Public knowledge of heart attack symptoms in Beijing residents

Background Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack.Methods A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community. Results A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7％ reported to call 120 or 999 while having a heart attack themselves; however 89.6％ reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms.Conclusions Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.     

药物洗脱支架治疗症状性椎动脉开口狭窄

目的 探讨药物洗脱支架辅助血管成形术治疗症状性椎动脉开口狭窄的手术安全性及近期疗效.方法 从2004年6月至2008年6月,采用药物洗脱支架对24例因椎动脉开口狭窄引发脑卒中或短暂性脑缺血发作的患者行血管成形术,并分析患者影像学资料、围手术期并发症和临床随访结果.结果 所有患者手术均成功,术后狭窄明显改善,平均随访时间(19±2)个月,2例有轻度的支架内再狭窄.结论 药物洗脱支架治疗症状性椎动脉开口狭窄安全、可行,短期疗效满意.     

肺心病急性期与缓解期“肺型P波”的变化

目的通过对肺心病急性发作期和缓解期心电图"肺型P波"的比较分析,探讨"肺P"对肺心病急性发作期的诊断价值。方法对67例肺心病急性发作期且心电图有明显"肺P"的患者,发作期和缓解期分别描记12导联心电图,对"肺型P波"进行比较分析。结果急性发作期心电图"肺型P波"出现率大于缓解期。结论心电图检查中"肺型P"的出现与肺心病病情变化有关。     

联合应用多种血管内支架治疗肌纤维发育不良性颈内动脉狭窄

目的：报告采用多支架治疗肌纤维发育不良笥颈内动脉狭窄1例。方法：采用2个球囊膨胀支架及1个自膨胀支架治疗1例肌纤维发育不良性颈内动脉狭窄,串珠样狭窄从颅外颈内动脉起始部到颅内海绵窦段,长约82mm。结果：一次性植入3个支架,成功进行血管成形,患症状消失,临床短期随访无脑缺血事件发生,5个月血管造影随访显示支架植入段血管通畅,无再狭窄。结论：血管内支架成形术治疗肌纤维发育不良性颈内动脉狭窄安全有效。     

Age, sex, ethnic origin and hospital admission for heart attack and stroke

The frequency of admission for heart attack and stroke in blacks, whites and Asians to Dudley Road Hospital, Birmingham, was studied. The study population (denominator) was 17 739 consecutive admissions to this hospital for the years 1975 to 1979, in 35- to 64-year-old men and women. Admission for heart attack was half as common in blacks compared with whites and, in some age groups, there was a slightly increased rate in Asians. By contrast, in both sexes and in all age groups, stroke admission was commoner in blacks. These differences cannot be explained by differing levels of blood pressure or cigarette smoking in the 3 ethnic groups.     

Aspirin for cardiovascular disease prevention

SECONDARY PREVENTION: Aspirin provides benefit in nearly all groups of patients with clinical manifestations of coronary heart disease. This includes patients with evolving acute myocardial infarction or after recovery from myocardial infarction, with unstable or stable angina, and those who undergo coronary artery bypass grafting or coronary angioplasty. Aspirin provides benefit in patients with peripheral arterial disease. This includes patients with acute or previous history of ischaemic stroke or transient ischaemic attack, those with lower limb arterial insufficiency, and those who undergo grafting or angioplasty of peripheral arterial vessels. PRIMARY PREVENTION: People without symptoms but at increased risk of a coronary heart disease event (> 1% annual risk) may reduce this risk by taking low-dose aspirin. However, the decision to take aspirin requires detailed consideration of individual cardiovascular risk and the potential benefit versus harm of treatment, particularly bleeding. Aspirin should only be used to prevent a cardiovascular event in association with an overall program of lifestyle measures including healthy eating, cessation of smoking, control of blood pressure and regular physical activity. ASPIRIN FOR PREVENTION: Prevention benefits of aspirin in heart disease can be achieved with doses as low as 75-150 mg daily. Unwanted effects of aspirin include stomach upsets, activation of peptic ulcers, an increased tendency to bruising, allergic reactions and increased risk of major gastrointestinal and other bleeding, including intracranial haemorrhage. In general, the risk of bleeding increases with increasing dose of aspirin and when it is used in combination with non-steroidal anti-inflammatory drugs or oral anticoagulants.     

