心脏病和心血管医学杂志》上 //m.lakotalakes.com/jccm Heighpubs开放获金博宝app体育取期刊上 en - us 心内直视手术在尼日利亚的孩子需要国际和地区合作:乔纳森家乡Bayelsa州和埃努古经验 07/09/2021//m.lakotalakes.com/jccm/jccm-aid1117.php & lt; h2> Abstract< / h2><p>Background: Children with congenital heart diseases (CHD) often require palliative or definitive surgical heart interventions to restore cardiopulmonary function. Lack of early cardiac intervention contributes to large numbers of potentially preventable deaths and sufferings among children with such conditions.</p> <p>Objectives: The aim of this study was to highlight our experience and the importance of international and regional collaboration for open heart surgery in children with CHD and capacity building of local cardiac teams in Bayelsa and Enugu States.</p> <p>Methodology: In November 2016, a memorandum of understanding (MOU) was signed by the managements of FMC, Yenagoa, Bayelsa State, UNTH, Enugu and an Italian-based NGO- Pobic Open Heart International for collaboration in the area of free open heart surgery for children with CHDs and training of local cardiac teams from both institutions either in Nigeria or in Italy. Patients for the program were recruited from Bayelsa and Enugu States with referrals from all over the country with combined screening and selection done in UNTH. Selected patients were operated on and funded free of charge by the Italian NGO. Hands on training of the local cardiac teams and cardiac intervention was done twice yearly in Nigeria.</p> <p>Result: From inception of the program in November, 2016 to May, 2019 a total of 47 children (21 Males, 26 Females; age range 6 months to 14 years) with various types of congenital heart defects had free open heart surgery from the program with 41 surgeries done in UNTH &amp; 6 in Italy (complex pathologies). Also, home cardiac teams from UNTH and FMC, Yenagoa gained from on-site capacity training &amp; retraining from the Italian cardiac team both in Nigeria and in Italy. The Success rate was 95.7% (44) and Case Fatality rate was 4.3% (2).</p> <p>Conclusion: There is a great efficacy in early cardiac intervention. This is with respect to a high success rate and minimal Case Fatality seen in this study. This was achieved through Regional and international collaboration.</p> 不寻常的和严重的peripartum心肌病:病例报告 05/05/2021//m.lakotalakes.com/jccm/jccm-aid1116.php & lt; h2> Abstract< / h2><p>Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (&lt; 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context.</p> 枸橼酸西地那非在健康和患病的心 04/23/2021//m.lakotalakes.com/jccm/jccm-aid1115.php & lt; h2> Abstract< / h2><p>Sildenafil citrate is one of the frontline drugs used to manage erectile dysfunction (ED). Chemically, it is described as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H&nbsp;&ndash;pyrazolo [4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C22H30N6O4&nbsp;S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type-5. There had been heightened concerns following reports that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. So the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. This article ties up the various outcomes of the investigations with a view to guiding physicians and patients that use sildenafil citrate to manage erectile dysfunction, especially as it concerns its effect on their cardiovascular function in health and in disease. Sildenafil citrate could impact negatively on ailing hearts, but on a healthy heart, there may not be any such impact, rather, it improves on heart performance as it lowers the blood pressure.</p> pVAD-assisted左主干DK-Crush分叉PCI Post-ViV TAVR 04/16/2021//m.lakotalakes.com/jccm/jccm-aid1114.php & lt; h2> Abstract< / h2><p>We describe successful percutaneous coronary intervention (PCI) of significantly diseased ostial left main (LM) and distal LM bifurcation (Medina 1,1,1) in a patient with a reduced left ventricular ejection fraction and a recent valve-in-valve balloon-expandable TAVR using the DK-Crush technique with the support of a percutaneous left ventricular assist device.</p> 腹部肥胖在预测心肌梗死的风险。腰臀比:度量困惑世界心脏病学了很长时间 03/24/2021//m.lakotalakes.com/jccm/jccm-aid1113.php <p>Important differences has been found in assessing the effects of obesity on cardiovascular disease (CVD) risk [1]. Interestingly, accurate estimation of the body composition (BC) is highly relevant from a public health perspective [2], and it has the importance of being essential in establishing the impact of adiposity on increased myocardial infarction (MI) risk. However, in non-randomized studies, baseline differences of BC between groups to be compared may introduce bias in results.</p> 尼日利亚:高血压管理的障碍和挑战 03/19/2021//m.lakotalakes.com/jccm/jccm-aid1112.php & lt; h2> Abstract< / h2><p>In recent years there has been increasing concern about the growing burden of cardiovascular disease (CVD) in developing countries. Systemic hypertension remains the commonest form of CVD and is identified as a key modifiable risk factor for cardiovascular morbidity and mortality. Primary and secondary prevention of cardiovascular adverse events are public health priorities. This review highlights the potential barriers and challenges to hypertension care in Africa&rsquo;s most populous country, Nigeria, and proffers relevant recommendations.</p> 肌肉的生长和控制肌节组件的生产 03/02/2021//m.lakotalakes.com/jccm/jccm-aid1111.php & lt; h2> Abstract< / h2><p>This presentation gives a description of the muscle and sarcomere followed by the main content summarized.</p> <p>&nbsp;</p> 一个不同寻常的房室结的可重入性心动过速 02/12/2021//m.lakotalakes.com/jccm/jccm-aid1110.php <h2>Summary</h2> <p>Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent supraventricular tachycardia, commonly manifesting as autolimited paroxysmal episodes of rapid regular palpitations that exceed 150 beats per minute (bpm), dizziness and pounding neck sensation.</p> <p>Case presentation: We present a case of a male patient, 70 years old, with ischemic heart disease and slow-fast AVNRT treated with radiofrequency catheter ablation (RFCA) in March 2019, with regular 6-months follow-ups. He was readmitted in our department in November 2020 for rest dyspnea and incessant fluttering sensation in the neck, without palpitations. The event electrocardiogram (ECG) was initially interpreted by general cardiologist as accelerated junctional rhythm, 75 bpm. Due to the persistence of symptoms and ECG findings, a differential diagnosis between reentry and focal automaticity was imposed. The response to vagal maneuvers and Holter ECG monitoring characteristics provided valuable information. We suspected recurrent slow ventricular rate typical AVNRT, which was confirmed by electrophysiological study and we successfully performed the RFCA of the slow intranodal pathway.</p> <p>Conclusion: AV nodal reentry tachycardia may have an unusual presentation, occurring in elder male patients with structural heart disease. Antiarrhythmic drugs can promote reentry in this kind of patients. In cases of slow ventricular rate, vagal maneuvers and Holter ECG monitoring can help with the differential diagnosis. The arrhythmia can be successfully treated with RFCA with special caution regarding the risk of AV block.</p> 新见解从心肌应用于骨骼肌 01/15/2021//m.lakotalakes.com/jccm/jccm-aid1109.php <p>I have recently described the origin of the second Ca2+ binding in the triggering of contractile activity in cardiac myofibrils that is the origin of the Ca2+ Hill coefficient of 2 for the ATPase. This site is not a simple protein binding site and cannot be measured by 45Ca2+ binding. The myofibril protein unit requirements are described by me and so are the consequences of disruption of the function of these units and the related medical outcomes. The purpose of this paper is to review the topic and extend the reasoning to the function of skeletal muscle and cite the literature that supports this.