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The impact scenarios, impact velocity were investigated based on 224 car-electric bicycle collision cases in IVAC (In-depth Investigation of Car Accident in Changsha) database. Cars were classified into three types: sedan, SUV and one box. According to analysis of traffic accident data, car-electric bicycle collision models were built up by using MADYMO. In order to analyze the kinematics of electric-bicycle-riders, this paper conducted a series of numerical experiments by changing the types of cars. Results show that the most prominent impact modes were frontal impact (54%) and side impact (33%), rider's head tend to strike sedan at upper part of the windscreen", "SUV at the front end of bonnet, and one box at lower part of the windscreen, The peak values of head's and pelvis' acceleration were higher and occurred earlier when a SUV or one box impacted with electric bicycle.

Objective To probe the clinical effect, safety, economic benefit and cost of early PCI after thrombolysis with reteplase in the treatment of STEMI. Methods Patients with STEMI who admitted in our hospital from June 2009 to December 2010 were included in this study. A total of 71 patients whose symptom and ECG indicated the sign of repatency with residual stenosis of IRA>75% was divided into early PCI group (35 cases) and elective PCI group (36 cases). PCI was performed 6 h after thrombolysis in early PCI group, and 7 to 10 days after onset of AMI in elective PCI group. The clinical data, rate of coronary repatency, stenosis degree of coronary, thrombolysis in myocardial infarction flow grade pre-PCI and post-PCI, as well the TIMI myocardial perfusion grading (TMPG) were compared between the two groups. Echocardiography was performed 1 week and 3 months after onset of AMI respectively to evaluate the left ventricular function. The major adverse cardiac events (MACE) in hospital after AMI were followed up and compared between the two groups. The in-hospital stay and charges were also calculated and compared between the two groups. Results There were no statistic significances between the two groups in baseline characteristics. There were no significant differences in TIMI flow grade before PCI between the two group (all p>0.05). The repatency rate of IRA (TIMI flow grade 2 and 3) before PCI in early PCI group was 96.9%, while it was 89.5% in elective PCI group (p>0.05). The complete repatency rate (TIMI flow grade 3) in early PCI group was higher than that in elective PCI group (p 0.05). The left ventricular function in early PCI group at 1 week after AMI was no significant difference compared with that in elective PCI group (all p>0.05). Though the LVEDVI, LVESVI and LVEF 3 months after PCI were not significantly different between the two groups (all p>0.05), the value of LVEDVI and LVESVI at 3 months after AMI decreased significantly compared with that 1 week after AMI in early PCI group (both p 0.05). The in-hospital stay in early PCI group was shorter than that in elective group (p Conclusions Early PCI after thrombolysis repatency with reteplase in STEMI patients can improve the coronary blood flow and myocardial perfusion. There is also improvement in heart function and inhibit myocardial remodeling, as well as decrease in the in-hospital stay and cost compared with elective PCI.

Objective To investigate anisodamine for the prevention of Contrast Induced Nephropathy (CIN) in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods Consecutive patients undergoing primary PCI were randomly assigned to one of two groups: (1) patients in anisodamine group (ANI group) were assigned to receive anisodamine (3–4 ug/kg/min intravenous infusion of anisodamine within 30 min before primary PCI), (2) control group (CON group) to isotonic saline (0.9%) with the same volume. All patients were hydrated with intravenous isotonic saline (0.9%) for 12 h after PCI. The Serum creatinine (SCr) concentrations, estimated glomerular filtration rate (eGFR) and incidence of CIN were measured and compared at admission, 24, 48 and 72 h after PCI between the two groups. Results A total of 126 consecutive STEMI patients were randomly assigned to receive anisodamine (n=60) or placebo (control, n=66) from admission to 24 h after PCI. The renal function of all patients after PCI underwent a course from injury to recovery. The incidence of CIN was 5.0%, 8.3%, and 6.7% at hour 24, 48 and 72 respectively after primary PCI in ANI group, while in CON group it was 16.7%, 22.7%, and 19.7% respectively. The incidence of CIN in ANI group was lower than that in CON group within 72 h after PCI (all p Conclusions Intravenous infusion of anisodamine prior to primary PCI may prevent the incidence of CIN in STEMI patients.

