ABSTRACT
Objective@#To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China.@*Methods@#Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort.@*Results@#The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (β=0.88); history of chest pain (β value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (β=0.84); ≥60 years old (β=0.51) and ≥3 risk factors (β=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95%CI 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (P<0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95%CI 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (P<0.01).@*Conclusion@#The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.
ABSTRACT
Objective To observe the effects ofXiangsha Liujunzi Decoction (XSLJZ) on levels and mRNA of IL-6, IL-10 and protein expression of HSP70 of gastric mucosa in chronic atrophic gastritis (CAG) rats with spleen-stomach deficiency; To discuss its mechanism.Methods Rats were divided into 2 groups through random number table: normal group and model group. The model of CAG rat with spleen-stomach deficiency type was induced by synthetic methods. After successful modeling, rats were divided into model group, positive control group, XSLJZ high-, medium-, low-dose group. Rats in normal and model group received distilled water 10 mL/(kg?d) for gavage; XSLJZ high-, medium-, low-dose group received XSLJZ 24, 12, 6 g/(kg?d), respectively; positive control group received mycin 0.30 g/(kg?d) for gavage for 120 consecutive days. Generally living conditions, levels and mRNA of IL-6, IL-10 and protein expression of HSP70 in gastric mucosa tissue were detected by protein immunoblotting.Results Compared with the normal group, generally living conditions of rats in the model group were poor; mRNA and the content of IL-6 increased significantly, and mRNA and the content of IL-10 decreased significantly (P<0.05,P<0.01); mRNA and protein expression of HSP70 in gastric tissues was much lower than that of normal group (P<0.05,P<0.01). Compared with model group, generally living conditions of rats in the XSLJZ high-dose groups were improved significantly; mRNA and the content of IL-6 decreased significantly, and mRNA and the content of IL-10 increased significantly (P<0.05); XSLJZ high-, medium-dose groups mRNA and protein expression of HSP70 in gastric tissues increased significantly(P<0.05).Conclusion XSLJZ has protective effects on gastric mucosa of CAG rats with spleen-stomach deficiency.
ABSTRACT
Objective To detect the physico-chemical properties , cytotoxicity and antimicrobial activity of dressings containing Ag +.Methods The morphology of this dressing was shown by the scanning electron microscope ( SEM ) .The cytotoxicity was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) method.Using the shake flask test method , the antibacterial effect of dressings was studied .Result There was no significant difference in the water vapor transmission rate between the dressings (P>0.05).Compared with the alginate calcium dressing ,silver ion dressings had a stronger swelling rate .A higher ion concentration would lead to a much larger swelling rate and slower degradation . A lower cytotoxicity was exhibited among the dressings .The silver ion dressing had stronger bacteriostasis to Gram-positive ( G+) and Gram-negative ( G-) bacteria than the alginate calcium dressing .Conclusion The experiment has proved that the silver ion dressing has stronger antibacterial activity and lower cytotoxicity , and it is more effective for wound surface healing, with a shortened treatment course .
ABSTRACT
ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
ABSTRACT
Objective To study effects ofXiangsha Liujunzi Decoction (XSLJZ) on gastric emptying function, pepsin activity and expression of HIF-1α gene and protein of gastric mucosa in chronic atrophic gastritis (CAG) of rats with deficiency of spleen and stomach.Methods Rats were randomly divided into normal group and model group. The models of CAG rats with deficiency of spleen and stomach type were induced by synthetic methods. After the modeling, models rats were divided into model group, positive control group and XSLJZ high-, medium-, and low-dose groups. Normal group and model group were given 10 mL/kg distilled water every day for gavage; XSLJZ high-, medium-, and low-dose groups were given 24, 12, and 6 g/kg XSLJZ Decoction for gavage; positive control group was given 0.30 g/kg Vatacoenayme for gavage, for successive 120 d. Gastric emptying function and pepsin activity were detected, and HIF-1α gene and protein expression in gastric mucosa were detected by RT-qPCR and IHC. Results Compared with the normal group, the gastric emptying function and pepsin activity in the model group were much lower (P<0.01); expressions of HIF-1α gene and protein in gastric tissues was much higher (P<0.01). Compared with model group, XSLJZ could increase the gastric emptying function and pepsin activity significantly (P<0.05), and decrease expressions of HIF-1α gene and protein (P<0.05).Conclusion XSLJZ has functions of improving the gastric emptying function, promoting pepsin activity, and reducing expressions of HIF-1α gene and protein.
