Objective To summarize the nursing care of acute appendicitis after orthotopic liver transplantation. Methods Clinical data and nursing experience of 3 liver transplantation recipients who complicated acute appendicitis and 4 cases who misdiagnosed acute appendicitis in the early postoperative period in our hospital were retrospectively analyzed. Results Three of which initially presented the symptoms of acute appendicitis in 8 d, 9 d and 13 d respectively after liver transplantation, including right lower quadrant paroxysmal pain, fever, and was emergently performed appendectomy and then got recover well. Of another 4 cases, duodenal diverticulum complicated perforation in 1 case in 9d and jejunum perforation in 1 case in 6d and bile leakage in another two cases respectively in 5d and 11d after liver transplantation. Conclusions Morbidity rate of acute appendicitis was low after liver transplantation, but it always had a severe situation, and immediately needed to be operated once diagnosed, which benefits for patients' recovery. Careful nursing management is very important for the immediate diagnosis of receipts complicated acute appendicitis and also enhanced the recipients' success rate after liver transplantation.

Objective The aim of this study is to investigate the macrolide resistance rate and molecular type withmultiple-locus variable-number tandem-repeat analysis (MLVA) of Mycoplasma pneumoniae of Beijing in 2016 in pediatric patients. Methods Real-time quantitative polymerase chain reaction (PCR) was used to identify M. pneumoniae, and MLVA was performed. The domain V of the 23S rRNA was sequenced to detect macrolide-resistant point mutations. We also investigated the activities of antibiotics against M. pneumoniae isolates in vitro. Results The PCR detection rate of M. pneumoniae in children in Beijing was 40％, and the macrolide resistance rate was 66％. The A2063G mutation in the 23S rRNA V region is the dominant mutation (137/146, 93.84％), whereas the A2064G mutation is rare (9/146, 6.16％). Seventy-three samples were typed successfully by MLVA typing, including 86.3％ (63/73) were MLVA type 4-5-7-2, and 13.7％ (10/73) were MLVA type 3-5-6-2. No other types were found. No strains were resistant to levofloxacin or tetracycline. Conclusion In 2016, a specific decrease in the macrolide resistance rate occurred in Beijing. The detection rate and macrolide resistance rate of outpatients are lower than those of inpatients. The A2063G mutants M. pneumoniae have high levels of resistance to erythromycin and azithromycin. The primary MLVA type is 4-5-7-2, followed by 3-5-6-2. No other MLVA types were detected. No strains resistant to tetracycline or levofloxacin were found in vitro.

BACKGROUNDAvailable drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently, investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.

METHODSA prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group: 156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤ 40 mm, reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years, including major adverse cardiac events (cardiac death, myocardial infarction, or target-lesion revascularization) and stent thrombosis.

RESULTSAngiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25 ± 0.33) mm vs. (0.57 ± 0.55) mm, diff (95%CI) -0.23 (-0.32, -0.14), P < 0.0001; in-segment (0.25 ± 0.33) mm vs. (0.42 ± 0.55) mm, diff (95%CI) -0.13 (-0.23, -0.02), P = 0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P = 0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P = 0.0495) at 2 years. The two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI group, but not significantly different (6.6% vs. 10.9%, P = 0.1630).

CONCLUSIONSTIVOLI was superior to ENDEAVOR stent with respect to late lumen loss at 8 months, and it yielded both lower rates of angiographic binary restenosis at 8 months and target lesion revascularization (TLR) at 2 years. The MACE rate at 2 years was comparable in both groups.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Artery Disease ; drug therapy ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Polymers ; chemistry ; Sirolimus ; analogs & derivatives ; therapeutic use ; Treatment Outcome

Objective:To explore the risk factors for in-hospital mortality in patients with non-ST segment elevation myocardial infarction (NSTEMI) in China.Methods:The information of 5816 NSTEMI patients from 2013-01 to 2014-09 by China Acute Myocardial Infarction (CAMI) registry were extracted.Our research included in 2 groups:In-hospital death group,n=352 and In-hospital survival group,n=5464.The baseline condition,laboratory examination,treatment and the in-hospital outcomes were collected;the independent risk factors for in-hospital mortality were studied by multivariable Logistic regression analysis.Results:6.05％ (352/5816) patients died during hospitalization.The baseline conditions were different between 2 groups.Multivariable Logistic regression analysis indicated that age,BMI,systolic blood pressure,Killip classification,heart arrest,ST-segment depression in ECG,new onset of Complete left bundle branch block,serum creatinine,white blood cells,Count nonsmoker,previous history of MI and PCI were the independent risk factors for in-hospital mortality in NSTEMI patients.Conclusion:The above 12 variables were the independent risk factors for in-hospital mortality in NSTEMI patients which should be helpful for identifying the high risk patients at the early stage in clinical practice.

BACKGROUNDRecent data have shown that sirolimus-eluting stents (SES) reduced not only the incidences of restenosis but also of target vessel revascularization (TVR). CYPHER and FIREBIRD stents are both widely used SES in China. However, comparative data concerning differences in long-term safety and efficacy regarding CYPHER and FIREBIRD stents in the Chinese population are still not available.

