吡格列酮对大鼠心肌缺血再灌注损伤中炎症反应及细胞凋亡的影响

目的探讨吡格列酮对大鼠心肌缺血再灌注损伤中炎症反应和细胞凋亡的影响及其机制。方法将80只SD大鼠随机分为假手术组、模型组、吡格列酮组、GW9662组及DMSO组,每组各16只,术前5 d分别给予相应处理。采取体内结扎左前降支的方法建立心肌缺血再灌注损伤模型,予ELISA法检测大鼠心肌组织中NF-κB p65及IFN-γ含量水平,HE染色观察左心室前壁细胞病理形态学改变,并采用原位末端标记法检测心肌细胞凋亡数。结果与假手术组相比,其余四组大鼠心肌组织中NF-κB p65及IFN-γ含量水平、心肌细胞凋亡数均显著升高（P〈0.05）;与模型组比较,吡格列酮组大鼠心肌组织中NF-κB p65及IFN-γ含量水平,心肌细胞凋亡数明显降低（P〈0.05）;模型组与吡格列酮组中NF-κB p65及IFN-γ含量水平均呈显著正相关（P〈0.001）。结论吡格列酮在心肌缺血再灌注损伤中可能通过负性调节NF-κB p65含量水平进而减少IFN-γ的释放,抑制心肌细胞的凋亡,从而发挥相应的心肌保护作用。     

麝香保心丸和吡格列酮对代谢综合征大鼠心肌NF-κB、PPAR-α和PPAR-γ表达影响

目的:探讨麝香保心丸和吡格列酮对代谢综合征(MS)大鼠心肌NF-κB、PPAR-α和PPAR-γ表达的影响。方法:60只大鼠随机分为空白对照组(A组)和MS模型组(B组),构建MS模型后将B组余下大鼠随机分为模型对照组(B1组)、麝香保心丸组(B2组,麝香保心丸13.5 mg·kg-1·d-1)、吡格列酮组(B3组,吡格列酮1.5 mg·kg-1·d-1)、麝香保心丸+吡格列酮组(B4组,麝香保心丸13.5 mg·kg-1·d-1+吡格列酮1.5 mg·kg-1·d-1)。比较不同药物干预对大鼠收缩压、血脂、血糖、空腹胰岛素(FINS)以及大鼠心肌组织NF-κB、PPAR-α和PPAR-γ表达的影响。结果:造模后B组大鼠收缩压、血脂、血糖及FINS较A组升高(P<0.05,P<0.01)。药物干预后,B2、B3、B4组收缩压、血脂、血糖及FINS较B1组改善(P<0.05,P<0.01),且B4组改善情况较B2、B3组更明显(P<0.05)。与B1组相比,B2、B3、B4组大鼠心肌组织NF-κB表达下调,PPAR-α、PPAR-γ表达增加(P<0.05),这种调控在B4组更明显(P<0.05)。结论:麝香保心丸和吡格列酮均可调控MS大鼠心肌NF-κB、PPAR-α和PPAR-γ的表达,改善MS大鼠心肌重构,两者合用时影响更明显。     

PPARγ激动剂对大鼠胰腺缺血再灌注损伤作用及机制

目的 探讨过氧化物酶体增殖物激活受体γ (PPARγ)激动剂吡格列酮在大鼠胰腺缺血再灌注损伤中的作用及机制.方法 建立大鼠胰腺缺血再灌注损伤模型,将40只SD大鼠随机分为假手术组(S组)、缺血再灌注损伤组(IR组)、吡格列酮预处理组(PGZ组)及吡格列酮+GW9662预处理组(PGZ+GW9662组),每组10只.再灌注后,取静脉血检测血淀粉酶、脂肪酶水平,取胰腺组织检测核因子-κB (NF-κB)、Bcl-2蛋白、超氧化物歧化酶(SOD)表达.结果 与S组相比,其余3组血淀粉酶和脂肪酶水平、胰腺组织NF-κB活性均明显升高,SOD、Bcl-2表达则明显降低(F=21.72～356.76,q=4.37～10.13,P<0.05);与IR组相比,PGZ组血淀粉酶、脂肪酶水平和胰腺组织NF-κB活性均明显降低,SOD、Bcl-2表达明显升高(q=3.45～8.72,P<0.05);而PGZ+GW9662组与IR组相比差异无统计学意义(q=0.16～1.13,P>0.05);与PGZ组相比,PGZ+GW9662 组血淀粉酶、脂肪酶水平和胰腺组织NF-κB活性表达明显增加,SOD、Bcl-2表达明显降低(q=3.77～8.98,P<0.05).结论 PPARγ激动剂吡格列酮可能是通过PPARγ途径上调SOD的活性、Bcl-2表达及下调NF-κB表达,对胰腺缺血再灌注损伤起保护作用.     

