Epidemiological Investigation on Children and Teenagers with Congenital Heart Disease in three Counties in Zhaotong Area from 2015 to 2016 / 昆明医科大学学报

Objective To make epidemiological investigation on children and teenagers with congenital heart disease (CHD) from October 2015 to November 2016 in three counties in Zhaotong area. Methods The examination was divided into the following two phases: primary screening, secondary screening. Standardized echocardiographic examination was performed for the students with suspected CHD. we combined comprehensive analysis of electrocardiogram, X-ray and cardiac catheterization to make a clear diagnosis for patients. The index of prevalence rate of CHD, the types of the disease, and gender of the patients in 14957 children and teenagers were statistically analyzed. Results Altogether 61 cases of CHD were discovered. The total prevalence of CHD was 4.08‰ (61 of 14957 cases), the prevalence rate in male was 4.55‰, in female was 3.61‰, No difference of the prevalence rate was found between male and female (χ2=0.823, P＞0.05);the difference among different age groups had no statistical significance (χ2=4.692, P＞0.05);The prevalence rate of CHD in Qiaojia was 5.17‰, in Daguan was 6.36‰, and in Zhenxiong was 3.03‰, There was no significant difference in the prevalence rate among different countries (χ2=5.897, P＞0.05). In terms of the types of the disease, atrial septal defect accounted for the first (37.7％ ), followed by ventricular septal defect (26.2％ ) and patent ductus arteriosus (19.7％ ), others types of CHD were rare. Conclusion The prevalence of CHD in investigated area is slightly higher than the average level of the nationwide. The main types of CHD are atrial septal defect, ventricular septal defect and patent ductus arteriosus.

Catheter directed thrombolysis for early left lower extremity deep venous thrombosis without vena cava filters protection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indications, safety and efficacy of catheter directed thrombolysis for early left lower extremity deep venous thrombosis (DVT) without vena cava filters protection.</p><p><b>METHODS</b>Clinical data of 54 cases of early left lower extremity DVT received catheter directed thrombolysis without vena cava filters from July 2008 to June 2010 were retrospectively analyzed. The thrombosis was entire without free floating clots and no thrombosis in vena cava detected with ultrasound scan. Twenty-five patients were male and 29 were female with the average age of 52.8 years. Fifty-one of which were iliofemoral and popliteal, the other 3 were iliofemoral. The course were ≤ 7 d in 45 cases and these were 8 to 30 d in 9 cases. Urokinase of 300 000 U was infused through catheters per 2 h twice a day. Meanwhile 4000 U of low weight heparin was administered subcutaneously per 12 h, or heparin infusion at dosage of 18 U×kg(-1)×h(-1).</p><p><b>RESULTS</b>The procedure technically succeeded in all patients. In total cases venous score decreased to 4.6 ± 2.1 post 6 to 10 d of thrombolysis from 10.8 ± 1.0 with thrombolysis rate of 58% ± 18% which was not significantly different between groups of ≤ 7 d and 8 to 30 d (t = 1.02, P = 0.34). On 14(th) day, 11 patients (20.4%) completely recovered, 35 cases (64.8%) experienced large improvement, 8 patients (14.8%) had mild improvement and nobody was failed, resulting in total efficacy of 100%. No patient developed clinical symptomatic pulmonary embolism. SpO2 did not alter markedly post thrombolysis [(91.0 ± 2.6)% vs. (90.8 ± 2.4)%, t = 2.03, P = 0.05]. No patients suffered from cerebral hemorrhage and haemoturia, and catheter induced inflammation occurred in 4 cases (7.41%). There was mild bleeding in puncture sites in 11 patients (20.4%) during the course. There were 36 patients (66.7%) had been followed up with the time of 6 to 21 months. In which 31 cases had no lower extremity edema or had mild edema after activities. Two patients developed serious edema after activities for deep venous insufficiency. Three cases combined with malignant tumor or renal failure recurred.</p><p><b>CONCLUSIONS</b>For early left extremity DVT which is entire without free floating clots and no thrombosis in vena cava, catheter directed thrombolysis without filter protection maybe administered with safety, efficiency and lower expense.</p>

Apolipoprotein e4 allele and the risk of CAD death in type 2 diabetes mellitus with ischaemia electrocardiographic change.