METHODSFrom April 2004 to October 2006, 3979 consecutive patients who underwent successful SES (FIREBIRD 2274; CYPHER 1705) implantation were prospectively enrolled into this study. All enrolled patients were divided into two groups based on stent type. Follow-up data, including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), TVR, and major adverse cardiac events (MACE, the composite of death, MI, and TVR) were obtained at 24 months. Cox's proportional-hazards models were used to assess relative risks of all the outcome measures between the two groups before and after propensity match.

RESULTSUnadjusted clinical outcomes demonstrated higher TVR (hazard ratio (HR) 1.78, 95%CI 1.26 - 2.50) and MACE (HR 1.40, 95%CI 1.08 - 1.82) for patients treated with FIREBIRD SES. After propensity match, the results showed a non-significant trend towards superiority of the CYPHER stent in all the analyzed parameters, however, no significant differences were found for all events at 24 months between FIREBIRD and CYPHER groups, and all thrombosis rates by Academic Research Consortium (ARC) definition were comparable between the two groups.

CONCLUSIONSIn this large, real-world population, the use of domestic FIREBIRD SES in China was associated with nearly the same safety and efficacy versus the imported CYPHER SES. FIREBIRD SES can be taken as an alternative for CYPHER SES in daily practice.

Aged ; Angioplasty, Balloon, Coronary ; methods ; China ; Coronary Restenosis ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Proportional Hazards Models ; Sirolimus ; Treatment Outcome

BACKGROUNDRecent studies have shown that drug eluting stent (DES) implantation improved clinical outcome concerning efficacy compared with bare-metal stent (BMS) implantation, and sirolimus-eluting stent (SES) seemed superior to paclitaxel-eluting stent (PES) in improving the outcomes. Firebird SES is the most widely used SES in China. Long-term comparison of safety and efficacy between Firebird SES and Taxus PES in Chinese population is still not available. The aim of this research was to compare the safety and efficacy at 24 months after the successful implantation of Firebird SES and TAXUS PES in Chinese population.

METHODSFrom April 2004 to October 2006, 3110 consecutive patients who underwent successful DES (Firebird SES 2274; Taxus PES 836) implantation were prospectively enrolled into this study. All enrolled patients were divided into two groups based on stent type. By outpatient clinic visit and telephone interview, we obtained 24-month clinical outcome including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We used Cox's proportional-hazards models to assess relative risks of all the outcome measures before and after propensity match.

RESULTSUnadjusted clinical outcomes indicated that the patients treated with Firebird SES were associated with lower risk of TLR (HR 0.38, 95%CI 0.26 - 0.54), TVR (HR 0.51, 95%CI 0.38 - 0.68) and MACE (HR 0.53, 95%CI 0.41 - 0.68). The results after propensity match were consistent with that before matching, lower risk of TLR (HR 0.33, 95%CI 0.19 - 0.58), TVR (HR 0.41, 95%CI 0.26 - 0.64), MACE (HR 0.48, 95%CI 0.33 - 0.68) in Firebird group.

CONCLUSIONCompared with Taxus PES, the use of domestic Firebird SES may decrease the risk of TLR, TVR and MACE in daily practice.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Anti-Bacterial Agents ; therapeutic use ; Antineoplastic Agents, Phytogenic ; therapeutic use ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel ; therapeutic use ; Sirolimus ; therapeutic use ; Treatment Outcome

Objectives:To explore the clinical and coronary disease characteristics and prognosis of Chinese patients with ST segment elevation myocardial infarction and without typical chest pain. Methods:By extracting data from China Acute Myocardial Infarction Registry, we included 12 145 STEMI patients who underwent coronary angiography between 01 January 2013 to 30 September 2014. Variables of interest were extracted and compared between AMI patients without vs with typical chest pain. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality. Results:There were approximately 24% (2922/12145) STEMI patients without typical chest pain. Compared with typical chest pain patients, patients without typical chest pain had higher prevalence of diabetes (20.0% vs 17.8%), longer time of disease onset to hospital, lower rate of IRA disease of left anterior descending artery (44.6% vs 51.2%). These patients were less likely to receive primary percutaneous coronary intervention (64.9% vs 73.9%) and had higher in-hospital mortality (3.3% vs 2.2%, P＜0.05). Multivarite Logistic regression analysis indicated atypical chest pain was an independent risk factor for in-hospital death (OR:1.364, 95% confidence interval:1.018-1.827). Conclusions:Approximately a quarter STEMI patients presented without typical chest pain in this patient cohort and they had longer disease onset to hospital time, were less likely to receive PCI, and associated with higher in-hospital mortality risk. Efforts should be made to identify these patients in order to apply the optimal treatments to them.

BACKGROUNDCoronary artery disease (CAD) is generally considered as a disease of middle-aged men. It is widely accepted that the risk for CAD of premenopausal women is low because of hormone protection. Based on our clinical experience, more and more premenopausal women suffer from angina and myocardial infarction without adequate concern. Even now, there are still limited detailed data to describe the characteristics, mechanism and prognosis of premenopausal CAD patients. This article aimed to analyze the clinical and angiographic characteristics of premenopausal women with CAD.

