It was estimated that about 428 species of genus Corydalis are distributed all worldwide, with about 298, especially 10 groups and 219 species being uniquely spread in China. The genus Corydalis have been widely employed as folk medicines in China, especially as traditional Tibetan medicines, for treatment of fever, hepatitis, edema, gastritis, cholecystitis, hypertension and other diseases. The phytochemical studies revealed that isoquinoline alkaloids are its major bioactive ingredients. The extensive biological researches suggested its pharmacological activities and clinic applications against cardiovascular diseases and central nervous system, antibacterial activities, analgesic effects, anti-inflammatory, anti-oxidation and anti-injury for hepatocyte, and so on. As an effort in promoting the research of pharmacodynamic ingredients, this article presents an overview focusing on the distribution, phytochemical and pharmacological results of Corydalis species that have been applied in traditional Tibetan medicinal, hopefully to provide a reference for the new Tibetan medicine development from Corydalis plant resource.
Alkaloids ; chemistry ; pharmacology ; Animals ; Anti-Infective Agents ; chemistry ; pharmacology ; Corydalis ; chemistry ; classification ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Humans ; Mice ; Molecular Structure ; Phytotherapy

OBJECTIVEThe infarct-related artery (IRA) could not always be identified by electrocardiogram (ECG). In the present study, we attempted to explore the reason for failed IRA identification by ECG based on the comparison between ECG records and coronary angiographic findings.

METHODSAll 18-lead ECG records were compared with respective angiographic findings in 1024 consecutive patients with ST elevation myocardial infarction (STEMI) between October 2004 and July 2009. More than two continuous 18-lead ECG records were performed within 12 hours of the symptom onset in all patients. Patients with previous myocardial infarction, coronary artery bypass surgery, pacemaker implantation or ECG evidence of left bundle branch block and angiography was performed more than 12 hours time from symptom onset were excluded.

RESULTSOf all 1024 patients enrolled, the IRA were correctly identified in 854 cases and identified wrong in 96 cases and could not be identified in 74 cases by ECG. Of the failed identification in these 170 cases, IRA was left circumflex coronary artery in 76 (44.7%)cases, right coronary artery in 66 (38.8%) cases, left anterior descending branch in 20 (11.8%) cases, ramus medianus branch in 7 (4.1%) cases, and left main in 1(0.6%) case. Double-vessel and triple-vessel diseases were recorded in 27(15.9%) patients and 47(27.6%) patients respectively. Early repolarization syndrome occurred in 8 (4.7%) patients, and dextrocardia in 1 patient (0.6%). Angiographic study showed acute occlusion of a small branch in 6 (3.5%) patients.

CONCLUSIONCoronary collateral vessel can mislead judgments of the IRA by ECG. When the IRA can not be determined by ECG, left circumflex coronary artery is most likely to be the culprit vessel. Occasionally, early repolarization syndrome and anatomic variation of the coronary artery or heart and a small branch occlusion could be causes of misjudgments of IRA by ECG.

Adult ; Aged ; Coronary Angiography ; Diagnostic Errors ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis

BACKGROUNDCurrent knowledge about clinical and genetic risk factors for aspirin-induced gastric mucosal injury is not sufficient to prevent these gastric mucosal lesions.

METHODSWe recruited aspirin takers as the exposed group and healthy volunteers as the control group. The exposed group was categorized into two subgroups such as subgroup A as gastric mucosal injury diagnosed by gastroscopy, including erosion, ulcer or bleeding of the esophagus, stomach, or duodenum; subgroup B as no injury of the gastric mucosa was detected by gastroscopy. Clinical information was collected, and 53 single nucleotide polymorphisms were evaluated.

RESULTSAmong 385 participants, 234 were in the aspirin-exposed group. According to gastroscopy, 82 belonged to subgroup A, 91 belonged to subgroup B, and gastroscopic results of 61 participants were not available. Using the Chi-square test and logistic regression, we found that peptic ulcer history (odds ratio [OR] = 5.924, 95% confidence intervals [CI]: 2.115-16.592), dual anti-platelet medication (OR = 3.443, 95% CI: 1.154-10.271), current Helicobacter pylori infection (OR = 2.242, 95% CI: 1.032-4.870), male gender (OR = 2.211, 95% CI: 1.027-4.760), GG genotype of rs2243086 (OR = 4.516, 95% CI: 1.180-17.278), and AA genotype of rs1330344 (OR = 2.178, 95% CI: 1.016-4.669) were more frequent in subgroup A than subgroup B. In aspirin users who suffered from upper gastrointestinal bleeding, the frequency of the TT genotype of rs2238631 and TT genotype of rs2243100 was higher than in those without upper gastrointestinal bleeding.

