Background: Telomere shortening is strongly associated with cardiovascular aging and disease, and patients with shorter telomeres in peripheral blood leukocytes are at higher risk of cardiovascular diseases such as heart failure and atrial fibrillation (AF). Telomerase reverse transcriptase (TERT) maintains telomere length, and overexpression of TERT has been shown to reduce cardiomyocyte apoptosis and myocardial infarct size, and extend the lifespan of aged mice. However, the specific impact of TERT on the electrophysiology of cardiomyocytes remains to be elucidated. The aims of this study were to evaluate the role of TERT in Ca2+ homeostasis and mitochondrial function in atrial myocytes as well as the underlying mechanisms. Methods: TERT overexpressed and silenced HL-1 cells were constructed with lentiviruses, and the respective empty lentiviral vectors were used as negative controls. Then the patch clamp technique was used to record the electrophysiological characteristics such as cell action potential duration (APD) and L-type Ca2+ currents (ICa,L), flow cytometry was used to detect intracellular Ca2+ concentration and mitochondrial membrane potential (MMP), and the Seahorse assay was used to measure the oxygen consumption rate (OCR). Results: TERT silencing led to intracellular Ca2+ overload, shortened APD, decreased ICa,L current density, altered Ca2+ gating mechanism, decreased MMP and OCR, and increased reactive oxygen species (ROS), whereas TERT overexpression led to the reverse effects. Additionally, TERT silencing resulted in intracellular Ca2+ overload with decreased expression of the SERCA2a, CaV1.2, and NCX1.1, whereas TERT overexpression had opposing effects. Furthermore, we discovered that TERT could regulate the expression of p53 and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α). The expression of PGC-1α was downregulated by the p53 agonist Tenovin-6 but upregulated by the p53 inhibitor PFTα. The effects of the PGC-1α inhibitor SR-18292 on intracellular Ca2+ and cell electrophysiology were similar to those of silencing TERT, whereas the PGC-1α agonist ZLN005 produced comparable outcomes to TERT overexpression. Conclusions: TERT silencing-induced Ca2+ overload and mitochondrial dysfunction may be one mechanism of age-related AF. Overexpression of TERT reduced the basis for arrhythmia formation such as AF, suggesting a favorable safety profile for TERT therapy. TERT regulated intracellular Ca2+ homeostasis and mitochondrial function through the p53/PGC-1α pathway. In addition, PGC-1α might be a novel target for AF, suggesting that intervention for AF should be not limited to abnormal cation handling.

The E-twenty-six variant 1 (ETV1)-dependent transcriptome plays an important role in atrial electrical and structural remodelling and the occurrence of atrial fibrillation (AF), but the underlying mechanism of ETV1 in AF is unclear. In this study, cardiomyocyte-specific ETV1 knockout (ETV1 f/f MyHC Cre/+ , ETV1-CKO) mice were constructed to observe the susceptibility to AF and the underlying mechanism in AF associated with ETV1-CKO mice. AF susceptibility was examined by intraesophageal burst pacing, induction of AF was increased obviously in ETV1-CKO mice than WT mice. Electrophysiology experiments indicated shortened APD 50 and APD 90 , increased incidence of DADs, decreased density of I Ca,L in ETV1-CKO mice. There was no difference in V INACT,1/2 and V ACT,1/2 , but a significantly longer duration of the recovery time after inactivation in the ETV1-CKO mice. The recording of intracellular Ca 2+ showed that there was significantly increased in the frequency of calcium spark, Ca 2+ transient amplitude, and proportion of SCaEs in ETV1-CKO mice. Reduction of Cav1.2 rather than NCX1 and SERCA2a, increase RyR2, p-RyR2 and CaMKII was reflected in ETV1-CKO group. This study demonstrates that the increase in calcium spark and SCaEs corresponding to Ca 2+ transient amplitude may trigger DAD in membrane potential in ETV1-CKO mice, thereby increasing the risk of AF.

