Objective To analyse effect of nifedipine sustained tablet on hemorheology in the treatment of patients with hypertension complicated with coronary disease.Methods 70 cases with hypertension complicated with coronary disease February 2014 to February 2015, were randomly divided into observation group and control group.35 cases in each group.Observation group received nifedipine treatment, control group were treated with conventional therapy with aspirin, recorded and analyzed related indexes and clinical efficacy of two groups patients after treatment.Results After treatment, patients plasma viscosity and hematocrit values were (1.59 ±0.12)mPa? s, (0.42 ±0.02)%, higher than control group (1.69 ±0.13) mPa ? s, (0.46 ±0.03)%(P<0.05); after treatment whole blood viscosity in observation group (high shear) and whole blood viscosity (low shear) values were (4.95 ±0.41),(9.87 ±1.01) mPa? s, lower than control group (5.89 ±0.43),(10.76 ±0.89) mPa? s(P<0.05); After observation group total effective rate was 91.43%, higher than 71.43%( P<0.05 ) .Conclusion Effect of nifedipine sustained-release tablets in patients with hypertension complicated with coronary disease is sure, precise, and could be compared to conventional treatment alone.It has no significant adverse reactions, can effectively improve hemorheology in patients with hypertension, hypertension complicated with coronary disease.

Objective To examine the efficacy and safety profile of vancomycin in treatment of pneumonia caused by methicillin‐resistant Staphylococcus aureus (MRSA)in the elderly patients .Methods The clinical data were retrospectively analyzed for 40 elderly patients with MRSA‐induced pneumonia .The patients were analyzed in terms of treatment regimen ,vancomycin (n=25)or linezolid (n= 15) .Vancomycin was administered intravenously at dose of 0 .5 g every 8 hours for 10‐14 days ,while linezolid was given intravenously at dose of 0 .6 g every 12 hours for 10‐14 days .The clinical efficacy and adverse events were compared between the two groups .Results The overall efficacy rate was 72 .0% in vancomycin group ,and 86 .7% in linezolid group (P>0 .05) .After treatment ,the clearance rate of MRSA was 76 .0% in vancomycin group ,and 80 .0% in linezolid group (P>0 .05) .Reduction of platelet counts by more than 25% was found in 3 (20 .0% )patients treated with linezolid ,but none patient in vancomycin group .Acute renal dysfunction was reported in 4 (16 .0% )patients in vancomycin group but not identified in linezolid group .Conclusions Vancomycin has positive effect in the treatment of MRSA pneumonia in the elderly . Vancomycin treatment is associated with lower risk of thrombocytopenia ,but relatively higher risk of acute renal dysfunction .

Objective To explore the association between HbA1c and acute myocardial infarction(AMI) in youth. Methods Seventy-two AMI patients (≤44y) diagnosed during the period from January in 2009 to August in 2012 were enrolled and 79 young age-matched adults without coronary artery disease at the same period were enrolled to be control group. The relationship between HbA1c, fasting blood-glucose(FBG) and AMI was explored. Results (1)Compared with the control group,the plasma FBG and HbA1C value were significantly higher(P<0.05) in AMI group. (2)Logistic regression analysis showed that HbA1c is the independent risk factor for AMI in youth. (3)In AMI group, the HbA1c level in single vessel disease had remarkable difference with that in double vessel disease and triple vessel disease(P<0.05). Conclusions Increasing HbA1c level is the independent risk factor for AMI in youth,and positively correlated with the degree of coronary artery lesions. Primary intervention of glycometabolism abnormality possibly becomes the new opinion for prevention and cure of AMI.