Objectives To evaluate the protective effects of higher dose statin on renal function and the incidence of CIN. Methods 228 patients with acute coronary syndrome undergoing delayed percutaneous coronary intervention were randomly divided into standard statin group (SSG n=115) and intensive statin group (ISG n=113). Patients in SSG were given simvastatin 20 mg/day and patients in ISG were given simvastatin 80 mg/day for at least 7 days before PCI, Serum creatinine was measured at admission, 24 h and 48 h after PCI, and the Creatinine clearance was calculated. The levels of hs-CRP, ICAM-1 and P-selectin were also measured. Results Serum creatinine underwent significant increase after PCI, the peak value occurred at 24 h, and then began to decrease. At 48 h after PCI, the creatinine level significantly decreased (p Conclusion Pretreatment with intensive statin dosage before PCI can further decrease the occurrence of CIN. This benefit may be associated with the lowering of hs-CRP, P-selectin and ICAM levels.

Objective To investigate the efficacy and safety of platelet glycoprotein IIb/IIIa inhibition (tirofiban) during PCI in AMI patients performed primary PCI. Methods A total of 96 patients with AMI were randomised to divide into two groups: the tirofiban group (TG, n=44,) and the control group (CG, n=52). Tirofiban was only administrated in the tirofiban group. Before the CAG, enough clopidogrel, aspirin and heparin be used in both groups. The MACE and the haemorrhage events were collected in each group during in-hospital. The lesion and reperfusion of the IRA and myocardial were analyses by QCA and TMPG. The platelet aggregation rate were recorded All patients received UCG 1 week and 24 weeks after PCI to evaluate the heart function. Results There was no significant differences in age, gender, risk factors, pre-angina, the location of the AMI, heart function, and the mean interval from onset to PCI between the two groups. A greater percentage of TIMI 1 flow of IRA was achieved in TG compared with the control group before PCI (p Conclusion Intravenous administration of trofiban can inhibit the platelet aggregation, improve the coronary flow of IRA, decrease the incidence of NRP in AMI patients performed PCI, which in turn will improve the heart function and decrease the incidence of MACE. Tirofiban can make more IRA patent before PCI, but do not increase the haemorrhage events.

Objective To assess the effects of RA-URIS dual chamber sequential pacing on left ventricular remodelling and cardiac function in SSS or AVB patients with chronic heart dysfunction. Methods 32 patients with SSS or AVB associated chronic heart dysfunction were divided two groups RA-URIS pacing group (13 cases) and RA-RVA pacing group (19 cases). The parameters including left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and 6 min walk test (6-MWT) were compared between two groups in pre-pacing and in follow up 24 months after pacing. Results There were no difference on LVEF, LVMI and 6-MWT between two groups before pacemaker implanted. But after 24 months for pacing therapy in RA-URIS group, there was significant increase in LVEF (48.3±10.1 vs 40.7±8.4, p Conclusion The results showed that RA-URIS pacing may reverse left ventricular remodelling in patients with chronic heart dysfunction as well as improving life quality.

Objective To assess the beneficial efficacy and safety of the high maintenance dose of clopidogrel in acute anterior myocardial infarction (AMI) patients undergoing selective percutaneous coronary intervention (PCI). Methods Fifty two patients were enrolled into this study. These cases were randomly divided into the high maintenance dose group (n=26, 14 males, 150 mg clopidogrel per day) and the control group (n=26, 15 males, 75 mg clopidogrel per day). QCA and TIMI Myocardial perfusion grading (TMPG) were used to analyse the lesion and reperfusion of the culprit vessel and myocardium. Record the information of patients in-hospital, in the 1 month and 6 months including the level of BNP, left ventricular ejection fraction (LVEF), the left ventricular peak ejection rate (LPER), the left ventricular peak filling rate (LPFR), the left ventricular time to peak ejection rate (LTPER) and left ventricular time to peak filling rate (LTPFR). Result 1. The CTFC of the high maintenance dose group after PCI was smaller than the standard dose group. The percentage of TMPG 3 grade was higher in the high maintenance dose group. 2. The left ventricular peak ejection rate (LPER), the left peak filling rate (LPFR) 6 months after PCI in the high maintenance dose group was higher than the control group. The left ventricular time to peak ejection rate (LTPER), left ventricular time to peak filling rate (LTPFR) 1 month after PCI in the high maintenance were lower than the control group. 3. There were less acute and subacute thrombosis cases in the high maintenance dose group than the standard dose group. There was no significant difference in haemorrhage events between two groups. Conclusion The high maintenance dose clopidogrel can improve cardiac function. There is potential benefit in increasing coronary blood flow and improving myocardium perfusion. High maintenance dose clopidogrel decreases the acute and subacute thrombosis but do not increase the haemorrhage events.

Objective To evaluate the method of yorkpig model of AMI-ADHF by coronary occlusion with balloon and injecting of microembolus and evaluate the change of coronary and renal haemodynamic parameters on York pig model on AMI-ADHF. Methods 10 York pigs were selected in this trial. LAD was occluded by balloon which was placed on mid-distal for 30–45 min until ST segment elevation for 15 min. After deflating the balloon, the sterile microembolus were injected into LAD intermittently and injecting stopped until LVEDP>18 mm Hg. The coronary pressure and flow velocity were recorded simultaneously at baseline, instant, 30 min and 60 min after AMI-ADHF model success. Average peak velocity (APV), coronary resistance and coronary flow reserve were obtained at basic and maximal hyperaemia. Renal artery angiography was performed and renal artery diameter and pressure was measured. Doppler flowire was placed in renal artery for measure of APV of renal artery (APV ra ), renal artery vascular resistance and renal blood flow. At the same time ECG were recorded per 15 min. CK-MB and TnI were measured in all York pigs at baseline, 2 h, 4 h, 8 h, 12 h and 24 h after reperfusion. Cardiac ultrasonograph was performed to evaluate the heart function. Results (1) According to the standards of AMI-ADHF, eight models were successfully established. (2) Basic and hyperaemia APV were all decreased significantly, they were lower than that of before AMI-ADHF. coronary resistance was increased after AMI-ADHF model success. coronary flow reserve was lower than that of baseline. (3) Renal artery pressure has increased trend than baseline. renal artery vascular resistance was increased, APVr and renal blood flow was decreased than baseline. Conclusion A stable experimental method of York pig model of AMI-ADHF was established successfully by coronary occlusion with balloon and injecting of microembolus in LAD. The method had advantages of closed chest, higher succeed rate and stablility to those of drug induced, tachycardia-pacing induced, coronary artery ligation induced or microsphere injection alone.

Objective To evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischaemic injury during PCI. Methods A total of 228 acute coronary syndrome (ACS) patients were randomly divided into standard statin group (SSG, n=115) and intensive statin group (ISG, n=113). Patients in SSG received 20 mg simvastatin and patients in ISG received 80 mg simvastatin for 7 days before PCI. TIMI grade flow (TGF), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Plasma level of CK-MB and cTnI were measured before and 24 h after the procedure. Results The TFG after stent deployment was significantly improved with less TIMI 0–1 patients and more TIMI 3 blood flow in ISG than in SSG (all p Conclusion Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect myocardium from ischaemic injury.

Objective To assess the adverse effects of glibenclamide on the myocardium, for investigating more effective and rational therapy. Methods 115 consecutive patients were enrolled into the study. All patients had clinical histories of acute myocardial infarction and losed the chance of thrombolysis and emergency PCI; Each patient was assigned to either insulin or glibenclamide group according to which treatment he accepted outside hospital regularly. The patients who took glibenclamide for group A, insulin for group B and diet for group C. Collected the basical clinical informations of all patients. One month after PCI all patients took SPECT to evaluate the condition of myocardial perfusion, and ERNA for LVEF. Results The ratio of the patients with Conclusion Glibenclamide would increase myocardial ischaemic area in patients with acute myocardial infarction and type 2 diabetes mellitus. Glibenclamide increases the possibility of malignant arrhythmias in the patients with acute myocardial infarction and type 2 diabetes mellitus.

