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Objective:Explore the characteristics of injury current changes in ventricular septal myocardium during left bundle branch area pacing (LBBAP) surgery.Methods:Retrospective analysis of clinical data of patients who underwent permanent pacemaker implantation at The Second People's Hospital of Wuxi in Jiangsu Province from January 2020 to November 2022. Among them, 42 patients were treated with LBBAP (LBBAP group) and 56 patients with Right ventricle septum pacing (RVSP group). Compare the conventional parameters such as threshold, perception, impedance during electrode implantation, damage current values at 0, 5, and 10 minutes before and after electrode rotation, and the correlation between damage current and conventional parameters. The measurement data is represented by xˉ± s, analysis of variance is used for comparison between multiple groups, t-test is used for comparison between two groups, and repeated measurement analysis of variance is used for comparison between two groups at multiple time points; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection; Pearson correlation analysis was used to analyze the correlation between the two variables. Results:There was no statistically significant difference in pacing threshold, perception, and impedance between the two groups of electrode implantation surgery (all P>0.05). The damage current values at 0, 5, and 10 minutes before and after electrode rotation in the LBBAP group were higher than those in the RVSP group [(7.19±1.26) mV compared to (5.33±0.79) mV, (22.50±3.06) mV compared to (10.85±1.70) mV, (15.75±2.63) mV compared to (8.01±1.09) mV, (9.24±2.00) mV compared to (5.51±0.98) mV]. The damage current values at 0 minutes after electrode rotation in both groups were higher than before electrode rotation, and gradually decreased thereafter, After 10 minutes of electrode placement, the damage current value of the LBBAP group was still higher than the level before electrode rotation (all P<0.05), while there was no statistically significant difference between the RVSP group and the level before electrode rotation ( P>0.05). The damage current value at 0 minutes after the LBBAP group electrode was in place was positively correlated with ventricular septal thickness and left ventricular posterior wall thickness ( r values 0.45 and 0.46, P values 0.003 and 0.002, respectively), and negatively correlated with conventional pacing parameter impedance ( r=-0.32, P=0.037). There was no correlation with threshold and perception ( r values 0.08 and 0.01, P values 0.604 and 0.968, respectively). The damage current value at 0 minutes after the RVSP group electrode was in place was negatively correlated with the threshold ( r=-0.28, P=0.036). Conclusions:The COI value of LBBAP interventricular septum myocardium increased significantly after the electrode was rotated out. The COI value at 0 min after the electrode put in place was positively correlated with the interventricular septum thickness and left ventricular posterior wall thickness, and negatively correlated with the electrode impedance, but there was no correlation with threshold and perception.
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Objective To evaluate the efficacy of Sacubitril/Valsartan in the treatment of chronic heart failure in elderly patients with dilated cardiomyopathy.Methods A total of 126 elderly patients with dilated cardiomyopathy induced chronic heart failure who were treated in Beijing Anzhen Hospital from January 2017 to December 2017 were enrolled and randomly divided into the experimental group(n=62)and the control group(n=64).All patients were given a standard heart failure treatment,and the experimental group underwent sacubitril/valsartan(100 mg Bid)and the control group received benazepril (10 mg Qd)additionally for 12 months.Left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),six-minute walk test(6MWT) and major adverse cardiovascular events(mortality and readmission for heart failure)were compared between the two groups.Results Of 126 elderly patients,73 patients(57.9％)were male,and 53were female,with a mean ± SD age of (67.2 ± 5.8) years.Basic characteristics,including age,gender,clinical history of hypertension and diabetes,LVEF,NT-proBNP and 6MWT,showed no significant difference between two groups (P ＜ 0.05).After 12 months of treatment,symptomatic hypotension occurred in one cases in each group.In the control group,NT-proBNP level was decreased after treatment as compared with before treatment[(983.3± 326.1) ng/L vs.(1 779.1 ± 478.1) ng/L,P ＜0.05],and no significant difference was found in LVEF and 6MWT at post-treatment versus pretreatment(P ＞ 0.05).In the experimental group,LVEF,NT-proBNP level and 6MWT were significantly improved in post-treatment versus pre-treatment (P ＞ 0.05).And LVEF,NT-proBNP level and 6MWT were significantly better in the experimental group than in the control group[(38.5 ±3.1)％ vs.(36.9±3.0)％,(744.5±246.7) ng/L vs.(983.3±326.1) ng/L,(323.4±60.5) m vs.(283.5±45.9)m,P＜0.05].The readmission rate for heart failure was lower in the experimental group than in the control group(26.6％ or 19 cases vs.46.8％ or 30 cases,P＜0.05),while no significant difference was found in mortality between the two groups (P ＞ 0.05).Conclusions Compared with benazepril,sacubitril/valsartan can improve the left ventricular function and exercise tolerance,and reduce the readmission rate due to chronic heart failure in patients with dilated cardiomyopathy.However,more studies are needed to assess the effects of sacubitril/valsartanthe on the prognosis of advanced elderly patients(＞88 years old)who have a preserved LVEF and a chronic end-stage heart failure(NYHA Ⅳ),and start the drug administration at different time points(before or after discharge).
