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Objective:To establish a long-term mortality rate prediction model for patients aged 60 years and over with atrial fibrillation and coronary heart disease using the machine learning method, and identify the corresponding risk factors of mortality.Methods:In this retrospective cohort study, a total of 329(11 cases lost of follow-up)patients with 183 males(55.6%)and 146 females(44.4%), aged(77.8±7.3)years, and 142 patients aged 80 years or older(43.2%)were selected in our hospitals from January 2013 to March 2015.And their clinical data on atrial fibrillation and coronary heart disease were analyzed.They were divided into the death group(151 cases)and the survival group(167 cases)according to the survival outcome.In addition, 60 patients aged 60 years and over admitted to our hospitals from April to July 2015 with atrial fibrillation and coronary heart disease were selected as external data validation set.The clinical data included age, gender, body mass index, diagnosis, co-morbidity, laboratory indicators, electrocardiogram, echocardiogram, treatment data.These patients were followed up for at least 6 years, and the main adverse cardiovascular and cerebrovascular events(MACCE), including death, were recorded.Finally, the data of the enrolled patients were randomly divided into the training set and the test set according to the ratio of 9∶1, Different models were established to predict the long-term mortality of patients with atrial fibrillation and coronary heart disease by machine learning algorithm.The optimal model was established by substituting external data(60 cases)into the model for verification and comparison.The top 20 risk factors for mortality were determined by Shapley additive explanation(SHAP)algorithm.Results:A total of 329 hospitalized patients were included in this study, the overall median follow-up time was 77.0 months(95% CI: 54.0~84.0), 11 cases lost during follow-up(3.3%), and 151 cases died(45.9%). The analysis found that the areas under the ROC curve for a support vector machine(SVM)model, k-Nearest Neighbor(KNN)model, decision tree model, random forest model, ADABoost model, XGBoost model and logistic regression model were 0.76, 0.75, 0.75, 0.91, 0.86, 0.85 and 0.81, respectively.The random forest model had the highest prediction efficiency, with the accuracy of 0.789 and F1 value of 0.806, which was better than the logistic regression model[the Area Under Receiver Operating Characteristic Curve(AUC): 0.91 vs.0.81, P<0.05]. D-dimer, age, number of MACCE, left ventricular ejection fraction, serum albumin level, anemia, New York Heart Association(NYHA)grade, history of old myocardial infarction, estimated glomerular filtration rate(eGFR)and resting heart rate were important risk factors for predicting long-term mortality. Conclusions:The random forest model based on machine learning method can predict the long-term mortality of patients with atrial fibrillation and coronary heart disease aged 60 years and over, have a good identification ability.Its accuracy is higher than that of the traditional Logistic regression model.Reducing the long-term mortality and improving the long-term outcomes can be achieved by intervening on D-dimer levels, correcting hypoproteinemia and anemia, improving cardiac function and controlling resting ventricular rates.
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Objective:To investigate the characteristics of multimodal ultrasound imaging in elderly hyperlipidemia patients with statin-related myopathy and to provide a reference of new method for non-invasive quantitative evaluation on statin myopathy.Methods:We collected 20 elderly hyperlipidemia patients with statin-related myopathy(the statin-related myopathy group), 20 elderly hyperlipidemia patients without statin-related myopathy after taking statins during the same period(the non-statin-related myopathy group), and 20 healthy volunteers who matched the age and sex of the above two groups during the same period(the healthy control group)in our hospital.Two-dimensional ultrasound, shear wave elastography and superb microvascular imaging were used to obtain thickness, echo, pinnation angle and shear wave velocity(SWV)values as well as vascular index(VI)values of the medial gastrocnemius during relaxation, dorsiflexion, and plantar flexion for each group, which were then analyzed.Results:There were no significant differences among the three groups in general conditions such as age, height, weight, and body mass index(all P>0.05). The mean thickness of the medial gastrocnemius in the statin-related myopathy group was about(1.04 ± 0.20)cm, which was less than(1.34 ± 0.16)cm in the non-statin-related myopathy group and(1.35 ± 0.15)cm in the healthy control group( F=22.03, P<0.001). The pinnation angle in the statin-related myopathy group was about(12.50 ± 1.10), which was less than(18.55 ± 1.28)in the non-statin-related myopathy group and(18.60 ± 1.35)in the healthy control group( F=158.03, P<0.001). Compared with the non-statin-related myopathy group and the healthy control group, SWV during resting, dorsiflexion and plantar flexion in the statin-related myopathy group decreased( F=61.71, 111.96 and 8.69, respectively, P<0.01). The average value of VI in the statin-related myopathy group was about(0.43 ± 0.12)%, which was less than that in the non-statin-related myopathy group(0.75 ± 0.20)% and in the healthy control group(0.93 ± 0.17)%( F=48.93, P<0.001). However, there was no significant difference in values from the parameters between the non-statin-related myopathy group and the healthy control group(all P>0.05). Conclusions:Multimodal ultrasound imaging of statin-related myopathy in elderly hyperlipidemia patients shows distinct characteristics and can be used to evaluate muscle damage of statin-related myopathy.
