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1.
ObjectivesThe aim of this study was to test whether optical coherence tomographic (OCT) guidance would provide additional useful information beyond that obtained by angiography and lead to a shift in reperfusion strategy and improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) with early infarct artery patency.BackgroundAngiography is limited in assessing the underlying pathophysiological mechanisms of the culprit lesion.MethodsEROSION III (Optical Coherence Tomography–Guided Reperfusion in ST-Segment Elevation Myocardial Infarction With Early Infarct Artery Patency) is an open-label, prospective, multicenter, randomized, controlled study approved by the ethics committees of participating centers. Patients with STEMI who had angiographic diameter stenosis ≤ 70% and TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 at presentation or after antegrade blood flow restoration were recruited and randomized to either OCT guidance or angiographic guidance. The primary efficacy endpoint was the rate of stent implantation.ResultsAmong 246 randomized patients, 226 (91.9%) constituted the per protocol set (112 with OCT guidance and 114 with angiographic guidance). The median diameter stenosis was 54.0% (IQR: 48.0%-61.0%) in the OCT guidance group and 53.5% (IQR: 43.8%-64.0%) in the angiographic guidance group (P = 0.57) before randomization. Stent implantation was performed in 49 of 112 patients (43.8%) in the OCT group and 67 of 114 patients (58.8%) in the angiographic group (P = 0.024), demonstrating a 15% reduction in stent implantation with OCT guidance. In patients treated with stent implantation, OCT guidance was associated with a favorable result with lower residual angiographic diameter stenosis (8.7% ± 3.7% vs 11.8% ± 4.6% in the angiographic guidance group; P < 0.001). Two patients (1 cardiac death, 1 stable angina) met the primary safety endpoint in the OCT guidance group, as did 3 patients (3 cardiac deaths) in the angiographic guidance group (1.8% vs 2.6%; P = 0.67). Reinfarction was not observed in either group. At 1 year, the rates of predefined cardiocerebrovascular events were comparable between the groups (11.6% after OCT guidance vs 9.6% after angiographic guidance; P = 0.66).ConclusionsIn patients with STEMI with early infarct artery patency, OCT guidance compared with angiographic guidance of reperfusion was associated with less stent implantation during primary percutaneous coronary intervention. These favorable results indicate the value of OCT imaging in optimizing the reperfusion strategy of patients with STEMI. (EROSION III: OCT- vs Angio-Based Reperfusion Strategy for STEMI; NCT03571269)  相似文献   
2.
[目的] 探讨《金匮要略·痉湿暍病脉证并治第二》“纳药鼻中”之“药”所指的具体方药。[方法] 从历代注家注疏入手,对不同观点进行源流上的梳理。同时,通过文字学考证,对“药”字在古汉语中的含义展开探讨。[结果] 对于“纳药鼻中”之“药”,历代注家观点大致可归纳为三类,即随文注解、认为“药”为具有某些特性的药物、认为“药”为瓜蒂散或其类方,其中认为“纳瓜蒂于鼻中”的观点流传较广。通过文字学考证,“药”在楚方言中有指代“白芷”之意,“纳药鼻中”即是“纳白芷于鼻中”,白芷治疗鼻病也为历代医家所习用。[结论] “纳瓜蒂于鼻中”与“纳白芷于鼻中”两种观点都具有一定证据支持,但从文献学角度和仲景书体例而言,“纳药鼻中”原意应为“纳白芷于鼻中”。  相似文献   
3.
目的观察小儿推拿联合耳穴贴压治疗小儿变应性鼻炎(AR)肺虚感寒证的临床疗效。方法选取2019年1月至2020年6月在丽水市人民医院儿科治疗的AR肺虚感寒证患儿70例,采用随机数字表法分为治疗组和对照组,各35例。对照组给予常规西药治疗,治疗组给予小儿推拿联合耳穴贴压法治疗,2组均以1个月为1个疗程,1个疗程后统计临床疗效、中医证候评分、治疗前后血清免疫球蛋白E(IgE)和白介素-4(IL-4)水平变化以及复发情况。结果治疗组总有效率为91.43%(32/35),显著高于对照组的68.57%(24/35),2组比较,差异有统计学意义(P<0.05)。治疗前,2组中医证候评分比较,差异无统计学意义(P>0.05),具有可比性;治疗后,2组中医证候评分较同组治疗前明显降低(P<0.05),且治疗组降低更显著,差异有统计学意义(P<0.05)。治疗前,2组血清IgE、IL-4水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后,2组IgE、IL-4水平较同组治疗前明显升高(P<0.05),且治疗组升高更显著,差异有统计学意义(P<0.05)。2组随访6个月,治疗组复发率为10.53%(2/19),显著低于对照组的42.86%(6/14),2组比较,差异有统计学意义(P<0.05)。结论小儿推拿联合耳穴贴压治疗小儿AR肺虚感寒证疗效满意,可明显缓解临床症状,提高机体免疫力,降低复发率,值得临床推广应用。  相似文献   
4.
