Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patient...Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.展开更多
Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not ...Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.展开更多
Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coron...Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coronary intervention （PCI）. Methods Two hundred and four patients with NSTE-ACS at high-risk undergoing PCI were randomized to upstream （4 -6 hours before coronary angiography） tirofiban or downstream （with the guidewire crossing the lesion） tirofiban. We evaluated myocardial damage after PCI by qualitatively analyzing cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB）. Platelet aggregation inhibition and thrombolysis in myocardial infarction （TIMI） flow grade were assessed. The incidences of major adverse cardiac events （MACE） at 24-hour, 90-day and 180-day after PCI were followed up. The incidences of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results There were 102 patients with NSTE-ACS randomly assigned to upstream group and downstream group respectively. The peak serum levels of cTnI within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.34 vs 0. 61 ; P 〈 0.05 ）. Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received upstream tirofiban than downstream tirofiban （63 % vs 82%, P 〈 0. 05 ）. The peak serum levels of CK-MB as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （ 15 vs 18 and 38% vs 43% ; respectively; P 〉 0. 05 ）. ECG changes and the inhibition of platelet aggregation between two groups were similar （ P 〉 0.05 ）. Although the inci- dences of MACE at 90-day and 180-day after PCI were not statistically different, they were consistently lower with upstream tirofiban （3 % vs 6% and 6% vs 16% ; P 〉 0.05 ）. The incidences of bleeding complications and thrombocyto- penia were similar in the two groups （ 11% vs 9% ; P 〉 0.05 ）. Conclusions Among patients with NSTE-ACS at high-risk undergoing PCI, upstream tirofiban is associated with attenuated myocardial damage without increasing complications. （ S Chin J Cardiol 2009; 10（4） ： 179 -185）展开更多
Abstract Objectives The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events （MACE）, and mortality among older patients undergoin...Abstract Objectives The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events （MACE）, and mortality among older patients undergoing per-cutaneous coronary intervention （PCI）.展开更多
Acute coronary syndrome(ACS),diagnosed by optical coherence tomography(OCT),is caused primarily by plaque rupture,plaque erosion,and calcified nodules.Plaque erosion is more common in patients with non-ST-segment elev...Acute coronary syndrome(ACS),diagnosed by optical coherence tomography(OCT),is caused primarily by plaque rupture,plaque erosion,and calcified nodules.Plaque erosion is more common in patients with non-ST-segment eleva-tion myocardial infarction than ST-segment elevation myocardial infarction.This study reports the details of a case of ACS caused by massive thrombus formation due to plaque erosion.The factors associated with plaque erosion and thrombosis could not be confirmed on the basis of clinical examination findings and the physicians’experience;there-fore,the initial diagnosis of an ischemic event was replaced by a diagnosis of rapid plaque progression,as microscopi-cally confirmed by OCT.Therefore,OCT examination must be performed for blurred or“rapidly progressing”lesions identified through angiography.展开更多
Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive pa...Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.展开更多
Objective: To investigate the effect of Shenmai injection combined with antiplatelet drugs on the plaque property and inflammatory response in patients with non-ST-segment elevation ACS. Methods: A total of 142 patien...Objective: To investigate the effect of Shenmai injection combined with antiplatelet drugs on the plaque property and inflammatory response in patients with non-ST-segment elevation ACS. Methods: A total of 142 patients with non-ST-segment elevation ACS who were treated in the hospital between June 2015 and September 2017 were divided into control group (n=71) and Shenmai injection group (n=71) by random number table method. Control group received antiplatelet drugs based on routine treatment, and Shenmai injection group received Shenmai injection combined with antiplatelet drugs on the basis of routine treatment. The differences in serum contents of plaque property-related indexes and inflammatory factors were compared between the two groups before and after treatment. Results: Before treatment, there was no significant difference in serum contents of metabolism indexes, lipid indexes, cell adhesion molecules and inflammatory factors between the two groups. After 1 week of treatment, serum metabolism indexes Hcy and UA contents of Shenmai injection group were lower than those of control group;serum lipid indexes ox-LDL and Lp-PLA2 contents were lower than those of control group;serum adhesion molecules sVCAM-1 and sICAM-1 contents were lower than those of control group;serum inflammatory factors IL-1β, IL-6, IL-17 and IL-23 contents were lower than those of control group. Conclusion: Adjuvant Shenmai injection therapy can further stabilize the plaques and inhibit the systemic inflammatory response in patients with non-ST-segment elevation ACS.展开更多
Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,p...Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.展开更多
The infrared channels of the FY-4B advanced geosynchronous radiation imagers(AGRI) play a crucial role in temperature and humidity analyses for mesoscale numerical weather prediction, particularly in enhancing the ini...The infrared channels of the FY-4B advanced geosynchronous radiation imagers(AGRI) play a crucial role in temperature and humidity analyses for mesoscale numerical weather prediction, particularly in enhancing the initial field quality and the forecasting accuracy of the model. This study assimilated FY-4B AGRI data into the CMA-MESO model and analyzed the bias characteristics and correction methods. Analysis of the AGRI data revealed a clear diurnal variation in the bias, which was positively correlated with the solar elevation angle. However, the diurnal variation in the bias lagged behind the solar elevation angle, likely owing to temperature changes and delayed instrument responses resulting from solar radiation. To address this issue, we propose a correction method that utilizes the solar elevation angle after an optimal time shift. Using the time-shifted solar elevation angle as a predictor effectively reduces the diurnal variation in bias and significantly improves the correction effect. This approach provides theoretical support for the assimilation of FY-4B AGRI data into mesoscale numerical weather predictions, thereby enhancing the reliability of the assimilation results.展开更多
Elevation patterns and assembly processes of soil microbial community structures are essential for understanding biogeo-chemical processes in mountain systems.Differences in soil properties caused by elevation gradien...Elevation patterns and assembly processes of soil microbial community structures are essential for understanding biogeo-chemical processes in mountain systems.Differences in soil properties caused by elevation gradients can regulate the spatial distribu-tion and network complexity of the community structure.To explore the variations in soil microbial community structures and their as-sembly mechanisms across different elevations of the Changbai Mountains,as well as their responses to environmental factors,we col-lected microbial samples along an elevational gradient(seven elevations containing four vegetation zones)on the western slope of the Changbai Mountains using the method of metagenomic sequencing.The results showed a significant difference(P<0.05)for the Chao1 index across different elevations,but no significant difference was observed for the Shannon and Simpson indices.With increasing elev-ation,the number of nodes and links in the microbial network gradually decreased.Acidobacteria were highly connected to many nodes.The microbial communities indicated a significant distance-decay relationship(P<0.001)and were affected more by stochastic pro-cesses along the elevation gradient.The results of the Structural Equation Model(SEM)showed that elevation had direct significant ef-fect on carbon(C,P<0.01),nitrogen(N,P<0.01),and phosphorus(P,P<0.05)and weak negative effect on their ecological stoi-chiometry.Elevation was one of the major variables contributing to microbial network topology.The contribution of C and N to micro-bial network complexity was higher than that of P.Our study provides valuable insights into the responses of soil microbial communit-ies to elevation variations.展开更多
Objective To investigate the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)and elevated levels of N-terminal pro-hormone B-type natriuretic peptide(NTproBNP)...Objective To investigate the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)and elevated levels of N-terminal pro-hormone B-type natriuretic peptide(NTproBNP)with levosimendan within 24 hours of first medical contact(FMC).展开更多
Satellites in LEO (Low Earth Orbits) are closest to the Earth’s surface, having the smallest coverage area compared to other orbits, depending on altitude and elevation angle, and providing relatively too short visib...Satellites in LEO (Low Earth Orbits) are closest to the Earth’s surface, having the smallest coverage area compared to other orbits, depending on altitude and elevation angle, and providing relatively too short visibility and communication duration, in range of (2 - 15) minutes. Communication duration represents the key performance indicator for LEO satellite communication systems. For longer communication sessions, more satellites must be involved, and the signals must be handed over from one satellite to the next to provide uninterrupted real-time services to the appropriate user or ground station. This leads to the concept and structure of the satellites organized in the constellation. Communication window (visibility window) depends on the designed horizon plane width determined by licensed elevation angle. For the appropriate calculations, a satellite from the Starlink constellation at altitude of 550 km is considered, observed under licensed designed elevations of 40˚ and 25˚. Calculations under two designed elevation levels confirmed the wider horizon and consequently longer communication under the lower elevation.展开更多
BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Allium stracheyi(Baker)is widely utilized as a culinary herb and is typically encountered in the higher elevations of the Himalayas.Consequently,it is of great significance to compare the ecological adaptability of th...Allium stracheyi(Baker)is widely utilized as a culinary herb and is typically encountered in the higher elevations of the Himalayas.Consequently,it is of great significance to compare the ecological adaptability of this indigenous species to alternative habitats and its introduction into new environments.This research aims to investigate and gain a comprehensive understanding of A.stracheyi,also known as faran,in Uttarakhand region.We aim to examine how this plant adapts morphologically,physiologically,biochemically,and anatomically to varying elevations,specifically at 550,2200,2460,and 3400 m above mean sea level(m AMSL).This plant demonstrated remarkable morphophysiological adjustments across various aspects of its development,encompassing modified growth patterns,alterations in leaf dimensions,leaf count,etc..Moreover,biochemical adaptations have been identified as pivotal in bolstering the plant resilience to the stress associated with higher elevation.Enzymes like superoxide dismutase(SOD)and peroxidase(POD)exhibited significant responsiveness to elevational variations,contributing to the plant's ability to confront the challenges posed by high-elevational conditions.In terms of anatomy,the plant manifested alterations in its leaf and vascular tissues along the elevational gradient.These modifications involve an increased density of stomata and a greater count of vascular bundles,optimizing gas exchange and adaptation to water stress in frequently encountered harsh environmental conditions at higher elevations.Understanding the adaptive mechanisms employed by A.stracheyi provides valuable insights,especially in forecasting how A.stracheyi might respond to global climate change,particularly in regions affected by habitat fragmentation.展开更多
Forests exert significant biogeophysical cooling effects(CE)through processes such as increased evapotranspiration,reduced albedo,and enhanced surface roughness.However,little is known about the extent to which elevat...Forests exert significant biogeophysical cooling effects(CE)through processes such as increased evapotranspiration,reduced albedo,and enhanced surface roughness.However,little is known about the extent to which elevation-induced temperature differences bias the observed CE and how this bias interacts with the underlying biogeophysical mechanisms.In this study,we integrated multisensor remote sensing products and Shuttle Radar Topography Mission(SRTM)elevation data on the Google Earth Engine(GEE)platform,and applied a spatial-temporal window regression approach to quantify and correct the sensitivity of land surface temperature(LST)to elevation for forest pixels across China from 2001 to 2022.First,we found that forest LST exhibited a significant negative relationship with elevation,leading to systematic CE overestimation by 0.61 K during the day and 0.60 K at night compared with altitudecorrected CE values.Second,after correction,the CE showed clear spatial heterogeneity,with stronger daytime cooling in tropical(-0.54 K)and temperate forests(-0.24 K),and warming in cold(+0.11 K)and arid regions(+0.53 K),while most regions experienced nighttime warming.Among forest types,evergreen needleleaf forests(ENF)exhibited the strongest daytime cooling(-0.36 K),whereas deciduous broadleaf(DBF)and open shrublands(OS)tended to warm.Third,mechanism analysis revealed that elevation correction strengthened the correlations of CE with leaf area index(LAI)and evapotranspiration,while maintaining a significant negative correlation with albedo,indicating that both radiative and non-radiative processes jointly shape the unbiased CE.These findings provide a more accurate quantification of forest CE by eliminating elevation-induced bias,which providing a more accurate assessment of the climate mitigation potential of forests,which is crucial for developing more effective forest management and ecological restoration strategies.展开更多
