目的 比较多学科合作(multi-disciplinary team,MDT)联合以问题为基础的(problem based learning,PBL)的整合教学法与传统教学法(lecture based learning,LBL)在心血管内科临床实习教学中的差别.方法 入选2018年1月～2020年1月在上海交通大学医学院附属第九人民医院心血管内科实习的80名临床五年级本科生,随机分为研究组(MDT联合PBL教学)及对照组(LBL教学).教学结束后对两组学生分别进行理论知识、临床病例分析以及教学满意度评价.结果 研究组学生理论知识、病例分析的成绩均高于对照组(P＜0.05).满意度问卷调查结果显示,研究组在增加学习兴趣、培养临床思维、教学新颖程度、提高人文素养以及整体满意度5个方面评分高于对照组.结论 MDT联合PBL教学模式在提升理论知识以及临床思维等方面优于LBL教学法,学生整体满意度更高.

目的 评价切割球囊联合药物涂层球囊在冠脉原发病变中的应用效果.方法 选择2017年8月11日～2020年6月11日行冠脉造影并拟行单纯药物涂层球囊治疗的冠脉原发病变患者,共91例.根据预处理方式的不同,将使用非顺应性或半顺应性球囊预处理的作为对照组(n=54),使用切割球囊预处理的作为观察组(n =37),比较两组在术中的预处理成功率.经过术后6个月的随访,比较两组患者的靶病变再狭窄、主要不良心血管事件发生率.结果 对照组的54例患者术中40例预处理成功,观察组37例患者术中36例预处理成功,两组差异具有统计学意义(P＜0.05).与对照组相比,观察组靶血管前降支和其他分支比例较高,回旋支、右冠比例较低,差异具有统计学意义(P＜0.05).对照组的54例患者中38例接受单纯药物涂层球囊治疗.观察组的37例患者中32例接受单纯药物涂层球囊治疗.与对照组比较,观察组预处理成功率较高,差异具有统计学意义(P＜0.05).预处理方式不同对预处理效果的影响具有统计学差异.非(不使用)切割球囊是预处理失败的独立危险因素.经过术后6个月随访,观察组中原靶病变再狭窄0例,非原靶病变血运重建1例.对照组中原靶病变再狭窄3例,非原靶病变血运重建2例,两组对比差异无统计学意义.结论 切割球囊完成冠脉原发病变预处理是一种非常良好的的病变准备手段,联合单纯药物涂层球囊后,获得了极低的靶血管失败率和良好的随访效果.

目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特征、冠状动脉(冠脉)病变特点及危险因素.方法:回顾性分析2016年1月-2017年12月于上海交通大学医学院附属第九人民医院住院的AMI患者共476例,根据冠脉造影的结果分为MINOCA组(56例)和MICAD组(420例).比较2组患者的临床特点、心脏结构、冠脉病变特征、危险因素等.结果:与MICAD组患者比较,MINOCA组患者的年龄较大(P＜0.05)、男性较少(P＜0.05),吸烟患者较少(P＜0.05),非ST段抬高急性心肌梗死比例较低(P＜0.05);空腹血糖、肌酸激酶、肌钙蛋白、白细胞计数、谷草转氨酶值、LDL-C值更低(P＜0.05);β受体阻滞剂、他汀类药物的应用比例更低(P＜0.05).MINOCA组患者的多支病变比例显著低于MICAD组(P＜0.05).在心脏结构方面,MINOCA组和MICAD组差异无统计学意义.多因素logistic回归分析结果表明,吸烟和糖尿病是MINOCA的相关危险因素(P＜0.05).结论:与MICAD患者相比,MINOCA年龄偏大,女性较多,肌钙蛋白、LDL-C及白细胞计数明显更低.MINOCA的相关危险因素主要为糖尿病和吸烟.

