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961.
冠心病心室晚电位与冠状动脉病变的关系 总被引:2,自引:0,他引:2
为观察心室晚电位(VLP)、心律失常事件(AE)与冠状动脉病变的关系,对145例冠心病患者(心绞痛55例、陈旧性心肌梗死90例)进行信号平均心电图的定性分析和24小时Holter监测,并同期进行冠状动脉造影,并长期随访观察。119例(失访26例)随访14.1±7.1(4~36)个月,发生AE7例。VLP阳性者AE发生率25%(4/16),明显高于VLP阴性者AE的发生率2.9%(3/103),P<0.001;VLP、AE与冠状动脉病变血管的支数和狭窄程度之间均无明显关系(P均>0.05)。结果提示VLP与AE密切相关,但VLP、AE与冠状动脉病变的范围和程度无明显关系。 相似文献
962.
The purpose of this article is to report the unusual presentation of a 63-year-old patient with Rutherford grade 2, category 5 tissue ischemic changes involving the right foot secondary to an occult popliteal stenosis that was obscured behind a prosthetic knee on diagnostic angiograms. Conventional abdominal angiography with bilateral lower extremity runoff showed no evidence of significant disease and the patient was misdiagnosed with atheroemboli syndrome secondary to ipsilateral common femoral access following recent catheterization. Ultimately, a meticulous physical examination disclosed a bruit in the right popliteal fossa and selective right leg angiography with oblique views confirmed eccentric complex luminal encroachment in the right popliteal artery that was eclipsed by a prosthetic knee on antecedent nonselective angiography. The lesion responded favorably to endovascular treatment with durable clinical improvement. This case illustrates the importance of a meticulous physical examination and noninvasive studies prior to angiography in patients with ischemic tissue changes and emphasizes the importance of oblique views to image any vessel that may be obscured by a metal prosthesis. 相似文献
963.
《JACC: Cardiovascular Interventions》2020,13(12):1417-1428
ObjectivesThe aim of this study was to evaluate the long-term impact of coronary artery calcification (CAC) on outcomes after percutaneous coronary intervention and the respective performance of first- and second-generation drug-eluting stents (DES).BackgroundWhether contemporary DES have improved the long-term prognosis after percutaneous coronary intervention in lesions with severe CAC is unknown.MethodsIndividual patient data were pooled from 18 randomized trials evaluating DES, categorized according to the presence of angiography core laboratory–confirmed moderate or severe CAC. Major endpoints were the patient-oriented composite endpoint (death, myocardial infarction [MI], or any revascularization) and the device-oriented composite endpoint of target lesion failure (cardiac death, target vessel MI, or ischemia-driven target lesion revascularization). Multivariate Cox proportional regression with study as a random effect was used to assess 5-year outcomes.ResultsA total of 19,833 patients were included. Moderate or severe CAC was present in 1 or more target lesions in 6,211 patients (31.3%) and was associated with increased 5-year risk for the patient-oriented composite endpoint (adjusted hazard ratio [adjHR]: 1.12; 95% confidence interval [CI]: 1.05 to 1.20) and target lesion failure (adjHR: 1.21; 95% CI: 1.09 to 1.34), as well as death, MI, and ischemia-driven target lesion revascularization. In patients with CAC, use of second-generation DES compared with first-generation DES was associated with reductions in the 5-year risk for the patient-oriented composite endpoint (adjHR: 0.88; 95% CI: 0.78 to 1.00) and target lesion failure (adjHR: 0.73; 95% CI: 0.61 to 0.87), as well as death or MI, ischemia-driven target lesion revascularization, and stent thrombosis. The relative treatment effects of second-generation compared with first-generation DES were consistent in patients with and without moderate or severe CAC, although outcomes were consistently better with contemporary devices.ConclusionsIn this large-scale study, percutaneous coronary intervention of target lesion moderate or severe CAC was associated with adverse patient-oriented and device-oriented adverse outcomes at 5 years. These detrimental effects were mitigated with second-generation DES. 相似文献
964.
Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study
Celestino Sardu Gianluca Gatta Gorizio Pieretti Luigi Viola Cosimo Sacra Graziella Di Grezia Lanfranco Musto Salvatore Minelli Daniele La Forgia Mariangela Capodieci Alessandro Galiano Angela Vestito Angela De Lisio Pia Clara Pafundi Ferdinando Carlo Sasso Salvatore Cappabianca Gianfranco Nicoletti Giuseppe Paolisso Raffaele Marfella 《JACC: Cardiovascular Imaging》2021,14(2):426-438
ObjectivesThis study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women.BackgroundTo our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women.MethodsProspective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition.ResultsThe propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation.ConclusionsAmong pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217) 相似文献
965.
