Association between Cardiovascular Burden and Requirement of Intensive Care among Patients with Mild COVID-19

BackgroundInformation regarding the impact of cardiovascular disease (CVD) on disease progression among patients with mild coronavirus disease 2019 (COVID-19) is limited. MethodsThis study evaluated the association of underlying CVD with disease progression in patients with mild COVID-19. The primary outcome was the need to be transferred to intensive care due to disease progression. The patients were divided with and without CVD as well as stable and intensive care groups. ResultsOf 332 patients with mild COVID-19, median age was 51 years (IQR, 40-59 years), and 200 (61.2%) were female. Of 48 (14.5%) patients with CVD, 23 (47.9%) progressed to severe disease status and required intensive care. Compared with patients without CVD, patients with CVD were older, and more likely to have fatigue, chest tightness, and myalgia. The rate of requiring intensive care was significantly higher among patients with CVD than in patients without CVD (47.92% vs. 12.4%; P<0.001). In subgroup analysis, rate of requiring intensive care was also higher among patients with either hypertension or coronary heart disease than in patients without hypertension or coronary heart disease. The multivariable regression model showed CVD served as an independent risk factor for intensive care (Odd ratio [OR], 2.652 [95% CI, 1.019-6.899]) after adjustment for various cofounders. ConclusionsPatients with mild COVID-19 complicating CVD in are susceptible to develop severe disease status and requirement for intensive care. Key PointsO_ST_ABSQuestionC_ST_ABSWhat is the impact of coexisting cardiovascular diseases (CVD) on disease progression in patients with mild COVID-19? FindingsAlthough most patients with mild COVID-19 were discharged alive from hospital, approximately 47.9% patients with coexisting CVD developed severe disease status and required intensive care. CVD is an independent risk factor of intensive care among patients with mild COVID-19. MeaningCoexisting CVD is associated with unfavorable outcomes among patients with mild COVID-19. Special monitoring is required for these patients to improve their outcome.

How to differentiate COVID-19 pneumonia from heart failure with computed tomography at initial medical contact during epidemic period

OBJECTIVESTo compare chest CT findings in heart failure with those of Corona Virus Disease 2019 (COVID-19) pneumonia. BACKGROUNDDuring epidemic period, chest computed tomography (CT) has been highly recommended for screening patients with suspected COVID-19. However, the comparison of CT imaging between heart failure and COVID-19 pneumonia has not been fully elucidated. METHODSPatients with heart failure (n=12), COVID-19 pneumonia (n=12) and one patient with both diseases were retrospectively enrolled. Clinical information and imaging of chest CT were collected and analyzed. RESULTSThere was no difference of ground glass opacity (GGO), consolidation, crazy paving pattern, lobes affected and septal thickening between heart failure and COVID-19 pneumonia. However, less rounded morphology (8.3% vs. 67%, p=0.003), more peribronchovascular thickening (75% vs. 33%, p=0.041) and fissural thickening (33% vs. 0%, p=0.028), less peripheral distribution (33% vs. 92%, p=0.003) were found in heart failure group than that in COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (75% vs. 8.3%, p=0.001), subpleural effusion and cardiac enlargement in heart failure group than that in COVID-19 group (50% vs. 0%, p=0.005, separately). Besides, more fibrous lesions were found in COVID-19 group although there was no statistical difference (25% vs. 0%, P=0.064) CONCLUSIONSAlthough there are some overlaps of CT imaging between heart failure and COVID-19, CT is still a useful tool in differentiating COVID-19 pneumonia.

Comparison of heart failure and 2019 novel coronavirus pneumonia in chest CT features and clinical characteristics / 中华心血管病杂志

Objective@#To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and novel coronavirus pneumonia(COVID-19).@*Methods@#This study was a retrospective study. A total of 7 patients with Heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed.@*Results@#There was no significant difference in age and sex between the two groups, but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 2/7, P=0.001; 12/12 vs. 4/7, P<0.001). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001; 0/12 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of small pulmonary veins was also higher (3/7 vs. 0, P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there are more disease with rounded morphology in COVID-19 (9/12 vs. 2/7, P=0.048) .@*Conclusions@#More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.

Comparison of One-Year Survival After Acute Coronary Syndrome in Patients ≥75 Years of Age With Versus Without Living With Spouse.

