[Value of cardiodynamicsgram in early diagnosis of patients with acute coronary syndrome].

OBJECTIVE: To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS). METHODS: Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95%CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. RESULTS: A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95%CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95%CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. CONCLUSIONS: CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.

Efficacy and Prognosis of Hyperbaric Oxygen as Adjuvant Therapy for Neonatal Hypoxic-Ischemic Encephalopathy: A Meta-Analysis Study.

Background: Preclinical and clinical evidence suggests that hyperbaric oxygen therapy (HBOT) may benefit newborns. The effectiveness of HBOT for neonatal hypoxic-ischemic encephalopathy (HIE) remains controversial. We conducted a meta-analysis to evaluate the efficacy and prognosis of HBOT in neonates with HIE. Methods: A systematic search of eight databases was performed for available articles published between January 1, 2015, and September 30, 2020, to identify randomized controlled clinical trials (RCTs) on HBOT for neonatal HIE. Methodological quality assessment was performed by applying the simple procedure detailed by the Cochrane collaboration. Afterward, quality assessment and data analysis were performed using Revman 5.3 software. STATA 15 software was used to detect publication bias as well as for sensitivity analysis. Results: A total of 46 clinical RCTs were selected for the study and included 4,199 patients with neonatal HIE. The results indicated that HBOT significantly improved the total efficiency (TEF) of treatment for neonatal HIE patients [odds ratio (OR) = 4.61, 95% confidence interval (CI) (3.70, 5.75), P < 0.00001] and reduced the risk of sequelae (OR = 0.23, 95% CI (0.16, 0.33), P < 0.00001) and the neonatal behavioral neurological assessment (NBNA) scores [mean difference (MD) = 4.51, 95%CI (3.83,5.19, P < 0.00001)]. Conclusion: In light of the effectiveness of HBOT neonatal HIE, this meta-analysis suggested that HBOT can be a potential therapy for the treatment of neonatal HIE. Due to the heterogeneity of studies protocol and patient selection being only from China, more research is needed before this therapy can be widely implemented in the clinic. Protocol Registration: PROSPERO (ID: CRD42020210639). Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020210639.

[Meta-analysis of the curative effect of low molecular weight heparin on acute respiratory distress syndrome].

OBJECTIVE: To observe the clinical effect of low molecular weight heparin on the curative effect of acute respiratory distress syndrome (ARDS) patients through a systematic evaluation method. METHODS: Databases such as PubMed, Cochrane Library database, Web of Science, CNKI, China Biological Medical Literature Database (CBM), VIP, Wanfang database were searched to retrieve randomized controlled trials (RCTs) on low molecular weight heparin and conventional treatment on the efficacy and prognosis of patients with acute lung injury (ALI)/ARDS from the establishment of the database to September 2020. The conventional treatment group was given conventional treatment, and the low molecular heparin group was given low molecular heparin based on conventional treatment. Outcome indicators were oxygenation index (PaO2/FiO2), acute physiology and chronic health evaluation II (APACHE II), activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count (PLT), interleukin-6 (IL-6) and the mortality at 7 days and 28 days. The literature was screened according to the proposed inclusion and exclusion criteria; the Cochrane collaboration evaluation tool was used to evaluate the quality of literature; Meta analysis used RevMan 5.3 software to perform funnel plot analysis on the outcome indicators of the included ≥ 11 literatures, and to evaluate the publication bias. RESULTS: A total of 12 RCTs and 623 patients were included. The results of Meta analysis showed that PaO2/FiO2 increased in the low molecular weight heparin group compared with the conventional treatment group [mean difference (MD) = 72.08, 95% confidence interval (95%CI) was 56.92-87.24, P < 0.000 01], APACHE II (MD = -4.34, 95%CI was -5.73 to -2.96, P < 0.000 01), IL-6 [standardized mean difference (SMD) = -2.13, 95%CI was -2.71 to -1.56, P < 0.000 01] and 7-day mortality [relative risk (RR) = 0.52, 95%CI was 0.30-0.90, P = 0.02] and 28-day mortality (RR = 0.55, 95%CI was 0.34-0.90, P = 0.02) were significantly reduced, APTT was significantly shortened (MD = -0.88, 95%CI was -1.51 to -0.26, P = 0.006); but PT (MD = -0.44, 95%CI was -1.23 to 0.36, P = 0.28) and PLT (MD = -0.08, 95%CI was -18.81 to 18.65, P = 0.99) between the two groups had no statistically significant differences. A funnel chart analysis of PaO2/FiO2 with 11 included papers showed that there might be publication bias. CONCLUSIONS: Low molecular weight heparin can improve the poor oxygenation of ARDS patients, reduce the mortality of ARDS patients in the acute stage and the inflammatory reaction, but it may increase the bleeding risk of ARDS patients.