辛伐他汀通过活化过氧化物增殖子激活受体γ减轻缺血-再灌注心肌炎症反应

目的炎性反应在心肌缺血-再灌注（ischemia reperfusion,IR）损伤过程中发挥重要作用。文中旨在观察辛伐他汀预处理对再灌注心肌炎性因子表达的影响,探讨过氧化物增殖子激活受体（peroxisome proliferators activated receptor,PPAR）-γ参与辛伐他汀调控再灌注心肌炎症反应的机制。方法通过冠状动脉结扎法建立大鼠心肌IR模型。实验动物分为假手术组、对照组和辛伐他汀组。辛伐他汀组将按照5 mg/（kg.d）的剂量术前7 d起辛伐他汀灌胃。采用不同方法检测各组血清心肌酶谱、脂质水平、心肌细胞凋亡指数、心肌肿瘤坏死因子（tumor necrosis factor,TNF）-α、白细胞介素（inferleukin,IL）-6和单核细胞趋化因子（monocyte chemoattractant protein,MCP）-1的含量,心肌组织PPAR-γ、核因子（nuclear factor,NF）-κB活性,及PPAR-γ在心肌组织中的表达。结果与对照组相比,辛伐他汀预处理能显著减少凋亡心肌细胞数,降低血清磷酸激酶同工酶（creatine kinase-MB,CK-MB）和乳酸脱氢酶（lactate dehydrogenase,LDH）水平,下调再灌注心肌组织TNF-α、IL-6和MCP-1的含量,而各组血清总胆固醇（total cholesterol,TC）、三酰甘油（triglycerides,TG）、低密度脂蛋白（low density lipoprotein,LDL）及高密度脂蛋白（high density lipoprotein,HDL）未见差异。再灌注后,心肌组织PPAR-γ、NF-κB活性均显著增高,辛伐他汀预处理能进一步增加PPAR-γ活性,同时抑制NF-κB活性。结论辛伐他汀预处理能降低IR心肌炎性因子的表达,其抗炎作用通过活化PPAR-γ、抑制NF-κB活性实现。     

阿托伐他汀、吡格列酮预处理对大鼠心肌缺血再灌注损伤的保护作用

目的探讨阿托伐他汀、吡格列酮及二者联用预处理对大鼠心肌缺血再灌注损伤的保护作用及可能的机制。方法将54只雄性SD大鼠随机分成5组：假手术组（n=6,生理盐水2ml/d）、缺血再灌注组（n=12,生理盐水2ml/d）、阿托伐他汀组（n=12,阿托伐他汀20mg.kg^-1·d^-1）、吡格列酮组（n=12,吡格列酮3mg.kg^-1·d^-1）、阿托伐他汀＋吡格列酮组（n=12,阿托伐他汀20mg.kg^-1·d^-1＋吡格列酮3mg.kg^-1·d^-1）。灌胃1周后,第8d制作大鼠在体心肌I/R模型。缺血30min,再灌注1h后测定血清心肌酶（CK-MB、LDH）及NO;Evance blue、TTC双染色后,计算心肌梗死面积。结果阿托伐他汀组、吡格列酮组及联合用药组与缺血再灌注组相比心梗面积缩小;CKMB、LDH降低,NO增加（P〈0.05）;阿托伐他汀＋吡格列酮组与阿托伐他汀组及吡格列酮组相比心梗面积缩小;CKMB、LDH降低,NO增加（P〈0.05）。结论阿托伐他汀、吡格列酮预处理能减轻大鼠心肌I/R损伤,联合用药作用更加明显,机制与增加血浆NO含量有关。     