Objective To investigate the effects of circumferential pulmonary vein isolation (CPVI) on atrial effective refractory period (ERP) in patients with paroxysmal atrial fibrillation.Methods 30 patients who underwent radiofrequency catheter ablation for paroxysmal AF were enrolled in this study.Using FAM mode,the RA and LA anatomical models were achieved in the CARTO 3 system.SVC,MRA,RAA,LA-A,LA-R,LA-P,LAA,LSPV,LIPV,RSPV,RIPV,CSp,CSd,were respectively located in the RA or LA anatomical model.Before and after CPVI,ERPs were measured in different locations of the atrium using programmed stimulation.The ERPs of the RA (SVC,MRA,RAA,CSp),LA (LA-A,LA-R,LA-P,LAA,CSd),PVs (LSPV,RSPV,LIPV,RIPV) were compared.Bilateral CPVIs were completed in all patients,and PV-LA bidirectional conduction block was achieved.The changes of electrophysiological characteristics of atrium before and after CPVI were observed.Results (1) ERP at different locations in the atrium before CPVI:Comparisons of ERPs at different locations of atrium:RAA had the minimal ERPs[(197.4 ± 28.6) ms (P ＜ 0.01);followed by PVs measuring,respectively,LSPV (213.0 ± 47.5) ms,LIPV (208.9 ± 45.9) ms,RSPV (209.3 ± 43.6) ms,RIPV (213.5 ± 48.1) ms and LAA (218.1 ± 27.7) ms.Comparisons of ERPs in RA,LA,and PVs showed:PVs had the lowest ERPs (211.2 ± 35.2) ms versus RA ERP (227.0 ± 23.7) ms versus LA ERP (241.0 ± 21.5) ms (P ＜ 0.05).(2) Comparisons of ERPs before and after CPVI:Comparisons of ERPs at different locations of atrium showed:RAA [(197.4 ± 28.6) ms vs.(208.6 ± 32.2) ms,P=0.003],CSp [(234.7 ± 29.1) ms vs.(246.9 ± 29.7) ms,P=0.007],LA-R [(242.9 ± 28.9) ms vs.(258.3 ± 26.9) ms,P=0.003],LA-P [(252.2 ± 28.5) ms vs.(261.1 ± 30.2) ms,P=0.039]and CSd [(238.6 ± 28.3) ms vs.(250.3 ± 23.6) ms,P =0.009].ERPs were found statistically prolonged at all different locations after CPVI.Comparisons of ERPs at RAand LA after CPVI showed:RA [(227.0 ± 23.7) ms vs.(235.9 ± 21.7)ms,P=0.002]and LA [(241.0 ± 21.5) ms vs.(249.7 ± 19.9) ms,P =0.001],which were statistically increased after CPVI.(3) A total of 90 episodes of atrial arrhythmias were induced before CPVI which were found at RAA (n =17),LAA (n =12),and PVs (n =36).After CPVI,8 episodes of atrial arrhythmias were induced which were found at,RAA (n =4),LAA (n =3),and SVC (n =1).Conclusions (1) Compared with other parts of atrium,ERPs at PVs,LAA and RAA are significantly shorter in patients with paroxysmal AF.At PVs,LAA and RAA,atrial arrhythmias are easily to be induce by programmed stimulation.(2) In patients with paroxysmal Af:PVs has the shortest ERPsfollowed by RAs whereas LA ERPs is the longest.There is a large ERP gradient change between PVs and LA.(3) The ERPs at RAs,LAs,As,and LA-PV are prolonged after CPVI.(4) Atrial arrhythmia is less likely to be induced after CPVI.

Objective To explore the clinicopathological features of adult pulmonary sequestration and summarize the misdiagnosis experiences.Methods Data of 16 cases of adult pulmonary sequestration ( 18 years),who were confirmed by surgery and biopsy in our hospital were collected and reviewed.Results The median age of all the patients was 38.5 years.The female seemed to be more likely to suffer from adult pulmonary sequestration ( n =12) with cough to be the most frequent symptom ( n =9 ).CT scans revealed most of the lesions were located in the left lower lobes of the lungs ( n =9 ).Half of the lesions were characterized by pulmonary cyst-like changes and/or multiple cystic bronchiectasis ( n =8 ),followed by soft tissue mass in or out of the lung fields ( n =7).Enhanced CT scans showed abnormal arteries from the systemic circulation.Only two cases were diagnosed as pulmonary sequestration correctly in the primary diagnosis.The remaining were mostly misdiagnosed as pulmonary cyst-like changes with bronchiectasis ( n =6) or tumors (n =6).According to the findings during surgery,13 cases were intralobar pulmonary sequestrations; 3 cases were extralobars,whose tissues were all detected dysplasia and chronic inflammatory by histopathological examinations.Conclusions The misdiagnosis rate of pulmonary sequestration is high because of its non-specific clinical symptoms.Since it is characterized by abnormal arteries and pulmonary dysplasia,enhanced CT scans should be used as a preferred screening method for suspected cases,especially for those middleaged patients with cystic or mass-like lesions in the left lower lobes of the lungs.

