Association between basal septal hypertrophy and left ventricular geometry in a community population.

BACKGROUND: Left ventricular (LV) geometry is closely associated with cardiovascular disease; however, few studies have evaluated the relationship between basal septal hypertrophy (BSH) and LV geometry. In this study, we examined the relationship between BSH and LV geometry in a Beijing community population. METHODS: The clinical and echocardiographic data of 1032 participants from a community in Beijing were analyzed. BSH was defined as a basal interventricular septal thickness ≥ 14 mm and a basal septal thickness/mid-septal thickness ≥ 1.3. On the basis of their echocardiographic characteristics, patients were described as having a normal geometry, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy. Multivariable logistic regression was used to analyze the relationship between BSH, LV mass index (LVMI), and relative wall thickness (RWT). RESULTS: The prevalence of BSH was 7.4% (95% confidence interval [CI] 5.8-9.0%). Basal and middle interventricular septal thickness, LV posterior wall thickness, and RWT were greater, while LVMI and LV end-diastolic dimension were lower in the BSH group than in the non-BSH group (p < 0.05). The BSH group accounted for the highest proportion of patients with concentric remodeling. A multivariable regression analysis showed that BSH increased by 3.99-times (odds ratio [OR] 3.99, 95% CI 2.05-7.78, p < 0.01) when RWT was > 0.42, but not when LVMI increased (OR 0.16, 95% CI 0.02-1.19, p = 0.07). There were no interactions between BSH and age, body mass index, sex, diabetes mellitus, coronary heart disease, stroke, and smoking in relation to an RWT > 0.42. CONCLUSION: BSH was independently associated with an RWT > 0.42.

Robust Controller Design for Multi-Input Multi-Output Systems Using Coefficient Diagram Method.

The coupling between variables in the multi-input multi-output (MIMO) systems brings difficulties to the design of the controller. Aiming at this problem, this paper combines the particle swarm optimization (PSO) with the coefficient diagram method (CDM) and proposes a robust controller design strategy for the MIMO systems. The decoupling problem is transformed into a compensator parameter optimization problem, and PSO optimizes the compensator parameters to reduce the coupling effect in the MIMO systems. For the MIMO system with measurement noise, the effectiveness of CDM in processing measurement noise is analyzed. This paper gives the control design steps of the MIMO systems. Finally, simulation experiments of four typical MIMO systems demonstrate the effectiveness of the proposed method.

Comparison of Mechanical Responses of Asphalt Mixtures under Uniform and Non-Uniform Loads Using Microscale Finite Element Simulation.

Continuously increasing traffic volumes necessitate accurate design methods to ensure the optimal service life and efficient use of raw materials. Numerical simulations commonly pursue a simplified approach with homogeneous pavement materials and homogeneous loading. Neither the pavement geometry nor the loading is homogeneous in reality. In this study, the mechanical response of the asphalt mixtures due to homogeneous loads is compared with their mechanical response to inhomogeneous loads. A 3D finite element model was reconstructed with the aid of X-ray computed tomography. Sections of a real tire's pressure distribution were used for the inhomogeneous loads. The evaluation of the material response analyzes the stress distribution within the samples. An inhomogeneous load evokes an increased proportion of high stresses within the sample in every case, particularly at low temperatures. When comparing the two types of loads, the average stresses on the interior (tension and compression) exhibit significant differences. The magnitude of the discrepancies shows that this approach yields results that differ significantly from the common practice of using homogeneous models and can be used to improve pavement design.

Investigation on the Cooling and Evaporation Behavior of Semi-Flexible Water Retaining Pavement based on Laboratory Test and Thermal-Mass Coupling Analysis.

The Semi-Flexible Water Retaining Pavement (SFWRP) has the capability to cool down the temperature of the road surface through its evaporation behavior, including absorbing and evaporating water; this is an efficient approach to relieve the heat island effect in a big city. The temperature feedback from different material surface were investigated in this paper in the same test condition, it has been proved that the SFWRP material can remarkably cool down the temperature of the road surface. The mechanism of the material evaporation behavior, including flux calculation formula of the water vapor inside the air void, were studied by inter-phase continuous function, in which the structural properties of the SFWRP material was taken into account. Furthermore, the function calculating the evaporation of the water vapor was then developed in this research through heat and mass transfer analogy. Besides, the calculating results can be captured by the self-coding program in Finite Element Modeling (FEM) for water evaporation simulation. Also, the results of laboratory tests were adopted to validate the calculating model. Finally, it has been proved that the mortar was recommended to be used in semi-flexible water retaining pavement to serve as material with permeable and water retaining property, and the semi-flexible water retaining pavement material is recommended to applied in the surface layer of the permeable pavement.

