Objectives We sought to determine the safety and efficacy of high-dose bolus( HDB) tirofiban in high-risk patients undergoing percutaneous coronary intervent ion(PCI). Background The use of HDB tirofiban in the cathet...Objectives We sought to determine the safety and efficacy of high-dose bolus( HDB) tirofiban in high-risk patients undergoing percutaneous coronary intervent ion(PCI). Background The use of HDB tirofiban in the catheterization laboratory is controversial. In particular, in patients with acute coronary syndromes under going PCI, there is no evidence that tirofiban administered in the catheterizati on laboratory is superior to heparin alone. This finding probably reflects the s uboptimal platelet inhibition when tirofiban is employed at RESTORE (Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis) regimen. Methods A tota l of 202 patients (mean age 69 ±8 years; 137 males <<68%>>) undergoing high-ris k PCI, pretreated with thienopyridines, were consecutively randomized to HDB tir ofiban (25 μg/kg/3 min, and infusion of 0.15 μg/kg/min for 24 to 48 h) or plac ebo immediately before the procedure and then followed for a median time of 185 days (range 45 to 324 days) for the occurrence of the primary composite end poin t of death, myocardial infarction, target vessel revascularization (TVR), and ba ilout use of glycoprotein (GP) IIb/IIIa inhibitors. Results The cumulative incid ence of the primary end point was 35%and 20%in placebo and HDB tirofiban group s, respectively (hazard ratio 0.51, 95%confidence interval 0.29 to 0.88; p=0.01 ). This difference was mainly due to the reduction of myocardial infarction and bailout use of GP IIb/IIIa inhibitors, with no significant effect on TVR or deat h. The safety profile did not differ between tirofi-ban and placebo. Conclusion s The use of tirofiban, when administered at HDB, is safe and significantly redu ces the incidence of ischemic/thrombotic complications during highrisk PCI.展开更多
随着中外文化的交流,陶渊明及其诗文被介绍到国外,受到很高的评价。(参见《陶渊明在国外》一文,载《南京师院学报》1982年3期。)据笔者有限视野,发现本世纪以来,西方学者不断将我国东晋大诗人陶渊明的诗文译成英语,例如,我们见到的译本...随着中外文化的交流,陶渊明及其诗文被介绍到国外,受到很高的评价。(参见《陶渊明在国外》一文,载《南京师院学报》1982年3期。)据笔者有限视野,发现本世纪以来,西方学者不断将我国东晋大诗人陶渊明的诗文译成英语,例如,我们见到的译本有:威廉·阿克(William Acher)的“Tao the Hermit”(Thames and Hudson,展开更多
Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormo...Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.展开更多
Coronary heart disease （CHD） is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older.Elderly patients are at a higher risk for complications and accelerated ...Coronary heart disease （CHD） is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older.Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event,especially compared to their younger counterparts.The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation （CR） and exercise therapy on mortality,exercise capacity,psychological risk factors,inflammation,and obesity among patients with CHD.Unfortunately,a significant portion of the available data in this field pertains to younger patients.A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician.In this article,we will review the benefits of CR programs among the elderly,as well as some of the barriers that hinder their participation.展开更多
Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Pekin...Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Peking University People＇s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older （69.3 ± 11.5 vs. 64.7 ± 12.8 years, P 〈 0.001） and had a higher prevalence of diabetes mellitus （DM） （52.2% vs. 35.0%, P 〈 0.001） compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age （OR = 1.03, 95% CI： 1.02-1.05; P 〈 0.001）, DM （OR = 1.86, 95% CI： 1.37-2.52; P 〈 0.001） and reperfusion therapy （OR = 0.74; 95% CI： 0.52-0.89; P 〈 0.001） were independent risk factors for recurrent AMI Recurrent AMI patients had a higher in-hospital death rate （12.1% vs. 7.8%, P = 0.039） than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AM1 was related with a high risk of in-hospital death.展开更多
Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention （PCI） with the routine use of drug-eluting stents is safe and effective, however, the patients ol...Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention （PCI） with the routine use of drug-eluting stents is safe and effective, however, the patients older than 75 years undergoing PCI are at increased risk for major adverse cardiac events, so that the patients are usually excluded from this trial. The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary PCI. Methods We analyzed the outcome after stenting in 136 patients older than 60 years in our coronary care unit with acute STEMI, and the patients were further classified in 2 age groups： patients≥75 years and 〈75 years. Results Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than those of the younger, the procedural success had no difference between two groups. The main adverse clinical events （MACE） for the old group was a little higher comparing with the younger in 12-month following up. Conclusions Our study suggest that drug-eluting stent implantation in elderly patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time form symptom onset to PCI and improve final TIMI flow strategy may decrease MACE among old patients following PCI（J Geriatr Cardio12009; 6：67-70）.展开更多