AL.: Pulmonary Vein Electrical Isolation for the Cure of Paroxysmal Atrial Fibrillation Guided by a Novel Geometry Mapping System. Objectives: The purpose of the study is to evaluate the feasibility and effect of left wall (LA) ablation guided by a novel geometry mapping system in the treatment of older patients with paroxysmal atrial fibrillation (PAF). Methods: Regular electrophysiological study was conducted to exclude atrioventricular reentrant tachycardia (AVRT) with accessory pathways, atrioventricular nodal reentrant tachycardia (AVNRT) and other inducible tachyarrhythmias. Twice transseptal puncture was achieved with L1 and R1 Swartz sheaths. Pulmonary vein (PV) angiographies were conducted to evaluate their orifices and branches. LA geometry was constructed under either sinus rhythm or PAF using Ensite3000 Navx system. Two lesion loops and three lines (see details in the text) for electrical isolation were outlined and created by radiofrequency catheter ablation on the three-dimension geometry of LA. Each lesion point was ablated in 30 seconds with preset temperature 50°C and energy 30W. The disappearance or 80% decrease of the amplitude of LA target potential and 10 to 20 Ω decrease of ablation impedance were used as effective index. Results: Three patients included two males and one female of age 67.3±3.6. PAF history was 7.4±5.1 years. Mean 3.5± 1.2 antiarrhythmic agents were used in 5.7±2.3 years without PAF effectively prevention. No organic heart diseases and stroke complications were founded. Left atrium was 38.7±3.2 mm and LVEF was 58.6±4.3 on echocardiography. Altogether 59-126 (63.7±11.2) lesion points were created to complete two loops and three lines. Rapid burst pacing up to 600 beats per minute was delivered from the distal coronary sinus electrode pair without PAF provoked. The procedure time was 2.8±0.7 hours and fluoroscopy time was 19.6± 8.3 minutes. Patients were discharged with long-term oral warfarin and without any antiarrhythmic agent. During the follow up of 5.6±2.3 months, one patient was free of symptom and PAF attacks were decreased more than 80% in the other two patients by evaluation of Holter monitoring. Conclusions: Ensite3000 Navx guided LA wall ablation near PV orifice to cure PAF in the elderly is safe and feasible and has the advantages of clear procedure endpoint, shorter X-ray exposure, less complication and satisfied long-term effect. Large number of cases and long-term follow up data are needed to validate these primary results. (J HK Coll Cardiol 2004;12: 58-63)

OBJECTIVE:To evaluate the efficacy of the figure-of-eight (FOE) suture technique in the treatment of tunnel bleeding after femoral artery puncture compared with manual compression (MC).METHODS:This prospective, randomized, controlled study enrolled patients that had received transfemoral coronary artery angiography or percutaneous coronary intervention and then developed tunnel bleeding. They were randomly assigned into two groups: FOE suture group (ES group) and manual compression group (MC group). Total treatment time, performance frequency, performance time, rate of deep vein thrombosis (DVT) and in-hospital time after the procedure were compared.RESULTS:A total of 152 patients were enrolled in the study (ES group, n = 63; MC group, n = 89). Compared with the MC group, the total treatment time (mean ± SD: ES 22.3 ± 5.4 h versus MC 26.8 ± 6.8 h), performance frequency (mean ± SD: ES 2.1 ± 0.7 versus MC 2.6 ± 1.1), performance time (mean ± SD: ES 8.9 ± 2.5 min versus MC 12.3 ± 4.1 min), in-hospital time after the procedure (mean ± SD: ES 3.5 ± 1.2 days versus MC 4.8 ± 2.1 days) and DVT rate (ES 0.0% versus MC 6.7%) were significantly lower in the ES group.CONCLUSION:The FOE suture technique effectively treated tunnel bleeding after femoral artery puncture.