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Objective To analyze the staff structure, turnover and income of human resources in disease control and prevention institutions(CDCs)at different levels in China, to identify the existing problems, and to make policy recommendations accordingly. Methods A questionnaire survey was used to collect the data on the staff of CDCs at different levels in China from 2016 to 2018. Descriptive analysis and trend analysis were conducted on the number of staff, recruitment and turnover, income and other indicators in the three years. Results A total of 606 CDCs were included in the study. The proportion of job openings was 11.97% in 2018. Although the median proportion of professional personnel and health professional personnel in the CDCs reached the national standard(85% and 70%, respectively), a considerable number of institutions failed to meet the national standard. From 2016 to 2018, staff turnover in the CDCs has been increasing, with a minimum of 0.73(in 2016, municipal CDCs)and a maximum of 10.52(in 2018, provincial CDCs). In the staff who quit the CDCs, the proportion of junior professionals was the highest, while that of medium and senior professional increased gradually. Of them, the proportion of staff with graduate education in eastern China and provincial CDCs was higher than that of undergraduate education, while the proportion of staff with graduation education in other regions also increased. From 2016 to 2018, the average annual income in the CDCs in most regions did not reach the national average wage level of urban employees in health, social security and social welfare field in the same period. In county and district level CDCs in central and western China, personal income in 2018 was even less than the national average wage level in 2016. Conclusion Human resources in the CDCs at different levels in China remains insufficient and unbalanced, which warrants a"supporting policy"mechanism for public health personnel. The loss of the personnel in the CDCs continues to increase, in which the loss of senior professionals become increasingly serious. It raises a new concern to establish and improve the incentive mechanism of public health personnel. Furthermore, personal income in the CDCs is lower than the local average level. It is necessary to set personal income reasonably according to local economic level.
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Objective To investigate the application of remote monitoring systems for cardiac implantable electronic devices (CIED) and its success rate of data transmission in elderly patients.Methods A total of 97 elderly patients who had previously undergone procedures for pacemaker implantation,implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) with remote monitoring capabilities between January 2013 and October 2016 at our hospital were enrolled.We evaluated the effect of the remote monitoring systems for data transmission,compared the outpatient follow-up rates between the groups one year after implantation,and conducted a telephone survey of patients.Results A total of 97 elderly patients,including 70 with pacemakers,20 with ICD and 7 with CRT,were enrolled in this study.Participants had a mean age of (78.2-±-6.4) years and 64 were male (66.0％).The Home Monitoring system was used for 85 cases and the Merlin.net remote monitoring system was used for 12 cases.Overall,95 patients (97.9 ％) completed the remote monitoring procedure,68 patients (70.1％) completed the outpatient follow-up,and 90 patients (92.8％) completed the telephone survey during a one-year follow-up period.The satisfaction rate for the remote monitoring systems was 94.4％ (85 patients),and 80 patients (90.0％％) expressed a willingness to continue to use the remote monitoring system if a replacement was needed.Conclusions For elderly patients with CIED,the remote monitoring systems can improve the follow-up rate with a high degree of satisfaction.
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Objective To study the the effectiveness of Entecavir on serum transforming growth factor-β1 (TGF-β1) in patients with decompensated cirrhosis .Methods Eighty patients with decompensated cirrhosis were randomly divided into two groups ,the control group(n=40 cases) and the observation group (n=40 cases).The pa-tients in the control group were treated through the conventional treatmeat ,while the patients in the observation group were treated through the conventional treatment plus entecavir .They were treated for 24 weeks.Liver function,HBV DNA and serum TGF-β1 were detected.Results ALT,Tbil and ALB were improved after treatment in both groups (t=6.724,13.306,3.064,4.172,2.924,3.172,all P<0.05).They were more significantly improved in the obser-vation group than that in the control group (t=2.469,2.160,3.064,all P<0.05).HBV-DNA negative rate in the observation group was higher these in the control group (χ2 =4.82,P<0.05).Serum TGF-β1 in both groups were decreased after treatment(t=6.842,8.062,all P<0.01).There was a significant difference between two groups (t=3.178,P<0.05).Conclusion Entecavir can decrease serum TGF-β1 in patients with decompensated cirrhosis .
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The Sino-foreign joint graduate education is an important measure of educational innovation.It has been implemented in Capital Medical University since 2009.Regulatory recruitments,strict managements,information system network and creating international exchange opportunities have been engaged in recent years for graduate students,Which wins great effects in Sino-foreign joint graduate education.The practice of the project has improved the graduate students' professional ability,broadened their international vision,and explored the new mode of cultivating creative talents.
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Objective To observe the safety and efficacy of different periprocedural anticoagulation strategies in patients undergoing catheter ablation of atrial ifbrillation. Methods Eighty-five patients aged over 75 undergoing catheter ablation of atrial fibrillation from Jul 2011 to Nov 2013 were enrolled. They all took warfarin and transesophageal echocardiograms were performed to rule out left atrium appendage thrombus before ablation. They were divided into 3 groups. In Group 1 (30 cases), warfarin was stopped and bridged with low molecular weight heparin (LMWH) 3 days before procedure and LMWH bridging followed by warfarin alone after procedure. In Group 2 (32 cases), warfarin was continued during periprocedural period. In Group 3 (23 cases), Dabigatran or Rivaroxaban alone was used 4 hours after procedure respectively. Unfractionated heparin was used during procedure in all three groups. These three anticoagulation strategies were compared in bleeding, embolism events and other complications during 3-month follow-up. Results In Group 1, there were 1 new-onset ischemic stroke during hospitalization, 7 lower extremity hematomas, 1 subdural hemorrhage during 3-month follow-up and 6 minor bleeding events. In Group 2, there were 4 lower extremity hematomas and 4 minor bleeding events during 3-month follow-up. As for Group 3, only 2 lower extremity hematomas during hospitalization was observed in each without any minor bleeding events during follow-up. Conclusions Catheter ablation in elderly atrial ifbrillation patients was safe and effective in general. Compared with traditional anticoagulation strategy, continuing warfarin or novel oral anticoagulants could reduce bleeding complications without increasing thromboembolism risk.
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Intravascular ultrasound (IVUS) is a commonly used technology in percutaneous coronary intervention (PCI) procedure. It has higher resolution and repeatability, and more importantly, it can make the vascular structure visiable which shows the plaque morphology and component, compared with traditional coronary angiography. Most researches indicated that IVUS can help doctors find out the optimized stent size, stent malapposition,stent disexpansion,and procedure complication, thus reduce the incidence of restenosis and stent thrombosis. IVUS has been widely applied in research about the predictors of PCI complication, these results benefit us to make better decision on PCI procedure. In this article, we reviewed the studies based on IVUS technology during the last 10 years and summrized according to restenosiss and stent thrombosis with BMS (bare metal stent) and DES (drug eluting stent) .
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Aiming at the cultivation goal and requirements as well as the current status of learning and applying medical statistics for medical doctoral students, a new idea of medical statistics teaching for medical doctoral students that combined theory with practice, science research and paper writing was proposed, with respect to improving the teaching content, teaching with clinical cases, enhancing the teaching material development, paying attention to the computer practice, and providing the writing standard for research papers.
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Objective To explore the impact of duration of catheter on incidences of PUR,UTI and reinserting catheter following LAVH,in order to determine the best time for withdrawing catheter.Methods 139 patients in keeping with the selected criteria were randomly divided into the non-catheter group,indwelling one-day and two-day group.The incidences of PUR,UTI and reinserting catheter were analyzed.Results There was significant difference in PUR and UTI among the three groups,and no difference was seen in reinserting catheter among them.Conclusions The catheter should be withdrawn as early as possible to prevent UTI.
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<p><b>OBJECTIVE</b>To investigate the role of reactive oxygen species (ROS) and the effect of vitamin E on proliferation of vascular smooth muscle cells (VSMCs) induced by homocysteine.</p><p><b>METHODS</b>DNA synthesis in the VSMCs cells was measured using [3H]-thymidine incorporation assay, and the cell number determined by trypan blue method. The level of ROS in the cells was determined using DCF-DA as the fluorescence probe.</p><p><b>RESULTS</b>Homocysteine promoted VSMC DNA synthesis, proliferation, and ROS production. Cysteine resulted in increased ROS production in VSMCs, but had no significant effect on DNA synthesis and cell proliferation. Catalase significantly inhibited ROS production induced by homocysteine, but did not significantly inhibited homocysteine-mediated proliferation of VSMCs. While alpha-tocopherol and beta-tocopherol both suppressed increased ROS production induced by homocysteine in VSMCs, only alpha-tocopherol significantly inhibited homocysteine-mediated VSMC proliferation.</p><p><b>CONCLUSION</b>ROS is not associated with VSMC proliferation, and vitamin E-induced suppression of VSMC proliferation is probably related to protein kinase C inhibition.</p>
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Animals , Rats , Antioxidants , Pharmacology , Cell Proliferation , Cells, Cultured , Homocysteine , Pharmacology , Muscle, Smooth , Cell Biology , Metabolism , Muscle, Smooth, Vascular , Cell Biology , Metabolism , Reactive Oxygen Species , Metabolism , Vitamin E , Pharmacology , alpha-Tocopherol , Pharmacology , beta-Tocopherol , PharmacologyABSTRACT
The paper set up a set of quality monitor measures from training important tache, beginning thesis, imposing advantage resource to strengthening practice ability to build a scientific quality monitor system for postgraduate training and ensure steadily improvement of the postgraduate training quality.
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This article reviewed the reform of the graduate student course study mode in Capital Medical University(CCMU),which included three aspects:the problem of course study,the measures of course study reform and the effect of course study reform.Then,it put forward some new opinions about the reform of course study in the future.
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With the advancement of society and development of medicine,how to improve the humanistic quality of medical graduate students becomes an important subject for medical graduate student education.Graduate school of Capital Medical University takes a series of effective measure to improve humanistic quality of medical graduate student in these years,and try hard to make students become persons with humanistic ability in the graduate education.
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The author has explored the cultivation mode of medical postgraduates which fits our country need and scientifically adopted the different cultivation mode for postgratuates of different degree and level to find out the cultivation mode that suits medical postgraduate of our university and lay a good basis for cultivating excellent doctors.
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This article reviewed the experience of the reform of the graduate student course system in Capital Medical University(CCMU),which included three aspects:the reform of course setting,the reform of course management rule and the reform of course management means.Then,it gives some new opinions about the reform of course system in the future.
