Clinical characteristics and prognostic analysis of female patients with Stanford type B aortic dissection / 中华心血管病杂志

Objective: To explore the clinical characteristics and prognostic factors of female patients with Stanford type B aortic dissection. Methods: This is a single-centre retrospective study. Consecutive patients diagnosed with Stanford type B aortic dissection in General Hospital of Northern Theater Command from June 2002 to August 2021 were enrolled, and grouped based on sex. According to the general clinical conditions and complications of aortic dissection tear, patients were treated with thoracic endovascular aortic repair, surgery, or optimal medication. The clinical characteristics and aortic imaging data of the patients at different stages were collected, adverse events including all-cause deaths, stroke, and occurrence of aortic-related adverse events were obtained during hospitalization and within 30 days and at 1 and 5 years after discharge. According to the time of death, death was classified as in-hospital death, out-of-hospital death, and in-hospital death was divided into preoperative death, intraoperative death and postoperative death. According to the cause of death, death was classified as aortic death, cardiac death and other causes of death. Aortic-related adverse events within 30 days after discharge included new paraplegia, post-luminal repair syndrome, and aortic death; long-term (≥1 year after discharge) aortic-related adverse events included aortic death, recurrent aortic dissection, endoleak and distal ulcer events. The clinical characteristics, short-term and long-term prognosis was compared between the groups. Logistic regression analysis was used to explore the association between different clinical factors and all-cause mortality within 30 days in female and male groups separately. Results: A total of 1 094 patients with Stanford type B aortic dissection were enrolled, mean age was (53.9±12.1) years, and 861 (78.7%) were male and 233 (21.3%) were female. (1) Clinical characteristics: compared with male patients, female patients were featured with older average age, higher proportion of aged≥60 years old, back pain, anemia, optimal medication treatment, and higher cholesterol level; while lower proportion of smoking and drinking history, body mass index, calcium antagonists use, creatine kinase level, and white blood cell count (all P<0.05). However, there was no significant difference in dissection tear and clinical stage, history of coronary heart disease, diabetes, hypertension, and cerebrovascular disease between female and male patients (all P>0.05). (2) Follow-up result: compared with male patients, female patients had a higher rate of 30-day death [6.9% (16/233) vs. 3.8% (33/861), P=0.047], in-hospital death (5.6% (13/233) vs. 2.7% (23/861), P=0.027), preoperative death (3.9% (9/233) vs. 1.5% (12/861), P=0.023) and aorta death (6.0% (14/233) vs. 3.1% (27/861), P=0.041). The 1-year and 5-year follow-up results demonstrated that there were no significant differences in death, cerebrovascular disease, and aorta-related adverse events between the two groups (all P>0.05). (3) Prognostic factors: the results of the univariate logistic regression analysis showed that body mass index>24 kg/m2 (HR=1.087, 95%CI 1.029-1.149, P=0.013), history of anemia (HR=2.987, 95%CI 1.054-8.468, P=0.032), hypertension (HR=1.094, 95%CI 1.047-1.143, P=0.040) and troponin-T>0.05 μg/L (HR=5.818, 95%CI 1.611-21.018, P=0.003)were associated with an increased risk of all-cause mortality within 30 days in female patients. Conclusions: Female patients with Stanford type B aortic dissection have specific clinical characteristics, such as older age at presentation, higher rates of anemia and combined back pain, and higher total cholesterol levels. The risk of death within 1 month is higher in female patients than in male patients, which may be associated with body mass index, hypertension, anemia and troponin-T, but the long-term prognosis for both female and male patients is comparable.

The influence of homogeneous medical concept combined with focused nursing on the body function of postoperative colostomy patients with colorectal cancer and nursing evaluation / 中国实用护理杂志

