Objective: To compare the safety profile, angiographic and clinical outcomes between drug-coated balloon(DCB) only strategy versus drug eluting stent(DES) implantation in primary percutaneous coronary intervention(PCI) for acute myocardial infarction(AMI) patients. Methods: A total of 380 AMI patients who underwent primary PCI in Beijing Chaoyang Hospital from January 2016 to May 2019 were enrolled. They were allocated into DEB group(n=180) or DES group(n=200). The Primary endpoint was the major adverse cardiac events(MACE) in hospital and within 3 months after discharge, the composite event of cardiac death, non-fatal myocardial infarction(MI), target vessel revascularization(TVR) and in stent thrombosis. The secondary endpoints included: (1)TIMI blood flow grade and myocardial perfusion grade (TMP grade) of infarct-related vessels before and after PCI. (2)The degree of ST segment resolution(STR) between half hour and two hours after PCI, and STR was represented by percentage of summed ST-segment reduction between baseline and post-PCI. Using the most significant lead of ST segment elevation, calculating the rate of decline in the ST segment after treatment; or the most significant lead of the ST segment depression, to calculate the rate of recovery in the ST segment after treatment. STR<50% was defined as incomplete STR. (3)The occurrence of coronary artery dissection during operation. (4)The peak value of myocardial enzymes. (5)The incidence of bleeding in hospital and within 3 months after discharge. The inverse probability weighting method based on propensity score (IPTW) was used to compare the effects of the two treatments on MACE occurrence in the logistic regression model. Results: There was no significant difference in sex, age, risk factors of coronary heart disease, type and site of AMI, interventional therapy data(P>0.05) between the two groups. The ratio of bifurcation lesions in DCB group was significantly higher than that in DES group, and the diameter of the DCB was smaller while the length was longer than that of DES (all P<0.05). One death occurred in each group during hospitalization. Compared with the DES group, the incidence of MI ［2.8%(5/180) vs. 0.5% (1/200), P=0.10］ and TVR ［2.8%(5/180) vs. 0.5%(1/200), P=0.10］ in the DCB group during hospitalization showed an increasing trend, and were mostly associated with delayed coronary dissection. The incidence of MACE was similar between the two groups (3.3%(6/180) and 1.0%(2/200), P=0.15) during hospitalization. There was no MACE occurred in the two groups within 3 months after discharge. There was no significant difference between the two groups in TIMI grade, TMP grade, incomplete STR rate and peak value of myocardial enzyme (all P>0.05). The incidence of coronary artery dissection was significantly higher in DCB group than in DES group (8.3%(15/180) and 3.0%(6/200), P=0.02), but most of them were type B or A dissection and did not need special treatment. There was no significant difference in bleeding event between the two groups(P=0.91). Logistic regression analysis showed that there was no difference in the risk of MACE during hospitalization between DES and DCB groups for AMI patients receiving PCI (compared with DCB, OR=0.35, 95%CI 0.08-1.43, P=0.13). Conclusions: The initial safety and efficacy profiles of DCB are similar with those of DES for the AMI patients during PCI. The study highlights that the incidence of coronary dissection (type A or B) is higher post DCB treatment than post DES, but it does not affect blood flow. However, the incidence of in-hospital MI due to delayed coronary dissection trends to be higher post DCB. So we should pay close attention to the risk of delayed coronary dissection after DCB in AMI patients with de novo lesion.
Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents ; Treatment Outcome

Objective To investigate whether elevated baseline levels of high sensitivity C-Reactive Protein (hsCRP) and neutrophil (NE) are associated with an increased risk of breast cancer in Kailuan female cohort. Methods Females from Kailuan cohort (2006-2007) were included in this study. Information on check-up, hsCRP and NE were collected at baseline for all subjects. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95%CI) of association between baseline hsCRP and NE values and breast cancer risk. Results By December 31, 2015, a total of 18 866 participants were enrolled in this study. During the follow-up, 183 new cases of breast cancer were observed. All participants were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The cumulative incidence of breast cancer were 829/105, 1 211/105 and 1 495/105 in these 3 groups, respectively ( 2=12.08， P=0.002). Compared with participants with lower hsCRP levels (<1 mg/L), individuals with the highest hsCRP (>3 mg/L) levels had significantly increased risk of breast cancer (HR=1.71,95%CI: 1.18-2.47, P=0.005), howerver, we didn’t find the statistically significant association between NE level (<3.70×109/Lvs. ≥3.70×109/L) and the risk of brease cancer (P>0.05). Conclusions Elevated levels of hsCRP at baseline might increase the risk of breast cancer in females.