Effects of elevated CO2 on the fitness and potential population damage of Helicoverpa armigera based on two-sex life table.

We evaluated the direct effects of three different atmospheric CO2 concentrations (380 ppm, 550 ppm and 750 ppm) on the population parameters of the cotton bollworm, Helicoverpa armigera fed an artificial diet. The life history and fitness of H. armigera were analyzed using an age-stage, two-sex life table. Our results showed significantly longer larval durations and lower female pupal weight under elevated CO2 than under ambient CO2. Additionally, the fecundity of H. armigera was lower under elevated CO2 than under ambient CO2. H. armigera reared under elevated CO2 conditions showed lower intrinsic and finite rates of increase but higher net consumption and finite consumption rates than H. armigera reared under ambient CO2 conditions. According to population projections, a much smaller total population size and reduced consumption capacities would be expected in an elevated CO2 atmosphere due to higher mortality and lower growth rate compared with ambient CO2 levels. These results indicate that the fitness of and potential damage caused by H. armigera would be affected by increased CO2 relative to ambient CO2 concentrations. Additional studies on the long-term direct and indirect effects of elevated CO2 levels on H. armigera are still needed.

Complete revascularization versus culprit-only revascularization in ST-segment elevation myocardial infarction and multivessel disease patients undergoing primary percutaneous coronary intervention: A meta-analysis and trial sequential analysis.

The present study compared the outcomes of complete revascularization (CR) and culprit-only revascularization (COR) performed during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease through a meta-analysis in order to determine which strategy is more appropriate. Published randomized controlled trials (RCTs) were retrieved from the PubMed, EMBASE, and CENTRAL databases. Eight RCTs with 2060 patients were selected (1080 patients underwent CR [immediate (ICR) or staged (SCR)] and 980 patients underwent COR). The follow-up was 6-38months. In the overall population, CR reduced major adverse cardiac events (MACE) and repeat revascularization when compared to those with COR (RR 0.60, 95% CI 0.50-0.72; RR 0.49, 95% CI 0.33-0.73). In the subgroups analysis, ICR reduced MACE, all-cause death and/or MI, non-fatal MI, and repeat revascularization compared to COR (RR 0.44, 95% CI 0.32-0.60; RR 0.55, 95% CI 0.36-0.85; RR 0.35, 95% CI 0.17-0.71; RR 0.35, 95% CI 0.24-0.52; SCR reduced only MACE when compared with those in COR (RR 0.71, 95% CI 0.56-0.89). However, trial sequential analysis powered for a 25% relative reduction indicated firm evidence (cumulative z-curve crossed the monitoring boundary) for only MACE and revascularization in the overall population and ICR subgroup. Contrast-induced nephropathy, major hemorrhage, and stroke incidences were not different between CR and COR. Based on these findings, we believe that CR is preferable to COR in STEMI and multivessel disease patients undergoing primary PCI.

Atorvastatin in improvement of cognitive impairments caused by amyloid ß in mice: involvement of inflammatory reaction.

BACKGROUND: The production of inflammatory cytokines resulting from amyloid ß (Aß) is associated with the initiation of Alzheimer's disease (AD). Atorvastatin (ATV) has been reported to improve AD, however, it is unclear how the anti-inflammatory mechanism is linked with its protection against the impairment of spatial cognitive function in AD. The present study was designed to explore what mechanism was possibly involved in the anti-inflammatory pathway in regard to the ATV treatment of AD. METHODS: We used an AD model induced by the administration of Aß(25-35) in male C57BL/6 mice and an in vitro culture system to study the protective effects of ATV on the spatial cognitive deficits, hippocampal long-term potentiation (LTP) impairment and inflammatory reaction. RESULTS: The intragastric administration of ATV (5 mg/kg) in Aß(25-35)-treated mice significantly ameliorated the spatial cognitive deficits and prevented the LTP impairment in hippocampal CA1. The increased Iba-1 positive cells and inflammatory components in the hippocampus were reduced after the ATV treatment. The anti-inflammatory and LTP protection of ATV were abolished using the replenishment of farnesyl pyrophosphate by the administration of farnesol (FOH). The hippocampal slices culture showed Aß(25-35)-induced neurotoxicity in the absence of the presence of ATV. Treatment with ATV (0.5, 1, 2.5 µmol/L) dose-dependently prevented the cell damage in hippocampus induced by Aß25-35. CONCLUSION: The administration of ATV ameliorated the cognitive deficits, depressed the inflammatory responses, improved the LTP impairment, and prevents Aß25-35-induced neurotoxicity in cultured hippocampal neurons. These protective functions of ATV involved the pathway of reducing farnesyl pyrophosphate (FPP).