</p> 颈动脉斑块的编织骨形成的证据 01/05/2021//m.lakotalakes.com/jccm/jccm-aid1108.php & lt; h2> Abstract< / h2>& lt; p>目的:斑块形态中扮演一个重要的预后脑血管事件的发生。尤其是Echolucent和异构斑块,随后中风的风险增加。根据斑块回声的质量基于b型超声检查,颈动脉斑块分为软lipid-rich斑块和硬斑块钙化。本研究的目的是调查的基底膜结构变化不同的颈动脉斑块类型。;/ p>& lt; p>病人和方法:活检被从10男性患者(平均年龄;75 + 1年)和7女性(68 + 3年)。研究人群包括从丝状的颈动脉狭窄患者,8例急性脑血管事件和9与无症状性狭窄。扫描电子和偏振光显微镜调查进行外植斑块确定血管病变钙化的形态地区。;/ p>& lt; p>结果:通过扫描电镜,多个地方钙化病灶被确定。 The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation.</p> <p>Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics.</p> Ivabradine与卡维地洛在管理与恢复COVID-19患者窦性心搏过速心悸 12/23/2020//m.lakotalakes.com/jccm/jccm-aid1107.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>One of the major complications among COVID-19 patients include cardiac arrhythmias. Commonest arrhythmia is sinus tachycardia which is usually associated with palpitation causing discomfort to patients. In this study, we present a comparative study of use of Ivabradine vs. Carvedilol for sinus tachycardia in post-COVID-19 infected patients.</p> <p><strong>Method:</strong> 50 consecutive recovered COVID-19 patients with sinus tachycardia were included in this open labelled RCT. 25 patients received Ivabradine and remaining 25 received Carvedilol. Single therapy non-responders were treated with Ivabradine with Atorvastatin.</p> <p><strong>Results:</strong> The mean age of all patients is 48.8&plusmn;7.66 years (Males 49.5 &plusmn; 7.21 years; Females 47.68 &plusmn; 8.23 years). The mean heart rate (MHR) of all patients is 125.52 &plusmn; 9.07/min (Males 125.67 &plusmn; 8.78/min; Females 125.26 &plusmn; 9.5/min). After five days of single drug therapy the mean drop in the heart rate was 35.04 &plusmn; 10.55/min (Males 34.41 &plusmn; 9.71/min; Females 36.05 &plusmn; 11.72/min), resulting in 27.88 &plusmn; 8.11% (Males 27.38 &plusmn; 7.56%; Females 28.69 &plusmn; 8.89%) reduction in MHR. Among the two groups, the Carvedilol group showed improvement of MHR in 14(56%) patients; whereas in Ivabradine group 18(72%) patients improved out of 25 patients each (p: 0.2385). In the Carvedilol group the MHR reduced from 128.6 &plusmn; 8.44 to 95.68 &plusmn; 10.63 (p &lt; 0.001), which is statistically significant; similarly, the Ivabradine group showed a MHR from 122.44 &plusmn; 8.62 to 85.28 &plusmn; 10.52 (p &lt; 0.001). The monotherapy therapy non-responders were treated with dual-therapy of (Ivabradine + Atorvastatin).</p> <p><strong>Discussion:</strong> Ivabradine is more effective in controlling heart rate compared to Carvedilol. Also, Ivabradine group scores very well in &lsquo;patient-satisfaction&rsquo; with regards to symptom (palpitation) relief.</p> <p><strong>Conclusion:</strong> The COVID-19 sequelae of sinus tachycardia can be better controlled with Ivabradine when compared to Carvedilol.</p> 急性缺血性中风管理患者心室辅助装置 12/23/2020//m.lakotalakes.com/jccm/jccm-aid1106.php <p>Ventricular assist device is a portable machine which is also called an artificial heart for the patients who have terminal heart failure. The device maintains the heart&rsquo;s vital functions until the suitable donor is found for the heart transplantation. It can be applied to either ventricles or both (biventricular).</p> Post-extrasystolic势差现象区分一个€œtruea€从€œpseudoa€低流量、坡度不大主动脉瓣狭窄 12/16/2020//m.lakotalakes.com/jccm/jccm-aid1105.php & lt; h2> Abstract< / h2><p>Post-extrasystolic potentiation (PESP) is a marker of contractile reserve and refers to the augmentation of left ventricular contractility due to preload recruitment and rise in intracellular calcium following a premature beat. In this case report we show that PESP might be a safe and helpful aid to evaluate low flow, low gradient aortic stenosis and contractile reserve in the cathlab, thereby reducing the potential risk of complications associated with intravenous dobutamine evaluation and reducing unnecessary testing.</p> 抗生素诱导线粒体变化导致致癌的潜在贡献,心脏疾病,其他医疗条件和生态系统的风险 10/02/2020//m.lakotalakes.com/jccm/jccm-aid1104.php & lt; h2> Abstract< / h2><p>With the discovery by Calghatgi (2013) that three common antibiotics (Abs) increased mitochondrial reactive oxygen (ROS) and lipid peroxide (LP) and depleted their natural absorbant glutathione led me to investigate further the potential impacts of these genotoxic substances on carcinogenesis. The range of impacts on mitochondria and cellular DNA varied by antibiotic to those consistent with known prior contributions to carcinogenesis. Specific cancers probably increased by these changes were HCC, RCC (KCC), CRC, cancer of the esophagus. Tumor suppressor gene mutations resulting from LP were noteworthy in this regard and mutations induced in CRC were consistent with those found in carcinogenesis of CRC. In addition depression of short chain fatty acids in microbiomes were found which depress the immune system increasing risk of all cancers. Many cancers were increased according to epidemiological studies linking Abs with elevated odds ratios, with one concern in particular, fatal breast cancer. The impact of loss of functionality of the mitochondria was also linked to depression of the citric acid cycle and therefore ATP which deflected metabolism to glycolysis, the Warburg mechanism also increasing risk of all cancers, favoured by cancer cells. In conclusion, some portion of many cancer types are probably increased in likelihood by number, type and frequency of Abs treatment and chronic residue exposure which varies from individual to individual. This led me to propose a three pronged carcinogenesis mechanism for Abs. 1. Cancer critical mutations 2. Immune depression 3. loss of mitochondrial functionality leading to Warburg effects. Damage to mitochondria were also noted by common pesticides tested in China and cancer associations were also found for many pesticides supporting a similar contributory etiology. Heart health concerns were raised by these findings because of the myriad mitochondria in the heart and because of long term reliability needs. Studies suggesting hearts were affected by Abs and pesticide exposure were presented. Because of their geographical ubiquitousness and the huge range of diseases associated with mitochondrial dysfunction, antibiotics and pesticides and bacteriocidal biocides are of concern for biodiversity and life in general. I propose research steps to evaluate Abs safety and suggest directions for further research and make suggestions on ways to ameliorate Abs toxicity.</p> 发病率和冠状动脉内介入治疗后的结果没有流主要在急性心肌梗塞 08/31/2020//m.lakotalakes.com/jccm/jccm-aid1102.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Primary percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI). Incidence of no flow is 8.8-10% in primary PCI of STEMI patients. Our aim was to study actual incidence and outcome of no flow patients.</p> <p><strong>Methods: </strong>Five hundred and eighty primary PCI patients were enrolled and evaluated from 2016 January to 2017 December.</p> <p>We used drug eluting stents in all cases. Majority of our patients (&gt; 90%) presented to emergency six hours after onset of symptoms. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have studied primary outcome (mortality) of no flow in those patients.</p> <p><strong>Results:</strong> There were 44 cases of no flow in our series (7.75%). Involvement of Left anterior descending artery (LAD) was in eighteen patients. Right coronary artery (RCA) was culprit in twenty four cases. Only two cases were seen in LCX territory. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group.