Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
Objective:To analyze the application effectiveness of the integrated medical-nursing comprehensive care model in cases of cerebral infarction and clarify its clinical practical value for the patient rehabilitation pro...Objective:To analyze the application effectiveness of the integrated medical-nursing comprehensive care model in cases of cerebral infarction and clarify its clinical practical value for the patient rehabilitation process.Methods:A total of 60 patients with cerebral infarction admitted from June 2024 to December 2024 were selected as the research subjects and randomly divided into a control group and a research group,with 30 cases in each group.Patients in the control group received routine clinical nursing measures,while those in the study group underwent collaborative healthcare intervention in addition to routine nursing.The intervention included joint disease assessment,personalized rehabilitation training guidance,psychological counseling,and continuous nursing services after discharge.A comparative study was conducted by evaluating indicators such as the scores on adverse emotion scales,the extent of neurological recovery,the effectiveness rate of clinical rehabilitation treatment,and the level of satisfaction with nursing services between the two groups.Results:After the intervention,the scores on the Self-Rating Anxiety Scale(SAS)and the Self-Rating Depression Scale(SDS)in the study group decreased to(40.12±5.01)and(41.36±5.20),respectively,both significantly lower than those in the control group,which were(47.36±5.82)and(48.95±5.63),respectively.The differences between the two groups were statistically significant(p<0.05).The improvement in the neurological deficit scores of patients in the study group reached(9.18±2.04),higher than that in the control group,which was(5.17±1.82)(p<0.05).The overall clinical rehabilitation effectiveness rate in the study group was 93.3%,significantly higher than that in the control group,which was 73.3%.The satisfaction rate with nursing services in the study group reached 96.7%,also higher than that in the control group,which was 83.3%.The differences between the two groups were statistically significant(p<0.05).Conclusion:The integrated healthcare nursing model can effectively alleviate adverse emotional states in patients with cerebral infarction,facilitate the repair and reconstruction of neurological function,improve the effectiveness of clinical rehabilitation treatment and satisfaction with nursing services,and thus holds high value for clinical promotion and application.展开更多
Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Met...Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Methods:A total of 90 elderly pregnant women with gestational diabetes who were delivered in our hospital from January 2023 to January 2024 were selected as the research objects.They were randomly divided into an observation group and a control group,with 45 cases in each group.The control group only received routine pregnancy care and basic nutrition guidance,while the observation group received personalized nutrition support on this basis.Compare the blood glucose control,incidence of pregnancy complications,pregnancy outcomes,and neonatal outcomes between two groups of parturient.Result:After intervention,the fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)of the observation group were significantly lower than those of the control group,and the differences were statistically significant(p<0.05);The incidence of complications such as gestational hypertension syndrome,polyhydramnios,premature rupture of membranes,and postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant(p<0.05);The cesarean section rate in the observation group was significantly lower than that in the control group,and the incidence of adverse neonatal outcomes such as fetal distress,macrosomia,neonatal asphyxia,and neonatal hypoglycemia in the observation group was significantly lower than that in the control group,with statistical significance(p<0.05).Conclusion:Individualized nutritional support for elderly women with gestational diabetes can effectively improve the level of maternal blood sugar control,reduce the incidence of complications during pregnancy,and improve the outcome of pregnancy and neonatal outcomes,which is of high clinical value.展开更多
BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of pr...BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.展开更多
BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities...BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.展开更多
Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes signif...Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.展开更多
Despite advanced therapies,the mortality of patients with myocardial infarction(MI)complicated by cardiogenic shock(CS)remains around 50%.Mechanical complications of MI are rare nowadays but associated with high morta...Despite advanced therapies,the mortality of patients with myocardial infarction(MI)complicated by cardiogenic shock(CS)remains around 50%.Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS.Different treatment strategies and mechanical circulatory support(MCS)devices have been increasingly used to improve the grim prognosis of refractory CS.This article discusses current evidence regarding the use of MCS in MI complicated by CS,ventricular septal rupture,free wall rupture and acute mitral regurgitation.Device selection should be tailored according to the cause and severity of CS.Early MCS initiation and multidisciplinary team cooperation is mandatory for good results.MCS associated bleeding remains a major complication and an obstacle to better outcomes.Ongoing prospective randomized trials will improve current knowledge regarding MCS indications,timing,and patient selection in the coming years.展开更多
Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with compl...Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.展开更多
Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduc...Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduced the incidence of these complications to less than 1%. These complications pose significant hemodynamic consequences and necessitate prompt diagnosis. Echocardiography, cardiac magnetic resonance imaging, and computed tomography are valuable tools for establishing an accurate and expedited diagnosis. Consequently, it is imperative to conduct further scientific research to enhance hemodynamic stabilization techniques such as intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation, in addition to exploring new surgical procedures that can reduce mortality resulting from mechanical complications. This article aims to provide a comprehensive review of mechanical complications following myocardial infarction and their correlation with multi-imaging, facilitating a better understanding of these complications.展开更多
Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) usually involves complete thrombotic occlusion of a coronary artery and require urgent reperfusion;it is one of the leading cause of global mortali...Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) usually involves complete thrombotic occlusion of a coronary artery and require urgent reperfusion;it is one of the leading cause of global mortality and morbidity worldwide. A variety of mechanical, rhythmic, conductive, embolic or hemodynamic complications can occur following STEMI, especially when the treatment is delayed or inadequate. Clinical presentation: A 58-year-old patient with hypertension was admitted to our department for a circumferential STEMI complicated by an ischemic stroke;received 24 hours after the onset of pain. His blood pressure was 100/60 mmHg, heart rate was 55 beats/min. The examination revealed right central facial paralysis and a slight motor deficit of the right upper limb (muscle strength 4/5). The first electrocardiogram (ECG) showed a significant circumferential ST-segment elevation with Q waves in the same territory, as well as a Luchiani Wenckebach atrio-ven- tricular block. The first echocardiography performed showed apical akinesia along with the presence of an apical thrombus. Coronarography was not performed because it was not available and the patient was given curative low molecular weight heparin combined with dual antiplatelet therapy, an angiotensin converting enzyme inhibitor and high dose statins. Seventy-two hours later, the ECG showed a complete atrioventricular block with narrow QRS and the average ventricular rate was 51 beats/min. The patient was asymptomatic. Another echocardiography was performed to assess new complications and showed a rupture of the left ventricular wall and a moderate amount of circumferential pericardial effusion, without any sign of cavity compression. No particular therapeutic attitude was adopted apart from close monitoring with daily ECG and echocardiography. Ten days later, spontaneous regression of the AV Bloc was noted. Conclusion: ST-Segment Elevation Myocardial Infarction is a major cause of morbidity and mortality worldwide. A variety of complications can occur after myocardial infarction, especially when revascularisation is delayed or inadequate.展开更多
There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these ...There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these complications is associated with extremely high mortality. Reviewing the scientific literature, we found descriptions of sporadic cases of both of those complications combined. We report an unusual case of simultaneous rupture of free wall and interventricular septum.展开更多
Revascularization to infarcted area after left ventricular free-wall rupture has been controversial. A 68-year-old man with acute myocardial infarction presented to our hospital and developed a left ventricular free-w...Revascularization to infarcted area after left ventricular free-wall rupture has been controversial. A 68-year-old man with acute myocardial infarction presented to our hospital and developed a left ventricular free-wall rupture. We repaired the left ventricular oozing rupture without culprit artery revascularization, however, followed by papillary muscle rupture and left ventricular blow-out rupture, which resulted in sudden death.展开更多
Objective: to observe the effect of individualized nursing in the treatment of myocardial infarction with stent implantation. Methods: 74 patients with acute myocardial infarction in our department were taken as the a...Objective: to observe the effect of individualized nursing in the treatment of myocardial infarction with stent implantation. Methods: 74 patients with acute myocardial infarction in our department were taken as the analysis target, and they were divided into personalized group and general group, using personalized comprehensive nursing and using basic nursing respectively. Results: in the comparison of satisfaction and complications between the personalized group and the general group, the personalized group was 97.29%, 5.55%, and the general group was 81.08%, 27.77% (χ2 = 20.758, P = 0.000). Conclusion: personalized nursing method is effective in the treatment of myocardial infarction with stent implantation and can be popularized.展开更多
Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated...Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated. Methods: 55 AMI patients admitted to our hospital from November 2019 to November 2020 were selected as the experimental group, and 55 AMI patients admitted to our hospital during the same period were selected as the reference group. The experimental group received integrated emergency care combined with evidence-based nursing, while the control group received outpatient and emergency routine emergency care. The duration of emergency treatment, rescue results, incidence of complications and cardiac function level of patients in two groups under different intervention modes were compared. Results: the duration of OTD, DTN, triage assessment, D2B and hospital stay in the experimental group were shorter than those in the reference group (P < 0.05). The rescue success rate of the experimental group was significantly higher than that of the reference group. The death rate, AMI recurrence rate and PCI rate were significantly lower than those in the reference group, with statistical significance (P < 0.05).The incidence of complications in the experimental group was 21.82%, significantly lower than that in the control group (50.91%, P < 0.05). Conclusion: through evidence-based nursing emergency identify first aid problem and solve to optimize the integration of inside and outside hospital emergency first aid process, which can effectively shorten the hospitalization time and start time for PCI treatment after admission, triage assessment and D2B time, thus improve rescue success rate, reduce recurrence AMI, again PCI rate and incidence of complications. It plays a positive role in reducing the case fatality rate.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy...Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy on serum inflammatory factors. Methods: In this study, 90 patients with acute cerebral infarction hospitalized in Zhuji People’s Hospital from December 2023 to December 2024 were selected and divided into two groups of 45 patients in each group. The control group used standard medical treatment, and the treatment group compared the changes of serum inflammatory factors IL-CRP, TNF-α, and Hcy with Huoxue Tongmai capsule for 7 days, 14 days and 30 days, and discussed the changes of the modified Rankin scale score (mRS) and National Institutes of Health Stroke Scale (NIHSS) score. Results: At 7 days, 14 days, and 30 days of treatment, the NIHSS score, mRS score, hs-CRP, IL-6, TNF-α, and Hcy levels were statistically significant (P α, and Hcy levels in the treatment group were significantly lower than those in the control group (P Conclusion: Patients with acute cerebral infarction received Huoxue Tongmai capsule combined with edaravone right camphor, which can reduce the inflammatory reaction, improve the nerve function and improve the prognosis.展开更多
BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompa...BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.展开更多
BACKGROUND： Heart rate variability refers to the beat-to-beat alteration in heart rate. It is usually a slight periodic variation of R-R intervals. Much information of autonomic nerve system balance can be obtained b...BACKGROUND： Heart rate variability refers to the beat-to-beat alteration in heart rate. It is usually a slight periodic variation of R-R intervals. Much information of autonomic nerve system balance can be obtained by measuring the heart rate variability of patients. It remains to be shown whether heart rate variability can be used as an index for determining the severity of insomnia and cerebral infarction. OBJECTIVE： This study aimed to analyze the correlation for each frequency spectrum parameter of heart rate variability with an insomnia index, as well as the degree of neurological defects in patients with simple cerebral infarction and cerebral infarction complicated by insomnia. The goal was to verify the feasibility of frequency spectrum parameters for heart rate variability as a marker for insomnia and cerebral infarction. DESIGN： A case-control observation. SETTING： Department of Neurology, First Hospital Affiliated to China Medical University. PARTICIPANTS： Sixty inpatients, and/or outpatients, with cerebral infarction were admitted to the 202 Hospital of Chinese PLA between December 2005 and October 2006, confirmed by CT, and recruited to the study. According to the insomnia condition （insomnia is defined by a Pittsburgh Sleep Quality Index score 〉 7）, the patients were assigned to a simple cerebral infarction group and a cerebral infarction complicated by insomnia group, with 30 subjects in each group. Thirty additional subjects, who concurrently received examinations and were confirmed to not suffer from cerebral infarction and insomnia, were recruited into the control group. Written informed consent was obtained from each subject for laboratory specimens. The protocol was approved by the Hospital＇s Ethics Committee. METHODS： Following admission, each subject＇s neurological impairment