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Ametropic visual impairment has become a public health problem in China and even in the world, especially the prevention and control of myopia development, and the Chinese government attaches great importances to the eye health of school-age children and adolescents.The establishment of visual health archives and the screening of refractive errors are important managements prevention and control.However, there has always been a lack of relevant domestic or international screening specifications, and which may result in screening implementation subject confusion, inconsistent screening indicators and boundary values, unscientific operation methods and feedback in the routine screening work in China.With the push and support of National Health Commission, a recommended national health standard Specification for Screening of Refractive Error in School-age Children and Adolescents (WS/T 663-2019) was officially issued on January 11, 2020 and will be implemented from June 1, 2020, which clarified the technical standardization for the specific requirement, methods, referral recommendation and management during screening of refractive error in school-age children and adolescents.Implementing an effective screening and prevention of ametropic visual impairment in school-age children and adolescents according to the standard is an important task and responsibility of medical and educational institutions.
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Objective To analyze the clinical, imaging and interventional data of patients with chronic total occlusion (CTO) lesions without myocardial infarction (MI) and to summarize the clinical and imaging characteristics of these patients. Methods The data of 2651 patients with CTO verified by coronary angiography between January 1995 and December 2014 were analyzed retrospectively. Results There were 1466 CTO patients (55. 3%) without MI (the control group) and 1185 CTO patients (44. 7%) with MI ( the MI group). The age, percentage of female patients, unstable angina, hypertention, mean triglyceride levels, left ventricular ejection fraction ( LVEF) were lower in the MI group than in the control group ( all P﹤0. 05). The rates of heart failure and serum creatinine levels were higher in the MI group than the control group (both P﹤0. 05). The rate of multi-vessel disease was higher in the control group than in the MI group (81. 4% vs. 76. 5%, P﹤0. 05). According to the target CTO vessel location, patients in the control group had lower rates of CTO in LAD (36. 2% vs. 40. 7%, P=0. 007) and higher rates of CTO in LCX (17. 0%vs. 12. 7%, P﹤0. 001). Patients in the control group without MI had better collateral circulation than that in the control group (32. 7% vs. 27. 0%, P﹤0. 001). There were no differences in success rate of PCI and complete revascularization between the two groups. Conclusions The present study showed that the CTO patients without MI were associated with better collateral development compared with the CTO patients with MI. Age, gender, unstable angina encouraging ischemic preconditioning and hypertension may be beneficial by facilitating collateral development through endogenous cardioprotective mechanisms.
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<p><b>BACKGROUND</b>The occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality. The aim of the present study was to appraise the diagnostic efficacy of age, estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml × min(-1)× 1.73 m(-2))) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).</p><p><b>METHODS</b>The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography. CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium. Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles. The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.</p><p><b>RESULTS</b>The AGEF score ranged from 0.49 to 3.09. The AGEF score tertiles were defined as follows: AGEFlow ≤ 0.92 (n = 1 006); 0.92 <AGEFmid ≤ 1.16 (n = 1 000), and ACEFhigh >1.16 (n = 992). The incidence of CIAKI was significantly different in patients with low, middle and high AGEF scores (AGEFlow = 1.1%, AGEFmid = 2.3% and AGEFhigh = 5.8%, P < 0.001). By multivariate analysis, AGEF score was an independent predictor of CIAKI (odds ratio = 4.96, 95% CI: 2.32-10.58, P < 0.01). ROC analysis showed that the area under the curve was 0.70 (95% CI: 0.648-0.753, P < 0.001).</p><p><b>CONCLUSION</b>The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography. (Clinical Trial identifier: NCT00786136).</p>
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Female , Humans , Male , Middle Aged , Acute Kidney Injury , Contrast Media , Glomerular Filtration Rate , Physiology , Multivariate Analysis , Renal Insufficiency, ChronicABSTRACT
ObjectiveTo evaluate the long-term efficacy of covered stent implantation in the treatment of elderly patients with coronary perforation while undergoing percutaneous coronary intervention (PCI).MethodsFrom June 2004 to June 2012, our center has followed ten elderly patients (age≥ 60 years) who sustained coronary perforation during PCI. The major adverse cardiac events (MACE) were observed as well. The patients were advised to take 75 mg/day Clopidogrel for two years, and indefinite use of 100 mg/day enteric-coated aspirin.ResultsSix out of the 10 patients aged from 60 to 76 years old (mean 68.6 ± 5.2 years) were male, four were female. The average diameter of the implanted stents was 3.3 ± 0.3 mm, and the average length was 22.1 ± 3.7 mm. All the ruptures were successfully sealed without intra-procedural death. The follow-up duration ranged from 0.6 to 67 months (mean 31.7 ± 24.5 months). One patient died of multiple organ failure due to lung infection in 19 days after PCI; one died of cardiac sudden death in 13 months after PCI; one had angina pectoris in 53 months after PCI; one underwent multi-slice CT examination in six months after PCI, and no in-stent restenosis was found. The other four patients received angiography follow-up, and the results showed that three patients had no intra-stent restenosis, while one had left anterior descending (LAD) restenosis in the covered stent in 67 months after PCI. The in-hospital mortality was 10% (1/10). The MACE rate in 12 months after PCI was 10% (1/10). During the entire followed-up period, the restenosis rate in target vessels was 20% (1/5), mortality was 20% (2/10), and the MACE rate was 40% (4/10).ConclusionTreatment of coronary perforation by using covered stents can achieve favorable long-term results; a two-year dual antiplatelet therapy (DAPT) after PCI can effectively prevent intra-stent thrombosis.