Climate warming causes mountainous species to shift their distributions towards higher elevations.How elevation influences growth-climate relationship in mountain regions has been intensively investigated.However,how ...Climate warming causes mountainous species to shift their distributions towards higher elevations.How elevation influences growth-climate relationship in mountain regions has been intensively investigated.However,how microtopography shapes tree growth and its drought resistance along the elevation gradient remains poorly understood.We used a network of Larix principis-rupprechtii tree-ring data comprising 1,918 trees from different age classes and mountain slopes,along an elevation gradient ranging from 970 to 1,869 m,to investigate how slope gradients mediate the growth and drought resilience of larch trees along an elevation gradient in North China.Growing season drought and temperature were the major limiting climatic factors for larch trees across the study region.Larch trees younger than 40 years exhibited a stronger positive correlation between basal area increment(BAI)and elevation on steep slopes(10°-35°)than on flat(0°-5°)or gentle(5°-10°)slopes.At low-elevation steep slopes,the growth of larch trees younger than 40 years showed a stronger correlation with the Palmer drought severity index(PDSI).Both resistance and resilience were found to increase along the elevation gradient on steep slopes for young larch trees but not for old larch trees.No significant differences were observed in the drought recovery ability of larch trees across all age groups at increasing elevation.Our results highlight that drought events may particularly affect the growth of young larch trees on low-elevation steep slopes,with potential repercussions on mortality rates.展开更多
Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly p...Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly patients-who are often underrepresented in validation studies and present with unique pathophysiology-is not well established.This study was designed to directly evaluate and compare the predictive value of the ACEF score for short-term mortality in elderly versus non-elderly STEMI patients,addressing a critical gap in its clinical application.Methods We enrolled 934 consecutive STEMI patients undergoing percutaneous coronary intervention,categorized into a non elderly group(<65 years,n=534)and an elderly group(≥65 years,n=400).The ACEF score was calculated as age/left ventricular ejection fraction+1(if serum creatinine>2 mg/dL).Its predictive ability for in hospital and one year mortality was assessed.Results Overall,in hospital and one year mortality rates were 4.4%and 8.2%,respectively.Elderly patients had significantly worse in hospital outcomes,including higher all cause mortality(6.5%vs.2.8%,P=0.006)and major adverse cardiovascular events(16.0%vs.9.2%,P=0.002).The predictive performance of the ACEF score for in hospital mortality was lower in the elderly group than in the non elderly group(area under the curve:0.753 vs.0.828,P=0.047).The optimal cut off value for ACEF was 1.65 in both groups.In multivariate analysis,an ACEF score>1.65 independently predicted in hospital mortality[adjusted odds ratio(OR):11.58,P=0.001]and one year mortality[adjusted hazard ratio(HR):7.12,P<0.001]in non elderly patients.Similar associations were observed in elderly patients(in hospital mortality:adjusted OR:3.26,P=0.027;one year mortality:adjusted HR:2.79,P=0.003).Conclusions Despite a relatively lower discriminatory ability for short-term mortality in elderly STEMI patients,the ACEF score still demonstrated significant predictive value and might serve as a practical,initial tool for identifying high-risk individuals in clinical settings.展开更多
Ice shelves are important passageways for ice sheets flowing into the ocean.Through iceberg calving and basal melting,ice shelves exert considerable influence on the mass balance of the Antarctic Ice Sheet and glacier...Ice shelves are important passageways for ice sheets flowing into the ocean.Through iceberg calving and basal melting,ice shelves exert considerable influence on the mass balance of the Antarctic Ice Sheet and glacier stability.The Ross Ice Shelf(RIS),the largest body of floating ice on Earth,plays an essential role in any changes in the mass balance of the Antarctic Ice Sheet.The long-term elevation change trend of RIS has been calculated with multiple satellite altimetry in previous studies.However,the seasonal variations were less revealed.Based on crossover analysis and indirect observation adjustments,this study proposed a new method for constructing seasonal records for surface elevation changes in the RIS using ICESat laser altimetry data from 2003 to 2009.The results showed that surface elevation changes exhibited seasonal variations with fluctuations over 20 cm,and the seasonal change characteristics were closely related to the temperature.Interannual variations in RIS surface elevation decreased from 2003 to2009 at a rate of 2 cm/yr.From March 2003 to April 2007,the surface elevation decreased at 3.7 cm/yr;however,after April 2007,the surface elevation increased at 5.5 cm/yr.The more recent stages of surface elevation growth have been influenced by reductions in the summer basal melt,which is related to the decreases in ocean heat content.展开更多
基金supported by National Key Technology R&D Program in the "Twelfth Five-Year" Plan of China(2011BAI11B07)
文摘Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.
