Objective: To study the efficacy and safety of Balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Patients who were diagnosed CTEPH in China-Japan Friendship Hospital from Feb 2018 to Sep 2019 were evaluated. The ineligibility for pulmonary endarterectomy (PEA) and the indication for BPA were decided on the basis of a consensus among the multidisciplinary team for all CTEPH patients. 6-min walk distance (6MWD), the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary artery pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were collected and analyzed before the first and the last BPA session. Results: A total of 67 BPA sessions were performed for 302 subsegmental pulmonary arteries in 25 inoperable CTEPH patients. 10 males (40.0%) and 15 females (60.0%), with the age of (57.8±7.1) years old. The median interval between CTEPH diagnosis and first BPA was 20.0 (9.0, 48.5) months. 18 patients were received more than 2 BPA sessions, the median follow-up time was 5.0 (3.5, 8.3) months. 6MWD, CI and the mixed venous oxygen saturation were significant improved after BPA [(425±74) vs (345±109) m, (1.99±0.45) vs (1.62±0.35) L·min(-1)·m(-2), (68.1%±6.5%) vs (61.2%±6.3%)](all P<0.05). The plasma level of NT-proBNP, mPAP and PVR were significantly decreased after BPA [259 (93, 739) vs 806 (148, 2 159) ng/L, (40.6±8.3) vs (47.3±10.7) mmHg (1 mmHg=0.133 kPa), (11.9±4.9) vs (17.2±6.5) WU (1 WU=80 dyn·s·cm(-5))](all P<0.05). Hemoptysis occurred in 5 sessions (7.5%) and reperfusion pulmonary edema (RPE) occurred in 2 sessions (1.5%), 1 patient needed non-invasive mechanical ventilation because of RPE, 1 patient died from right heart failure caused by hemoptysis during perioperative period. Conclusions: BPA can significantly improve the exercise tolerance and hemodynamic parameters for inoperable CTEPH patients, the risks of BPA are acceptable. BPA is an effective and relatively safe treatment for inoperable CTEPH patients.

目的 观察强化阿托伐他汀联合法舒地尔治疗冠状动脉慢血流现象(coronary slow flow,CSF)患者的临床效果.方法 选择2016年8月至2018年1月在河北医科大学第一医院心内科因胸痛就诊,经冠状动脉造影诊断为CSF的患者72例为研究对象.患者按随机数字表法分为强化他汀组(n=36)和联合用药组(n=36).强化他汀组给予阿托伐他汀40 mg/晚;联合用药组给予阿托伐他汀40 mg/晚,法舒地尔60 mg/d(14 d)静脉注射.6个月后复查冠状动脉造影再次评估冠状动脉血流状态.检测及比较治疗前、后血清三酰甘油(triacylg?lycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)及高敏C-反应蛋白(high-sensitivity C reactive protein,hs-CRP)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-1(interleukin-1,IL-1),一氧化氮(nitric oxide,NO)浓度.结果 治疗6个月后强化他汀组及联合用药组患者各支冠状动脉血流速度均优于治疗前,差异有统计学意义(P<0.05);并且联合用药组各支冠状动脉血流速度改善优于强化他汀组,差异有统计学意义(P<0.05).与治疗前比较,联合用药组治疗后与强化他汀组患者治疗后血清TC、TG、LDL-C、hs-CRP、TNF-α、IL-1浓度均明显降低,而NO浓度明显升高,差异有统计学意义(P<0.05).治疗后,联合用药组患者血清TC、TG、LDL-C浓度与强化他汀组治疗比较,差异无统计学意义(P>0.05),而联合用药组患者血清hs-CRP及TNF-α、IL-1浓度明显低于强化他汀组,NO浓度明显升高,差异有统计学意义(P<0.05).结论 强化阿托伐他汀联合法舒地尔可通过抑制炎症反应、改善内皮功能进而改善CSF,效果优于单独应用强化阿托伐他汀.