</p> <p><strong>Conclusion:</strong> Refractory no flow during STEMI intervention is associated with increased incidence of major adverse cardiovascular events (MACE).<br /> There is no established strategy to solve this phenomenon.</p> 临床资料及手术结果法乐四联症的儿童出现畸形学 09/14/2020//m.lakotalakes.com/jccm/jccm-aid1103.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Tetralogy of Fallot (TOF) is a very common cyanotic congenital heart disease presenting early at birth with various degrees of cyanosis. If left uncorrected surgically, can lead to death.</p> <p><strong>Objectives:</strong> This study is aimed at determining pattern and surgical outcome of children with teratology of Fallot in a budding health facility in India over a year period.</p> <p><strong>Result:</strong>&nbsp;A total of 51 children were diagnosed of TOF over the period, of which 66.7% were males with mean age of 48.14 &plusmn; 45.36 months.</p> <p>The surgical outcome showed only 3.9% mortality. The death was among children &gt;1 to 5 years. The mean number of days in intensive care unit (ICU) was 5.8 &plusmn; 11.2 days. 82.4% of the patients were off-pump post-operatively, compared to 17.6% with re-pump. Among those who had re-pump, 77.8% were males and among those without re-pump, 64.3% were likewise males (&chi;2 = 0.6, p = 0.41). About 92.2% (47/51) of patients had pulmonary regurgitation post-op, ranging from mild to moderate regurgitation. 51.1% of the regurgitations were mild while 25.5% and 23.4% were moderate and severe regurgitations respectively.</p> <p>Post-operative VSD was detected in 51% (26/51) of the patients. The post-op right ventricular pressure (RVOT) was significantly lower than that of pre-op pressure, 10.8 &plusmn; 1.5 mmHg vs. 31.7 &plusmn; 4.5 mmHg (pair t test = 8.7, p &lt; 0.001).</p> <p><strong>Conclusion:&nbsp;</strong>Timely surgical repair is crucial in alleviating several morbidity and mortality associated with teratology of fallot. Pulmonary regurgitation is a very common sequel after surgery and can result in death.</p> 心脏肌肉疾病的机制,一种动力学的方法:主要审查 07/16/2020//m.lakotalakes.com/jccm/jccm-aid1101.php <p>The normal adult heart is a well maintained machine that has a mechanism for growth replacement of the sarcomere that is lost by natural degeneration. This process ensures the heart has the strength of contraction to function correctly giving blood supply to the whole body.</p> 股静脉闭合:只有回顾性分析在现实世界中所有来者MynxGripA®血管闭合装置 06/18/2020//m.lakotalakes.com/jccm/jccm-aid1100.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Vascular closure devices (VCD) are routinely used to achieve haemostasis following percutaneous arterial procedures. The extravascular polyethylene-glycol based MynxGrip&reg; device (Cardinal Health) received FDA approval for use in the closure of femoral veins, but so far limited data is available on its use, especially with concomitant use of anticoagulants.</p> <p><strong>Method: </strong>This is a retrospective analysis of data from a single-centre on the effectiveness and complication rates following the use of the MynxGrip&reg; device for femoral venous closure in patients undergoing diagnostic/interventional (temporary pacing during balloon aortic valvuloplasty, or electrophysiology) procedures utilising 5-7F sheaths.</p> <p><strong>Results:</strong> 85 patients (mean age 74 years) underwent femoral venous closure with the MynxGrip&reg; device. 51.8% were male. The rate of concomitant anticoagulant or antiplatelet use was 52.9%. Device deployment was 100% successful with full haemostasis in all cases. There were no major vascular complications (bleeding, thrombosis, or infections). There was one case of a minor small venous hematoma which did not require treatment. The mean length of stay was less than 1 day (67.1% patients discharged the same day) and overnight stay only indicated by interventional procedure.</p> <p><strong>Conclusion: </strong>This data supports safety and efficacy of the MynxGrip&reg; device for femoral venous closure with same-day discharge, even with concomitant aggressive antiplatelet and anticoagulant use. It has the potential for use in other large bore venous access sites.</p> 纤溶与tPA治疗失败,因为它是基于一个错误的概念 06/16/2020//m.lakotalakes.com/jccm/jccm-aid1099.php & lt; h2> Abstract< / h2><p>Fibrinolytic therapy has become synonymous with tissue plasminogen activator (tPA) based on the belief that tPA alone was responsible for natural fibrinolysis. Although this assumption was belied from the outset by disappointing clinical results, it persisted, eventually causing fibrinolysis to be discredited and replaced by an endovascular procedure. Since time to reperfusion is the critical determinant of outcome, which in acute myocardial infarction (AMI) means within two hours, a time-consuming hospital procedure is ill-suited as first line treatment. For this purpose, fibrinolysis is more fitting. The assumption that tPA is responsible for fibrinolysis is contradicted by published findings. Instead, tPA &lsquo;s function is limited to the initiation of fibrinolysis, which is continued by urokinase plasminogen activator (uPA) and that has the dominant effect. tPA and uPA gene deletion and clot lysis studies showed the activators have complementary functions, requiring both for a full effect at fibrin-specific doses. They are also synergistic in combination thereby requiring lower doses for efficacy.&nbsp; A clinical proof of concept study in 101 AMI patients who were treated with a 5 mg bolus of tPA followed by a 90 minute infusion of prouPA, the native form of uPA. A near doubling of the 24 h TIMI-3 infarct artery patency rate was obtained compared to that in the best of the tPA trials (GUSTO). In further contrast to tPA, there were no reocclusions and the mortality was only 1% [1]. A sequential combination of both activators, mimicking natural fibrinolysis, holds promise to significantly improve the efficacy and safety of therapeutic fibrinolysis.</p> 长期结果介入性血管成形术后全身肝素化外围血管 06/15/2020//m.lakotalakes.com/jccm/jccm-aid1098.php & lt; h2> Abstract< / h2><p><strong>Objective: </strong>The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with different low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The aim of this study was to determine gender-specific risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation.</p> <p><strong>Methods:</strong> In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels. Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention.</p> <p><strong>Results:</strong> 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classification of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classification occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superficialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. artery and external iliacal artery are significantly independent of risk factors better than the femoral vessels, and these in female patients better than in male patients. Male patients do not benefit significantly from stent implantation in the long term. As the COXI and II regression analyses show, gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels.</p> <p><strong>Conclusion:</strong> Under consideration of gender and risk factors, while male patients with diabetes mellitus, renal insufficiency and/or poor run-off did not benefit from stent implantation in the long-term, female patients with similar risk factors showed higher patency rates after stent therapy. In addition, the long-term results after PTA of femoral superficialis artery and poplitea artery are significantly worse than PTA of the pelvic vessels in both genders.