Given that low-dose computed tomography significantly amplifies image noise due to the mitigation of radiation exposure,which degrades image quality and lowers the precision of clinical diagnoses,a novel model incorporating convolutional neural network and Transformer is established,in which an intra-patch feature extraction module is used to effectively preserve tiny details in the image.A double attention Transformer is constructed by incorporating a multiple-input channel attention module into the self-attention for tackling the problem of incorrect restoration of texture details during denoising using Swin Transformer.AAPM dataset is used for testing,and the results demonstrate that the proposed algorithm not only surpasses the existing algorithms in denoising performance,but also excels in preserving tiny details in the image.

Objective:To investigate the different types of renal artery involvement in Stanford type B aortic dissection (TBAD) and the comparison of clinical effecacy after thoracic endovascular aortic repair (TEVAR).Methods:This is a retrospective cohort study included 330 patients with TBAD and renal artery involvement treated with TEVAR from June 2002 to September 2021 in General Hospital of Northern Theater Command of the PLA. According to aortic CTA image, unilateral renal artery involvement conditions were divided into 5 types: the true lumen type (renal artery opening completely from the true lumen), false lumen type (renal artery opening completely from the false lumen), double lumen type (renal artery opening from the true and false double lumen), compression type (renal artery opening connected with the true lumen, but the renal artery opening was extremely squeezed by the inner membrane), open type (renal artery opening with intimal tear). There were seven types of bilateral renal artery involvement: true-true type (true lumen-true lumen type), true and false type (true lumen-false lumen type), true-double type (true lumen-double lumen type), true-opening type (true lumen-opening type), false-false type (false lumen-false lumen type), false-compression type (false lumen-compression type), double-double type (double lumen-double lumen type). The primary observation index of this study was the comparison of postoperative renal function and the incidence of clinical adverse events of different types of renal artery involvement. One-way ANOVA test, Kruskal-Wallis H test and paired sample rank sum test were used to compare postoperative renal function between different types of bilateral renal artery involvement. The Chi-square test or Fisher′s exact probability test were used to compare the near and long term adverse events between different types of bilateral renal artery involvement. Kaplan-Meier method was used to compare the all-cause mortality of patients with severe renal functional injury and non-severe renal functional injury before surgery. Results:The average age of the patients included in this study was (53±11) years, including 276 males (83.6%) and 54 females (16.4%). There were statistical difference in the level of serum creatinine (preoperative: H=18.686, P=0.005, postoperative: H=18.101, P=0.006) and cystatin C (preoperative: H=17.566, P=0.007, postoperative: H=10.433, P=0.016), pre-and post-operative, between the seven groups of TBAD patients with different renal artery involvement types ( P<0.05), and the false-false type group shown the worst kidney function. However, no statistically significant differences were shown when comparing their pre- and post-operative change values ( P>0.05). The 30-day follow-up result showed that there were statistically significant differences in the incidence of postoperative acute kidney injury ( χ2=15.623, P=0.007), aorta-related adverse events ( χ2=15.523, P=0.010), and intraoperative endoleak ( χ2=17.935, P=0.004) among the seven groups, and the false-false group was the highest (2/9, 5/9 and 5/9, respectively). In terms of long-term follow-up results, there were statistically significant differences in all-cause death ( χ2=14.772, P=0.011) and non-aortic death ( χ2=15.589, P=0.008) among the seven groups. Kaplan-Meier survival analysis showed that patients with worse pre-operative renal function showed higher long-term all cause death (17.7% vs. 4.8%, P=0.009). Conclusions:For TBAD patients with renal artery involvement, there were differences in renal function among different types, and TEVAR showed no significant effect on renal function in TBAD patients. The long-term all cause death was higher in patients with worse renal function pre-operative.

