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15 November 2017, Volume 45 Issue 11 Previous Issue    Next Issue

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Early diagnosis and optimal treatment of acute myocardial infarction#br# GE Jun-bo, DAI Yu-xiang 2017, 45 (11):  1121-1123.  doi: 10.11958/20170912 Abstract ( 789 )   PDF (323KB) ( 3493 )    In recent years, benefited from the progress of clinical studies of early diagnosis and early revascularization in acute myocardial infarction (AMI), the guidelines for Europe and the United States and the Chinese academic continue to be updated to guide our clinical practice. However, AMI still remains one of the major causes of death in the worldwide. Over the past 10 years, the incidence of AMI increased rapidly in China, and the mortality kept at a high level. There is still plenty of room to improve in the early diagnosis of cardiac troponin, revascularization strategy optimization of non-infarct-related vascular, optimized new antiplatelet therapy, development of regional synergies network and chest pain center. There is still a long way from the standardized treatment of AMI. It is very important to complete early diagnosis and optimum treatment of AMI. Related Articles | Metrics

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Progress and current challenges in treatment of acute myocardial infarction in China LIU Yin, GAO Jing 2017, 45 (11):  1124-1129.  doi: 10.11958/20171128 Abstract ( 681 )   PDF (442KB) ( 3558 )   With high incidence, high mortality, high disability and high medical cost, acute myocardial infarction(AMI), the most acute events of coronary heart disease (or the acute exacerbation of chronic coronary disease), becomes the priority in preventing and treating cardiovascular diseases and the vital point of reducing cardiovascular mortality. In recent years, with the continuous improvement of AMI treatment strategy and the application of new treatment methods, based on the recent large-scale clinical trials, the guideline of treating AMI are constantly updated at home and abroad to better guide clinical work. In this paper, we share the advanced technologies and concepts in treating AMI, and look forward to the new academic frontiers. We aim to make a brief analysis of the latest treatment guidelines and the latest research progress. Related Articles | Metrics

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The timing of intervention of acute ST-segment elevation myocardial infarction ZHANG Wen-juan, ZHANG Yun-sheng 2017, 45 (11):  1130-1134.  doi: 10.11958/20170795 Abstract ( 825 )   PDF (361KB) ( 3463 )   Recently, early reperfusion therapy has become the optimal treatment for acute ST-segment elevation myocardial infarction (STEMI). One of the most effective reperfusion strategies is percutaneous coronary intervention (PCI).Depend on the time of chest pain onset, transfer mode of patients and treatment capacity of hospital, the methods of PCI are different, including primary PCI, rescue PCI and facilitated PCI. How to seize the optimal time of intervention therapy and reduce the time interval from symptom onset to reperfusion to rescue the dying myocardial cells are the key for improving prognosis, reducing mortality and decreasing major adverse cardiovascular events (MACE) of patients. Related Articles | Metrics

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Revascularization strategy for STEMI patients with multivessel disease ZHAO Guan-qi, SHI Shu-tian, WANG Xiao, NIE Shao-ping 2017, 45 (11):  1135-1138.  doi: 10.11958/20170928 Abstract ( 698 )   PDF (2772KB) ( 3661 )   ST-segment elevation myocardial infarction (STEMI) in patients with multivessel disease is a common situation, and suggests poor prognosis. After the reperfusion of infarct-related blood vessels in the primary PCI (PPCI), how to deal with the non-infarct related vessel has been a hot issue. In recent years, more and more evidence suggests that compared with treatment of infarct-related vessels only, revascularization of non-infarct related vessels will result in a better prognosis. But the timing and the choice of non-infarct-related vessel revascularization are still controversial. This article reviews the latest clinical evidence to improve the diagnosis and treatment of STEMI patients with multivessel disease. Related Articles | Metrics

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Discussion on hot issues in acute myocardial infarction complicated with cardiogenic shock CHEN Yan, LIU Yin 2017, 45 (11):  1138-1140.  doi: 10.11958/20170766 Abstract ( 716 )   PDF (305KB) ( 3534 )   Cardiogenic shock (CS) is defined as a state of critical tissue hypoperfusion and endorgan failure because of reduced cardiac output. Acute myocardial infarction (AMI) is a prominent cause of CS. Despite advances in interventional and medical treatment, CS remains the leading cause of death in AMI. Early revascularization can reduce the mortality. The guideline for primary percutaneous coronary intervention (PCI) indicates that emergency revascularization is recommended in suitable patients with cardiogenic shock due to pump failure after AMI regardless of the duration of the disease. The type of revascularization, either PCI or coronary artery bypass grafting (CABG), might the optimal treatment strategy. The use of mechanical circulatory support devices appears to provide temporary circulatory support for patients with CS. Related Articles | Metrics