</p> 评估期间心血管和肾脏功能的治疗与山蚂蝗属adscendens疗法 06/09/2020//m.lakotalakes.com/jccm/jccm-aid1097.php & lt; h2> Abstract< / h2><p>Desmodium adscendens is a rain forest medicinal herb used in managing quite a number of medical conditions. Its efficacy in the treatment of several diseases has made it a first line herb for doctors, especially in managing all forms of spasm. It is however common knowledge that some of these medicinal herbs impact severely on the normal functioning of some vital organs of the body during their administration. The present study was carried out to assess the renal and cardiovascular performance in subjects undergoing treatment with Desmodium adscendens with a view to advising against its indiscriminate use. The parameters used for the assessment of renal functions were serum creatinine and urea concentrations and their clearance. Also, changes in electrolyte concentration of Sodium, Potassium and Chloride concentration were used to assess cardiovascular performance. The histology of the kidney and heart tissues was also done to determine if the extract has impact on the cyto-architecture of the organs. Twenty-four (24) wistar rats were used for the experiment. The rats were grouped randomly into four groups (n = 6). Group 1 served as control, and the rats in the group were given normal rat feeds and water. Group 2 served as low dose group, and rats in this group were administered with low dose of extract 300 mg/kg. Group 3 served as medium group, and rats in this group were treated with medium dose of extract, 450 mg/kg. Group 4 served as high dose group, and rats in this group were treated with high dose of extract 600 mg/kg. The extract was administered for 28 days. Result showed that the extract did not impact negatively on the normal function of the renal and cardiovascular system of the treated groups, rather it enhanced their performances. It can therefore be concluded that the extract is beneficial to renal and cardiovascular functions if used within the treatment dosage.</p> 撒哈拉以南非洲peripartum心肌病的预后(布基纳法索西南PPCM寄存器) 05/19/2020//m.lakotalakes.com/jccm/jccm-aid1096.php & lt; h2> Abstract< / h2><p>Peripartum cardiomyopathy is one of the curable cardiomyopathy. It&rsquo;s a severe and frequent disease arising among women of childbearing age. Its evolution in the long-term among some patients leads to chronic heart failure. Our study aims to determine from a prospective cohort, the factors associated with the non-recovery of myocardial function upon 12 months of diagnosis. Sociodemographic, clinical and echocardiographic data were collected at the time of diagnosis and then in months 3, 6 and 12. The outcome was the non-recovery of myocardial function at one year, defined by a left ventricular ejection fraction (LVEF) below 50%. 60 patients were analyzed after 12 months of follow-up. Mortality was about 13.3% and recovery rate of myocardial function reached 42.3%. After logistic regression, delay diagnosis and observance were the factors related to non- recovery of myocardial function.</p> 我们的经验与单完全房室隔的补丁修复缺陷 05/02/2020//m.lakotalakes.com/jccm/jccm-aid1095.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Various surgical methods have been utilized in the management of complete atrioventricular septal defects (CAVSD). Early intervention and achievement of a competent left atrioventricular valve are the key factors for successful treatment.</p> <p><strong>Methods:</strong> A total of 66 patients with complete atrioventricular septal defect have been operated in a tertiary care center. Patient group consisted of 28 males and 38 females with an average age of 6.2 &plusmn; 3.3 months. Ventricular and atrial defects were repaired generally with single-patch technique using autogenous pericardium.</p> <p><strong>Results:</strong> Preoperative catheterization and angiography was performed in 41 patients. Single patch and modified single patch techniques were preferred in 57 and 9 patients respectively. The average duration for respiratory support, intensive care unit stay and discharge from hospital were 36 &plusmn; 49.3 hours, 4.1 &plusmn; 1.9 days, and 10.1 &plusmn; 3.3 days respectively. In the left atrioventricular valve mild, moderate and severe regurgitation were detected in 44 (66.6%), 17 (25.7%) and 2 (3%) patients postoperatively. No regurgitation was determined in 3 patients (4.5%). Two cases ended up with mortality (3%).</p> <p><strong>Conclusion:</strong> Single patch repair technique can provide satisfactory surgical outcomes in patients with complete atrioventricular septal defect.</p> 在老年患者保守治疗和侵入性方法没有的st段抬高心肌梗死 04/30/2020//m.lakotalakes.com/jccm/jccm-aid1094.php <p>Myocardial infarction without ST segment elevation is one of the most common causes of hospitalization of the elderly patient [1]. Coronarography followed by revascularization, is performed in the vast majority of cases of myocardial infarction without ST segment elevation, in the regions with a well-developed health system.</p> sacubitril /缬沙坦协会最高剂量的影响相比,低剂量死亡率和室性心律失常 04/24/2020//m.lakotalakes.com/jccm/jccm-aid1092.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>心源性猝死是一个主要的医疗保健问题减少射血分数心力衰竭(HFrEF)患者。最近,新的sacubitril协会/缬沙坦显示减少室性心律失常(VA)和死亡率相比,即使在低剂量卡托普利在心力衰竭患者。我们的研究的目的是评估是否sacubitril /缬沙坦的最高剂量相比,低剂量可能改善的速度在人口死亡和VA患者HFrEF和植入式心脏除颤器(ICD)。; / p>& lt; p> & lt; strong>方法:& lt; / strong>104高频减少患者EF sacubitril /缬沙坦与ICD被分为2组:第一个sacubitril /缬沙坦的低剂量(24/26毫克或49个毫克/ 51毫克每日两次)和第二最大剂量(97毫克/ 103毫克每日两次)。主要的结果是死亡或适当的复合ICD治疗VA。; / p>& lt; p> & lt; strong>结果:& lt; / strong>平均随访14个月后,39例患者接受低剂量和剂量最高的65名患者。 Patients from the lower doses group were older (70 [60-80] vs. 66 [60-70]; p = 0,03), more symptomatic at initiation (NYHA 3: 44% vs. 19%; p &lt; 0,01) and more often in atrial fibrillation (31% vs. 12%; p = 0,04). The primary composite endpoint occurred in 14 patients (36%) in the low doses group versus 7 patients (11%) in high dose group (p &lt; 0,01). This difference was particularly observed in the subgroup of patients with ischemic cardiomyopathy. In a multivariable analysis, the higher dose was independently associated with the primary outcome with an HR = 2,934 [IC 95% 1,147 &ndash; 7,504]; p = 0,03. Kaplan-Meier curve showed an early effect of the highest dose of sacubitril/valsartan association.</p> <p><strong>Conclusion:</strong> Patients with HFrEF under the highest dose of sacubitril/valsartan showed better clinical outcomes with a decrease of both mortality or appropriated ICD therapies related to ventricular arrhythmias.</p> 葡糖氨基葡聚糖作为体内对比增强磁共振成像的新靶点的动脉粥样硬化 04/20/2020//m.lakotalakes.com/jccm/jccm-aid1091.php & lt; h2> Abstract< / h2><p>Atherosclerosis is an important promoter of cardiovascular disease potentiating myocardial infarction or stroke. Current demand in biomedical imaging necessitates noninvasive characterization of arterial changes responsible for transition of stable plaque into rupture-prone vulnerable plaque. In vivo contrast enhanced magnetic resonance (MR) imaging (MRI) allows quantitative and functional monitoring of pathomorphological changes through signal differences induced by the contrast agent uptake in the diseased vessel wall, therefore it is the ideal modality toward this goal. However, studies have so far focused on the cellular targets of persisting inflammation, leaving extracellular matrix (ECM) far behind. In this review, we portray ECM remodeling during atherosclerotic plaque progression by summarizing the state of the-art in MRI and current imaging targets. Finally, we aim to discuss glycosaminoglycans (GAGs) and their functional interactions, which might offer potential toward development of novel imaging probes for in vivo contrast-enhanced MRI of atherosclerosis.