PPAR-γ激动剂环格列酮对大鼠心肌缺血再灌注损伤保护作用的研究

目的 探讨应用过氧化物酶体增殖物激活受体-γ(PPAR-γ)激动剂环格列酮减轻大鼠心肌缺血再灌注损伤(MIRI)的作用及其量效关系.方法 70只健康SD大鼠建立心肌缺血再灌注模型后,随机分成假手术组(S组)、缺血再灌注组(I/R组)、环格列酮组1(cig1组)、环格列酮组2(cig2组)、环格列酮组3(cig3组),每组14只.各组中又随机分为两个亚组.亚组1(6只)在缺血30 min、再灌注120 min后,以Evans blue、NBT双重染色法测定心肌梗死面积;亚组2(8只)以生物信号分析系统监测记录缺血1、30 min,再灌注后1、30、60 、90、120 min各时间点的左室舒张末压(LVEDP)、左室内压(LVSP)及左室内压发展最大速率(±dp/dt)等血流动力学指标.实验结束时取心肌组织,光镜下观察心肌组织损伤情况,免疫组化法检测心肌组织中细胞间黏附分子-1(ICAM-1)蛋白表达,酶联免疫吸附法(ELISA)测定心肌组织细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的含量,比色法测定心肌组织髓过氧化物酶(MPO)活性.结果 与S组比较,I/R组大鼠心肌梗死面积增大,心肌MPO活性升高、中性粒细胞(PMN)浸润严重,心肌细胞因子TNF-α、IL-6含量明显增多,心肌组织高表达ICAM-1(均P＜0.01).Cig各组缺血前60 min预先应用PPAR-γ激动剂环格列酮可减小心梗范围,改善心脏舒缩功能,降低心肌MPO活性及心肌TNF-α、IL-6含量,并能抑制心肌组织ICAM-1的表达,起到减轻MIRI的作用.结论 PPAR-γ激动剂环格列酮通过减少PMN浸润,降低心肌促炎细胞因子TNF-α、IL-6的含量,抑制心肌ICAM-1的表达,从而减少心肌缺血再灌注时心肌梗死面积,改善心脏舒缩功能,起到保护心肌的作用.     

缺血/再灌注大鼠心肌PPAR-γ表达变化对再灌注心律失常的影响

目的 探讨不同预处理的心肌缺血/再灌注(I/R)动物模型中PPAR-γ表达对再灌注心律失常的影响.方法 32只SD大鼠分为4组(n=8):罗格列酮+I/R组(ROS组),GW9662+I/R组(GW组),I/R组(I/R组),假手术组(Sham组).采用冠状动脉左前降支结扎法制造缺血/再灌注动物模型,缺血30 min,再灌注2h.动态肢体Ⅱ导联心电图检测,荧光定量PCR检测PPAR-γ mRNA和Western blot检测PPAR-γ蛋白质的表达变化.结果 分别在术前、缺血30 min、再灌注1h、再灌注2h4个时间点检测心电图QRS波宽度增加幅度由大到小依次是ROS组、I/R组、GW组、Sham组;ROS组较其他组大鼠再灌注心律失常评分明显较高(P＜0.05),GW组则相对减少.荧光定量PCR检测ROS组PPAR-γ mRNA表达水平明显上调(P＜0.05),GW较I/R组和ROS组表达下调(P＜0.05).PPAR-γ蛋白质表达结果与PPAR-γ mRNA相似.结论 心肌PPAR-γ表达上调可能增加心肌I/R动物模型再灌注心律失常的发生.     