was assessed with the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index. Heart rate variability of each subject was measured with an autonomic nerve analyzer （Weijin Science and Technology Co., Ltd., Taiwan）. Each frequency spectrum parameter of heart rate variability was obtained, including very low frequency, low frequency, high frequency, total power, R-R interval, and its mean square. In addition, percentage of low frequency, high frequency, and ratio of low frequency to high frequency were calculated. For each heart rate frequency spectrum parameter, the difference between groups was analyzed. Moreover, correlations of each frequency spectrum parameter with insomnia and disease condition were analyzed. Data from each index, which were not normally distributed, were processed by logarithmic transformation. The t-test was used for the comparison of intergroup differences. Single-factor linear regression analysis and t-test were used for the analysis of factor-factor correlation and coefficient of correlation, respectively. MAIN OUTCOME MEASURES： （1） Differences of scores in the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index between the simple cerebral infarction group and the cerebral infarction complicated by insomnia group. （2） Differences of heart rate variability parameters between the simple cerebral infarction group and the control group. （3） Correlation of heart rate variability parameters, the Pittsburgh Sleep Quality Index score, and the neurological impairment score. RESULTS： Sixty patients and thirty healthy controls were included in the final analysis. （1） The scores of the Pittsburgh Sleep Quality Index and the neurological impairment were significantly higher in the cerebral infarction complicated by insomnia group compared to the simple cerebral infarction group （P 〈 0.05-0.01）. （2） R-R interval was significantly longer in the simple cerebral infarction group than in the control group, while R-R interval variance and high-frequency band were significantly lower in the simple cerebral infarction group compared to the control group （P 〈 0.05）. （3） For cerebral infarction patients with insomnia, the Pittsburgh Sleep Quality Index score was significantly positively correlated with neurological impairment （r = 0.54, P 〈 0.01）. The low-frequency band, very low-frequency band, high-frequency band, R-R interval variance, total power, R-R interval, and the percentage of high-frequency were significantly negatively correlated with the National Institutes of Health Stroke Scale score （r =4）.45 to 4）.90, P 〈 0.054）.01） and with the Pittsburgh Sleep Quality Index scores （r = 4）.56 to 4）.36, P 〈 0.054）.01）. CONCLUSION： Each heart rate variability parameter can be used as an index for assessing dyssomnia and neurologic impairment （r =4）.56 to 4）.36, P 〈 0.054）.01）.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study ai...It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.展开更多
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
基金Science and Technology Support Program Project of Baoding City,Hebei Province(Project No.:2541ZF107)。
文摘Objective:To analyze the application effectiveness of the integrated medical-nursing comprehensive care model in cases of cerebral infarction and clarify its clinical practical value for the patient rehabilitation process.Methods:A total of 60 patients with cerebral infarction admitted from June 2024 to December 2024 were selected as the research subjects and randomly divided into a control group and a research group,with 30 cases in each group.Patients in the control group received routine clinical nursing measures,while those in the study group underwent collaborative healthcare intervention in addition to routine nursing.The intervention included joint disease assessment,personalized rehabilitation training guidance,psychological counseling,and continuous nursing services after discharge.A comparative study was conducted by evaluating indicators such as the scores on adverse emotion scales,the extent of neurological recovery,the effectiveness rate of clinical rehabilitation treatment,and the level of satisfaction with nursing services between the two groups.Results:After the intervention,the scores on the Self-Rating Anxiety Scale(SAS)and the Self-Rating Depression Scale(SDS)in the study group decreased to(40.12±5.01)and(41.36±5.20),respectively,both significantly lower than those in the control group,which were(47.36±5.82)and(48.95±5.63),respectively.The differences between the two groups were statistically significant(p<0.05).The improvement in the neurological deficit scores of patients in the study group reached(9.18±2.04),higher than that in the control group,which was(5.17±1.82)(p<0.05).The overall clinical rehabilitation effectiveness rate in the study group was 93.3%,significantly higher than that in the control group,which was 73.3%.The satisfaction rate with nursing services in the study group reached 96.7%,also higher than that in the control group,which was 83.3%.The differences between the two groups were statistically significant(p<0.05).Conclusion:The integrated healthcare nursing model can effectively alleviate adverse emotional states in patients with cerebral infarction,facilitate the repair and reconstruction of neurological function,improve the effectiveness of clinical rehabilitation treatment and satisfaction with nursing services,and thus holds high value for clinical promotion and application.
