150例颈动脉粥样硬化斑块患者相关危险因素的分析

目的对颈动脉粥样硬化斑块患者的相关危险因素进行分析。方法经颈部血管彩色超声证实,颈动脉粥样硬化斑块患者1 50例,男91例,女59例;颈动脉狭窄<50%80例,颈动脉狭窄50%～70%49例,颈动脉狭窄>70%21例;合并脑卒中45例,无脑卒中105例。采用Essen脑卒中风险评分量表(ESRS)对危险因素进行评估。结果颈动脉粥样硬化斑块男性患者ESRS为(3.1 98±1.701)分,女性患者ESRS为(2.441±1.643)分,男性明显高于女性,差异有统计学意义(P<0.05);颈动脉狭窄<50%患者ESRS为(2.658±1.632)分,颈动脉狭窄50%～70%患者ESRS为(2.612±1.742)分,颈动脉狭窄>70%患者ESRS为(4.429±1.121)分,颈动脉狭窄>70%患者ESRS评分明显高于其他2个狭窄段患者,差异有统计学意义(P<0.05);合并脑卒中患者ESRS为(4.578±1.305)分,无脑卒中患者ESRS为(2.215±1.332)分,合并脑卒中患者ESRS评分明显高于无脑卒中患者,差异有统计学意义(P<0.05)。结论颈动脉粥样硬化斑块患者的危险因素与性别、颈动脉狭窄程度及是否合并脑卒中相关。     

Gender and Age Impacts on the Association Between Thyroid Function and Metabolic Syndrome in Chinese

The relationship between thyroid dysfunction and metabolic syndrome (MS) is complex. We aimed to explore the impact of gender and age on their association in a large Chinese cohort.This cross-sectional study enrolled 13,855 participants (8532 male, 5323 female), who self-reported as healthy without any known previous diseases. Clinical data including anthropometric measurements, thyroid function, and serum metabolic parameters were collected. The associations between thyroid function and MS of both genders were analyzed separately after dividing thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and age into subgroups. MS risks were calculated by binary logistic regression models.Young males had significantly higher MS prevalence than females, yet after menopause, females had higher prevalence than males. Females had higher incidence of thyroid dysfunction than males. By using TSH quartiles as the categorical variables and the lowest quartile as reference, significantly increased MS risk was demonstrated in quartile 4 for males, yet quartiles 3 and 4 for females. By using FT3 quartiles as the categorical variables, significantly increased MS risk was demonstrated in quartile 2 to 4 for females only. By using age subgroups as the categorical variables, significantly increased MS risk was shown in both genders, with females (4.408–58.455) higher than males (2.588–4.943).Gender and age had substantial influence on thyroid function and MS. Females with high TSH and high FT3 had higher MS risks than males. Aging was a risk for MS, especially for females. Urgent need is necessary to initiate interventional programs.     

The impact of the menopause on coronary artery calcification examined by multislice computed tomography scanning

Background and aimsTo examine whether there is a difference in coronary artery calcification (CAC) scores between males and females aged above 50 years.Methods and resultsA total of 479 subjects aged between 40 and 70 years with no clinical or family history of cardiovascular disease (CVD) were enrolled for this study. All subjects were assessed by multislice CT scanning (MCTS), and the CAC scores obtained were assigned to one of four quartiles for further assessment and comparison. The main outcome evaluated was the percentage of high CAC scores and mean CAC scores, comparing males and females of different age groups.This study found that the percentage of high CAC scores increased markedly from 5% (40–49 age group) to 21.2% (50–59 age group) among females. The increase was significantly less when comparing males from different age groups (from 25% in the 40–49 age group to 31.2% in the 50–59 age group). Females had higher odds ratios (ORs) postmenopausally (4.3 in the 50–59 age group) than males in the same age group (1.6).ConclusionsThese initial findings seem to indicate that above 50 years of age, CAC is more dependent on age in females than in males, which might be due to the effect of the menopause.     

