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Objective:To investigate the influencing factors for major adverse cardiovascular events(MACE)in older patients with preserved ejection fraction(HFpEF)or with mid-range ejection fraction(HFmrEF)heart failure in the vulnerable phase.Methods:Data for 312 patients with preserved or mid-range ejection fraction heart failure hospitalized at the Department of Geriatrics, General Hospital of Tianjin Medical University from January 2017 to October 2019 were retrospectively collected, and 17 patients were lost to follow-up.A total of 295 elderly patients with preserved or mid-range ejection fraction heart failure were included in this study.According to whether major cardiovascular events occurred in the vulnerable phase(90 d after discharge), patients were divided into a MACE group(n=87)and anon-MACE group(n=208). Baseline data between the two groups were compared.Univariate logistic regression analysis wasused to determine risk factors for patients in the vulnerable phase, and COX regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the influence of resting heart rate and hematocrit on MACE in the vulnerable phase.The predictive value of resting heart rate and hematocrit in MACE was analyzed by the ROC curve.Results:The resting heart rate at discharge in the MACE group was(78.6±6.9)bpm, higher than(71.1±8.4)bpm in the non-MACE group( t=7.30, P<0.01), whereas hematocrit was(32.3±3.6)%in the MACE group, lower than(36.6±4.9)% in the non-MACE group( t=-8.22, P<0.01). Resting heart rate and hematocrit were risk factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.Multivariate Cox regression analysis showed that HR was 1.11 for resting heart rate(95% CI: 1.07-1.14, P<0.001)and 0.91 for hematocrit(95% CI: 0.83-0.99, P=0.034). The survival times of patients with low and high resting heart rate were(86.5±1.2)d and(57.9±3.2)d, respectively.The survival rate of the high resting heart rate group(87.3%, 89/102)was lower than that of the low resting heart rate group(98.4%, 190/193)( χ2=116.30, P<0.01). The survival times of patients with high and low hematocrit values were(84.6±1.7)d and(67.0±2.4)d, respectively.The survival rate of the low hematocrit group(91.9%, 148/161)was lower than that of the high hematocrit group(97.8%, 131/134)( χ2=40.32, P<0.01). ROC curve analysis revealed that the cut-off values for resting heart rate and hematocrit were 73.5 bpm and 35.4%, respectively.The area under the ROC curve(0.919, 95% CI: 0.882-0.947, P<0.05)for the diagnosis of MACE using the combination of both parameters was significantly larger than that using resting heart rate(0.885, 95% CI: 0.843-0.919, P<0.05)or hematocrit(0.747, 95% CI: 0.694-0.796, P<0.05)alone. Conclusions:Resting heart rate and hematocrit are the main influencing factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.
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Objective To explore the effects of delayed umbilical cord clamping on full-term newborns and maternal outcomes.Methods From January 2017 to April 2018,287 normal full-term newborns delivered by vagina in the First People's Hospital of Xiaoshan District were selected in the research ,and randomly divided into the control group (141 cases) and observation group (146 cases ) according to the order of entering the delivery room.The control group was ligated the umbilical cord 15-20 s after delivery, while the observation group was ligated the umbilical cord 60 s after delivery.The level of hemoglobin ,hematocrit,the incidence of anemia,polycythemia,hyper-bilirubinemia and phototherapy time of full-term newborns were compared between the two groups 3 days after birth. The third stage of labor, the amount of postpartum hemorrhage and the incidence of postpartum hemorrhage were compared between the two groups.Results The hemoglobin [(181.49 ±16.84) g／L] and hematocrit (0.545 ± 0.055) in the observation group were significantly higher than those in the control group [(175.90 ±17.49 ) g／L, (0.515 ±0.062)] at the third day after birth (t＝2.748,3.409,all P＜0.05).The incidence of neonatal anemia in the observation group was 0.68%(1／146),which was significantly lower than that in the control group [4.96%(7／141)],and the difference was statistically significant (χ2 ＝4.848,P＜0.05).The incidence rates of neonatal polycythemia,hyperbilirubinemia and phototherapy time in the observation group were 2.05%(3／146),24.66%(36／146),(65.50 ±14.63)h,respectively,which in the control group were 0.17%(1／141),22.70%(32／141) and (62.09 ±14.40)h,respectively,there were no statistically significant differences between the two groups (χ2 ＝0.945,0.153,t＝0.953,all P＞0.05).The third stage of labor time ,postpartum hemorrhage volume ,incidence of postpartum hemorrhage in the observation group were (5.97 ±4.17)min,(239.04 ±69.15)mL,2.05%(3／146), respectively,which in the control group were (5.84 ±3.62 ) min, (227.73 ±56.99 ) mL,0.71%( 1／141 ), respectively,there were no statistically significant differences between the two groups (t＝0.281,1.504,χ2 ＝0.945, all P＞0.05).Conclusion Delayed umbilical cord clamping can increase the level of hemoglobin and hematocrit in newborns,reduce the incidence of anemia in newborns ,and without increasing postpartum hemorrhage.
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Objective@#To explore the effects of delayed umbilical cord clamping on full-term newborns and maternal outcomes.@*Methods@#From January 2017 to April 2018, 287 normal full-term newborns delivered by vagina in the First People's Hospital of Xiaoshan District were selected in the research, and randomly divided into the control group (141 cases) and observation group (146 cases) according to the order of entering the delivery room.The control group was ligated the umbilical cord 15-20 s after delivery, while the observation group was ligated the umbilical cord 60 s after delivery.The level of hemoglobin, hematocrit, the incidence of anemia, polycythemia, hyperbilirubinemia and phototherapy time of full-term newborns were compared between the two groups 3 days after birth.The third stage of labor, the amount of postpartum hemorrhage and the incidence of postpartum hemorrhage were compared between the two groups.@*Results@#The hemoglobin[(181.49±16.84) g/L] and hematocrit (0.545±0.055) in the observation group were significantly higher than those in the control group[(175.90±17.49 )g/L, (0.515±0.062)] at the third day after birth (t=2.748, 3.409, all P<0.05). The incidence of neonatal anemia in the observation group was 0.68% (1/146), which was significantly lower than that in the control group [4.96% (7/141)], and the difference was statistically significant (χ2=4.848, P<0.05). The incidence rates of neonatal polycythemia, hyperbilirubinemia and phototherapy time in the observation group were 2.05% (3/146), 24.66% (36/146), (65.50 ±14.63)h, respectively, which in the control group were 0.17% (1/141), 22.70% (32/141) and (62.09±14.40)h, respectively, there were no statistically significant differences between the two groups (χ2=0.945, 0.153, t=0.953, all P>0.05). The third stage of labor time, postpartum hemorrhage volume, incidence of postpartum hemorrhage in the observation group were (5.97 ±4.17)min, (239.04±69.15)mL, 2.05% (3/146), respectively, which in the control group were (5.84±3.62)min, (227.73±56.99)mL, 0.71% (1/141), respectively, there were no statistically significant differences between the two groups (t=0.281, 1.504, χ2=0.945, all P>0.05).@*Conclusion@#Delayed umbilical cord clamping can increase the level of hemoglobin and hematocrit in newborns, reduce the incidence of anemia in newborns, and without increasing postpartum hemorrhage.
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Objective Mean platelet volume (MPV) and Red Blood Cell Distribution Width (RDW) have been demonstrated to be associated with deep vein thrombosis (DVT).However,their role in the prediction of pulmonary embolism (PE),which is a major complication of DVT,are still unclear.Therefore,we investigated the association of MPV and RDW values with acute PE in patients with DVT.Methods A case-control study was conducted in patients hospitalized in emergency department of Beijing Friendship Hospital from November 2006 to June 2016.The study included three groups:patients with DVT and PE (PE group,n =96),patients with DVT without PE (non PE group,n =95),and control group (No DVT,No PE,n =96).Results (1) MPV was significantly higher in all DVT patients than that in control group (9.8 ±0.5 vs7.8 ±0.6,P ＜0.05;8.6±0.6 vs7.8 ± 0.6,P＜0.05) and MPV was significantly higher in DVT patients with PE than that in DVT patients without PE [(9.8 ± 0.5) fL,(8.6 ± 0.6) fL] (P ＜ 0.05).(2) The percentage of patients with RDW ＞ 14.5％ was significantly higher in PE group and non PE group than that in control group (52.1％ vs 20.8％),and (45.3 ％ vs 20.8％) (P ＜ 0.05).(3) In logistic analysis,MPV is an independent risk factor for PE patients (OR:22.18,95％ CI:9.36-53.16,P ＜0.01),the area under receiver operating characteristic (ROC) curve is 0.91,and the best critical value is 9.15 fL.The incidence of PE in patients with MPV ＞ 9.15 fL and MVP ＜ 9.15 fL was 75.6％ vs 15％ respectively,with statistically significance (P ＜ 0.05).Conclusions Combining use of RDW and MPV may be used as an early assessment of venous thromboembolism.MPV ＞ 9.15 fL suggests that patients may have PE.