Patients with acute coronary syndrome (ACS) face high postevent mortality. This study aims to evaluate the impact of living without spouse on 1-year mortality of ACS patients. This retrospective study enrolled a total of 600 consecutive patients (≥75 years of age) with ACS hospitalized in our hospital between January 2013 and December 2016. Patients' clinical characteristics, laboratory values, hospital course, demographic characteristics, and angiographic data were collected. Patients were divided into 2 groups according to living with (n = 396) or without (n = 204) spouse. Patients living without spouse were older (79 [77,82] vs 77 [76,80], p <0.001), more frequently female (54.9% vs 31.8%, p <0.001), less smokers (23.5% vs 38.9%, p <0.001), lower left ventricular ejection fraction value (52.1±10.7% vs 54.4±9.8%, p = 0.021) compared with patients living with spouse. In addition, compared to patients living with spouse, patients living without spouse were less likely to get percutaneous coronary intervention (41.2% vs 54.0%, p = 0.003) during hospitalization and had higher 1-year mortality post-ACS (22.1% vs 13.4%, p = 0.006). Multivariate logistic regression analysis showed that living without spouse remained an independent risk factor for 1-year mortality after ACS in patients ≥75 years (odds ratio 2.350, 95% confidence interval 1.245 to 4.434, p = 0.008), after adjusted with age, gender, heart rate, systolic blood pressure, left ventricular ejection fraction value at baseline, hemoglobin, white blood cell, alanine aminotransferase, albumin, creatinine, brain natriuretic peptide, type of ACS, severe heart failure at admission, percutaneous coronary intervention treatment, ß blocker, diuretics application during hospital. In conclusion, living without spouse is an independent risk factor for 1-year all-cause mortality in ACS patients ≥75 years.

Risk factors for early death in acute myocardial infarction patients complicating with ventricular septal rupture / 中华心血管病杂志

Objective@#To assess the clinical characteristics and identify the risk factors in the acute myocardial infarction (AMI) patients complicating with ventricular septal rupture (VSR).@*Methods@#A retrospective study was performed on 96 AMI patients complicating with VSR, who were hospitalized in the Second Xiangya Hospital of Central South University, Hunan Provincial Peoples′ Hospital, the First Affiliated Hospital of University of South China, the Second Affiliated hospital of University of south China, Xiangtan Central Hospital from December 2007 to May 2017. There were 46 females and the age was (66.2±10.7) years (from 43 to 90 years). Patients were divided into in-hospital survival group (n=64) and in-hospital death group (n=32). The 96 patients were also divided into the early death group (survived ≤2 weeks after admission, n=50) and non-early death group (survived>2 weeks after admission, n=46). Multivariate logistic regression was used to analyze the independent risk factors of the early death.@*Results@#Location of VSR was available in 71 patients, VSR was located at the apical or anterior septum near the apical region in 64.0% (32/50) patients with the anterior AMI, VSR was located at the posterior wall and basal inferior segment in 57.1% (12/21) patients with non-anterior AMI. Compared to the in-hospital survival group, patients in the in-hospital death group were older ((69.6±11.3) years vs. (64.6±10.1) years, P=0.031), incidence of non-ventricular aneurysm (71.9% (23/32) vs. 37.5% (24/64), P=0.001) and anterior AMI (84.4%(27/32) vs. 62.5%(40/64), P=0.028) was significantly higher in the in-hospital death group than in the in-hospital survival group. The comparison between the early death group and non-early death group showed that older age, female, no history of angina or myocardial infarction, Killip grade>Ⅲ, and non-ventricular aneurysm were related to increased risk of the early mortality in this patient cohort. Logistic regression analysis revealed that female (OR=5.109,95%CI 1.19-22.00, P=0.012), no history of angina or myocardial infarction (OR=23.34, 95%CI 3.44-158.37, P=0.001), Killip grade>Ⅲ(OR=5.35, 95%CI 1.26-22.66, P=0.019) and non-ventricular aneurysm (OR=6.30,95%CI 1.67-23.73, P=0.005) were independent risk factors for early death in this patient cohort.@*Conclusion@#The risk factors of in-hospital death include older age, non-ventricular aneurysm and anterior AMI. Female, no history of angina or myocardial infarction, Killip grade>Ⅲ and non-ventricular aneurysm are independent risk factors for the early death of AMI patients complicating VSR.