Age-related differences in intravascular ultrasound findings in 1,009 coronary artery disease patients

BACKGROUND: The aim of this study was to assess the age-related differences in intravascular ultrasound (IVUS) findings of target lesions in patients with coronary artery disease. METHODS AND RESULTS: The 1,009 patients who underwent IVUS imaging were grouped according to an increase of 10 years of age: Group I [<50 years (n=144)]; Group II [51-60 years (n=259)]; Group III [61-70 years (n=249)]; Group IV [71-80 years (n=264)]; and Group V [>80 years, (n=93)]. Calcified plaque (18%, 25%, 33%, 38%, and 46%, p<0.001) and negative remodeling (29%, 48%, 44%, 44%, and 66%, p<0.001) were most common, and reference segment plaque burden (35+/-11%, 35+/-10%, 39+/-10%, 38+/-10%, and 40+/-11%, p<0.001) was greatest in Group V. Plaque rupture (52%, 31%, 42%, 38%, and 20%, p=0.009) and thrombus (38%, 30%, 31%, 24%, and 11%, p=0.026) were most common in Group I. In the multiple logistic regression analysis, patient age was an independent predictor of calcified plaque (odds ratio (OR)=1.03, p=0.001), negative remodeling (OR=1.04, p=0.001), and mean reference segment plaque burden >50% (OR=1.03, p=0.006). CONCLUSION: Elderly patients have more severe calcifications with negative remodeling and diffuse atherosclerosis, whereas younger patients have more unstable plaque morphology.     

东北地区城市脂肪肝的患病率及其危险因素的流行病学调查

目的探讨东北地区成人脂肪肝的流行病学特征及其危险因素。方法选取2009年1月~2009年12月具有完整资料的某体检中心的健康体检者15 635例,其中男9 037例,女6 598例,男女之比为1.37：1,年龄16~95岁,平均年龄（47.85±13.21）岁。通过性别、年龄分层后比较脂肪肝的患病率,并将脂肪肝患者的体质量指数、血压、血脂、血糖、尿酸、血常规、肝功能等检测结果与非脂肪肝组进行对比分析。结果 B超共检出脂肪肝患者5 955例,总患病率为38.1%,男性患病率显著高于女性（48.8%vs23.4%,χ2=1039.853,P〈0.001）;30~69岁的男性脂肪肝的患病率超过50%,尤以40~49岁最高（55.2%）,女性在39岁之前脂肪肝的发生率不足10%,50岁后骤然上升至35%以上,60~69岁达到高峰并超过男性（43.4%vs40.5%）,70岁以后女性脂肪肝患病率仍显著高于同龄男性（35.5%vs28.3%,χ2=7.670,P〈0.006）。非脂肪肝人群超重者占35.6%,肥胖占7.5%,而脂肪肝人群两者分别为51.0%,36.8%。脂肪肝组的血压、血糖、甘油三酯（TG）等增高的检出率明显高于非脂肪肝组,高密度脂蛋白胆固醇（HDL-C）降低的检出率明显低于非脂肪肝组（P均〈0.001）。单因素分析显示,体质量指数（BMI）、收缩压、TG、空腹血糖（FBG）和血尿酸（UA）,以及γ谷氨酰基转移酶和丙氨酸氨基转移酶在脂肪肝组明显高于非脂肪肝组（P均〈0.001）;相反,HDL-C则显著低于非脂肪肝组（t=47.174,P〈0.001）。多因素Logistic回归分析提示,脂肪肝危险因素包括BMI、TG、UA、FBG、舒张压、胆固醇等,OR值分别为3.590、1.936、1.567、1.508、1.346和1.177。结论东北地区城市男女脂肪肝的发生率在各年龄段有明显差异,脂肪肝的发生与代谢综合征的组分明显相关,尿酸的增高也与脂肪肝的发生明显相关。     

Females,Hispanics and older individuals are at greatest risk of developing metabolic syndrome in the U.S.

BackgroundThe increasing prevalence of metabolic syndrome (MetS) and MetS related complications in the U.S. poses a serious public health burden. We aim to identify high risk groups at greatest risk of developing MetS in the U.S.MethodsUsing data from the 2001–2012 National Health and Nutrition Examination Survey (NHANES), MetS prevalence among adults (age ≥ 18) was stratified by sex, race/ethnicity and age to identify groups at greatest risk of MetS. Mutlivariate logistic regression models evaluated for predictors of MetS.ResultsOverall, the prevalence of MetS in the U.S. was 78 million during the study period. There was a greater prevalence of MetS in females compared to males (34.4% vs. 29.6%, p < 0.001). Females had a 25% higher risk of MetS compared to males (OR, 1.25; 95% CI, 1.18–1.32, p < 0.001). Hispanics had a higher risk of MetS when compared to non-Hispanic whites (OR, 1.13; 95% CI, 1.04–1.23, p < 0.01). The prevalence of MetS increased with increasing age (age <40: 17.5% vs. age 40–49: 29.7% vs. age 50–59: 37.5% vs. age 60–69: 44.4% vs. age ≥70: 47.0%, p < 0.001), and individuals age 70 and over were more than 5 times more likely to have MetS than those less than age 40 (OR, 5.12, 4.71–5.57, p < 0.001)ConclusionsThe high prevalence of MetS in the U.S. affects females, Hispanics, and older individuals the greatest. The aging population and increasing Hispanic population further highlight the huge burden of disease MetS will place on the healthcare system in the U.S.     

New insights into spotty calcification and plaque rupture in acute coronary syndrome: an optical coherence tomography study

Although recent optical coherence tomography (OCT) studies have focused on spotty calcification, whether there were any characteristics in the concomitant existence of calcification and plaque rupture remains unknown. The aim of the present study was to investigate the characteristics of spotty calcification in acute coronary syndrome (ACS) patients with or without plaque rupture, using OCT. This study enrolled 98 consecutive patients with ACS. OCT image acquisitions were performed in the culprit lesions, and patients were divided into the plaque rupture group (n = 38) and the non-rupture group (n = 60). The frequency of spotty calcification (p = 0.006), thin-capped fibroatheroma (p = 0.012), macrophage infiltration (p = 0.022), and the number of spotty calcification per patient (p < 0.001) were significantly higher and the largest arc and the minimum depth of spotty calcification from the luminal surface were significantly smaller in the rupture group. Moreover, in the rupture group, most of the spotty calcifications in the site nearest to the minimum lumen area were observed in the proximal portion of that site, and tended to be located near the plaque rupture. Multivariate analysis revealed that the presence of spotty calcification (OR 3.19, 95 % CI 1.12–9.76, p = 0.030) and age (OR 1.08, 95 % CI 1.02–1.14, p = 0.008) were independent predictive factors for plaque rupture. This study demonstrates the characteristics of spotty calcification in ACS patients with plaque rupture and the positional relationship between spotty calcification and plaque rupture. These detailed observations could impact on treatment strategies for the prevention of ACS.     

Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction

OBJECTIVE—To evaluate the prevalence of plaque erosion as a substrate for coronary thrombosis.
DESIGN—Pathological study in patients with acute myocardial infarction not treated with thrombolysis or coronary interventional procedures.
PATIENTS—298 consecutive patients (189 men, mean (SD) age 66 (11) years; 109 women, 74 (8) years) dying in hospital between 1984 and 1996 from acute myocardial infarction, diagnosed by ECG changes and rise in cardiac enzymes.
MAIN OUTCOME MEASURES—Histopathological determination of plaque erosion as substrate for acute thrombosis; location and histological type of coronary thrombosis; acute and healed myocardial infarcts; ventricular rupture.
RESULTS—Acute coronary thrombi were found in 291 hearts (98%); in 74 cases (25%; 40/107 women (37.4%) and 34/184 men (18.5%); p = 0.0004), the plaque substrate for thrombosis was erosion. Healed infarcts were found in 37.5% of men v 22% of women (p = 0.01). Heart rupture was more common in women than in men (22% v 10.5%, p = 0.01). The distribution of infarcts, thrombus location, heart rupture, and healed infarcts was similar in cases of plaque rupture and plaque erosion.
CONCLUSIONS—Plaque erosion is an important substrate for coronary thrombosis in patients dying of acute myocardial infarction. Its prevalence is significantly higher in women than in men.


Keywords: plaque erosion; rupture; acute myocardial infarction     

African Americans and men with severe COPD have a high prevalence of osteoporosis

Osteoporosis is a non-pulmonary manifestation whose true prevalence is uncertain in severe chronic obstructive pulmonary disease (COPD). We describe the prevalence and risk factors for osteoporosis in a large, well characterized COPD cohort. Dual energy x-ray absorptiometry of the lumbar spine and hip, full pulmonary function testing, cardiopulmonary exercise test, 6 minute walk distance and demographics were performed in 179 non-selected COPD patients. Patients were 59 +/- 7 years old, smoked 53 +/- 32 pack years, FEV(1) 26% +/- 9.8, and 45% were currently taking prednisone. Bone mineral density measurements were abnormal in 97%; 66% had dual energy X-ray absorptiometry defined osteoporosis, while 31% had osteopenia. The prevalence of osteoporosis in males versus females was 70% versus 62% (p = 0.33); both groups had similar fracture rates. The prevalence of osteoporosis in African Americans versus Caucasians was 69% versus 65% (p = 0.78). Caucasians had a significantly lower Ward's Triangle T score than African Americans (-2.52 +/- -0.96 vs. -2.16 +/- -0.91, p = 0.04). Those with bone fractures took higher doses of prednisone than those without fractures. Univariate analysis identified BMI and FVC% as predictors for osteoporosis (p = 0.03 OR 0.934 p = 0.006 OR 0.974). Multivariate analysis revealed only FVC% as a significant predictor (p = 0.006, OR 0.974). Osteoporosis is highly prevalent in severe COPD, and affects males and African Americans to a similar degree as females and Whites. Osteoporosis should be considered in severe COPD regardless of race or gender.     

Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography.

OBJECTIVES: The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT). BACKGROUND: Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain. METHODS: Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined. RESULTS: We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 +/- 5.9 mm2 vs. 9.1 +/- 4.8 mm2 vs. 13.5 +/- 10.7 mm2, p = 0.02; and 1.4 +/- 0.3 vs. 1.0 +/- 0.4 vs. 1.2 +/- 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina. CONCLUSIONS: We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.     

High-Risk Plaque Detected on Coronary CT Angiography Predicts Acute Coronary Syndromes Independent of Significant Stenosis in Acute Chest Pain : Results From the ROMICAT-II Trial

Background

It is not known whether high-risk plaque, as detected by coronary computed tomography angiography (CTA), permits improved early diagnosis of acute coronary syndromes (ACS) independently to the presence of significant coronary artery disease (CAD) in patients with acute chest pain.

Objectives

The primary aim of this study was to determine whether high-risk plaque features, as detected by CTA in the emergency department (ED), may improve diagnostic certainty of ACS independently and incrementally to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction (MI).

Methods

We included patients randomized to the coronary CTA arm of the ROMICAT-II (Rule Out Myocardial Infarction/Ischemia Using Computer-Assisted Tomography II) trial. Readers assessed coronary CTA qualitatively for the presence of nonobstructive CAD (1% to 49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low <30 Hounsfield units plaque, napkin-ring sign, spotty calcium). In logistic regression analysis, we determined the association of high-risk plaque with ACS (MI or unstable angina pectoris) during the index hospitalization and whether this was independent of significant CAD and clinical risk assessment.

Results

Overall, 37 of 472 patients who underwent coronary CTA with diagnostic image quality (mean age 53.9 ± 8.0 years; 52.8% men) had ACS (7.8%; MI n = 5; unstable angina pectoris n = 32). CAD was present in 262 patients (55.5%; nonobstructive CAD in 217 patients [46.0%] and significant CAD with ≥50% stenosis in 45 patients [9.5%]). High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (odds ratio [OR]: 8.9; 95% CI: 1.8 to 43.3; p = 0.006) after adjustment for ≥50% stenosis (OR: 38.6; 95% CI: 14.2 to 104.7; p < 0.001) and clinical risk assessment (age, sex, number of cardiovascular risk factors). Similar results were observed after adjustment for ≥70% stenosis.

Conclusions

In patients presenting to the ED with acute chest pain but negative initial electrocardiogram and troponin, presence of high-risk plaques on coronary CTA increased the likelihood of ACS independent of significant CAD and clinical risk assessment (age, sex, and number of cardiovascular risk factors). (Multicenter Study to Rule Out Myocardial Infarction by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239)     

Correlation of lipoprotein (a) levels and plaque morphology in very young acute coronary syndrome patients using optical coherence tomography

IntroductionLevels of lipoprotein (LP) (a) are useful marker for risk stratification of cardiovascular disease. This genetic biomarker is suggestive of patient predisposition to acute coronary event. The present study was to study correlation of LP(a) levels and plaque morphology in very young patients (<35 years) with acute coronary syndrome (ACS).MethodsA prospective, single-center, observational study consisting of very young patients with ACS and fit for optical coherence tomography (OCT) guided invasive coronary angiography was conducted at tertiary-care centre. LP(a) levels were compared between healthy controls and very young ACS patients. Correlation of LP(a) levels and plaque characteristics in very young ACS patients was done using OCT imaging.ResultsOut of enrolled 80 subjects, 40 were very young ACS and 40 were matched healthy controls. In very young patients, plaque rupture and erosion were mechanism of ACS in 67.5% and 32.5% patients, respectively. Mean levels of LP(a) were 28.10 ± 13.96 nmol/l in healthy controls and 47.19 ± 29.85 nmol/l in very young patients with ACS (p = 0.022). Among very young ACS patients, patients with LP(a) levels<75 nmol/l and ≥75 nmol/l had mean thin cap fibroatheroma thickness of 117.08 ± 52.542 μm and 95.00 ± 36.286 μm, respectively (p = 0.2355).ConclusionHigher levels of LP(a) were seen in younger patients with ACS compared with matched healthy individuals. Plaque rupture was the commonest mechanism of ACS in very young ACS patients. Patients with high LP(a) levels had lesser thickness of fibrous cap in OCT imaging compared with low levels of LP(a).     

Clinical findings and educational status in chest pain patients admitted to an emergency department. Report from a three-month survey at Be'sat hospital, Teheran, Iran.

BACKGROUND: Cardiovascular disease is a major cause of death in Iran. With regard to the socio-economic status, a low educational level is associated with a higher frequency of disease. The aim of this study was to investigate, in a developing country, the influence of educational level and gender on the prevalence of coronary artery disease and cardiovascular risk factors in patients with chest pain at the time of admission and after 3 months of follow-up. METHODS: We studied 240 consecutive patients (113 males, 127 females, age 16-97 years) who presented with chest pain believed to be of cardiac origin. The patients were admitted to a metropolitan hospital in Teheran from September 8, 2001 to December 8, 2001. RESULTS: Males were found to have a higher educational level than females (p = 0.0001). Females more frequently had a history of hypertension (44.9 vs 23%, p = 0.0001) and of diabetes mellitus (24.4 vs 11.5%, p = 0.01) and presented with more electrocardiographic abnormalities (37.0 vs 27.4%, p = 0.033) than males. Furthermore, patients with a low educational level were less likely to be on beta-blockers (23.9 vs 53.3%, p = 0.000), nitrates (20.2 vs 42.2%, p = 0.002) and acetylsalicylic acid (22.4 vs 50%, p = 0.000) compared to patients with a high educational level. Males were more often transported by ambulance to the hospital than females (p = 0.001). There was a high prevalence of risk factors for ischemic heart disease (cigarette smoking, diabetes mellitus, hypertension and dyslipidemia) (65% had one or more risk factors) with no relation to educational level. CONCLUSIONS: We found a high prevalence of risk factors for coronary artery disease in an Iranian population admitted with chest pain. In particular less educated women were at an increased risk and had more electrocardiographic abnormalities. Our findings stress the importance of the socio-economic status in cardiovascular disease and of the need for health promotion and lifestyle changes.     

Can OCT change the therapeutic strategy in ACS due to plaque erosion?

The pathophysiology of acute coronary syndromes was thought to be coronary thrombosis over a plaque rupture. Autopsy studies revealed that not all cases were due to plaque rupture, even denuded endothelium or calcific nodule can beget a thrombus. Introduction of OCT made, in vivo recognition of lesion morphology clear. Plaque ruptures are most common and need primary angioplasty. Recent studies established plaque erosion is responsible for ACS in one third of the cases and majority of them present as Non ST elevation myocardial infarction and commonly found in young patients without major risk factors. Evidence from recent studies suggested that stenting can be deferred and they can be managed conservatively with good long term outcomes. More randomized trials are needed comparing plaque rupture and plaque erosion as regards conservative versus invasive management. If these studies substantiate the concept of conservative management, it will lead to a paradigm shift in their management.     

Determinants of age at sexual debut and associated risks among South African youths

The research uses data from a representative national survey to explore the determinants of age at sexual debut among South African youths in the age group 15–24 years. A random sample of 5 708 youths were interviewed and 92% responded to questions on whether or not they had ever had sex and their age at first sex for those who had. The research used survival analyses techniques to combine ‘current status data’ and ‘recall data’ for respondents who reported ever having had sex. The females were more likely than the males to report ever having had sex (p≤0.001). The median age at sexual debut was 18 years for both males and females. The hazard ratio pertaining to early sexual debut was 0.81-times less for those in the age group 15–19 as compared to those in the age group 20–24 (p≤0.001). Age, race, geographical location, and level of education were found to be important determinants of age at sexual debut. The ‘hazards of sexual debut’ (θ=0.112; p≤0.001) varied significantly between geographical areas (rural or urban). Youths with an earlier age of sexual debut were less likely to have used condoms, a behaviour which increases their risk of HIV infection. HIV prevalence was consistently higher among the females than among the males. We recommend that HIV-prevention interventions target community sets rather than only individuals at higher risk of exposure to HIV.     

Iron status in young Danes. Evaluation by serum ferritin and haemoglobin in a population survey of 634 individuals aged 14–23 yr

Abstract: Iron status was assessed by serum ferritin and haemoglobin in a population survey comprising 634 randomly selected urban Danes (312 males, 322 females) 14–23 yr old. At all ages, males had significantly higher serum ferritin and haemoglobin values than females. Males: median serum ferritin displayed a steady increase with age from 33 to 109 μg/l (r_s=0.53, p<0.0001). The prevalence of absent mobilizable body iron stores (serum ferritin <13 μg/l) was 3.5% at 16–17 yr of age, gradually declining to 0% at 22–23 yr. None of the males had iron deficiency anaemia (serum ferritin <13 μg/l and haemoglobin <129 g/l). Females: median ferritin values displayed a slight increase with age from 28 to 39 μg/l (r_s=0.19, p<0.001). The prevalence of absent iron stores was 12.5% at 16–17 yr of age, declining to 6.6% at 22–23 yr. The prevalence of iron deficiency anaemia (serum ferritin <13 μg/l and haemoglobin <121 g/l) was 4.7% at 16–17 yr of age, declining to 1.3% at 22–23 yr of age. Compared with surveys in other parts of Scandinavia, young Danes had slightly higher serum ferritin levels, and a lower prevalence of iron deficiency.     

Multiple plaque rupture and C-reactive protein in acute myocardial infarction

OBJECTIVES: This study sought to investigate the relationship between multiple plaque ruptures, C-reactive protein (CRP), and clinical prognosis in acute myocardial infarction (AMI). BACKGROUND: Several studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients. Recent studies have reported that a ruptured plaque at the culprit lesion is associated with elevated CRP, which indicates a poor prognosis in patients with ACS. METHODS: We performed intravascular ultrasound in 45 infarct-related arteries and another 84 major coronary arteries in 45 first AMI patients. RESULTS: Plaque rupture was observed in 21 patients (47%) at the culprit site. Intravascular ultrasound revealed 17 additional plaque ruptures at remote sites in 11 patients (24%). Patients with multiple risk factors were more frequently found in our multiple-plaque rupture patients compared with single-plaque rupture or nonrupture patients (82% vs. 40% vs. 29%, p = 0.01). High-sensitive CRP levels had a positive correlation with the number of plaque ruptures (p < 0.01). All culprit lesions were successfully treated by percutaneous coronary intervention. Patients with multiple plaque rupture showed significantly poor prognosis compared with others (p = 0.01). CONCLUSIONS: Multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Our results suggest that AMI treatment should focus not only on stabilization of the culprit site but also a systemic approach to systemic stabilization of the arteries.     

Introduction of direct oral anticoagulant within 7 days of stroke onset: a nomogram to predict the probability of 3-month modified Rankin Scale score &gt; 2

In clinical practice, direct oral anticoagulants (DOACs) are often started earlier (≤?7 days) than in randomized clinical trials after stroke. We aimed to develop a nomogram model incorporating time of DOAC introduction?≤?7 days of stroke onset in combination with different degrees of stroke radiological/neurological severity at the time of treatment to predict the probability of unfavorable outcome. We conducted a multicenter prospective study including 344 patients who started DOAC 1–7 days after atrial fibrillation-related stroke onset. Computed tomography scan 24–36 h after stroke onset was performed in all patients before starting DOAC. Unfavorable outcome was defined as modified Rankin Scale (mRS) score?>?2 at 3 months. Based on multivariate logistic model, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve (AUC–ROC) and calibration of risk prediction model by using the Hosmer–Lemeshow test. Onset-to-treatment time for DOAC (OR: 1.21, p?=?0.030), NIH Stroke Scale (NIHSS) score at the time of treatment (OR: 1.00 for NIHSS?=?0–5; OR: 2.67, p?=?0.016 for NIHSS?=?6–9; OR: 26.70, p?<?0.001 for NIHSS?=?10–14; OR: 57.48, p?<?0.001 for NIHSS?≥?15), size infarct (OR: 1.00 for small infarct; OR: 2.26, p?=?0.023 for medium infarct; OR: 3.40, p?=?0.005 for large infarct), and age?≥?80 years (OR: 1.96, p?=?0.028) remained independent predictors of unfavorable outcome to compose the nomogram. The AUC–ROC of nomogram was 0.858. Calibration was good (p?=?2.889 for the Hosmer–Lemeshow test). The combination of onset-to-treatment time of DOAC with stroke radiological/neurological severity at the time of treatment and old age may predict the probability of unfavorable outcome.     

Sex differences in lung vulnerability to tobacco smoking.

Studies have indicated that females are more vulnerable to the deleterious effect of tobacco smoking than males. The current study aimed to investigate the associations between tobacco smoking and reported respiratory symptoms, self-rated health, and lung function by sex. In 1995-1997 65,225 subjects aged > or = 20 yrs (71% of invited) attended for screening within the Nord-Tr?ndelag Health Study. Among these, 10,941 subjects selected randomly or because they reported having asthma or asthma-related symptoms, participated in the Bronchial Obstruction in Nord-Tr?ndelag study consisting of spirometry and a personal interview. Tobacco smoking was associated with increased prevalence of respiratory symptoms, reduced lung function, and lower score on global self-rated health (SRH). Adjusted for smoking burden and lung function, females had a higher risk for reporting respiratory symptoms and lower SRH compared with males. Further, smoking burden was associated with a larger relative reduction in expiratory lung function in females than in males. Females reported more symptoms and lower self-rated health compared with males with similar smoking burden. Even if smoking in females was associated with a larger reduction in per cent predicted lung function compared with males, this does not fully explain the higher symptom prevalence in females.     

Prevalence and clinical characteristics of fatty pancreas in Yangzhou,China: A cross-sectional study

Objective

The aim of this study was to investigate the prevalence and risk factors of fatty pancreas in Yangzhou, China.