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Objective To observe the efifcacy and safety of ticagrelor in patients received percutaneous coronary intervention (PCI). Methods 50 patients with non-responding platelet aggregation rate and CYPC219 gene after clopidogrel treatment were given ticagrelor and enrolled in the study. All enrolled patients received aspirin loading dosage 300 mg, followed by maintenance dosage 100 mg, once daily and ticagrelor maintenance dosage 90 mg twice daily, for 1 year. The primary endpoint for the study were the incidence of major cardiovascular events (including death, stent thrombosis, stent restenosis, nonfatal myocardial infarction, target vessel revascularization) and stroke after followed up for a month. The secondary endpoint were the incidence of general events (including minor bleeding, allergies, breathing dififculties) and platelet count changes. Results No occur major cardiovascular and stroke events record after 1 month of ticagrelor treatment. The general events rates included 2 cases of dyspnen, 1 case of epitaxis and 1 case of subcutaneous bleeding. The platelet aggregation with ticagrelor was signiifcantly lower than clopidogrel without signiifcant decrease in platelets count. Conclusions Using ticagrelor for antiplatelet in patients with coronary artery stenting in clopidogrel resistance cases is safe and effective.
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Objective To study the effect of biodegradable polymer drug-eluting stents (DES) on maintenance hemodialysis (MHD) patients with acute coronary syndrome. Methods From 2008 January to 2013 July, a total of 100 MHD patients with ACS who were treated with PCI in our centre were randomly divided into two groups, 50 patients in the EXcellstent group (biodegradable polymer DES) and the others in the FIREBIRD stent group (Ordinary DES). The patients included 61 male and 39 female, while the mean age was (58.4±9.2) years old (43-74 years old). After procedure, the EXcellstent group patients took aspirin (100 mg qd) and clopidogrel (75 mg qd) for 6 months, then aspirin (100 mg qd) for lifelong. The FIRDBIRD stent group patients also took aspirin (100 mg qd) and clopidogrel (75 mg qd), then aspirin (100 mg qd) lifetime too. To observe the main adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events during 12 months after procedure. Results The clinical data and angiographic results had no significant difference. No MACCE occurred during hospitalization. In 12 months after PCI, MACCE had no significant difference between two groups (P>0.05), and no stent thrombosis occured. One patient presented gastroin testinal bleeding in the EXcellgroup and 2 patients had cerebral hemorrhage in the FIRBIRD group. FIRBIRD group had more total hemorrhages events than that in EXcellgroup (P<0.05). Conclusions The treatment of biodegradable polymers DES in MHD patients with ACS was effective, and dual anti-platelet for 6 months was safe.
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Background To investigate the effects of collateral coronary circulation on the outcome of the patients with anterior myocardial infarction (NII) with left anterior desending artery occlusion abruptly.Methods Data of 189 patients with acute anterior MI who had a primacy percutaneous coronary intervention (PCI) in the fast 12 h from the onset of symptoms between January 2004 and December 2008 were retrospective analyzed.Left anterior descending arteries (LAD) of all patients were occluded.LADs were reopened with primary PCL According to the collateral circulation,all patients were classified to two groups:no collateral group (n＝111),patients without angiographic collateral filling of LAD or side branches (collateral index 0) and collateral group (n＝78),and patients with angiographic collateral filling of LAD or side branches (collateral index 1,2 or 3).At one year's follow-up,the occurrence of death,reinfarction,stent thrombosis (ST),target vessel revascularization and readmission because of heart failure were observed.Results At one year,the mortality was lower in patients with collateral circulation compared with those without collateral circulation (1% vs.8%,P＝0.049),whereas there were no differences in the occurrence of reinfarction,ST,target vessel revascularization and readmission because of heart failure.The occurrence of composite of endpoint was lower in patients with collateral circulation compared with those without collateral circulation (12% vs.26%; P＝0.014).Conclusions Pre-exist collateral circulation may prefigure the satisfactory prognosis to the patients with acute anterior MI after primary PCI in the fast 12 h of MI onset.