Analysis on clinical effect of volar side locking compression titanium plate and external fixation trestle for treating unstable type C distal radius fracture / 重庆医学

Objective To comparatively analyze the clinical effects of volar locking compression titanium plate and external fixation trestle for treating unstable type C distal radius fracture.Methods The clinical data of 78 patients with unstable type C distal radius fracture treated in this hospital from March 2014 to February 2016 were analyzed retrospectively.The patients were di-vided into the volar locking plate group and external fixattio trestle group according to different treatment methods,39 cases in each group.The clinical efficacies of different treatment methods were observed.Results The postoperative bleeding volume,operation time,hospitalization time and fracture healing time in the external fixation group were less than those in the volar locking plate frac-ture group(P<0.05).The palmar tilt angle,ulnar inclination angle and radial height on postoperative 3 d,6 weeks and 24 mopnths in the volar locking plate group were significantly better than those in the external fixation group(P<0.05).The last follow-up showed that the palmar flexion degree,dorsiflexion degree,VAS score and Gartland-Werley score had no statistical difference be-tween the two groups(P>0.05).The incidence rates of postoperative incision infection,carpal tunnel syndrome and thumb extensor tendon rupture had no statistical differences between the two groups(P>0.05).Conclusion The two kinds of treatment method all have better clinical curative effect.The external fixation trestle treatment has the advantages of shorter operation time and shorter hospitalization time,while the volar locking compression titanium plate can reset the fractures under direct vision,is significantly su-perior to the external fixation trestle treatment in the aspects of recovery of palmar tilt angle,ulnar inclination angle and radial height,and is more suitable for the patients with unstable type C distal radius fracture..

Prognostic significance of CUEDC2 expression in hepatocellular carcino-ma / 中国病理生理杂志

AIM:To investigate the expression of CUE domain-containing 2 (CUEDC2) in hepatocellular car-cinoma ( HCC) and to analyze its clinical prognostic significance .METHODS:Total 186 formalin-fixed paraffin-embed-ded tissues obtained from surgical HCC with detailed clinicopathological and follow -up data were used .The expression of CUEDC2 was detected by immunohistochemistry .The relationships between the expression of CUEDC 2 and clinicopatholog-ical characteristics and prognosis were analyzed .RESULTS: The positive rate of CUEDC 2 in HCC was 85.5% ( 159/186), among which, the low expression was 52.2%(97/186) and the high expression was 47.8%(89/186).CUEDC2 expression was correlated with serum alpha-fetal protein (AFP) level, tumor size, tumor number, tumor differentiation and TNM stage (P<0.05).Kaplan-Meier survival curves showed that the patients with high expression of CUEDC 2 were asso-ciated with significantly shorter overall survival and recurrence-free survival than those with low CUEDC 2 expression ( P<0.05).Multivariate Cox regression analysis revealed 3 independent prognostic factors including CUEDC 2 expression, ser-um AFP and tumor number .CONCLUSION:CUEDC2 was expressed in most HCC tissues , which was relevant to tumor growth, tumor differentiation and prognosis .CUEDC2 could be a novel valuable molecular marker to predict the HCC prog-nosis.

Human KIAA1018/FAN1 nuclease is a new mitotic substrate of APC/C(Cdh1) / 癌症

A recently identified protein, FAN1 (FANCD2-associated nuclease 1, previously known as KIAA1018), is a novel nuclease associated with monoubiquitinated FANCD2 that is required for cellular resistance against DNA interstrand crosslinking (ICL) agents. The mechanisms of FAN1 regulation have not yet been explored. Here, we provide evidence that FAN1 is degraded during mitotic exit, suggesting that FAN1 may be a mitotic substrate of the anaphase-promoting cyclosome complex (APC/C). Indeed, Cdh1, but not Cdc20, was capable of regulating the protein level of FAN1 through the KEN box and the D-box. Moreover, the up- and down-regulation of FAN1 affected the progression to mitotic exit. Collectively, these data suggest that FAN1 may be a new mitotic substrate of APC/CCdh1 that plays a key role during mitotic exit.

