ObjectiveTo explore the in-hospital mortality and its determinants for very eldly (80 + years of age) patients with acute myocardial infarction (AMI).MethodsA retrospective cohort method was used.The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1,2002 and February 22,2010.ResultsNinety-seven out of 499 patients died during hospitalization period,with total in-hospital mortality of 19.4％.Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades,complete A-V block,renal dysfunction,stent implant,and the type of AMI.Conclusions The independent determinants for mortality of elderly AMI patients are as following,cardiac Killip grade,complete A-V block,renal dysfunction,stent implant,and the type of MAI.Urgent PCI is safe and effective for some very elderly with AMI,which could improve their survival rate within hospitalization period.

OBJECTIVETo explore the effect of chronological age and acoustic device in cognitive development of congenital hearing-impaired infants and toddlers, and analyze the correlation of abilities in cognitive development with other factors.

METHODSDepending on chronological age (1 year old group and 2 years old group) and acoustic device (hearing aids and cochlear implantation), locomotor, personal-social, hearing and speech, hand and eye co-ordination, performance tests in Griffith Cognitive Development Scale were used to assess the cognitive development of 80 hearing-impaired infants and toddlers aged 0-2 years, including before intervention (0 month), after intervention (6, 12 months). Datas were analyzed by Repeated Measurements and Pearson Correlation Test.

RESULTSDuring 1 year hearing intervention and rehabilitation, hearing and speech, performance and cognitive were extremely significant difference for each phase of early intervention (P < 0.01), the development of locomotor, personal-social, hand and eye co-ordination were no significant difference (P > 0.05). Personal-Social in 1 year old group with hearing impairment was much higher than 2 years old group P < 0.05). Hearing and speech in cochlear implanted group with hearing loss was much higher than hearing aids group. Cognitive development was positive correlation with various region development P < 0.01), and was negatively correlated with chronological age (P > 0.05).

CONCLUSIONSCognitive development is proportional to recovery time. The chronological age of early intervention obviously affect deaf children's cognitive development. The ability of hearing and speech in cochlear implanted children is superior to children with hearing aids in severe and profound hearing impaired children.

Child Development ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Cognition ; Deafness ; congenital ; rehabilitation ; Hearing ; Hearing Aids ; Hearing Loss ; congenital ; rehabilitation ; Hearing Tests ; Humans ; Infant ; Longitudinal Studies ; Motor Skills ; Speech ; Speech Perception

BACKGROUNDLarge-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary. However, it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring. This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.

METHODSAcute coronary syndrome (ACS) patients (n = 384) who received high-risk, complex PCI were randomized into two groups. PCI in the two types of lesions described below was defined as high-risk, complex PCI: lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis. The patients in the conventionally treated group received standard dual antiplatelet therapy. The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping: If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d, for three months. The primary efficacy endpoint was a composite of myocardial infarction, emergency target vessel revascularization (eTVR), stent thrombosis, and death in six months.

RESULTSThis study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group, respectively. No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups. In the platelet function monitoring guided group, the mean IPA induced by AA and ADP were (69.2 ± 24.5)% (range, 4.8% to 100.0%) and (51.4 ± 29.8)% (range, 0.2% to 100.0%), respectively. The AA-induced IPA of forty-three (22.2%) patients was less than 50% and the ADP-induced IPA of fifty-seven (29.5%) patients was less than 30%; therefore, their drug dosages were adjusted. The TEG was rechecked one to four weeks after PCI, and the results indicated that the IPAs had significantly improved (P < 0.01). However, no significant differences were found in the rates of the primary efficacy endpoint. Rates in the conventionally treated group and platelet function monitoring guided group were 4.7% and 5.2%, respectively (hazard ratio: 1.13; P = 0.79).

CONCLUSIONAn antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI.

Acute Coronary Syndrome ; drug therapy ; Aged ; Arachidonic Acid ; therapeutic use ; Aspirin ; therapeutic use ; Blood Platelets ; drug effects ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; therapeutic use