Aorto-enteric fistula:A case report

Aorto-enteric fistula(AEF)is a rare entity that accounts for high mortality. Early diagnosis is paramount to improving the survivals of patients with AEF but the diagnosis tends to be delayed in practice due to extremely variable clinical presentations. Contrasted computer tomography(CT),oesophagastroduodenoscopy(OGDS)or angiography should be prompted in a timely manner based on a high index of clinical suspicion. In this article,a case of primary AEF(PAEF)with herald gastroenteric tract haemorrhage is presented. In addition to the pathophysiology and managements,the pitfalls of the diagnostic studies are discussed,pinpointing the importance of high index of clinical suspicion.

The SYNTAX score as a predictor of contrast-induced nephropathy patients with chronic total occlusion undergoing percutaneous coronary intervention

Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevation myocardial infarction（STEMI） and non-STEMI（NSTEMI）. However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups： a low-risk group（SYNTAX score 〈 23; n = 231）, a moderate-risk group（SYNTAX score = 23-32; n = 214）, and a high-risk group（SYNTAX score〉32; n = 222）. CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74（11.09%） of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN（6.93%,13.08%,13.51%P = 0.044）. In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN（OR：1.956,95% CI： 1.014-3.773; P = 0.045; OR： 1.942,95% CI： 1.005-3.752; P = 0.048）. The incidence of in-hospital（1.3% vs. 4, 21% vs. 5.86%, P = 0.035） and long-term MACE（4.59% vs. 7.88% vs. 11.66%, P = 0.046） rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.

Prevalence and risk factors of hypertension in southern China guided by new ACC guideline

Background Hypertension is one of the most common chronic diseases which threatens human health. However,epidemic data of hypertension guided by new ACC hypertension guideline is limited. Methods Residents from four cities in urban and country areas were enrolled by the probability proportional to size method in Guangdong province,China. Results A total of 19,031 participants were enrolled. The age-standardized prevalence of hypertension was 32.07% guided by previous guideline and 56.67%guided by the new guideline. Notably,when guided by new guideline,the prevalence of hypertension in younger(15~24 years,313%;25~34 years,270%;35~44 years,186%),lower body mass index(BMI<24 kg/m^2,102%)and high-educated(undergraduates,194%;postgraduates,137%)participants increased more compared to older(55~64 years,47%;65~74 years,33%;75~84 years,23%),obesity(BMI≥28 kg/m^2,46.6%)and low-educated(primary school,42%)participants. Age,gender,alcohol taking,BMI,waist circumference,education,medical insurance and hypertension family history were found to be independent risk factors of hypertension in new guidelines. Conclusions The prevalence of hypertension changed greatly when guided by the new hypertension guideline. When applying the new hypertension guideline,subjects with younger age,lower BMI and high-educated tend to be more susceptible to hypertension compared to traditional high risk population. Further studies are needed to explore indicators that can predict the morbidity of hypertension.