Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST- segment elevation myocardial infarction （STEMI） who undergo primary percutaneous cronary intervention （PCI）, t...Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST- segment elevation myocardial infarction （STEMI） who undergo primary percutaneous cronary intervention （PCI）, there is still concern about its benefit and safety on elderly population. Methods Data of 172 consecutive elderly patients （~〉75 years） with STEMI who underwent primary PCI at Guangdong Provincial Cardiovascular Institute from January 2008 to December 2011 were retrospectively collected. Patients were divided into 600-mg loading clopidogrel group and 300-mg clopidogrel group accoring to the loading dose of clopidogrel before primary percunaeous coronary intervention（PCI）. Enzymatic myocardial infarction size estimated by peak creatine kinase-myocardial band （CK-MB） and patency of the infarct-related artery （IRA） were compared. Thirty-day major adverse cardiac events （MACEs）, which consist of death, nonfatal myocardial infarction （MI）, nonfatal stroke, target vessel revascularization （TVR） or stent thrombosis （ST） were compared to assess the efficacy of different loading dose. Bleeding information was compared as well to assess the safety of different pretreatment stragety before primary PCI. Results 96 patients were adminstered with 600-mg loading clopidogrel before primary PCI while 76 were administered with 300-mg. Patency of the IRA was significantly higher in patients administered with 600-mg loading clopidogrel therapy as compared with those who received 300-mg loading clopidogrel （94.8% vs. 85.5%, P = 0.038）. 600-mg loading dose of clopidogrel was associated with lower incidence of 30-day MACEs compared with 300-mg loading dose of clopidogrel （8.3% vs. 19.7%, P = 0.029） while did not increase the risk of TIMI major （3.1% vs. 3.9%, P = 0.770） and minor bleeding （10.4% vs. 6.6%, P = 0.376）. Conclusion 600-mg loading clopidogrel improves final patency of the IRA and clinical outcome as compared with 300-mg loading clopidogrel without increasing bleeding hazard.展开更多
We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations int...We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations into the risk assessment. The ATBM is a finite element model managed by the Joint Non-Lethal Weapons Directorate for the purpose of assessing the risk of injury caused by blunt impacts from non-lethal weapons. In ATBM simulations, the quantity that determines arm bone fracture is the calculated maximum strain in the bone. The main obstacle to accurate prediction is that the calculated strain is incompatible with the measured strain. The fracture strain measured in bending tests of real bones is affected by random inhomogeneity in bones and uncertainty in measurement gauge attachment location/orientation. In contrast, the strain calculated in ATBM simulations is based on the assumption that all bones are perfectly elastic with homogeneous material properties and no measurement uncertainty. To connect test data and ATBM simulations in a proper and meaningful setting, we introduce the concept of elasticity-homogenized strain. We interpret test data in terms of the homogenized strain, and build an empirical dose-injury model with the homogenized strain as the input dose for predicting injury. The maximum strain calculated by ATBM has randomness due to uncertainty in specifications of ATBM setup parameters. The dose propagation uncertainty formulation accommodates this uncertainty efficiently by simply updating the shape parameters in the dose-injury model, avoiding the high computational cost of sampling this uncertainty via multiple ATBM runs.展开更多
目的探讨腹腔镜胆囊切除术(LC)全麻诱导前预注射不同剂量右美托咪定(DEX)对患者血流动力学水平及不良反应的影响。方法行LC患者140例随机分为A、B、C、D四组,麻醉诱导前A组以0.5 mL/kg恒定静脉泵入生理盐水,B组(0.5μg/kg)、C组(0.75μg...目的探讨腹腔镜胆囊切除术(LC)全麻诱导前预注射不同剂量右美托咪定(DEX)对患者血流动力学水平及不良反应的影响。方法行LC患者140例随机分为A、B、C、D四组,麻醉诱导前A组以0.5 mL/kg恒定静脉泵入生理盐水,B组(0.5μg/kg)、C组(0.75μg/kg)、D组(1.0μg/kg)预注射DEX,比较各组患者手术指标,不同时间点血流动力学指标、视觉模拟评分法(VAS)评分、镇静评分标准(RSS)评分,苏醒时间、拔管时间,不良反应发生情况。结果与A、B组比较,C组术后苏醒时间、拔管时间显著缩短,D组术后苏醒时间、拔管时间显著延长,且D组较C组也显著延长(P<0.05);与A组比较,B、C、D组T1~T7时间点HR水平显著降低,D组T1~T7时间点HR水平低于B组(P<0.05);与A组比较,B、C、D组T2~T7时间点MAP水平均显著降低(P<0.05);与A组比较,B、C、D组术后6、12、24、48 h VAS评分均显著降低(P<0.05),B、C、D组术后6、12、24、48 h VAS评分比较,差异无统计学意义(P>0.05),四组患者术后6、12、24、48 h Ramsay评分比较,差异无统计学意义(P>0.05);A组恶心呕吐、躁动发生率(20.00%、14.29%)高于B、C、D组,D组患者心动过缓、低血压发生率(37.14%、11.43%)高于A、B、C组(P<0.05)。结论0.75μg/kg DEX在LC全麻诱导前预注射可维持患者血流动力学指标稳定,缩短术后苏醒时间、拔管时间,缓解术后疼痛,减少不良反应的发生,促进患者术后康复,值得推广。展开更多