Objective: To evaluate the long-term efficacy of a second generation biodegradable polymer sirolimus-eluting stent (EXCEL2) in treating patients with de novo coronary artery diseases. Methods: CREDIT Ⅱ trial was a prospective, multicenter, randomized, controlled study, conducted at 15 Chinese cardiac centres from November 2013 to December 2014. In this analysis, eligible patients for coronary stenting (n=419) were randomized to receive either the EXCEL2 stent (n=208) or the EXCEL stent (n=211). The primary endpoint was target lesion failure (TLF) at 3 years after PCI defined as a composite endpoints of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI-TLR). Secondary endpoints included patient-oriented composite endpoint (PoCE) including all-cause death, all MI, or any revascularization at 3 years and independent components, and stent thrombosis according to Academic Research Consortium′s (ARC) definition. Results: Among 419 enrolled patients, 413 (98.6%) patients completed 3-year clinical follow-up. Compared with the EXCEL group, 3-year TLF (5.4%(11/204) vs. 11.5% (24/209), P=0.025) and PoCE (9.8% (20/204) vs. 20.1% (42/209), P=0.003) were significantly lower in the EXCEL2 group. The cumulative event rate of CI-TLR (2.0% (4/204) vs. 5.7% (12/209), P=0.042) and any revascularization (4.9% (10/204) vs. 14.4% (30/209), P=0.001) were statistically lower in the EXCEL2 group than in the EXCEL group. There were no significant difference between two groups in terms of all-cause death and all MI. Rates of stent thrombosis were low without significant difference between the two groups (EXCEL2 vs. EXCEL, 1.0% (2/204) vs. 2.9% (6/209), P=0.285). Conclusion 3-year clinical follow-up results demonstrate that EXCEL2 stents are effective and safe in treating CAD patients with de novo coronary lesions.

Objective To evaluate the long?term efficacy of a second generation biodegradable polymer sirolimus?eluting stent (EXCEL2) in treating patients with de novo coronary artery diseases. Methods CREDITⅡtrial was a prospective, multicenter, randomized, controlled study, conducted at 15 Chinese cardiac centres from November 2013 to December 2014. In this analysis, eligible patients for coronary stenting (n=419) were randomized to receive either the EXCEL2 stent (n=208) or the EXCEL stent (n=211). The primary endpoint was target lesion failure (TLF) at 3 years after PCI defined as a composite endpoints of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI?TLR). Secondary endpoints included patient?oriented composite endpoint (PoCE) including all?cause death, all MI, or any revascularization at 3 years and independent components, and stent thrombosis according to Academic Research Consortium＇s (ARC) definition. Results Among 419 enrolled patients, 413 (98.6%) patients completed 3?year clinical follow?up. Compared with the EXCEL group, 3?year TLF (5.4%(11/204) vs. 11.5% (24/209), P=0.025) and PoCE (9.8% (20/204) vs. 20.1% (42/209), P=0.003) were significantly lower in the EXCEL2 group. The cumulative event rate of CI?TLR (2.0% (4/204) vs. 5.7% (12/209), P=0.042) and any revascularization (4.9% (10/204) vs. 14.4% (30/209), P=0.001) were statistically lower in the EXCEL2 group than in the EXCEL group. There were no significant difference between two groups in terms of all?cause death and all MI. Rates of stent thrombosis were low without significant difference between the two groups (EXCEL2 vs. EXCEL, 1.0% (2/204) vs. 2.9% (6/209), P=0.285). Conclusion 3?year clinical follow?up results demonstrate that EXCEL2 stents are effective and safe in treating CAD patients with de novo coronary lesions.

Objective To observe the efficacy and prognosis of recombinant human brain natriuretic peptide ( rhBNP) and conventional treatment in acute myocardial infarction patients undergoing percutaneous coronary intervention therapy complicated by acute of left heart failure. Methods Retrospective analysis of 229 cases of hospitalized patients with acute myocardial infarction undergoing percutaneous coronary intervention therapy in 24 hours after admission, complicating with acute left ventricular failure in Shenyang Military General Hospital from June 2012 to January 2014 were enrolled and devided into: the conventional heart failure therapy group (the control group, n=122) and the rhBNP plus conventional treatment group ( the treatment group, n =107 ) , according to the patient's economic conditions and wishes. Observed improvement in heart failure symptoms before and after treatment during hospitalization and follow-up and also the 30 days and 12 months mortality. Results After 72 hrs of treatment of heart failure, both groups had decrease in heart rates, systolic blood pressure and NT-proBNP levels as compared to pre-treatment levels ( all P ﹤ 0. 05 ) . The NT-proBNP levels and heart rate of the treatment group decreased more significantly compared to the control group (both P﹤0. 05). Compared with the control group, rhBNP which to be used 72 hrs, can improve the cardiac function of AMI patients with the ratio of KillipⅡ-Ⅲ(72. 9%vs. 54. 9%, P=0. 005). There was no significant differences between two groups in in-hospital mortality and early follow-up period ( 30 days ) ( P ﹥0. 05 ) . After 12 months of follow-up, the mortality of the treatment group was lower than the control group ( 6. 5% vs. 13. 9%, P = 0. 068 ) . Through logistic regression analysis, the value of NT-proBNP and whether patients were treated with rhBNP on the basis of the routine drug were independent influencing factors for mortality of 12 months. Conclusions Additional to standard conventional therapy for acute left heart failure in patients with acute myocardial infarction undergoing PCI, rhBNP can lower the 12 months mortality and improve prognosis.

