Soluble CD40 ligand is associated with angiographic severity of coronary artery disease in patients with acute coronary syndrome

Background Recently,studies have disclosed soluble CD40 ligand （sCD40L） during atherosclerosis development and plaque destabilization.The objective of the present study was to test the hypothesis that sCD40L levels are higher in acute coronary syndrome （ACS） patients with a greater extent of angiographic coronary involvement.Methods This cross-sectional study examined ACS patients who underwent coronary angiography by measuring their sCD40L levels.In order to estimate the serum levels of sCD40L,10 ml of peripheral venous blood was drawn within 24 hours of admission.sCD40L levels were measured using an enzyme-linked immunosorbent assay （ELISA,RapidBio,West Hills,CA,USA）.Demographic data,presence of concomitant diseases,ACS characteristics,and angiographic findings were evaluated.A review of medical records and patient interviews were conducted to assess coronary risk factors.And the severity of coronary artery disease was evaluated using the Gensini score index.Results Two hundred and eighty-nine patients were included in the study,of whom 186 were male,with an average age of 64.1±10.0 years.Median sCD40L levels were 1.7 ng/ml （0.3-7.3 ng/ml） and Gensini scores were 50 （0-228）.After adjusting for demographic variables and cardiovascular risk factors,the Gensini score was associated with the natural logarithm of the sCD40L level （Coefficient b=0.002,95％ CI 0.000-0.003,P=0.029）.Conclusion sCD40L levels were independently associated with angiographic severity of coronary artery disease in patients with ACS.     

Coronary artery anomalies: the left main coronary artery or left anterior descending coronary artery originating from the proximal of right coronary artery

Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.     

Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

Background The anomalous origin of the left coronary artery （LCA） from the pulmonary artery （ALCAPA） and congenital left main coronary artery atresia （CLMCA-A） are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients （13 males and 10 females,aged ranging from 2.5 months to 65 years） identified with ALCAPA were classified into infantile type （age of onset younger than 12 months,16 cases） and adult type （age of onset older than 12 months,7 cases）.Four patients were diagnosed with CLMCA-A （three males and one female,aged ranging from 3 months to 2 years）.The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination：Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography：pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in adult type.In ech     

Coronary heart disease: incidence, risk factors and interventions in Jiaozhou of Shandong province

Background Coronary heart disease （CHD） is the most common type of heart disease and cause of heart attacks.This study investigated the epidemiological characteristics of CHD and its risk factors in Jiaozhou,Shandong province,to ultimately find a way of reducing the prevalence of cardiovascular disease,and to provide a theoretical basis for establishing a cardiovascular disease management path under the regional medical collaborative mechanism.Methods A questionnaire survey was performed including 1 952 people aged 35 years or older who were questioned by means of stratified,cluster,proportional sampling to investigate the prevalence of CHD and its risk factors.The data were inputted into SPSS11.0 statistical software for processing and analysis.We advised the local medical institutions to establish health files for the residents with CHD and risk factors.They were followed up regularly.Their risk factors and life-style were monitored,and advice was given as to proper medications.Green channels were established,and the patients were transmitted in a timely manner to superior hospitals for better treatment if the necessary treatments were not available in the local hospitals.The control of risk factors was observed after the follow-up for half a year.Results In Jiaozhou,the rates of coronary artery disease,hypertension,diabetes,hyperlipidemia and overweight were 8.15％,28.54％,11.43％,35.46％,and 18.70％ respectively.The rates of hypertension,diabetes,hyperlipidemia and overweight were higher than the data published in ＂The report of Chinese cardiovascular disease 2012＂; which are 24％,9.7％,18.6％,and 9.7％,respectively.The control of risk factors improved significantly after the guidance of the residents lifestyle and medication for six months.Conclusions The high prevalence of coronary artery disease in Jiaozhou is closely related to age,gender,diet structure,family history of cardiovascular disease,hypertension,diabetes,hyperlipidemia,overweight,and unhealthy lifestyle.Under the regional medic     