为了解胃粘膜癌变过程中多基因蛋白的表达及意义,应用免疫组化技术检测107例内镜活检胃粘膜组织中增殖细胞核抗原(PCNA)及p53、K-ras、bc1-2基因蛋白。结果各基因蛋白阳性率随病变程度加重而增加。Ⅲ型肠化生者增殖细胞核抗原标记指数(PCNALI)及K-ras、bc1-2基因蛋白阳性率较之Ⅰ、Ⅱ型肠化亦有增高趋势但未见统计学差异(P≥0.05)。12例Ⅲ型肠化中有9例出现K-ras或bc1-2蛋白异常表达(75.0%),显著高于Ⅰ、Ⅱ型肠化(23.8%)(P<0.05)。在肠型及胃型胃癌p53表达率为53.3%、37.0%(P>0.05);K-ras为40.0%、7.4%(P<0.05);bc1-2为93.3%、59.3%(P<0.05)。15例肠型胃癌中有9例同时存在2种或2种以上蛋白异常表达(3例p53与bc1-2表达异常,2例bc1-2与K-ras表达异常,4例p53与bc1-2、K-ras异常表达),高于胃型胃癌(P<0.05)。结果提示以上基因产物的表达异常与胃粘膜癌变相关,Ⅲ型肠化属于胃癌癌前病变范畴,肠型胃癌发生发展的分子机制与胃型胃癌显著不同。 相似文献
966.
《JACC: Cardiovascular Interventions》2020,13(1):116-127
ObjectivesThe aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging.BackgroundSerial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported.MethodsIn the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT).ResultsLuminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference −0.37 mm [95% confidence interval: −0.50 to −0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm2 vs. 7.15 ± 2.16 mm2, mean difference −1.04 mm2 [95% confidence interval: −1.66 to −0.42 mm2]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm2 vs. 1.86 ± 0.64 mm2, mean difference 0.24 mm2 [95% confidence interval: 0.06 to 0.43 mm2]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention.ConclusionsIn this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284) 相似文献
967.
《Journal of the American College of Cardiology》2019,73(22):2859-2868
BackgroundTrastuzumab is highly effective for human epidermal growth factor receptor type 2 (HER2)–positive breast cancer but is associated with a decline in left ventricular ejection fraction.ObjectivesThe purpose of this study was to determine whether angiotensin-converting enzyme inhibitors or beta-blockers reduce the rate of trastuzumab-induced cardiotoxicity (left ventricular ejection fraction decrease >10%, or >5% if below 50%) and limit treatment interruptions.MethodsIn this double-blind, multicenter, placebo-controlled trial, cardiotoxicity and treatment interruptions in patients with HER2-positive breast cancer treated with trastuzumab for 12 months were evaluated over a 2-year period. Patients were stratified by anthracycline use and then randomized to receive lisinopril, carvedilol, or placebo.ResultsThe study included 468 women, age 51 ± 10.7 years. For the entire cohort, cardiotoxicity was comparable in the 3 arms and occurred in 32% of patients on placebo, 29% on carvedilol, and 30% on lisinopril. For patients receiving anthracyclines, the event rates were higher in the placebo group (47%) than in the lisinopril (37%) and the carvedilol (31%) groups. Cardiotoxicity-free survival was longer on both carvedilol (hazard ratio: 0.49; 95% confidence interval: 0.27 to 0.89; p = 0.009) and lisinopril (hazard ratio: 0.53; 95% confidence interval: 0.30 to 0.94; p = 0.015) than on placebo. In the whole cohort, as well as in the anthracycline arm, patients on active therapy with either angiotensin-converting enzyme inhibitor or beta-blockers experienced fewer interruptions in trastuzumab than those on placebo.ConclusionsIn patients with HER2-positive breast cancer treated with trastuzumab, both lisinopril and carvedilol prevented cardiotoxicity in patients receiving anthracyclines. For such patients, lisinopril or carvedilol should be considered to minimize interruptions of trastuzumab. (Lisinopril or Coreg CR in Reducing Side Effects in Women With Breast Cancer Receiving Trastuzumab; NCT01009918) 相似文献
968.
Dr. Linda S. Kinsinger MD MPH Russell Harris MD MPH Bahjat Qaqish MD PhD Victor Strecher PhD MPH Arnold Kaluzny PhD 《Journal of general internal medicine》1998,13(8):507-514
OBJECTIVE: To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance
rates of breast cancer screening through implementation of office systems in community primary care practices.
