简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.

简介：ObjectivesToinvestigatetheanti-apoptoticeffectsofmesenchymalstemcells(MSCs)onhypoxicinjuredcardiacmyocytesinvitro.MethodsMSCswereisolatedfrombonemarrowofSprague-Dawley(SD)rats,andcardiacmyocytesfromneonatalrats.Theratcardiacmyocyteswereco-culturedwithMSCsorMSC-conditionedmediainanoxia(95%N2+5%CO2)for72hours.CellapoptosiswasmeasuredbyHoechst33258staining.TheexpressionofBcl-2andBaxincardiacmyocyteswastestedbyWesternBlot.ResultsTheapoptoticratewas51.6%±2.4%whencardiacmyocyteswereculturedincontinuoushypoxiaandwassignificantlydecreasedwhencardiacmyocyteswerecoculturedwithMSCsorMSC-conditionedmedia(15.1%±5.4%and24.0%±4.2%respectively,P<0.001).ThedecreasedexpressionofBaxinthecardiacmyocyteswasgreatlyrelatedtothedecreasingofapoptosis,buttherewasnodifferenceinBcl-2expressionamongthesegroups.ConclusionsCo-culturedMSCsshowedsignificantanti-apoptoticeffectsoncardiacmyocytesincontinuoushypoxia.ThemechanismmaybetheinteractofcelltocellandparacrineofcytokineswhicheffectedtheexpressionofBaxinthecardiacmyocytes.

简介：BackgroundTheclinicalcharacteristicsofstrokepatientstreatedwithdoubleanti-platelettherapy(DAPT)afterpercutaneouscoronaryintervention(PCI)isnotclear.MethodsIntotal,2675patientsunderwentPCIandDAPTinGuangdongGeneralHospital,and68outofthemwerehospitalizedduetosuspectedstroke,ofwhom23werediagnosedashavingstroke.Dataofthe23strokepatientswerecollectedandtraditionalriskfactorsassociatedwithstrokewereanalyzedretrospectively.ResultsThemeanageofthesepatientswas75.6±8.7years,and20(87.0%)weremales.Notably,19patientswerecomplicatedwithhypertension,7withdiabetesmellitus,7withprevioushistoryofstroke,nonewithatrialfibrillation(AF)orpatentforamenovale(PFO).Specifically,22patientswerediagnosedwithischemicstroke,and1patientwithhemorrhagicstroke.ConclusionStrokeinpatientstreatedwithDAPTafterPCIwascorrelatedwithadvancedage,gender,hypertension,diabetesmellitus,strokehistory.Longtermelectrocardiography(ECG)maybeneededforthediagnosisofAF,whiletrans-esophagealechocardiography(TEE)maybeneededforPFO.

简介：Background:Thesafetyandefficacyofcoronaryarterybypassgrafting(CABG)andsecond-generationdrug-elutingstents(DESs)inpatientswithcoronaryarterydisease(CAD)remaincontroversial.ThereforeweaimedtocomparetheoutcomesofCADpatientstreatedwithCABGandsecond-generationDESs.Methods:WesystematicallysearchedthePubMed,CochraneLibrary,Ovid,andElsevierdatabases.Studiescomparingsecond-generationDESswithCABGinCADpatientswereincluded.RevMan5.3wasusedtoextractandpoolthedatafromtheapplicablestudies.Results:Sixtrials(N=6604participants)wereincludedinthismeta-analysis.AmongalloftheCADpatients,second-generationDESswereassociatedwithnodifferencesintherisksofall-causedeath[riskratio(RR)1.18,95%confidenceinterval(CI)0.98–1.43,P=0.09],cardiovasculardeath(RR1.14,95%CI0.81–1.59,P=0.45),myocardialinfarction(RR1.22,95%CI0.98–1.54,P=0.08),andstroke(RR0.83,95%CI0.59–1.17,P=0.29),butincreasedtherisksofrevascularization(RR1.95,95%CI1.66–2.30,P<0.001)andmajoradversecardiacandcerebrovascularevents(RR1.72,95%CI:1.31–2.26,P<0.001)whencomparedwithCABG.Conclusions:InthetreatmentofCADpatients,second-generationDESswasnotassociatedwithincreasedrisksofall-causedeath,cardiovasculardeath,myocardialinfarction,andstroke,butincreasedtherisksofrevascularizationandmajoradversecardiacandcerebrovasculareventswhencomparedwithCABG.

简介：BackgroundAdvancedpracticenursetransitionalcarehasbeenproofedtobeimportantforolderadultswithchronicconditions.However,sucheffectivenesshasneverbeenstudiedinthemanagementofappropriateWarfarinuseinclinicalpractice.MethodsAtotalof97patientswererandomlydistributedintocontrolgroupwhoreceivedusualcare,andinterventionalgroupwhoreceivedtransitionalcareprovidedbyAPNs.A12-monthobservationofbothgroupswererecordedbyphysiciansandAPNsandtheimpactofAPNsonthemanagingofWarfarintherapywasalsoevaluatedbasedontimeinthetherapeuticrange(TTR).ResultsAPNstransitionalcaresignificantly(P<0.01)improvedpatients’adherence,increasedTTRandhighTTRratiocomparedwithcontrolgroup.Re-admissionduetostrokewassignificantly(P<0.01)reducedbyAPNstransitionalcare.ConclusionAPNstransitionalcareimprovespatients’knowledgeonAFandreducesstrokerisk.ThecurrentresearchstronglysuggestthenecessityofAPNstransitionalinterventionalinmanaginganticoagulationtherapyinAFpatientsinChina.

简介：BackgroundInclopidogrel-treatedpatientsundergoingpercutaneouscoronaryintervention(PCI),theeffectofconcomitantuseofPPIsonprognosisremainsunclear.MethodsFromJuly2010toJune2012,600patientsafterimplantationofdrug-elutingstent(DES)wereassignedto3groupsaccordingtothemedicaltherapy:group1(n=200)receivedduralantiplatelettherapy(DAPT)alone(aspirine100mgdailyplusclopidogrel75mgdaily),group2(n=199)receivedDAPTpluspantoprazole20mgdailywhilegroup3(n=201)receivedDAPTplusomeprazole20mgdailyfor1year.Theprimaryoutcomewasmajoradversecardiovascularevents(MACEs)whichcomposeofdeath,nonfatalmyocardialinfarction(MI),nonfatalstroke,targetvesselrevascularization(TVR)orstentthrombosis(ST)at1year.PlateletreactivitywasevaluatedforallpatientsbeforePCIand1yearafterPCI.ResultsTherewasnosignificantdifferenceintheplateletreactivityamongthe3groupsat1-yearfollow-up(27.3%versus29.9%versus29.3%,respectively,P=0.339).Neitherwastheresignificantdifferenceintheincidenceof1-yearMACEs(13%versus14.6%versus12.4%,respectively,P=0.809).ConclusionsConcomitantuseofpantoprazoleoromeprazoledidnotinfluenceplateletreactivityorclinicaleventsinpatientsreceivingDAPTafterimplantationofDES.

简介：BackgroundCreatinekinase-MB(CK-MB)elevationafterpercutaneouscoronaryintervention(PCI)hasbeenassociatedwithincreasedriskformortality.Althoughmoststudieshavedefinedperiproceduralmyocardialinfarction(pMI)asanelevationinCK-MB>3×upperlimitofnormal(ULN),useofdifferentCK-MBassaysandvariationinsite-specificdefinitionsoftheULNmaylimitthevalueofsuchrelativethresholds.MethodsandResultsWeuseddatafromthemulticenterEvaluationofDrug-ElutingStentsandIschemicEvents(EVENT)registrytoexaminetheimpactofvariationsinsite-specificthresholdsforCK-MBelevationontheincidenceofpMIaswellastherelationshipbetweenabsolutepeaklevelsofCK-MBafterPCIand1-yearmortality.Thestudycohortconsistedof6347patientswhounderwentnonemergentPCIandhadnormalCK-MBatbaseline.Acrossthe59studycenters,theULNforCK-MBrangedfrom2.6to10.4ng/mL(median,5.0ng/mL),andtherewasaninverserelationshipbetweenthesite-specificULNandtheincidenceofpMI(definedasCK-MBelevation>3×ULN).AlthoughanypostprocedureelevationofCK-MBwasassociatedwithanadverseprognosis,incategoricalanalyses,onlyCK-MB≥50ng/mLwasindependentlyassociatedwithincreased1-yearmortality(hazardratio,4.71;95%confidenceinterval,2.42to9.13;P<0.001).SplineanalysisusingpeakCK-MBasacontinuousvariablesuggestedagraded,nonlinearrelationshipwith1-yearmortality,withaninflectionpointat≈30ng/mL.ConclusionsAmongunselectedpatientsundergoingPCI,thereisagradedrelationshipbetweenCK-MBelevationafterPCIand1-yearmortalitythatisparticularlystrongforlargeCK-MBelevations(>30to50ng/mL).FuturestudiesthatincludepMIasaclinicalendpointshouldconsiderusingacorelaboratorytoassessCK-MB(toensureconsistency)andraisingthethresholdfordefiningpMIabovecurrentlevels(toenhanceclinicalrelevance).

简介：BackgroundPriorrandomizedtrialshaveshownreducedbleedingwithbivalirudincomparedwithunfractionatedheparin(UFH)inpatientsundergoingpercutaneouscoronaryintervention(PCI).However,itisnotknownifthisbenefitisalsopresentwhenUFHdosesaremoretightlycontrolled(asmeasuredbyactivatedclot-tingtime,ACT).MethodsandResultsPatientsenrolledintheEVENT(EvaluationofDrug-ElutingStentsandIschemicEvents)registry,weredividedinto3groups,basedontheantithromboticdrugusedduringPCI(UFHmonotherapy,UFH+glycoproteinIIb-IIIareceptorinhibitor[GPI],orbivalirudinalone).Propensityscorematchingwasusedtoadjustformeasuredcovariates(89variables)andtocomparebivalirudinversusUFHmonotherapyandbivalirudinversusUFH+GPIgroups.TheUFHgroupswerestratifiedbasedonACTachieved(optimalACTdefinedas250-300forUFHmonotherapyand200-250whenGPIwasalsoused).Theprimarybleedingoutcomewasin-hospitalcompositebleeding,definedaseventsofaccesssitebleeding,ThrombolysisInMyocardialInfarctionmajor/minorbleeding,ortransfusion.Primary(in-hospitaldeath/myocardialinfarction)andsecondaryischemicoutcomes(death/MI/unplannedrepeatrevascularizationat12months)werealsoevaluated.Propensityscorematchingyielded3022patientsfortheUFHmonotherapyversusbivalirudincomparisonand3520patientsfortheUFH+GPIversusbivalirudincomparison.BivalirudinusewasassociatedwithnumericallylowerbleedingratesatallcategoriesofachievedACTwhencomparedwithUFH(low,optimal,highACT:2.5%versus4.7%,1.9%versus6.0%,3.1%versus4.8%,respectively)orheparin+GPIgroups(low,optimal,highACT:0.0%versus2.7%,2.7%versus5.2%,2.4%versus6.1%,respectively)andwasnotassociatedwithanystatisticallysignificantincreaseineitherprimaryorsecondaryischemicoutcomes.ConclusionsAmongunselectedpatientsundergoingPCI,bivalirudinuseduringPCIwasassociatedwithalowerriskofbleedingatall