ObjectiveTo analyze prognostic ability of inflammation-based Glasgow prognostic score (GPS) in patients with ST-segment elevation myocardial infarction (STEMI).MethodsWe retrospectively analyzed the clinical data of 289 patients with STEMI admitted to the Department of Emergency in West China Hospital from April 2015 to January 2016. All study subjects were divided into three groups: a group of GPS 0 (190 patients including 150 males and 40 females aged 62.63±12.98 years), a group of GPS 1 (78 patients including 58 males and 20 females aged 66.57±15.25 years), and a group of GPS 2 (21 patients including 16 males and 5 females aged 70.95±9.58 years). Cox regression analysis was conducted to analyze the independent risk factors of predicting long-term mortality of patients with STEMI.ResultsThere was a statistical difference in long-term mortality (9.5% vs. 23.1% vs. 61.9%, P<0.001) and in-hospital mortality (3.7% vs. 7.7% vs. 23.8%, P<0.001) among the three groups. The Global Registry of Acute Coronary Events (GRACE) scores and Gensini scores increased in patients with higher GPS scores, and the differences were statistically different (P<0.001). Multivariable Cox regression analysis showed that the GPS was independently associated with STEMI long-term all-cause mortality (1 vs. 0, HR: 2.212, P=0.037; 2 vs. 0, HR: 8.286, P<0.001).ConclusionGPS score is helpful in predicting the long-term and in-hospital prognosis of STEMI patients, and thus may guide clinical precise intervention by early risk stratification.
ObjectiveTo systematically review the efficacy and safety of primary percutaneous coronary intervention (PCI) via radial access versus via femoral access for patients with acute ST-segment elevation myocardial infarction (STEMI). MethodsRandomized controlled trials (RCTs) about the clinical efficacy and safety of radial access for PCI in patients with acute STEMI were searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 6, 2014), CNKI, VIP, and WanFang Data from 2000 to November 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of included studies were completed by two reviewers independently. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of fourteen RCTs involving 5 212 patients were enrolled. The results indicated that:a) radial access was associated with decreased risks of mortality (OR=0.54, 95%CI 0.40 to 0.74, P=0.000 1); decreased incidences of major bleeding (OR=0.50, 95%CI 0.34 to 0.74, P=0.000 8), major adverse cardiac events (MACE) (OR=0.65, 95%CI 0.50 to 0.83, P=0.000 6), and puncture site complications (OR=0.35, 95%CI 0.25 to 0.49, P < 0.000 01); and decreased hospital duration (MD=-2.14, 95%CI-3.97 to-0.31, P=0.002). b) However, the two groups were alike in the success rate of operation, exposure time of X ray, risk of stroke, and the rate of CABG. PCI via radial access took more operation time than that via femoral access, and PCI via radial access had a higher incidence of changing puncture access. ConclusionFor acute STEMI patients undergoing PCI, radial access could significantly reduce mortality, and incidences of major bleeding, MACE and puncture site complications. Therefore, under the conditions of strict indication control and increased operation skills, PCI via radial access is effective and safe in the treatment of acute STEMI. Due to limited quality and quantity of the included studies, more large-scale, multi-centre, high quality RCTs are needed to verify the above conclusion.
Objective To discuss the effects of the temporoparietal fascial flap and the postauricular fascial flap as the materials to cover the postauricular-frame during the second stage operation of the total auricular reconstruction Methods From June 2005 to May 2007, the second stage elevation of the reconstructed auricle was performed at 6-10 months after the first stage total auricular reconstruction for 72 cases (left 31, right 41), 47 males and 25 females, aged 5-28 years old (12on average). According to the Nagata’s classification, 56 cases were lobule-type microtia with no external auditory canal, and the other 16 cases were concha-type microtia with external auditory canal (narrow in 9 cases). Homolateral temporoparietal fascial flap was used to cover the postauricular-frame in 29 patients (group A), and the homolateral postauricular fascial flap was used in the other 43 patients (group B). Results All the patients were followed up for 3-22 months. A total of 55 cases had excellent skin flap and fascial flap (22 in group A and 33 in group B). Darker epidermis could be seen in 15 cases (6 in group A and 9 in group B), and it healed within one month after the operation. Two cases (1 in group A and 1 in group B) suffering from partial grafted skin and fascial flap necrosis (lt; 1 cm2) healed by means of coverage of local flap transfer. All the patients’ reconstructed auriculocephal ic angles were close to the normal side. There existed scars of varying degrees at the area of skin graft in both groups: 47 cases had flat scars (19 in group A and 28 in group B); 18 cases had hyperplastic scars (7 in group A and 11 in group B); and 7 cases had severe scars with the auriculocephal ic angles draw-off (3 in group A and 4 in group B). Furthermore, there were obvious scars in temporal region and severe hair thinning at the donor site in group A, but there were no such conditions in group B. At 6 months of follow-up, reduction of the auriculocephal ic angle occurred in 3 cases of group A and obvious in 5 cases of group B (gt; 0.5 cm). Conclusion Both the temporoparietal fascial flap and the postauricular fascial flap can be appl ied to cover the postauricular-framework in the second stage reconstructed ear elevation, with superiority of the latter over the former.
ObjectiveTo explore the predictive value of a simple prediction model for patients with acute myocardial infarction.MethodsClinical data of 280 patients with acute ST-segment elevation myocardial infarction (STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group (n=34) and a survival group (n=246).ResultsAge, heart rate, body mass index (BMI), global registry of acute coronary events (GRACE), thrombolysis in myocardial infarction trial (TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group (P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE (0.816). The H-L test showed that the simple model had high accuracy in predicting death (χ2=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE (r=0.651, P<0.001) and coronary artery stenosis score (r=0.210, P=0.001).ConclusionThe simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.
