Acute adverse events and pregnancy outcome after inactivated COVID-19 vaccination in first trimester / 中华围产医学杂志

Objective:To investigate acute adverse events and pregnancy outcome after vaccination of inactivated COVID-19 vaccine in the first trimester of pregnancy.Methods:The retrospective-prospective cohort study was conducted among pregnant women of 11-13 +6 weeks of gestation who visited the obstetric clinics for prenatal check in Lianyungang Maternal and Child Health Hospital from May to November in 2021, after registration for perinatal health cards in the community. Those who met the inclusion criteria were recruited and were divided into vaccination group and non-vaccination group according to whether they received inactivated COVID-19 vaccine in the first trimester. Women in the vaccination group were further divided into 1-dose group and 2-dose group. Information, including pregnancy-related screening, pregnancy complications, pregnancy outcome and acute adverse events, were collected and compared with independent samples t-test or ANOVA, Kruskal- Wallis H test or Mann-Whitney U test, χ2 test or Fisher's exact probability method. Results:Totally, 105 pregnant women were analyzed in 1-dose group, 90 in 2-dose group, and 194 in non-vaccination group. (1) There were no statistically significant differences in the occurrence of acute adverse events [1-dose group: 2.86% (3/105); 2-dose group: 6.67% (6/90); non-vaccination group: 4.63% (9/194); χ2=1.59; vaccination group was 4.61% (9/195), when compared with non-vaccination group, χ2=0.00], abnormal pregnancy-related screening indicators and abnormal pregnancy outcome among the three groups (all P>0.05), neither between the vaccination and non-vaccination group (all P>0.05). The acute adverse events in these women included fever, pain at the inoculation site, fatigue, local induration and rash.(2) The differences in hypertensive disorders in pregnancy among the three groups were statistically significant [1-dose group: 10.5%(11/105); 2-dose group: 17.8%(16/90); non-vaccination group: 7.7%(15/194); χ2=6.46, P=0.040], and the incidence was higher in the 2-dose group than that in the non-vaccination group (adjusted by Bonferroni, P<0.017). (3) Regarding other pregnancy complications, no difference was found among the three groups (all P>0.05), neither between the vaccination and non-vaccination group (all P>0.05). Conclusion:The risk of acute adverse events and adverse pregnancy outcome is similar in pregnant women who received inactivated COVID-19 vaccine versus those who did not in the first trimester, and regular blood pressure monitoring is recommended for those who received two doses of inactivated COVID-19 vaccine.

Chinese expert consensus on management of dyslipidemia in the elderly / 中华内科杂志

Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.

Influencing factors of image cleanliness scores of magnetically-controlled capsule endoscopy / 中华消化内镜杂志

Objective:To explore the influencing factors of the image cleanliness scores of magnetically-controlled capsule endoscopy (MCE) and the methods to improve cleanliness scores.Methods:Data of patients undergoing MCE from October 2017 to August 2020 in Peking University First Hospital were analyzed retrospectively. The cleanliness scores at six regions of the stomach (cardia, fundus, body, angularis, antrum, and pylorus) were recorded (1-4 points), and the sum of the scores from these six regions was also calculated. Clinical features [gender, age, body mass index, indication, use of esophagus cap, and medication of proton pump inhibitors(PPI)], and gastric preparation regimens (one dose of pronase: simethicone 5 mL + pronase 20 000 U + sodium bicarbonate 1 g; or two doses of pronase: simethicone 5 mL + pronase 40 000 U + sodium bicarbonate 2 g) were collected. Cleanliness scores were defined as poor (group P, total cleanliness scores≤18) and as good (group G, total cleanliness scores>18). Clinical features, indication, use of esophagus cap and PPI, and preparation regimes were compared. Factors influencing cleanliness scores were analyzed.Results:A total of 238 consecutive patients with median age of 61.5 (54.0, 76.3) years were recruited according to inclusion criteria, among whom 68(28.6%) were female. There were 35 patients (14.7%) in group P with median age of 67.0 (56.0, 83.0) years. There were 203 patients(85.3%)in group G with median age of 61.0 (53.0, 75.0) years. No significant differences were found in age, sex, body mass index or esophagus cap use( P>0.05). Indications of abdominal symptoms or digestive system diseases( OR= 2.899, 95% CI: 1.258-6.681, P=0.012) and PPI use ( OR=3.168, 95% CI: 1.261-7.959, P=0.014) were more likely to yield a low cleanliness score. Gastric preparation regimen with two doses of pronase ( OR=0.201, 95% CI: 0.067~0.603, P=0.004)was more likely to avoid a low cleanliness score. Conclusions:Indications of digestive system diseases or abdominal symptoms and PPI use may decrease the cleanliness scores of MCE, while gastric preparation with double doses of pronase may improve it.

Study on the efficacy and influencing factors of Dabigatran in elderly patients / 中华老年医学杂志

Objective:To observe the efficacy of Dabigatran etexilate anticoagulation therapy and analyze its influencing factors in elderly patients.Methods:The clinical data of the elderly patients using Dabigatran etexilate anticoagulation for prevention or treatment of thrombosis in the Department of Geriatrics, Peking University First Hospital were collected.Changes of coagulation indexes and its influencing factors were analyzed when taking Dabigatran in different doses.Results:A total of 142 patients receiving Dabigatran therapy were collected, with an average age of(79.0±7.5)years.Among them, 128 patients had atrial fibrillation and 14 had deep venous thrombosis and/or pulmonary embolism.After taking Dabigatran, the trough values of activated partial thromboplastin time(APTT)and thrombin time(TT)were increased significantly in all patients compared with that before administration( P<0.001). In patients taking Dabigatran 110 mg once a day, APTT was(32.4±3.0)s before administration, with a trough value of(41.4±5.4)s and a peak value of(53.9±9.8)s.In patients taking Dabigatran 110 mg twice a day, APTT was(31.0±3.1)s before administration, with a trough value of(42.4±5.5)s and a peak value of(48.7±7.3)s.Compared with patients taking Dabigatran 220 mg/d, those who took Dabigatran 110 mg/d were older( P<0.0001), often women( P<0.0001), had lower body weight( P=0.001), body mass index( P=0.018)and creatinine clearance rate( P<0.001), and higher basal( P=0.008)and peak values( P=0.002)of APTT, but with similar trough values.Multivariate analysis showed that the APTT trough values were significantly related with APTT basal value( β=0.885, P<0.001), creatinine clearance rate( β=-0.121, P<0.001), dosage of Dabigatran( β=0.037, P<0.001)and combined amiodarone( β=3.784, P=0.022). Conclusions:There are individual differences in the anticoagulant effect of Dabigatran etexilate.The APTT trough value is higher in patients with high APTT basal value, high Dabigatran dose, low creatinine clearance rate and combined use of amiodarone.Dabigatran 110 mg/d was often used in women, elderly patients, and those with low body weight, and decreased renal function, and with a similar trough value and a high peak value of APTT compared with patients on Dabigatran 220 mg/d.

Analysis on the characteristics of postural blood pressure changes recorded with continuous non-invasive arterial pressure monitoring system and the correlative factors in elderly hospitalized patients / 中华心血管病杂志

Objective@#To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH).@*Methods@#This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis.@*Results@#The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group.@*Conclusions@#OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.

Role of Hedgehog signaling pathway in the development of retinal cells and pathological angiogenesis / 中华实验眼科杂志

The pathological growth of retinal cells and ocular pathologic angiogenesis can be seen in a variety of eye diseases,which seriously affect the visual acuity of patients.The Hedgehog signal pathway has been demonstrated to be involved in the development of retinal ganglion cells,amacrine cells,cone cells and rod cells,Müller glial cells and retinal pigment epithelial cells.This paper discusses the function of Hedgehog signal pathway in the development of retinal cells and ocular pathologic angiogenesis,which may provide a new therapeutic target for retinal and ocular vascular diseases.

