Score du risque échocardiographique après un syndrome coronaire aigu

AimsIdentify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores.MethodsWe recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months.ResultsThe echocardiographic risk score has four variables: LV-EF (RR = 0.931; 95%CI = 0.885–0.979, P < 0.01), RV-AF (RR = 0.951; 95%CI = 0.903–0.999, P < 0.05), iMAE-M-strain (RR = 1.226; 95%CI = 1.081–1.390, P < 0.01) and ULCs (RR = 1.151; 95%CI = 1.081–1.224, P < 0.01). Its discrimination capacity (AUC = 0.85), greater than that of the clinical risk scores, (GRACE: AUC = 0.72, TIMI: AUC = 0.71 and CRUSADE: AUC = 0.76).DiscussionThe risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate.ConclusionThe developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.     

Genetically determined lean mass and dietary response

Weight loss attenuates many obesity-related co-morbidities, but is difficult to sustain with dietary change. Dietary adherence, not macronutrient composition, is a better predictor of weight loss. Weight loss-induced endocrine changes promote food intake and increase energy efficiency, contributing to the difficulty with dietary adherence and weight regain. Macronutrient preference is partly genetically determined, suggesting that personalized dietary interventions might be more successful. In this issue, Li et al. report that a genetic risk score comprising the cumulative weighted effects of variants previously associated with increased lean mass is associated with increased satiety and weight loss 6 months after initiating a low- but not a high-fat diet. The effects were attenuated by 2 years. These findings suggest that genetic variants may influence response to specific diet. Further studies are necessary to assess whether genetically determined lean mass is causally associated with dietary response. Significant progress has recently been made in identifying additional genetic determinants of lean mass, which will enable such investigations and potentially inform future nutritional studies.     

Discourses on the Toxic Effects of Internal Chemical Contamination in Catalonia,Spain

Human exposure to and contamination by environmental toxic compounds generates discourses and practices that merit greater attention. In this article, we assess internal chemical contamination and the risk of toxic effects as an experience related to the production of meaning in everyday life. Drawing on the analysis of semantic networks of narratives from semi-structured interviews conducted with 43 informants in Catalonia, Spain, we consider participants’ perceptions of the health risks of toxic compounds, including social discourses on exposure, toxicity, and internal chemical contamination, and on responsibilities, consequences, and proposed strategies for controlling toxic compounds. Informants’ narratives on the relationships between nature and nurture suggest that they no longer perceive rigid boundaries separating the human body from the external environment and its chemical pollutants.     

护理专案改善在减少住院患者跌倒中的应用

目的了解护理专案改善在降低住院患者跌倒发生率中的应用效果。方法将医院2016年1月—2018年12月的80例住院患者随机分组,传统护理组对于住院患者给予传统护理,护理专案模式组对于住院患者采取护理专案模式。比较两组满意评分;护理人员工作积极性评分;护理前后住院患者对跌倒危险因素的掌握水平、住院患者遵医行为;跌倒的发生率。结果护理专案模式组满意评分、住院患者对跌倒危险因素的掌握水平、住院患者遵医行为、护理人员工作积极性评分、跌倒的发生率对比传统护理组有优势,P<0.05。结论住院患者实施护理专案模式效果确切,可提高护理服务质量和住院患者自我防护能力,降低跌倒的发生率。     

Preferences and attitudes of young Chinese clinicians about using a shared decision making tools for communicating cardiovascular risk

ObjectiveThis study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM).MethodsFrom May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann–Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario.ResultsOf the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM.ConclusionsMost young Chinese clinicians want to participate in SDM. However, they state the main barriers to perform SDM are lack of experience and time. The educational intervention about SDM that exposes clinicians to DAs was found to increase their receptivity.     

胃肠道间质瘤的MSCT表现与病理危险程度分析

目的研究胃肠道间质瘤的MSCT表现与病理危险程度分级的关系。方法此项研究对象为医院2014年1月—2018年12月经过手术、病理等确诊为胃肠道间质瘤的患者,共计50例,对其MSCT表现进行回顾分析,评估肿瘤最大径、生长方式等和病理危险程度分级关系。结果50例胃肠道间质瘤患者中,胃部18例,胃肠道外5例,肠道27例;病理分级中低度危险7例,中度危险8例,重度危险35例。不同危险程度肿瘤出现的位置和强化情况差异无统计学意义(P>0.05),肿瘤生长方式、形态、转移情况等对比差异有统计学意义(P<0.05)。结论胃肠道间质瘤的MSCT表现有特性,和病理危险程度分级密不可分,对治疗、确定预后等有积极影响。     

Optimal cut-off value of preprocedural geriatric nutritional risk index for predicting the clinical outcomes of patients undergoing endovascular revascularization for peripheral artery disease

BackgroundMalnutrition measured by the geriatric nutritional risk index (GNRI) was reported to be associated with poor prognosis for patients with peripheral artery disease (PAD). However, the optimal cut-off value of preprocedural GNRI for critical limb ischemia (CLI) and intermittent claudication (IC) is unknown. We aimed to determine its optimal cut-off value for CLI or IC patients requiring endovascular revascularization.MethodsWe explored data of 2246 patients (CLI: n = 1061, IC: n = 1185) registered in the Tokyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry, which prospectively enrolled consecutive PAD patients who underwent endovascular revascularization in 34 hospitals in Japan from August 2014 to August 2016. The optimal cut-off values of GNRI were assessed by the survival classification and regression tree (CART) analyses, and the survival curve analyses for major adverse cardiovascular and limb events (MACLEs) were performed for these cut-off values.ResultsIn addition to the first cut-off value of 96.2 in CLI and 85.6 in IC, the survival CART provided an additional cut-off value of 78.2 in CLI and 106.0 in IC for further risk stratification. The survival curve was significantly stratified by the GNRI-based malnutrition status in both CLI [high risk: 47.7% (51/107), moderate: 30.1% (118/392), and low: 10.2% (53/520), log–rank p < 0.001] and IC [high risk: 14.3% (7/49), moderate: 4.5% (29/646), and low: 0.5% (2/407), log–rank p < 0.001]. The multivariate Cox-proportional hazard analysis showed that a higher GNRI was significantly associated with a better outcome in both CLI [hazard ratio (HR) per 1-point increase: 0.97, 95% CI: 0.96–0.98, p < 0.001] and IC (HR: 0.94, 95% CI: 0.91–0.97, p < 0.001).ConclusionsPreprocedural nutritional status significantly stratified future events in patients with PAD. Given that the optimal cut-off value of GNRI in CLI was almost 10-points lower than that of IC, using a disease-specific cut-off value is important for risk stratification.