MRA在识别颅内小动脉瘤形状上的应用价值:与DSA对比

目的 探讨磁共振血管成像(MRA)识别小尺寸未破裂颅内动脉瘤形状的应用价值。方法 回顾性分析由MRA发现并经DSA证实的38例未破裂颅内小动脉瘤(<7 mm)。将所有动脉瘤分为两组(≤3mm及3.1mm-6.9mm),使用MRA分析动脉瘤的形状,数字减影血管造影(DSA)检查结果作为动脉瘤形状的参考标准,评估MRA的敏感性、特异性和准确性。结果 MRA评估≤3mm组动脉瘤的敏感性41.6%、特异性57.1%、阴性预测值36.4%、阳性预测值62.5%、准确性47.4%,评估3.1mm-6.9mm组动脉瘤的敏感性81.8%、特异性91.7%、阴性预测值84.6%、阳性预测值90.0%、准确性87.0%。结论 MRA评估≤3mm颅内小动脉瘤形状的价值较低,而对3.1mm-6.9mm动脉瘤的应用价值较高。

动脉几何形状对血液动力学因素影响的晶格玻尔兹曼方法研究

利用晶格玻尔兹曼方法研究了局域动脉几何形状对血液动力学参数的影响。通过分析狭窄、弯曲、扩张等动脉内的血液流量和局部剪切力，获取了血管构型和血液动力学参数的关系。研究可以为了解血液动力学的力学机理和心血管疾病的诊断和防治提供一定的帮助。

主动脉瓣重度狭窄的主动脉根部重塑:对经导管主动脉瓣植入的影响

详细了解主动脉根部的几何形状是预测经导管主动脉瓣（TAV）植入产生并发症的先决条件。我们通过CT检查确定主动脉瓣狭窄（AS）病人的冠状动脉开口的位置和主动脉根部的尺寸大小，并将上述值与正常个体的进行比较。研究资料包括经心脏双源CT检查的连续100例主动脉3个瓣重度狭窄的AS病人和连续100例无瓣膜病变病人（作为对照）。测量由主动脉环（AA）到左冠状动脉口（LCO）和到右冠状动脉口（RCO）的距离，测量左冠窦（HLS）和右冠窦的高度（HRS），

Cutting-balloon angioplasty before drug-eluting stent implantation for the treatment of severely calcified coronary lesions

Background Severely calcified coronary lesions respond poorly to balloon angioplasty, resulting in incomplete and asymmetrical stent expansion. Therefore, adequate plaque modification prior to drug-eluting stent （DES） implantation is the key for calcified lesion treat- ment. This study was to evaluate the safety and efficacy of cutting balloon angioplasty for severely calcified coronary lesions. Methods Ninety-two consecutive patients with severely calcified lesions （defined as calcium arc 〉 180% calcium length ratio 〉 0.5） treated with bal- loon dilatation before DES implantation were randomly divided into two groups based on the balloon type： 45 patients in the conventional balloon angioplasty （BA） group and 47 patients in the cutting balloon angioplasty （CB） group. Seven cases in BA group did not satisfactorily achieve dilatation and were transferred into the CB group. Intravascular ultrasound （IVUS） was performed before balloon dilatation and after stent implantation to obtain qualitative and quantitative lesion characteristics and evaluate the stent, including minimum lumen cross-sectional area （CSA）, calcified arc and length, minimum stent CSA, stent apposition, stent symmetry, stent expansion, vessel dissection, and branch vessel jail. In-hospital, 1-month, and 6-month major adverse cardiac events （MACE） were reported. Results There were no statistical differences in clinical characteristics between the two groups, including calcium arc （222.2° ± 22.2° vs. 235.0° ± 22.1 °, p=0.570）, calcium length ratio （0.67 ± 0.06 vs. 0.77± 0.05, P = 0.130）, and minimum lumen CSA before PCI （2.59 ±0.08 mm2 vs. 2.52 ± 0.08 mm2, P = 0.550）. After stent implantation, the final minimum stent CSA （6.26 ± 0.40 mm2 vs. 5.03 ± 0.33 mm2; P = 0.031） and acute lumen gain （3.74 ±0.38 mm2 w. 2.44 ± 0.29 mm2, P = 0.015） were significantly larger ila the CB group than that of the BA group. There were not statis tically differences in stent expansion, stent symmetry, incomplete stent apposition, vessel dissection and branch vessel jail between two groups. The 30-day and 6-month MACE rates were also not different. Conclusions Cutting balloon angioplasty before DES implantation in severely calcified lesions appears to be more efficacies including significantly larger final stent CSA and larger acute lumen gain, without increasing complications during operations and the MACE rate in 6-month.

