Volume 85  ·   Issue 31  ·  2005

Since the Swiss scholar Gruentzig completed the first percutaneous transluminal coronary angioplasty (PTCA) in Zurich, Switzerland in September 1977, PTCA has occupied a place in the field of coronary heart disease treatment with its unique advantages, and has become another major treatment method after drug therapy and coronary artery bypass grafting (CABG). In 1981, Gruentzig and his assistant Meyer spread the PTCA treatment technology to the United States and held a PTCA training course. After the Japanese scholar Masakichi Yanji participated in this training, the first PTCA in Asia was carried out in Japan at the end of the same year. At the invitation of Xi'an Fourth Military Medical University, Mr. Liu Cijiang, a Chinese-American professor at the University of Southern California School of Medicine, held two consecutive cardiovascular angiography/PTCA classes in 1983 and 1984 in Xijing Hospital, and demonstrated 4 operations. In May 1985, Xijing Hospital of Xi'an Fourth Military Medical University held the first PTCA demonstration in China, and completed the first PTCA in China. In July of the same year, in<This year marks the 20th anniversary of percutaneous coronary intervention (PCI) in China.

Atherosclerotic thrombosis is the pathological basis of clinical cardiovascular and cerebrovascular adverse events, and platelet activation and aggregation play a central role in its formation. Therefore, antiplatelet therapy can help to reduce the incidence of clinical adverse events in patients with coronary heart disease. At present, the commonly used antiplatelet drugs in clinic include aspirin (cyclooxygenase 1 inhibitor), thiophenopyridines (ticlopidine and clopidogrel, ADP receptor antagonists), cilostazol (phosphodiesterase Ⅲ inhibitor) and platelet GPⅡb/Ⅲa receptor antagonists, etc. The above drugs are very different in routes of action, antiplatelet strength, onset and duration of action, metabolic pathway, price, etc. There are still many problems worth exploring how to use antiplatelet drugs rationally.

acute myocardial infarction (AMI) is dangerous and fatal, mainly caused by acute thrombotic occlusion of coronary arteries supplying myocardium. Therefore, coronary recanalization, including thrombolysis or emergency percutaneous coronary intervention (PCI), is the most important therapeutic measure to restore coronary blood flow and achieve complete reperfusion of myocardial tissue [1].

Thrombosis or embolism is the last key link leading to cardiac, cerebral and peripheral vascular events, and it is the direct cause of death and disability. Without thrombosis, there will be no cardiovascular events. At present, we are facing the great challenge of thromboembolic diseases. The latest statistical data released by the American College of Cardiology in early 2004 show that atherosclerosis is still the number one killer in the United States. The prevalence of venous thromboembolic diseases and atrial fibrillation is increasing year by year, which will bring huge health and economic burden. However, there are irregularities and irrational places in the diagnosis and treatment of thromboembolic diseases in China at present, such as lack of basic theoretical knowledge of arterial and venous thromboembolism, failure to choose different drugs for different thrombosis, irregular or inappropriate medication methods and excessive implementation of invasive treatment methods such as catheters and filters. Therefore, it is urgent to apply scientific guidelines to standardize medical behavior. Here, we will combine the latest antithrombotic and thrombolytic guidelines of the American College of Chest Physicians in 2004 [1], In view of the existing problems in China, the important progress in the prevention of thromboembolism in venous, arterial and atrial fibrillation is discussed.

Objective to study the effect of increased abdominal pressure on renal function. Methods Thirty patients with increased abdominal pressure, 26 males and 4 females, with mean age 42 ± 17 years, were measured at the same time every day. The mean arterial pressure and central venous pressure were recorded, and blood samples were taken to detect serum creatinine. Results When the abdominal pressure increased, the urine volume decreased from the basal level of 78 ml/h ± 26 ml/h to 31 ml/h ± 11 ml/h (P<0.01), and the serum creatinine increased from 110 mmol/L ± 98 mmol/L to 224 mmol/L ± 147 mmol/L (P<0.01). 6.0 mm Hg ± 2.1 mm Hg to 8.8 mm Hg ± 2.5 mm Hg, 1 mm Hg =0.133 kPa, P<0.01) And mean arterial pressure (from 79 mm Hg ± 8 mm Hg to 86 mm Hg ± 10 mm Hg, P<0.01). The increase of abdominal pressure was negatively correlated with urine output (r = -0.747, P<0.01); There was a positive correlation with serum creatinine (r =0.816, P<In the subsequent treatment, 12 patients died, 8 of them died of multiple organ failure caused by sepsis, and 4 died of massive abdominal hemorrhage. Conclusion The increase of abdominal pressure in patients is closely related to oliguria and serum creatinine increase; After the abdominal pressure was reduced, the above clinical results were improved.