目的 在冠心病患者中应用光学相干断层成像(OCT)评估分层斑块并探讨其与冠状动脉易损性的关系.方法 入选2017年6月至2020年12月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病的患者222例.入院后行冠状动脉造影,并对靶血管行OCT检查.记录患者的一般资料、既往病史、心血管用药史、临床生化指标以及OCT数据.结果 共入选222例冠心病患者,OCT提示109例(49.1％)靶血管见分层斑块,其中左前降支61例(56.0％)、左回旋支20例(18.3％)、右冠状动脉28例(25.7％).心肌梗死患者中分层斑块占比65.0％(39/60),不稳定型心绞痛患者中分层斑块占比44.6％(25/56),稳定型心绞痛患者中分层斑块占比42.5％(45/106).两组患者生化指标比较,分层斑块组小而密低密度脂蛋白胆固醇[(1.16±0.38)mmol/L比(0.99±0.45)mmol/L]、肌钙蛋白[(2.69±11.57)ng/ml比(1.18±9.06)ng/ml]均高于非分层斑块组,差异均有统计学意义(均P<0.05).靶血管OCT特征方面,与非分层斑块组比较,分层斑块组最小管腔面积更小[(2.37±1.31)mm2比(3.35±2.23)mm2]、面积狭窄率更大[(69.11±12.26)％比(59.41±17.12)％]、病变长度更长[(20.05±8.94)mm比(17.03±7.75)mm]、脂质斑块弧度更大[(250.33±88.02)°比(181.55±115.71)°]、脂质斑块更长[(17.13±8.78)mm比(11.28±8.52)mm]、纤维帽更薄[(49.04±19.32)μm比(61.21±9.12)μm],差异均有统计学意义(均P<0.05).分层斑块组血栓形成、斑块破裂、巨噬细胞、微血管化、胆固醇结晶、内膜溃疡、内膜夹层、钙化斑块、薄纤维帽脂质斑块例数均较非分层斑块组更多,差异均有统计学意义(均P<0.05).受试者工作特征曲线显示,脂质斑块弧度预测分层斑块的曲线下面积(AUC)为0.683,敏感度为87.2％,特异度为43.4％,诊断临界值为167°(P<0.001);脂质斑块长度预测分层斑块的AUC为0.688,敏感度为77.1％,特异度为54.0％,诊断临界值为11.8 mm(P<0.001).非分层斑块组和分层斑块组9个月累计主要不良心血管事件发生率比较,差异有统计学意义(P=0.038),分层斑块组累计发生的MACE较多.结论 分层斑块不仅反映既往有斑块破裂或血栓形成的愈合史,还反映脂质斑块易损性,可能有预测未来冠状动脉事件潜在风险的价值.

Objective:To explore the effect of online appointment system of standardized patient in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing standardized patient database and typical case database, online appointment system of standardized patient for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)活性水平联合肌钙蛋白(cTn)对急性心肌梗死(AMI)的早期诊断价值.方法 连续收集2019年1月至12月来我院胸痛中心做冠脉造影的患者182例.根据造影结果,患者分为AMI组和稳定/不稳定型心绞痛组(SA/UA).结果 与SA/UA组比较,AMI组患者血清Lp-PLA2活性水平更高[(175.41±58.05)u/L比(152.28±46.82)u/L,P<0.01].Lp-PLA2与年龄和低密度脂蛋白(LDL)存在正相关.Lp-PLA2活性ROC曲线下面积(AUC)为0.612(95％CI:0.514～0.709,P=0.030),Lp-PLA2的cut-off值为156.5 u/L(敏感性61％,特异性62％).Lp-PLA2水平与AMI的患病率相关,OR为1.008[95％CI:1.000～1.016,P=0.043].结论 Lp-PLA2活性水平不依赖于肾功能,联合cTn I,可作为胸痛患者AMI的早期生物学标志物之一.

