BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities...BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.展开更多
Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI...Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran.Methods A total of 509 elderly NVAF patients,who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran,were analyzed.The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months,respectively.Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding.Moreover,the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted.Results During the six-month follow-up,50 participants experienced bleeding.Every 1 kg/m^2 increase in BMI was associated with a 12%increased risk of bleeding(P=0.021).Compared to those with BMI values in Tertile 1(<22.5 kg/m^2),the adjusted hazard ratio(HR)of bleeding for participants in Tertile 2(22.5–25.3 kg/m^2)and Tertile 3(>25.3 kg/m^2)were 2.71(95%CI:1.02–7.17)and 3.5(95%CI:1.21–8.70),respectively.The Ptrend-value was significant in all models.The adjusted smooth curve showed a linear association between BMI and bleeding.None of the stratified variables showed significant effect modification on the association between BMI and bleeding(Pinteraction>0.05).Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.展开更多
Objective To assess whether Community Periodontal Index (CPI) teeth and random half-mouth methods are representative of full-mouth method in gingival bleeding examination. Methods Data from 1000 untreated adults (age ...Objective To assess whether Community Periodontal Index (CPI) teeth and random half-mouth methods are representative of full-mouth method in gingival bleeding examination. Methods Data from 1000 untreated adults (age > 18) collected in Beijing from January 2000 to January 2001 were utilized in the analysis. Half of the subjects were examined by Gingival Bleeding Index (GBI) and the other half by Sulcus Bleeding Index (SBI). The data were sorted out and calculated according to CPI teeth and random half-mouth teeth methods. The results of the 2 methods were separately compared with those of full-mouth examination. Results There was a significant difference between CPI teeth method and full-mouth examination (P<0.05) in both GBI and SBI. In contrast, compared with full-mouth examination, significant difference was not observed in diagonal or ipsilateral half-mouth results in SBI (P>0.05), nor in diagonal half-mouth results in GBI (P>0.05) Conclusions The results of CPI teeth method on gingival bleeding could not reflect the full-mouth situation. Ipsilateral and diagonal half-mouth results can serve as a substitute for full-mouth results in SBI, while diagonal half-mouth results in GBI.展开更多
Objective:To explore the effect of the combined application of the Shock Index(SI)and the Early Warning Score(EWS)in patients with acute gastrointestinal bleeding.Methods:Seventy patients with acute gastrointestinal b...Objective:To explore the effect of the combined application of the Shock Index(SI)and the Early Warning Score(EWS)in patients with acute gastrointestinal bleeding.Methods:Seventy patients with acute gastrointestinal bleeding admitted to a hospital from June 2022 to May 2024 were selected and randomly divided into two groups:the control group and the observation group,with 35 patients in each group.The control group received conventional emergency care measures,while the observation group received SI combined with NEWS emergency care measures.The treatment effects in both groups were compared.Results:The observation group had shorter waiting times for consultation(4.45±1.59 minutes),intravenous access establishment(6.79±2.52 minutes),hemostasis time(4.41±1.52 hours),and hospital stays(8.39±2.13 days)compared to the control group,which had times of 5.46±1.34 minutes,8.41±2.16 minutes,5.16±1.47 hours,and 10.26±2.98 days,respectively.The differences were statistically significant(P<0.05).Before management,there were no significant differences in the levels of hemoglobin,prealbumin,and serum protein between the two groups(P>0.05).However,after systematic emergency management,the serum indexes in both groups significantly improved,with the observation group showing greater improvement than the control group,and these differences were statistically significant(P<0.05).In the observation group,only one case of cardiovascular complications occurred during the rescue period,with an incidence rate of 2.86%.In contrast,the control group experienced eight cases of complications,including hemorrhagic shock,anemia,multi-organ failure,cardiovascular complications,and gastrointestinal rebleeding,with an incidence rate of 22.85%.The difference between the groups was statistically significant(P<0.05).Conclusion:The application of SI combined with EWS emergency care measures in patients with acute gastrointestinal hemorrhage can effectively improve serum indexes,shorten resuscitation time and hospital stay,and reduce the risk of complications such as hemorrhagic shock,anemia,infection,multi-organ failure,cardiovascular complications,acute renal failure,and gastrointestinal rebleeding.This approach has positive clinical application value.展开更多
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.
