OBJECTIVETo identify the risk factors associated with increased combined end points (including death, new myocardial infarction and stroke) of patients with non-ST elevation acute coronary syndrome in China.

METHODSPatients with non-ST elevation acute coronary syndrome hospitalized in 38 hospitals in China were included in this registry study as part of an international multicentre registry-OASIS. Data including clinical characteristics, previous medical history, therapeutic procedure and follow-up medicines, were collected and analyzed. The follow up period was two years. Cox regression model was used to analyze the association between multiple risk factors and combined end points.

RESULTSFrom April 1999 to December 2001, 2294 eligible patients were enrolled nationwide and 2294 patients finished the 2 years follow up (mean age: 62.8 +/- 8.3 years and 62.3% males). The mortality was 7.6% (174/2294), 168 new myocardial infarction and 93 stroke were recorded during follow up and the combined end point events was 365 (15.9%) at the end of the two year's follow-up. Forty-eight factors were analyzed by Cox regression model to determine the impact of these factors on the occurrence of end point event. Risk factors that promoting end points were: thrombolysis during hospitalization, heart rate more than 120 bpm at admission, current smoker, history of PTCA, length of the first hospitalization, intravenous nitrate use during hospitalization, history of heart failure, low molecular weight heparin or subcutaneous heparin use during hospitalization, former smoker, calcium antagonist use during hospitalization, history of hypertension or coronary artery disease, recurrent angina pectoris during hospitalization and age by the first hospitalization. Protective factors that reducing end point were: normal ECG at admission, use of oral nitrate, anti-platelet medicine, calcium antagonist, lipid lowering agents and angiotensin converting enzyme inhibitor during follow-up period.

CONCLUSIONThe two-years incidence of combined endpoints of death, new myocardial infarction and stroke in patients with non-ST elevation acute coronary syndromes is 15.9% in China. Fifteen factors are associated with increased and 8 factors (mostly related to regular medication use) are associated with reduced occurrence of endpoints during follow up in this cohort.

Acute Coronary Syndrome ; epidemiology ; physiopathology ; Aged ; China ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Registries ; Risk Factors

OBJECTIVETo evaluate the impact of admission heart rate (HR) on 30-day all-cause death and cardiovascular events in Chinese patients with ST-elevation acute myocardial infarction (STEMI).

METHODSA total of 7485 Chinese STEMI patients from a global randomized controlled trial (CREATE) database were divided into six groups by admission HR: < 60, 60 - 69, 70 - 79, 80 - 89, 90 - 99 and ≥ 100 bpm. The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death, reinfarction, cardiogenic shock or deadly arrhythmia.

RESULTSAdmission glucose level, proportion of female gender, incidence of anterior myocardial infarction, previous diabetes mellitus, hypertension and Killip level II-IV were significantly higher in patients with admission HR ≥ 90 bpm compared to 60 - 69 bpm group (P < 0.05). The 30-day mortality was lowest (6.3%) in the 60 - 69 bpm group and was 9.6% in HR < 60 bpm group (P < 0.05 vs. 60 - 69 bpm group). In patients with admission HR > 60 bpm, the 30-day mortality increased in proportion to higher admission HR: 8.1% in 70 - 79 bpm, 9.2% in 80 - 89 bpm, 12.6% in 90 - 99 bpm and 24.6% in ≥ 100 bpm groups (all P < 0.05 vs. 60 - 69 bpm group). The incidence of MACE was similar as that of 30-day mortality: 27.0% in < 60 bpm, 12.5% in 60 - 69 bpm, 13.7% in 70 - 79 bpm, 14.3% in 80 - 89 bpm, 17.5% in 90 - 99 bpm and 31.1% in ≥ 100 bpm groups. Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR (P < 0.05) except in the patients with admission HR < 60 bpm (OR = 0.832, P = 0.299), the risk of joint endpoint events was higher in the patients with HR < 60 bpm (OR = 1.532, 95%CI: 1.201 - 1.954, P < 0.05), 90 - 99 bpm (OR = 1.436, 95%CI: 1.091 - 1.889, P < 0.05) or ≥ 100 bpm (OR = 1.893, 95%CI: 1.471 - 2.436, P < 0.001).

CONCLUSIONAdmission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.

