Volume 87  ·   Issue 22  ·  2007

Coronary interventional surgery (PCI) has a history of more than 20 years. During this period, the rapid development of new technologies and new instruments has made us more involved in the fields that we have not tried before, such as left main trunk (LM), chronic occlusive disease (CTO), bifurcation disease, etc. At the same time, it also brings more problems, which make us fall into contradictions and confusions. How to face contradictions and confusions, how to evaluate the rapid development of coronary interventional surgery, and how to use new technologies and new instruments in clinical work are worthy of our good analysis and thought.

Drug-eluting coronary stents (DES) have become a milestone in the interventional treatment of coronary artery disease. However, although the first generation of DES significantly reduces the restenosis rate compared with bare metal stents (BMS), the results of the Basel Stent Potency Ratio-Late Thrombotic Events Trial (BASKET-LATE) study published by the American Heart Association (ACC) at the 2006 Annual Meeting showed that the risk of death and myocardial infarction in patients receiving DES after discontinuation of clopidogrel 6 months after surgery for 1 year was 3 times higher than that in the BMS group, and the incidence of LATE thrombotic events between 7 and 18 months after surgery was 1 times higher than that in the BMS group, suggesting that the risk of adverse events caused by delayed (>1 year) thrombotic events was increased in patients receiving DES after discontinuation of clopidogrel [1].

Objective to observe the incidence of postoperative acute radial artery occlusion (RAO) in patients undergoing radial artery coronary intervention, and to explore the related factors affecting the occurrence of RAO after radial artery coronary intervention. Methods 7215 patients undergoing radial artery coronary intervention were divided into normal group and RAO group according to whether RAO occurred after operation. The risk factors of RAO were analyzed by multivariate Logistic regression. Results 68 of 7215 patients (0.94%) developed acute radial artery occlusion after operation. Compared with the normal group, the proportion of female, diabetic and previous patients undergoing radial artery coronary intervention in RAO group was higher. The average intraoperative heparin dosage in RAO group was significantly lower than that in the normal group (3723 IU ± 556 IU vs 7603 IU ± 1533 IU, P<0.01), and the postoperative compression time was longer than that in the normal group (103.8min±23.3min vs 87.7min±31.2min, P =0.02). The proportion of hydrophilic coating sheath was lower than that in the normal group, and the proportion of 7F artery sheath was higher in RAO group (11.8%vs 1.8%,P<0.01 Logistic regression analysis showed that the independent risk factors affecting the occurrence of RAO were the choice of 7F arterial sheath, low heparin dosage, long postoperative compression of the radial artery and the use of non-hydrophilic coated arterial sheath. Conclusion the choice of appropriate size arterial sheath, sufficient anticoagulation therapy, avoiding long postoperative compression and hemostasis and the use of hydrophilic coated arterial sheath in the diagnosis and treatment of radial artery coronary intervention can reduce the incidence of RAO.

Objective to investigate whether the level of asymmetric dimethylarginine (ADMA) is related to the extent and severity of coronary atherosclerosis. Methods 110 patients undergoing coronary angiography were divided into control group with normal coronary angiography (22 cases) and mild arteriosclerosis group (21 cases) according to the angiographic results. The intima of coronary artery was not smooth, but there was no obvious stenosis or stenosis less than 50%; In 22 cases of single-vessel lesion group, the angiography showed obvious stenosis (≥50%) in one major coronary artery branch; The two main coronary artery branches in 22 cases showed obvious stenosis; Plasma ADMA levels were detected by enzyme-linked immunoassay (ELISA). Results the ADMA levels of single-vessel lesion group, double-vessel lesion group and multiple-vessel lesion group were higher than those of control group (1.52 μ mol/L ± 0.61 μ mol/L, 1.67 μ mol/L ± 0.80 μ mol/L, 2.60 μ mol/L ± 0.62 μ mol/L vs 0.79 μ mol/L ± 0.54 μ mol/L, P<0.01), except for the low ADMA levels in mild arteriosclerosis group (1.21 μ mol/L ± 0.36 μ mol/L, P =0.288). Through multivariate correlation and Logistic rank regression analysis, the level of ADMA is closely related to the degree of coronary artery disease. Conclusion the increase of plasma ADMA level can predict the occurrence of coronary atherosclerosis, and ADMA may be a new risk factor for coronary artery disease.

