Objective To analyze the causes of death in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI).Methods The clinical data of 1 213 patients [845 males and 368 females,mean age:(60.83±12.31) years] with STEMI who underwent direct PCI in Linyi People's Hospital from January 2010 to May 2014 and followed-up for 3-7 years were retrospectively analyzed.The causes of death and predictors were analyzed.Results Among 1 135 patients,129 died during the follow-up.Thirty nine patients died in the first 2 weeks and 97.4％ (38/39)due to cardiovascular causes;29 died between 2 weeks and 1 year and 62.1％ (18/29)due to cardiovascular causes;61 died after 1 year and 40.9％ (25/61)from cardiovascular causes,19.7％ (12/61) from cancer,14.8％ (9/61)from stroke.Multivariate Cox regression analysis showed that age ≥70 years,increase of serum creatinine,LVEF≤40％,symptom-to-balloon time＞360 min,cardiac shock,triple vessel lesion,TIMI blood flow less than grade 3 were independent predictors of all death.Conclusion Cardiovascular conditions are the main cause of death in the first year and non-cardiovascular conditions are the main cause of death 1 year after primary PCI in patients with STEMI.It is suggested that long-term surviving patients should also pay close attention to non-cardiac risk factors.

Objective To investigate the effectiveness of treatment of primary orbital varix via venous embolization therapy approach. Methods From January 2007 to January 2015,the clinical data of 12 patients with primary orbital varix were analyzed retrospectively. All the micro-catheters were implanted via the inferior petrosal sinus approach. The microcoils and Onyx18 were used to embolize the primary orbital varix. Four patients were embolized with micro-coils only, three were embolized with Onyx, and five were embolized with microcoil + Onyx. Results After successful catheterization, the lesions were totally embolized in 12 patients. The symptoms of postural exophthalmos disappeared and the pain was relieved,the depressed symptom of eyeball disappeared in 10 cases, and two patients were relieved partially ( single material embolization) . Nine patients were followed up for 6 to 24 months. The orbital DSA,MRI or CT re-examination was performed. The thrombosis of orbital varices within the lesions was observed and no cavity was found. One of the patients suffered from limited lateral eyeball abduction. Another three were lost to follow up. Conclusion The embolization treatment of primary orbital varix is safe, effective, and convenient via inferior petrosal sinus approach.

Objective:To investigate the relationship between early international normalized ratio(INR)and overanticoagulation in elderly patients with atrial fibrillation(AF)treated with Warfarin, and to evaluate its clinical value in predicting overanticoagulation.Methods:A total of 470 elderly patients with AF treated with Warfarin for anticoagulation were enrolled retrospectively.INR was detected in the morning of the next day after 3 days and 7 days of Warfarin treatment.According to whether INR was greater than 3.0 after 7 days of Warfarin treatment, the patients were divided into over-anticoagulation group(n=107)and non-over-anticoagulation group(n=363). The general clinical data of the two groups were analyzed.The receiver operating characteristic curve(ROC)was used to evaluate the value of 3-day INR(early INR)level in predicting overanticoagulation.Logistic regression was used to analyze the factors related to overanticoagulation in elderly AF patients receiving Warfarin treatment.Results:The age, initial warfarin dose, early INR and serum aspartate transferase level in the over-anticoagulation group were higher than those in the non-over-anticoagulation group( P<0.05 for all). The proportions of patients with initial Warfarin dose≥2.5 mg, age≥70 years old, body weight≤65 kg, valvular atrial fibrillation, hypoproteinemia, abnormal liver function, and combined use of antibiotics were higher in the over-anticoagulation group than those in the non-over-anticoagulation group( P<0.05 for all). The body weight, serum albumin level and the proportion of diabetes mellitus in the over-anticoagulation group were lower than those in the non-over-anticoagulation group( P<0.05). ROC curve showed that the area under the curve(AUC)of early INR in predicting over-anticoagulation was 0.927(95% CI: 0.900-0.949, P<0.0001), the sensitivity was 82.86% and the specificity was 88.43%, the optimal cutoff value for predicting overanticoagulation was INR≥1.66.Multiple Logistic regression analysis showed that early INR level≥1.66( OR=33.871, P<0.001), initial warfarin dose≥2.5 mg( OR=17.062, P=0.011), body weight≤65 kg( OR=2.824, P=0.002), age≥70 years old( OR=2.678, P=0.003), and abnormal liver function( OR=2.091, P=0.022)were related factors for over-anticoagulation in elderly patients with atrial fibrillation. Conclusions:Early INR level is closely related to overuse of anticoagulation in elderly AF patients receiving Warfarin treatment, which can be regarded as a predictor of overuse of anticoagulation.Early INR level in elderly AF patients receiving warfarin treatment should be monitored to reduce the incidence of anticoagulant overuse.