Aged ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; physiopathology ; Prognosis ; Randomized Controlled Trials as Topic ; Risk Factors

OBJECTIVETo evaluate the impact of admission blood glucose level on 30-day mortality in ST-segment elevation acute myocardial infarction (STEMI) patients with or without known diabetes.

METHODThis observational analysis enrolled 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset joining a global randomized controlled trial. The patients with or without known diabetes were divided into different groups by the admission blood glucose level: < 6.1 mmol/L (n = 2018), 6.1 to 7.7 mmol/L (n = 2170), 7.8 to 11.0 mmol/L (n = 1929), 11.1 to 13.0 mmol/L (n = 465), > 13.0 mmol/L (n = 864), the last three groups were defined as the hyperglycemia group. The 30-day mortality was analyzed.

RESULTA substantial proportion of hyperglycemic patients did not have recognized diabetes. Insulin use during hospitalization in hyperglycemic patients without known diabetes was significantly lower than that in known diabetics with similar glucose levels. Incidence of 30-day mortality increased in proportion to increasing admission glucose levels in patients without known diabetes (glucose< 6.1 mmol/L 6.8%, 6.1 to 7.7 mmol/L 8.3%, glucose > 13.0 mmol/L 18.6%, P < 0.001). In patients with known diabetes, the 30-day mortality was 16.7% with admission glucose < 6.1 mmol/L and 8.2% with admission glucose 6.1 to 7.7 mmol/L, and 22.0% with admission glucose > 13.0 mmol/L (P < 0.001). Except in patients with admission glucose > 13.0 mmol/L, the 30-day mortality was significantly higher in patients without known diabetes than in patients with known diabetes at comparable admission glucose levels (all P < 0.05).

CONCLUSIONComparing with the known diabetic patients, admission hyperglycemia is common in STEMI patients without known diabetes and was associated with higher 30-day mortality compared to known diabetes patients with comparable admission glucose level with the exception of admission glucose level > 13.0 mmol/L.

Aged ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; blood ; mortality ; Female ; Humans ; Hyperglycemia ; blood ; mortality ; Male ; Middle Aged ; Myocardial Infarction ; blood ; mortality ; physiopathology ; Placebos ; Prognosis ; Randomized Controlled Trials as Topic

OBJECTIVETo analyze the clinical characteristics of 18 patients with isolated right sided infective endocarditis (RSIE) who hospitalized in our department between August 2005 and February 2009.

METHODSThe epidemiological and clinical data of 18 non-drug addicts with RSIE were retrospectively analyzed.

RESULTSThe incidence of RSIE accounted for 7.23% of all IE patients hospitalized in our department during the same period. Predisposing conditions were as follows: congenital heart disease (76.5%, 14/18), post operative procedures (3/18) and high dose glucocorticoids use (1/18). Fever (100%) was the most common clinical manifestation. Septic pulmonary embolism was the most prevalent complication (5/18). Staphylococci aureus (4/7) were the most common causative patho organisms, while the most common etiological organisms of left-sided and both-sided IE were Streptococci Viridans. Transthoracic echocardiography evidenced 17 cases of vegetations including 59.1% (13/22) tricuspid vegetations. There was no in-hospital death and the mean hospitalization duration was (22.0 +/- 18.9) days.

CONCLUSIONSCongenital heart diseases, but not intravenous drug abuse, were the most prevalent predisposing factors for RSIE in this cohort. Staphylococci aureus were the most common causative organisms.

Adolescent ; Adult ; Causality ; Child ; Child, Preschool ; Endocarditis, Bacterial ; diagnostic imaging ; epidemiology ; microbiology ; Female ; Heart Defects, Congenital ; epidemiology ; Humans ; Incidence ; Infant ; Male ; Retrospective Studies ; Staphylococcal Infections ; diagnostic imaging ; epidemiology ; Substance Abuse, Intravenous ; epidemiology ; Ultrasonography ; Young Adult

OBJECTIVETo investigate the mechanism of tazarotene against active psoriasis vulgaris.

METHODSA randomized, controlled trial was conducted in 43 patients with active psoriasis vulgaris, who were divided into tazarotene and control groups. Promyelocytic leukemia (PML) mRNA in active psoriatic lesions before and 14 days after tazarotene treatment was detected by in situ hybridization.

