郑州市某医院体检的中青年职工肥胖分型及肌肉均衡性情况分析

目的:了解郑州市某医院体检人群肥胖分型和各节段肌肉分布及变化情况。方法:选取2018年5—7月在河南省某三甲医院进行体检的2289名轻体力劳动职工为研究对象,采用生物电阻抗法测定体脂百分比、各节段肌肉量、体质指数(BMI)等人体成分指标,分析不同性别和年龄组的分布特征。结果:体脂百分比超标1850人(80.8%),BMI超标1436人(62.7%);隐性肥胖检出率19.9%,女性(26.4%)高于男性(16.8%),差异有统计学意义(P<0.05)。50岁之前,肥胖检出率随着年龄增长逐渐增加;50岁之后,超重肥胖率下降,隐性肥胖检出率增加。男性40岁及以后,身体各节段肌肉量均逐渐减少;女性40~49岁双上肢及躯干肌肉量最高,之后逐渐下降;双下肢肌肉量50岁以后明显下降。无论男、女,双下肢肌肉低标准率均明显高于双上肢,差异有统计学意义(P<0.05);在年龄组分布上,40~49岁组双上肢和躯干肌肉比率达标者最高,20~29岁组双下肢达标者最高,50~59岁组最低。结论:中青年轻体力劳动人群体脂超标率较高,肌肉量自40岁后逐渐下降,可根据其肥胖分型和各节段肌肉量随年龄的变化规律进行有针对性的干预。

Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

Objective:To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.Methods:The clinical data of 623 patients with pernicious placenta previa combined with placenta accrete,who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed.All patients underwent abdominal aortic balloon occlusion combined with cesarean section,and 78 patients underwent sequential bilateral uterine artery embolization.We analyzed the operation time,intraoperative blood loss,blood transfusion volume,intraoperative and postoperative complications,fetal radiation exposure time and dose,and the Apgar score of the newborns.We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete.Results:Of the 623 patients,545 underwent only abdominal aortic balloon occlusion,and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding.The uterus was successfully preserved in all patients.Except for five cases of right lower extremity arterial thrombosis,the remaining patients did not have postoperative lower extremity arteriovenous thrombosis,renal insufficiency,late postpartum hemorrhage,ectopic embolism,spinal cord or peripheral nerve damage,pelvic infection,or other serious complications.The mean operative time was 65.3(±14.5)min.The mean intraoperative blood loss was620(±570)ml.Ninety-six patients(15.4%,96/623)were treated with blood transfusion,and the average amount of blood transfused was 750(±400)ml.The average number of hospitalization days was 6.8(±3.4)days,the average time of fetal ray exposure was 5.2(±1.6)s,and the average radiation dose was 4.1(±2.7)m Gy.The neonatal Apgar score,was 8.4(±0.6)points at 1 min,and 9.6(±0.4)points at 5 min.In the follow-up to May 31,2019,29 patients were lost to follow-up,96 were lactating,and 498 were menstruating.Except for the cases lost to follow-up,the remaining 596 surviving newborns(including 2 twins)showed no abnormalities at the 42-day postnatal outpatient follow-up examination.Conclusion:Balloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

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.

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.

Use of Impella cardiac axial flow pump for cardiogenic shock(A newer alternative)-How good is the evidence?

The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.

Uric acid is associated with cardiac death in patients with hypertrophic obstructive cardiomyopathy

