Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutane...Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutaneous coronary intervention （PCI）. The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. Methods A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution （ST-R） and myocardial blush grades （MBG） were evaluated immediately after PCI. Left ventricular ejection fraction （LVEF） was obtained at baseline and 12-18 months after PCI. Results Postprocedural WBC count was an independent inverse predictor of ST-R （OR 0.80, P 〈0.0001） and MBG 3 （OR 0.82, P 〈0.0001）. It was negatively correlated with LVEF （baseline r=0.22, P=0.001; 12-18 months r=0.29, P 〈0.0001）. The best cutoff value of WBC for predicting death was determined to be 13.0×10^9/L. The patients with a postprocedural WBC count above 13.0×10^9/L showed a significantly lower cumulative survival rate （30 days, 82.4% vs. 99.0%, P 〈0.0001 and 2 years 75.0% vs. 96.4%, P 〈0.0001）. Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality （HR 8.48, P=0.019） and 2-year mortality （HR 4.93, P=0.009）. Conclusions Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.展开更多
Background Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making f...Background Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making for patients with intermediate coronary stenosis is still controversial. We designed this study to assess the optimal intravascular ultrasound （IVUS） criteria for predicting functional significance of intermediate coronary lesions. Methods We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter 〉2.50 mm. IVUS of intermediate coronary lesions were performed before intervention. Pressure-derived fractional flow reserve （FFR） was measured at maximal hyperemia induced by adenosine infusion. An FFR 〈0.80 was considered as abnormal functional significance. Results For the overall 165 lesions, the mean FFR value was 0.84±0.09. The diameter of the stenosis by visual estimation on angiogram was （59.63±11.29）%. Minimum lumen diameter （MLD）, minimum lumen area （MLA） and plaque burden （PB） were （2.00±0.36） mm, （3.88±1.34） mm2, （67.28±9.89）% respectively by IVUS measurements. An FFR 〈0.80 was seen in 43 lesions （30.5%）. There was a moderate correlation between IVUS parameters and FFR, including MLD （r=0.372, P 〈0.001 ）, MLA （r=0.442, P 〈0.001 ） and PB （t=-0.172, P 〈0.05）. MLA was a predictor for FFR as a continuous variable independent of possible confounding variables （P 〈0.05）, and MLA and PB, were predictors for FFR 〈0.80 as binary variables （P 〈0.05）. The best cutoff value of MLA to predict FFR 〈0.80 was 〈3.15 mm2, with a 73.6% diagnostic accuracy; sensitivity 71.4%, specificity 67.0%, AUC=0.709, and P 〈0.001. The cutoff value of the PB to predict FFR 〈0.80 was 65.45%; sensitivity 82.6%, specificity 41.2%, AUC=0.644, and P 〈0.01. If both MLA and PB were taken into account, the negative predictive value and the positive predictive value were 88.7% and 64.8% respectively. Conclusions Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values. IVUS-derived MLA 〉3.15 mm2 may be useful to exclude FFR 〈0.80, but poor specificity limits its applicability for physiological assessment of lesions 〈3.15 mm2. MLA was one of many factors affecting coronary flow hemodynamics. Both MLA and PB should be taken into account when determining functional ischemia.展开更多
Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoper...Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.展开更多
文摘Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutaneous coronary intervention （PCI）. The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. Methods A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution （ST-R） and myocardial blush grades （MBG） were evaluated immediately after PCI. Left ventricular ejection fraction （LVEF） was obtained at baseline and 12-18 months after PCI. Results Postprocedural WBC count was an independent inverse predictor of ST-R （OR 0.80, P 〈0.0001） and MBG 3 （OR 0.82, P 〈0.0001）. It was negatively correlated with LVEF （baseline r=0.22, P=0.001; 12-18 months r=0.29, P 〈0.0001）. The best cutoff value of WBC for predicting death was determined to be 13.0×10^9/L. The patients with a postprocedural WBC count above 13.0×10^9/L showed a significantly lower cumulative survival rate （30 days, 82.4% vs. 99.0%, P 〈0.0001 and 2 years 75.0% vs. 96.4%, P 〈0.0001）. Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality （HR 8.48, P=0.019） and 2-year mortality （HR 4.93, P=0.009）. Conclusions Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.
基金This work was supported by grants from the Capital Characteristic Clinical Application Research from Beijing Science and Technology Committee （No. Z111107058811003）, the National Natural Science Foundation of China （No. 81070260, No. 81200167）, the Beijing Natural Science Foundation （No. 7102099） and the Young Core Fund from Peking University Third Hospital.
文摘Background Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making for patients with intermediate coronary stenosis is still controversial. We designed this study to assess the optimal intravascular ultrasound （IVUS） criteria for predicting functional significance of intermediate coronary lesions. Methods We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter 〉2.50 mm. IVUS of intermediate coronary lesions were performed before intervention. Pressure-derived fractional flow reserve （FFR） was measured at maximal hyperemia induced by adenosine infusion. An FFR 〈0.80 was considered as abnormal functional significance. Results For the overall 165 lesions, the mean FFR value was 0.84±0.09. The diameter of the stenosis by visual estimation on angiogram was （59.63±11.29）%. Minimum lumen diameter （MLD）, minimum lumen area （MLA） and plaque burden （PB） were （2.00±0.36） mm, （3.88±1.34） mm2, （67.28±9.89）% respectively by IVUS measurements. An FFR 〈0.80 was seen in 43 lesions （30.5%）. There was a moderate correlation between IVUS parameters and FFR, including MLD （r=0.372, P 〈0.001 ）, MLA （r=0.442, P 〈0.001 ） and PB （t=-0.172, P 〈0.05）. MLA was a predictor for FFR as a continuous variable independent of possible confounding variables （P 〈0.05）, and MLA and PB, were predictors for FFR 〈0.80 as binary variables （P 〈0.05）. The best cutoff value of MLA to predict FFR 〈0.80 was 〈3.15 mm2, with a 73.6% diagnostic accuracy; sensitivity 71.4%, specificity 67.0%, AUC=0.709, and P 〈0.001. The cutoff value of the PB to predict FFR 〈0.80 was 65.45%; sensitivity 82.6%, specificity 41.2%, AUC=0.644, and P 〈0.01. If both MLA and PB were taken into account, the negative predictive value and the positive predictive value were 88.7% and 64.8% respectively. Conclusions Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values. IVUS-derived MLA 〉3.15 mm2 may be useful to exclude FFR 〈0.80, but poor specificity limits its applicability for physiological assessment of lesions 〈3.15 mm2. MLA was one of many factors affecting coronary flow hemodynamics. Both MLA and PB should be taken into account when determining functional ischemia.
文摘Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.
