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1.
BMC Fam Pract ; 21(1): 80, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375674

RESUMO

BACKGROUND: Studies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs' perceptions of their professional identity. METHODS: A multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups' differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs. RESULTS: Based on a total score of 65 on the professional identity scale, the average score for GPs' professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity. CONCLUSIONS: Professional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.

2.
J Interv Cardiol ; 2020: 9190702, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32082099

RESUMO

Objectives: To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk. Background: Previous studies about the outcomes of RA were limited with small sample size and low-risk population. Methods: Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events. Results: The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively). Conclusions: The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.

4.
J Card Surg ; 35(1): 48-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31899832

RESUMO

BACKGROUND: Precisely evaluating the need for transannular patch (TAP) placement is very important in the surgical treatment of tetralogy of Fallot. We hypothesized that the pulmonary annulus area index (PAAI, the pulmonary-to-aortic valve annulus cross-sectional area ratio) could be a useful and accessible predictor for TAP placement. METHODS: The medical records of patients who underwent tetralogy of Fallot repair between 1 January 2016 and 31 December 2017 were reviewed retrospectively. A total of 255 patients were included and categorized into two groups: patients who needed TAP placement and patients who did not. Various candidate predictors for TAP placement (PAAI, pulmonary annulus z-score, and velocity across the pulmonary annulus) were compared using receiver operating characteristic curves. The optimal cutoff for each predictor was assessed. RESULTS: Among the 255 patients included, 156 needed TAP placement (156/237, 65.8%). Both the PAAI (0.28 [0.20/0.34] vs 0.14 [0.09/0.19]; P < .0001) and z-score (-1.5 [-2.9, -0.4] vs -3.6 [-5.3/-2.6]; P < .0001) were smaller in the TAP group. The PAAI is a useful predictor of the pulmonary annulus z-score (AUC 0.830 vs 0.811, P = .19). Combination analysis of the PAAI and velocity across the pulmonary annulus (PV vmax ) showed better predictive value than the PAAI and z-score (AUC 0.860, sensitivity 89.7%, specificity 61.7%, P < .0001). CONCLUSIONS: Our results suggest that the PAAI is a useful and accessible predictor for TAP placement and can be applied readily and simply in clinical practice. A combination with the velocity across the pulmonary annulus could promote the accuracy of prediction.

5.
J Card Surg ; 35(1): 75-82, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31692110

RESUMO

OBJECTIVES: The "modified single-patch" technique (Nunn's technique) has become more widely adopted, especially in small infants with common atrioventricular septal defect (CAVSD). In this study, we retrospectively reviewed our surgical experiences of the "modified single-patch" technique with CAVSD patients, including newborns and adults, to reveal the early and midterm clinical results. METHODS: There were 233 cases diagnosed with CAVSD undergoing biventricular repair in our hospital from June 2009 to 2016. A total of 197 cases (84.5%) with the "modified single-patch" technique were enrolled in the final analysis, including type A in 106 cases (53.8%), type B in 13 cases (6.6%), type C in 15 cases (7.6%), and intermediate type in 63 cases (32%). Major associated cardiovascular malformations included five cases of unroofed coronary sinus syndrome with LSVC (UCS), five cases of coarctation of the aorta and one case of translocation of the great artery. The median age at operation of the studied 197 cases was 44.3 ± 103.3 months (ranging from 18 days to 58 years old), including two newborns. Detailed information on the "modified single-patch" procedure was described previously, and the other cardiac malformations were repaired simultaneously with surgical repair. RESULTS: There were 14 (7.1%) early deaths and 3 (1.5%) late deaths at 3 months and 1 year after the initial operation, respectively. The total mortality rate was 8.1%, and there was no significant difference in mortality among the different age groups (P = .291). Five patients (2.5%) underwent reoperation because of severe mitral insufficiency (MI), and another patient was reoperated for left ventricular outflow tract obstruction 3 years after the initial surgery. Long-term survival in the <3 months group was significantly lower than that in the group of older children (1-18 years old). Of the 180 survivors who were followed up for at least 1 year, the proportion of severe MI began to drop from 26.2% before the operation to 13.8% just 1-week postoperation and continued to decline to the lowest level, 3.4%, at 3 months postoperation. However, MI began to rebound at 3 months and reached 20.8% at 1-year postoperation. The rebound of MI was evident in the (3 months, 6 months) age group and the >18 years age group. However, compared to the preoperation situation, the proportion of severe tricuspid insufficiencies decreased each month from 24.8% to 0.0% until 3 months after the operation and remained at a relatively low level within 1 year after surgery. CONCLUSIONS: In our experience, age is not a limitation of the modified single-patch technique, and patients even in adults with surgical indications can apply this technique. In older children and adults, we should pay more attention to atrioventricular valve annuloplasty. Infants may suffer from severe residual left atrioventricular valve regurgitation, especially in the <3 months age group, so we should improve postoperative follow-up work during infancy.

