ABSTRACT
Objectives: To analyze the clinical features, pathogenic distribution, treatment and prognosis of patients with infective endocarditis (IE) hospitalized in Fuwai Hospital during the latest 4 years, and to improve the diagnosis and treatment of this disease. Methods: This retrospective study included a cohort of 300 IE patients hospitalized in Fuwai Hospital from 2013 to 2016. Predisposing cardiac disease,pathogenic distribution and clinical outcomes were analyzed.Clinical and epidemiological features of patients treated with medications or surgery were compared. Results: There were 228 male and 72 female patients in this cohort; the mean age was (40.0±15.7) years old. Among the IE patients, 35.3% patients had congenital heart diseases, 22.3% had non-rheumatic valve diseases, and 10.3% had history of PCI or heart surgery. Only 4.3% patients suffered from rheumatic heart diseases. Cardiac murmur (93.3%) and fever (84.3%) were the most common clinical presentations. Congestive heart failure was the most common complication (75.3%), followed by systemic and pulmonary embolism (16.7%). Incidence of positive blood culture was 52.4%.Streptococcus (76.3%) were the most common causative organisms, followed by Staphylococcus (11.0%). 91.3% IE was detected by echocardiography. In-hospital mortality rate was 3.0%. Subgroup analysis showed that the cure rate of surgical treatment group was significantly higher than that of the medical treatment group (96.6% vs 48.6%, P<0.001). Conclusion: Congenital heart disease is the main underlying disease related to IE.Streptococcus is still the primary pathogen of IE. Due to the 1ower positive rate of blood culture, echocardiography serves as the most important diagnostic tool for infective endocarditis.Early, effective and regular antibiotic therapy is still the cornerstone of the treatment of IE. Cardiac surgery treatment can reduce the mortality rate of IE.
ABSTRACT
<p><b>BACKGROUND</b>Bacterial infections remain a serious complication following coronary artery bypass grafting (CABG). The objective of the study was to determine the effectiveness of a guideline for the appropriate use of antibiotics in CABG during the perioperative period.</p><p><b>METHODS</b>Six hundred and fourteen hospitalized patients who had undergone CABG from January to June 2006 were randomly allocated to an intervention group and a control group. The data on the hospital stay, days of antibiotic used, types of prophylactic antibiotics used, surgical wound infection and pulmonary infection and antibiotic costs for the patients were compared.</p><p><b>RESULTS</b>The postoperative hospitalization days of the intervention group were significantly fewer than that for the control group (P < 0.05). The time of antibiotic use and post-infection treatment time were also significantly less in the intervention group than in the control group (P < 0.05). The average hospital daily cost and total cost of antibiotics were less in the intervention group than in the control group (P < 0.05). Compared with the control group, prophylactic antibiotic use in the intervention group was more reasonable.</p><p><b>CONCLUSIONS</b>The guideline for the appropriate use of antibiotics in CABG during the perioperative period is effective strategies for reducing antibiotic costs, the time of antibiotic use and post-infection treatment time without compromising the patients' clinical outcome.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents , Economics , Therapeutic Uses , Coronary Artery Bypass , Economics , Methods , Perioperative PeriodABSTRACT
<p><b>OBJECTIVE</b>To explore the changes of mRNA and protein expressions of glycolytic and fatty acid metabolic enzymes early after acute myocardial ischemia.</p><p><b>METHODS</b>Twelve dogs were randomly divided into 3 groups (sham, 20 min ischemia and 40 min ischemia, n = 4 each). Myocardial samples from ischemic and nonischemic zone were obtained for histology examination, and the mRNA expressions for Phosphofructokinase (PFK), Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), GLUT1, GLUT4, Medium-chain acyl-CoA dehydrogenase (MCAD) and Heart-fatty acid binding protein (H-FABP) were determined by Real Time PCR-SYBR Green RT-PCR. GLUT1 protein expression was determined by immunohistochemistry. The apoptotic cardiomyocytes was evaluated by TUNEL.</p><p><b>RESULTS</b>Compared to sham hearts, H-FABP mRNA was decreased in nonischemic and ischemic zone (P < 0.05) while GLUT1 mRNA expression was significantly increased in nonischemic and ischemic zone (P < 0.05) in dogs underwent 20 and 40 min ischemia. PFK mRNA tended to be higher in ischemic myocardium (P = 0.065) and GAPDH, MCAD as well as GLUT4 remained unchanged post ischemia (all P > 0.05). Positive GLUT1 protein staining was visualized in ischemic myocardium of hearts underwent 20 and 40 min ischemia. The myocardial apoptosis cells was 6.4% +/- 0.9% in sham hearts, 28.0% +/- 3.7% in hearts underwent 20 min ischemia (P < 0.05 vs. sham) and 38.4% +/- 1.9% in hearts underwent 40 min ischemia (P < 0.05 vs. sham).</p><p><b>CONCLUSIONS</b>Significant down and up-regulated glycolytic and fatty acid metabolic enzymes early after myocardial ischemia suggested that these enzymes might play an important role in acute myocardial ischemia.</p>
Subject(s)
Animals , Dogs , Disease Models, Animal , Fatty Acids , Metabolism , Glycolysis , Myocardial Ischemia , Myocardium , RNA, Messenger , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the applicative value of higenamine used as a new agent for pharmaceutical stress test in detection of coronary artery disease by radionuclide myocardial perfusion imaging.</p><p><b>METHODS</b>Thirteen pigs with chronic coronary artery stenosis by placement of the Ameroid constrictor in the middle section of left anterior descending artery were included in this study. Rest, higenamine and dobutamine stress radionuclide myocardial perfusion imaging was performed with Tc-99m-sestamibi.</p><p><b>RESULTS</b>The sensitivity for detection of coronary artery disease by radionuclide myocardial perfusion imaging was 85% in both higenamine and dobutamine stress imaging. Imaging scores (9.9 +/- 8.5 vs. 9.4 +/- 8.6, P = NS) and defect severity (68% +/- 12% vs. 68% +/- 15%, P = NS) showed no significant difference between higenamine and dobutamine stress test. Agreement of imaging scores between higenamine and dobutamine stress imaging was good (kappa = 0.849, P < 0.0001).</p><p><b>CONCLUSION</b>Our study demonstrates that detection of coronary artery stenosis and ischemic myocardium by myocardial perfusion imaging with higenamine is highly sensitive.</p>