目的 对不典型症状急性心肌梗死和典型胸痛急性心肌梗死病人的临床特征以及治疗和预后进行观察.方法 回顾性选择2016年6月至2018年5月上海交通大学医学院附属第九人民医院收治的急性心肌梗死病人共202例,其中不典型症状心肌梗死52例,有典型胸痛心肌梗死150例,对两组病人进行临床特征观察比较.结果 与典型胸痛急性心肌梗死组比较,不典型症状急性心肌梗死组发病年龄较大[(75.6±13.2)岁比(65.2±12.1)岁,P<0.05],女性(28.8％比18.7％,P<0.05)及伴有糖尿病(48.1％比24.7％,P<0.05)病人比例更高.其中非ST段抬高型心肌梗死病人比例较典型胸痛组高(46.2％比20.7％,P<0.05).不典型症状心肌梗死病人组院前延误时间较长[(380±46)min比(240±21)min,P<0.05],在到达医院后确诊时间延长[(125±23)min比(20±5)min,P<0.05],接受急诊再灌注治疗者比率低(38.5％比70.6％,P<0.05).不典型症状心肌梗死病人住院期间B型钠尿肽水平更高[(501±102)pg/mL比(305±83)pg/mL,P<0.05],心超测得射血分数较低[(43.6±7.2)％比(48.2±6.8)％,P<0.05],发生心力衰竭(30.8％比15.3％,P<0.05)及心源性休克(9.6％比5.3％,P<0.05)比例高.同时住院期间死亡率(15.4％比6.7％,P<0.05)较典型胸痛组高.结论 不典型症状急性心肌梗死病人较典型胸痛心肌梗死病人年龄大,并发症多,就诊延迟,预后较差.

目的:探讨脉压(PP)、脉压指数(PPI)与冠脉钙化严重程度的关系.方法:回顾性分析我院心内科冠心病患者255例的临床资料,根据冠脉有无钙化及钙化病变的最大弧度分为无钙化组(63例),轻度钙化组(127例),重度钙化组(65例),比较3组之间的外周动脉血压、PP、PPI水平.钙化患者再按PP水平分为低PP组(42例),中PP组(109例),高PP组(41例),比较各组间血压及钙化情况.分析影响冠脉重度钙化的因素.结果:1、与无钙化组和轻度钙化组相比,重度钙化组收缩压[(136.2±13.7)mmHg、(136.2±14.1))mmHg比(144.6±14.2)mm-Hg]、PP[(54.1±11.0)mmHg、(56.8±11.2)mmHg,比(69.9±13.8)mmHg],PPI[(0.40±0.06)、(0.42±0.06)比(0.48±0.07)]均显著升高,舒张压[(82.1±10.7)mmHg、(79.3±9.2)mmHg比(74.7±11.0)mmHg]显著下降,P均<0.01;2、与低、中PP组比较,高PP组血管钙化长度[(7.35±6.14)mm、(8.99±7.58)mm比(14.37±8.87)mm],最大钙化角(103.48±58.03)°、(139.78±105.56)°比(245.83±105.12)°],病变长度[(16.34±6.90)mm、(17.61±7.78)mm比(21.34±10.78)mm]均显著增加,P<0.05或<0.01;3、二元Logistic回归分析显示,PP和年龄为冠脉重度钙化的独立危险因素(OR=1.084、1.052,P=0.001、0.029).结论:PP可能在冠脉钙化的发生发展中发挥作用,并能够预测冠脉重度钙化.

