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Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction

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Journal of Geriatric Cardiology 2019年第6期16卷 458-467页

作者： Jin-Wen TIAN Mei ZHU Feng-Qi WANG Ke LI Chao-Fei ZHOU Bo LI Min WANG Jue-Lin DENG Bo JIANG Jing BAI Yi GUO Rong-Jie JIN Zhao ZHANG Ying LIN Ji-Hang WANG Shi-Hao ZHAO Ming-Zhi SHEN Department of Cardiology Hainan Hospital of PLA General Hospital Hainan China Department of Cardiology Chinese PLA General Hospital Beijing China

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

关键词： ST elevation myocardial infarction Therapeutic thrombolysis Thrombus Urokinase

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Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases

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World Journal of Gastrointestinal Oncology 2017年第5期9卷 218-227页

作者： Min Hoe Chew Yu-Ting Yeh Ee-Lin Toh Stephen Aditya Sumarli Ghee Kheng Chew Lui Shiong Lee Mann Hong Tan Tiffany Priyanthi Hennedige Shin Yi Ng Say Kiat Lee Tze Tec Chong Hairil Rizal Abdullah Terence Lin Hon Goh Mohamed Zulfikar Rasheed Kok Chai Tan Choong Leong Tang Department of Colorectal Surgery Singapore General Hospital Department of Obstetrics and Gynaecology Singapore General Hospital Department of Urology Singapore General Hospital Department of Orthopaedic Surgery Singapore General Hospital Division of Oncological Imaging National Cancer Centre Singapore Department of Anaesthesiology Singapore General Hospital Vascular Surgery Singapore General Hospital Department of Plastic Reconstructive and Aesthetic SurgerySingapore General Hospital

To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit. METHODSThis retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ2 test or Fisher’s exact test, as applicable. RESULTSAll 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedura

关键词： Colorectal cancer Advanced pelvic tumour Sacrectomy Oncological outcome Pelvic exenteration Chordoma

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Handgrip Strength as a Predictor of Nutritional Status in Chinese Elderly Inpatients at hospital Admission

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Biomedical and Environmental Sciences 2017年第11期30卷 802-810页

作者： ZHANG Xin Sheng LIU Ying Hua ZHANG Yong XU Qing YU Xiao Ming YANG Xue Yan LIU Zhao LI Hui Zi LI Feng XUE Chang Yong Department of Nutrition Chinese PLA General Hospital Department of Nutrition Chinese PLA General Hospital of Rocket Forces

Objective To assess nutritional status and define gender-and age-specific handgrip strength（HGS） cut-point values for malnutrition or nutritional risk in elderly inpatients. Methods A cross-sectional study of 1,343 elderly inpatients was conducted in the Chinese PLA general hospital. Nutrition Risk Screening（NRS 2002） and Subjective Global Assessment（SGA） were administered. Anthropometric measurements and blood biochemical indicators were obtained using standard techniques. The gender-and age-specific receiver operating characteristic（ROC） curves were constructed to evaluate the HGS for nutritional status by SGA and NRS 2002. Sensitivity, specificity, and areas under the curves（AUCs） were calculated. Results According to NRS 2002 and SGA, 63.81% of elderly inpatients were at nutritional risk and 28.22% were malnourished. Patients with higher HGS had an independently decreased risk of malnutrition and nutritional risk. The AUCs varied between 0.670 and 0.761. According to NRS 2002, the optimal HGS cut-points were 27.5 kg（65-74 years） and 21.0 kg（75-90 years） for men and 17.0 kg（65-74 years） and 14.6 kg（75-90 years） for women. According to SGA, the optimal HGS cut-points were 24.9 kg（65-74 years） and 20.8 kg（75-90 years） for men and 15.2 kg（65-74 years） and 13.5 kg（75-90 years） for women. Conclusion Elderly inpatients had increased incidence of malnutrition or nutritional risk. HGS cut-points can be used for assessing nutritional status in elderly inpatients at hospital admission in China.