6.
Clin Nutr ; 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31759771

RESUMO

BACKGROUND & AIMS: Leveraging prokinetics to facilitate trans-pyloric migration is a conventional strategy. However, due to restrictions on the use of domperidone suspension, oral prokinetics is relatively modest. The study aims to assess the effectiveness of simo decoction as an alternative to domperidone suspension in facilitating post-pyloric placement of spiral nasoenteric tubes. METHODS: A prospective, open-label, parallel, and non-inferiority randomized controlled trial was performed involving critically ill adults in 6 university hospitals in China between September 2017 and May 2019. Patients were randomly assigned to receive either simo decoction 20 ml q8h, or domperidone suspension 20 mg/20 ml q6h for 24 h. The primary outcome was procedure success defined as post-pyloric placement (spiral nasoenteric tubes reached the first portion of the duodenum or beyond confirmed by abdominal X-ray 24 h after tube insertion). RESULTS: Of 268 patients assessed for eligibility, 224 patients were enrolled and randomly assigned to the simo decoction group or the domperidone suspension group (n = 112 per group). The success rate of post-pyloric placement was 41.1% (46/112) in the simo decoction group, as compared with 47.3% (53/112) in the domperidone suspension group (a risk difference of -6.3%, 95% CI, -19.2% to 6.7%, adjusted risk difference -3.7%, 95% CI -16.3% to 9.0%), in the intention-to-treat analysis, crossing the prespecified margin of -10% for non-inferiority. There were no differences between groups in the success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond) and proximal jejunum placement, the incidences of any adverse events, length of ICU stay or mortality in ICU. CONCLUSIONS: Non-inferiority of simo decoction to domperidone suspension was not confirmed in facilitating post-pyloric placement of spiral nasoenteric tubes. Registration: The trial was registered with the Chinese Clinical Trial Registry at http://www.chictr.org.cn (registration number ChiCTR-INR-17011311).

7.
Artigo em Inglês | MEDLINE | ID: mdl-31740945

RESUMO

OBJECTIVES: The modified extracardiac Fontan of direct total cavopulmonary connection (dTCPC) with entirely autologous vessels is a better solution in selected patients with functionally univentricular hearts because it combines the advantages of a tubular connection and of full growth potential. We investigated the mid-term to long-term outcomes of the physical condition of patients who had the dTCPC and assessed the growth potential of the autologous dTCPC pathway. METHODS: From July 2005 to June 2014, 31 patients, aged 1.8-14.0 years, underwent a modified extracardiac Fontan with dTCPC at our institution. Twenty-two patients underwent a 1-stage dTCPC and 9 patients underwent a 2-stage dTCPC. The preoperative and postoperative data were reviewed retrospectively. RESULTS: There were 17 (54.8%) boys and 14 (45.2%) girls, with a median age of 6.4 years (range 1.8-14.0 years) and a mean weight of 17.8 kg (range 9-41 kg). The mean follow-up period was 6.0 years (range 2.1-10.2 years). There was 1 early death and 2 late deaths. The event-free survival rate for the 31 patients was 88.9% at 10 years during the follow-up period. Late protein-losing enteropathy, thromboembolism, arrhythmia or heart failure were not observed. There was a significant difference between the preoperative and postoperative data for body mass index and the diameters of the autologous dTCPC pathway and pulmonary artery branches, confirming that the growth potential of the autologous dTCPC pathway was realized. CONCLUSIONS: The dTCPC procedure could be performed with satisfactory midterm to long-term outcomes in selected patients. It has the potential of retaining the advantage of the extracardiac Fontan operation together with the potential for growth and the avoidance of prosthetic materials.