Objective:To construct an evaluation indicator system for the health management effects in high-risk stroke population.Methods:From March to May 2020, based on health ecology theory, social cognitive theory and knowledge, attitude/belief, practice theory, the first draft of the evaluation index system for health management effects of high-risk stroke groups was drawn up by literature review and group discussion. Through two rounds of Delphi expert consultation, the evaluation index system of health management effects of high-risk stroke groups was established, and the weight of each index was determined by analytic hierarchy process (AHP). A total of 22 experts were invited to participate in expert consultation. Twenty-two questionnaires were sent out in the first round, and 20 questionnaires were recovered, of which 20 were valid (90.9%). In the second round of correspondence, 20 questionnaires were sent out and 19 questionnaires were recovered, of which 19 were valid (95.0%).Results:The authority coefficients of the two rounds of expert consultation (Cr) was 0.933 and 0.937, respectively. The Kendall coordination coefficients W of importance in the second round was significantly higher than that in the first round (0.299 vs 0.172) ( P<0.001). The mean of importance score (Mj) of each index was 4.10-5.00, coefficient of variation (CV) was 0-0.235, and full mark ratio (Kj) was 0.26-1.00. Finally, an evaluation index system of the health management effects for high-risk stroke population was constructed, which included 3 first-level indicators (individual characteristics, behavior style, environmental support), 12 second-level indicators and 58 third-level indicators. Conclusions:The evaluation index system of the health management effects for high-risk stroke population is established in this study, which provides scientific quantitative indicators and evaluation tools. The enthusiasm, authority and coordination of consultation experts are strong, which indicates that the indicator system is feasible.

Objective:To investigate the effect of preoperative use of diuretics on cardiac surgery-associated acute kidney injury(CSA-AKI)in elderly patients.Methods:In this single-center retrospective study, 1 638 patients aged ≥60 years and undergone cardiac surgery(including coronary artery bypass grafting, valve replacement and valvuloplasty)in the Department of Cardiovascular Surgery, Linyi People's Hospital between January 2015 and December 2022 were recruited.The last preoperative serum creatinine(SCr)level was taken as the baseline value, and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Patients were divided into an AKI group and a non-AKI group according to whether AKI occurred after surgery.The clinical characteristics of the two groups were compared, and the effect of preoperative use of diuretics on CSA-AKI was evaluated by multivariate Logistic regression analysis.Results:Of 1638 patients enrolled in the study, 284 patients(17.3%)developed CSA-AKI.Compared with the non-AKI group, there were higher proportions of patients in the AKI group receiving furosemide(62.7% or 178/284 vs.46.2% or 626/1 354, χ2=25.397, P<0.001), spironolactone(70.1% or 199/284 vs.49.9% or 676/1 354, χ2=38.284, P<0.001), and hydrochlorothiazide(8.1% or 23/284 vs.3.5% or 47/1354, χ2=12.288, P<0.001). The number of diuretics in the AKI group was higher than in the non-AKI group[2(0, 2) vs.1(0, 2), Z=-6.381, P<0.001], and the proportion of patients using ≥2 diuretics was higher in the AKI group than in the non-AKI group(70.1% or 199/284 vs.49.0% or 664/1354, χ2=41.652, P<0.001). Multivariate Logistic regression analysis showed that, after adjusting for hypertension, diabetes mellitus, hypoalbuminemia, NYHA functional class Ⅲ/Ⅳ, cardiopulmonary bypass during surgery, operative duration≥6 h, postoperative blood transfusion>600 ml, postoperative use of >3 vasoactive drugs and other variables, preoperative use of ≥2 diuretics remained an independent risk factor for CSA-AKI in elderly patients( OR=1.580, 95% CI: 1.042-2.396, P=0.031). Conclusions:AKI is a common complication after cardiac surgery in elderly patients.Preoperative use of ≥2 diuretics used may be an independent risk factor for CSA-AKI.