BACKGROUND The role of uric acid(UA) in survival of patients with hypertrophic obstructive cardiomyopathy(HOCM) has not been fully evaluated. This study aimed to determine whether UA could be an independent risk factor of cardiac death in patients with HOCM.METHODS A total of 317 patients with HOCM, who were receiving conservative treatment in Fuwai Hospital from October2009 to December 2014, all of them completed UA evaluations, were analyzed. Patients were divided into three groups according to the UA levels: Tertile 1(≤ 318 μmol/L, n = 106), Tertile 2(319 to 397 μmol/L, n = 105), and Tertile 3(≥ 398 μmol/L, n = 106).RESULTS During a median follow-up of 45 months, 29 cardiac deaths(9.1%) occurred, including 6 sudden cardiac deaths and23 heart failure-related deaths. Cardiac death in Tertile 3(n = 16, 55.2%) was significantly higher than in Tertile 1(n = 6, 20.7%)and Tertile 2(n = 7, 24.1%). In univariate model, UA level(continuous value) showed predictive value of cardiac death [hazard ratio(HR) = 1.006, 95% CI: 1.003-1.009, P = 0.009]. Univariate Cox survival analysis had shown a significant higher property of cardiac death in patients of Tertile 3 when compared with those of Tertile 1, but cardiac death in patients of Tertile 2 did not show significant prognositic value compared with those of Tertile 1(HR = 3.927, 95% CI: 0.666-23.162, P = 0.131). UA was found to be an independent risk factor(HR = 1.005, 95% CI: 1.001-1.009, P = 0.009) of cardiac death in the multivariate regression analysis after the adjustment for age, body mass index, atrial fibrillation, hemoglobin, creatinine, high-sensitivity C-reactive protein, interventricular septum/left ventricular posterior wall ratio, left ventricular outflow tract and left ventricular ejection fraction.CONCLUSIONS UA concentration was found to be independently associated with cardiac death in HOCM patients receiving conservative treatment. Randomized trials of UA-lowering agents for HOCM patients are warranted.

Banking of perinatal mesenchymal stem/stromal cells for stem cellbased personalized medicine over lifetime:Matters arising

Mesenchymal stromal/stem cells(MSCs)are currently applied in regenerative medicine and tissue engineering.Numerous clinical studies have indicated that MSCs from different tissue sources can provide therapeutic benefits for patients.MSCs derived from either human adult or perinatal tissues have their own unique advantages in their medical practices.Usually,clinical studies are conducted by using of cultured MSCs after thawing or short-term cryopreserved-then-thawed MSCs prior to administration for the treatment of a wide range of diseases and medical disorders.Currently,cryogenically banking perinatal MSCs for potential personalized medicine for later use in lifetime has raised growing interest in China as well as in many other countries.Meanwhile,this has led to questions regarding the availability,stability,consistency,multipotency,and therapeutic efficiency of the potential perinatal MSC-derived therapeutic products after longterm cryostorage.This opinion review does not minimize any therapeutic benefit of perinatal MSCs in many diseases after short-term cryopreservation.This article mainly describes what is known about banking perinatal MSCs in China and,importantly,it is to recognize the limitation and uncertainty of the perinatal MSCs stored in cryobanks for stem cell medical treatments in whole life.This article also provides several recommendations for banking of perinatal MSCs for potentially future personalized medicine,albeit it is impossible to anticipate whether the donor will benefit from banked MSCs during her/his lifetime.

Chinese Expert Consensus on Microvascular Protection Strategy During Emergency Percutaneous Coronary Intervention Therapy in Patients With ST-elevation Myocardial Infarction

Microcirculatory dysfunction(CMD)typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention,which is associated with more severe myocardial injury and a worse prognosis.With the advancement of intracoronary physiology and imaging technology,the prevention and therapeutic interventions of CMD have attracted more attention.However,relevant guidelines or consensus on CMD are lacking in China.The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies,guidelines,and consensus from international sources.

Epidemiology and factors predicting survival of amyotrophic lateral sclerosis in a large Chinese cohort

Background:Amyotrophic lateral sclerosis(ALS)is a fatal neurodegenerative disorder associated with loss of motor neurons.Our objective was to explore the epidemiology,clinical features,and survival factors of 1809 patients with ALS.Methods:We analyzed 1809 ALS patients,who were recruited from the Peking University Third Hospital from January 2005 to December 2015.Demographic data and disease-related parameters were collected.Kaplan-Meier curves were used to compare survival time.Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors.Results:The results showed that the average annual incidence in Beijing alone was 0.38 cases/100,000 person-years and the mean age of onset was 48.88±11.35(95%confidence interval[CI]:48.17–49.85)years.The median survival time from onset to death/tracheostomy was 58.89±33.03(95%CI:51.46–63.84)months.In the adjusted Cox proportional hazard model,age of onset,diagnosis delay,rate of disease progression(Amyotrophic Lateral Sclerosis Functional Rating Scale Revised decline[points/month]),and body mass index all had an independent effect on survival in ALS.Conclusions:Our study provides information on epidemiology,clinical features,and survival factors of patients with ALS in China.These results can be helpful in clinical practice,clinical trial design,and validation of new tools to predict disease progression.