8.
Ann Thorac Surg ; 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31610168

RESUMO

BACKGROUND: Diabetes mellitus (DM) has been proved to be a potent, independent risk factor for mortality in patients with heart failure. However, the influence of DM on post continuous-flow left ventricular assist device (CF-LVAD) implantation outcomes is still under debate. This study sought to investigate the effect of preoperative DM on all-cause mortality and major postoperative complications in patients with contemporary CF-LVAD support. METHODS: A systematic literature search (PubMed, Embase, and ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials) was performed. Primary endpoint was hazard ratio (HR) for all-cause mortality. Secondary endpoints were postoperative complications, including infection, transient ischemia attack, intracranial hemorrhage, and pump thrombosis. A meta-analysis was conducted to generate pooled HR and 95% confidence interval (CI) for all-cause mortality and pooled odds ratios (ORs) and 95% CIs for postoperative complications. RESULTS: A total of 1120 patients (Diabetic patients: 478; Nondiabetic patients: 642) from 4 studies were included in this study. DM did not increase the risk for all-cause mortality among patients with CF-LVAD support (HR, 1.33; 95% CI, 0.88-2.02; P=0.18). Moreover, pooled analysis demonstrated no significant difference was found in diabetic and nondiabetic groups in terms of infection (OR, 1.18; 95% CI, 0.89-1.56; P=0.24), transient ischemia attack (OR, 1.30; 95% CI, 0.86-1.97; P=0.21), intracranial hemorrhage (OR, 1.86; 95% CI, 0.93-3.71; P=0.08), and pump thrombosis (OR, 1.01; 95% CI, 0.68-1.48; P=0.97). CONCLUSIONS: The results of this meta-analysis demonstrate that DM does not increase all-cause mortality or rates of major adverse events during contemporary CF-LVAD support.

9.
Medicine (Baltimore) ; 98(35): e16861, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464913

RESUMO

Some children hospitalized for severe influenza virus infection require intensive care or die because of disease progression, which may be combined with other complications. The objective of this study was to identify the mortality risk factors in the patients with severe influenza virus infection admitted to the pediatric intensive care unit (PICU).Seventy-seven pediatric patients with severe influenza virus infection who were admitted in the PICU at Guangzhou Women and Children's Medical Center between 2013 and 2017 were evaluated. Data were transcribed and analyzed.The patients' median age was 3.0 years (interquartile range, 1.0-4.0 years), with 59.7% of the patients aged <3 years. The mortality was 16.9%, and patients aged >3 years accounted for 69.2% of the cases. Influenza A virus infection was found in 83.1% of the patients. Coinfection was detected in 58.7% of the patients. Haemophilus influenzae (11.7%) and adenovirus (9.1%) were the predominant bacterial and viral pathogens isolated, respectively. Older age, oxygen saturation level of <90% at admission, acute respiratory distress syndrome, pneumorrhagia, influenza-associated encephalopathy (IEA), septic shock, low ratio of partial pressure of oxygen in arterial blood (PaO2, <60 mm Hg) to the fraction concentration of oxygen in inspired air (FiO2; P/F), higher oxygenation index, increased alanine aminotransferase level (>100 IU/L), increased aspartate aminotransferase level (>100 IU/L), increased lactate dehydrogenase level (>500 IU/L), high fraction concentration of oxygen in inspired air (FiO2 > 60%), and positive end-expiratory pressure (>8 cmH2O) were associated with poor outcome. The deceased patients were more likely to have oxygen saturation levels of <90% at admission and IEA than those who survived. Higher P/F ratio was a protective factor against death in patients.The children with severe influenza virus infection who were admitted in the PICU were mainly aged <3 years. The presence of an oxygen saturation level of <90% at admission and IEA were the prognostic variables independently associated with mortality. Higher P/F ratio was a protective factor against death in patients.