文摘Objective:To explore the clinical effect of personalized nutritional support in elderly women with gestational diabetes(GDM),and explore its impact on the incidence of maternal complications and pregnancy outcomes.Methods:A total of 90 elderly pregnant women with gestational diabetes who were delivered in our hospital from January 2023 to January 2024 were selected as the research objects.They were randomly divided into an observation group and a control group,with 45 cases in each group.The control group only received routine pregnancy care and basic nutrition guidance,while the observation group received personalized nutrition support on this basis.Compare the blood glucose control,incidence of pregnancy complications,pregnancy outcomes,and neonatal outcomes between two groups of parturient.Result:After intervention,the fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)of the observation group were significantly lower than those of the control group,and the differences were statistically significant(p<0.05);The incidence of complications such as gestational hypertension syndrome,polyhydramnios,premature rupture of membranes,and postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the difference was statistically significant(p<0.05);The cesarean section rate in the observation group was significantly lower than that in the control group,and the incidence of adverse neonatal outcomes such as fetal distress,macrosomia,neonatal asphyxia,and neonatal hypoglycemia in the observation group was significantly lower than that in the control group,with statistical significance(p<0.05).Conclusion:Individualized nutritional support for elderly women with gestational diabetes can effectively improve the level of maternal blood sugar control,reduce the incidence of complications during pregnancy,and improve the outcome of pregnancy and neonatal outcomes,which is of high clinical value.
文摘BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.
文摘Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.
基金supported by the Agency for the Czech Republic Health Research(No.15-27994A)。
文摘Despite advanced therapies,the mortality of patients with myocardial infarction(MI)complicated by cardiogenic shock(CS)remains around 50%.Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS.Different treatment strategies and mechanical circulatory support(MCS)devices have been increasingly used to improve the grim prognosis of refractory CS.This article discusses current evidence regarding the use of MCS in MI complicated by CS,ventricular septal rupture,free wall rupture and acute mitral regurgitation.Device selection should be tailored according to the cause and severity of CS.Early MCS initiation and multidisciplinary team cooperation is mandatory for good results.MCS associated bleeding remains a major complication and an obstacle to better outcomes.Ongoing prospective randomized trials will improve current knowledge regarding MCS indications,timing,and patient selection in the coming years.
文摘Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.
文摘Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduced the incidence of these complications to less than 1%. These complications pose significant hemodynamic consequences and necessitate prompt diagnosis. Echocardiography, cardiac magnetic resonance imaging, and computed tomography are valuable tools for establishing an accurate and expedited diagnosis. Consequently, it is imperative to conduct further scientific research to enhance hemodynamic stabilization techniques such as intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation, in addition to exploring new surgical procedures that can reduce mortality resulting from mechanical complications. This article aims to provide a comprehensive review of mechanical complications following myocardial infarction and their correlation with multi-imaging, facilitating a better understanding of these complications.
文摘Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) usually involves complete thrombotic occlusion of a coronary artery and require urgent reperfusion;it is one of the leading cause of global mortality and morbidity worldwide. A variety of mechanical, rhythmic, conductive, embolic or hemodynamic complications can occur following STEMI, especially when the treatment is delayed or inadequate. Clinical presentation: A 58-year-old patient with hypertension was admitted to our department for a circumferential STEMI complicated by an ischemic stroke;received 24 hours after the onset of pain. His blood pressure was 100/60 mmHg, heart rate was 55 beats/min. The examination revealed right central facial paralysis and a slight motor deficit of the right upper limb (muscle strength 4/5). The first electrocardiogram (ECG) showed a significant circumferential ST-segment elevation with Q waves in the same territory, as well as a Luchiani Wenckebach atrio-ven- tricular block. The first echocardiography performed showed apical akinesia along with the presence of an apical thrombus. Coronarography was not performed because it was not available and the patient was given curative low molecular weight heparin combined with dual antiplatelet therapy, an angiotensin converting enzyme inhibitor and high dose statins. Seventy-two hours later, the ECG showed a complete atrioventricular block with narrow QRS and the average ventricular rate was 51 beats/min. The patient was asymptomatic. Another echocardiography was performed to assess new complications and showed a rupture of the left ventricular wall and a moderate amount of circumferential pericardial effusion, without any sign of cavity compression. No particular therapeutic attitude was adopted apart from close monitoring with daily ECG and echocardiography. Ten days later, spontaneous regression of the AV Bloc was noted. Conclusion: ST-Segment Elevation Myocardial Infarction is a major cause of morbidity and mortality worldwide. A variety of complications can occur after myocardial infarction, especially when revascularisation is delayed or inadequate.