基金supported by the Major New Drug Creation Program from National Science and Technology Major Project of China(2014ZX09303305).
文摘Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran.Methods A total of 509 elderly NVAF patients,who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran,were analyzed.The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months,respectively.Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding.Moreover,the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted.Results During the six-month follow-up,50 participants experienced bleeding.Every 1 kg/m^2 increase in BMI was associated with a 12%increased risk of bleeding(P=0.021).Compared to those with BMI values in Tertile 1(<22.5 kg/m^2),the adjusted hazard ratio(HR)of bleeding for participants in Tertile 2(22.5–25.3 kg/m^2)and Tertile 3(>25.3 kg/m^2)were 2.71(95%CI:1.02–7.17)and 3.5(95%CI:1.21–8.70),respectively.The Ptrend-value was significant in all models.The adjusted smooth curve showed a linear association between BMI and bleeding.None of the stratified variables showed significant effect modification on the association between BMI and bleeding(Pinteraction>0.05).Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.
文摘Objective To assess whether Community Periodontal Index (CPI) teeth and random half-mouth methods are representative of full-mouth method in gingival bleeding examination. Methods Data from 1000 untreated adults (age > 18) collected in Beijing from January 2000 to January 2001 were utilized in the analysis. Half of the subjects were examined by Gingival Bleeding Index (GBI) and the other half by Sulcus Bleeding Index (SBI). The data were sorted out and calculated according to CPI teeth and random half-mouth teeth methods. The results of the 2 methods were separately compared with those of full-mouth examination. Results There was a significant difference between CPI teeth method and full-mouth examination (P<0.05) in both GBI and SBI. In contrast, compared with full-mouth examination, significant difference was not observed in diagonal or ipsilateral half-mouth results in SBI (P>0.05), nor in diagonal half-mouth results in GBI (P>0.05) Conclusions The results of CPI teeth method on gingival bleeding could not reflect the full-mouth situation. Ipsilateral and diagonal half-mouth results can serve as a substitute for full-mouth results in SBI, while diagonal half-mouth results in GBI.
文摘Objective:To explore the effect of the combined application of the Shock Index(SI)and the Early Warning Score(EWS)in patients with acute gastrointestinal bleeding.Methods:Seventy patients with acute gastrointestinal bleeding admitted to a hospital from June 2022 to May 2024 were selected and randomly divided into two groups:the control group and the observation group,with 35 patients in each group.The control group received conventional emergency care measures,while the observation group received SI combined with NEWS emergency care measures.The treatment effects in both groups were compared.Results:The observation group had shorter waiting times for consultation(4.45±1.59 minutes),intravenous access establishment(6.79±2.52 minutes),hemostasis time(4.41±1.52 hours),and hospital stays(8.39±2.13 days)compared to the control group,which had times of 5.46±1.34 minutes,8.41±2.16 minutes,5.16±1.47 hours,and 10.26±2.98 days,respectively.The differences were statistically significant(P<0.05).Before management,there were no significant differences in the levels of hemoglobin,prealbumin,and serum protein between the two groups(P>0.05).However,after systematic emergency management,the serum indexes in both groups significantly improved,with the observation group showing greater improvement than the control group,and these differences were statistically significant(P<0.05).In the observation group,only one case of cardiovascular complications occurred during the rescue period,with an incidence rate of 2.86%.In contrast,the control group experienced eight cases of complications,including hemorrhagic shock,anemia,multi-organ failure,cardiovascular complications,and gastrointestinal rebleeding,with an incidence rate of 22.85%.The difference between the groups was statistically significant(P<0.05).Conclusion:The application of SI combined with EWS emergency care measures in patients with acute gastrointestinal hemorrhage can effectively improve serum indexes,shorten resuscitation time and hospital stay,and reduce the risk of complications such as hemorrhagic shock,anemia,infection,multi-organ failure,cardiovascular complications,acute renal failure,and gastrointestinal rebleeding.This approach has positive clinical application value.