CONCLUSIONSPeptic ulcer history, dual anti-platelet medication, H. pylori current infection, and male gender were possible clinical risk factors for aspirin-induced gastric mucosal injury. GG genotype of rs2243086 and AA genotype of rs1330344 were possible genetic risk factors. TT genotype of rs2238631 and TT genotype of rs2243100 may be risk factors for upper gastrointestinal bleeding in aspirin users.

Aged ; Aspirin ; adverse effects ; Female ; Gastric Mucosa ; drug effects ; injuries ; Genotype ; Helicobacter Infections ; physiopathology ; Humans ; Male ; Middle Aged ; Peptic Ulcer ; physiopathology ; Platelet Aggregation Inhibitors ; adverse effects ; Polymorphism, Single Nucleotide ; genetics ; Risk Factors

OBJECTIVETo investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.

METHODSIn this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 µg tirofiban administration, with subsequent 12-hour intravenous infusion of 0.1 µg×kg(-1)×min(-1) after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspiration group). The primary end points included thrombolysis in myocardial infarction (TIMI) flow immediately after angioplasty, complete ST-segment elevation resolution (> 70%) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events (MACE: cardiac death, target vessel revascularization, re-infarction) at 9 months and any bleeding events.

RESULTSBaseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87.04%, P = 0.011) and the complete ST-segment resolution rate (66.67% vs. 50.91%, χ(2) = 6.129, P = 0.047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126.1 U/L, P = 0.034) and TnI (42.7 ng/ml vs. 72.5 ng/ml, P = 0.029) were significantly lower in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiration + tirofiban the group (45.7% ± 10.8%, 42.9% ± 9.9%, t = 1.99, P = 0.049). There was a tendency to decreased MACE rate at 9-month follow-up, which favored thrombus aspiration + tirofiban the group (logrank χ(2) = 2.865, P = 0.09). Bleeding events were similar between the two groups.

CONCLUSIONThrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Thrombosis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Retrospective Studies ; Tyrosine ; adverse effects ; analogs & derivatives ; therapeutic use

OBJECTIVETo determine whether early catheterization laboratory activation would reduce median door-to-balloon time in patients with ST elevation myocardial infarction (STEMI).

METHODSConsecutive patients with STEMI underwent primary percutaneous coronary intervention (PCI) from January 2006 to December 2008 in Beijing Anzhen Hospital were analyzed. Patients were divided into three groups. Group A included patients without prehospital ECG (n = 168), group B included patients with prehospital ECG (n = 224) and group C included patients with prehospital ECG and early telephonic notification to activate catheterization laboratory (n = 114). Primary end point was door-to-balloon time, secondary end points included peak Troponin I elevation, left ventricular ejection fraction, length of hospital stay, hospital mortality and 30 days follow-up mortality.

RESULTSBaseline characteristics were similar among groups. Door-to-balloon time and door-to-catheter laboratory time (110 minutes, 94 minutes and 85 minutes, respectively, all P < 0.01; 91 minutes, 74 minutes and 64 minutes, respectively, all P < 0.01) were significantly shorter in group B and C than those in group A. The percentage of patients with door-to-balloon time less than 90 minutes increased significantly from 32% in group A to 43% in group B and 59% in group C (P < 0.01).

CONCLUSIONEarly activation of catheterization laboratory by prehospital ECG and telephonic notification could markedly reduce door-to-balloon time in patients with STEMI.

Aged ; Angioplasty, Balloon, Coronary ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; physiopathology ; therapy ; Time Factors

OBJECTIVETo study the three-dimensional (3D) reconstruction and the visualization simulation surgery of spleen based on the scanning data of 64-slice helical computed tomograph (CT).

METHODSThe original data of 64-slice helical CT of spleen was collected, and then the CT image sequences were segmented and automatically extracted using auto-adapted region growth algorithm, and were conducted with the segmented images by adopt self-developed image processing software for 3D reconstruction. Finally, the 3D models were imported into FreeForm Modeling System for modifying and smooth. And the visualization simulation surgery was performed before splenectomy.

RESULTSIt was fast and effective to utilize auto-adapted region growth algorithm to conduct spleen image program segmentation; the reconstructed models were seen clearly and could reappear the structure of the spleen and the important surrounding organs. The effect of the splenectomy simulation surgery was similar to the practical surgery.

CONCLUSIONSThe research on 3D models of spleen and visualization simulation surgery of splenectomy could lead to clinical benefits. It maybe improve the surgical effect and decrease the surgical risk and reduce the complication demonstrating visualized operation before surgery.

Adult ; Computer Simulation ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Models, Anatomic ; Spleen ; diagnostic imaging ; Splenectomy ; Tomography, Spiral Computed

BACKGROUNDA growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.

METHODSFrom September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).

RESULTSBaseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P = 0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P = 0.74). Aspirated thrombi were categorized as small thrombi (< 3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (> 7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P = 0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P = 0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.

CONCLUSIONSBoth Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.