关键词： Handgrip strength Elderly inpatients Nutrition assessment Nutrition status Malnutrition

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Synergistic effects of elevated homocysteine level and abnormal blood lipids on the onset of stroke

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Neural Regeneration Research 2013年第31期8卷 2923-2931页

作者： Lu Hao Liming Chen Xiaoyong Sai Zhefeng Liu Guang Yang Rongzeng Yan Lili Wang Caiyun Fu Xuan Xu Zhenzhen Cheng Qiang Wu Shuzhang Li Chinese PLA general hospital Institute of Geriatrics Chinese PLA General Hospital Beijing Key Laboratory of Geriatrics

Hyperhomocysteinemia and abnormal blood lipids are independent risk factors for stroke. However, whether both factors exert a synergistic effect in the onset of stroke remains unclear. The present study is a retrospective analysJs of 2 089 cases of stroke and 2 089 control cases of simple in- tervertebral disk protrusion using a paired multivariate logistic regression method. Adjusting for known confounding variables including the patients＇ age, gender, smoking status, alcohol con- sumption status, patient and family medical history, and clinical biochemical indices, elevated ho- mocysteine level was related to the onset of stroke. Patients with elevated homocysteJne levels and abnormal blood lipids showed a 40.9 % increase in the risk for stroke compared to patients with normal homocysteine levels and blood lipids （odds ratio 1.409; 95% confidence interval 1.127-1.761）. These results indicate that elevated homocysteine and abnormal blood lipids exert synergistic effects in the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids are predisposed to stroke.

关键词： neural regeneration stroke cysteine risk factor case-control study abnormal bloodmedication inpatients cardiovascular disease paired analysis grants-supportedneuroregenerationlipidspaper

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Bacterial Translocation and Change in Intestinal Permeability in Patients after Abdominal Surgery

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2009年第4期29卷 486-491页

作者：乔治黎沾良李基业陆连荣吕艺黎君友 Department of general Surgery the First Affiliated Hospital of Chinese PLA General Hospital Research Department of Burn Institute the First Affiliated Hospital of Chinese PLA General Hospital

The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled in the study. Blood samples were collected prior to operation and 2, 24, 48 h after surgery for bacterial culture, microbial DNA extraction, plasma D-lactate and endotoxin measurement. PCR analysis was performed after DNA extraction, with β-lactosidase gene of E. coli and 16S rRNA gene as target genes. All patients were observed for a period of 30 days for infectious complications. Our results showed that no bacterial DNA was detected before surgery, but after operation it was found in 12 patients （19.0%）. Bacterial DNA was detected in 41.7% （10/24） of SIRS patients and 5.1% （2/39） of non-SIRS patients （P〈0.01）. About 83.3% of PCR-positive patients developed systemic inflammatory response syndrome （SIRS）, but only 27.5% of PCR-negative patients did so （P〈0.01）. Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did （P〈0.01）. The blood culture was positive only in 3 patients （4.8%）, who were all PCR-positive. E. coli DNA was found in 66.7% of the PCR-positive patients. The plasma levels of D-lactate and endotoxin were elevated significantly 2, 24 and 48 h after operation in PCR-positive patients, with a significant positive correlation found between them （r=0.91, P〈0.01）. It is concluded that increased intestinal permeability was closely related with bacterial translocation. Intestinal bacterial translocation （most commonly E. coli） might occur at early stage （2 h） after abdominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.

关键词： bacterial translocation intestinal permeability abdominal surgery polymerase chain reaction (PCR)

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Establishment of a rat model of chronic thoracolumbar cord compression with a flat plastic screw

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Neural Regeneration Research 2016年第6期11卷 963-970页

作者： Yong Sun Li-hai Zhang Yang-mu Fu Zhi-rui Li Jian-heng Liu Jiang Peng Bin Liu Pei-fu Tang Department of Orthopedics Chinese PLA General Hospital Department of Orthopedics Research Institute Chinese PLA General Hospital

Previous studies of animal models of chronic mechanical compression of the spinal cord have mainly focused on cervical and thoracic lesions, but few studies have investigated thoracolumbar injury. The specific pathophysiological mechanism of chronic thoracolumbar cord injury has not yet been elucidated. The purpose of this study was to improve animal models of chronic thoracolumbar cord compression using the progressive screw. A custom-designed flat plastic screw was implanted in the spinal cord between thoracic vertebrae 12 and lumbar 1 of rats. The screw was tightened one complete turn（0.5 mm） every 7 days for 4 weeks to create different levels of chronic spinal cord compression. Following insertion of the screw, there was a significant decline in motor function of the hind limbs, and severe stenosis of micro-computed tomography parameters in the spinal cord. Cortical somatosensory evoked potential amplitudes were reduced remarkably, and latencies were prolonged at 30 minutes after surgery. The loss of motor neurons in the gray matter was marked. Demyelination and cavitation were observed in the white matter. An appropriate rat model of chronic thoracolumbar cord compression was successfully created using the progressive screw compression method, which simulated spinal cord compression injury.