Aim: We aimed to study the effect of allocryptopine (All) on the late sodium current (I-Na,I-Late) of atrial myocytes in spontaneously hypertensive rats (SHR). Methods: The enzyme digestion method was used to separate single atrial myocytes from SHR and Wistar-Kyoto (WKY) rats. I-Na,I-Late was recorded using the patch-clamp technique, and the effect of All was evaluated on the current. Results: Compared with WKY rat cells, an increase in the I-Na,I-Late current in SHR myocytes was found. After treatment with 30 mu M All, the current densities were markedly decreased; the ratio of I-Na,I-Late/I-Na,I-peak of SHR was reduced by30 mu M All. All reduced I-Na,I-Late by alleviating inactivation of the channel and increasing the window current of the sodium channel. Furthermore, I-Na,I-Late densities of three SCN5A mutations declined substantially with 30 mu M All in a concentration-dependent manner. Conclusion: The results clearly show that an increase in I-Na,I-Late in SHR atrial myocytes was inhibited by All derived from Chinese herbal medicine.

Objective To evaluate the efficacy of figure 8 suturing technique in treatment of tunnel bleeding after femoral artery puncture.Methods A total of 152 patients,who had undergone transfemoral percutaneous coronary intervention and then developed bleeding after catheter insertion,admitted in our department from December 2013 to December 2016 were enrolled in the study consecu-tively.These patients were assigned randomly into figure 8 suturing group(n=63)and strengthened compression group(n=89). Five parameters,including mean compression time,bandaging frequency,mean operation time,incidence rate of lower limb deep vein thrombosis(DVT),and length of hospital stay after operation,were compared between the 2 groups.SPSS statistics 22.0 was used to perform the statistical analysis, and Student′s t test or Chi-square test was employed to make comparison for different data types. Results Compared to the strengthened compression group,the figure 8 suturing group had shorter compression time[(22.3 ±5.4)vs (26.8 ±6.8)h, P<0.01], less bandaging frequency[(2.1 ±0.7)vs(2.6 ±1.1)times, P <0.01], shorter operation time [(8.9 ±2.5)vs(12.3 ±4.1)min,P<0.01], lower incidence rate of DVT(0.0% vs 6.7%, P<0.05), and shorter length of hospital stay[(3.5 ±1.2)vs(4.8 ±2.1)d,P<0.01].Conclusion Figure 8 suturing technique is effective and easy-to-operate in treatment of tunnel bleeding after femoral artery puncture,and obviously superior to conventional compression method.

目的 :探讨分析丹参多酚酸盐治疗冠心病的临床疗效及安全性.方法 :将我院2017年6月到2017年12月收治的75例冠心病患者随机分为两组,对照组患者(37例)应用马来酸桂哌齐特治疗,对观察组患者(38例)应用丹参多酚酸盐治疗,对比2组总有效率及不良反应情况.结果 :观察组总有效率为89.47％,对照组为62.16％,对比P<0.01,差异具有显著性;观察组不良反应发生率为7.89％,对照组不良反应发生率为10.82％,对比P>0.05,无明显差异.结论 :丹参多酚酸盐治疗冠心病临床疗效可靠、安全.

Objective To review the teaching effect of 3-min+task teaching method on advanced students practicing in department of cardiology. Methods The advance students (n=72, male 32, female 40 and aged from 28 to 42) studied in the Department of Cardiology of Chinese PLA General Hospital were chosen from May 2013 to Apr. 2017. All students were randomly divided into control group and test group (each n=36). The control group was given clinical teaching with routine teaching method, and test group, additionally with 3-min+task teaching method. The results of theory, manipulation and comprehensive examinations were reviewed in 2 groups, and satisfaction of students' on clinical teaching and general evaluation of doctors' and nurses' without teaching tasks and patients' on students were surveyed by using questionnaire. Results Compared with control group, the results of theory and comprehensive examinations were significantly increased in test group [(81±16) vs. (90 ±18)] and [(79±15) vs. (91±19), all P<0.05]. Compared with control group, satisfaction was higher in test group [(3.2±1.4) vs. (4.5±1.1)], and general evaluation of doctors' and nurses' without teaching tasks increased in test group [(3.0±1.5) vs. (4.3±1.2)] and [(3.5±1.1) vs. (4.6±1.4), all P<0.05]. Conclusion The teaching method of 3-min+task is a simple, feasible and effective method for clinical teaching, which is worth to be popularized in clinical practical teaching.