Purpose: To determine the effect of tangeritin on cadmium-induced cardiotoxicity in rats. Methods: Cardiotoxicity was induced by intra-gastric administration of 5 mg/kg cadmium chloride to rats, once daily for 4 weeks. The animals were treated with tangeritin at 10 and 20 mg/kg p.o. 60 min before the administration of cadmium, for 4 weeks. Thereafter, the concentrations of cadmium in serum and cardiac tissue were determined, and markers of cardiac function, antioxidant enzyme activities and levels of pro-inflammatory mediators were evaluated in cardiac tissues. Histopathological examination and western blot assay were also performed. Results: Treatment with tangeritin significantly decreased the cadmium levels in the heart tissue and serum of the cadmium-exposed rats, when compared to the negative control group (p < 0.01). There was significant decrease in cardiac function markers in the tangeritin-treated rats, relative to negative control group (p < 0.01). However, antioxidant enzyme activity and levels of pro-inflammatory mediators were attenuated in the cardiac tissues of cadmium-treated rats by tangeritin treatment. Expressions of HO-1 and Nrf-2 were significantly enhanced in the cardiac tissues of tangeritin-treated group, relative to negative control group (p < 0.01). Histopathology revealed that tangeritin attenuated cadmium-induced cardiac injury in cadmium-exposed rats. Conclusion: These results demonstrate the protective effect of tangeritin against cadmium-induced cardiotoxicity via attenuation of oxidative stress and pro-inflammatory mediators. Keywords: Tangeritin, Cadmium, Cardiotoxicity, Oxidative stress, Anti-inflammation

目的 对比不同剂量阿托伐他汀联合法舒地尔治疗冠状动脉慢血流(CSF)的效果.方法 将102例CSF患者随机分为对照组、常规组和强化组,每组34例.3组患者均给予阿司匹林治疗,在此基础上常规组给予阿托伐他汀20 mg/d和法舒地尔60 mg/d治疗,强化组给予阿托伐他汀40 mg/d和法舒地尔60 mg/d治疗.观察治疗后2周3组患者治疗总有效率,比较治疗前后3组患者高敏C反应蛋白(hs-CRP)、血清肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、一氧化氮水平.结果 治疗后,强化组、常规组总有效率均高于对照组(均P<0.05),但常规组与强化组总有效率差异无统计学意义(P>0.05);强化组及常规组hs-CRP、TNF-α、IL-1水平均较治疗前及对照组降低,一氧化氮水平较治疗前及对照组升高(均P<0.05).结论 在常规治疗基础上,联用法舒地尔和阿托伐他汀,可有效地改善CSF患者炎症反应,提高治疗效果,但常规剂量和强化剂量阿托伐他汀效果相当.

Abstract To investigate factors predicting the onset of major adverse cardiovascular and cerebrovascular events (MACCEs) after primary percutaneous coronary intervention (pPCI) for patients with non-ST-segment elevation infarction (NSTEMI) and single concomitant chronic total occlusion (CTO). Neutrophil gelatinase-associated lipocalin (NGAL) and glycosylated hemoglobin (HbA1c) both play essential role in cardiovascular and cerebrovascular homoeostasis. However, current knowledge of its predictive prognostic value is limited. 422 patients with NSTEMI and CTO (59.7 ± 12.4 years, 74.2% men) who underwent successful pPCI were enrolled and followed for 2 years. Multivariate cox regression analysis and receiver operating characteristic (ROC) curve analysis were performed to determine the factors predicting MACCEs. 140 patients (33.2%) experienced MACCEs in the follow-up period. Multivariate cox regression analysis found when we process the model with NGAL at admission, low left ventricular ejection fraction (LVEF, HR = 0.963, 95% CI 0.940 to 0.987, P = .003) and fasting blood glucose (HR = 1.078, 95% CI 1.002 to 1.159, P = .044), but not NGAL at admission, were independent predictors of 2 years MACCEs. While HbA1C (HR = 1.119, 95% CI 1.014 to 1.234, P = .025), LVEF (HR = 0.963, 95% CI 0.939 to 0.987, P = .003), estimated glomerular filtration rate (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) and NGAL value 7 day (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) showed their predictive value in another model. ROC analysis indicated NGAL 7 day (AUC = 0.680, P = .0054 and AUC = 0.622, P = .0005) and LVEF (AUC = 0.691, P = .0298 and AUC = 0.605, P = .0021) could predict both in-hospital and 2 years MACCEs, while higher NGAL at admission could only predict poorer in-hospital prognosis (AUC = 0.665, P = .0103). Further analysis showed the prognostic value of NGAL was particularly remarkable among those HbA1C<6.5%. Patients with NSTEMI and single concomitant CTO receiving pPCI with higher NGAL on 7 days during hospitalization are more likely to suffer 2 years MACCEs, particularly in those with lower HbA1C.

