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Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with a range of symptoms, including palpitations, cognitive impairment, systemic embolism, and increased mortality. It places a significant burden on healthcare systems worldwide. Despite decades of research, the precise mechanisms underlying AF remain elusive. Current understanding suggests that factors like stretch-induced fibrosis, epicardial adipose tissue (EAT), chronic inflammation, autonomic nervous system (ANS) imbalances, and genetic mutations all play significant roles in its development. In recent years, the advent of wearable devices has revolutionized AF diagnosis, enabling timely detection and monitoring. However, balancing early diagnosis with efficient resource utilization presents new challenges for healthcare providers. AF management primarily focuses on stroke prevention and symptom alleviation. Patients at high risk of thromboembolism require anticoagulation therapy, and emerging pipeline drugs, particularly factor XI inhibitors, hold promise for achieving effective anticoagulation with reduced bleeding risks. The scope of indications for catheter ablation in AF has expanded significantly. Pulsed field ablation, as a novel energy source, shows potential for improving success rates while ensuring safety. This review integrates existing knowledge and ongoing research on AF pathophysiology and clinical management, with emphasis on diagnostic devices, next-generation anticoagulants, drugs targeting underlying mechanisms, and interventional therapies. It offers a comprehensive mosaic of AF, providing insights into its complexities.
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Humans , Atrial Fibrillation/drug therapy , Stroke , Risk Factors , Anticoagulants/therapeutic use , Blood Coagulation , Catheter Ablation , Treatment OutcomeABSTRACT
Objective To investigate the risk factors of ventilator-associated pneumonia (VAP) and the distribution and drug resistance of pathogens in intensive care unit (ICU) of county hospital. Methods 234 patients on mechanical ventilation for more than 48 hours admitted to ICU of Shexian People's Hospital of Huangshan City from January 2016 to June 2018 were enrolled. The clinical data of all patients including gender, age, past medical history, exposure to antibiotics, medication, the duration of mechanical ventilation, the length of ICU stay, serum albumin, tracheotomy, re-intubation, prognosis, and pathogenic bacteria and drug sensitivity test of VAP patients were collected. The patients were divided into VAP group and non-VAP group according to the occurrence of VAP. The differences of each index between the two groups were compared. The risk factors of VAP were analyzed by multivariate Logistic regression. The distribution and drug resistance of pathogenic bacteria in sputum culture of lower respiratory tract of VAP patients were analyzed. Results Among the 234 patients on mechanical ventilation, 95 patients had VAP, and the incidence of VAP was 40.60%. ① Risk factors of VAP: it was shown by univariate analysis that there were significant differences between VAP patients and non-VAP patients in past history, the duration of mechanical ventilation, the length of ICU stay, albumin < 28 g/L, antibiotic exposure and tracheotomy, but there were no significant differences in gender, age, glucocorticoid, sedative, gastric motility and coma between the two groups. It was shown by multivariate Logistic regression analysis that brain injury and cerebrovascular accident, the duration of mechanical ventilation > 7 days, albumin < 28 g/L and tracheotomy were independent risk factors for VAP occurrence [brain injury: odds ratio (OR) =41.40, 95% confidence interval (95%CI) = 2.14-799.60, P = 0.014; cerebrovascular accident: OR = 36.07, 95%CI =1.86-699.64, P = 0.018; the duration of mechanical ventilation > 7 days: OR = 1.23, 95%CI = 1.11-1.36, P < 0.001;albumin < 28 g/L: OR = 2.27, 95%CI = 1.03-5.01, P = 0.042; tracheotomy: OR = 3.33, 95%CI = 1.30-8.56, P = 0.012].② Distribution and drug resistance of VAP pathogens: a total of 108 strains of pathogens were isolated from sputum samples of 95 patients with VAP. Gram-negative (G-) bacteria accounted for 86.11% (93/108). The isolation rate of Klebsiella pneumoniae was the highest, reaching 31.48% (34/108); the isolation rates of Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii were 22.22% (24/108), 8.33% (9/108) and 9.26% (10/108), respectively. Gram-positive (G+) bacteria accounted for 6.48% (7/108), of which Staphylococcus aureus was 4.63% (5/108); and fungi was 7.41% (8/108). Drug resistance analysis showed that Klebsiella pneumoniae was 100% sensitive to amikacin (AMK), meropenem (MEM) and polymyxin (POL), and were suggested as the preferred drug. Pseudomonas aeruginosa was 100% sensitive to AMK, tobramycin (TOB) and POL, but 100% resistant to compound trimethoprim (PCST). Stenotrophomonas maltophilia was 100% sensitive to PCST and 100% resistant to AMK, piperacillin (PIP), piperacillin tazobactam (TZP) and TOB. Acinetobacter baumannii was 100% sensitive to cefoxitin (FOX), cefuroxime (CXM) and POT. Staphylococcus aureus was 100% sensitive to gentamicin (GEN), furantoin (NIT), rifampicin (RIF), vancomycin (VAN) and teicoplanin (TEC), while the drug resistance to clindamycin (CLI) and penicillin (PEN) was high (both 80.00%). Most pathogens were multidrug-resistant. The mortality of patients with multidrug resistant bacteria infection was significantly higher than that of non-multidrug resistant bacteria infection [51.85% (28/52) vs. 30.56% (11/36), χ2= 4.240, P = 0.046]. Conclusions VAP was associated with brain injury and cerebrovascular accident, duration of mechanical ventilation > 7 days, albumin < 28 g/L and tracheotomy. VAP patients were infected mainly with G- bacteria and showed multiple drug resistance.