Objective To summarize clinical application, method and result of extra-corporeal membrane oxygenation ( ECMO) used during beating heart coronary artery bypass grafting ( CABG) in high risk patients. Methods Twenty one patients [ mean age ( 75. 7 ± 3. 6 ) years old ] who received beating-heart CABG surgery assisted with ECMO were included in the study. We observed the condition when ECMO weaned off, the duration on mechanical rentilato time of ICU stay and the occurance of related complications. Results Among the 21 patients, ECMO was weaned off uneventfully after surgery in 8 patients. Immediate weaning was failed in another 8 patients and required gradual weaning in 2. 0-4. 5 hrs. Five patients could not wean off the ECMO in operation room needing continuous ECMO support in CCU. ECMO was weaned off in CCU gradually with IABP support [mean IABP support time: (115. 0 ± 25. 9) hrs]. Among the 5 patients admitted into CCU, 1 patient had oozing from insertion site at femoral artery/rein region and was stopped with compressive bandage. Lower limb ischemia happened in another 1 patient and was recovered after set up of by-pass circulation. All 21 patients recovered well and smoothly. Mean in-hospital stay was (17. 4 ± 2. 8) d. Conclusions ECMO is a safe and effective circulatory support during beating heart coronary artery bypass surgery for high-risk patients with severe coronary artery disease in reducing the mortality and complications.

Objective To evaluate the clinical efficacy of inhaled corticosteroids combined with Streptococcus pneumoniae vaccines for acute exacerbation of chronic obstructive pulmonary disease in elderly patients.Methods A total of 150 elderly patients with chronic obstructive pulmonary disease were enrolled in this study from February 2014 to May 2016 at our hospital.All patients were randomly divided into three groups with 50 cases in each group.All patients received routine therapy.Meanwhile,patients in Group A were also treated with inhaled corticosteroids,patients in Group B were given pneumococcal vaccines,and patients in Group C received inhaled corticosteroids combined with Streptococcus pneumoniae vaccines.Clinical symptom improvement,pulmonary function,frequency of acute attacks,mortality and adverse reactions were compared between the three groups.Results There were no severe adverse reactions observed in Group C after vaccination.After treatment,incidences of cough,asthma and expectoration in both Group B and Group C were significantly lower than those in Group A (P＜ 0.05).However,there was no statistically significant difference between Group C and Group B(P＞0.05).Before treatment,levels of FEV1 and FEV1/FVC were comparable between the three groups(P＞0.05).However,after treatment,FEV1 (F =2.301,P =0.396) and FEV1/FVC (F =1.290,P =0.266) of the three groups were significantly improved compared with pre-treatment levels.Moreover,FEV1 and FEV1/FVC in Group B and Group C were significantly higher than those in Group A,and FEV1 and FEV1/FVC in Group C were significantly higher than those in Group B(P＜0.05).In addition,the incidence of acute exacerbation,the frequency and duration of hospitalization in Group B and Group C were significantly lower than in Group A,and acute attack intervals in Group B and Group C were significantly longer than inGroup A (all P ＜ 0.05).Furthermore,the incidence of acute exacerbation,the frequency and duration of hospitalization in Group C were significantly lower than in Group B,and acute attack intervals in Group C were significantly longer than inGroup B(all P＜0.05).During follow-up,there were not statistically significant differences in mortality between the groups(P＞0.05).Conclusions The combination of inhaled corticosteroids with Streptococcus pneumoniae vaccines is effective and safe for the treatment of acute exacerbation of chronic obstructive pulmonary disease in elderly patients.

Objective: To evaluate the effect of the ischemic post-conditioning (IPC) on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods: A total of 251 consecutive STEMI patients underwent PPCI in the heart center of Tianjin Third Central Hospital from January 2012 to June 2014 were enrolled in this prospective, randomized, control, single-blinded, clinical registry study. Patients were randomly divided into IPC group (123 cases) and control group (128 cases) with random number table. Patients in IPC group underwent three times of inflation/deflation with low inflation pressure using a balloon catheter within one minute after culprit vessel blood recovery, and then treated by PPCI. Patients in control group received PPCI procedure directly. The basic clinical characteristics, incidence of reperfusion arrhythmia during the procedure, the rate of electrocardiogram ST-segment decline, peak value of myocardial necrosis markers, incidence of contrast induced acute kidney injury(CI-AKI), and one-year major adverse cardiovascular events(MACE) which including myocardial infarction again, malignant arrhythmia, rehospitalization for heart failure, repeat revascularization, stroke, and death after the procedure were analyzed between the two groups. Results: The age of IPC group and control group were comparable((61.2±12.6) vs. (64.2±12.1) years old, P=0.768). The incidence of reperfusion arrhythmia during the procedure was significantly lower in the IPC group than in the control group(42.28% (52/123) vs. 57.03% (73/128), P=0.023). The rate of electrocardiogram ST-segment decline immediately after the procedure was significantly higher in the IPC group than in the control group (77.24% (95/123) vs. 64.84% (83/128), P=0.037). The peak value of myocardial necrosis markers after the procedure were significantly lower in the IPC group than in the control group(creatine kinase: 1 257 (682, 2 202) U/L vs. 1 737(794, 2 816)U/L, P=0.029; creatine kinase-MB: 123(75, 218)U/L vs.165(95, 288)U/L, P=0.010). The rate of CI-AKI after the procedure was significantly lower in the IPC group than in the control group(5.69%(7/123) vs. 14.06%(18/128), P=0.034). The rate of the one-year MACE was significantly lower in the IPC group than in the control group(7.32%(9/123) vs. 15.63% (20/128), P=0.040). Conclusion The IPC strategy performed eight before PPCI can reduce myocardial ischemia- reperfusion injury, decline the rates of CI-AKI and one-year MACE significantly in STEMI patients, thus has a significant protective effect on heart and kidney in STEMI patients. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-ICR-15006590.