Correlation of vitamin D with essential hypertension and its target organ damages in the elderly / 中华老年医学杂志

Objective To investigate the correlation of vitamin D with essential hypertension and its target organ damages in the elderly.Methods In the retrospective study,365 elderly participants aged ≥ 60 years hospitalized in our department during January 2013 to February 2014 were involved,including 247 patients with confirmed essential hypertension(HT)and 118 patients without HT.Serum 25-hydroxy vitamin D[25(OH)D]levels were measured and compared between HT and non-HT group,and binary regression analysis was used to discuss potential influencing factors of HT.The damage index of vitamin D target organ was compared between vitamin D deficiency group(n=198)and vitamin D non deficiency group(n=49).Results The median serum 25(OH)D level of participants is 35.3 nmol/L,77.5%(283 cases)were in the insufficient vitamin D status.The level of 25(OH)D was significantly lower in HT group than in non-HT group(34.0 vs.38.7 nmol/L,P0.05)in albumin/creatinine ratio,serum creatinine,estimated glomerular filtration rate,ankle-brachial index,pulse wave velocity,intima media thickness of carotid artery,Sokolow-Lyon index,cornell index and left ventricular mass index.The serum 25(OH)D level was significantly lower in CHD plus HT group than non-CHD(P<0.05).The 25(OH)D level was negatively correlated with coronary heart disease(B=-0.021,P=0.019).The serum 25(OH)D level was significantly lower in groups with double-and triple-vessel coronary artery disease than in non-CHD group(P<0.01).Conclusions Vitamin D insufficiency is common in the elderly.The serum 25(OH)D level is significantly lower in old patients with HT especially with stage 3 HT than in non-HT ones.The 25(OH)D level is lower in HT patients with comorbid CHD,and more obvious in HT patients with multi-vessel coronary artery disease.An insufficient vitamin D status is not correlated with hypertensive target organ damages including kidney,peripheral vascular and left ventricular cardiac structure.

Dose-response of aspirin on platelet function in very elderly patients / 北京大学学报(医学版)

Objective:To assess the consequences of switching aspirin dosage from 100 mg/d to 40 mg/d on cardiovascular benefit,bleeding risk and platelet aggregation in very elderly patients. Methods:Arachidonic acid induced platelet aggregation(AA-Ag)was measured in 537 patients aged 80 or older treated with aspirin (100 mg/d).In the study,100 patients with low on-treatment platelet ag-gregation and at high risk of bleeding and low risk of cardiovascular events,were switched to aspirin (40 mg/d)and their platelet aggregation was measured again 7 days later.Their bleeding and upper gastroin-testinal symptoms were also recorded in following 3 months.Results:The study observed a heterogeneous distributed aspirin 100 mg/d AA-Ag (range:0.42% to 28.78%)in the 537 very elderly patients.Aspi-rin 100 mg/d AA-Ag before the switch in aspirin 40 mg/d group was 5.00% ±2.32% and the rate of the patients with low on-treatment platelet aggregation was 71.00%.The rates of melena or occult blood positive,other minimal bleeding,upper gastrointestinal symptoms and a history of gastrointestinal bleeding in 40 mg/d group were higher than those in 100 mg/d group.On a regimen of aspirin 40 mg/d,AA-Ag increased to 11.21% ±4.95%(range:2.12% to 28.84%)with 95.00%of the patients with AA-Ag<20%and the rate of the patients with low on-treatment platelet aggregation was 15.00%.Multiple vari-able analysis revealed that aspirin 40 mg/d AA-Ag was significantly influenced by aspirin 100 mg/d AA-Ag,BMI and platelet counts.The rate of gastrointestinal bleeding decreased from 12.00% to 5.00%, and upper gastrointestinal symptoms decreased from 59.00% to 21.00% after the switch in 40 mg/d group.Conclusion:Switching aspirin dosage from 100 mg/d to 40 mg/d reduces the bleeding events and improves upper gastrointestinal symptoms,thus inhibiting platelet aggregation effectively in very elderly patients.

