Vessels with semi-closed tanks(i.e.,well docks)are widely applied in the military operation and maritime engineer-ing.The water is bound by the semi-closed floating tank and forced by both the incident waves and ship...Vessels with semi-closed tanks(i.e.,well docks)are widely applied in the military operation and maritime engineer-ing.The water is bound by the semi-closed floating tank and forced by both the incident waves and ship’s motions.The free surface oscillations inside the flooded well dock is thus distinctive and very complicated.So far,the natural modes of semi-closed floating tanks have not yet been studied.This paper investigates the characteristics of natural modes of a floating semi-closed tank by combining a mode-resolving model based on mild-slope equations and a hydrodynamic model based on computational fluid dynamics.Results show that the first three natural periods(i.e.,74,23.6,and 14 s)of the tank fall into the band of swell and infragravity waves and they could be triggered under certain circumstance.Multi-period free surface oscillations are observed inside the tank,including the longest natural period(i.e.,74 s),though the incident waves are monochromatic.A possible generation mechanism for the long-period mode is explained on the basis of liquid sloshing and harbor oscillations.Moreover,a long-period component with a period close to the natural mode of well dock is observed in the ship motions,which is generated by the interaction between the waves and ship.展开更多
Myocardial bridge （MB） is regarded as a common .anatomic variant rather than a congenital conditionanomaly, defined as the intrainyocardial course of a portion of the coronary artery. It was first mentioned by Rayma...Myocardial bridge （MB） is regarded as a common .anatomic variant rather than a congenital conditionanomaly, defined as the intrainyocardial course of a portion of the coronary artery. It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s. The current gold standard tor diagnosing MB is coronary angiography with the typical systolic compression of the epicardial coronary vessel （milking effect）.展开更多
Primary percutaneous coronary intervention （PCI） has been the standard of care for patients with acuteST-elevation myocardial infarction hours of symptom onset in modem and applications of robust （STEMI） within 12...Primary percutaneous coronary intervention （PCI） has been the standard of care for patients with acuteST-elevation myocardial infarction hours of symptom onset in modem and applications of robust （STEMI） within 12 era.1＇2 The advances anti-platelet and anti-coagulation medicines further improve the outcome of STEMI patients undergoing primary PCI^3 ,and展开更多
Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes ...Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein （hs-CRP）, pro-matrix metalloproteinase-1 （proMMP-1）, tissue inhibitors of matrix metalloproteinase-1 （TIMP-1） and coronary plaque morphology. Methods Intravascular ultrasound （IVUS） examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay （ELISA）. Results Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group, hs-CRP〉8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval （CI）, 67.0%-85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% （P〈0.01）, similarly for proMMP-1〉0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2%- 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% （P〈0.01）, and TIMP-1〉83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2%-78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% （P〈0.01）. Conclusion The plaque characteristics correlate with the clinical presentation. The elevation of hs-CRP, oroMMP-1 and TIMP-1 are related to the plaque instability and rupture.展开更多
Background Off-label application of drug-eluting stents （DES） during percutaneous coronary intervention （PCI） was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset...Background Off-label application of drug-eluting stents （DES） during percutaneous coronary intervention （PCI） was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent （SES） in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry.Methods The FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.Results Long lesions （59.2%）, multi-vessel disease （50.4%）, and small vessel disease （31.6%） were mostly found in angiography. Major adverse cardiac events （MACE） occurred in 51 （5.1%） patients at 1 year clinical follow-up,including cardiac mortality in 6 （0.6%）, non-fatal myocardial infarction in 11 （1.1%）, and target lesion revascularization in 36 （3.5%） of the patients. Definite and probable stent thrombosis （ST） by Academic Research Consortium （ARC） definition occurred in 12 （1.36%） patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was （0.21±0.40） mm in-segment and （0.23±0.36） mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.Conclusions The results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. （NCT00552656）展开更多
