RESUMEN
Hypertension is an important risk factor for the morbidity and mortality of cardiovascular and cerebrovascular diseases. Improving compliance is the key to the prevention and control of hypertension in community. This paper summarizes the improvement of compliance of patients with hypertension， analyzes the ideas and feasibility of assisting hypertension community prevention and control from three aspects： improving medication compliance， improving behavior compliance and digital intelligent management， and puts forward corresponding suggestions to improve the compliance of patients with hypertension.
RESUMEN
The standardized training of medical specialists in China is far from perfect. The training contents, training system, training methods, supervision and assessment methods need to be improved. The First Clinical College of The First Hospital of China Medical University have guided the trainees to strengthen the study of guidelines and consensus by emphasizing the concept of evidence-based medicine (EBM) of training teachers by means of Sino-U.S. exchanges, case discussions and other ways. At the same time, with the help of the modern network education platform and the problem-based learning teaching mode, the concept of EBM education has been further developed, which greatly enhances the ability of specialists to analyze and solve problems, and improves the training effect.
RESUMEN
Objective:The present study was designed to explore the role of ER stress in cardiac hypertrophy of adult APPswe /PS1dE9 transgenic mice.Methods:10 adult APPswe/PS1dE9 transgenic mice and 10 C57BL/6 wild type (WT) mice were divided into the transgenic experimental and control group,WT experimental and control group,respectively,with 5 mice in each group.Experimental groups received a low dose ofIsoproterenol (ISO) (2 mg/kg) once a day for 4 weeks to induce cardiac hypertrophy,while control groups received the same volume of normal saline.After 4 weeks,the mice were anesthetized,followed by,electrocardiogram (ECG) recording and the measurement of the heart rate and body weight before being sacrificed.The heart was dissected out,and the masses of heart and the left ventricle were measured,the left ventricule mass index (LVW/BW) and the whole heart weight ratio (HW/BW) were calculated.HE staining was used to observe the pathological and morphological changes of cardiomyocytes,and Western Blot and immunohistochemistry were used to detect the expressions of ER stress relevant proteins-GRP78,JNK,P-JNK and CaMKII.Results:Compared with WT experimental mice,the ventricular wall in the APPswe/PS1dE9 transgenic experimental mice was apparently hypertrophic after the induction by low doses of ISO,and the HW/BW and the LVW/BW were also significantly increased in the APPswe/PS1dE9 transgenic experimental mice than those in the transgenic control mice,WT experimental and control mice (P＜0.05).HE staining showed that compared with the transgenic control mice,WT experimental and WT control mice,in the adult APPswe/PS1dE9 transgenic experimental mice,the cardiomyocyte diameter was obviously increased,cell density was decreased,the capillary density was decreased,the intercellular substance was increased,and the intercellular space was increased.Western blot showed that the expression of GRP78,p-JNK and CaMKII in the experimental group of adult APPswe / PS1dE9 transgenic mice were significantly higher than those in the transgenic control mice and WT mice (P＜0.05,P＜0.01).There were no significant difference among the control group oftransgenic mice and the two groups of WT mice.Immunohistochemistry showed that the positive rates of GRP78 and CaMKII in the cytoplasm of cardiomyocytes of the APPswe/PS1 dE9 transgenic experimental mice were significantly higher than those of experimental WT mice (80％&40 ％)(P＜0.05),and the expressions in the two control groups were negative.The positive rates of p-JNK and JNK in the APPswe/PS1dE9 transgenic experimental mice were 90％ and 40％ respectively,and the expressions were negative in other three groups.Conclusions:The adult APPswe/PSldE9 transgenic mice are more prone to cardiac hypertrophy than WT mice after the induction with a low dose of ISO.ER stress is involved in the formation of cardiac hypertrophy in adult APPswe/PS1dE9 transgenic mice.