Objective to investigate the feasibility of magnetic resonance imaging (MRI) to trace BM-MNC (MR-MNC) by using magnetic probe to label pig bone marrow mononuclear cells (BM-MNC). Methods A pig model of acute myocardial infarction was prepared. Autologous BM-MNC was isolated and cultured from 14 miniature domestic pigs (9 in experimental group and 5 in control group). The MR-MNC (experimental group) and BM-MNC (control group) were implanted into the infarction-related arteries of the model pigs through coronary route. The transplanted cells were traced by MRI in vivo and compared with myocardial tissue sections. Results the superparamagnetic iron oxide labeling rate of BM-MNC was nearly 100%. MRI tracing results were obtained in 10 pigs (7 in experimental group and 3 in control group). MRI showed that the model of myocardial infarction was successful. After MR-MNC transplantation, the T2-weighted image (T2*WI) sequence of 3 pigs showed a blurred low-signal area around the myocardial infarction, and after enhancement, this area showed clearer hypoechoic signal than that before enhancement. Two isolated T2*WI sequences showed a dot-like low signal area around the infarction area, but no low signal area was found in the control group. Histological examination showed that five (MR-MNC106 or above) Prussian staining positive blue cells were distributed around the infarcted myocardium, which was basically consistent with the area with reduced magnetic resonance signal. Conclusion 1.5T MR can trace MR-MNC implanted by coronary route in pigs with myocardial infarction in vivo, but the number of MR-MNC transplanted should not be less than 106.

Objective to investigate the effect of drug-eluting stent (DES) on coronary artery bypass grafting (CABG) in patients with coronary artery disease who were first diagnosed in cardiology department.Methods 2598 patients who were first diagnosed in cardiology department of Beijing Anzhen Hospital and underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) from July 1, 2001 to June 30, 2002 (BMS era) and July 1, 2003 to June 30, 2004 (DES era) were enrolled. The clinical characteristics and coronary artery lesions of patients who were transferred to CABG in BMS era and DES era were analyzed, and the effect of DES on CABG was evaluated. Results 1333 patients (80.1%) received PCI in DES era, 331 patients (19.9%) were transferred to CABG, 721 patients (77.2%) received PCI in BMS era, and 213 patients (22.8%) were transferred to CABG in BMS era. The referral rate decreased by 12.7%. Compared with BMS era, left main disease (1.4% vs 3.2%, P =0.025), proximal anterior descending artery (39.8% vs 44.2%, P =0.047) and diffuse long disease in DES era Patients with left main lesion, chronic occlusive lesion, proximal anterior descending artery lesion and open lesion were still the most common types of coronary artery disease treated with CABG. The revascularization rate of patients treated with PCI in DES era was significantly lower than that in BMS era (12.7% vs 7.1%, P<0.001). Multivariate Logistic analysis showed that the number of diseased vessels, left main lesion, chronic occlusive lesion and proximal anterior descending artery lesion were the main predictors of choosing CABG. Conclusion DES has some influence on the revascularization mode and strategy of patients with coronary artery disease.

Objective to investigate the presence of synapses and their constituent protein connexin (Cx) in normal human bladder. Methods the smooth muscle of 6 patients with total cystectomy was studied by transmission electron microscope, cryoburst electron microscope, reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry. Results the results of electron microscope showed that there were synapses in bladder smooth muscle, but these synapses were small and irregular in shape. The results of RT-PCR showed that two fragments were amplified in all samples, with the size of 300 bp and 200 bp, respectively, and the sequencing results showed that it was consistent with the published Cx45. Fluorescence immunohistochemistry showed that most detrusor muscles had Cx45 immune signal. Conclusion the non-obstructive human bladder smooth muscle cells are electrically coupled through synapses.

Objective to investigate whether the single nucleotide polymorphism (SNP) site G14595T in the coding region of the palatine, lung and nasopharyngeal epithelial clone (PLUNC) gene is significantly associated with the susceptibility of nasopharyngeal carcinoma in Guangdong.Methods the coding region, regulatory region, flanking region and some intron regions of the gene were detected by direct sequencing to determine the position and type of SNP.The correlation of the coding region polymorphism site G14595T in 239 nasopharyngeal carcinoma patients and 286 controls was analyzed by polymerase chain reaction-restriction enzyme fragment length polymorphism (PCR-RFLP) combined with sequencing. Results A total of 9 SNPs were obtained by sequencing; Eight SNP sites showed high linkage disequilibrium; Three SNP sites can be used as hSNPs; Conclusion There is little difference in allelic frequency of polymorphic locus G14595T in the coding region of PLUNC gene between 239 patients with nasopharyngeal carcinoma and 286 controls, which indicates that there is no significant association between this locus and the susceptibility of nasopharyngeal carcinoma in Guangdong, China.

Objective to detect the expression of microfibrin-1 in congenital bileaf aortic valve and investigate the molecular mechanism of congenital bileaf aortic valve. Methods Children with bileaf aortic valve replacement due to congenital bileaf aortic valve with aortic stenosis (AS) and/or aortic insufficiency (AI) were selected AS the study group (11 males and 1 female, aged 10-18 years, mean 16.7 years, including 3 cases with AS alone, 8 cases with AI alone, and 1 case with AS-AI alone), normal trilobar aortic valve (6 males and 2 females, aged 1-17 years, mean 9.1 years) of children with congenital bileaf aortic valve with similar sex and age, without cardiovascular disease and collagen system, and accidental death, and the aortic valve of children with rheumatic heart disease (13 males and 5 females, aged 12-18 years, mean 16.5 years) of similar sex and age were selected AS the control group. Results The expression of microfibrin 1 in aortic valve was 170±10 in congenital bilobar aortic valve group, 126±8 in normal control group and 73±16 in rheumatic heart disease group. The expression of microfibrin 1 in congenital bilobar aortic valve group was significantly lower than that in normal control group and rheumatic heart disease group (P<0.05), and the expression of microfibrin 1 in rheumatic heart disease group was significantly higher than that in congenital bilobar aortic valve group and normal control group (P<0.05). The expression of microfibrin 1 in congenital bilobar aortic valve was 167±6, 171±8 and 168±6, respectively. Conclusion The decrease of microfibrin 1 expression in congenital bilobar aortic valve may be caused by insufficient congenital synthesis and/or excessive degradation

Objective to investigate the value of 16-slice spiral CT in the diagnosis of the relationship between lumbar nerve root reconstruction and lumbar intervertebral disc herniation and/or bulge (LDHB), and to provide evidence for the diagnosis of clinically related diseases.Methods A total of 31 patients (50 segments) with typical clinical symptoms and signs of LDHB were selected and diagnosed as LDHB by multi-plane CT scanning, which was confirmed by surgery and pathology.The multi-plane reconstruction of lumbar nerve root was performed by Light Speed 16-slice spiral CT scan manufactured by GE Company, USA, on ADW4.1 workstation and UNIX operating system, and the abnormal manifestations of the relationship between the lumbar nerve root and the intervertebral disc were analyzed at the same slice display. Results The absence or absence of LDHB was clearly seen under the same slice display, and the abnormal changes of many indexes of the whole nerve root movement were also demonstrated, including: There are abnormal changes in contact or contact range (100%), nerve root displacement (96%), morphological change (94%), thickness change (92%), running direction change (88%), density change (80%), angle between dural sac and nerve root increase (76%) and secondary changes in surrounding tissues, etc. With the prolongation of LDHB time, the compressed nerve root can appear from thickening to thinning. Conclusion 16-slice spiral CT reconstruction can ideally show the abnormal relationship between LDHB and nerve root running as a whole and judge the pathological changes of old and new nerve root injuries.