Objective: To investigate the distribution of Chinese medicine (CM) syndrome in patients with acute myocardial infarction (AMI) on admission and its impact on prognosis. Methods: A total of 525 AMI patients were prosp...Objective: To investigate the distribution of Chinese medicine (CM) syndrome in patients with acute myocardial infarction (AMI) on admission and its impact on prognosis. Methods: A total of 525 AMI patients were prospectively recruited and classified into 4 groups based on their clinical characteristics: excess-heat, excess-cold, deficiency-heat and deficiency-cold syndromes. Major adverse cardiovascular events (MACEs) were followed up. Results: The excess syndrome was more common than deficiency syndrome (72.95% vs. 27.05%;P<0.05). Totally 495 (94.29%) of 525 AMI patients were followed up (median 277 days). There were 59 (11.92%) MACEs. After adjusted with confounding factors in Cox regression models, the hazard ratio (95% confidence interval) of excess-heat, excess-cold, deficiency-heat and deficiency-cold syndrome groups were 1, 1.25 (0.63, 2.49;P<0.05), 2.37 (1.14, 4.94;P<0.05), 3.76 (1.71, 8.28;P<0.05), respectively. Conclusions: Excess syndrome was more common in AMI patients and had better prognosis, while deficiency-cold syndrome had the poorest prognosis. CM syndrome was of value in predicting long-term outcomes in AMI patients.展开更多
With increasing morbidity and mortality,acute myocardial infarction(AMI)has become one of the major causes of human death,leading to heavy burdens to individuals,families and society.Previous researches have found tha...With increasing morbidity and mortality,acute myocardial infarction(AMI)has become one of the major causes of human death,leading to heavy burdens to individuals,families and society.Previous researches have found that though large amount of resources and great effort were devoted,no significant improvements were achieved in reducing the in-hospital mortality of AMI patients.Meanwhile,extensive studies about Chinese medicine(CM)have found that CM has special advantages in treating AMI patients.However,there is no standardized and unified clinical practice guideline(CPG)of CM for AMI.Therefore,a CPG with strict standard and generally acknowledgement is urgent to be established.This guideline was developed following the methodological process established by the World Health Organization Handbook for Guideline Development.Extensive search on clinical evidences including systematic review(SR),randomized controlled trial(RCT),observational study and case reports was launched,covering evidence of CM for AMI on several aspects,such as diagnosis,CM patterns,CM interventions on AMI and complications,cardiac rehabilitation and clinical pathway management.Besides,the application of Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach enabled the evaluation of evidence and formulation of grade of recommendation(GOR)and level of evidence(LOE).With the help of GOR and LOE,this CPG recommends the integrative CM and WM treatment method in AMI patients and provides useful information on medical decision for clinical physicians.展开更多
Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with ...Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.展开更多
Background The safety and efficacy of drug-eluting stents （DES） implantation in unprotected left main （LM） bifurcation lesions has yet to be determined. The aim of the present report was to evaluate the long-term ...Background The safety and efficacy of drug-eluting stents （DES） implantation in unprotected left main （LM） bifurcation lesions has yet to be determined. The aim of the present report was to evaluate the long-term outcome following implantation of DES in unprotected LM bifurcation lesions.Methods We identified 70 consecutive patients treated with DES in unprotected LM bifurcation lesions from April 2003 to January 2005. Of them, 42 patients were treated with sirolimus-eluting stent （SES） and 28 patients were treated with paclitaxel-eluting stent （PES）. Results Stents to the left anterior descending and to the circumflex were implanted in 62 patients. During 1-year follow-up, 3 （4.3%） patients died of cardiac causes. One of them had myocardial infarction and adjudicated as possibly due to stent thrombosis. Angiographic follow-up was available in 80% of patients. The per lesion restenosis rate was 13.4% in the entire cohort, of which 10.7% occurred in lesions treated with SES and 16.1% in those treated with PES （P=0.58）. All restenosis was focal and occurred in the lesions treated with a stent with stent size to post-procedural reference vessel diameter ratio 〈1.0 （17.6% vs 0, P=0.04）. The per patient target lesion revascularization rate at 1 year was 17.1%. One year survival free from major adverse cardiac events was 77.1%. Conclusions Treatment of LM bifurcation lesions using DES is a safe and feasible way with a low one-year mortality. The need for revascularization in 17% of patients demands for improvement.展开更多
Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging afte...Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging after coronary microembolization. This study was designed to investigate the imaging of the left ventricle using delayed contrast enhanced magnetic resonance imaging as well as the left ventricular ejection fraction after coronary microembolization in animal models.Methods Eight miniswine, of either sex （body weight 21-25 kg）, were used to make the coronary microembolization model. After coronary angiography, a 2.8F infusion catheter was placed in the left anterior descending artery with the tip located between the second and third diagonal branches. Microspheres with the diameter of 42μm and mean dosage of 1.2×10^5 were selectively infused into the left anterior descending artery. First pass and stressed first pass perfusion scan were performed after cine images were acquired. Then a second bolus of 0.15 mmol/kg gadolinium DTPA was given at a rate of 2 ml/s. Ten minutes later, delayed contrast enhanced magnetic resonance images of the left ventricular wall were evaluated. Serum changes of tumor necrosis factor a （TNF-α） were evaluated by enzyme-linked immunosorbent assay （ELISA）.Results Hypoenhancement was not observed at first pass perfusion at the anterior wall of the left ventricle. Hyperenhancements of the anterior-septal and anterior wall of the left ventricle was in evidence on delayed enhancement images 6 hours after microembolization and disappeared one week later. The characteristic change of coronary microembolization on delayed contrast enhanced magnetic imaging was non-enhanced regions within the hyperenhancement zone. Left ventricular ejection fraction measured by magnetic resonance imaging decreased significantly from 0.451±0.063 at baseline to 0.362±0.070 at the sixth hour （P 〈0.01）, and recovered to 0.431±0.053 one week later （P 〈0.01 vs 6th hour）. Compared with baseline values, the left ventricular end systolic volume enlarged significantly at 6th hour and at one week after microembolization （P 〈0.05 and P 〈0.01 respectively）. Serum TNF-α increased significantly at 6th hour （22.62±6.96） pg/ml compared with baseline （16.83±3.45） pg/ml （P 〈0.05） and it further increased to （27.44±3.97） pg/ml at one week after coronary microembolization and was significantly higher than that at baseline （P 〈0.01）.Conclusions On delayed contrast enhanced magnetic resonance imaging, hyperenhancement of the anterior-septal and anterior wall of the left ventricle show at 6th hour but not at one week after coronary microembolization. This might represent the characteristic imaging after coronary microembolization. The left ventricular ejection fraction decreased at 6th hour and recovered one week later after coronary microembolization. Although impairment of left ventricular function could be recovered at 1 week after coronary microembolization, the left ventricular remodeling process still continued in concert with continuously elevation of serum TNF-α.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.51979029)。
文摘Vessels with semi-closed tanks(i.e.,well docks)are widely applied in the military operation and maritime engineer-ing.The water is bound by the semi-closed floating tank and forced by both the incident waves and ship’s motions.The free surface oscillations inside the flooded well dock is thus distinctive and very complicated.So far,the natural modes of semi-closed floating tanks have not yet been studied.This paper investigates the characteristics of natural modes of a floating semi-closed tank by combining a mode-resolving model based on mild-slope equations and a hydrodynamic model based on computational fluid dynamics.Results show that the first three natural periods(i.e.,74,23.6,and 14 s)of the tank fall into the band of swell and infragravity waves and they could be triggered under certain circumstance.Multi-period free surface oscillations are observed inside the tank,including the longest natural period(i.e.,74 s),though the incident waves are monochromatic.A possible generation mechanism for the long-period mode is explained on the basis of liquid sloshing and harbor oscillations.Moreover,a long-period component with a period close to the natural mode of well dock is observed in the ship motions,which is generated by the interaction between the waves and ship.
文摘Myocardial bridge （MB） is regarded as a common .anatomic variant rather than a congenital conditionanomaly, defined as the intrainyocardial course of a portion of the coronary artery. It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s. The current gold standard tor diagnosing MB is coronary angiography with the typical systolic compression of the epicardial coronary vessel （milking effect）.
文摘Primary percutaneous coronary intervention （PCI） has been the standard of care for patients with acuteST-elevation myocardial infarction hours of symptom onset in modem and applications of robust （STEMI） within 12 era.1＇2 The advances anti-platelet and anti-coagulation medicines further improve the outcome of STEMI patients undergoing primary PCI^3 ,and
基金This work was supported by grants from the Health Bureau of Zhejiang Province (No. 2004A075) and the Scientific Bureau of Hangzhou, Zhejiang Province (No. 2004433Q06).
