1 病例 患者男性,57岁,因8个月前突发心前区疼痛不适及左侧肢体无力,于外院行冠状动脉(冠脉)造影示:左主干+三支病变(图1),适合冠状动脉旁路移植术(CABG),出于应急给予右冠药物球囊成形治疗.出院后患者反复出现心前区疼痛,口服硝酸酯类药物可缓解,未系统治疗.发病1月后,脑血管造影显示:右侧颈内动脉(ICA)起始部接近完全闭塞、左侧ICA重度狭窄伴溃疡斑块,为进一步诊治来我院.

主动脉夹层指主动脉腔内血液从主动脉内膜撕裂处进入主动脉中膜,使中膜分离,沿主动脉长轴方向扩展形成主动脉壁的真假两腔分离状态,发病时间<14 d为急性期.本病虽少见,但死亡率甚高[1].如不及时治疗,2周内死亡率达90％以上.急性主动脉夹层(AAD)临床表现多样,病情变化复杂,误诊率和漏诊率高,导致大多数患者得不到及时有效的治疗[2].

OBJECTIVE: To examine the difference in safety and effectiveness of directional atherectomy (DA) and plain balloon angioplasty with adjunctive stenting (BA-STENT) in the treatment of de novo femoropopliteal artery occlusive lesions. MATERIALS AND METHODS: This prospective, randomized trial of DA versus BA-STENT in femoropopliteal arteries was carried out in a single medical center. Demographic data, procedural characteristics, and follow-up information were recorded. The technical, procedural, and clinical outcomes were reported. The primary endpoint was the primary stenosis-free patency rate at 12 and 18 months after the intervention. The secondary endpoints included the rates of technical success, freedom from clinically driven target lesion revascularization (TLR), limb amputation, and all-cause mortality. RESULTS: A total of 188 patients were included in this study. The DA group consisted of 89 (47.3%) patients, and the BA-STENT group consisted of 99 (52.7%) patients. There were 134 males and 54 females with an average age of 68 years, all of which had lesions of Rutherford Grade 2 and above. There was no statistically significant difference in age, gender, smoking, or comorbidities between two groups. The technical success rates were 98.9% in the DA group and 100% in the BA-STENT group (P = 0.47). There was no statistically significant difference in primary stenosis-free patency (90.0% vs. 90.6% at 6 months, 76.7% vs. 77.8% at 12 months, and 72.3% vs. 68.9% at 18 months after the intervention) or freedom from TLR (96.3% vs. 95.8% at 6 months, 88.3% vs. 91.6% at 12 months, and 86.1% vs. 85.4% at 18 months after the procedure) between the DA and the BA-STENT groups. There was no statistically significant difference in terms of distal embolization, thrombosis, and mortality between two groups. No patient underwent major amputation. CONCLUSION: For the treatment of de novo Trans-Atlantic Inter-Society Consensus (TASC) II A-C femoropopliteal artery lesions, DA demonstrated comparable results with the plain balloon angioplasty with adjunctive stenting.

Periodontitis is a chronic infectious disease that leads to progressive destruction of periodontal tissue. Human periodontal ligament stem cells (PDLSCs) are the most favorable candidate for the reconstruction of tissues destroyed by periodontal diseases. PDLSCs derived from inflammatory microenvironment show attenuated differentiation potential, however the mechanism is still unclear. MicroRNAs (miRNAs) are a newly discovered class of posttranscriptional regulators, and they play key roles in regulating cell differentiation. Recent studies have demonstrated that inflammatory cytokines could regulate miRNAs and contribute to some inflammatory diseases. Tumor necrosis factor (TNF-α) is a potent negative regulator of cell differentiation. Elevated levels of TNF-α were confirmed to be associated with the severity of periodontal disease. Here, we found TNF-α inhibited the adipogenic and osteogenic differentiation of PDLSCs. Based on this, we hypothesized that TNF-α could participate in PDLSC differentiation by regulating miRNA signal pathway. Moreover, we demonstrated that the expression of miR-21 was suppressed by TNF-α in impaired adipogenic and osteogenic differentiation of PDLSCs. Upregulating miR-21 can partly rescue TNF-α-impaired adipogenesis and osteogenesis by repressing its target gene Spry1, suggested that miR-21/Spry1 functional axis plays critical role in PDLSC differentiation under inflammatory microenvironment. During adipogenesis and osteogenesis, TNF-α significantly increased Spry1 levels and overexpression of miR-21 dramatically decreased Spry1 levels in the presence of TNF-α, indicated important roles of miR-21 in modulating link between TNF-α and Spry1. Our findings introduce a molecular mechanism in which TNF-α suppresses adipogenic and osteogenic differentiation of PDLSCs by inhibiting miR-21/Spry1 functional axis. This study may indicate a molecular basis for novel therapeutic strategies against periodontitis and other inflammatory diseases.

Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female=6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.

The clinical profiles and outcomes of acute aortic dissection (AAD) have not been evaluated in China. We retrospectively analyzed, from January 1, 2008 to December 31, 2011, the data from 1,812 patients (mean age 51.1 +/- 10.9 years; 77.5% men) with AAD (726 with type A and 1,086 with type B) from 19 large hospitals. Most patients had hypertension and presented with an abrupt onset of chest and/or back pain. Patients with type A AAD were more likely to present with typical symptoms and signs. Computed tomography was the most common initial imaging modality, used in 76.3% of patients with an AAD. The overall in-hospital mortality rate was 17.7%, with most of the deaths occurring within the first week. Surgery was used in 75.3% of patients with type A AAD. The mortality in this cohort was 33.8%. Endovascular treatment was performed in 76.1% of patients with type B AAD. The mortality rate was 2.2%. Multivariate analysis showed that hypertension (odds ratio 2.80, p < 0.001), Marfan syndrome (odds ratio 1.76, p = 0.017), anterior chest pain (odds ratio 1.62, p = 0.004), abdominal pain (odds ratio 1.51, p = 0.041), migrating pain (odds ratio 1.56, p = 0.04), and arch vessel involvement (odds ratio 1.70, p < 0.001) were predictive factors for increased in-hospital mortality in patients with an AAD. In conclusion, our study has provided insight into the current profiles and outcomes of AAD in China. This knowledge might be useful for clinicians when diagnosing and treating these patients. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1056-1061)

Estimation of the time since death (postmortem interval [PMI]) is one of the most difficult problems in forensic investigations, and many methods currently are utilized to estimate the PMI. The goal of this study was to investigate the changes of attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra of rat brain from postmortem time 0144 h. The intensity ratios of major absorbance bands were examined (I1066/I1392, I1168/I1392, I1234/I1454, I1301/I1392, I1647/I2956, I2921/I2850, and I1647/I1539). The spectra of rat brain displayed prominent changes with increasing PMI. The band at 2871 and 1737 per cm became weak with the time increasing and even disappeared at postmortem 96 and 72 h, respectively. A close linear correlation was shown between the relative absorption intensity and the PMI, and the I1234/I1454 offered a stronger correlation (r = 0.973). Our results indicate that ATR-FTIR spectroscopy may be a useful technique for estimating the PMI.

We report a 16-day-old boy who had transposition of great arteries combined with interrupted aortic arch （IAA）. The boy developed cyanotic lips and body bruising 2 h after birth. Color Doppler sonography showed transposition of great arteries. The patient underwent total surgical correction of the transfection and defects. We summarized our experience in the perioperative management of the patient, including maintenance of body temperature, close intraoperative monitoring, anesthesia management, cardiopulmonary bypass （CPB） management and so on.