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<p><b>OBJECTIVE</b>To investigate the effect of negative charge aerosol (NCA) on the treatment of burn wound.</p><p><b>METHODS</b>Patients with superficial or deep partial thickness burn only were enrolled in the study, and they were randomly divided into trial group (T, including 180 cases of superficial thickness burn and 100 cases of deep partial thickness burn), control group (C, including 30 cases with superficial thickness burn and 30 with deep partial thickness burn), and self control group (SC, including 10 cases with superficial thickness burn and 10 with deep partial thickness burn). The patients in T and SC groups were treated with NCA for 1.5 hours, 1-2 times a day, from 6 postburn hour (PBH) to 2 postburn day (PBD), while those in C group received conventional treatment. For those in SC group, some of the wounds were covered with sterile schissel, while other wounds without schissel covering. The general changes in the wounds during NCA treatment were observed, and bacterial culture before and after NCA treatment was performed. The healing time was recorded and the blood biochemical parameters were determined. Rat model with deep partial thickness scald was established, and the rats were also divided into T and C groups, and received treatment as in human. Tissue samples were harvested from the wounds of rats in the 2 groups before and 1, 2, 3 weeks after treatment for pathological examination.</p><p><b>RESULTS</b>There was no infection and little exudation in the patients in T group. No bacteria were found in the wound before and after NCA treatment. The healing time of the wounds of patients with superficial and deep partial thickness burn in T group was 6.3 +/- 1.6 d and 15.1 +/- 3.1 d, respectively, which was obviously shorter than those in C group (11.3 +/- 1.4 d and 21.2 +/- 1.4 d, P < 0.01). In SC group, the healing time of those with sterile schissel coverage was also significantly shorter than those without covering (P < 0.01). There was no obvious change in the liver and kidney functions and blood biochemical parameters among the patients. Pathological examination showed that the skin structure was almost recovered in the rats in T group 3 weeks after treatment, while those in C group was not.</p><p><b>CONCLUSION</b>Negative charge aerosol is safe and effective in promoting wound healing of the patients with partial thickness burns.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Rats , Young Adult , Aerosol Propellants , Therapeutic Uses , Burns , Pathology , Therapeutics , Disease Models, Animal , Rats, Wistar , Wound HealingABSTRACT
Objective To investigate the way of pacemaker implantation in 127 elderly patients over 80 years old to reduce postoperative complications and improve the life quality. Methods One hundred and twenty-seven patients over 80 years old had the dual chamber pacing in 95 cases(74. 8%, including tri-chamber pacing) and the single ventricular pacing in 32 cases (25. 2%). Cephalic veins were used primarily in all patients with modified methods. The safe fixation of pacing leads were emphasized not only in the heart but also in the site of pacemaker pocket. The pacemaker package was made prior to the leads insertion in order to have enough time for stopping bleeding. It was necessary for some cases with diffused bleeding to use electric coagulation. All patients were told to get out of bed in the operating day or the day after procedure. Results Cephalic vein was well exposed. The successful rates of implanting pacing leads directly through cephalic vein were 92. 0% and 81. 5% in the single chamber and dual chamber patients, respectively. The overall complications observed in 5 cases(3. 9%) were pocket hematoma formation in 3 cases (2. 4%), cardiac tamponade in 1 case (0.8%), and disconnection of pacemaker with lead in 1 case (0.8%). There were no hemothorax, infection and lead dislodgement. Conclusions Insertion of pacing lead through cephalic vein is important, especially for the advanced aged patients. This operation can decrease the complications of subclavian vein puncture. Leads dislodgement are mainly due to the inadequate skill of operator, not to the patient s early activity out of bed. Appropriate way for stopping bleeding is the key to protect the patients from pacemaker pocket effusion and hemotama.
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Objective To investigate the feasibility of exposing cephalic vein with horizontal incision on the chest and the successful rate of implanting pacing leads using guide wire and split sheath. Methods Right cephalic vein was separated with horizontal incision on the right lateral upper part of chest in 220 patients with permanent pacing indication. The pacing lead was advanced through the cephalic vein directly or by using a guidewire and a split sheath if the direct approach was unsuccessful. The subclavian venous puncture through the incision was used finally to implant the endocardial lead when the cephalic approach failed. All pacemakers were placed in the subcutaneous package at the inner part of the incision. Results Cephalic vein was well exposed with horizontal incision. Additionally, it is safe and convenient to puncture the subclavian vein through this incision. The successful rate of implanting pacing leads directly through cephalic vein was only 71% with single lead and 58% with dual pacing leads, respectively. However, it increased to 94% with single lead and 88% ( P