Patients with ST-segment elevation of myocardial infarction miss out on early reperfusion： when to undergo delayed revascularization

Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction （STEMI） missing out early reperfusion even in the primary percutaneous coronary intervention （PCI） era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial. Methods We investigated all STEMI patients who underwent delayed PCI （2-28 days after STEMI） during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was maj or adverse cardiovascular events （MACEs）. Results This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time （Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%）. During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death （hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, P = 0.030） than Late group and less repeat revascularization （hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, P = 0.007） than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event （MACE） by delayed time as a quadratic curve and found the bottom appeared at day 14. Conclusions The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.

Diaphragmatic suture with tubular stomach to prevent early delayed gastric emptying after esophagectomy

Objective The objective of this study was to evaluate the clinical efficacy of a diaphragmatic suture with tubular stomach to prevent delayed gastric emptying(DGE) after esophagectomy through the cervico-thoracoabdominal approach. Methods A total of 980 patients with esophageal cancer undergoing esophagectomy through the cervico-thoracoabdominal approach were retrospectively included in this study and divided into two groups. All patients underwent tubular stomach creation(group A; n = 530) or a diaphragmatic suture and tubular stomach creation(group B; n = 450). The incidence of early DGE was observed. Results The incidence of early DGE in group A was significantly higher than that in group B(P < 0.05). Conclusion This observation study suggests that the use of a diaphragmatic suture with tubular stomach through the cervico-thoracoabdominal approach can decrease the incidence of early DGE after esophagectomy.

Impact of adjuvant chemotherapy delay on survival in cancer breast patients

Objective： The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. It is usually prescribed within 2-3 months after definitive surgery. The aim of this retrospective study was to assess the impact of adjuvant chemotherapy （CT） delay beyond 3 weeks （ 21 days） in premenopausal patients with ER-absent tumors being treated for early stages breast cancer on overall survival （OS） and disease-free survival （DFS）. Methods： This retrospective study was conducted through revision of medical records of premenopausal patients diagnosed with early stage ｜-｜IIA breast cancer and ER-absent tumors who received adjuvant CT after definitive surgery at the Department of Clinical Oncology, Ain-Shams University Hospitals. Results： Between 2005 and 2008, 105 patients were retrospectively analyzed and included. Patients were divided into 2 groups： Group A including 48 patients who started adjuvant CT 〈 21 days of surgery and group B which included 57 patients who had CT delay 〉 21 days. Both groups were matched demographically. Comparisons of overall survival, and disease-free survival between group A and group B patients all favored group A. At 5-year the OS rates were 87% and 73% for groups A and B respectively （P = 0.001）, while DFS rates were 85% and 64% in groups A and B respectively （P = 0.001）. Analysis of other prognostic factors （age, T, N, grade, HER2 status, surgery type, CT type, local radiotherapy received） were analyzed. Only nodal status predicted for worse DFS （P = 0.05） and OS （P = 0.006）. Conclusion： Delay in initiating adjuvant chemotherapy for early stage breast cancer patients with ER-absent tumors was associated with a decrease in both OS and DFS rates.

Effect of Delayed Insemination on Holstein Cows＇ Reproductive Performance

Holstein cows＇ fertility has decreased in the last decade, creating a need for new management methods to improve the reproductive performance which in this case was defined by pregnancy rates and number of artificial inseminations （AI） per pregnancy. Previous studies showed that deliberately delaying rebreeding until after peak lactation can improve reproductive performance compared with the traditional rebreeding in early lactation. The objective was to compare the reproductive performance of cows in consecutive lactations of different lengths. The reproductive performance （pregnancy rate and number of insemination to pregnancy） of 62 Holstein cows involved in a 16 months extended lactation trial was recorded and compared with the reproductive performance of the previous and following 10 months lactation of the same cows. It was hypothesized that a late rebreeding （at eight months, 16 months lactation） will improve the reproductive performance compared with an early rebreeding （at two months, 10 months lactation） in the previous lactation, and it will have no negative effect on the reproductive performance in the following lactation with an early rebreeding. The results showed that the pregnancy rates were similar for the 16 months lactation and the previous and following 10 months lactations, while the number of AI to pregnancy was increased in the 10 months lactation, following by the 16 months lactation. The use of the double AI technique did not improve pregnancy rates compared with a single AI per estrus, and induced confusion, as how to report the herd reproductive performance. To conclude, the reproductive performance was similar between the heifers, primiparous and multiparous cows, and between 10 months and 16 months lactations.

呼吸机辅助时机改善急性左心衰伴呼衰患者预后的分析

目的:探讨呼吸机(Continuous Positive Airway Pressure,CPAP)辅助时机对急性左心衰伴呼衰(Acute left ventricular failure,ALVF伴Respiratory failure,RF)患者的改善效果。方法:选择80例ALVF伴RF患者,分为2组。对照组行延迟无创CPAP,观察组行早期无创CPAP。对比两组生命体征、血气、心功能等指标。结果:观察组生命体征、血气、心功能等均优于对照组(P<0.05)。结论:对ALVF伴RF早期行无创CPAP辅助治疗,能尽早改善症状,加快疾病康复,远期预后理想。