Background Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Met...Background Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Methods Elderly patients （n = 1130） with stable chronic coronary heart disease who were taking aspirin （75 mg） for 〉 2 months were included. Details of their basic characteristics, laboratory test results, and medications were collected. Logistic regression analysis was performed to establish a predictive model for aspirin resistance. Risk score was finally established according to coefficient B and type of variables in logistic regression. The Hosmer-Lemeshow （HL） test and receiver operating characteristic curves were performed to respectively test the calibration and discrimination of the model. Results Seven risk factors were included in our risk score. They were serum creatinine （〉 110 μmol/L, score of 1）; fasting blood glucose （〉 7.0 mmol/L, score of 1）; hyperlipidemia （score of 1）; number of coronary arteries （2 branches, score of 2; 〉 3 branches, score of 4）; body mass index （20-25 kg/m2, score of 2; 〉 25 kg/m2, score of 4）; percutaneous coronary intervention （score of 2）; and smoking （score of 3）. The HL test showed P ≥ 0.05 and area under the receiver operating characteristic curve ≥ 0.70. Conclusions We explored and quantified the risk factors for aspirin resistance. Our predictive model showed good calibration and discriminative power and therefore a good foundation for the further study of patients undergoing anti-platelet therapy.展开更多
Cardiovascular disease, and in particular ischemic heart disease （IHD）, is a major cause of morbidity and mortality in the very elderly （〉 80 years） worldwide. These patients represent a rapidly growing cohort pr...Cardiovascular disease, and in particular ischemic heart disease （IHD）, is a major cause of morbidity and mortality in the very elderly （〉 80 years） worldwide. These patients represent a rapidly growing cohort presenting for percntaneous coronary intervention （PCI）, now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indicates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI settings： elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients.展开更多
Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. Methods. To produce the model of acu...Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. Methods. To produce the model of acute myocardial ischemia,we partially ligated the left anterior decending(LAD)coronary artery of canine hearts between lst.and 2nd.diagonal branches and then performed transmyocardial revascularization in this region with Ho-YAG laser.Myocardial contrast echocardiography was made with a new generation of ultrasound contrast agent and second harmonic imaging of this region before,after ischemia and after laser revascularization.Pictures were taken with “R” wave trigger skill. Results.Acoustic density derterming in the ischemia region (anterior wall)with MCE(myocardial contrast echocardiography)was obviously decreased(540±181) after the LAD was ligated,as compared with before(1169±161, P<001).It was increased remarkably after transmyocardial laser revascularizatuon(TMLR)(112±201, P<001)as compared with that when ischemia and approximated to that before ischemia(P>005).There were no differences in acoustic density in the lateral wall(as control)among these comprehensive three periods(P>005).Contrast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region. Conclusion.Acute ischemic myocardium can be perfused by oxygenated blood from the left ventricle through Ho-YAG laser channels.Evidence of blood perfusion through laser channels during systolic phase was detected,and myocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin rnay be regarded as a reliable method in the study of transmyocardial revascularization.展开更多
Cardiovascular diseases constitute approximately 50% of deaths among dialysis patients in the USA and Europe. The increase in traditional and nontraditional cardiovascular risk factors in determining the high mortalit...Cardiovascular diseases constitute approximately 50% of deaths among dialysis patients in the USA and Europe. The increase in traditional and nontraditional cardiovascular risk factors in determining the high mortality of patients with end-stage renal disease （ESRD） is complicated due to the high frequency of risk factors in these patients. Some laboratory markers like homocysteine, albumin, cholesterol, triglycerides, LDL-cholesterol, and creatinine could be efficient in marking the risk of cardiovascular disease in these patients. We use Roche assay tests, based on routinely principles to determine this laboratory parameters used in the clinical laboratory. All laboratory parameters we measured on a biochemistry auto analyser Cobas Integra 400 at the clinical laboratory of University Hospital--Pleven. Using a statistical program a research was done on the quantitative characteristics and prognostic capabilities of homocysteine and other biochemical parameters. We determined the diagnostic specificity and sensitivity of our lab performance against vascular disease （heart attack or stroke） by ROC curves. For each of the observed values of biochemical parameters we calculated the diagnostic sensitivity and specificity. The threshold values for which the parameters have the highest sensitivity and specificity have been concluded. Summary of diagnostic value of parameters to judge the coefficient AUC--area under the curve, for cholesterol, LDL, triglycerides, albumin, it was a significant （P 〈 0.05）. Homocysteine and the rest of the studied by us laboratory parameters can be regarded as laboratory markers of choice for assessing the risk of heart attack or stroke in patients on dialysis.展开更多
Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used f...Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used for the treatment of cardiovascular diseases,such as hypertension,coronary artery disease,and stroke,but its mechanisms of actions remain poorly understood.The efficacy of acupuncture depends on multiple constituent elements including acupoints,manipulation skills,and implementation programs,which are termed as acupuncture prescription.This review summarized the previous information of experimental use of acupuncture on animals including species,hypertension models,acupoints selection,acupoint location,stimulation protocols,and evaluation of effectiveness to provide useful guidance for researchers when performing acupuncture in animal experiments.展开更多
文摘Background Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Methods Elderly patients （n = 1130） with stable chronic coronary heart disease who were taking aspirin （75 mg） for 〉 2 months were included. Details of their basic characteristics, laboratory test results, and medications were collected. Logistic regression analysis was performed to establish a predictive model for aspirin resistance. Risk score was finally established according to coefficient B and type of variables in logistic regression. The Hosmer-Lemeshow （HL） test and receiver operating characteristic curves were performed to respectively test the calibration and discrimination of the model. Results Seven risk factors were included in our risk score. They were serum creatinine （〉 110 μmol/L, score of 1）; fasting blood glucose （〉 7.0 mmol/L, score of 1）; hyperlipidemia （score of 1）; number of coronary arteries （2 branches, score of 2; 〉 3 branches, score of 4）; body mass index （20-25 kg/m2, score of 2; 〉 25 kg/m2, score of 4）; percutaneous coronary intervention （score of 2）; and smoking （score of 3）. The HL test showed P ≥ 0.05 and area under the receiver operating characteristic curve ≥ 0.70. Conclusions We explored and quantified the risk factors for aspirin resistance. Our predictive model showed good calibration and discriminative power and therefore a good foundation for the further study of patients undergoing anti-platelet therapy.
