Sensorineural hearing dysfunction after discharge from critical care in adults:A retrospective observational study

Background Patients undergoing intensive care are exposed to risk factors for hearing impairment.This study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factors associated with worse hearing function.Methods We conducted a single-centre retrospective study,and included adult patients admitted to the intensive care unit(ICU)of Kurashiki Central Hospital between January 2014 and September 2019,who had regular pure tone audiometry performed before and after ICU admission.Correlations between changes in PTA threshold and patient characteristics,were evaluated.The included ears were classified as those with worse hearing(>10 dB increase in the PTA threshold)and those without worse hearing,and the baseline characteristics were compared.Results During the study period,125 ears of 71 patients(male:female ratio,35:36;mean age,72.5±12.3 years)met the eligibility criteria.Age,sex,and the use of furosemide were not correlated with changes in PTA threshold.Univariate analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing(153±85×10^(9)/L vs.206±85×10^(9)/L,respectively;P=0.010),and the rate of planned ICU admission(elective surgery)was higher in the worse hearing group(57.1% vs.28.8%,respectively;p=0.011).Conclusions Age,sex,and the use of furosemide did not have adversely affect hearing function.Low serum platelet count and planned admission appear to be risk factors for worse hearing.

Effects of angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor blocker on one-year outcomes of patients with atrial fibrillation: insights from a multicenter registry study in China

Objective To evaluate the effect of angiotensin-converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB)therapy on the prognosis of patients with atrial fibrillation(AF).Methods A total of 1,991 AF patients from the AF registry were divided into two groups according to whether they were treated with ACEI/ARB at recruitment.Baseline characteristics were carefully collected and analyzed.Logistic regression was utilized to identify the predictors of ACEI/ARB therapy.The primary endpoint was all-cause mortality,while the secondary endpoints included cardiovascular mortality,stroke and major adverse events(MAEs)during the one-year follow-up period.Univariable and multivariable Cox regression were performed to identify the association between ACEI/ARB therapy and the one-year outcomes.Results In total,759 AF patients(38.1%)were treated with ACEI/ARB.Compared with AF patients without ACEI/ARB therapy,patients treated with ACEI/ARB tended to be older and had a higher rate of permanent AF,hypertension,diabetes mellitus,heart failure(HF),left ventricular ejection fraction(LVEF)<40%,coronary artery disease(CAD),prior myocardial infarction(MI),left ventricular hypertrophy,tobacco use and concomitant medications(all P<0.05).Hypertension,HF,LVEF<40%,CAD,prior MI and tobacco use were determined to be predictors of ACEI/ARB treatment.Multivariable analysis showed that ACEI/ARB therapy was associated with a significantly lower risk of one-year all-cause mortality[hazard ratio(HR)(95%CI):0.682(0.527-0.882),P=0.003],cardiovascular mortality[HR(95%CI):0.713(0.514-0.988),P=0.042]and MAEs[HR(95%CI):0.698(0.568-0.859),P=0.001].The association between ACEI/ARB therapy and reduced mortality was consistent in the subgroup analysis.Conclusions In patients with AF,ACEI/ARB was related to significantly reduced one-year all-cause mortality,cardiovascular mortality and MAEs despite the high burden of cardiovascular comorbidities.

Impact of main vessel calcification on procedural and clinical outcomes of bifurcation lesion undergoing provisional single-stenting intervention: a multicenter, prospective, observational study

Background Few data on the combined effects of bifurcation and calcification on coronary artery disease(CAD)patients undergoing percutaneous coronary intervention(PCI)are available.This study evaluated the impact of main vessel(MV)calcification on the procedural and long-term outcomes in patients with CAD who underwent provisional single stent PCI.Methods This is a multicenter,prospective,observational study.Patients with bifurcation lesions were enrolled at 10 PCI centers in China from January 2015 to December 2017.Intravascular ultrasound or optical coherence tomography was performed in all patients to evaluate the MV calcification.Patients were treated with provisional single stent strategy using drug eluting stents and followed-up at 1 month,6 months and 12 months after discharge by telephone contact or outpatient visit.Repeated coronary imaging was performed within one year.We compared the procedural success rates in MV and in side branch(SB),and target lesion failure(TLF),defined as a composite of cardiac death,non-fatal myocardial infarction,definite or possible stent thrombosis and target lesion revascularization between patients with and without MV calcification.Results A total of 185 subjects were enrolled according to the inclusion and exclusion criteria of this study.MV calcification was detected in 119(64.3%,calcification group)and not found in 66(35.7%,non-calcification group)patients.The angiographic success rate of MV was 95.8%in the calcification group and 97.0%in the non-calcification group(P=0.91);the angiographic success rate of SB was 32.8%in the calcification group and 53.0%in the non-calcification group(P<0.05).During the one-year follow-up period,TLF occurred in 14(11.8%)patients in the calcification group and in 13(19.7%)in the non-calcification group{P=0.31).Multivariate regression analysis showed the same result(HR=1.23,95%CI:0.76-1.52,P=0.47).Calcification on group had higher recurrent angina than non-calcification group(13.51%vs.17.65%,P<0.05).Conclusions In patients with coronary bifurcation lesion treated with provisional one stent approach,calcification of MV is associated with lower SB procedural success rate,it could increase recurrence of angina;however,it was not associated with an increased risk of TLF.