目的 探讨不同时期慢性阻塞性肺疾病(COPD)患者血清诱饵受体3(DcR3)、凋亡抑制蛋白(Survivin)表达水平及临床意义。方法 选取2018年9月—2019年12月本院收治的92名COPD患者为研究对象,其中稳定型COPD 50例,急性加重期COPD 42例;同期本院健康体检者88例为对照组。测定各组研究对象血清DcR3、Survivin水平及肺功能指标。 与对照组[DcR3(106.54±48.35)pg/mL,Survivin(98.85±26.59)pg/mL]比较,稳定期组和急性加重期组血清DcR3[(395.23±123.85)pg/mL,(1 248.81±213.59)pg/mL]、Survivin [(267.54±84.69)pg/mL,(1 233.95±307.26)pg/mL]水平升高;与稳定期组比较,急性加重期组血清DcR3、Survivin水平升高。与对照组比较,稳定期组和急性加重期组FEV1%、FEV1 /FVC、DLCO%水平降低(P<0.001);与稳定期组比较,急性加重期组FEV1%、FEV1 /FVC、DLCO%水平降低(P<0.001)。随着低氧血症严重程度的增加,COPD患者血清DcR3、Survivin水平逐渐增加(P<0.001)。多因素logistics回归分析显示,高水平DcR3、Survivin、IL-12、hs-CRP为COPD病情的危险因素(P<0.001)。DcR3、Survivin与FEV、FEV1 /FVC呈负相关,与IL-12、TNF-α、hs-CRP呈正相关(P<0.001)。 COPD稳定期、急性加重期患者血清DcR3、Survivin表达水平升高,且DcR3、Survivin与COPD病情严重程度呈正相关。  相似文献   
5.
患者女,58岁,无明显诱因出现右侧腰骶部及右下肢疼痛麻木3年余,伴右下肢上抬无力和大小便感觉异常,近半年来症状加重;既往无腰部外伤史及其他疾病史。查体:右下肢肌力4级,实体觉、图形觉、两点分辨异常,巴宾斯基征及霍夫曼征阴性。实验室检查未见明显异常。腰椎CT:L3~L4椎体层面椎管内不规则稍高密度影,内见斑点状钙化(图1A),邻近骨质无破坏。  相似文献   
6.
7.
目的 观察双能量CT (DECT)定量参数术前预测实性肺腺癌气道播散(STAS)状态的价值。方法 回顾性分析52例经手术病理确诊实性肺腺癌患者的DECT及病理学资料,评估其STAS状态(阳性或阴性);对比STAS阳性、阴性实性肺腺癌CT表现(最大径、周围不透明影、空气支气管征、胸膜凹陷征)及DECT定量参数的差异。针对差异有统计学意义的DECT定量参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估DECT定量参数单独及联合预测实性肺腺癌STAS的效能,并以二元logistic回归分析筛选实性肺腺癌STAS的独立预测因子。结果 52例中,25例STAS阳性,27例STAS阴性,其间病灶CT表现差异均无统计学意义(P均>0.05),DECT定量参数中的动脉期碘浓度(ICA)、动脉期标准化碘浓度(NICA)及静脉期碘浓度(ICV)差异均有统计学意义(P均<0.05)。ICA、NICA及ICV预测实性肺腺癌STAS的AUC为0.82、0.83及0.73;ICA和NICA均为实性肺腺癌STAS的独立预测因子,其联合AUC为0.89。结论 DECT定量参数可有效预测实性肺腺癌STAS。  相似文献   
8.
The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.  相似文献   
9.
10.
The foodscape (the built food environment) is considered one of the driving factors of the higher burden of obesity and chronic disease observed in low socio-economic status (SES) groups. Traditional data collection methods struggle to accurately capture actual access and exposure to the foodscape (realised foodscape). We assess the use of anonymised mobile phone location data (location data) in foodscape studies by applying them to a case study in Perth, Western Australia to test the hypothesis that lower SES groups have poorer realised foodscapes than high SES groups. Kernel density estimation was used to calculate realised foodscapes of different SES groups and home foodscape typologies, which were compared to home foodscapes of the different groups. The location data enabled us to measure realised foodscapes of multiple groups over an extended period and at the city scale. Low SES groups had poor availability of food outlets, including unhealthy outlets, in their home and realised foodscapes and may be more susceptible to a poor home foodscape because of low mobility.  相似文献   
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