OBJECTIVE: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event. METHODS: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event. RESULTS: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035). CONCLUSION The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
Humans ; Heart Failure/physiopathology* ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects* ; Myocardial Infarction/complications* ; Male ; Female ; Hospitalization ; Middle Aged ; Aged ; Echocardiography ; Coronary Circulation ; Predictive Value of Tests ; Troponin I/blood*

Objectives:To evaluate the impact of global longitudinal strain(GLS)for prognosis in ST-segment elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention(PCI). Methods:We enrolled 156 STEMI patients who underwent PCI and spackle tracking imaging(STI)during hospitalization from September 2020 to August 2023.Patients with Killip Ⅱ-Ⅳ at baseline were excluded,138 patients were finally included.GLS was detected by STI.Patients were divided into more impaired group(GLS>-11.7%,n=57)and less impaired group(GLS≤-11.7%,n=81)according to Youden index.Clinical characteristics and echocardiography data were analyzed.Patients were followed up for a median of 21(13,28)months.Heart failure events were compared between the two groups. Results:The peak troponin I(TnI)was significantly higher in patients with GLS>-11.7%than those with GLS≤-11.7%at admission(85 160[31 297,214 226]pg/ml vs.34 942[13 571,92 713]pg/ml,P<0.001).Culprit vessel was different between the 2 groups(P<0.001).Compared with patients with GLS≤-11.7%,patients with GLS>-11.7%had lower left ventricular ejection fraction(LVEF)([60.1±8.7]%vs.[49.2±8.3]%,P<0.001),higher proportion of regional wall motion abnormality(90.1%vs.100%,P=0.015).Both LVEF and GLS recovered in patients with GLS>-11.7%during follow-up,but remained lower as compared to patients with GLS≤-11.7%(both P<0.001).The median follow-up time was 21(13,28)months.After adjusting age,sex,culprit vessel and peak TnI,the risk of heart failure of patients with GLS>-11.7%was significant higher(HR=9.123,95%CI:1.720-43.394,P=0.009). Conclusions:STEMI patients with more impaired GLS have a higher risk of heart failure post PCI.

Objective To investigate the projects and effects of the comprehensive and conservative treatment of patients with keen osteoarthritis and meniscus injury.Methods 120 patients with keen osteoarthritis and meniscus injury were randomly divided into the control group A(n =40),B(n =40)and comprehensive treatment group C(n =40).Patients in group A were treated with ozone and glass sodium injection;Patients in group B were treated with ozone,glass sodium and Triamcinolone Acetonide injection;Patients in group C were treated with ozone, glass sodium and Triamcinolone Acetonide injection,superlaser local irradiation,glucosamine tablet oral,Lornoxicam intravenous injection.The effects of the treatment according to keen joints function scores were compared after two weeks and six months.Patients in group C were randomly divided into group C1(n =20)and group C2(n =20)after one year,patients in group C1 with the same treatment as patients in group A and oral glucosamine tablet for one course of treatment,patients in group C2 without any further treatment.The follow up was completed for two years. Results The excellent and good rate in group C was better than that of group B and group C after two weeks (70.0%,22.5%,42.5%,χ2 =18.152,6.146,P <0.01 or P <0.05).After six month,the excellent and good rate in group C was better than that of group A and group B (87.5%,42.5%,60.0%,χ2 =17.802,7.813,all P <0.01).There was no significant difference between group C1 and group C2 after one years(t1 =2.014,P <0.01). There was significant difference between group C1 and group C2 after two years(t2 =16.152,P <0.01).Conclusion The effects of comprehensive conservative treatment are better than simple keen joint injection in patients with keen osteoarthritis and meniscus injury.The function of keen joint with maintenance care treatment is better than without maintenance care.Comprehensive conservative and maintenance care treatment is a good clinical treatment project.

OBJECTIVE:To investigate the breakthrough point of clinical pharmacists participating in the treatment for a child with Mycoplasma pneumonia complicating with Kawasaki disease,and standardize pharmaceutical care mode. METHODS:Taking a case of Mycoplasma pneumonia complicating with Kawasaki disease as example,according to the use of antibiotics,human im-munoglobulin (pH4) for intravenous injection,non-steroidal anti-inflammatory drugs (NSAIDS),glucocorticoids,combined with clinical manifestations and disease,whole course pharmaceutical care was conducted,using drug interaction,ADR,precautions, discharge education as breakthrough points. RESULTS:In view of possible ADR,clinical pharmacists adopted combination mea-sures for early prevention,and monitoring measures for early identification and intervention to find problems in time,prevent the occurrence of ADR and improve patient compliance. CONCLUSIONS:What clinical pharmacists carry out pharmaceutical care in the treatment group is beneficial to improve the level of clinical treatment,so as to better safeguard patients’medication safety.