急性ST段抬高型心肌梗死患者1年主要不良心血管事件危险因素分析

目的探讨急性ST段抬高型心肌梗死(ASTEMI)患者1年内发生主要不良心血管事件(MACE)的独立危险因素。方法回顾性分析自2006年2月至2012年9月于沈阳军区总医院行经皮冠状动脉介入治疗(PCI)的1 368例ASTEMI患者的临床资料。按照1年内是否发生MACE,将患者分为发生组251例和未发生组1 117例。采用Logistic回归分析ASTEMI患者1年内发生MACE与患者一般临床特征、治疗方式等的相关性。结果两组患者既往心肌梗死比例、既往行PCI比例、Killip分级、冠状动脉病变血管支数、植入支架支数、口服阿司匹林比例、左心室射血分数比较,差异均有统计学意义(P<0.05);其余基线资料差异无统计学意义(P>0.05)。Logistic回归分析中,既往行PCI[比值比(OR)=1.70,95%可信区间1.08~2.70,P<0.05]、Killip分级>1级(OR=1.55,95%可信区间1.30~1.86,P<0.05)、冠状动脉病变血管>1支(OR=3.07,95%可信区间2.19~4.29,P<0.05)是患者1年内发生MACE的独立危险因素。结论患者既往曾行PCI、心功能差、冠状动脉多支血管病变是ASTEMI患者1年内发生MACE的独立危险因素。     

急性心肌梗死合并室间隔穿孔糖尿病患者临床预后

目的探讨急性心肌梗死(AMI)合并室间隔穿孔(VSR)的糖尿病患者的临床预后。方法选取自2008年8月至2016年6月于北部战区总医院确诊为AMI合并VSR的60例患者为研究对象,并将其按是否合并糖尿病分为糖尿病组(n=20)与非糖尿病组(n=40)。观察两组患者入院化验、用药、冠脉造影情况及远期病死率。结果糖尿病组吸烟人群比例、甘油三酯水平高于非糖尿病组,差异有统计学意义(P<0.05);两组住院期间药物应用情况及冠脉造影情况比较,差异均无统计学意义(P>0.05);Logistic回归分析结果显示,糖尿病(OR=1.360,95%可信区间0.274～6.749,P=0.049)、年龄(OR=0.900,95%可信区间0.823～0.983,P=0.019)、吸烟史(OR=0.027,95%可信区间0.002～0.469,P=0.013)是影响远期死亡的独立危险因素。Kaplan-Meier生存曲线显示,在随访期间,糖尿病组病死率明显高于非糖尿病组,差异有统计学意义(P<0.05)。结论 AMI合并VSR的糖尿病患者,远期病死率明显高于非糖尿病患者,并且年龄和吸烟是影响其远期死亡的独立危险因素。     

综合危险因素预测稳定型心绞痛患者冠状动脉病变

目的分析肾功能损害等危险因素对稳定性心绞痛患者冠状动脉(冠脉)病变程度的相关性,并建立评估冠脉病变的数学模型。方法1024例行冠脉造影患者分为病变组(625例)和对照组(399例),评估肾功能损害等冠心病的临床危险因素,以Logistic回归结合ROC曲线分析其与冠脉病变的相关性,并建立评估冠脉病变的回归模型。结果回归分析显示尿蛋白:肌酐比值>7.25μg/mg(OR=3.6;95%CI2.6～4.9;P<0.001),超敏C反应蛋白(hsCRP)>20mmol/L(OR=3.2;95%CI2.3～4.4;P<0.01),GFR<60ml/min·1.73m2(OR=2.3;95%CI1.4～3.8;P<0.01),左室射血分数(LVEF)<50%(OR=2.3;95%CI1.4～3.6;P<0.01),低密度脂蛋白>2.6mmol/L(OR=2.1;95%CI1.6～2.9;P<0.01),吸烟史(OR=2.0;95%CI1.4～2.8;P<0.01),男性(OR=1.8;95%CI1.2～2.6;P=0.002),糖尿病(OR=1.6;95%CI1.1～2.4;P<0.05)及高血压(OR=1.5;95%CI1.1～2.1;P<0.01)为冠脉病变相关的独立因素。建立评估冠脉病变回归模型:P/(1-P)=EXP(-2.453 1.270×尿蛋白:肌酐比值>7.25μg/mg 1.158×hsCRP>20mmol/L 0.819×GFR<60ml/min·1.73m2 0.813×LVEF<50% 0.761×低密度脂蛋白>2.6mmol/L 0.676×吸烟史 0.594×男性 0.459×糖尿病 0.425×高血压)。ROC曲线下面积0.811,切点为0.977,灵敏度49.0%,特异度92.7%。结论肾功能损害等危险因素与冠脉病变显著相关。Logistic回归模型对无创评估冠脉病变有一定的临床实用价值。     