RESUMEN
Objective To investigate the efficacy and safety of 6-month and 12-month oral dual-antiplatelet therapy This work was supported by the National Key Technology Research and Development Program in the Twelfth Five-year Plan of China (2011BAIl1B07) and the Military Clinical Key Technology and Development Program (2010gxjs001)(DAPT) on patients implanted with biodegradable polymer-coated and drug-eluted long stents (BP-DES).Methods In the I-LOVE-IT 2 trial,574 patients implanted with biodegradable polymer-coated and sirolimus-eluted long stent (BP-SES) (total stent length ≥50mm) were randomized to accepting either 6-month (n=270) or 12-month (n=304) DAPT.The primary endpoint of present study was 12-month target lesion failure (TLF),including cardiac death,target vessel myocardial infarction and clinically indicated target lesion revascularization (CI-TLR).The major secondary endpoint was 12-month net adverse clinical events (NACE),including all-causes of death,myocardial infarction,stroke,all revascularization (CI-TLR plus clinically indicated nontarget lesion revascularization) and bleeding.Results For the patients implanted with BP-SES of total stent length≥ 50mm,the total stent length was 73.0 ± 22.5mm and 69.8 ± 19.4mm in the 6-month DAPT group and 12-month group,respectively (P=0.07).No significant difference existed in the incidence of 12-month TLF between 6-month DAPT group and 12-month DAPT group (11.1％ vs.9.2％,P=0.47).The incidence of NACE was similar between the 2 groups (21.9％ vs.19.7％,P=0.57).The incidence of revascularization was lower in 12-month DAPT group (5.6％) than in 6-month DAPT group (11.1％,P=0.01).Furthermore,6-month landmark analysis showed that 12-month DAPT was associated with significantly lower risk of TLF (2.6％ vs.6.3％,P=0.03) at a cost of slightly increased risk of all bleeding events (1.6％ vs.0.7％,Log-rank P=0.32) between 6 and 12-months compared to 6-month DAPT.Conclusions In patients treated with BP-SES of total stent length ≥ 50mm,12-month DAPT have similar impacts on 12-month clinical outcomes except for all revascularization.However,12 months DAPT decreased the incidence of TLF and total revascularization between 6 months to 12 months after PCI.
RESUMEN
Objective To evaluate the influence of renal insufficiency (RI) on long-term major adverse cardiac events (MACE) of patients with acute myocardial infarction (AMI) plus metabolic syndrome (MetS) and received percutaneous coronary intervention (PCI). Methods This was a retrospective study. From February, 2011 to Octorber, 2013 , we consecutivly enrolled 223 AMI patients with MetS in the First Affiliated Hospital of China Medical University. There were 88 patients with RI in group A, and 135 patients as the control group (group B). Patients were followed up for major adverse cardiac events (MACE) for 1 year. Results Compared with group B, the incidence of 1-year MACE of patients in group A was increased (36.4% vs. 18.5%, P= 0.003). Result of Cox proportional hazard regression analysis showed that RI was a predictive factor for 1-year MACE (HR = 3.56,95%CI 1.004 ~ 4.170, P = 0.002). Conclusion The incidence of 1-year MACE for AMI patients with RI and MetS post-PCI was high. RI was a risk factor for poor prognosis of AMI patients with MetS.
RESUMEN
Objective: To explore the clinical value of adenosine triphosphate (ATP) stress99mTc-methoxyisobutylisonitrile (99mTc-MIBI) gated myocardial perfusion imaging (G-MPI) for evaluating the severity and region of myocardial ischemia and left ventricular function in patients with myocardial bridge. Methods: A total of 58 patients with CAG or CTA confirmed diagnosis of myocardial bridge received ATP stress99mTc-MIBI G-MPI examination in our hospital. The short and vertical long-axis image of left ventricular myocardium were divided into 13 segments and the radionuclide distribution was semi-quantitatively evaluated into 4 classes by 0-3 scores visually (0: normal, 1: mild reduction, 2: moderate reduction, 3: severe reduction). The summed stress score (SSS) of left ventricular myocardium was calculated, the severity and region of myocardial ischemia were judged and compared with the severity of myocardial bridge. The LVEF obtained by ATP stress 99mTc-MIBI G-MPI was compared with LVEF obtained by cardiac color ultrasound (UCG).Results: The detection rate of myocardial ischemia by ATP Stress 99mTc-MIBI G-MPI and by 24h dynamic ECGwere 82.76% vs 56.10%, P 0.05 and they had positive correlation (r =0.555, P <0.05).Conclusion: ATP stress 99mTc-MIBI G-MPI could accurately and intuitively evaluate the severity and region ofmyocardial ischemia and left ventricular function in patients with myocardial bridge, it has certain guiding value inclinical practice.
