Issues influencing development of the Canadian Cardiovascular Information Network

The 1995 Consensus Conference of the Canadian Cardiovascular Society on "Indications for and Access to Revascularization" recommended that Canadian centres with invasive cardiovascular facilities should participate in a national observational database that monitors the selection of patients, as well as evaluate outcomes. The Canadian Cardiovascular Society, the Heart and Stroke Foundation of Canada, and Health Canada with IBM as a partner, initiated a process to identify factors influencing the development of the Canadian Cardiovascular Information Network. IBM's "Business Discovery Methodology" was adapted for health care. Structured interviews with representatives of health organizations, cardiovascular databases and research institutes were conducted across Canada, followed by a workshop to identify goals, issues and challenges. Participants identified goals for a cardiovascular database (eg, evidence-based decision-making), project related issues (eg, respecting the integrity of existing databases) and health care related issues (eg, cardiac waiting lists). Challenges included initial mistrust between representatives of provincial cardiovascular databases and national agencies, and a lack of sustained funding. A Project Team was formed to address 'cardiac waiting lists'. Analysis of Alberta and Ontario data identified differences in definitions, such as when the waiting time for bypass surgery began, that impeded detailed comparisons. Development of a centralized national database was not feasible at this time for political, technical and financial reasons. However, provincial cardiovascular database representatives agreed to work together and to share aggregate data and analyses. A first step toward developing a national surveillance system for cardiovascular services will be achieving consensus about standardizing data definitions. This process will require sustained funding.     

Ductal and acinar differentiation in pancreatic endocrine tumors

Rare pancreatic endocrine tumors consisting of both exocrine and endocrine components have been reported sporadically. We investigated the ductal and acinar differentiation in pancreatic endocrine tumors. In immunohistochemical studies of 28 pancreatic endocrine tumors, staining with anti-carcinoembryonic antigen (CEA) or CA19-9 antibody indicated ductal differentiation, while staining with anti-amylase or anti-trypsin antibody indicated acinar differentiation. K-ras gene mutations and p53 gene alterations also were studied. Ten tumors were immunoreactive for CEA or CA19-9. Five tumors diffusely immunoreactive for CEA or CA19-9, in addition to endocrine markers, were diagnosed as duct–endocrine cell tumors of the pancreas. Two tumors diffusely immunoreactive for CEA or CA19-9 and also for pancreaticogut hormones as well as endocrine markers were diagnosed as duct–acinar–endocrine cell tumors. These tumors showed uniform histologic features and synchronous ductal, acinar, and endocrine differentiation, distinct from the coexisting different cellular populations seen in collision tumors. All tumors were malignant. These duct–endocrine cell tumors or duct–acinar–endocrine cell tumors of the pancreas may be derived from a stem cell that retains the capability of expressing either an exocrine or endocrine phenotype. Only one K-ras gene mutation and no p53 gene alterations were detected in these tumors, which suggests that they constitute an entity with a different origin than ductal carcinomas.     

Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials.

OBJECTIVES: We sought to best estimate the benefits and risks associated with rescue percutaneous coronary intervention (PCI) and repeat fibrinolytic therapy as compared with conservative management in patients with failed fibrinolytic therapy for ST-segment myocardial infarction (STEMI). BACKGROUND: Fibrinolytic therapy is the most common treatment for STEMI; however, the best therapy in patients who fail to achieve reperfusion after fibrinolytic therapy remains uncertain. METHODS: We performed a meta-analysis of randomized trials using a fixed-effects model. We included 8 trials enrolling 1,177 patients with follow-up duration ranging from hospital discharge to 6 months. RESULTS: Rescue PCI was associated with no significant reduction in all-cause mortality (relative risk [RR] 0.69; 95% confidence interval [CI] 0.46 to 1.05), but was associated with significant risk reductions in heart failure (RR 0.73; 95% CI 0.54 to 1.00) and reinfarction (RR 0.58; 95% CI 0.35 to 0.97) when compared with conservative treatment. Rescue PCI was associated with an increased risk of stroke (RR 4.98; 95% CI 1.10 to 22.5) and minor bleeding (RR 4.58; 95% CI 2.46 to 8.55). Repeat fibrinolytic therapy was not associated with significant improvements in all-cause mortality (RR 0.68; 95% CI 0.41 to 1.14) or reinfarction (RR 1.79; 95% CI 0.92 to 3.48), but was associated with an increased risk for minor bleeding (RR 1.84; 95% CI 1.06 to 3.18). CONCLUSIONS: Rescue PCI is associated with improved clinical outcomes for STEMI patients after failed fibrinolytic therapy, but these benefits must be interpreted in the context of potential risks. On the other hand, repeat fibrinolytic therapy is not associated with significant clinical improvement and may be associated with increased harm.     