文摘There are three major mechanical complications of acute myocardial infarction: rupture of the left ventricular free wall, rupture of the interventricular septum, and development of mitral regurgitation. Each of these complications is associated with extremely high mortality. Reviewing the scientific literature, we found descriptions of sporadic cases of both of those complications combined. We report an unusual case of simultaneous rupture of free wall and interventricular septum.
文摘Revascularization to infarcted area after left ventricular free-wall rupture has been controversial. A 68-year-old man with acute myocardial infarction presented to our hospital and developed a left ventricular free-wall rupture. We repaired the left ventricular oozing rupture without culprit artery revascularization, however, followed by papillary muscle rupture and left ventricular blow-out rupture, which resulted in sudden death.
文摘Objective: to observe the effect of individualized nursing in the treatment of myocardial infarction with stent implantation. Methods: 74 patients with acute myocardial infarction in our department were taken as the analysis target, and they were divided into personalized group and general group, using personalized comprehensive nursing and using basic nursing respectively. Results: in the comparison of satisfaction and complications between the personalized group and the general group, the personalized group was 97.29%, 5.55%, and the general group was 81.08%, 27.77% (χ2 = 20.758, P = 0.000). Conclusion: personalized nursing method is effective in the treatment of myocardial infarction with stent implantation and can be popularized.
文摘Objective: the effect of survival rate and complications of integrated emergency care inside and outside the hospital combined with evidence-based nursing for patients with acute myocardial infarction was investigated. Methods: 55 AMI patients admitted to our hospital from November 2019 to November 2020 were selected as the experimental group, and 55 AMI patients admitted to our hospital during the same period were selected as the reference group. The experimental group received integrated emergency care combined with evidence-based nursing, while the control group received outpatient and emergency routine emergency care. The duration of emergency treatment, rescue results, incidence of complications and cardiac function level of patients in two groups under different intervention modes were compared. Results: the duration of OTD, DTN, triage assessment, D2B and hospital stay in the experimental group were shorter than those in the reference group (P < 0.05). The rescue success rate of the experimental group was significantly higher than that of the reference group. The death rate, AMI recurrence rate and PCI rate were significantly lower than those in the reference group, with statistical significance (P < 0.05).The incidence of complications in the experimental group was 21.82%, significantly lower than that in the control group (50.91%, P < 0.05). Conclusion: through evidence-based nursing emergency identify first aid problem and solve to optimize the integration of inside and outside hospital emergency first aid process, which can effectively shorten the hospitalization time and start time for PCI treatment after admission, triage assessment and D2B time, thus improve rescue success rate, reduce recurrence AMI, again PCI rate and incidence of complications. It plays a positive role in reducing the case fatality rate.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
文摘Objective: To explore the therapeutic effect of Huoxue Tongmai capsule combined with edaravone right camphor on patients with acute cerebral infarction (Acute Cerebral Infarction) and the effect of combination therapy on serum inflammatory factors. Methods: In this study, 90 patients with acute cerebral infarction hospitalized in Zhuji People’s Hospital from December 2023 to December 2024 were selected and divided into two groups of 45 patients in each group. The control group used standard medical treatment, and the treatment group compared the changes of serum inflammatory factors IL-CRP, TNF-α, and Hcy with Huoxue Tongmai capsule for 7 days, 14 days and 30 days, and discussed the changes of the modified Rankin scale score (mRS) and National Institutes of Health Stroke Scale (NIHSS) score. Results: At 7 days, 14 days, and 30 days of treatment, the NIHSS score, mRS score, hs-CRP, IL-6, TNF-α, and Hcy levels were statistically significant (P α, and Hcy levels in the treatment group were significantly lower than those in the control group (P Conclusion: Patients with acute cerebral infarction received Huoxue Tongmai capsule combined with edaravone right camphor, which can reduce the inflammatory reaction, improve the nerve function and improve the prognosis.
文摘BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.