Objective To explore the safety and efficacy of policosanol in elder patients with high on-treatment platelet reactivity ( HPR) after drug-eluting stent ( DES) implantation. Methods This study was a prespecified subgroup analysis of the multicenter, randomized SPIRIT trial,in which there were a total of 169 elder patients (≥60 years old) with HPR. Among these patients, 30 patients were in group A ( given clopidogrel 75 mg/d for one year) , 75 patients in group B ( given clopidogrel 150 mg/d for 30 days followed by 75 mg/d until one year ) and 64 patients in group C ( given policosanol 40 mg/d for 6 month and clopidgrel 75 mg/d for one year ) . All patients were treated with aspirin at the same time. The primary endpoint was the reversion rate of HPR at 30 days (reversion was defined as platelet aggregation ﹤65%). The secondary endpoint was 2-year major adverse cardiac events ( MACE ) rate, which included cardiac death, non-fatal myocardial infarction and ischemic symptoms driven target vessel revascularization. The safety endpoint was any bleeding as defined by the Bleeding Academic Research Consortium ( BARC ) definition. Results At 30 days, the reversion rate of HPR in group C was numerically higher as compared with group A ( 42. 9% vs. 23. 3. 0%, P=0. 068 ) , and similar with group B ( 42. 9% vs. 49. 3%, P=0.447). MACE occurred in 4 (13.3%), 5(6.7%) and 3(4.7%) patients in group A, B and C respictively ( P=0. 352). Bleeding events in group A and group C were both markedly lower in comparison to group B (3. 3% vs. 17. 3% vs. 1. 6%, P=0. 001). At the 24-month follow-up, the MACE-free survival rates were not significantly different (95. 3% vs. 93. 3% vs. 86. 7%, P=0. 146). Conclusions For elder patients with HPR, policosanol reduced platelet reactivity to a similar extent in comparison of high maintenance dose of clopidogrel without increasing bleeding risk.

Objective: To evaluate the long-term efifciency of percutaneous transluminal septal myocardial ablation (PTSMA) for treating the patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods: A total of 66/94 (70.2%) HOCM patients received PTSMA in Shenyang PLA general hospital from 2001-10 to 2012-10 were retrospectively studied. The left ventricular out lfow gradient (LVOFG) was measured at before and after the operation, ECG and echocardiography were examined at 1 month, 6 months and 1 year after operation, and then examined once per year for (63.8±28.5) months.
Results: There were 26 patients lost contact during follow-up period, 40 returned to routine clinical check-up and 2 patients died thereafter, 1 because of sudden death and 1 because of cerebral bleeding. The pre-operative average LVOTG was (102.7 ± 47.5) mmHg, compared with the values at 6 months post-operation and long term (>6 months) after operation (33.9 ± 30.2) mmHg and (29.7 ± 25.4) mmHg,P<0.001. The pre-operative average inter ventricular septal (IVS) was (20.1 ± 3.6) mm, compared with the values at 6 months post-operation and long term after operation (17.5 ± 2.9) mm and (16.4 ± 3.6) mm, P=0.028 andP<0.001. There were 7 patients with NYHA class at II-III and having occasional chest suppression and short of breath. There were no heart transplantation, frequent premature ventricular contraction, tachycardia and other malignant arrhythmia occurred in 38 survivors.
Conclusion: PTSMA may reduce LVOTG, IVS thickness and improve the clinical symptoms in HOCM patients, the long-term efifcacy is reliable.

Objective:To establish the post-discharge disease management program for patients with chronic heart failure,and observe the effects of disease management on prognosis.Methods:Totally 207 patients with chronic heart failure,who were ad-mitted to hospital due to acute exacerbation,were enrolled.After discharge these patients were randomly divided into the study group (103 cases)and the control group (104 cases).Disease management program was implemented in the study group,and only routine outpatient follow-up was implemented in the control group.The clinical follow-up results one year after discharge were compared between the two groups.Results:Excluding the patients lost during follow-up,totally 1 88 patients completed the data collection,among which 98 cases were from the study group and 90 cases were from the control group.There was no significant difference regarding the baseline of clinical characteristics between the two groups (P >0.05 ).Follow-up results showed that compared with that in the control group,within the six months after discharged,the readmission rate,the multi-ple readmission rate,and the readmission or death joint events rate in the study group decreased significantly (P <0.05).The percentage of cardiac function NYHA class I to II and the left ventricular ejection fraction in the study group were higher than that in the control group (P <0.05),and the left ventricular end-diastolic diameter was in contrast (P <0.05).The score of Minnesota Living with Heart Failure Questionnaire in the study group was superior to that in the control group (P <0.05 ). Conclusions:The implementation of post-discharge disease management for the patients with chronic heart failure can signifi-cantly reduce the risk of the readmission,the multiple readmission,and the readmission or death joint events within the six months after discharge,and improve the patients’cardiac function and quality of life.