文摘Cardiovascular disease, and in particular ischemic heart disease （IHD）, is a major cause of morbidity and mortality in the very elderly （〉 80 years） worldwide. These patients represent a rapidly growing cohort presenting for percntaneous coronary intervention （PCI）, now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indicates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI settings： elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients.
文摘Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. Methods. To produce the model of acute myocardial ischemia,we partially ligated the left anterior decending(LAD)coronary artery of canine hearts between lst.and 2nd.diagonal branches and then performed transmyocardial revascularization in this region with Ho-YAG laser.Myocardial contrast echocardiography was made with a new generation of ultrasound contrast agent and second harmonic imaging of this region before,after ischemia and after laser revascularization.Pictures were taken with “R” wave trigger skill. Results.Acoustic density derterming in the ischemia region (anterior wall)with MCE(myocardial contrast echocardiography)was obviously decreased(540±181) after the LAD was ligated,as compared with before(1169±161, P<001).It was increased remarkably after transmyocardial laser revascularizatuon(TMLR)(112±201, P<001)as compared with that when ischemia and approximated to that before ischemia(P>005).There were no differences in acoustic density in the lateral wall(as control)among these comprehensive three periods(P>005).Contrast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region. Conclusion.Acute ischemic myocardium can be perfused by oxygenated blood from the left ventricle through Ho-YAG laser channels.Evidence of blood perfusion through laser channels during systolic phase was detected,and myocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin rnay be regarded as a reliable method in the study of transmyocardial revascularization.
文摘Cardiovascular diseases constitute approximately 50% of deaths among dialysis patients in the USA and Europe. The increase in traditional and nontraditional cardiovascular risk factors in determining the high mortality of patients with end-stage renal disease （ESRD） is complicated due to the high frequency of risk factors in these patients. Some laboratory markers like homocysteine, albumin, cholesterol, triglycerides, LDL-cholesterol, and creatinine could be efficient in marking the risk of cardiovascular disease in these patients. We use Roche assay tests, based on routinely principles to determine this laboratory parameters used in the clinical laboratory. All laboratory parameters we measured on a biochemistry auto analyser Cobas Integra 400 at the clinical laboratory of University Hospital--Pleven. Using a statistical program a research was done on the quantitative characteristics and prognostic capabilities of homocysteine and other biochemical parameters. We determined the diagnostic specificity and sensitivity of our lab performance against vascular disease （heart attack or stroke） by ROC curves. For each of the observed values of biochemical parameters we calculated the diagnostic sensitivity and specificity. The threshold values for which the parameters have the highest sensitivity and specificity have been concluded. Summary of diagnostic value of parameters to judge the coefficient AUC--area under the curve, for cholesterol, LDL, triglycerides, albumin, it was a significant （P 〈 0.05）. Homocysteine and the rest of the studied by us laboratory parameters can be regarded as laboratory markers of choice for assessing the risk of heart attack or stroke in patients on dialysis.
基金the National Basic Research Program of China:the Epigenetic Regulatory Mechanism of the Specificity of Acupoints(973 Program,No.2012CB518501)the National Natural Science Foundation of China:the Regulatory Mechanism of AS-Neuron Crosstalk With Energy for Promoting Synaptic Plasticity in Hippocampus Treated by Acupuncture(No.81202743)+1 种基金Deacetylation Modification in Personalized Medicine for Acupuncture-Based Weight-Loss(No.81303019)Mechanistic Study of STAT5-miR-193b Pathway in Obesity and Weight Loss by Acupuncture(No.81273838)
文摘Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used for the treatment of cardiovascular diseases,such as hypertension,coronary artery disease,and stroke,but its mechanisms of actions remain poorly understood.The efficacy of acupuncture depends on multiple constituent elements including acupoints,manipulation skills,and implementation programs,which are termed as acupuncture prescription.This review summarized the previous information of experimental use of acupuncture on animals including species,hypertension models,acupoints selection,acupoint location,stimulation protocols,and evaluation of effectiveness to provide useful guidance for researchers when performing acupuncture in animal experiments.