吡格列酮对胰腺炎相关性腹水诱导的人单核细胞炎症信号通路的影响

目的 用胰腺炎相关性腹水(PAAF)刺激人单核细胞,探讨PPARγ激动剂吡格列酮对细胞炎症信号通路的影响.方法 PAAF收集自重症胰腺炎患者.将体外培养的人单核细胞THP-1分为4组:对照组(C组)、实验组(A组)、吡格列酮组(P组)、GW9662(G组).A组用PAAF刺激细胞;P组加入终浓度为20 μmol/L吡格列酮,2h后再用PAAF刺激细胞;G组先加入PPARγ拮抗剂GW9662,30 min后加入吡格列酮,2h后再用PAAF刺激细胞.12 h后收集4组细胞,采用实时定量PCR方法检测细胞TNF-α、IL-6的mRNA表达,蛋白质印迹法检测NF-κB p65、p38MAPK的活化程度和IκB蛋白表达变化.结果 PAAF刺激后,A组细胞促炎细胞因子TNF-α、IL-6的mRNA表达增加,NF-κB、p38MAPK活化,IκB蛋白水平降低,与C组相比差异有统计学意义(P＜0.05) ;P组经吡格列酮干预后,TNF-α、IL-6的mRNA表达降低,NF-κB、p38MAPK活性下调,IκB蛋白表达升高,与A组比较差异有统计学意义(P＜0.05);G组应用GW9662后可拮抗吡格列酮降低促炎细胞因子的作用,TNF-α、IL-6的mRNA表达增加,NF-κB、p38MAPK活化,IκB蛋白水平降低,与P组相比差异有统计学意义(P＜0.05).结论 吡格列酮可能通过抑制NF-κB、p38MAPK炎症信号通路活化,减少促炎细胞因子产生,控制炎症发生发展.     

双参通冠方对急性心肌缺血再灌注NF-κB信号途径的影响

目的探讨双参通冠方(SSTG)对急性心肌缺血再灌注损伤心肌核因子-κB(nuclear factor-κappaB, NF-κB)信号途径(NF-κB-TNF-α-ICAM-1)的影响。方法冠状动脉前降支结扎放松法复制大鼠心肌缺血再灌注损伤模型,免疫组织化学法检测心肌组织NF-κBp65表达,酶联免疫法测定血清肿瘤坏死因子(TNF-α)、细胞间粘附分子-1(ICAM-1)含量。结果缺血再灌注模型组NF-κBp65表达较正常组明显增强,血清中TNF-α及ICAM-1含量显著升高(P<0.05),SSTG处理后NF-κBp65表达抑制,血清中TNF-α、ICAM-1水平下调(P<0.05)。结论缺血再灌注刺激可激活NF-κB信号途径,SSTG可能通过抑制NF-κB的活化,阻断NF-κB信号途径而起到心肌保护作用。     

过氧化体增殖物激活型受体-γ对肥厚心肌炎症反应调控作用的初步研究

目的探讨压力负荷性心肌肥厚过程中过氧化体增殖物激活型受体-γ(PPAR-γ)配体-罗格列酮钠对肥厚心肌中炎性反应的影响.方法采用腹主动脉缩窄法复制压力超负荷大鼠心肌肥厚模型. 分组:对照组(C组)、假手术-生理盐水组(S-组)、假手术-罗格列酮组(S 组)、心肌肥厚-生理盐水组(H-组)、心肌肥厚-罗格列酮组(H 组).罗格列酮组:于术后4周用罗格列酮钠生理盐水溶液(4 ml·kg-1·d-1)腹腔注射1周;生理盐水组:于术后4周用生理盐水腹腔注射1周(1 ml*kg-1*d-1).术后5周测定心肌肥厚指数及血液动力学指标;放免法检测左心室肌肿瘤坏死因子-α(TNF-α)、血小板活化因子(PAF),以及髓过氧化物酶(MPD)含量;逆转录聚合酶链反应法检测心肌中过氧化体增殖物激活型受体(PPAR-γ)mRNA的表达;EMSA法检测核因子-κB(NF-κB)活性.结果术后5周手术组左心室心肌明显肥厚;心肌中TNF-α、PAF、MPD含量增高(P<0.01);罗格列酮干预能显著降低肥厚心肌中TNF-α、PAF、MPD的含量(P<0.01) ,但仍高于对照组水平(P<0.01).罗格列酮组PPAR-γmRNA的表达明显增高(P<0.01).心肌肥厚组NF-κB活性明显增强(P<0.01),罗格列酮能减轻NF-κB的激活(P<0.01). 结论压力负荷增加引起心肌肥厚,肥厚心肌组织中NF-κB激活明显增强,TNF-α、PAF、MPD表达升高,这一明显增强的炎症反应能被PPAR-γ人工合成配体罗格列酮钠所抑制.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.     

