住院冠心病患者甲状腺功能减退与冠心病关系的探讨

目的探讨住院冠心病患者甲状腺功能减退与冠心病的关系。方法选取2010年4月～2011年5月我院住院冠心病患者和非心血管疾病的患者各80例。将其分别作为实验组与对照组。两组患者分别进行外周甲状腺激素(FT3、FT4)、TSH和血脂[(TC、TG、LDL、HDL、LP(a)]的检测。结果在住院冠心病患者中,合并有甲状腺功能低下者显著高于非心血管疾病的患者,本组实验,前者为22.5%,后者仅为7.5%,两组数据差异具有统计学意义(P均<0.05)。实验组甲减患者血脂异常率为94.44%,甲功正常者血脂异常率为59.68%,差异有统计学意义(P值<0.05);对照组甲减患者血脂异常率为83.33%,甲功正常者血脂异常率为25.68%,差异有统计学意义(P值<0.05)。结论与非心血管疾病的患者相比,住院冠心病患者与甲状腺功能减退有更高的相关性。甲状腺功能减退可能提高冠心病的发病率。     

Predicting Factors for Mortality in the Penetrating Abdominal Trauma

Purpose: penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT.

Methods: the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups: “Healthy Group” (HG) (n = 942) and “Deathly Group” (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multi-variate analyses.

Results: a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01 ± 63.9 (14–74) years and 30 ± 12.5(15–71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09 ±1.3 (0.5–3) and 6.9 ±11.4 (1–6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98 ±1.08 (1–7) and 4.67 ±1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78 ± 9.44 (158) and 46.24 ± 22.18 (15-119) in the HG and DG respectively (p = 0.000).

In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03–38.12, P = 0.000], the long IBIO (OR = 1.82, CI = 1.39–2.40, P = 0.000), PSDA (OR = 94.45, CI = 28.32–314.95, P = 0.000), presence of cranial injury (OR = 0.03, CI = 0.002–0.363, P = 0.006) and high PATI (OR = 1.14, CI = 1.09–1.19, P = 0.000), were found significantly important for mortality.

Conclusion: we determined that conditions such as, female gender, long interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.     

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

Background: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established.

Objective: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF.

Methods: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed.

Results: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001–1.04), and (OR: 1.09, 95% CI: 1.03–1.15), respectively.

Conclusion: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode.     

Serum C-peptide as a key contributor to lipid-related residual cardiovascular risk in the elderly

ObjectivesThe serum levels of C-peptide, an important risk factor for cardiovascular disease (CVD), increase with age. This study aimed to investigate the association between serum C-peptide and increased risk for CVD with altered lipid metabolism in the elderly.MethodsThis was a population-based cross-sectional study that included 3091 elderly participants aged ≥65 years. Serum C-peptide and lipid levels were measured according to standard protocols. Sampling weights were used to estimate the characteristics of study participants. Stratified analysis of covariance was used to evaluate the changes in the serum lipid levels according to quartiles of serum C-peptide levels, and the linear trend was assessed using a linear model. The logistic regression model was carried out to determine the association between the serum C-peptide levels and serum lipid levels.ResultsThe results of the analysis of covariance stratified by sex and serum insulin level showed that the serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were significantly associated with changes in the serum C-peptide levels, independent of the serum insulin level. The logistic regression analyses indicated that the serum C-peptide levels were positively associated with the serum TG levels, and negatively associated with the serum HDL-C levels. A significant dose-response association was obtained in both men and women.ConclusionsSerum C-peptide levels were strongly associated with increased serum TG and reduced HDL-C levels in the elderly. Our results suggest that serum C-peptide increases the risk of CVD via a pathway that increases TG or decreases HDL-C levels.     