Cardiac perforation and tamponade in percutaneous cardiac intervention / 中南大学学报(医学版)

OBJECTIVE@#To explore the cause of cardiac perforation and tamponade during cardiac catheterization and intervention and to evaluate the effectiveness of the emergency treatment for tamponade in our hospital.@*METHODS@#The clinical data from 23, 319 patients who received diagnostic catheterization or therapeutic procedures were analyzed retrospectively.@*RESULTS@#Cardiac perforation and cardiac tamponade were observed in 22 of the 23, 319 patients during catheter procedures. It includes 1 in coronary artery angiography, 9 in percutaneous balloon mitral valvuloplasty, 3 in diagnosis, 2 in congenital heart disease intervention, 2 in pacemaker implantation, 2 in atrial fibrillation ablation and the other 3 in coronary revascularization. The occurrence of cardiac perforation in 11 patients was related to puncture of the interatrial septum and/or the procedure in the left atrial procedure and 2 were related to high pressure injection. Seventeen patients were found cardiac tamponade in the process of catheterization, and 5 were found at 2-14 h after operation. Pericardiocentesis and pericardial catheter drainage were performed in 20 patients and 11 of them succeeded. Among the other 11 patients, 7 were successfully saved by thoracotomy and 4 died.@*CONCLUSION@#Cardiac tamponade is a severe and fatal complication that may occur in different catheter procedures. Early prevention and diagnosis and performingperi cardiocentesis and drainage timely are critical to reduce the mortality.

Research on relationship between social support and subjective well-being of labor workers in Shenzhen / 中华行为医学与脑科学杂志

Objective To study the relationship between social support and subjective well-being(SWB) of labor workers.Methods 1038 labor workers in Shenzhen were evaluated by subjective well-being scale for Chinese citizen (SWBS-CC), social support rating scale ( SSRS ).Results There was no significant difference in SWB between male and female( ( 63.51 ± 11.03 ) vs ( 63.22 ± 12.02 ), t = 0.389, P ＞ 0.05 ).The 30 ～ 49 age group's score was significantly higher than the 16 ～29 age group's( (62.80 ± 11.80) vs (64.54 ± 11.28), t=2.21, P ＜ 0.05 ).The married group's score was significantly higher than the unmarried group's ( (62.50 ± 12.18)vs (64.27 ± 10.80 ), t= 2.44, P ＜ 0.05 ).Social support was significant positively correlative with subjective well-being ( r=0.075 ～0.391, P＜0.05), except support availability was not correlative with both subscales.Subjective support, support availability and objective support were significantly positive predictions of SWB, meanwhile subjective support was the biggest( β =0.297).Conclusion Subjective well-being of the labor workers in Shenzhen have significant relationship with age and social support.To increase the emotional support for the labor workers could possibly help to improve their subjective well-being.

Stent-delayed implantation strategy of acute myocardial infarction with high thrombus burden in primary percutaneous coronary intervention / 中南大学学报(医学版)

OBJECTIVE@#To retrospectively evaluate the efficacy of stent-delayed implantation in patients with acute myocardial infarction (AMI) with high thrombus burden after thrombus extraction was performed.@*METHODS@#Of 186 consecutive AMI patients, 56 were included according to thrombus score(TS)>or=2, and then were divided into 2 groups based on the thrombus score after thrombus extraction was executed: the stent-direct implantation group (TS=0 or 1)and the stent-delayed implantation group (TS>or=2) even if 3 times thrombus extraction were given. Thrombolysis in myocardial infarction(TIMI)flow grade and TIMI myocardial perfusion (TMP) were used to assess the coronary artery flow and myocardial perfusion,respectively.@*RESULTS@#TIMI score in the stent-direct implantation group was lower than that in the stent-delayed implantation group. There was no significant difference(P=0.07). TMP score in the stent-direct implantation group was significantly lower than that in the stent-delayed implantation group (P<0.05).@*CONCLUSION@#Stent-delayed implantation can remarkably improve myocardial perfusion in AMI patients with high thrombus burden after thrombus extraction and intensive anti-thrombosis therapy is administrated.