RESUMEN
Objective To investigate the value of ATP stress 99Tcm-MIBI G-MPI in evaluating instent restenosis.Methods Seventy-one patients (56 males,15 females,age range:37-83 (60.2±9.5) yeas) who had undergone coronary stent implantation at least 3 months ago,accompanying a typical angina pectoris symptom,were included in this perspective study.All patients underwent ATP stress 99Tcm-MIBI G-MPI and CAG (gold standard) within 1 month.The diagnostic efficiency of ATP stress 99Tcm-MIBI G-MPI on in-stent restenosis was evaluated.Fisher exact probability method was used to analyze data with SPSS 17.0.Results Five patients were excluded because of new stenosis.According to the results of CAG,39 patients with 45 coronary arteries showed in-stent restenosis among 66 patients with 99 coronary arteries.There were 19 patients with myocardial infarction among the 39 patients with in-stent restenosis.Contrarily,there were 16 patients with myocardial infarction among the 27 patients without in-stent restenosis.The diagnostic Se,Sp,Ac,PPV and NPV of ATP stress 99Tcm-MIBI G-MPI for in-stent restenosis were 85％(33/ 39),89％(24/27),86％ (57/66),92％ (33/36) and 80％ (24/30),respectively in 66 patients.Those were 79％(15/19),88％(14/16),83％(29/35),88％(15/17) and 78％(14/18) in patients with myocardial infarction,and 90％ (18/20),91％ (10/11),90％ (28/31),95％ (18/19) and 83％ (10/12) in patients without myocardial infarction (all P＞0.05).Conclusion ATP stress 99Tcm-MIBI G-MPI has high diagnostic efficiency in evaluating in-stent restenosis.
RESUMEN
Objective: To explore the influencing factors of slow blood flow phenomenon after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: Clinical and PCI angiographic data of 488 patients, who were diagnosed as AMI and received primary PCI in our hospital from Jan 2010 to Jun 2011, were retrospectively analyzed. Patients were divided into slow blood flow group (n=51, TIMI flow ≤ grade 2) and normal flow group (n=437, TIMI flow= grade 3). Their clinical characteristics between two groups were compared. Results: Compared with normal flow group, there were significant reductions in percentages of thrombus aspiration (75.3% vs. 60.8%) and application of platelet glycoprotein IIb/IIIa receptor antagonist (81.7% vs. 68.6%) during PCI, and significant rise in total length of implanted stents [(31.8±12.2) mm vs. (35.7±12.0) mm] in slow blood flow group, P<0.05 all. Multi-factor Logistic regression analysis indicated that percentages of thrombus aspiration during PCI and total length of stents were independent influencing factors for slow blood flow (P<0.05 both). Conclusion: Percentages of thrombus aspiration and total length of stents during PCI are independent influencing factors for slow blood flow.
