Risk of venous thromboembolism in Chinese pregnant women: Hong Kong venous thromboembolism study

BACKGROUND: Previous Caucasian studies have described venous thromboembolism in pregnancy; however, little is known about its incidence during pregnancy and early postpartum period in the Chinese population. We investigated the risk of venous thromboembolism in a “real-world” cohort of pregnant Chinese women with no prior history of venous thromboembolism. METHODS: In this observational study, 15,325 pregnancies were identified in 14,162 Chinese women at Queen Mary Hospital, Hong Kong between January 2004 and September 2016. Demographic data, obstetric information, and laboratory and imaging data were retrieved and reviewed. RESULTS: The mean age at pregnancy was 32.4±5.3 years, and the median age was 33 years (interquartile range, 29–36 yr). Pre-existing or newly diagnosed diabetes mellitus was present in 627 women (4.1%); 359 (0.7%) women had pre-existing or newly detected hypertension. There was a small number of women with pre-existing heart disease and/or rheumatic conditions. Most deliveries (86.0%) were normal vaginal; the remaining were Cesarean section 2,146 (14.0%). The incidence of venous thromboembolism was 0.4 per 1,000 pregnancies, of which 83.3% were deep vein thrombosis and 16.7% were pulmonary embolism. In contrast to previous studies, 66.7% of venous thrombosis occurred in the first trimester. CONCLUSION: Chinese women had a substantially lower risk of venous thromboembolism during pregnancy and the postpartum period compared to that of Caucasians. The occurrence of pregnancy-related venous thromboembolism was largely confined to the early pregnancy period, probably related to the adoption of thromboprophylaxis, a lower rate of Cesarean section, and early mobilization.

Role of Soluble ST2 Levels and Beta-Blockers Dosage on Cardiovascular Events of Patients with Unselected ST-Segment Elevation Myocardial Infarction / 中华医学杂志(英文版)

<p><b>Background</b>Serum soluble ST2 (sST2) levels are elevated early after acute myocardial infarction and are related to adverse left ventricular (LV) remodeling and cardiovascular outcomes in ST-segment elevation myocardial infarction (STEMI). Beta-blockers (BB) have been shown to improve LV remodeling and survival. However, the relationship between sST2, final therapeutic BB dose, and cardiovascular outcomes in STEMI patients remains unknown.</p><p><b>Methods</b>A total of 186 STEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sST2 was measured at baseline. Patients were divided into four groups according to their baseline sST2 values (high >56 ng/ml vs. low ≤56 ng/ml) and final therapeutic BB dose (high ≥47.5 mg/d vs. low <47.5 mg/d). Cox regression analyses were performed to determine whether sST2 and BB were independent risk factors for cardiovascular events in STEMI.</p><p><b>Results</b>Baseline sST2 levels were positively correlated with heart rate (r = 0.327, P = 0.002), Killip class (r = 0.408, P = 0.000), lg N-terminal prohormone B-type natriuretic peptide (r = 0.467, P = 0.000), lg troponin I (r = 0.331, P = 0.000), and lg C-reactive protein (r = 0.307, P = 0.000) and negatively correlated to systolic blood pressure (r = -0.243, P = 0.009) and LV ejection fraction (r = -0.402, P = 0.000). Patients with higher baseline sST2 concentrations who were not titrated to high-dose BB therapy (P < 0.0001) had worse outcomes. Baseline high sST2 (hazard ratio [HR]: 2.653; 95% confidence interval [CI]: 1.201-8.929; P = 0.041) and final low BB dosage (HR: 1.904; 95% CI, 1.084-3.053; P = 0.035) were independent predictors of cardiovascular events in STEMI.</p><p><b>Conclusions</b>High baseline sST2 levels and final low BB dosage predicted cardiovascular events in STEMI. Hence, sST2 may be a useful biomarker in cardiac pathophysiology.</p>

Eff ect of early intervention on 12-month follow-up clinical prognosis in patients with high-risk non-ST-segment elevation acute coronary syndrome / 中国介入心脏病学杂志