文摘Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.
文摘Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coronary intervention （PCI）. Methods Two hundred and four patients with NSTE-ACS at high-risk undergoing PCI were randomized to upstream （4 -6 hours before coronary angiography） tirofiban or downstream （with the guidewire crossing the lesion） tirofiban. We evaluated myocardial damage after PCI by qualitatively analyzing cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB）. Platelet aggregation inhibition and thrombolysis in myocardial infarction （TIMI） flow grade were assessed. The incidences of major adverse cardiac events （MACE） at 24-hour, 90-day and 180-day after PCI were followed up. The incidences of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results There were 102 patients with NSTE-ACS randomly assigned to upstream group and downstream group respectively. The peak serum levels of cTnI within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.34 vs 0. 61 ; P 〈 0.05 ）. Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received upstream tirofiban than downstream tirofiban （63 % vs 82%, P 〈 0. 05 ）. The peak serum levels of CK-MB as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （ 15 vs 18 and 38% vs 43% ; respectively; P 〉 0. 05 ）. ECG changes and the inhibition of platelet aggregation between two groups were similar （ P 〉 0.05 ）. Although the inci- dences of MACE at 90-day and 180-day after PCI were not statistically different, they were consistently lower with upstream tirofiban （3 % vs 6% and 6% vs 16% ; P 〉 0.05 ）. The incidences of bleeding complications and thrombocyto- penia were similar in the two groups （ 11% vs 9% ; P 〉 0.05 ）. Conclusions Among patients with NSTE-ACS at high-risk undergoing PCI, upstream tirofiban is associated with attenuated myocardial damage without increasing complications. （ S Chin J Cardiol 2009; 10（4） ： 179 -185）
文摘Abstract Objectives The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events （MACE）, and mortality among older patients undergoing per-cutaneous coronary intervention （PCI）.
基金supported by the Langfang City Science and Technology Support Program Project(grant number:2020013106)Hebei Province Key R&D Program Self-funded Project(grant number:182777166).
文摘Acute coronary syndrome(ACS),diagnosed by optical coherence tomography(OCT),is caused primarily by plaque rupture,plaque erosion,and calcified nodules.Plaque erosion is more common in patients with non-ST-segment eleva-tion myocardial infarction than ST-segment elevation myocardial infarction.This study reports the details of a case of ACS caused by massive thrombus formation due to plaque erosion.The factors associated with plaque erosion and thrombosis could not be confirmed on the basis of clinical examination findings and the physicians’experience;there-fore,the initial diagnosis of an ischemic event was replaced by a diagnosis of rapid plaque progression,as microscopi-cally confirmed by OCT.Therefore,OCT examination must be performed for blurred or“rapidly progressing”lesions identified through angiography.
文摘Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
文摘Objective: To investigate the effect of Shenmai injection combined with antiplatelet drugs on the plaque property and inflammatory response in patients with non-ST-segment elevation ACS. Methods: A total of 142 patients with non-ST-segment elevation ACS who were treated in the hospital between June 2015 and September 2017 were divided into control group (n=71) and Shenmai injection group (n=71) by random number table method. Control group received antiplatelet drugs based on routine treatment, and Shenmai injection group received Shenmai injection combined with antiplatelet drugs on the basis of routine treatment. The differences in serum contents of plaque property-related indexes and inflammatory factors were compared between the two groups before and after treatment. Results: Before treatment, there was no significant difference in serum contents of metabolism indexes, lipid indexes, cell adhesion molecules and inflammatory factors between the two groups. After 1 week of treatment, serum metabolism indexes Hcy and UA contents of Shenmai injection group were lower than those of control group;serum lipid indexes ox-LDL and Lp-PLA2 contents were lower than those of control group;serum adhesion molecules sVCAM-1 and sICAM-1 contents were lower than those of control group;serum inflammatory factors IL-1β, IL-6, IL-17 and IL-23 contents were lower than those of control group. Conclusion: Adjuvant Shenmai injection therapy can further stabilize the plaques and inhibit the systemic inflammatory response in patients with non-ST-segment elevation ACS.