</p> 肺静脉隔离后房颤复发,我们应该改变能源和技术吗? 04/03/2020//m.lakotalakes.com/jccm/jccm-aid1090.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Pulmonary vein isolation (PVI) is the accepted standard nowadays for atrial fibrillation (AF) ablation. The most widespread ablation techniques are cryoballoon (CB) and point-by-point radiofrequency (RF) ablation. Comparative studies between both techniques have shown their equivalence for the first ablation procedure, but no trial has explored the potential incremental benefit of crossing over the ablation technique after AF recurrence.</p> <p><strong>Objective:</strong> To explore the potential incremental benefit of a crossover ablation strategy for AF recurrences, comparatively with repeating the same ablation energy used for the first procedure.</p> <p><strong>Methods:</strong> Retrospective analysis of patients undergoing a second AF ablation procedure after documented AF recurrence. Patients were excluded if all 4 PV were isolated at the beginning of the second procedure or extra-PVI ablation was used for the second procedure. Crossover group (n = 16) included patients in which two different techniques were used for the first and second procedure (CB-RF or RF-CB). Control group (n = 23) for those with same ablation procedure (RF-RF of CB-CB). Acute procedure end-point was PVI of all four pulmonary veins. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram and a 24 h-holter. Arrhythmia-free survival at 1 year after the second ablation procedure was studied, comparing efficiency and safety of the two approaches (crossover vs. same energy). Success was defined as freedom from AF or atrial tachycardia lasting &gt; 30 s off antiarrhythmic drugs (AADs).</p> <p><strong>Results:</strong> A cohort of 39 paroxysmal and persistent AF patients was analyzed. PVI after the second procedure was 100% in all patients in both groups. There were no baseline relevant differences between the two groups. No deaths or hospitalizations occurred during follow up (data censored at 24h moths). At 1 year, arrhythmia free-survival was significantly higher in the crossover group compared to control group [93,3% vs. 47,8%; HR 0.19 (0.06-0.66); p = 0,009].</p> <p><strong>Conclusion:</strong> Crossing the ablation technique (point-by-point radiofrequency or cryoballoon PVI) after AF recurrence significantly improved arrhythmia free-survival at one year, despite no difference in acute success (PVI isolation). Randomized controlled trials with a higher amount of patients are needed to confirm the results and widespread this approach.</p> 一级预防的SCD ICD的老人 03/30/2020//m.lakotalakes.com/jccm/jccm-aid1089.php <p>Implantable cardioverter defibrillators (ICDs) are electronic devices that can prevent sudden cardiac death (SCD) caused by arrhythmic events in patients.</p> 榫眼审查 03/25/2020//m.lakotalakes.com/jccm/jccm-aid1088.php & lt; h2> Abstract< / h2><p>Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor has been consistently shown to reduce recurrent major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) compared with aspirin monotherapy but at the expense of an increased risk of significant bleeding. Among patients with stable CAD undergoing PCI with drug-eluting stents (DES), shorter duration of DAPT (3&ndash;6 months) were shown non-inferior to 12 or 24 months duration concerning MACE but reduced the rates of major bleeding? Contrariwise, prolonged DAPT durations (18&ndash;48 months) reduced the incidence of myocardial infarction and stent thrombosis, but at the cost of an increased risk of maj&ouml;r bleeding and all-cause mortality. Until more evidence becomes available, the choice of optimal DAPT regimen and duration for patients with CAD requires a tailored approach based on the patient clinical presentation, baseline risk profile and management strategy. Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. This article provides a contemporary state-of-the-art review of the current evidence on DAPT for secondary prevention of patients with CAD and its future perspectives.</p> 研究起搏器感染口袋 03/25/2020//m.lakotalakes.com/jccm/jccm-aid1087.php & lt; h2> Abstract< / h2><p>Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor has been consistently shown to reduce recurrent major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) compared with aspirin monotherapy but at the expense of an increased risk of significant bleeding. Among patients with stable CAD undergoing PCI with drug-eluting stents (DES), shorter duration of DAPT (3&ndash;6 months) were shown non-inferior to 12 or 24 months duration concerning MACE but reduced the rates of major bleeding? Contrariwise, prolonged DAPT durations (18&ndash;48 months) reduced the incidence of myocardial infarction and stent thrombosis, but at the cost of an increased risk of maj&ouml;r bleeding and all-cause mortality. Until more evidence becomes available, the choice of optimal DAPT regimen and duration for patients with CAD requires a tailored approach based on the patient clinical presentation, baseline risk profile and management strategy. Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. This article provides a contemporary state-of-the-art review of the current evidence on DAPT for secondary prevention of patients with CAD and its future perspectives.</p> 临床相关性与超声心动图诊断在平淡无奇,白色和花环综合症 03/06/2020//m.lakotalakes.com/jccm/jccm-aid1086.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>Bland, White and Garland syndrome is a coronary anomaly with high mortality without treatment. Its clinical presentation is varied which makes epidemiological documentation difficult. Echocardiography is a useful non-invasive tool for diagnosis.</p> <p><strong>Objective: </strong>To determine the echocardiographic variables that lead to the diagnosis of Bland, White and Garland syndrome and their clinical relevance.<br /> Material: Observational, prospective and cross-sectional study in 31 patients of the &ldquo;William Soler&rdquo; Pediatric Cardiocenter, from 2005 to 2018. To check the association of echocardiographic variables with the diagnosis of Bland, White and Garland syndrome, an effectiveness study was carried out that included the analysis of the incidence of echocardiographic variables that lead to the diagnosis of this entity. The clinical relevance was estimated according to the minimum importance limit. The statistical validation of the research results adopted a significance level of less than 5% (p &lt; 0.05).</p> <p><strong>Results: </strong>The variables that facilitate the echocardiographic diagnosis of Bland, White and Garland syndrome were the echocardiographic visualization of the anomalous connection and the reversed flow in the anomalous left coronary artery. These echocardiographic measures have clinical relevance according to the quantification of risk estimators (incidence) the echocardiographic visualization of the anomalous connection, RR 39.00 and the reversed flow in the anomalous coronary artery, RR 26.31. LIM&acute;s calculation value amounted to 6.31 and coincided with the risk estimators (incidence).</p> <p><strong>Conclusion: </strong>The echocardiographic visualization of the anomalous origin of the left coronary artery from the pulmonary arterial trunk and the detection of the local intracoronary reversed flow instituted as factors to be considered for the effective diagnosis of the disease. The documentation of the diagnostic aspects of the syndrome through echocardiography contains high statistical value and clinical relevance.</p> 病态的左心室肥大和流出道梗阻在糖尿病母亲的婴儿:一个案例报告 03/03/2020//m.lakotalakes.com/jccm/jccm-aid1085.