RESUMEN
The objective of the study was to estimate the prevalence of hypertension and associated factors among older rural adults in Liaoning Province, China. The study was conducted in 2004-2006, using a multistage, stratified clustering sampling scheme to select a representative sample. A total of 10,065 adults aged 60 years or older were examined. A survey of blood pressure and associated factors was carried out. All data analyses were conducted using SPSS 11.5 statistical software package. Overall, the prevalence rates of hypertension are 57, 64.4 and 64.9% for the age groups 60-69, 70-79 and >/= 80 years, respectively. The prevalence of hypertension was positively correlated with age, female gender, Mongolian ethnicity, overweight and obesity, smoking and drinking, whereas income level was a protective factor for hypertension. The rates of awareness, treatment and control among older rural adults were very low [overall 35.2, 28.7 and 1.0%, respectively] Hypertension was highly prevalent among older rural adults in Liaoning Province, and it was associated with many factors. The percentages of hypertensives who were aware, treated, and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure monitoring system to better manager hypertension among older adults in rural China
Asunto(s)
Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Población Rural , Prevalencia , Fumar , Obesidad , Distribución por Sexo , Estudios Transversales , Consumo de Bebidas Alcohólicas , Distribución por EdadRESUMEN
Objective To evaluate the 64-slice CT angiography in characterizing the coronary venous anatomy and the arterio-venous relationship.Methods Sixty-four slice CT coronary veins angiography images of 300 patients(187 men and 113 women,)were analyzed.The visibility of the coronary veins and arterio-venous spatial relationship were assessed qualitatively on two-and three-dimensional displays.The diameter of the coronary sinus ostium(CSO),middle cardiac vein ostium(MCVO)and posterior vein of left ventricle ostium(PVLVO)were measured.All data was statistically processed with SPSS for Windows.Results The CS,great cardiac vein(GCV)and MCV could be clearly visualized in all of the images.1-3 branches of PVLV could be observed in 273 patients(91.0%).Small cardiac vein(SCV)and Marshall vein were found in 56(18.7%)and 24(8.0%)cases respectively.Three patients had permanent vena cava superior on the left and one patient had a CS diverticulum.Posterior descending artery(PDA)was concomitant with MCV in 189 cases(63.0%)and intersected with MCV in 96 cases(32.0%).Left circumflex artery(LCX)was concomitant with CS in 122 cases(40.7%),intersected with MCV in 15 cases(5.0%),and intersected with PVLV in 104 cases(34.7%).There were no significant differences in age,sex and CHD groups among CSO,MCV,PVLV value.The supero-inferior diameter of CSO had a significant difference between male and female(F=6.67,P＜0.05).Conclusion Sixty-four slice CT venous angiography is able to be used for guiding electrophysiological procedures,which is especially useful due to the considerable variations in venous anatomy.
RESUMEN
Objective To prospectively evaluate the sensitivity and specificity of ankle brachial index (ABI) in the diagnosis of lower extremity arterial disease(LEAD)by using conventional digital subtraction angiography (DSA) as the reference standard, and to research the threshold value of ABI screening test for diagnosis. Methods A total of 383 consecutive patients (245 men and 138 women, mean age (64.1±11.7) years] underwent conventional DSA and ABI measurement. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values for predicting the LEAD in these patients. Results Conventional DSA was used as the gold standard in defining≥50% luminal stenosis for the diagnosis of LEAD. 0. 95 was the overall cutoff of ABI which was associatcd with 93.0% sensitivity, 85.0% specificity, 8.81 positive likelihood ratio(+LR) and 0. 23 negative likelihood ratio(-LR) for detection of hemodynamically significant stenosis (lesions>≥50%) in all 383 subjects (P<0.01). The area under the ROC curve was 0. 953(95%CI 0.920～0.985). Conclusions ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the diagnosis of lower extremity arterial disease. And the cut-off 0.95 is the threshold ABI value for detecting LEAD in Chinese population.
RESUMEN
Objective To study mortality of acute myocardial infarction caused by acute left main coronary artery occlusion.The objectives of this analysis were to determine the effect of primary PCI and the impact of cardiogenic shock on acute myocardial infarction caused by acute left main coronary artery occlusion.Methods From 1999 to 2005,of 752 consecutive patients with acute myocardial infarction,16 patients had acute left main coronary artery occlusion with TIMI flow≤2.All patients were given primary PCI.Results Of these 16 patients,9(56.25%)died in hospital,and 7(43.75%)discharged.In the survival group reperfusion was successful in 100% of patients,as opposed to 44.44% in the mortality group(P=0.019).Cardiogenic shock was overt in 12(75.00%)patients,42.86% of the survival group and 100% of the mortality group(P=0.020).Shock patients had higher in-hospital mortality than stable patients(75 % vs 0%,odds=4.0,95%CI 1.50~10.66,P=0.019).Conclusion Patients presenting with AMI caused by acute left main coronary artery occlusion and cardiogenic shock have poor survival regardless of primary PCI.Nevertheless,primary PCI is a feasible and effective procedure,and it may save lives in this clinical setting.
