Objective To evaluate the prognosis capacity of the Primary Angioplasty in Myocardial Infarction (PAMI) risk score for 6 months mortality in the clinical patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI), in addition to asses the incremental value of EF and multivessel disease for risk stratification. Methods Six clinical variables and their relative value of score derived from PAMI risk scoring system were used to determine individual's risk score. The patients with STEMI were evaluated during the in-hospital period and followed-up for a mean of (10.34?3.24) months for mortality. The p values were calculated using a Kruskal-Wallis H test for categorical variables when appropriate; otherwise Independent-samples test was used. Logistic regression examined the discriminant accuracy of the PAMI risk score to predict death and assessed the incremental value of the EF and multivessel disease. Results A 88.8% of patients (183 patients) finished the follow up of 6 months. The overall in-hospital mortality rate was 4.4%, 30-day mortality rate was 6% and 6 months mortality rate was 9.3%. Eighty-eight patients scored 0-2 points, 54 patients scored 3-5 points, 17 patients scored 6-8 points and 24 patients scored ≥9 points. The 6 months mortality were 1.1%,3.7%, 17.6% and 41.7% respectively. Logistic regression analysis indicated that multivessel disease is a risk factor (OR 10.189) and EF is a protected factor (OR 0.849) for 6 months mortality after PCI. Multivessel disease and EF provided incremental information over that provided by the PAMI risk score. Conclusion The PAMI risk score can be applied in early stage after PCI for mortality risk assessment for patients with STEMI. EF and multivessel disease also convey important prognostic information and should be included in risk stratification after STEMI.

Objective To investigate the effect of seasonal variation of blood pressure (BP) on the incidence of cardiovascular and cerebrovascular events in the elderly aged 80 years and over.Methods The 67 patients (aged 80-86 years) with essential hypertension were enrolled, the BP were measured at home, in consulting room, and by 24-h ambulatory BP monitor in every season for 2 years. The incidences of cardiovascular and cerebrovascular events were recorded in the meantime.Results Both systolic BP (SBP) and diastolic BP (DBP) were lower in summer than in any other season (P＜0. 01 ). SBP was higher in winter than in any other season. (P＜0.01), DBP was higher in winter than in summer(P＜0. 01). There were no significant differences in SBP and DBP between spring and autumn. The incidence of cardiovascular and cerebrovascular events were higher in winter and summer than in spring and autumn (P＜0.05). The season (OR= 1. 525, P=0. 001), BMI (OR =1.145, P=0.018) and heart function (OR= 2. 037, P=0.01) were related to the incidence of cardiovascular events. And the season (OR = 1. 604, P= 0. 001 ), history of cerebrovascular disease (OR= 1. 598, P=0. 034), office-measured SBP (OR=0.960, P=0.013) and ambulatory DBP (OR =0. 936, P = 0. 008) were related to the incidence of cerebrovascular events.Conclusions The blood pressure measured by three methods in the elderly aged 80 and over shows that both SBP and DBP are at the lowest in summer; SBP is at the highest in winter, DBP is higher in winter than in summer. There are no significant differences in BP between spring and autumn. The incidences of cardiovascular and cerebrovascular events are significantly higher in winter and summer than in spring and autumn.

Objective To investigate the blood glucose control level,the characteristics of complications and treatment programme in senile patients with type 2 diabetes.Methods From Aug 2010 to Jul 2011,gender,age,height,weight,disease course and underlying disease were recorded in 119 patients with type 2 diabetes aged 80 years and over.The levels of glycosylated hemoglobin (HbA1c),fasting C-peptide (FC-P) and 2 hours postprandial C-peptide (2h C-P),urinary albumin excretion rate (UAER) were tested.Ultrasonic Doppler examination of lower-limb arteries as well as non-mydriatic colour eye-ground photography were also examined,peripheral nerve lesions were evaluatcd according to the criteria of diabetic neuropathy system (DNS).The patients were divided into two groups:HbA1c＜7.0％ group (65 cases) and HbA1c ≥ 7.0 ％ group(54 cases).Results The disease course[(12.1±8.5)years vs.(16.6±7.5)yeas,t=3.01,P=0.003],UAER[(20.2±11.9)μg/min vs.(47.0±21.4)μg/min,t=2.48,P=0.015] and incidence of diabetic nephropathy [23.1％(15/65)vs.50.0％(27/54),x2=9.36,P=0.002] were all less in HbA1c＜7.0％ group than in HbA1c ≥ 7.0％ group,while the levels of FC-P and 2hC P were higher in HbA1c＜7.0％than in HbA1c ≥ 7.0％ group[(2.1±1.2)μg/L vs.(1.5±1.0)μg/L,t=1.87,P=0.042; (6.5± 3.3)μg/L vs.(4.3 ± 2.9) μg /L,t =2.10,P =0.037].The proportion of patients who took oral hypoglycemic agents was increased while those who received insulin therapy decreased in HbA1c＜7.0％ group (all P=0.000).The α-glucosidase inhibitors were the most commonly used in each group,followed by metformin and insulin secretagogue,and the thiazolidinediones were rarely used,while there was no significant difference in the proportion of medicine between the groups.The overall incidence of symptomatic hypoglycemia was 23.5％(28/119).It was higher in HbA1c ≥ 7％ group than in HbA1c＜7.0％ group[33.3％(18/54)vs.15.4％(10/65),x2 =5.20,P=0.022].However,71.4％(5/7)of the patients with hypoglycemic coma came from HbA1c＜7.0％ group.Conclusions There are obvious individual differences in blood glucose control and complications among senile type 2 diabetes patients,thus the characteristics of the elderly should be considered in the choice of drugs while hypoglycemic events should be paid more attention.

