Objective To investigate the effects of edaravone dextran combined with argatroban on neurological function,blood rheology and posterior circulation hemodynamics in patients with acute cerebral infarction in the posterior circulation.Methods One hundred and fifty-six patients with acute cerebral infarction in the posterior circulation were collected and randomly divided into the conventional treatment group,edaravone dextranol treatment group(EDD treatment group)and edaravone dextranol combined with argatroban treatment group(combined treatment group),with 52 cases in each group.The general data of patients in the three groups were collected,and the changes of NIHSS score and Barthel index,blood rheology and posterior circulation hemodynamics were evaluated before and after treatment in the three groups.Results After treatment,NIHSS scores and Barthel index were significantly lower in all three groups than before treatment(all P＜0.01).The NIHSS score and Barthel index of the combined treatment group were significantly lower than those of the EDD treatment group and the conventional treatment group after treatment(all P＜0.05).The difference in total effective rate among the three groups was statistically significant(P＜0.05),and the total effective rate among in combined treatment group was significantly better than those in the EDD treatment group and the conventional treatment group(all P＜0.05).The platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity in the three groups after treatment were significantly lower than those before treatment(all P＜0.01).After treatment,the platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity of combined treatment group were lower than those of EDD treatment group and conventional treatment group(all P＜0.05).Peak systolic blood flow velocity(Vs)of basilar artery,vertebral artery and posterior cerebral artery in the three groups after treatment were significantly higher than those before treatment(all P＜0.01),and resistance index(RI)was significantly lower than that before treatment(all P＜0.01).The Vs of basilar,vertebral and posterior cerebral arteries in the combined treatment group were significantly higher than those in the conventional treatment group and the EDD treatment group(all P＜0.05),and the RI was significantly lower than that in the EDD treatment group and the conventional treatment group(all P＜0.05).There was no significant difference in the comparison of adverse reactions among the three groups(all P＞0.05).Conclusion Edaravone dextranol combined with argatroban can exert a good protective effect on neurological function in patients with acute cerebral infarction in the posterior circulation by improving blood rheology and posterior circulation hemodynamics.

Cardiovascular disease is a leading cause of death among the elderly and the incidence of coronary artery disease progressively increases with advancing age.Traditional risk factors are incompletely predictive of cardiovascular disease development.With the advent of high-throughput next-generation genome sequencing technologies in recent years, some studies have indicated that aging is associated with an increased frequency of somatic mutations of hematological neoplasm-related genes in the hematopoietic system, providing a competitive growth advantage for mutant hematopoietic cells and thus allowing for their clonal expansion, a phenomenon known as clonal hematopoiesis of indeterminate potential(CHIP). CHIP is common in middle-aged and elderly populations and is associated with increased risks of hematological cancer and all-cause death.There is growing evidence that CHIP is involved in the development and progression of multiple cardiovascular disorders through the activation of inflammatory responses.In this review, we will give an overview of current advances in the understanding of clonal hematopoiesis in cardiovascular disease.

【Objective】 To assess the effect of reconstruction kernels and window settings on the detection and measurement of pulmonary solid nodules and their measurement variability and repeatability. 【Methods】 We retrospectively recruited 49 patients with pulmonary solid nodules who had undergone low-dose CT scanning. Images were reconstructed using five reconstruction kernels： lung， bone， chest， detail and standard kernels. Two radiologists independently assessed the detection rate， diameter and CT number measurement of nodules under the five kernels and two window settings （lung-window and mediastinal-window）. Bland-Altman plots and relative average deviation （RAD） were used to evaluate the repeatability and variability of nodule diameter and CT number measurement. 【Results】 Seventy-seven nodules were detected on lung-window regardless of reconstruction kernels， while the detection rates （75.3%-98.7%） were significantly different （P<0.001） on the mediastinal-window， with the lung kernel significantly improving the detection of nodules with the diameter below 6 mm. In both display windows， the diameter and CT number measurements among reconstruction kernels were similar except for the lung kernel. The lung-window had better variability in the diameter measurement while mediastinal-window was better in CT number measurement among various reconstruction kernels. Although the variability in the diameter of the nodule on the lung-window and mediastinal-window was similar， there was a significant difference in the variability in the diameter measurement among different reconstruction kernels on the mediastinal-window （P=0.004）. No significant difference in the variability in the CT number measurement was found among the different reconstruction kernels （lung-window P=0.163； mediastinal-window P=0.201）， and the variability in the CT number measurements on the mediastinal-window was smaller than that of the lung-window. Both window displays had acceptable repeatability in diameter and CT number measurement； however， the mediastinal-window was better in CT number measurement. 【Conclusion】 The lung kernel can improve the detection of pulmonary solid nodules below 6 mm， but is limited in the CT number measurement. The lung-window display provides better variability in measuring nodule diameter， while mediastinal-window display is better at measuring CT numbers.