Education Time Out and Debrief: Structured Implementation of Perioperative Resident Technical Education Discussion

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高血压心肌肥厚患者心脏交感神经分布与勿动蛋白A表达变化的关系

目的探讨高血压心肌肥厚患者心脏交感神经分布与神经元轴突生长抑制因子勿动蛋白A(neurite out-growth inhibitor-A,Nogo-A)的表达变化。方法从我院老年患者尸体标本库中,随机入选男性高血压患者10例,并根据患者去世前1周心脏超声结果分为心肌肥厚组4例和非心肌肥厚组6例。检测超声心动图,并计算左心室重量指数。免疫组织化学分析测定酪氨酸羟化酶(tyrosine hydroxylase,TH)与Nogo-A的表达。结果与非心肌肥厚组比较,心肌肥厚组患者室间隔厚度、左心室后壁厚度、左心室重量指数明显升高(P<0.05);心肌肥厚组患者心肌TH阳性表达明显降低[(6.35±3.85)%υs(22.17±8.19)%,P<0.05],Nogo A表达明显增加[(11.34±7.16)%υs(2.17±4.10)%,P<0.05]。心肌肥厚患者心肌Nogo-A表达与心肌TH表达呈负相关(r=-0.33,P<0.05)。结论老年高血压心肌肥厚患者心肌交感神经分布减低,然而心肌神经元轴突生长抑制因子Nogo-A表达增加,两者间存在密切相关性。     

Decrease in inner retinal thickness at para- and perifoveal areas before vascular retinopathy in patients with metabolic risk factors

BackgroundHypertension, dyslipidemia, and hyperglycemia are major risk factors for vascular retinopathy. The relationship between retinal thickness at the macular area and metabolic risk factors, as well as visual impairment, in elderly patients before developing vascular occlusion needs to be investigated.MethodsIn this prospective, case-control study, patients >60 years old, without objective visual threatened ocular diseases or systemic abnormalities, except for hypertension, dyslipidemia or/and hyperglycemia, were included for measurement of retinal thickness at the macular area by optical coherence tomography (OCT).ResultsFifty-four patients were analyzed; 11 patients had no metabolic risk factors, 16 had one, 17 had two, and 10 had three. There was no significant difference in age, and full and outer retinal thickness, but there was a significantly lower inner retinal thickness at the parafoveal (p = 0.0013) and perifoveal (p = 0.018) areas in patients with at least one metabolic risk factor. The superior (p = 0.040) and inferior (p = 0.046) inner retina at the perifovea and superior (p = 0.013) inner retinal thickness at the parafovea were sensitive to metabolic abnormalities. Only patients with three factors had significantly reduced best corrected visual acuity (BCVA).ConclusionElderly patients with metabolic risk factors had decreased inner retinal thickness at the para- and perifoveal areas before retinal vascular diseases. Accelerated inner retinal degeneration occurred prior to visual impairment.     

阻塞性睡眠呼吸暂停低通气综合征高危人群 658例的患病率及认知度调查

目的调查阻塞性睡眠呼吸暂停低通气综合征( OSAHS)高危人群患病率及疾病认知度。方法选取 2020年 1—12月青海省心脑血管病专科医院进行体检的志愿者中 658例 OSAHS高危人群，收集其基本资料，统计 OSAHS患病率，采用自制问卷调查所有人的 OSAHS疾病认知度，分析 OSAHS高危人群对疾病的认知情况以及疾病认知度的影响因素。结果 658例 OSAHS高危人群共有 302例被确诊患有 OSAHS，患病率为 45.90%(302/658)。 658例 OSAHS高危人群中共有 382例对 OSAHS存在总体认知，占比 58.05%(382/658)。对 OSAHS存在总体认知的志愿者对 OSAHS可造成白天嗜睡、肥胖是 OSAHS的高危因素这两项掌握较好，回答正确率均在 70.00%以上，其余的项目掌握较差，回答正确率均在 50.00%以下。受教育程度、房颤史、脑卒中史均是 OSAHS高危人群疾病认知度的影响因素( P<0.05)。结论 OSAHS高危人群的患病率较高，且其对 OSAHS的疾病认知度依然有待提高，受教育程度、房颤史、脑卒中史均是 OSAHS高危人群疾病认知度的影响因素。