OBJECTIVESTo evaluate the clinical characteristics, in-hospital and three-year outcome in ST-elevation myocardial Infraction (STEMI) patients receiving conservative treatment (CT), thrombolytic treatment (TT) and primary percutaneous coronary intervention (PCI) in Beijing.

METHODSThis 12-month prospective, multicenter registry study was conducted in 19 hospitals with 808 patients with STEMI in Beijing between Jan. 2006 and Dec. 2006, 518 (64%) received PCI, 106 (16.1%) received TT and 184 (22.8%) received CT therapy. Patients were followed up for 3 years.

RESULTSAt baseline, the age of patients in CT group [(64.5 ± 13.5) years] was significantly higher than those in TT group p(57.9 ± 11.0) years] and in PCI group [ (60.4 ± 12.3) years, all P<0.01]; and the median time from symptom onset to hospital in CT group (207 min) was significantly longer than those in TT group (130 min) and PCI group (130 min, all P<0.01). Emergency Medical Service (EMS) use was significantly higher in PCI group (184/518, 35.5%) than in CT group (46/184, 27.3%) and TT group (29/107, 25.0%, all P<0.05). Health insurance holder was the highest in PCI group (P<0.01). PCI was performed less frequently than thrombolytic therapy [66.6% (345/518) vs. 80.2% (85/106)m P=0.02] during off-hours and more frequently performed in tertiary hospitals than in secondary hospitals[66.8%(437/651) vs. 52.6% (81/154, P<0.01)]. The in-hospital mortality and the cardiovascular mortality at 3 year after hospital discharge was significantly higher in CT group [9.2% (17/185) and 9.4% (15/159)] than in PCI group [3.5% (18/518), 4.5% (20/446)] and TT group [6.6% (7/106), 2.3% (2/86), all P<0.01]. Patients in PCI group had the highest adherence level of aspirin, β-blocker, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or statins at 3-years follow-up (all P<0.05). Multivariable Cox proportional hazards regression analysis showed that only PCI was associated with lower risk of cardiovascular death (HR-0.40, 95% CI:0.21-0.73, P<0.01).

CONCLUSIONSSocial and clinical setting may affect the physician's decision to provide reperfusion therapy in Beijing for STEMI patients. Better adherence of secondary preventive drugs and lower cardiovascular death are observed in STEMI patients receiving PCI during the 3-year follow-up

Aged ; China ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Percutaneous Coronary Intervention ; Prognosis

OBJECTIVETo study clinical effects of the over-articular external fixator combined with limited internal fixation for the treatment of Pilon fractures caused by high energy.

METHODSFrom September 2003 to April 2011, 36 patients with Pilon fractures caused by high energy were treated with the over-articular external fixator combined with limited internal fixator. There were 25 males and 11 females, ranging in age from 16 to 72 years old,with an average of 38 years old. The diagnoses of all patients were determined by conventional X-ray examination or three-dimensional spiral CT examination. The AOFAS scoring criteria was used to evaluate the therapeutic effects. The patients with comminuted fractures were treated with screw or Kirschner wire fixation without uncovering periost so as to enhance stability between fracture end and bone blocks,followed by the fixation with over-articular external fixators.

RESULTSAll the patients were followed up, and the duration ranged from 4 to 27 months, with an average of 13 months. Thirty-two patients got wound healing at the first stage. And the bone union duration ranged from 2 to 6 months, with a mean of 3 months. According to the AOFAS ankle-hindfoot subjective scoring standard, 13 patients got an excellent result, 20 good and 3 fair, with an score of 88.2 +/- 3.6. Twelve patients had infections at pinhole, 5 patients had pinhole pain. One patient had the fixator broken induced by over loading, who was cured after treatment. There were no complications such as nerve or vascular injuries, or osteomyelitis.

CONCLUSIONThe over-articular external fixation combined with limited internal fixation for the treatment of Pilon fractures caused by high energy is an ideal method, which has such advantages as reliable fixation, simple operation, coincidence with principles of biomechanical fixation, and benefit for fracture healing.

Adolescent ; Adult ; Aged ; Ankle Injuries ; diagnostic imaging ; surgery ; Ankle Joint ; diagnostic imaging ; surgery ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult

ObjectiveTo examine the relationship between ankle brachial index (ABI) and the extent of coronary stenosis and evaluate the usefulness of ABI to predict the extent of coronary stenosis in old patients.Methods118 patients with coronary angiography were examined by ABI and hemostatic factors evaluation in addition to history collection.ResultsABI was inversely and significantly associated with Gensini score. ABI reduced significantly (P<0.001) in the patients with 3-vessel or left main coronary artery disease (CAD). But there were no significant differences in ABI among the patients with no CAD, 1-vessel or 2-vessel CAD. The corresponding area under the ROC curve was 0.75±0.045, with 95% CI=0.67～0.84 (P<0.001) in ABI in 3-vessel or left main CAD. When ABI≤0.9, it had a relatively high specificity (89.1%) and sensitivity (55.6%) for predicting the presence of 3-vessel disease or left main CAD.ConclusionIn the old patients, ABI is inversely and significantly associated with the extent of coronary stenosis, and ABI≤0.9 has a relatively high specificity and sensitivity for predicting the presence of 3-vessel or left main CAD.