Repeated exhaustive exercise could cause obvious oxidative stress-related injury in cardiomyocytes. This study was designed to investigate effects of allicin on rat myocardial oxidative injury during repeated exhaustive exercise, and its molecular mechanisms. Forty Sprague Dawley rats (6-7 wk old) were randomly divided into five groups: control (Control group); rats undergoing seven consecutive daily sessions of exhaustive swimming (SW group); and three groups of SW rats also receiving allicin at 4.2, 6.3 or 12.6 mg/kg for 7 d (SW+Allicin group). The effects of repeated exhaustive exercise on structural, functional and molecular biological changes in heart have been examined. Haematoxylin-eosin staining showed that treatment with allicin relieved myocardial cell swelling and inflammatory cell infiltration induced by repeated exhaustive exercise. Myocardial superoxide dismutase (SOD) activity was significantly reduced in the SW group compared with the Control group (P<0.01), while the levels of cardiac troponin T (cTnT), heart fatty acid binding protein (H-FABP), cortisol (COR), high sensitivity C reactive protein (hs-CRP), malondialdehyde (MDA), and the apoptotic index were significantly higher in the SW group than in the Control group (P<0.01). In addition, the protein levels of phosphorylated (p-) Akt, p-FOXO3a, Bcl-xL and nuclear sirtuin 1 (SIRT1) were significantly lower in the SW than in the Control group (P<0.01). All these effects were reversed by allicin (P<0.01). Allicin treatment significantly increased the activity of SOD, and inhibited the activities of cTnT, H-FABP, COR, hs-CRP and MDA, especially in the SW+Allicin (6.3 or 12.6 mg/kg) groups. Moreover, allicin treatment (4.2, 6.3 or 12.6 mg/kg) significantly increased the protein levels of p-Akt, p-FOXO3a, SIRT1, Bcl-xL compared with those in the SW group, while the protein levels of FOXO3a, Bax, cytochrome c and cleaved caspase-3 were changed in the opposite direction. These data suggested that allicin protected rat cardiomyocytes from oxidative stress-induced injury and apoptosis during repeated exhaustive exercise by enhancing FOXO3a phosphorylation via Akt and SIRT1 activation.

Objective To improve the effect of clinical training for interns at cardiovascular department, the method of 3 minutes plus task was established to teach interns and was evaluated, in the light of one minute preceptor clinical teaching method. Methods Undergraduate students majored in clinical medicine who were in their practice stage of the fifth year were enrolled in when they were trained in cardiovascular department from March 2016 to April 2017.56 interns were assigned randomly into control group and experimental group. Control group were given traditional clinical training only while experimental group were given additional 3 minutes plus task teaching. Evaluations of the two groups were firstly done by means of paper examination of theory and knowledge, operation assessment and composite examination. Then questionnaire were given to interns for their level of satisfaction about the clinical teaching. Questionnaire were also sent to doctors without teaching task, nurses and patients related for their assessment about overall performance of interns. Results Compared to control group, the experimental group achieved better scores in all aspect of evaluation and questionnaires. Conclusions Three minutes plus tasks is an easy and effective clinical teaching method and deserves dissemination and further investigation.