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Progress in revascularization strategy of ST-segment elevation myocardial infarction with multiple vessel disease#br# DAI Yu-xiang, QIAN Ju-ying 2017, 45 (11):  1141-1144.  doi: 10.11958/20170913 Abstract ( 638 )   PDF (329KB) ( 3559 )   ST-segment elevation myocardial infarction (STEMI) is the most serious type of coronary heart disease,accounting for 25% to 40% of acute myocardial infarction (AMI). The key to treat STEMI is to restore myocardial perfusion in the infarct area, to rescue the ischemic myocardium, and to reduce the size of infarction. About 41% to 67% of patients with STEMI have multiple vascular disease (MVD). Compared with single vessel disease, the clinical outcome of MVD is worse. In these patients, it still remains a controversial topic in emergency interventions for STEMI patients, the infarct-related artery only revascularization or multi-vessel revascularization, and the timing of revascularization. The clinical studies of revascularization strategy for MVD in STEMI patients have been ongoing, and the results have also led to the continuous updating of guidelines and treatment strategies. Related Articles | Metrics

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The progress of interventional therapy time and influential factors in patients with ST-segment elevation myocardial infarction#br# LIU Ze, WANG Le-feng 2017, 45 (11):  1145-1149.  doi: 10.11958/20170966 Abstract ( 710 )   PDF (369KB) ( 3553 )   Acute myocardial infarction is one of the most severe diseases that cause higher incidence and mortality. It is important to take effective clinical measures to improve the prognosis. Shortening the time of treatment is controllable in clinical work, which plays a key role in limiting and reducing the myocardial infarction size. This article summarized the interventional therapy time and influential factors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, providing the basis for clinical application. Related Articles | Metrics

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The characteristics and progress of treatment in ventricular septum rapture after acute#br# myocardial infarction#br# SHAO Ying, LIU Yin 2017, 45 (11):  1149-1152.  doi: 10.11958/20170763 Abstract ( 746 )   PDF (326KB) ( 3778 )   As the development of percutaneous coronary intervention (PCI), the incidence of ventricular septum rapture(VSR) after acute myocardial infarction (AMI) is getting lower and lower, but the mortality is still high. Promptly diagnosis and surgery are still the first choose for treatment. Delay surgery may bring better result for patients with stable conditions.Internal medicine treatment is usually useless, and mechanical support may offer chance of delay surgery. Percutaneous interventional closure can reduce shunt for patients who are not able to tolerate surgery in the acute phase. Related Articles | Metrics

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The effect of nicorandil on slow-flow phenomenon in PCI in patients with non-ST segment elevated myocardial infarction#br# LI Wen-ting, YAO Zhu-hua, PANG Zhi-hua, CAI Hong-bin, CHENG Li-song, CAO Ming-ying, SONG Min 2017, 45 (11):  1153-1157.  doi: 10.11958/20170799 Abstract ( 831 )   PDF (369KB) ( 3586 )   Objective To observe the effect of nicorandil on slow-flow phenomenon in percutaneous coronary intervention (PCI) in patients with acute non-ST segment elevated myocardial infarction (NSTEMI). Methods A total of 159 NSTEMI patients were enrolled. Based on the TIMI flow of target lesion blood vessels after PCI, patients were divided into two groups. There were 31 cases in no flow/slow flow group (TIMI≤2), and 128 cases in normal group (TIMI=3). The general clinical data, immediate TIMI flow grade of infarct-related artery (IRA) after PCI treatment, post-operative corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG), thrombolysis in myocardial infarction signs of a blood clot, number of diseased vessels and major adverse cardiac events were compared between the two groups. The patients in no flow / slow flow group were given nicorandil, and changes of blood flow before and after treatment were observed. The influence factors of no flow/slow flow were analyzed by multifactor Logistic regression. Results The proportions of patients with history of smoking, the proportion of patients with diabetes history, the proportion of patients with hyperlipidemia, the proportion of patients with low blood pressure in operation, and the number of implanted stents, the proportions of patients took tirofiban in operation, post-operative CTFC, the proportions of patients with thrombosis signs were significantly higher in no flow/slow flow group than those in the normal group (P＜0.05). There were no significant differences in heart rates in operation, IRA distribution and the number of lesion vessels between the two groups. There were also no significant differences in the incidence of MACE and left ventricular ejection fraction between the two groups. After the application of nicorandil, the proportion of patients with TIMI blood flow 3 and proportions of cTFC and TMPG were significantly higher than before treatment (P＜0.05). Results showed that smoking history, history of diabetes, multiple stents (more than 3),hypotension in PCI, and signs of blood clot were factors influencing the slow flow of coronary arteries. Conclusion Nicorandil can significantly improve the no flow/slow flow in PCI in patients with NSTEMI. Related Articles | Metrics

