2012年 · 第125卷第19期

Diabetes is a key risk factor for chronic kidney disease,1 and patients with type 2 diabetes and coronary artery disease are at high risk of cardiovascular events particularly when renal function is impaired.2-4 Decision on how and when to proceed to coronary revascularization in an individual type 2 diabetic patient should be based on the extent of coronary disease,ischemic burden, ventricular function, as well as co-morbidities (e.g., renal insufficiency)。

Abstract：Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation.We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy (CIN) in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty.Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of 60 ml-1 ·min-1.1.73 m-2 or less,who were undergoing coronary angiography or angioplasty,were randomly assigned to receive an infusion of either sodium chloride (control group,n=128) or anisodamine (treatment group,n=132).Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg-1.min-1 from 12 hours before to 12 hours after coronary angiography or angioplasty,while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group.All patients received intravenous sodium chloride hydration.CIN was defined as a 25％ increase in serum creatinine from baseline or an absolute increase of ＞0.5 mg/dl within three days after contrast exposure.The primary end point was the incidence of CIN.The secondary end point was a 25％ or greater reduction in eGFR.Results There were no significant differences between the two groups with regard to age,gender,risk factors,laboratory results,medications and interventions.The incidence of CIN was 9.8％ (13/132) in the treatment group and 20.3％ (26/128) in the control group (P ＜0.05).The secondary end point was 6.0％ (8/132) in the treatment group and 16.4％ (21/128) in the control group (P＜0.05).Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty。

Abstract：Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies.However,this has not been thoroughly evaluated in ST elevation myocardial infarction.Methods This was a prospective,randomized,controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction,treated with zotarolimus-eluting stents or sirolimus-eluting stents.From March 2007 to February 2009,122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion.The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography,and secondary endpoints were percent diameter stenosis,binary restenosis rate,major adverse cardiac events (a composite of cardiac death,non-fatal myocardial infarction,and target vessel revascularization),and late-acquired incomplete stent apposition.Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs.(0.10±0.46) mm,P=0.001).Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)％ vs.(17.6±14.0)％,P ＜0.001).In-segment analysis showed similar findings.There were no significant differences in binary restenosis rate,major adverse cardiac events,and late-acquired incomplete stent apposition.Conclusions Compared to sirolimus-eluting stents,the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction.Although there was no significant difference in 1-year clinical outcomes,the clinical implication of increased late lumen loss should be further studied。

Abstract：Background Transradial coronary intervention (TRI) introduces injury to the radial artery (RA) which will affect repeat transradial coronary procedure and the quality as a bypass conduit.We sought to compare the early radial injury after TRI between first-TRI and repeat-TRI by ultrasound biomicroscopy (UBM).Methods A total of 1116 patients who underwent the transradial coronary procedures were enrolled.The patients depending on whether for the first time to accept transradial coronary procedure were divided into first-TRI group and repeat-TRI group.The RA was examined by UBM before and one day after the procedure.Results Compared with first-TRI group,the mean RA diameter of repeat-TRI one day after the procedure decreased significantly (P ＜0.05).In first-TRI group,the mean RA diameter was (2.32±0.53) and (1.93±0.57) mm before procedure and one day after the procedure respectively (P ＜0.05).In repeat-TRI group,the mean RA diameter was (2.37±0.51) and (1.79±0.54) mm before procedure and one day after the procedure,respectively (P ＜0.01).Compared with first-TRI group,the mean RA diameter was reduced significantly in repeat-TRI group one day after the procedure (P＜0.05).The early radial injuries and intimal thickening were compared between first-TRI and repeat-TRI.The mean intima-media thickness of RA was (0.24±0.13) mm and (0.59±0.28) mm before procedure and one day after the procedure in first-TRI group.The mean intima-media thickness of RA was (0.29±0.16) mm and (0.68±0.32) mm before procedure and one day after the procedure in repeat-TRI group.Compared with first-TRI group,the mean intimal thickening was increased significantly in repeat-TRI group one day after the procedure (P＜0.05).Intimal dissection,stenosis and occlusion were all significantly greater in repeat-TRI RAs (P ＜0.05).Linear regression analysis revealed that diameter,repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.Conclusions RA early injuries were greater in repeat-TRI patients than in first-TRI patients.We first use high-resolution UBM imaging to demonstrate the rate of radial injury and revealed that diameter,repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening。

Abstract：Background Since permanent polymer is implicated in adverse events associated with delayed vessel healing after drug eluting stents (DES) implantation,great efforts have been made to develop more biocompatible DES with biodegradable polymer or without polymer.The present study aimed to evaluate the safety and efficacy of polymer free paclitaxel-eluting stents (PF-PES) in comparison with permanent polymer sirolimus-eluting stents (PP-SES) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Patients with STEMI were randomly assigned to receive PP-SES (n=55),and PF-PES (n=50).The 6-month angiographic and 1-year clinical outcomes were compared between the two groups.Target lesion failure (TLF) was defined as the composite of cardiac death,recurrent nonfatal myocardial infarction (Re-MI),or target lesion revascularization (TLR).Results Follow-up angiography at six months was performed in 72.7％ of the PP-SES group and 70.0％ of the PF-PES group (P=0.757).The two groups had comparable angiographic outcomes including minimal luminal diameter,diameter stenosis,late loss and binary restenosis.All patients were clinically followed up to one year.The two groups had similar clinical outcomes with relatively low rates of target lesion failure (10.9％ PP-SES vs.12.0％ PF-PES,P=0.861) and definite or probable stent thrombosis (1.8％ PP-SES vs.2.0％ PF-PES,P=1.000) at one year.Conclusions The present study suggests that the safety and efficacy of PF-PES in the setting of STEMI are comparable to PP-SES.Further randomized trials with larger study populations are needed to get definite conclusions。

Abstract：Background Restenosis of bare-metal stents (BMS) and drug-eluting stents (DES) has been increasingly treated with sirolimus-eluting stents (SES),but the long-term outcomes are unknown.Methods In our study,388 consecutive patients (144 DES restenosis and 244 BMS restenosis) with 400 lesions (147 DES restenosis and 253 BMS restenosis) treated with SES were included.The rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) at 42 months were analyzed.Results At the mean follow-up of 42 months,the rates of death (3.5％ vs.3.3％,P=1.000) and myocardial infarction (2.8％ vs.1.2％,P=0.431) in the DES group and BMS group were comparable.Compared with the BMS group,ischemia-driven TLR occurred with a higher frequency in the DES group (18.8％ vs.10.7％,P=0.024).This translated into an increased rate of MACE in the DES group (22.2％ vs.14.0％,P=0.034).Stent thrombosis occurred with a similar frequency in both groups (2.8％ vs.1.6％,P=0.475).Multivariate analysis showed that DES restenosis (OR=1.907,95％Cl 1.108-3.285,P=0.020) and smoking (OR=2.069; 95％ C/ 1.188-3.605; P=0.010) were independent predictors of MACE.Conclusions Although SES implantation appears to be safe and effective,it was associated with higher TLR recurrence for DES than BMS restenosis。

Abstract：Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population.Pre-hospital delay is an important cause of increasing early and also late mortality in AMI.Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.Methods Between August 2010 and May 2011,a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr.Heshmat Hospital,Rasht.All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic,clinical,situational and cognitive factors.Data were analyzed by descriptive and Logistic regression model at P ＜ 0.05 using SPSS 16.Results Mean age was (60.11±12.29) years in all patients.Majority of patients (65.4％) were male.The median of pre-hospital delay was 2 hours,with a mean delay of 7.4 hours (±16.25 hours).Regression analysis showed that admission in weekend (P ＜0.04,OR=1.033,95％ Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P ＜0.002,OR=1.986,95％ Cl=1.254-3.155) and perceiving symptoms to not be so serious (P ＜0.003,OR=3.264,95％Cl=1.492-7.142) were factors influencing pre-hospital delay ＞ 2 hours.Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays.Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment。

Abstract：Background Pregnant women with heart disease are at high risk.Studies of risk factors of these patients are of great significance to improve maternal and fetal outcomes.In this paper,we try to discuss the main risk factors of cardiac events in pregnant women with heart disease and to establish a risk assessment system.Methods A retrospective analysis was carried out for pregnancies in 1741 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and September 2010.A Logistic regression model was used to identify independent risk factors of cardiac events and calculate the risk index in pregnant women with heart disease.Results The composition of heart disease in pregnant women was arrhythmia (n=662,38.00％),congenital heart disease (CHD; n=529,30.40％),cardiomyopathy (n=327,18.80％),rheumatic heart disease (RHD; n=151,8.70％),and cardiopathy induced by pre-eclampsia (n=53,3.00％).Main cardiac events were heart failure (n=110,6.32％),symptomatic arrhythmia needing medication (n=43,2.47％),cardiac arrest (n=2,0.11％),syncope (n=3,0.17％),and maternal death (n=10,0.57％).Six independent risk factors to predict cardiac events in pregnant women with heart disease were cardiac events before pregnancy (heart failure,severe arrhythmia,cardiac shock,etc.,P=0.000),New York Heart Association (NYHA) class ＞ll (P=0.000),oxygen saturation ＜90％ (P=0.018),pulmonary artery hypertention (PAH)＞50 mmHg (P=0.025),cyanotic heart disease without surgical correction (P=0.015),and reduced left ventricular systolic function (ejection fraction ＜40％,P=0.003).Every risk factor was calculated as 1 score.The incidence of cardiac events in patients with scores 0,1,2,3,and ≥4 was 2.10％,31.61％,61.25％,68.97％,and 100.00％ respectively.Conclusions Pregnancy with heart disease could lead to undesirable pregnancy outcomes.The risk of cardiac events in pregnant women with heart disease could be assessed by risk index。

Abstract：Background The left atrial appendage (LAA) is an important source of thrombus formation.We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography (RT3D-TEE) method in assessment of the morphology and function of the LAA.Methods Ninety-six consecutive patients (58 males with a mean age of (43.4±12.5) years) who were referred for 2-dimensional (2D) transesophageal echocardiography (TEE) underwent additional RT3D-TEE.LAA morphology was visualized in multiple views.Orifice size,depth,volumes and ejection fraction (EF) of the LAA,were measured.Results All the patients underwent RT3D-TEE examination without complications.Ninety-two patients (95.8％) had adequate images for visualization and quantitative analysis of the LAA.The LAA exhibited great variability with respect to relative dimensions and morphology.LAA orifice area was (3.8±1.2) cm2 with a diameter of (2.4±0.9) cm x (1.4±0.6) cm.The mean depth of the LAA was (2.9±0.7) cm.End-diastolic volume (EDV-LAA),end-systolic volume (ESV-LAA) and EF of the LAA were (6.2±3.7) ml,(4.1±2.8) ml,and 0.35±0.16,respectively.EDV-LAA,ESV-LAA and the orifice area of the LAA in patients with atrial fibrillation (AF) were larger than those without AF,whereas the EF was smaller in the AF patients.Conclusions Defining LAA morphology and quantitative analysis of the size and function of the LAA with superior quality and resolution of images using RT3D-TEE is feasible.This technique may be an ideal tool for guidance of the LAA occlusion procedure.Determination of LAA volumes and volume-derived EF by RT3D-TEE provides new insights into the analysis of LAA function。

Abstract：Background The impact of home monitoring system in the early detection of ventricular arrhythmia and inappropriate shock in daily work is not clear.The aim of this study was to investigate the impact of home monitoring system on the early detection of ventricular arrhythmia and inappropriate shock in daily clinical practice.Methods Cases of implantable cardioverter defibrillator (ICD) implantation with or without the home monitoring system from June 2010 to October 2011 at our center were reviewed.Follow-up was scheduled after implantation.Data relating to the home monitoring ICD were retrieved using a remote transmitter system.Data relating to the other devices were obtained during scheduled follow-up or unscheduled visits.Results Our study involved 69 patients (mean age (68.4±17.6) years,64.3％ males,26 in the home monitoring group vs.43 in the non-home monitoring group).In all,561 ventricular arrhythmia episodes were detected in 17 patients (39.5％) in the non-home monitoring group:495 episodes were ventricular tachycardia and 66 episodes were ventricular fibrillation; among these,476 episodes of ventricular tachycardia and 45 episodes of ventricular fibrillation were appropriately diagnosed (96.1％ and 68.2％,respectively).In the home monitoring group,389 ventricular arrhythmia episodes were transmitted by the home monitoring system in nine patients (34.6％):348 ventricular tachycardia episodes and 41 ventricular fibrillation episodes.Device detection was appropriate in 348 ventricular tachycardia episodes (100.0％) and 36 ventricular fibrillation episodes (87.8％).The home monitoring group showed a higher appropriate detection rate of ventricular tachycardia (P ＜0.01) and ventricular fibrillation (P=0.02).The proportion of inappropriate shock was comparable in the two groups (6/11 in the non-home monitoring group vs.1/7 in the home monitoring group; P=O.08).Conclusions The home monitoring ICD was able to provide information relating to inappropriate detection and shock earlier than conventional devices.It proved to be a reliable tool and has a strong potential to provide greater reaction time in the case of inappropriate shock。

Abstract：Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF).The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF.Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins (PV) ablation were retrospectively analyzed.Of these patients,250 (51.2％) patients had HATCH score=0,185(37.9％) patients had HATCH score=1,and 53 (10.9％) patients had HATCH score ＞2 (28 patients had HATCH score=2,23 patients had HATCH score=3,and 2 patients had HATCH score=4).Results The patients with HATCH score ＞2 had significantly larger left atrium size,the largest left ventricular end systolic diameter,and the lowest ejection fraction.After a mean follow-up of (823±532) days,the recurrence rates were 36.4％,37.8％ and 28.3％ from the HATCH score=0,HATCH score=1 to HATCH score ＞2 categories (P=0.498).Univariate analysis revealed that left atrium size,body mass index,and failure of PV isolation were predictors of AF recurrence.After adjustment for body mass index,left atrial size and PV isolation,the HATCH score was not an independent predictor of recurrence (HR=0.92,95％ confidence interval=0.76-1.12,P=0.406) in multivariate analysis.Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation。

Abstract：Background The difference in clinical outcome between paclitaxal-eluting stents (PES) and sirolimus-eluting stents with bio-degradable polymer (SES-BDP) for bifurcation lesions remains unclear.The present study aimed to investigate the one-year clinical outcome after DK crush stenting using PES (TaxusTM) vs.SES-BDP (ExcelrM) from our database.Methods A total of 275 patients (90 from the DKCRUSH-I and 185 from the DKCRUSH-Ⅱ study) were studied.The primary endpoint was the occurrence of major adverse cardiac events (MACE) at 12 months; including cardiac death,myocardial infarction (MI),or target vessel revascularization (TVR).The rate of binary restenosis and stent thrombosis served as secondary endpoints.Results At follow-up,minimal luminal diameter (MLD) in the Taxus group was (2.11±0.66) mm,with resultant increased target lesion revascularization (TLR) 12.2％ and TVR 14.4％,significantly different from the Excel group; (2.47±0.56) mm,P ＜0.001,3.2％,P=0.006,4.9％,P=0.019,respectively.As a result there was a significant difference in MACE between the Taxus (20.0％) and Excel (10.3％,P=0.038) groups.Overall stent thrombosis was monitored in 11 patients (4.0％),with five in the Excel group (2.7％) and six in the Taxus group (6.7％).All stent thrombosis in the Excel group was classified as early,and all were defined as late in the Taxus group.Conclusion The Excel stent had lower rate of stent thrombosis,TLR,TVR,and composite MACE at 12-month after an indexed stenting procedure,compared to the Taxus stent。

Abstract：Background Studies have confirmed that angiotensin Ⅱ receptor blocker (ARB) and angiotensin converting enzyme inhibitors (ACEI) in the treatment of diabetic nephropathy (DN) has special advantages.We observed the effects of valsartan and metoprolol tartrate hydrchloride in treatment of DN patients with positive β1-adrenergic and anti-angiotensin Ⅱ type 1 (AT1) receptor antibody.Methods The epitopes of the second extracellular loop of β1 receptor (197-222) and AT1 receptor (165-191),were synthesized and used respectively to screen serum autoantibodies from patients with DN (n=371,group A),diabetes mellitus (DM) without renal failure (n=107,group B) and healthy blood donors (n=47,control,group C) by enzyme-linked immunosorbent assay (ELISA).Metoprolol tartrate 25-50 mg,three times per day,valsartan 160 mg,once a day,aspirin 100 mg,once a day,and nitrendipine 10-20 mg,three times per day,were given to DN patients with positive or negative autoantibodies.The cystatin C level and 24-hour urinary protein were measured before and after treatment.Results In DN patients,the positive rate of the autoantibodies against β1 receptors and AT1 receptor was 47.7％ and 51.5％,respectively,which were significantly higher than those in DM patients and healthy controls (all P ＜0.01).Patients with anormalous cystatin C had higher positive rates of the autoantibodies than patients with normal cystatin C.Valsartan and metoprolol tartrate reduced proteinuria significantly (P ＜0.01) in DN patients with positive autoantibodies.Conclusions The findings suggest that these autoantibodies against β1 and AT1-receptor may play important roles in the pathogenesis of DN.Valsartan and metoprolol tartrate are effective and safe in the treatment of DN.Chin Med J 2012; 125(19):3543-3547

Abstract：Objective To review the updated research progress about the application of echocardiography in resynchronization treatment of chronic heart failure patients.Data sources The data used in this review were from PubMed,published in English and using the key terms "heart failure","echocardiography" and "cardiac resynchronization therapy".Study selection Relevant articles were reviewed and selected to address the stated purpose.Results Increasing numbers of studies have suggested the importance of echocardiography in resynchronization treatment of chronic heart failure patients.Echocardiography can evaluate atrioventricular,inter- and intra-ventricular mechanical dyssynchrony before cardiac resynchronization therapy (CRT),as a guidance to assess the optimal left ventricular (LV) pacing location,optimize the atrioventricular and interventricular delays and predict response to CRT.Conclusions Echocardiography is both non invasive and easily repeatable,and plays a crucial role in appraisal of heart synchronism,instruction of actuator placement,optimization of the device procedure,and prediction of the response to CRT.Chin Med J 2012; 125(19):3548-3555

Abstract：Objective To summarize the clinical applications of arsenic trioxide (ATO) in the treatment of acute promyelocytic leukemia (APL),as well as non-APL malignancies and to discuss the mechanisms and adverse effects involved in ATO administration.Data sources The data in this article were collected from PubMed and CHKD database with relevant English and Chinese articles published from 1957 to 2011,with key words including acute promyelocytic leukemia,arsenic trioxide,treatment,and mechanism.Study selection Articles including any information about ATO in the treatment of APL were selected.Results APL is a rare subtype of acute myeloid leukemia,with dismal prognosis under treatment with traditional chemotherapy.ATO impressively increases the complete remission rate and prolongs survival of patients with APL,with only mild and transient adverse effects.The advances in the understanding of multiple mechanisms involved in ATO treatment will benefit more cancers in future.Conclusion Deeper understanding of mechanisms involved in ATO treatment may provide rationales for future clinical applications in a number of human malignancies.Chin Med J 2012; 125( 19):3556-3560

The systemic nature of vascular atherosclerosis involves all vascular territories.As interventional cardiologists,we are familiar with coronary artery bifurcation treatment.In other parts of the human body,the vascular tree develops similar bifurcation in the carotid,renal,aortoiliac and tibio-peroneal segments.Even with some differences depending on specific vascular wall composition,the atherosclerotic process affects all such bifurcations in a similar way。

Atherosclerotic process has a predilection for bifurcation due to the complex hemodynamics and resultant altered shear stress that contributes to the localization and progression of atheromatous plaques.1Coronary intervention,especially the placement of stents further alters the hemodynamics and shear forces.These factors may account for the increased incidences of in-stent restenosis,stent thrombosis,side-branch (SB)restenosis,etc,that continue to plague bifurcation intervention.2

Left main coronary artery stenosis traditionally resided exclusively in the realm of coronary artery bypass grafting surgery (CABG) as a means of revascularization.Due to growing evidence in the literature,including multiple recent registries and even some randomized controlled trials showing similar rates of major adverse outcomes for CABG and left main artery percutaneous coronary intervention (PCI),there is increased interest in and even an upgraded status in current guidelines for left main PCI as a viable option for left main revascularization.1-3

Abstract：Background Cytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients.Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients.This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.Methods Plasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers.The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.Results CMV-DNA was detected in 29 of 77 recipients,yielding a positive rate of detection of 37.7％ for this procedure.Twelve of the 21 recipients (57.1％) who suffered acute rejection had positive CMV-DNA.Among the 56 recipients suffered from chronic or mild rejection,17 (30.4％) had positive CMV-DNA plasma.Moreover,of the 29 recipients who had detectable CMV-DNA after transplant,12 (41.4％) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA,only nine (18.8％) developed acute rejection.Post-transplant patients with acute rejection had a higher rate (57.1％ vs.30.4％,P=0.03) of post-transplant CMV infection than those with chronic or mild rejection.Conclusion CMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.Chin Med J 2012; 125(19):3575-3577

Abstract：Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility.Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment.This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.Chin Med J 2012; 125(19):3578-3580

Coronary artery disease (CAD) is the leading cause of cardiovascular death in the Chinese population.Coronary angiography is the golden standard for the diagnosis of CAD and coronary tortuosity (CT) is a common coronary angiographic finding,however,little work has been done on clinical manifestation and significance of CT.It was hypothesized that CT may be associated with angina pectoris and abnormal exercise stress test in patients without CAD,1 but weather CT can lead to cardiac ischemia has not yet been clarified.The purpose of this study was to determine the impact of CT on myocardial perfusion defects。

Subarachnoid hemorrhage (SAH) is a subtype of stroke that is most commonly caused by the rupture of intracranial aneurysm.Endovascular occlusion of intracranial aneurysms has emerged as an alternative to the established microsurgical clipping.1,2 The decision process when choosing a treatment for ruptured intracranial aneurysm should comprise an algorithm that was based on the characteristics of the aneurysm and patient status,age,and neurological condition,rather than

Ebstein's anomaly is a kind of congenital heart disease with part or all leaflets of tricuspid valve not normally attaching to the tricuspid annulus in the normal position,but spirally shifting downward and abnormally attaching to the right ventricular wall.Ebstein's anomaly patients often suffer from arrhythmias,featured by paroxysmal supraventricular tachycardia, atrial fibrillation and atrial flutter,etc.The occurrence of

Myocardial bridge (MB) is regarded as a common anatomic variant rather than a congenital condition anomaly,defined as the intramyocardial course of a portion of the coronary artery.It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s.The current gold standard for diagnosing

A52-year-old man presented with a history of angina pectoris over 3 months. He had a history of hypertension and hyperlipidemia. His physical examination,blood chemistry,ECG,chest X-ray were normal.A treadmill exercise ECG test was performed using the Bruce protocol.Owing to 1 mm ST segment depressions at derivations DⅡ,DⅢ,aVF,V4-V6,and typical chest pain at third stage the test was evaluated as ischemia-positive test.Therefore,he was scheduled for

A46-year old non-smoking Chinese man was found accidently elevated D-dimer during his annual health checkup on June 10,2010.The value of his D-dimer was found substantially elevated (6110 ng/ml) (reference range ＜350 ng/ml) by automated latex-enhanced light-scattering immunoassays.Prothrombin time,activated partial thromboplastin time and fibrinogen were within the reference range.The patient had no history of

Primitive neuroectodermal tumors (PNETs) are a rare group of small round cell tumors belonging to the same family of tumors.According the primary location the neoplasms were divided into central and peripheral PNET (pPNET).Renal PNET was extremely rare.We report two cases of renal PNET conformed operationally and pathologically。

As surgical approaches accessing orbital apex carry significant risk and require strong expertise and skills,it is important for surgeons to share their know-how and to evaluate the surgical interventions they practiced on a number of patients.We retrospectively studied 9 cases of orbital apex lesions which were excised via posterior lateral orbitotomy。

To the Editor:We carefully read with interest an original article by Wang et al,1 entitled "Different effects of telmisartan and valsartan on human aortic vascular smooth muscle cell proliferation",published in a recent issue of the Chinese Medical Journal.In this study,the effects of angiotensin receptor blokers (ARBs) including telmisartan and valsartan on human aortic vascular smooth muscle cell proliferation (VSMC) in cell culture were investigated and compared.Telmisartan was shown to inhibit