Objective To explore the changes of cardiovascular system of military personnel during highly intensive training. Methods One hundred and seventy officers and soldiers were as research subjects, including 100 individuals in high- intensity group and 70 in control group. The levels of serum cortisol (COR), high sensitivity C-reactive protein (hs-CRP), cardiac- specific Troponin T (cTnT) and human heart fatty acid binding protein (H-FABP) were measured when military training ended. All subjects were tested with fatigue assessment instrument (FAI). The data of blood pressure and electrocardiogram were collected from 40 individuals randomly selected from high-intensity group and 36 from control group before and after training for analyzing the blood pressure, arrhythmia and heart rate variability (HRV). Results The levels of COR (indicator related to stress) and hs-CRP (indicator related to inflammation) were significantly higher in high intensity group than in control group (P<0.05). Highly intensive training can lead to the emergence of myocardial micro-injury, the levels of cTnT and H-FABP were obviously higher than those in control group (P<0.01), and the mean blood pressure and the severity of fatigue status were significantly higher than those in control group (P<0.05). The incidence of severe ventricular arrhythmia was lower in both groups (P=1.000). The average heart rate, total heart beats, total number of atrial premature beat, total number of ventricular premature beat, the incidence of sinus arrhythmia and intermittent second degree type I atrioventricular block were significantly higher in high intensity group than in control group (P<0.05). The HRV of high intensity group was obviously decreased (P<0.01). Conclusion Highly intensive training may induce the military personnel into the state of acute stress and inflammation, which may lead to myocardial injury, increase severity of fatigue status, accompanied with the rise of blood pressure, low HRV and increased incidence of various arrhythmias. DOI: 10.11855/j.issn.0577-7402.2018.04.15

Objective To investigate the safety and efficacy of mapping and ablating paroxysmal atrial fibrillation (PAF) by using remote magnetic navigation system (MNS, Niobe Ⅲ, Stereotaxis) vs manual navigation.Methods Totally 103 consecutive patients diagnosed as PAF in our department from October 2014 to November 2016 were enrolled in our study.They were randomly divided into MNS group [(n=53, 27 males and 26 females, at an age of (65±13) years] and manual navigation group [(n=50, 23 males and 27 females, at an age of (62±15) years].Procedure time, ablation time, X-ray exposure time, and recurrence in 3 months' follow-up were collected and compared between the 2 groups.Results Pulmonary vein isolation was accomplished in 52 cases from the MNS group, and in 49 cases of the manual navigation group.The success rate was 98% in both group, without significant difference (P>0.05).Compared with the manual navigation group, the MNS group had significantly longer procedure and ablation times, but obviously shorter X-ray exposure time (P<0.05).There was no notable difference in the recurrent rate between the MNS (10 cases) and manual navigation groups (12 cases) in 3 months after surgery (19% vs 24%, P>0.05).Conclusion In comparison with manual navigation, Niobe Ⅲ remote magnetic navigation system is safe and effective in mapping and ablation of PAF, and it reduces the X-ray exposure time.

Objective: To explore the onset features and prognosis in "migratory birds" population with acute myocardial infarction (AMI) in Hainan province. Methods: A total of 1246 patients diagnosed as coronary aretery disease and admitted in our Hospital during 2012-2015 were consecutively enrolled, including "Migratory birds" group (n=197) and Hainan group (n=58). Clinical information, risk factors, interventional strategies and in-hospital outcomes were recorded and compared. Results: The patients' age, histories of hypertension, diabetes, smoking and blood lipids were similar between 2 groups. In "Migratory birds" group, the average time from arriving Hainan to AMI onset was (3.15±2.67) days. Compared with Hainan group, "Migratory birds" group had the higher ratio of acute STEMI occurrence [70.56% (139/197) vs 51.72% (30/58), P=0.003], more patients with single+double coronary artery diseases (P=0.009), and thrombus aspiration (P=0.008); while less stent implantation, P=0.007. "Migratory birds" group also presented the higher ratios of cardiac shock after AMI (12.69%vs 3.45%, P=0.044), and cardiac shock+death (16.24% vs 3.45%, P=0.022). Conclusion: "Migratory birds" AMI patients had the higher ratios of acute STEMI, with more simple lesions and thrombus aspiration, they usually had poor prognosis.