低分子肝素钙治疗急性冠状动脉综合征79例临床疗效观察

急性冠状动脉综合征（acute coronary syndrome，ACS）是心血管内科最常见的急症之一，它包括了ST段抬高的ACS和ST段不抬高的ACS，而ST段不抬高的ACS又包括了不稳定型心绞痛及非ST段抬高的心肌梗死。对于ACS的治疗因介入治疗的日益完善，使其预后得到明显改善，     

Correlation between low tube voltage in dual source CT coronary artery imaging with image quality and radiation dose

The influence of low tube voltage in dual source CT（DSCT） coronary artery imaging on image quality and radiation dose and its application value in clinical practice were investigated. Totally, 300 cases of chest pain with low body mass index（BMI 〈18.5 kg/m2） subjected to DSCT coronary artery imaging were prospectively enrolled. The heart rate in all patients were greater than 65/min. The retrospective ECG gated scanning mode and simple random sampling method were used to assign the patients into groups A, B and C（n=100 each）. The patients in groups A, B and C experienced 120-, 100-, and 80-kV tube voltage imaging respectively, and the image quality was evaluated. The CT volume dose index（CTDIvol） and dose length product（DLP） were recorded, and the effective dose（ED） was calculated in each group. The image quality scores and radiation doses in groups were compared, and the influence of tube voltage on image quality and radiation dose was analyzed. The results showed that the excellent rate of image quality in groups A, B and C was 95.69%, 94.72% and 96.33% respectively with the difference being not statistically significant among the three groups（P〉0.05）. The CTDIvol values in groups A, B and C were 51.35±12.21, 21.28±7.13 and 6.34±3.34 mGy, respectively, with the difference being statistically significant（P〈0.05）. The ED values in groups A, B and C were 9.27±1.63, 4.56±2.29 and 2.29±1.69 mSv, respectively, with the difference being statistically significant（P〈0.05）. It was suggested that for the patients with low BMI, the application of DSCT coronary artery imaging with low tube voltage can obtain satisfactory image quality, and simultaneously, significantly reduce the radiation dose.     

Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital mortality.Poor CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.     

Prevalence of depression in coronary heart disease in China: a systematic review and meta-analysis

Background Coronary heart diseases （CHD） have been identified as one of topmost diseases affecting the Chinese population.However,depression in CHD has not been reported and there are limited high quality empirical studies in China focused on the prevalence of the comorbidity.This study aimed to estimate the pooled prevalence of depression with CHD in China.Methods Systematic review and meta-analysis of published epidemiologic studies on the depression in CHD patients in China were conducted.The research findings dated before 30 September 2013 were obtained from Ovid Medline,EMBASE and two Chinese electronic publication libraries WANFANG and CNKI.We used ＂cardiovascular disease＂,＂depression＂ and ＂China＂ as the search themes in Ovid Medline and EMBASE and ＂cardiovascular disease＂ and ＂depression＂ in WANFANG and CNKI.Random-effects meta-analysis was used to estimate the prevalence of depression in CHD patients.Results Twenty-seven studies were included in the review.Twenty-three studies had 5 236 participants who were hospitalized and four studies had 1 353 participants from community.The overall prevalence of depression in CHD from hospital was 51% （95% CI：0.43,0.58; Ⅰ-squared=97%,P=-0.000）.The prevalence of depression in CHD from community ranged between 34.6% to 45.8%,and the severe depression was found ranging between 3.1% to 11.2%.Conclusions On comparing data with other countries,the prevalence of depression in CHD among admitted patients in China was found to be high.The physicians and healthcare providers should pay more attention to the ＂physical-mental＂ health of the CHD patients.     

Inflammatory response, drug-eluting stent and restenosis

Cardiovascular diseases are the major cause of mortality in the Western world and it is expected that this will rem-ain so during the foreseeable future. 1 Among them, coronary artery disease （CAD） is the most important underlying cause of death due to cardiovascular disease.^2 Current treatment of pattents with CAD includes mainly risk factor management, drug therapy and revascularization techniques.     