Objective to investigate the related factors affecting the life of dual-chamber cardiac pacemaker (PM) and provide clinical basis for the rational application and design of dual-chamber PM. Methods 71 patients with dual-chamber PM were followed up and observed since 1991. From the time the patients were installed with PM, the relevant pacing parameters such as sensed current, pacing voltage and impedance of each PM were observed and recorded regularly. By the end point of observation in 2005, the patients were grouped according to the gender, age, diagnosis and different values of each pacing parameter of PM, and the relevant parameters that may affect the life of dual-chamber PM were statistically processed. Results The average service life of dual-chamber PM was 111 months ± 19 months. Univariate statistical analysis showed that the basal heart rate, battery capacity, pacing voltage, pacing frequency, impedance, threshold, pulse width and sensed current of patients had an influence on the life of PM (all P<Cox proportional hazard regression analysis showed that perceived current (P =0.000, relative risk (RR) =3.072, 95% confidence interval (CI) =2.130~4.429), pacing voltage (P =0.040; RR =2.121, 95% CI =1.126~3.998) and impedance (P =0.049, RR =1.786, 95% CI =1.007~3.169) were important predictors of PM life. Conclusion Perceived current, pacing voltage and impedance were the important factors affecting the life of dual-chamber PM, and basal heart rate, battery capacity, threshold, pacing frequency and pulse width of patients also affected the service life of dual-chamber PM.

Methods From November 1999 to December 2003, 110 patients with femoral shaft fractures underwent closed reduction and locking intramedullary needle fixation. Among them, 62 patients in the first group were fixed with the injured foot in neutral position. In the second group of 27 cases, the fractures were fixed at the position of femoral anteversion of 15 degrees; The rotational alignment of femoral shaft fracture on the injured side was adjusted according to the femoral anteversion angle of the healthy side and the fracture was fixed. On the third day after operation, the bilateral femoral anteversion angle was measured by X-ray and CT examination. The difference of femoral anteversion angle between the injured side and the healthy side was the degree of rotational displacement of the fracture end. Another 11 normal subjects were taken as the control group by CT examination to measure the bilateral femoral anteversion angle. Results The maximum value of anteversion angle in the control group was 26 degrees, the minimum value was-8 degrees, the mean value of left side was 12.82 degrees, the mean value of right side was 12.45 degrees, and the maximum difference between the two sides was 7 degrees. The mean value of femoral anteversion angle on the healthy side in the treatment group was 14.67 degrees, the maximum value was 51 degrees, and the minimum value was-24 degrees. The mean value of femoral anteversion angle on the injured side in the treatment group was 14.27 degrees, the maximum value was 40 degrees, and the minimum value was-23 degrees<There were 53 and 52% of 10 degrees and 19 and 11% of>20 degrees. The difference was statistically significant compared with the control group (P<0.05). In Group 3, the rotational displacement of all cases was<Conclusion After closed reduction and locking intramedullary needle fixation, nearly 50% of femoral shaft fractures have rotational displacement>10 degrees.The rotational alignment of femoral shaft fractures can be accurately adjusted by X-ray fluoroscopy equipment during surgery. Only by adjusting the rotational alignment of injured femur based on the anterior angle of femur on the healthy side can the rotational reduction standard of fracture be achieved.