METHODSA total of 565 premenopausal women and 721 postmenopausal women (56 - 60 years old) who underwent coronary angiography for the first time from April 2004 to December 2007 were enrolled. The clinical data and coronary angiographic characteristics (presence, localization, length and severity) were compared between the premenopausal and postmenopausal CAD groups.

RESULTSPremenopausal CAD patients presented less frequently with hypertension, diabetes mellitus and dyslipidemia compared with postmenopausal CAD patients (55.0% vs 66.0%, 15.0% vs 31.5%, 23.9% vs 37.4%, respectively; all P < 0.05). Although we found more frequent involvement of single vessel in premenopausal CAD (43.2% vs 26.9%, P = 0), and triple vessels in postmenopausal (56 - 60 years old) CAD patients (33.8% vs 20.4%, P = 0), much more severe lesions (> or = 90%) at left main (2.9% vs 1.1%, P = 0.048) and proximal left anterior descending artery (LAD) (28.2% vs 16.6%, P = 0) in the premenopausal CAD group were found.

CONCLUSIONPremenopausal women with chest discomfort are always found to have obvious atherosclerosis, more inclined to be located at the left main and proximal LAD, which is a strong predictor of an adverse clinical outcome.

Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Diabetes Mellitus ; pathology ; Dyslipidemias ; pathology ; Female ; Humans ; Hypertension ; pathology ; Middle Aged ; Postmenopause ; Premenopause

OBJECTIVETo compare the clinical and angiographic outcome in patients with total occlusion lesion treated with drug-eluting stent (DES) or bare-metal stent (BMS).

METHODSA total of 155 (138 males) consecutive patients with total occlusion lesion underwent successful revascularization with DES (n = 74) or BMS (n = 81) in our hospital were included in this study. All patients received aspirin 300 mg and clopidogrel 75 mg once daily for at least 3 months after the procedure. Clinical and angiographic follow-up were completed in all patients at 6 months post stenting.

RESULTSDemographic data between the two groups were similar except there was more diabetic patients in DES group (33.8% vs. 18.5%, P < 0.05). A total of 232 stents for 159 target lesions (77 treated with DES, 82 treated with BMS) were implanted. There were 85.4% C ACC/AHA type lesions and 17.0% lesions were treated with overlapping stents. Six months post stenting, the incidence of restenosis (15.6% vs. 41.5%, P < 0.001), the cumulative rate of major adverse cardiac events (MACE) (1.4% vs. 11.1%, P = 0.032) and TLR (5.8% vs. 19.9%, P = 0.001) were significantly lower in DES group than that of BMS group. The incidence of local restenosis in DES group is higher in DES group than that in BMS group (58.3%, 17.6%, P < 0.001). Two DES treated patients developed late in-stent thrombosis.

CONCLUSIONFor patients with total occlusion lesion, the clinical and angiographic outcome 6 months post DES stenting is clearly superior to that of BMS stenting.

Aged ; Coronary Angiography ; Coronary Disease ; complications ; diagnostic imaging ; therapy ; Diabetes Mellitus, Type 2 ; complications ; diagnostic imaging ; Female ; Follow-Up Studies ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Prognosis ; Stents

OBJECTIVETo compare the clinical and angiographic outcome in patients with type-II diabetes mellitus undergoing drug-eluting stent (DES) or bare-metal stent (BMS).

METHODSA total of 139 consecutive diabetic patients (114 males) with coronary disease who underwent successful elective percutaneous coronary intervention with DES (n = 83 with 151 lesions) or BMS (n = 56 with 70 lesions) on native coronary arteries from April 2004 to August 2005 at our institution were included in this study. All patients were treated according to guidelines and coronary angiography was repeated at 6 months post procedure in all patients. Aspirin (300 mg/d) and clopidogrel (75 mg/d) were administered till 6 months after the procedure.

RESULTSThere were 42.5% C type by ACC/AHA and 19.0% total occlusion lesions. The average stent length of each lesion was 26.53 +/- 14.72 mm, and mean reference diameter was 2.80 +/- 0.43 mm. Baseline characteristics were similar between DES and BMS groups except lower mean reference vessel diameter in DES than that of BMS group (2.71 +/- 0.41 mm vs. 2.98 +/- 0.53 mm, P < 0.001). The in stent restenosis rate at 6 months (10.6% vs. 38.6%, P < 0.001) and in-segment late loss (0.24 +/- 0.56 mm vs. 0.91 +/- 0.77 mm, P < 0.001) were significantly lower in DES group than those of BMS group. The target lesion revascularization (TLR) incidence was also significantly lower in DES group compared to BMS group (8.6% vs. 30.0%, P < 0.001). However, 4 late in-stent thrombosis were seen in DES group and none in BMS group of DES (P = 0.148).

CONCLUSIONDES implantation in patients with diabetes mellitus is associated with lower in-stent restenosis and TLR rates compared to BMS implantation 6 months after procedure and attention should be paid on late in-stent thrombosis after DES implantation.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; complications ; therapy ; Diabetes Mellitus, Type 2 ; complications ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome