BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine...BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.展开更多
Background:Reduced application of percutaneous coronary intervention(PCI)is associated with higher mortality rates after STsegment elevation myocardial infarction(STEMI).We aimed to evaluate potential factors contribu...Background:Reduced application of percutaneous coronary intervention(PCI)is associated with higher mortality rates after STsegment elevation myocardial infarction(STEMI).We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments(EDs)of six public hospitals in China.The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI.Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years(odds ratio[OR]2.66,95%confidence interval[Cl]1.56-4.52,P<0.001),low body mass index(BMI)(OR 0.91,95%Cl 0.84-0.98,P=0.013),not being married(OR 0.29,95%Cl 0.17-0.49,P<0.001),history of myocardial infarction(MI)(OR 2.59,95%Cl 1.33-5.04,P=0.005),higher heart rate(HR)(OR 1.02,95%Cl 1.01-1.03,P=0.002),cardiac shock in the ED(OR 5.03,95%Cl 1.48-17.08,P=0.010),pre-hospital delay(>12 h)(OR 3.31,95%Cl 1.83-6.02,P<0.001)and not being hospitalized in a tertiary hospital(OR 0.45,95%Cl 0.27-0.75,P=0.002).Compared to men,women were older,were less often married,had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older,had lower economic or social status,and had poorer health status were more likely to refuse PCI after STEMI.There was a sex difference in the potential predictors of refusing PCI.Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.展开更多
Objective: High frequency ultrasound combined with policy thermal perception testing (QTT) was used to analyze the characteristics of nerve damage in diabetic peripheral neuropathy (DPN), and then provided the basis f...Objective: High frequency ultrasound combined with policy thermal perception testing (QTT) was used to analyze the characteristics of nerve damage in diabetic peripheral neuropathy (DPN), and then provided the basis for the clinical prevention, diagnosis and treatment of DPN. Methods: A total of 110 DPN patients admitted to the hospital from December 2015 to May 2018 were selected, and the characteristics of nerve damage in diabetic peripheral neuropathy were analyzed by ultrasound and QTT. Results: In the results of QTT, the abnormal proportion of the CDT, WDT, CPT and HPT of the lower limbs in DPN's were all higher than the upper limbs;The difference of WDT and HPT in the age and course groups of patients in the upper limbs was statistically significant, the abnormal proportion of WDT and HPT in patients aged 60 years or above or with a course of 10 years or more were all above 45%, higher than those in other groups. The patients with larger mean amplitude of glycemic excursions (MAGE) were significantly higher than those with smaller MAGE, regardless of the abnormal proportion of WDT and HPT observed in upper limbs, lower limbs or upper and lower limbs;The results of ultrasonic measurement of nerve cross sectional area showed: the proportion of patients with ulnar nerve and median nerve abnormally thickened in the high age group (≥45 years) and the long course group (>10 years) was significantly higher than that in the low age group (<45 years) and the short course group (<10 years), the proportion of patients with larger MAGE with abnormal enlargement of median nerve was significantly higher than those with smaller MAGE. The thickening of ulnar nerve, median nerve and peroneal nerve was obvious in the patients of MAGE > 4 mmol/L. Conclusion: (1) The main nerve damage in DPN patients was thermal sensation damage, and the lower limb nerve was more vulnerable than the upper limb nerve. (2) The incidence of ulnar and median nerve damage was higher in patients aged 45 years and older or over 10 years of course. 展开更多
Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clin...Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The compos展开更多
目的:探讨超声(US)和多层螺旋CT(MSCT)两种检查方法在胃肠道间质瘤(GIST)诊断中的应用价值。方法:选择2015年2月到2017年2月在我院诊治的疑似胃肠道间质瘤患者60例作为研究对象,均进行超声与MSCT检查,判定诊断效果与检查特征。结果:60...目的:探讨超声(US)和多层螺旋CT(MSCT)两种检查方法在胃肠道间质瘤(GIST)诊断中的应用价值。方法:选择2015年2月到2017年2月在我院诊治的疑似胃肠道间质瘤患者60例作为研究对象,均进行超声与MSCT检查,判定诊断效果与检查特征。结果:60例患者经过病理诊断为胃肠道间质瘤35例,诊断为非胃肠道间质瘤25例,胃肠道间质瘤35例中超声表现为低回声32例,伴后方声影27例,内部血流丰富23例,轮廓模糊24例;非胃肠道间质瘤25例中超声表现为低回声8例,伴后方声影6例,内部血流丰富9例,轮廓模糊5例,两组超声特征对比有明显差异(P<0.05)。胃肠道间质瘤患者的CT增强成像参数AT(增强开始时间,Arrival time)、TTP(达峰时间,Time to peak enhancement)值明显低于非胃肠道间质瘤患者(P<0.05),而T1/2(强度半降时间,Time from peak to half)、AUC(曲线下面积,Area under the curve)与EI(增强强度,Enhanced intensity)值明显低于非胃肠道间质瘤患者(P<0.05)。US诊断胃肠道间质瘤的敏感性与特异性分别为80.0%和92.0%,MSCT诊断胃肠道间质瘤的敏感性与特异性分别为97.1%和100.0%,MSCT在胃肠道间质瘤诊断中的敏感性明显高于超声(P<0.05)。结论:US和MSCT检查均可应用于胃肠道间质瘤的诊断,其中MSCT检查效果更佳,具有很好的应用价值,应加以推广。展开更多
基金This study was supported by grants from the National Key R&D Program of China (2017YFC0908700, 2017YFC0908703)National S&T Fundamental Resources Investigation Project (2018FY100600, 2018FY100602)+2 种基金Taishan Pandeng Scholar Program of Shandong Province (tspd20181220)Taishan Young Scholar Program of Shandong Province (tsqn20161065, tsqn201812129)Key R&D Program of Shandong Province (2020SFXGFY03, 2019GSF108073)
文摘BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.