目的 探讨冠状动脉病变特征与支架置入术后斑块脱垂的关系.方法 回顾性分析2017年1月至2019年5月于上海交通大学医学院附属第九人民医院心内科住院诊断为急性冠状动脉综合征的33例患者,均行冠状动脉造影和支架置入术,术中行光学相干断层成像(OCT)检查,收集支架置入术前及术后OCT的斑块成像指标.结果 根据有无斑块脱垂分为斑块脱垂组(22例)和无斑块脱垂组(11例),两组患者基线资料比较,差异均无统计学意义(均P>0.05).斑块脱垂组患者C反应蛋白[(4.93±3.42)mg/L比(1.36±0.25)mg/L,P<0.001]、肌红蛋白[(245.11±349.05)ng/ml比(55.35±51.97)ng/ml,P=0.020]、白细胞计数[(8.59±2.41)×109/L比(5.90±1.52)×109/L,P=0.002]均大于无斑块脱垂组,差异均有统计学意义.斑块脱垂组平均脂质弧[(277.80±63.40)°比(227.73±29.61)°,P=0.004]与白色血栓(12/22比0.0,P=0.002)、红/混合血栓(10/22比0.0,P=0.007)、夹层(12/22比1/11,P=0.013)及薄帽纤维粥样斑块(TCFA)(18/22比1/11,P<0.001)比例均大于无斑块脱垂组,差异均有统计学意义.Kendall tau-b相关系数分析显示,斑块脱垂与TCFA(r=0.694,P<0.001)、纤维帽厚度(r=0.543,P<0.001)、脂质弧度(r=0.304,P=0.028)、夹层(r=0.439,P=0.009)、白色血栓(r=0.533,P<0.001)、红色血栓(r=0.466,P<0.001)均有相关性.斑块脱垂组最小管腔面积明显小于无斑块脱垂组[(5.73±1.67)mm2比(8.06±2.50)mm2,P=0.003],但合并血栓脱垂比例(9/22比0.0,P=0.013)显著高于无斑块脱垂组,差异均有统计学意义.结论 斑块脱垂与冠状动脉脂质斑块包括脂质弧、夹层、合并血栓等特征密切有关;并提示术后获得的管腔面积也更小.

Objective:To explore the application of optical coherence tomography (OCT) in the interventional diagnosis and treatment of intermediate coronary disease.Methods:Patients were enrolled during January 2017 to January 2019, in the Department of Cardiology, the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.The patient whose diagnosis was confirmed as intermediate coronary artery lesion by coronary angiography then underwent coronary OCT examination.The general information, disease history, drug use, biochemical indicators and OCT imaging indicators were collected.Results:(1)A total of 75 borderline lesions were detected in 69 patients with coronary heart disease, including 52 cases of left anterior descending artery (LAD) (75.4%), 4 cases of left circumflex artery (5.8%, 4/69), and 19 cases (27.5%, 19/69) of right coronary artery (RCA). (2) According to the analysis of the plaque characteristics of borderline lesions OCT, 7 cases were accompanied with thrombosis, 6 cases with plaque rupture, 25 cases with thin fiber cap lipid plaque, 49 cases with macrophages, 35 cases with microvascular, 35 cases with cholesterol crystallization, 3 cases with ulcer and 6 cases with intimal dissection.(3)The median of the minimum lumen area (MLA) determined by OCT was 2.9 mm 2.In the MLA<2.9 mm 2 group, C-reactive protein (CRP) ((2.92±2.44) mg/L vs.(1.98±1.30) mg/L, P=0.045), total cholesterol (TC) ((4.13±0.78) mmol/L vs.(3.74±0.75) mmol/L, P=0.041), low density lipoprotein cholesterol ((2.77±0.83) mmol/L vs.(2.22±0.78) mmol/L, P=0.007), small and dense LDL ((1.02±0.44) mmol/L vs.(0.80±0.34) mmol/L, P=0.024), lipoprotein a ((1.16±0.17) mg/L vs.(0.95±0.09) mg/L, P=0.042) were significantly higher than those in MLA≥2.9 mm 2 group.(4). According to the interventional strategy, patients were divided into two groups: percutaneous coronary intervention (PCI) group (N=16) and non-PCI group (N=59). The area stenosis (AS%) ((68.58±4.90)% vs.(63.10±7.09)%, P=0.001), diameter stenosis (DS%) ((65.65±6.91)% vs.(60.77±8.41)%, P=0.024), lipid plaque curvature ((245.3±41.0)° vs.(189.8±99.6)°, P=0.001), lipid plaque length ((19.11±6.40) mm vs.(14.72±9.30) mm, P=0.035) were deteriorated significantly in the PCI group than those in non-PCI group, the differences were all of them were statistically significant.(5)The incidence of 1-year major cardiovascular adverse events (MACE) was 6.25% in Oct guided PCI group and 5.08% in patients without PCI.There was no significant difference between the two groups ( P=0.317). Conclusion:According to the OCT assessment in the intermediate coronary lesions, it is found that the smaller the luminal area, the higher the serum LDL cholesterol level.More Interventional therapy were performed in the vulnerable plaques with large lipid cores.Decision-making for intermediate lesion was highly depended on the plaque tissue characteristics, rather than just MLA size.