Objective: The prognostic utility of serum albumin level for mortality in heart failure patients has received considerable attention. This meta-analysis sought to examine the prognostic significance of hypoalbuminemia for prediction of all-cause mortality in patients with heart failure. Materials and methods: Pubmed and Embase databases were systematically searched up to 10 March 2019 to identify eligible studies. Epidemiological studies reporting a multivariable-adjusted risk estimate of all-cause mortality associated with hypoalbuminemia in acute or chronic heart failure patients were included. Results: Nine studies from 10 articles involving 16,763 heart failure patients were included in the final analysis. Hypoalbuminemia was associated with an increased in-hospital mortality (risk ratio [RR] 4.90; 95% confidence interval [CI] 2.96-8.10) and long-term all-cause mortality (RR 1.75; 95% CI 1.35-2.27) in acute heart failure patients. Chronic heart failure patients with hypoalbuminemia exhibited a 3.5-fold (95% CI 1.29-9.73) higher risk for long-term all-cause mortality. Conclusions: Hypoalbuminemia is possibly an independent predictor of all-cause mortality in patients with acute or chronic heart failure. However, the current findings should be further confirmed in future prospective studies. Moreover, future well-designed randomized controlled trials would be required to investigate whether correcting hypoalbuminemia in heart failure patients has potential to improve survival outcome.

Early spontaneous reperfusion (SR) before recanalization therapy can reduce the infarct size and preserve left ventricular function to provide a more favorable prognosis for patients with ST-elevation myocardial infarction (STEMI); however, whether SR patients should receive primary percutaneous coronary intervention (pPCI) remains unclear. This study aimed to evaluate whether pPCI is beneficial for patients with STEMI and SR. STEMI patients with SR (n=229; defined as achievement of initial TIMI grade 3 flow in the infarction-related artery (IRA) before reperfusion therapy) who received either pPCI or non-pPCI therapy were reviewed retrospectively. The average follow-up periods were 24±4 and 23±5 months for the pPCI and non-pPCI group. Compared with the non-pPCI group, the pPCI group showed shorter hospital stay (7±3 vs. 9±5 days; P=0.02), lower in-hospital reinfarction rate (0% vs. 3%, P=0.04), lower 1-year reinfarction rate (5% vs. 10%; P=0.02), lower 1-year unscheduled PCI rate (4% vs. 12%; P=0.02), and lower 1-year composite cardiac event rate (10% vs. 29%; P<0.01). In conclusion, pPCI is beneficial for STEMI patients with angiographic SR, leading to better shortand long-term major adverse cardiac events.

目的:探讨临床药师通过参与感染性心内膜炎药物治疗,保障药物治疗的安全性和有效性.方法:临床药师参与1例缺陷乏养菌所致的感染性心内膜炎的抗感染治疗,对患者的用药方案、药物治疗特点和药物监护上进行分析,评估患者的治疗效果.结果:患者的感染症状明显好转,为快速控制病情及后期手术治疗提供有利条件.结论:临床药师参与临床实践,协助医师为患者提供安全、有效的治疗方案.

