Correlation between acute coronary syndrome classification and multi-detector CT characterization of plaque

Objective To determine if multi-detector CT (MDCT) characterization of plaque is corre-lated with the classification of acute coronary syndrome (ACS). Methods Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group (n=61) and diffuse plaque group (n=34) based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and re-modeling index. The incidences of major adverse cardiac events in follow-up period were also recorded. Results The patients of the diffuse plaque group were older than those of the discrete plaque group (P<0.0001). The diffuse plaque group presented more cases of hypertension, pe-ripheral artery disease, diabetes, and heart failure than discrete plaque group (all P<0.05). All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group (5.15±3.55 vs. 14.91±5.37, P<0.001). The other four scores demonstrated significant inter-group difference as well (all P<0.05). The remodeling index of the discrete plaque group was higher (1.12±0.16 vs. 0.97±0.20, P<0.05). Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group (29.41% vs. 11.48%, P=0.0288). Conclusions Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.     

血浆脂蛋白相关磷脂酶A2对急性心肌梗死患者住院预后的影响

Objective: To determine the prognostic utility of lipoprotein -associated phospholipase A2 (Lp-PLA2) for in-hospital major adverse cardiovascular events （MACE） in patients with acute myocardial infarction(AMI); Methods: A total of 167 patients referred for AMI participated, including 86 patients who were diagnosed as ST-segment elevation Acute Myocardial Infarction (STEMI) and 81 patients without ST-elevation (non-STEMI)) ,while 80 patients without AMI were selected as the control group; The following in-hospital MACE were recorded: death , remyocardial infarction , angina pectoris after MI , acute heart failure, and life threatening arrhythmias. The Lp-PLA2 levels among each group were compared, and the correlation between in-hospital MACE and Lp-PLA2 levels was explored. Results: (1)The plasma concentration of Lp-PLA2 was higher in patients with AMI than those of the control group, and the（加上） STEMI group was the highest, P<0.05; （2）The occurrence rate of in-hospital MACE rose was elevated significantly with the increased level of Lp-PLA2, P<0.05;(3) Levels of Lp-PLA2 were significantly higher in patients suffered from an event than those event -free subjects [（288.732±124.873） ng/ mL vs (231.537±92.059) ng/ mL],P<0.05;(4)Lp-PLA2 was found to be an independent risk factor in AMI patients for the in-hospital MACE in the regression analysis . Conclusions:Lp-PLA2 is positively correlated with the in-hospital adverse cardiovascular events in patients with AMI,and it’s an important biomarker in the risk stratification for in-hospital AMI patients.     

Combined Low-dose Aspirin and Warfarin Anticoagulant Therapy of Postoperative Atrial Fibrillation Following Mechanical Heart Valve Replacement

The safety and efficacy of combined low dose aspirin and warfarin therapy in patients with atrial fibrillation after mechanical heart valve replacement were evaluated. A total of 1016 patients （620 females, mean age of 36.8-4-7.7 years） admitted for cardiac valve replacement and complicated with atrial fibrillation after surgery were randomly divided into study （warfarin plus 75-100 mg aspirin） or control （warfarin only） groups. International normalized ratio （INR） and prothrombin time were main- tained at 1.8-2.5 and 1.5-2.0 times the normal values, respectively. Thromboembolic events and major bleedings were registered during the follow-up period. Patients were followed up for 24±9 months. The average dose of warfarin in the study and control groups was 2.91±0.83 mg and 2.88±0.76 mg, respec- tively （P〉0.05）. The incidence of overall thromboembolic events in study group was lower than that in control group （2.16% vs. 4.35%, P=0.049）. No statistically significant differences were found in hem- orrhage events （3.53% vs. 3.95%, P=-0.722） or mortality （0.20% vs. 0.40%, P=0.559） between the two groups. Combined low dose aspirin and warfarin therapy in the patients with atrial fibrillation following mechanical heart valve replacement significantly decreased thromboembolic events as compared with warfarin therapy alone. This combined treatment was not associated with an increase in the risk of major bleeding or mortality.     