文摘Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein （hs-CRP）, pro-matrix metalloproteinase-1 （proMMP-1）, tissue inhibitors of matrix metalloproteinase-1 （TIMP-1） and coronary plaque morphology. Methods Intravascular ultrasound （IVUS） examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay （ELISA）. Results Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group, hs-CRP〉8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval （CI）, 67.0%-85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% （P〈0.01）, similarly for proMMP-1〉0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2%- 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% （P〈0.01）, and TIMP-1〉83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2%-78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% （P〈0.01）. Conclusion The plaque characteristics correlate with the clinical presentation. The elevation of hs-CRP, oroMMP-1 and TIMP-1 are related to the plaque instability and rupture.
基金National Natural Science Foundation of China，Beijing Natural Science Foundation，Specilized Research Fund for the Doctoral Program of High Education of China
文摘Background Off-label application of drug-eluting stents （DES） during percutaneous coronary intervention （PCI） was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent （SES） in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry.Methods The FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.Results Long lesions （59.2%）, multi-vessel disease （50.4%）, and small vessel disease （31.6%） were mostly found in angiography. Major adverse cardiac events （MACE） occurred in 51 （5.1%） patients at 1 year clinical follow-up,including cardiac mortality in 6 （0.6%）, non-fatal myocardial infarction in 11 （1.1%）, and target lesion revascularization in 36 （3.5%） of the patients. Definite and probable stent thrombosis （ST） by Academic Research Consortium （ARC） definition occurred in 12 （1.36%） patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was （0.21±0.40） mm in-segment and （0.23±0.36） mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.Conclusions The results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. （NCT00552656）
基金Supported by the National Basic Research Program of China(No.2012CB518605)Science and Technology Innovative Program of Shanghai,China(No.10DZ1975400)
文摘Objective: To investigate the distribution of Chinese medicine (CM) syndrome in patients with acute myocardial infarction (AMI) on admission and its impact on prognosis. Methods: A total of 525 AMI patients were prospectively recruited and classified into 4 groups based on their clinical characteristics: excess-heat, excess-cold, deficiency-heat and deficiency-cold syndromes. Major adverse cardiovascular events (MACEs) were followed up. Results: The excess syndrome was more common than deficiency syndrome (72.95% vs. 27.05%;P<0.05). Totally 495 (94.29%) of 525 AMI patients were followed up (median 277 days). There were 59 (11.92%) MACEs. After adjusted with confounding factors in Cox regression models, the hazard ratio (95% confidence interval) of excess-heat, excess-cold, deficiency-heat and deficiency-cold syndrome groups were 1, 1.25 (0.63, 2.49;P<0.05), 2.37 (1.14, 4.94;P<0.05), 3.76 (1.71, 8.28;P<0.05), respectively. Conclusions: Excess syndrome was more common in AMI patients and had better prognosis, while deficiency-cold syndrome had the poorest prognosis. CM syndrome was of value in predicting long-term outcomes in AMI patients.
基金Supported by Guangdong Provincial Science and Technology Project(No.2014A020221103)Traditional Chinese Medicine Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine(No.YK2013B2N14)Joint Scientific Project of Department of Science and Technology of Guangdong Province and Guangdong Provincial Academy of Traditional Chinese Medicine(No.2014A020221048)。
文摘With increasing morbidity and mortality,acute myocardial infarction(AMI)has become one of the major causes of human death,leading to heavy burdens to individuals,families and society.Previous researches have found that though large amount of resources and great effort were devoted,no significant improvements were achieved in reducing the in-hospital mortality of AMI patients.Meanwhile,extensive studies about Chinese medicine(CM)have found that CM has special advantages in treating AMI patients.However,there is no standardized and unified clinical practice guideline(CPG)of CM for AMI.Therefore,a CPG with strict standard and generally acknowledgement is urgent to be established.This guideline was developed following the methodological process established by the World Health Organization Handbook for Guideline Development.Extensive search on clinical evidences including systematic review(SR),randomized controlled trial(RCT),observational study and case reports was launched,covering evidence of CM for AMI on several aspects,such as diagnosis,CM patterns,CM interventions on AMI and complications,cardiac rehabilitation and clinical pathway management.Besides,the application of Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach enabled the evaluation of evidence and formulation of grade of recommendation(GOR)and level of evidence(LOE).With the help of GOR and LOE,this CPG recommends the integrative CM and WM treatment method in AMI patients and provides useful information on medical decision for clinical physicians.
