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Objective To investigate the factors associated with delay in decision to seek treatment in patients with acute myocardial infarction(AMI) in Beijing. Methods This prospective,cross-sectional,multicenter survey was conducted from November 1,2005 and December 31 ,2006. The participants consisted of 799 patients with STEMI admitted within 24 h of symptom onset to 19 hospitals in Beijing. Data were collected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off. Results The median(25%,75%) decision delay in STEMI patients was 60(20, 180)min. Factors associated with late decision in an univariate analysis were age ≥65 years, retirement or unemployment, history of myocardial infarction,symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends,coworkers or even strangers,unbearable symptoms,dyspnea,sweating,syncope and attribution of symptoms to cardiac origin were related to early decision. Multivariate logistic analysis showed that history of myocardial infarction,absence of syncope, intermittent symptoms,bearable symptoms and attribution of symptoms to noncardiac origin were independent predictors of decision delay＞30 min. Patients in the early decision group had more chances to receive acute reperfusion therapies(P=0.001) and shorter time intervals from symptom onset to reperfusion therapies(P＜0.001). Conclusions To a great extent patients with AMI in Beijing delayed in decision to seek treatment. History of myocardial infarction, symptom characteristics and symptom attribution were associated with decision delay.
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BACKGROUND: Being a traditional Chinese herb, huangqi (astragalus membranaceus) resists free radical, enhances immunity, promotes microcirculation and protects vascular endothelial cell and nervous system; of which, the protection of huangqi (astragalus membranaceus) on nervous vessel is related to its regulation on local cerebral cortical blood flow rate. OBJECTIVE: To observe the effects of huangqi (astragalus membranaceus) on local cerebral cortical blood flow rate after traumatic injury. DESIGN: Randomized paired experiment.SETTING: Neurological Surgical Institute of Lanzhou Military Area Command of Chinese PLA.MATERIALS: The experiment was performed in Traumatic Experimental Room of Neurological Surgical Institute of Lanzhou Military Area Command of Chinese PLA from February to May 2000, in which, 75 healthy male SD rats were employed and randomized into the control (5 rats), saline control (35 rats) and experimental group (35 rats). The latter two groups were subdivided into 7 time spots of 1, 3, 6, 8, 12, 24 and 48 hours after traumatic injury, 5 rats were involved in each spot.METHODS: In normal control, the model was not prepared and in the other two groups, the modified Feeney's method was used to establish craniocerebral traumatic model. In experimental group, right after injury, huangqi injection (5 g/kg) was applied abdominally and in saline control, physiological saline 0.5 mL was injected abdominally. MAIN OUTCOME MEASURES: It was to determine the blood flow rates in local cerebral cortex at corresponding time spots after traumatic injury. Fenestration was done in normal control for direct determination. RESULTS: By supplemented, 75 rats entered result analysis. Blood flow rates in local cerebral cortex: the rate in saline control 1 hour after trauma was lower than the control [(6.90±0.68), (7.94±0.65), P < 0.05], it was de creased to the minimum in 24 hours and began increasing in 48 hours [(5.86±0.61), (6.15±0.60)]; the rate in experimental group at every time spot was higher than saline control (P < 0.05). CONCLUSION: Huangqi (astragalus membranaceus) increases remark ably blood flow rate in local cerebral cortex, which is associated with its neurovascular protection.
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AIM To study the effects of puerarin on the expression of Bcl-2 and Bax, genes relating to neuronal apoptosis after cerebral ischemia and reperfusion. METHODS After global cerebral ischemia followed by reperfusion, changes in protein expression of Bcl-2 and Bax were detected by immunohistochemical method. The number of neuronal apoptosis was assessed by TUNEL. The effects of puerarin intervention were observed. RESULTS In CA1, the level of positive expression of Bcl-2 varied to the duration of reperfusion and the peak level was at 6 h reperfusion after 10 min global cerebral ischemia,the peak expression of Bax was at 24 h. The number of neuronal apoptosis after cerebral ischemia reperfusion was increased. In puerarin group, the expression of Bcl-2 was up-regulated and that of Bax was down-regulated, the number of neuronal apoptosis after cerebral ischemia reperfusion was decreased. CONCLUSION Our result indicate that Bcl-2 may restrain apoptosisl. Bax may promote apoptosis after cerebral ischemia and reperfusion and puerarin ameliorate ischemic damage by reducing the apoptosis through regulating Bcl-2 and Bax.
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<p><b>OBJECTIVES</b>To evaluate clinical manifestations of 21 patients with subclinical pituitary apoplexy and their diagnosis and treatment.</p><p><b>METHOD</b>Clinical data from 21 patients with subclinical pituitary apoplexy treated from October 1989 to November 2001 were analyzed retrospectively.</p><p><b>RESULTS</b>Their clinical manifestations included chronic headache, visual deficit and field cut. Three patients showed no clinical signs. Microsurgery was performed in 20 patients, of whom 3 were treated by emergency operation. Microsurgery included transsphenoidal decompression in 17 patients, and transpterioral approach in 3. One patient was given conservative therapy, and 12 were given endocrine replacement therapy. Nineteen patients recovered with marked visual improvement (7), partial improvement (8), no changes (4); deterioration was noted in 1.</p><p><b>CONCLUSIONS</b>Subclinical pituitary apoplexy characterized by atypical clinical manifestations may be misdiagnosed or in appropriately treated. MRI is superior to CT scan for the diagnosis of subclinical pituitary apoplexy. Patients with persistent chiasmatic syndromes are indicated for emergency surgery. Endocrine replacement and transsphnoidal decompression are effective for the improvement of severe visual disturbance.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Magnetic Resonance Imaging , Pituitary Apoplexy , Diagnosis , General Surgery , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.</p><p><b>METHODS</b>Eighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.</p><p><b>RESULTS</b>With the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.</p><p><b>CONCLUSIONS</b>Brain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon , Methods , Carotid Stenosis , Therapeutics , Follow-Up Studies , Intracranial Embolism , Protective Devices , Stents , Vertebrobasilar Insufficiency , TherapeuticsABSTRACT
Objective To evaluate the effect of holidays on door-to-reperfusion time in patients with ST-segment elevation myocardial infarction(STEMI).Methods Using the data from the Registry of ST-segment elevation Myocardial Infarction in Beijing,we studied the data of 297 patients with STEMI who received acute reperfusion from November 2005 to July 2006.The association between holidays and door-to-reperfusion time in these patients was studied.Results Ninty four patients in this study were admitted in holidays(26 of them received fibrinolytic therapy and 68 received PCI)and the other 203 patients were admitted during routine weekdays(61 of them received fibrinolytic therapy and 142 received PCI).After adjusting for patient characteristics,admission during holidays was associated with a longer median door-to-balloon time[162.2 min(95% CI:160.8,165.3)vs 141.8 min(95% CI:137.8,144.1);P