文摘Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.
基金National Key Research and Development Program of China (2022YFC3004004)National Natural Science Foundation of China (42075155,12241104)National Natural Science Foundation of China Joint Fund (U2342213)。
文摘The infrared channels of the FY-4B advanced geosynchronous radiation imagers(AGRI) play a crucial role in temperature and humidity analyses for mesoscale numerical weather prediction, particularly in enhancing the initial field quality and the forecasting accuracy of the model. This study assimilated FY-4B AGRI data into the CMA-MESO model and analyzed the bias characteristics and correction methods. Analysis of the AGRI data revealed a clear diurnal variation in the bias, which was positively correlated with the solar elevation angle. However, the diurnal variation in the bias lagged behind the solar elevation angle, likely owing to temperature changes and delayed instrument responses resulting from solar radiation. To address this issue, we propose a correction method that utilizes the solar elevation angle after an optimal time shift. Using the time-shifted solar elevation angle as a predictor effectively reduces the diurnal variation in bias and significantly improves the correction effect. This approach provides theoretical support for the assimilation of FY-4B AGRI data into mesoscale numerical weather predictions, thereby enhancing the reliability of the assimilation results.
基金Under the auspices of the National Natural Science Foundation of China(No.42430511,U20A2083)the National Key Research and Development Program of China(No.2022YFF1300900)the Science and Technology Development Program of Jilin Province(No.20210509037RQ,20230101348JC)。
文摘Elevation patterns and assembly processes of soil microbial community structures are essential for understanding biogeo-chemical processes in mountain systems.Differences in soil properties caused by elevation gradients can regulate the spatial distribu-tion and network complexity of the community structure.To explore the variations in soil microbial community structures and their as-sembly mechanisms across different elevations of the Changbai Mountains,as well as their responses to environmental factors,we col-lected microbial samples along an elevational gradient(seven elevations containing four vegetation zones)on the western slope of the Changbai Mountains using the method of metagenomic sequencing.The results showed a significant difference(P<0.05)for the Chao1 index across different elevations,but no significant difference was observed for the Shannon and Simpson indices.With increasing elev-ation,the number of nodes and links in the microbial network gradually decreased.Acidobacteria were highly connected to many nodes.The microbial communities indicated a significant distance-decay relationship(P<0.001)and were affected more by stochastic pro-cesses along the elevation gradient.The results of the Structural Equation Model(SEM)showed that elevation had direct significant ef-fect on carbon(C,P<0.01),nitrogen(N,P<0.01),and phosphorus(P,P<0.05)and weak negative effect on their ecological stoi-chiometry.Elevation was one of the major variables contributing to microbial network topology.The contribution of C and N to micro-bial network complexity was higher than that of P.Our study provides valuable insights into the responses of soil microbial communit-ies to elevation variations.
文摘Objective To investigate the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)and elevated levels of N-terminal pro-hormone B-type natriuretic peptide(NTproBNP)with levosimendan within 24 hours of first medical contact(FMC).
文摘Satellites in LEO (Low Earth Orbits) are closest to the Earth’s surface, having the smallest coverage area compared to other orbits, depending on altitude and elevation angle, and providing relatively too short visibility and communication duration, in range of (2 - 15) minutes. Communication duration represents the key performance indicator for LEO satellite communication systems. For longer communication sessions, more satellites must be involved, and the signals must be handed over from one satellite to the next to provide uninterrupted real-time services to the appropriate user or ground station. This leads to the concept and structure of the satellites organized in the constellation. Communication window (visibility window) depends on the designed horizon plane width determined by licensed elevation angle. For the appropriate calculations, a satellite from the Starlink constellation at altitude of 550 km is considered, observed under licensed designed elevations of 40˚ and 25˚. Calculations under two designed elevation levels confirmed the wider horizon and consequently longer communication under the lower elevation.
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
基金supported by Uttarakhand Council for Biotechnology(grant number UCB/R&D PROJECT/2022/20 dated 06.05.2022).