The presence of apolipoprotein (Apo) e4 allele is reported to be associated with the increased risk of coronary artery disease (CAD), as well as the impairment of endothelium-dependent arterial dilation in type 2 diabetes mellitus. Therefore, we hypothesized that Apo e4 allele increases the death risk from coronary artery disease in type 2 diabetes with ischaemia electrocardiographic change. From January 1993 to December 1999, 46 type 2 diabetic patients with e4/4 or e4/3, 96 with e3/3 and 45 with e2/2 or e3/2 genotypes were recruited. All subjects were unrelated elderly type 2 diabetic patients with ischaemia electrocardiographic change, aged 60-87 years, and their cardiac function were all the class I stage at their time of enrollment. A follow-up study of 3-10 years was undergone. The results are as follows: At baseline, serum total cholesterol and low-density lipoprotein (LDL) cholesterol concentrations were higher in subjects with e4/3 or e4/4 than in subjects with e2/2 or e3/2 (p<0.05). Lipoprotein(a) concentration was lower in subjects with e2/2 or e3/2 than in subjects with e3/3 and e4/3 or e4/4 (p < 0.05). During the 3-10 years follow-up period, a total of 55 patients who died from CAD were recorded in this sample. Compared with patients with e3/3 (p = 0.024) and patients with e2/2 or e2/3 genotypes (p = 0.002), the mortality rate of CAD in patients with e4/3 or e4/4 genotypes was the highest (47.8%). Stepwise discriminant analysis revealed that in the diabetic population studied Apo e4 allele was independently and significantly associated with CAD death (B = 0.65). However, the strength of the association decreased (B = 0.44) when total cholesterol, LDL-cholesterol and lipoprotein(a) were included in the model. Therefore, we concluded that Apo e4 allele increases the risk of CAD death in elderly type 2 diabetes mellitus with ischaemia electrocardiographic change.

Apolipoprotein e4 allele is predictor of coronary artery disease death in elderly patients with type 2 diabetes mellitus.

The presence of the apolipoprotein (Apo) e4 allele is reported to be associated with the increased risk of coronary artery disease (CAD), as well as the impairment of endothelium-dependent dilation in type 2 diabetes mellitus. Therefore, we hypothesized that the Apo e4 allele increases the death risk from coronary artery disease in type 2 diabetes. From January 1993 to December 1999, 36 type 2 diabetic patients with e4/4 or e4/3, 62 with e3/3 and 33 with e2/2 or e3/2 genotypes were recruited. All subjects were unrelated, elderly, type 2 diabetic patients with coronary artery disease, aged 60-84 years, with cardiac function at the Class I stage at time of enrollment. A follow-up study of 3-10 years was undergone. The results are as follows: At baseline, serum total cholesterol and low density lipoprotein (LDL) cholesterol concentrations were higher in subjects with e4/3 or e4/4 than in subjects with e2/2 or e3/2 (P = 0.026). Lipoprotein(a) concentration was lower in subjects with e2/2 or e3/2 than in subjects with e3/3 (P = 0.044) and e4/3 or e4/4 (P = 0.038). During the 3-10 years follow-up period, a total of 39 patients who died from CAD was recorded in this sample. Compared with patients with e3/3 (P = 0.030) and patients with e2/2 or e3/2 genotypes (P = 0.001), the mortality rate of CAD in patients with e4/3 or e4/4 genotypes was the highest (50%). Stepwise discriminant analysis revealed that in the diabetic population studied the Apo e4 allele was independently and significantly associated with CAD death (B = 0.64). However, the strength of the association decreased (B = 0.48) when total cholesterol, LDL-cholesterol and lipoprotein(a) were included in the model. Therefore, we concluded that Apo e4 allele increases the risk of CAD death in elderly patients with type 2 diabetes mellitus.