Objective:To explore effect of homogeneous medical concept nursing mode combined with focused solution mode on self-efficacy and immunity function and nursing satisfaction analysis of patients with postoperative enterostomy of colorectal cancer.Methods:A total of 102 patients with colorectal cancer undergoing postoperative enterostomy admitted to Suining Central Hospital from December 2019 to December 2020 were selected and divided into control group and observation group according to random number table method, with 52 cases in observation group and 50 cases in control group. The control group received homogeneous medical concept nursing mode, and the observation group combined with the focused solution mode nursing intervention on this basis. The self-efficacy, immune function and nursing satisfaction of the two groups were compared.Results:The general self-efficacy of the observation group was higher than that of the control group ( χ2=2.61, P<0.05). After nursing, the stomato-related self-efficacy score of the observation group was 102.69 ± 12.37, which was higher than that of the control group (90.13±11.22). There was significant difference between the two groups ( t= 5.37, P<0.05). There was no significant difference in peripheral blood CD3+, CD4+ and CD4+/CD8+ and NK levels between 2 groups one day after surgery ( P>0.05). The levels of CD3+, CD4+ and CD4+/CD8+ and NK in peripheral blood of the observation group after nursing care were (67.21 ± 6.21)%, (67.22 ± 8.76)%, (2.65 ± 0.45)% and (19.50 ± 2.05)%, respectively, which were higher than those of the control group (60.32 ± 5.45)%, (60.21 ± 8.25)%, (2.41 ± 0.32)% and (15.62 ± 1.81)%. The differences were statistically significant ( t=5.95, 4.21, 3.11, all P<0.05). The total satisfaction rate of nursing in the observation group was 98.08% (51/52), which was higher than 84.00% (42/50) in the control group, and the difference was statistically significant ( χ2= 2.63, P<0.05). Conclusions:The application of homogenous medical concept nursing mode combined with focused solution mode in colorectal cancer postoperative enterostomy patients is helpful to improve patients' self-efficacy, enhance patients ′ immune function, and improve nursing satisfaction degree, which is worthy of further promotion in clinical practice.

One-year follow-up results of atrial fibrillation patients who undergoing transcatheter aortic valve implantation / 中华心血管病杂志

Objective: To investigate whether atrial fibrillation (AF) before transcatheter aortic valve implantation (TAVI) will affect the prognosis of patients post TAVI. Methods: This is a single center retrospective study. A total of 115 patients with severe aortic stenosis (AS) who were admitted to General Hospital of Northern Theater Command from May 2016 to November 2020 and successfully received TAVI treatment were included. According to absence or accompaniment of AF pre-TAVI, they were divided into AF group (21 cases) and non-AF group (94 cases). The patients were followed up for postoperative antithrombotic treatment and the occurrence of the net adverse clinical and cerebrovascular events (NACCE) at 12 months post TAVI, including cardiogenic death, readmission to hospital for heart failure, nonfatal myocardial infarction, ischemic stroke and severe bleeding (BARC levels 3-5). Univariate logistic regression was used to analyze the related factors of NACCE. Results: Among the 115 selected patients, age was (73.8±6.9) years, there were 63 males. And 21 cases (18.2%) were diagnosed as AFbefore TAVI. In terms of postoperative antithrombotic therapy, 48.9% (46/94) of the patients in the non-AF group received monotherapy and 47.9% (45/94) received dual antiplatelet therapy. In the AF group, 47.6% (10/21) received anticoagulants and 33.3% (7/21) received dual antiplatelet therapy. The proportion of patients in the AF group taking non-vitamin K antagonist oral anticoagulants (NOAC) was higher than that in the non-AF group (38.1% (8/21) vs. 2.1% (2/94), P<0.001). Patients in both groups were followed up to 12 months after TAVI. During the 12 months follow-up, the incidence of NACCE after TAVI was 14.3% (3/21) in the AF group, which was numerically higher than that in the non-AF group (6.4% (6/94)), but the difference was not statistically significant (P=0.441). The incidence of severe bleeding was significantly higher in the AF group than in the non-AF group (9.5% (2/21) vs. 0, P=0.032). Univariate logistic regression analysis showed that hypertension was associated with the risk of NACCE (OR=8.308, P=0.050), while AF was not associated with the risk of NACCE (P=0.235). Conclusion: The incidence of severe bleeding after TAVI is higher in patients with AF than in patients without AF prior TAVI, and there is a trend of increased risk of NACCE post TAVI in AF patients.

