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Objective:To investigate the characteristics of coronary angiography and types of intracoronary thrombus in patients with acute myocardial infarction (AMI) who were classified according to changes of ST segment in electrocardiogram (ECG).Methods:A total of 232 consecutive AMI patients within 24 h of symptom onset undergoing primary percutaneous coronary intervention (PCI) in Henan Provincial People’s Hospital from September 2016 to August 2018 were included. According to the changes of ST segment, patients were divided into three groups: ST-elevated group (161 cases), ST-unoffset group (28 cases) and ST-depression group (43 cases). Optical coherence tomography (OCT) during primary PCI were performed and intracoronary thrombus types were differentiated according to OCT. One-way analysis of variance, Chi-square test and Fisher exact probability test were used to analyze the clinical baselines, angiographic characteristics and intracoronary thrombus types among the three groups. A P<0.05 was considered statistically significant. Results:Left anterior descending coronary artery and right coronary artery were the most common infarct related arteries in the ST-elevated group and ST-depression group, while left circumflex artery was more common in the ST-unoffset group ( P<0.001). The infarct sites in the ST-elevated group and ST-depression group were mostly located in the proximal and middLe segments, while those in the ST-unoffset group were mostly located in the middLe and distal segments ( P=0.008). The proportion of occlusive lesion in the ST-elevated group and ST-unoffset group was higher than that in the ST-depression group (68.3% vs. 30.2%, P<0.05; 67.9% vs. 30.2%, P<0.05). The proportion of single vessel in the ST-elevated group and ST-unoffset group was higher than that in the ST-depression group (36.0% vs. 4.7%, P<0.05; 39.3% vs. 4.7%, P<0.05). The proportion of collateral circulation of infarct related artery in the ST-unoffset group and ST-depression group was higher than that in the ST-elevated group (35.7% vs. 16.1%, P<0.05; 58.1% vs. 16.1%, P<0.05). The incidence of red thrombus in the ST-elevated group and ST-unoffset group was significantly higher than that in ST-depression group (76.4% vs. 34.9%, P<0.05; 64.3% vs. 34.9%, P<0.05). Conclusions:Compared with the ST-depression group, the proportions of single-vessel, occlusive lesion and red thrombus are higher in the ST-unoffset group and ST-elevated group. Therefore, in acute non ST-segment elevated myocardial infarction, those without ST-segment deviation are different from those with ST-segment depression. It is recommended to further divide acute myocardial infarction into ST segment elevation type, ST segment unoffset type and ST segment depression type according to ECG.
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Objective:To investigate the risk factors of ST-segment elevation myocardial infarction (STEMI) with early left ventricular thrombus (LVT) under emergency percutaneous coronary intervention(PCI)mode.Methods:The clinical data were collected from 784 patients with STEMI treated with emergency percutaneous coronary intervention (pPCI) in our hospital from January 2014 to April 2019 . The observation indexes included baseline data, coronary angiography, disease course, laboratory examination and auxiliary examination. Patients with severe organic heart disease and having previous history of LVA and LVT were excluded. Totally 38 patients with LVT were selected as the experimental group and 114 patients with non-LVT selected as the control group according to the principle of age (the smallest absolute age difference between the experimental group and the control group) and sex. Data was analyzed by software Graphpad Prism5, SPSS 22.0 and Medcalc software were used for statistical analysis, and the Logistic regression model was established. A P<0.05 was considered statistically significant, and the risk factors of early LVT formation were retrospectively analyzed. Results:There was a linear relationship between the prolongation of TIT and the occurrence of LVT ( χ2= 304, P<0.01), and the Spearman relation was highly positive ( ρ=0.626, P<0.01). Multivariate conditional logistic regression analysis showed that prolonged TIT (total ischemic time), increased total amplitude of ST elevation, TIMI blood flow ≤ grade 2 after pPCI, decreased LVEF and LVA were independent risk factors for LVT, and their odds ratios ( OR) were 1.996, 13.689, 16.996, 0.868 and 9.195, respectively. Model 1 was constructed as LVA and the total amplitude of elevation of ST segments, and the receiver operating characteristic (ROC) was drawn, and the area under the ROC curve (AUC) was calculated as 0.889. Model 2 was obtained by adding TIT, LVEF and postoperative TIMI blood flow≤2, and the AUC was 0.990. Delong method was used to compare the AUC values between the two groups, and there was a statistical difference ( Z=3.294, P=0.001). Conclusions:The risk factors of STEMI complicated with early LVT under "emergency PCI mode" may have changed. Clinicians should conduct early screening of high-risk people factors of LVT in order to reduce its incidence and improve the prognosis. It may be helpful to actively carry out emergency bedside echocardiography before operation.
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Objective To explore the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods Retrospective data were collected from September 2014 to October 2018 in Henan Province People's Hospital for emergency interventional treatment of patients with STEMI. According to the type of thrombus detected by OCT, they were divided into two groups, which were red thrombus group and white thrombus group. Clinical baseline data, coronary angiographic findings, and OCT results were collected in patients with STEMI. Logistic regression analysis was used to analyze the type of thrombosis in patients with STEMI. Results The rate of thrombus detection was 100％ in 92 patients with STEMI. According to OCT diagnostic criteria, 73 (79.3％) patients were classified into red thrombus and 19 (20.7％) were white thrombus. There was no significant difference in infarct-related artery and location between the two groups (P>0.05) , but there was more multiple vascular lesions in the white thrombus group than that in the red thrombus group. There was significant difference in the incidence of plaque rupture and thin fibrous cap in the two groups (P<0.05). The incidence of plaque rupture and thin fibrous cap lipid plaque was higher in the red thrombus group. Plaque rupture (OR = 2.894, 95％CI:2.704-2.956) , thin fibrous cap plaque (OR = 8.033, 95％CI: 7.985-8.283) , single vessel disease (OR = 1.746, 95％ CI: 1.659-1.785) are risk factors for red thrombosis formation. Conclusion Single vessel lesion, plaque rupture andthin fibrous cap lipid plaque are associated with red thrombus formation.While, multiple vessel lesions and stable plaque are associated with white thrombus formation.
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Objective To investigate the clinical effect of ropivacaine hydrochloride at 0.25%, 0.375% and 0.5% concentration for lower limb nerve block anesthesia.Methods75 cases of lower extremity nerve block anesthesia from Ningbo Zhenhai District Hospital of traditional Chinese Medicine from September 2014 to February 2015 were enrolled in the course of the study, they were divided into three groups: group 0.25%, the equivalent number of 0.375% and 0.5% groups, and three groups of patients were made with a concentration of 0.25%, 0.375%, 0.5% ropivacaine hydrochloride for lower extremity nerve block anesthesia;the clinical data of three groups were analyzed retrospectively, observation of three groups of patients with lower limb nerve block effect.ResultsThe results showed that 0.25% groups of patients in the motor block time was (36.8±5.9) minutes, motor block in patients with a total of 7 cases, with nerve block in patients with a total of 11 cases.0.375% groups of patients in the motor block time was (23.1±4.3) minutes, motor block in patients with a total of 14 cases, with nerve block in patients with a total of 18 cases.0.5% groups of patients in the motor block time was (20.6±5.7) minutes, motor block in patients with a total of 16 cases, with nerve block in patients with a total of 18 cases.Available block time of 0.375% groups of more than 0.5% groups, less than 0.25% groups;0.375% motor block group was 56.0%, higher than the 0.25% group, lower than the 0.5% group;the 0.375% group and 0.5% group of nerve block ratio is same, higher than the 0.25% group, the difference was statistically significant (P<0.05).ConclusionThe effect of anesthesia using concentration of 0.375% ropivacaine hydrochloride is relatively good, can reduce the dosage of anesthetic drugs, but also ensure the anesthetic effect, meet the clinical requirement, this method will be applied to.
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Objective To explore the influencing factors for the smoking cessation attempts in male current smokers.Methods This cross-sectional study was conducted in nine villages selected from three counties (Pingyin,Junan and Liangshan) of Shandong province in August,2010 through household questionnaire survey in villagers aged ≥ 15 years to collect the information about current smokers demographic characteristics and smoking-related behaviors.A hurdle count data model was used to assess factors associated with the times of past smoking cessation attempts.Results Among 1 798 male current smokers,29.53％ had at least one smoking cessation attempt.Smokers who were married (3=0.705,P=0.002),had high educational level (β=0.214,P=0.026) and had higher level of awareness of smoking risks (β=0.237,P=0.009) were more likely to have smoking cessation attempt.Young age at smoking initiation (3 =-0.167,P=0.035) and higher level of awareness of smoking risks (β =0.146,P=0.020) were associated with increased smoking cessation attempts.Conclusions Less male current smokers had smoking cessation attemps in rural area in Shandong.The factors influencing smoking cessation attempt varied.It is necessary to conduct targeted intervention according to the smokers' smoking cessation experience.
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Objective To explore the influencing factors for the smoking cessation attempts in male current smokers.Methods This cross-sectional study was conducted in nine villages selected from three counties (Pingyin,Junan and Liangshan) of Shandong province in August,2010 through household questionnaire survey in villagers aged ≥ 15 years to collect the information about current smokers demographic characteristics and smoking-related behaviors.A hurdle count data model was used to assess factors associated with the times of past smoking cessation attempts.Results Among 1 798 male current smokers,29.53％ had at least one smoking cessation attempt.Smokers who were married (3=0.705,P=0.002),had high educational level (β=0.214,P=0.026) and had higher level of awareness of smoking risks (β=0.237,P=0.009) were more likely to have smoking cessation attempt.Young age at smoking initiation (3 =-0.167,P=0.035) and higher level of awareness of smoking risks (β =0.146,P=0.020) were associated with increased smoking cessation attempts.Conclusions Less male current smokers had smoking cessation attemps in rural area in Shandong.The factors influencing smoking cessation attempt varied.It is necessary to conduct targeted intervention according to the smokers' smoking cessation experience.
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The Expert Consensus on the Diagnosis and Therapy of myelodysplastic syndrome (MDS) (2014) will be interpreted in this paper focusing on whether it is scientific and reasonable.Some advises and views will be put forward,hoping that it will be useful to improve the diagnostic and therapeutic ability on MDS for clinicians in our country.