RESUMEN
The new cholesterol absorption inhibitor Ezetimibe(EZ)could markedly reduce the LDL-C level and increase the HDL-C level with little adverse effect.EZ combined with statins shows cooperative effect and avoids the latent adverse effect of large dose of statins.Thus this combined therapy is a reasonable choice for the patients whose cholesterol level could not reach the standard after using optimum dose of statins.
RESUMEN
<p><b>OBJECTIVE</b>To discuss the diagnosis and therapy of chylous reflux and external chylous fistula.</p><p><b>METHODS</b>All of 6 patients were diagnosed with direct lymphagiography, lymphscintigraphy. Among them, 2 patients received CT after direct lymphagiography. Retroperitoneal lymphangiectomy plus lymph-vein shunting was performed in 5 patients, and retroperitoneal lymphangiectomy in 1 patient.</p><p><b>RESULTS</b>The 6 patients were followed up from 6 months to 6 years. In 5 patients, chylous cysts disappeared and chylous fistula closed, and in 1 patient, chylous fistula didn't cicatrize, and chyle still leak out from the scrotum.</p><p><b>CONCLUSIONS</b>Retroperitoneal lymphangiectomy plus lymph-vein shunting has curative effect on chylous external fistula of the lower extremity and genitalia, but it has the chance to not obstruct all paths of chylous reflex.</p>
Asunto(s)
Humanos , Quilo , FístulaRESUMEN
Objective To investigate the mechanism of chaos during ventricular fibrillation(VF)after acute myocardial infarction(AMI)and observe the property of nonlinear dynamics of VF in order to provide clinical doctors with theory evidences to prevent VF after AMI.Methods From Jun.2003 to Dec.2005,we made the acute myocardial infacrtion model and induced VF of canine in vivo by using rapid pacing,and recorded the cardiac electrophysiological parameters by using 64-trains multi-polar epicardial-mapping electrocardiogram system to observe the change of the cycle length(CL)of ventricular arrhythmia in the Second Affiliated Hospital of China Medical Univercity.Results The pacing interval of VF in acute ischemia myocardium had been significantly increased; the cycle length(CL)showed the spatiotemporal complexity,such as period doubling bifurcation and quasiperiodicity and its Poincar'e plots formed a ring-like structure meaning nonlinear dynamics property during VF.Conclusion The liminal value of VF has been significantly increased during acute myocardial infarction.VF is induced by system come-into period doubling bifurcation,quasiperiodicity and chaos.
RESUMEN
Objective The aim of this study was to evaluate the value of QT dispersion and heart rate variability in predicting early ventricular fibrillation during hospitalization after acute myocardial infarction.Methods Seventy-two patients underwent 24-hour Holter monitoring within 6 hours after onset of acute myocardial infarction.They were divided into 2 groups,VF group (12 cases) and Non-VF group (60 cases),based on whether they had experienced an episode of ventricular fibrillation during their hospitalization.Index of QT dispersion and heart rate variability were calculated on the basis of 24 hours Holter recording.Results The HRV indexes showed significant difference (respectively,.P.
RESUMEN
0.05),(94.7?21.9)ms(P
RESUMEN
Through cluster multistage sampling,a resident group of 6 412 subjects with hypertension in the rural area of Liaoning province were recruited.According to IDF and NCEP-ATPm criteria the age-standardized prevalences of metabolic syndrome were 36.2%and 25.9%respectively.The prevalence of metabolic syndrome decreased with advancing age,but increased with rising of blood pressure.