Application of Upper Arm Circumference and Calf Circumference in Screening and Diagnosis of Sarcopenia for Old Adults in Community / 中国康复理论与实践

Objective:To explore the correlation of upper arm circumference and calf circumference with muscle mass, and the screening effect and the cut-off values for low muscle mass and sarcopenia. Methods:From March to August, 2020, a total of 831 community-dwelling old people (≥ 60 years old) were recruited by using convenience sampling. Muscle mass and other body composition indicators were tested by body composition tester. The upper arm circumference, calf circumference, grip strength and gait speed were measured at the same day. Pearson cofficient was used to analyze the correlation of upper arm circumference and calf circumference with muscle mass, and receiver operation characteristic (ROC) curve was used to analyze the diagnostic effect of upper arm circumference and calf circumference on low muscle mass and sarcopenia, and the Youden index (YI) was used to determine the cut-off values. Results:Upper arm circumference and calf circumference were positively correlated with appendicular skeletal muscle mass (ASM) and skeletal mass index (SMI) (r = 0.6 to 0.8, P < 0.001). For diagnosing low muscle mass, the areas under the ROC curve (AUC) of upper arm circumference were 0.888 for male, 0.787 for female; and that of calf circumference were 0.933 for male, 0.854 for female, respectively. The cut-off values of upper arm circumference for low muscle mass were 26 cm for both male and female; and that of calf circumference were 34 cm for male and 33 cm for female, respectively. For diagnosing sarcopenia, the AUC of upper arm circumference was 0.902 for male, 0.744 for female; and that of calf circumference was 0.923 for male, 0.832 for female, respectively. The cut-off values of upper arm circumference and calf circumference for sarcopenia were 26 cm and 33 cm for both male and female. The AUC of combined diagnosis with age, upper arm circumference, calf circumference, grip strength and gait speed for low muscle mass and sarcopenia in males and females was all greater than 0.85. Conclusion:In the community old adults, upper arm circumference and calf circumference are positively correlated with muscle mass, and both indices can be used to diagnose low muscle mass and sarcopenia. multi-indices combination can improve the diagnosis effect of upper arm circumference in females.

Perioperative serious complications in patients undergoing transcatheter aortic valve replacement: a single-center experience / 中华心血管病杂志

Objective: To observe the incidence of perioperative severe complications in aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVR), and to explore the influence of the accumulated experience of the operators on the incidence of complications. Methods: This is a single-center retrospective study. Patients with AS who underwent TAVR from May 2016 to November 2020 in General Hospital of Northern Theater Command were included. The occurrence of severe complications during perioperative period was recorded. Severe complications included all-cause death, surgical transfer to thoracotomy, coronary artery occlusion, peripheral vascular approach complications, severe cerebrovascular events, moderate or above perivalvular leakage, valve displacement (implanted valve middle valve), pacemaker implantation, etc. In order to observe the influence of the accumulated experience of the operators on the occurrence of postoperative complications, the complications in each stage of the patients were counted and the bar chart was drawn with interval of every 30 patients. Results: A total of 119 patients were included, including 64 males and 55 females, the mean age was (73.9±6.9) years. The valve implantation was unsuccessful in 3 out of 119 patients (2.5%). There were 39 cases of severe complications during perioperative period, including 1 death (0.8%), 2 cases of thoracotomy (1.7%), 2 cases of coronary artery occlusion (1.7%), 8 cases of peripheral vascular approach complications (6.7%), and 1 case of new severe cerebrovascular event (0.8%), 3 cases of moderate or higher perivalvular leakage (2.5%), 8 cases of valve displacement leads to midvalvular implantation (6.7%), 14 cases of permanent pacemaker implantation due to new atrioventricular block (11.8%). The bar chart showed that the incidence of permanent pacemaker implantation and in-valve implantation did not significantly decrease with the accumulation of experience, while the incidence of other complications showed a decreasing trend after 30 cases. Conclusions: Most serious complications occurred in the early stage of TAVR in our center. The incidence of all cause death, coronary artery occlusion and peripheral vascular approach complications in the perioperative period post TAVR could be reduced in the TAVR center in the learning stage through the accumulation of procedure-related experience, but the incidence of pacemaker placement and the implanted valve within the valve dose not significantly decrease over time.