[Activated clotting time post therapeutic anticoagulation with unfractionated heparin in patients undergoing elective percutaneous coronary intervention].

OBJECTIVE: To investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI). METHODS: We performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed. RESULTS: (1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05). CONCLUSIONS: In this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.

[Influence of gender on 30-day outcomes of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction].

OBJECTIVE: To investigate the impact of gender on early outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI) as their reperfusion strategy. METHODS: The present study included consecutive patients with STEMI treated with primary PCI in our hospital from November 2003 to December 2012. Gender difference and predictors of 30 day all-cause death were examined among 957 patients, 197 of whom were women (20.6%). The impact of gender on 30 all-cause death was further evaluated by a propensity-matched analysis to adjust the differences in baseline characteristics between men and women. RESULTS: Compared with men, women were older ((69.4±10.2) years old vs. (60.6±12.6) years old, P<0.001), more likely to have hypertension (72.1% (142/197) vs. 54.6% (415/760), P<0.001) and diabetes (45.2% (89/197) vs. 32.4% (246/760), P = 0.001), but less likely to be treated with ß-blockers (85.3% (168/197) vs. 92.0% (699/760), P = 0.006) and angiotensin converting-enzyme inhibitors/angiotensin-receptor blockers (82.2% (162/197) vs. 88.4% (672/760), P = 0.024). Symptom-to-balloon time was longer in women than in men (330 (240, 600) minutes vs. 270 (180, 450) minutes, P < 0.001). Multivariate linear regression analysis of log-transformed symptom-to-balloon time revealed that female gender was an independent predictor of longer symptom-to-balloon time (ß = 0.141, 95% confidence interval (CI) 0.053-0.228, P = 0.002). Women with STEMI had higher unadjusted 30 day all-cause death (12.6% vs. 4.2%, P < 0.001) than men. Female gender independently predicted 30 day all-cause mortality both with (hazard ratio (HR) = 3.497, 95% CI 1.485-8.234, P = 0.004) and without (HR = 2.495, 95% CI 1.170-5.323, P = 0.018) the adjustment for baseline characteristics by propensity-matched analysis. CONCLUSIONS: Even with primary PCI as their reperfusion strategy, women with STEMI had higher 30 day all-cause death than men. Aggressive control of cardiovascular risk factors, adequate medical treatment and shortening of delay in reperfusion therapy might further improve the outcomes of female STEMI patients undergoing primary PCI.

Renal Dysfunction and hsCRP Predict Long-term Outcomes of Percutaneous Coronary Intervention in Acute Myocardial Infarction.

BACKGROUND: This study assessed the combined utility of estimated glomerular filtration rate (eGFR) and serum high-sensitivity C-reactive protein (hsCRP) levels to predict long-term mortality and cardiovascular outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Elevated CRP levels and renal dysfunction have both been shown to independently and jointly predict mortality and cardiovascular outcomes after PCI in the short term. However, long-term results in patients with acute STEMI undergoing PCI have not been reported. METHODS: A total of 262 patients with acute STEMI undergoing primary PCI were classified at admission into quartiles according to eGFR (<60, 60-70, 70-80 and ≥80 mL·min·1.73 m) and hsCRP (<3 and ≥3 mg/L). Mortality, nonfatal myocardial infarction (MI) and major adverse cardiac events (MACEs) were compared among the groups. RESULTS: During a median follow-up of 48.3 months, the composite of all-cause mortality and nonfatal MI (mortality + MI) was significantly higher (35.09%) in the group with the lowest eGFR compared with that of the other 3 eGFR groups (14.29%, 3.77% and 9.43%, respectively, P < 0.0001) and the group with elevated hsCRP (34.29%) versus that with hsCRP <3 mg/L (4.41%, P < 0.0001). A combined analysis showed an exaggerated hazard in patients with the lowest eGFR and highest hsCRP (hazard ratio: 44.658; 95% confidence interval: 5.955-111.890). CONCLUSIONS: Renal dysfunction and elevated hsCRP predict a high long-term incidence of MACE in patients with acute STEMI undergoing primary PCI, with the combination being of prognostic significance for long-term mortality and MI in these patients.

[Bilateral thyroid carcinoma: a case report].