Objective To analyze the risk factors for venous thrombosis related to the lead of cardiovascular implantable electronic device (CIED) in order to provide the theoretical basis for clinical prevention.Methods A total of 112 patients undergoing CIED implantation and with full follow-up data who hospitalized in our department from September 2013 to December 2015 were recruited in this study.According to the results of postoperative vascular ultrasound examination, they were assigned to the thrombosis group [n=56, at an age of (71.86±8.35) years] and the non-thrombosis group [n=56, at an age of (71.23±10.62) years].Their clinical data were collected and retrospectively analyzed.Multivariate logistic regression analysis was applied to assess the risk factors of the related venous thrombosis.Results There were significant differences in the numbers of patients with atrial fibrillation, those with implanted defibrillator leads and those taking anticoagulant medications, the left ventricular ejection fraction, the serum level of glycosylated hemoglobin, as well as the times of venipuncture, operation time, and lead numbers between the thrombosis and the non-thrombosis groups (P<0.05).Multivariate logistic regression analysis showed atrial fibrillation, times of venipuncture, operation time and lead numbers were the risk factors for the related venous thrombosis, and administration of anticoagulant medications was the protective factor.Conclusion Atrial fibrillation, times of venipuncture, operation time and lead numbers are the independent risk factors for venous thrombosis related to CIED leads.

Objective To investigate the efficacy and safety of mapping and ablating premature ventricular contractions (PVCs) originated from ventricular outflow tract using remote magnetic navigation system (MNS, Niobe III, Stereotaxis) vs. manual navigation.Methods 68 consecutive patients diagnosed as outflow tract PVCs from Oct 2014 to Jan 2017 were enrolled in our study, the mean age was 43±13 years and 38±12 years in MNS group and manual group, respectively. Mapping and ablating were performed by MNS or CARTO 3 system. The operative efficacy, safety and other relevant clinical data were compared between the two groups.Results There was no significant difference between two groups according to clinic profiles. The acute success rate was 93.9% (31/33)vs. 91.4% (32/35) (P>0.05), respectively. Total procedure time and ablation time was (125±45 minvs. 105±40 min, P>0.05), and (270±60 svs. 240±55 s,P>0.05), respectively. The power was much higher in MNS group than that in manual group (40±10 Wvs. 25±5 W, P<0.05). MNS group had less fluoroscopic time than manual group (1.2 ±0.5 minvs. 3.2±1.2 min,P<0.05). Both groups had no severe complications.Conclusion The Niobe III remote magnetic navigation system for mapping and ablation of outflow tract PVCs is effective and safe. Furthermore, it may reduce the exposure time from radiation for both patients and physicians. But higher power maybe needed.

BACKGROUND:Sympathetic nerves-fire rate is generally enhanced in some types of hypertension models. Renal sympathetic denervation(RSD) by the radiofrequency ablation was used to treat the hypertension has achieved curative effect.HTN-1 and HTN-2 trial reported catheter-based renal denervation may cause substantial and sustained blood-pressure reduction in patients with resistant hypertension. However, recent controlled HTN-3 trial questioned the BP lowering effect of Renal denervation treatment. The controversial results maybe arised from the incompleted RSD which implemented inside the renal artery. Now renal denervation therapy for resistant hypertension is in attractive and controversial status. Our aim is to define the hyotensive value of complete renal denervation in adult spontaneous hypertensive rats.METHODS:Male spontaneous hypertensive rats(SHR) aged 12 weeks were randomly selected for either unilateral renal artery sympathetic nerves ablation (URSNA), or conventional technique of renal denervation (CRD), or bilateral renal artery sympathetic nerves ablation (BRSNA) and sham operation. Blood pressure, sodium and water balance,serum reninangiotensin II and Norepinephrine concentration were measured during 20 weeks after renal denervation operation. Internal diameters of renal arteries and renal blood flow rate was tested by ultrasonic contrast imaging.RESULTS:The continued increased blood pressure in SHR was delayed and significantly reduced by conventional renal denervation over a period of 8 weeks. Both the bilateral and unilateral renal sympathetic nerve ablation procedure did not prevent the development of hypertension in SHR. The attenuation of hypertension was accompanied with the increase of urinary sodium excretion and depression of rennin angiotensin system (RAS).CONCLUSIONS:We concluded that renal denervation may not be an effective therapeutic method in the long-term control of hypertension in adult SHR.