Pudilan Xiaoyan Oral Liquid has effects in clearing away heat and detoxifying,and is used to treat pharynx and throat swelling caused by the syndrome of excessive heat and toxin accumulation. Its efficacy is to relieve swelling and pain( redness,swelling and hot pain). It is included in the Chinese Pharmacopoeia of 2015 Edition,and has been listed in provincial health insurance directories of Shaanxi,Jiangsu,Liaoning,Hunan,Tianjin,Xinjiang and Hebei. It has been recommended by health departments of Beijing,Chongqing and other provinces as a preferred drug for the prevention and treatment of H1 N1 and HFMD,and listed in the diagnosis and Treatment Guide of HFMD by the Ministry of Health,the Clinical Application Guide of Chinese Patent Medicine edited by the Lung Department Disease Branch of China Association of Chinese Medicine,and the Clinical Practice Guide of Single Administration/Combined Administration of Antibiotics in Treatment of Common Infectious Diseases by China Association of Chinese Medicine. To further improve the clinician's understanding of drugs and better guide the rational clinical application,we invited front-line clinical experts from respiratory department,infectious department and dermatology of traditional Chinese and Western medicine to develop and compile the expert consensus. The consensus fully considered the clinical evidence and the expert clinical experience to give recommendations for clinical problems with evidence support and consensus suggestions for clinical problems without evidence support by the nominal group method.This consensus is based on clinical research evidence and expert experience in a simple and clear format,which provides a preliminary reference for the clinical use of the drug.
China ; Consensus ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Nonprescription Drugs

OBJECTIVETo observe the effect and safety of Xiaozhi particles, integrated taohong Siwu tang and Erchen tang and Xuezhikang capsule in treating hyperlipidaemia (HLP) associated with highly active antiretroviral therapy (HAART).

METHODIn the multi-centered, randomized controlled clinical study, 180 hyperlipidaemia associated with highly active antiretroviral therapy cases were divided into the treatment group treated by Xiaozhi particles, integrated Taohong Siwu tang and Erchen tang, and the control group treated by Xuezhikang capsule. The treatment course was 12 weeks. The total cholesterol (Tch), triglyceride (TG), low density lipoprotein (LDL) and high-density lipoprotein(HDL) were observed.

RESULTAfter 12 weeks, compared with Xuezhikang capsule, the change difference of Tch, LDL, HDL in the Chinese traditional medicine formula groups of patients is significant (P < 0.05), the change of the TG has no significant difference. The effect of Tch, LDL in Xuezhikang capsule groups is better than in traditional Chinese medicine formula group,but the effect of HDL in traditional Chinese medicine formula group is better than in Xuezhikang capsule groups.

CONCLUSIONIntegrated Taohong Siwu tang and Erchen tang, Xiaozhi particles and Xuezhikang capsule can be used to control the hyperlipidaemia associated with highly active antiretroviral therapy as one of the main Chinese native medicine preparation.

Adult ; Antiretroviral Therapy, Highly Active ; adverse effects ; Cholesterol ; blood ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Hyperlipidemias ; blood ; chemically induced ; drug therapy ; Lipoproteins, HDL ; blood ; Lipoproteins, LDL ; blood ; Male ; Triglycerides ; blood

Objective To explore the demographic characteristics and clinical features of patients with idiopathic pulmonary arterial hypertension ( IPAH ) in China.Methods Between March 2007 and September 2010,IPAH diagnosis was confirmed by right heart catheterization in 150 adult patients from 31 clinical centers in China.Clinical and hemodynamic data were analyzed and patients were divided into WHO functional class Ⅰ / Ⅱ and WHO functional class Ⅲ/Ⅳ group.Results The mean age of 150 patients were 36 ± 13 years with female patient/male patient ratio of 2∶1,and mean BMI was ( 21.3 ± 3.5 ) kg/m2.Fatigue (n =123,82.0％ ) and dyspnea ( n =112,74.7％ ) are the most common symptoms.Accentuated pulmonic second sound ( P2 ) was detected in 92.0％ ( n =138 ) of patients during physical examination,which was also the most common sign.About 49.0％ ( n =73 ) patients were WHO functional class Ⅰ/ Ⅱ patients and 46.0％ ( n =68 ) patients were WHO functional class Ⅲ/Ⅳ patients. Six minutes walking distance (6MWD) and Borg dyspnea score was (337 ± 101 ) m and 2.0 (2.0,4.0),respectively.Right ventricular hypertrophy was suggested by ECG in 93.1％ ( n =140 ) patients.Right atrial pressure was (10 ±6) mm Hg,mean pulmonary artery pressure was (61 ±16) mm Hg,cardiac index was (2.3 ±0.8)L · min-1 · m-2 and pulmonary vascular resistance(1484 ±699) dyn · s-1 · cm-5 in this cohort.6 MWD (305 m ±89 m vs.377 m ±88 m) was significantly shorter while Borg dyspnea score [3.0 (3.0,5.0) vs.2.0 (2.0,3.0) ] was significantly higher in WHO functional class Ⅲ/Ⅳ patients than in WHO functional class Ⅰ/Ⅱ patients. Similarly hemodynamic parameters were also worse in WHO functional class Ⅲ/Ⅳ patients than in WHO functional class Ⅰ / Ⅱ patients ( all P ＜ 0.05).Conclusion Idiopathic pulmonary arterial hypertension patients in this cohort affect mostly young adults,dominated by female gender and lower body mass index. Fatigue and dyspnea are the most common symptoms and accentuated pulmonic second sound ( P2 ) is the most common sign.IPAH patients are often displaying severe functional and hemodynamic disturbance at first visit to hospitals.Dyspnea and hemodynamic impairment are related to 6MWD and WHO functional class.