Objective to detect the paternal mutation of SEA α thalassemia 1 (SEA α thalassemia 1) in the plasma fetal DNA of pregnant women for non-invasive prenatal genetic diagnosis. Methods Fluorescence polymerase chain reaction (PCR) and gene scanning were used to analyze the paternal mutation and short tandem repeat (STR) of SEA α thalassemia 1 in the plasma fetal DNA of 10 pregnant women. Results the paternal STR allele was detected in the plasma fetal DNA of 10 pregnant women, and the paternal SEA α thalassemia 1 gene mutation was detected in 4 cases; No paternal SEA α thalassemia 1 gene mutation was detected in 6 cases, which is consistent with the routine prenatal genetic diagnosis of fetal DNA from villi, amniotic fluid or umbilical cord blood. Conclusion Fluorescence PCR and gene scanning were used to detect paternal SEA α thalassemia 1 gene mutation in fetal DNA of pregnant women, which can exclude fetuses with hemoglobin H disease.

Objective to study the subtypes and sequence variation of HIV-1 virus in previous blood donors in Fuyang City, Anhui Province. Methods nested-PCR was used to amplify the outer membrane protein (env) gene and core protein (gag) gene of HIV-1. The sequences of env gene V3-C3 and its adjacent regions in 244 patients and gag gene region in 245 patients were obtained. The sequences of env gene V3-C3 and its adjacent regions in 244 patients and gag gene region in 245 patients were analyzed by MEGA software, and the correlation was studied in combination with the disease progression stage of patients. Results Phylogenetic tree showed that the sequences of env and gag region of HIV in Fuyang City, Anhui Province belonged to Thai subtype B; The intra-group gene distances of env and gag regions were 9.11% and 3.59%, respectively; According to the stratification of absolute CD4 cell count, with the decrease of absolute CD4 cell count, the gene distance in env and Gag groups increased significantly; With the increase of viral load level, the gene distance of each group increased, and the differences were statistically significant (P<0.001). The apical tetrapeptide of 13 patients with long-term non-progression of V3 loop sequence in env region was GPGQ, and the apical tetrapeptide of 53 patients with slow progression was GPGR, and the differences between them were statistically significant (P =0.038). Conclusion The endemic strain of HIV-1 infected patients in Fuyang City, Anhui Province was B' subtype. CD4 and viral load, as indicators of different stages of disease progression, were correlated with virus mutation, that is, with the decrease of CD4 and the increase of viral load, the gene distance in the virus group increased.

Objective to investigate the relationship between the efficacy of chemotherapy in vivo and the prediction of drug susceptibility of tumor cells in vitro by animal experiments. Methods EL4/melphalan-resistant cell line of mouse lymphoma EL4 was prepared by concentration gradient increasing method, and its resistance index to melphalan in vitro was detected by tetramethylazolazole blue (MTT) colorimetric assay. An animal model of tumor-bearing mice cured by a single dose of chemotherapy was used. Equal amounts of EL4/melphalan and EL4 cells were inoculated subcutaneously in wild type C57BL/6 mice. Twelve days after inoculation, EL4/melphalan-bearing mice and EL4-bearing mice were randomly divided into melphalan-treated group and control group, with 5 mice in each group. In vivo experiments showed that 7.5 mg/kg melphalan could not only regress the tumor nodules in mice with EL4 tumor, but also cure the tumor in mice with EL4/melphalan tumor. Conclusion The efficacy of in vivo chemotherapy for malignant tumor is not related to whether tumor cells are resistant to the chemotherapy drug in vitro, and tumor cells resistant to melphalan in vitro are still sensitive to melphalan in vivo therapy.