Background Kounis syndrome (KS) is the concurrence of acute coronary syndrome associated with mast-cell and platelet activation in the setting of hypersensitivity and allergic or anaphylactic insults. Many drugs and environmental exposures had been reported as inducers, but various inducers and the mechanism of KS remained unknown till now. The widely used traditional Chinese medicine (TCM) as a potential sensitizer were scarcely reported to induce allergic vasospasm due to the ignorance of the linkage between traditional medicine allergy and vasospasm. Case presentation We described 5 rare cases of KS including unreported triggers of TCM and abortion, reported the treatment strategy and 1~4 years’ follow-up results, and tried to probe into the etiology of KS. Case 1 and case 2 for the first time reported acute ST-segment elevation myocardial infarction (STEMI) caused by Chinese herbs related allergic coronary vasospasm. Case 3 reported recurrent angina following allergen contact and wheezing, indicating the internal linkage of coronary vasospasm and allergic asthma. Case 4 described a childbearing-age woman suffered refractory ischemic chest pain due to coronary vasospasm in a special period of post-abortion, the attacks suddenly disappeared when her menopause recovered. Case 5 described an isolated episode of allergic coronary vasospasm under exposure of smoking and stress, which was successfully prevented by avoiding the exposures. Conclusion Kounis syndrome is not rare but rarely recognized and under-diagnosed. It is necessary to recognize KS and various inducers, especially for the patients suffering refractory vasospastic cardiac attacks concentrating in special periods. Blood test of eosinophil might contribute to diagnose KS and anti-allergic agents might be helpful for controlling KS attacks.

Objective To compare the value of right ventricular (RV) free wall longitudinal strain (FWLS) by speckle tracking echocardiography (STE) and conventional parameters in evaluation of RV dysfunction in chronic thromboembolic pulmonary hypertension (CTEPH). Methods Sixty CTEPH patients were enrolled as group A and 45 pulmonary embolism (PE) patients with normal pulmonary pressure were enrolled as group B in this study. CTEPH patients were divided into 2 subgroups using the World Health Organization (WHO) function classification: patients with WHO Ⅰ-Ⅱ were designated as group A1 and those with WHO Ⅲ-Ⅳ were designated as group A2. Conventional RV functional parameters including tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived tricuspid annular systolic velocity (S′), fractional area change (FAC), RV index of myocardial performance (RVIMP), and STE-derived RV FWLS were measured and compared. Clinical right heart failure (RHF) was defined as the presence of symptoms of heart failure and signs of systemic circulation congestion during hospitalization. Results Compared to group B, group A patients had significant enlarged right heart dimension and impaired RV systolic function parameters (all P<0.001). The TAPSE, S′, FAC, and RV FWLS showed significant differences between CTEPH patients with mild (group A1) and severe symptoms (group A2) (all P<0.01), while RVIMP showed no significant difference (P=0.188). On receiver operating characteristic analysis, FWLS had the largest AUC to identify RHF (AUC=0.864, P<0.001), when the cutoff value was 15.05%, the sensitivity was 85.71%, and the specificity was 64.29%, respectively. On binary logistic regression analysis, only right atria area (OR=1.212, 95%CI=1.004-1.48, P=0.046) and RV FWLS (OR=0.662, 95%CI=0.470-0.933, P=0.018) were identified as independent predictor of RHF. Conclusions Compared with conventional parameters, RV FWLS showed advantages in identifying abnormal RV function in CTEPH patients. Key words: Echocardiography; Pulmonary embolism; Hypertension, pulmonary; Ventricular function, right; Strain

