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Objective To analyze the relationship of oxidized low density lipoprotein (ox-LDL) and homocysteine (Hcy) with coronary in-stent restenosis (ISR),and to discuss the clinical predictors of ISR after rapamycin-eluting coronary stent implantation.Methods A total of 400 patients,who had received rapamycin-eluting coronary stent implantation,were enrolled in this study.According to follow-up coronary angiography findings,the patients were divided into ISR group and non-ISR group.Plasma ox-LDL and Hcy levels were tested before percutaneous coronary intervention (PCI) as well as at the time of follow-up coronary angiography.Multivariate logistic regression analysis was used to evaluate ISR-related clinical parameters,angiographic features and surgical factors.Results ISR group had 48 patients and non-ISR group had 352 patients,the clinical incidence rate of ISR was 13.6％.Compared with non-ISR group,the plasma ox-LDL and Hcy levels tested before stent implantation and at the time of follow-up coronary angiography were strikingly increased,the differences were statistically significant (P＜0.05).The results of multivariate logistic regression analysis showed that the independent correlative factors for ISR included hypertension (OR=1.12,95％CI:1.02-3.92;P=0.033),diabetes (OR=2.61,95％CI:1.93-4.26;P=0.016 0),Hcy (OR=2.45,95％CI:1.57-4.48;P=0.036),ox-LDL (OR=2.18,95％CI:1.45-4.96;P=0.006),taking statins (OR=0.50,95％CI:0.26-0.82;P=0.013),smoking (OR=5.62,95％CI:4.13-7.18;P=0.002),coronary artery disease (OR=3.32,95％CI:2.12-5.34;P=0.017),coronary bifurcation lesion (OR=3.51,95％CI:2.36-5.58;P=0.021),chronic total occlusion (OR=2.01,95％CI:1.22-4.84;P=0.014),reference vessel diameter (OR=0.25,95％CI:0.12-0.62;P=0.001),preoperative vascular stenosis degree (OR=2.06,95％ CI:1.21-4.32;P=0.024),stent diameter (OR=0.20,95％CI:0.10-0.53;P=0.001) and stent length (OR=2.60,95％CI:1.22-4.84;P=0.036).Conclusion Clinically,ISR is not an uncommon finding in patients who have received rapamycin-eluting coronary stent implantation.This study indicates that hypertension,diabetes,Hcy,ox-LDL,taking statins,smoking,coronary artery disease,coronary bifurcation lesion,chronic total occlusion,reference vessel diameter,preoperative vascular stenosis degree,stent diameter and stent length are the independent factors for ISR.Long-term use of statins can reduce the risk of ISR.
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Objective To investigate the relationship between cardiac vagus nerves and changes of connexins(Cx)and intracellular gap junction(GJ)distribution pattern in superior vena cava(SVC)myosleeve in dog with atrial fibrillation(AF).Methods Twenty four hybrid dogs were divided into sham operation group(Sham group,n=8),SVC-AO fat pad removed group(RM group,n=8)and SVC-AO fat pad reserved group(RS group,n=8).In RM group and RS group,right atrial pacing was performed at a frequency of 500～650/min for 6 weeks to establish AF model.AF was induced by programmed stimulation or burst stimulation of atrial pacing.The expression and distribution of Cx40 and Cx43 in the SVC myosleeve tissue in three groups were analyzed by immunofluorescence staining.Transmission electron microscopy was used to observe the uhrastructural organization of gap junction(GJ).Results The rate of inducing sustained AF(＞ 15 min)in RS group was significantly higher than that in RM group (P ＜ 0.01).The expression of Cx40 and Cx43 in the SVC myosleeve in sham group and RS group were significantly higher than that in RM group(P ＜ 0.05).Furthermore,the expression of Cx40 and Cx43 in RS group were obviously higher than that in sham group(P ＜0.05).The ratio of end-to-end to side-to-side in RS group was lower than that in Sham group and RM group.Comparing with RM group,the channel of GJ became shorter and wider in RS group(P ＜0.05).Sarcomere was dissolved and mitochondrion showed vacuole degeneration in RS group.Conclusion The remodeling of Cx40 and Gx43 in SVC myosleeve tissue may be mediated by vagus nerves.It is conducive to the maintenance and stability of AF.However,this effect can be weakened by removing SVC-AO fat pad of canine.
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Objective To improve the specific nursing standards of neostomy and chronic wounds,make patients receive professional guidance and standard treatment. Methods To establish professional team in the neostomy and conduct systematic and specialized training for team members, to work out nursing standards in the neostomy and execute nursing consultation and discussion in team on special types of chronic wounds. Results The professional knowledge of the team members and clinical nurses was enhanced, 18lessons about 50 class-hours were given, the attendance rote reached above 96% since the establishment of professional team in the neostomy, the quality of clinical nursing was improved and the complications were reduced. Conclusions The establishment of professional team provides clinical nurses with a platform of communication and learning, reflect their own value, and promote development of nursing science.