Relationship between pregnancy-associated plasma protein A level and restenosis after elective coronary stenting / 中华老年医学杂志

Objective To investigate the relationship between pregnancy-associated plasma protein A(PAPP-A)level and restenosis after elective coronary stenting by coronary artery angiography(CAG)and intravascular ultrasound(IVUS). Methods The study consisted of 132patients with successful coronary stent placement:left anterior descending coronary artery(LAD)62,left circumflex coronary artery(LCX)36,right coronary artery(RCA)34.The follow-up CAG and IVUS were Derformed at the 6th month after stent placement.Diameter stenosis≥50%on CAG was regarded as in-stent restenosis.Neointimal areas(IA),stent volume(SV)and neointimal volume(IV)were measured by IUVS during follow-up.According to the PAPP-A level,lesions were divided into 2groups:high PAPP-A group(PAPP-A level≥12.11 mIU/L)and low PAPP-A group(PAPP-A level＜12.11 mIU/L). Results Total restenosis rate was 31.8%.There were no significant differences in age.sex and risk factors of coronary heart disease(hypertension,diabetes,smoking)between restenotic and nonrestenotie groups(all P＞0.05).The restenotic group had higher PAPP-A level than nonrestenotic group[(18.14±2.26)mIU/L vs. (10.95±2.12)mlU/L,P＜0.01].Angiographic restenosis occurred in 28 of 66 lesions(42.4%)in the high PAPP-A group and in 14 of 66 lesions(21.2%)in the low PAPP-A group(P＜0.01).Plasma PAPP-A level was positively correlated with IA,IV(r=0.47 and 0.54 respectively,all P＜0.05). Conclusions Elevated PAPP-A level is correlated well with the severity of the intimal hyperplasia.Plasma PAPP-A level affects restenosis after elective stent placement by promoting intimal hyperplasia.

Clinical treatment of 368 sepsis patients induced by severe surgical abdominal infection / 中华急诊医学杂志

Objective To investigate and find a multiple treatment to reduce the mortality of sepsis patients induced by severe surgical abdominal infection.Methods While treating to severe surgical abdominal infection,inflammatory mediator bacteria,extoxin and endotoxin,immunity,dysfunction of microcirculation,nutrition and metabolism and the function of organs should be paid more attention on and considered as a whole.We also carried out 14 concrete treating measurement.Combined high dosage of anisodaminum and dexamethason were used in sbort-term.Bring forward nourishment support according to different stage of MODS and applying it in clinic could significantly reduce the companion syndrome.Oral administration of“JIE-DU-GU-BEN-TANG”which developed by our division could regulate the imbalance of immunity and inflammatory mediator.Results There were 46 patients died in 368 patients,mortality was 12.50%. Conclusion It was difficult to treat sepsis patients induced by severe abdominal infection and our new multiple treatment could significantly reduce the mortality of severe sepsis.

The effect of release and debridement with arthroscopy in the treatment of elbow malfunction / 中华骨科杂志

Objective To explore the effect of elbow release and debridment with arthroscopy for elbow malfunction. Methods The study was carried out on 15 patients (male 11, female 4; age 21-63 years old, average 40.1 years old) with the use of arthroscopy to brisement accretion and articular capsule from August 2001 to December 2003. The mean course was 55.2 months (range, 8-24 months). The flexion angle of joint preopration was 15?-60?, average 30.4?, the extension angle was -80?--20?, average -51.2?. The diagnosis was osteophyma and liberum in 4. The old fracture of radius capitulum was in 2; the old fracture of ulnar olecranon in 2; the old fracture of condyle of humerus in 3; degeneration in 4. The brachial plexus anesthesia,the elbow hung to traction, interna and extra-pathway, to cut synovium and accretion fibers with shver, removal liberum and milling osteophyma, meanwhile brisement articular capsule. Pathology manifestation in arthroscopy: there were a lot hyperemia synovium and fiber accretion. There was cartilage exfoliation in 8, hyperplasy and liberum in 5, ossification of cicatricle in 2. The motion range of elbow was reexamined, if the extension function was restricted, release was performed on anterior soft tissue and capsule. If the flexion function was restricted, release was carried out on posterior capsule via posterior straight approach(3 cm supra point of olecranon). Results All patients recovered daily life and occupation postoperative 7 to 14 days. Transient ulnar nerve paralysis occurred postoperatively in one case, which recovered three months later. There were no blood vessel and nerve injury. The mean follow-up period was 14.1 months (range, 7-20 months). At the final follow-up, the flexion of joint post operation was 70?-120?, to improve average 60.5?; the extension of joint post operation was -20?--5?, to improve average 37.6?. In accordance with HSS scoring system, excellent 7, good 5, fail 3. Conclusion Using of arthroscopy to release elbow joint have many advantages such as less trauma, quick recovery and less sequela. The application in release with arthroscopy is a good way for elbow malfunction.