Objective to investigate the role and mechanism of differentiation inhibitor 1 (Id-1) in cyclooxygenase 2 (COX-2) -mediated angiogenesis of gastric carcinoma. Methods SGC7901 cells with high expression of COX-2 and COX-2 specific siRNA were established. The expression of Id1 in the two subcell lines was detected by Western blot and reverse transcription PCR. The difference of expression of vascular endothelial growth factor (VEGF) in the two cell supernatants was analyzed by ELISA. The effects of supernatants of the two cell lines on the proliferation of umbilical vein endothelial cells (HU-LT) in vitro were analyzed by tetrazolium salt colorimetric (MTT) assay. After inhibiting Id1 in SGC7901/COX-2, the changes of VEGF in the culture supernatant and the effects on the proliferation of umbilical vein endothelial cells (HU-LT) were observed. Results Stable clones with high COX-2 expression and specific COX-2 small interfering RNA (siRNA) expression were successfully established, and the transfection efficiency of different clones was identified. The protein and mRNA expression levels of Id1 in SGC7901 cells with high COX-2 expression were increased, while the expression of Id1 in SGC7901 cells transfected with COX-2-siRNA was lower than that in the control group. The protein content of VEGF in the supernatant of SGC7901/COX-2 cells with high COX-2 expression was higher than that in the control group (2060±42 vs 1248±28, P =0.000), while the protein content of VEGF in the supernatant of SGC7901/COX-2-siRNA cells was lower than that in the control group (1024±20, 2033±27 vsP =0.000). In the conditioned medium of SGC7901/COX-2 cells, the growth of HU-LT cells was faster than that in the control group; In SGC7901/COX-2-SiRNA cell conditioned medium, the growth of HU-LT cells was slower than that of the control group. After inhibiting Id1 in SGC7901/COX-2, the content of VEGF in culture supernatant increased and the effect on the proliferation of HU-LT was reversed. The tumorigenesis test in nude mice showed that after inhibiting Id1, the tumorigenicity of SGC7901/COX-2 cells decreased [(353±12) mg vs (1020±91) mg, P =0.038], and the MVD decreased (8.8±1.6 vs 20±1.7, P =0.001). Conclusion COX-2 can up-regulate the expression of Id1 in SGC7901 cells and affect the proliferation ability of endothelial cells in vitro through this pathway. Therefore, Id1 participates in the pro-angiogenesis process mediated by COX-2 in the development of gastric cancer, and may become a new target for antivascular therapy of gastric cancer.

Objective to investigate the regulatory effect of RHOGTPase on the transdifferentiation of hepatic sinusoidal endothelial cells, and its effect on the capillary vascularization of hepatic sinusoidal cells in schistosomiasis rats and its possible mechanism.Methods the model of schistosomiasis liver fibrosis was established by infecting schistosomiasis cercariae with abdominal application method. The liver tissues of normal control group (group A, 10 rats) and schistosomiasis group (group B, 6 rats) were collected by laparotomy after 16, 19 and 21 weeks (group B), insecticidal control group (group C), schistosomiasis + hydroxyfasudil group (group D) and insecticidal + hydroxyfasudil group (group E). HE, Masson staining and transmission electron microscopy were used to observe the liver tissues. Immunohistochemical detection: P-annexin, CTGF, CD31, ColⅣ and LN; Western blot was used to detect the expression of P-annexin, CTGF, RhoA, ColⅣ and LN protein; The mRNA levels of CTGF, RhoA and ROCK Ⅱ were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results Compared with group A, the expression levels of RhoA, ROCK Ⅱ and CTGF in liver tissue of group B were significantly increased, and the expression levels of P-annexin, CTGF, RhoA, COL Ⅳ and LN protein were also increased. Compared with group B, the expression of P-annexin in group D and group E was significantly decreased at 16 weeks, but the expression of P-annexin in group D gradually returned to the original level at 19 weeks, and the expression level of P-annexin in group D was significantly lower than that in group D. The ultrastructural observation of hepatic sinus showed that at 21 weeks, the infiltration of inflammatory cells and collagen fibers in Disse cavity were significantly reduced in group C compared with group B and group D, respectively, but the difference of endothelial cell fenesters and subendothelial basement membrane in hepatic sinus was not statistically significant. Inhibition of rhoGTPase signaling pathway by up-regulating CTGF and P-annexin may provide a new effective target for the prevention and treatment of hepatic sinusoidal capillarization.

Objective to investigate the effect of abundant environment exposure on hippocampal neurogenesis before weaning and its possible mechanism.Methods Thirty-six 10-day-old SD rats were randomly divided into control group and abundant environment group, 18 rats in each group.At 10-24 days old, the rats in the two groups were injected intraperitoneally with BrdU 50 mg/kg every other day, and the rats in the abundant environment group were exposed to abundant environment for 20 min every day. At the end of abundant environment exposure at 24 days of age, 6 rats in each group were taken to detect the hippocampal nuclein leaving protein for calmodulin and phosphorylated CREB Western blot. At the age of 63 days, the rest of the rats were sacrificed and frozen brain sections were taken, and the sections at 3.6 mm after the anterior fontanel were taken for Nissl staining, and the number of cells in the dentate gyrus of right hippocampus was counted. After BrdU immunohistochemistry, the number of BrdU positive cells in the DG region of right hippocampus was calculated. After immunofluorescence double labeling, the differentiation ratio of BrdU positive cells into neurons (BrdU/NeuN co-expression) and astrocytes (BrdU/GFAP co-expression) was calculated. Results The results of Western blot detection showed that compared with the control group, the levels of calmodulin (0.605 ± 0.035 vs 0.245 ± 0.035, t = -10.182, P =0.01) and phosphorylated CREB (0.485 ± 0.007 vs 0.220 ± 0.014, t = -23.702, P =0.002) in the hippocampal nuclein protein of the enriched environment group were higher. And astrocyte differentiation rate was higher than that of control group (4.0%±0.5%vs 2.6%±0.6%,t = -6.493, P<0.01). Conclusion Before weaning, abundant environmental exposure can promote hippocampal neurogenesis, and its mechanism may be related to the activation of hippocampal calmodulin and CREB by abundant environmental exposure.

In Hepatology, 2007, 45:560-568, Damink et al. simulated the onset of upper gastrointestinal hemorrhage (UGB) in patients with liver cirrhosis by intranasal perfusion of amino acid solution and intravenous injection of isoleucine. The results showed that isoleucine can significantly improve the protein synthesis function of liver and muscle in "hemorrhagic patients", and it is expected to be a new method for treating and improving the prognosis of UGB.

The malignant degree of pancreatic cancer is extremely high, the incidence rate is 98%, and the incidence rate in China is also increasing year by year. Surgical resection is the only radical treatment at present, but due to the poor biological behavior of pancreatic cancer, the 5-year survival rate of even surgical resection patients is only 23.4%. Obviously, surgical resection alone cannot bring long-term survival after pancreatic cancer operation.

A 42-year-old male was admitted to the Department of Hematology of Peking University People's Hospital on July 17, 2006, after being diagnosed with Ph-positive acute lymphocytic leukemia (ALL) for 9 months, 2 months after human leukocyte antigen (HLA) matching incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT), with fever for 5 days and neck swelling for 3 days.

dendritic cells (DCs) are full-time antigen presenting cells (APCs) of the immune system. They are the direct initiators and regulators of T cell specific immune response and the bridge between natural immunity and specific immunity. After DCs take up and process antigens in peripheral blood and tissues, they migrate to drainage lymph nodes and present antigens to quiescent lymphocytes in T cell enriched areas of lymph nodes.

The patient was a 65-year-old female with abdominal pain, black feces, abdominal mass, weight loss for 2 months and fever for 1 week. He had a history of upper gastrointestinal bleeding 10 years ago, and the etiology was unknown. A 2 cm ×2 cm mass in the right abdomen was found by B-ultrasound 1 year ago, but no further diagnosis and treatment was made. Physical examination: body temperature 38.5℃, blood pressure 130/85 mm Hg (1 mm Hg =0.133 kPa).

A 29-year-old female was admitted to hospital due to intermittent edema and shortness of breath for 15 months, and the episode recurred for 7 days. Two years ago, the patient developed general edema and shortness of breath at 7 months of pregnancy, and was diagnosed as perinatal cardiomyopathy. After cesarean section, her condition was stable after improving cardiac function. Nine months ago, she suffered from sudden convulsions and then coma. CT showed acute large-area cerebral infarction of right frontal, temporal and parietal lobes.