Objective to observe the changes of bone quality in patients with primary glomerular disease after glucocorticoid treatment, and to explore the efficacy and safety of different doses of alfacalcidol in the prevention of glucocorticoid-induced osteoporosis in primary glomerular disease.Methods 89 patients with primary glomerular disease treated with glucocorticoid were randomly divided into 3 groups, and the treatment group 1 was given alfacalcidol 1.0 μ g/d and calcium carbonate 750 mg three times a day; Treatment group 2 was given alfacalcidol 0.5 μ g/d and calcium carbonate 750 mg three times a day; The bone mineral density of lumbar spine (L2-L4) and femoral neck was measured before treatment and at 3, 6 and 12 months, and the conventional biochemical indexes such as serum osteocalcin, serum calcium, 24-h urine protein quantitation and serum albumin were measured at the same time. Results There was no significant change in the bone mineral density of lumbar spine and femoral neck of patients in treatment group 1 and treatment group 2 at 3, 6 and 12 months. The bone density of lumbar vertebra in the control group decreased significantly compared with that before treatment (0.897 ± 0.099, 0.874 ± 0.098, 0.856 ± 0.109 vs 0.981 ± 0.113, P<0.05), the bone mineral density of femoral neck did not change significantly; The lumbar bone density of the control group was significantly lower than that of the treatment group 1 and the treatment group 2 in the same period (P<0.05). The levels of osteocalcin in treatment group 1 and treatment group 2 were not significantly changed at 3, 6 and 12 months compared with those before treatment, but decreased significantly in control group (2.43±0.66, 2.12±0.61, 1.96±0.53 vs 5.92±1.33, P<0.05), the level of osteocalcin in the control group was significantly lower than that in the treatment group 1 and the treatment group 2 (P<Conclusion Glucocorticoid and alfacalcidol 0.5 μ g/d plus calcium can prevent bone loss in patients with primary glomerular disease.

Objective to investigate the protective effect and mechanism of different components extracted from astragalus on kidney injury induced by extracorporeal shock wave lithotripsy (ESWL). Methods 64 rabbits were randomly divided into normal saline control group, astragalus total saponin group, total flavonoid group and total polysaccharide group. The contents of injury-related factors endothelin (ET-1), malondialdehyde (MDA) and protective factor nitric oxide (NO) in blood and kidney tissue homogenates before and after ESWL were measured, and the changes of kidney tissue morphology and cell ultrastructure were observed. Results After ESWL, the increases of ET-1 and MDA in blood and kidney tissue homogenates of the three astragalus components were significantly lower than those in the control group (P<0.05), among which the effects of total saponins and total flavonoids were particularly prominent. There was no significant difference between ET-1 in total saponins group and MDA in total flavonoids group before and after shock (all P>0.05); The decrease of NO in the total saponin group was significantly lower than that in the control group (P<0.05) and returned to normal after 24 h; The damage of renal tissue morphology and cell ultrastructure in the total saponin group and total flavonoids group was significantly lighter than that in the control group, and the effect of saponin was more significant. Conclusion Total saponin and total flavonoids, especially total saponin, were the main effect components of astragalus in resisting shock wave renal injury.

Objective to investigate the expression of enhanced green fluorescent protein (EGFP) gene and transduction efficiency of recombinant adeno-associated virus (rAAV1, rAAV2 and rAAV5) vectors into rat brain through different routes, and to select rAAV serotypes and feasible gene transduction routes that are more suitable for transgenic therapy of central nervous system (CNS). Methods Fifty-four healthy male adult SD rats were randomly divided into 9 groups: rAAV1/2/5 hippocampal injection group, rAAV1/2/5 ventricular injection group and rAAV1/2/5 cortical injection group, 6 rats in each group. Each group was stereotactically injected with rAAV1-EGFP, rAAV2-EGFP and rAAV5-EGFP with matching dose and titer. The brains of the rats were sacrificed 8 weeks after injection, and the expression of EGFP in the brain was observed by fluorescence microscope, or the brain (n =2) was observed by real-time fluorescence quantitative PCR. The positive expression of rAAV5-EGFP was only scattered in a few pyramidal cells in CA1 and CA2 regions. However, only rAAV1-EGFP expression was observed in the ventricular and cortical injection groups, but neither rAAV2-EGFP nor rAAV5-EGFP expression was observed.<The expression of rAAV1-EGFP was the strongest, rAAV2-EGFP was the weakest, and rAAV5-EGFP was between the two. Conclusion rAAV1 can be effectively transduced in all brain injection sites, and the gene expression range and mRNA expression level mediated by rAAV1 are significantly higher than rAAV2 and rAAV5. rAAV1 is a more efficient transgenic vector than rAAV2 and rAAV5.

With the emergence of a series of public health emergencies such as SARS, avian influenza and meningococcal brain, how to effectively deal with public health emergencies has become a challenge that people's governments at all levels must face. Among the many matters in dealing with public health emergencies, preparing standardized emergency plans is a very important task. Under the circumstances that the country still lacks a set of unified standards for preparing emergency plans for public health emergencies, this paper intends to make a preliminary discussion on the basic concepts, preparation procedures and preparation contents of emergency plans for public health emergencies through theoretical analysis and literature review, for reference of local governments at all levels.

