Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective To evaluate the efficacy and safety of intravascular lithotripsy(IVL)in the treatment of coronary artery calcification in patients with acute coronary syndrome(ACS)and chronic coronary syndrome(CCS).Methods In a retrospective study,patients with coronary artery calcified lesions who underwent IVL treatment at the Department of Cardiology,Second Affiliated Hospital of Xi'an Jiaotong University between February 2023 and June 2024 were enrolled.Among them,22 patients in ACS group and 25 patients in CCS group.The differences in baseline data,complication,clinical success rate and major cardiovascular adverse events(MACE)in patients followed one month after the procedure were compared between the two groups.Results In the ACS group,21 stent implantations were successful(95.5％success rate),while in the CCS group,25 cases were successful(100.0％success rate),showing no statistically significant difference between the two groups(P=0.468).There was one case of intraoperative IVL balloon rupture in the ACS group(1/22;4.5％),while in the CCS group,three cases were observed(3/25;12.0％).Additionally,one case in the ACS group(1/22;4.5％)with slow blood flow after IVL calcification modification.No instances of IVL-related vessel dissection or target vessel rupture occurred between the two groups,and there was no statistically significant difference in intraoperative complications(all P＞0.05).There was no significant difference in the MACE(9.1％vs.4.0％,P=0.593)between the two groups for follow up of one month.Conclusions The technique of IVL is a safe and effective treatment option for patients with ACS or CCS who have coronary artery calcification lesions.

Objective To evaluate the efficacy and safety of intravascular lithotripsy(IVL)in the treatment of coronary artery calcification in patients with acute coronary syndrome(ACS)and chronic coronary syndrome(CCS).Methods In a retrospective study,patients with coronary artery calcified lesions who underwent IVL treatment at the Department of Cardiology,Second Affiliated Hospital of Xi'an Jiaotong University between February 2023 and June 2024 were enrolled.Among them,22 patients in ACS group and 25 patients in CCS group.The differences in baseline data,complication,clinical success rate and major cardiovascular adverse events(MACE)in patients followed one month after the procedure were compared between the two groups.Results In the ACS group,21 stent implantations were successful(95.5％success rate),while in the CCS group,25 cases were successful(100.0％success rate),showing no statistically significant difference between the two groups(P=0.468).There was one case of intraoperative IVL balloon rupture in the ACS group(1/22;4.5％),while in the CCS group,three cases were observed(3/25;12.0％).Additionally,one case in the ACS group(1/22;4.5％)with slow blood flow after IVL calcification modification.No instances of IVL-related vessel dissection or target vessel rupture occurred between the two groups,and there was no statistically significant difference in intraoperative complications(all P＞0.05).There was no significant difference in the MACE(9.1％vs.4.0％,P=0.593)between the two groups for follow up of one month.Conclusions The technique of IVL is a safe and effective treatment option for patients with ACS or CCS who have coronary artery calcification lesions.

OBJECTIVETo study clinical effects of double plates fixation for the treatment of acromion base fracutres.

METHODSFrom January 2010 to May 2012, 7 patients with acromion base fractures were treated with double plates ORIF surgical treatment. There were 5 males and 2 females, with an average age of 36.3 years old (ranged, 24 to 62 years old). All fractures were acuted and closed injuries. The duration from injury to surgery was 4.6 days (ranged, 2 to 10 days). Hardegger functional criterion, Visual Analogue Scale (VAS) and complications of the patients were documented analysis.

RESULTSAll the patients were followed up,and the duration ranged from 4 to 13 months (averaged 8.9 months). The healing duration of fractures ranged from 8 to 14 weeks without any infection, shoulder instability, subacromial impingement syndrome, nonunion and failure of internal fixation. At the latest follow-up, the VAS ranged from 0 to 5. According to Hardegger criterion, 2 patients got an excellent result, 4 good and 1 poor.

CONCLUSIONDouble plates ORIF plays a positive role in the treatment of acromion base fractures, which reduces complications and maximally restore the function of shoulder.

