ObjectiveTo explore the relationship of circadian distribution of acute myocardial infarction with AMI location and ST segment changes in elderly patients.MethodsThe time of infarction, its anatomic location, changes of ST segment, and coronary angiography were studied in 909 elderly patients with acute myocardial infarction (AMI) ( 412 with anterior AMI and 423 with inferior AMI) admitted to our coronary care units from January 1996 to January 2006.ResultsThe onset of inferior myocardial infarction were more frequent between midnight and 6AM than other periods of the day (n=138/423,32.6% of all inferior myocardial infarction patients, P<0.01). The onset of anterior myocardial infarction were more frequent between 6AM and noon than other periods of the day (n=156/412, 37.9% of all anterior myocardial infarction patients, P<0.01). Coronary angiography was performed in 789 patients (86.8%, 516/909).118 cases of them with inferior infarction occured between midnight and 6AM, including 85.6% of them were due to right coronary artery occlusion and 14.0%(17/118) of them were due to left coronary artery occlusion (P<0.01).275 cases of them with inferior infarction oecured between 6AM and midnight, including 52.2% (149/275) of them were due to right coronary artery occlusion and 45.8% of them were due to left coronary artery occlusion (P>0. 05). The onset of inferior myocardial infarction between 6AM and noon was the most frenquent in patients with ST segment elevation (44.0%, 263/644), while the onset of inferior myocardial infarction between midnight and 6 AM was the most frenquent in patients with non-ST segment elevation (36.6%,96/265). ConclusionsThe frequency of AMI at night is higher in elderly patients with ST segment elevation than in elderly patients with non-ST segment elevation.AMI at night is usually due to right coronary artery occlusion, which suggests that a protective role of sleep may be limited to left coronary artery -related events and AMI of non-ST segment.

Objective To discuss the application value of transthoracic echocardiography (TTE) and lower extremity deep venous ultrasonography in patients of pulmonary thromboembolism (PTE) combined with coronary heart disease (CHD).Methods Nine hundred and seventy-four hospitalized patients of PTE in the first hospital of China medical university between December 2010 and March 2015 was enrolled,119 cases of these were combined with CHD (12.22％),including 94 cases of unstable angina and 25 cases of myocardial infarction.To review the general information,embolism area and ultrasonic report of the patients of PTE combined with CHD.The patients were divided into two groups according to whether they were combined with left ventricular systolic or diastolic dysfunction or valvular diseases.To compare TTE parameters between the two groups with two-sample t-test and calculate the sensitivity and specificity of diagnosing imaging massive pulmonary embolism (MPE) by TTE.Results (1) Seventeen cases thrombosis (3.43％) were observed in PTE patients who underwent TTE.The majority were pulmonary artery thrombosis (11 cases).Four cases of thrombosis (5.63％) were observed in PTE patients combined with CHD.The majority were right heart embolus (3 cases).(2) Lower extremity deep venous thrombosis (LEDVT)was observed in 52.60％ of all the PTE patients and 34.62％ of PTE patients combined with CHD.The majority were on the left and the deep venous thrombosis of the calf.(3) Fouty-six cases (64.79％) were PTEindirect signs in TTE.The sensitivity of echocardiography diagnosis of MPE was 84.38％ and the specificity was 52.60％.(4) Pulmonary arterial systolic pressure [(47.90± 21.49) mmHg vs (31.18± 22.43) mmHg(1 mmHg=0.133 kPa),t=3.227,P ＜0.05] and inferior caval vein diameter [(19.66±4.41) mm vs (16.20± 3.46) mm,t=3.598,P ＜ 0.05] in CHD combined with left ventricular systolic or diastolic dysfunction or valvular heart disease were higher than the control group.The differences were statistically significant.Conclusions The proportion of CHD in hospitalized PTE patients was high.TTE could find PTE signs and had high sensitivity for diagnosis ofMPE.TTE could prompt the possibility of PTE combined with left heart disease.

Objective To evaluate the effect of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)combined with regular lung recruitment maneuvers(RMs)on atelectasis in elderly patients undergoing laparoscopic surgery in the Trendelenburg position using lung ultrasound.Methods A total of 62 patients aged 65-85 years old and classified by ASA status Ⅰ-Ⅲ undergoing laparoscopic radical resection of colorectal cancer were included and randomly divided into the experimental group(n=31)and the control group(n=31).Both groups received one RM after the beginning of pneumoperitoneum,followed immediately by titration of individualized PEEP with the lowest DP,and both groups received another RM after the end of pneumoperitoneum.The experimental group received additional RM every 30 min from the beginning of pneumoperitoneum,while the control group received no intervention.Recording time points for observation were:before induction of anesthesia(T0),30 min after pneumoperitoneum(T1),90 min after pneumoperitoneum(T2),at the end of surgery(T3)and 45 min after entering the postanesthesia care unit(PACU,T4).Lung ultrasound score(LUS)was recorded at T0,T3 and T4.Dynamic lung compliance(Cdyn)was recorded at T1-T3.Oxygenation index(OI),mean arterial pressure(MAP)and heart rate(HR)were recorded at T0-T4.Hypotension during RM,hypoxic saturation events in PACU and the incidence of pulmonary complications(POPC)within the first 7 days after surgery were recorded.Results Compared with the control group,LUSs at T3 and T4 were significantly decreased in the experimental group(P<0.05),and OI and Cdyn at T2 and T3 were significantly increased(P<0.05).In addition,the incidence of hypoxia saturation events in PACU was lower in the experimental group than that in the control group(P<0.05).There were no significant differences in the incidence of hypotension during lung recruitment and the incidence of POPC within 7 days after surgery between the two groups.Conclusion The individualized PEEP combined with regular RMs can effectively reduce the atelectasis observed by lung ultrasound immediately after laparoscopic radical resection of colorectal cancer and in PACU in elderly patients.

Objective: To analyze the epidemiological characteristics and distribution characteristics of tick-borne encephalitis in China in 2014, and to provide scientific basis for formulating specific prevention and control measures. Methods: The epidemic data were obtained from the "infectious disease report information management system" , using Excel 2016, GIS and other software to summarize and analyze the cases of tick borne encephalitis (TBE) reported, using the number of cases, incidence, composition ratio and other indicators to analyze and describe the TBE epidemiological characteristics in China in 2014. Results: In 2014, a total of 322 cases of TBE were reported in 9 provinces in China, with an annual incidence of 0.024/100, 000 and 1 death of patient. The provinces with high number of cases were Jilin province, Inner mongolia autonomous region and Heilongjiang province, and the number of cases in the other six provinces is no more than two. TBE was distributed in spring and summer, and it is concentrated in May to July. The age of the affected population was mostly concentrated in 40-49 years old, the male-female ratio was 1.6∶1 (198/124), and the patients were dominantly farmers, household and unemployed workers, and forestry workers, they accounted for 49.40% (159/322), 26.40% (85/322) and 18.60% (60/322) of the national TBE cases respectively. The three hospitals that reported the most TBE cases in 2014 were Inner mongolia forestry general hospital, Jiangyuan People′s hospital of Baishan city, Jilin province and Mudanjiang forestry central hospital of Heilongjiang province. The number of reported cases in these three hospitals accounted for 68.6% of the whole country. The laboratory diagnosis rate of Inner mongolia forestry general hospital was the highest (91.9%). Conclusions In 2014, the incidence of TBE in China has continued to rise compared with the previous two years. The geographical focus is mainly on the forest areas of Daxing′anling, Xiaoxing′anling and Changbai Mountain.