Correlation between the level of the urinary 11-dehydrothromboxane B2 and the clinical efficacy of aspirin in patients with type 2 diabete and coronary artery disease / 北京大学学报(医学版)

Objective:To elucidate the correlation between urinary 11-dehydro-thromboxane B2 ( 11 dhTxB2 ) and clinical efficacy of aspirin treatment in patients with type 2 diabete and coronary artery disease ( CAD) . Methods:In this prospective cohort study, 169 aged patients with type 2 diabete accom-panying CAD in Peking University First Hospital were enrolled. The level of urinary 11dhTxB2 was detec-ted using enzyme-linked immuno-sorbent assay. Low aspirin response or high on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1 500 ng/g. All the included patients were divided into two groups based on the results, HAPR group and No-HAPR group. Results:Baseline urinary 11dhTxB2 of the patients with type 2 diabete accompanying CAD was ( 3 687 ± 3 052 ) ng/g, while the urinary 11dhTxB2 was (1 954 ± 859) ng/g in patients after 100 mg/d aspirin treatment (P<0. 001). Preva-lence of HAPR in patients with type 2 diabete accompanying CAD were 32 . 5%. Within a mean follow-up time of 12 months, the outcomes occurred more frequently in HAPR group than in No-HAPR group ( P<0 . 05 ) . Conclusion:Urinary 11 dhTxB2 can be recognized as an effective indicator in evaluating aspirin clinical efficacy of patients with type 2 diabete accompanying CAD.

Association between CMTM5 gene rs723840 single nucleotide polymorphism and high on asprin platelet reactivity / 北京大学学报(医学版)

Objective: To elucidate the correlation between the single nucleotide polymorphism of CKLF-like MARVEL transmembrane member 5 ( CMTM5 ) gene rs723840 and the occurrence of high on aspirin platelet reactivity ( HAPR) . Methods:The present study is a case-control study. A total of 210 hospitalized patients in Peking University First Hospital were enrolled. Aspirin response was assessed by 0. 5 g/L arachidonic acid (AA)-induced platelet aggregation ratio (PR), and ≥3/4 quartile of PR of the population was defined as HAPR. Accordingly all the enrolled 210 coronary artery diseases ( CAD) patients were divided into HAPR group and No-HAPR group. The genotypes were determined by poly-merase chain reaction ( PCR) and sequencing analysis for rs723840 of CMTM5 gene. Results:The geno-type frequencies in rs723840 C>T of CMTM5 gene conformed well to the Hardy-Weinberg equilibrium in both HAPR group and No-HAPR group. Between the two groups, the genotypes frequencies in HAPR and No-HAPR groups were 48 . 4%, 51 . 6%, 0 . 0% and 73 . 7%, 22 . 9%, 0 . 034%, respectively ( P=0. 004). The C, T allele frequencies were significantly different in the two groups (P =0. 031,OR =0 . 501 , 95%CI:0 . 264-0 . 947 ) . Conclusion:Our study finds a significant correlation between CMTM5 gene rs723840 polymorphism and high on aspirin platelet reactivity.