Optimal timing of biliary drainage based on the severity of acute cholangitis:A single-center retrospective cohort study

BACKGROUND Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis(AC).Although early biliary drainage is recommended by the treatment guidelines for AC,the best time for performing this procedure is yet to be established.Furthermore,since the clinical outcomes of patients with severe AC vary dramatically,screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade criteria.AIM To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction.METHODS In this retrospective monocenter cohort analysis,we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December 2020.Demographic characteristics including age and sex,clinical and laboratory characteristics,and imaging findings of each patient were obtained from electronic medical records.We investigated the all-cause in-hospital mortality(IHM),hospital length of stay(LOS),and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors[age,white blood cell(WBC)count,total bilirubin,albumin,lactate,malignant obstruction,and Charlton comorbidity index(CCI)].RESULTS Biliary drainage within 24 or 48 h in Grade Ⅲ AC patients could dramatically decrease IHM(3.9%vs 9.0%,P=0.041;4%vs 9.9%,P=0.018,respectively),while increasing LOS and hospitalization costs.Multivariate logistic analysis revealed that neurological,respiratory,renal,and cardiovascular dysfunctions,hypoalbuminemia,and malignant obstruction were significantly associated with IHM(odds ratio=5.32,2.541,6.356,4.021,5.655,and 7.522;P<0.001,P=0.016,P<0.001,P=0.012,P<0.001,and P<0.001;respectively).Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neurological dysfunction(0%vs 17.3%,P=0.041)or with serum lactate>2 mmol/L(0%vs 5.4%,P=0.016).In the subgroup of AC patients with renal dysfunction,abnormal WBC count,hyperbilirubinemia,or hypoalbuminemia,early drainage(<24 h)reduced the IHM(3.6%vs 33.3%,P=0.004;1.9%vs 5.8%,P=0.031;1.7%vs 5.0%,P=0.019;0%vs 27%,P=0.026;respectively).The IHM was lower in patients with AC combined with hepatic dysfunction,malignant obstruction,or a CCI>3 who had undergone biliary drainage within 48 h(2.6%vs 20.5%,P=0.016;3.0%vs 13.5%,P=0.006;3.4%vs 9.6%,P=0.021;respectively).CONCLUSION Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction,while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade Ⅲ AC.

Over-expression of programmed death-ligand 1 and programmed death-1 on antigen-presenting cells as a predictor of organ dysfunction and mortality during early sepsis: a prospective cohort study

BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortality during early sepsis.METHODS:In total,40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PDL1 and PD-1 was determined on APCs,such as B cells,monocytes,and dendritic cells(DCs),by flow cytometry.Cytokines in plasma,such as interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6,IL-10,and IL-17A were determined by Luminex assay.RESULTS:PD-1 expression decreased significantly on B cells,monocytes,myeloid DCs(mDCs),and plasmacytoid DCs(pDCs)as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast,PD-L1 expression was markedly higher on mDCs,pDCs,and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs(monocytes and DCs)was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve(AUC)of the PD-1 percentage of monocytes(monocyte PD-1%)+APACHE II model(0.823)and monocyte PD-1%+SOFA model(0.816)had higher prognostic value than other parameters alone.Monocyte PD-1%was an independent risk factor for 28-day mortality.CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1%could improve the prediction ability for mortality.

