替罗非班在ST段抬高型急性冠脉综合征介入治疗围手术期中的应用价值研究

目的:分析替罗非班在ST段抬高型急性冠脉综合征介入治疗围手术期中的应用价值。方法:选择接受介入治疗的ST段抬高型急性冠脉综合征患者,并随机将其分为接受常规治疗的对照组和接受替罗非班治疗的观察组,并检测治疗前后患者的血小板CD40L表达、血清CRP水平以及心血管事件发生等情况。结果:1治疗后,观察组患者的血小板CD40L表达强度明显低于对照组患者,差异有统计学意义(t=3.281,P<0.05);2给药后1 d、1周和4周观察组患者的血清CRP水平均明显低于对照组患者,差异有统计学意义(t=2.183,t=2.748,t=4.719;P<0.05);3接受药物治疗后,观察组患者介入治疗后心血管事件发生率明显低于对照组,差异有统计学意义(x2=6.493,P<0.05)。结论:围术期替罗非班治疗可以有效降低患者的血小板表达及炎症水平,减少不良心血管事件的发生,具有积极的临床意义。     

宁波市某高职院校结核病知晓率现状和干预效果分析

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813名医院职工体检结果分析及干预措施

目的：了解医院职工的整体健康水平,为制订干预措施提供参考。方法选取2013年1~12月的813名医院职工体检资料作为研究对象,按异常指标分布、年龄、性别及工种进行汇总分析。结果指标异常检出率由高到低依次为高脂血症(47.85%)、乳腺增生症(18.06%)、慢性宫颈炎(17.89%)、肝功异常(15.74%)、心电图异常(14.88%)、体重超重或肥胖(11.93%)、胆囊息肉样变(10.33%)。不同工种间的心电图异常、肝功异常、体重超重或肥胖、慢性胆囊炎、高血压或血压偏高检出率比较,差异有统计学意义(P<0.05)。男性与女性、≥40岁与<40岁职工之间的体重超重或肥胖、肝功异常、胆囊息肉样病变、慢性胆囊炎、高血压或血压偏高检出率比较,差异有统计学意义(P<0.05)。结论医院职工的健康状况不容乐观,应积极采取干预措施,提高职工的整体健康水平。     

鹤山市3~6岁儿童单纯性肥胖症调查及相关干预对策分析

目的：调查鹤山市3~6岁儿童单纯性肥胖症情况,探究相关干预对策对减少儿童单纯性肥胖症发生的效果。方法2013年2~6月,从鹤山市不同区域抽取4所规模较大的幼儿园,在这4所幼儿园中随机选取3~6岁儿童1500例作为研究对象,根据相关肥胖标准筛选出单纯性肥胖症儿童240例,将其将其随机分成对照组和干预组,各120例。对照组不给予干预措施,干预组给予相关干预措施。结果单纯性肥胖症检出率为16.0%（240/1500）。男童单纯性肥胖症的检出率（9.4%）明显高于女童（6.6%）（P<0.05）。5~6岁组的单纯性肥胖症检出率明显高于3~4岁组（P<0.05）。干预组干预后的单纯性肥胖症检出率明显低于对照组（P<0.05）。结论加强心理和行为干预、改变儿童的饮食习惯、加强体育锻炼等多种干预措施能有效预防和减少儿童肥胖症的发生,效果显著。     

“翻山鞘”联合大腔导管抽吸技术在下肢深静脉血栓中的应用

目的：探讨“翻山鞘”联合大腔导管抽吸技术治疗下肢深静脉血栓方法与疗效。方法回顾分析28例下肢深静脉血栓患者先行下腔静脉滤器植入,而后采取“翻山鞘”联合大腔导管抽吸治疗下肢深静脉血栓,配合导管溶栓及抗凝。结果28例患者“翻山鞘”全部跨越髂静脉分叉,进入患侧髂外静脉。本组显效16例;有效10例,无效2例,术后无并发症出现。结论下肢深静脉血栓通过“翻山鞘”联合大腔导管抽吸技术治疗取得了满意的疗效,节约手术时间,降低手术风险。     

Effect of Intravenous Administration of Liposomal Prostaglandin E1 on Microcirculation in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Background:

Several studies have demonstrated that primary percutaneous coronary intervention (PCI) can result in reperfusion injury. This study aims to investigate the effectiveness of liposomal prostaglandin E1 (Lipo-PGE1, Alprostadil, Beijing Tide Pharmaceutical Co., Ltd.) for enhancing microcirculation in reperfusion injury. In addition, this study determined the optimal administration method for acute ST elevation myocardial infarction (STEMI) patients undergoing primary PCI.

Methods:

Totally, 68 patients with STEMI were randomly assigned to two groups: intravenous administration of Lipo-PGE1 (Group A), and no Lipo-PGE1 administration (Group B). The corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC) and myocardial blush grade (MBG) were calculated. Patients were followed up for 6 months. Major adverse cardiac events (MACE) were also measured.

Results:

There was no significant difference in the baseline characteristics between the two groups. The cTFC parameter in Group A was significantly lower than Group B (18.06 ± 2.06 vs. 25.31 ± 2.59, P < 0.01). The ratio of final MBG grade-3 was significantly higher (P < 0.05) in Group A (87.9%) relative to Group B (65.7%). There was no significant difference between the two groups in final TIMI-3 flow and no-reflow. Patients were followed up for 6 months, and the occurrence of MACE in Group A was significantly lower than that in Group B (6.1% vs. 25.9% respectively, P < 0.05).

Conclusions:

Myocardial microcirculation of reperfusion injury in patients with STEMI, after primary PCI, can be improved by administering Lipo-PGE1.     

Adjuvant Efficacy of Nutrition Support During Pulmonary Tuberculosis Treating Course: Systematic Review and Meta-analysis

Background:

Malnutrition and tuberculosis (TB) tend to interact with each other. TB may lead to nutrition deficiencies that will conversely delay recovery by depressing immune functions. Nutrition support can promote recovery in the subject being treated for TB. The aim of this study was to evaluate the effectiveness of nutrition support on promoting the recovery of adult pulmonary TB patients with anti-TB drug therapy.

Methods:

English database of the Cochrane Controlled Trials Register, PubMed, EMBASE, and Chinese database of CBM, CNKI, VIP, and WANFANG were searched. Randomized controlled trials comparing nutrition support (given for more than 2 weeks) with no nutrition intervention, nutrition advice only, or placebo-control for TB patients being anti-TB treated were included. Two reviewers conducted data extraction, assessed the quality of the studies independently, and any discrepancies were solved by the third reviewer. Data were entered and analyzed by RevMan 5.2 software, and meta-analysis was done using risk ratios (RRs) for dichotomous variables and mean differences (MDs) for continuous variables with 95% confidence intervals (CIs).

Results:

A total of 19 studies (3681 participants) were included. In nutritional support for TB patients, pooled RR and its 95% CI of sputum smears- or culture-negative conversion rate and chest X-ray (CXR) absorption rate were 1.10 (1.04, 1.17) and 1.22 (1.08, 1.39), respectively, the pooled MD and its 95% CI of body mass index (BMI) and time of sputum smears or culture negativity were 0.59 (0.16, 1.2) and − 5.42 (−7.93, −2.92), respectively, compared with the control group. The differences in outcomes of CXR zone affected, TB score, serum albumin, and hemoglobin were not statistically significant (P = 0.76, 0.24, 0.28, and 0.20, respectively) between the intervention group and the control group. No systemic adverse events were recorded.

Conclusions:

During anti-TB course, nutrition support may be helpful in treatment of TB patients by improving both sputum smears- or culture-negative conversion rate and BMI, shortening the time of sputum conversion negative. Whether it can improve the final clinical effect, there still needs high-level quality studies to confirm in the future.     

Comparison of the Efficacy of Drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

Background:

Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations.

Methods:

From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation.

Results:

Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21–0.63, P = 0.029) and 0.29 (95% CI: 0.08–0.92, P = 0.037), respectively.

Conclusions:

DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.