关键词： screw thoracic lumbar vertebral minutes evoked stenosis progressive custom prolonged

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Effective suppression of fibronectin synthesis by retrovirus delivered shRNA in rat cardiac fibroblasts

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Science China(Life Sciences) 2004年第4期47卷 368-375页

作者： WU Di1, HONG Quan1, CHEN Xiangmei1, FU Bo1, LI Aipingi2, LIU Hang1, BAI Xueyuan1 & WANG Jianzhong1 1. Department of Nephrology, general hospital of PLA, Beijing 100853, China 2. Department of Cardiology, general hospital of PLA, Beijing 100853, China Department of Nephrology General Hospital of PLA Beijing China Department of Cardiology General Hospital of PLA Beijing China

Extracellular matrix overexpression is a common final pathway that leads to ventricular remodeling. Fibronectin plays a pivotal role in this progress. In the work presented here, we explored the possibility of direct inhibition of fibronectin synthesis in rat cardiac fibroblasts by small interference RNA (siRNA). We found that siRNA could successfully suppress the fibronectin overexpression stimulated by angiotensin II. To overcome the limitations of plasmid-based siRNA, we subcloned the H1 promoter into pLXIN, a commercially available retroviral vector. We found that H1 promoter worked very well to form the small hairpin RNA (shRNA) on the retroviral vector, and the fibronectin expression was dramatically down regulated by shRNA. We think the retroviral shRNA delivery system that we have constructed may have potential roles in treating ventricular remodeling. Keywords RNA interference (RNAi) - Angtiotensin II (ATII) - extracellular matrix - fibronectin

关键词： RNA interference (RNAi) Angtiotensin II (ATII) extracellular matrix fibronectin

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Retrospective study of steroid therapy for patients with autoimmune pancreatitis in a Chinese population

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World Journal of Gastroenterology 2013年第4期19卷 569-574页

作者： Bin Liu Jing Li Lu-Nan Yan Hao-Ran Sun Tong Liu Zhi-Xiang Zhang Department of general Surgery General Hospital of Tianjin Medical University Department of Anesthesiology General Hospital of Tianjin Medical University Department of general Surgery West China HospitalSichuan University Department of Radiology General Hospital of Tianjin Medical University

AIM:To explore the optimal steroid therapeutic strategy for autoimmune pancreatitis(AIP).METHODS:This study was conducted retrospectively in two large institutions in *** with clinically,radiologically and biochemically diagnosed AIP were *** performed radiological investigations and biochemical tests,the regimen of the given steroid treatment,remission and relapse whether with and without steroid therapy were ***:Twenty-eight patients with AIP received steroid treatment,while 40 patients were treated surgically by pancreatoduodenectomy,distal pancreatectomy and choledochojejunostomy,radiofrequency ablation for the enlarged pancreatic head,percutaneous transhepatic biliary drainage and endoscopic biliary *** starting oral prednisolone dose was 30 mg/d in 18(64.3%) patients and 40 mg/d in 10(35.7%) patients administered for 3 *** remission rate of AIP patients with steroid treatment(96.4%) was significantly higher than in those without steroid treatment(75%).Maintenance therapy(oral prednisolone dose 5 mg/d) was performed after remission for at least 6-12 mo to complete the treatment ***,the relapse rate was significantly lower in AIP patients with steroid treatment(28.6%) than in those without steroid treatment(42.5%).Steroid re-treatment was effective in all relapsed patients with or without steroid ***:Steroid therapy should be considered in all patients with active inflammatory phase of ***,the optimal regimen still should be trailed in larger numbers of patients with AIP.

关键词： Autoimmune pancreatitis Chinese population Steroid therapy Remission Relapse

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Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review

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World Journal of Clinical Cases 2018年第7期6卷 143-149页

作者： Xian-Qiang Wang Shu-Juan Xu Zheng Wang Yuan-Hong Xiao Jing Xu Zhen-Dong Wang Di-Xiang Chen Department of Pediatrics PLA General Hospital Center of Anesthesia and Operation PLA General Hospital

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3 rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3(0.3-15.9) years; the maleto-female ratio was 1:3.5(19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9%(79/86). The average total operation time was 426(180-520) min, the operation time on the machine was 302(120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of roboticassisted choledochocystectomy was 8.8 d. Eight patientshad biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.

关键词： Choledochocystectomy Robotic surgery Pediatrics Congenital choledochal cysts

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Aneurysm Resection and Vascular Reconstruction for True Aneurysm at the Initial Segment of Splenic Artery

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第3期35卷 439-444页

作者：王春喜韩丽娜梁发启褚福涛贾鑫 Department of general Surgery of PLA general hospital Department of Cardiovascular Internal Medicine Nanlou Branch of PLA General Hospital

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography（CT） and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10–14 days after operation. A 1–14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

关键词： aneurysm resection artery reconstruction

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