To study the changes of serum miR-128 in patients with first-visit Parkinson’s disease (PD) before and after treatment, and the correlation between serum miR-128 and unified PD rating scale (UPDRS) scores and inflammatory factors in patients with PD. It is helpful to explore the diagnostic value and pathogenesis of miR-128 in PD. Methods Serum miR-128 levels were measured in 54 patients with first-visit PD ( first-visit PD group) before and after treatment, and were compared with 50 cases of healthy controls (healthy control group). The UPDRS scale was evaluated and the serum levels of IL-1β and TNF-α were measured, and the results were analyzed. Results The level of serum miR-128 in first-visit PD group was significantly lower than that in healthy control group (t = 8. 87, P< 0.01 ). After two months of treatment, the level of serum miR-128 in first-visit PD group was significantly higher than that before treatment (t= -5.13, P<0.01), and the UPDRS score was significantly lower than that before treatment (t=9.67, P<0.01). There was a negative correlation between serum miR-128 level and UPDRS score, IL-1β and TNF-α levels in first-visit PD group, respectively ( r= -0.763, r= -0.656, r= -0.674; all P<0.01). The area under the working characteristic curve of serum miR128 was 0.882 (95% CI:0.776-0. 952, P<0.01 ). The sensitivity of diagnosis of PD was 72. 0% , and the specificity was 88. 9%. Conclusion Among the first first-visit PD patients, the level of serum miR-128 is abnormal, and it can be used as a better index of peripheral blood for evaluating the condition and auxiliary diagnosis of PD, which plays an important role in the pathogenesis of depression.

Objective Myocardial bridging is a congenital anomaly.However,little data is available for patients with myocardial bridging (MB) associated with acute myocardial infarction (AMI).The goals of this study are to evaluate characteristics of MB in patients with AMI.Methods From March 1999 to February 2006,137 patients with both MB and AMI,were identified by coronary angiography,including 117 men and 20 women with an average age of 60.77±12.01 years (range 30-83 years) were enrolled in the present study.Results There were 119 patients with MB at the middle segment of left anterior descending artery (LAD),15 patients at distal segment of LAD,2 patients at middle segment of left circumflex (LCX),and 1 at the proximal segment of the obtuse marginal branch (OM) of LCX.There are 36 patients with non-ST elevation acute myocardial infarction (NSTEAMI),38 patients with anterior ST elevation AMI (STEAMI),40 patients with inferior STEAMI and 23 patients with inferior-posterior STEAMI.Risk factors such as hypertension,diabetes,hyperlipidemia and smoking were not different among four groups.Patients with anterior AMI included 8 patients who showed no stenosis at the segment of MB.Conclusion Patients with MB and ST elevation AMI were mainly inferior AMI.MB might be one of the causes of AMI.

Objective: To investigate the safety and efficacy of rotational atherectomy in the interventional treatment of coronary chronic total occlusion lesions. Methods: In this retrospective study,a total of 31 consecutive patients with coronary chronic total occlusion(CTO) lesions underwent rotational atherectomy in our hospital from February 2004 to December 2016 were enrolled,and the clinical features were analyzed. Coronary atherectomy was performed if balloon failed to cross the CTO lesions or balloon could not be fully dilated in the CTO lesions after wire crossing. The definition of procedure success was defined as residual stenosis less than 20% after implantation of drug eluting stent and rotational atherectomy. After the procedure, the patients were followed up to observe major adverse cardiac and cerebral vascular events which including cardiogenic death, myocardial infarction, cerebrovascular accident, and target lesion revascularization. Results: The 1.25 mm diameter burr was firstly selected in 80.6% (25/31) patients,and 96.8%(30/31) patients used only 1 burr to complete the rotational atherectomy procedure. The complication rate was 9.8% (3/31) including 1 patient with coronary dissection and 3 patients with slow flow or no flow. There was 1 patent with both coronary dissection and slow flow. The procedure success rate was 96.8%(30/31). Interventional treatment related myocardial infarction occurred in 3 patients during hospitalization.The 30 patients with procedure success were followed up 36(11, 96) months. The incidence rate of major adverse cardiac and cerebral vascular events was 13.3% (4/30), of which the cardiogenic death rate was 3.3% (1/30), the myocardial infarction rate was 6.7% (2/30), cerebrovascular accident rate was 3.3%(1/30),and the target lesion revascularization rate was 6.7% (2/30). Conclusion Rotational atherectomy is safe and effective in the interventional treatment of coronary CTO lesions.

Objective To observe the efficacy of antithrombotic treatment of acute ST-segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden,and its effect on elective percutaneous coronary intervention.Methods Eight acute ST-segment elevation myocardial infarction patients were enrolled,who suffered from failure of primary percutaneous coronary intervention because of high thrombus burden.Summarize the antithrombotic strategies in perioperative and postoperative period,the operative strategies and the follow-up coronary intervention were recorded and reviewed.Results All the patients were male and most of them had acute inferior myocardial infarction with right coronary occluded because of high thrombus burden.Four patients received thrombus aspiration and balloon dilation.One patient received thrombus aspiration and the other three patients did not receive coronary intervention.Tirofiban were given in perioperative period to all the patients.Low molecular weight heparin was given to 6 patients.Dual antiplatelet therapy was given to 6 patients (aspirin 100 mg/day plus clopidogrel 75 mg/day) and 1 patient required up-titration of aspirin to 200 mg/day.Coronary angiography were repeated (29.00 ± 23.25) days later,and the thrombus in the culprit vessels disappeared in two patients,and coronary stent implantation was performed in three patients.Conclusions The routine antithrombotic strategies play limited roles in thrombus clearance in acute ST segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden.The time for the thrombus to be totally organized and the timing of elective percutaneous coronary intervention are still uncertain and need to be further studied.