ABSTRACT
Objective To investigate the effects of Danshen Duofensuanyan on the blood coagulation,inflammatory and cardiac function in acute myocardial infarction(AMI) patients who did not accept emergency percutaneous coronary intervention.Methods One hundred and twenty patients,from January 2012 to November 2014 in the First Hospital of Qinhuangdao admission due to acute myocardial infarction frequent episodes of angina(Killip grade Ⅱ,grade m),were randomly divided into two groups:control group (n =60) and observation group (n =60).All patients suffered from severe angina after AMI and heart failure but without PCI.All included patients were gave antiplatelet drug,anticoagulants and Statins,etc.And the patients in observation group were additionally given 7-day Danshen Duofensuanyan injection 200 mg/d once daily intravenously.Platelet aggregation rate (PAG),fibrinogen (FIB),c-reaction protein (CRP),erythrocyte sedimentation rate (ESR),troponin Ⅰ (TNI),plasma brain natriuretic peptide (BNP) and left ventricular end diastolic dimension(LVEDD),left ventricular ejection fraction (LVEF) and cardiac output (CO) of two group were monitored before and after treatment.Results (1)Changes in coagulation,inflammatory cytokines and enzymes between the treatment group and the control group after treatment (Treatment Group:PAG (22.32 ±17.61) ％,FIB(3.58±0.74) g/L,CRP(9.34±1.82) mg/L,ESR(10.1±4.6) mm/1 h,TNI(4.51± 1.89) ng/ml);control group:PAG(31.32±21.62)％,FIB(3.84±0.62) g/L,CRP (14.32±1.79) mg/L,ESR(13.2 ± ±5.4) mm/1 h,TNI(5.32±2.31) μg/L) and before treatment(Treatment group:PAG(88.87± 18.21) ％,FIB (4.78±0.97) g/L,CRP(32.13±11.59) mg/L,ESR(28.5±6.1) mm/1 h,TNI (56.43 ± 21.87) μg/L);control group:PAG (89.53± 19.35) ％,FIB (4.66 ± 0.78) g/L,CRP (29.06± 12.47) mg/L,ESR (29.3 ± 3.2) mm/1 h,TNI (53.69± 18.76) μg/L) were significandy improved,and the differences were statistically significant (P＜0.01),and observation group had more significant improvements than the control group(P＜0.05 or P ＜0.01) after treatment.(2) All aboved indexes were improved after treatment except LVEDD.And Danshen Duofensuanyan can significantly improve PAG,FIB,CRP,ESR,TNI,BNP LVEF and CO(P＜0.05 or P ＜0.01).Conclusion Danshen Duofensuanyan can effectively improve the blood rheology and the frequency of angina,and then improve heart functions.
ABSTRACT
ObjectiveTo investigate the effect and medical cost of different revascularization strategies for acute myocardial infarction (AMI) patients with multi-vessel disease (MVD).Methods A prospective randomized controlled trial (RCT) was conducted. From January 2009 to June 2012, patients with AMI and MVD undergoing primary percutaneous coronary intervention (PCI) were enrolled. They were randomly assigned to group A [staged PCI for non-infarction related artery (non-IRA) within 7-10 days after AMI] and group B (subsequent PCI for non-IRA recommended only for those with evidence of ischemia). All of patients were given optimized medical therapy according to clinical guideline, and they were followed up for 24 months at regular intervals. Major adverse cardiovascular events(MACE) including recurrence of myocardial infarction and death due to cardiac ailments were recorded. Meanwhile, re-hospitalization from cardiac causes, recurrence of angina, heart failure, and re-PCI, number of stents, total hospital stay days, and total medical expenditure were recorded.Results A total of 428 patients accomplished the 24-month follow up. All the patients underwgennt PCI for non-IRA in group A (215 patients), while 62 patients in group B (213 patients) undergone PCI for myocardial ischemia, and 51 patients received non-IRA treatment. There was no significant difference in MACE incidence between group A and group B [8.4% (18/215) vs. 10.8% (23/213),χ2= 0.727,P = 0.394]. The difference of death rate due to cardiac causes (5.1% vs. 6.6%), recurrence of myocardial infarction (4.2% vs. 6.6%), and heart failure (4.2% vs. 7.0%) were not significantly different between groups A and B (allP> 0.05). The rate of recurrence of angina (14.4 % vs. 32.9%), re-hospitalization from cardiac causes (14.4% vs. 33.8%), and re-treatment of implanting stents (12.6% vs. 29.1%) were significantly lower in group A than group B (allP< 0.01), and the rate of revascularization was significantly higher in group A than group B (10.7% vs. 5.2%,P< 0.05). The total number of stents (610 vs. 366), mean number of stents per patient (2.83±0.91 vs. 1.72±0.91,t = 12.725,P = 0.000), and total cost per patient (kRMB: 63.7±12.6 vs. 51.5±12.3,t = 10.107,P = 0.000) in group A were significantly higher than those in group B. Total hospital stay days in group A was significantly less than group B (days: 8.21±2.45 vs. 9.89±3.23, t = 6.071,P = 0.000). Because non-IRA-vascular reconstruction rate was low in group B, the rate of usingβ-blocker and anti-anginal agents during the 24-month follow up in group B was significantly higher than group A [59.2% (126/213) vs. 47.0% (101/215),χ2= 6.371,P = 0.012; 56.3% (112/213) vs. 17.6% (36/215),χ2 = 64.704,P = 0.000]. Conclusions In patients with AMI and MVD undergone emergency PCI, staged PCI within 7-10 days for non-IRA cannot decrease the incidence of myocardial infarction and death due to cardiac causes, recurrence of angina and rehospitalization for cardiac causes was diminished, and it may increase the number of stents and medical cost significantly.