Five-year clinical outcomes of the second generation biodegradable polymer sirolimus-eluting stent (EXCROSSAL) in treating patients with de novo coronary lesions / 中华心血管病杂志

Objective: To evaluate the five-year safety and efficacy of the second generation biodegradable polymer sirolimus-eluting stent (EXCROSSAL) in treating patients with de novo coronary artery diseases. Methods: Patients with coronary artery disease (CAD)who were implanted with EXTROSSAL stents in CREDIT Ⅱ and CREDIT Ⅲ study were included. CREDIT Ⅱ was a randomized trial, and CREDIT Ⅲ was a single-arm study. From November 2013 to December 2014, 833 CAD patients with de novo coronary lesions implanted with EXTROSSAL stents were selected from 33 centers in China. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularization. Secondary endpoints was patient-oriented composite endpoint (PoCE), including all-cause death, all myocardial infarction, or any revascularization within 5 years post stenting and stent thrombosis according to Academic Research Consortium's (ARC) definition. Kaplan Meier method was used to calculate the incidence of TLF and PoCE within 5 years after operation. Univariate Cox regression analysis was used to analyze the impacts of diabetes, small vessel disease (vessel diameter ≤ 2.74 mm), lesion length ≥ 16.7 mm and multivessel disease on the incidence of TLF within 5 years after operation. Results: A total of 833 patients were included in this study including 579 males (69.5%), the age was (59.3±9.1) years. And 832 (99.9%) patients completed 5-year clinical follow-up. The incidence of TLF and PoCE in the 5-year follow-up were 10.6%(86/811) and 15.5%(126/811), respectively. Stent thrombosis occurred in 1.0%(8/811) of patients. Univariate Cox regression analysis showed that vessel diameter ≤ 2.74 mm (HR=3.20,95%CI 1.90-5.39,P<0.001), lesion length ≥ 16.7 mm (HR=1.88,95%CI 1.18-2.99,P=0.007) and multivessel disease (HR=2.44,95%CI 1.60-3.72,P<0.001) were related factors of TLF within 5 years after operation. Conclusion: EXCROSSAL stent is effective and safe in treating CAD patients with de novo coronary lesions, with low incidence of TLF and PoCE within 5 years after operation.

A drug-eluting Balloon for the trEatment of coronarY bifurcatiON lesions in the side branch: a prospective multicenter ranDomized (BEYOND) clinical trial in China / 中华医学杂志(英文版)

BACKGROUND@#Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions.@*METHODS@#Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses.@*RESULTS@#At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was -11.3% (95% confidence interval: -16.3% to -6.3%, Psuperiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (-0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group.@*CONCLUSIONS@#In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov.

Characteristics of plasmids in KPC-2-producing Serratia marcescens / 中华微生物学和免疫学杂志

Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.

The clinical, angiographic and percutaneous coronary intervention characteristics in young patients with chronic total occlusion / 中国介入心脏病学杂志

Objective To investigate the characteristics in clinical, angiographic and percutaneous intervention (PCI) aspects of patients with chronic total occlusion (CTO) across different age groups, especially in young patients. Methods This study retrospectively analyzed 195 cases of CTO lesions admitted to the Department of Cardiology, General Hospital of Northern Theater Command from 2009 to 2014. These 1951 patients with CTO had undergone PCI and were divided into the young CTO group (≤44 years), the middle-aged CTO group (45-59 years) and the senior CTO group (≥60 years) according to their age. All patients had objective evidence of angina pectoris or myocardial ischemia before PCI. All the clinical features, coronary angiographic results, PCI related data and hospitalization outcome were all derived from our hospital PCI archives. Results There were significant differences in male ratio, body mass index, smoking and, drinking habit, creatinine clearance, triglyceride and LDL levels across the three groups (all P<0.05), and the highest values were found in the young patient group. The prevalence of unstable angina pectoris, hypertension and stroke were lowest in the young patient group (all P<0.05). The number of stenotic vessels and CTO occlusion time were less in young patients (all P <0.05). There was no significant difference among the three groups in CTO vascular distribution, coronary collateral Rentrop degree, CTO lesion length, CTO lesion diameter and CTO lesion characteristics (blunt CTO, CTO with bridging collateral and proximal branch of CTO lesion). There were no significant differences among the three groups in the volume of contrast agent used, CTO operation time, average stent number and average stent length (P>0.05). The procedural success rate of target vessels, races complete revascularization and mean stent diameter were highest in the young patient group (P<0.001).Conclusions Young CTO patients had typical risk factors of coronary heart disease with higher PCI success rate to target vessels and complete revascularization rate, which may be related to the short history of CTO.

Intervention treatment opportunity for non-IRA chronic total occlusions in patients with ST-segment–elevation myocardial infarction / 中国实用内科杂志

During primary percutaneous coronary intervention(PCI), a concurrent chronic total occlusion(CTO) is found in 12%-13% of patients with ST-elevation myocardial infarction(STEMI). Long-term benefits of CTO-PCI have been suggested; however, when is the best opportunity to take PCI for CTO is lacking. Our aim was to disscuss the best time for CTO-PCI with STEMI.