Objective To compare 12-month follow-up clinical outcome of an early to a delayed intervention in the management of high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods 758 consecutive high-risk NSTE-ACS patients treated with percutaneous coronary artery intervention(PCI)were enrolled between Jauary 2015 and December 2015 in Wuhan Asia Heart Hospital. They were divided into 2 groups according to diff erent intervention time, the early PCI group(within 24 h after diagnosis,n=185)and the delayed group (more than 24 h after diagnosis, n=573).The baseline clinical data, angiographic features, data related to PCI, the 12-month follow-up major adverse cardiac events (MACE) were analyzed retrospectively. MACE were defi ned as all-cause death and recurrent nonfatal myocardial infarction. Results Primary endpoint status after 12-month follow-up were collected in 711 of 758 initially enrolled patients. Incidence of MACE was 14.5% in the early and 11.2% in the delayed PCI group(χ2=1.289,P=0.256). No signifi cant diff erences were found in the occurrence of the individual components of all-cause death and nonfatal myocardial infarction. Mean hospital stay were(7.6±3.1)d in the early and (10.7±3.8)d in the delayed PCI group(t=2.489,P=0.014). Mean medical expenses in RMB were(48.5±13.5) thousand yuan in the early and(52.8±16.4)thousand yuan in the delayed PCI group(t=2.132,P=0.038). Conclusions After 12-month follow-up,no diff erence in incidence of MACE was seen between early and delayed invasive strategy,but with shorter hospital stay and reduced medical expenses.

Effect of magnesium isoglycyrrhizinate on PLA2 during liver tissue injury following limb ischemia/reperfusion in rats / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the effects of magnesium isoglycyrrhizinate (MI) on the changes of phospholipase A2 (PLA2) induced during liver tissue injury following limb ischemia/reperfusion (I/R) in rats.</p><p><b>METHOD</b>Twenty-four healthy male Sprague-Dawley rats weighing (230+/-30) g were randomly divided into three groups (n = 8 each) as follows: control (Group C: anesthetization without any ischemia); I/R injury (Group I/R: 4 h ischemia induced by rubber band ligation of the left hind limb around the roots of the hind limb, followed by 6 h of reperfusion, with 1 mL normal saline given via tail vein prior to reperfusion); MI-treated group (Group MI: underwent ischemia and reperfusion, with 1 mL MI (30 mg/kg) infused prior to reperfusion). Levels of TNFa and PLA2 in plasma and liver tissue were measured by enzyme-linked immunosorbent assay (ELISA). Levels of plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), myeloperoxidase (MPO), and malondialdehyde (MDA), and activities of MPO and MDA in liver tissue were measured by colorimetry. Ultrastructural changes of liver tissue were observed by electron microscopy.</p><p><b>RESULTS</b>The MI group had significantly lower PLA2 and TNFa in liver homogenates and serum than the I/R group (both P less than 0.05). Serum ALT, AST, LDH, and CK were significantly lower in the MI group than in the I/R group (all P less than 0.05), as were the levels of MPO and MDA in liver homogenates and serum (all P less than 0.05). The I/R group showed significantly more liver tissue damage, which appeared to be attenuated in the MI group.</p><p><b>CONCLUSION</b>MI treatment can inhibit the I/R-induced TNFa, PLA2, and MDA in plasma and liver tissue, as well as decrease the I/R-induced MPO activity in rats. Thus, MI may have protective effects against liver tissue injury following limb ischemia/reperfusion.</p>

Correlation among cognition impairment, P300 value and MR diffusion tensor imaging data in patients with depression / 中华神经医学杂志

Objective To investigate the cognition impairment in depression patients with its event-related potential P300 and MR diffusion tensor imaging (DTI) and explore the mechanism of depression combined with cognition impairment Methods We conducted a study of 60 people: 30 patients with depression and 30 healthy controls group-matched by age, educational level andsocioeconomic status. The latency period and amplitude of P3, and the data of fractional anisotropy (FA) were measured by P300 examination and DTI, respectively, in the bilateral white matter of interested region. Correlation analysis of these 3 factors was performed in the 2 groups. At the same time, the scores of Wisconsin card sorting test (WCST) were detected. Results The WCST scores of each sub-item,and the P3 latency and amplitude between the control group and depression group had statistically significant differences (P<0.05). FA value in the white matter of the both frontal lobe, the anterior cingulate gyms, the supramarginal gyrus, splenium of the corpus callosum in the patients was significantly lower than that in the controls (P<0.05). P3 latency and percentage of persistent errors in depression patients were positively correlated (r= 0.677, P=0.009). P3 amplitude and both percentage of persistent errors and percentage of not being able to maintain a complete classification were negatively correlated, respectively (r=0.765,P=0.001; r=-0.654, P=0.012). FA values and both percentage of persistent errors and percentage of not being able to maintain a complete classification were negatively correlated in patients with depression in the bilateral frontal white matter, respectively (left: r=-0.544,P=0.003; r=0.489, P=0.023; right: r=0.665, P=0.002; r=0.448,P=0.027). Conclusions Neuropsychology and event-related potential P300 reflected the cognition impairment in patients with depression; the latency period and amplitude of P3 could be a reference index of evaluating the cognitive function. The outcome of DTI can reveal the possible abnormality of neurofibra in the white matter region, which may be one of its neuropathology in depression patients with cognition impairment.