蜂皇浆联合碘伏治疗新生儿重Ⅱ度臀红的临床观察

[目的]观察蜂皇浆联合碘伏治疗新生儿重Ⅱ度臀红的临床效果。[方法]将80例重Ⅱ度臀红新生儿随机分为观察组和对照组各40例。观察组温水清洗臀部后用清洁棉布吸干水分,先用0.5%碘伏消毒臀部创面,待碘伏自然干燥后用无菌棉签蘸蜂皇浆涂于创面,约5min后蜂皇浆凝固形成保护膜,然后用纸尿裤包裹臀部,每日3次。对照组采用临床常规方法治疗:0.02%高锰酸钾溶液坐浴15min后涂氧化锌油膏,再用纸尿裤包裹臀部,每日3次。两组患儿治疗期间均指导家属保持臀部清洁,勤换尿布。观察两组患儿哭闹发生率、治疗总有效率及创面愈合时间。[结果]观察组治疗总有效率(100.0%)高于对照组(85.0%);观察组创面愈合时间(4.23d±1.06d)短于对照组(5.35d±1.25d);观察组新生儿哭闹发生率(5.0%)低于对照组(80.0%)。[结论]蜂皇浆联合碘伏治疗新生儿重Ⅱ度臀红效果显著。     

The Risk of Erectile Dysfunction in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study in Taiwan

The prevalence of erectile dysfunction (ED) in patients with chronic obstructive pulmonary disease (COPD) seemed high; however, large scale of population-based study was absent.We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. The cohort included 29,042 male patients who were newly diagnosed with COPD. Patients were recruited between 2000 and 2011, and the date of diagnosis was defined as the index date. Each patient was randomly matched with 1 male person from the general population without COPD according to age and the index year. The occurrence of ED was followed up until the end of 2011. The hazard ratios of ED were estimated using the Cox proportional hazard model after adjusting for age, index year, comorbidities, and medications.The overall incidence of ED was 1.88-fold greater in the COPD cohort than in the non-COPD cohort (24.9 vs 13.3/1000 person-years, 95% confidence interval [CI] = 1.61–2.18). Compared with non-COPD patients, the hazard ratio increased with the number of emergency room visits and admissions for COPD from 1.51 (95% CI 1.29–1.77) to 5.46 (95% CI 3.03–9.84) and from 1.50 (95% CI 1.28–1.76) to 11.5 (95% CI 5.83–22.6), respectively.Patients with COPD are at a significantly higher risk of developing ED compared with the general population regardless of age and presence of comorbidity. The results also support that poor control of COPD status is a key factor affecting ED development.     

基于中医证候与危险分层关系的高脂血症神经网络预警模型研究

目的：探讨基于高脂血症中医证候与危险分层的神经网络预警模型。方法：在Matlab R2010a环境下,以高脂血症中医证候为输入,高脂血症危险分层为输出,建立反向传播（BP）神经网络预警模型。随机选取286例作为神经网络学习训练样本,剩余的30例作为测试样本。为了提高模型精度,建模前先对输入自变量进行降维处理。结果：降维前后的结果对比显示,经过降维处理后的神经网络预测准确率有所提高,平均误差为10%左右,说明建立的神经网络模型能够较好地预测高脂血症的风险等级。结论：研究结果表明,所建立的模型能够较好地提取中医证候与高脂血症危险分层的内在关系,将神经网络技术用于高脂血症中医证候与危险分层的研究是可行的。