文摘BACKGROUND： Heart rate variability refers to the beat-to-beat alteration in heart rate. It is usually a slight periodic variation of R-R intervals. Much information of autonomic nerve system balance can be obtained by measuring the heart rate variability of patients. It remains to be shown whether heart rate variability can be used as an index for determining the severity of insomnia and cerebral infarction. OBJECTIVE： This study aimed to analyze the correlation for each frequency spectrum parameter of heart rate variability with an insomnia index, as well as the degree of neurological defects in patients with simple cerebral infarction and cerebral infarction complicated by insomnia. The goal was to verify the feasibility of frequency spectrum parameters for heart rate variability as a marker for insomnia and cerebral infarction. DESIGN： A case-control observation. SETTING： Department of Neurology, First Hospital Affiliated to China Medical University. PARTICIPANTS： Sixty inpatients, and/or outpatients, with cerebral infarction were admitted to the 202 Hospital of Chinese PLA between December 2005 and October 2006, confirmed by CT, and recruited to the study. According to the insomnia condition （insomnia is defined by a Pittsburgh Sleep Quality Index score 〉 7）, the patients were assigned to a simple cerebral infarction group and a cerebral infarction complicated by insomnia group, with 30 subjects in each group. Thirty additional subjects, who concurrently received examinations and were confirmed to not suffer from cerebral infarction and insomnia, were recruited into the control group. Written informed consent was obtained from each subject for laboratory specimens. The protocol was approved by the Hospital＇s Ethics Committee. METHODS： Following admission, each subject＇s neurological impairment was assessed with the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index. Heart rate variability of each subject was measured with an autonomic nerve analyzer （Weijin Science and Technology Co., Ltd., Taiwan）. Each frequency spectrum parameter of heart rate variability was obtained, including very low frequency, low frequency, high frequency, total power, R-R interval, and its mean square. In addition, percentage of low frequency, high frequency, and ratio of low frequency to high frequency were calculated. For each heart rate frequency spectrum parameter, the difference between groups was analyzed. Moreover, correlations of each frequency spectrum parameter with insomnia and disease condition were analyzed. Data from each index, which were not normally distributed, were processed by logarithmic transformation. The t-test was used for the comparison of intergroup differences. Single-factor linear regression analysis and t-test were used for the analysis of factor-factor correlation and coefficient of correlation, respectively. MAIN OUTCOME MEASURES： （1） Differences of scores in the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index between the simple cerebral infarction group and the cerebral infarction complicated by insomnia group. （2） Differences of heart rate variability parameters between the simple cerebral infarction group and the control group. （3） Correlation of heart rate variability parameters, the Pittsburgh Sleep Quality Index score, and the neurological impairment score. RESULTS： Sixty patients and thirty healthy controls were included in the final analysis. （1） The scores of the Pittsburgh Sleep Quality Index and the neurological impairment were significantly higher in the cerebral infarction complicated by insomnia group compared to the simple cerebral infarction group （P 〈 0.05-0.01）. （2） R-R interval was significantly longer in the simple cerebral infarction group than in the control group, while R-R interval variance and high-frequency band were significantly lower in the simple cerebral infarction group compared to the control group （P 〈 0.05）. （3） For cerebral infarction patients with insomnia, the Pittsburgh Sleep Quality Index score was significantly positively correlated with neurological impairment （r = 0.54, P 〈 0.01）. The low-frequency band, very low-frequency band, high-frequency band, R-R interval variance, total power, R-R interval, and the percentage of high-frequency were significantly negatively correlated with the National Institutes of Health Stroke Scale score （r =4）.45 to 4）.90, P 〈 0.054）.01） and with the Pittsburgh Sleep Quality Index scores （r = 4）.56 to 4）.36, P 〈 0.054）.01）. CONCLUSION： Each heart rate variability parameter can be used as an index for assessing dyssomnia and neurologic impairment （r =4）.56 to 4）.36, P 〈 0.054）.01）.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
基金funded in part by the National Key R&D Program of China(Grant No.2022YFC2402404)the National Natural Science Foundation of China(Grant Nos.82170351 and 82370342)+1 种基金the Natural Science Foundation of Jiangsu Province(Grant Nos.BK20222002 and BK20231145)the Clinical Capacity Enhancement Project of Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)(Grant No.J SPH-MA-2022-3)。
文摘It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.