Objective To investigate clinical effects of clopidogrel combined with simvastatin or fluvastatin on the platelet aggregation rate (PAR), platelet activation marker CD62P and the incidence of major adverse cardiovascular events (MACE) in patients with ACS. Methods From April 2008 to December 2009, one hundred patients (79 male and 21 female, average age 61.46±12.84 years) who had been diagnosed as ACS were enrolled into this study. These cases were randomly divided into two groups, the Group A (n=50, treated with simvastatin 20 mg per night); the Group B (n=50, treated with fluvastatin 40 mg per night). Detailed clinical information was collected. PAR, CD62P, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) of the two groups were measured. All cases received clopidogrel (a loading dose of 300 mg and then 75 mg daily), aspirin and Low molecular weight heparin. The MACE within 14 days were recorded. Results There was no significant differences in baseline between the Group A and Group B. There was no significant differences in the PAR and expression rate of CD62P after 300 mg clopidogrel (p>0.05). 1h after treated with statins the expression rate of CD62P and PAR in the two groups were lower than that before treated with statins (p 0.05). After the above-mentioned medical treatment, the expression rate of CD62P and PAR in the two groups were similar (p>0.05). There were no significant differences in the incidence of MACE between two groups. Conclusion ACS patients with loading dose clopidogrel combined with simvastatin or fluvastatin could decrease the MACE, the results in two groups are similar. Neither simvastatin with clopidogrel nor fluvastatin with clopidogrel decreases the platelet activity of clopidogrel.

Objectives To evaluate the additional benefit of preventive administration of anisodamine to tirofiban during primary PCI on myocardial reperfusion. Methods This study was prospectively observed the hemodynamic effects of anisodemine in STEMI patients undergoing early PCI following thrombolysis. From March 2010 to December 2010, consecutive STEMI patients within 12 h after thrombolysis were enrolled. All eligible patients were randomly assigned to anisodamine group (ANI) and control group (CON). Patients in ANI group received intracoronary bolus injection of anisodamine (2000 µg, 10 ml) over 2 min according to the heart rate and blood pressure, and the same volume of 0.9% sodium chloride in the CON group. The other medications and laboratory examinations were the same as phase 1. The primary end point was the level of TMPG after PCI, and the second end points were including the hemodymanic parameters, STR, peak level of CK-MB, TIMI flow grade and major adverse cardiac events after PCI. Results Seventy-six patients were prospectively enrolled, with 39 in ANI group and 37 in CON group. No significant differences in baseline clinical data and baseline angiography data were found (all p>0.05). Compared to CON group, the rate of TMPG 3 was higher in ANI group, while the CTFC was lower (both p Conclusions Intracoronary administration of anisodamine before PCI could improve the myocardil perfusion which may be result in the hemodynamic effects of anisodamine.