OBJECTIVE: To extract sperm DNA from mixed stain by the modified differential lysis method combined with silicon bead method and to evaluate its application value. METHODS: Fifty-two mixed stains containing female STR genotypes detected by differential lysis method were collected. The sperm DNA was extracted by the modified method combined with silicon bead method, then genotyped with the Identifiler Kit, and compared with the results of genotyping by the conventional differential lysis method as control. RESULTS: Of the 52 samples, 38 samples with sole male STR genotypes in all loci were detected. The detection rate of male STR genotypes was 98.08% through the modified method combined with silicon bead method. CONCLUSION The modified differential lysis method combined with silicon bead method can be used in extraction of sperm DNA from mixed stain.
DNA/isolation & purification* ; DNA Fingerprinting ; Female ; Genotype ; Humans ; Male ; Polymerase Chain Reaction ; Silicon ; Spermatozoa

OBJECTIVETo determine the content of 7 anthraquinones in Semen Cassiae.

METHODA HPLC method was developed, with Inertsil ODS-3 column, acetonitrile and 0.1% H3PO4 solution as mobile phases in gradient elution. The detection wavelength wasset at 278 nm, and the flow rate was 0.8 mL x min(-1).

RESULTRecoveries of all 7 anthraquinones were between 95%-105%. The content of the anthraquinones in crude drug produced in different habitation were different.

CONCLUSIONThe method is convenient and accurate, which provides the foundation for the research of Semen Cassiae.

Anthraquinones ; analysis ; Cassia ; chemistry ; Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; chemistry ; classification ; isolation & purification

Antiviral Agents ; administration & dosage ; therapeutic use ; Hepatitis B ; drug therapy ; therapy ; Humans ; Immunosuppressive Agents ; Liver Transplantation ; Postoperative Period

Increasing demands for zirconia material in clinics, assessment of biocompatibility of zirconia is essential. In this article, a review of in vitro studies of zirconia compatibility was performed. Zirconia showed great biocompatibility at in vitro studies with various cell lines such as fibroblasts, osteoblasts, and lymphocytes. Many studies reported that zirconia caused no cytotoxicity or mutation. Zirconia also showed less bacterial adhesion. There were no adverse effects except for small reduced strength with in vitro study mimicking long-term exposure of body fluid. According to the study with ostoblast-like cells, zirconia could regulate genes of immunity, molecular transport, and cell cycle. Such gene regulating was considered as one of the reasons of zirconia biocompatibility. With biocompatibility of zirconia powders, in vitro studies had controversial conclusions. It seems that zirconia powders might have cytotoxicity
Bacterial Adhesion ; Body Fluids ; Cell Cycle ; Cell Line ; Fibroblasts ; In Vitro Techniques* ; Lymphocytes ; Osteoblasts ; Powders

Increasing demands for esthetic dental treatment, zirconia, which has high mechanical and esthetic properties, had been applied more and more in clinics. Therefore, assessment of biocompatibility of zirconia is necessary. In this article, a review of in vivo studies of zirconia compatibility was performed. In vivo studies showed zirconia had great biocompatibility both on soft and hard tissue. Studies with various animals and patients reported high biocompatibility of zirconia. In terms of bone synthesis and bone adhesion, zirconia showed similar biocompatible properties to titanium. On the other hand, zirconia could be used as implant. For using as an implant, various methods of Hydroxyapatite (HA) coating had been suggested. Since HA coating on titanium implant showed some problems such as low bonding strength and degeneration of HA, HA-zirconia composite, HA-coated zirconia, and HA-zirconia functionally graded material (FGM) or intermediate layer of alumina had been proposed. These methods showed higher bonding strength and biocompatibility.
Aluminum Oxide ; Animals ; Durapatite ; Hand ; Humans ; Titanium

BACKGROUNDDelay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.

METHODSBetween November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.

RESULTSThe median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%), radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P < 0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P < 0.001) compared to those who interpreted their symptoms as cardiac in origin.

CONCLUSIONSSymptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).

Aged ; Chest Pain ; diagnosis ; pathology ; Cross-Sectional Studies ; Emergency Medical Services ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; pathology ; Patient Acceptance of Health Care ; statistics & numerical data ; Time Factors

BACKGROUNDCumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group).

METHODSBetween January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.

RESULTSAmong the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI: 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI: 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI: 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI: 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI: 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group.

CONCLUSIONSAbove one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.

Acute Disease ; Adult ; Aged ; Angioplasty, Balloon, Coronary ; China ; Cross-Sectional Studies ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; therapy ; Patient Acceptance of Health Care ; Quality of Health Care ; Thrombolytic Therapy