文摘Allium stracheyi(Baker)is widely utilized as a culinary herb and is typically encountered in the higher elevations of the Himalayas.Consequently,it is of great significance to compare the ecological adaptability of this indigenous species to alternative habitats and its introduction into new environments.This research aims to investigate and gain a comprehensive understanding of A.stracheyi,also known as faran,in Uttarakhand region.We aim to examine how this plant adapts morphologically,physiologically,biochemically,and anatomically to varying elevations,specifically at 550,2200,2460,and 3400 m above mean sea level(m AMSL).This plant demonstrated remarkable morphophysiological adjustments across various aspects of its development,encompassing modified growth patterns,alterations in leaf dimensions,leaf count,etc..Moreover,biochemical adaptations have been identified as pivotal in bolstering the plant resilience to the stress associated with higher elevation.Enzymes like superoxide dismutase(SOD)and peroxidase(POD)exhibited significant responsiveness to elevational variations,contributing to the plant's ability to confront the challenges posed by high-elevational conditions.In terms of anatomy,the plant manifested alterations in its leaf and vascular tissues along the elevational gradient.These modifications involve an increased density of stomata and a greater count of vascular bundles,optimizing gas exchange and adaptation to water stress in frequently encountered harsh environmental conditions at higher elevations.Understanding the adaptive mechanisms employed by A.stracheyi provides valuable insights,especially in forecasting how A.stracheyi might respond to global climate change,particularly in regions affected by habitat fragmentation.
基金Under the auspices of National Social Sciences Foundation of China(No.21BJY114)。
文摘Forests exert significant biogeophysical cooling effects(CE)through processes such as increased evapotranspiration,reduced albedo,and enhanced surface roughness.However,little is known about the extent to which elevation-induced temperature differences bias the observed CE and how this bias interacts with the underlying biogeophysical mechanisms.In this study,we integrated multisensor remote sensing products and Shuttle Radar Topography Mission(SRTM)elevation data on the Google Earth Engine(GEE)platform,and applied a spatial-temporal window regression approach to quantify and correct the sensitivity of land surface temperature(LST)to elevation for forest pixels across China from 2001 to 2022.First,we found that forest LST exhibited a significant negative relationship with elevation,leading to systematic CE overestimation by 0.61 K during the day and 0.60 K at night compared with altitudecorrected CE values.Second,after correction,the CE showed clear spatial heterogeneity,with stronger daytime cooling in tropical(-0.54 K)and temperate forests(-0.24 K),and warming in cold(+0.11 K)and arid regions(+0.53 K),while most regions experienced nighttime warming.Among forest types,evergreen needleleaf forests(ENF)exhibited the strongest daytime cooling(-0.36 K),whereas deciduous broadleaf(DBF)and open shrublands(OS)tended to warm.Third,mechanism analysis revealed that elevation correction strengthened the correlations of CE with leaf area index(LAI)and evapotranspiration,while maintaining a significant negative correlation with albedo,indicating that both radiative and non-radiative processes jointly shape the unbiased CE.These findings provide a more accurate quantification of forest CE by eliminating elevation-induced bias,which providing a more accurate assessment of the climate mitigation potential of forests,which is crucial for developing more effective forest management and ecological restoration strategies.
基金funded by the National Natural Science Foundation of China(No.U24A20353)the S&T Program of Hebei(Nos.226Z6801G,C2021204002,and 20210365)+1 种基金the Talent Introduction Program in Hebei Agricultural University(No.YJ201918)supported by the SERI-funded ERC Starting Grant,project MB23.00011.