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Objective To assess the feasibility and safety of transradial approach in Chinese elderly patients undergoing coronary intervention.Methods In this prospective study, 764 elderly patients with coronary artery disease received percutaneous coronary intervention via either a transradial approach (TRA group) or a transfemoral approach (TFA group). The procedural success rate, success rate of artery access, puncture time, fluoroscopy time, dose of contrast, local complications and post-procedural pulmonary embolism were recorded and compared between 2 groups. Results There was no significant difference of the procedural success rate between the TRA group and the TRF group (96.3% vs. 98.2%, P＞0.05); there were also no differences of success rate of cannulation, mean fluoroscopy time and mean dose of contrast between the 2 groups. The mean puncture time was longer in the TRA group than in the TFA group (3.8±2.1 min vs. 2.0±3.4 min, P＜0.05). However, there were fewer access site-related complications in the TRA group than in the TFA group. Postprocedural pulmonary embolism occurred in 2 patients in the TFA group but none in the TRA group. Conclusion Transradial coronary intervention was feasible and safe in most Chinese elderly patients when performed by experienced operators.
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Objective:To evaluate one-year efficacy and safety of sirolimus-eluting stent with biodegradable polymer coating (EXCEL stent) in treating patients with coronary artery disease. Methods:One hundred consecutive hospitalized patients with coronary artery diseases exclusively treated with EXCEL stents were prospectively enrolled.After undergoing porcutaneous coronary intervention (PCI) all patients received dual anti-platelet therapy with clopidogrel and aspirin for 6 months and followed by aspirin alone.The primary end point was major adverse cardiac events(MACE) at 12 months.The secondary end points included binary in-stent restenosis rate(ISR)measured by quantitative coronary angiography (QCA) analysis at mean 8 months post the index PCI procedure,and MACE at 30 days and 6 months. Results:All patients were successfully treated with EXCEL stents during PCI procedure.Among all 153 target lesions,127 lesions were type B2/C complex lesions (83.0%).The mean length and diameter of the target lesions were 29.42?15.90 mm and 3.17?0.53 mm,respectively.A total of 211 EXCEL stents were implanted with average stent number of 2.02?1.53 per patient.The mean stent length and diameter were 35.34?17.35 mm and 3.23?0.46 mm,respectively.Four patients (4.0%) reached the primary end point at 12 months,which were 4 target lesion re-PCI due to ISR.No death,MI,or in-stent thrombosis occurred during the 6-month aspirin treatment alone after comleting 6-month dual anti-platelet therapy.QCA analysis of 112 le- sions of 75 patients showed 3.6% (4/112) of in-stent restenosis and 5.4% (6/112) of in-segment restenosis. Conclusions:The initial registry study showed that comparison with the published data from previous pivotal studies of others drug-eluting stents,the EXCEL stent revealed similarly incidence of 12-month ISR and/or MACE for the real world patients with coronary artery disease.The anti-platelet regimen of 6-month clopidogrel treatment after EXCEL implantation was safe.This con- clusion requires further investigation by large scale,multi-center,and longer-term follow-up clinical trials.
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5 cm?5 cm) (n=6).All patiens with complications were successfully treated except 8 with side branch closure,who were failed to response but cured by drugs after procedure.Three elder patients died,from sudden death(n=1),stoke (n=1),and kidney failure (n=1) after PCI. Conclusion:The complication incidence in patients with CTO lesions is relatively low and most of the complications can be cured by proper management.Revascularization by PCI for patients with CTO is an effective and safe treatment method.
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0.05).The rates of the local hematoma,pseudoaneurysm and aberration reflex in Group via radial artery were significantly lower than those in Group via femoral artery.Conclusion The transradial approach of PCI compared to traditional transfemoral approach in STEMI is safe and feasible,with relatively less vascular complications and more comfortable to the patients.