单用酚妥拉明与联合垂体后叶素治疗支气管扩张咯血Meta分析

目的研究单独应用酚妥拉明与联合垂体后叶素治疗支气管扩张咯血的疗效评价。方法计算机检索Pub Med、Elsevier、Wiley、万方数字化期刊、中国期刊全文数据库及维普中文科技期刊数据库中有关单用酚妥拉明与联合垂体后叶素治疗支气管扩张咯血的临床随机对照研究,检索时间为2005年1月至2017年9月,采用Rev Man5.3软件进行Meta分析,比较单用酚妥拉明与联合垂体后叶素的有效性及安全性。结果本研究共纳入5篇文献,共计388例患者。与单用酚妥拉明治疗比较,酚妥拉明联合垂体后叶素治疗支气管扩张咯血的显效率(OR合并=1.69,95%可信区间1.10~2.61,P<0.05)及总有效率更高(OR合并=5.09,95%可信区间2.47~10.49,P<0.01),无效率(OR合并=0.20,95%可信区间0.10~0.40,P<0.01)及不良反应发生率更低(OR合并=0.38,95%可信区间0.19~0.75,P<0.01)。结论酚妥拉明联合垂体后叶素治疗支气管扩张咯血的效果更加显著,安全性更高。     

利伐沙班与传统抗凝方案对冠脉事件影响Meta分析

目的评估利伐沙班与传统抗凝方案对冠脉事件发生率的影响。方法检索英文医学数据库PubMed、Medline、Cochrane,根据纳入和排除标准进行文献检索与筛选。采用改良的Jadad量表对纳入文献进行评价,使用Revman 5.3软件进行Meta分析,比较利伐沙班与传统抗凝方案对主要有效性终点栓塞事件、主要安全性终点大出血相关事件以及冠脉事件(心肌梗死等)的发生风险。结果本研究共检索到118篇文献,最终纳入8篇随机对照试验,共涉及32 029例患者。其中,利伐沙班组15 993例,传统抗凝组16 036例。利伐沙班组栓塞性事件的发生率显著低于传统抗凝组,差异有统计学意义[比值比(OR)=0.60,95%可信区间为0.53~0.67,P<0.05]。两组在大出血事件的发生率方面比较,差异无统计学意义(OR=1.01,95%可信区间为0.94~1.09,P>0.05)。与传统抗凝组相比较,利伐沙班组冠脉事件的发生率呈减少趋势,但两组间比较,差异无统计学意义(OR=0.82,95%可信区间为0.63~1.02,P>0.05)。结论利伐沙班在降低栓塞事件的发生率方面明显优于传统抗凝方案,且不增加大出血风险。     