We describe a case of bilateral thyroid carcinoma in a 48-year-old woman. She was admitted to our hospital as a case of cervical nodular goiter. Multifocality of the thyroid nodules were evaluated by preoperative ultrasonography. The patient received bilateral thyroid lobe total resection and bilateral IV lymph node dissection. Medullary thyroid cancer was confirmed by intraoperative frozen pathology in the right lobe of thyroid gland and papillary thyroid microcarcinoma in the left lobe of thyroid gland. No tumor recurrence and metastasis were found after 3-months follow-up.

[Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease].

OBJECTIVES: To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD). METHODS: Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed. RESULTS: The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD. CONCLUSIONS: Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up.

BACKGROUND: The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. METHODS: A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n = 83) or BMS (n = 108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups. RESULTS: The clinical follow-up duration was 3 years ((41.7 ± 16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P = 0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P = 0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P = 0.379) and stent thrombosis (1.20% vs. 1.85%, P = 0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P = 0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P = 0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n = 73) and paclitaxel-eluting stents (PES, n = 10) subgroups (2.74% vs. 20.00%, P > 0.05). CONCLUSIONS: This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.

[Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease].

OBJECTIVE: To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. METHOD: Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. RESULTS: There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients. CONCLUSION: Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.

[Effect of left ventricular ejection fraction on clinical long-term follow-up outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate the effect of left ventricular ejection fraction (LVEF) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 158 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. They were divided into three groups: LVEF≤40% (n=14), LVEF 41%-55% (n=46) and LVEF>55% group (n=98). The clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. The clinical follow-up duration was 43.1±15.2 months. MACE occurred in 15 patients. RESULTS: The rates of infarction site, infarction relative artery, 1-vessel disease, 2-vessel disease, hypertension, diabetes, hyperlipidemia, smoking, obesity and aspirin use were not different in three groups (P>0.05). Average CTnI, CK, CK-MB and duration of clopidogrel use were not different in three groups (P>0.05). The rate of 3-vessel disease was significantly higher in the LVEF≤40% group than that in the LVEF 41%-55% and LVEF>55% groups (P=0.0036). The rates of TIMI flow grades (Grade III) and complete revascularization were significantly higher in the LVEF 41%-55% and LVEF>55% groups than that in the LVEF≤40% group (P=0.0099, P=0.0010). The rates of Killip classification (classes II, III, IV) and average symptom-onset-to balloon-time (SOTB) were significantly lower in the LVEF 41%-55% and LVEF>55% groups than that in the LVEF≤40% group (P=0.0100, P=0.0087). The rate of drug-eluting stents was significantly lower in the LVEF≤40% group and LVEF 41%-55% group than that in LVEF>55% group (P=0.0242). Logistic regression analysis showed that LVEF was independent predictor for MACE in the follow-up period (P=0.0029). With LVEF decrease, incidence of MACE in the follow-up period significantly increased in LVEF>55% group, LVEF 41%-55% group and LVEF≤40% group (6.12% vs 8.7% vs 35.71%, P=0.0019). Incidence of total death and cardiac death in the follow-up period significantly increased in LVEF>55% group, LVEF 41%-55% group and LVEF≤40% group (1.02% vs 4.35% vs 21.43%, P=0.0090; 1.02% vs 2.17 vs 14.29%, P=0.0060). CONCLUSION: In patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, LVEF was independent predictor for MACE in the follow-up period. With LVEF decrease, incidence of MACE in the follow-up period significantly increased.

[Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke].

OBJECTIVE: To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke. METHODS: A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up. RESULTS: There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. CONCLUSION: Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.