Background:The proportion of recurrences after discharge among patients with coronavirus disease 2019(COVID-19)was reported to be between 9.1%and 31.0%.Little is known about this issue,however,so we performed a meta-a...Background:The proportion of recurrences after discharge among patients with coronavirus disease 2019(COVID-19)was reported to be between 9.1%and 31.0%.Little is known about this issue,however,so we performed a meta-analysis to summarize the demographical,clinical,and laboratorial characteristics of non-recurrence and recurrence groups.Methods:Comprehensive searches were conducted using eight electronic databases.Data re-garding the demographic,clinical,and laboratorial characteristics of both recurrence and non-recurrence groups were extracted,and quantitative and qualitative analyses were conducted.Results:Ten studies involving 2071 COVID-19 cases were included in this analysis.The proportion of recurrence cases involving patients with COVID-19 was 17.65%(between 12.38%and 25.16%)while older patients were more likely to experience recurrence(weighted mean difference(WMD)=1.67,range between 0.08 and 3.26).The time from discharge to recurrence was 13.38 d(between 12.08 and 14.69 d).Patients were categorized as having moderate severity(odds ratio(OR)=2.69,range between 1.30 and 5.58),while those with clinical symptoms including cough(OR=5.52,range between 3.18 and 9.60),sputum production(OR=5.10,range between 2.60 and 9.97),headache(OR=3.57,range between 1.36 and 9.35),and diz-ziness(OR=3.17,range between 1.12 and 8.96)were more likely to be associated with recurrence.Patients pre-senting with bilateral pulmonary infiltration and decreased leucocyte,platelet,and CD4+T counts were at risk of COVID-19 recurrence(OR=1.71,range between 1.07 and 2.75;WMD=?1.06,range between?1.55 and?0.57,WMD=?40.39,range between?80.20 and?0.48,and WMD=?55.26,range between?105.92 and?4.60,respectively).Conclusions:The main factors associated with the recurrence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)after hospital discharge were older age,moderate severity,bilateral pulmonary infiltration,laboratory findings including decreased leucocytes,platelets,and CD4+T counts,and clinical symptoms including cough,sputum production,headache,and dizziness.These factors can be considered warning indicators for the recurrence of SARS-CoV-2 and might help the development of specific management strategies.展开更多
文摘Objectives We sought to determine the safety and efficacy of high-dose bolus( HDB) tirofiban in high-risk patients undergoing percutaneous coronary intervent ion(PCI). Background The use of HDB tirofiban in the catheterization laboratory is controversial. In particular, in patients with acute coronary syndromes under going PCI, there is no evidence that tirofiban administered in the catheterizati on laboratory is superior to heparin alone. This finding probably reflects the s uboptimal platelet inhibition when tirofiban is employed at RESTORE (Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis) regimen. Methods A tota l of 202 patients (mean age 69 ±8 years; 137 males <<68%>>) undergoing high-ris k PCI, pretreated with thienopyridines, were consecutively randomized to HDB tir ofiban (25 μg/kg/3 min, and infusion of 0.15 μg/kg/min for 24 to 48 h) or plac ebo immediately before the procedure and then followed for a median time of 185 days (range 45 to 324 days) for the occurrence of the primary composite end poin t of death, myocardial infarction, target vessel revascularization (TVR), and ba ilout use of glycoprotein (GP) IIb/IIIa inhibitors. Results The cumulative incid ence of the primary end point was 35%and 20%in placebo and HDB tirofiban group s, respectively (hazard ratio 0.51, 95%confidence interval 0.29 to 0.88; p=0.01 ). This difference was mainly due to the reduction of myocardial infarction and bailout use of GP IIb/IIIa inhibitors, with no significant effect on TVR or deat h. The safety profile did not differ between tirofi-ban and placebo. Conclusion s The use of tirofiban, when administered at HDB, is safe and significantly redu ces the incidence of ischemic/thrombotic complications during highrisk PCI.
文摘随着中外文化的交流,陶渊明及其诗文被介绍到国外,受到很高的评价。(参见《陶渊明在国外》一文,载《南京师院学报》1982年3期。)据笔者有限视野,发现本世纪以来,西方学者不断将我国东晋大诗人陶渊明的诗文译成英语,例如,我们见到的译本有:威廉·阿克(William Acher)的“Tao the Hermit”(Thames and Hudson,
基金Supported by the Military Health Care Grant (01AM301, 06G105)
文摘Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.
文摘Coronary heart disease （CHD） is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older.Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event,especially compared to their younger counterparts.The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation （CR） and exercise therapy on mortality,exercise capacity,psychological risk factors,inflammation,and obesity among patients with CHD.Unfortunately,a significant portion of the available data in this field pertains to younger patients.A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician.In this article,we will review the benefits of CR programs among the elderly,as well as some of the barriers that hinder their participation.
文摘Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Peking University People＇s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older （69.3 ± 11.5 vs. 64.7 ± 12.8 years, P 〈 0.001） and had a higher prevalence of diabetes mellitus （DM） （52.2% vs. 35.0%, P 〈 0.001） compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age （OR = 1.03, 95% CI： 1.02-1.05; P 〈 0.001）, DM （OR = 1.86, 95% CI： 1.37-2.52; P 〈 0.001） and reperfusion therapy （OR = 0.74; 95% CI： 0.52-0.89; P 〈 0.001） were independent risk factors for recurrent AMI Recurrent AMI patients had a higher in-hospital death rate （12.1% vs. 7.8%, P = 0.039） than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AM1 was related with a high risk of in-hospital death.
文摘Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention （PCI） with the routine use of drug-eluting stents is safe and effective, however, the patients older than 75 years undergoing PCI are at increased risk for major adverse cardiac events, so that the patients are usually excluded from this trial. The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary PCI. Methods We analyzed the outcome after stenting in 136 patients older than 60 years in our coronary care unit with acute STEMI, and the patients were further classified in 2 age groups： patients≥75 years and 〈75 years. Results Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than those of the younger, the procedural success had no difference between two groups. The main adverse clinical events （MACE） for the old group was a little higher comparing with the younger in 12-month following up. Conclusions Our study suggest that drug-eluting stent implantation in elderly patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time form symptom onset to PCI and improve final TIMI flow strategy may decrease MACE among old patients following PCI（J Geriatr Cardio12009; 6：67-70）.
基金Project supported by the National Science and Technology Major Project of China(Nos.2018ZX10302206 , 2017ZX10202203)the Zhejiang University Academic Award for Outstanding Doctoral Candidates(No.2020052),China。
文摘Background:The proportion of recurrences after discharge among patients with coronavirus disease 2019(COVID-19)was reported to be between 9.1%and 31.0%.Little is known about this issue,however,so we performed a meta-analysis to summarize the demographical,clinical,and laboratorial characteristics of non-recurrence and recurrence groups.Methods:Comprehensive searches were conducted using eight electronic databases.Data re-garding the demographic,clinical,and laboratorial characteristics of both recurrence and non-recurrence groups were extracted,and quantitative and qualitative analyses were conducted.Results:Ten studies involving 2071 COVID-19 cases were included in this analysis.The proportion of recurrence cases involving patients with COVID-19 was 17.65%(between 12.38%and 25.16%)while older patients were more likely to experience recurrence(weighted mean difference(WMD)=1.67,range between 0.08 and 3.26).The time from discharge to recurrence was 13.38 d(between 12.08 and 14.69 d).Patients were categorized as having moderate severity(odds ratio(OR)=2.69,range between 1.30 and 5.58),while those with clinical symptoms including cough(OR=5.52,range between 3.18 and 9.60),sputum production(OR=5.10,range between 2.60 and 9.97),headache(OR=3.57,range between 1.36 and 9.35),and diz-ziness(OR=3.17,range between 1.12 and 8.96)were more likely to be associated with recurrence.Patients pre-senting with bilateral pulmonary infiltration and decreased leucocyte,platelet,and CD4+T counts were at risk of COVID-19 recurrence(OR=1.71,range between 1.07 and 2.75;WMD=?1.06,range between?1.55 and?0.57,WMD=?40.39,range between?80.20 and?0.48,and WMD=?55.26,range between?105.92 and?4.60,respectively).Conclusions:The main factors associated with the recurrence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)after hospital discharge were older age,moderate severity,bilateral pulmonary infiltration,laboratory findings including decreased leucocytes,platelets,and CD4+T counts,and clinical symptoms including cough,sputum production,headache,and dizziness.These factors can be considered warning indicators for the recurrence of SARS-CoV-2 and might help the development of specific management strategies.