ONTARGET系列研究带来对阻断RAS治疗策略的进一步思考

1同一个研究，不同的解释 继HOPE研究之后，2008年3月发表的ONTARGET研究（Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial）再次证明了血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitors，ACEI）雷米普利是抗动脉粥样硬化的标准对照药。进一步丰富了ACEI的临床试验证据。     

Wire trapping technique combined with retrograde approach for recanalization of chronic total occlusion

Coronary chronic total occlusion （CTO）, defined as a ,total occlusion of duration 〉3 months, remains a technical challenge for the interventional cardiologists. The major limitation in percutaneous coronary intervention （PCI） of CTO is the inability to penetrate and cross the occlusion with a guidewire. It was reported that the immediate angiographic success rate varied from 50% to 70% using the standard antegrade techniques.1 To improve this suboptimal success rate, the authors firstly introduced retrograde approach through the collateral channels as a novel technique and successfully recanalized a left main CTO using this technique when demonstrating the live cases in Transcatheter Cardiovascular Therapeutics （TCT） 2005. Recently, modified techniques based on the retrograde approach have demonstrated that this approach could provide a high success rate with PCI.3-5 In the present report, we described a new method, wire trapping technique combined with retrograde approach, which was applied successfully in three patients with CTO.     

Evaluation of triple anti-platelet therapy by modified throm- belastography in patients with acute coronary syndrome

Most cases of acute coronary syndrome （ACS） involve coronary atherosclerosis and plaque rupture, as well as subsequent thrombosis. The initial thrombotic events leading to red thrombus formation are platelet adherence and aggregation. Platelets play a very important role during the establishment and progression of a thrombosis in a coronary artery. Therefore, in recent years guidelines have been developed in an effort to strengthen antiplatelet therapy in ACS, but unfortunately the methods to evaluate platelet activity and the strength of platelet inhibition are lacking.     

冠心病中医诊疗思考

冠心病是一个危害人类健康的主要的、非传感性疾病。根据WHO的统计,冠心病是世界上最常见的死亡原因,被称为“第一杀手”,2004年全世界死于新老心血管病为1530万人,占总死亡人数的1／4,其中冠心病死亡占1,2以上。目前研究表明：本病最常在男性40～60岁之间表现症状,女性发病多在绝经期前后。其发病男性多于女性。WHO的MONICA47个协作中心35-46岁年龄组急性冠心病事件标准化发病率的资料显示,我国男性发病率仅高于日本,居第46位;女性发病率仅高于日本和西班牙,居第45位。本文就冠心病近年研究的主要进展及中医对策的思考作一概述。     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

Confluence at distal end of multiple coronary artery fistulae: two cases treated with interventional approach

Coronary artery fistula （CAF）, an uncommon congenital heart disease, often results in myocardial ischemia. In the last two decades, there are some reports about interventional treatment of CAF,4-6 but few on transcatheter treatment of multiple CAFs. With different interventional procedures, we treated successfully two cases of percutaneous closure of two multiple CAFs which were confluent at the distal ends.     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI）分子靶向治疗研究为肇始,转化性研究使基础实验和临床实践间的鸿沟迅速填平,改变着人们认识治疗肺癌的视角。无可否认,EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段,但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度,     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

Spontaneous coronary dissection associated with myocardial bridge causing acute myocardial infarction

Spontaneous coronary artery dissection （SCAD） is a rare cause of myocardial ischemia, myocardial infarction and sudden-cardiac death.This disease mainly occurs in young women with oral contraceptive or during the peripartum period, without risk factors for coronary artery disease. Although SCAD results in a hemorrhagic separation of the intima and the media, and creates a false lumen, leading to distal myocardial ischemia, infarction and sudden death, the causes and the optimal management for this challenging condition are still controversial.     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。