Acromion ; injuries ; surgery ; Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Visual Analog Scale

OBJECTIVETo investigate the operative reduction techniques and clinical results of surgical treatment of type C1 (AO/ASIF) acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation.

METHODSFrom August 2004 to January 2012, 13 patients with type C1 (AO/ASIF) acetabular fracture were treated by posteroproximal-posteroanterior sequential reduction and internal fixation. Of them, 8 cases were male and 5 cases were female with an average age of 42 years years old (ranged, 18 to 64). Pelvis 3-dimentional CT reconstruction were used to confirmed the classification of fracture, and the operation were performed during from 5 to 20 days with an average of 9.5 days. Operation time, blood loss, complications and reduction were recorded and evaluated. The function of hip joint were accessed at the final follow-up.

RESULTSThe operation time ranged from 190 to 290 min with an average of 240 min. The mean blood loss was 1 800 ml (ranged, 1 300 to 3 000 ml). One case had superficial infection and healed after 3 weeks. According to Matta reduction criteria, 8 cases obtained anatomical reduction, 4 cases got satisfied results and 1 cases got unsatisfied results. Eleven cases were followed up with an average of (24.0 +/- 8.0) months, and 2 cases were lost to follow-up. According to revised Mede d'Aubingne and Postel evaluation system, 7 cases got excellent results, 2 good, 1 moderate and 1 poor.

CONCLUSIONPosteroproximal-posteroanterior sequential reduction and internal fixation for the treatment of type C1 (AO/ASIF) acetabular fracture can achieve satisfied surgical proces and operation quality.

Acetabulum ; diagnostic imaging ; injuries ; surgery ; Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; Hip Fractures ; diagnostic imaging ; surgery ; Hip Joint ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult

OBJECTIVETo study the relationship between the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene and hereditary susceptibility to non-alcoholic fatty liver disease (NAFLD) by detecting single nucleotide polymorphisms (SNPs).

METHODSPeripheral blood DNA from 315 patients diagnosed with NAFLD (including the spectrum of simple steatosis (SS) and non-alcoholic steatosis (NASH)) and 336 control subjects was used to determine the PNPLA3 genotype by polymerase chain reaction (PCR) and direct sequencing. The relationship of SNPs and NAFLD-related markers of liver function were assessed by correlation analysis.

RESULTSThe SNP rs738409 was identified in more of the NAFLD patients (allele variant frequencies: NAFLD, 65.40%; NASH: 71.87%; SS, 56.47%) than in the controls (33.18%). Case-control analysis revealed that carriers of the 148GG genotype were at 3.81-fold (95% CI: 3.03 ~ 4.79) higher risk of developing NAFLD and at 1.97-fold (95% CI: 1.41 ~ 2.75) higher risk of progressing from SS to NASH, compared with non-carriers. rs738409 was also found to be associated with serum levels of alanine aminotransferase (ALT) and y-glutamyltransferase (y-GT) (both P less than 0.05). Carriers of the 148GG genotype had significantly higher body mass index, ALT, and fasting insulin than carriers of the 148CC genotype (all P less than 0.05), and significantly higher level of serum HDL than carriers of either the 148CC genotype or the 148GC genotype (both P less than 0.05).

CONCLUSIONPolymorphisms in the PNPLA3 gene may play an important role in mediating susceptibility to developing NAFLD in the Chinese population. The rs738409 polymorphism, in particular, is related to development and progression of NAFLD and may play a role in the contribution of PNPLA3 to NAFLD pathogenesis.

