Table of Content

05 September 2018, Volume 33 Issue 9

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Revascularization strategy of acute myocardial infarction with cardiogenic shock

Jin Xin, Li Yongjun

2018, 33(9):  737-740.  doi:10.3969/j.issn.1004-583X.2018.09.001

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Despite the extensive implementation of early revascularization, acute myocardial infarction(AMI)  with cardiogenic shock remains the emphasis and difficulty of treatment programs.  In addition,  it is often combined with multiple vascular lesions (MVD). The optimal strategy of revascularization of  AMI  with cardiogenic shock is still uncertain. This review focuses on the definition and etiology of cardiogenic shock, the importance of early revascularization in patients with  AMI  combined with cardiogenic shock and the selection of revascularization strategies.

Optimal percutaneous coronary interventional strategy of  chronic total  occlusion

Chang Liang,Li Yongjun

2018, 33(9):  741-752.  doi:10.3969/j.issn.1004-583X.2018.09.002

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Chronic total occlusion (CTO) , which was regarded as a contraindication of PCI, is believed as a difficult point in percutaneous coronary intervention (PCI).  However,  thanks to the improvement of guide wire crossing technique, the use of new instruments and the deepening understanding of pathological anatomy, great progress has been made in CTO PCI over past 30 years . CTO has been a global hot spot in the field of PCI, with more and more countries touching upon it, including China. This paper reviews the strategies of CTO PCI.

Progress of treatment in ventricular tachycardia and ventricular fibrillation

Miao Chenglong, Li Yongjun

2018, 33(9):  753-756.  doi:10.3969/j.issn.1004-583X.2018.09.003

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Ventricular tachycardia and ventricular fibrillation are the most common causes of sudden cardiac death. This article summarizes the recent advances in drug therapy, device therapy, catheter ablation, and other treatments of structural, idiopathic and ion channel ventricular tachycardia and ventricular fibrillation. It aims to strengthen the ventricular tachycardia and ventricular fibrillation management in clinical practice.

Research progress of percutaneous left atrial appendage clouser

Yang Jing, Xie Ruiqin

2018, 33(9):  757-760.  doi:10.3969/j.issn.1004-583X.2018.09.004

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The atrial fibrillation （AF） with increasing annual incidence has become one of the most common arrhythmia in clinical practice, with cerebral embolism being its major complication. Although anticoagulant therapy is still the principal means of prevention of  cerebral apoplexy, both warfarin and other new anticoagulant drugs have some limitations  and are often contraindicated or underutilized. Given that the left atrial appendage (LAA) has proved as the main position of thrombogenesis in patients with AF, percutaneous LAA closure is becoming a new choice of replacing warfarin in AF patients to reduce the risk of stroke.

Advances in anticoagulant therapy after acute coronary syndrome

Rao Mingyue, Wang Yaling, Zhang Guoru, Wang Mei

2018, 33(9):  761-766.  doi:10.3969/j.issn.1004-583X.2018.09.005

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Vascular endothelial damage caused by erosion or rupture of coronary atherosclerotic plaque is the pathophysiological basis of thrombosis in coronary artery lesions. The onset of acute coronary syndrome(ACS)   is often accompanied by changes in electrocardiogram,  increased markers of myocardial injury and the appearance of symptoms of angina pectoris. Antiplatelet and anticoagulant therapy is the key to the treatment of ACS. The effective use of antiplatelet and anticoagulant drugs can reduce the occurrence of ischemic events such as myocardial infarction,  thrombosis in stent and a reduction in mortality. This article reviews current  evidences for anticoagulants in ACS.

Research progress on antiplatelet therapy in special populations of acute coronary syndrome

Li Liang Wang Mei

2018, 33(9):  767-770.  doi:10.3969/j.issn.1004-583X.2018.09.006

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Antiplatelet therapy is the cornerstone of the treatment for patients with acute coronary syndrome (ACS), and aspirin combined with a P2Y12 receptor inhibitor is currently the I recommendation in the guidelines. Antiplatelet therapy increases the risk of bleeding while reducing major cardiovascular adverse events in ACS patients. Therefore, for some special populations such as advanced age, diabetes, stroke/TIA,  and STEMI patients receiving thrombolysis, the antiplatelet therapy regimen and duration are presenting huge individual differences while evaluating the ischemia risk and bleeding risk. This article reviews the current research progress of antiplatelet therapy in these special populations.

Pathophysiological mechanism of exercise rehabilitation in  treatment of chronic heart failure

Pan Ya1, Chen Yali2

2018, 33(9):  771-774,778.  doi:10.3969/j.issn.1004-583X.2018.09.007

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Heart failure is the common ending of many cardiovascular diseases at their terminal stages, which imposes a huge burden on individuals and society. Exercise rehabilitation can delay disease progression, reduce cardiovascular risk factors, and improve patients' quality of life. This article mainly introduces the pathophysiological mechanism of exercise rehabilitation in the treatment of patients with chronic heart failure.

Research and clinical significance of long  noncoding RNA and heart failure

Pan Ya1, Chen Yali2

2018, 33(9):  775-778.  doi:10.3969/j.issn.1004-583X.2018.09.008

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With the advancement of precision medicine,  the study of the relationship between long noncoding RNA (lnc RNA) and disease has become a hot topic.The value of  lnc RNA in the field of cardiac development,  pathological progression of heart failure,  prognosis and its gene regulatory network has all been explored. This article reviews the latest research and clinical significance of lnc RNA and heart failure.

Brain activation in the whiter matter during active unilateral limb movement

Bao Ruixue1, Wei Pengxu2

2018, 33(9):  779-782,786.  doi:10.3969/j.issn.1004-583X.2018.09.009

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Objective  To investigate effects of brain activation in the whiter matter during active unilateral limb movement. Methods  A functional magnetic resonance imaging study was performed  in 21 male subjects in three conditions: active ankle movement on the right side; movement plus concurrent stimulation over the tibialis anterior;  and movement plus concurrent stimulation over a control area. SPM8 was used to analyze data. The threshold was set at a familywise error rate correction P<0.01. Results  All conditions evoked bilateral activation in the corona radiate. The activation was mainly distributed on the left side. Conclusion  Unilateral limb movement can evoke brain activation in the corona radiate on the contralateral side. Such activation may indicate the functional state of neural pathways.

Effects of surface gastrointestinal pacing therapy on intestinal barrier function in severe acute pancreatitis

Chen Tengqian, Jiang Yigui, Zhang Shengjun, Jiang Lihua, Hu Yongmin, You Licai

2018, 33(9):  783-786.  doi:10.3969/j.issn.1004-583X.2018.09.010

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Objective  To observe the effect of surface gastrointestinal pacing therapy on intestinal barrier function in patients with severe acute pancreatitis (SAP). Methods  A total of 47 patients with SAP were divided into the control group (22 cases) and the experimental group (25 cases). Apart from the treatment received by the control group, which included conventional treatment such as  fasting,  gastrointestinal decompression,  antiinfection,  antiinflammatory (ulinastatin),  inhibition of gastric acid secretion (Omeprazole),  somatostatin (somatostatin injection), patients in the experimental group also need to receive the treatment of surface gastrointestinal pacing therapy. The number of bowel sounds and plasma endotoxin, Dlactic acid, and serum diamine oxidase (DAO) levels were monitored respectively before the treatment and 24, 48, and 96 h after the treatment. The number of cases whose abdominal pain and abdominal distension had disappeared  24, 48, and 96 h after the treatment was measured.Results  The levels of endotoxin,  Dlactic acid, and DAO in two groups 24, 48, and 96 h after the treatment were significantly lower than those before the  treatment (P<0.05), and the number of bowel sounds increased 48 and 96 h after the treatment(all P<0.05). There were no statistical significance between the two groups in terms of the comparison of frequency of bowel sounds and endotoxin,  Dlactate and DAO 24 and 48 h after the treatment (all P>0.05). Compared with the control group, the number of patients in the experimental group with abdominal pain,  abdominal distension and decreasing borborygmus increased significantly, and their levels of endotoxin, Dlactic acid, and DAO significantly decreasedg 96 h after the treatment(all P<0.05).Conclusion  The use of surface gastrointestinal pacing therapy in SAP patients can restore gastrointestinal motility as soon as possible,  thereby improving gastrointestinal barrier function,  reducing endotoxin translocation,  preventing intestinal failure,  and promoting early recovery of the disease. It is a simple and worthwhile promotion of supplementary treatment measures.

Efficacy and safety of tirofiban in mechanical thrombectomy for acute ischemic stroke

Li Changqing1,2， Chai Erqing2， Jiang Lei1

2018, 33(9):  787-791,795.  doi:10.3969/j.issn.1004-583X.2018.09.011

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Objective  To investigate the clinical efficacy and safety of tirofiban in stent thrombectomy for acute ischemic stroke. Methods  A total of  66 patients with acute ischemic stroke who received endovascular sent mechanical thrombectomy in the Gansu Provincial Hospital Department of Cerebrovascular Disease Center were includedfrom December 2015 to August 2017 .They were divided into thrombectomy plus tirofiban group(n=32) and stent thrombectomy alone (n=34) . Postoperative blood perfusion of the two groups was evaluated by Thrombolysis Incerebral Infarction（TICI）  blood flow fractionation. All patients underwent NIHSS score at 4 hours，24 hours and 14 days after operation. The Heidelberg Bleeding Classification was used to identify symptomatic intracrainal hemorrahage （SICH）  after operation. The modified Rankin scale was used to evaluated the patients fuctional outcome after 3 months. Results  The refusion TICI blood flow fractionation was increased after tirofiban treatment and the rate of TICI 3 stage blood flow of tirofiban group was significantly higher than that of the single embolectomy group(P＜0.05),  and the NIHSS score at 14 days after operation of tirofiban group was significantly improved(P＜0.05), The mRS score was significantly improved in the tirofiban group compared with that in the simple stent thrombectomy group after 90 days (P＜0.05),No significant difference was found in reinfarction rate and symptomatic bleeding after operatione in two groups（P＞0.05）.Conclusion  Tirofiban treatment during stent embolization in patients with AIS can improve vascular reperfusion and prognosis without increasing the risk of bleeding.

Clinical features of patients with diabetic cranial neuropathy and effect on prognosis

Zhu Juhua, Huang Jie, Jiang Weiqing, Dong Jun

2018, 33(9):  792-795.  doi:10.3969/j.issn.1004-583X.2018.09.012

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Objective  To observe the clinical features of patients with diabetic cranial neuropathy (DCN),  and analyze the risk factors for DCN and the influence factors for prognosis. Methods  The clinical features of  36 patients with DCN (DCN group) and 40 diabetic patients (DM group)  were analyzed and compared. Multifactor logistic regression was used to analyze the risk factors of diabetic patients with DCN and the risk factors affecting the prognosis of DCN. Results  ①The DM course,  FPG,  2 hPG,  HbA1c and the ratio of smoking and DR were significantly higher in DCN group than those in DM group (P＜0.01). ②The levels of Vs,  Vm,  PI and RI were significantly higher in DCN group than those in DM group (P＜0.01). ③Logistic regression analysis showed that FPG,  2 hPG,  HbA1c and with DR were risk factors for diabetic patients with DCN; DM course,  HbA1c and with hypertension were influence factors for prognosis of  DCN patients. Conclusion  Positive control of blood sugar is the key to prevent the diabetic patients with DCN; the prognosis of DCN patients may be related to  long DM course,  higher HbA1c and hypertension.

Analysis of antibiotic use and bacterial drug resistance in the elderly patients

Ni Linga, Zhou Yinga, Chen Weib, Yu Jianhuaa, Gui Xueqionga, Wang Xiwena, Lu Zhonghuaa

2018, 33(9):  796-799.  doi:10.3969/j.issn.1004-583X.2018.09.013

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Objective  To investigate the use of antibiotics,  the distribution of common infection sites and pathogens and their drug resistance in elderly inpatients in geriatric wards,  and to provide reference for clinical antiinfective therapy in elderly patients. Methods  A retrospective analysis was conducted on the of discharged geriatric patients from January 2015 to December 2017, including 306 cases using antibiotics. The susceptibility test of the isolated strain was carried out by disk expansion method (KB),  and the results were judged according to the clsi100 standard.The results were judged according to CLSI100 standard. Results  The monthly antibiotic use rate was 37.74%  in January and 26.56% in December, which was significantly higher than those in other months (P<0.05).The total number of isolated strains was 254. Gramnegative(G-) bacteria accounted for 53.54%,  Grampositive(G+)  bacteria 34.65%, and fungi 11.81%. Pseudomonas aeruginosa, Escherichia coli are highly sensitive to piperacillin,  etapenem and imipenem.No resistance to linazolamine, vancomycin and rifampicin were found in these G+ strains.Conclusion  January and December are highincidence season for infection in the elderly, and community and hospital should make full preparation to prevent it. G- bacteria infection is  still the most common one  in the elderly. Clinically speaking, it is necessary to culture bacteria as early as possible and select sensitive antibiotics.

Meta analysis of short term efficacy and side effects of eltrombopag in the treatment of adult  idiopathic thrombocytopenic purpura

Yan Chaoqi1， Leng Qing1， You Guoping2， Zhang Lijun3

2018, 33(9):  800-804.  doi:10.3969/j.issn.1004-583X.2018.09.014

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Objective  To evaluate the shortterm efficacy,  bleeding improvement and safety of Ai Cooperpa in the treatment of adult idiopathic thrombocytopenic purpura(ITP). Methods  Randomized controlled study or single arm study of eltrombopag for the treatment of adult ITP were collected from Pubmed,  Wanfang database,  Vipu database,  CNKI,  Chinese biomedical literature database. The quality of the methodology used by the study was evaluated, the data was extracted, and  R software meta package was used to analyze the results.  Pubmed,  Wanfang Database,  Wipe Database,  CNKI,  and Chinese Biomedical Literature Database before April 2018 were retrieved for randomized controlled or singlearm studies of atropine in the treatment of adult ITP. After evaluating the methodological quality of the included studies and extracting the data,  R software meta package was used to merge and analyze the results. Results  Altogether, 5 randomized controlled trials and 2 single arm clinical trials were included,  including 633 adult ITP patients. The total effective rate of eltrombopag treatment was 68% and the rate of bleeding improved was 65%. Compared with the placebo group,  the total effective rate and the rate of bleeding improvement were significantly different,  and the adverse reaction was not statistically significant. Conclusion  Eltrombopag has definite curative effect and low adverse reaction on the treatment of adult ITP. It is a new choice for adult ITP treatment.