ANTI-PROLIFERATION EFFECT OF ORIDONIN ON HL-60 CELLS AND ITS MECHANISM

Objcetive To investigate the anti-proliferation effect of oridonin on leukemic HL-60 cells and its mechanism. Methods HL-60 cells in vitro in culture medium were given different concentrations of oridonin. The inhibitory rate of cells were measured by microculture tetrazolium (MTT) assay, cell apoptotic rate was detected by flow cytometry (FCM), morphology of cell apoptosis was observed by hoechst 33258 fluorescence staining, and the activity of telomerase was detected using telomere repeat amplification protocol (TRAP) PCR-ELISA before and after apoptosis occurred. Results Oridonin could decrease telomerase activity, inhibit growth of HL-60 cells, and cause apoptosis significantly. The suppression was both in time- and dose-dependent manner. Marked morphological changes of cell apoptosis including condensation of chromatin and nuclear fragmentation were observed clearly by hoechst 33258 fluorescence staining especially after cells were treated 48-60 hours by oridonin. Conclusions Oridonin has apparent anti-proliferation and apoptotic effects on HL-60 cells in vitro, decreasing telomerase activity of HL-60 cells may be one of its most important mechanisms. These results will provide strong laboratory evidence of oridonin for clinical treatment of acute leukemia.     

HOUSE DUST MITE ALLERGEN （Derp1 AND Blot5） LEVELS IN ASTHMATICS＇ HOME IN HONGKONG

Objective To measure Derpl and Blot5 allergen levels in asthmatics' homes in Hongkong.Methods Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients' house: bed and floor. Derpl and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique.Results The levels of Derpl allergens found in bed (geometric mean (GM) 3.43 μg/g of dust; 95%CI, 1.89-4.96 μg/g)and on the floor (GM 1.12 μg/g of dust; 95%CI, 0.71-1.53 μg/g) indicated significant differences (P=0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 μg/g of dust; 95%CI, 0.89-38.90 μg/g) and on the floor (GM 6.14 μg/g of dust; 95%CI, 0.40-11.90 μg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derpl and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 ≥ 10 μg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P＜ 0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 =0 μg/g of dust as compared with Derpl in bed and on the floor (4.3% and 14.5% respectively, P＜ 0.05).Conclusions Derpl and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus (Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hongkong.     

Acute and mid-term results of pecutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective: To assess the acute and mid-term results of cardiac function improvements and left ventricular outflow tract gradient (LVOTG)changes in 30 patients displaying hypertrophic obstructive cardiomyopathy (HOCM) treated with percutaneous transluminal septal myocardial ablation (PTSMA). Methods: PTSMA was intended for 32 patients comprising of 13 women and 19men (average years being 54.1 ± 15.5) to be treated in accordance with the following inclusion criteria: The New York Heart As-sociation(NYHA) definition for cardiac functional class Ⅲ or Ⅳ , or class Ⅱ but for whom medical therapies were not tolerated or with syncope; intraventricular septal (IVS) and left ventricular posterior wall (LVPW) hypertrophy asymmetrically associated with ratio of IVS to LVPW≥1.3 and LVOTG≥50 mm Hg at rest or ≥100 mm Hg at provocation (Valsalva maneuver). The target vessels were determined by coronary arteriography that demonstrated more than one septal branch and probatory balloon occlusion produced greater than 50% decrease of LVOTG. Once the target vessel established, the alcohol was administrated into septal ventricular via over-the-wire balloon. LVOTG was assessed by means of echocardiography measurements immediately after procedure and 3 months. Simultaneously, cardiac function class was also evaluated. Results: Two patients were abandoned prior to intervention due to inappropriate septal target vessels and DDD Pacemakers were chosed. Immediately after the procedure, resting LVOTG was reduced from 73.8 ± 35.5 to 16.6 ± 7.8 mmHg, at provocation LVOTG from 149.3 ± 42.5 to 61.9 ± 43.0 mmHg(P ＜0.0001 each) by echocardiography measurements. After 3 months, the mean New York Heart Association class was reduced from 2.8 ± 0.6 to 1.1 ± 1.0(P ＜ 0.0001) and the LVOTG also remained decrease(28.5 ± 6.4 mmHg at rest and 75.3 ± 11.6 mmHg at provocation). Conclusion: PTSMA is a promising nonsurgical technique for relief of symptoms and reduction of LVOTG in hypertrophic obstructive cardiomyopathy.     

IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic value of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.