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Objective@#Previous cross-sectional studies suggested that elevated levels of total cholesterol content of erythrocyte membrane (CEM) could significantly increase the risk of acute coronary syndrome (ACS). The purpose of the present study was to assess the predictive value of baseline CEM levels for the risk of clinical endpoint events in patients with ACS through prospective follow-up studies.@*Methods@#This study is a prospective follow-up study, which consisted of 859 patients with first ACS (698 patients with unstable angina pectoris and 161 patients with acute myocardial infarction), diagnosed and hospitalized in the First and Second Affiliated Hospital of Anhui Medical University. The routine blood lipid levels and CEM were measured. Patients were divided into two groups according to the median of baseline CEM: CEM≤131.56 μg/mg group (n=430) and CEM>131.56 μg/mg group (n=429). Patients were followed up at 6 months interval. The clinical endpoints were nonfatal myocardial infarction, nonfatal stroke, all-cause mortality, all-cause mortality, heart failure requiring hospitalization, and coronary artery revascularization. Kaplan-Meier curve analysis and Cox proportional hazard model were used to analyze the impact of elevated CEM on the occurrence of clinical end-point events. HR values and 95%CI of each variable were obtained. Cox regression analysis of all-cause mortality was performed according to whether patients had risk factors for coronary heart disease (hypertension, diabetes, smoking and elevated LDL-C) and whether they were treated with PCI.@*Results@#The follow-up time was 1 640 (1 380, 2 189) days. Cox analysis after adjustment showed that an elevated baseline of CEM (>131.56 μg/mg) was associated with an increased risk of all-cause mortality (HR=1.690, 95%CI 1.041-2.742, P=0.034), but had no significant predictive effect on the other clinical endpoints. Subgroup analysis showed that elevated baseline CEM levels in ACS patients with LDL-C>1.8 mmol/L (HR=1.687, 95%CI 1.026-2.774, P=0.039), receiving in-hospital PCI (HR=2.365, 95%CI 1.054-5.307, P=0.037), or male (HR=1.794, 95%CI 1.010-3.186, P=0.046) were associated with an increased risk of all-cause mortality.@*Conclusion@#The results showed that elevated CEM levels can increase the risk of all-cause mortality in ACS patients.
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AIM:Chronic heart failure (CHF), caused by ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM), is among the leading causes of mortality and morbidity worldwide .Low-density lipoprotein receptor-related protein 6 (LRP6) plays a criti-cal role in regulating Wnt signaling .Dysregulated Wnt signaling contributes to high incidence of arrhythmias .Thus, there might be an association between genetic variations of LRP6 and sudden cardiac death ( SCD) .The objective of the study was to examine the associ-ation between common variants of LRP6 and prognosis of CHF patients .METHODS:From July 2005 to December 2009, patients with CHF referred from 10 hospitals and participants without structural heart disease in China were undergone a prospective study .The sin-gle-nucleotide polymorphism rs 2302684 was selected to evaluate the effect of LRP6 polymorphisms on the survival of the patients .RE-SULTS:A total of 1 887 patients (1 437 with CHF and 450 in the control group)were finally enrolled for the analysis.During a medi-an follow-up of 61 months, a total of 546 (38.00%) patients died, including 201(36.81%) cases with SCD and 345 (63.19%) ca-ses with NSCD.No end point event occurred in the control group .Patients carrying A allele of rs2302684 had increased risks of all-cause death (PA in LRP6 is associated with an increased risk of all-cause death and SCD in patients with CHF in Chinese Han population , and the association is more prevalent in patients with CHF caused by ICM.Thus, LRP6 might be added as a novel predictor of SCD and could provide an attractive and direct therapeutic target in SCD prevention .