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Objective To explore the clinical application value of the prealbumin (PA),total bile acid (TBA),and red blood cell volume distribution width (RDW) in chronic liver disease.Methods Totally 393 cases of patients with chronic liver disease admitted by Xiangya Hospital of Central South University from March 2015 to March 2016 were selected as group observation,and were divided into chronic hepatitis,compensated liver cirrhosis,decompensated liver cirrhosis and primary liver cancer.At the same time,200 cases of healthy volunteers were collected as normal control.Serum prealbumin and total bile acids were tested as well as the RDW of all cases.SPSS 17.0 software was used for data statistics processing.The receiver-operating characteristic curve (ROC) was drawn to evaluate the diagnosis value of the indexes in chronic liver disease severity.Results PA in the observation group was significantly lower than normal control,while its TBA and RDW were significantly higher than normal control.All of three parameters in patients,especially with liver cirrhosis and decompensated liver cirrhosis,had higher positive rate.When the clinical diagnosis was taken as gold standard,the best level of PA to diagnose primary liver cancer,chronic hepatitis and decornpensated liver cirrhosis was 244.7 mg/L,238.5 mg/L and 132.8 mg/L,the AUC was 0.973,0.909 and 0.879,the sensitivity was 92.3％,95.1％ and 85.6％,and the specificity was 95.8％,72.8％ and 79.7％;the best level of RDW to diagnose primary liver cancer,chronic hepatitis and decompensated liver cirrhosis was 13.2％,13.8％ and 14.3％,the AUC was 0.816,0.827 and 0.818,the sensitivity was 66.7％,77.4％ and 72.2％,and the specificity was 79.5％,73.8％ and 77.3％.When combined detection of PA and RDW,the diagnostic performance had improved significantly.Conclusions Serum prealbumin and total bile acid,as well as the whole blood RDW may objectively reflect the injury of liver metabolism and synthesis function,and for the early diagnosis and prognosis of patients with chronic liver disease has a important clinical significance.
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Objective To observe the changes of red blood cell distribution width, mean platelet volume and cardiac troponin I in patients with Acute Coronary Syndromes, and to evaluate the value for early diagnosis by using ROC curve. Methods 191 patients with ACS and 206 patients with the chest pain syndromes non-ACS were selected in this study. Electrocardiogram,blood routine,creatinine, LDL-C and cardiac troponin I were determined within six hours after hospitalized,meanwhile the feature of ROC curves was observed. Results There was no significant difference between ACS group and non-ACS group about red blood cell, hemoglobin, platelet,creatinine and LDL-C［(3.82±0.57)×1012/L,(101.3±3.3)g/L,195（98.6-334.8）×109/L,69（45-120）μmol/L,(2.95±0.85)mg/dl vs (3.89±0.50）×1012/L,(103.5±3.7)g/L,201（135.2-346.9）×109/L,71（49-100）μmol/L,(2.82±0.75)mg/dL］ (P＞ 0. 05). Red blood cell distribution width, mean platelet volume and the cardiac troponin I in ACS group［13.70(12.00-15.20)%,9.4（7.42-12.31）fL,(5.63±1.39)μg/L］ were significantly higher than that of non-ACS group［12.60（11.20-13.83）%,8.2（6.24-10.97）fL,(0.04.±0.01)μg/L］ (P＜0.01) .The area under ROC curves of red blood cell distribution width,mean platelet volume and cardiac troponin I were 73.5%, 78.8%, 98.1% respectively, while the best cut-off value was 13.15%, 12.45 fL, 0.06 μg/L respectively. Conclusions The combination using of red blood cell distribution width andmean platelet volume and cardiac troponin I and other conventional cardiac markers might be served as early diagnosis marker for the ACS patients admitted to emergency departments.