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背景目前,临床上仍缺乏急性心肌梗死(AMI)患者择期经皮冠状动脉介入治疗(PCI)后主要不良心血管事件(MACE)发生风险的预测指标。心电图和血清氨基末端脑钠肽前体(NT-proBNP)均可评价心功能,推测可用于预测AMI患者择期PCI后MACE发生风险。目的探讨心电图联合血清NT-proBNP对AMI患者择期PCI后近期发生MACE的预测价值。方法本研究为回顾性研究。选取2017年1月—2020年4月重庆市巴南区人民医院收治的169例AMI患者,均行择期PCI。统计AMI患者择期PCI后T波倒置、早期ST段回落<50%及近期MACE发生情况;比较发生与未发生MACE患者一般资料(包括性别、年龄、合并症、病变血管支数、罪犯血管、发病至择期PCI时间)及T波倒置发生率、早期ST段回落<50%发生率、血清NT-proBNP升高者所占比例;AMI患者择期PCI后近期发生MACE的影响因素分析采用多因素Logistic回归分析;以随访结果为"金标准",绘制四格表以评估T波倒置、早期ST段回落<50%、血清NT-proBNP升高及三者联合对AMI患者择期PCI后近期发生MACE的预测价值。结果本组患者择期PCI后24 h内T波倒置发生率为47.9%(81/169),择期PCI后1 h ST段回落<50%发生率为41.4%(70/169),随访期间MACE发生率为27.2%(46/169)。多因素Logistic回归分析结果显示,高血压[OR=4.773,95%CI(1.750,13.020)]、2型糖尿病[OR=5.452,95%CI(1.907,15.589)]、高脂血症[OR=8.029,95%CI(2.689,23.967)]、T波倒置[OR=9.728,95%CI(3.019,31.347)]、早期ST段回落<50%[OR=12.013,95%CI(4.144,34.823)]及血清NT-proBNP升高[OR=7.199,95%CI(2.598,19.949)]是AMI患者择期PCI后近期发生MACE的独立危险因素(P <0.05)。T波倒置预测AMI患者择期PCI后近期发生MACE的正确率为72.19%,早期ST段回落<50%预测AMI患者择期PCI后近期发生MACE的正确率为76.33%,血清NT-proBNP升高预测AMI患者择期PCI后近期发生MACE的正确率为75.74%,三者联合预测AMI患者择期PCI后近期发生MACE的正确率为94.08%。结论 AMI患者择期PCI后近期MACE发生风险较高,T波倒置、早期ST段回落<50%联合血清NT-proBNP升高对AMI患者择期PCI后近期发生MACE的预测价值较高。  相似文献   
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《Indian heart journal》2021,73(4):487-491
IntroductionThe time from symptom onset to arrival at healthcare facility, and door to reperfusion time in treatment of acute coronary syndrome (ACS) can be improved significantly if the patient or the relatives can record a 12-lead ECG at home and transmit it to the physician for prompt interpretation. To make this widely applicable, the 12-lead ECG recording device has to be simple and user friendly. In this regard, torso ECG (T-ECG) electrode positions that are less cumbersome than the conventional ECG (C-ECG) electrode positions are an alternative worthy of consideration.Objectiveand setting: To study the utility of T-ECG versus C-ECG in ACS patients.Designand intervention: We proposed torso electrode positions in which upper limb electrodes were placed in the respective deltopectoral grooves below the lateral end of the clavicle; the right lower limb electrode was placed 2 finger breadths above the umbilicus and the left lower limb electrode, 2 finger breadths to the left of the umbilicus. We then studied the ECGs recorded, to ascertain whether T-ECGs miss or over-diagnose ACS changes. Twelve lead ECGs were recorded by both techniques (C-ECG & T-ECG) in 1361 patientsfrom the coronary care unit & out-patient department of a tertiary care hospital. A total of 1526 sets of ECGs (each set consisting of one C-ECG and one T -ECG) were read by two trained cardiologists independently and in a blinded fashion. There were 457 ECG sets from 342 patients with ACS. Of these, 116 ECG sets from 112 patients of anterior infarction who had changes restricted to precordial leads were excluded. Finally, 341 ECG sets from 230 patients with ACS and 324 sets of patients diagnosed to be normal on C-ECG were considered for the purpose of this study.Main resultsAll 341 ECG sets from the 230 patients of ACS diagnosed by C-ECG were correctly diagnosed by T-ECG (100% sensitivity) and all 324 normal ECGs on C-ECG were also identified as normal on T-ECG (100% specificity). Of the ACS ECGs, ST elevation was seen in 234 ECGs and ST depressions 154 ECGs. The localizations of ST elevation and ST depression were also accurately diagnosed by the T-ECG.ConclusionThe ECG recorded by our novel proposed torso electrode positions is comparable to a conventional ECG for the diagnosis of ACS.  相似文献   
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Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.  相似文献   
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BackgroundAnaphylaxis is a severe and potentially fatal allergic response. Early-life exposure to rural environments may help protect against allergic reaction. This study assesses urban/rural differences by age and race/ethnicity in emergency department (ED) pediatric visit rates for food-induced anaphylaxis.MethodsThis observational study examined 2009–2014 inpatient and ED data from New York and Florida, using ICD-9-CM diagnostic code (995.6) to identify food-induced anaphylaxis cases <18 y/o. Primary predictor of interest was urban/rural setting, with race/ethnicity and age also evaluated. Associations between ED visit rates and urban/rural setting were evaluated by multivariable hierarchical negative binomial regression with state and year fixed effects.ResultsED visit rates (per 100,000) for food-induced anaphylaxis were 12.31 and 4.60 in urban and rural settings, respectively. Rates were highest among Blacks (15.26) younger urban children (17.29) and older rural children (6.99). Compared to rural, urban children had significantly higher anaphalaxis ED visit rates (IRR 2.77).ConclusionsFood-induced anaphylaxis ED visit rates were highest among younger urban children and Black children, with a notable contrast in age distribution between urban and rural rates. Higher urban rates may be attributed to Hygiene Hypothesis, though racial, economic and emergency care access disparities may also influence these outcomes.  相似文献   
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目的分析12导联心电图中T波峰末间期(Tp-Te)及QT间期离散程度(QTd)与冠心病严重程度的相关性及对冠心病的诊断价值。 方法回顾性分析50例健康体检者(健康组)及50例冠心病患者(冠心病组)的临床病例资料,对比两组Tp-Te、QTd差异,分析冠心病组Tp-Te、QTd与冠心病严重程度的相关性及对冠心病的诊断价值。 结果冠心病组Tp-Te及QTd均高于健康组,差异有统计学意义(P<0.05)。冠心病组Tp-Te、QTd与冠状动脉狭窄程度均呈显著的正向直线相关性,差异有统计学意义(P<0.05)。在冠心病的诊断中,Tp-Te及QTd均具有较高的灵敏性、特异性及准确性,且经分析,Tp-Te及QTd对冠心病均具有显著的诊断价值(P<0.05)。 结论Tp-Te及QTd与冠心病严重程度存在显著的正向相关性,且对于冠心病具有显著的诊断价值。  相似文献   
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《Heart rhythm》2022,19(1):70-78
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