Objective :To analyze correlation among fasting (FBL) and postprandial blood lipids (PBL) ,blood lipid fluctuation (absolute value of PBL‐FBL) and severity of coronary artery disease .Methods :Cross‐sectional study was performed among 264 patients undergoing coronary angiography (CAG) in our hospital .According to percutaneous coronary intervention (PCI) or not based on CAG results ,patients were divided into plaque group (n＝128) and PCI group (n＝136).Gensini score was used to assess severity of coronary artery disease .Blood lipid levels and its fluctu‐ation were compared between two groups .Correlation among blood lipid levels ,blood lipid fluctuation and severity of coronary artery disease were analyzed .Results :Compared with plaque group ,there were significant rise in per‐centages of men and smokers ,waist circumference ,levels of postprandial‐fasting (P‐F ) serum LDL‐C (ΔLDL‐C ) and P‐F plasma apolipoprotein B (ΔApoB ) , and significant reduction in plasma level of P‐F apolipoprotein A1 (ΔApoA1) in PCI group , P＜0. 05 or ＜ 0. 01. Pearson correlation analysis indicated that serum fasting and post‐prandial HDL‐C levels ,plasma fasting and postprandial levels of ApoA1 and ΔApoA1 were significant inversely cor‐related with Gensini score ( r＝ －0. 130～ －0.218 , P＜0. 05 or ＜0. 01) ,and levels of plasma fasting lipoprotein a (Lp (a)) ,serum fasting and postprandial levels of free fatty acid (FFA) ,serum P‐F FFA (Δ FFA) were significant positively correlated with Gensini score ( r＝0. 139－0. 176 , P＜0.05 or ＜0.01).Multifactor linear regression anal‐ysis indicated that postprandial serum HDL‐C was protective factor for Gensini score (B＝ －22.274 , P＝0.002 ) , while postprandial serum FFA ,Δ FFA ,waist circumference and hyperlipidemia history were its influencing factors (B＝0. 388～24. 135 , P＜0. 05 or ＜0.01).Conclusion :Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease .

打破传统的教学模式,借鉴目前国内外翻转课堂的经验,以急性心肌梗死为例,通过对心内科教学结构的颠倒安排,设计构建本土化、个性化的以微课为基础的翻转课堂教学模式,从教与学实践具体问题出发,通过恰当的学习方式和学习技能,将专业知识全面传递给学生.总结积累相关教学经验,真正实现个性化教学,为临床服务.

目的 研究心脏结构与射血分数(EF)均正常的轻中度原发性高血压患者的左室中层缩短率(MFS)在不同血压昼夜节律变化模式中与早期左室收缩功能受损的相关性,以进一步了解血压昼夜节律变化与心脏靶器官损害的关系.方法 选择血压控制良好的心脏结构与EF正常的高血压患者193例,根据血压昼夜节律划分为深杓型组45例,杓型组47例,非杓型组53例和反杓型组48例,超声检测心功能,分别测量收缩和舒张功能指标,分析收缩功能指标EF、短轴缩短率(FS)、MFS之间的相关性及MFS与血压昼夜节律和临床各项指标之间的关系.结果 深杓型、杓型组、非杓型组和反杓型组4组间一般情况、平均血压、左室重量指数、降压药物使用间差异无统计学意义.关于舒张功能E/E'等指标,反杓型组、非杓型组均明显高于杓型和深杓型组,差异有统计学意义(P<0.05).常规检测的心脏收缩功能指标左心室射血分数EF、左室短轴缩短率FS 4组间比较,差异无统计学意义(P>0.05),且均在正常范围,但4组MFS均低于正常对照组MFS预测值95％的可信区间,有统计学差异,其中非杓型组和反杓型组明显低于深杓型组和杓型组(P<0.05).MFS与其他超声评价指标中收缩功能指标均有相关性,而与舒张功能指标均不相关.结论 高血压患者心脏早期收缩功能障碍与血压昼夜节律异常模式密切相关.收缩功能参数中室壁中层缩短率MFS是相对独立于负荷指标的早期评估亚临床收缩功能障碍的敏感参数,能早期发现无症状高血压患者心功能的异常及异常的程度,收缩功能损害从深杓型、杓型、到非杓型组、反杓型组逐渐加重.