文摘Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST- segment elevation myocardial infarction （STEMI） who undergo primary percutaneous cronary intervention （PCI）, there is still concern about its benefit and safety on elderly population. Methods Data of 172 consecutive elderly patients （~〉75 years） with STEMI who underwent primary PCI at Guangdong Provincial Cardiovascular Institute from January 2008 to December 2011 were retrospectively collected. Patients were divided into 600-mg loading clopidogrel group and 300-mg clopidogrel group accoring to the loading dose of clopidogrel before primary percunaeous coronary intervention（PCI）. Enzymatic myocardial infarction size estimated by peak creatine kinase-myocardial band （CK-MB） and patency of the infarct-related artery （IRA） were compared. Thirty-day major adverse cardiac events （MACEs）, which consist of death, nonfatal myocardial infarction （MI）, nonfatal stroke, target vessel revascularization （TVR） or stent thrombosis （ST） were compared to assess the efficacy of different loading dose. Bleeding information was compared as well to assess the safety of different pretreatment stragety before primary PCI. Results 96 patients were adminstered with 600-mg loading clopidogrel before primary PCI while 76 were administered with 300-mg. Patency of the IRA was significantly higher in patients administered with 600-mg loading clopidogrel therapy as compared with those who received 300-mg loading clopidogrel （94.8% vs. 85.5%, P = 0.038）. 600-mg loading dose of clopidogrel was associated with lower incidence of 30-day MACEs compared with 300-mg loading dose of clopidogrel （8.3% vs. 19.7%, P = 0.029） while did not increase the risk of TIMI major （3.1% vs. 3.9%, P = 0.770） and minor bleeding （10.4% vs. 6.6%, P = 0.376）. Conclusion 600-mg loading clopidogrel improves final patency of the IRA and clinical outcome as compared with 300-mg loading clopidogrel without increasing bleeding hazard.
文摘We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations into the risk assessment. The ATBM is a finite element model managed by the Joint Non-Lethal Weapons Directorate for the purpose of assessing the risk of injury caused by blunt impacts from non-lethal weapons. In ATBM simulations, the quantity that determines arm bone fracture is the calculated maximum strain in the bone. The main obstacle to accurate prediction is that the calculated strain is incompatible with the measured strain. The fracture strain measured in bending tests of real bones is affected by random inhomogeneity in bones and uncertainty in measurement gauge attachment location/orientation. In contrast, the strain calculated in ATBM simulations is based on the assumption that all bones are perfectly elastic with homogeneous material properties and no measurement uncertainty. To connect test data and ATBM simulations in a proper and meaningful setting, we introduce the concept of elasticity-homogenized strain. We interpret test data in terms of the homogenized strain, and build an empirical dose-injury model with the homogenized strain as the input dose for predicting injury. The maximum strain calculated by ATBM has randomness due to uncertainty in specifications of ATBM setup parameters. The dose propagation uncertainty formulation accommodates this uncertainty efficiently by simply updating the shape parameters in the dose-injury model, avoiding the high computational cost of sampling this uncertainty via multiple ATBM runs.
文摘目的探讨腹腔镜胆囊切除术(LC)全麻诱导前预注射不同剂量右美托咪定(DEX)对患者血流动力学水平及不良反应的影响。方法行LC患者140例随机分为A、B、C、D四组,麻醉诱导前A组以0.5 mL/kg恒定静脉泵入生理盐水,B组(0.5μg/kg)、C组(0.75μg/kg)、D组(1.0μg/kg)预注射DEX,比较各组患者手术指标,不同时间点血流动力学指标、视觉模拟评分法(VAS)评分、镇静评分标准(RSS)评分,苏醒时间、拔管时间,不良反应发生情况。结果与A、B组比较,C组术后苏醒时间、拔管时间显著缩短,D组术后苏醒时间、拔管时间显著延长,且D组较C组也显著延长(P<0.05);与A组比较,B、C、D组T1~T7时间点HR水平显著降低,D组T1~T7时间点HR水平低于B组(P<0.05);与A组比较,B、C、D组T2~T7时间点MAP水平均显著降低(P<0.05);与A组比较,B、C、D组术后6、12、24、48 h VAS评分均显著降低(P<0.05),B、C、D组术后6、12、24、48 h VAS评分比较,差异无统计学意义(P>0.05),四组患者术后6、12、24、48 h Ramsay评分比较,差异无统计学意义(P>0.05);A组恶心呕吐、躁动发生率(20.00%、14.29%)高于B、C、D组,D组患者心动过缓、低血压发生率(37.14%、11.43%)高于A、B、C组(P<0.05)。结论0.75μg/kg DEX在LC全麻诱导前预注射可维持患者血流动力学指标稳定,缩短术后苏醒时间、拔管时间,缓解术后疼痛,减少不良反应的发生,促进患者术后康复,值得推广。