Objective To study the suitable dose of intracoronary adenosine (AD) on fractional flow reserve (FFR) measurement in Chinese patients with angiographic coronary artery disease. Methods FFR was measured in 32 patients with 40 moderate coronary stenosis. Boluses of intracoronary AD at increasing doses of 60μg (A1), 80μg (A2), 100μg (A3) and 120μg (A4) were randomly administered. FFR values, symptoms, systemic effects and development of atrioventricular block were recorded. Results FFR value decreased significantly by 8.99%(A1), 11.24%(A2), 13.48%(A3) and 13.48%(A4) compared with the baseline distal coronary pressure/aortic pressure (0.891±0.044, all P<0.001). A3 and A4 showed significantly lower FFR values than A1 (t=6.331、6.343, all P < 0.001),A2 (t=2.974、3.058, P=0.005、0.004). Positive rates of an FFR of<0.75 were 30.0%(n=12), 32.5%(n=13), 35.0%(n=14) and 35.0%(n=14) in A1, A2, A3 and A4. A total of 13 patients(40.6%) reported at least one side effects. Conclusions This study suggests a dose-response relationship for intracoronary AD on the measurement of FFR in Chinese patients with angiographic coronary artery disease. The suitable dose of bolus of intracoronary AD is 100μg.

BACKGROUNDThe lack of medical facilities causes delayed diagnosis and treatment of coronary heart disease in remote mountainous area and/or at disaster site. The miniature mobile cardiac catheterization laboratory was developed to be an intervention platform for coronary heart disease diagnosis and treatment by our team. Pre-clinical research indicated that the miniature mobile cardiac catheterization laboratory performed well in the rescue of critical cardiovascular diseases, even ST-segment elevation myocardial infarction. The present study aimed to evaluate the clinical safety and timeliness of the miniature mobile cardiac catheterization laboratory for emergent coronary interventional diagnosis and treatment.

METHODSX-ray radiation safety and disinfection efficacy in the miniature mobile cardiac catheterization laboratory were tested during working status. Coronary angiography and/or percutaneous coronary intervention were performed in remote mountainous areas on patients who were first diagnosed as having coronary heart disease by senior interventional cardiologists. The percutaneous coronary intervention procedures and results from patients in the miniature mobile cardiac catheterization laboratory were compared with patients who were treated in the hospital catheter lab.

RESULTSThe X-ray radiation dosages in the miniature mobile cardiac catheterization laboratory were 39.55 µGy/s, 247.4 µGy/h, 90.3 µGy/h and 39.4 µGy/h which were corresponded to 0 m, 1 m, 2 m and 3 m away from the tube central of the medium C-arm. And the radiation dosages used in the miniature mobile cardiac catheterization laboratory were less than the corresponding positions in the hospital catheter lab. The numbers of bacteria colonies in the miniature mobile cardiac catheterization laboratory in different environments range from (60 ± 8) cfu/m(3) to (120 ± 10) cfu/m(3) and met the demands of percutaneous coronary intervention. A total of 17 patients who received angiography in the miniature mobile cardiac catheterization laboratory, eight received percutaneous coronary intervention. The operations were all successfully accomplished without intraoperative and postoperative complications. The average angiography and percutaneous coronary intervention times were 35 ± 9 minutes and 55 ± 11 minutes, respectively. There was no significant difference in immediate percutaneous coronary intervention results between the miniature mobile cardiac catheterization laboratory and the catheter lab.

CONCLUSIONSIt is safe and feasible to carry out clinical interventional diagnosis and treatment in the miniature mobile cardiac catheterization laboratory as determined by this research. The miniature mobile cardiac catheterization laboratory may be considered a newly developed diagnosis and treatment platform for rescuing coronary heart disease patients in remote mountainous areas and/or at disaster sites.

Adult ; Aged ; Cardiac Catheterization ; methods ; Coronary Artery Disease ; surgery ; Coronary Disease ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention