[The cardiac function changes before and after pituitary tumor resection in patients with pituitary adenoma complicated with dilated cardiomyopathy].

OBJECTIVE: To evaluate the cardiac function changing before and after resection of pituitary tumor in patients with pituitary adenoma complicated with dilated cardiomyopathy with retrospective analysis method. METHODS: The clinical data of 14 cases of patients with pituitary adenoma complicated with dilated cardiomyopathy, treated with resection of pituitary tumor, in PLA General Hospital, from 2005 to 2011, were collected and analyzed. Comparative analysis of cardiac function were made in these patients before and after the surgery, also with the postoperative recovery status, using echocardiography and other noninvasive detection means to detect the growth hormone (GH), left ventricular end-diastolic diameter (LVEDD), septal thickness (ST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF) values. RESULTS: After the resection of pituitary tumor, the LVEDD, ST, LVPWT, LVEF levels were all significantly better than that before the surgery. Before the surgery the GH, ST, LVPWT, LVEF levels were 93.89 µg/L, 11.13 mm, 43.92% and 10.53 mm, while those after the surgery were 5.16 µg/L, 10.64 mm, 49.28% and 8.87 mm. The difference of the GH level before and after the surgery was correlated with the difference of ST, LVEDD and LVEF in a linear manner. CONCLUSIONS: Resection of pituitary tumor can significantly improve the cardiac function in patients with pituitary adenoma complicated with dilated cardiomyopathy, and the cardiac function improving level is correlated with the difference of GH levels before and after the surgery.

[Prevention of restenosis in the canine coronary stents through local delivery of paclitaxel using the double-balloon perfusion catheter].

OBJECTIVE: To evaluate the safety and efficiency of local paclitaxel delivery using the double-balloon perfusion catheter to prevent restenosis in the canine coronary artery. METHODS: Twenty domestic canines underwent bare-mental stent implantation after balloon injure of the left coronary artery. A novel double-balloon perfusion catheter was used to deliver the drug locally in the canine coronary artery. In the treatment group (n = 15), paclitaxel (10 ml, 20 micromol/L) was delivered using the double-balloon perfusion catheter before stent implantation. In the control group (n = 5), 10 ml saline was delivered using the double-balloon perfusion catheter before stent implantation. The perfusion time in both groups was (26.45 +/- 5.18) s. Animals underwent coronary angiography and optical coherence tomography (OCT) 90 days after stent implantation and were sacrificed. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques. RESULTS: Coronary angiography results showed restenosis rate in control group was significantly higher than that in treatment group (60% vs. 33.33%, P < 0.05). The parameters of OCT showed in treatment group and control group: the neointimal thickness was (0.19 +/- 0.08) mm and (0.38 +/- 0.03) mm, the neointimal area was (1.52 +/- 0.49) mm2 and (2.51 +/- 0.47) mm2, the lumen area was (3.50 +/- 0.66) mm2 and (2.78 +/- 0.57) mm2, the extent of stenosis was (30.13 +/- 8.56)% and (47.40 +/- 4.50)%, and all the variances above were significantly different between the two groups (P < 0.05). The histologic parameters showed in treatment group and control group: the neointimal thickness was (0.22 +/- 0.10) mm and (0.47 +/- 0.05) mm, the neointimal area was (1.85 +/- 0.78) mm2 and (3.43 +/- 0.25) mm2, the lumen area was (3.15 +/- 0.43) mm2 and (1.85 +/- 0.55) mm2, the extent of stenosis was (36.00 +/- 10.97)% and (65.40 +/- 8.23)%, and all the variances above were also significantly different between the two groups (P < 0.05). The stents of both the groups were fully endothelialized. No thrombus or aneurysm was found in stents. CONCLUSION: Local delivery of paclitaxel with the double-balloon perfusion catheter to prevent restenosis in coronary stents is safe and efficient.

[Ex vivo assessment of coronary lesions by optical coherence tomography and intravascular ultrasound in comparison with histology results].

OBJECTIVE: To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results. METHODS: OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results. RESULTS: Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01). CONCLUSIONS: Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.

[Immune state of Th1, Th2 and Th17 subpopulation in experimental autoimmune myocarditis].

OBJECTIVE: To shed light on changes in the gene expression of T helper lymphocyte (Th) subpopulation, Th1, Th2 and Th17 in autoimmune myocarditis and to gain insight into the immunological mechanisms underlying the essence of myocarditis. METHODS: An experimental Lewis rat autoimmune myocarditis model was induced by immunization with cardiac C protein and completed Freund adjuvant in double foot pads and subsequent intraperitoneal injection of pertussis toxin. Two groups of normal rats without immunological injection acted as control group. Transthoracic echocardiography was performed and subsequently hearts and spleens were obtained from EAM rats at 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks after immunization. The pathological sections of heart samples were prepared, the inflammatory score was determined by hematoxylin and eosin stain, the fibrosis score was determined by picrosirius red stain. The ratio of Th1, Th2 and Th17 subpopulation in spleen cells were measured by flow cytometry, and enzyme linked immunoabsorption assay (ELISA) was used to determine the serum level of Th1 related cytokine interferon-gamma (IFN-gamma), Th2 related cytokine interleukin (IL)-4 and Th17 related cytokine IL-17. RESULTS: In EAM rats, cardiac ejection fraction remained normal until 4th week, and left ventricular end systolic diameter and left ventricular end diastolic diameter decreased. However, cardiac ejection fraction decreased obviously and left ventricular end systolic diameter and left ventricular end diastolic diameter rose until 8th week. Inflammatory score increased rapidly at 2nd week after immunization and remained peek level until 4th week and then gradually decreased at 6th and 8th week. Fibrosis score and fibrosis content increased from 4th week and maintained the peek level until 8th week. Ratio of Th1 in spleen cells of EAM rats and its related cytokine in serum, IFN-gamma, increased at 1st week, arrived at the peek level until 4th week and gradually decreased at 6th week. Ratio of Th17 and IL-17 rose from 2nd-4th week and remained until 6th to 8th week. Ratio of Th2 showed no change in the previous four weeks, ratio of IL-4 increased from 4th week, and both rose at 6th week rapidly and remained until 8th week. CONCLUSIONS: In EAM Lewis rats, The time duration from 2nd to 4th week was inflammatory stage of myocarditis while during the period of 4th week to 8th week myocarditis develops into fibrotic stage. Imbalance of Th1/Th2 takes part in the occurrence of ventricular remodeling, cellular immunity mediated by Th1 and Th17 being preponderant at inflammatory myocarditis stage while humoral immunity mediated by Th2 and Th17 being preponderant at fibrotic carditis stage.

[Effects of matrix metalloproteinase-9 inhibitor in Lewis rats with experimental autoimmune myocarditis].

OBJECTIVE: To investigate the effects of matrix metalloproteinase-9 (MMP-9) inhibitor minocyclin hydrochloride in Lewis rats with experimental autoimmune myocarditis (EAM). METHODS: EAM was induced by injection of cardiac C protein emulsified in completed Freund adjuvant in double footpad and intraperitoneal injection of pertussis toxin on 6- to 8-week old Lewis rats. Sixty EAM Lewis rats were divided into 3 groups (early, middle and late intervention groups, n = 20 each: 10 minocyclin treated and 10 control rats). In early intervention group, rats in treatment group received intraperitoneal injection of minocyclin hydrochloride from 1(st) to 21(st) day after immunization; in middle intervention group, rats were treated from 8(th) to 28(th) day after immunization and in late intervention group, rats were treated from 15(th) to 35(th) day after immunization (50 mg/kg body weight, once daily). Control rats received intraperitoneal injection of same volumetric physiological saline at corresponding time periods. At the end of intervention, rats were euthanatized and hearts were harvested. Paraffin sections were used for hematoxylin and eosin stain to determine the inflammatory score, for picrosirius stain to determine fibrosis score and collagen content, and for immunohistological stain to determine macrophages and T lymphocytes. Real time PCR was used to detect mRNA expression of myocardial MMP-2 and MMP-9. Cryostat sections were used for in situ zymography to detect protein activity of gelatinase. RESULTS: Inflammatory score in cardiac paraffin slides, number of cardiac macrophages and T lymphocytes, cardiac interstitial fibrosis score and content, expression of MMP-2, 9 mRNA and activity of gelatinase in treatment group were all significantly lower than in control group for early and middle intervention groups (inflammatory score: early control group vs. treatment group: 3.03 ± 1.35 vs.1.51 ± 0.36, P < 0.05, middle control group vs. treatment group: 3.75 ± 0.29 vs. 2.11 ± 0.82, P < 0.01; cardiac interstitial fibrosis score, early control group vs. treatment group: 2.75 ± 0.29 vs.1.51 ± 0.35, P < 0.01, middle control group vs. treatment group: 2.50 ± 0.41 vs. 1.61 ± 0.42, P < 0.05; gelatinase, early control group vs. treatment group: 162 367 ± 5095 vs. 62 366 ± 2131, P < 0.01, middle control group vs. treatment group: 184 256 ± 5427 vs. 113 197 ± 4809, P < 0.01) while these parameters were similar between minocyclin-treated and control rats in late intervention group (all P > 0.05). CONCLUSIONS: MMP-9 plays an important role in the pathogenesis of autoimmune myocarditis. Inhibition of MMP-9 in early and middle stage could significantly attenuate inflammatory responses and myocardial fibrosis in this experimental EAM model.

[Influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction in the elderly patients: an analysis of 2,535 cases].

OBJECTIVE: To investigate the influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction (AMI) in 2 535 elderly patients of different age. METHODS: A total of 2,535 patients with AMI were divided into different age groups or outcome groups, and the outcome or the incidence of in-hospital complications were reviewed in different groups. RESULTS: (1)The rate of in-hospital death was higher in > or =80 years group (22.75%, 326/422) compared with that in 60-79 years group (12.26%, 1 854/2 113, chi (2)=42.15, P<0.01). (2)Compared with the survivors (1,854 cases, 27.1%, 17.4%, 7.5%, 4.5%, 4.5%, 40.3%, 9.1%), patients who died in hospital (259 cases) were more likely to have cardiogenic shock (44.0%), Killp II-III heart function (28.2%), respiratory failure (14.3%), stroke (11.2%), renal failure (11.2%), cardiac arrhythmia (49.8%), and anemia (14.7%) in 60-79 years group (all P<0.01). No difference in the rate of pulmonary infection (24.7% vs. 20.2%) and alimentary tract hemorrhage (5.8% vs. 3.9%) was found between two groups (both P>0.05). The incidence of cardiogenic shock (28.1%), Killp II-III heart function (32.3%), respiratory failure (17.7%), renal failure (16.7%), alimentary tract hemorrhage (10.4%), cardiac arrhythmia (49.0%) and anemia (21.9%) was higher in non-survival group (96 cases) than that in survival group (326 cases, 12.9%, 21.2%, 9.2%, 5.2%, 2.1%, 35.0%, 10.1%, P<0.05 or P<0.01) in patients> or =80 years. There was no difference in the incidence of stroke (11.4% vs. 5.8%) and pulmonary infection (32.3% vs. 23.3%) between two groups (both P>0.05). (3) The foremost four in-hospital complications in the non-survivors and survivors were cardiac arrhythmia, cardiogenic shock, Killp II-III heart function and pulmonary infection in 60-79 years group, but they were cardiac arrhythmia, pulmonary infection, Killp II-III heart function and cardiogenic shock in > or =80 years group. When compared the cases of in-hospital death between these two different age groups, the incidence of cardiogenic shock was significantly lower in the > or =80 years group (28.1% vs. 44.0%, P<0.01). However, the incidence of sudden death was higher in the > or =80 years group than that in 60-79 years group (22.92% vs. 7.34%, P<0.01). CONCLUSION: The number and degree of in-hospital complications in elderly patients with AMI are increased by age. Cardiac arrhythmia is the major complication in elderly patients. For the patients 60-79 years old, it is more important to prevent and treat cardiogenic shock in order to improve the outcome in the 60-70 years group. In very old people with AMI, it is important to prevent sudden death.

[Association between stent fracture and restenosis after drug-eluting stent implantation].

OBJECTIVE: This study was performed to evaluate the relationship between the stent fracture and restenosis after drug-eluting stent implantation. METHODS: The study enrolled 536 patients with angiographies during stenting procedure and follow-up, the patients were divided into DES group (n=397) and BMS group (n=139). The coronary angiography images were analyzed to detect restenosis and stent fracture. RESULTS: Restenosis rate was significantly lower in DES group (31/397, 7.8%) compared that in BMS group (30/139, 21.6%, P<0.05). Stent fracture (n=5) was found only in DES group and not in BMS group (P<0.05). Restenosis were found in all stent fracture segments. The stent fracture developed at the angulated tortuosity lesions. CONCLUSION: Stent fracture is one of the causes of restenosis after drug-eluting stents implantation and related to implantation of long DES stent at the location of angulated tortuosity lesions.

[Evaluation of the late stent malposition after drug-eluting stent implantation by optical coherence tomography].

OBJECTIVE: To evaluate the characteristic of late stent malposition after drug-eluting stent implantation by optical coherence tomography (OCT). METHODS: The study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year ago [average (14.8 +/- 5.2) months]. OCT images of the stent were analyzed at interval of 0.5 mm. The stent malposition was detected, the thickness of intima and gap between the stent strut and vessel wall were measured. RESULTS: Stent malposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n = 4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others [(0.06 +/- 0.05) mm vs. (0.05 +/- 0.03) mm, P > 0.05]. CONCLUSION: The causes of late stent malposition include the primary malposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the ostium of side branch. Thinner intima coverage was also observed on the stent struts with malposition.

[Chronic effects of spironolactone in conjunction with an angiotensin-converting enzyme inhibitor enalapril on circulating procollagen marker P III NP and vascular resistance in patients with essential hypertension].

OBJECTIVE: Disturbances of the synthesis and breakdown of the extracellular matrix of arterial walls have emerged as key features of the atherosclerotic process. We observed the changes of circulating procollagen marker for type III collagen turnover rate, the N-terminal propeptide P III NP and vascular resistance in hypertensive patients treated with various antihypertensive regimens. METHOD: A total of 130 light to moderate hypertensive patients were randomly assigned to receive enalapril (group B, n = 43), enalapril + spirolactone (20 mg/d, group A, n = 44) and anti-hypertensive drugs not directly affecting RAAS (calcium antagonist, beta-blocker, group C, n = 43) for 1 year. Target blood pressure is < 130/80 mm Hg. RESULTS: Target blood pressure was reached in all treated patients and was similar among various groups. Under the same blood pressure controlling precondition, serum P III NP were similar at baseline among various groups and remained unchanged in group B [(3.4 +/- 0.3) microg/L vs. (3.7 +/- 0.3) microg/L, P > 0.05] and significantly decreased in group A [(2.3 +/- 0.2) microg/L vs. (3.8 +/- 0.2) microg/L, P < 0.05] while significantly increased in group C [(3.9 +/- 2.0) microg/L vs. (3.2 +/- 1.5) microg/L, P < 0.05]. Vascular resistance was similar among groups before therapy and all significantly decreased after 1 year antihypertensive therapy and the decrease was more significant in group A [(1064.3 +/- 158.6) dyn.s(-1).cm(-5)] than that in group B [(1200.8 +/- 298.7) dyn.s(-1).cm(-5)] and group C [(1205.1 +/- 206.4) dyn.s(-1).cm(-5)]. CONCLUSION: Spironolactone in conjunction with enalapril is a more favorable antihypertensive regimen in decreasing P III NP and improving vascular resistance than enalapril alone or antihypertensive drug regimens not directly affecting RAAS.

[Changes in clinical characteristics and interventional modalities of renal artery stenosis in recent years].

OBJECTIVE: To observe the changes of clinical characteristics and interventional methods of patients with renal artery stenosis in recent 17 years. METHODS: Comparing the clinical characteristics and interventional treatment of patients diagnosed renal artery stenosis by the means of renal angiography in recent 17 years. RESULTS: The numbers of renal artery stenosis were increasing year by year. the average ages before the year of 2000 was younger than that after 2000 (P < 0.05) and the main cause of renal artery stenosis was aorto-arteritis at that time, however, it turned to atherosclerosis after the year of 2000. Same patients indicated renal angiography due to plash pulmonary edema, unstable angina on abnormal serum creatinine. The interventional methods to renal artery stenosis shifted from balloon angioplasty only before the year of 2000 to stent implantation post-balloon dilatation after the year of 2000. The distal protective device was more used during the procedure. CONCLUSIONS: The numbers of patients indicated renal angiography had been increasing in the two decades. The main causes of renal artery stenosis had been considered arthro-sclerosis instead of aorta-arteritis before. The methods of treatment to renal artery stenosis had been changed to renal stenting post-balloon angioplasty after the year of 2000.

[Experimental study of effect of carvedilol on myocardial collagen network remodeling after acute myocardial infarction in rats].

OBJECTIVE: To investigate the effects of carvedilol, irbesartan and their combination on myocardial collagen network remodeling after acute myocardial infarction (AMI) in rats. METHODS: Twenty-four hours after ligating left anterior descending coronary artery, 35 surviving AMI male Sprague-Dawley rats were randomly assigned to control (n=8), carvedilol (n=9, 10 mg.kg(-1).d(-1)), irbesartan (n=9, 45 mg.kg(-1).d(-1)), and carvedilol (10 mg.kg(-1).d(-1)) plus irbesartan (45 mg.kg(-1).d(-1), n=9) groups. Sham operating group was comprised of 8 rats without coronary artery ligation as controls. After 8 weeks of administration of the drug by gastric gavage, hemodynamics and left ventricular function were measured, then the rat hearts were fixed, sectioned, and stained with Sirius red, and pathologically analyzed using polarized light. The total collagen volume density fraction (CVF) and type I and III CVF in the infarcted and noninfarcted zone (IZ/NIZ) were measured by computer-assisted image analysis system. RESULTS: There were no significant differences in myocardial infarction size among the four AMI groups (40.02%-44.70%, P>0.05). Compared with the sham operation group, left ventricular (LV) end diastolic pressure (LVEDP), left and right ventricular relative weight (LVRW/RVRW), the total CVF and the CVF of type I and III in the IZ and NIZ were all significantly higher (P<0.05 or P<0.01), and in contrast, blood pressure, left ventricular systolic pressure (LVSP), the left ventricular pressure maximal rate of rise and fall (+/-dp/dt max) and their adjustment by LVSP (+/-dp/dt max/LVSP) were significantly decreased (P<0.05 or P<0.01). Compared with the control group, LVEDP, LVRW, RVRW, the total CVF and the CVF of type I and III in the NIZ were all significantly decreased (P<0.05 or P<0.01), while +/-dp/dt max and +/-dp/dt max/LVSP were all significantly increased (all P<0.01) in the carvedilol, irbesartan and their combination therapy groups. CONCLUSION: Carvedilol, irbesartan and their combination can all effectively decrease collagen deposition in the NIZ of left ventricle, prevent left ventricular remodeling after AMI in rats, improve hemodynamics and LV function.

[Clinical efficacy and safety of emergent percutaneous coronary intervention for vein-grafts in the patients with acute myocardial infarction: comparison between age groups].

OBJECTIVE: To evaluate the efficacy and the safety of emergent primary percutaneous coronary intervention (PCI) in the saphenous vein bypass graft (SVBG) of acute myocardial infarction (AMI), and compare the results between aged -patients with non-aged patients. METHODS: Three hundred and nine consecutive AMI patients with culprit SVBG vessels, were analysed, including aged patients 213 cases(>or=70 years old), non-aged patients 96 cases(<70 years old), underwent the emergent primary PCI after confirmed below TIMI III perfusion(TIMI 0-TIMI II) in coronary angiographies. The immediate results and in-hospital outcomes were compared between two groups. RESULTS: Procedural successful rate, re-occlusion rate, and emergency re-CABG had no significant differences between two groups. The rate of slow-flow/no-reflow and in-hospital mortality rate were significantly higher in elderly group (19.7% vs 10.4%, 9.4% vs 4.2%, both P<0.05), with no difference in the rate of the using of distal protection devices between two groups. The comparison of the rate of direct stenting in slow-flow/no-reflow subgroup with normal-flow subgroup, had not showed statistic difference (73.5% vs 67.3%, P>0.05). There was no statistic difference of heavy hemorrhage between two different age groups. CONCLUSION: The primary PCI for the elderly AMI patients with infarction-related SVBG vessels, has higher risks in slow-flow/no-reflow and the mortality, even with using the distal protection devises and direct stents implantation.

[The influence of coronary main vessel stenting on side branches].

OBJECTIVE: To evaluate the influence of stenting main vessel on side branches and to compare the different effects on side branches between BMS and DES (Taxus and Cypher). METHODS: We reviewed the angiograms and the medical records of 183 patients who had received stent implantation in coronary main vessels and had follow-up angiograms. Any side branch was jailed by stent was evaluated. RESULTS: Side branch occlusion occurred in 8.9% in all branches (10.5% in Cypher DES group, 11.1% in Taxus DES group and 7.8% in BMS group). Spontaneous recanalization of side branches was observed in 72% (90.9% in Cypher DES, 66.7% in Taxus stent group and 66.7% in BMS). The ostial side branch stenosis before stenting and the involvement of the side branch origin within the lesion of the parent vessel are the major independent predictors for side branch occlusion. CONCLUSIONS: The influence of different DES implantations in coronary main vessels on side branches were similar and there was no difference between DES and BMS. Side branch occlusion had relatively benign clinical course. Most occluded side branches had late spontaneous reperfusion.

Effects of sleep deprivation on serum cortisol level and mental health in servicemen.

This study aimed to investigate the effects of sleep deprivation on serum cortisol level and mental health and explore the correlations between them in servicemen. A total of 149 out of the 207 Chinese servicemen were randomly selected to go through 24hour sleep deprivation, leaving the rest (58) as the control group, before and after which their blood samples were drawn for cortisol measurement. Following the procedure, all the participants were administered the Military Personnel Mental Disorder Prediction Scale, taking the military norm as baseline. The results revealed that the post-deprivation serum cortisol level was positively correlated with the factor score of mania in the sleep deprivation group (rSp=0.415, p<0.001). Sleep deprivation could significantly increase serum cortisol level and may affect mental health in servicemen. The increase of serum cortisol level is significantly related to mania disorder during sleep deprivation.

[Effects of Ca2+ antagonist on cardiomyocytic apoptosis after experimental myocardial infarction].

OBJECTIVE: To explore the effects of Ca(2+) antagonist on apoptosis of cardiomyocytes after myocardial ischemia. METHODS: The model of myocardial infarction was made by ligating left coronary artery in SD rats. In experimental group, the rats were administrated with Adalat through oral cavity (1 mg/kg) before operation and through peritoneal cavity (0.4 mg/kg 3 hours after operation. In ischemic control group the rats were injected with placebo and in normal control group the rats were treated with sham operation (no ligating left coronary artery) and placebo. The rats were killed 6 hours after operation, with their left ventricular function had been measured. Apoptotic myocardial cells were detected by terminal deoxynucleotidyl transferase mediated dUTP nick end-labeling (TUNEL) method, Fas and Bcl-2 proteins by the ABC immunohistochemistry method. Apoptosis indexes were calculated under high magnification field of microscopy. RESULTS: The systolic pressure, end-diastolic pressure and dp/dt of left ventricle in experiment group were not significant different from those in the ischemic control group, they were 76.7+/-7.5/8.0+/-6.1 mm Hg vs. 74.9+/-11.1/11.6+/-8.3 mm Hg (P>0.05) and (777.3+/-128.6)mm Hg/s vs. (761.8+/-136.4)mm Hg/s (P>0.05) respectively; but those in both the experimental group and the ischemic control group were lower than those in the normal control group, they were 94.9+/-7.5/2.8+/-3.2 mm Hg (P<0.001) and (1131.5+/-112.8)mm Hg/s(P<0.001). There were a lot of positive myocytes with TUNEL stain in the ischemic region of left ventricle in both the experimental and the ischemic control group, apoptosis index in the experimental group was lower than that in the ischemic control group (0.201+/-0.053 vs. 0.261+/-0.045, P<0.05). The positive myocytes of Fas and Bcl-2 protein appeared in the region surrounding ischemic myocytes. There were no positive myocytes with the three types of stain in normal control group. CONCLUSION: Ischemia could induce apoptosis of myocytes and expression of Fas and Bcl-2 gene; Ca(2+) antagonist could protect myocytes from apoptosis.

Protective effect of metoprolol on arrhythmia and heart rate variability in healthy people with 24 hours of sleep deprivation.

PURPOSE: Sleep deprivation, which is a strong stressor, can greatly affect the cardiovascular system of rescue workers. This study aimed to investigate the effect of 24-h sleep deprivation on heart rate variability (HRV) in young healthy people and the protective effect of metoprolol on arrhythmia. METHODS: Sixty young, healthy subjects (6 women and 54 men), aged 25 ± 4.5 years, were enrolled in this study. All participants received 24-h continuous ambulatory electrocardiogram monitoring. Arrhythmia, time, and frequency domain parameters were analyzed in subjects at the following three stages: normal sleep stage, sleep deprivation stage, and metoprolol treatment before sleep deprivation stage. RESULTS: After 24-h sleep deprivation, the high frequency (HF) of HRV was significantly decreased (p < 0.05), low frequency (LF) was remarkably increased (p < 0.05), and LF/HF was significantly increased compared with those in normal sleep (p < 0.05). Some subjects presented with mild palpitation due to premature atrial complexes and premature ventricular complexes. At the metoprolol treatment stage, compared with the sleep deprivation stage, LF and LF/HF were significantly reduced, HF of HRV was elevated (p < 0.05), and the total amount of premature atrial and ventricular complexes was decreased. CONCLUSION: The underlying mechanism of arrhythmia and HRV alteration after 24-h sleep deprivation could be attributable to lower vagal activity and elevated sympathetic activity. Metoprolol improves the change in autonomic nervous system activity after 24-h sleep deprivation, which may be responsible for its protective role on arrhythmia in healthy subjects undergoing sleep deprivation.

Efficacy and safety of the treatment: combination of benazepril/lercanidipine vs. benazepril alone in patients with mild-to-moderate hypertension.

BACKGROUND: Combination therapy is an effective method to reduce the blood pressure (BP) for patients with hypertension. This study was performed to evaluate the efficacy and safety of benazepril/lercanidipine compared with benazepril alone in patients with mild-to-moderate hypertension. METHODS: One hundred and eighty-one patients with mild-to-moderate primary hypertension were assigned in this randomized, single-blind, parallel-group study and were randomly divided into group A (benazepril 10 mg/lercanidipine 10 mg) and group B (benazepril 10 mg) for 8 weeks. At 4 weeks, the dosage of Benazepril was titrated up to 20 mg if the diastolic blood pressure (DBP) remained ≥ 90 mmHg. BP control and side effects were evaluated at the end of 1, 4 and 8 weeks. RESULTS: The baseline characteristics of the two groups were similar. The BP in both groups decreased from the baseline (P < 0.05). At the end of 4 and 8 weeks, Benazepril/Lercanidipine produced greater BP reduction than Benazepril alone (P < 0.05). The comparison of the rate of BP control for the benazepril/lercanidipine and benazepril groups at the end of 1, 4, and 8 weeks were 41.2% vs. 37.6% (P > 0.05), 67.1% vs. 44.7% (P < 0.05), and 71.8% vs. 45.9% (P < 0.05). There was no significant difference of side effects between the two groups. CONCLUSION: The benazepril/lercanidipine combination is more effective in reducing BP than benazepril alone, while it does not increase the incidence of side effects.

Thrombosis and morphology of plaque rupture using optical coherence tomography.

BACKGROUND: Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis. METHODS: We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded. RESULTS: The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076). CONCLUSIONS: Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.

Optical coherence tomography assessment of edge dissections after drug-eluting stent implantation in coronary artery.

BACKGROUND: Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation. METHODS: Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. RESULTS: Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072). CONCLUSIONS: The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.