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The relationship between serum level of H-FABP before PCI and prognosis in patients with STEMI#br# YANG Qin, ZHANG Jian-qi, ZHANG Mei, SHI Rui, ZHANG Juan 2017, 45 (11):  1157-1161.  doi: 10.11958/20170887 Abstract ( 815 )   PDF (365KB) ( 3557 )   Objective To observe the relationship between serum level of H-FABP before percutaneous coronary intervention (PCI) and prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 104 cases were recruited in this study. PCI was performed 12 h after onset. The concentration of H-FABP was detected before operation. Gensini score system was used to calculate the integral of all patients after coronary angiography. According to Gensini score, patients were divided into three groups, 34 cases in group A (8≤Gensini scores＜41), 34 cases in group B(41≤Gensini scores＜64) and 36 cases in group C (Gensini scores≥64). Indicators were analyzed statistically including systolic blood pressure (SBP), diastolic blood pressure (DBP), smoking history, H-FABP, left ventricular ejection fraction (LVEF), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), fasting blood sugar, diabetes (DM) and hypertension. The patients were followed up for 12 months after operation. According to the occurrence of major adverse cardiovascular events (MACE), patients were divided into MACE group and non- MACE group.The related factors of two groups were statistically analyzed. The multivariate Logistic regression analysis was used to screen the risk factors of MACE for patients with STEMI after emergency PCI. Results There is a gradually increasing tendency in total cholesterol levels among three A, B and C groups (P＜0.05). LVEF values were lower in B group and C group than that of A group (P＜0.05). There were no significant differences in levels of SBP, DBP, H-FABP, TG, HDL-C, LDL-C, fasting plasma glucose and smoking history, DM, and hypertension between three groups (P＞0.05). In 12-month follow-up, the proportion of STEM combined with DM, the time from onset to PCI, the level of TC, the level of H-FABP before operation and Gensini score were significantly higher in MACE group than those of non-MACE group (P＜0.05). Logistic regression analysis showed that STEM combined with DM, higher serum level of H-FABP before operation were risk factors of MACE in 12-month after operation (P<0.05). Conclusion For patients with acute STEM combined with diabetes and elevated preoperative serum level of H-FABP, be alert to the occurrence of MACE in 12-month after PCI Related Articles | Metrics

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Clinical characteristics of acute myocardial infarction in very elderly patients ZHANG Ming-ming, MA Xiang-hong 2017, 45 (11):  1162-1166.  doi: 10.11958/20170701 Abstract ( 707 )   PDF (344KB) ( 3481 )   Objective To analyze the clinical characteristics of very elderly patients (age ≥80 years) with acute myocardial infarction (AMI) and to provide basis for the treatment and prevention of AMI. Methods The clinical data of 296 patients with ST-segment elevation AMI who admitted in the Second Hospital of Tianjin Medical University during May 2012 to July 2014 were retrospectively analyzed. The patients were divided into very elderly group (≥80 years old, n=54),elderly group (60-79 years old, n=148) and younger group (<60 years old, n=94). The clinical baseline data, infarction area,imaging data, medication in-hospital and adverse cardiovascular events were compared between the three groups. Results The proportion of smoking, diastolic blood pressure, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C),erythrocyte count (RBC) and hemoglobin (HGB) at admission were significantly lower in the very elderly group. Results of electrocardiogram (ECG) showed mainly anterior wall infarction in three groups, and there were higher proportions of multiple infarcts in very elderly group and elderly group than those of younger group (31.5% vs. 31.8% vs. 17.0%, χ2=6.994,P < 0.016 7). Coronary angiography (CAG) indicated that the target vessels were mostly right coronary arteries (61.1%) invery elderly group, while they were mainly left anterior descending (proportions were 50.7% and 43.6% respectively) in elderly group and the younger group. The proportion of high thrombotic load, the proportion of temporary cardiac pacing and no-reflow rate were significantly higher but the proportion of percutaneous coronary intervention (PCI) was lower in the very elderly group than those of younger group. The result of ultrasonic cardiogram (UCG) illustrated that the diameter of the left atrial diameter (LAD) and the left ventricular end-systolic dimension(LVDs) were larger in very elderly group than those of younger group (P < 0.016 7). The left ventricular ejection fraction (LVEF) was lower in the very elderly group and the elderly group than that of the young group, and the incidence of ventricular aneurysm was higher than that of the young group.During the hospitalization, the percentage of using diuretics, positive inotropic drugs and intraoperative tirofiban were higher in the very elderly group than those of elderly group and younger group. Meanwhile, all-cause mortality, the percentage of new-onset atrial fibrillation (NOAF) and the percentage of atrioventricular block were also higher in the very elderly group compared with those of other two groups (P < 0.016 7). Conclusion The very elderly patients with AMI are generally related with complex diseases and more postoperative complications. It is important to perform the blood vessel recanalization early according to the specific conditions, and to assess the risk of postoperative bleeding, thrombosis and other related risks in order to select the appropriate treatment with low mortality and less risk of hospital complications in the very elderly patients with AMI. Related Articles | Metrics

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Clinical characteristics of patients with acute myocardial infarction and hypothyroidism SHU Wen, LIU Ying-chuan, ZHANG Mei 2017, 45 (11):  1167-1170.  doi: 10.11958/20170756 Abstract ( 769 )   PDF (312KB) ( 3476 )   Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) combined with hypothyroidism, and to explore the correlation between thyroid function and AMI. Methods The clinical data of 511 patients with AMI combined with hypothyroidism were retrospectively analyzed. According to thyroid function,patients were divided into hypothyroidism group (n=40), subclinical hypothyroidism group (n=67), low T3 syndrome group (n=52) and normal thyroid function group (the normal group, n=352). The general situation, biochemical indexes, coronary lesions and echocardiographic indexes were compared between the four groups. Multivariate Logistic regression analysis of the influencing factors of hypothyroidism were analysed in patients with myocardial infarction. Results Compared with the control group, patients showed higher age, increased proportion of hypertension, Gensini score and lower level of highdensity lipoprotein cholesterol (HDL-C) in the hypothyroidism group and the low T3 group (P < 0.05). Compared with the control group, the level of low-density lipoprotein cholesterol (LDL-C) was significantly elevated, left atrial diameter (LAD) increased, and left ventricular ejection fraction (LVEF) decreased in hypothyroidism group (P < 0.05). Logistic regression analysis showed that advanced age (OR=1.038), hypertension (OR=1.992) and high level of LDL-C (OR=1.649) were the risk factors for the occurrence of hypothyroidism in patients with myocardial infarction, and the high level of HDL-C (OR=0.172),free triiodothyronine (FT3, OR=0.550) and LVEF (OR=0.953) may be protective factors. Conclusion Patients with AMI and hypothyroidism show dyslipidemia, increased coronary stenosis, cardiac insufficiency, and the lower level of FT3. In the early clinical stage, the development of myocardial infarction can be predicted from the thyroid function in patients,especially the level of FT3. Related Articles | Metrics

