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811.
Mert İlker Hayıroğlu Muhammed Keskin Ahmet Okan Uzun Ceyhan Türkkan Ahmet İlker Tekkeşin Ömer Kozan 《Journal of electrocardiology》2018,51(3):524-530
Background
Electrical phenomenon and remote myocardial ischemia are the main factors of ST segment depression in inferior leads in acute anterior myocardial infarction (AAMI). We investigated the prognostic value of the sum of ST segment depression amplitudes in inferior leads in patients with first AAMI treated with primary percutaneous coronary intervention. (PPCI).Methods
In this prospective analysis, we evaluated the in-hospital prognostic impact of the sum of ST segment depression in inferior leads on 206 patients with first AAMI. Patients were stratified by tertiles of the sum of admission ST segment depression in inferior leads. Clinical outcomes were compared between those tertiles.Results
Univariate analysis revealed higher rate of in-hospital death for patients with ST segment depression in inferior leads in tertile 3, as compared to patients in tertile 1 (OR 9.8, 95% CI 1.5–78.2, p < 0.001). After adjustment for baseline variables, ST segment depression in inferior leads in tertile 3 was associated with 5.7-fold hazard of in-hospital death (OR: 5.7, 95% CI 1.2–35.1, p < 0.001). Spearman rank correlation test revealed correlation between the sum of ST segment depression amplitude in inferior leads and the sum of ST segment elevation amplitude in V1–6, L1 and aVL. Multivessel disease and additional RCA stenosis were also detected more often in tertile 3.Conclusion
The sum of ST segment depression amplitude in inferior leads of admission ECG in patients with first AAMI treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggest the sum of ST segment depression amplitude to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with first AAMI. 相似文献812.
Alain Putot Sophie Buet Derrida Marianne Zeller Aurélie Avondo Patrick Ray Patrick Manckoundia Yves Cottin 《The American journal of medicine》2018,131(10):1209-1219
BACKGROUND
Type 2 myocardial infarction and nonischemic myocardial injury, corresponding to troponin elevation without atherothrombosis, are emerging concepts suspected of being common in emergency departments (ED). However, their respective frequencies, risk profiles, and short-term prognoses remain to be investigated.METHODS
Among all the patients admitted from January 2014 to December 2016 in a university hospital ED (n?=?33,669), those with elevated conventional troponin Ic (≥0.10 µg/L) (n?=?4436, 13%) were systematically adjudicated as having type 1 or type 2 myocardial infarction in the presence of symptoms or signs of myocardial ischemia (typical chest pain or electrocardiographic changes) or myocardial injury without such signs.RESULTS
Among the 4436 patients included, 1453 (33%) were classified as having myocardial injury, 947 (21%) as having type 2 and 2036 (46%) as having type 1 myocardial infarction. Compared with type 1 patients, patients with type 2 myocardial infarction and myocardial injury were markedly older (respective median ages: 67, 81, and 84 years; P < .001) with more frequent comorbidities. In multivariate analysis, myocardial injury was associated with a lower risk of cardiovascular death (odds ratio 43; 95% confidence interval, 0.29-0.65; P < .001) but a higher risk of all-cause in-hospital death (odds ratio 1.43; 95% confidence interval, 1.02-2.00; P?=?.037). Systolic blood pressure <90mm Hg and heart rate >100 beats per minute at admission were strongly associated with all-cause mortality, and the troponin rate was associated with cardiovascular mortality in all groups.CONCLUSIONS
In a large study of patients with elevated troponins in an ED, myocardial injury and type 2 myocardial infarction were frequent and associated with a worse in-hospital prognosis than type 1 myocardial infarction resulting from noncardiovascular events. 相似文献813.
Synthesis and Characterization of Four‐Arm Star Polystyrene Based on a Novel Tetrafunctional RAFT Agent 下载免费PDF全文
Trevor Gavin Wright Wolfgang Weber Helen Pfukwa Harald Pasch 《Macromolecular chemistry and physics.》2015,216(14):1562-1572
Reversible addition fragmentation chain transfer polymerization (RAFT) is a very versatile polymerization technique whereby the topology of the final polymer can be tailored using specific RAFT agents. The tetrafunctional RAFT agent, tetrabenzyl(1,3‐dithietane‐2,2,4,4‐tetrayl)tetracarbanotrithioate, has not previously been used to synthesize polymers. Polystyrene (PS) is synthesized using this tetrafunctional RAFT agent and advanced characterization is performed using spectroscopic and separation methods. In situ 1H nuclear magnetic resonance spectroscopy (NMR) and size‐exclusion chromatography (SEC) are used to determine the topology of the resultant PS. The polymerization is followed by in situ 1H NMR, using styrene‐d8 rather than hydrogenous styrene. In situ 1H NMR spectra show that the RAFT agent is incorporated into the polymer as a terminal group. Aminolysis of the star‐shaped PS is performed and the SEC and NMR results before and after aminolysis are compared. These results indicate that the expected star‐shaped topology of the polymer is achieved.
814.
目的 调查广州市某三级甲等综合医院基于胰岛素泵治疗的院内血糖管理现状。方法 分析286例实施胰岛素泵治疗患者餐前、餐后2 h血糖(2 hour postprandial blood glucose,2h PBG)检测率,高血糖、低血糖及严重低血糖发生情况,对比非内分泌科与内分泌科的差异。 结果 非内分泌科胰岛素泵治疗的患者餐后2 h血糖检测率为33.12%,糖基化血红蛋白检测率为75.16%,均明显低于内分泌科患者(χ2=94.272,P<0.001; χ2=37.104,P<0.001)。非内分泌科低血糖与严重低血糖密度明显高于内分泌科,其中外科低血糖密度最高。非内分泌科与内分泌科使用胰岛素泵患者血糖总达标率比较,差异无统计学意义(χ2=2.697,P=0.101),非内分泌科不同科室患者血糖总达标率比较,差异有统计学意义(χ2=18.900,P=0.002)。结论 非内分泌科应加强对胰岛素泵治疗患者的血糖监测,结合科室特点积极预防低血糖的发生,降低院内血糖管理风险,提升血糖达标率。 相似文献
815.
2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究 总被引:1,自引:0,他引:1
目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征。方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统。AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例。结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2%。3年中AMI患者平均住院病死率为10.0%,女性为14.3%,高于男性的7.9%(P<0.001)。在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4%比9.0%,P<0.001),中医医院高于西医医院者(17.5%比9.5%,P<0.001)。ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4%比8.4%,P<0.001)。住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4%比1.9%,P<0.001)。2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7%、9.8%和9.4%,3年间下降了12.1%,男女两性分别下降了11.1%和10.7%。结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高。不同特征AMI患者的住院病死率存在差异。研究结果为进一步改善北京市AMI的住院治疗水平提供了依据。 相似文献
816.
J. Sanz-Reig J. Salvador Marín J. Ferrandez Martínez D. Orozco Beltran J.F. Martínez Lopez J.A. Quesada Rico 《中华创伤杂志(英文版)》2018,21(3):163-169
Purpose
The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years.Methods
This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients' demographics, prehospitalization residential status, prefracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded.Results
The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was ≥2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed. Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality (c-statistic 0.77).Conclusion
Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality. 相似文献817.
ELEVATED SOLUBLE EPIDERMAL GROWTH FACTOR RECEPTOR LEVEL IN PITUITARY ADENOMA AND CARCINOMA 总被引:3,自引:0,他引:3
Yan-guo Kong* Zu-yuan Ren Chang-bao Su Ren-zhi Wang Wen-bing Ma and Wei LianLaboratory of Neurosurgery Peking Union Medical College Hospital Chinese Academy ofMedical Sciences Peking Union Medical College Beijing 《中国医学科学杂志(英文版)》2004,19(3):199-202
Objective To investigate effect of the soluble epidermal growth factor receptor (sEGFR/sErbB1) level in the peripheral blood in development, invasiveness, apoplexy of each type of pituitary tumor.Methods The sEGFR level was determined in peripheral serum from 190 patients with pituitary diseases by enzyme linked immunosobent assay. The sEGFR levels were measured in 10 pituitary Rathke's pouch, 18 pituitary hyperplasia, 161pituitary adenomas including 30 microadenomas, 83 large adenomas, 48 giant adenomas, 1 pituitary carcinoma, and 28 healthy controls.Results In the patients with pituitary hyperplasia, microadenoma, large adenoma, giant adenoma, and pituitary carcinoma, the sEGFR level was 188.92 32.62, 209.83 19.01,333.20 69.33, 405.85 37.38, and 617.45 fmol/mL independently. They were all significantly higher than patients with pituitary Rathke's pouch (156.78 18.24 fmol/mL, P < 0.001)and healthy control group (159.11 40.50 fmol/mL, P < 0.05). The sEGFR level in pituitary carcinoma was higher than pituitary adenoma. In patients with pituitary adenoma, the sEGFR level was positive correlated to the size of pituitary adenomas (r = 0.998), the significant difference was observed for the sEGFR level in each group of the patients with pituitary adenomas (P < 0.001). Furthermore, in patients with pituitary ACTH-secrefing microadenomas, the serum sEGFR levels in invasiveness (295.00 77.80 fmol/mL) was higher than that in non-invasiveness (210.60 16.4 fmol/mL, P < 0.05). In patients with pituitary ACTH-secreting, PRL-secreting, GH-secreting, and non-functioning large adenomas, the serum sEGFR levels in invasiveness (407.86 28.50, 399.25 30.10, 386.00 13.08, and 369.25 36.70 fmol/mL) was higher than that in non-invasiveness (335.25 63.49, 300.64 47.57, 297.00 61.93, and 269.30 25.68 fmol/mL) respectively (P < 0.05). In patients with invasive pituitary PRL-secreting, GH-secreting, and non-functioning giant adenomas, the serum sEGFR levels not significantly different in between invasiveness (417.50 35.94, 409.50 69.14, and 417.50 44.13 fmol/mL) and noninvasiveness (386.00 49.64, 417.50 44.03, and 409.51 35.17 fmol/mL) (P > 0.05). In patients with pituitary large adenomas, the sEGFR levels in pituitary apoplexy (377.48 39.18 fmol/mL) was higher than that in non-pituitary apoplexy(343.18 68.17 fmol/mL, P > 0.05).Conclusions The increased level of peripheral serum sEGFR is concomitant with development, proliferous size of the adenomas in patients with pituitary adenomas. In addition, the elevated levels of serum sEGFR occur in pituitary apoplexy as clinical active tumors, and the non-invasive ACTH secreting adenomas. The sEGFR levels could be differentiated helpfully between pituitary adenomas and non-pituitary adenomas. These data suggest that serum sEGFR could be as a referable marker of the size and activation of proliferation in pituitary adenoma. 相似文献
818.
目的:探讨四妙丸加减对痛风性关节炎的治疗效果及对实验室指标的影响。方法:选取2014年12月至2017年8月延安市人民医院收治的痛风性关节炎患者98例为研究对象,根据随机数字表法随机分为观察组和对照组,每组49例。对照组采用常规西药治疗,观察组在对照组的基础上采用四妙丸加减方治疗,2组均连续治疗1个月。统计2组患者临床疗效;比较治疗前后2组中医证候积分及相关实验室指标。结果:治疗后观察组的总有效率为89.80%,显著高于对照组的79.59%(P0.05);与治疗前比较,治疗后2组关节疼痛、肿胀、发红、关节功能受限及全身症状等中医证候积分均显著下降(P0.01),且观察组显著低于对照组(P0.05或P0.01);与治疗前比较,治疗后2组患者血清IL-6、IL-8、CRP、TNF-α及全血BUA、ESR、WBC水平均显著下降(P0.01),且观察组显著低于对照组(P0.05或P0.01)。结论:四妙丸加减治疗痛风性关节炎可降低患者炎性反应因子及相关实验室指标水平,显著缓解患者关节症状,临床疗效优于单用西药治疗。 相似文献
819.
820.
Defining the impact of weakly estrogenic chemicals on the action of steroidal estrogens. 总被引:6,自引:0,他引:6
We tested whether bisphenol A (BPA) or o,p'-DDT, when combined with 17beta-estradiol (E2), would contribute to the overall mixture effect using a yeast reporter gene assay, the yeast estrogen screen. Following comprehensive concentration-response analyses of the single agents, the pharmacologically well-founded models of concentration addition and independent action were used to predict entire concentration-response relationships for mixtures of the agents with a variety of fixed mixture ratios, assuming additivity. For molar mixture ratios proportional to the levels normally found in human tissues (i.e., below 1:5000, E2:BPA or o,p'-DDT), these predictions suggest that the effects of individual xenoestrogens are too weak to create an impact on the actions of steroidal hormones. However, at mixture ratios more in favor of the xenoestrogens, a significant contribution to the overall mixture effect was predicted. The predictions were tested experimentally. The observed combined effects of mixtures of E2 with either BPA or o,p'-DDT did not deviate from the additivity expectation. On combining E2 with either BPA or o,p'-DDT at approximately equieffective concentrations corresponding to molar mixture ratios between 1:20,000 and 1:100,000 (E2:BPA or o,p'-DDT), substantial modulations of the effects of E2 became discernible. The assumption that weak xenoestrogens are generally unable to create an impact upon the already strong effects of endogenous steroidal estrogens is not supported by our observations. Our studies indicate that the potential health implication of additive combination effects between xenoestrogens and steroidal estrogens deserve serious consideration. 相似文献