ABSTRACT
To evaluate the long-term results in elderly patients undergoing percutaneous coronary intervention [PCI] with drug-eluting stents for unprotected left main coronary artery disease by transradial approach. This study took place in Qinhuangdao First Hospital, Hebei Medical University, Hebei, China between October 2006 and December 2009. Seventy-nine elderly patients with unprotected left main coronary artery [ULMCA] stenosis, aged >/= 70 years, that underwent drug-eluting stent were evaluated. The occurrence of major adverse cardiac events [MACE] [death, non-fatal myocardial infarction, stroke or target lesion revascularizations] was recorded after 3 years of follow-up. After 3 years follow-up, the MACE free survival rate was 72.2%. Cardiac deaths occured in 7.6% of patients. Myocardial infarction occurred in 5.1%, and target lesion revascularization in 13.9% of patients. Age and left main distal bifurcation were favorable predictors of MACE. Percutaneous coronary intervention can be performed with good angiographic and clinical results through a transradial approach in the elderly. The long term survival suggests that PCI in ULMCA patients >/= 70 years is safe and efficacious
Subject(s)
Humans , Male , Female , Coronary Artery Disease/surgery , Stents , Coronary Stenosis/surgery , Coronary Angiography , Percutaneous Coronary Intervention , Aged , Retrospective StudiesABSTRACT
Human umbilical cord stromal cells derived from Wharton's jelly bear the potential of stem cells. They share the common surface markers with mesenchymal stem cells derived from bone marrow. They have a relatively higher proliferation rate and self-renewal capacity and can be successfully differentiated into mature neurons, cardiomyocytes, endothelial, adipocytes, chondrocytes and skeletal cells. Researches have shown their promising foregrounds in regenerative therapeutic applications. This article will give a review about the separation and cultivation methods, in vitro differentiation, and in vitro and in vivo transplantation experiments of the aforementioned stromal cells.
ABSTRACT
Objective To evaluate the accuracy of 64-slice spiral CT(64 SCT)in assessing the mild and severe stenosis of coronary artery.Methods A total of 72 patients suspected to suffer from coronary artery disease underwent orderly both 64 SCT and selective coronary angiography(SCAG).Volume rendering (VR),multi-planar reconstruction(MPR),maximum intensity projection(MIP)and transverse section wasused to analyze the 64 SCT data.The results were compared with those of SCAG to investigate the accuracy of the 64 SCT in assessing the≥50% stenosis of coronary artery.Results In the 720 SCAG segments of 72 patients.684 of them could be evaluated by 64 SCT.The evaluated rate Was 95.0%.Compared with SCAG,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate was 67.4%,92.9%,69.5%,92.3% and 88.0% respectively.Conclusion The accuracy of 64 SCT in assessing mild and severe stenosis is relatively high and it can be used for screening patients with suspected coronary artery diseases as a non-invasive method.
ABSTRACT
Objective To research the validity of PET/CT in clinic for detecting lung cancer. Method There were 20 subjects who may have lung cancer according to the result form other detecting way, including 15 males and 5 females with an average age from 54 to 86. Results Malignant lesions were found in 15 cases and benign lesions in 5 cases. Discussion The examination of chest with PET/CT is suit for early diagnosis of lung cancer. The number of patient of false postive and false negative is decreased by controlling some factor.