Assuntos
Coinfecção/epidemiologia , Vírus da Influenza A/isolamento & purificação , Influenza Humana/mortalidade , Adenoviridae/isolamento & purificação , Pré-Escolar , China/epidemiologia , Coinfecção/virologia , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Influenza Humana/virologia , Unidades de Terapia Intensiva Pediátrica , Masculino , Fatores de Risco
10.
J Biomed Nanotechnol ; 15(7): 1492-1505, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31196353

RESUMO

Rapid endothelialization of tissue-engineered blood vessels (TEBVs) is an essential strategy to inhibit thrombosis, chronic inflammation and intimal hyperplasia after transplantation into the body. Monocytes will be recruited to the transplantation site and converted to macrophages after TEBV implantation. Macrophages play an important role in angiogenesis; however, whether engineered macrophages can be utilized to promote rapid endothelialization of TEBVs remains unclear. Thus, a cell bioreactor that can engineer macrophages via graphene quantum dot (GQD)-mediated microRNA (miR) delivery was built in the TEBV. Briefly, GQD-miR-150 linked by disulfide bonds was adopted to functionalize both the inner and outer TEBVs. The GQD-miR-150 conjugation as an intracellular gene delivery system was taken up by macrophages. Under the protection of GQDs, miR-150 was transfected into the cytosol, allowing continuous secretion of vascular endothelial growth factor (VEGF) via upregulation of HIF-1α protein expression, and promoted the migration of endothelial cells (ECs) in vitro. An in vivo study showed a rapid endothelialization of the inner TEBVs after transplantation for 7 days, especially a holonomic endothelial layer after 30 days. For the outer TEBVs, neovascularization (vasa vasorum) accompanied by nerve growth was observed around the adventitia on day 90. In conclusion, the designed cell bioreactor consisting of GQD-miR-engineered macrophages can effectively promote endothelialization and neuralization in vivo for TEBVs.


Assuntos
Macrófagos , Pontos Quânticos , Prótese Vascular , Grafite , MicroRNAs , Fator A de Crescimento do Endotélio Vascular
11.
Eur J Prev Cardiol ; 26(16): 1693-1706, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31213079

RESUMO

BACKGROUND: Hypertensive patients are highly heterogeneous in cardiovascular prognosis and treatment responses. A better classification system with phenomapping of clinical features would be of greater value to identify patients at higher risk of developing cardiovascular outcomes and direct individual decision-making for antihypertensive treatment. METHODS: An unsupervised, data-driven cluster analysis was performed for all baseline variables related to cardiovascular outcomes and treatment responses in subjects from the Systolic Blood Pressure Intervention Trial (SPRINT), in order to identify distinct subgroups with maximal within-group similarities and between-group differences. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular outcomes and compare the effect of intensive antihypertensive treatment in different clusters. RESULTS: Four replicable clusters of patients were identified: cluster 1 (index hypertensives); cluster 2 (chronic kidney disease hypertensives); cluster 3 (obese hypertensives) and cluster 4 (extra risky hypertensives). In terms of prognosis, individuals in cluster 4 had the highest risk of developing primary outcomes. In terms of treatment responses, intensive antihypertensive treatment was shown to be beneficial only in cluster 4 (HR 0.73, 95% CI 0.55-0.98) and cluster 1 (HR 0.54, 95% CI 0.37-0.79) and was associated with an increased risk of severe adverse effects in cluster 2 (HR 1.18, 95% CI 1.05-1.32). CONCLUSION: Using a data-driven approach, SPRINT subjects can be stratified into four phenotypically distinct subgroups with different profiles on cardiovascular prognoses and responses to intensive antihypertensive treatment. Of note, these results should be taken as hypothesis generating that warrant further validation in future prospective studies.

12.
J Thorac Cardiovasc Surg ; 158(6): 1559-1570.e2, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30952540

RESUMO

OBJECTIVE: Because of an increased risk of sternal wound complications, the use of bilateral internal thoracic artery grafting in diabetic patients remains controversial. The objective of the present meta-analysis is to compare the safety and efficacy of single internal thoracic artery and bilateral internal thoracic artery grafting in the diabetic population. METHODS: Four electronic databases, including PubMed, the Cochrane Library, Embase, and ISI Web of Knowledge, were comprehensively searched. Prospective randomized trials or observational studies comparing single internal thoracic artery and bilateral internal thoracic artery were considered eligible for the current study. RESULTS: A literature search yielded 1 randomized controlled trial and 17 observational studies (129,871 diabetic patients: 124,233 single internal thoracic arteries and 5638 bilateral internal thoracic arteries). Pooled analysis demonstrated overall incidence of deep sternal wound infection in the bilateral internal thoracic artery grafting group was significantly higher than in the single internal thoracic artery grafting group (3.26% for bilateral internal thoracic artery vs 1.70% for single internal thoracic artery). No significant difference was found between both groups in terms of risk of deep sternal wound infection when the skeletonized harvesting technique was adopted. Furthermore, in-hospital mortality was comparable between both groups (2.80% for bilateral internal thoracic artery vs 2.36% for single internal thoracic artery). However, compared with single internal thoracic artery grafting, bilateral internal thoracic artery grafting could confer a lower risk for long-term overall mortality (hazard ratio, 1.41; 95% confidence interval, 1.18-1.67; P < .001; I2 = 63%) and cardiac mortality (hazard ratio, 3.15; 95% confidence interval, 2.23-4.46; P < .001; I2 = 0%). CONCLUSIONS: Compared with single internal thoracic artery grafting, bilateral internal thoracic artery grafting is associated with enhanced long-term survival among diabetic patients. Skeletonization of bilateral internal thoracic artery is not associated with an increased risk of deep sternal wound infection. Therefore, surgeons should be encouraged to adopt bilateral internal thoracic artery grafting in a skeletonized manner more routinely in diabetic patients.