患者男性,33岁,因“持续腹痛半天”于2017年10月1日就诊于我院急诊科.患者近3d大量进食油腻食物及饮酒,半天前出现上腹持续性胀痛,伴间断左上腹绞痛、大汗,持续约10余分钟未缓解;无胸闷、胸痛;无恶心、呕吐、反酸.既往体健,否认高血压史、糖尿病史、冠心病家族史及无吸烟史.入院查体:T 36.5℃,P 98次/min,R18次/min,Bp 136/90mmHg,神志清,精神差;全身皮肤黏膜无黄染,颈静脉无怒张;双肺呼吸音清,未闻及干湿啰音;心界不大,心率98次/min,律齐,各瓣膜区未闻及病理性杂音;上腹部压痛,左上腹为著,无反跳痛、肌紧张,Murphy(-),肝脾肋下未触及.

Objective: To investigate the correlation between the distribution of Apo lipoprotein E (ApoE) gene polymorphism and the severity of chronic heart failure (CHF) secondary to non-ischemic cardiomyopathy (NICM). Methods: One hundred and twenty patients with CHF due to NICM and one hundred and eighty patients with CHF due to ischemic cardiomyopathy (ICM) treated in our hospital from January 2013 to December 2016 were selected as NICM group and ICM group, respectively. The genomic DNA of the two groups was extracted for the genotyping of epsilon locus of ApoE gene by PCR-RFLP. The left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured by color Doppler ultrasonography. Results: In NICM group, the epsilon 4/4 and epsilon 3/4 genotypes and the frequency of allele epsilon 4 were significantly higher than those in ICM group (P < 0.05); epsilon 2/3 and epsilon 2/4 genotypes and frequency of allele epsilon 2 were significantly lower than ICM group (P < 0.05); but there was no significant difference between both group in epsilon 2/2 and epsilon 3/3 genotypes and e3 frequency (P > 0.05). Logistic regression analysis showed that epsilon 4/4 genotype and allele epsilon 4 were the influencing factors of CHF secondary to NICM (P < 0.05). Patients in the NICM group showed different genotypes and different features in both LVEF and LVEDD, the order of which is: LVEDD (epsilon 4/4) > LVEDD (epsilon 3/4) > LVEDD (epsilon 3/3) > LVEDD (epsilon 2/4) > LVEDD (epsilon 2/3) > LVEDD (epsilon 2/2) (P < 0.05); LVEF (epsilon 4/4) < LVEF (epsilon 3/4) < LVEF (epsilon 3/3) < LVEF (epsilon 2/4) < LVEF (epsilon 2/3) < LVEF (epsilon 2/2) (all P < 0.05). Conclusion: ApoE gene polymorphism is closely related to CHF secondary to NICM, and CHF is more severe in NICM patients with epsilon 4/4 type ApoE gene.

Background: Coronary intervention therapy is the main treatment for uremic patients with coronary heart disease. The studies on whether dialysis reduces the efficacy of dual antiplatelet drugs are limited. The aim of this study was to examine the effect of dialysis on antiplatelet drugs in uremic patients with coronary heart disease. Methods: This study included 26 uremic patients who had undergone percutaneous coronary intervention in China-Japan Friendship Hospital from November 2015 to May 2017. We examined their thromboelastography results before and after hemodialysis. Self-paired t-tests were employed to analyze changes in the inhibition rate of platelet aggregation. Results: The mean inhibition rates of arachidonic acid-induced platelet aggregation before and after hemodialysis were 82.56 ± 2.79% and 86.42 ± 3.32%, respectively (t = −1.278, P = 0.213). The mean inhibition rates of adenosine diphosphate-induced platelet aggregation before and after hemodialysis were 67.87 ± 5.10% and 61.94 ± 5.90%, respectively (t = 1.425, P = 0.167). There was no significant difference in the inhibition rates of platelet aggregation before or after hemodialysis. These results also applied to patients with different sensitivity to aspirin and clopidogrel. Conclusion: Dialysis did not affect the antiplatelet effects of aspirin and clopidogrel in uremic patients with coronary heart disease.