Impact on the carotid intima-medial thickness and safety of rosuvastatin in Chinese patients with carotid atherosclerosis: a meta-analysis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of rosuvastatin in Chinese patients with carotid atherosclerosis.</p><p><b>METHOD</b>A systematic search of Pubmed, EMBase, CENTRAL, CBMdisc, CNKI and WANFANG databases up to January 2013 was performed to identify studies comparing rosuvastatin with a placebo or other statins on carotid intima-medial thickness (IMT) with a minimum follow-up of 6 months in Chinese patients. Meta-analysis was performed by using RevMan 5.0 software after the strict evaluation of the methodological quality of the included studies independently by two reviewers.</p><p><b>RESULTS</b>Twenty-eight studies involving 1 392 individuals were included in this review. The pooled weighted mean difference (WMD) between rosuvastatin and placebo or control on IMT was 0.28 mm (95%CI 0.14-0.42, P < 0.01), with 0.31 mm (95%CI 0.14-0.49, P < 0.01) on 6-8 months and 0.16 mm (95%CI 0.05-0.27, P = 0.005) on 12 months, respectively. Analysis on studies in core journals showed the WMD between rosuvastatin and placebo or control on IMT was 0.18 mm (95%CI 0.09-0.27, P < 0.01). The WMD between rosuvastatin and other statins on IMT was 0.06 mm (95%CI 0.04-0.08, P < 0.01). The WMD between rosuvastatin and placebo or control on plaque score was 0.89 (95%CI 0.78-0.99, P < 0.01). The WMD between rosuvastatin and placebo or control on plaque area was 1.46 (95%CI 0.67-2.25, P < 0.01).Reports of adverse effect were elevated liver enzyme (2.30%, 19/825), elevated muscle enzyme (0.73%, 6/825), muscle aches (0.61%, 5/825).</p><p><b>CONCLUSIONS</b>Rosuvastatin therapy is effective and safe to decrease IMT in Chinese patients with carotid atherosclerosis.</p>

Comparison between CHADS2 score and CHA2DS2-VASc score on assessing the risk of ischemic stroke in patients with nonvalvular atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the value between CHADS2 score and CHA2DS2-VASc score on assessing the risk of ischemic stroke in patients with nonvalvular atrial fibrillation.</p><p><b>METHODS</b>In this retrospective study, nonvalvular atrial fibrillation patients with acute ischemic stroke hospitalized from January 2004 to March 2013 in our department were included. CHADS2 score (range, 0-6) and CHA2DS2-VASc score (range, 0-9) before acute ischemic stroke was calculated. For both schemes, patients were also classified with scores of 0, 1 and ≥ 2 in low-risk, intermediated-risk and high-risk categories, respectively, the difference between the two risk stratification schemes was evaluated by each category.</p><p><b>RESULTS</b>A total of 599 patients [320 men, mean age (75.4 ± 9.1) years] were collected. According to CHADS2 score, 30 (5.0%), 132 (22.0%) and 437 (73.0%) patients were classified in the low-risk, intermediated-risk and high-risk categories, respectively. The corresponding classification by CHA2DS2-VASc score was 6(1.0%), 25(4.2%) and 568 (94.8%) cases. The number of low-risk category patients (5.0% vs. 1.0%, χ(2) = 22.04, P < 0.001) and in intermediate-risk category patients (22.0% vs. 4.2%, χ(2) = 84.81, P < 0.001, Kappa = 0.075) was significantly higher in CHADS2 score group than in CHA2DS2-VASc score group, and the consistence between the two scores was poor (Kappa = 0.322). There were less patients classified in the high-risk group by CHADS2 score compared to CHA2DS2-VASc score (73.0% vs. 94.8%,χ(2) = 131.00, P < 0.001, Kappa = 0.257).</p><p><b>CONCLUSION</b>Compared with CHADS2 score, CHA2DS2-VASc score is more valuable in predicting ischemic stroke for patients with nonvalvular atrial fibrillation.</p>

Efficacy and safety comparison of different statins in elderly patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of atorvastatin, rosuvastatin and xuezhikang capsule in elderly.</p><p><b>METHODS</b>A total of 314 60-to-94-year-old (average (73.6 ± 7.9) years old) patients who were given different doses and types of statins were divided into three groups: the atorvastatin group (108 patients), the rosuvastatin group (104 patients) and the xuezhikang capsule group (102 patients). The serum TG, TC, LDL-C, HDL-C,ALT and CK were examined before and after the treatment which lasted for at least 4 weeks. All patients were divided into moderate risk group (13, 12 and 21 patients respectively in 3 groups); high risk group (40, 44 and 48 patients respectively in 3 groups) and very high risk group (55, 48 and 33 patients respectively in 3 groups ) according to guidelines on prevention and treatment of dyslipidemia in chinese adults (2007 version). The rate of reaching target goal and the dose when reaching target levels in different risk stratification groups were calculated and compared.</p><p><b>RESULTS</b>Serum TC, LDL-C and non-HDL-C were significantly reduced after the 4-week-treatment in all the three groups (P < 0.01). Serum LDL-C level before and after treatment were (3.14 ± 0.78)mmol/L vs. (2.14 ± 0.65)mmol/L in atorvastatin group (the arevage dose was (16.4 ± 4.8)mg/d), (2.92 ± 0.77)mmol/L vs. (1.96 ± 0.55)mmol/L in rosuvastatin group (the arevage dose was (8.7 ± 3.0) mg/d), and (2.70 ± 0.62)mmol/L vs. (2.16 ± 0.61) mmol/L in xuezhikang capsule group (the arevage dose was (0.9 ± 0.3) g/d ). Among all the three groups of patients, the cases of reaching target levels of LDL-C were 13, 11 and 20 in patients at moderate risk, were 38(95.0%), 38(86.4%) and 40 (83.3%) in patients at high risk, and were 22(40.0%), 30(62.5%) and 17(51.5%) in patients at very high risk. There were no statistical differences in the rate of reaching target levels of LDL-C, non-HDL-C and TC in the three groups and at different risks (P > 0.05). One patient in the atorvastatin group showed ALT level elevation >3 times of the upper limit of normal value, there was no patient with CK level elevation >5 times of the upper limit of normal value.</p><p><b>CONCLUSION</b>Atorvastatin, rosuvastatin and xuezhikang capsule at low dose and/or standard dose are effective and safety in elderly patients.</p>

Diabetic cardiomyopathy in medical examination patients with impaired glucose tolerance and Type 2 diabetes / 中南大学学报(医学版)

OBJECTIVE@#To investigate the change of diabetic cardiomyopathy in patients with impaired glucose tolerance (IGT) and Type 2 diabetes (T2DM) and its influencing factors.@*METHODS@#Patients with IGT and T2DM were divided into an IGT group (n=314), a T2DM group (n=368) and an NC group (400 normal subjects). The left ventricular ejection fractions (LVEF) and the interventricular septal depth (IVSd) were measured by Doppler echocardiography. The general information and blood biochemistry were also collected during the corresponding time period.@*RESULTS@#Compared with the NC group, waist circumference (WC), bodymass index (BMI), premature family history of cardiovascular disease, the serum levels of fasting plasma glucose (FPG), HbA1c, TC, TG, hyperlipidemia, BUN and Cr significantly increased (P<0.01) in the IGT and T2DM groups. Compared with the NC group and the IGT group, the LVEF significantly decreased (P<0.01) and the IVSd significantly increased (P<0.01) in the T2DM group. The LVEF and IVSd did not have obvious difference between the NC group and the IGT group. Pearson correlation analysis showed a negative correlation between LVEF and HbA1c, TC and duration of disease (P<0.01); but a positive correlation between IVSd and WC, BMI, HbA1c and duration of disease, and a negative correlation between IVSd and HDL (P<0.05). In the multiple linear stepwise regression, HbA1c and duration of disease showed a significant association with both LVEF and IVSd (P<0.05).@*CONCLUSION@#T2DM has a close association with cardiomyopathy. HbA1c and duration of disease are the independent predictors for LVEF and IVSd.

The clinical features of gastrointestinal bleeding complicating aortic stenosis / 中华内科杂志

Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11％,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 ％,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P ＜0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR) successfully (6/11) and no recurrent gastrointestinal bleeding was ever found.Conservative treatment was performed in the other 5 patients with severe aortic valve stenosis (5/11) and resulted in sudden death in 2 patients (2/5).Conclusions Prompt echocardiography and gastrointestinal endoscopy should be performed in the elderly patients with obscure gastrointestinal bleeding to facilitate the early diagnosis and treatment of Heyde's syndrome.AVR is a fundamental procedure to improve the prognosis of Heyde's syndrome.

Anomalous origin of coronary artery in elderly adults:classification and incidence / 中华老年医学杂志

Objective To estimate the patterns and frequency of anomalous coronary origin with angiography in the Chinese elderly population and evaluate the correlation between anomalous coronary origin and development of coronary atherosclerotic stenosis. Methods A retrospective analysis was performed on the basis of angiographic data among elderly patients who underwent coronary arteriography in Beijing University First Hospital. Those with anomalous origin of coronary arteries were selected for further assessment and significant stenosis in coronary arteries was recorded.Results Among 2031 patients, 46 patients were found to have anomalous origin of coronary artery,with an incidence rate of 2.3%. Right coronary artery was the most common anomalous vessel, being involved in 26 patients (56.5%). The anomalous origin was more frequent in right coronary artery than in left coronary artery (41.3%). The most common anomaly was right coronary artery arising from left coronary sinus in 13 patients (28.3%). Significant atherosclerotic lesions in the anomalous arteries were seen in 37 patients (80.4%). Conclusions In Chinese elderly population, the anomalous origin of coronary artery is more frequent in right coronary artery, the most common anomaly resides in right coronary artery arising from left coronary sinus. The anomalous coronary artery increases risk for development of coronary atherosclerotic stenosis.

Relationship between peripheral atherosclerosis and coronary heart disease in elderly people / 中华老年医学杂志

Objective To investigate the relationship between peripheral atheroselerosis and coronary heart disease(CHD) in the elderly.MethodsCarotid and femoral intima-media thickness (IMT),total plaque area and carotid total plaque score were measured in 152 elderly inpatients by vascular ultrasound one week before coronary angiography,meanwhile carotid atherosclerosis was classified.The severity of CHD was estimated by the number of vessel lesions and Gensini score. ResultsCarotid and femoral IMT,plaque morbidity,total plaque area and total plaque score were much higher in the patients with CHD than in those without(all P<0.05).Carotid total plaque area,total plaque score,femoral total plaque area and femoral IMT were much higher in the patients with two-vessel lesions[(1.57±0.37)mm~2,(4.595±3.39),(0.51±0.21)mm~2 and (1.07±0.15)mm] or three-vessel lesions [(1.885±0.15) mm~2,(6.67±5.90),(0.59±0.23) mm~2 and (1.15±0.14) mm] than in those with single-vessel lesion [(0.58±0.11 )mm~2,(3.82±2.11),(0.24±0.26) mm~2 and (0.97±0.11)mm,all P<0.05)].There was positive correlation between the classification of carotid atherosclerosis(r= 0.282,P< 0.01),total plaque score (r= 0.307,P < 0.01),total plaque area ( r=0.494,P<0.01) and the number of vessel lesions.There was also positive correlation between carotid total plaque area and Gensini score(r=0.472,P<0.01),between femoral IMT(r=0.415,P<0.01),total plaque area and the number of vessel lesions(r=0.692,P<0.01),and between femoral IMT(r=0.404,P<0.01),total plaque area ( r=0.648,P<0.01 ) and Gensini score.Using multiple stepwise regression analysis,the following parameters were found to be independent predictors of coronary artery Gensini score: carotid total plaque area (OR=2.2; 95% CI:0.79 ～2.46),femoral total plaque area(OR= 1.6;95% CI:O.28～1.35) and femoral IMT (OR=1.6;95% CI:1.20～15.10).Conclusions The assessment of peripheral atherosclerosis by ultrasonography is significantly associated with the prevalence and severity of CHD.