Methods Thirty-two Chinese mini-pigs were randomly divided into (1) control group, (2) clopidogrel and aspirin combined group (clopidogrel 300 mg/d on the first day, 3 mg·kg-1·d-1 after, and aspirin 10 mg·kg-1·d-1 once a day for 3 days), (3) tirofiil plaque treatment group (15 μ g/kg intravenous bolus injection followed by 0.5 μ g kg-1·min-1 until the end of the experiment) and (4) sham operation group, 8 rats in each group. The control group and the two treatment groups were treated with coronary artery ligation for 3 h and release for 1 h to prepare AMI reperfusion model. Hemodynamic measurements and contrast myocardial echocardiography (MCE) were performed before, after and after AMI, and finally pathological analysis was performed. Results The maximum platelet aggregation rate was significantly reduced in the tirofiil plaque and clopidogrel and aspirin combined group (46.8% and 45.7% before administration, respectively,<0.05~0.01), the coronary blood flow increased (45.8% in the control group and 73.2% in the tirofib plaque group, P<0.01), decreasing the myocardial extent (LA) in the area without reflow ligation (LA 78.5% in MCE control group; LA 82.3% in pathological staining; LA 22.8% in MCE staining group; LA 23.2% in pathological staining group (P<0.01), and reduced the range of myocardial necrosis (NA) in the area without reflow ligation (control group: 98.5%; tirofib plaque group: 89.2% LA, P<However, there were no significant differences in hemodynamic indexes, coronary blood flow, range of no reflux and range of myocardial necrosis in clopidogrel and aspirin combined group compared with the control group (all P>0.05). Conclusion Tirofiil plaque can effectively prevent and treat myocardial infarction without reflux after reperfusion, while clopidogrel and aspirin combined treatment is completely ineffective.

Objective to compare the short-term and long-term efficacy of rapamycin (CYPHER) and paclitaxel (TAXUS) drug-eluting stents (DES) in complex coronary artery disease. Methods 611 patients (642 lesions with 698 stents) and 450 patients (534 lesions with 600 stents) were treated with rapamycin and paclitaxel DES from April 2002 to June 2004, respectively. The types of complex lesions included long-segment diffuse stenosis, chronic complete occlusive lesion, bifurcation lesion, in-stent restenosis, coronary artery opening lesion and left main coronary artery lesion. Results the successful rates of rapamycin and paclitaxel DES were 99.2% (606/611) and 98.8% (445/450), respectively. The incidence of cardiac events (death, acute myocardial infarction, revascularization of target lesion, major adverse cardiac events (MACE)) during hospitalization were 0.65% and 1.30% (P>0.05), respectively, and the follow-up rates were 97.5% (596/611 The incidence of thrombosis was 0.49% and 0.89% respectively (P>0.05). Conclusion Rapamycin and paclitaxel DES have good short-term and long-term clinical efficacy for complex lesions of coronary heart disease. Rapamycin stent is superior to paclitaxel stent in the incidence of restenosis.

Objective to analyze the baseline characteristics and treatment status of ST-segment elevation myocardial infarction (STEMI) in China.Methods As part of the international multicenter trial CREATE, STEMI patients within 12 hours of symptoms were enrolled from July 2001 to July 2004, and the baseline characteristics and treatment status were analyzed.Results Among 7510 patients enrolled in 274 centers in China, 0.7% of STEMI patients had new left bundle branch block, the average age was 62.7 years. 11.5% received PCI, 52.5% received thrombolysis, 0.1% received coronary bypass grafting, and 62.4% received overall reperfusion therapy (including thrombolysis and direct PCI). Other drug therapy was similar to that of previous registry studies.The combined endpoint of death, stroke and reinfarction at 7 days was 10.3%, and the overall mortality at 30 days was 11.1%. Conclusion Compared with the whole group acute coronary event registry study; The age of onset of STEMI patients in China is similar, with more hypertension and less diabetes, and the rate of reperfusion is similar, but there is still room for further improvement in reperfusion therapy and drug therapy.

The patient, a 44-year-old female, was admitted to hospital on July 16, 2001 due to weight loss and fatigue for half a year, edema of both lower limbs with abdominal distension and oliguria for 1 month. The patient developed fatigue without obvious trigger six months ago, edema of both lower limbs and decreased daily urine volume (at least about 200 ml/d) two months ago.

