ABSTRACT
OBJECTIVE@#To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals.@*METHODS@#A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality.@*RESULTS@#Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis ( n= 664, 61.5%) and primary percutaneous coronary intervention (PCI) ( n= 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio ( HR): 0.59, 95% confidence interval ( CI) 0.44-0.80] and primary PCI (6.8%, HR= 0.32, 95% CI: 0.22-0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85-2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR= 1.30, 95% CI: 0.93-1.81).@*CONCLUSION@#In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.
Subject(s)
Humans , ST Elevation Myocardial Infarction/therapy , Percutaneous Coronary Intervention , East Asian People , Treatment Outcome , Myocardial Reperfusion , Myocardial Infarction , Registries , HospitalsABSTRACT
OBJECTIVES@#To investigate the value of CCKBRfl/fl villin-Cre mice as a mouse model of salt-sensitive hypertension (SSH).@*METHODS@#In the first part, 2-month-old CCKBRfl/fl villin-Cre mice (CKO) and control CCKBRfl/fl mice (WT) were fed with normal diet (0.4% NaCl) or high salt diet (4% NaCl), separately for 6 weeks. In the rescue study, one week of hydrochlorothiazide or saline injection were treated with the CKO mice fed high salt diet. The blood pressure, biochemical indexes, and the expression of small intestinal sodium transporters (NHE3, NKCC1, eNaC) was detected. The organ injury markers (MMP2/MMP9) and the histopathological changes of kidneys were observed, whereas the changes of duodenal sodium absorption were detected by small intestinal perfusion in vivo.@*RESULTS@#The CCKBRfl/fl villin-Cre mice with high salt intake exhibited high blood pressure, increased duodenal sodium absorption and urinary sodium excretion, and with renal injury. The protein expression of NHE3, NKCC1 and eNaC were also significant increase in the intestine of CKO-HS mice. Treatment with hydrochlorothiazide remarkably attenuated the elevated blood pressure by high salt absorption in the CCKBRfl/fl villin-Cre mice, but no significant histopathological changes were observed.@*CONCLUSIONS@#These results support a crucial role of intestinal Cckbr deficiency on SSH development and the diuretic antihypertension effect in CCKBRfl/fl villin-Cre mice. The CCKBRfl/fl villin-Cre mice with the high salt intake may serve as a stable model of salt-sensitive hypertensive induced by sodium overloading.
ABSTRACT
Objective:To investigate the effect of modified Ditantang on autophagy and relevant proteins in brain cells of rats with cerebral ischemia reperfusion injury. Method:The cerebral ischemic reperfusion (CIR) injury model in rats was built by reversible middle cerebral artery occlusion artery suture of middle cerebral embolism method, and randomly divided into sham group, model group, high-dose modified Ditantang group(H-dose), low-dose modified Ditantang group (L-dose, 0.384 g·kg-1) and PLXT group (0.1 g·kg-1). Sham and model groups were given normal saline by gastric perfusion, H-dose and L-dose groups were given modified Ditantang, and the PLXT group were given Piracetam tablets, intragastric volume 10 mL·kg-1. The treatment lasted for 7 d. Within 24 hours after administration, the histopathological examination was performed, the volume of cerebral infarction, neuronal apoptosis and serum levels of inflammatory factors were compared, and the expressions of autophagy related microtuble-associated protein 1 light chain 3(LC3)Ⅱ, Beclin1, B-cell lymphoma-2(Bcl-2) and p62 in brain tissues were determined. Result:Cells and blood vessel necrosis, neuron swelling and interstitial edema were observed in model group, a few neurons died, edema was reduced, swelling of nerve cells was alleviated in H-dose, L-dose and PLXT groups. The volume of cerebral infarction and neuronal apoptosis in H-dose, L-dose and PLXT groups were lower than those in model group (Pα, intedeukin (IL)-2 and IL-8 in H-dose, L-dose and PLXT groups were lower than those in model group (PPConclusion:Modified Ditantang can improve brain injury and interfere with autophagy after MCAO/R, alleviate inflammation, and regulate autophagic activity, which may be related to the down-regulation of expressions of LC3 Ⅱ, Beclin1 and the up-regulation of expression of p62.
ABSTRACT
Objective To explore the effect of nursing intervention on the psychological status and clinical efficacy in patients with rheumatoid arthritis (RA).Methods Two hundreds and ten RA patients were randomly divided into the observation group and the control group.The control group was given routine nursing care of RA,the observation group was given comprehensive nursing intervention that was based on psychological intervention,and combined with drugintervention,exercise,life guidance.After 8 weeks of intervention,the psychological status and clinical efficacy of the two groups were compared and analyzed.Results There was no significant difference between two groups of patients in SAS score and SDS score before intervention (P ＞ 0.05).After the intervention,SAS score and SDS score of two groups of patients were significantly decreased (P ＜ 0.05),and that of the observation group decreased more significantly than that of the control group (P ＜ 0.05).The total effective rate of observation group was 91.4％,which was significantly higher than that of the control group (81.0％),the difference was statistically significant (P＜0.05) Conclusion Nursing intervention can relieve the anxiety and depression of RA patients,that can exercise synergistic influence for clinical therapy,which is worth to clinical promotion.