Coronary Angiography ; Echocardiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; pathology ; surgery ; Thrombectomy ; instrumentation ; methods ; Treatment Outcome

OBJECTIVETo assess the feasibility of visual-reality technique for simulating surgical resection of pancreatic tail carcinoma using a 3-dimensional pancreas model reconstructed on the basis of the CT data.

METHODSThe original image data of 64-slice spiral CT was obtained from a patient with pancreatic tail carcinoma. Using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted for 3-dimensional reconstruction of the pancreas and the anatomically related structures with a self-designed program. The model was then processed with Freeform Modeling System for image modification and smoothing. With the assistance of GHST SDK and PHANTOM software systems, preoperative simulation of surgical resection of the carcinoma was performed on the basis of the established pancreatic model.

RESULTSThe reconstructed 3-dimensional pancreatic model with the related structures clearly visualized the 3-dimensional structures of the pancreas, the pancreatic tail compromised by the carcinoma, and the adjacent organs, displaying also the distribution, courses and the anatomical relations of the ductal systems including the main pancreatic duct, abdominal aorta, portal vein system, and the biliary tract. During simulated surgery for pancreatic tail carcinoma resection, the GHOST SDK system allowed effective application of the virtual surgical instruments, and the use of PHANTOM software produced a surgical experience with high resemblance of that from an actual operation.

CONCLUSIONThe serial CT data-based reconstruction of 3-dimensional pancreas model and simulated operation on this model using virtual-reality technique has great potentials for application in individualized surgical planning and surgical risk assessment in cases of pancreatic tail carcinoma, and also facilitates clinical training of the surgeons.

Computer Simulation ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Models, Biological ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; User-Computer Interface

OBJECTIVETo study the two-dimensional (2D) image segmentation, three-dimensional (3D) reconstruction and virtual surgery of cholecystectomy based on the 2D image data of the liver, biliary track and cholecystolithiasis obtained by 64-slice spiral CT.

METHODSThe image data of the liver, biliary track and cholecystolithiasis were obtained by 64-slice spiral CT scanning. Segmentation and automatic extraction of the images were performed using auto-adapting region growing algorithm. 3D reconstruction of the segmented data was carried out using MIMICS10.0 and self-designed software, and the data of the 3D model of the liver with the billiary tract were imported into FreeForm Modeling System for registration and smoothing. Virtual surgery of cholecystotomy for calculus removal and cholecystectomy were performed with Phantom.

RESULTSThe auto-adapting region growing algorithm allowed rapid image segmentation, and the 3D model of the liver based on the segmentation data clearly displayed vivid 3D structures of the liver. Virtual operations of cholecystectomy could be performed in the FreeForm Modeling System.

CONCLUSIONThe algorithm we proposed can correctly and rapidly complete image segmentation and 3D reconstruction of cholecystolithiasis from the data 64-slice spiral CT, and allows virtual operations on the gallbladder.

Cholecystectomy ; Cholecystolithiasis ; diagnostic imaging ; surgery ; Cholecystostomy ; Computer Simulation ; Computer-Assisted Instruction ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Surgery, Computer-Assisted ; methods ; Tomography, Spiral Computed ; User-Computer Interface

OBJECTIVEIn this randomized prospective single-center study, we compared the efficacy of adjunctive thrombectomy using Diver CE device (Linvatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) in patients with <12 h acute inferior myocardial infarction (AIMI) and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 to 1. The primary end point was the magnitude of ST-segment resolution after PCI.

METHODSA total of 122 patients (61 in Diver CE group and 61 in Guardwire Plus group) were studied. The magnitude of ST-segment resolution, myocardial blush grade and slow flow or no re-flow 1 h after PCI were measured in study patients.

RESULTSBaseline characteristics were similar between groups: age (59.6 +/- 14 years vs. 60.1 +/- 13 years), males (82% vs. 84%), diabetes (31% vs. 28%), previous coronary artery disease (25% vs. 23%), onset-to-angiogram (350 +/- 185 min vs. 345 +/- 180 min), and glycoprotein IIb/IIIa inhibitor use (11% vs. 13%, all P > 0.05). The magnitude of ST-segment resolution was also similar in these two groups: ST-segment resolution > 70% (57% vs. 59%, P > 0.05). Slow flow/no reflow rate (8% vs. 7%), TIMI flow grade 3 (95% vs. 97%) and myocardial blush grade 3 (70% vs. 72%) post PCI were not different in the groups (all P > 0.05). Left ventricle ejection fraction (0.54 +/- 0.12 vs. 0.53 +/- 0.11), death (3% vs. 3%), re-myocardial infarction (2% vs. 0) and target vessel revascularization (2% vs. 2%) at one month post PCI were comparable (all P > 0.05).

CONCLUSIONEfficacy of removing thrombus burden with Diver CE device or Guardwire Plus device was similar in patients with < 12 h acute inferior myocardial infarction.

Aged ; Angioplasty, Balloon, Coronary ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies ; Stents ; Thrombectomy ; instrumentation