RESULTSPML mRNA expression was detected not only in the basal layer (86.96%), but also in the suprabasal layers of the epidermis in the manner of focal expression (78.26%). After tazarotene treatment, virtually no PML mRNA expression could be detected in the psoriatic lesions (8.69% in the basal layer and 4.35% in the suprabasal layers). PML mRNA expression in the control group underwent no obvious changes during the observation.

CONCLUSIONSTazarotene may inhibit abnormal proliferation of keratinocytes through down-regulating PML gene expression in active psoriatic epidermis.

Adolescent ; Adult ; Double-Blind Method ; Down-Regulation ; drug effects ; genetics ; Epidermis ; drug effects ; metabolism ; pathology ; Female ; Gene Expression ; drug effects ; Humans ; In Situ Hybridization ; Keratolytic Agents ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Neoplasm Proteins ; genetics ; Nicotinic Acids ; administration & dosage ; therapeutic use ; Nuclear Proteins ; genetics ; Promyelocytic Leukemia Protein ; Psoriasis ; drug therapy ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Transcription Factors ; genetics ; Tumor Suppressor Proteins ; genetics

BACKGROUND: Many studies have showed that apoptosis of endothelial cells plays a curial role in the progress of sepsis. But the role of simvastatin in apoptosis of endothelial cells induced by sepsis is not clear. The present study aimed to investigate the role of simvastatin in apoptosis of endothelial cells induced by sepsis and its mechanism. METHODS: Human umbilical vein endothelial cells (HUVECs) were randomly divided into three groups: control group, sepsis serum intervention group (sepsis group) and simvastatin+sepsis serum intervention group (simvastatin group). After 24-hour incubation with corresponding culture medium, the relative growth rate of HUVECS in different groups was detected by MTT assay; the apoptosis of HUVECs was detected by Hoechst33258 assay and flow cytometry; and the expression of the Bcl-2 and Bax genes of HUVECs was detected by PCR. RESULTS: Compared with the sepsis group, HUVECs in the simvastatin group had a higher relative growth rate. Apoptotic HUVECs decreased significantly in the simvastatin group in comparison with the sepsis group. Expression of the Bcl-2 gene in HUVECs decreased obviously, but the expression of the Bax gene increased obviously after 24-hour incubation with sepsis serum;however, the expression of the Bcl-2 and Bax genes was just the opposite in the simvastatin group. CONCLUSIONS: Our study suggests that simvastatin can inhibit apoptosis of endothelial cells induced by sepsis through upregulating the expression of Bcl-2 and downregulating Bax. It may be one of the mechanisms for simvastatin to treat sepsis.

Objective To determine the risk factors related to tuberculosis infection among people living with HIV/AIDS and to develop strategies for preventing the co-infection.Methods A 1:2matched nested case-control study was carried out to analyze the influencing factors of tuberculosis among people living with HIV/AIDS.Results 1018 people living with HIV/AIDS were followed up for one year with a total number of 736.75 person-years,among them 62 tuberculosis cases were diagnosed.The incidence density of tuberculosis among people living with HIV/AIDS was 8.42 persons per 100 person-years.Factors as education level(OR=0.483),vaccination history of Bacille Calmette Guerin(OR=0.561),CD_4~+ count T-lymphocyte(OR=0.356),unemployment(OR=1.976),living alone(OR=2.646),and smoking(OR=2.215)were significantly related to the prevalence of tuberculosis among people living with HIV/AIDS.Conclusion High education level,with vaccination history of Bacille Calmette Guerin and high level of CD_4~+ T-lymphocyte count were protective factors while being unemployed,living alone,and smoking habit were risk factors related to the prevalence of tuberculosis among people living with HIV/AIDS.

OBJECTIVETo observe the clinical characteristics, treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes (NSTEACS).

METHODSConsecutive patients admitted with NSTEACS from 38 centers in north China were enrolled. Medical histories, clinical characteristics, treatments and outcomes were evaluated and follow-up was made at 6, 12, and 24 months after their initial hospital admission. Cumulative event rates were compared between diabetic and non-diabetic patients.

RESULTSThere were 420 diabetic patients out of 2294 NSTEACS patients (18.3%). Diabetic patients were older [(64.9 ± 6.7) years vs. (62.3 ± 8.6) years, P < 0.01], more often women (48.1% vs. 35.3%, P < 0.05) and were associated with higher baseline comorbidities such as previous hypertension, myocardial infarction, congestive heart failure and stroke than non-diabetic patients. The incidence of antiplatelet therapy (92.1% vs. 95.0%, P < 0.05), coronary angiography (30.0% vs. 36.3%, P < 0.05) and revascularization (12.1% vs.18.8%, P < 0.05) was lower in patients with diabetes than non-diabetic patients. In hospital and 2-year mortality as well as the incidence of congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death were substantially higher in diabetic patients compared with non-diabetic patients. Multivariate Cox regression analysis revealed that age ≥ 70 years, diabetes, previous myocardial infarction, previous congestive heart failure, systolic blood pressure less than 90 mm Hg (1 mm Hg = 0.133 kPa) and heart rate more than 100 bpm at admission were risk factors for 2-year death.

CONCLUSIONIn NSTEACS, diabetes is associated with higher rate of in-hospital and 2-year death, congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death. Diabetes mellitus is a major independent predictor of 2-year mortality post NSTEACS. Status of antiplatelet therapy, coronary angiography and revascularization should be improved for diabetic patients with NSTEACS during hospitalization.

Acute Coronary Syndrome ; complications ; diagnosis ; epidemiology ; therapy ; Aged ; China ; epidemiology ; Diabetes Complications ; diagnosis ; epidemiology ; therapy ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Regression Analysis ; Treatment Outcome

OBJECTIVETo explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated with fatal arrhythmia.

METHODSWe analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial. Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables.

RESULTSThe overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [(66.1 ± 11.9) years and 62.4% male] was 52.9%. Logistic regression analysis showed that age (OR = 1.82, 95%CI:1.449-2.285), anterior infarction (OR = 4.419, 95%CI:2.645-7.384), heart rate > 60 bpm (OR = 3.32, 95%CI:1.898- 5.808), killip class IV (OR = 3.686, 95%CI:1.684-8.06), admission hemoglobin A1c < 5.6% (OR = 2.564, 95%CI:1.199-5.484), no use of ACEI (OR = 1.827, 95%CI:1.099-3.038) and no use of lipid-low drugs (OR = 2.034, 95%CI:1.196-3.458) were independent risk factors for short term mortality after STEMI. The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0.830 (95%CI: 0.796-0.865) and 0.866 (95%CI: 0.835-0.896), respectively.

CONCLUSIONThe 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high. Age, anterior infarction, heart rate > 60 bpm, killip class IV, admission hemoglobin A1c level < 5.6%, no use of ACEI and no use of lipid-low drugs are independent risk factors for 30-day mortality in these patients.

Aged ; Aged, 80 and over ; Arrhythmias, Cardiac ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVETo compare the impact of the first 24 hours mean blood glucose (MBG) level and admission glucose (AG) during hospitalization on the short term mortality and combined end point events in patients with ST-segment elevation acute myocardial infarction (STEMI).

METHODSA total of 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset were included. Plasma glucose was measured at admission, 6 and 24 hours after admission, respectively. The MBG level through the first 24 hours for each patient was calculated. Patients were stratified into six groups according to their MBG levels: < 4.5, 4.5 - 5.5, 5.6 - 7.0, 7.1 - 8.5, 8.6 - 11.0 and > 11.0 mmol/L. The incidence of all-cause mortality and combined end point of death, re-infarction, cardiogenic shock, recurrence ischemia, and stroke at 7 days and 30 days post hospitalization were analyzed. Nested models were compared to determine whether logistic regression models that included MBG provided a significantly better fit than logistic regression models included AG.

RESULTSCompared with the MBG of 4.5 - 5.5 mmol/L group, 7-day and 30-day mortality and combined end point events increased in proportion to plasma MBG level increase. Multivariate logistic regression analysis showed that elevated MBG (equal or greater than 7.1 - 8.5 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. Nested models analysis showed that the prognostic impact of MBG is superior to AG (P < 0.001) on predicting 7-day and 30-day mortality and combined end point events in this patient cohort.

CONCLUSIONElevated MBG (≥ 7.1 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. MBG is superior to AG on predicting short-term prognosis in this patient cohort.

Aged ; Blood Glucose ; analysis ; China ; Electrocardiography ; Endpoint Determination ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; diagnosis ; mortality ; physiopathology ; Prognosis