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Objectives To evaluate the efficacy and safety of administering Ivabradine in the elder patients with chronic heart failure(HF).Methods Totally 52 outpatients with chronic stable HF in Fuwai Hospital and Anzhen Hospital from August 2015 to February 2016,with heart rates (HR)of >70 bpmafter optimized medical therapy were selected and administrated Ivabradine for 3 months(Ivabradine group).50 patients who received optimized medical therapy except Ivabradine for economic or other reasons were recruited as control group during the same period.Initial dose of Ivabradine was 2.5 mg two times a day,up to a maximum of 7.5 mg two times a day,adjusting the dose according to HR.Resting HR of the patients was maintained around 60 beats/min and not lower than 55 beats/min.HR,N-terminal pro-brain natriuretic peptide (NT-proBNP),6-minute walk distance,Minnesota heart failure quality of life(MLHFQ),left ventricular ejection fraction(LVEF) and adverse effects were recorded.Results At baseline,no significant differences were found in HR,NT-proBNP,the scores of MLHFQ,6-minute walk distance (all P> 0.05) between Ivabradine group and control group.After 3 months of treatment,compared with control group,Ivabradine group showed significantly decreased levels of HR,the scores of MLHFQ and NT-proBNP(allP<0.01),and significantly increased 6-minute walk distance and LVEF(all P<0.01).Compared with baseline data,Ivabradine treatment showed the decreased levels of HR [(69.5 ± 10.2)bpm vs.(80.2 ± 7.8)bpm,P<0.05],the scores of MLHFQ [(14.9±4.3)scores vs.(23.5±6.2)scores(P<0.05)]and NT-proBNP [1 682 ng/L (212-3 628) vs.2 450 (254-5 344) ng/L,P < 0.05] significantly,and showed the significantly increased levels of 6-minute walk distance [(386.4 ± 101.8)m vs.(282.9 ± 86.3)m,P< 0.05]and LVEF [(40.0±6.0)%vs.(31.0±7.0)% (P<0.05)].Few adverse effects were recorded.Conclusions In elderly outpatients with stable HF,Ivabradine treatment is effective and safe.
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Objective To research the recent prognosis of vertebral artery dominance in patients with posterior circula-tion transient ischemic attack. Methods All 120 patients were diagnosed with posterior circulation transient ischemic attack from January 2012 to October 2013 hospitalization, collected the vertebral artery MRA, clinical data ABCD2 score, the incidence of cerebral infarction within 7 days with the patients, and compared the differences. Results The share of vertebral artery dominance was higher than non-vertebral artery dominance in the posterior circulation TIA. According to ABCD2 score stratification, the incidence of cerebral infarction was rising from low-risk group to the risk group to the high-risk group. 7 days after TIA, the incidence of cerebral infarction in group with the vertebral artery dominant compared with the non-vertebral artery dominance had significant difference (P<0.05). If ABCD2 score<4 points, there was no significant difference in incidence of cerebral infarction between the group with vertebral artery dominant and non-vertebral artery dominance (P>0.05). If ABCD2≥ four points, the result was opposite (P<0.05). Conclusion The vertebral artery dominance is one of the risk factors for cerebral infarction to the patient with posterior circulation TIA. ABCD2 score in the high-risk patients'risk of vertebral artery advantage is particularly evident.
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Objective To explore detection value of vacuum sealing drainage in osteomyelitis of sternum after cardio-thoracic surgery operation.Methods 132 cases of osteomyelitis of sternum after cardio-thoracic surgery operation were randomly divided into two groups(research group and control group).The research group had 72 cases)and the control group had 60 cases.The control group was treated with conventional treatment.The research group was treated with vacuum sealing drainage.The average healing time and clinical therapeutic effect of the two groups were observed.Results The patients'age and the sternum of osteomyelitis was significantly related,with OR=1.153 and P<0.05.After treatment,the average healing time of the research group was(3.1±0.8)months.The average healing time of the control group was(7.2±1.5)months.The average healing time of the two groups had significant difference(P<0.05).Conclusion Vacuum sealing drainage in osteomyelitis of sternum after cardio-thoracic surgery operation has sure curative effect.It can change chronic wounds for acute tissue effectively,shorten the healing time.It has high application value in the first phase of treatment and the second phase of repair.