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The impact of Spry1 on adipocyte differentiation CEN Yun-zhu, LIU Ying, YANG Wei-li, WANG Bao-li 2017, 45 (11):  1171-1174.  doi: 10.11958/20170715 Abstract ( 677 )   PDF (451KB) ( 3871 )   Objective To investigate the effect of Spry1 on adipocyte differentiation from ST2 cells by using siRNA.Methods Synthesized siRNA targeting Spry1 was used as experimental group, and control siRNA was used as control group. Spry1 siRNA and control siRNA were transfected into ST2 cells, then treating with adipogenic medium to induce adipocyte differentiation. The mRNA expression levels of Spry1 and adipocyte differentiation-specific genes PPARγ(peroxisome proliferator-activated receptor gamma), C / EBP α (CCAAT enhancer binding protein α), FABP4 (adipocyte marker gene fatty acid binding protein 4) and adipsin were examined by quantitative real-time PCR. The mature adipocytes were stained with oil red O, the staining adipocytes were observed by microscope, then understanding the effect of Spry1 siRNA on adipocyte differentiation. In addition, oil red O of the staining adipocytes was extracted with isopropanol, optical density (OD) values of oil red O were measured at a wavelength of 520 nm. Results Spry1 siRNA was transfected into ST2 cells. Compared with control group, the mRNA expression level of Spry1 was significantly reduced. The number of differentiated adipocytes from ST2 cells was decreased after staining with oil red O. And the OD value was lower than that of control group. The mRNA expression levels of adipocyte differentiation-specific genes PPARγ, C / EBP α, FABP4 and adipsin were significantly reduced compared with those of control group (P<0.05). Conclusion Spry1 siRNA can effectively suppresse adipogenic differentiation from progenitor cells. Related Articles | Metrics

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Effects of extracts of pericarpium citri reticulatae and pogostemon cablin on the contraction of#br# gastrointestinal smooth muscle and gastrointestinal hormones in rats with gastrointestinal motility disorder#br# HE Zhan-kun, ZHANG Guo-liang, TANG Fang, DU Jin-chao, JIN Wen-jie 2017, 45 (11):  1175-1179.  doi: 10.11958/20170739 Abstract ( 763 )   PDF (360KB) ( 3610 )   Objective To investigate the effects of different extracts of pericarpium citri reticulatae (PCR) and pogostemon cablin benth (PCB) on the contraction of gastrointestinal smooth muscle and the level of gastrointestinal hormones in rat model of gastrointestinal motility disorder. Methods Seventy Wistar rats were randomly divided into groups of control, model, water extractive of PCR, hesperidin, water extractive of PCB, water extractive of PCB plus volatile oil and patchouli alcohol, ten rats in each group. Except the control group, the rest groups were established gastrointestinal motor disorder model via limb ischemia-reperfusion (LIR). After modeling rats of groups were intervened with corresponding extracts. The effects of different extracts on contraction amplitude of corpora ventriculi and small intestine smooth muscle were observed. The levels of gastrointestinal hormones including motilin (MOT), gastrin (GAS), cholecystokinin (CCK) and somatostatin (SS) were detected by radioimmunoassay. Results The contraction amplitudes of corpora ventriculi and small intestine smooth muscle were decreased (P < 0.05), the serum level of GAS and plasma level of MOT were also significantly decreased, while CCK and SS levels in the gastric antrum were significantly increased in model group than those of the control group (P < 0.05). Water extractive of PCR, hesperidin, water extractive of PCB and water extractive of PCB +patchouli oil can increase the contraction amplitudes of corpora ventriculi and small intestine smooth muscle, increase the serum level of GAS and reduce levels of CCK and SS in the gastric antrum (P < 0.05), whereas showed no influence in the plasma level of MOT (P > 0.05)]. Compared with model group, patchouli alcohol showed no influence in the contraction of gastrointestinal smooth muscle and levels of MOT, GAS, CCK and SS (P > 0.05). In the aspect of regulating the contraction of gastrointestinal smooth muscle and the level of GAS, CCK and SS, the pharmacological effect of PCR water extract was better than that of hesperidin (P < 0.05), while water extractive of PCB + volatile oil was better than that of water extractive of PCB(P < 0.05). Conclusion The active ingredients of PCR and PCB have variant regulative effects on the contraction of gastrointestinal smooth muscle and the serum level of GAS, CCK and SS in the gastric antrum in rat model of gastrointestinal motility disorder. Related Articles | Metrics