Objectives This study was to investigate the safety and efficacy of thrombolysis followed by early PCI via transradial artery approach in patients with ST-segment elevation myocardial infarction (STEMI). Methods From September 2009 to March 2010, all consecutive STEMI patients within 12 h from symptom onset or thrombolysis in the Department of Cardiology of the Second Hospital of Hebei Medical University were enrolled. All eligible STEMI patients were divided into two groups according to patients received thrombolysis or not: early PCI group (E-PCI group, patients received thrombolytic agents in non-PCI capable hospital and immediately transferred to receive early PCI) and primary PCI group (P-PCI group, patients received primary PCI). Coronary angiography (CAG) and PCI were performed immediately after admission via transradial artery approach for patients in both groups with standard technique. According to the results of angiography, PCI was performed unless the blood flow of IRA achieved TIMI flow grade 3 without significant stenosis. Thrombus score, TIMI flow grade (TFG) of IRA before and after PCI, corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG) post PCI were analysed. Bleeding complications was also observed and evaluated. All patients were followed up for 6 months to assess major adverse cardiac events (MACE). Results A total of 161 cases were enrolled, with 53 cases in E-PCI group and 108 cases in P-PCI group. The patients in E-PCI group were younger than those in P-PCI group (51.36±12.24 vs 57.31±9.87, p=0.003). The other baseline clinical characteristics such as gender distribution, baseline levels of serum BNP, SCr and Hb, and the medication therapies were similar between the two groups (all p>0.05). The mean time from symptom onset to thrombolysis was 3.62±1.85 h in E-PCI group, and the time from thrombolysis to PCI was 5.13±3.03 h. Compared to P-PCI group, the mean time from onset to PCI was longer in E-PCI group (8.75±2.86 vs 6.03±3.19 h, p 0.05). However, cTFC of IRA post PCI in E-PCI group was lower than that in P-PCI group (28.12±5.06 vs 30.89±8.74, p 0.05). There was a trend toward lower in the peak value of serum CK-MB in E-PCI group. No significant differences were found in the incidence of bleeding complications and hospital stay between the two groups. There was a trend of better left ventricular function 7 days after PCI in E-PCI group than that in P-PCI group. After 6-month follow-up, the left ventricular function was improved in both the two groups (all p Conclusions The myocardial perfusion and left ventricular function were better in patients underwent thrombolysis followed by early PCI, without increases of bleeding complications and incidence of MACE. It is safe and efficacious for STEMI patients to receive thrombolysis followed by early PCI via transradial artery approach.

Objective To explore preventive effects of intracoronary administration of Anisodamine on myocardial microcirculation perfusion after primary PCI in STEMI patients. Methods From March 2009 to August 2010, a total of 86 consecutive patients with first STEMI who underwent primary PCI within 12 h of symptom onset were enrolled in this study. Patients were divided into anisodamine group (n=43) and saline control group (n=43) randomly. The lesion of IRA was treated by percutaneous transluminal coronary angioplasty with over the wire balloon. In anisodamine group, 2000 ug anisodamine (concentration 500 ug/ml) was injected into the coronary artery as a preventive measure via over-the-wire-balloon. In control group, equal volume of saline was injected into the coronary artery in the same way. After that the lesion was predilated with the balloon. Angiography was done after 5 min of stent implanted, CTFC and TMPG were recorded and compared. 200 ug nitroglycerin was bolus injected intracoronary before angiography to exclude spasm of coronary artery. The major adverse cardiac events (MACE) in hospital of the two groups were compared. Results There was no significant difference between the two groups in baseline characteristics (all p>0.05). There were no significant differences in IRA distribution, multi-vessel lesion and the use of tirofiban between the two groups. No significant differences were found in the oral drugs used after pPCI in the two groups (all p>0.05). Compared to control group, the proportion of patient with TMPG 3 grade in anisodamine group was much higher (83.72% vs 62.79%, p 0.05). The heart rate increased significantly, but no reperfusion arrhythmia happened in anisodamine group, while 10 cases of reperfusion arrhythmia (23.26%) happened in the control group (p Conclusion Preventive intracoronary administration of anisodamine can effectively improve myocardial microcirculation perfusion after primary PCI in acute STEMI, and decrease the incidence of reperfusion arrhythmia and MACE in hospital.

Objective To explore the safety and efficacy of early application of tirofiban in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Methods From September 2008 to march 2011, 157 STEMI patients who were preparing for PCI were enrolled into this study. All patients were randomly divided into early group (patients received tirofiban in emergency room) and late group (patients received tirofiban immediately before PCI in catheterisation laboratory). The patients in each group were divided into different subgroups after coronal artery angiography on the basis of characteristic of infarction related artery (IRA). The clinical information, the result of PCI, and the incidence of major cardiovascular adverse events (MACE) during the hospitalisation were compared between two subgroups. Results There were no significant difference in percentage of TIMI3 flow of IRA before PCI between early and late LAD group (p>0.05). However, TIMI 3 flow was significantly less frequent with late RCA group compared with that in early RCA group (p>0.05). After dilation with balloon, cTFC was significantly lower in early LAD group (p>0.05). In the RCA comparison group, early application of tirofiban was associated with lower cTFC in culprit vessel compared with late application of tirofiban (30.00±6.32 vs 36.36±8.83, p 0.05), and TMPG2/3 perfusion was significantly less frequent with late RCA group (74% vs 47%, p 0.05). There were no significant difference in the percentage of no-flow and slow-flow between early and late LAD group during the PCI (p>0.05), and percentage of no-flow and slow-flow was significantly lower in early group than in late group (6% vs 22%, p Conclusions Early application of tirofiban could improve the effect of primary PCI and could effectively limit the expansion of infarction area. Early application of tirofiban dose not increases the incidence of MACE during the hospitalisation.