Objective To investigate the correlation between benign prostate hyperplasia(BPH) and atherosclerotie related indicators.Methods Totally 125 patients were divided into two groups based on prostate volume(PV):50 cases without BPH (PV≤30 ml) and 75 cases with BPH (PV＞30 ml).Age,body mass index (BMI),triglycerides (TG),total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,glycosylated hemoglobin,prostate specific antigen (PSA),HOMA-IR,bilateral ankle brachial index (ABI) and cardio-ankle vascular index (CAVI) were measured and calculated.All these indicators were compared between two groups.The correlations of these indicators with PV were analyzed.Results BMI,TG,PSA,HOMA-IR and right-CAVI in BPH group were higher than in group without BPH (t=2.177,2.033,3.060,2.859,3.085,all P＜0.05),and right ABI was lower in the BPH group than in group without BPH (t=2.557,P＜0.05).The incidences of diabetes and coronary diseases in BPH group were increased compared with those without BPH (52％ and 36％ vs.30％ and 10％,x2 =5.917,10.648,P =0.015,0.001,respectively).PV was positively correlated with BMI,TG,PSA,right CAVI,left CAVI(r=0.336,0.216,0.556,0.295,0.389,all P＜0.05)by Pearson analysis.Conclusions BPH is closely correlated with insulin resistance and atherosclerosis.Atherosclerosis might cause prostate chronic ischemia and hypoxia,which may play a role in the pathogenesis of BPH.

ObjectiveTo investigate the correlation between benign prostate hyperplasia (BPH) and atherosclerosis (AS).Methods 95 cases were divided into two groups based on prostate volume (PV):24 cases with non-BPH (PV≤20 ml) and 71 cases with BPH (PV＞20 ml).Carotid intinal medial thickness (IMT) was determined by high resolution color Doppler sonography.ResultsLevels of triglyeeride (TG),hypersensitive C reactive protein (hs-CRP),ln fasting insulin [ln (FINS)],ln insulin resistance index [ln (HO)MA-IR)] and IMT in BPH group were significantly higher than in non-BPHgroup.The morbidity rate of coronary heart disease and cerebral arteriosclerosis in the BPH group enhanced as compared with non-BPH group.PV were positively correlated with ln(FINS),ln(HOMA-IR),TG and high density lipoprotein (HDL-C).Conclusions BPH is closely correlated with AS and their co-pathogenesis might be insulin resistance,inflammatory reaction and endothelial dysfunction.

Objective To study the prothrombotic state ,the factors leading to this status,and its relation-ship with the risk of cardiovascular disease in impaired glueese tolerance (IGT) patients. Methods The patients were divided into 4 groups : ①20 control subjects, ②38 patients with IGT, ③20 patients with diabetes only,④31 with diabetes and coronary heart disease. The vWF, throbomodulin, protein C, protein S, plasminogen activator inhibi-tor 1 were measured by ELISA. Results ①)There was statistical difference between IGT and controls in vWF, activi-ty of PC and PAI-1 (P <0.01 ,respectively). ②There were different factors that probably lead to the prothrombotic status among patients with IGT and diabetes. ③There were statistical differences among IGT, diabetes and diabetes with coronary heart disease in vWF, activity of Protein C. There were statistical difference among IGT , diabetes and diabetes with Coronary heart disease in PAI-1 (P < 0.05,respectively). Conclusion ①There is the prothrombotic status in the patients with IGT, similarly to those with diabetes.② IGT has the similar prethrombotic status as diabe-tes, So IGT could be considered as the predromal stage of diabetes, because of some continuity in the progress. Mean-while,it still has some different specialties. ③The abnormality of the system of endothelium, anti-coagulation and fi-brolysis in the patients of IGT is similar to those with diabetes. These variations might have the similar risk of cardio-vascular disease with the diabetes.