Objective To explore the clinical effect of primary percutaueous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) induced by left main artery total or subtotal occlusion.Methods Between January 1995 and June 2010,there were 28 AMI patients [24 males,mean age(61.5 ±2.3)years,15 patients complicated with cardiac shock] with left main occlusion or severe stenosis who were treated with PCI in our center.The clinical features were compared between death group and survival group.All survival cases were prospectively followed up for the occurrence of major adverse cardiac events.Results Totally 25 patients received stent implantation,2 received balloon dilation followed by coronary artery bypass graft,and 1 patient died during PCI.Total in-hospital mortality was 35.7 ％ (10/28),and mortality was 53.3％ (8/15) in cardiac shock patients.Compared with survival group,ratio of cardiac shock [80.0％ (8/10)vs.38.9％ (7/18),P ＜0.05] and poor collateral circulation flow [100％ (10/10)vs.33.3％ (6/18),P ＜0.01] were higher in death group,and there was no significant difference in TIMI 3 grade of forward flow post procedure (P ＞ 0.05).Hospital stay was (22.1 ± 2.6) days and the cumulative survival was 64.3％ during 3 months follow up for survival group.Conclusions Short-term clinical outcome is favorable for survived AMI patients with left main disease who underwent PCI.The ratio of cardiac shock and poor collateral circulation flow are risk factors for in-hospital death in AMI patients with left main disease who underwent PCI.

BACKGROUNDPrimary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.

METHODSFrom February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2 ± 9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5 ± 10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.

RESULTSThere were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.

CONCLUSIONSDalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.

Aged ; Angioplasty, Balloon, Coronary ; Anticoagulants ; therapeutic use ; Dalteparin ; administration & dosage ; therapeutic use ; Female ; Heparin ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; therapy ; Treatment Outcome ; Tyrosine ; analogs & derivatives ; therapeutic use

BACKGROUNDChronic obstructive pulmonary disease (COPD) has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.

METHODSA multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents (over 40 years old) were interviewed with a standardized questionnaire and spirometry. Post-bronchodilator forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic, personal and exposure variables were collected and analyzed.

RESULTSAmong the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 (35.3%) were asymptomatic. The age, sex, body mass index (BMI), rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group. Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV(1) (73.1% vs. 61.0%), FVC (91.9% vs. 82.0%), and a higher ratio of FEV(1)/FVC (62.9% vs. 58.7%) (all P < 0.001) than symptomatic group. More asymptomatic patients were underdiagnosed (91.9% vs. 54.3%, P < 0.001) than symptomatic patients.

CONCLUSIONSThis large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Educational Status ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; epidemiology ; Risk Factors ; Smoking ; Spirometry ; Surveys and Questionnaires

Objective To compare the different surveillance system evaluation guidelines proposed by US Center for Disease Control and Prevention (CDC) and WHO, so as to develop an evaluation strategy suitable for communicable disease surveillance systems in China. Methods Systematic collection and review on the guidelines that were proposed by US CDC and WHO.Situation analysis together with feasibility analysis were linked to the analysis of evaluation strategy used in China. Results US CDC guidelines were more appropriate for evaluating those single or appropriate for evaluating the multi-system or complicated system which focusing on data related to moment to start to evaluate the functions. Conclusion More flexible and comprehensive strategy based on national conditions is needed when constitute the national communicable disease surveillance evaluation guidelines. The multi-step strategy described in this article could be used as reference.

Objective To explore the prognostic impact of post primary percutaneous coronary intervention (PCI) reperfusion status on outcome in patients with acute ST-elevation myocardial infarction (STEMI). Methods A retrospective analysis was performed in 964 patients undergoing primary PCI for STEMI. Electrocardiogram and TIMI myocardial perfusion grade (TMPG) were analyzed by reader blinded to the clinical course. Patients were divided to four groups according to ST segment resolution (STR) and TMPG: group A were patients with good STR and TMPG(425/964), group B were patients with poor STR and good TMPG (239/964), group C were patients with good STR and poor TMPG (113/964) and group D were patients with poor STR and TMPG (113/964). Results Although TIMI grade Ⅲ flow was achieved after mechanical reperfusion, abnormal reperfusion was still present in about 1/3 patients as shown by poor STR or TMPG. Older age, cardiac dysfunction and diabetes, prolonged time of pain to balloon/emergency room are independent risk factors for abnormal reperfusion post PCI. Major aclverse cardiac events events in hospital ( RR = 64. 63, P < 0. 01 ) and during follow up( RR = 11.69, P < 0. 01 ) were significantly higher in group D than in group A. Conclusion Poor post PCI reperfusion status is associated with higher in hospital and during follow up major aclverse cardiac events event in STEMI patients.