Full neurological recovery from severe nonexertional heat stroke with multiple organ dysfunction:A case report

BACKGROUND We report a rare case of full neurological recovery from severe nonexertional heat stroke in a 67-year-old woman with an initial Glasgow Coma Scale of 3.This report raises awareness among doctors that when heatstroke is diagnosed,comprehensive treatment should be implemented as soon as possible.Moreover,targeted temperature management,combination therapy with hemodialysis and hemoperfusion,and hyperbaric oxygen therapy may alleviate multiorgan failure and prevent neurological sequelae caused by heatstroke.CASE SUMMARY A previously healthy 67-year-old woman with an initial Glasgow Coma Scale of 3 was found lying prone on the road at noon on a summer day.Laboratory tests revealed multiorgan failure.As soon as heatstroke was diagnosed,comprehensive treatment was implemented.On hospital Day 3,the patient was extubated.Her initial Sequential Organ Failure Assessment score at hospitalization was 14 and decreased to 2 on hospital Day 4.On the seventh day following hospital admission,as the patient’s general condition improved,the levels of laboratory test findings decreased rapidly.Finally,the patient gradually recovered with no other neurological symptoms(the Glasgow Coma Scale at discharge was 15,and her ability to walk independently was restored).CONCLUSION This case demonstrated that targeted temperature management,combination therapy with hemodialysis and hemoperfusion,and hyperbaric oxygen therapy may alleviate multiorgan failure and prevent neurological sequelae caused by heatstroke.

Clinical characteristics and management of coexistent cardiomyopathy in patients with bicuspid aortic valve

BACKGROUND Bicuspid aortic valve(BAV)is the most common congenital heart disease.However,the prevalence,clinical characteristics,and current management of BAV associated with inherited cardiomyopathy,including hypertrophic cardiomy-opathy(HCM),dilated cardiomyopathy(DCM),and left ventricular noncompaction(LVNC)have not been well described.METHODS Consecutive patients diagnosed with BAV at a large tertiary cardiovascular referral center between 2009 and 2018 were retrospectively assessed for HCM,DCM,and LVNC based on clinical and echocardiographic criteria.Patients with coexist-ent conditions were investigated further.RESULTS Of 3533 patients with BAV screened,57(1.6%)had concomitant cardiomyopathy.BAV was combined with HCM in 30 of these patients,with DCM in 19,and with LVNC in eight.Forty-six patients(80.7%)were male,and the mean age at first dia-gnosis was 47 years for BAV with HCM,49 years for BAV with DCM,and 35 years for BAV with LVNC.Heart failure and aortic valve dysfunction were common in these patients,and the prevalence of coexisting aortopathy was 43.3%,26.3%and 25.0%,re-spectively,for BAV with HCM,DCM and LVNC.During the index hospitalization,24 of the 57 patients(42.1%)underwent sur-gery,16(28%)underwent aortic valve and/or aortic surgery,and 16 of the 30 patients with HCM had a Morrow procedure.There were no deaths or other major adverse cardiovascular events.CONCLUSIONS The prevalence of inherited cardiomyopathy was higher in our patients with BAV than in the general popula-tion.Aortopathy and heart failure were common,with almost half of patients requiring surgery at diagnosis.

Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome

Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various complications severely affect the quality of life of survivors.The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability,an influx of protein-rich pulmonary edema fluid,and surfactant dysfunction leading to severe hypoxemia.At present,the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema,which primarily improves symptoms,but the prognosis of patients with ARDS is still very poor.Mesenchymal stem cells(MSCs)are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation.MSCs can be isolated from a variety of tissues,such as the umbilical cord,endometrial polyps,menstrual blood,bone marrow,and adipose tissues.Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases.Recently,the potential of stem cells in treating ARDS has been explored via basic research and clinical trials.The efficacy of MSCs has been shown in a variety of in vivo models of ARDS,reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury.This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.

Non-invasive ventilation improves hemorheology status in hypoxemic patients with acute myocardial infarction after PCI

血氧不足有时在经皮的冠的干预(一种总线标准) 以后与尖锐心肌的梗塞(AMI ) 在病人发生在紧急情况房间里，甚至在那些与常规高流动的氧吸入的管理。现在的学习是在与 AMI 和 hypoxemia.MethodsThis 在病人改进血氧内容和 hemorheology 评估非侵略的通风(NIV ) 的有效性的 of 未来的学习与 AMI 注册了 50 个连续合格病人(72.3 ??? 折？？

C-reactive protein as a predictor of malignant ventricular arrhythmias in non-ST elevation myocardial infarction

Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.

Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection

BackgroundAcute 肾损害(AKI ) 在为尖锐大动脉的解剖(AAD ) 的外科以后是普通的并且增加在里面医院和长期的死亡。然而，很少数据与类型在病人在早外科手术前的 AKI 的临床、预示的关联上存在 AAD。我们试图在病人在在里面医院结果上决定外科手术前的 AKI 的发生和 AKI 的影响与打阿德梅索兹夫罗姆·梅 2009 到 2014 年 6 月，我们回顾地注册了为类型从症状发作和收到的开的外科在 48 h 以内进入我们的医院的 178 个病人 AAD。病人被划分成没有 AKI 和 AKI 组并且在 surgery.ResultsAKI 发生在 41 个病人(23.0%) 以前，根据 KDIGO 标准与 AKI 上演了严厉。在里面医院复杂并发症的发生在有与没有 AKI 相比的外科手术前的 AKI 的病人是显著地更高的(41.5% 对 9.5% ， P <；0.001 ) ，包括肾的梗塞(7.3% 对 0， P = 0.012 ) ，并且它与 AKI 严厉增加了(P 趋势 <；0.001 ) 。尽管没有重要差别被发现，没有 AKI，有 AKI 的病人与病人相比有更高的在里面医院死亡(14.6% 对 5.1% ， P = 0.079 ) 。Multivariate 分析显示那男性，承认上的心脏舒张的血压和双边的肾的动脉参与 AAD.ConclusionsEarly 是在有类型 A 的病人的外科手术前的 AKI 的独立预言者在外科前的 AKI 在有类型的病人是普通的 AAD，并且与增加的在里面医院复杂并发症被联系。男性，承认上的心脏舒张的血压和双边的肾的动脉参与是为外科手术前的 AKI 的主要预言者。

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

ObjectiveAcute 肾损害(AKI ) 经常发生在基于导管的 interventional 过程和增加死亡以后。然而，类型 B 尖锐大动脉的解剖(AAD ) 的 AKI 以前胸的 endovascular 动脉瘤修理(TEVAR ) 的含意仍然保持不清楚。这研究与类型 B AAD.MethodsBetween 2009 在病人在 TEVAR 前评估了 AKI 的发生，预言者，和在里面医院结果并且 2013， 76 个病人回顾地被评估从症状发作在 36 h 以内为类型 B AAD 收到了 TEVAR。病人被分类进 no-AKI 对 AKI 组，并且 AKI 的严厉进一步根据肾疾病被上演：在外科手术前的 AKI 的 TEVAR.ResultsThe 发生前改进全球结果标准是 36.8% 。在里面医院复杂并发症与 no-AKI 相比在有外科手术前的 AKI 的病人是显著地更高的(50.0% 对 4.2% 分别地；P &#x0003c；0.001 ) ，包括尖锐肾的失败(21.4% 对 0 分别地；P &#x0003c；0.001 ) ，并且他们与 AKI 的严厉增加了(P &#x0003c；0.001 ) 。身体温度和白血房间计数的最大的层次是以前显著地与最大的浆液 creatinine 有关铺平 TEVAR。Multivariate 分析在承认上显示出那收缩血压(或：1.023；95% CI：1.003-1.044；P = 0.0238 ) 并且双边的肾的动脉参与(或：19.076；95% CI：1.914-190.164；P = 0.0120 ) 外科手术前的 AKI.ConclusionsPreoperative AKI 的强壮的预言者经常与类型 B AAD 在病人被发生，并且与更高的在里面医院复杂并发症相关并且提高了煽动性的反应。承认和双边的肾的动脉参与上的收缩血压是为在 TEVAR 前的 AKI 的主要风险因素。

Positive correlation between plasma PCSK9 and tissue factors levels in patients with angiographically diagnosed coronary artery disease and diabetes mellitus