Adolescent ; Adult ; Aged ; Alleles ; Case-Control Studies ; Fatty Liver ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Lipase ; genetics ; Male ; Membrane Proteins ; genetics ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; Polymorphism, Single Nucleotide ; Young Adult

Animals ; Calcitriol ; pharmacology ; Diabetes Mellitus, Experimental ; complications ; Diabetes Mellitus, Type 2 ; complications ; Liver ; drug effects ; Liver Diseases ; complications ; drug therapy ; Male ; Rats ; Rats, Sprague-Dawley

Objective To explore the diagnostic value of two-dimensional speckle tracking technology in the evaluation of right ventricular systolic function in patients with pulmonary disease .Methods Thirty patients with pulmonary heart disease were divided into two groups:group of compensated pulmonary heart disease(compensated group ) (n =15),group of decompensated pulmonary heart disease (decompensated group)( n =15).30 healthy subjects were enrolled in control group .The displacement of the tricuspid annulus at the midpoint(TADmid),the displacement of the tricuspid annulus at the free wall (TADfre) and the displacement of the tricuspid annulus at the septum (TADsep) were acquired,and simultaneous real-time three-dimensional ultrasound detection of right ventricular ejection fraction (RVEF) were taken.The correlation of TADmid with RVEF and pulmonary artery systolic pressure ( PASP) were analyzed.Results TADmid of the healthy control group,the compensated group and the decompensated group were(17.1 ±3.9)mm, (13.6 ±2.6)mm,and(9.5 ±3.2)mm respectively.TADfre were(21.1 ±3.0)mm,(17.6 ±4.2)mm,and (11.5 ±3.8) mm respectively.TADsep were(12.0 ±2.5) mm,(9.7 ±3.3) mm,and(7.4 ±2.7) mm respectively.RVEF were(56.3 ±8.2)%,(39.6 ±6.4)%,and(28.1 ±5.9)% respectively.PASP were (20.6 ±2.6) mm Hg (1 mm Hg =0.133 kPa), (63.3 ±5.6) mm Hg, and (82.5 ±11.2)mm Hg respectively.There were significant differences of TADmid , RVEF, and PASP among the 3 groups ( F =8.581,7.816,9.300,6.507,10.235, all P <0.05).TADfre, TADmid, TADsep and RVEF were all decreased in the compensated group comparing to the healthy control group ,while PASP was increased.The decrease of TADmid was the most significant ,while that of TADfre was the slightest .There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups(t=2.703,2.536,2.379, 2.817,3.026,all P<0.05).TADfre,TADmid,TADsep and RVEF of decompensated group reduced more significantly than the compensated group , while PASP was increased significantly .There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups(t=2.519,2.493,2.236, 2.621,2.985,all P<0.05);TADfre and TADmid were decreased more apparently in decompensated group than that in compensated group ,and so were TADsep and RVEF,while PASP were increased.There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups (t =1.947, 2.680,2.016,2.653,2.893,all P<0.05).There was significant positive correlation between TADmid and RVEF measured by real-time three-dimensional ultrasound (r =0.904,P <0.01 ).There was significant negative correlation between TADmid and PASP (r=-0.686,P<0.01).The cut-off point value of TADmid measured by speckle tracking technology for evaluation of RVEF <45% and<30% were 13.65 mm and 9.80 mm,respectively.The sensitivity were 94.4%and 90.0%respectively,and the specificity were 78.6%and 90.0%respectively.Conclusions TADmid is hardly affected by the external factors ,and it can better reflect the changes of right ventricular systolic function for patients with pulmonary heart disease .TADmid is positively correlated with RVEF measured by real-time three-dimensional ultrasound and negatively correlated with PASP.Further more,the correlations is significant.The three parameters can authenticate mutually ,and the combination of them can evaluate the right ventricular systolic function in patients with pulmonary heart disease precisely.

BACKGROUNDRoux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes. The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.

METHODSPatients with type 2 diabetes were randomly divided into two groups: those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass. Blood glucose alterations, operation time, and operation complications were observed.

RESULTSGastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes. Compared with gastrojejunal Roux-en-Y bypass, gastrojejunal loop anastomosis bypass had the advantages of easier implementation, shorter operation time, and fewer operation complications.

CONCLUSIONSGastrojejunal loop anastomosis is effective in treatment of type 2 diabetes. It is safe, easy to implement, and worthy of clinical popularization.

Adult ; Anastomosis, Roux-en-Y ; Blood Glucose ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; surgery ; Female ; Gastric Bypass ; methods ; Humans ; Male ; Middle Aged ; Treatment Outcome