Objective To investigate the delivery efficacy of periadventitial delivery of 125I-iododeoxyuridine (125I-IUdR) in comparison of intravascular delivery to determine the optimal delivery method for inhibiting post-angioplasty restenosis. Methods In 8 pigs, one side carotid, subclavian and iliac arteries of each pig were injured by balloon angioplasty with a 20% overstretches. Then, 4 mCi of 125I-IUdR was delivered at each targeted vessel with periadventitial method in 4 pigs (periadventitial group) and with intravascular method via a porous balloon catheter in other 4 pigs (intravascular group). The animals survived for 5 hours and the blood radioactivity was investigated prior to and hourly after procedure until sacrifice. The targeted vessels and renal arteries (for control) were harvested for gamma-counting and histological observation. Meanwhile, the radioactivity in thyroid, liver, bladder, small bowel and each kidney also were measured to determine the biodistribution of 125I. The activities of 125I presented in arterial and tissue specimens were compared between the two delivery groups. The targeted arteries were histologically observed and the ratio of intima to media (I∶M ratio) was calculated. Results The target arterial walls in the periadventitial group had 3.4 times as much of 125I radioactivity as in the intravascular group, respectively (P=0.038); the blood activity in intravascular group was significantly higher than periadventitial group immediate after procedure (P<0.05) and intravascular delivery resulted in much higher activity in urine than periadventitial delivery (P<0.05). The systemic biodistributions of 125I-IUdR in the organs were slightly higher in the intravascular group (P>0.05). The mean I: M ratios in both groups were 0.05 without additional injury at the vessel wall. Conclusion The periadventitial delivery offered substantial advantage over intravascular approach with high local delivery efficacy. The apparent redistribution rate is more rapid following intravascular delivery.

贫血对冠心病患者冠状动脉介入治疗术后急性造影剂肾损伤的影响

Objective The aim of the present study was to assess the influence of anemia on devel-opment of contrast-induced acute kidney injury ( AKI) after percutaneous coronary intervention.Methods The subject group consisted of 1026 patients who had undergone coronary intervention procedure between January 1,2008 and October 31,2009. A nonionic,low osmolality contrast agent was used in our la-boratory at this time. Serum creatinine values were measured before and within 48 h of administration of con-trast agents. Contrast-induced nephropathy was defined as an increase of 0. 5 mg/dl or 25% in serum creati-nine concentration over baseline within 48 h of angiography, anemia as hemoglobin ( Hb) < 120 g/L in women and < 130 g/L in men. Results Among the 1026 patients studied,32(3. 1% ) experienced AKI af-ter procedure. AKI occurred in 6. 3% of the anemic patients and 2.2% of the non-anemic patients (P <0. 01). The incidence of AKI increased with decreasing of baseline estimated glomerular filtration rate ( eG-FR)in both the anemia and non-anemia groups. In patients with baseline eGFR < 30 ml· mi-1·(1. 73 m2 ) -1 ,a high proportion of both anemic and non-anemic patients experienced (24. 6% vs. 18. 5% ).When baseline eGFR was 30-59 ml·min-1·(1. 73 m2)-1 ,the incidence of in anemic patients was 2-fold higher than in non-anemic patients (7. 9% vs. 3. 8% ;P <0. 05). The amount of the contrast agent adminis-tered was similar for AKI and non- AKI patients [ (182 ±46)ml vs. (176±48) ml,P>0.05) ]. Multivariate Logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of AKI. When presence of anemia was introduced into the multivariate model instead of baseline hemoglobin, it was also showed a significant association with AKI. Conclusions Anemia increases the incidence of AKI in patients with moderate renal dysfunction. Patients with both preexisting renal insufficiency and anemia are at high risk of AKI. Baseline eGFR and baseline hemoglobin (or anemia) are independent predictors of AKI.

Ojbective To find the independent predictors for restenosis after coronary stenting.Methods Quantitative angiography was performed on 60 cases (67 successfully dilated lesions) after angioplasty over 6-months follow-up, and both univariate and multivariate logistic regression analysis were done to identify the correlations of restenosis with clinical factors. Results The total restenosis rate was 31.3％(21 of 67 lesions), and according to univariate analysis the patients who underwent coronary stenting ≥3.5mm had a lower rate of restenosis ( P ＜ 0. 01).Collateral circulation to the obstruction site, high maximal inflation pressure, smoking and the less minimal lumen diameter after PTCA made the rate of restenosis higherower ( P ＜ 0.05) . Multivariate logistic regression analysis showed that coronary stenting ≥ 3.5mm had a low rate of restenosis, but high maximal inflation pressure and smoking made the restenosis rate higher. Conclusion Coronary stent size, maximal inflation pressure and. smoking were independent predictors for restenosis.