(PCSK9 )BackgroundPro 蛋白质 convertase subtilisin/kexin 类型 9 是影响低密度的脂蛋白胆固醇(LDL-C ) 的血浆层次的分泌蛋白质。氧化 LDL 和织物因素(TF ) 贡献了 prothrombotic 状态的发展。探索在血浆之间的关系的现在的学习目的与冠的动脉疾病(CAD ) 在病人 PCSK9 和 TF 的铺平 .MethodsFrom 2013 年 7 月到 2014 年 3 月，我们注册了因为怀疑的 CAD，在这研究在北京 Anzhen 医院经历了冠的 angiography 的 197 个连续病人。所有病人没有使用类脂化合物阴沉的药的历史。这 197 个病人(131 男性和 66 女性，意味着年龄 56.9 &#x000b1；11.8 年) ， 81 angiographically 诊断了 CAD。临床的数据是镇定的。血浆 PCSK9 和 TF 用连接酶的 immunosorbent 试金(ELISA ) 被测量。血浆 PCSK9 和 TF 的层次被比较，他们的关联在 PCSK9 的不同耐心的 groups.ResultsBoth 血浆层次之中分析了(279.8 &#x000b1；60.4 &#x000b5； g/L 对 216.5 &#x000b1；45.3 &#x000b5； g/L， P &#x0003c；0.01 ) 并且 TF (156.4 &#x000b1；26.6 &#x000b5； g/mL 对 112.1 &#x000b1；38.3 &#x000b5； g/L， P &#x0003c；0.01 ) 在有 CAD 的病人是显著地更高的，作为与那些相比没有 CAD。关联分析证明 PCSK9 的血浆水平显著地有或没有 CAD 在两个病人与 TF 的被相关。然而，在调整以后的 multivariate 回归分析好久，性，吸烟，酒精，高血压和 hyperlipidemia 与类型 2 糖尿病 mellitus 仅仅在 CAD 病人显示出那，在 PCSK9 和 TF 的血浆层次之间有重要积极关联(&#x003b2；= 0.353， P &#x0003c；0.01 ) 没有糖尿病 mellitus， PCSK9 的 .ConclusionsThe 血浆水平独立地并且断然与糖尿病 mellitus 在 CAD 病人，然而并非在那些与 TF 的被联系。进一步的学习被需要调查内在的机制。

Clinical characteristics and one year outcomes in Chinese atrial fibrillation patients with stable coronary artery disease： a population-based study

然而， BackgroundAtrial 纤维性颤动(AF ) 和冠的动脉疾病(CAD ) 经常共存临床的特征和在有 AF 的中国病人的结果上的稳定的 CAD 的影响一直不好在到 2011 年 10 月的从 2008 年 11 月的中国的 20 所医院里的 understood.MethodsConsecutive AF 病人被注册。主要端点包括了 1 年的所有原因死亡，击，非中央的神经系统(non-CNS ) 栓塞，和 1947 个 AF 病人的主要 bleeding.ResultsA 总数被分析，谁 40.5% 有的稳定的 CAD。在 CAD 病人的吝啬的纸孔 2 分数比非 CAD 病人的显著地高(2.4 ±；1.4 对 1.4 ±；1.2， P <；0.001 ) 。在后续时期期间， warfarin 使用在两个组是低的，与在与 CAD 病人相比的非 CAD 病人的相对更高的比例(22.3% 对 10.7% ， P <；0.001 ) 。与非 CAD 病人相比， CAD 病人有更高的一个年所有原因死亡(16.8% 对 12.9% ， P = 0.017 ) 并且击的发生(9.0% 对 6.4% ， P = 0.030 ) ，当 non-CNS 栓塞和主要流血率在二个组之间是可比较的时。在 multivariate 调整以后，稳定的 CAD 独立地与 1 年的所有原因死亡的增加的风险被联系(HR = 1.35， 95% CI：1.01 −； 1 .80， P = 0.040 ) ，然而并非与击联系了(HR = 1.07， 95% CI：0.72-1.58， P = 0.736 ).ConclusionsStable CAD 在中国 AF 病人是流行的并且独立地与 1 年的所有原因的增加的风险被联系死亡。有稳定的 CAD 的中国 AF 病人收到了不适当的 antithrombotic 治疗和需要着急地被改善的 antithrombotic 治疗的这冷酷的地位。

Ectopic gastrointestinal variceal bleeding with portal hypertension

Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we report a case of ectopic ileal variceal bleeding in a 57-year-old woman, which was successfully diagnosed by multi-detector row CT(MDCT) and angiography and treated by segmental ileum resection. To date, there have been no consensus for the treatment of ectopic ileal variceal bleeding. This review was designed to clarify the clinical characteristics of patients with ectopic ileal variceal and discuss possible treatment strategies. From the PubMed database and our own database, we reviewed 21 consecutive cases of ileal variceal bleeding diagnosed from 1982 to 2017. MDCT and angiography is useful for the rapid examination and surgical resection of an affected lesion and is a safe and effective treatment strategy to avoid further bleeding.