Superior mesenteric artery syndrome in a diabetic patient with acute weight loss

Superior mesenteric artery(SMA)syndrome is an un- common disease resulting compression of the third portion of the duodenum from the superior mesenteric artery.This disease shares many common manifestations with diabetic gastroparesis,including postprandial fullness,nausea,vomiting,and bloating.Therefore,it is often overlooked in diabetic patients.Here,we report a 41-year-old man with poorly controlled diabetic mellitus who developed SMA syndrome due to rapid weight loss. The diagnosis was confirmed by computed tomography and an upper gastrointestinal series.His condition improved after parenteral nutrient,strict sugar control, and gradual weight gain.

Clinical Observation on Shu Xin Yi Mai Capsules for Prevention of Recurrent Stricture after Coronary Artery Introducing Treatment

Shu Xin Yi Mai Capsules (舒心益脉胶囊) combined with western medicine was used in the routine treatment of 22 cases who successfully received coronary artery introducing therapy (Chinese-western medicine group),and the results was compared with the 26 cases treated routinely with simple western medicine in the control group (western medicine group).It was found that both the recurrence rate of angina pectoris and the incidence rate of recurrent stricture in the Chinese-western medicine group were significantly lower than that in the control group (both P<0.05).There was no significant difference between the two groups in expression of platelet activating molecules CD62P (a-granular membrane protein),CD63 (lysosome intact membrane protein) and CD41 (glucoprotein IIb) before the treatment,but with a significant difference after the treatment (P<0.05).

Delayed post-dilated stenting to treat an embolic myocardial infarction

Thromboembolism infrequently occurs in coronary arteries. In contrast to an in situ thrombosis, a thrombus is not fresh and floating. There has been no recommended treatment strategy for this rare condition, especially for large thrombi in main arteries. Here, we report a modified stenting strategy to treat thromboembolism in the left main coronary artery.

Acute myocardial infarction in patients of nephrotic syndrome： a case series

Thromboembolic complications have been frequently re- ported in patients with long-lasting nephrotic syndrome （NS）. Although thrombotic complications in the venous system are common in patients with NS, arterial thromboses associated with NS are much less common. However, coronary thromboses are extremely rarely observed. So, NS is a rare cause of acute coronary syndrome （ACS）. As such, the incidence, pathogenesis, and treatment of these patients have yet to be clearly defined. In the current litera- ture, publications contain less than 15 patients, most of whom are young children.

Optimization of rotor shape for constant torque improvement and radial magnetic force minimization

The design of notch and barrier was optimized in order to improve the characteristics of constant torque while minimizing the cogging torque that occurs as a result of teeth and slot structure. The barrier was installed in order to minimize the cogging torque and torque ripple by finite element method (FEM) with a reduced barrier width toward the center of magnetic pole. The position and width of notch, which can offset cogging torque, can be calculated with energy distribution of air-gap using Fourier series. The optimized model demonstrates a 60% decrease in the cogging torque, a 75.3% decrease in the torque ripple and a 3% increase in the operating torque when compared with the basic model.

