Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.

Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD). Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia. Results There were 5 cases of type I ISSMAD, 14 cases of type 2, 1 case of type 3, 7 cases of type 4 and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6% vs. 76.0%, t=-14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment. Follow-up was complete in 30 cases. Follow-up CT angiography of superior mesenteric artery showed dissection remodeling in 12 patients. Conclusion Multi-detector CT is a valuable method in diagnosis and classification of ISSMAD and monitoring the changes of dissection.
Aged ; Aneurysm, Dissecting ; classification ; diagnostic imaging ; surgery ; Female ; Humans ; Intestines ; blood supply ; Male ; Mesenteric Artery, Superior ; diagnostic imaging ; Mesenteric Ischemia ; classification ; diagnostic imaging ; surgery ; Middle Aged ; Tomography, X-Ray Computed ; methods

OBJECTIVE: To investigate the spectrum-effect relationship between the total anthraquinone extract of Cassia seeds and fluorouracil (5-Fu)-induced liver injury in mice and identify the effective components in the extract. METHODS: A mouse model of liver injury was established by intraperitoneal injection of 5-Fu, with bifendate as the positive control. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and myeloperoxidase (MPO), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in the liver tissue were detected to investigate the effect of the total anthraquinone extract of Cassia seeds (0.4, 0.8 and 1.6 g/kg) on liver injury induced by 5-Fu. HPLC fingerprints of 10 batches of the total anthraquinone extracts were established to analyze the spectrum- effectiveness of the extract against 5- Fu- induced liver injury in mice and screen the effective components using the grey correlation method. RESULTS: The 5- Fu- treated mice showed significant differences in liver function parameters from the normal control mice (P < 0.05), suggesting successful modelling. Compared with those in the model group, serum ALT and AST activities were decreased, SOD and T- AOC activities significantly increased, and MPO level was significantly lowered in the mice treated with the total anthraquinone extract (all P < 0.05). HPLC fingerprints of the 31 components in the total anthraquinone extract of Cassia seeds showed good correlations with the potency index of 5-Fu-induced liver injury but with varying correlation strengths. The top 15 components with known correlations included aurantio-obtusina (peak 6), rhein (peak 11), emodin (peak 22), chrysophanol (peak 29) and physcion (peak 30). CONCLUSION The effective components in the total anthraquinone extract of Cassia seeds, including aurantio-obtusina, rhein, emodin, chrysophanol, and physcion, are coordinated to produce protective effects against 5-Fu-induced liver injury in mice.
Animals ; Mice ; Emodin ; Cassia ; Chemical and Drug Induced Liver Injury, Chronic ; Anthraquinones ; Antioxidants ; Fluorouracil/adverse effects* ; Plant Extracts/pharmacology*