基金This study was supprted by grants from the National Key R&D Program of China(Nos.2017YFC0908700,2017Y FC0908703)National S&cT Fundamental Resour-ces Investigation Project(Nos.2018FY 100600,2018FY 100602)+2 种基金Taishan Pandeng Scholar Program of Shandong Province(No.tspd20181220)Taishan Young Scholar Program of Shandong Province(Nos.tsqn20161065,tsqn201812129)Key R&D Program of Shandong Province(Nos.2016ZDJS07A14,2018GSF118003)。
文摘Background:Reduced application of percutaneous coronary intervention(PCI)is associated with higher mortality rates after STsegment elevation myocardial infarction(STEMI).We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments(EDs)of six public hospitals in China.The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI.Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years(odds ratio[OR]2.66,95%confidence interval[Cl]1.56-4.52,P<0.001),low body mass index(BMI)(OR 0.91,95%Cl 0.84-0.98,P=0.013),not being married(OR 0.29,95%Cl 0.17-0.49,P<0.001),history of myocardial infarction(MI)(OR 2.59,95%Cl 1.33-5.04,P=0.005),higher heart rate(HR)(OR 1.02,95%Cl 1.01-1.03,P=0.002),cardiac shock in the ED(OR 5.03,95%Cl 1.48-17.08,P=0.010),pre-hospital delay(>12 h)(OR 3.31,95%Cl 1.83-6.02,P<0.001)and not being hospitalized in a tertiary hospital(OR 0.45,95%Cl 0.27-0.75,P=0.002).Compared to men,women were older,were less often married,had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older,had lower economic or social status,and had poorer health status were more likely to refuse PCI after STEMI.There was a sex difference in the potential predictors of refusing PCI.Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
基金National Natural Science Foundation(81701891)Shiyan Municipal Leading Scientific Research Project in 2018(18Y63).
文摘Objective: High frequency ultrasound combined with policy thermal perception testing (QTT) was used to analyze the characteristics of nerve damage in diabetic peripheral neuropathy (DPN), and then provided the basis for the clinical prevention, diagnosis and treatment of DPN. Methods: A total of 110 DPN patients admitted to the hospital from December 2015 to May 2018 were selected, and the characteristics of nerve damage in diabetic peripheral neuropathy were analyzed by ultrasound and QTT. Results: In the results of QTT, the abnormal proportion of the CDT, WDT, CPT and HPT of the lower limbs in DPN's were all higher than the upper limbs;The difference of WDT and HPT in the age and course groups of patients in the upper limbs was statistically significant, the abnormal proportion of WDT and HPT in patients aged 60 years or above or with a course of 10 years or more were all above 45%, higher than those in other groups. The patients with larger mean amplitude of glycemic excursions (MAGE) were significantly higher than those with smaller MAGE, regardless of the abnormal proportion of WDT and HPT observed in upper limbs, lower limbs or upper and lower limbs;The results of ultrasonic measurement of nerve cross sectional area showed: the proportion of patients with ulnar nerve and median nerve abnormally thickened in the high age group (≥45 years) and the long course group (>10 years) was significantly higher than that in the low age group (<45 years) and the short course group (<10 years), the proportion of patients with larger MAGE with abnormal enlargement of median nerve was significantly higher than those with smaller MAGE. The thickening of ulnar nerve, median nerve and peroneal nerve was obvious in the patients of MAGE > 4 mmol/L. Conclusion: (1) The main nerve damage in DPN patients was thermal sensation damage, and the lower limb nerve was more vulnerable than the upper limb nerve. (2) The incidence of ulnar and median nerve damage was higher in patients aged 45 years and older or over 10 years of course.
基金National natural science foundation of China(No.81701891)Guided scientific research project of Shiyan science and technology bureau(No.18Y63)。
文摘Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The compos
文摘目的:探讨超声(US)和多层螺旋CT(MSCT)两种检查方法在胃肠道间质瘤(GIST)诊断中的应用价值。方法:选择2015年2月到2017年2月在我院诊治的疑似胃肠道间质瘤患者60例作为研究对象,均进行超声与MSCT检查,判定诊断效果与检查特征。结果:60例患者经过病理诊断为胃肠道间质瘤35例,诊断为非胃肠道间质瘤25例,胃肠道间质瘤35例中超声表现为低回声32例,伴后方声影27例,内部血流丰富23例,轮廓模糊24例;非胃肠道间质瘤25例中超声表现为低回声8例,伴后方声影6例,内部血流丰富9例,轮廓模糊5例,两组超声特征对比有明显差异(P<0.05)。胃肠道间质瘤患者的CT增强成像参数AT(增强开始时间,Arrival time)、TTP(达峰时间,Time to peak enhancement)值明显低于非胃肠道间质瘤患者(P<0.05),而T1/2(强度半降时间,Time from peak to half)、AUC(曲线下面积,Area under the curve)与EI(增强强度,Enhanced intensity)值明显低于非胃肠道间质瘤患者(P<0.05)。US诊断胃肠道间质瘤的敏感性与特异性分别为80.0%和92.0%,MSCT诊断胃肠道间质瘤的敏感性与特异性分别为97.1%和100.0%,MSCT在胃肠道间质瘤诊断中的敏感性明显高于超声(P<0.05)。结论:US和MSCT检查均可应用于胃肠道间质瘤的诊断,其中MSCT检查效果更佳,具有很好的应用价值,应加以推广。