ObjectiveTo explore the effect of continuous improvement of quality control system on the emergency treatment efficiency for patients with acute ST segment elevation myocardial infarction (STEMI) after the establishment of Chest Pain Center. MethodsWe retrospectively analyzed the differences of theory examination scores acquired by the Chest Pain Center staff one month before and after they got the system training. Moreover, we designated the STEMI patients treated between May and August 2015 after the establishment of Chest Pain Center but before optimization of process to group A (n=70), and patients treated from September to December 2015 after optimization of process to group B (n=55). Then we analyzed the differences between these two groups in terms of the time from patients' arriving to registration, the time from arriving to first order, the length of stay in Emergency Department, and even the time from door to balloon (D2B). ResultsThe scores acquired by Chest Pain Center staff before and after system training were 69.89±6.34 and 87.09±4.39 respectively, with a significant difference (P＜0.05). All the time indicators of both group A and group B were shown as median and quartile. The time from patients' arriving to registration of group A and group B was 6.0 (0.0, 11.0) minutes and 1.0 (0.0, 3.0) minutes (P＜0.05); the time from arriving to first order was 12.8 (9.0, 18.0) minutes and 5.0 (3.0, 9.0) minutes (P＜0.05); the length of stay in Emergency Department was 54.0 (44.0,77.0) minutes and 33.0 (20.0, 61.0) minutes (P＜0.05); and the time of D2B was 107.5 (89.0, 130.0) minutes and 79.0 (63.0, 108.0) minutes (P＜0.05). ConclusionAfter taking measures such as drawing lessons from the past, training staff and optimizing process continuously, we have significantly shortened the acute STEMI patients' length of stay in the Emergency Department, which has saved more time for the following rescue of STEMI patients.
Objective To assess the clinical value of a novel surgical technique——Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60-150 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. ConclusionThe tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.
ectus exeavatum is the most common chest wall deformity. The impairment of cardiopulmonaryfunction, severe psychological injury and other complications will be caused by the deformity. ″TheSternal Turnover″and″ The Sternal Elevation″are respective difference in indications andcharacteristics to treatment of pectus exeavatum. Pectus excavatum deformity will be repaired with theproper procedure and postoperative treatment. Their exercise tolerance and cardiac function will alsobe impro...
ObjectiveTo summarize the research status of normocalcemic parathormone elevation after parathyroidectomy for patients with primary hyperparathyroidism. MethodsThe related literatures on normocalcemic parathormone elevation after parathyroidectomy were collected and reviewed. ResultsMost of the patients with primary hyperparathyroidism received radical treatment postoperation. NPE didn't predict failure of operation. The relationship between normocalcemic parathormone elevation and recurrent primary hyperparathyroidism remained to be further explored. Patients with normocalcemic parathormone elevation after parathyroidectomy had a higher risk of cardiovascular disease. Postoperative vitamin D and calcium supplementation could reduce the incidence of normocalcemic parathormone elevation. ConclusionsThe clinical significance of normocalcemic parathormone elevation is still unknown at present. Further researches of multicenter, huge sample, and long-term follow-up will be necessary.
ObjectiveTo observe the clinical efficacy and safety of reteplase in prehospital thrombolysis for ST-segment elevation acute myocardial infarction. MethodsWe retrospectively analyzed the clinical data of 62 patients with acute ST-segment elevation myocardial infarction treated in our hospital between September 2010 and December 2012.They were randomly divided into two groups:the treatment group with 22 patients given reteplase thrombolysis therapy in the prehospital ambulance and/or emergency department,and the control group with 40 patients receiving thrombolytic therapy in the hospital.Then,we compared 60-minute and 120-minute recanalization rate,the rate of complicating with various kinds of adverse reactions and the composite end-point event rate between the two groups. ResultsSixty minutes and 120 minutes after thrombolysis,the clinical judgment recanalization rate in the treatment group was significantly higher than that in the control group (P<0.05).Four weeks after hospitalization,the rate of complicating with various kinds of hemorrhage,hypotension and death rate in the two groups had no statistical difference (P>0.05). ConclusionPrehospital thrombolysis treatment for ST-segment elevation acute myocardial infarction has a better clinical efficacy and is worth popularizing in basic unit hospitals.
Objective To investigate the correlation between plasma aminoterminal pro-B-type natriuretic peptide (NT-proBNP) level and severity of coronary artery lesions in patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods NSTEMI patients presenting to the Emergency Department and Department of Cardiology from January 2013 to March 2017 were divided into four groups: thrombosis without stenosis, single vessel disease, double vessel diseases, and three vessel diseases. The general situation of the patients, the plasma NT-proBNP, troponin T, echocardiogram and coronary angiography results were analyzed. Results A total of 88 patients were included including 6 in thrombosis without stenosis group, 20 in single vessel disease group, 31 in double vessel diseases group, and 31 in three vessel diseases group. The NT-proBNP level, left ventricular ejection fraction, left ventricular end diastolic diameter, and coronary Gensini score in three vessel diseases group differed much from those in the other groups (P<0.05). The correlation of NT-proBNP with coronary Gensini score in all the patients was positve (t=0.663, P<0.05). Conclusion The level of plasma NT-proBNP in patients with NSTEMI is related to the severity of coronary artery disease.