Treatment of complex coronary lesions by excimer laser coronary atherectomy: the experiences of single center / 中国实用内科杂志

OBJECTIVE: The aim of this study was to introduce the experience in treatment of acute ST segment elevation myocardial infarction(STEMI), saphenous vein graft(SVG), Chronic total occlusion(CTO),In-stent restenosis(ISR)and diffuse calcification lesions by excimer laser coronary atherectomy(ELCA). METHODS: Twenty-two patients were enrolled through our center from November 2016 to May 2017 and ELCA was performed on 22 lesions.The clinical and procedure endpoints were recorded. RESULTS: All the lesions were successfully crossed with laser catheterand and finally were performed by ELCA. Five cases(22.7%)with STEMI, ten cases(45.5%) with SVG lesions,five cases with ISR and other cases were CTO(4.5%) and Calcification(4.5%) lesions.Seventeen patients underwent balloon dilatation and successful implantation of drug-eluting stents(DES) and one patients was treated with drug-eluting balloon(DEB).the procedual and clinical success rates were 100%. At 6.6±2.7 months follow-up, there were no major adverse cardiac events(MACEs) and ELCA relatedcomplications recorded. Conclution This limited evdiences showed that treatment of complex coronary lesions by excimer laser coronary atherectomy may be a Safe and effective choice.It can be further popularized in complex coronary artery disease.

Sex-Related Differences in Short- and Long-Term Outcome among Young and Middle-Aged Patients for ST-Segment Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention / 中华医学杂志(英文版)

<p><b>Background</b>Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEMI is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI after percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, 1-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI.</p><p><b>Methods</b>This study retrospectively analyzed 1920 consecutive STEMI patients (age ≤60 years) treated with PCI from January 01, 2006, to December 31, 2012. A propensity score analysis between males and females was performed to adjust for differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was performed using a Cox proportional hazards model for 3-year NACE.</p><p><b>Results</b>Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P < 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2.12, 3.00], P < 0.001), high-density lipoprotein (1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P = 0.003), total cholesterol (4.98 ± 1.10 vs. 4.70 ± 1.15, t = -3.508, P < 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ± 18.03, t = -11.834, P < 0.001) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415-4.620, P = 0.002), hypertension (HR: 2.017, 95% CI: 1.138-3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI: 1.115-4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI: 0.437-0.894, P = 0.010) was independent protective factors of NACE.</p><p><b>Conclusions</b>Females with STEMI undergoing PCI have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians.</p>

Correlation between Sex and Prognosis of Acute Aortic Dissection in the Chinese Population / 中华医学杂志(英文版)

<p><b>Background</b>The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection (AAD) is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and long-term.</p><p><b>Methods</b>We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher's exact test, and continuous parameters were assessed with Student's t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis.</p><p><b>Results</b>A total of 884 patients (76.1% male, mean age 51.4 ± 11.8 years) were included in this study. There were fewer current smokers in female compared with male (17.5% vs. 67.2%, χ = 160.06, P < 0.05). The percentage of men who reported regular alcohol consumption was significantly higher than that in women (40.6% vs. 3.8%, χ = 100.18, P < 0.05). About 6.2% (55 of 884) of patients with AAD died before vascular or endovascular surgery was performed, 34.4% (304 of 884) of patients underwent surgical procedures, and 52.7% (466 of 884) and 12.8% (113 of 884) of patients received endovascular treatment and medication. Postoperative mortality similar (6.0% vs. 5.6%, respectively, χ = 0.03, P = 0.91) between men and women. Follow-up was completed in 653 of 829 patients (78.8%). Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme (ACE) inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age (odds ratios [OR s], 1.04; 95% confidence interval [CI], 1.01-1.07; P < 0.05), using of calcium-channel blockers (OR, 0.37; 95% CI, 0.18-0.74; P < 0.05), at discharge were independent predictors of late mortality, ACE inhibitors (OR, 1.91; 95% CI, 1.03-3.54; P = 0.04) was independent risk factor of late mortality.</p><p><b>Conclusions</b>In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term outcomes.</p>