Objective:The goal of this study was to analyze the clinical significance of relationship between myocardial collateral and the levels of hypoxia‐inducible factor 1‐alpha (HIF‐1α) and vascular endothelial growth factor A (VEGF‐A) in patients with coronary chronic total occlusion lesion .Methods:89 patients with coronary chronic total occlusion lesion confirmed by clin‐ical data and coronary angiography were identified .The levels of HIF‐1αand VEGF‐A were measured by ELISA ,and the rela‐tive expression of VEGF‐A of peripheral blood mononuclear cell (PBMC) were measured by real‐time PCR .The results were statistically analyzed by the statistical programme for social sciences (SPSS version 18 .0) and software SAS JMP 9 .0 .Results:Compared to Rentrop 0‐1 grade group (18/38 ,47 .4% ) ,Rentrop 2 (11/31 ,35 .5% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer diabetes mellitus .Rentrop 2 [(6 .67 ± 1 .41) mmol/L] and Rentrop 3 [(5 .48 ± 1 .26) mmol/L] grade group had low‐er fasting blood glucose than Rentrop 0‐1 grade group [(7 .24 ± 1 .39) mmol/L] .Rentrop 2 (12/31 ,38 .7% ) and Rentrop 3 (3/20 ,15 .0% ) grade group had fewer clinical heart failure (NYHA Ⅱ ~ Ⅳ grade) than Rentrop 0‐1 grade group (20/38 , 52 .6% ) .Rentrop 2 [(85 .5 ± 27 .7) pg/mL ,(139 .5 ± 42 .1) pg/mL] and Rentrop 3 [(103 .3 ± 30 .2) pg/mL ,(162 .6 ± 43 .3) pg/mL] grade group had higher levels of HIF‐1αand VEGF‐A than Rentrop 0‐1 grade group [(42 .0 ± 16 .1) pg/mL ,(76 .5 ± 32 .2) pg/mL] .Rentrop 2 (1 .31 ± 0 .46) and Rentrop 3 (1 .38 ± 0 .44) grade group had higher level of relative expression of VEGF‐A in PBMC than Rentrop 0‐1 grade group (1 .00 ± 0 .28) .Conclusions:Chronic and consistent ischemia and hypoxia in‐duced the increase of expression of HIF‐1αand VEGF‐A is important for establishment of coronary collateral ,increasing blood supply and improving the heart function and prognosis .

Objective:To analyze the clinical characteristics of patients with immediate severe coronary artery spasm(CAS) af‐ter stent implantation .Methods:The clinical data of 6918 patients who received percutaneous coronary intervention(PCI) from Jan 2012 to Dec 2013 in Zhongshan Hospital ,Fudan University were retrospectively analyzed .And 102 patients with immediate severe CAS after stent implantation were identified and 204 age‐and gender‐matched patients without immediate severe CAS af‐ter stent implantation were selected as control subjects .The general information ,blood indexes ,number and length of stents in the two groups were compared .Results:Compared with the control group ,the ratios of males ,smoking and dyslipidemia were higher in CAS group (P<0 .05) .Patients with CAS had higher neutrophil count and higher level of high sensitive C‐reactive protein(P<0 .05) and received more and longer stents implantation than the control group(P<0 .05 or 0 .01) .Conclusions:Male patients and patients with history of smoking are prone to have immediate severe CAS after stent implantation .Moreover , patients with more and longer stents implantation are prone to have immediate severe CAS .Inflammation may play an important role in the development of CAS after stent implantation .

Objective The aim of this study was to evaluate the safety and efficacy of 135 cm Corsair microcatheter inpercutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) with antegrade approach via radial artery. Methods From June 2010 to February 2014, a total of 81 patients with CTO lesions treated with 135cm Corsair microcatheter (Asahi Intec Co, Japan) and transradial antegrade approach was enrolled in this study. The success rate of CTO-PCI, the rate of Corsair microcatheter crossing the CTO lesions and the number of balloon catheters utilization were retrospectively analyzed. Unique complications related to the Corsair microcatheter were also documented. Results Success recanalization of CTO were achieved in 73 (90.1%) patients. Crossing the CTO body with Corsair microcatheter was found in 56(84.8%) patients. The number of balloon utilized after Corsair microcatheter crossing the CTO was much lower than that of patients who Corsair microcatheter failed to cross (1.3±0.6 per patient versus 2.8±1.2per patient, P < 0.05). The success recanalization rate of combined using Fielder XT guidewire with Corsair microcatheter was 51.5%. There was no complications related to Corsair microcatheter during the index procedure, no major adverse cardiac events during in-hospital clinical follow-up. Conclusions Corsair microcatheter was safe and effective in the recanalization for CTO with transradialantegrade approach. It can simplify the CTO-PCI procedure and reduce the number of balloon catheters.