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Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR ＜90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases (12.6％) vs 15 cases (4.9％),P =0.001].There was no difference of the secondary endpoint events incidence in the two groups.The incidence rate of all-cause mortality [8.9％ (22 cases) vs 2.2％ (7 cases),P ＜0.001] and cardiac death [6.5％ (16 cases) vs 1.3％ (4 cases),P =0.001] was higher in mild renal insufficiency group,but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups.The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2.265 folds (95％ CI 1.076-4.771,P=0.031) of patients with normal renal function.Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality (HR 3.118,95％ CI 1.197-8.125,P =0.020),not for heart failure and revascularization.According to the Kaplan-Meier curves results,the incidences of the primary endpoint events (P =0.004) and all-cause mortality (P =0.001) were higher in mild renal insufficiency group than in normal renal function group.Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.
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Objective To explore a new microsurgical method for reconstruction of finger pulp defect.Methods From May 2008 to May 2009,10 male patients with finger pulp defect were treated in our hospital,aged from 18 to 38 years (average,26 years).The index finger was involved in 6 patients,the middle finger in 3 patients and the ring finger in 1 patient.All finger pulp defects were caused by machine injury.The defect sizes ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.Six patients suffered from single skin defect,and 4 patinets suffered from skin defect combined with nail bed laceration and distal phalangeal fractures.All patients were performed emergency operations.The defects were reconstructed by using arterialized venous flap with microsurgical suture of the dorsal branch of the proper digital nerve.The fractures were fixed by Kirschner wires.The donor area was covered with skin grafts.Results All flaps survived completely.The fractures healed 8 to 10 weeks postoperatively.All patients were followed up for 4 to 6 months,all flaps presented satisfactory appearance,normal texture,with no pigmentation at the last followup.The static 2-point discrimination of the flaps ranged from 8 to 12mm.All injured fingers obtained good recovery of flexion and extension of the distal interphalangeal joints.The nails of the fingers with laceration of nail bed grew smoothly.The nail bed with laceration grew smoothly,and some new nails could be seen.The skin grafts applied to the donor area survived completely.Conclusion The arterialized venous flap with suture of the dorsal branch of the proper digital nerve is a good method for reconstruction of finger pulp defect,which had the following advantages:slight donor injury,low anesthesia risk,simple operative technique,and satisfactory postoperative function and appearance.
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Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ± 5.6 per-year in group I, 10.8 ± 3.9 per-year in group II, and 9.8 ± 4.2 per-year in group III. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1-7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.
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Objective To evaluate the correlation between seram interleukin-10 (IL-10) and testosterone with coronary heart disease (CHD). Methods 387 patients were divided into CHD group (n = 239) and control group ( n = 148 ) according to the results of coronary angiography. CHD patients were divided into subgroups accord-ing to the numbers, Gensini score of lesions in the coronary arteries and clinical severity ( statue of stable coronary artery disease, unstable angina or acute myocardial infarction). Serum IL-10 and testosterone levels were measured by ELASA. Logistic regression and partial correlation were used to evaluate the correlation of serum IL-10 and testoster-one with CHD. Results IL-10 was significantly lower in the CHD group than in the control group[ (39.08 ± 14.22) ng/L vs (49.27 ± 24.67)ng/L, P < 0. 001 ]. The partial correlation analysis results in subgroups showed that the correlation coefficient of IL-10 with number of lesions,gensini score and clinical severity of CHD was - 0.25, P < 0.001, -0.25 ,P <0.05 and -0.25 ,P <0.001 ,respectively. Serum testosterone had no difference in control group and CHD group (P >0.05 ). Logistic regression analysis found that only smoking (OR = 3.79,95% CI 2.09～ 6.84,P<0.01) ,diabetes mellitus (OR =2.48,95% CI 1.05 ～5.88,P <0. 05) ,apoB ( OR = 14.3,95% CI 4.29～46.61 ,P <0.01 ) and IL-10 ( OR =0.74,95%, CI 0.57～0.89 ,P <0.01 ) entered the model. Conclusions Serum IL-10 is not only significantly correlated with CHD but also with its severity. IL-10 is an independent pro-tective factor for CHD.