Stratagy and prognosis of managing culprit vessel with two lesions undergoing primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To asess the primary percutaneous coronary intervention(PPCI) strategies of culprit vessel with two lesions in ST-segment elevation myocardial infarction(STEMI) patients and their prognosis.Methods The study retrospectively reviewed 418 patients with STEMI undergoing PPCI in the General Hospital of Shenyang Military Region from January 1st to June 30th in 2015 and 75 patients were included. According to whether the non-infarct-related lesions(N-IRL) being treated or not,the patients were identified as both IRL and N-IRL being treated(the research group,n=33) or the culprit lesion(or infarct-related lesion,IRL) being treated only(control group,n=42). The endpoint was major adverse cardiocascular event(MACE) which was a composite of death from cardiac causes,nonfatal myocardial infarction,target vessel revascularization(TVR) and hospitalization with angina or heart failure.Results The study endpoint betwwen the two groups showed no statistical differences in MACE(P=0.446). Multivariate Cox regression analysis showed that age, diameter of N-IRL were predictive factors of MACE. When N-IRL located beyond the culprit lesion, the research group showed higher risk of MACE(P=0.022) and TVR(P=0.039).Conclusions The non-infarct-related lesions of patients with STEMI undergoing PPCI may be left for conventional medical treatment. It may be reasonable to choose drug therapy for distal N-IRL and to choose PCI for proximal N-IRL.

A multicenter prospective registration study of iodixanol in the treatment of major adverse cardiovascular and cerebrovascular events and contrast-induced acute kidney injury, in Chinese patients with chronic kidrey disease undergoing percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To evaluate the infl uence of iodixanol on Chinese patients who had chronic kidney disease(CKD) and received percutaneous coronary intervention complicated with major adverse cardiovascular and cerebrovascular events(MACCE) and contrast-induced acute kidney injury(CIAKI). Methods From 30th October 2013 to 7th October 2015, 3042 patients were enrolled in 30 centers in China. Patients were monitored in the hospital for 3 days and followed-up at 1 month. Patients were divided into chronic kidney disease group(n=105)and non chronic kidney disease group (n=2937) according to whether the patient has chronic nephropathy or not.The primary end point was the incidence rate of MACCE (re-revascularization of target lesions, stroke, stent thrombosis,cardiac death and myocardial infarction) and CIAKI in hospital 72 hours after PCI. The secondary end point was the incidence rate from 72 hours to 30 days post-PCI. Resuits (1)There were obvious differences between the two groups in baseline demographic date including age,BMI,comorbidities of hypertension,congestive heart failure, dyslipidemia,diabetes mellitus,peptic ulcer,ischemic stroke,previous use of antihypertensive drugs, diuretics,lipid-regulating drugs,hypoglycemic drugs,antiplatelet drugs and anticoagulants(all P<0.05).(2) There were obvious differences the CKD and non-CKD groups in perioperative date including operative route,preoperative hydration volume,postoperative hydration volume,total hydration volume,degree of postoporation lesion stenosis, contrast media used and machine injection rate(all P<0.05).(3)There were signifi cant diff erences between the two groups in the percentage of prescription of β-blocker,lipid-regulating drugs and antiplatelet drugs after PCI(all P<0.05).(4)There was not statistical diff erences between two groups in MACCE incidence in hospital and from 72 hours to 30 days post-PCI(P>0.05). (5)There was not statistical diff erences between two the groups in CIAKI incidence in hospital (P>0.05). Conclusions Iodixanol had no signifi cant eff ect on the incidence of MACCE and CIAKI in Chinese chronic kidney disease patients and non-CKD patients who received PCI.

Six versus twelve months of dual antiplatelet therapy after implantation of biodegradable polymer sirolimus-eluting stent in elderly patients / 中国介入心脏病学杂志