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Infants of diabetic mothers (IDMs) are at increased risk of developing congenital anomalies including cardiac defects. Pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction is a rare but known cardiac comorbidity in infants of diabetic mothers. The severity of this condition in IDMs can vary from an incidental finding on echocardiography to an infant with severe symptoms of congestive heart failure and specific management of the condition varies.</p> <p><strong>Aim:</strong> The aim of this article is to report this clinical entity in a Nigerian infant born to a mother with poor glycaemic control in pregnancy and highlight management</p> <p><strong>Case report:</strong> We report a term neonate who was diagnosed as a case of pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction delivered to a mother with gestational diabetics with poor glycaemic control in pregnancy. Child was treated successfully with &beta;-adrenergic blocker and showed resolution of hypertrophy in follow-up echocardiography.</p> <p><strong>Conclusion:</strong> Infants of diabetic mothers are very high risk infants. Pathological left ventricular hypertrophy in IDM have good prognosis. Early recognition and prompt intervention is advocated.</p> 他包踱步在心力衰竭:回顾当前的文学 03/03/2020//m.lakotalakes.com/jccm/jccm-aid1084.php & lt; h2> Abstract< / h2>& lt; p>双(出)节奏彻底改变了窦性心律患者心力衰竭的管理和左束支阻滞;然而,离开ventricular-lead放置在技术上并不总是可行的。BiV,节奏也不完全正常心室激活和,因此,心室再同步是不完美的。另一方面,右心室节奏为心动过缓引起或加重心力衰竭在一些病人造成dyssynchronous心室激活。他包踱步来代替当前的方法,因为它通过本机His-Purkinje系统激活心室,导致真正的生理节奏,和,因此,是一种很有前途的网站中踱步心动过缓和传统CRT显示在这种情况下,它可以克服左束支阻滞。此外,它有可能开辟新的适应症踱步治疗心脏衰竭,如针对公关延长患者,但窄QRS持续时间。在本文中,我们探索的历史,临床证据,提出机制、程序特点,和他的角色在当前治疗包踱步的预防和治疗心脏衰竭。你们;/ p> 心电图的解释和评论 02/18/2020//m.lakotalakes.com/jccm/jccm-aid1083.php & lt; h2> Abstract< / h2>& lt; p>这是选择ecg的示范学习或考试;教授指导下伟大的老师教训啊韦伦医生。在这里,我们提供先进的例子和评论和分析。;/ p> 本地化的闭塞静脉急性心肌梗塞 02/18/2020//m.lakotalakes.com/jccm/jccm-aid1082.php & lt; h2> Abstract< / h2><p>This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.</p> 血管紧张素ⅱ1型受体和肌球蛋白轻链激酶的活化蛋白激酶c²II:迷你回顾 02/17/2020//m.lakotalakes.com/jccm/jccm-aid1081.php <h2>Summary</h2> <p>The involvement of the angiotensin II type 1 receptor in the Frank-Starling Law of the Heart, where the various activations are very limited, allows simple analysis of the kinase systems involved and thence extrapolation of the mechanism to that of angiotensin control of activation of cardiac and skeletal muscle contraction. The involvement of phosphorylation of the myosin light chain in the control of contraction is accepted but not fully understood. The involvement of troponin-I phosphorylation is also indicated but of unknown mechanism. There is no known signal for activation of myosin light chain kinase or Protein Kinase C-&beta;II other than Ca2+/calmodulin but the former is constitutively active and thus has to be under control of a regulated inhibitor, the latter kinase may also be the same. Ca2+/calmodulin is not activated in Frank-Starling, i.e. there are no diastolic or systolic [Ca2+] changes. I suggest here that the regulated inhibition is by myosin light chain phosphatase and/or &beta;-arrestin. Angiotensin activation, not involving G proteins. is by translocation of the &beta;-arrestin from the sarcoplasm to the plasma membrane thus reducing its kinase inhibition action in the sarcoplasm. This reduced inhibition has been wrongly attributed to a mythical downstream agonist property of &beta;-arrestin.</p> 性别协会的人体测量与血压和高血压肥胖年轻的中国医科大学的学生 01/31/2020//m.lakotalakes.com/jccm/jccm-aid1080.php & lt; h2> Abstract< / h2><p><strong>Purpose:</strong> There are uncertainties about whether general or central obesity is the more important determinant for blood pressure and hypertension in young Chinese. We aim to investigate the association between adiposity measures and blood pressure and hypertension in young medical students.</p> <p><strong>Methods:</strong> A total of 380 medical students were recruited from the 2012 batch in the Clinical College of Dali University. Anthropometric measures and office blood pressure were measured. Blood pressure status was defined by Chinese hypertension guidelines and ACC/AHA 2017 hypertension guidelines, respectively. We examined the associations of adiposity measures (body weight, body mass index [BMI], waist circumference, hip circumference, waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], ponderal index [PI], body adiposity index (BAI) and conicity index [CI]) with blood pressure and hypertension by sex.</p> <p><strong>Results:</strong> In 380 subjects (women 66.6%, mean age 21.5 years), the prevalence of obesity (BMI &ge; 28 kg/m2) was 2.1%, and the prevalence of hypertension was 2.6% (&ge; 140/90 mmHg) and 24.5% (&ge; 130/80 mmHg), respectively. In correlation analyses and multivariable-adjusted linear regression analyses, most adiposity measures of central obesity were significantly associated with blood pressure in men, while in women, either adiposity measures of central or general obesity were associated with blood pressure. The predictive power of adiposity measures for hypertension was generally low in men. However, adiposity measures of either general obesity or central obesity were predictive for hypertension defined by Chinese hypertension guidelines in women.</p> <p><strong>Conclusion:</strong> There are gender-specific associations of central and general obesity with blood pressure and hypertension in young Chinese medical students.</p> 闭塞的上腔静脉和失败的心外膜踱步:一种非传统的解决方案 01/13/2020//m.lakotalakes.com/jccm/jccm-aid1079.php & lt; h2> Abstract< / h2><p>Permanent pacemaker implantation is conventionally done via upper limb veins. But in 1% - 6% cases, usual sub clavicular approach is either not possible or contraindicated due to complete occlusion of superior vena cava (SVC) or bilateral subclavian vein and/or bilateral implant site infection or thin skin [1]. Alternative approaches are warranted, including leadless pacemaker or complex lead extraction techniques, before considering surgical epicardial lead placement as a last resort because it has own hazards. We report a patient with complete heart block, total SVC obstruction, and a previously implanted malfunctioning epicardial lead presenting with pacemaker end of life. In view of exhaustion of the surgical option and in a resource constrained situation for lead extraction or leadless pacemaker, transiliac endocardial pacemaker implantation was done and a repeat surgery was averted.</p> Coronary-intercostal偷综合症,一种罕见的这个联系左回旋支冠状动脉、肋间动脉:一个案例报告 01/13/2020//m.lakotalakes.com/jccm/jccm-aid1078.php & lt; h2> Abstract< / h2><p>A 60-year-old female patient presented with typical anginal pain on exertion and relieved by rest for about one month. Percutaneous coronary angiography was done and showed an abnormal left circumflex coronary artery connecting to intercostal artery. Embolization of that abnormal connection was done successfully and the patient discharged from hospital after 24 hours. This case shows a new form of coronary steal syndrome. This cause could be missed if not put under the differential diagnosis of typical anginal pain with normal coronary arteries.</p> 血液透析会话对急性炎症和心血管风险标志物的变化 01/09/2020//m.lakotalakes.com/jccm/jccm-aid1077.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Inflammation is associated with enhanced cardiovascular risk profile and increased cardiovascular mortality in end-stage kidney disease patients undergoing hemodialysis. Mechanisms of activated acute phase reaction in patients on chronic hemodialysis remain to be identified. As successful treatment of the inflammatory condition in these patients may improve long-term survival, we studied potential changes in different inflammatory biomarkers of cardiovascular risk in end-stage kidney disease patients after a mid-week hemodialysis session.