Objective To explore the risk factors for acute kidney injury (AKI)in patients with acute myocardial infarction (AMI).Method The medical data of hospitalized patients with AMI admitted from October 2013 to May 2014 were reviewed.All patients were divided into AKI group and non-AKI group.The univariate comparison analysis were performed to obtain the AKI risk factors.Results A total of 565 patients were enrolled.The incidence of AKI (n =91 )was 16.1% and there were 474 non-AKI patients.The mortality of AKI group was 19.8% and mortality of non-AKI group was 0.4% (P <0.01). Univariate analysis demonstrated that the risk factors of AKI were age,hypertension,previous myocardial infarction,heart failure history,chronic kidney disease,cerebral infarction history,peripheral vascular disease;ventricular fibrillation,heart rate,Killip grade ≥3 stage,left ventricular ejection fraction,serum creatinine,eGFR,hemoglobin,blood urea nitrogen,troponin I,B-type natriuretic peptide and C-reactive protein,fasting glucose,albumin,maximum daily dose of furosemide,non-use of ACEI /ARB and statins, the use of intra-aortic balloon pump, temporary pacemaker and pulmonary mechanical ventilation, implementation of PCI and coronary artery bypass graft surgery.Conclusions These risk factors for AKI after AMI were found to identify high-risk patients,helping the clinicians to make decision for preventive intervention.

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

Local maxima in multimodality image registration based on mutual information is discussed in this paper. Particle swarm optimization (PSO) and filter preprocessing based on hamming window is used to search the registration parameters. Simulations have been done to illustrate that after low-pass filter preprocessing local maxima is eliminated to a great extent. In most case the global maxima can be found by PSO. Simulations illustrate the efficiency and accuracy of this method in registration strategy.
Algorithms ; Artifacts ; Diagnostic Imaging ; methods ; Humans ; Image Enhancement ; methods ; Image Processing, Computer-Assisted ; methods ; Subtraction Technique

Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI).Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People's Hospital was reviewed.Exclusion criteria included contrast agent allergy,previous renal diseases,chronic renal failure,heart failure,tumor,acute infection,only one renal function test available during hospitalization and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,laboratory findings,etc,were collected.Patients were divided into CIN group and non-CIN group.The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN.Results A total of 236 patients were enrolled.The incidence of CIN was 10.2％ (24/236).Univariable analysis demonstrated that the risk factors of CIN were age,diabetes mellitus,Killip grade ≥ 3 stage,serum uric acid (SUA) level at admission,blood glucose level at admission.Binary logistic regression analysis showed that SUA ≥ 350 μ mol/L at admission,blood glucos ≥ 11 mmol/L at admission,age ≥ 75 years were independent risk factors for CIN.Conclusion SUA ≥ 350 μ mol/L at admission,blood sugar ≥ 1 1 mmol/L at admission,age ≥ 75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI.

Objective To explore the risk factors for acute kidney injury (AKI) in patients with acute heart failure (AHF).Methods A total of 254 patients with AHF admitted in the emergency department of Peking University People's Hospital from January 2015 to September 2016 were enrolled for retrospective study.Exclusion criteria included:age ＜ 18 years old,end stage renal disease or long-term dialysis,length of hospital stay ＜ 2 days,only one renal function test available during hospitalization,patients discharged by themselves and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,accessory examinations and treatments,etc,were collected.Patients were divided into AKI group and non-AKI group according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Univariate comparison analyses were performed to evaluate the differences between the two groups.Results Of 254 eligible patients,there were 78 (30.7％) in AKI group and 176 (69.3％) in non-AKI group.The mortality rates of AKI group and non-AKI group were 34.6％ and 11.9％ (P ＜ 0.05),respectively.Compared with the non-AKI group,baseline serum creatinine,C-reactive protein,the peak level of B-type natriuretic peptide,the proportion of proteinuria,cardiac function grade Ⅳ,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy in the AKI group were significantly higher;the estimated glomerular filtration rate was significantly lower (P ＜ 0.05).Conclusions The incidence of AKI in patients with AHF was high and the prognosis of patients with AHF developing to AKI was poor.The baseline serum creatinine,estimated glomerular filtration rate,proteinuria,C-reactive protein,cardiac function grade Ⅳ,the peak level of B-type natriuretic peptide,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy were the significant risk factors of AKI in patients with AHF.

Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.

BACKGROUND:Previous studies have shown that the modified Tsuge suture method can be used to repair chicken tendon injuries.However,the lack of post-repair functional exercise leads to obvious tendon adhesions.Therefore,a functional exercise after tendon repair is very important. OBJECTIVE:To explore a scheme for passive functional exercise against tendon adhesion in a chicken model of flexor toe tendon rupture following repair using the modified Tsuge suture method. METHODS:A total of 100 Sanhuang chickens,10 months of age,were taken to make animal models of deep flexor tendon Ⅱ rupture of the third toe of the right foot.Animal models were randomized into five groups(n=20 per group):groups A,B,C and D were given plaster immobilization for 3 weeks after surgery,and were simultaneously given passive functional exercise 1,2,3,and 0 times a day for 3 weeks,respectively;group E had neither plaster immobilization nor passive functional exercise after surgery.The gross morphology of the chicken claw,the morphology of the tendon anastomosis end and the degree of peritendinous adhesion were observed.The slipping distance of the deep flexor tendon of the third toe,the flexion angles of all joints,the pathological morphology of the tendon at the anastomotic end and the hydroxyproline content were measured. RESULTS AND CONCLUSION:The tendon of group E was completely ruptured around 6 day after surgery and was removed from the experiment.The chicken claws in groups B and C had better grasping morphology,group D had almost no grasping morphology,and group A had worse grasping morphology than groups B and C.In groups B and C,the tendon anastomosis end was not obviously expanded,with the texture similar to that of normal tendon tissue.Compared with group C,tendon adhesion was relatively mild in group B.In group D,the tendon anastomosis end was obviously expanded,with the hard texture,obvious peritendinous scar and serious adhesion.Expansion at the tendon anastomosis end was more obvious than groups B and C but less severe than group D.The slipping distance and the related flexion angles of the deep flexor tendon of the third toe were better in groups B and C than groups A and D(P<0.05).The content of hydroxyproline in the tendon of chickens in group B was higher than those in groups A,C and D(P<0.05).Findings from hematoxylin-eosin and Sirius red staining showed that collagen fibers of the tendon in groups A,C and B were gradually arranged in a directional manner,where the number of bright red and thick type Ⅰ collagen fibers was gradually increased and the number of tiny green type Ⅲ collagen fibers was gradually decreased.In group E,collagen fibers of the tendon were poorly arranged in a directional manner and type Ⅰ and type Ⅲ collagen fibers were cross-distributed.To conclude,adequate passive functional exercises twice a day following repair with the modified Tsuge suture method could effectively alleviate tendon adhesion and reduce tendon rupture in the chicken model of deep flexor tendon rupture.