Objective To explore the eff cacy and safety of 6-month and 12-month dual antiplatelet therapy(DAPT)after implantation of biodegradable polymer-drug eluting stents(BP-DES) in elderly patients. Methods This study was a subgroup analysis of the I-LOVE-IT 2 trial, which was a prospectively randomized study enrolling 2737 patients receiving either a BP-SES or a DP-SES in a 2:1 ratio. This studied further divided the patients who were randomized to the BP-SES group,whose age ≥ 65 year old, in a 1:1 ratio to receive a 6-month DAPT (n=319) or 12-month DAPT (n=308)randomly before the index PCI. The primary end point of this study was 12-month target lesion failure (FhF, including cardiac death,target vessel myocardial infarction and clinically indicated target lesion revascularization)and the secondary end points was 12-month net adverse clinical and cerebral events (including all-cause death, all myocardial infarction, stroke and all bleeding). Results Rates of TLF at 12 months were 7.1% in the 6-month DAPT group and 7.2% in the 12-month DAPT group (P=0.980). No diff erences were observed in the occurrence of events in the secondary endpoint at 12 months follow-up between the 6-month DAPT group and 12-months DAPT group(14.1% versus 13.0%, P=0.726). There were no signifi cant diff erences in stent thrombosis or bleeding complications between the 2 groups. Conclusions This study shorted that 6-month DAPT did not increase the risk of TLF at 12 months after implantation of DES in elderly patients compared with 12-month DAPT. Elderly patients are at high risk of bleeding and ischemic events and study show that 6-month DAPT would be adequate. These results need to be confi rmed with trials of scale in the future.

Comparison of the effect between percutaneous nephrolithotomy and retroperitoneal laparoscopic pyelolithotomy in the treatment of renal pelvis calculus / 新乡医学院学报

Objective To compare the clinical effect between percutaneous nephrolithotomy (PCNL) and retroperitoneal laparoscopic pyelolithotomy (RLP) in the treatment of renal pelvis calculus,so as to provide evidence for the treatment of renal pelvis calculus.Methods A total of 108 patients with renal pelvis calculus were selected from January 2012 to December 2016 in Zhumadian Central Hospital.The patients were divided into PCNL group (n =59) and RLP group (n =49) according to the therapeutic method.The operation time,intraoperative blood loss,intraoperative blood transfusion rate,operative success rate,stone clearance rate,postoperative hemoglobin reduction,postoperative analgesia time,postoperative hospitalization time and the incidence of complications were compared between the two groups.Results The success rate of operation in PC-NL group and RLP group was 94.9％ (56/59) and 100.0％ (49/49) respectively,there was no significant difference in the success rate of operation between the two groups (x2 =1.026,P ＞ 0.05).The stone clearance rate in PCNL group and RLP group was 94.9％ (56/59) and 98.0％ (48/49) respectively,there was no significant difference in the stone clearance rate between the two groups (x2 =0.140,P ＞ 0.05).The intraoperative blood transfusion rate in PCNL group and RLP group was 5.1％ (3/59) and 2.0％ (1/49) respectively,there was no significant difference in the intraoperative blood transfusion rate between the two groups (x2 =0.105,P ＞ 0.05).There was no significant difference in operation time and postoperative analgesia time between the two groups (P ＞ 0.05).Compared with the PCNL group,the blood loss and postoperative hemoglobin reduction were less,and the postoperative hospitalization time was shorter in the RLP group (P ＜ 0.05).The incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in PCNL group was 3.4％ (2/59),8.5％ (5/59)and 6.8％ (4/59) respectively;the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in RLP group was 8.2％ (4/49),4.1％ (2/49) and 4.1％ (2/49) respectively;there was no significant difference in the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage between the two groups (x2 =2.975,1.064,1.811;P ＞ 0.05).Conclusion The clinical effect of PCNL and RLP in the treatment of renal pelvis calculus is fairly,and their safety is high.However,RLP has the advantages of less intraoperative bleeding,quick postoperative recovery and short hospitalization time.

A Multicenter, Randomized, Double-Blind, and Placebo-Controlled Study of the Effects of Tongxinluo Capsules in Acute Coronary Syndrome Patients with High On-Treatment Platelet Reactivity / 中华医学杂志(英文版)