Efficacy and safety of a parylene-coated occluder for atrial septal defect:a prospective,multi-center,randomized controlled clinical trial

Background:Nitinol-containing devices are widely used in clinical practice.However,there are concerns about nickel release after nitinol-containing device implantation.This study aimed to compare the efficacy and safety of a parylene-coated occluder vs.a traditional nitinol-containing device for atrial septal defect(ASD).Methods:One-hundred-and-eight patients with ASD were prospectively enrolled and randomly assigned to either the trial group to receive a parylene-coated occluder(n=54)or the control group to receive a traditional occluder(n=54).The plugging success rate at 6 months after device implantation and the pre-and post-implantation serum nickel levels were compared between the two groups.A non-inferiority design was used to prove that the therapeutic effect of the parylene-coated device was non-inferior to that of the traditional device.The Cochran–Mantel–Haenszel chi-squared test with adjustment for central effects was used for the comparison between groups.Results:At 6 months after implantation,successful ASD closure was achieved in 52 of 53 patients(98.11%)in both the trial and control groups(95%confidence interval(CI):[4.90,5.16])based on per-protocol set analysis.The absolute value of the lower limit of the 95%CI was 4.90%,which was less than the specified non-inferiority margin of 8%.No deaths or severe complications occurred during 6 months of follow-up.The serum nickel levels were significantly increased at 2 weeks and reached the maximum value at 1 month after implantation in the control group(P<0.05 vs.baseline).In the trial group,there was no significant difference in the serum nickel level before vs.after device implantation(P>0.05).Conclusions:The efficacy of a parylene-coated ASD occluder is non-inferior to that of a traditional uncoated ASD occluder.The parylene-coated occluder prevents nickel release after device implantation and may be an alternative for ASD,especially in patients with a nickel allergy.

新型完全生物可吸收封堵器经导管封堵膜周部室间隔缺损:一项多中心前瞻性随机对照研究

生物可吸收封堵器的应用有望降低传统金属封堵器并发症的风险.之前研制的生物可吸收封堵器存在不完全降解的局限性并导致新的并发症,因此目前尚未有相关产品获批上市.本研究使用了一种新型完全可吸收封堵器,旨在探索完全可吸收封堵器治疗室间隔缺损的疗效和安全性.从2019年4月到2020年1月,本研究在七个医学中心入组125名膜周部室间隔缺损患者,经筛查后108名患者被纳入研究并随机分为植入生物可吸收封堵器实验组和金属封堵器组.所有受试者均成功植入封堵器并完成24个月的随访.生物可吸收封堵器组患者经胸超声心动图显示高亮回声在24个月内逐渐消失,说明可吸收封堵器在体内实现完全降解.对比金属封堵器,实验组器械相关心律失常发生率(5.56%vs.14.81%,P=0.112)和持续传导阻滞发生率(0/54 vs.6/54,P=0.036)显著降低.本研究提示新型完全可吸收封堵器可以在单纯超声引导下实现成功植入,同时降低术后永久性心律失常的发生率.

Quality Measurement and Improvement Study of Surgical Coronary Revascularization： Medication Adherence （MISSION-2）

Background： Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting （CABG）. However, medication adherence alter CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG. Methods： The Measurement and Improvement Studies of Surgical Coronary Revascularization： Medication Adherence （MISSION-2） study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1 ： 1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage lnedication adherence in the intervention group through a health self management program initiated dnring hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac edticational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization.Discussion： Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model tor outpatient health self-managenlent that could be translated to various chronic diseases and widely disseminated across resource-limited settings.

Expert consensus on the use of human serum albumin in adult cardiac surgery

Introduction Albumin,which is a 65-kDa liver-synthesized protein,accounts for nearly 50%of total plasma protein and contributes to approximately 80%of intravascular oncotic pressure.Albumin helps maintain microvascular integrity,functions as an antioxidant,and transports hormones,fatty acid,bile salts,bilirubin,electrolytes(e.g.,calcium,magnesium,copper,zinc,et al.),and drugs.[1–3]Human serum albumin(HSA)is a sterile,liquid albumin product derived from large pools of human plasma by fractionation and pasteurization.The medical use of HAS could date back to approximately the time of World War II.