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The effect of galangin on the inhibition of proliferation and invasion of human lung cancer cells and its mechanism#br# WANG Jun-jian, HUANG Shao-xiang 2017, 45 (11):  1179-1182.  doi: 10.11958/20170622 Abstract ( 740 )   PDF (794KB) ( 3542 )   Objective To explore the effect of galangin on the inhibition of proliferation and invasion in human lung cancer A549 cell lines and its mechanism thereof. Methods MTS assay was employed to detect the ability of cell proliferation with different concentrations (0, 5, 10, 20, 40, 60 and 100 μmol/L) of galangin after A549 cells were cultured in 96 well-plate. Transwell assay was employed to detect the ability of cell invasion. Western blot assay was employed to detect the protein expression levels of Survivin, p27, CD44, ICAM, MMP-2/9 and the phosphorylation of PI3K and AKT. Results The cell proliferation rate of A549 cell line was suppressed with increased concentration of galangin treatment, and IC50 was 44.7 μmol/L. The concentrations of 10 μmol/L and 20 μmol/L were used for the following study. The ability of cell invasion was decreased with 0, 10 and 20 μmol/L concentrations of galangin treatment (P＜0.05). The protein expression of p27 was increased and the expressions of other proteins were decreased with 0, 10 and 20 μmol/L galangin treatmenmt (P＜0.05).Conclusion Galangin can significantly inhibit the cell proliferation and invasion of human lung cancer A549 cell line, and which is a potential anti-lung cancer drug. The mechanisms may be related with the regulated related gene expression and the inhibited phosphorylation of PI3K and AKT. Related Articles | Metrics

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Comparison of anesthetic effect of different anesthetic drugs in the pediatric tonsilloadenoiectomy#br# HUANG Xiao-mei, CHEN Chao, ZHANG Feng-chao, LI Li, SHI Xu-xu, WANG Chen-chen 2017, 45 (11):  1183-1187.  doi: 10.11958/20170765 Abstract ( 1066 )   PDF (372KB) ( 3873 )   Objective To investigate different anesthetic effects of remifentanil, sufentanil, and fentanyl in the pediatric tonsilloadenoiectomy. Methods Totally 210 cases of tonsilloadenoiectomy enrolled in our institution from March 2016 to February 2017 were selected as study objects. Children were divided randomly into three groups, with 70 cases in each group, including remifentanil group, sufentanil group, and fentanyl group. Child patients in the remifentanil group were induced by remifentanil with 1 mg/kg, and were maintained with 0.1 mg·kg-1·min-1. Remifentanil was withdrawn 5 minutes before the end of operation. Child patients in the sufentanil group were induced by sufentanil with 0.2 mg / kg, and were maintained with 0.1 mg·kg-1·h-1. Sufentanil was withdrawn 30 minutes before the end of operation. Child patients in the fentanyl group were induced by fentanyl with 2 mg/kg, and were maintained with 1 mg·kg-1·h-1. Fentanyl was withdrawn 30 minutes before the end of operation. During the anesthesia, the indexes of heart rate (HR), mean arterial pressure (MAP), and oxygen saturation were recorded in the three groups. The time of eyelash reflex disappearance, pain reflex disappearance, postoperation eye open, and extubation were also recorded. The incidences of perioperative adverse events were compared between the three groups. Results HR and MAP at time points of anesthesia induction, 5 minutes after anesthesia induction, and 10 minutes after anesthesia induction were higher in the remifentanil group than those in the other two groups (P＜0.05). And the differences of the above indexes at all time points between sufentanil group and fentanyl group showed no statistical significance (P＞0.05). The time of pain reflex disappearance, postoperation eye open, and extubation were higher in the fentanyl group than those in the other two groups (P＜0.05). And the differences of the above indexes between sufentanil group and remifentanil group showed no statistical significance (P＞0.05). Incidence rate of postoperative  agitation was higher in the remifentanil group than that in the other two groups (P＜0.01). And the difference of incidence rate of postoperative agitation between the sufentanil group and fentanyl group showed no statistical significance (P＞0.05).Conclusion The effect of sufentanil is better than remifentanil and fentanyl in the anesthesia of pediatric tonsilloadenoiectomy, with fast effect, fast analepsia, stable haemodynamics, and low incidence rate of postoperative agitation. Related Articles | Metrics

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Relationship of ultrasonic elastography and serologic indexes in patients with papillary thyroid carcinoma#br# DING Guan-bao, YU Qiu-yu, FANG Kai-feng 2017, 45 (11):  1187-1190.  doi: 10.11958/20170747 Abstract ( 765 )   PDF (746KB) ( 3708 )   Objective To evaluate the elastic score (ES) and strain ratio (SR) in papillary thyroid carcinoma patients,and analyse their relationship with serologic index. Methods Totally one hundred and six patients with thyroid neoplasm were divided into papillary thyroid carcinoma group (n=56) and thyroid adenoma group ( n=50) according to histopathology results. Another fifty cases of healthy people were chosen as normal control group at the same period. The ES and SR were evacuated by color Doppler ultrasonic diagnostic apparatus in three groups of patients. Thyroid stimulating hormone (TSH),thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TpoAb) were detected by electrochemiluminescence immunoassay. Data of galectin-3 (Gal-3), vascular endothelial growth factor (VEGF), and cytokeratin 19 fragment (Cyfra21.1) were tested by automatic optical inspection. Results Indexes of ES, SR, Gal-3, VEGF and Cyfra21.1 showed statistically increasing tendency in the control group, thyroid adenoma group and papillary thyroid carcinoma group sequentially (P＜0.05). Serum levels of TSH, TgAb and TpoAb were significantly higher in the papillary thyroid carcinoma group than those in the other two groups (P＜0.05). And there were no significant differences in serum TSH, TgAb and TpoAb between the control group and thyroid adenoma group (P＞0.05). There were positive correlation between ES, SR and TSH, TgAb, TpoAb, Gal-3, VEGF, Cyfra21.1 in patients with papillary thyroid carcinoma (P＜0.05). Conclusion Papillary thyroid carcinoma shows increased ES and SR detected by ultrasound, and which are relevant to related serological indicators. The two indices may be used for auxiliary diagnosis of papillary thyroid carcinoma. Related Articles | Metrics