<p><b>Background</b>High platelet reactivity (HPR) during clopidogrel treatment predicts postpercutaneous coronary intervention (PCI) ischemic events strongly and independently. Tongxinluo capsules (TCs) are a traditional Chinese medicine formulation used as antiplatelet treatment. However, its efficacy against HPR is not known. The aim of the present study was to evaluate the effects of TCs in acute coronary syndrome (ACS) patients with HPR.</p><p><b>Methods</b>This multicenter, randomized, double-blind, placebo-controlled study prospectively analyzed 136 ACS patients with HPR who underwent PCI. The patients were enrolled from November 2013 to May 2014 and randomized to receive placebo or TCs in addition to standard dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. The primary end points were the prevalence of HPR at 30 days and the mean change in P2Yreaction units (PRUs) between baseline and 30 days. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups.</p><p><b>Results</b>Both groups had a significantly reduced prevalence of HPR at 30 days versus baseline, but the TC group, compared with the placebo group, had greater reduction (15.8% vs. 24.8%, P = 0.013), especially among patients with one cytochrome P450 2C19 loss of function (LOF) allele (χ= 2.931, P = 0.047). The TC group also had a lower prevalence of HPR (33.3% vs. 54.2%, t = 5.284, P = 0.022) and superior performance in light transmittance aggregometry and higher levels of high-sensitivity C-reactive protein (hsCRP), but the composite prevalence of ischemic events did not differ significantly (χ= 1.587, P = 0.208).</p><p><b>Conclusions</b>In addition to standard DAPT with aspirin and clopidogrel, TCs further reduce PRU and hsCRP levels, especially in patients carrying only one LOF allele. The data suggest that TCs could be used in combination therapy for ACS patients with HPR undergoing PCI.</p>

Relative risk factors of patients with coronary heart disease combined with renal artery stenosis / 解放军医学杂志

Objective To investigate the risk factors of atherosclerotic renal artery stenosis (ARAS) in patients with coronary heart disease.Method Six hundred and seventy-seven patients with suspected or certainly diagnosed as coronary heart disease consecutively underwent selective coronary angiography and non-selective renal artery angiography during May to Sep.2016 in the Department of Cardiology of General Hospital of Shenyang Military Region.According to the degree of renal artery stenosis,the subjects were divided into renal artery normal group,renal artery slight stenosis group (renal artery stenosis ＜50％) and renal artery obvious stenosis group (renal artery stenosis ＞50％).Both univariate and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS.Results By analysis of clinical data,it was found that age,systolic blood pressure,pulse pressure and creatinine level were higher in patients with different degrees of renal artery stenosis than in renal artery normal group (P＜0.05).There were significant differences in different degrees of renal artery stenosis groups in female,hypertension,left main coronary artery (P＜0.05).The proportion of coronary double vessel lesions was higher in renal artery slight stenosis group than in renal artery normal group (P＜0.05).Age,pulse pressure and creatinine level were significantly higher in renal artery obvious stenosis group than in the other two groups (P＜0.05).Peripheral vascular disease,left main coronary artery disease,single coronary artery and three vessel disease were significantly higher than that in other two groups (P＜0.05).The incidence of renal artery obvious stenosis was 18.9％ in patients with renal artery obvious stenosis,and was 16.7％ in renal arteries slight stenosis group.By univariate and multivariate Logistic regression analysis,age,female,peripheral vascular disease,and multivessel coronary artery disease were independent risk factors for ARAS.Conclusion Renal artery angiography should be routinely performed for patients with coronary artery disease undergoing coronary angiography to identify ARAS,especially for elderly and female patients associated with peripheral vascular disease.

Correlation between microalbuminuria and short-term outcome in patients with acute ischemic stroke / 国际脑血管病杂志

ObjectiveTo investigate the relationship between microalbuminuria (MAU) and short-term outcome in patients with acute ischemic stroke.MethodsThe consecutive patients with acute ischemic stroke admitted to hospital were enrolled prospectively.The first urine specimen was taken on the following morning after admission for detecting urine albumin/creatinine ratio (UACR).UACR 30-300 mg/g was defined as MAU positive.Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin Scale (mRS) was used to evaluate functional outcome at discharge, and good outcome was defined as mRS score of 0 to 2.ResultsA total of 244 patients with acute ischemic stroke were enrolled, including MAU positive in 53 patients (27.12%), and poor outcome in 67 patients (27.50%).Univariate analysis showed that age, baseline NIHSS score, systolic blood pressure, fasting blood glucose, globulin, D-dimer, white blood cell count, neutrophils, and the proportions of ischemic heart disease in patients of the MAU positive group were significantly higher than those of the MAU negative group (all P<0.05).Multivariate logistic regression analysis showed that MAU (odds ratio [OR] 1.520, 95% confidence interval [CI] 1.151-1.794;P=0.031), baseline NIHSS score (OR 1.570,95% CI 1.357-1.808;P<0.001) were the independent risk factors for short-term poor outcome in patients with acute ischemic stroke.ConclusionsThe incidence of MAU is high in patients with acute ischemic stroke.MAU positive can be used as one of the independent predictors of short-term poor outcome in patients with acute ischemic stroke.