文摘Climate warming causes mountainous species to shift their distributions towards higher elevations.How elevation influences growth-climate relationship in mountain regions has been intensively investigated.However,how microtopography shapes tree growth and its drought resistance along the elevation gradient remains poorly understood.We used a network of Larix principis-rupprechtii tree-ring data comprising 1,918 trees from different age classes and mountain slopes,along an elevation gradient ranging from 970 to 1,869 m,to investigate how slope gradients mediate the growth and drought resilience of larch trees along an elevation gradient in North China.Growing season drought and temperature were the major limiting climatic factors for larch trees across the study region.Larch trees younger than 40 years exhibited a stronger positive correlation between basal area increment(BAI)and elevation on steep slopes(10°-35°)than on flat(0°-5°)or gentle(5°-10°)slopes.At low-elevation steep slopes,the growth of larch trees younger than 40 years showed a stronger correlation with the Palmer drought severity index(PDSI).Both resistance and resilience were found to increase along the elevation gradient on steep slopes for young larch trees but not for old larch trees.No significant differences were observed in the drought recovery ability of larch trees across all age groups at increasing elevation.Our results highlight that drought events may particularly affect the growth of young larch trees on low-elevation steep slopes,with potential repercussions on mortality rates.
文摘Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly patients-who are often underrepresented in validation studies and present with unique pathophysiology-is not well established.This study was designed to directly evaluate and compare the predictive value of the ACEF score for short-term mortality in elderly versus non-elderly STEMI patients,addressing a critical gap in its clinical application.Methods We enrolled 934 consecutive STEMI patients undergoing percutaneous coronary intervention,categorized into a non elderly group(<65 years,n=534)and an elderly group(≥65 years,n=400).The ACEF score was calculated as age/left ventricular ejection fraction+1(if serum creatinine>2 mg/dL).Its predictive ability for in hospital and one year mortality was assessed.Results Overall,in hospital and one year mortality rates were 4.4%and 8.2%,respectively.Elderly patients had significantly worse in hospital outcomes,including higher all cause mortality(6.5%vs.2.8%,P=0.006)and major adverse cardiovascular events(16.0%vs.9.2%,P=0.002).The predictive performance of the ACEF score for in hospital mortality was lower in the elderly group than in the non elderly group(area under the curve:0.753 vs.0.828,P=0.047).The optimal cut off value for ACEF was 1.65 in both groups.In multivariate analysis,an ACEF score>1.65 independently predicted in hospital mortality[adjusted odds ratio(OR):11.58,P=0.001]and one year mortality[adjusted hazard ratio(HR):7.12,P<0.001]in non elderly patients.Similar associations were observed in elderly patients(in hospital mortality:adjusted OR:3.26,P=0.027;one year mortality:adjusted HR:2.79,P=0.003).Conclusions Despite a relatively lower discriminatory ability for short-term mortality in elderly STEMI patients,the ACEF score still demonstrated significant predictive value and might serve as a practical,initial tool for identifying high-risk individuals in clinical settings.
基金supported by the National Key Research and Development Program of China under grant numbers 2023YFC2809103 and 2024YFC2813505the National Natural Science Foundation of China under the grant number 41706216+2 种基金the Fundamental Research Funds for the Central Universities under grant numbers 2042022kf1204,2042022kf1069,2042023gf0012,2042022dx0001the Hubei Provincial Natural Science Foundation of China under grant number 2022CFB081the State Key Laboratory of Geodesy and Earth's Dynamics,Innovation Academy for Precision Measurement Science and Technology under grant number SKLGED2023-2-6。
文摘Ice shelves are important passageways for ice sheets flowing into the ocean.Through iceberg calving and basal melting,ice shelves exert considerable influence on the mass balance of the Antarctic Ice Sheet and glacier stability.The Ross Ice Shelf(RIS),the largest body of floating ice on Earth,plays an essential role in any changes in the mass balance of the Antarctic Ice Sheet.The long-term elevation change trend of RIS has been calculated with multiple satellite altimetry in previous studies.However,the seasonal variations were less revealed.Based on crossover analysis and indirect observation adjustments,this study proposed a new method for constructing seasonal records for surface elevation changes in the RIS using ICESat laser altimetry data from 2003 to 2009.The results showed that surface elevation changes exhibited seasonal variations with fluctuations over 20 cm,and the seasonal change characteristics were closely related to the temperature.Interannual variations in RIS surface elevation decreased from 2003 to2009 at a rate of 2 cm/yr.From March 2003 to April 2007,the surface elevation decreased at 3.7 cm/yr;however,after April 2007,the surface elevation increased at 5.5 cm/yr.The more recent stages of surface elevation growth have been influenced by reductions in the summer basal melt,which is related to the decreases in ocean heat content.