Objectives Toexplorethe effect of the Balint group on improving the empathy and doctorpatient communication skills among medical students in clinical practice.Methods We investigated 500 clinicalmedicalstudentsin fourth grade by JSE-HP and SEGUE framework scalein Shanghai Jiao Tong university school of medicine between July 2016 and December 2016.60 students with insufficientempathy and doctor-patient communication skills were selected randomly.These students were thanrandomly divided into the Balint group (experimental group) and the routine clinical practice group(control group).The experimental group participated inthe Balint group activitiesin addition to routine clinical practice,whilethe control group only participated in routine clinical practice.After 20 weeks of the Balintgroup intervention,the two groups were invited to assess theempathy and doctor-patient communication skills again to analyze the effect of the Balintgroup on improving the empathy and doctor-patient communication ability among intern students.The evaluation result was analyzed by SPSS 22.0 software.Data comparison was conducted using pair t test,independent sample t test and x2 testing.Results There were no statistically significant differences in age,sex,whether only child or class leader and previous year theoretical exam scoresbetween the two groups (all P＞0.05).For empathy,there was no statistically significant difference in terms of opinion,emotional care,empathy,and total scorebefore the routine clinical practicebetween the two groups (P＞0.05) and they all improvedsignificantly after the routine clinical practice (all P＜0.05).But the experimental group had higher scoresin all above scalesthan the control group (all P＜0.05).For communication skills with patients,there were no statistically significant differencesbetween the two groupsin communication initiation,information collection,understanding of patients,information giving,end questioning,and SEGUE scoresbefore the routine clinical practice (all P＞0.05),and they allimprovedsignificantly in all above 5 scales after the routine clinical practice (all P＜0.05).While except for understanding of patients,the experimental group had higher gains in other scales than the control group (all P＜0.05).Conclusion Use of the Barring group activities on the basis of routine clinical practice canimprove the empathy andthedoctor-patientcommunication skills in medical students.

Objective To study the effectiveness of danlou tablets on chronic heart failure in the patients.Meth-ods The patients with less than 50% LVEF in echocardiography were selected as the subjects.A total of 96 cases were included and randomized into two groups.In the treatment group,the routine medicines and danlou tablets were used.In the control group,only the routine medicines were prescribed.The indexes of the therapeutic effects were compared between the two groups after 3-month treatment.Results Compared with those before treatment,BNP was reduced obviously(P <0.05),EF value improved obviously(P <0.001),CRP reduced significantly(P <0.05),the 6min walking distance in-creased obviously(P <0.05),the self-assessment of exercise tolerance increased obviously(P <0.001)and the exercise tolerance score in VASQ improved apparently(P <0.001)in the treatment group after treatment.Regarding the effects on TCM symptoms,after treatment,the effects in the treatment group with symptomatic formula were better obviously than the control group(P <0.05).Conclusion Danlou tablets obviously relieve the symptoms and improve the living quality of the patients with chronic heart failure.

Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population

Objective: To explore therapeutic effect of in-hospital intravenous alprostadil injection on patients with acute myocardial infarction (AMI) complicated diabetic nephropathy (DN) undergoing percutaneous coronary intervention (PCI), and evaluate their long-term prognosis.Methods: A total of 80 AMI + DN patients undergoing PCI were selected from our hospital.They were randomly divided into alprostadil group (n=40) and routine treatment group (n=40).Renal function after PCI, cardiac function during hospitalization, serum creatinine (Scr) level on 72h after PCI and incidence of major adverse cardiovascular events (MACE) within one-year follow-up were compared between two groups.Results: Compared with routine treatment group on 72h after PCI, there was significant reduction in Scr level [(126.92±35.28) μmol/L vs.(104.32±22.91) μmol/L], and significant rise in estimated glomerular filtration rate [eGFR, (55.23±31.48) ml·min-1·1.73m-2 vs.(62.14±36.23) ml·min-1·1.73m-2] in alprostadil group, P<0.05 both.Postoperative one-year follow-up indicated that there were no significant difference in incidence rate of MACE and percentage of kidney replacement therapy between two groups, P>0.05 all.Conclusion: Intravenous alprostadil injection based on routine treatment possesses significant therapeutic effect on renal function in AMI + DN patients after PCI, and it's safe

Objectives Aiming at the current health management mode of chronic disease preven-tion and control as the focus of work, this paper was to evaluate the effect of chronic disease management-based education on clinical teaching and training in cardiovascular medicine. Methods Totally 54 students participating in internship training in Department of Cardiology, the Shanghai Ninth People’s Hospital be-tween July 2013 and Aug 2014 were enrolled. Twenty-eight students were taught by chronic disease man-agement-based method while twenty-six students were taught by traditional method. After the internship training in cardiology, final examination (theoretical exam, skill appraisal and case analysis) were compared between the two groups to assess the teaching efficacy. Questionnaire survey was employed to investigate student satisfaction with chronic disease management-based teaching method. Data were analyzed by SPSS 13.0 software. Quantitative data or enumeration data between two groups were compared by t-test or chi-square test respectively. Results There was no significant difference in the theoretical exam score between two groups (P=0.422). However, the scores of skill appraisal and case analysis in students taught by chronic disease management-based method were significantly higher than those in students taught by traditional method (P<0.05). Most students taught by chronic disease management-based method were satisfied with the novel teaching method. Conclusion In the course of clinical medicine education, the emphasis on the management of chronic diseases can not only significantly improve the quality of clinical teaching in car-diovascular medicine, but also lay the foundation for the implementation of the concept of chronic disease management.

Objective To study the possible influencing factors in the formation of coronary collateral circulation in patients with chronic total occlusion (CTO). Methods Patients were enrolled having at least 1 major coronary artery angiography revealed as CTO of 144 patients. According to the Rentrop classification, patients with grade 0 and grade 1 filling were catogorized as insufficient collateral circulation group (n=72) and patients with grade 2 and grade 3 filling as collateral circulation group (n=72). Serum biomarkers and insulin-resistance by HOMA model were also studied in all patients. Results In the insufficient collateral circulation, BMI,TC,ApoB, lipoprotein a, fasting insulin HOMA-IR,HOMA- beta, CRP was significantly higher than the well collateral circulation group and ApoA-Ⅰ, ISI lower than the well collateral group ( all P ﹤0. 05 ) . Bivariate correlation alaysis showed. Rentrop score, BMI, TC, ApoB, lipoprotein a, fasting insulin, HOMA-IR,HOMA- beta and CRP are positively correlated to the formation of collateral circulation ( P ﹤ 0. 05 ); ApoA-Ⅰ and ISI were negatively correlated ( P ﹤0. 05 ) . Logistic regression analysis after calibration with weight, ApoA-Ⅰ and HOMA-beta factors, lipoprotein a ( OR&nbsp;7. 575,P=0. 009), TC (OR 2. 154,P =0. 001) were found to be the independent factors of coronary collateral circulation formation. Conclusions TC, lipoprotein a, obesity, CRP, and HOMA-IR are correlated with the formation of coronary collateral circulation and may predict formation of collateral circulation in patients with CTO.