Impact of meteorological conditions and PM2.5 on the onset of acute aortic dissection in monsoonal climate

ObjectiveTo 在 monsoonal climate.MethodsA 在尖锐大动脉的解剖的发作上调查气象学的条件和下午2.5的影响线性回归分析在 monsoonal 气候被执行为气象学的因素的影响上的四年的经期的流行病学的调查(最小的温度，吝啬的温度，最大的温度，平均每日的表面温度，天温度范围，相对湿度，吝啬的风速度，和气压)并且下午2.5 co 气象学的变量和首相2.5集中从北京地区性的气候中心和人们中华民国的环境保护的部在一个每日的基础上被检索网站，并且尖锐大动脉的解剖的每日的发生在紧急情况和北京 Anzhen Hospital.ResultsDuring 的批评照顾中心从临床的数据分析和报导系统被检索学习时期(从2011年1月到2014年12月)， 1164 个病人作为 h 被识别分别地，在春天和秋天的相应发生是 0.96 和 1.00 它比那显著地高在夏天和冬季。在一天内的尖锐大动脉的解剖的发生能被预言由日报用下列线性多重回归的温度范围(数据终端就绪) 当模特儿：尖锐大动脉的解剖 = 的发生 0.543 + 0.025 mstring 腱首先与开的腱 str 近似地被收获？？

Genetically confirmed familial hypercholesterolemia in outpatients with hypercholesterolemia

BackgroundFamilial 血胆脂醇过多(FH ) 是能导致早熟的冠的心疾病(pCHD ) 的脂蛋白新陈代谢的正染色体的主导的混乱。在中国有大约 380 万个潜在的 FH 病人，而 FH 的临床、基因的数据是 limited.MethodsDutch 类脂化合物诊所网络(DLCN ) 标准被用来与血胆脂醇过多在门诊病人诊断 FH。与定序确认的 Sanger 相结合的重新定序的薄片分析被用来根据 DLCN 标准在明确的 FH 病人识别变化。在 silico，分析与以前未知的致病力在变化被进行。然后，新奇变异的受体是进人的胚胎肾 293 的 transfected (HEK-293 ) 房间。绑定和变异的受体的成为主观活动被明确的 FH 的流动 cytometry.ResultsThe 流行在这研究与血胆脂醇过多在门诊病人分析是 3.2% 。用基因测试，一同型结合的 FH (HoFH ) ，一异质接合的 FH (HeFH ) 和三复合异质接合的 FH，病人们被证实。在低密度的脂蛋白的八个变化受体(LDLR ) 基因被识别，在哪个 c.357delG 是一个新奇变化并且与 FH 显型共同分离。生物信息的分析证实 c.357delG 是一个病原的变化。而且，当与由流动 cytometry 分析，绑定和成为主观的野类型的 LDLR 相比 c.357delG 异种 LDLR 的活动被 35% 和 49% 减少时， respectively.ConclusionsThis 学习与明确的 FH， c.357delG 在是一个新奇病原的变化在五个病人识别了八个 LDLR 基因变化。这些调查结果增加我们在中国的 FH 的基因光谱的理解。

Successful opening in-stent chronic total occlusion lesion of coronary artery by excimer laser coronary angioplasty

In percutaneous coronary intervention (PCI), chronic total occlusion (CTO) coronary artery disease still remains difficult to treat. One of the reasons for the failure is the hard of the CTO lesions that balloon is difficult to pass through or expand. Previous methods to deal with CTO lesions that cannot be passed by balloon, include selecting reinforced catheter (such as 5 in 6 guiding catheter, Guidzilla catheter, or Tornus microcatheter), guidewire extrusion or rotary grinding technology. In recent years, excimer laser coronary angioplasty (ELCA) has been gradually applied to CTO lesions. Using inert halide as the laser medium, ELCA emits a 308 nm high-intensity unidirectional light wave with absorption depth of only 50 μmL, resulting in less thermal effect and less damage to non-target lesions. In this paper, we will describe a successful PCI case of an in-stent CTO lesion using ELCA with long term coronary angiography follow-up.

Successful cardiopulmonary resuscitation combined with thrombolysis for massive pulmonary embolism during peri-cardiac arrest

Dear editor,Pulmonary thromboembolism(PTE)has become the third most lethal type of thrombotic disease in the world.[1]Thrombolysis has been advised for high-risk PTE patients,however due to its unique pathophysiology,which differs from other atherosclerotic diseases,this can still be a challenge for PTE patients.[2]We reported two cases with a high-risk of PTE that had the onset of or progressed to cardiac arrest(CA)during hospitalization and were successfully managed with cardiopulmonary resuscitation(CPR)combined with thrombolytic therapy.