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Objective@#To investigate the incidence and rank of chronic obstructive pulmonary disease and pneumoconiosis to the workers in different occupational positions in Jinchang Cohort.@*Methods@#In January 2014, a cohort of follow-up population in jinchang city was taken as the research object, 17843 individuals among follow-up populations in Jinchang Cohort Study, removed the individuals with chronic obstructive pulmonary disease and pneumoconiosis before 2013, and counted the new incidence individuals diagnosed by the A-Class hospital in Grade III in Jinchang City, Gansu Province, as the investigation objects to investigate the incidence rate & rank of chronic obstructive pulmonary disease and pneumoconiosis. The statistical significance was tested by chi-square test.@*Results@#The 2-year incidence rate of Chronic Obstructive Pulmonary Disease and Pneumoconiosis in the population of Jinchang Cohort Study were 11.60‰, 13.51‰ for male and 8.46‰ for female. the ranks of 2-year incidence rates of chronic bronchitis, emphysema, pneumoconiosis and other phenotypes of chronic obstructive pulmonary disease were 7.06‰、3.42‰、0.84‰、0.34‰, respectively. Incidence rate of chronic bronchitis among administrators and executive staffs were 10.45‰; incidence rate of chronic bronchitis among service staffs were 10.45‰; incidence rate of pneumoconiosis among mining staffs were 3.44‰.@*Conclusion@#The first incidence rank of chronic obstructive pulmonary disease and pneumoconiosis in Jinchang cohort is chronic bronchitis, and the risk factors are smoking and occupational exposure.
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Objective To evaluate the predictive value of IABP SHOCK Ⅱ risk score in in-hospital mortality of patients with ST segment elevation myocardial infarction complicated with cardiogenic shock (CS). Methods From August 2011 to August 2013, the clinical data of 89 patients with cardiogenic shock after STEMI treated with primary PCI and then supported by using IABP were retrospectively analyzed. The IABP SHOCK Ⅱ risk score were calculated from the data at admission and primary PCI. Comparisons of general information, medication and intervention, pre/post IABP vital life signs and in-hospital death were carried out among patients with different risk stratifications. Results The area under ROC curve of risk stratification was 0.723. The patients were categorized into low risk group (score 0-2, n=71) and intermediate-high risk group (score 3-9, n=18).The patients in intermediate-high risk group were with advanced age, high rate of diabetes mellitus, history of stroke, renal insufficiency, higher serum lactate and glucose at admission compared with low risk group. And more patients in intermediate-high risk group had impaired post-PCI coronary flow (TIMI flow grade<3). Conclusions The IABP SHOCK Ⅱ risk score is a simple and useful risk score for predicting in-hospital mortality of STEMIpatients complicated with CS. Though the patietns are treated with primary PCI and then supported by IABP, the in-hospital mortality of patients with IABP SHOCK Ⅱ risk score ≥ 3 increases significantly.
