prospective,randomized and double-blind clinical trial.Patients who received transradial coronary intervention were divided into three groups: group A(verapamil 200 ?g),group B(verapamil 1mg) and group C(verapamil 200 ?g plus nitroglycerin 200 ?g).Different drug protocols were given randomly to the patients after sheath insertion.The diagnostic criteria is clinical definition of RAS documented by angiography.The incidence of RAS and adverse effects in each group was compared.Results A total of 621 patients were enrolled,and there were 205 in group A,207 in group B and 210 in group C.The baseline characteristics were of no difference among the three groups.Univariate analysis showed that the incidence of RAS in group A is higher than that in group B(17.1% vs.10.2%,P=0.045) and in group C(17.1% vs.9.5%,P=0.029),but there was no statistical difference in the RAS incidence between group B and C(10.2% vs.9.5%,P=0.870).Binary logistic regression analysis showed that the relative risk of RAS in group B decreased by 32.1% compared with group A(P=0.038),and the relative risk in group C decreased by 43.8% compared with group A(P=0.017).The incidences of adverse effect were similar in groups A and C,but was higher in group B when compared with group A(9.7% vs.2.4%,P=0.003) and C(9.7% vs.3.8%,P=0.019),respectively.Conclusion Verapamil 200 ?g plus nitroglycerin 200 ?g is recommended to prevent RAS during transradial coronary intervention in Chinese.