Prevalence and predictors associated with severe pulmonary hypertension in COPD

Background

Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients.

Association of mental health with the risk of coronary artery disease in patients with diabetes: A mendelian randomization study

Background and aimsObservational studies have shown an association between mental health and coronary artery disease (CAD) in patients with diabetes. Nevertheless, whether these associations are causal is still unknown. In this two-sample Mendelian randomization (MR) study, we aimed to assess the causality between mental health and CAD in patients with diabetes.Methods and resultsSingle-nucleotide polymorphisms (SNPs) associated with: depression (807,553 individuals), anxiety (83,556 individuals) and neuroticism (329,821 individuals) were identified from the largest genome-wide association studies (GWAS). Summary-level data for CAD were extracted from the recently published GWAS of 15,666 diabetic patients (3968 CAD cases and 11,696 controls). The inverse-variance weighted (IVW) method was used for the main analysis. Sensitivity analyses included weighted median, maximum likelihood, and the MR-Egger method. Genetic liability to depression was significantly associated with a higher risk of CAD in patients with diabetes (odds ratio [OR], 1.286; 95%CI,1.018–1.621;p = 0.035). For anxiety and neuroticism, no causal association with CAD in patients with diabetes was observed. Consistent results were obtained in most sensitivity analyses.ConclusionsThis MR study provides genetic evidence that depression is a potential risk factor for CAD in patients with diabetes. However, anxiety and neuroticism were not causally associated with CAD in patients with diabetes. Mental health treatments should be enhanced to prevent CAD in patients with diabetes.     

Evaluating Quality in Adult Cardiac Surgery

National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.     

原发性高血压患者颈动脉粥样硬化与血清SF,FFA及HCY的相关性研究

目的:通过观察原发性高血压(EH)患者颈动脉内膜中层厚度(CAIMT)和血清铁蛋白(SF)、游离脂肪酸(FFA)及同型半胱氨酸(HCY)的水平,探讨EH患者颈动脉粥样硬化(CAS)与血清SF,FFA及HCY的相关性。方法:以266例EH患者为研究对象,检测CAIMT(彩色多普勒超声仪)和血清SF(电化学发光免疫法)、FFA(酶联法)及HCY(循环酶法)水平,据CAIMT结果分组后进行统计学对比分析。结果:对照组、CAIMT非增厚组和CAIMT增厚组,三组血清SF,FFA及HCY水平依次升高,差异有统计学意义(F=69.171,50.492,38.618,P<0.01);CAIMT增厚组与非增厚组差异具有统计学意义(t=12.561,8.296,4.581,P<0.01);CAIMT非增厚组与对照组差异也具有统计学意义(t=6.305,4.062,2.913,P<0.01)。CAIMT分别与血清SF,FFA及HCY水平具有相关性,呈显著正相关(r=0.597,0.493,0.451;t=9.560,7.279,4.533,P<0.01)。结论:EH患者体内存在着高水平的SF,FFA及HCY,CAS的发生与血清SF,FFA及HCY水平显著相关,改善其水平可能是防治或延缓EH合并CAS的策略之一。     

颈动脉硬化斑块超声造影评估

目的：探讨颈动脉硬化斑块超声造影的临床价值。方法：将171例患者分成急性脑梗塞组、有症状组、无症状组,进行常规超声检查和斑块超声造影,根据斑块超声造影增强强度进行定性和半定量比较。结果：3组患者在斑块回声强度、斑块内血流信号和溃疡性斑块上有显著差异（P<0.01）;患者颈动脉斑块CEUS增强分级在3组间无显著差异（P>0.01）;颈动脉斑块超声造影增强定量测值比较,EI值和Ratio比值在急性脑梗塞组与有症状组间没有显著差异（P>0.01）,但在急性脑梗塞组与无症状组、有症状组与无症状组间有显著差异（P<0.01）。结论：超声造影对患者颈动脉硬化斑块稳定性的评估提供了较可靠的方法,与常规超声的联合应用大大提高超声诊断率,对脑卒中患者的筛查和指导临床治疗将大有裨益。     

Angled views in the evaluation of the right coronary artery

The use of cranial and caudal angulated views in the angiographic evaluation of the right coronary artery (RCA) was assessed in 61 patients. Each patient had a standard LAO and RAO view, followed by one or more angled views. The standard LAO view showed the area about the origin of the posterior descending artery (PD₀) adequately in 33 of 46 patients (72% ), and the mid and distal portions of the posterior descending artery (PD_m&d) adequately in 26/46 (56% ). The standard RAO view showed the PD₀ adequately in only 17/46 (37% ) and the PD_m&d adequately in 41/46 (89% ). With the LAO cranial view, however, the PD₀ was seen well in 45/46 (98% ), and PD_m&d was seen well in 44/46 (96% ). The RAO angled views, although of more limited utility, also afforded improved visualization of the distal segments of the RCA. We recommend the use of angled views in the evaluation of the right coronary artery, as these views, particularly the LAO cranial view, afford improved visualization of the distal segments of the RCA.