</p> <p><strong>Methods:</strong> Inflammatory biomarkers of cardiovascular risk (cystatin-C, homocysteine, C-reactive protein, procalcitonin, pentraxin-3, serum amyloid-A) and atherogenic plasma lipoproteins (Lipoprotein(a), cholesterol low and high density lipoproteins) were studied in 21 end-stage kidney disease patients previously and after a mid-week hemodialysis session.</p> <p><strong>Results:</strong> We found a significant reduction in serum levels of low molecular weight molecules: cystatin-C (5.56 to 1.85 mg/L, 66.73%, p &lt; 0.001), homocysteine (22.85 to 13.25 &micro;mol/L, 42.01%, p &lt; 0.001) and procalcitonin (0.788 to 0.457 ng/mL, 42.01%, p &lt; 0.001). Large molecules as C-reactive protein (9.70 to 9.90 mg/L, 2.06%, p = 0.022) and pentraxin-3 (1.67 to 4.28 ng/mL, 156%, p &lt; 0.001) increased, but serum amyloid-A decreased (15.90 to 12.70 mg/L, 20.13%, p &lt; 0.05). There was no change in Lipoprotein (a) levels.</p> <p><strong>Conclusion:</strong> Pentraxin-3 was a more specific inflammatory vascular marker than C-reactive protein, and the best inflammatory marker associated with hemodialysis. Homocysteine, procalcitonin and the other small proteins could be released and removed during hemodialysis session. Further studies are needed to understand the behavior and significance of these markers after successive hemodialysis.</p> 拟议的机制来解释增加颅内压:脑动脉楔压力的概念 01/08/2020//m.lakotalakes.com/jccm/jccm-aid1076.php & lt; h2> Abstract< / h2><p>We hypothesize that, with elevated cerebral spinal fluid (CSF) pressure, cerebral micro-vascular obstruction and congestion may occur despite (subdural) large-vein pressures being normal. Smaller veins emptying into these larger, dura-enveloped veins are not immune to the compressive effects of elevated CSF pressure and a &ldquo;Starling Resistor&rdquo; mechanism might explain why elevated CSF pressures collapse these smaller veins. This small cerebral venous starling resistor compression mechanism may be the final common pathway for many patients suffering from increased CSF pressures and might also be an important contributor to impaired focal venous drainage presenting as a headache with normal venous sinus pressures.</p> 评价冠状动脉旁路移植的影响右心室功能使用散斑跟踪超声心动图 12/30/2019//m.lakotalakes.com/jccm/jccm-aid1075.php & lt; h2> Abstract< / h2><p><strong>Purpose:</strong> This was a prospective study conducted at Benha University hospital and National Heart Institute on one hundred patients undwent coronary artery bypass grafting (CABG) to evaluate the effect of CABG on the right ventricular (RV) function using speckle tracking echocardiography (STE).</p> <p><strong>Methods:</strong> All cases were subjected to detailed medical history, full physical examination, 12 leads electrocardiogram (ECG), routine laboratory tests including (complete blood picture, liver functions, renal functions and lipid profile) and echocardiography either conventional echocardiography or STE, all parameters obtained before and within 2 weeks after surgery.</p> <p><strong>Results:</strong> By conventional echocardiography there was statistically significant decrease in peak right ventricle systolic velociy (RVS&acute;) from (12.76 &plusmn; 1.72) to (7.33 &plusmn; 1.71) and tricuspid annular plane systolic excursion (TAPSE) from (22.8 &plusmn; 3.99) to (13.77 &plusmn; 4.63) among the studied patients after CABG. While there was significant increase in right ventricle fractional area change (RVFAC) from (44.69 &plusmn; 3.25) to (49.01 &plusmn; 3.36). On the other hand, there was non-significant change in right ventricle end diastolic diameter (RVEDD) at mid-cavity from (26.37 &plusmn; 2.72) to (26.53 &plusmn; 2.72) and basal segment from (36.05 &plusmn; 2.98) to (36.29 &plusmn; 3.04), right ventricle stroke volume (RVSV) from (65.44 &plusmn; 7.02) to (65.85 &plusmn; 6.86) and right myocardial performance index (RMPI) from (0.491 &plusmn; 0.088) to (0.498 &plusmn; 0.086).</p> <p>By STE There was statistically significant decrease in right ventricle global longitudinal strain (RVGLS) from (-20.63 to -14.1) after CABG. There was statistically significant decrease in right ventricle free wall longitudinal strain [apical decreased from (-23.73 to -13.7), mid-cavity decreased from (-25.76 to -11.53), basal decreased from (-20.39 to -10.13) and lateral wall declined from (-23.01 to -9.13)]. There was statistically significant decrease in interventricular septum longitudinal strain [apical decreased from (-19.77 to -10.06), mid-cavity decreased from (-17.81 to -10.87) and basal decreased from (-15.89 to -11.13)]. There was statistically significant increase in RV circumferential strain of lateral free wall from (-12.04 to -16.21), while there was non-significant change in RV circumferential strain of septum from (-19.77 &plusmn; 4.86) to (-20.37 &plusmn; 5.14).</p> <p><strong>Conclusion:</strong> Distorted RV geometry after CABG can lead to altered deformation parameters, in other words longitudinal functional parameters may underestimate RV function and the decrease in RVGLS was compensated by increase in circumferential strain of lateral free wall of RV without change in RVSV or RMPI. Therefor changes in deformation parameters should always be interpreted in relation to change in geometry.</p> 主动脉夹层引起2心肌梗死 12/16/2019//m.lakotalakes.com/jccm/jccm-aid1074.php & lt; h2> Abstract< / h2><p>A 56-year-old man was admitted to our hospital because of sudden onset of right-sided thoracic pain. The ECG showed inferior ST segment elevations. He has been treated with aspirin, clopidogrel, unfractionated heparin and tenecteplase, and his symptoms resolved after 30 minutes. About half an hour later, the patient developed again left-sided thoracic pain and the signs of an anterior myocardial ST-segment elevation infarction. 90 minutes after receiving the initial medications, the performed coronary angiography revealed a long dissection of a large ramus circumflexus. Furthermore, the left anterior descending coronary artery was occluded at about the mid-level. The left ventriculography showed a reduced ventricular function and a Stanford type A aortic dissection. Immediate patient transfer for emergency surgical intervention was arranged. However, ventricular fibrillation occurred during transport and he required endotracheal intubation and prolonged cardiopulmonary resuscitation. Unfortunately, he died during further transport.</p> <p>In a patient with massive thoracic pain of initially uncommon localization in combination with fluctuation of ST-segment elevations, aortic dissection should be seriously taken into the differential diagnosis as well as into therapeutic management decisions (in particular antiplatelet and thrombolytic therapy).</p> 长期影响肺移植的冠状动脉疾病 11/26/2019//m.lakotalakes.com/jccm/jccm-aid1073.php & lt; p> & lt; strong>背景:& lt; / strong>Adoption of the Lung Allocation Score (LAS) has led to increased listing of older patients and those with idiopathic pulmonary fibrosis (IPF) for lung transplantation (LTX). Older patients and those with IPF have higher prevalence of coronary artery disease (CAD), a relative contraindication for LTX. The impact of the LAS on CAD prevalence and cardiovascular morbidity in LTX recipients is unknown.