Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction.

OBJECTIVES: Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND: MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS: The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair. RESULTS: Baseline midventricular pressure gradient and symptoms were comparable between the ASA and TEM groups. During follow-up, both groups demonstrated substantial reduction in pressure gradient (the ASA group: 79.7 ± 21.2 mm Hg to 43.7 ± 28.9 mm Hg, P < 0.001; the TEM group: 69.0 ± 23.9 mm Hg to 15.0 ± 16.9 mm Hg, P < 0.001). The reduction in pressure gradient was greater (78.9 ± 18.6% vs. 46.4 ± 33.4%, P < 0.001) and the residual pressure gradient was lower after TEM versus ASA (P < 0.001). Patients with New York Heart Association class III/IV dyspnea decreased from 59.1 to 18.2% (P = 0.022) in the ASA group and from 56.8 to 5.6% (P < 0.001) in the TEM group. Patients with Canadian Cardiovascular Society class III/IV angina decreased from 40.9 to 9.1% (P = 0.016) in the ASA group and from 32.4 to 0% (P < 0.001) in the TEM group. CONCLUSIONS: While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.

Pilot-scale bioelectrochemical system for efficient conversion of 4-chloronitrobenzene.

4-Chloronitrobenzene (4-CNB) is one of the highly toxic contaminants that may lead to acute, chronic or persistent physiological toxicity to ecology and environment. Conventional methods for removing 4-CNB from aquatic environment may be problematic due to inefficiency, high cost and low sustainability. This study develops a pilot-scale bioelectrochemical system (BES, effective volume of 18 L) and examines its performance of bioelectrochemical transformation of 4-CNB to 4-chloroaniline (4-CAN) under continuous operation. The results demonstrate that the initial 4-CNB concentration in the influent and hydraulic retention time (HRT) has a significant impact on 4-CNB reduction and 4-CAN formation. Compared with the conventional anaerobic process in the absence of external power supplied, the 4-CNB conversion efficiency can be enhanced with power supplied due to microbial-mediated electron transfer at the negative cathode potential. At a voltage of 0.4 V and HRT of 48 h, the 4-CNB reduction and 4-CAN formation efficiency reached 99% and 94.1%, respectively. Based on a small external voltage applied, the pilot-scale BES is effective in the conversion of 4-CNB to 4-CAN, an intermediate that is of less toxicity and higher bioavailability for subsequent treatment. This study provides a new strategy and methods for eliminating 4-CNB, making wastewater treatment more economical and more sustainable.

[Exercise echocardiography in the evaluation of obstructive types of hypertrophic cardiomyopathy].

OBJECTIVE: To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients. METHODS: A total of 60 patients with HCM and left ventricular outflow tract gradient (LVOTG) <50 mm Hg (1 mm Hg = 0.133 kPa) at rest were enrolled consecutively, and LVOTG at rest and exercise were measured by echocardiography. Of 51 patients with gradients <30 mm Hg at rest, 26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg, 25 were non LVOTO with exercise peak value LVOTG < 30 mm Hg, and 9 were resting obstruction with LVOTG 30-49 mm Hg. The morphological characteristics of different types of obstruction were analyzed. RESULTS: Patients with latent LVOTO were more likely to have SAM (73.1% vs 8.0%) , narrow of LVOT (46.2% vs 4.0%) , higher resting gradients [(16.9 ± 7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values <0.05). The distribution of septal hypertrophy were different in the two groups (P < 0.05). Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431, 95%CI 2.323-291.112, P = 0.002) at rest and distribution of septal hypertrophy(OR 0.011, 95% CI 0.001-0.179, P = 0.008). CONCLUSIONS: Approximately half of patients with non-obstructive HCM at rest have latent LVOTO. SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

[Association study between Chinese medicine blood stasis syndrome and TIMI risk stratification of patients with unstable angina pectoris].

OBJECTIVE: To study the correlation between thrombolysis in myocardial infarction (TIMI) risk stratification and blood stasis syndrome (BSS) score in patients with unstable angina pectoris (UAP), and to analyze the relation of BBS degree and UAP clinical outcomes. METHODS: Collected were general data, demographic data, risk factors, Chinese medical symptoms and syndromes, coronary artery angiography results, relevant physical and chemical examinations from 114 UAP inpatients. Gensini score, TIMI risk score, and BSS score of these patients were calculated. RESULTS: The BBS score and Gensini score were significantly positively correlated (r = 0.78, P < 0.01). The BBS score was significantly higher in those with lesion in three branches than those with lesion in one branch or in two branches (P < 0.05). The BBS score was significantly higher in the high risk group than in the lower risk group and the medium risk group (P < 0.01). The TIMI risk score was obviously higher in the severe blood stasis group than in the moderate blood stasis group and the mild blood stasis group (P < 0. 05, P < 0.01). The BBS score and TIMI risk score was positively correlated (r = 0.23, P < 0.05). CONCLUSION: The BBS score was positively correlated with more coronary arteries involved. The more severe BBS degree, the TIMI risk score more higher, and the BBS degree more syndrome.

[Clinical outcomes of rotational atherectomy followed by drug-eluting stenting via the transradial approach for the treatment of heavily calcified coronary lesions].

OBJECTIVE: To assess the clinical outcomes of rotational atherectomy followed by drug-eluting stenting via the transradial approach for the treatment of heavily calcified coronary lesions. METHODS: From January 2009 to October 2012, 114 consecutive patients with heavily calcified coronary lesions underwent rotational atherectomy and drug-eluting stents via transradial approach in our hospital were enrolled in this retrospective study. Characteristics of heavily calcified coronary lesions, the success rates of rotational atherectomy and stenting, rates of complication during perioperative treatments, and adverse cardiovascular events during hospitalization and follow up were analyzed. RESULTS: All 114 patients were successfully treated with rotational atherectomy and drug-eluting stent placement, and totally 120 target lesions of type B or C were treated including 8 left main lesions, 93 left anterior descending and 2 circumflex, 17 right coronary lesions. No-reflow was observed in 7 patients during the procedure, there was one case of entrapped rotablator burr which was successfully retrieved together with guiding catheter without serious complication. During the 6 months (median) follow-up, angina was reported in 11 patients and revascularization was performed in 8 patients due to stent restenosis and intensified medical therapy was applied in 3 patients. There was no acute myocardial infarction and death during follow-up. CONCLUSION: Rotational atherectomy followed by drug-eluting stenting via transradial approach is feasible, effective and safe and the short-term outcome is satisfactory for patients with heavily calcified coronary lesions.

Temperature-regulated and starvation-induced refractory para-toluic acid anaerobic biotransformation.

Little research was focused on the anerobic degradation of refractory para-toluic acid at present. Thus, temperature-regulated anaerobic system of para-toluic acid fed as sole substrate was built and investigated via microbiota, metabolism intermediates, and function prediction in this study. Results showed that low methane yield was produced in para-toluic acid anaerobic system at alkaline condition. And the causes were owing to anaerobic methane oxidation and potentially H2S production at 37 °C, N2 production by denitrification before starvation and propionic acid occurrence after starvation at 27 °C, and production of N2 and free ammonia, and accumulation of acetic acid at 52 °C. Simultaneously, hydrogenotrophic methanogenesis dependent on syntrophic acetate oxidation (SAO) was predominant, facilitating the removal of para-toluic acid at 52 °C. Moreover, the key intermediate changed from phthalic acid of 37 °C and 27 °C before starvation to terephthalic acid of 52 °C. Starvation promoted removal of para-toluic acid through benzoyl-CoA pathway by Syntrophorhabdus, enrichment of syntrophic propionate degraders of Bacteroidetes and Ignavibacteriaceae, and increase of methylotrophic methanogens.

Deciphering the fate of osmotic stress priming on enhanced microorganism acclimation for purified terephthalic acid wastewater treatment with high salinity and organic load.

Osmotic stress priming (OSP) was an effective management strategy for improving microbial acclimation to salt stress. In this study, the interaction between pollutants and microbiota, and microbial osmoregulation were investigated triggered by OSP (alternately increasing salinity and organic loading). Results showed that OSP significantly improved COD removal from 31.53 % to 67.99 % and mitigated the terephthalate inhibition produced by toluate, decreasing from 1908.08 mg/L to 837.16 mg/L compared with direct priming. Due to an increase in salinity, Pelotomaculum and Mesotoga were enriched to facilitate terephthalate degradation and syntrophic acetate oxidation (SAO). And organic load promoted acetate formation through syntrophic metabolism of Syntrophorhabdus/Pelotomaculum and SAO-dependent hydrogenotrophic methanogenesis. K+ absorbing, proline and trehalose synthesis participated in osmoregulation at 0.5 % salinity, while only ectoine alleviated intracellular osmolarity under 1.0 % salinity with OLR of 0.44 kg COD /m3. This study provided in-depth insight for microbial acclimation process of anaerobic priming of saline wastewater.

PKA-mediated eNOS phosphorylation in the protection of ischemic preconditioning against no-reflow.

OBJECTIVE: To investigate whether ischemic preconditioning (IP) can reduce myocardial no-reflow by activating endothelial (e-) nitric oxide synthase (NOS) via the protein kinase A (PKA) pathway. METHODS AND RESULTS: In a 90-min ischemia and 3-h reperfusion model, minipigs were assigned into sham, ischemia-reperfusion (IR), IR+IP, IR+IP+L-NNA (an eNOS inhibitor, 10mg·kg(-1)), IR+IP+H-89 (a PKA inhibitor, 1.0µg·kg(-1)·min(-1)), IR+L-NNA, and IR+H-89 groups. IP pretreatment improved cardiac function and coronary blood flow, decreased the activities of creatine kinase by 36.6% after 90 min of ischemia and by 32.8% after 3 h of reperfusion (P<0.05), reduced the no-reflow areas from 49.9% to 11.0% (P<0.01), and attenuated the infarct size from 78.2% to 35.4% (P<0.01). IP stimulated myocardial PKA activities and the expression of PKA and Ser(133) phosphorylated (p-) cAMP response element-binding protein (CREB) in the reflow and no-reflow myocardium, and enhanced the activities of constitutive NOS and the phosphorylation of eNOS at Ser(1179) and Ser(635) in the no-reflow myocardium. IP suppressed the expression of tumor necrosis factor-α and P-selectin, and attenuated cardiomyocytes apoptosis by regulating the expression of Bcl-2 and caspase-3 in the reflow and no-reflow myocardium. The eNOS inhibitor L-NNA completely canceled these beneficial effects of IP without any influence on PKA activity, whereas the PKA inhibitor H-89 partially blocked the IP cardioprotective effects and eNOS phosphorylation at the same time. CONCLUSION: IP attenuates myocardial no-reflow and infarction after ischemia and reperfusion by activating the phosphorylation of eNOS at Ser(1179) and Ser(635) in a partly PKA-dependent manner.

[Comparison of dobutamine stress echocardiography and exercise echocardiography in evaluating left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy].

OBJECTIVE: To compare left ventricular outflow tract (LVOT) gradient induced by dobutamine stress echocardiography (DSE) and exercise echocardiography (EE) in patients with hypertrophic cardiomyopathy (HCM). METHODS: DSE and EE were performed in 40 consecutive patients with HCM and LVOT gradient < 50 mm Hg (1 mm Hg = 0.133 kPa) at rest. Dobutamine was administered intravenously at incremental doses of 200, 400, 600, 800 and 1200 µg/min at 5 min intervals. LVOT gradients were measured at rest, at peak exercise and during each dose of DSE. RESULTS: LVOT gradient at rest was lower than 30 mm Hg in 36 patients and between 30 and 49 mm Hg in 4 patients. Of the 36 patients with LVOT gradient < 30 mm Hg at rest, mechanical LVOT obstruction (latent LVOTO) was evidenced in 17 patients during EE and in 18 patients during DSE and good consistency (91.7%, kappa value 0.833) was found between the two maneuvers. The provoked gradient was similar between DSE at 800 µg/min and EE at peak exercise (P = 0.181). In the 4 patients with LVOT gradient between 30 and 49 mm Hg [(38.8 ± 2.6) mm Hg], LVOT gradient increased to (85.3 ± 26.4) mm Hg during EE and (105.0 ± 28.0) mm Hg during DES. CONCLUSIONS: DES and EE are comparable and suitable provoke methods for identifying LVOT obstruction in patients with HCM.

[Impact of cytochrome P450 2C19 polymorphisms on outcome of cardiovascular events in clopidogrel-treated Chinese patients after percutaneous coronary intervention].

OBJECTIVE: To investigate the impact of cytochrome P450 (CYP) 2C19 681G > A polymorphism on long-term prognosis of clopidogrel-treated Chinese patients after percutaneous coronary intervention (PCI). METHODS: Between January 1, 2009 and August 31,2009, 267 patients with coronary heart disease who received PCI and treated with clopidogrel for 12 months were enrolled. CYP2C19 * 2 was detected by MALDI-TOF MS and patients were grouped into CYP2C19 * 1/ * 1 (n = 130) and CYP2C19 * 2 carriers group (n = 137). Follow-up was 12 months. The primary endpoint was angina recurrence, urgent coronary revascularization, acute myocardial infarction, stent thrombosis, death and the combined end points. RESULTS: Baseline data were similar between two groups (P > 0.05). Urgent coronary revascularization and the combined end points occurred more frequently in CYP2C19 * 2 carriers than in CYP2C19 * 1/* 1 patients (7.3% vs. 1.5% and 8.0% vs. 2.3% respectively, all P < 0.05). But incidence of angina recurrence, acute myocardial infarction, stent thrombosis and death was similar between two groups (all P > 0.05). Hazard risk of 1 year cumulative survival of CYP2C19 * 2 carriers group was significantly higher than CYP2C19 * 1/ * 1 group after PCI ( HR = 3.59, 95% CI: 1.02 - 12.87, P < 0.05). CONCLUSION: CYP2C19 681G > A polymorphism is a determinant of prognosis in coronary heart disease patients receiving chronic clopidogrel treatment after PCI.

[The in-hospital outcome and predictors of major adverse cardiac events after transradial intervention in patients with coronary artery disease].

OBJECTIVE: The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of clinical outcome. METHODS: From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events (composite of death, myocardial infarction, or target lesion revascularization) of TRI. RESULTS: The annulations time was significantly longer for TRI than TFI (P < 0.01), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96.2% for TFI) were similar between the two groups. However, the rates of vascular complications (0.1% for TRI group and 1.3% for TFI group, P < 0.01), incidence of in-hospital major adverse cardiac events (1.6% vs. 3.8%, P < 0.01) and in-hospital death (0.2% vs. 0.4%, P < 0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥ 65 (OR: 1.98, 95%CI: 1.50 - 2.61, P < 0.01), prior myocardial infarction (OR: 2.14, 95%CI: 1.63 - 2.82, P < 0.01), use of drug-eluting stent (DES) (OR: 0.68, 95%CI: 0.47 - 0.98, P = 0.04), dissection during procedure (OR: 4.08, 95%CI: 2.28 - 7.33, P < 0.01), left main lesion (OR: 2.12, 95%CI: 1.09 - 4.13, P = 0.03), number of implanted stents (OR: 1.25, 95%CI: 1.09 - 1.43, P < 0.01), and total stented length (OR: 1.01, 95%CI: 1.00 - 1.02, P = 0.03). CONCLUSIONS: In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.

Effect of intracoronary infusion of bone marrow mononuclear cells or peripheral endothelial progenitor cells on myocardial ischemia-reperfusion injury in mini-swine.

OBJECTIVE: To simulate and assess the clinical effect of intracoronary infusion of bone marrow mononuclear cells or peripheral endothelial progenitor cells on myocardial reperfusion injury in mini-swine model. METHODS: Twenty-three mini-swine with myocardial reperfusion injury were used as designed in the study protocol. About (3.54 +/- 0.90) x 10(8) bone marrow mononuclear cells (MNC group, n = 9) or (1.16 +/- 1.07) x 10(7) endothelial progenitor cells (EPC group, n = 7) was infused into the affected coronary segment of the swine. The other mini-swine were infused with phosphate buffered saline as control (n = 7). Echocardiography and hemodynamic studies were performed before and 4 weeks after cell infusion. Myocardium infarction size was calculated. Stem cell differentiation was analyzed under a transmission electromicroscope. RESULTS: Left ventricular ejection fraction dropped by 0% in EPC group, 2% in MNC group, and 10% in the control group 4 weeks after cell infusion, respectively (P < 0.05). The systolic parameters increased in MNC and EPC groups but decreased in the control group. However, the diastolic parameters demonstrated no significant change in the three groups (P > 0.05). EPC decreased total infarction size more than MNC did (1.60 +/- 0.26 cm2 vs. 3.71 +/- 1.38 cm2, P < 0.05). Undermature endothelial cells and myocytes were found under transmission electromicroscope. CONCLUSIONS: Transplantation of either MNC or EPC may be beneficial to cardiac systolic function, but might not has obvious effect on diastolic function. Intracoronary infusion of EPC might be better than MNC in controlling infarction size. Both MNC and EPC may stimulate angiogenesis, inhibit fibrogenesis, and differentiate into myocardial cells.

[Comparison of outcomes after transradial intervention in patients of different age groups].

OBJECTIVE: To compare the in-hospital clinical outcome of patients with coronary artery disease in different age groups [< 65 years (younger), 60 to 79 years (older), and ≥ 80 years (octogenarians)] underwent transradial intervention (TRI) so asto analyze the predictors of adverse events. METHOD: From May 2004 to May 2009, a total of 16 293 patients underwent transradial intervention at our institution. The in-hospital outcome for patients in different age groups after TRI was investigated. Multivariable logistic regression analysis was performed to determinate the predictors of in-hospital major adverse cardiac events (MACE) (composed of death, myocardial infarction or target vessel revascularization). RESULTS: Angiographic success rates were not different (97.5%, 97.4%, 98.1%, P > 0.05) between 3 groups. However, the rates of procedural complications became progressively higher with age group (0.8%, 1.2%, 4.0%, P < 0.01). In-hospital MACE (1.3% vs 2.2% vs 7.5%, P < 0.01) and mortality (0.1% vs 0.3% vs 2.9%, P < 0.01) increased incrementally with age group. Aad it was associated with a significant decrement of DES (92.0%, 89.6%, 57.3%, P < 0.01). The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events: age ≥ 80 (OR 6.26, 95%CI: 3.33 to 11.74; P < 0.01), prior myocardial infarction (OR 2.19, 95%CI: 1.66 to 2.88; P < 0.01), left main lesion (OR 2.02, 95%CI: 1.04 to 3.91; P = 0.04), age of 65 to 79 (OR 1.83, 95%CI: 1.37 to 2.43; P < 0.01), number of implanted stents (OR 1.31, 95%CI: 1.15 to 1.50; P < 0.01), total stented length (OR 1.01, 95%CI: 1.01 to 1.02; P = 0.03), and use of DES (OR 0.59, 95%CI: 0.39 to 0.89; P = 0.01). CONCLUSIONS: The younger and older patients undergoing TRI have a more favorable in-hospital outcome. However the octogenarians has a substantially higher risk of in-hospital MACE.

[Clinical characteristics and outcome comparison between young (< or = 45 years) female and male patients with coronary artery disease undergoing percutaneous coronary intervention].

OBJECTIVE: To compare the clinical characteristics and clinical outcomes in young (< / = 45 years) female and male coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). METHODS: Angiographic and clinical data from 124 premenopausal female patients who underwent elective PCI from April 2004 to February 2008 were compared to age-matched 430 male patients who underwent elective PCI between 2006 and 2007 in our department. All patients were treated according to guidelines and coronary angiography was repeated after 6 months. One year clinical follow-up were performed in all patients. RESULTS: Incidences of dyslipidemia, the history of myocardial infarction and smoking were significantly lower in female patients than in male patients (all P < 0.01). Left main, left anterior descending and bifurcation lesions were more common while type C lesion and right coronary lesion were less common in young female CAD group compared to young male CAD group (P < 0.01-0.05). The average lesion length in female patients was significantly longer than that in male patients [(20.36 +/- 13.37) mm vs. (23.04 +/- 13.86) mm, P < 0.05]. The in-hospital and follow-up incidences of major adverse cardiac events, stent thrombosis and in-stent restenosis were similar between young female and male CAD patients. CONCLUSIONS: CAD risk factors were less and vessel lesions were more likely to be found at left main, left anterior descending and bifurcation in young female CAD patients compared to young male CAD patients. The clinical outcomes were similar between young female and male CAD patients.

Fate and removal of antibiotic resistance genes in heavy metals and dye co-contaminated wastewater treatment system amended with ß-cyclodextrin functionalized biochar.

Biochar has been received increasing concerns regarding its environmental effect, which is promising in wastewater treatment. In this study, the performance of ß-cyclodextrin functionalized biochar (ß-BC) on the removal of antibiotic resistance genes (ARGs) in wastewater treatment under the co-stresses of heavy metals and dye is evaluated. Results show that when 20 mg/L heavy metals (HMs) and 150 mg/L methyl orange (MO) are present in daily fed influent, only 0.05 mg/L HMs residual and 96.79%-98.84% MO removal efficiency achieved in ß-BC additive group, compare to 0.16 mg/L and 87.92%-94.11% of that in control, respectively, indicating that ß-BC can benefits the performance of contaminants removal. To evaluate the role of ß-BC plays on ARGs in multi-contaminants stressed system, tet W, tet M, sul-1, sul-2, blaTEM, oxa-1, qnr-S, erm-B and intI-1 are identified. The relative abundance of all identified ARGs are decreased when ß-BC presence compared to the corresponding groups without ß-BC additive. The diversity and composition of microbial community are explored and the reduction of potential antibiotic-resistant bacteria is speculated as a driver of ARGs removal. In conclusion, our study demonstrates that ß-BC possesses the ability to promote the removal of ARGs during continuous wastewater treatment under HMs-MO co-contaminant.

[Analysis of acute myocardial infarction one month after stent implantation].

OBJECTIVE: To study the possible causes of ST-elevated acute myocardial infarction (STEAMI) occurring one month after percutaneous coronary intervention (PCI). METHODS: One hundred and ninety two patients aged from 40 - 79 years who had a successful previous PCI and also received primary PCI due to STEAMI in this hospitalization were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and the acute results of last PCI, etc. were recorded in detail. If the AMI-related lesion was localized in-stents or at the edge of stents (distance from the edge < or = 5 mm), it was defined as late thrombosis, otherwise it was regarded as an AMI induced by new-lesion. RESULTS: New lesions, as the cause of STEAMI, were found in 144 cases (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). There was a significant difference in the average time from previous PCI to AMI (30.1 +/- 12.4 vs. 20.3 +/- 11.9 months) between the two groups. Diabetes mellitus (DM) and drug-eluting stents (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted logistic regression analysis [hazard ratio (HR) 3.387, 95% CI 1.053 - 10.898 and HR 5.311, 95%CI 1.066 - 26.464]. CONCLUSIONS: STEAMI occurred 1 month after PCI are more likely to be developed from previous insignificant lesions than from late thrombosis in stents. Moreover, DM and DES are associated with a high incidence of late thrombosis, which may indicate that intensive antiplatelet therapy should be considered in diabetic patients receiving PCI.

Short- and long-term outcomes of single bare metal stent versus drug eluting stent in nondiabetic patients with a simple de novo lesion in the middle and large vessel.

OBJECTIVE: This study was aimed to investigate the short- and long-term outcomes of percutaneous coronary intervention (PCI) between single bare metal stent (BMS) and single drug eluting stent (DES) in nondiabetic patients with a simple de novo lesion in the middle and large vessel. METHODS: Two hundred and thirty-five consecutive patients with a simple de novo lesion in the middle and large vessel were treated with BMS or DES in our hospital from Apr. 2004 to Dec. 2004. The inclusion criteria: a simple de novo lesion in the middle and large vessel, stent diameter > or = 3.0 mm, stent length < or = 18 mm, the exclusion criteria: diabetes mellitus, left main trunk disease and left ventricular ejection fraction < or = 30%. Of them, there were 150 patients in BMS group and 85 patients in DES group, and the rates of lost to follow up were 6.7% and 1.2% respectively. RESULTS: BMS group had lower hypercholesteremia rate (22.0% vs 38.8%) and higher proportion of TIMI grade 0 (12% vs 1.2%) than DES group (all P < 0.05), but both groups had similar stent length (16.16 +/- 2.81 mm vs 16.06 +/- 2.46 mm) and stent diameter (3.85 +/- 3.07 mm vs 3.19 +/- 0.24 mm) after procedure, in-segment restenosis rate (0% vs 1.2%) and target lesion revascularization (TLR, 2.0% vs 2.4%) at 6-month follow-up (all P > 0.05). No difference was found in TLR (1.3% vs 1.2%, P = 1.00) and recurrent myocardial infarction (Re-MI) (0% vs 1.2%, P = 0.36), cardiac death (0.7% vs 1.2%, P = 1.00) between 1- and 3-year. So were TLR (6.0% vs 5.9%, P = 0.97), Re-MI (0% vs 2.4%, P = 0.06), cardiac death (2.0% vs 3.5%, P = 0.48) and major adverse cardiac events (MACE, 8.7% vs 10.6%, P = 0.63), cardiac death-free cumulative survival (98.7% vs 97.7%, P = 0.56), TLR-free cumulative survival (94.0% vs 94.1%, P = 0.98) and Re-MI-free cumulative survival (100% vs 97.7%, P = 0.06) at 3-year follow-up. CONCLUSION: The single BMS has similar efficacy and safety to single DES in nondiabetic patients with a simple de novo lesion in the middle and large vessel at short- and long-term follow-up.

Drug-eluting stents for the treatment of ostial coronary lesions: comparison of sirolimus-eluting stent with paclitaxel-eluting stent.

BACKGROUND: Treatment of ostial coronary lesions represents a challenge for interventional cardiologists. The efficacy of drug-eluting stents (DES) has been demonstrated as improving the outcomes of patients in a few studies. It is not known, however, which DES, sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES), is superior for the treatment of ostial lesions. METHODS: In this retrospective study, 95 consecutive patients with de-novo ostial lesions underwent coronary SES (n=47, lesions=48) or PES implantation (n=45, lesions=47), and quantitative coronary analysis was performed at the time of stent implantation and subsequently at 8 months post stenting. Ostial lesion was defined as > or =50% diameter stenosis rising within 3 mm of either left anterior descending coronary artery or left circumflex artery or right coronary artery measured by quantitative coronary analysis. Major adverse cardiac events including death, thrombosis, nonfatal myocardial infarction, and target lesion revascularization were compared between the two groups. RESULTS: Baseline clinical and angiographic characteristics were well balanced between the two groups. At 8 months clinical and angiographic follow-up, overall major adverse cardiac events and target lesion revascularization rates were similar in both groups (6.4 vs. 11.2%, P=0.184; 4.3 vs. 8.9%, P=0.170, respectively). The in-stent and in-segment restenosis were, however, significantly higher in PES group compared with SES group (15.5 vs. 0%, P=0.001; 22.2 vs. 4.3%, P=0.003). Similarly, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (0.65+ or -0.67 vs. 0.16+ or -0.18 mm; 0.68+ or -0.65 vs. 0.15+ or -0.12 mm; P<0.001, respectively). CONCLUSION: In this small sample-size, nonrandomized, and nonprospective study, the data indicated that implantation of DES appears safe and effective for the treatment of patients with de-novo ostial coronary lesions, but SES implantation showed more favorable results in respect of restenosis compared with PES implantation.

Membrane coagulation bioreactor (MCBR) for drinking water treatment.

In this paper, a novel submerged ultrafiltration (UF) membrane coagulation bioreactor (MCBR) process was evaluated for drinking water treatment at a hydraulic retention time (HRT) as short as 0.5h. The MCBR performed well not only in the elimination of particulates and microorganisms, but also in almost complete nitrification and phosphate removal. As compared to membrane bioreactor (MBR), MCBR achieved much higher removal efficiencies of organic matter in terms of total organic carbon (TOC), permanganate index (COD(Mn)), dissolved organic carbon (DOC) and UV absorbance at 254nm (UV(254)), as well as corresponding trihalomethanes formation potential (THMFP) and haloacetic acids formation potential (HAAFP), due to polyaluminium chloride (PACl) coagulation in the bioreactor. However, the reduction of biodegradable dissolved organic carbon (BDOC) and assimilable organic carbon (AOC) by MCBR was only 8.2% and 10.1% higher than that by MBR, indicating that biodegradable organic matter (BOM) was mainly removed through biodegradation. On the other hand, the trans-membrane pressure (TMP) of MCBR developed much lower than that of MBR, which implies that coagulation in the bioreactor could mitigate membrane fouling. It was also identified that the removal of organic matter was accomplished through the combination of three unit effects: rejection by UF, biodegradation by microorganism and coagulation by PACl. During filtration operation, a fouling layer was formed on the membranes surface of both MCBR and MBR, which functioned as a second membrane for further separating organic matter.

Incidence of thrombosis after implantation of drug-eluting stents in patients with coronary artery disease.

BACKGROUND: Randomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents (DES) implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease (CAD) in China. METHODS: From December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up: 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird. After two years of follow-up, there were 2176 patients (1245 Cypher, 558 Taxus and 373 Firebird). All patients were treated with aspirin and clopidogrel over at least 9 months. RESULTS: Among 8190 patients, 17 patients had acute stent thrombosis (0.24%): 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis: 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%: 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%: 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%: 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up. CONCLUSION: The first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.