《黄帝内经素问》“七损八益”之我见

《内经》“七损八益”乃是古今注家争论很大的一个问题,尤其在马王堆汉墓医书出土之后又常被释为房中术,与经旨大相径庭。本文根据《内经》七心八肝之义和《易经》损益二卦之理,认为经文“是以圣人为无为之事……此圣人之治身也”即是对“七损”的解释,“年四十而阴气自半也……壮者益治”即是解释“八益”,这是道家延年益寿的秘旨,也是医家祛病复康的妙诀,值得深入研究。     

经皮冠脉腔内成形术(PTCA)支架术前后QT离散度的变化

目的 :探讨经皮冠脉腔内成形术 (PTCA)及支架术对冠心病患者QT离散度的影响。方法 :对 1 5 6例成功实施PTCA及支架术的冠心病患者 ,记录术前 1天和术后第 1天的 1 2导联心电图 ,计算各QTd、QTcd。结果 :术后患者心电图QTd、QTcd较术前明显减小 ,有显著性差异 (P <0 .0 1 )。结论 :冠脉腔内成形及支架术可使冠心病患者病变部位心肌缺血得以改善 ,心肌细胞的电生理活动及功能得到恢复 ,改善心室肌复极的不均一性 ,从而使QT间期离散度显著缩短 ,可有效地避免严重心律失常及猝死的发生。     

Risk factors and 30-day case fatality of first-ever stroke in Basrah,Iraq

Background:

The aim of this hospital-based study is to determine the types, the frequency of risk factors and the 30-day case fatality of first-ever stroke in Basrah, Iraq.

Materials and Methods:

This was a hospital-based prospective study between January 2008 and July 2008 in Basrah, Iraq. Two hundred twenty-five (225) patients, who were admitted for first-ever stroke to the four major hospitals in Basrah, were interviewed and followed up for 30 days. Risk factors studied were smoking, history of diabetes mellitus, hypertension, atrial fibrillation, ischaemic heart diseases and transient ischaemic attack.

Results:

The mean age of the studied subjects was 63.8 ± 12.3 years. Males constituted 56% of cases. Clinical types of stroke were ischaemic stroke (83.6%), intracerebral haemorrhage (16%) and subarachnoid haemorrhage (0.4%). The prevalence of risk factors was; hypertension (66.2%), family history of stroke (31.6%), ischaemic heart diseases (28.9%), smoking (28.4%), diabetes mellitus (28%), transient ischaemic attack (10.2%), atrial fibrillation (9.8%) and heart failure (5.8%). The 30-day case fatality rate was 22.7%.

Conclusions:

Ischaemic stroke was the highly prevalent type. Hypertension, family history of stroke, ischaemic heart diseases, smoking and diabetes mellitus were the major risk factors of first ever stroke in Basrah. The 30-day case fatality rate of stroke in Basrah was nearly similar to that in western countries, but higher than that reported in the neighbouring Arab countries. Early detection of modifiable risk factors that can prevent stroke or at least minimise its complications is highly recommended.     

冠心病患者支架植入术前后hs-CRP变化及氟伐他汀的干预作用

目的观察冠状动脉内支架成形术治疗冠心病患者手术前后血清hs—CRP含量的变化，以及术后使用氟伐他汀对其的影响。方法冠心病患者64例，随机分为治疗组（术后24h在常规治疗基础上加用氟伐他汀）32例和对照组（仅常规治疗）32例。采用免疫浊度法动态观察不同时间点血清hs-CRP含量。结果两组患者术后血清hs-CRP含量显著升高（P〈0．05）；术后8周治疗组hs-CRP显著降低（P〈0．001），两组比较有显著性差异（P〈0．001）。结论冠状动脉内支架植入术可致血清hs-CRP升高，氟伐他汀可降低血清hs-CRP含量，具有抗炎、稳定斑块的作用。     

经桡动脉与经股动脉入径冠心病介入治疗的对比观察(英文)

目的评价经桡动脉冠心病介入治疗的可行性,安全性及治疗效果。方法91例冠心病患者经桡动脉穿刺冠状动脉成形术(TRCA)组51例;经股动脉穿刺冠状动脉成形术(TFCA)组40例。观察两组手术在成功率、并发症等。结果两组插管成功率分别为94.1%与90%,两组冠状动脉成形术成功率分别为95.8%与97.2%,两组间差异无显著性(P>0.05)。但出血并发症TRCA组为1例(1.96%),而TFCA组为4例(10%),两组间差异有显著性(P>0.01)。结论实施PCI术的两种途径都是安全、有效和可行的方法,与经股动脉比较,经桡动脉途径可减少并发症的发生。     

Bioshock: Biotechnology and Bioterrorism

In the recent past, the threat of a global bioterrorist attack has increased dramatically. In addition to the already existing microorganisms and techniques, the recent explosion in biotechnology has considerably added to the arsenal of the bioterrorist. Molecular technologies are now available which can be used by committed bioterrorist groups to manipulate and modify microorganisms so as to make them increasingly infectious, virulent or treatment resistant for causing maximum casualties. Infectious diseases which are likely to be used as bioweapons are Anthrax, Botulism, Plague, Smallpox and Brucella. Molecular techniques like immunoassays and nucleic acid amplification are now available to detect bioattacks. This article discusses the threat of bioterrorism. It also evaluates the molecular diagnostic methods and the future of early containment of a bioterrorist attack using molecular techniques.Key Words: Bioterrorism, Molecular techniques     

经肱动脉行冠脉介入治疗32例的经验探讨

目的探讨经肱动脉行冠状动脉介入治疗的可行性和安全性。方法选择2006年5月～2009年6月我院冠心病患者32例（其中18例为行股动脉失败）,穿刺肱动脉行冠状动脉介入治疗。结果 32例经肱动脉介入治疗均告成功,有2例发生前臂血肿,经治疗后消失,未出现严重并发症。结论经肱动脉行冠脉介入治疗是一种有效安全的途径。     

急性心肌梗死早期C反应蛋白水平对介入治疗效果的预测价值

目的:探讨急性心肌梗死(AM I)患者发病6 h内C反应蛋白(CRP)变化对PT-CA术后预后的预测意义。方法:测定92例AM I患者发病6 h内的血浆CRP浓度,根据CRP浓度将患者分为CRP增高组(CRP浓度>5m g/L)和CRP正常组(CRP浓度<5m g/L)。所有患者均予介入性治疗。比较两组之间年龄、性别、糖尿病、高血压、高脂蛋白血症、不稳定性心绞痛病史、冠状动脉病变情况等因素,观察再狭窄、再梗死、再发心绞痛、心衰和心源性猝死的发生情况。结果:CRP增高组患者入院时的CRP和CRP峰值分别为13.11±1.02m g/L和124.11±59.64m g/L,均高于CRP正常组2.56±1.45m g/L和78.26±57.05m g/L,有显著性差异(P<0.05)。两组患者既往病史无显著性差异,CRP增高组患者的发生冠状动脉病变的数量多于CRP正常组,有显著性差异(P<0.05)。CRP增高组患者随访期间冠状动脉再狭窄、再发心绞痛、心衰的发生率及病死率均高于CRP正常组,有显著性差异(P<0.05)。结论:AM I发病6 h内CRP水平反应出冠脉损伤的易患性,可能作为预测PTCA预后的指标之一。     

心肌缺血阈与冠心病相关性研究

目的:探讨无痛性心肌缺血发生机制及规律。方法:采用24h动态心电图记录结合患者生活日志分析诊断。结果:172%无痛性心肌缺血ST段下移发生于轻体力和脑力劳动时,发作高峰位于上午6:00～12:00时(P<0.01),90.7%ST段压低时心率加快(P<0.01),缺血发作的最高心率与24h内最高心率差距很小,与ST段压低相平行(P<0.01)。2无痛性心肌缺血ST段弓背抬高幅度及阵次以夜间为著,发作高峰位于1:00～6:00(P<0.01),心率减慢时ST段弓背抬高(P<0.01),夜间心肌缺血阈变异性增高、心率变异性低频/高频比值降低、ST段下移和ST段抬高持续时间延长(P<0.01),缺血发作的最低心率发生于夜间,与ST段弓背抬高相平行(P<0.01)。结论:缺血阵次、ST段移位幅度、缺血持续时间、心肌缺血阈、心肌缺血阈变异性、心率变异性低频/高频比值可了解心肌缺血时耗氧水平、交感神经系统活性、冠状动脉张力的高低,是冠心病患者和各种治疗疗效的有价值的指标。交感神经兴奋致耗氧量增加为缺血发作的重要机制,主张给β受体阻滞剂。冠状动脉张力增加与副交感神经张力异常引起相对冠状动脉供血不足,主张给钙离子拮抗剂和硝酸类药物。     

Percutaneous renal artery angioplasty and stenting: indications, technique and results

Background

Percutaneous interventions for renal arterial disease can be used to treat a variety of conditions including both atherosclerotic and non-atherosclerotic renal artery stenosis (RAS) as well as endovascular management of renal artery aneurysms (RAA).

Aim

We sought to examine the indications, techniques and results of percutaneous renal angioplasty and stenting in our institution over a 6-year period and review the current evidence for practice.

Methods

Patient demographics, procedure indications, technical procedural details, complications, baseline and follow-up renal profile indices were analysed.

Results

The most common indication for intervention was atherosclerotic RAS (69.2 %) followed by RAS secondary to fibromuscular dysplasia (15.3 %) and RAA (15.3 %). There was a 100 % technical success in our cohort of patients. The majority of patients (84.6 %) had cross-sectional imaging in the form of computed tomography or magnetic resonance angiography prior to intervention.

Conclusion

When performed in appropriate settings following close liaison with referring physicians, percutaneous renal angioplasty and stenting remains an important treatment modality for renovascular disease.     

距离测试中拉布拉多犬行为及心率变化对导盲犬培训成功率的影响

目的 采用距离测试（distance test,DT）评价拉布拉多犬行为学及心率变化特征,以期为导盲犬的前期筛选提供有效的行为学方法和生理依据。方法 本实验所用60只拉布拉多犬（8～15月龄,雌性22只,雄性38只）由中国导盲犬大连培训基地提供,其中30只经培训后通过考核,被认定为成功培训的导盲犬,其余30只被认定为不适合作为导盲犬的淘汰犬。采取距离测试中兴趣,探索及游戏邀请三个变量进行犬的行为学测试,实时监测心率变化。结果 距离测试中导盲犬的平均心率变化显著低于淘汰犬心率变化（P<0.05）。导盲犬和淘汰犬之间在兴趣,探索及游戏邀请测试中行为学变化差异无显著性（P>0.05）。结论 距离测试中,导盲犬心率变化显著低于淘汰犬心率变化;导盲犬相对于淘汰犬,具有更加稳定的心理素质及较好的控制情绪的能力。本研究可为距离测试与心率结合预测导盲犬培训成功率提供理论基础。     

动态心电图监测无症状性心肌缺血的价值

目的探讨无痛性心肌缺血发生机制及规律。方法采用24h动态心电图记录结合患者生活日志分析诊断。结果①72％无痛性心肌缺血性ST段下移发生于轻体力和脑力劳动时,发作高峰位于上午6：00—12：00时（P〈0．01）,90．7％ST段压低时心率加快（P〈0．01）,缺血发作的最高心率与24h内最高心率差距很小,与ST段压低相平行（P〈0．01）。②无痛性心肌缺血ST段弓背抬高幅度及阵次以夜间为著,发作高峰位于1：00—6：00（P〈0．01）,心率减慢时ST段弓背抬高（P〈0．01）,夜间心肌缺血阈变异性增高、心率变异性低频／高频比值降低、ST段下移和ST段抬高持续时间延长（P〈0．01）,缺血发作的最低心率发生于夜间,与ST段弓背抬高相平行（P〈0．01）。结论缺血阵次、ST段移位幅度、缺血持续时间、心肌缺血阈变异性、心率变异性低频／高频比值可了解心肌缺血时耗氧水平、交感神经系统活性、冠状动脉张力的高低,是冠心病患者和各种治疗疗效的有价值的指标。交感神经兴奋致耗氧量增加为缺血发作的重要机制,主张给β受体阻滞剂。冠状动脉张力增加与副交感神经张力异常引起相对冠状动脉供血不足,主张给钙离子拈抗剂和硝酸类药物。     

Surgical standby for coronary balloon angioplasty.

OBJECTIVE--To assess the predictability of need for emergency surgery after coronary balloon angioplasty. DESIGN-- Nonrandomized intervention study. SETTING--Nonprofit university hospital. PATIENTS--Prior to balloon angioplasty, 1000 consecutive patients were assigned to either the "standby" group (189 patients [19%]) or the "no-standby" group (811 patients [81%]). Patients in the standby group (intervention coordinated with cardiac surgery) included all operable patients undergoing angioplasty of their largest coronary arteries that were not currently or previously totally occluded or collateralized; the no-standby group consisted of the remainder of patients. INTERVENTION--Allocation to coronary angioplasty with or without surgical standby. MAIN OUTCOME MEASURES--Need for bypass surgery, occurrence of myocardial infarction, and mortality from complications of angioplasty. RESULTS--Bypass surgery immediately after angioplasty was done in one patient in each group (standby, 0.5%, vs no-standby, 0.1%). The frequency of infarction was 5% vs 4%, respectively. All eight deaths occurred in the no-standby group (1.0%), but none of them were consequences of a lack of surgical standby. They occurred in situations in which bypass surgery would not have changed the outcome (two cardiac failures late after technically successful angioplasty for postinfarct cardiogenic shock, one in-laboratory rupture of an unrecognized ventricular pseudoaneurysm, and one protamine reaction), secondary to acute problems late after successful angioplasty (two sudden deaths and one vessel occlusion in an inoperable patient), or despite surgery (one patient with left main stem dissection). CONCLUSIONS--Performing roughly 80% of coronary angioplasties without surgical standby did not increase patient risk. Coronary angioplasty without surgical backup, albeit not an ideal setting, appears ethically feasible in selected patients if dictated by logistic considerations.