ObjectiveTo observe the effects of telmisartan on toll-like receptor (TLR) 4 expression in monocytes of mice atherosclerosis (AS)model, and explore the mechanism of inflammation.MethodsAS mice model were established in ApoE-deficient mice fed with high-fat diet,and treated with telmisartan as intervention group. After 8 weeks, serum low density lipoprotein,triacylglycerol and total cholesterol were detected in group fed with high-fat diet and intervention group.TLR 4 expressions in two groups were analyzed by flow cytometry. Results There was no significant difference in levels of blood lipids between the two groups.TLR4 expression in monocytes in telmisartan intervention group was lower than group fed with high-fat diet (P＜0.05).ConclusionsTelmisartan may intervene the inflammation during atherosclerosis by downregulating TLR4 expression in monocytes.

[ABSTRACT]OBJECTIVE To summarize the clinical related factors and prognostic influence factors of perioperative pulmonary embolism of head and neck malignant tumor.METHODSFrom 2010-2014, our hospital carried out a total of 2736 cases of head and neck malignant tumor surgical operations, of which, 10 cases were clinically diagnosed as postoperative pulmonary embolism, retrospectively analyzed the process of clinical treatment of the patients of pulmonary embolism with head and neck malignant tumors, and summarized their etiological factors, clinical manifestations, diagnosis and treatment. RESULTS The preoperative period incidence of pulmonary embolism in patients with head and neck malignant tumor was 0.37%(10/2736). Their clinical manifestations were mainly of asthma and breathing difficulty, and 3 cases of asymptomatic hypoxemia. 8 cases of patients showed pulmonary artery and branch filling defects after pulmonary artery angiography (CTA), 7 cases of patients got cured and were discharged from the hospital after comprehensive treatment such as anticoagulation etc; 3 cases of patients died after emergency treatment. 2 cases of patients suffered cavity bleeding, and there was no anticoagulant drug adjustment.CONCLUSIONThe mortality of head and neck cancer patients with perioperative pulmonary embolism is high, and therefore, preventive measures and timely treatments are important to reduce the incidence of pulmonary embolism.

Objective To investigate clinical characteristics and risk factors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD).Methods Two hundred and two T2DM patients aged ≥60 y admitted in Tongren Hospital from August 2009 to February 2012 were enrolled in the study,including 64 cases complicated with CKD (CKD group)and 138 cases without CKD (non-CKD group).Hemoglobin (Hgb),albumin (ALB),glycated hemoglobin A1C (HbA1 c),fasting plasma glucose(FBG),postprandial glucose (PBG),serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),total cholesterol (TC),triglyceride (TG),high densitylipoprotein (HDL-C),low density lipoprotein (LDL-C) were measured and ratio of urinary albumin to creatinine (UAER/CR) were calculated,ankle brachial index (ABI) and ambulatory blood pressure was examined.Results The duration of diabetes in CKD group was longer than that in non-CKD group [(13 ± 11) vs.(10 ± 7) y,t =2.35,P ＜ 0.05].Hgb and ALB in CKD group were lower than those in non-CKD group [(12.1 ± 1.7) vs.(13.3 ±1.3) g/L,(34.4±2.6) vs.(36.8 ±3.4) g/L,t=-5.73,-4.75,allP＜0.01]; UA,TG,24 h systolic blood pressure (SBP),24 h pulse pressure (PP)in CKD group were higher than those in non-CKD group [(367 ± 81) vs.(323 ± 74) μmol/L,(1.6 ± 0.9) vs.(1.3 ± 0.7) mmol/L,(133 ± 14) vs.(127±16)mmHg,(65 ±12) vs.(58 ±12)mmHg,t =3.82,2.50,2.47,3.68,all P＜0.1].The UAER/CR in CKD group and non-CKD group was 86.2 mg/g (24.6-374.8 mg/g) and 6.0 mg/g (3.6-17.8 mg/g),respectively (P ＜ 0.01) and ABI in CKD group and non-CKD group was 0.94 ± 0.18 and 1.03 ±0.18 (-2.78,P ＜0.05).There were no significant differences in FBG,PBG,HbA1c,TC,HDL-C andLDL-C between two groups(t =-2.02,1.47,1.48,-0.53,-1.20,-0.76,all P＞0.05).Logistic regression analysis showed that ALB,TG and UAER/CR were the independent risk factors of CKD in T2DM patients(OR:0.79,3.63 and 1.04,95％ CI:0.62-1.01,1.45-9.01 and 1.00-1.08).Spearman correlation analysis demonstrated that eGFR was positively associated with Hgb,ALB,ABI (r =0.38,0.33 and 0.28,all P ＜ 0.01),negatively associated with age,BUN,Cr,UA,TG,UAER/CR,24 hSBP and PP in all diabetes patients(r =-0.32,-0.63,-0.89,-0.34,-0.18,-0.65,-0.16 and -0.248,all P ＜0.01).Conclusions ALB,TG,UAER/CR are the independent risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus.

Fall is one of major causes of disability, reduced mobility, shortness of life span and increased medical costs in the elderly.There are multiple risk factors for falls in the elderly, but they can be preventable and controlled.This article reviews the evidences regarding the clinical effectiveness, practicalness and security of these fall risk assessment methods and measures of interventions by evidence-based medicine in the elderly and analyzes their research directions.