The incidence and mortality of lung cancer are extremely high, and the 5-year survival rate of patients after diagnosis is less than 20%; as such, early screening and intervention are important. However, doctors are overwhelmed with a large workload of CT scan review in a short period of time and should ensure that the rate of missed diagnosis and misdiagnosis is low. Artificial intelligence can assist doctors in early diagnosis and precise treatment of lung cancer, but this technology has problems. This paper reviews the application of artificial intelligence in the prediction of benign and malignant lung nodules, pathology, gene mutation, intervention scheme, treatment response, and prognosis and presents the corresponding challenges.

Objective:To explore the relationship between the selection of different P2Y 12 inhibitors and the long-term prognosis of acute coronary syndrome (ACS) patients with and without CYP2C19 defect gene. Method:289 consecutive ACS patients who underwent percutaneous coronary intervention (PCI) at Tianjin Third Central Hospital from March 2016 to October 2016 were selected for CYP2C19 gene polymorphism detection. According to the detection results, the patients were divided into group A (with CYP2C19 loss-of-function gene, 199 cases) and group B (without CYP2C19 loss-of-function gene, 90 cases). After PCI, different P2Y 12 inhibitors were selected. The patients were followed up for 3 years, and 23 cases were lost to follow-up. Finally, 182 cases were enrolled in group A and 84 cases were enrolled in group B. According to whether there were major adverse cardiovascular events (MACE) within 3 years, the patients in groups A and B were divided into MACE subgroups (58 cases, 32 cases) and non-MACE subgroups (124 cases, 52 cases). The single factor analysis of the two subgroups in groups A and B was carried out based on the patient's clinical data, coronary artery disease and intervention status, and postoperative drug treatment plan. Risk factors with statistical significance ( P<0.05) were selected, and multivariate logistic regression analysis was performed on groups A and B to compare the effects of different P2Y 12 inhibitors on the prognosis of the two groups. Results:The differences in platelet volume, fasting blood glucose, HbA1c, left ventricular end-diastolic diameter, proportion of single-branch lesions, proportion of intervention for left main lesions, and dual antiplatelet therapy were statistically significant between the two subgroups in group A (all P<0.05). The differences in low-density lipoprotein (LDL), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, proportion of two-branch lesions, proportion of three-branch lesions, and proportion of using tirofeben were statistically significant between the two subgroups in group B (all P<0.05). In the group A, the choice of different P2Y 12 inhibitors was the independent risk factor for the long-term prognosis. Compared with patients treated with Ticagrelor, the probability of long-term MACE was 11.971 times larger ( OR=12.971, 95% CI: 5.028~33.464, P<0.001) among patients treated with Clopidogrel 75 mg/day, and 5.029 times larger ( OR=6.029, 95%CI: 2.278~15.958) among patients treated with Clopidogrel 100 mg/day. No significant correlation was witnessed between different P2Y 12 inhibitors and long-term prognosis in group B. In the group B, different P2Y 12 inhibitors have no significant correlation with their long-term prognosis of patients( P>0.05). Conclusions:For ACS patients with CYP2C19 loss-of-function gene, the choice of P2Y 12 inhibitors is associated with their long-term MACE events after PCI. Ticagrelor therapy brings the lowest risk of long-term MACE. For those without CYP2C19 loss-of-function gene, the correlation between the choice of different P2Y 12 inhibitors and their prognosis is not significant.