Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS / 生物医学与环境科学（英文）

OBJECTIVE@#We aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS.@*METHODS@#Enrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo'ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.@*RESULTS@#According to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death ( vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization ( vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs.@*CONCLUSION@#Compared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.

Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction / 中华内科杂志

Objective To explore the risk factors and prognoses of new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI).Methods A total of 468 patients with AMI were admitted into Beijing Anzhen Hospital for emergency pereutaneous coronary intervention (PCI).According to the NOAF occurred during hospitalization,the patients were divided into two groups:the NOAF (n=37) group and the non-NOAF (n=431) group.Parameters including general clinical conditions,coronary lesions,echocardiography,biochemical markers,C-reactive protein (CRP),N-terminal pro-brain natriuretic peptide (NT-pro-BNP),and myocardial markers were collected.In-hospital mortality and incidence of in-hospital main adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two groups.Logistic multivariate regression analyses were performed for the association between the risk factors and NOAF.Results The incidence of NOAF was 7.9％ in AMI patients undergoing emergency PCI.There were no significant differences in door-to-balloon time,weight,platelet counts,baseline serum creatinine (SCr),postoperative SCr,triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,uric acid,glycosylated hemoglobin A1c,preoperative medication,number of lesions,thrombus aspiration,location of myocardial infarction,and history of hypertension,diabetes,peripheral vascular disease and old myocardial infarction between the two groups.The percentage of women was in the NOAF group (32.4％ vs.16.7％,P＜0.05) and subjects in this group were significantly elder than those in the non-NOAF groups [(66±10) years vs.(571±11) years,P＜0.001].Moreover,the levels of no-reflow rate (40.5％ vs.12.6％,P＜0.001),CRP [25.2 (15.43,29.97)mg/L vs.5.21 (2.33,16.98) mg/L,P＜0.001],white blood cell counts [(11.19±3.44)× 109 vs.(9.91 ±3.23)× 109,p=0.022],NT-pro-BNP [(652.6± 108.8) ng/L vs.(258.3±105.9) ng/L,P＜0.001],and troponin I (TnI) [20.41(1.78,87.89) μg/L vs.7.72(1.29,36.39) μg/L,P=0.006] were significantly higher in the NOAF group than in the non-NOAF group,while left ventricular ejection fraction [(47.70± 7.34)％ vs.(53.35 ± 8.05)％,P＜0.001],and hemoglobin [137.0(125.5,146.0) g/L vs.144.0(133.0,156.0) g/L,P=0.042] were significantly lower in the NOAF group than the non-NOAF group.Patients in the NOAF group had significantly longer hospital stay than those in the non-NOAF group [(8.7± 5.6) d vs.(6.0± 2.3) d,P=0.007].The in-hospital mortality (8.1％ vs 1.4％ P=0.004) and the incidence of in-hospital MACCE (37.8％ vs.7.7％,P＜0.001) in the NOAF group were significantly higher than those in the non-NOAF group.Logistic multivariate regression analyses showed that age (HR 1.083,95％CI 1.028-1.141,P=0.003),CRP (HR 1.116,95％CI 1.049-1.187,P=0.001),NT-pro-BNP (HR 1.463,95％CI 1.001-4.064,P=0.001) and no-reflow (HR 4.388,95％CI 1.006-19.144,P=0.049) were independent predictors of NOAF after AMI.Conclusions Age,elevated levels of CRP,NT-pro-BNP,and the absence of no-reflow are risk factors for incident NOAF in patients with AMI in hospital.

Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions / 中华医学杂志(英文版)

Background@#Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions.@*Methods@#From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.@*Results@#The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043).@*Conclusions@#In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.

