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Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.
ABSTRACT
Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.
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Objective To compare the experience of perioperative management and anesthesia in VHL syndrome and non-VHL patients undergoing pheochromocytoma resection .Methods 50 patients scheduled for surgical removal of pheochromocytoma in PUMC Hospital from 2009-01-01 to 2014-12-31 were included in this retrospective analysis . Among them,12 patients were diagnosed with VHL syndrome ,others were non-VLH patients.We focused on the clini-cal records , especially clinical manifestation , preoperative preparation , intraoperative anesthetic management , opera-tion duration and postoperative hospital stay .Results Comparing with non-VHL patients , VHL syndrome patients undergoing pheochromocytoma resection surgery were much younger , with multiple pheochromocytoma and a signifi-cantly increased norepinephrine release .The drug preparation period was much longer , as well as the operative time and hospital stay (P<0.05).But no statistical difference existed in the intraoperative hemodynamic fluctuation and the outcomes of the patients .Conclusions VHL syndrome patients mainly present with multiple pheochromocytoma which has more aggressive function .Since the long operation duration and high risk , the optimization of perioperative management and adequate drug preparation are the key factors to ensure the operation safety .
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Both basic and clinical studies have confirmed that inflammatory response plays an important role in the occurrence and development of atherosclerosis (AS) as well as its caused clinical events.The aggregation phenomena of T lymphocytes,macrophages and dendritic cells (DCs) can be observed in intima and atherosclerotic plaques in the event of atherosclerosis.As the most important antigen-presenting cells activating T lymphocytes,DCs have the important functions of determining T lymphocyte activation,apoptosis,and aggregation.This article reviews the correlation between DCs and atherosclerotic lesions.
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Objective To compare the efficacy of interscalene brachial plexus block using an ultrasound-guided method with nerostimulator-guided method.Methods Ninety ASAⅠ～Ⅱ patients scheduled for surgery of the upper extremity were randomly allocated into three groups(n=30),Control group: nerve stimulator-guided and single-injection group;US group: ultrasound-guided with nerve stimulator confirmation and single-injection group;UD group: ultrasound-guided with nerve stimulator confirmation and double-injection group.Thirty mL 0.5% ropivocaine was injected in each group.The patient in group UD received half the volume of ropivocaine injected around the two target nerves.Results The average onset time of sensory blockade in the UD group was significantly shorter than in the US group and Control group.The rate of satisfactory sensory blockade in the UD group was significantly higher than in the US group and Control group.Conclusion Ultrasound-guided interscalene brachial plexus block may shorten the onset time with fewer adverse events.The ultrasound-guided double-injection method may significantly improve the quality of blockade.
ABSTRACT
The special nature of medical care determines the high riskiness of the medical profession that is lacking in other professions. In view of the high-techness and high riskiness of the medical profession, it is only proper to start thinking about setting up corresponding mechanisms for guarding against and dissolving the risks so as to safeguard the legitimate rights of the doctors. Guarding against and dissolving risks of the medical profession fall into a systematic framework of regulations and legal arrangements that are composed of mechanisms for dispersing risks of the medical profession, mechanisms for sharing medical liabilities and systems of medical care and social security.