The present study investigated the protective effects and molecular mechanism of prostaglandin A1 (PGA1) and triptolide (TRI) on apoptosis of cardiac microvascular endothelial cells (CMVECs) in rats. CMVECs of rats were isolated and then cultured. MTT method was used to select and establish a cell hypoxia reoxygenation cell model. The cells were divided into four groups: Normoxia control group (C, normal oxygen), hypoxia reoxygenation group (H/R, hypoxia for 12 h/reoxygenation for 6 h), PGA1 group (H/R+PGA1) and TRI group (H/R+TRI). The growth of cells in each of the group was observed. B-cell lymphoma 2 (Bcl-2) mRNA expression in CMVECs and expression of Bcl-2 mRNA after PGA1 and TRI treatment were determined by RT-PCR. Cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. Bcl-2 mRNA decreased significantly after hypoxia stimulation of CMVECs of rats. The expression of Bcl-2 mRNA was significantly higher in comparison to hypoxia stimulation group after treatment with PGA1 and TRI (P<0.01). The elevated effect of PGA1 on Bcl-2 mRNA was stronger than that of the TRI group (P<0.05). The number of CMVECs reduced significantly after hypoxia. By contrast, DNA fragmentation and the number of endothelial cell apoptosis were increased significantly. However, Bcl-2 mRNA expression decreased significantly, after PGA1 and TRI treatments. Furthermore, the number of apoptotic cells reduced and Bcl-2 mRNA expression increased (P<0.01). PGA1 and TRI significantly upregulated the expression of Bcl-2 mRNA, inhibited the activation of CMVECs and were able to achieve the protective effect on apoptosis of CMVECs in hypoxia-oxygenated rats.

Objective To investigate the efficacy and safety of optimized axillary vein puncture for cardiovascular implantable electronic device (CIED) lead implantation.Methods Two hundred and twenty patients with indications of CIED implantation were randomized into optimized axillary vein puncture group (experimental group) or subclavian vein puncture group (control group).The efficacy and safety of the two techniques were compared.Results The success rate (96.6％ vs.96.0％),one-time success rate (68.8％ vs.69.3％) and X-ray exposure time[(152.1±32.7) s vs.(145.6±46.1) s]of axillary vein puncture and subclavian vein puncture were similar between the two groups.There were one case of pneumothorax and three cases of lead operating diff culties in subclavian vein puncture group.No complication occurred in axillary vein puncture group.In the follow-up,Electrode crash syndrome occurred in two patients in the control group.The incidence of complications showed a decreased tendency in the optimized axillary vein puncture group(1.82％ vs.7.27％,P=0.11).Conclusion Optimized axillary venous approach may be superior to traditional subclavian vein approach for pacemaker lead placement.

Objective To explore the correlation between CYP2C19 genotype and the platelet inhibition rate in patients taking clopidogrel with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Methods A total of 500 patients with CHD after PCI were enrolled and divided into 3 groups, as fast, intermediate and slow metabolizer, according to the results of CYP2C19 genetic testing. The ADP-induced platelet inhibition rate was measured by thromboelastography ( TEG) . The relationships between CYP2C19 genotype and platelet inhibition rate among 3 groups were analyzed. Cardiovascular event recurrent rates were followed up 6 months after PCI. Results (1)The distribution of fast, intermediate or slow metabolizer among the 500 patients was 42. 0% , 44. 8% and 13. 2% , respectively. (2)The population distribution of platelet inhibition rates of 0-20% , 20% -50% , 50% -75% and 75% -100% were 1. 90% , 14. 29% , 30. 00% and 53. 81% in the group of fast metabolizer, 3. 57% , 17. 86% , 22. 32% and 56. 25%in the group of intermediate metabolizer, and 7. 58% , 21. 21% , 30. 30% and 40. 91% in the group of slow metabolizer. There was no significant difference of the ADP-induced platelet inhibition rates among three groups (P ﹥ 0. 05). (3)Cardiovascular ischemic events occurred in 9 cases in fast metabolizer group, 13 in intermediate metabolizer group and 4 in slow metabolizer group during 6 months after PCI ( P ﹥ 0. 05) . Conclusions Prediction of clopidogrel resistance can’t be decided only by CYP2C19 genotype. In these groups of people, none between CYP2C19 genotype and clopidogrel platelet inhibition was significantly correlated.