The Joint Committee on Traceability on Laboratory Medicine (JCTLM) was established by the International Bureau of Metrology (CIPM), the International Union of Clinical Chemistry and Laboratory Medicine (IFCC), and the International Collaboration for Laboratory Accreditation (ILAC).

Professor Miao Xiaohui of Changzheng Hospital affiliated to the Second Military Medical University pointed out at the 12th National Academic Conference on Viral Hepatitis and Liver Diseases held by the Chinese Medical Association in May 2005 that covalently closed circular DNA (cccDNA) is the original template for the replication of hepatitis B virus pregenome RNA. Although its content is small, there are only about 5~50 copies in each hepatocyte, it is of great significance for the replication of hepatitis B virus and the establishment of infection status. Only by removing cccDNA in the nucleus can the virus carrier status of hepatitis B patients be completely eliminated, which is the goal of antiviral therapy.

lung resistance-related protein (LRP) is a recently discovered protein that can cause multidrug resistance in tumors, and can mediate drug resistance to P-gp and multidrug resistance-related protein (MRP), such as platinum and alkylating agents, which cannot be mediated by P-gp and multidrug resistance-related protein (MRP) [2]. LRP is expressed in blood cell subsets like P-gp, and the invasion of tumor to human body can cause the reaction of peripheral blood cells [3]. At present, the expression of P-gp and LRP is mostly detected by tumor tissues. However, the tumor tissues regressed to varying degrees after chemotherapy, which brings some difficulties to the detection of tumor tissues after chemotherapy. Flow cytometry was used to detect the expression of LRP and P-gp in peripheral blood mononuclear cells of patients with nasopharyngeal carcinoma after chemotherapy, which provides a theoretical basis for clinical drug use and a simple and feasible method for the detection of multidrug resistance in nasopharyngeal carcinoma.

A 47-year-old male patient suffered from intractable hypertension for more than 10 years. The effect of long-term oral antihypertensive drugs was unsatisfactory, and his blood pressure was maintained at about 200~220/110~150 mm Hg (1 mm Hg =0.133 kPa). In the past 2 years, he gradually developed progressive intermittent claudication of both lower limbs, walking about 100 m each time. Enhanced CT angiography (CTA) examination before admission showed that the left renal artery was completely occluded, the left kidney atrophy, and the aorta below the renal artery was completely occluded (Figure 1). The volume of the right kidney increased compensatingly, and a large number of mural thrombus in the aortic cavity above the opening of the right renal artery reached the level of diaphragmatic hiatus (Figure 2); Stenosis of the initial part of the right kidney was 80%. He was admitted to hospital with renal hypertension and aortoiliac artery occlusion. Physical examination after admission: general condition, self-care. Blood pressure of upper limbs 210/160 mm Hg. Carotid artery, brachial artery and radial artery pulsed strongly, without vascular murmur. No abnormalities were found in cardiopulmonary examination. The abdomen was flat, the liver and spleen were not touched, there was no pulsation at the distal end of the abdominal aorta, and no vascular murmur was heard. The pulsation of both femoral arteries, popliteal arteries and dorsal pedis arteries disappeared. The skin of both feet was warm and cool, without necrosis.

A 55-year-old male with low fever, fatigue, emaciation and eating discomfort for 3 months was admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Kunming Medical College with "giant benign esophageal tumor".

A 15-year-old female was admitted to the hospital for a second time due to sudden vomiting. The patient had vomited without obvious inducement 2 hours ago, and the vomit was stomach content, without blood and pus; Persistent upper abdominal pain and cough after vomiting, coughing up pink foamy sputum; Then he was confused and sweating profusely, and his blood pressure dropped to 70/50 mm Hg (1 mm Hg =0.133 kPa). After dopamine was given to the local hospital, his blood pressure rose. Physical examination showed negative heart and lung, flat and soft abdomen, no tenderness, rebound pain, liver and spleen were not reached under the costs, no mass was palpable in abdomen, and moving voiced sound (-).

A 55-year-old male complained of fever and cough for 8 days. He was admitted to Beijing Naval General Hospital on September 30, 2003. Eight days ago, the patient went to Japan on a business trip. Because of catching cold after being exposed to rain, he developed fever, and his body temperature reached 39.7℃, accompanied by sore throat and headache, followed by cough. Then, he went to a local clinic in Japan, and his body temperature dropped after taking oral antibiotics methylerythromycin, antipyretic loxoprofen and antitussive and expectorant asverin.