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@# Objective To explore the predictive value of a simplified signs scoring system for the severity and prognosis of patients with coronavirus disease 2019 (COVID-19). Methods Clinical data of 1 605 confirmed patients with COVID-19 from January to May 2020 in 45 hospitals of Sichuan and Hubei Provinces were retrospectively analyzed. The patients were divided into a mild group (n=1 150, 508 males, average age of 51.32±16.26 years) and a severe group (n=455, 248 males, average age of 57.63±16.16 years). Results Age, male proportion, respiratory rate, systolic blood pressure and mean arterial pressure in the severe group were higher than those in the mild group (P<0.05). Peripheral oxygen saturation (SpO2) and Glasgow coma scale (GCS) were lower than those in the mild group (P<0.05). Multivariate logistic regression analysis showed that age, respiratory rate, SpO2, and GCS were independent risk factors for severe patients with COVID-19. Based on the above indicators, the receiver operating characteristic (ROC) curve analysis showed that the area under the curve of the simplified signs scoring system for predicting severe patients was 0.822, which was higher than that of the quick sequential organ failure assessment (qSOFA) score and modified early warning score (MEWS, 0.629 and 0.631, P<0.001). The ROC analysis showed that the area under the curve of the simplified signs scoring system for predicting death was 0.796, higher than that of qSOFA score and MEWS score (0.710 and 0.706, P<0.001). Conclusion Age, respiratory rate, SpO2 and GCS are independent risk factors for severe patients with COVID-19. The simplified signs scoring system based on these four indicators may be used to predict patient's risk of severe illness or early death.
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@#Obesity, sleep disorders, psychological stress, sedentary are modifiable cardiovascular risk factors. There is growing evidence that these risk factors may accelerate the chronic inflammatory process of atherosclerosis and lead to myocardial infarction. Studies on the role of immune cells and their related immune mechanisms in atherosclerosis have shown that the above modifiable risk factors can affect the hematopoiesis of the bone marrow system, affect the production of immune cells and phenotypes, and then affect the progress of atherosclerosis. This review will focus on the effects of modifiable cardiovascular risk factors on the progression of atherosclerosis through the role of the innate immune system.
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@#The Chinese Guidelines on Diagnosis and Management of Atrial Fibrillation, jointly formulated by the Chinese Society of Cardiology, Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering, was first released on June 15, 2023. The guidelines elaborate the various aspects of atrial fibrillation management, in which emergency management of atrial fibrillation is also an integral part. This article interpreted the emergency management part in the guidelines in detail by reviewing relevant literature.
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@#The Medical Administration and Hospital Administration of the National Health Commission released the "2021 China Chest Pain Center Quality Control Report" in January 2022. This report analyzes the construction ratio of chest pain centers in the second-level and above medical institutions nationwide in 2021 and the construction of standard and basic chest pain centers, mainly from the way of coming to the hospital, symptom onset to first medical contact time, door to wire time, reperfusion therapy ratio, in-hospital mortality, proportion of discharges with medication recommended by the guidelines and average length and cost of hospital stay of ST-segment elevation myocardial infarction patients to comprehensively describe the current status of the construction of the national chest pain centers. This article interprets the report in detail by reviewing relevant literature.
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@#Objective To explore the predictive value of a simple prediction model for patients with acute myocardial infarction. Methods Clinical data of 280 patients with acute ST-segment elevation myocardial infarction (STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group (n=34) and a survival group (n=246). Results Age, heart rate, body mass index (BMI), global registry of acute coronary events (GRACE), thrombolysis in myocardial infarction trial (TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group (P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE (0.816). The H-L test showed that the simple model had high accuracy in predicting death (χ2=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE (r=0.651, P<0.001) and coronary artery stenosis score (r=0.210, P=0.001). Conclusion The simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.
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@#The World Health Organization (WHO) released the WHO 2020 guidelines on physical activity and sedentary behaviour in November 2020. Compared with the 2010 WHO guidelines, this guideline has incorporated more extensive medical evidence and made targeted recommendations for special populations. The main content includes physical activity and sedentary behaviour advice for children and adolescents, adults, older adults, pregnant and postpartum women, people with chronic conditions, and disability. This review will interpret the 2020 WHO guidelines in detail.
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Objective To observe changes in mean platelet volume ( MPV) and investigate its possibility as a predictor and influence in patients with pulmonary artery hypertension associated with secundum atrial septal defect (ASD-PAH) . Methods 627 patients who suffered from secundum ASD were included in the study from the First Affiliated Hospital of Xinjiang Medical University Heart Center between January 2010 and March 2014. Patients were divided into two groups based on whether they had PAH or not (PAH group, n = 420 and non-PAH group, n = 207) . We also included 690 healthy people as a control group who received routine body check up at the same time. Examinations including complete blood count, serum biochemistry and ECG were done. Right heart catheterization examination was performed in patients who suffered from secundum ASD. Results The MPV was significantly higher in secundum ASD patients than in the control group [ (9. 4 ± 1. 6) fl vs. (8. 9 ± 1. 5) fl, P ﹤ 0. 001] . No significant difference was observed in MPV between PAH group and non-PAH group (P = 0. 268) . In univariate and multivariate logistic regression analysis, age ( OR 1. 401, 95% CI 1. 087 to 1. 806, P = 0. 009), RV diameter (OR 1. 101, 95% CI 1. 026 - 1. 181, P = 0. 008) and ASD defect diameter (OR 1. 064, 95% CI 1. 013 - 1. 118, P = 0. 013) were associated with ASD-PAH. Conclusions Our study demonstrated that age, RV diameter and ASD defect diameter were associated with ASD-PAH. Platelet activation exists in ASD-PAH, but this may not be the precipitating cause that contribute to the pathogenesis of ASD-PAH. MPV at admission does not predict the risk of PAH in patients with secundum ASD.
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<p><b>OBJECTIVE</b>To explore the value of mean platelet volume (MPV) and Gensini score on predicting short-term prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) post emergency percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>From September 2011 to June 2013, 102 consecutive hospitalized STEMI patients undergoing emergency PCI were included. All patients routine blood test was made immediately after admission, and Gensini score was calculated according to the results of coronary angiography. Incidence of major adverse cardiac events (MACE) during hospitalization and 6 months after PCI was observed.</p><p><b>RESULTS</b>MPV, Gensini score and percent of coronary artery three vessel lesions were significantly higher in MACE patients than in patients without MACE(P < 0.05 or 0.01). Area under the curve (AUC) of MPV plus Gensini score for predicting in hospital MACE and at 6 months post PCI was 0.836 (95%CI:0.706-0.966, P = 0.003) and 0.718 (95%CI:0.571-0.866, P = 0.006) , respectively. Kaplan-Meier survival analysis showed that incidence of without MACE at 6 months post PCI was significantly lower in patients with high MPV (>10.65 fl) than in patients with low MPV ( ≤ 10.65 fl) at admission (log-rank = 4.272, P = 0.039), and in patients with high Gensini score (>89) than in low Gensini score ( ≤ 89) (log-rank = 7.355, P = 0.007) at admission.</p><p><b>CONCLUSIONS</b>High MPV and Gensini score are associated with lower MACE during hospitalization and at 6 months after PCI in acute STEMI patient. These two parameters could thus be used to predict short-term MACE in STEMI patients post PCI.</p>
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Humans , Anterior Wall Myocardial Infarction , Therapeutics , Coronary Angiography , Hospitalization , Mean Platelet Volume , Percutaneous Coronary Intervention , Prognosis , Treatment OutcomeABSTRACT
Objective To evaluate the effectiveness of ultrafiltration in acute heart failure syndrome(AHFS).Methods Da-tabases including PubMed,WanFang and CBM were searched to collect RCTs on ultrafiltration in AHFS.Two reviewers independ-ently screened literature according to the inclusion and exclusion criteria,extracted data,and evaluated the methodological quality of the included studies.Then the Meta-analysis was conducted using RevMan5.3.Results A total of 14 trials involving 755 patients were included.The results of Meta-analyses showed that ultrafiltration was not associated with significantly decreased risk of all-cause mortality(RR=0.95,95%CI :0.65 to 1.38,P =0.77),rehospitalization(RR =0.78,95%CI :0.49 to 1.24,P =0.29)and change in serum creatinine(WMD = 0.02 mg/dL,95%CI :- 0.18 to 0.21,P = 0.87 ).However,there was significantly more weight loss(WMD =1.32 kg,95%CI :0.29 to 2.35,P =0.01)and net fluid removal(WMD =1.27 kg,95%CI :0.43 to 2.12,P =0.003)in the ultrafiltration group.Conclusion For patients with AHFS,ultrafiltration is effective in reducing fluid retention,with no significant benefits in renal function preservation,mortality and rehospitalization.
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Objective: To study the predictive value of combination scores of leukocyte and platelet counts (COL-P) for in-hospital mortality in patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) treatment. Methods: A total of 660 STEMI patients with emergent PCI in our hospital from 2009-11 to 2013-08 were retrospectively studied. The patients were divided into 3 groups according to COL-P scores: COL-P0 group,n=283, COL-P1 group,n=319 and COL-P3 group,n=58. The relationship between the in-hospital mortality and COL-P scores was analyzed among different groups. Results: There were 88/660 in-hospital death. The patients in death group had the higher white blood cell count and lower platelet count than those in survival group, bothP<0.01. Logistic regression analysis indicated that compared with COL-P0 group, the COL-P scores at COL-P1 level (OR 4.346, 95% CI 2.134-8.850,P<0.001) and COL-P2 level (OR 10.126, 95% CI 4.061-25.250,P<0.001) were the independent risk factors for in-hospital death in STEMI patients after emergent PCI. The in-hospital mortality in COL-P0, COL-P1 and COL-P2 groups were at 4.9%, 15.4% and 43.1% respectively, allP<0.001. Conclusion: COL-P score was useful for predicting the in-hospital mortality in STEMI patients after emergent PCI, while the long term mortality estimation should be further studied.
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Objective To evaluate in vitro transfection of anti-nuclear factor-κB ( NF-κB) ribozyme gene to human umbilical vein endothelial cells (HUVECs) and human aortic smooth muscle cells (HASMCs) mediated by recombinant adeno-associated virus 9 carrying enhanced green fluorescent protein gene ( rAAV9-EGFP-R65 ) and to study their effects on cell proliferation and NF-κB P65 expression.Methods HUVECs and HASMCs were respectively transfected with rAAV9-EGFP-R65 at different multiplicity of infection ( MOI=1 ×105 , 1 ×106 and 1×107).The expression of EGFP was observed with fluorescence microscopy .Flow cytometry was performed to evaluate the transfection efficiency .Alamar Blue assay was used to measure the proliferation of the transfected cells.Western blot was used to detect NF-κB P65 expression .Results The fluorescence intensity was enhanced along with an increased MOI and an extended time of transfection .HUVECs and HASMCs transfected with rAAV 9-EGFP-R65 began to express EGFP at 24 h after transfection .The expression peak appeared on the sixth day in HUVECs, and the fifth day in HASMCs.The efficiencies of transfection in HUVECs at MOI of 1×105, 1×106 and 1×107 on the sixth day were (1.40±1.20)%, (12.30±1.35)%and (52.80±2.05)%, respectively.The trans-fection efficiencies of HASMCs on the fifth day were (5.30±1.04)%, (18.30±2.24)% and (52.40±3.21)%at MOI of 1×105 , 1×106 and 1×107 .Cell growth and morphology were not affected by transfection .Alamar Blue assay confirmed that there was no significant difference in the absorbance value between the transfected cells and two types of control cells .Western blot assay showed that the expression of NF-κB P65 was decreased by the trans-fection of rAAV9-EGFP-R65 in HUVECs and HASMCs .Conclusion rAAV9-EGFP-R65 can be efficiently trans-fected into two types of human vascular cells .It shows no inhibitory effects on cell proliferation , but can repress NF-κB P65 expression.