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Objective:To examine the effects of heart rate control during hospitalization on short-term prognosis of heart failure in elderly patients.Methods:As a prospective study, 150 elderly patients with heart failure were selected from the Department of Geriatrics, Qilu Hospital of Shandong University.The subjects were divided into an experimental group and a control group by digitally generated random numbers, with 75 individuals in each group.Both groups received conventional anti-heart failure therapy during hospitalization, but patients from the control group had doses of heart rate control drugs adjusted every 2-4 weeks, with no special requirement for the heart rate before hospital discharge.In contrast, patients from the experimental group were given heart rate control drugs with timely dose adjustment to achieve more proactive heart rate control, aiming for a rate <70 beat/min, as long as heart failure symptom improvement and good volume management could be maintained.Values of cardiac function indexes were compared between the two groups at discharge and 6 months after discharge.Heart failure readmission rates within 6 months, cardiovascular disease mortality rates and the incidences of composite endpoint events after readmission due to heart failure aggravation were compared between the two groups.Treatment safety was also evaluated.Results:There was no statistical difference in blood pressure, heart rate, N-terminal pro-B-type natriuretic peptide(NT-pro-BNP), left ventricular ejection fraction(LVEF), left ventricular end systolic diameter(LVESD), or left ventricular end diastolic diameter(LVEDD)between the two groups at admission( P>0.05), and there was no statistical difference in the average length of hospitalization between the two groups( P>0.05). The experimental group had a lower average heart rate and diastolic pressure than the control group at discharge and 6 months latter[at discharge: (61.6±4.2)beat/min(1 mmHg=0.133 kPa) vs.(78.0±7.1)beat/min, (62.1±10.4)mmHg vs.(66.1±10.2)mmHg; at 6 months: (64.7±12.1)beat/min vs.(71.8±11.2)beat/min, (62.8±11.2)mmHg vs.(68.6±10.2)mmHg; P<0.05 or P<0.01]. NT-pro-BNP in the experimental group was significantly lower than that in the control group at discharge[(1 706±1 408)ng/L vs.(2 806±3 812)ng/L, P<0.05]. The absolute values of changes in LVEF(ΔLVEF), LVESD(ΔLVESD)and LVEDD(ΔLVEDD)after 6 months in the experimental group were significantly higher than those in the control group[ΔLVEF: (0.08±0.09) vs.(0.02±0.09), P<0.05; ΔLVESD: (-5.82±7.44)mm vs.(-1.63±6.07)mm, P<0.01; ΔLVEDD: (-2.76±5.52)mm vs.(-0.86±4.44)mm, P<0.05]. The rate of readmission and the incidence of composite endpoint events within 6 months in the experimental group were significantly lower than those in the control group[21.3%(16 cases) vs.36.0%(27 cases), P<0.05]; 25.3%(19 cases) vs.44.0%(33 cases), P<0.05.There was no significant difference in all-cause mortality between the two groups( P>0.05). Conclusions:For elderly patients with heart failure, proactive active heart rate control during hospitalization and a rate <70 beat/min before discharge will improve cardiac function indexes and lower the rate of readmission with exacerbation of heart failure, cardiovascular disease mortality and the incidence of composite end-point events after readmission.This strategy has good safety and is beneficial for short-term prognosis.
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Comprehensive unit-based safety program(CUSP)is a project aimed at improving the patient safety culture and promoting the safety of patients. As a mature patient safety practice tool, it has carried out various successful research practices in the United States. This article summarizes the contents of the CUSP toolkit and reviews the domestic and international application status of CUSP, then discusses the application value and application space of CUSP in China, in order to provide new ideas for the development of the localized patient safety practice.
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Objective To induce the immunoincompetence of T cells to oxidized-low density lipoprotein(ox-LDL)in vitro,in order to prevent immune injuries in atherosclerosis(AS)and to find new strategies to prevent AS.Methods Monocytes were separated from peripheral blood to induce dendritic cells (DC).DCs were treated with LPS(30 ng/m1),ox-LDL(10μg/m1)and LDL(10μg/m1)for 48 h,respectively.Then DCs were mixed with allogeneic T lymphocytes to earry out mixed lymphoeytes reaction (MLR).CTLA4Ig in different concentrations was added into the MLR of ox-LDL group.MTr method was used to assay the proliferation of T cells.The CD25 expression and apoptosis of T cells in MLR were tested by flow cytometry.And the excretion of IL-2,IFN-γ and IL-4 were assayed by ELISPOT method.Results SI of the ox-LDL group was higher than that of the LDL group significantly(DC:T=1:5,1.6717±0.3152vs 1.4250±0.2874.P<0.05;DC:T=1:10,1.5458±0.2748 vs 1.3352±0.2991,P<0.05),and CTLA4Ig inhibited the SI of the ox-LDL group in dose-dependence(CTLA4Ig 1.25μg/ml,0.96±0.30 vs μg/ml 1.29±0.28 vs 1.64±0.33 P<0.05).CTLA4Ig caused the decrease of CD25 expression(CTLA4Ig 1.25 μg/ml,11.26±0.58 vs 14.25±1.02,P<0.05;CTLA4Ig 10μg/rnl 8.42±0.45,P<0.01)and induced apoptosis of T cells in MLR(CTLA4Ig 1.25μg/ml,12.54±3.69 vs 6.09 4-2.24,P<0.05;CTLA4Ig 10μg/ml,26.87±5.06 VS 6.09±2.24,P<0.01).CTLA4Ig caused the decrease of ELISPOT counts of IL-2(CTLA4Ig 1.25μg/ml,386±42 VS 534±54,P<0.05;CTLA4Ig 10μg/rnl,230±27 VS 534±54,P<0.01)and IFN-γ(CTLA4Ig 1.25μg/ml,445±48 VS 672±46,P<0.05;CTLA4Ig 10μg/ml,193±39 VS 672±46,P<0.01),while that of IL-4 increased(CTLA4Ig 1.25μg/ml,401±32 VS 332±41,P<0.05;CTLA4Ig 10μg/ml,453±57 VS 332±41,P<0.05).Conclusion CTLA4Ig can induce T cens immunoin competence to ox-LDL in vitro by inhibiting T cells activation,inducing T cells apoptosis and TH 1/TH2 immune deviation.
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AIM: Recently,it is widely accepted that atherosclerosis(AS) is an auto-immune related disease and the oxidized-low density lipoprotein(ox-LDL) is the most important AS-related antigen.In order to prevent immune injuries in AS and find new strategies to prevent AS,the immune tolerance of T cells to ox-LDL in vitro was induced in this study.METHODS: Human monocytes were separated from peripheral blood to induce dendritic cells(DCs).DCs were treated with LPS(30 ?g/L),ox-LDL(10 mg/L) and LDL(10 mg/L) for 48 h.Then DCs were mixed with allogenic T lymphocytes to carry out mixed lymphocytes reaction(MLR).CTLA4Ig in different concentrations was added in the MLR of ox-LDL group.MTT method was used to assay the proliferation of T cells and expressed in stimulation index(IS).The CD25 expression and apoptosis of T cells in MLR were tested by flow cytometry.The excretion of IL-2,IFN-? and IL-4 was assayed by ELISpot method.RESULTS: SI in ox-LDL group was higher than that in LDL group significantly(P