Shenfu Injection () inhibits inflammation in patients with acute myocardial infarction complicated by cardiac shock / 中国结合医学杂志

<p><b>OBJECTIVES</b>To investigate the effect of Shenfu Injection (, SFI) on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock (CS) treated with and intra-aortic balloon pump (IABP).</p><p><b>METHODS</b>This study enrolled 60 patients with ST-segment elevation myocardial infarction (STEMI) complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention (PCI) were randomly divided into two groups by random number table with 30 cases in each group, one given Sfitreatment (100 mL/24 h), one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins (CRP), interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α). Major adverse cardiac and cerebrovascular events (MACCE) events were compared between patients of the two groups both in-hospital and in follow-ups.</p><p><b>RESULTS</b>The IABP support treatment times of patients in the IABP+Sfigroup were signifificantly shorter than the IABP group (52.87±28.84 vs. 87.45±87.31, P=0.047). In the patients of the IABP+Sfigroup, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP+Sfigroup was signifificantly lower than that in the IABP group (31.27±3.93 vs. 34.62±3.47, P=0.001). The increases in range of TNF-α in the patients of the IABP+Sfigroup were signifificantly lower than those of the IABP group (182.29±22.79 vs. 195.54±12.02, P=0.007). The increases in range of IL-1 in the patients of the IABP+Sfigroup were signifificantly lower than those of the IABP group (214.98±29.22 vs. 228.60±7.03, P=0.019). The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events (OR 0.973, 95% CI 0.890-0.987, P=0.014) in patients with STEMI and CS.</p><p><b>CONCLUSION</b>Patients with STEMI complicated by CS treated by IABP and Sfihad a reduced inflammatory reaction, a reduced dependence of CS on IABP and shortened the course of disease.</p>

Study of bacterial contamination associated with bandage contact lenses after photorefractive keratectomy / 国际检验医学杂志

Objective To evaluate the occurrence rate and agents of the bacterial contamination of bandage contact lenses after photorefractive keratectomy(PRK) .Methods In a prospective study ,50 patients (100 eyes) underwent PRK .Conjunctival sac se‐creta were placed onto chocolate agar before PRK .All patients accepted bandage contact lenses and anti‐inflammatory drug therapy . Contact lenses and conjunctival sac secreta were placed onto chocolate agar after PRK .Corrected visual acuity ,intraocular pressure and corneal thickness were compared in the 2 groups .Results Among 100 pieces of cornea contact lens ,3 pieces (3% ) were tested positive for bacteria detection and bacteria were staphylococcus epidermis .All conjunctival sac secreta of preoperative and postoper‐ative were not detected bacteria ,postoperative eye infection was not found .Between the positive and negative groups ,tear secretion , may be related to cultivate positive correlation .Conclusion Bacterial contamination is possible when using bandage contact lenses after PRK ,specially for patients with less tear secretion .

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection / 老年心脏病学杂志（英文版）

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

Application value of blood culture combined with serum procalcitonin and CRP in diagnosing infectious fever patients / 国际检验医学杂志

Objective To evaluate the application value of the blood culture combined with the detection of serum procalcitonin and C-reactive protein(CRP)in diagnosing infectious fever patients.Methods The PCT and CRP detection results on the blood sampling day in 126 cases of fever with positive blood culture and 123 cases of fever with negative blood culture in the emergency department were retrospectively analyzed,and the two sets of data were compared and statistically analyzed by the SPSS 16.0 soft-ware.Results The positive rates of CRP and PCT in 126 cases of positive blood culture were 100% and 100%,the detection values were 26.9-256.8 and 0.25-98.6,the positive rates of CRP and PCT in 123 cases of negative blood culture 95.5% and 15.4% re-spectively,the detection values were 1 .2-126.8 and 0.02-0.98.The PCT and CRP detection values in the positive blood culture group were significantly higher than those in the negative blood culture group,the difference was statistically significant(P <0.01). Conclusion PCT and CRP can be served as the monitoring indicators for blood bacterial infections,the blood culture combined with PCT and CRP detection has the guidance significance for early diagnosing bacterial infection.