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A clinical experience of endoscopic treatment for benign and malignant tumors of skull base LIU Xue-tao, YANG Hao-xi, WANG Hong 2017, 45 (11):  1191-1194.  doi: 10.11958/20170504 Abstract ( 647 )   PDF (610KB) ( 3561 )   Objective To summarize the surgical skills and experience of skull base surgery by endoscopic treatment.Methods A total of 8 cases with benign and malignant tumors were treated in our hospital from August 2014 to December 2016, including orbital region, sellar region, clivus, pterygopalatine fossa and infratemporal fossa. The endoscopic endonasal surgery involved optic nerve decompression, internal carotid artery, treatment of middle skull base and clivus dura tumors,opening of pterygopalatine fossa and infratemporal fossa. The anti infection and anti inflammation treatment of the dura and the internal carotid artery and the treatment of the complications such as diplopia, vision decrease, and the adjustment of pituitary hormones were given to patients after operation. Results The visual of a patient with fungal sinusitis recovered from no light perception to "finger / 1 m" at one week after surgery. One of the patients with pituitary tumor underwent unilateral eyeball abduction limitation. The symptoms disappeared after one week treatment. Insipidus occurred in 1 patient with invasive pituitary adenoma, after symptomatic treatment for half a month, urine volume and specific gravity tend to normal. Two patients with adenoid cystic carcinoma underwent enhanced MRI examination at 10 days, 3 months and 1 year after operation, both achieved total resection and no local recurrence. The patient with nasopharyngeal carcinoma reached total resection after operation, and showed no local recurrence after six-month follow-up. All the 8 patients achieved complete resection in one stage, without any serious complication after operation. Conclusion Endoscopic endonasal surgery is an important method for the treatment of tumour in anterior skull base, which needs extensive surgical experience and cooperation with other clinical departments. Related Articles | Metrics

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Clinical analysis of the etiology and severity of acute pancreatitis GONG Fu-lin 2017, 45 (11):  1195-1198.  doi: 10.11958/20170321 Abstract ( 642 )   PDF (343KB) ( 3375 )   Objective To investigate the relationship between the etiology and the severity of acute pancreatitis (AP).Methods The clinical data of 590 patients with AP who were admitted into our hospital from January 2007 to December 2016 were retrospectively analyzed. In these patients there were 459 patients with mild acute pancreatitis (MAP), 68 patients with moderate acute pancreatitis (MSAP) and 63 patients with severe acute pancreatitis (SAP). The relationship between the severity of disease and age, gender, etiologies and complications was analyzed. Results There were no significant differences in age, gender, and incidence rate of partial illness complication between three groups of patients. While the incidence rate of systemic complications was significantly higher in SAP group than that of other two groups (P < 0.05). In 590 patients, 352 patients (59.7%) were biliary pancreatitis, which was the first leading pathogenesis. There were 120 patienets (20.3%) were hyperlipidemic pancreatitis, which was the second pathogenesis. The incidence rate of hyperlipidemic AP was significantly higher in MSAP group and SAP group than those of MAP group, while the alcoholic AP was lower (P < 0.05). A total of 7 cases (1.2%) of SAP were dead during hospitalization, and no patients were admitted to hospital for the second time due to AP during the follow ups (1 month after discharge). Conclusion Biliary pancreatitis is the primary pathogenesis of clinical acute pancreatitis, and its incidence rate of complication is higher. The obstruction of the biliary obstruction should be relieved as soon as possible to prevent the progression of the disease. Early diagnosis and symptomatic treatment can improve prognosis. Related Articles | Metrics

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Analysis of C5 palsy with C4/5 foraminotomy after posterior cervical decompression surgery JING Feng, DENG Shu-cai, MA Yi 2017, 45 (11):  1198-1201.  doi: 10.11958/20170807 Abstract ( 910 )   PDF (386KB) ( 3562 )   Objective To evaluate the effects of C4-5 partial foraminotomy on reducing the occurrence of C5 palsy after posterior cervical decompression surgery. Methods A total of 127 patients (male 62, female 65) underwent the cervical decompression surgery with lateral cervical mass screw insertion between January 2011 and December 2015 were retrospectively analyzed. In these patients sixty-one cases (Group A) underwent the posterior laminectomy with lateral cervical mass screw insertion, while 66 cases (Group B) received posterior laminectomy with lateral cervical mass screw insertion, combined with partial C4/5 foraminotomy at C4-5 level. The clinical data, radiographic parameters and the occurrence of C5 palsy were assessed in two groups of patients. Results There was no significant difference in JOA recovery rate and change of cervical curvature index between preoperation and postoperation in each group (P＞0.05). Postoperative C5 palsy occurred in 11 cases (18.03%) in group A and 3 cases (4.05%) in group B. The difference in the incidence of C5 palsy was significant between the two groups (P=0.022). Conclusion The cervical decompression surgery can improve the function of the spinal cord effectively. C4-5 partial foraminotomy after cervical decompression surgery is effective for preventing C5 palsy. Related Articles | Metrics

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Study on the correlation between prognosis and ECG changes in patients with acute spontaneous intracerebral hemorrhage#br# ZHU Wei, YANG Peng 2017, 45 (11):  1202-1205.  doi: 10.11958/20170749 Abstract ( 703 )   PDF (310KB) ( 3487 )   Objective To study the relationship between changes of electrocardiogram (ECG) and the prognosis of patients with acute spontaneous intracerebral hemorrhage. Methods The relationship between ECG changes and location data of intracerebral hemorrhage in 183 patients was analyzed. The prognosis of spontaneous intracerebral hemorrhage in acute stage and the abnormal ECG were analyzed by Logistic regression analysis. Results In 183 patients, there were 44 cases of brainstem hemorrhage, 21 cases of thalamic hemorrhage, 42 cases of basal ganglia hemorrhage and 76 cases of cerebellar hemorrhage. In these patients, there were abnormal ECG findings in 35 cases (79.5%), 16 cases (76.2%), 21 cases (50.0%) and 31 cases (40.8%). There were significant differences in the proportions of patients with ECG abnormalities in different bleeding sites (χ2=21.638，P＜0.05). Abnormal ECG was more common when intracerebral hemorrhage was located at the midline structures. According to the hematoma volumes, there were 20 cases with hematoma volumes ≤ 10 mL(35.0%), 25 cases with hematoma volumes between 10 mL - 30 mL (72.0%) and 18 cases with hematoma volumes ≥ 30 mL(88.9%). There were 7 cases with abnormal ECG, 18 cases with abnormal ECG and 16 cases with abnormal ECG in these three groups of patients. There were significant differences in the proportions of patients with ECG abnormalities between three groups (χ2=12.979，P＜0.05). There were more patients with abnormal ECG in hematoma volumes between 10 mL - 30 mL group and hematoma volumes ≥ 30 mL group than those of patients with hematoma volumes ≤ 10 mL group (χ2=6.161 and 11.515, P＜0.05). There was no significant difference in patients with ECG abnormalities between hematoma volumes of 10 mL - 30 mL group and hematoma volumes ≥ 30 mL group (χ2=1.804，P＞0.05). There were 51 cases with abnormal ECG in 69 cases of death group (73.9%). There were 52 cases with abnormal ECG in 114 cases of survival group (45.6%). There was significant difference between the two groups (χ2=13.990，P＜0.05). Logistic regression analysis revealed that the ST-T change, U-wave abnormality and long QT interval were risk factors for death in the acute phase of spontaneous intracerebral hemorrhage. Conclusion While actively treating primary brain diseases, we should closely monitor changes of ECG and deal with them in time so as to prevent the death of patients with acute phase of spontaneous intracerebral hemorrhage. Related Articles | Metrics

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An analysis of breast metastasis from renal clear cell carcinoma: report of three cases WANG Qiong, GU Lin ZHENG Hong, ZHAO Yan-rui, ZHANG Li-na 2017, 45 (11):  1205-1207.  doi: 10.11958/20170825 Abstract ( 1158 )   PDF (366KB) ( 3716 )    Metastasis of renal cell carcinoma to mammary gland is rare clinically. Based on the retrospective analysis of  3 cases of metastatic clear cell renal cell carcinoma of the breast identified pathologically from January 2010 to June 2017 in Tianjin Medical University Cancer Institute and Hospital, we discussed the clinical manifestation, pathological characteristics, diagnosis, treatment and prognosis of metastatic breast cancer of renal cell carcinoma. Related Articles | Metrics

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Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicated with central nervous system vasculitic-like presentation: a case report#br# LIAO Hai-bing, XU Lin, XIE Bing-di, BAO Jie, SONG Yi-jun 2017, 45 (11):  1208-1212.  doi: 10.11958/20170806 Abstract ( 1114 )   PDF (795KB) ( 3870 )   Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a serious adverse drug reaction,characterized with rash, fever, lymphadenectasis, eosinophilia and visceral involvement. This article describes the clinical case of a patient with renal insufficiency after receiving sensitizing drugs，which resulted in limb weakness and cognitive impairment of center nervous system characterized by vasculitis imaging and responded well to glucocorticoid treatmentDRESS syndrome. Related Articles | Metrics

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Case report and literature review of streptococcal toxic shock syndrome SHI Wu-juan, MA Qing-rong, WANG Dan 2017, 45 (11):  1212-1214.  doi: 10.11958/20170720 Abstract ( 725 )   PDF (321KB) ( 3594 )   Streptococcal toxic shock syndrome (STSS) has a low morbidity and high mortality in neonates. We recently diagnosed and treated a case of neonatal streptococcal toxic shock syndrome. This paper reviewed the diagnosis and treatment of the patient and reviewed the relevant literature of the epidemiology, diagnosis and treatment. Related Articles | Metrics

