Influence of Bleeding Risk on Outcomes of Radial and Femoral Access for Percutaneous Coronary Intervention: An Analysis From the GLOBAL LEADERS Trial

BackgroundRadial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding.MethodsPatients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days.ResultsIn the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; P_interaction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; P_interaction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant.ConclusionsOur findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because this was not a primary analysis, it should be considered hypothesis generating.     

Paeonol ameliorates CFA-induced inflammatory pain by inhibiting HMGB1/TLR4/NF-κB p65 pathway

Metabolic Brain Disease - The enhanced release of inflammatory cytokines mediated by high mobility group box1 (HMGB1) leads to pain sensation, and has been implicated in the etiology of...     

柔红霉素联合阿糖胞苷对急性早幼粒细胞白血病的疗效分析

目的:研究在维甲酸、亚砷酸联合诱导基础上,不同时间应用柔红霉素联合阿糖胞苷对低危组急性早幼粒细胞白血病(APL)的疗效。方法:初治急性早幼粒细胞白血病低危组患者23例,根据白细胞(WBC)计数变化调整化疗方案的合理应用时间,观察在白细胞上升至10×109/L(观察组)及20×109/L(对照组)时加用柔红霉素联合阿糖胞苷的作用效果,以达到提高完全缓解(CR)率,减少APL分化综合征(DS)、弥散性血管内凝血(DIC)等严重并发症的治疗目标。结果:两组初诊WBC计数比较,差异无统计学意义(P>0.05),但治疗后观察组中WBC平均上升速率及上升最高值均低于对照组,且观察组中的DS发生率低于对照组;观察组中位CR时间为26.3 d,对照组中位CR时间为39.6 d,观察组明显早于对照组;另一方面,两组DIC的发生率和CR率比较,差异均无统计学意义(P>0.05)。结论:根据白细胞计数变化(≥10×109/L)加用化疗,可提高低危组急性早幼粒细胞白血病诱导化疗的治疗效果,有效控制疾病进展。     

Natural developing process of immunoglobulin G4-related sialadenitis after submandibular gland excision: a retrospective cohort study

Clinical Rheumatology - This study aimed to evaluate the long-term outcome and quality of life of IgG4-related sialadenitis (IgG4-RS) patients after submandibular gland (SMG) excision without...     

二尖瓣瓣膜成形术治疗非风湿性二尖瓣关闭不全的临床效果

目的 探讨二尖瓣瓣膜成形术(MVP)治疗非风湿性二尖瓣关闭不全的临床效果.方法 选择2006年1月至2013年11月内蒙古医科大学附属医院非风湿性二尖瓣关闭不全患者43例,病因包括先天性瓣叶脱垂、缺血性改变、退行性改变、感染性病变.手术方式为单纯瓣叶部分切除、单纯腱索短缩或转移、瓣膜裂修补、瓣叶部分切除+双孔成形、腱索短缩或转移+瓣膜裂修补、术中均放置二尖瓣成形环,同期冠状动脉旁路移植术,术中采用注水试验和食管内超声评价成形效果.结果 术前超声心动图示二尖瓣均为中大量关闭不全,术中食管内超声发现中量关闭不全2例,改行二尖瓣置换术.43例患者中术后在院死亡1例.出院后随访1 ～83个月,平均(43±17)个月,无再次手术者,无死亡者,超声心动图示40例二尖瓣瓣膜成形术患者中无或少量二尖瓣关闭不全27例,少量到中量关闭不全13例.结论 应用二尖瓣瓣膜成形术治疗非风湿性二尖瓣关闭不全是可行的,可以取得良好的效果.     

食管射频消融术后发热的影响因素分析

目的　探讨食管内镜下射频消融术（radiofrequency ablation,RFA）后患者发热的独立危险因素。方法　2016年1月—2021年4月,因早期食管癌就诊于长海医院消化内科,且病变范围超过食管3/4环周的51例病例纳入病例对照研究。患者均行RFA治疗,按术后是否发热分成发热组（n=15）和未发热组（n=36）,主要收集患者一般情况、消化道肿瘤家族史、病变长度、病变范围、消融能量和消融次数用于单因素分析,其中P<0.1的变量再进一步纳入多因素Logistic回归分析探究RFA术后发热的独立危险因素。结果　单因素分析发现,病变长度（t=-3.89,P<0.001）、病变范围（χ2=11.52,P=0.001）和消融能量（P=0.001）在2组间差异有统计学意义。Pearson相关性显示,病变长度与病变环周长度存在明显正相关（r=0.71,P<0.001）,而病变范围由病变环周长度决定,因此最终将病变长度和消融能量这两个变量纳入Logistic回归方程。Logistic回归分析结果显示,食管病变长度每增加1 cm,患者发生RFA术后发热的风险是前者的1.21倍（95%CI：1.01～1.43,P=0.037）;术中使用12 J消融能量者,发生RFA术后发热的风险是使用10 J消融能量者的0.43倍（95%CI：0.22～0.85,P=0.015）。结论　病变长度和消融能量是导致食管RFA术后发热的独立危险因素。长节段早期食管癌者更易发生RFA术后发热,术中使用低消融能量者更易发生RFA术后发热。     

内镜黏膜下剥离术切除胃内异位胰腺伴导管内乳头状黏液性肿瘤1例

异位胰腺伴导管内乳头状黏液性肿瘤形成是一种罕见的疾病,国内鲜见报道,主要位于胃、肝内胆管和小肠。本文报道1例病例,病变位于胃壁,术前超声内镜显示病变位于黏膜下层,内部回声局部呈中高回声,可见囊腔样无回声区,经内镜黏膜下剥离术完整切除,术后病理为异位胰腺伴导管内乳头状黏液性肿瘤（胃型）。     

城市固体废物产生量与经济增长脱钩关系的实证研究——以北京市为例

采用脱钩理论的3种评价方法 (脱钩指数法、IPAT模型法以及弹性分析法)对北京市城市固体废物产生量与经济增长之间的状态进行对比分析,发现:3种评价方法的原理不同,但评价结果基本一致,但Tapio(2005)提出的弹性分析法模型在指标细分上存在问题;北京市1979—2011年城市固体废物产生量总体实现相对脱钩,但通过分析个别年份状态数据发现要真正实现城市固体废物的减量化需要管理制度的改进,以及市民环保素质的提升。     

淮安市清河区公厕空间布局探讨

运用人群密度分析法和人口分布分析法,对淮安市清河区公共厕所的布局、质量、数量进行分析,并提出了公厕布局方案。