[Effects of hemoglobin levels on long-term prognosis in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate the effects of hemoglobin (Hb) levels on long-term prognosis in the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 150 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. They were divided into 2 groups: Hb < 120 g/L group (n = 21) and Hb ≥ 120 g/L group (n = 129). The mean clinical follow-up period was 3 years (range: 41.4 ± 16.1 months). The differences of major adverse cardiac events (MACE), including death, acute myocardial infarction, stent thrombosis & stent restenosis), were observed between two groups. RESULTS: The parameters of infarction site, infarction relative artery, 2-vessel disease, 3-vessel disease, Killip class ≥ II, drug-eluting stent, TIMI grade 3 flow, hypertension, hyperlipidemia, smoking, obesity, aspirin and clopidogrel use were not different between two groups (all P > 0.05). The rate of diabetes was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (47.62% vs 18.60%, P = 0.0032). The mean age and symptom-onset-to balloon-time (SOTB) were significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (68.5 ± 9.2 vs 61.2 ± 12.2 years, P < 0.0001; 8.8 ± 10.5 vs 6.3 ± 5.0 h, P < 0.0001). The mean LVEF (left ventricular ejection fraction)(%) and rate of complete revascularization were significantly lower in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (51.25 ± 11.34 vs 58.79 ± 10.38, P < 0.0001; 61.9% vs 86.8%, P = 0.0045). Logistic regression analysis showed that LVEF was an independent predictor of MACE during the follow-up period (P = 0.0140). During a 3-year follow-up, MACE occurred in 16 patients. The incidence of MACE was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (33.33% vs 6.98%, P = 0.0003); Moreover the all-cause mortality and cardiac mortality were significantly higher in Hb < 120 g/L group than those in Hb ≥ 120 g/L group (28.57% vs 3.10%, P < 0.0001; 23.81% vs 2.33%, P < 0.0001). CONCLUSION: In the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, hemoglobin level < 120 g/L at baseline is markedly associated with adverse outcomes and an elevated incidence of MACE and mortality during the follow-up period.

[The investigation about the influence of deviated nasal septum on the adolescents learning quality].

OBJECTIVE: To investigate the incidence rate of deviated nasal septum (DNS) of the young men who are going to join the army, and of the students in key high schools in Jimo, and record their educational background, then analysis the influence of DNS on the youth's learning quality. METHOD: Random select 3085 young men who are going to be recruited in 2006-2008, and 2628 students in 3 key high schools of Jimo. Investigate the two groups' incidence rate of DNS and make a correlative statistic analyses with their educational background. RESULT: There are 395 young men with DNS, which account 12.8% of the 3085 men, with the educational background of college degree and above account 3.0%; high school diploma 12.4%; junior secondary education 27.5%. One hundred and ninety-four students with DNS in key high schools, which account 7.4, and the subsequent entrance examination results shows, undergraduate students account 14.9%, junior college students and considerable education 32.5%, and graduates 52.6%. CONCLUSION: DNS can influence the learning quality of the adolescent. It is necessary to operate on those patients and improve the complaint symptom.

[Effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use: <1 year group (n=59) and > or =1 years group (n=155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes, hyperlipidemia, obesity and smoking] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 +/- 16.3 months. MACE occurred in 28 patients. RESULTS: Rates of male, infarction site, infarction relative artery, multivessel disease, Killip classification (class I), aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different (P > 0.05) in duration of clopidogrel use <1 year group and > or =1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P < 0.0001, P < 0.0001, P = 0.0065). Average CK, CK-MB, CTnI were significantly higher in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (P < 0.0001). Rate of diabetes and average age were significantly higher in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P = 0.0190, P < 0.0001). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use < 1 year group (6.45% vs. 30.51%, P < 0.01). After stopping clopidogrel use, incidence of MACE in followup period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (2.58% vs. 20. 34%, P < 0.01). CONCLUSION: Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

[Clinical manifestations of premenopausal women with coronary arterial disease].

OBJECTIVE: To compare clinical characteristics among premenopausal women with coronary arterial disease (CAD) with or without atherosclerosis (AS) and postmenopausal women with CAD. METHODS: The clinical and coronary angiographic data, traditional risk factors (age, smoking, blood pressure, lipid profile, blood glucose, BMI, family history) were compared among premenopause (Pre-M, n=42) and post-menopause (Post-M, n=172) women with CAD as well as Pre-M patients with non-AS CAD (non-AS CAD, n=8). RESULTS: Compared with the Post-M patients with CAD, Pre-M CAD patients had significantly fewer traditional risk factors, such as hypertension, diabetes and hypercholesterolemia, significantly more acute coronary syndrome and fewer previous history of chest pain, significantly more single vessel lesion and lower Gessini score (all P < 0. 01). The logistic regression results showed that obesity is an independent risk factor for the development of CAD in premenopausal women (OR = 3. 655, 95% CI: 1. 5-11.59, P = 0.028). Hypertension (OR = 4.73, 95% CI: 0.991-22.589, P = 0.051) and hypercholesterolemia (OR = 4.68, 95% CI: 0.971-22.564, P = 0.055) might also contribute to the development of CAD in these patients. Clinical characteristics were similar between Pre-M and non-AS CAD patients (P > 0.05). CONCLUSIONS: Pre-M CAD patients had less traditional risk factors and lower coronary lesion score compared to post-M CAD patients. Obesity is an independent risk factor for Pre-M CAD. Non-AS coronary artery disease is also an important reason for the development of coronary arterial events in premenopausal women.