Objective To evaluate the protection effects of preinfarction angina (PA) on patients with first acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods From 2009–2006 to 2010–2009, a total of 104 AMI patients undergoing emergency PCI within 12 h after sympotom onset were enrolled in the study (74 male and 30 female). Each patient was assigned to without angina group (A group 38 cases), PA group (B group, 31 cases) according to occurrences of typical angina within 24 h before AMI and a group with angina but without PA (C group 35 cases). Coronary angiography was performed immediately after admission. Characteristics of lesion, infarction related artery (IRA), TIMI, spontaneous recanalisation and collateral circulation were recorded. Baseline clinical information of each patient was collected and compared. Echocardiography at 1 week and 3 month after PCI were performed. Results There were no significantly differences in baseline clinical characteristics among the three groups (p>0.05). The peak value of CK-MB was higher in group A and group C than that in group B (266.12±197.49 vs 177.29±73.85 vs 232.31±90.93, p=0.001). The blood flow of the IRA before the stent implanation was lower in group A and group C than that in group B. The incidence of ventricular arrhythmia in the three groups was similar, and the score of ventricular arrhythmia in group B was lower than that in group A and C (42 vs 29 vs 38, p=0.035). There was no significantly difference in the value of BNP in the three groups (413.99±207.69 vs 302.49±146.73 vs 396.57±189.81, p=0.035). The value of BNP in group B was lower then that in group A and group B. There was a significantly difference in EF among the three groups (45.70±5.16 vs 51.37±4.45 vs 45.93±5.94, p=0.000) at 1 week after PCI, and EF in group A and group C was lower than that in group B. EF in group B and group C was higher than that in group A, group B was higher than group C at the thr month after PCI. Conclusion Preinfarction angina can reduce the injure extent of myocardium in patients with first AMI undergoing primary PCI.

Objectives To investigate the safety and efficacy of early percutaneous coronary intervention (early PCI) in patients with non-ST Segment elevation infarction (NSTEMI) undergoing elective PCI. Methods Ninety-one patients (79 males) who suffered from first NSTEMI within 24 h from symptom onset during October 2009 and July 2010 were enrolled in this study. All the cases were randomly divided into early PCI group (n=44) and elective PCI group (n=47). PCI was performed immediately after admission in early PCI group. Patients in elective PCI group received the same medical therapies with those in early PCI group, and PCI was performed 7–10 days after admission. TIMI flow of IRA before and after PCI, as well as TIMI Myocardial perfusion grading (TMP) after PCI were compared between the two groups. The differences of left ventricular function and MACE during hospitalisation and 6-month follow-up were analysed. Results Baseline characteristics were similar between the two groups. There were no differences in the rates of IRA total occlusion, TIMI flow grade 1, and TIMI flow grade 2 before PCI between the two groups (all p>0.05), while the rate of TIMI flow grade 3 in early PCI group was lower than that in elective group (22.73% vs 42.55%, p 0.05). After 6-month follow-up, both LVEDV and LVESV decreased significantly, and LVEF increased. The incidence of cardiac rehospitalisation was lower in early PCI group, while the cardiac death, severe heart failure, reinfarction, malignant arrhythmias, revasculisation of IRA, and bleeding complications were similar. Conclusions Both early and elective PCI can improve the heart function in NSTEMI patients at 6 months, and the effects of early PCI on improving heart function is better without increase of bleeding complications.