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1.
Objective: Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI). Background: Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use. Methods: Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared. Results: Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively ( P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia ( n = 1) and aortic rupture ( n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups. Conclusion: Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring. 相似文献
2.
Infarct artery stenting with adjunctive abciximab therapy is widely used treatment for patients with acute myocardial infarction
(AMI). However, bleeding complications have been associated with a worse clinical outcome. Randomized trials in elective patients
have shown that postprocedural protamine administration is safe and associated with a significant reduction in bleeding complications.
The aim of the current study was to evaluate in STEMI patients undergoing primary percutaneous coronary intervention (PCI)
with abciximab and stenting whether immediate reversal of anticoagulation by protamine is safe and associated with a reduction
in the occurrence of bleeding complications. From January 2004 to June 2005, 254 patients with STEMI had immediate reversal
of anticoagulation by protamine administration after infarct artery stenting and received abciximab therapy without heparin
infusion (Group 1). These patients were compared with a control group of 265 patients (June 2002–December 2003) treated with
the standard heparin therapy: bolus in order to achieve an activated coagulation time of 250–300 s during PCI plus 12-h infusion
(7 UI/kg/h; Group 2). We excluded patients undergoing IABP implantation. The two groups were similar in all baseline characteristics.
There were no differences in in-hospital mortality, reinfarction, urgent target vessel revascularization, stroke or acute
or subacute stent thrombosis, while Group 1 patients showed a lower incidence of major bleeding complications (ACUITY scale:
1.1 vs. 4.0%, P = 0.035) and a shorter length of hospital stay (3.5 ± 1.7 vs. 4.0 ± 1.6 days, P = 0.002) as compared with heparin treated patients. Among patients undergoing primary stenting with abciximab administration,
immediate post-PCI reversal anticoagulation by protamine without associated heparin infusion is safe and associated with a
significant reduction in major bleeding complications. 相似文献
3.
BackgroundMajor bleeding is one of the most frequent procedural-related complications of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infraction (STEMI). We investigated the incidence, predictors, and prognostic impact of peri-procedural bleeding in a cohort of unselected patients undergoing contemporary primary PCI. MethodsA total of 831 consecutive patients who underwent primary PCI between 1/2001 and 6/2005 were studied. Major bleeding was defined as hemorrhagic stroke, hemoglobin (Hb) drop of >5 g%, or 3–5 g% with a need for blood transfusion. Clinical outcomes were evaluated at 30 days and 6 months. ResultsMajor bleeding occurred in 27 patients (3.5%). Those who experienced major bleeding were older (66±15 vs. 61±13, P=.02), more frequently female gender (48% vs. 27%, P=.0001), presented more often with cardiogenic shock (37% vs. 8%, P=.0001), and had higher CADILLAC score (7.8±4.5 vs. 5.1±4.0, P=.002) and activated clotting time (ACT) levels (284±63 vs. 248±57 s, P=.007). In multivariate analysis, significant predictors of major bleeding were female gender (OR 5.1, 95% CI 1.7–15.2, P=.004), ACT levels >250 s (OR 3.6, 95% CI 1.1–12.1, P=.04), and use of intra-aortic balloon pump (IABP) (OR 3.5, 95% CI 1.0–12.1, P=.047). Major bleeding was associated with increased 6-month mortality rates (37% vs. 10%, P=.0001), which remained significant after adjustment for baseline CADILLAC score (37% vs. 19.4%, P=.05). ConclusionsMajor bleeding complicating primary PCI is associated with increased 6-month mortality. Women and those who need IABP support are at particularly high risk. Tight monitoring of anticoagulation may reduce the risk of bleeding. 相似文献
4.
Objectives: The objective of this study was to compare door‐to‐balloon times and other variables in ST‐segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) using transfemoral or transradial approaches. Background: Transradial PCI has been shown to lower the risk of access site complications but the procedure is not applied to STEMI patients, due to concerns of procedural complexity adversely affecting prompt reperfusion. There is paucity of real‐world data comparing TRI with TFI in patients with STEMI. Methods: Three hundred sixteen consecutive patients with STEMI undergoing primary PCI were studied. Patients were divided in two groups, Group I ( n = 204) undergoing PCI transfemorally and Group II ( n = 109) patients transradially. Demographic data, door‐to‐balloon times, procedural variables, predischarge adverse events, access site complications, and 1 year follow‐up major adverse cardiac events (MACE) were recorded. Results: Door‐to‐balloon time was 72 ± 14 min in Group I compared with 70 ± 17 min in Group II, the difference was not statistically significant ( t = 1.096, P > 0.27). Group II patients had significantly fewer access site complications compared with Group I (20 vs. 1 patient, χ 2 = 10.8, P < 0.05). Demographics, predischarge adverse events, and MACE at 1 year follow‐up were comparable between the two groups. Conclusions: Transradial approach to primary PCI provides similar door‐to‐balloon times to transfemoral approach, and significantly lowers access site related complications, in patients presenting with STEMI. © 2010 Wiley‐Liss, Inc. 相似文献
5.