13.
Environ Sci Pollut Res Int ; 26(13): 12731-12740, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30879233

RESUMO

Secondary aluminum smelting industry, as an important source of polychlorinated naphthalene (PCN) in environment, has been concerned in recent years. To figure out the emission characteristics of PCNs and the potential influence on surrounding environment, two typical secondary aluminum smelting plants were selected and PCNs were determined in flue gas, fly ash, aluminum slag, soil, and air samples collected at and around the plants by GC-MS coupled with DFS. PCN emission factors from the flue gas of the two plants (mean 0.006 ng toxic equivalents/t) were found obviously decreased compared with similar smelting process detected in 2010. The stage of feeding material was still the major PCNs discharge period during the whole smelting process. The total PCN concentrations in air were found to be ranked as following: workshops (290-1917 pg/m3), the area near the workshops (62.3-697 pg/m3), and the surrounding areas (29.9-164 pg/m3, mean 64.5 pg/m3). Similar high concentrations of PCNs were found in soil from by the workshop door (983 ng/g dry weight). Soil-air exchange calculations indicated that mono-CN to tetra-CN would volatilize but hepta-CN and octa-CN would be deposited to the soil. Exposure of plant workers and local inhabitants to PCNs through inhalation was found to be acceptable but higher (especially for workers in the workshops) than living areas. The workshop and the nearby area are potential PCNs polluted areas and should be paid attention during the practical operation.


Assuntos
Poluentes Atmosféricos/análise , Metalurgia , Naftalenos/análise , Poluentes do Solo/análise , Alumínio , Atmosfera , China , Cinza de Carvão/análise , Monitoramento Ambiental , Humanos , Hidrocarbonetos Clorados/análise , Inalação , Naftalenos/química , Exposição Ocupacional/análise , Medição de Risco
14.
Chemosphere ; 214: 379-388, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267911

RESUMO

In this work, the concentrations of polybrominated diphenyl ethers (PBDEs) were determined in air, dust and fly ash samples from three legal waste electrical and electronic equipment dismantling plants with strict pollution controls. The risks posed by PBDEs to workers at the plants were assessed. The atmospheric concentrations of PBDEs in the different e-waste recycling workshops were 0.58-2.89 × 103 ng/m3, and predominantly distributed in the particle phase (90.7%-99.9%). The concentrations of the PBDEs in the floor dust and fly ash samples from bag-type dust collectors in different workshops were 2.39-125 µg/g, 5.84-128 µg/g, respectively. The contributions of BDE-209 in air, floor dust and fly ash samples were 84.0%-97.9%, 11.2%-95.3% and 74.0%-94.9%, respectively, indicating that deca-BDE commercial formulations were their major sources. Daily exposure to PBDEs was also lower than has been found for workers in other recycling workshops. Human exposures to BDE-47, BDE-99, BDE-153, and BDE-209 were all below the levels considered to pose appreciable risks. Dust ingestion was the main exposure route for manual recyclers, and inhalation was the main exposure route for waste transportation workers. The results of this study indicate that PBDEs emissions and risks are lower in modern, legal e-waste recycling facilities with effective pollution controls. However, the effectiveness of the pollution controls need to be further researched in plastic crushing areas.


Assuntos
Poeira/análise , Resíduo Eletrônico/análise , Monitoramento Ambiental/métodos , Éteres Difenil Halogenados/análise , Exposição Ocupacional/análise , Bifenil Polibromatos/análise , China , Humanos , Reciclagem
15.
Vascular ; 27(2): 190-198, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30547720

RESUMO

OBJECTIVE: Data about renal artery stenosis association with left ventricular remodeling in patients coexisting with coronary artery disease are scanty. METHODS: Patients with suspected both coronary artery disease and renal artery stenosis undergoing coronary and renal arteriography between October 2013 and December 2015 were prospectively enrolled. Left ventricular remodeling patterns were compared among different severity of renal artery stenosis group. Logistic regression was done to investigate the determinants of the left ventricular morphology. RESULTS: The overall prevalence of left ventricular hypertrophy was 40.5%, the highest in bilateral renal artery stenosis group compared to unilateral or normal ones (65.4% versus 41.8% versus 34.8%, p = 0.012). Significantly lower estimated glomerular filtration rate and higher cystatin C level were found in bilateral renal artery stenosis group than that in other two groups. Multivariate regression analysis showed that bilateral renal artery stenosis was associated with increased left ventricular hypertrophy and concentric hypertrophy with statistical significance (adjusted odds ratio = 2.909 (95%CI: 1.063-7.961), and 3.021 (95%CI: 1.136-8.033)). In addition, estimated glomerular filtration rate level was also related to left ventricular hypertrophy, while there was no significant interaction between renal artery stenosis and coronary artery disease on left ventricular hypertrophy/concentric hypertrophy occurrence. CONCLUSIONS: Bilateral renal artery stenosis is significantly associated with increased left ventricular hypertrophy/concentric hypertrophy in patients with suspected concomitant coronary and renal artery disease, while no synergic effect could be found in coronary artery disease.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Obstrução da Artéria Renal/fisiopatologia , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , China/epidemiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
16.
Clin Res Cardiol ; 108(3): 273-281, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30167807

RESUMO

OBJECTIVE: To determine whether the effects of intensive (< 120 mmHg) compared with standard (< 140 mmHg) systolic blood pressure (SBP) treatments are different among those with different baseline SBP. METHODS: De-identified SPRINT database was used for this post hoc analysis. SPRINT participants were categorized by baseline SBP status, defined as high-SBP (≥ 140 mmHg) group versus the low-SBP (< 140 mmHg) group. The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Treatment-related adverse events including hypotension, syncope, and bradycardia were also evaluated. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment between these two groups. RESULTS: Among 9361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 4964 and 4397 had baseline low SBP (< 140 mmHg) and high SBP (≥ 140 mmHg), respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.65 (95% CI 0.50, 0.83) and 0.84 (95% CI 0.66, 1.06) among those in the low-SBP group and high-SBP group, respectively (P value for interaction 0.15). For treatment-related adverse events, the hazard ratio with intensive SBP treatment was 2.03 (95% CI 1.44, 2.85) for the low-SBP group and 1.80 (95% CI 1.32, 2.47) for the high-SBP group (P value for interaction 0.28). CONCLUSIONS: Hypertensive patients with low baseline SBP may benefit from intensive SBP lowering, whereas benefits were inconclusive among those with high baseline SBP.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/tratamento farmacológico , Idoso , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Incidência , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Porto Rico/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Sístole , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
17.
Sci Total Environ ; 647: 1305-1313, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30180338

RESUMO

Organic ultraviolet absorbents (UVAs) have been detected in various materials and biota, but little is known about the distributions of UVAs in the tissues of biota. In this study, tissue-specific UVA accumulation in six fish species from Lake Chaohu, China, was investigated. The sums of 12 UVA concentrations in muscles, gills, and livers were 7.65-120, 10.1-281, and 26.4-359 ng/g dry weight, respectively. Ethylhexyl methoxycinnamate, 4-methylbenzylidene-camphor, and 2-(2'-hydroxy-3',5'-di-tert-butylphenyl)-5-chlorobenzotriazole were the dominant UVAs. Ethylhexyl salicylate and homosalate have been found in the aquatic species firstly. UVAs were taken up to different degrees by different fish species. The UVA muscle bioconcentration factors were lower than predicted by the Estimation Programs Interface Suite model, suggesting that such models may overestimate UVA accumulation in fish. The tissue distribution patterns indicated that UVAs are easily transferred to the muscles after being absorbed through the gills. The liver was found to preferentially accumulate UVAs and have a high UVA accumulation capacity, implying liver damage may be caused by UVAs. This is the first time the partitioning of UVAs between the liver, muscle, and gills of freshwater fish has been studied. The data acquired will improve our understanding of the pharmacokinetics and toxicities of UVAs in aquatic organisms.