Effect of intracoronary tirofiban on coronary slow flow patients with acute myocardial infarction during primary percutaneous coronary intervention / 中华急诊医学杂志

Objective To investigate the effect of intracoronary application of tirofiban on coronary slow flow patients with acute myocardial infarction during primary percutaneous coronary intervention (PPC1).Method It was a retrospective analysis of 187 patients with acute myocardial infarction treated with PPCI in the emergency department of Beijing Anzhen Hospital enrolled in this study from January,2008 through January,2011.The patients divided into 2 groups in terms of intra-coronary administration of tirofiban (tirofiban group) and intra-coronary use of nitroglycerol (control group).Data were statistically analyzed by using SPSS 13.0 software.Categorical variables were analyzed using x2 test and continuous variables were compared by t test.Results Between two groups,there were no differences in preoperative systolic pressure (P =0.245),the rate of TIMI flow 3 (P =0.568) after PPCI and ST segment resolution (P =0.824),LVEF (P =0.275) and in-hospital mortality (P =0.502).Compared with tirofiban group,the systolic pressure was lower and the rate of using intra-aortic counter-pulsation was higher in control group.Although the incidence of slight bleeding in the control group was lower than that in the tirofiban group,no severe bleeding was observed in both groups.Conclusions The effect of intracoronary use of tirofiban was similar to that of nitroglycerol in terms of improving slow flow of coronary artery.It could safely and effectively reduce the incidence of the coronary slow flow in the patients after PPCI,but it produced a little impact on systolic pressure.It may be a better method of choice for AMI patient with low blood pressure.

C-reactive protein and non-valvula atrial fibrillation combining with thrombosis / 中华内科杂志

ObjectiveTo investigate the alteration of plasma C-reactive protein (CRP) count in patients with non-valvula atrial fibrillation combining thrombosis.MethodsA total of 154 patients with non-valvula atrial fibrillation were divided into thrombus group (n = 46) and non-thrombus group (n = 108)in accordance with transesophageal echocardiography (TEE) results.The concentration of CRP by scattering turbidimetry, D-dimer by immunoturbidmetry, left atrium diameter (LAd), fraction shortening (FS) and left ventricular ejection fraction (LVEF) by TEE or echocardiography were detected.Logistic multi-factors regression analysis was performed.ResultsThere were significant differences in CRP [(5.77 ± 6.37)mg/L vs (1.73 ±2.39)mg/L,P =0.003], LAd [(59.86 ± 10.70) mm vs (47.97 ± 13.19)mm,P ＜0.001]and LVEF[(58.75 ±8.28)％vs (64.10 ±6.75)％, P ＜0.001]between thrombus group and nonthrombus group.The results of logistic regression analysis found CRP ≥ 1.33 mg/L(OR 2.856, 95％ CI 1.235-6.600,P =0.014) and LAd≥54.5 mm(OR 4.236, 95％ CI 1.877-9.562,P =0.001) were independent risk factors of patients with non-valvula atrial fibrillation combining with thrombosis.ConclusionsCRP and LAd are independent risk factors for patients with non-valvula atrial fibrillation combining with thrombosis.Inflammation may involve with the formation of thrombosis.

Effects of TSP2-8 and CUB1+2 domains on secretion direction of von Willebrand factor-cleaving protease / 中国实验血液学杂志

This study was aimed to explore if the intracellular transportation direction of von Willebrand factor-cleaving protease (ADAMTS13, vWF-CP) after synthesis is determined by the carboxyl terminal TSP2-8CUB1+2 domains of ADAMTS13 and to decipher the relationship between the structure and function of ADAMTS13. The recombinant plasmids pcDNA3.1-ADAMTS13 and pcDNA3.1-delTSP2-8CUB1+2 ADAMTS13 were introduced into Madin-Darby canine kidney cells (MDCK) by lipofectamine-mediated DNA transfection. Positive cell clones gained after antibiotic-screening were grown on 6-well transwell filter units with a zeolite membrane in the middle layer. The conditioned culture media in both apical and basolateral wells were collected when cells reached confluency and the tight cell monolayer formed. ADAMTS13 proteases in the conditioned media were determined by Western blot, and the direction of ADAMTS13 secretion in polarized cells was comparatively analyzed. The results showed that Madin-Darby canine kidney cells stably expressing wild-type ADAMTS13 were grown on 6-well transwell filter units, then ADAMTS13 protease was only determined in the apical area of the transwell filter units by Western blot, but the recombinant ADAMTS13 protease was determined both in the apical and basolateral area of cells in the group of expressing TSP2-8CUB-1+2 domain-deleted ADAMTS13. It is concluded that the metalloprotease ADAMTS13 is sorted apically in polarized cells, and the carboxyl-terminal TSP2-8 and CUB1+2 domains of ADAMTS13 are important for the direction of ADAMTS13 protease transportation in the cells after being synthesized.

Analysis of the factor of effective thrombus aspiration on patients in primary percutaneous coronary intervention / 中华急诊医学杂志

Objective To find the factors lowering the rate of effective thrombus aspiration in patients with STsegment elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention(PCI). Method From January to December 2008 , a total of 226 AMI patients from Beijing Anzhen Hospital,treated with primary PCI to aspirate the thrombus from the infracted coronary artery via a cannula, were enrolled in a single center retrospective study. The criterion of successful thrombectomy (device success) was defined as the coronary blood flow of involved vessel after PCI resumed to greater than TIMI grade 1. One hundred seventy-eight patients were assigned to effective thrombus aspiration group, and 48 patients without improvement in coronary blood flow of involved vessel after PCI to control group. Data collected after PCI including the normalization of the elevated ST segment,the use of direct stent, ratio of no-flow/slow flow, intra-coronary administration of Tirofiban and the rate of thrombolysis in myocardial infarction (TIMI) flow grade 3 were analyzed with logistic analysis soas to find out the factors affecting the efficacy of thrombus aspiration. Results There were no significant differences in data before PCI between two groups ( P ＞0.05). Compared with the control group, the factors studied such as smoke, diabetes, the rate of pre-PCI TIMI flow grade 0,the post-PCI ratio of no-reflow/slow flow,and the intra-coronary administration of Tirofiban were fewer significantly in the effective thrombus aspiration group. And the rate of post-PCI TIMI flow grade 3, and the rate of direct stent were higher in the effective thrombus aspiration group. Logistic analysis showed that smoke ( OR = 1.551,95%CI: 1.018 ～ 2. 154, P = 0.012), diabetes ( OR = 1. 132,95%CI:0.276 ～ 3.562, P =0.044), and pre-PCI TIMI flow grade 0 OR = 0.544,95%CI:0.368 ～ 1.911,P = 0.035) were independent factors of effective thrombus aspiration. Conclusions Effective thrombus aspiration may improved the coronary blood flow to TIMI flow grade 3 after PCI and reduce the impaiment of myocardial perfusion, and the factors affecting the efficacy of thrombus aspiration should be paid more attention to and should be minimized to achieve the better clinical outcomes.

Influence of sex on the prognosis of acute ST elevated myocardial infarction after primary percutaneous coronary intervention / 中国综合临床

Objective To study the influence of sex on the prognosis in acute ST elevated myocardial in- farction(STEMI)patients after primary percutaneous coronary intervention(PCI).Methods :The risk factors, coronary angiography and prognosis in 478 males and 101 females with STEMl were compared.Results:Mortality of STEMI was significantly different in different age groups(P<0.01).The attack of the STEMI in women was 10 vears later than that of men(P<0.01),especially in those women whose age was over 71 years oId.The complica- tion ratio of hypertension and type 2 mellitus diabetes was higher in female patients than that in male(P<0.01). More multi-vessel lesions were found in female patients than those in male(P<0.01).The incidence of in-hospital mortality,pseudoaneurysm,haematoma Was significantly higher in females than in males(P<0.05.P<0.01).Con- clusions The in-hospital mortalitv and puncture complications in STEMI female patients treated with primary PCI are higher than male patients.

Diver CE versus Guardwire Plus for thrombectomy during primary angioplasty for inferior myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>In this randomized prospective single-center study, we compared the efficacy of adjunctive thrombectomy using Diver CE device (Linvatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) in patients with <12 h acute inferior myocardial infarction (AIMI) and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 to 1. The primary end point was the magnitude of ST-segment resolution after PCI.</p><p><b>METHODS</b>A total of 122 patients (61 in Diver CE group and 61 in Guardwire Plus group) were studied. The magnitude of ST-segment resolution, myocardial blush grade and slow flow or no re-flow 1 h after PCI were measured in study patients.</p><p><b>RESULTS</b>Baseline characteristics were similar between groups: age (59.6 +/- 14 years vs. 60.1 +/- 13 years), males (82% vs. 84%), diabetes (31% vs. 28%), previous coronary artery disease (25% vs. 23%), onset-to-angiogram (350 +/- 185 min vs. 345 +/- 180 min), and glycoprotein IIb/IIIa inhibitor use (11% vs. 13%, all P > 0.05). The magnitude of ST-segment resolution was also similar in these two groups: ST-segment resolution > 70% (57% vs. 59%, P > 0.05). Slow flow/no reflow rate (8% vs. 7%), TIMI flow grade 3 (95% vs. 97%) and myocardial blush grade 3 (70% vs. 72%) post PCI were not different in the groups (all P > 0.05). Left ventricle ejection fraction (0.54 +/- 0.12 vs. 0.53 +/- 0.11), death (3% vs. 3%), re-myocardial infarction (2% vs. 0) and target vessel revascularization (2% vs. 2%) at one month post PCI were comparable (all P > 0.05).</p><p><b>CONCLUSION</b>Efficacy of removing thrombus burden with Diver CE device or Guardwire Plus device was similar in patients with < 12 h acute inferior myocardial infarction.</p>

Diver CE versus Guardwire Plus for thrombectomy in patients with inferior myocardial infarction: a trial of aspiration of thrombus during primary angioplasty for inferior myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thrombolysis in myocardial infarction (TIMI) flow grade 0 to 1, and total occlusion of the proximal right coronary artery (= 3 mm in diameter) in a prospective randomized single-center study.</p><p><b>METHODS</b>The primary end point was the magnitude of ST-segment resolution (STR) (> 70%) measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization and stroke at 30 days.</p><p><b>RESULTS</b>A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60 +/- 14) years vs (60 +/- 13) years), male (82% vs 84%), diabetes (31% vs 28%), previous coronary artery disease (25% vs 23%), onset-to-angiogram ((350 +/- 185) min vs (345 +/- 180) min), and use of glycoprotein IIb/IIIa inhibitor (11% vs 13%). The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution > 70% (57% vs 59%; P > 0.05). Similar slow flow/no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively (P > 0.05). Myocardial blush grade 3 was similar (70% vs 72%; P > 0.05). Thirty-day clinical outcome was comparable (LVEF, 0.54 +/- 0.12 vs 0.53 +/- 0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P > 0.05, respectively).</p><p><b>CONCLUSIONS</b>Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery (= 3 mm in diameter) compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.</p>

Firebird sirolimus eluting stent versus bare mental stent in patients with ST-segment elevation myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction (STEMI). We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent (Firebird stent) and bare metal stent (BMS).</p><p><b>METHODS</b>Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss (LLL) at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events (MACE) at 6 months.</p><p><b>RESULTS</b>During one year period, 156 patients were randomized into the Firebird stent group (101 patients with an average age of 57.8 years) or the BMS group (55 patients with 59.7 years on average). Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up, mortality, target vessel revascularization (TVR) and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group (P < 0.05). Subacute thrombosis occurred in 1 patient in both groups, respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group.</p><p><b>CONCLUSION</b>Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.</p>

Surveillance of Antimicrobial Resistance in Staphylococcus spp and Enterococcus spp / 中华医院感染学杂志

OBJECTIVE To analyze the resistant rates of Staphylococcus spp and Enterococcus spp isolated from clinical infections to antibiotics,and to provide reference method for effective control infections of Staphylococcus.METHODS The Staphylococcus spp and Enterococcus spp were identified with VITEK-32 automicrobiology system(AMS) and GPI card,drug resistance was detected with VITEK-32 AMS and GPS-107 card.Laboratory data were analyzed by WHONET-5 statistic software.RESULTS Among 1 445 Staphylococcus spp and Enterococcus spp strains isolated from clinical samples,330 strains(22.8%) were Staphylococcus aureus,872 strains(60.3%) were coagulase negative Staphylococcus,213 strains(14.7%) were Enterococcus faecalis,and 30 strains(2.1%) were E.faecium.From S.aureus 223 strains(67.6%) were MRSA,718 strains(82.3%) of coagulase negative Staphylococcus were MRCNS.The detectable rates of MRSA and MRCNS in 2004 were 75.3% and(82.3%,) which were higher than those in 2003(48.4% and 78.4%).Neither strains of S.aureus nor strains of coagulase negative Staphylococcus were found resistant to vancomycin.MRSA and MRCNS resistant rates were found(higher) than MSSA and MSCNS.From the isolated strains of E.faecalis in 2004,the resistance rates to(ciprofloxacin,) nitrofurantoin,gentamicin-500,levofloxacin,and penicillin G were found higher than that in 2003.(E.faecium)(resistant) rates were found significantly higher than E.faecalis.CONCLUSIONS Staphylococcus spp and Enterococcus spp are the main pathogens leading to clinical infections.The findings of these(surveillance)(studies) will enhance our knowledge regarding the problem of antimicrobial resistance and will serve as a basis for future policies and practice styles.

Frequency of infarct-related artery with myocardial bridging in patients with ST-elevation myocardial infarction and its impact upon percutaneous coronary intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial bridging (MB) as a congenital condition with a reported frequency of 5% - 12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery (IRA) of patients with ST-elevation myocardial infarction (STEMI) and the impact upon percutaneous coronary intervention (PCI) remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI.</p><p><b>METHODS</b>The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events (MACE) (death, recurrent myocardial infarction, target lesion or vessel revascularization) between the MB patients and the non-MB patients.</p><p><b>RESULTS</b>A frequency of MB in the IRA of 46 patients (8.3%) was identified in this series; it was more common in patients > or = 65 years old (36/206) than in those < 65 years old (10/348) (17.5% vs 2.9%, P < 0.001). The trend of MB in the IRA was observed more frequently in women without significant difference than in men (10.2% vs 7.8%). TIMI grade III flow was achieved in 91.9% (509/554) of all patients following primary PCI, in 60.9% (28/46) of the MB patients and in 94.7% (481/508) of the non-MB patients respectively (P < 0.001). The in-hospital mortality was 4.7% (26/554) in this series including 13.0% (6/46) of the MB patients and 3.9% (20/508) of the non-MB patients (P < 0.001). A significant difference in 6 months MACE was seen between the MB patients (19%) and the non-MB patients (6.2%) (P < 0.001).</p><p><b>CONCLUSIONS</b>MB in the IRA is relatively common in elderly patients with STEMI with a more evident trend in women, suggesting that arteriosclerosis and plaque rupture occurs more easily in the proximal artery to MB than in younger patients. Poor TIMI grade flow in patients with MB in the IRA after primary PCI may contribute to a high in-hospital mortality rate (13%) and 6-month MACE (19%) in the MB patients.</p>