Gender based differences in patients with acute coronary syndrome: findings from Chinese Registry of Acute Coronary Events (CRACE)

Background Many studies have examined gender related differences in the presenting symptoms, management and prognosis of patients with acute coronary syndrome (ACS). Much data are available from industrialized countries, in which ACS is a major cause of morbidity and mortality, but relatively little information has been obtained from China, where an epidemic of cardiovascular disease is starting to emerge. The purpose of this study was to assess the differences in clinical practice in a national Chinese sample.Methods A total of 12 medical teaching hospitals participated in CRACE. Data collection began in 2001 and continued until 2004, 1301 patients with ACS were enrolled into the study. We compared the clinical demographics, different therapies and outcomes in hospitals between female and male patients with ACS.Results Patients had an average age of 63.13 years (ranging from 27 to 93 years) and 318 female and 983 male subjects were enrolled. Female subjects were older than male patients (67.23 years vs 61.80 years, P&lt;0.0001). The incidence of angina, heart failure, diabetes mellitus and hypertension in the female group was higher than in male group (73.6% vs 62.3%, P&lt;0.0001; 8.2% vs 5.7%, P=0.031; 30.8% vs 18.6%, P&lt;0.0001 and 66.4% vs 56.8%, P=0.001 respectively), but the incidence of smoking was less in the female group than in the male group (6.6% vs 66.2%, P&lt;0.0001). More male patients presented with ST-segment elevation myocardial infarction (STEMI) compared with female patients (48.5% vs 39%, P=0.002). With the exception of β-blocker administration, no differences were found among medications including aspirin, ACEI, lipid lowering agents and low-molecular-weight heparin (LMWH) between female and male patients presenting with ACS in hospitals. Compared with male patients with non-ST-segment elevation (NSTE) ACS, female subjects were more prone to receive β-blockers (75.1% vs 63.4%, P=0.001). Among STEMI and NSTE-ACS patients, fewer female subjects received reperfusion therapy compared with male subjects (37.1% vs 26.8%, P=0.013 for STEMI; 53.6% vs 37.2 %, P&lt;0.0001 for NSTE-ACS). Recurrent angina was more often seen in the female group of patients with the whole spectrum of ACS (25% vs 14.5%, P=0.005 for STEMI; 29.4% vs 20.2%, P=0.001 for NSTE-ACS) as was true for patients with congestive heart failure. There was no significant difference in in-hospital death rates between the two groups with ACS (5.6% vs 7.1%, P=0.2 for STEMI, and 2.1% vs 1.4%, P=0.738 for NSTE-ACS). Conclusions Female patients with ACS were older than male subjects and thus more often had concomitant diseases but less often had a history of smoking. They less often received reperfusion therapies and more often had higher in-hospital recurrent angina. However, there was no significant difference in in-hospital mortality between the female and male patients.     

Prospective multicenter randomized trial comparing physician versus patient transfer for primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction

Background Primary percutaneous coronary intervention （PCI） has been identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction （STEMI）. The strategy of transferring patient to a PCI center was recently recommended for those with acute STEMI who were present to PCI incapable hospitals, which include lack of facilities or experienced operators. In China, some local hospitals have been equipped with PCI facilities, but they have no interventional physicians qualified for performing primary PCI. This study was conducted to assess the feasibility, safety and efficacy of the strategy of transferring physician to a PCI-equipped hospital to perform primary PCI for patients with acute STEMI. Methods Three hundred and thirty-four consecutive STEMI patients with symptom presentation 〈12 hours in five local hospitals from November 2005 to November 2007 were randomized to receive primary PCI by either physician transfer （physician transfer group, n=165） or patient transfer （patient transfer group, n=169） strategy. Door-to-balloon time, in-hospital and 30-day major adverse cardiac events （MACE, including death, non-fatal re-infarction, and target vessel revascularization） were compared between the two groups. Results Baseline characteristics between the two groups were comparable. Thrombolysis in myocardial infarction （TIMI） 3 flow was revealed in more patients in the physician transfer group at initial angiography （17.6% vs 10.1%, P〈0.05）. The success rate of primary PCI （96.3% vs 95.4%, P〉0.05） and length of hospital stay were similar between the two groups （（15±4） days vs （14±3） days, P〉0.05）. In the physician transfer group, door-to-balloon time was significantly shortened （（95±20） minutes vs （147±29） minutes, P〈0.0001） and more patients received primary PCI with door-to-balloon time less than 90 minutes （21.2% vs 7.7%, P〈0.001）. During hospitalization, MACE occurred in 6.7% and 11.2% of patients     

Evaluation on the Safety and Efficacy of Tirofiban in the Treatment of Acute Coronary Syndrome

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.     

COMPARISON OF CLINICAL OBSERVATIONS BETWEEN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITH ALL-TRANS RETINOIC ACID AND CHEMOTHERAPY

Clinical observations were retrospectively compared between 2 matched groups of patients with acute promyelocytic leukemia (APL) each 20. The first group were treated with chemotherapy, the other with all-tram retinoic acid (ATRA) alone at a dose of 45-60mg/M~2/d. The complete remission (CR) rate of ATRA group was significantly higher than that of chemotherapy (90% vs 55%). The time for obtaining CR as well as the duration of fever and hospitalization were shorter and the amount of blood transfused was less in the former than in the latter group. Seven cases were complicated by DIC and 4 died in the group of chemotherapy, while no case was by of DIC or death in the ATRA group. The mechanism was discussed. ATRA is an alternative effective drug for remission induction therapy in APL with high rate of CR.     

Outcomes after primary coronary intervention with drug-eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P&lt;0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) ≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.     

Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine

Objective:To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture (EA) in treating depression.Methods:Forty-two patients with depression were randomly assigned to the observation group (22 patients) treated with EA combined with Paroxetine,and the control group (20 patients) treated with Paroxetine alone,and the therapeutic course for both groups was 6 weeks.The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale (HAMD) and treatment emergent symptoms scale (TESS), respectively.Results:HAMD scores determined at the end of the 1st,2nd,4th,and 6th week of the treatment course were significantly lower in the observation group than those in the control group (P<0.05).The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group (72.7% vs 40.0%).No significant difference of TESS scores was found between the two groups.Conclusion:EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone,with milder adverse reaction and quicker initiation of effect.     

Clinical Observation of Shuanghuang Shengbai Granule(双黄升白颗粒) on Prevention and Treatment of Myelosuppression Caused by Chemotherapy in Cancer Patients

Objective: To study the efficacy and safety of Shuanghuang Shengbai Granule(双黄升白颗粒, SSG), a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy. Methods: A total of 330 patients were randomly assigned to the treatment group(220 cases, analysed 209 cases) and the control group(110 cases, analysed 102 cases) with a 2:1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation. Results: At the 7th day of chemotherapy, the white blood cells(WBCs) level in the treatment group was significantly higher than that in the control group(P0.05). After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade Ⅰ, while 8.1% and 5.7% of patients emerged grade Ⅲ and grade Ⅳ myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group(P0.05). The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group(84.2% vs. 72.5%, P0.05). The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3~+ and CD4~+ cells were significantly increased in the treatment group after treatment(P0.05). The discrepancy of CD3~+ and CD4~+ cell activity before and after treatment in both groups were significantly different(P0.05). No obvious adverse event occurred in both groups. Conclusion: SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.     

Short-term Effect of Combined Therapy with Jinlong Capsule(金龙胶囊)and Transcatheter Arterial Chemoembolization on Patients with Primary Hepatic Carcinoma and Its Influence on Serum Osteopontin Expression

<正>Objective:To observe the clinical combination effect of Jinlong Capsule(金龙胶囊,JLC) and transcatheter arterial chemoembolization(TACE) on the patients with primary hepatic carcinoma(PHC) and JLC's influence on serum osteopontin(OPN) expression and elucidate the correlation between the serum OPN level and curative effect of JLC and TACE.Methods:A total of 98 patients with PHC were observed in a randomized controlled trial(RCT).They were assigned to the Chinese medicine(CM) group(53 patients who were treated with TACE and JLC) and the intervention group(45 patients who were treated with TACE only).The serum OPN levels were measured before and after treatment by quantitative sandwich enzyme-linked immunosorbent assay(ELISA).Forty healthy people were assigned to the control group.The clinical efficacy was observed and Karnofsky score(KPS) was graded.Results:The clinical efficacy of the CM group(60.38%) was better than that of the intervention group(40.00%),and the KPS(84.35±12.19) was higher than the intervention group(69.86±11.58)(P0.05).The serum OPN levels before and after treatment in the patients with PHC were significantly elevated compared with those in the control group(P0.01).After treatment,the OPN levels in CM group(117.69±78.50) were significantly lower compared with those in intervention group(151.09±83.90,P0.05).The OPN levels of responders were remarkably lowered than the non-responders after treatment,and the level of OPN in the CM group was lower than the intervention group(P0.05).Conclusions:The short-term clinical efficacy and the quality of life of patients with PHC can be improved by combining JLC with TACE.The serum OPN levels in PHC patients can reflect the curative effect of treatment and the prognosis of the disease.     

A One-year Evaluation of Radiographic Progression in Patients with Rheumatoid Arthritis Treated by Qingre Huoxue Decoction(清热活血方)

<正>Objective:To investigate the effects of Qingre Huoxue Decoction(清热活血方,clearing heat and promoting blood flow;QRHXD),on the radiographic progression in patients with rheumatoid arthritis(RA) by X-ray imaging.Methods:Eighty-six patients with active RA diagnosed as damp-heat and blood stasis syndrome were randomized into a QRHXD group and a QRHXD plus methotrexate(MTX) group,with 43 cases in each group.After one-year of treatment,21 cases in each group(42 in total) were evaluated.Radiographs of hands were obtained at the baseline and after 12 months of treatment.Images were evaluated by investigators blinded to chronology and clinical data,and assessed according to the Sharp/Van der Heijde methods.Results:High intrareader agreements were reached(mean intraobserver intraclass coefficients:0.95).No significant change in any imaging parameters of joint destruction was observed at 12 months in either group;and the differences between the two groups were not significant(P0.05).The mean of the changing score in the QRHXD group was 3.5±4.1,and 2.4±3.5 in the QRHXD+MTX group,while the baseline radiographic score of patients in the QRHXD group was relatively higher(18.9±19.1 vs.14.0±14.0).The mean rates of the changing scores of the two groups were similar(0.24±0.28 vs.0.25±0.44,P=0.40).The severity of progression in the two groups was also similar(P=0.46),7 cases without radiographic progression in the QRHXD group and 8 in the QRHXD+MTX group,3 cases with obvious radiographic progression in the QRHXD group and 1 in the QRHXD+MTX group. Conclusion:Radiographic progression of RA patients in both groups is similar,indicating that the QRHXD Decoction has a potential role in preventing bone destruction.     

Role of Removing Stasis and Reducing Heat Formula in Clearance of Proximal Ureteral Calculi after Ureteroscopic Ho:YAG Laser Lithotripsy: A Prospective Randomized Study

Objective To prospectively evaluate the efficacy of Removing Stasis and Reducing Heat Formula in accelerating calculus clearance and improving lower urinary tract symptoms of patients with proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy. Methods A total of 138 patients with proximal ureteral calculi underwent ureteroscopic Ho:YAG laser lithotripsy by a single endocrinologist. Stone size varied from 10 to 15 mm. After operation, the patients were randomly divided into three groups: the control group(group A), tamsulosin group(group B), and Removing Stasis and Reducing Heat Formula group(group C). The treatment lasted for 4 weeks or until stone clearance. The primary and secondary outcomes of the three groups at follow-up were assessed. Results Of the 131 patients available for follow-up, 44 cases were in the group A, 45 in the group B, and 42 in the group C, respectively. The stone free rate at 2 weeks in the groups B and C were significantly higher than that in the group A(95.56%, 97.62% vs. 79.55%; all P<0.05). The ureteral colic rate and mean time of fragment expulsion were significantly reduced in the groups B(4.44% and 7.86±4.99 days) and C(2.43% and 6.76±4.37 days) compared with the group A(22.73% and 11.54±9.89 days, all P<0.05). On the day of double-J ureteric stent removal, the group C differed significantly from the group A in the total International Prostate Symptom Score, irritative subscore, obstructive subscore, and quality of life score(all P<0.05). Conclusion Removing Stasis and Reducing Heat Formula in the medical expulsive therapy might be an effective modality for patients with calculus in the proximal uretera after ureteroscopic Ho:YAG laser lithotripsy.     

Effects of Electro-Acupuncture at Zusanli, Guanyuan for Sepsis Patients and Its Mechanism through Immune Regulation

Objective:To evaluate the effect of electro-acupuncture on Zusanii(ST 36),Guanyuan(RN 4)in patients with sepsis,and explore its mechanism in term of immune regulation.Methods:In this prospective randomized controlled trial,60 patients with sepsis were randomly assigned to the control group and the intervention group equally by block randomization.Patients in the control group received routine treatment and those in the intervention group received electro-acupuncture at bilateral Zusanii and Guanyuan in addition to routine treatment,respectively.The mortality at 28 days,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ score were compared to evaluate the effect,and the levels of T cell subsets(CD3+,CD4+,CD8+,CD4+/CD8+) and monocytes of human leukocyte antigen(HLA)-DR using flow cytometry were compared to explore the mechanism of this combined treatment.Results:Fifty-eight patients completed the trial with29 in each group.There was no significant difference of mortality in the 28 th day between the two groups,with 5 death of 29 patients in the intervention group(17.2%) and 9 of 29 in the control group(31.0%).After treatment,APACHE- II score of both groups was significantly decreased,however,score of the intervention group was lower than the control group(13.28 ±7.07 vs.17.10 ±5.83;P0.01).The levels of CD3+,CD4+,CD8+ and CD4+/CD8+ ratio of the intervention group improved after treatment and were higher than the control group(59.71%±11.94%vs.52.54%± 11.86%;36.46%±7.60%vs.31.58%±10.23%;18.40%±8.82%vs.23.07%±7.30%;2.38±1.14 vs.1.54±0.80,respectively;all P0.05).The expression of HLA-DR significantly increased after treatment in the intervention group than that in the control group(7.28%± 9.26%vs.1.27%±7.00%;P0.01).Conclusion:Electro-acupuncture at Zusanii and Guanyuan could improve clinical curative effect in patients with sepsis,which might be achieved by regulation of the immune system.     

Clinical study of acoustic densitometry technique in detecting atherosclerotic plaque

Objective: To investigate the effect of Quyu Xiaoban Capsule (祛瘀消斑, QYXB) on the regressive treatment of atherosclerosis (AS) with acoustic densitometry (AD) technique. Methods: Eighty patients with AS were randomly divided into two groups, trial group was treated with QYXB and conventional medicine, and control group was treated with conventional medicine alone. Normal arterial wall and different types of atherosclerotic plaques were detected with AD technique before treatment and 10 months later. Resuits: The corrected averages in intimal echo intensity (AIIc%) were elevated in both groups but without significant difference, AIIc% of fatty plaques were increased in both groups and the value after treatment was significantly higher than that of pre-treatment in the trial group (68.12±5.54 vs 61.43±5.37, P＜0.05).The increment rate of AIIc% in trial group was significantly higher than that in control group (10.9±5.1% vs2.5±5.5%, P＜0.05). Conclusion: QYXB can stabilize the atherosclerotic plaque by increasing its acoustic density. Acoustic densitometry technique can differentiate the different histological plaques and monitor the histological changes of plaques during treatment.     

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Background The clinical outcome of percutaneous coronary intervention （PCI） is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction （STEMI）.
Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged 〉55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis 〈20% with thrombolysis in myocardial infarction flow grade 〉2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events （MACE）, including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.
Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups （94.4% vs 92.2%）. The occurrence rate of MACE did not differ during the hospitalization （4.2% vs 6.0%, P=0.50）, but was significantly higher in the female group during follow-up （mean （16.0±11.2） months） than that in the male group （5.4% vs 0.7%, P=0.02）.
Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.     

Clinical observation of Esomeprazole combined with magnesium aluminum carbonate in patients with gastric ulcer

Objective To investigate the clinical effect of esomeprazole combined with magnesium aluminum carbonate in patients with gastric ulcer. Methods A total of 106 patients with gastric ulcer who were treated in our hospital from September to September 20, 2017 were enrolled in this study. They were randomly divided into two groups, 53 patients in each group. The control group received oral esomeprazole. Study group On this basis, magnesium aluminocarbonate was added for treatment, and the total clinical effective rate and ulcer diameter of the two groups were compared. Results The total effective rate of the study group was 92.45% higher than that of the control group(77.36%)(P 0.05). The diameter of the study group was(2.21±1.83) mm. The study group was significantly lower than the control group. The difference was statistically significant(P 0.05).Conclusion The combination of esomeprazole and aluminum magnesium carbonate in gastric ulcer disease can promote the healing of gastric ulcer and improve the clinical efficacy.     

Plasma Homocysteine and Gene Polymorphisms Associated with the Risk of Hyperlipidemia in Northern Chinese Subjects

To examine the relationship between occurrence of hypedipidemia,plasma homocysteine and polymorphisms of methylenetetra hydrofolate reductase (MTHFR) gene and methionine synthase (MS) gene.Methods A total of 192 hyperlipidemia patients were selected and divided into hypercholesterolemia group,hypertriglyceridemia group,and combined hyperlipidemia group.Another 208 normal individuals were selected as control.Total plasma homocysteine (tHcy)concentration was measured by high-performance liquid chromatography (HPLC).Lipid profiles were measured for all subjects.The polymorphisms of MTHFR gene C677T and MS gene A2756G were analyzed by PCR-RFLP.Results The tHcy concentration in the combined hyperlipidemia patients was significantly higher than that in the control (15.95 μmol/L vs 13.43 μmol/L,P＜0.05).The prevalence of hyperhomocysteinemia (Hhcy) in the combined hyperlipidemia group was significantly higher than that in the control (42.2% vs 23.0%,P=0.015),with the odds ratio (OR) of 3.339 (95%CI:1.260-8.849).The hyperlipidemia patients with Hhcy had a higher concentration of total cholesterol (TC) than that in the normal they patients (5.67±0.95 mmol/L vs 5.47±0.92 mmol/L,P=0.034).There was no significant difference in genotype or allele frequencies of MTHFR C677T between the hyperlipidemic and control groups.The hyperlipidemia patients with MTHFR CT/TT genotype had a higher concentration of triglyceride (TG) than those with CC genotype (2.24±1.75 mmol/L vs 1.87±0.95 mmol/L,P＜0.05).Individuals with CT/TT genotype had a higher concentration of tHey than those with 677CC genotype both in the hyperlipidemia group (12.61±1.24 μmol/L vs 11.20±1.37 μmol/L,P＜0.05) and in the control group (14.04±1.48 μmol/L vs 12.61±1.24 μmol/L,P＜0.05).The percentage of MS 2756 GG/AG genotype in the combined hyperlipidemia group was significantly higher than that in the control (26.7% vs 13.0%,P=0.012),with the OR of 3.121 (95%CI:1.288-7.651).The hyperlipidemia patients with MS 2756AG/GG genotype had a higher concentration of TC (5.87±0.89 mmol/L vs 5.46±0.93 mmol/L,P＜0.05) and LDL-C (3.29±0.81 mmol/L vs 2.94±0.85 mmol/L,P＜0.05)than those with AA genotype.However,individuals with 2756AG/GG genotype showed no significant difference in tHcy among those with AA genotype.Conclusion Hhcy and MS A2756G mutation may be the risk factors for combined hyperlipidemia.Further study is needed to confirm the role of Hhcy and MS A2756G mutation in the development of hyperlipidemia.     

No Additional Cholesterol-Lowering Effect Observed in the Combined Treatment of Red Yeast Rice and Lactobacillus Casei in Hyperlipidemic Patients:A Double-Blind Randomized Controlled Clinical Trial

Objective:To observe the effect of combining red yeast rice and Lactobacillus casei(L.casei)in lowering cholesterol in patients with primary hyperlipidemia,the later has also been shown to remove cholesterol in in vitro studies.Methods:A double-blind clinical trial was conducted to evaluate the cholesterol-lowering effect of the combination of red yeast rice and L.casei.Sixty patients with primary hyperlipidemia were recruited and randomized equal y to either the treatment group(red yeast rice+L.casei)or the control group(red yeast rice+placebo).One red yeast rice capsule and two L.casei capsules were taken twice a day.The treatment lasted for 8 weeks,with an extended follow-up period of 4 weeks.The primary endpoint was a difference of serum low-density lipoprotein cholesterol(LDL-C)level at week 8.Results:At week 8,the LDL-C serum level in both groups was lower than that at baseline,with a decrease of 33.85±26.66 mg/dL in the treatment group and 38.11±30.90 mg/dL in the control group;however,there was no statistical difference between the two groups(P0.05).The total cholesterol was also lower than the baseline in both groups,yet without a statistical difference between the two groups.The only statistical y significant difference between the two groups was the average diastolic pressure at week 12,which dropped by 2.67 mm Hg in the treatment group and increased by 4.43 mm Hg in the placebo group(P0.05).The antihypertensive activity may be associated with L.casei.Red yeast rice can significantly reduce LDL-C,total cholesterol and triglyceride.Conclusion:The combination of red yeast rice and L.casei did not have an additional effect on lipid profiles.     

In-hospital delay to primary angioplasty for patients with ST- elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.