Effect of different isoforms of tocopherols on expression of intercellular adhesion molecule-1 in human umbilical vein endothelial cells / 北京大学学报(医学版)

Objective: To observe the influence of different tocopherol isoforms on oxidized low density lipoprotein (oxLDL) or recombinant human C reactive protein (rhCRP) induced expression of intercellular adhesion molecule 1 (ICAM 1) in human umbilical vein endothelial cells (HUVECs) and to investigate the potential mechanisms and effects of different tocopherols on atherosclerosis. Methods: Cultured HUVECs were incubated with oxLDL,oxLDL+? tocopherol,oxLDL+? tocopherol,oxLDL+mixed tocopherols,rhCRP,rhCRP+? tocopherol,rhCRP+? tocopherol, rhCRP+mixed tocopherols for 24 hours, respectively. The ICAM 1 expressions of protein and mRNA were detected by cell enzyme linked immunosorbent assay (ELISA), flow cytometric technique and RT-PCR. Results : Incubation of HUVECs with oxLDL or rhCRP for 24 hours significantly increased ICAM 1 expressions of proteins and mRNA . The different tocopherols inhibited oxLDL induced ICAM 1 expression in HUVECs in a concentration dependent manner(50-200 ?mol/L) and mixed tocopherols were more potent than ? tocopherol or ? tocopherol alone. However, rhCRP induced ICAM 1 expression in HUVECs was not inhibited by tocopherols. Conclusion :The different tocopherols inhibited oxLDL induced ICAM 1 expression in HUVECs and mixed tocopherols were more potent than ? tocopherol or ? tocopherol alone, which may be important for the beneficial effects of tocopherols on atherosclerosis and cardiovascular disease.

Influence of percutaneous coronary intervention on NT-proBNP and Hs-CRP levels of the elderly with coronary heart disease / 中国介入心脏病学杂志

Objective To evaluate the influence of percutaneous coronary intervention (PCI) on NT-proBNP and Hs-CRP level of the elderly with coronary heart disease. Methods Twenty-four patients who underwent PCI, and thirty patients who underwent coronary angiography (CAG) were enrolled in this study. Plasma NT-proBNP and Hs-CRP concentrations before and at 0, 1 h, 24 h and 72 h after PCI were assayed in all patients. Results There were no significant difference in plasma NT-proBNP level at baseline level between the PCI and CAG group, and also no significant change in the CAG group after the procedure. Plasma NT-proBNP level was increased significantly from 231.31?233.52 pg/mL to the peak concentration of 663.75?614.93 pg/mL at 24 h after PCI. Statistical differences were observed between the baseline levels and at 24 h as well as 72 h after the operation in the PCI group. Plasma NT-proBNP concentrations also showed significant differences between the PCI and CAG group at each time point after the procedures. Remarkable elevation in plasma Hs-CRP level was observed at 72 h after procedure in all patients. Conclusion Elevation of plasma NT-proBNP concontrations might be induced by transient myocardial ischemia in PCI. NT-proBNP may be a marker of myocardial ischemia and may be useful to detect untypical ischemia in the elderly. Plasma Hs-CRP increased at 72 h after PCI and CAG, which may be related to inflammation reaction induced by vessel puncture.

Relationship between plasma cortistatin and coronary heart disease / 北京大学学报(医学版)

Objective:To analyze the relationship between plasma level of cortistatin(CST) and coronary heart disease(CHD) and the factors that influence the level of CST.Methods: Plasma levels of CST were measured using ELISA method.The clinical data and the levels of CST of 40 healthy subjects and 39 CHD patients before and 1 d after percutaneous coronary intervention(PCI) were compared.And the factors that influenced the CST level were analyzed.Results: The CST levels of CHD group before or 1 d after PCI were significantly higher than those of the control group(1.97?1.12 and 2.01?0.77 vs 1.21?0.27,P0.05);There was no correlation between CST levels and fasting blood glucose(FBG),high sensitivity C-reactive protein(hsCRP),left ventricular ejection fraction(LVEF),severity of lesions of coronary arteries or history of hypertension;The levels of triglyceride(TG) and total cholesterol(TCHOL) negatively correlated with CST levels(?=-2.594,P