Background: A standard resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD). Several analytic methods exist to enhance the sensitivity and specificity of resting ECG for diagnosis of CAD. We compared a new computer-enhanced, resting ECG analysis device, the cardiac quantum spectrum (CQS) technique, with coronary angiography in the detection of CAD.Material/Methods: A consecutive sample of 93 patients with a history of suspected CAD scheduled for coronary angiography was evaluated with CQS before coronary angiography. The sensitivity and specificity of CQS and standard 12-lead ECG for detecting hemodynamically relevant coronary stenosis were compared, using coronary angiography as the reference standard. Kappa analysis was performed to assess the agreement between CQS severity scores and the level of stenosis determined by coronary angiography..Results: The CQS system identified 78 of 82 patients with hemodynamically relevant stenosis (sensitivity, 95.1%; specificity, 63.6%; accuracy, 91.4%; positive predictive value, 95.1%; negative predictive value, 63.6%). Sensitivity and accuracy were much higher for CQS analysis than for the standard ECG. The Kappa value, assessing the level of agreement between CQS and coronary angiography, was 0.376 (P<0.001).Conclusions: CQS analysis of resting ECG data detects hemodynamically relevant CAD with high sensitivity and specificity.

Objective To evaluate the effect of prolonged compression bandaging time on bleeding Atotol of complications after closing the femoral artery puncture point with the Angioseal artery occluders in the elderly. Methods Totally 728 elderly patients were selected for coronary angiography and interventional treatment, whose femoral artery puncture points were closed with Angioseal. These patients were randomly divided into the conventional treatment group (keeping postoperative straight leg lie for 6 hours, and then elastic pressure bandage was removed within 2h) and delayed bandaging group (keeping postoperative straight leg lie for 6 hours, and then elastic pressure bandage was not removed until 20?24h). The vascular complications and occurrent time were observed. Results There was significant difference in femoral artery puncture site complications between two groups. The incidence of puncture site bleeding and pseudoaneurysm from conventional treatment group was significantly higher than that from delayed bandaging one (7.42%vs 1.78%, P=0.001). And bleeding complications were manifested as increased hemorrhagic complications after removement of compression bandage (conventional treatment group, 6.14%, and delayed bandaging group, 0.59%, P=0.001). The formation incidence of pseudoaneurysm due to hemorrhage increased significantly in the conventional treatment group (1.53% vs 0.00%, P=0.033). Although incidence of venous thrombosis due to local pressed hemostasis after bleeding increased (0.77% vs 0.30%, P=0.628), there was no statistical difference. Conclusion Bleeding complication of femoral artery puncture site with Angioseal not only related with the puncture technique, but also with PCI postoperative anticoagulation and antiplatelet treatment. Extending compression time and reducing the early activities appropriately are very important means of reducing femoral artery puncture site bleeding complications.

Background/objectivesThe relative efficacy and safety of limus-eluting stent (LES) versus paclitaxel-eluting stent (PES) in DM patients remain unclear.MethodsThe PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were searched from January 2001 to December 2013. Clinical trials that performed head-to-head comparisons of LES versus PES implantation in patients with DM were considered for inclusion.ResultsThis meta-analysis included 28 clinical trials involving 23,678 patients: 9953 who underwent sirolimus-eluting stent (SES) implantation, 4209 underwent everolimus-eluting stent (EES) or zotarolimus-eluting stent (ZES) implantation, and 9516 underwent PES implantation. The short-term target lesion revascularization (TLR) rate was significantly lower after SES implantation than after PES implantation (3.6% vs 6.3%; odds ratio (OR): 0.659; P=0.014), but there were no significant differences in the rates of target vessel revascularization (TVR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, or major adverse cardiac events (MACE). There were no differences in the longer-term rates of TLR, TVR, ST, MI, all-cause mortality, or MACE between SES versus PES. Second-generation LES (EES or ZES) implantation resulted in lower rates of ST (2.1% vs 3.3%; OR: 0.586; P<0.001), MI (2.3% vs 4.1%; OR: 0.527; P=0.001), and MACE (8.0% vs 10.3%; OR: 0.796; P=0.007) than PES implantation.ConclusionsIn patients with DM, short- and longer-term MACE rates were similar after first-generation LES and PES implantation. The second-generation LES may be better than PES implantation in rates of ST, MI, and MACE.