Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement: A Contemporary Nationwide Perspective

ObjectivesThis study sought to use a national representative database to assess the incidence, predictors, and outcomes of balloon aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve replacement (TAVR) in contemporary practice.BackgroundNationwide data on the use and outcomes of BAV as a bridge to TAVR are limited.MethodsPatients who underwent BAV between January and June in 2015 and 2016 were identified in the National Readmission Database. We assessed rate of subsequent TAVR following BAV, and predictors and timing of subsequent TAVR. We then identified a group of patients who had direct TAVR (without prior BAV) in the original 2015 to 2016 National Readmission Database dataset. We compared in-hospital outcomes following TAVR between patients with prior bridging BAV and those undergoing direct TAVR.ResultsAmong the 3,691 included patients 1,426 (38.6%) had subsequent TAVR. Timing of TAVR was pre-discharge in 7.4%, within 30 days in 35%, between 31 and 90 days in 47%, between 91 and 180 days in 14%, and >180 days in 4%. Negative predictors of subsequent TAVR included prior defibrillator (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.36 to 0.85), dementia (OR: 0.60; 95% CI: 0.46 to 0.79), malnutrition (OR: 0.64; 95% CI: 0.45 to 0.90), and malignancy (OR: 0.62; 95% CI: 0.47 to 0.82). In propensity-score matched cohorts of patients who underwent direct TAVR versus those with prior BAV, in-hospital mortality during TAVR admission was similar (3.7% vs. 3.5%; p = 0.91). Major complications, length of stay, and discharge disposition were also comparable. However, cost of the hospitalization was higher in the direct TAVR group.ConclusionsAbout 40% of BAV patients undergo subsequent TAVR mostly within 90 days. In-hospital outcomes of TAVR in these patients were comparable with propensity-score matched patients who underwent TAVR without prior BAV. Further investigations are needed to define the role of BAV in contemporary practice.     

Granulocytapheresis (GCAP) for severe alcoholic hepatitis-A preliminary report.

AIM: To evaluate the efficacy of granulocytapheresis therapy in alcoholic hepatitis. METHODS: We attempted to trap leukocytes in the peripheral circulation using the granulocytapheresis (GCAP) technique in patients with severe alcoholic hepatitis who showed a marked elevation of peripheral leukocytes. Corticosteroids were co-administered. RESULTS: The Maddrey's indices for these patients varied between 42 and 117 and MELD scores for alcoholic hepatitis (Mayo) ranged from 20 to 44. Survival rate was 50% (3/6), which is better than the results reported recently for similar patients in a national survey (29%). The effect of GCAP was reflected in decreases in interleukin-6 and interleukin-8 levels as well as in serum concentrations of soluble intercellular adhesion molecule. White blood cell counts were not affected. In the surviving patients, the Maddrey's indices and MELD scores for alcoholic hepatitis varied between 49 and 67, and 20 and 22, respectively, showing that GCAP is effective in patients with disease of moderate severity. Hemolytic anemia occurred in one patient after GCAP therapy. Other events such as pancreatitis, pneumonia, and cerebral hemorrhage were considered to be related to the alcoholic hepatitis itself. CONCLUSION: GCAP therapy deserves further evaluation as a new therapeutic modality for a moderately severe alcoholic hepatitis.     

Usefulness of multidetector CT imaging to assess vascular stents in children with congenital heart disease: An in vivo and in vitro study

Objective : To evaluate varying CT settings to visualize pediatric vascular stents in comparison to digital angiography (DA). Background : There is a great clinical interest in substituting noninvasive methods to follow up children with congenital heart disease after interventional treatment. Materials and Methods : CT studies in small children with transcatheter placed stents were reviewed, retrospectively. Furthermore, eight stents were implanted in tubes and partially obstructed. CT exams were performed on varying scanners (4 up to 64 slices) with corresponding tube settings. The effects of dose on image quality were evaluated regarding stent size, strut thickness, and in‐stent stenoses in comparison to DA. Results : Fourteen children with 28 implanted stents were identified. Significant differences between higher and lower radiation settings were not found, corresponding with the phantom, where moderate tube setting showed the best results. In vitro, there was an improvement with increasing number of detector rows, which resulted in a decrease of stent strut overestimation (295% down to 201%; P < 0.0001) and a better agreement with DA measurements for mild (78% up to 91%; P = 0.003) and moderate in‐stent stenoses (80% up to 99%; P = 0.0001). Conclusion : Higher radiation exposure settings did not improve image quality, suggesting that the exams could be performed at a lower radiation dose. © 2008 Wiley‐Liss, Inc.     