文摘Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. Conclusions Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.
文摘Background The safety and efficacy of drug-eluting stents （DES） implantation in unprotected left main （LM） bifurcation lesions has yet to be determined. The aim of the present report was to evaluate the long-term outcome following implantation of DES in unprotected LM bifurcation lesions.Methods We identified 70 consecutive patients treated with DES in unprotected LM bifurcation lesions from April 2003 to January 2005. Of them, 42 patients were treated with sirolimus-eluting stent （SES） and 28 patients were treated with paclitaxel-eluting stent （PES）. Results Stents to the left anterior descending and to the circumflex were implanted in 62 patients. During 1-year follow-up, 3 （4.3%） patients died of cardiac causes. One of them had myocardial infarction and adjudicated as possibly due to stent thrombosis. Angiographic follow-up was available in 80% of patients. The per lesion restenosis rate was 13.4% in the entire cohort, of which 10.7% occurred in lesions treated with SES and 16.1% in those treated with PES （P=0.58）. All restenosis was focal and occurred in the lesions treated with a stent with stent size to post-procedural reference vessel diameter ratio 〈1.0 （17.6% vs 0, P=0.04）. The per patient target lesion revascularization rate at 1 year was 17.1%. One year survival free from major adverse cardiac events was 77.1%. Conclusions Treatment of LM bifurcation lesions using DES is a safe and feasible way with a low one-year mortality. The need for revascularization in 17% of patients demands for improvement.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30671998）.
文摘Background Detection of coronary microembolization is of clinical importance for patient management and prediction of long-term outcome. However, there are few studies of the changes of magnetic resonance imaging after coronary microembolization. This study was designed to investigate the imaging of the left ventricle using delayed contrast enhanced magnetic resonance imaging as well as the left ventricular ejection fraction after coronary microembolization in animal models.Methods Eight miniswine, of either sex （body weight 21-25 kg）, were used to make the coronary microembolization model. After coronary angiography, a 2.8F infusion catheter was placed in the left anterior descending artery with the tip located between the second and third diagonal branches. Microspheres with the diameter of 42μm and mean dosage of 1.2×10^5 were selectively infused into the left anterior descending artery. First pass and stressed first pass perfusion scan were performed after cine images were acquired. Then a second bolus of 0.15 mmol/kg gadolinium DTPA was given at a rate of 2 ml/s. Ten minutes later, delayed contrast enhanced magnetic resonance images of the left ventricular wall were evaluated. Serum changes of tumor necrosis factor a （TNF-α） were evaluated by enzyme-linked immunosorbent assay （ELISA）.Results Hypoenhancement was not observed at first pass perfusion at the anterior wall of the left ventricle. Hyperenhancements of the anterior-septal and anterior wall of the left ventricle was in evidence on delayed enhancement images 6 hours after microembolization and disappeared one week later. The characteristic change of coronary microembolization on delayed contrast enhanced magnetic imaging was non-enhanced regions within the hyperenhancement zone. Left ventricular ejection fraction measured by magnetic resonance imaging decreased significantly from 0.451±0.063 at baseline to 0.362±0.070 at the sixth hour （P 〈0.01）, and recovered to 0.431±0.053 one week later （P 〈0.01 vs 6th hour）. Compared with baseline values, the left ventricular end systolic volume enlarged significantly at 6th hour and at one week after microembolization （P 〈0.05 and P 〈0.01 respectively）. Serum TNF-α increased significantly at 6th hour （22.62±6.96） pg/ml compared with baseline （16.83±3.45） pg/ml （P 〈0.05） and it further increased to （27.44±3.97） pg/ml at one week after coronary microembolization and was significantly higher than that at baseline （P 〈0.01）.Conclusions On delayed contrast enhanced magnetic resonance imaging, hyperenhancement of the anterior-septal and anterior wall of the left ventricle show at 6th hour but not at one week after coronary microembolization. This might represent the characteristic imaging after coronary microembolization. The left ventricular ejection fraction decreased at 6th hour and recovered one week later after coronary microembolization. Although impairment of left ventricular function could be recovered at 1 week after coronary microembolization, the left ventricular remodeling process still continued in concert with continuously elevation of serum TNF-α.