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Severe immune-related adverse events in the treatment with Pembrolizumab for a patient with ampullar carcinoma#br# WANG Wei, XING Ze, CAO Ran-hua, YAN Hai-cheng, SU Wu-yun 2017, 45 (11):  1215-1217.  doi: 10.11958/20170859 Abstract ( 869 )   PDF (312KB) ( 3673 )   Programmed death receptor-1 inhibitor pembrolizumab can restore the function of T cell activity and enhance the anti-tumor immune response by inhibiting the binding of PD-1 to its ligand PD-L1 and blocking the negative regulation of signal pathway. The activated T cells may cause immune-mediated adverse events in the process of anti-tumor.This article reported the severe immune related adverse effects induced by PD-1 inhibitor, pembrolizumab, in a patient with advanced ampullar carcinoma. The patient eventually died due to liver injury, leukocytosis，thrombocytopenia，and disseminated intravascular coagulation (DIC). This article reviewed the diagnosis and treatment of the patient, and reviewed the relevant literatures. Related Articles | Metrics

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Conventional transbronchial needle aspiration technique guided by rapid on-site evaluation FENG Jing, LI Cai-li, CAO Jie 2017, 45 (11):  1218-1221.  doi: 10.11958/20170911 Abstract ( 613 )   PDF (307KB) ( 3647 )    Transbronchial needle aspiration (TBNA), which has excellent sensitivity and specificity, is one of the key techniques of diagnostic interventional pulmonology. The conventional TBNA (C-TBNA) is routinely operated with ordinary bronchoscopy under local anesthesia. The efficacy of C-TBNA can be improved when rapid on-site evaluation (ROSE) is used during operating procedure. This paper describes technical essentials of ROSE-based C-TBNA. Related Articles | Metrics

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The effectiveness of 3D printed titanium alloy trabecular reconstruction rod for the treatment of early osteonecrosis of femoral head#br# ZHANG Ying, ZHANG Lei-lei, MA Xiang-hao, CHEN Xian-tao, WANG Hui-chao, LIU You-wen 2017, 45 (11):  1222-1227.  doi: 10.11958/20170547 Abstract ( 1104 )   PDF (815KB) ( 3749 )   Objective To evaluate the safety of 3D printed titanium alloy trabecular reconstruction rod, bone grafts and its clinical efficacy. Methods Sixty patients with osteonecrosis of femoral head (ONFH) stage Ⅱ (ACRO Ⅱ) were randomly divided into experimental group (titanium rod group) and control group (tantalum rod group). Patients were followed up at 6,12 and 24 months after the operation. Harris score and visual analogue scale (VAS) were used to evaluate the postoperative function. Changes of X-ray were observed before and after operation. The imaging evaluation was analyzed after 24 months.Results The Harris score was decreased in titanium rod group compared with that of tantalum rod group at six-month.There were no significant differences in Harris scores for other time points between two groups. Repeated measures analysis of variance showed that there was a significant difference in time effect. The X-ray staging results changed gradually before and after operation in two groups, stage Ⅲ and stage Ⅳ gradually increased with time. There was progress in ONFH after operation in two groups. No infection or rejection was found in the two groups. There were higher improvement rates of stage ⅡA and stage ⅡB. There were no significant differences in improvement rate and hip preservation rate between two groups.The transparent lines disappeared in the positive and lateral X-ray films 6 months after the operation. No new transparent lines were found. The bone enhancement was not found in two groups of patients during follow-up period. No stress occlusion and bone trabecular bone enhancement were observed in two groups. Conclusion Titanium rods are satisfactory for the treatment of femoral head necrosis in the early stage of ACRO Ⅱ, which is not recommended for the treatment of relatively large ACRO Ⅱ C stage of necrotic area. Related Articles | Metrics

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Advance in mechanism of vascular endothelial injury and targeted therapy in patients with overlap syndrome#br# BI Hong, JIN Zhi-xian, ZHOU Kai-hua, HE Xu, CHEN Min, WANG Qing, HUANG Zhao-ming 2017, 45 (11):  1228-1232.  doi: 10.11958/20170752 Abstract ( 704 )   PDF (434KB) ( 3542 )   The changes of pathophysiology and clinical symptoms in patients with overlap syndrome (OS) are more serious than those of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea hypopnea syndrome (OSAHS). OS is more prone to cardiovascular disease, which the makes treatment more difficult and prognosis worse. There is a lack of drugs that can significantly slow or prevent the progression of OS and cardiovascular complications. The damage of vascular endothelium is closely related to cardiovascular diseases. At present, COPD and OSAHS have received extensive attention in the vascular endothelial injury and the treatment. This article summarizes the progress in the mechanism of injury of vascular endothelium in OS in recent years, including the damage of hypoxia, inflammation, oxidative stress and changes of sympathetic nerve activity, and summarizes targeted therapy for vascular endothelial injury, mainly including non-invasive ventilator, cell transplantation and targeted drug treatment. This study provides theoretical basis for the clinical treatment and prognosis improvement in patients with OS. Related Articles | Metrics