Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinica...Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.展开更多
Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study a...Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.展开更多
文摘Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.
基金supported by the Science and Technology Planning Project of Guangdong Province(2014A020212022).
文摘Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.