Una puntuación de riesgo genético predice recurrencias en pacientes jóvenes con infarto agudo de miocardio

Introduction and objectivesTo evaluate whether a genetic risk score (GRS) improves prediction of recurrent events in young nondiabetic patients presenting with an acute myocardial infarction (AMI) and identifies a more aggressive form of atherosclerosis.MethodsWe conducted a prospective study with consecutive nondiabetic patients aged < 55 years presenting with AMI. We performed a genetic test, cardiac computed tomography, and analyzed several biomarkers. We studied the association of a GRS composed of 11 genetic variants and a primary composite endpoint (cardiovascular mortality, a recurrent event, and cardiac hospitalization).ResultsA total of 81 patients were studied and followed up for a median of 4.1 years. There were 24 recurrent cardiovascular events. Compared with the general population, study participants had a higher prevalence of 9 out of 11 risk alleles. The GRS was significantly associated with recurrent cardiovascular events, especially when baseline low-density lipoprotein cholesterol (LDL-C) levels were elevated. Compared with the low-risk GRS tertile, the multivariate-adjusted HR for recurrences was 10.2 (95%CI, 1.1-100.3; P = .04) for the intermediate-risk group and was 20.7 (2.4-181.0; P = .006) for the high-risk group when LDL-C was ≥ 2.8 mmol/L (≥ 110 mg/dL). Inclusion of the GRS improved the C-statistic (ΔC-statistic = 0.086), cNRI (continuous net reclassification improvement) (30%), and the IDI (integrated discrimination improvement) index (0.05). Cardiac computed tomography frequently detected coronary calcified atherosclerosis but had limited value for prediction of recurrences. No association was observed between metalloproteinases, GRS and recurrences.ConclusionsA multilocus GRS may identify individuals at increased risk of long-term recurrences among young nondiabetic patients with AMI and improve clinical risk stratification models, particularly among patients with high baseline LDL-C levels.     

不同剂量拉莫三嗪治疗老年癫痫的比较研究

目的 探讨不同剂量拉莫三嗪治疗老年癫痫患者的临床疗效。方法 选择2014年7月—2018年2月洛阳市第三人民医院神经内科诊治的老年癫痫患者88例作为研究对象,根据拉莫三嗪使用剂量分为对照组（40例）和观察组（48例）。对照组患者给予大剂量拉莫三嗪片治疗,拉莫三嗪起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量100 mg/d,维持100 mg/d治疗观察至第8周。观察组患者给予小剂量拉莫三嗪片治疗,起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量50 mg/d,维持50 mg/d治疗观察至第8周。观察两组患者的临床疗效,同时比较两组患者蒙特利尔认知评估量表（MoCA）评分、P300潜伏期、波幅和不良反应情况。结果 治疗后,对照组和观察组总有效率分别为97.5%、97.9%,两组对比差异无统计学意义。治疗后,两组患者的MoCA评分均显著高于治疗前,同组治疗前后比较差异具有统计学意义（P<0.05）;且观察组治疗后的MoCA评分显著高于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,观察组的P300潜伏期显著降低,波幅明显升高,同组治疗前后比较差异具有统计学意义（P<0.05）;且观察组治疗后P300潜伏期及波幅显著优于对照组,两组比较差异具有统计学意义（P<0.05）。观察组治疗期间的不良反应发生率为6.3%,显著低于对照组的32.5%,两组比较差异具有统计学意义（P<0.05）。结论 相对于大剂量,小剂量拉莫三嗪治疗老年癫痫患者能达到很好的疗效,能减少不良反应的发生,改善患者的神经电生理功能与认知功能。     