Objective To explore the impact on intervascular blood flow perfusion among coronary arteries in order to illuminate the mechanism of acute simultaneous occlusion of double vessels in patients with ST-elevation myocardial infarction (STEMI).Methods A cohort of 15 consecutive STEMI patients with acute simultaneous occlusion of double vessels admitted from February 2013 to February 2014 were enrolled in this study.Those patients were treated with emergency primary percutaneous coronary intervention (p-PCI) after admission.The clinical data,the procedure of emergency p-PCI and the findings of coronary artery angiography (CAG) were retrospectively analyzed.Results Of 15 patients with STEMI,there were 8 with acute anterior and inferior wall MI,5 with acute inferior and posterior wall MI and 2 with acute anterior and lateral wall MI.Of them,14 patients manifested abruptly in the clinical feature of cardiagenic shock,and treatment strategy was one-step revascularization with p-PCI or muhiple-step revascularization procedures.All patients were survived after emergency p-PCI and then cared continuously in the Coronary Care Unit.They were checked with CAG,and CAG showed that 6 totally occluded coronary arteries resumed blood perfusion of more than TIMI 2 grade of the blood flow after p-PCI.Conclusions The double vessel occlusion STEMI is rare occurred in clinical medicine.The perfusion of non-culprit artery may be impaired and blocked as soon as the culprit artery was obstructed by thrombus to produce an acute double vessel occlusion of STEMI.And cardiogenic shock might be involved in the pathogenesis process.One-step treatment strategies for STEMI with cardiogenic shock could have clinical practice value.

目的 观察改良腋静脉穿刺技术应用于心脏起搏器电极植入手术的有效性和安全性.方法 选取2012年3月至2012年10月北京市中日友好医院收治的因病态窦房结综合征、房室阻滞或心房颤动伴心室长间歇而行永久心脏起搏器植入手术的患者50例,采用改良的腋静脉穿刺技术行起搏电极植入,观察围术期并发症情况,术后常规随访.结果 50例患者均成功完成腋静脉穿刺,共植入起搏电极95根.手术期间未发生血胸、气胸、植入电极操作不顺等情况.随访时间(9.3±3.1)个月,所有患者的起搏参数未见明显异常.结论 临床初步研究证实了改良的腋静脉穿刺技术的安全性和有效性.

目的:通过一项5年的随访初步探讨尾加压素Ⅱ(UⅡ)水平对非心肌梗死冠心病患者的预后判断价值,并同传统的危险评分作比较.方法:入选冠脉造影确诊冠心病的非心梗患者共84例,每年电话随访并查阅门诊病历,记录每名患者5年内的再发缺血或再次血管重建事件,心脏事件(心绞痛、心梗、心衰),脑血管事件,死亡,总事件率等.UⅡ水平＞2.8ng/ml计19例.EUROPA危险评分≥10,为高危(n=9).结果:列入统计的84例患者,全部完成9个月随访,完成5年随访75例(随访率90％),平均随访时间为4.8年,在UⅡ高水平组仅脑梗死率升高( 10.5％vs0％,P＜0.05),总事件率等未见统计学的差异(23.8％vs 18.5％).高危险评分组总事件率、死亡率均较低分组显著升高(44.6％vs26.7％,22.2％vs3.0％,P＜0.05),脑梗死及再次血管重建率虽然也增高,但无统计学差异(P＞0.05).结论:在非心肌梗死冠心病患者,基础UⅡ水平高者可能脑梗死发生率较高,其他的事件率包括总事件、死亡、再次血管重建等均未见到UⅡ的预测价值.