DESIGN: Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with
the practice as the unit of analysis.
SETTING: Twenty mostly rural counties in North Carolina.
PARTICIPANTS: Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service,
half group practices and half solo practitioners.
INTERVENTION: Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide
feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored
to increase breast cancer screening.
MEASUREMENTS AND MAIN RESULTS: Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system.
Three of the five indicators of office systems increased significantly more in intervention practices than in control practices,
but the mean number of indicators in intervention practices at follow-up was only 2.8 out of 5. Cross-sectional reviews of
randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline (n=2,887) and follow-up (n=2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded
in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed
an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44%
in control practices (p=.01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention
group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p=.56). There was a nonsignificant trend (p=.06) toward a greater increase in performance of clinical breast examination in intervention versus control practices.
CONCLUSIONS: A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office
systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but
had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system
for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but
need further development.
Presented in part at the 19th annual meeting of the Society of General Internal Medicine, Washington, DC, May 1996.
This research was supported under grant CA 54343-02 from the National Cancer Institute. 相似文献
969.
肝硬化伴高甲胎蛋白血症的中医证候分析 总被引:1,自引:0,他引:1
目的:探讨肝炎肝硬化伴高甲胎蛋白(AFP)血症的中医证候学特点,为实施肝癌阻断性治疗提供中医辨证论治思路。方法:采用前瞻性流行病学调查方法,提取115例肝炎肝硬化伴高AFP血症患者的中医症状、体征、舌、脉等四诊信息,对患者进行中医辨证,统计分析这类患者的证候学特点。结果:常见的症状依次为:尿黄(93.92%)、倦怠乏力(93、05%)、食少纳呆(72.18%)、脘腹胀满(71.31%)、身目发黄(46.96%)、恶心呕吐(42.61%);体征依次为:面色晦暗(70.44%)、肝掌(47.83%)、蜘蛛痣(37、40%)。舌苔白腻(36.53%),舌苔黄腻(34.79%),舌质红(33.92%),脉弦滑(26.96%)。中医证型依次为:湿热内蕴证(46.09%)、血瘀证(44.35%)、脾虚湿盛证(36、53%)、肝气郁结证(22.61%)、肝肾阴虚证(13.05%)、脾肾阳虚证(2.61%)。结论:肝硬化伴高甲胎蛋白血症阶段的中医证候特点以标实为主,正虚为次。标实主要是湿热、气滞、血瘀,正虚主要是气阴两虚。 相似文献
970.
《JACC: Cardiovascular Imaging》2020,13(10):2162-2173
ObjectivesThis study sought to identify culprit lesion (CL) precursors among acute coronary syndrome (ACS) patients based on qualitative and quantitative computed tomography–based plaque characteristics.BackgroundCoronary computed tomography angiography (CTA) has been validated for patient-level prediction of ACS. However, the applicability of coronary CTA to CL assessment is not known.MethodsUtilizing the ICONIC (Incident COroNary Syndromes Identified by Computed Tomography) study, a nested case-control study of 468 patients with baseline coronary CTA, the study included ACS patients with invasive coronary angiography–adjudicated CLs that could be aligned to CL precursors on baseline coronary CTA. Separate blinded core laboratories adjudicated CLs and performed atherosclerotic plaque evaluation. Thereafter, the study used a boosted ensemble algorithm (XGBoost) to develop a predictive model of CLs. Data were randomly split into a training set (80%) and a test set (20%). The area under the receiver-operating characteristic curve of this model was compared with that of diameter stenosis (model 1), high-risk plaque features (model 2), and lesion-level features of CL precursors from the ICONIC study (model 3). Thereafter, the machine learning (ML) model was applied to 234 non-ACS patients with 864 lesions to determine model performance for CL exclusion.ResultsCL precursors were identified by both coronary angiography and baseline coronary CTA in 124 of 234 (53.0%) patients, with a total of 582 lesions (containing 124 CLs) included in the analysis. The ML model demonstrated significantly higher area under the receiver-operating characteristic curve for discriminating CL precursors (0.774; 95% confidence interval [CI]: 0.758 to 0.790) compared with model 1 (0.599; 95% CI: 0.599 to 0.599; p < 0.01), model 2 (0.532; 95% CI: 0.501 to 0.563; p < 0.01), and model 3 (0.672; 95% CI: 0.662 to 0.682; p < 0.01). When applied to the non-ACS cohort, the ML model had a specificity of 89.3% for excluding CLs.ConclusionsIn a high-risk cohort, a boosted ensemble algorithm can be used to predict CL from non-CL precursors on coronary CTA. 相似文献