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Objective To investigate the significance of heat shock protein 60 (HSP60) and heat shock protein 65 (HSP65) on prognosis acute coronary syndrome (ACS) within one year.Methods Eightynine hospitalized patients were collected from department of Cardiovascular disease,the people's hospital of Wuxi city affiliated of Nanjing Medical University and the Second People's Hospital Wuxi City from November 2009 to February 2011,and divided into ACS group (n =50),stable angina pectoris (SAP) group (n =19) and nonCHD group(n =20).HSP60,HSP65 levels in human serum were measured at the time of admission.The followup records of all patients were established to observe the occurrence of coronary events during one year,and analyzed its relationship between with HSP60,HSP65.Results Eighty-four cases were successful followed-up,and lost cases were 5.Eighteen patients occurred cardiovascular events within one year,and their content of serum HSP60 and HSP65 were significantly higher than that of without cardiovascular events (HSP60:(1026.19 ± 253.47) ng/L vs.(845.75 ± 138.52) ng/L,t =2.49,P ＜ 0.05 ; HSP65:(2573.95 ± 768.75) ng/L vs.(2076.38 ± 385.46) ng/L,t =2.58,P ＜ 0.05).In ACS group,the level of serum HSP60 and HSP65 of the patients occurred cardiovascular events was significant higher than that of without cardiovascular events,and there was significant difference(HSP60:(1162.73 ±249.14) ng/L vs.(892.55 ±204.62) ng/L,t =2.19,P ＜ 0.05 ; HSP65:(2714.39 ± 738.44) ng/L vs.(2136.85 ± 472.62) ng/L,t =2.65,P ＜ 0.05).COX regression analysis showed that HSP65 was an independent risk factor for recent cardiovascular events in patients with ACS (RR =1.002,95％CI 1.000-1.004,P =0.035).Conclusion The detection of HSP60,HSP65 in prognostic coronary artery disease prognosis has important value,and HSP65 was an independent risk predictor of ACS in recent cardiovascular events within one year.
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Objective To examine the advanced oxidation protein products (AOPP) in patients with acute coronary syndrome(ACS) and discuss the relationship between oxidative stress with the development of atherosclero-sis(AS). Methods Plasma were collected in 59 acute myocardial infarction (AMI) patients including 35 patients underwent selective PCI,24 patients underwent emergency PCI,43 unstable angina pectoris(UA) patients and 10 non-coronary artery disease (non-CAD) patients. All cases underwent coronary angiography (CAG). Plasma was collected immediately,post-24 hours and post-48 hours after admission. AOPP was determined by measurements of absorbance (A) at 340 nm under acidic conditions via spectrophotometry. Results AOPP was (236.42±30.41) ( n = 35 ), ( 207.84±29.50 ) mmol/L ( n = 35 ), ( 227.79 ± 35.18 ) mmol/L ( n = 31 ) respectively immediately, post-24 hours and post-48 hours after admission in AMI ( selective PCI ), ( 239.95 ±39.94 ) mmol/L ( n = 43 ), (175.92 ±29.46) mmol/L(n =38) ,and (156.54 ±28.29) mmol/L(n =35) in UA group and (57.41 ± 13.60) mmol/L( n = 9 ), (56.11 + 11.90) mmol/L ( n = 10 ) and ( 61.75 ± 12.28 ) mmol/L ( n = 8 ) in non-CAD group. Compared with normal group ( without CAD ) , significantly higher plasma AOPP was detected in AMI ( selective PCI) and UA patients ( P < 0.05 ). AOPP level was significantly increased in AMI selective PCI patients as compared with that of emergency PCI group immediately and post-24 hours after admission( P <0.01 ) ,and post-48 hours after admission( P < 0.05 ), but there was no statistical significance between emergency PCI and UA group( P > 0.05 ). Conclusions Oxidative stress is an important step in the development of atherosclerosis, and the higher levels of AOPP in ACS patients show that AOPP may be as good markers in these patients.