Assuntos
Monitoramento Ambiental , Peixes/metabolismo , Protetores Solares/metabolismo , Poluentes Químicos da Água/metabolismo , Animais , China , Lagos
18.
J Nucl Cardiol ; 26(2): 633-641, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-28770462

RESUMO

BACKGROUND: The clinical course and predictors of adverse aortic events (AAE) in patients with acute Stanford type B intramural hematoma (IMH) remain controversial. This study aimed to investigate whether 18F-FDG PET/CT can predict risk in patients with acute type B IMH. METHODS AND RESULTS: This study included 34 patients with acute type B IMH who underwent PET/CT within 14 days from the onset of symptoms. The maximal standardized uptake values (SUVmax) of 18F-FDG uptake was significantly different between patients with or without AAE (4.3 ± 0.6 vs 3.7 ± 1.0, P = 0.020), but not the target to blood ratio (TBR, SUVmax divided by SUV in the superior vena cava) (1.6 ± 0.2 vs 1.5 ± 0.5, P = 0.064). In patients with initial ulcer-like projection (ULP), a blood-filled pouch protruding into the IMH, which was seen in 25 patients(74%), both the SUVmax and TBR were significantly higher in patients who developed AAE, (4.3 ± 0.6 vs 3.3 ± 0.5, P = 0.001; 1.6 ± 0.2 vs 1.4 ± 0.2, P = 0.01); the TBR >1.5, which is determined from receiver-operating-characteristic curve, had a sensitivity of 73% and a specificity of 80% in predicting AAE. CONCLUSION: Patients with ULP and high 18F-FDG uptake were more likely to develop AAE and may require closer surveillance with serial imaging.

19.
Clin Nutr ; 38(6): 2799-2805, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30579668

RESUMO

BACKGROUND & AIMS: Equipment-aided or experience-dependent methods for postpyloric nasoenteric tube placement are not so readily accessible in the critically ill setting. Self-propelled postpyloric placement of a spiral nasoenteric tube can serve as an alternative approach. However, the success rate of this method is relatively low despite using prokinetics. This study aims to develop a user-friendly nomogram incorporating clinical markers to individually predict the probability of successful postpyloric nasoenteric tube placement and facilitate intensivists with improved decision-making before tube insertion. METHODS: Patients consecutively recruited in the stage between May 2012 through December 2016 constituted the development cohort for retrospective analysis to internally test the nomogram, and patients in the stage between January 2017 through March 2018 constituted the validation cohort for prospective analysis to external validate the nomogram. A multivariate logistic regression analysis was firstly performed in the development cohort by a backward stepwise method to identify the best-fit model, from which a nomogram was obtained. The nomogram was validated in the independent external validation cohort concerning discrimination, calibration. A decision curve analysis was also performed to evaluate the net benefit of insertion decision with the nomogram. RESULTS: A total of 364 and 119 patients, 52.7% and 55.5% with successful postpyloric placement, were included in the development and validation cohort, respectively. Predictors contained in the prediction nomogram included primary diagnosis, APACHE II score, AGI grade. The derived model showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.809 (95%CI, 0.765-0.853) and good calibration. Application of the nomogram in the validation cohort also gave good discrimination with an AUROC of 0.776 (95%CI, 0.694-0.859) and good calibration. The decision curve analysis of the nomogram provided better net benefit than the alternate options (insert-all or insert-none). CONCLUSIONS: A prediction nomogram that incorporates primary diagnosis, together with APACHE II score and AGI grade can be conveniently used to facilitate the pre-insertion individualized prediction of postpyloric nasoenteric tube placement in critically ill patients.

20.
Intensive Care Med ; 44(12): 2174-2182, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30465070

RESUMO

PURPOSE: To determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients. METHODS: A prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion). RESULTS: A total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI - 3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of - 10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups. CONCLUSIONS: Erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.


Assuntos
Antagonistas dos Receptores de Dopamina D2/uso terapêutico , Nutrição Enteral , Eritromicina/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Intubação Gastrointestinal/métodos , Metoclopramida/uso terapêutico , Adulto , Idoso , China , Cuidados Críticos , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piloro
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