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective:To explore the latent classes of health behavior and explore the predictive factors among stroke patients.Methods:A total of 1 250 participants were recruited using cluster random sampling in September 2022. The general information, the modified Rankin scale(mRS), stroke prevention knowledge questionnaire(SPKQ), health behavior scale for stroke patients (HBS-SP), and short form-health belief model scale (SF-HBMS) were administered in the cross-sectional survey. Mplus 8.3 software was used to conduct a latent class analysis (LCA) on the health behavior of stroke patients, and SPSS 27.0 software was used to carry out multinomial Logistic regression to analyze the predictive factors of different latent classes of health behavior of stroke patients.Results:The health behavior of stroke patients obtained three latent classes: low health behaviors-lack of health responsibility group (66.9%, n=794), moderate health behaviors-poor compliance group (11.9%, n=141), and good health behaviors-insufficient exercise group (21.2%, n=251). Compared with good health behaviors-insufficient exercise group, stroke patients with shorter duration education time ( B=-0.589, OR=0.555, P=0.036), hemorrhagic stroke ( B=0.082, OR=1.086, P<0.001), fewer comorbidities ( B=-0.022, OR=0.978, P=0.026), higher mRS score ( B=-0.046, OR=1.047, P=0.004), lower SPKQ score ( B=-0.055, OR=0.947, P=0.016), and lower SF-HBMS score ( B=-0.085, OR=0.919, P<0.001) were more likely to be included in moderate health behaviors-poor compliance group. However, stroke patients with shorter duration education time ( B=-0.026, OR=0.974, P=0.003), rural areas dwelling ( B=0.800, OR=2.225, P=0.004), fewer comorbidities ( B=-0.056, OR=0.945, P<0.001), lower SPKQ score ( B=-0.101, OR=0.904, P<0.001), and lower SF-HBMS score ( B=-0.071, OR=0.931, P<0.001) were more likely to be included in low health behaviors-lack of health responsibility group. Conclusion:The health behavior of stroke patients has three latent classes. A targeted intervention should be carried out according to the characteristics of different classes to improve their health behavior levels.

The teeth are highly differentiated chewing organs formed by the development of tooth germ tissue located in the jaw and consist of the enamel, dentin, cementum, pulp, and periodontal tissue. Moreover, the teeth have a complicated regulatory mechanism, special histologic origin, diverse structure, and important function in mastication, articulation, and aesthetics. These characteristics, to a certain extent, greatly complicate the research in tooth regeneration. Recently, new ideas for tooth and tissue regeneration have begun to appear with rapid developments in the theories and technologies in tissue engineering. Numerous types of stem cells have been isolated from dental tissue, such as dental pulp stem cells (DPSCs), stem cells isolated from human pulp of exfoliated deciduous teeth (SHED), periodontal ligament stem cells (PDLSCs), stem cells from apical papilla (SCAPs), and dental follicle cells (DFCs). All these cells can regenerate the tissue of tooth. This review outlines the cell types and strategies of stem cell therapy applied in tooth regeneration, in order to provide theoretical basis for clinical treatments.
Adult Stem Cells ; physiology ; Animals ; Cell Differentiation ; Humans ; Stem Cell Transplantation ; Tissue Engineering ; Tooth ; cytology ; growth & development ; physiology ; Wound Healing