安宫牛黄丸联合阿加曲班治疗急性脑梗死的临床研究

目的研究安宫牛黄丸联合阿加曲班注射液治疗急性脑梗死的临床疗效。方法选取2017年10月—2019年10月在河南中医药大学第三附属医院治疗的120例急性脑梗死患者为研究对象,将所有患者随机分为对照组和治疗组,每组各60例。对照组患者静脉泵注阿加曲班注射液,10 mg溶于100 mL生理盐水,持续静脉泵注3 h,2次/d。治疗组在对照组基础上口服安宫牛黄丸,1丸/次,1次/d。两组患者接受治疗时间为4周。观察两组的临床疗效,比较两组Barthel指数、美国国立卫生研究院卒中量表(NHISS)评分、大脑平均血流速度和血液学指标[神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)]。结果治疗后,治疗组总有效率(95.00%)显著高于对照组(83.33%)(P0.05)。治疗后,两组Barthel指数显著升高,NHISS评分显著降低(P0.05);且治疗组Barthel指数、NHISS评分改善较明显(P0.05)。治疗后,两组患者大脑中动脉、大脑前动脉、大脑后动脉的平均血流速度均明显升高(P0.05);且治疗组患者平均血流速度升高较明显(P0.05)。治疗后,两组患者血清NSE水平明显降低,BDNF水平明显升高(P0.05);且治疗组血清NSE、BDNF水平改善较明显(P0.05)。治疗后,两组患者血清hs-CRP、TNF-α、IL-8水平明显降低(P0.05);且治疗组患者血清hs-CRP、TNF-α和IL-8水平均降低较为明显(P0.05)。结论安宫牛黄丸联合阿加曲班注射液治疗急性脑梗死具有较好的临床疗效,能够改善患者神经功能和生活质量,调节血液学指标,值得在临床上推广应用。     

金刚藤胶囊联合头孢美唑钠治疗慢性盆腔炎的临床研究

目的探讨金刚藤胶囊联合注射用头孢美唑钠治疗慢性盆腔炎的临床疗效。方法选取2018年11月—2019年10月在郑州大学医院进行治疗的108例慢性盆腔炎患者为研究对象,根据用药差别分为对照组(54例)和治疗组(54例)。对照组患者静脉滴注注射用头孢美唑钠,1.0g加入生理盐水100m L,2次/d;治疗组患者在对照组治疗基础上口服金刚藤胶囊,2 g/次,3次/d。两组均经2周治疗后进行效果比较。比较两组的临床疗效,观察两组治疗前后中医症候积分、WHOQOL-100评分、血清学指标和子宫动脉血流动力参数的变化情况。结果治疗后,治疗组总有效率是98.15%显著高于对照组的85.19%(P0.05)。经治疗,两组中医症候积分均较治疗前显著降低,而WHOQOL-100评分均增高(P0.05);治疗后,治疗组中医症候积分低于对照组,而WHOQOL-100评分高于对照组(P0.05)。经治疗,两组血清C反应蛋白(CRP)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、降钙素原(PCT)、血红素氧合酶1(HO-1)、单核细胞趋化蛋白-1(MCP-1)水平均较治疗前显著降低(P0.05);且治疗后治疗组这些血清学指标显著低于对照组(P0.05)。经治疗,两组子宫动脉血流搏动指数(PI)、阻力指数(RI)、收缩期峰值血流速度(PSV)均显著改善(P0.05),且以治疗组改善更显著(P0.05)。结论金刚藤胶囊联合注射用头孢美唑钠治疗慢性盆腔炎具有较好的临床疗效,可有效改善患者临床症状,降低机体炎症反应,有利于改善子宫动脉血流动力学指标,提高患者生活质量,具有一定的临床推广应用价值。     

西尼必利联合胃复春片治疗慢性萎缩性胃炎的临床研究

目的 探讨酒石酸西尼必利片联合胃复春片治疗慢性萎缩性胃炎的临床疗效。方法 选取2018年1月—2019年3月天津中医药大学第一附属医院收治的120例慢性萎缩性胃炎患者作为研究对象,按照随机数字表法将所有患者分为对照组和治疗组,每组各60例。对照组口服胃复春片,4片/次,3次/d。治疗组在对照组的基础上饭前15 min口服酒石酸西尼必利片,1 mg/次,3次/d。两组患者连续治疗12周。观察两组临床疗效,比较两组的临床症状评分、胃黏膜炎症病理评分、胃泌素（GAS）、胃动素（MTL）及谷胱甘肽过氧化物酶（GSH-Px）、前列腺素E₂（PGE₂）。结果 治疗后,治疗组的临床总有效率为93.33%,明显高于对照组80.00%,差异具有统计学意义（P<0.05）。治疗后,两组患者胃脘疼痛评分、胃中嘈杂评分、嗳气泛酸评分、胃黏膜炎症病理评分均较治疗前明显降低（P<0.05）;并且治疗后治疗组患者临床症状评分、胃黏膜炎症病理评分均明显低于对照组（P<0.05）。治疗后,两组患者GAS、MTL水平均较治疗前明显降低,GSH-Px、PGE₂水平较治疗前明显升高（P<0.05）;治疗后,治疗组患者GAS、MTL水平明显低于对照组,GSH-Px、PGE₂水平明显高于对照组（P<0.05）。结论 酒石酸西尼必利片联合胃复春片治疗慢性萎缩性胃炎的疗效确切,能有效改善临床症状、减轻胃黏膜炎症。     

安胃疡胶囊联合替普瑞酮治疗胃溃疡的临床研究

目的探讨安胃疡胶囊联合替普瑞酮胶囊治疗胃溃疡的临床疗效。方法选取2017年6月-2019年6月在驻马店市中医院治疗的102例胃溃疡患者,根据用药差别分为对照组(51例)和治疗组(51例)。对照组患者口服替普瑞酮胶囊,50mg/次,3次/d;治疗组在对照组基础上口服安胃疡胶囊,0.4g/次,4次/d。两组患者均经4周治疗。观察两组患者临床疗效,比较两组患者症候积分、GQOL-74量表评分、幽门螺杆菌根除率、溃疡愈合率、胃动素(MTL)、胃泌素(GAS)、生长抑素(SS)和降钙素基因相关肽水平(CGRP)水平,以及血清血管内皮生长因子(VEGF)、白细胞介素-8(IL-8)、IL-17、高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶-9(MMP-9)和前列腺素E2(PGE2)水平。结果治疗后,对照组和治疗组临床有效率分别为80.39%、98.04%,两组比较差异有统计学意义(P<0.05)。经治疗,两组患者症候积分和GQOL-74评分均明显下降(P<0.05),且治疗组比对照组降低更明显(P<0.05)。经治疗,治疗组幽门螺杆菌根除率和溃疡愈合率均显著高于对照组(P<0.05)。经治疗,两组患者MTL、GAS、IL-8、IL-17、HMGB1、MMP-9表达均明显下降(P<0.05),CGRP、SS、VEGF和PGE2水平均明显升高(P<0.05),且治疗后治疗组这些指标水平明显好于对照组(P<0.05)。结论安胃疡胶囊联合替普瑞酮胶囊治疗胃溃疡可显著促进患者临床症状改善,改善患者生活质量、胃肠激素水平,促进溃疡愈合。     

阿托伐他汀联合米力农治疗慢性心力衰竭的临床研究

目的探讨阿托伐他汀钙联合米力农注射液治疗慢性心力衰竭的临床疗效。方法选取2018年12月—2019年12月于河南省人民医院进行治疗的慢性心力衰竭患者93例,随机分为对照组(46例)和治疗组(47例)。对照组iv米力农注射液,首次采用50μg/kg负荷剂量静脉推注10 min,随后以0.25～0.50μg/(kg·min)静脉匀速泵入,连续使用72 h;治疗组患者则在对照组基础上口服阿托伐他汀钙片,10 mg/次,2次/d。两组均连续治疗1周。观察两组的临床疗效,比较两组治疗前后临床症状评分、6 min步行距离、心功能指标及血清去甲肾上腺素、细胞间黏附分子-1(ICAM-1)、超敏C反应蛋白(hs-CRP)、醛固酮(ALD)、脑自然肽氨基端前体蛋白(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平。结果治疗后,对照组临床总有效率78.26%明显低于治疗组93.62%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者临床症状评分显著降低,但6 min步行距离显著升高(P0.05);且治疗后治疗组临床症状评分和6 min步行距离相较于对照组改善更为显著(P0.05)。治疗后,两组患者心功能指标左心室射血分数(LVEE)、左心室收缩末内径(LVESD)、左心室收缩末期容积(LVESV)均较治疗前明显改善(P0.05);且治疗后治疗组心功能相关指标相较于对照组改善更为显著(P0.05)。治疗后,两组患者血清去甲肾上腺素、ICAM-1、hs-CRP、ALD、NT-proBNP、cTnI水平均较治疗前明显降低(P0.05);且治疗后治疗组这些相关血清生化指标显著低于对照组(P0.05)。结论阿托伐他汀钙联合米力农注射液治疗慢性心力衰竭疗效确切,能显著改善患者临床症状及心功能指标,可改善患者相关血清生化指标,具有一定的临床推广应用价值。