高血压前期合并糖尿病患者临床特点及高盐饮食对其预后影响

目的评估高血压前期合并糖尿病患者的临床特点以及高盐饮食对其预后的影响。方法选取自2004年1月至2014年12月可疑冠心病于沈阳军区总医院心血管内科住院的45~75岁行冠状动脉造影并最终纳入诊断为高血压前期的421例患者为研究对象,按照是否合并糖尿病,分为糖尿病组(n=139)与非糖尿病组(n=282),比较高血压前期两组患者冠状动脉特点。同时,根据饮食情况将糖尿病组患者分为高盐组(n=83)与正常盐组(n=56)。比较并分析高血压前期各组患者临床特点,对患者进行随访,并对随访期间发生高血压及主要不良心血管事件(MACE)的相关因素进行COX回归分析,比较各组随访期间药物使用情况以及高血压、MACE发生情况。结果高血压前期各组患者临床特点比较发现,糖尿病组患者甘油三酯、Gensini评分均明显高于非糖尿病组,而高密度脂蛋白、血红蛋白含量低于非糖尿病组,差异均有统计学意义(P<0.05);高盐组吸烟史、冠心病家族史患者比例、体质量指数(BMI)及甘油三酯水平均明显高于正常盐组,差异均有统计学意义(P<0.05)。高血压前期冠状动脉特点比较,糖尿病组患者多支冠脉病变、行经皮冠状动脉介入治疗(PCI)患者比例,平均支架数、平均支架长度均高于非糖尿病组,无血管病变患者比例低于非糖尿病组,差异均有统计学意义(P<0.05)。随访期间,各组药物使用情况比较,差异均无统计学意义(P>0.05)。糖尿病组患者高血压及MACE发生率均明显高于非糖尿病组,差异有统计学意义(P<0.05)。高盐组患者MACE发生率明显高于正常盐组患者,差异有统计学意义(P<0.05);高盐组患者高血压发生率较正常盐组有增高趋势,但差异无统计学意义(P>0.05)。K-M生存曲线显示,在随访期间高盐组高血压及MACE发生率均明显高于正常盐组,差异有统计学意义(P<0.05)。COX回归分析显示,高盐饮食(风险比=1.97,95%可信区间为1.07~3.63,P<0.05)、高血压家族史(风险比=1.91,95%可信区间为1.04~3.53,P<0.05)为高血压前期合并糖尿病患者发展为高血压的独立危险因素;高盐饮食(风险比=2.12,95%可信区间为1.03~4.35,P<0.05)为高血压前期合并糖尿病患者发展为MACE的独立危险因素。结论高血压前期合并糖尿病的患者血脂高,冠脉病变程度较重,临床预后差;高盐饮食可进一步导致高血压前期合并糖尿病患者高血压及不良心血管事件的发生。     

血清同型半胱氨酸水平与无症状中度颈动脉狭窄患者发生斑块相关脑血管事件相关性研究

目的探讨血清同型半胱氨酸水平与无症状中度颈动脉狭窄患者发生斑块相关脑血管事件的相关性。方法选取自2012年3月至2015年6月收治的无症状中度颈动脉狭窄(50%~69%)患者167例,随访2年,记录患者一般资料、检查结果及斑块相关脑血管事件发生情况等。Logistic回归分析无症状中度颈动脉狭窄患者发生斑块相关脑血管事件的影响因素。结果 167例患者中,12例发生斑块相关脑血管事件。年龄、性别、伴发糖尿病或高血压对无症状中度颈动脉狭窄患者发生斑块相关脑血管事件无影响(P>0.05);血清同型半胱氨酸水平升高是无症状中度颈动脉狭窄患者发生斑块相关脑血管事件的危险因素[比值比(OR)=1.146,95%可信区间1.024~1.283,P<0.05],而规律服用他汀类药物是保护因素(OR=0.177,95%可信区间0.043~0.722,P<0.05)。结论血清同型半胱氨酸水平升高是无症状中度颈动脉狭窄患者发生斑块相关脑血管事件的独立危险因素,规律服用他汀类药物可降低其风险。     