AbstractBackground: Intra-aortic balloon pump (IABP) counterpulsation and primary percutaneous coronary intervention (PCI) are standard treatment modalities in cardiogenic shock (CS) complicating acute myocardial infarction. The aim of this study was to investigate the impact of the timing of IABP treatment start in relation to PCI procedure. Methods: Data were obtained from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) about 139 consecutive patients with CS due to ST-elevation myocardial infarction (STEMI) who received IABP treatment. The patients were hospitalized at Sahlgrenska University Hospital, Gothenburg, during 2004–2008. The cohort was divided into the two groups: group (A) in whom IABP treatment started before start of PCI ( n = 72) and group (B) in whom IABP treatment started after PCI treatment ( n = 67). The primary endpoint was 30-day mortality. Propensity score (PS) adjusted Cox proportional hazards regression was used to analyze predictors of 30-day mortality. Results: Mean age was 66.5 ± 12 and 28% were women. All patients have received IABP treatment 30 min before or 30 min after primary PCI. 63% had diabetes and 28% had hypertension. 16% were active tobacco smokers. The mortality rate at 30 days was 38%. IABP treatment commenced before or after PCI was not an independent predictor of mortality ( P = 0.72). Conclusion: In this non-randomized trial the treatment with insertion of IABP before primary PCI in patients with CS due to STEMI is not associated with a more favorable outcome as compared with IABP started after primary PCI. 相似文献
6.
This cross‐sectional study examined possible associations of peritoneal glucose load with male sexual dysfunction and depression in peritoneal dialysis patients. Compared to patients with peritoneal glucose load ≤3 g/kg per day, those with load >3 g/kg per day had higher Beck Depression Inventory scores, (18.9 ± 5.4 vs. 11.4 ± 5.8, P = 0.002) and lower International Index of Erectile Function scores, serum total testosterone and DHEA [(15.4 ± 6.4 vs. 45.1 ± 20.7, P < 0.001), (8.5 ± 3.0 vs. 13.9 ± 3.2, P < 0.001), (113.9 ± 58.8 vs. 280.2 ± 128.3, P < 0.001); respectively)]. Of participants with peritoneal glucose load >3 g/kg per day, 84.6% had mild to moderate erectile dysfunction and 92.3% had abnormal Beck Depression Inventory scores. Peritoneal glucose load inversely correlated with International Index of Erectile Function scores ( P < 0.001), total serum testosterone ( P = 0.002) and serum DHEA ( P = 0.001); and directly with Beck Depression Inventory scores ( P < 0.001) and serum estradiol ( P < 0.001). This study demonstrated higher prevalence of sexual dysfunction, depression and sex hormone disturbances in male peritoneal dialysis patients receiving higher peritoneal glucose load. 相似文献
7.
Background: Historical data report fatal myocardial infarction occurring when mildly-stenotic coronary plaques rupture; however, recent data suggest haemodynamically-significant coronary stenoses with fractional flow reserve (FFR) ≤ 0.8 and vessels with high plaque burden and minimum luminal area (MLA) < 4 mm 2 by intravascular ultrasound (IVUS) may be prognostically important. Therefore, we sought to re-evaluate culprit stenosis severity in patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: Patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI with adjunctive thrombectomy between October 2008 and February 2010 ( n = 336/572; 59%) underwent quantitative coronary angiography (QCA) after thrombus aspiration to determine vessel reference area (RA), MLA and percentage area stenosis (AS). To validate findings, QCA and FFR were measured in 50 patients with stable angina and an angiographically-intermediate lesion. Results: STEMI patients had anatomically-severe underlying culprit disease similar to that of the stable cohort (AS: 91.6 ± 9.5% versus 90.1 ± 8.1%; P = 0.11). Additionally, anatomically-severe lesions defined by QCA were more likely to be functionally-significant by FFR and vice-versa ( P = 0.02 and 0.002 respectively). Conclusion: These contemporary data suggest that STEMI culprit lesions, defined by luminal stenosis after thrombus aspiration, are angiographically significant, with similar stenosis severity to stable, ischaemia-inducing lesions. 相似文献
8.
Background: The simultaneous use of deferoxamine (DFO) and deferiprone (DFP) has an additive effect in iron excretion in transfusion-dependent thalassemic patients. Aim of the work: To evaluate the efficacy and safety of a prospective alternating therapy with DFO and DFP in patients with β-thalassemia major (TM) and increased serum ferritin with DFO monotherapy alone. Patient and methods: Sixty patients with β-TM (mean age ± SD, 13.05 ± 6.1, range 10–20 years) with iron overload (serum ferritin > 2000 ng/ml) were studied. They received DFO at a daily dose of 40 mg/kg/day for 5–7 nights/week for the past several years. These patients were randomly assigned either to continue treatment with DFO alone (DFO group, n = 30) or prospectively receive additional alternating therapy with DFP at 75 mg/kg/day for 4 days/week and DFO for the other 2 days/week (alternating therapy group, n = 30). The efficacy of both groups was assessed by measurements of serum ferritin, echocardiography, and 24 h urine iron excretion (UIE) levels throughout 1 year follow-up. Results: In the 60 evaluable patients, the mean serum ferritin (± SD) fell dramatically from 4500 (± 1250) ng/ml at the start of the study to 1250 (± 750) ng/ml (alternate therapy group; P < 0.001) at the end of the study. There was also a significant improvement in the myocardial function as assessed by the ejection fraction ( P < 0.002) and fractional shortening ( P < 0.01) in those patients on alternate therapy for 1 year. Their mean urinary iron excretion elevated from 0.41 ± 0.27 to 0.76 ± 0.49 mg/kg/24 h ( P < 0.003). There was a significant difference between both groups as regard the studied parameters at the end of the study. Whereas, there was no statistical difference as regard the studied parameters at the start and the end of the study in the DFO group. No significant adverse effects had occurred in both groups that necessitated withdrawal from the study. Conclusions: β-Thalassemic major patients with transfusional iron overload can be safely and effectively treated with an alternate therapy of DFO/DFP with a progressive fall in the mean serum ferritin and significant improvement of myocardial performance. 相似文献
9.
To investigate associations between early atherosclerosis and possible risk factors for it in young patients with established Type 1 diabetes mellitus (DM), we measured the combined intima-media thickness (IMT) of the common carotid arteries with high resolution ultrasound in 310 young patients (age ≤ 40 years, mean 27.9 ± 6.5) with a diabetes duration ≥ 2 years, and in two control groups of similar age (control 1:40 healthy subjects, control 2: 40 Type 1 DM recently diagnosed patients). Albumin excretion rate and lipids (total cholesterol and triglycerides) were measured and retinopathy and hypertension (systolic blood pressure > 140 or diastolic blood pressure > 90 mmHg) sought in the patients. Mean maximum IMT was 0.52 ± 0.06 mm in control group 1 and 0.50 ± 0.05 mm in control group 2 with a mean difference of 0.02 mm (95% CI: −0.01, 0.04). The more established Type 1 DM patients had a significantly greater IMT (0.57 ± 0.13 mm, p < 0.001) than both control groups. In a subgroup analysis, patients with microvascular diabetic complications ( n = 99) had a significantly greater IMT (0.63 ± 0.17 vs 0.55 ± 0.10 mm, p < 0.001) than those without ( n = 211). In a multiple linear regression analysis with a significance level of ≤ 0.10, the carotid artery IMT of our established diabetic patients was related to age, male gender, triglycerides and nephropathy, suggesting the latter as the main diabetes-specific risk for intima-media thickening in young Type 1 DM patients. © 1998 John Wiley & Sons, Ltd. 相似文献
10.
Granulocyte-macrophage colony-stimulating factor (GM-CSF) (250 μg/m 2) was administered subcutaneously to 7 normal volunteers for up to 14 days to study its effects on neutrophil kinetics and function. With treatment, blood neutrophil counts rose gradually to peak at 3½ times baseline by day 14. At day 5 marrow mitotic cells were increased and post-mitotic cells decreased, and the transit time through the post-mitotic marrow pool accelerated (normal = 6.4 days, GM-CSF = 3.9 days; P < 0.01). Treatment had little effect on the blood neutrophil half-life (normal = 9.6 ± 1.3 hours; GM-CSF = 13.1 ± 2.4 hours, P > 0.05); or the neutrophil turnover rate (normal = 78.5 ± 11.9 × 10 7/cells/kg/day, GM-CSF = 91.4 ± 19.8 × 10 7/cells/kg/day, P > 0.05). GM-CSF reduced the number of neutrophils migrating to skin chambers (normal = 104 ± 25.0 × 10 6/cells, GM-CSF = 48.6 ± 16.0 × 10 6/cells; P < 0.05). Treatment increased expression of CD11b/CD18 but not Fcγ receptors (CD16, CD32, CD64). Treatment also stimulated the in vitro neutrophil respiratory burst in response to a variety of agonists, and this enhancement persisted for the duration of treatment. All subjects experienced local and systemic adverse effects and developed eosinophilia. This study indicates that GM-CSF at a dose of 250 μg/m 2 causes neutrophilia chiefly by accelerating delivery of neutrophils from the marrow to the blood and by decreasing migration from the blood to the tissues, with only a modest effect on neutrophil production and blood half-life. Am. J. Hematol. 57:7–15, 1998. © 1998 Wiley-Liss, Inc. 相似文献
11.
Objectives To evaluate the efficacy and safety of intracoronary administration of prourokinase via balloon catheter during primary percutaneous coronary interventions (PCI) in patients with acute ST‐segment elevation myocardial infarction (STEMI). Methods Acute STEMI patients underwent primary PCI were randomly divided into two groups: intracoronary prourokinase (IP) group ( n = 118) and control group ( n = 112). During primary PCI, prourokinase or saline were injected to the distal end of the culprit lesion via balloon catheter after balloon catheter dilatation. Demographic and clinical characteristics, infarct size, myocardial reperfusion, and cardiac functions were evaluated and compared between two groups. Hemorrhagic complications and MACE occurred in the 6‐months follow up were recorded. Results No significant differences were observed between two groups with respect to baseline demographic, clinical, and angiographic characteristics ( P > 0.05). In IP group, more patients had complete ST segment resolution (>70%) compared with control group ( P < 0.05). Patients in IP group showed lower levels of serum CK, CK‐MB and TnI, and a much higher myocardial blood flow (MBF) than those in control group ( P < 0.05). No significant differences of TIMI major or minor bleeding complications were observed between the two groups ( P > 0.05). At 6‐months follow‐up, there was a trend that patients in the IP group had a less chance to have MACE, though it was not statistically different (8.5% vs 12.5%, P > 0.05). Conclusions Intracoronary administration of prourokinase via balloon catheter during primary PCI effectively improved myocardial perfusion in STEMI patients. 相似文献
12.
AbstractIntroduction: Stress hyperglycemia (SH) in STEMI is associated with high risk of in-hospital mortality. It is still controversial if SH is marker of high post-hospital risk. ?Objectives: The aim was to analyze in-hospital and one-year risk associated with SH in STEMI and to study if SH is marker of LV remodeling. ?Methods: We enrolled 275 patients who were admitted with first STEMI and reperfused. Patients were divided according to admission glycemia in three groups: (1) with diabetes mellitus (DM); (2) with SH, without DM and; (3) without both DM and SH. SH was defined as admission blood glucose level ≥ 8 mmol/l. ?Results: In-hospital mortality was higher in patients with known DM (5%) and highest in patients with SH without previous DM (9.3%), and only 1.6% in the third group, P < 0.05. In patients without known DM, SH was associated with 6.378-fold higher in-hospital mortality. Total mortality was double in group with SH without DM compared to the third group (13.9% versus 6.3%). EDV changed in patients with SH without DM from 126 ± 37 to 145 ± 30 ml after one year, P < 0.05. ?Conclusion: SH is associated with high in-hospital mortality risk and it could be marker of LV remodeling (significant increase of EDV during one year). 相似文献
13.
AbstractAims: The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI). Methods: We registered complication and mortality rates in all patients with STEMI admitted for primary PCI at a high-volume center over a two-year period (2004 to 2006). Results: We included 1022 consecutive patients (mean age 64 years; 69% men). In-hospital and one-year mortality were 8% and 12%, respectively. Cardiac arrest, cardiogenic shock, left ventricular ejection fraction ≤40% and atrioventricular block significantly predicted increased one-year mortality in univariate analysis ( P < 0.001 for all) and were considered high-risk complications. 65% of patients had no high-risk complications. One-year mortality for patients without high-risk complications was 4% compared with 28% for those with high-risk complications ( P < 0.001). Conclusion: Unselected patients with STEMI treated with primary PCI have mortality rates corresponding to those reported in randomized clinical studies including transport of patients. Mortality is strongly related to high-risk complications developed during admission. Thus, patients with high-risk complications should receive special attention. The majority of patients (65%) without high-risk complications have an excellent short- and long-term prognosis following primary PCI. 相似文献
14.
ObjectivesThis study aimed to determine whether the elective insertion of an intra-aortic balloon counter pulsation (IABP) device at the time of myocardial revascularization in patients presenting with an acute anterior ST-elevation myocardial infarction (STEMI) without cardiogenic shock has any impact on the in-hospital rate of cardiac mortality. BackgroundThe role of IABP in patients presenting with an acute MI without cardiogenic shock remains ill defined. MethodsThe present study comprised 605 consecutive patients who underwent primary percutaneous coronary intervention for an anterior STEMI without cardiogenic shock. Patients who received IABP at the time of their coronary revascularization ( n = 105) were compared to those who had not ( n = 500). Patients with stable angina, unstable angina, non-STEMI, non-anterior STEMI, and cardiogenic shock were excluded. ResultsThe two cohorts were well matched for the conventional risk factors for coronary artery disease. Although the left ventricular ejection fraction was significantly lower in the patients who received IABP (0.32 ± 0.11 vs. 0.39 ± 0.12; P < 0.001), the two cohorts were well matched for history of MI, coronary revascularization, and chronic renal impairment. Following propensity scoring, the in-hospital rate of cardiac death was similar between the two cohorts (5.6% vs. 0%; P = .12) as was the rate of vascular complications. Major bleeding was significantly greater in the IABP cohort (10.0% vs. 0%; P = .01) leading to a greater transfusion requirement (14.9% vs. 2.9%; P = .01). ConclusionThe adjunctive use of an IABP in patients presenting with an acute anterior STEMI without cardiogenic shock may not be associated with an in-hospital mortality benefit. 相似文献
15.
We aimed to assess the plasma oxidant and antioxidant levels in systemic sclerosis (SS) patients with interstitial lung involvement.
Twenty-seven female SS patients and 17 healthy female volunteers were included in the study. Plasma levels of oxidants and
antioxidants levels were studied of two groups. The median oxidant and antioxidant levels in study and control groups were,
MDA 5.2 ± 0.4/3.7 ± 0.5 nmol/ml ( P < 0.001), NO 45.4 ± 3.7/34.2 ± 2.9 nmol/l ( P < 0.001) , SOD 25.6 ± 2.3/24.6 ± 2.0 U/ml ( P > 0.05) , catalase 99.9 ± 9.9/140.0 ± 10.0 U/ml ( P < 0.001) , vitamin E 20.5 ± 1.3/22.6 ± 2.0%mg ( P < 0.001) , vitamin C 70.6 ± 8.7/83.5 ± 7.3 mg/dl ( P < 0.001) , respectively. There was also no correlation between plasma levels of oxidants–antioxidants levels and disease duration, duration
of pulmonary signs, pulmonary function test values, HRCT scores in SS patients ( P > 0.05). In our study, the oxidant burden in SS patients with interstitial lung involvement was found to be increased; however
no correlation was detected between the severity of lung involvement and oxidant–antioxidant levels. 相似文献
16.
BackgroundWe focused on the Systemic Inflammatory Response Syndrome (SIRS) duration after surgery for esophageal squamous cell carcinoma (ESCC) as the prognostic marker. MethodsWe enrolled a total of 222 patients with local ESCC, who underwent curative esophagectomy between 2005 and 2015. SIRS was diagnosed according to the criteria as a condition involving two or more of the following factors after surgery: (a) body temperature of?>?38 °C or?<?36 °C; (b) heart rate?>?90 beats/min; (c) respiratory rate?>?20 breaths/min (d) WBC count?>?12,000 or?<?4000 cells/mm3. We defined SIRS duration as the total sum of the days defined as SIRS conditions during 7 days after surgery. The SIRS duration was analyzed by Cox hazards modeling to determine the independent prognostic factors for overall survival (OS) and Cancer-specific survival (CSS). ResultsThe cutoff point of SIRS duration was determined to be set at 5.0 days according to the receiver operating characteristic (ROC) curve, which was plotted using 5-year OS as the endpoint. Of the 222 patients, 165 (74.4%) and 57 (25.6%) were classified as having short (<?5.0) and long (≥?5.0) SIRS, respectively. The long SIRS was significantly associated with postoperative pneumonia (Hazard Ratio (HR):9.07; P?<?0.01), great amount of blood loss during surgery (HR: 2.20: P?=?0.04), preoperative high CRP value (HR: 2.45: P?=?0.04) and preoperative low albumin (HR: 2.79: P?=?0.03) by logistic-regression multivariate analysis. Cox Hazard Multivariate analyses revealed that long SIRS was a worse prognostic factor for OS (HR: 2.36; 95% Confidence Interval (CI):1.34–4.20, P?<?0.01) and CSS (HR: 2.07; 95% CI:1.06–4.06, P?=?0.03), while postoperative pneumonia and postoperative high CRP value were not worse prognostic factors for OS and CSS. ConclusionSIRS duration is a more reliable prognostic marker than the development of pneumonia and high postoperative CRP value after surgery for ESCC. The surgeons should aim to reduce the SIRS duration to improve the prognosis of ESCC patients. 相似文献
17.
Encapsulating peritoneal sclerosis (EPS) is a serious complication that occurs in patients with long‐term peritoneal dialysis (PD). Investigation of risk factors that contribute to EPS in patients on long‐term PD therapy is needed. In a retrospective, observational study, data were collected for 107 patients treated with PD therapy for more than 5 years. Fifty cases of EPS were compared with 57 cases of non‐EPS. To evaluate the impact of PD‐associated peritonitis in EPS, univariate and multivariate logistic regression models were applied. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis were included as explanatory variables in addition to previously reported risk factors. D/P Cr and serum β2MG levels in the EPS and non‐EPS groups were: 0.82 ± 0.10 and 0.67 ± 0.12 ( P < 0.01), and 33.8 ± 8.54 and 29.2 ± 8.18 mg/L ( P < 0.01), respectively. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis was 68% and 42% ( P < 0.01), 1.80 ± 2.19 and 0.75 ± 1.07 times ( P < 0.01), and 18.1 ± 15.3 and 10.2 ± 4.90 days ( P < 0.01), in the EPS and non‐EPS groups, respectively. Furthermore, multivariate logistic regression models demonstrated that both D/P Cr and the duration of peritonitis were independently associated with EPS ( P < 0.01 and P < 0.05, respectively). In patients on long‐term PD therapy, D/P Cr and the duration of peritonitis are independently associated with EPS. Earlier treatment to promote an early recovery from PD‐associated peritonitis could be critical in preventing EPS. 相似文献
18.
Hepatocyte growth factor (HGF) is a pleiotropic cytokine known to be involved in tissue regeneration and repair. We measured
serum levels of HGF in patients with insulin-dependent diabetes mellitus (type 1). The patients were divided into four groups:
(1) 10 patients at clinical presentation before insulin treatment; (2) 19 patients with newly diagnosed type 1 diabetes (diabetes
duration 1/2–3 years); (3) 14 patients with long-standing type 1 diabetes without renal involvement (diabetes duration >10
years, and urinary albumin excretion (UAER) <20 μg/ min); and (4) 20 patients with long-standing type 1 diabetes with renal
involvement (diabetes duration >10 years and UAER 20–500 μg/min). Sera from 24 age- and sex-matched healthy blood donors constituted
a control group. The HGF levels of the four groups were (mean±SD); group 1, 0.74±0.14; group 2, 0.78±0.40; group 3, 0.86±0.42;
group 4, 0.79±0.27 ng/ml, compared to 0.43±0.24 ng/ml in the control group ( P<0.0008). HGF levels were not significantly different between the four patient groups. The elevated serum HGF levels did not
correlate with complications related to type 1 diabetes, such as UAER, retinopathy and macrovascular complications, suggesting
that HGF levels were not associated with the type 1 diabetes complications. In conclusion, our results show that type 1 diabetic
patients have increased serum HGF levels compared with controls and that HGF is elevated to the same extent in newly diagnosed
as well as in long-standing type 1 diabetes.
Received: 29 November 1997 / Accepted in revised form: 11 March 1998 相似文献
19.
Background Patients with atrial myocardial infarction (ATMI) have frequent cardiac and noncardiac complications. However, ATMI is uncommonly diagnosed because of its nonspecific ECG changes. Our objective was to analyze the ECG characteristics of ATMI in patients with inferior STEMI. Hypothesis Electrocardiographic P wave parameters can help in diagnosis of ATMI. Methods We evaluated 932 patients who underwent coronary angiography and recruited 39 patients with ATMI and 33 patients without ATMI with inferior STEMI for a retrospective study. Twelve‐lead ECGs were obtained to measure P‐wave parameters in diagnosis of ATMI. P‐wave parameters and PR‐segment displacement were compared in patients with and without ATMI. Results In inferior leads, PWD and PWDisp were significantly longer in the ATMI group than in the non‐ATMI group (limb lead II, 109.79 ±15.51 ms and 86.65 ±5.02 ms, respectively; P < 0.001; limb lead III, 108.31 ±12.51 ms and 85.27 ±7.47 ms, P < 0.001; aVF, 106.49 ±13.68 ms and 83.01 ±7.89 ms, P < 0.001; PWDisp, 41.67 ±10.72 ms and 25.18 ±5.17 ms, P < 0.001). By contrast, PWA was significantly lower in the ATMI group than in the non‐ATMI group (limb lead II, 0.96 ±0.18 mV and 1.39 ±0.22 mV, respectively; P < 0.001; limb lead III, 0.90 ±0.11 and 1.21 ±0.23, P < 0.001; aVF, 0.88 ±0.17 and 1.26 ±0.28, P < 0.001). PR‐segment displacement was found in 8 (20.5%) patients with ATMI. A PWD ≥95.5 ms in lead DII diagnosed ATMI with a higher sensitivity and specificity (90%, 94%) than did PWA or PWDisp. Conclusions This study suggests P‐wave parameters might be considered ECG findings in diagnosis of ATMI in patients with inferior STEMI. 相似文献
20.
Sleep fragmentation, decreased rapid eye movement (REM) sleep time, and REM sleep hypoxemia have been reported in infants with chronic neonatal lung disease (CNLD) in early infancy despite an awake hemoglobin oxygen saturation (SaO 2) >93%. Interestingly, higher inspired O 2 concentrations have been demonstrated to reduce REM sleep fragmentation in CNLD patients in middle infancy. However, the effect of increased SaO 2 on sleep architecture in infants with CNLD near the time of discharge from neonatal intensive care has not been reported. We performed paired overnight polysomnography in a sleep laboratory on 16 infants with CNLD (4 weeks median corrected age) in air or their usual inspired oxygen (SaO 2 >93%) and again when receiving 0.25 L/min higher than baseline inspired oxygen via nasal catheters (SaO 2 >97%). A control group of seven healthy preterm infants was similarly studied. For CNLD infants on supplemented O 2, sleep duration decreased by 15% (422 ± 66 min vs. 359 ± 89 min; P < 0.005), and sleep efficiency decreased by 7% (73.2 ± 10.6% vs. 66.4 ± 14.0%; P < 0.005) but percentage of time in REM sleep (REM%) (31.5 ± 8.9% vs. 29.8 ± 8.6%; P = 0.560), REM epoch duration (12.4 ± 2.8 min vs. 13.4 ± 4.3 min; P = 0.420), and REM arousal index (18.6 ± 6.5 vs. 18.8 ± 7.2; P = 0.990) were not significantly affected. Conversely, higher O 2 did not alter sleep architecture in the control group. The mean non-REM (NREM) respiratory rate decreased (CNLD: P = 0.003; controls: P = 0.02), NREM SaO 2 increased ( P < 0.05), although the mean transcutaneous CO 2 was unaltered in both CNLD and control groups. This study confirmed low REM% in CNLD infants in early infancy and demonstrated that a higher SaO 2 adversely affected sleep time but did not influence REM sleep duration or arousal frequency. A target SaO 2 >93% is, therefore, as efficacious as an SaO 2 >97% in optimizing sleep architecture in CNLD infants. Pediatr Pulmonol. 1998; 26:235–240. © 1998 Wiley-Liss, Inc. 相似文献
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