Relationships between vascular factors and plaque morphology in patients with acute coronary syndrome

Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound（lVUS） was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors（sPE,t-PA, MCP-1, IL-8,1L-6,sVCAM-1, and sCD40L） was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction （AMI） and ustable angina （UA） patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-lsPE, sVCAM-I-sCD40L, sCD40L-sPE, IL-6-ILS,ILS-MCP1, and MCPI-sVCAM-1; CRP （18.868±4.907mg/L vs 5.806±3.553 mg/L）and IL-6 （19.5 pg/ml [9.2 - 44.6 pg/ml]vs 5.3 pg/ml [2.3- 13.4 pg/ml]）were elevated in the vulnerable plaque group（P 〈0.05）. sCD40L（473.82± 126.11 vs 237.94± 34.78 pg/ml）,sPE （107.21±39.90 vs 49.06 ±5.61ug/L） and MCP-1（132.42 ± 17.85 vs 127.17±13.27 pg/ml） were increased in the plaque rupture group（P 〈 0.05）;There was correlation between tPA and plaque morphology（P 〈 0.05）. Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis ofAMI, sCD40L, MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.

A Theoretical Study on the Interaction of Crown Tetraalanylpeptide with NO3- and SO4/2-

Crown peptide is a kind of special conformation found on the homodetic cyclopeptide, regular array about the main chain containing imido groups, and the monolithic conformation presents coronary analogy to crown ether. There are high symmetrical ionophores belonging to Cn point group. The channels or apertures can form easily for recognizing certain ion or molecular, and also the function of intending dual-recognition and the ability for transporting as ionophores can be possessed. Under the method of density functional theory, the geometry structures, values energy and population analysis of the combo of crown tetraalanylpeptide （C4-Ala） with NO3- and SO4/2- are calculated, based on the foundation of former studies. Compared with the structure of C4-AIa without NO3- and SO4/2- it is found that the coronary shape changes little in the complex of C4-Ala-YOm/n-, and the electrons transfer between C4-AIa and YOm/n- at the mean time. There are hydrogen bond between oxygen of YOm/n- and the hydrogen from imine groups of C4-AIa, and they become weaker when the average charge density lessens.

Cell Area and Strut Distribution Changes of Bent Coronary Stents:A Finite Element Analysis

Coronary stents are metal coils or mesh tubes delivered to blocked vessels through catheters, whic Recently, special drugs h are expanded by balloons to reopen and scaffold target vessels. are carried by stents （drug-eluting stents） to further reduce instent restenosis rate after stenting procedure. However, continual study on biomechanical characteristics of stents is necessary provide a more suitable drug loading for better interactions between stents and tissue, or to platform for drug-eluting stents. The purpose of this paper is to show how finite element methods can be used to study cell area and strut distribution changes of bent coronary stents. A same bending deformation was applied to two commercial coronary stent models by a rigid curved vessel. Results show that the stent design influenced the changes of cell area and strut distribution under bending situation. The stent with links had more cell area changes at outer curvature, and the stent with peak-peak （ 〉 〈 ） strut design could have strut contact and overlapping at inner curvature. In conclusion, this finite element method can be used to study and compare cell area and strut distribution changes of bent stents, and to provide a convenient tool for designers in testing and improving biomechanical characteristics of new stents.

Use of cutting balloons in coronary interventions

Objective To study the efficacy and safety of cutting balloons in coronary interventions.Methods Twenty-two patients with 23 narrowed coronary arteries and 25 lesions enrolled the study, 17 of whom had 18 diseased coronary arteries and 18 lesions were in-stent restenosis. The average time from previous stenting was 7.60±3.53 months. The lesions were dilated with cutting balloons. Results All of the lesions were dilated successfully by 5.16±2.30 inflations of a cutting balloon. The mean total duration of balloon inflation was 233.96±94.83 seconds at pressures up to 9.40±1.96 bars. The severity of vascular stenosis was lessened substantially (89.64±8.65% vs 17.60±17.15%, P=0.000) without severe complications. Three restenotic lesions were further dilated with conventional balloons, another one was stented again because of a dissection distal to the previous stent. Three primary lesions were stented for dissection or residual stenosis. Angina pectoris reoccurred in two patients in a mean follow-up period of 7.42±6.87 (range 0.5-20) months. Conclusion Cutting balloon dilation is an effective and safe choice in interventions for coronary disease especially for in-stent restenosis.

Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

Objective To observe the immediate angiographic and intravascular ultrasound (IVUS) results and their effects on one month clinical outcomes in forty one patients who submitted to coronary stent deployment with IVUS guidance Methods All patients were allocated to coronary stent implantation with high inflation pressure After good angiographic results (<20% residual stenosis), all patients underwent IVUS and higher pressure dilatation would be necessary if criteria for optimal coronary stent implantation were not met The optimal criterion of IVUS for stent implantation was the ratio of intrastent lumen cross sectional area to the average of the proximal and distal reference lumen cross sectional areas ≥80% All patients had aspirin and ticlopidine therapy on the day of angioplasty and during the one month follow up period Results Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty five patients but intrastent higher pressure dilatation was performed in fourteen patients whose ultrasound results did not reach the criteria In these patients, we increased the minimal intrastent lumen area 25 7% ( P <0 05) Thirty five patients (90%) had good minimal intrastent lumen area of IVUS There were no deaths, myocardial infarction, acute stent thrombosis or need for revascularization during the study and the one month follow up Conclusions Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical outcomes after one month follow up

Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective To examine long term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this hospital were followed by direct interview or letter The rate of follow up was 84 2% and the period of follow up was 0 9-12 7 (3 5±2 4) years Results During follow up, 4 (0 5%) patients died, 22 (2 8%) had nonfatal acute myocardial infarction, 10 (1 3%) had coronary artery bypass surgery, and 98 (12 4%) had repeat PTCA The rate of recurrent angina pectoris was 31 1% The cardiac event free survival rate calculated by the Kaplan Meier method was 88 2% at 1 year and 80 6% at 12 7 years Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events Compared to the PTCA group, patients with PTCA+stent had significantly lower rates of total cardiac events Conclusion The long term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treatment for revascularization in patients with coronary heart disease

Recurrence quantification analysis on pulse morphological changes in patients with coronary heart disease

OBJECTIVE： To show that the pulse diagnosis used in Traditional Chinese Medicine, combined with nonlinear dynamic analysis, can help identify car- diovascular diseases. METHODS： Recurrence quantification analysis （RQA） was used to study pulse morphological changes in 37 inpatients with coronary heart dis- ease （CHD） and 37 normal subjects （controls）. An in- dependent sample t-test detected significant differ- ences in RQA measures of their pulses. A support vector machine （SVM） classified the groups accord- ing to their RQA measures. Classic time-domain pa- rameters were used for comparison. RESULTS： RQA measures can be divided into two groups. One group of measures [ecurrence rate（RR）, determinism （DEL）, average diagonal line length （L）, maximum length of diagonal structures （Lmax）, Shannon entropy of the frequency distribu- tion of diagonal line lengths （ENTR）, laminarity （LAM）, average length of vertical structures （TT）, maximum length of vertical structures （Vmax）] showed significantly higher values for patients with CHD than for normal subjects （P〈0.0S）. The other measures （RR_std, L_std, Lmaxstd, TT_std, Vmax_std） showed significantly lower values for the CHD group than for normal subjects （P〈0.05）. SVM classification accuracy was higher with RQA measures： With RQA （16 parameters） accuracy was at 88.21%, and with RQA（12 parameters） accuracy was at 84.11%. In contrast, with classic time-do- main （15 parameters） accuracy was 75.73%, and with time-domain （7 parameters） accuracy was 74.7O%. CONCLUSION： Nonlinear dynamic methods such as RQA can be used to study functional and struc- tural changes in the pulse noninvasively. Pulse sig- nals of individuals with CHD have greater regulari- ty, determinism, and stability than normal subjects, and their pulse morphology displays less variabili- ty. RQA can distinguish the CHD pulse from the healthy pulse with an accuracy of 88.21%, thereby providing an early diagnosis of cardiovascular dis- eases such as CHD.