替格瑞洛用于急性冠脉综合征行药物洗脱支架植入患者抗血小板治疗有效性及安全性分析

目的探讨替格瑞洛对急性冠脉综合征行药物洗脱支架植入患者抗血小板治疗的有效性及安全性。方法选取4 401例接受药物洗脱支架植入的急性冠脉综合征患者,在规律应用阿司匹林的基础上(300 mg负荷剂量,100 mg 1次/d),联用替格瑞洛(180 mg负荷剂量,90 mg 2次/d)或氯吡格雷(300~600 mg负荷剂量,75 mg 1次/d),并根据联合用药分为替格瑞洛组和氯吡格雷组。研究终点为术后1年内的有效性终点事件(心血管死亡、心肌梗死、缺血性脑卒中、支架内血栓及复合终点事件)和安全性终点事件(根据美国出血学术研究会制定的标准定义划分的全部出血、大出血和小出血事件)。结果替格瑞洛组的有效性的复合终点事件(HR=0.64,95%可信区间0.42~0.99,P<0.05)和心血管死亡事件(HR=0.07,95%可信区间0.02~0.30,P<0.01)明显低于氯吡格雷组,且安全性终点中大出血事件,差异无统计学意义(HR=0.97,95%可信区间0.50~1.87,P>0.05),但替格瑞洛组小出血和总出血事件明显高于氯吡格雷组。结论对于急性冠脉综合征行药物洗脱支架植入的患者,替格瑞洛与氯吡格雷相比能够明显减少血栓事件再发风险且不增加致命性大出血事件。     

西宁地区中老年男性血尿酸与冠状动脉病变的关系

目的:探讨西宁地区中老年男性血尿酸与冠状动脉病变的关系.方法:入选行冠状动脉造影住院男性病例290例,检测血脂、血糖、血压、血尿酸等.根据血尿酸水平分为两组:正常尿酸组与高尿酸血症组,再根据是否合并糖尿病、高血压分为4个亚组,比较各组间冠脉病变支数、病变总积分及心血管危险因素聚集性.结果:高尿酸血症组较正常尿酸组在肥胖、嗜酒、吸烟、高血压、高血糖、高甘油三酯血症、低高密度脂蛋白血症的发生率上明显偏高(P＜0.05),高尿酸血症组2支血管病变、3支血管病变发生率及Gensini积分明显高于正常血尿酸组(P＜0.05);同样高尿酸血症合并糖尿病或高血压等时冠脉单支病变、2支病变、3支病变的发生率及Gensini积分均显著高于正常尿酸合并糖尿病或高血压组(P＜0.05).结论:高尿酸血症患者合并更多的心血管危险因素,冠脉病变更严重且弥漫,并与糖尿病、高血压等有协同作用.     

GRACE风险评分联合脑钠肽对急性冠状动脉综合征近期死亡率预测研究

目的探讨全球急性冠状动脉事件注册(GRACE)风险评分联合脑钠肽(BNP)对急性冠脉综合征(ACS)患者近期死亡率(≤30 d)的预测价值。方法连续选取诊断为ACS的患者240例,测定各患者的BNP值,并计算GRACE风险评分,根据GRACE风险评分将研究人群分为低危组、中危组和高危组,分析ACS患者在院及出院后30 d内随访期间的死亡率与入院时BNP及GRACE风险评分的相关性。结果各组患者间性别、肥胖状况比较,差异有统计学意义(P<0.05);且高危组BNP的自然对数(Ln BNP)明显高于低危组,差异有统计学意义(P<0.01)。应用二元Logistic回归分析,Ln BNP与GRACE风险评分对于近期死亡率的预测均有统计学意义(P<0.01)。进一步绘制受试者工作特征(ROC)曲线提示,GRACE风险评分曲线下面积(AUC)为0.869(95%可信区间0.785~0.952,P<0.01),Ln BNP的AUC为0.861(95%可信区间0.755~0.967,P<0.01),两者联合AUC为0.900(95%可信区间0.806~0.989,P<0.01)。结论 GRACE风险评分联合BNP对ACS患者近期死亡率有更好的预测价值。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.