</p> <p><strong>Methods:</strong> Retrospective review of single institution database from January 2000 to December 2010. Patients with and without CAD were compared by age, gender, LAS, single vs double LTX, and transplant indication. Survival was calculated by Kaplan-Meier method, and statistical significance determined by log-rank method. Survival analysis was performed on all patients and by 3:1 propensity matching. Differences in CAD, gender, and indication were determined by Chi-squared test. Differences in LAS and age were calculated with a two-tailed&nbsp; <em>t</em> - test.</p> <p><strong>Results:</strong> In the pre-LAS era, 6.2% (9/145) recipients had CAD vs. 9.2% (17/184) in the post-LAS era (<em>p</em> = 0.411). Among all patients, recipients with CAD had a worse long term survival as estimated by Kaplan-Meier method (<em>p</em> = 0.001), although there was no statistically significant difference after propensity matching ((<em>p</em> = 0.14). Although more recipients in the post-LAS era had a diagnosis of IPF [15/145 vs. 71/184 patients, (<em>p</em> &lt; 0.001)], there was no difference in the prevalence of CAD in the IPF cohort compared to others. There were no differences in cardiovascular deaths among recipients with CAD, with IPF, or in the post-LAS era. Patients with a pre-transplant diagnosis of CAD had an descreased risk of new onset postoperative atrial fibrillation (AF) (<em>p</em> = 0.007; HR:0.133; CI:0.030-0.583).</p> <p><strong>Conclusion:</strong> Adoption of the LAS was not associated with a significant change in proportion of recipients with CAD who underwent LTX at our institution, despite an increase in recipients with IPF. Recipients with CAD had a higher risk of developing new postoperative AF and worse survival than patients without CAD. Differences in survival, however, could not be attributed directly to CAD based on propensity matched analysis.</p> 调整抗凝治疗的中风患者由于多角度发现 11/26/2019//m.lakotalakes.com/jccm/jccm-aid1072.php & lt; p> & lt; strong>目标:& lt; / strong>Cardioembolic etiology is a frequent source of ischemic stroke. Echocardiogram is the mainstay of cardioembolic source detection with regard to plan secondary stroke management, however it remains unclear how often clinically actionable findings are provided hereby. In addition, it is uncertain whether echocardiography should be performed transthoracic or transesophageal (TEE). In a monocenter study, we evaluated the frequency of pathological findings from TEE evaluation in patients with ischemic stroke with suspected cardioembolic and cryptogenic source and determined whether there was an associated adjustment in the prescribed administration of antithrombotic therapy.</p> <p><strong>Materials and Methods:</strong> Over a 21-month period (2012-2013), we enrolled 143 patients in a prospective monocenter study (mean age &plusmn; standard deviation, 70 &plusmn; 12 years; females, 44.1%) who were admitted to the Department of Neurology at the University of L&uuml;beck due to ischemic stroke and who underwent TEE due to supposed cardiac embolism. We assessed the presence of atrial fibrillation; days from admission to TEE; and TEE findings, including atrial septal aneurysm, thrombogenic aortic arch, valve failure, presence of left atrial thrombus, and patent foramen ovale. Demografic information and medical history were drawn from patient records and the hospital information system.</p> <p><strong>Results:</strong> On average, TEE was performed 4 days after admission to the hospital. Left atrial thrombus was detected in 3 patients (2.1%), patent foramen ovale (PFO) in 27 (18.9%), atrial septum aneurysm in 17 (11.9%), and thrombogenic aortic arch in 29 (20.3%). Findings from TEE were commonly associated with therapeutic adjustment; antiplatelet therapy increased from 30.1% to 80.4%, oral anticoagulation therapy increased from 2.8% to 27.3%.</p> <p><strong>Conclusion:</strong> Findings from TEE for the evaluation of ischemic stroke lead to frequent adjustment of prior antithrombotic therapy, antiplatelet as well as anticoagulation.</p> 解决完全房室传导阻滞和左心室的严重功能障碍患者Wegenera€™s granulomatis环磷酰胺和皮质类固醇治疗 11/25/2019//m.lakotalakes.com/jccm/jccm-aid1071.php & lt; h2> Introduction< / h2><p>Wegener&rsquo;s granulomatosis is a systemic granulomatous focus on small to medium sized vessels. It typically affects sinuses, lungs and kidneys due to necrotizing granulomatous vasculitis. Less commonly, cardiac involvement is reported up to 8%-44% of cases [1-3]. It often rises to supraventricular arrhythmia, left ventricular systolic dysfunction, pericarditis, myocarditis, and valvulitis [4,5].</p> 肾素-血管紧张素系统:Alamandine特发性肺纤维化患者减少 11/20/2019//m.lakotalakes.com/jccm/jccm-aid1070.php & lt; h2> Abstract< / h2><p>Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive disease without treatment that leads to death. Therefore, to control its progression to pulmonary hypertension is still a challenge. Moreover, there is no study that has investigated the Renin-Angiotensin System in patients with IPF.</p> <p><strong>Objective: </strong>Verify the plasma concentrations of Angiotensin I, Angiotensin II (AngII), Angiotensin-(1-7) [Ang- (1-7)] and Alamandine in patients with IPF.</p> <p><strong>Methods:</strong> Ten IPF patients, with or without PH, were included, and ten controls matched by sex and age. Quantitative plasma peptide concentrations (PPC) were expressed as mean and standard deviation or median and interquartile range. The Student Newman-Keuls t test was used for parametric data, Mann-Whitney for nonparametric data and, to compare proportions, the Fisher exact test was performed. The associations between clinical variables and the PPC were evaluated by Pearson or Spearman correlation coefficients. A <em>p</em> &le; 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The Alamandine plasma concentration was significantly (365%) lower in the IPF group and positively associated (<em>r</em> = 0.876) with pulmonary artery pressure (PAP). In addition, only in control group, the forced expiratory volume (FEV1%) was positively associated (<em>p</em> = 0.758) with Ang-(1-7).</p> <p><strong>Conclusion:</strong> This study showed, for the first time, that there is a decrease in Alamandine participation in patients with IPF. The ACE-AngII-AT1 axis may be more active in this disease. In addition, our results suggest that Alamandine might be compensating the increase in PAP, as well as the Ang-(1-7) is improving the forced expiratory volume.</p> 只有低强度的有氧运动可以提高呼吸道合规肺高血压大鼠 11/20/2019//m.lakotalakes.com/jccm/jccm-aid1069.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>目的:& lt; / strong>调查在肺动脉高压(PH)的动物模型,野百合碱是否降低运动强度,降低可能引起呼吸困难的症状,可以防止增加右心室压力和减少呼吸合规。你们;/ p>& lt; p> & lt; strong>设置:& lt; / strong>一个研究实验室。动物:21 Wistar鼠被随机分配到组:控制(有限公司;生理盐水);PH-sedentary;PH-low和PH-moderate强度的运动训练(ET)。; / p>& lt; p>干预措施:他们接到一个盐水或野百合碱皮下注射(50毫克/公斤)。 The exercise program was performed during 3-weeks.</p> <p><strong>Main Outcome Measures:</strong> Rats were evaluated by their morphometric and hemodynamic changes and by the respiratory mechanic responses induced by the exercise protocols.</p> <p><strong>Results:</strong> Both protocols of ET significantly (<em>p</em> &lt; 0.05) attenuated the increase in the right ventricular systolic pressure. However, the lower intensity was more effective to prevent the impairment in the respiratory and quasi-static compliance.</p> <p><strong>Conclusion:</strong> Collectively, our results showed for the first time the benefits of ET to the respiratory system mechanics. We also demonstrated that intensity is crucial in PH, probably due to the difficulty to match VO2 capacity and O2 demand during exercise. The improvement in quasi-static compliance not only might improve the ability to breathe, and capture oxygen, but also welfare.</p> 左心室射血分数和对比诱导急性肾损伤的病人接受心导管检查:回顾性的图表总结的结果 11/15/2019//m.lakotalakes.com/jccm/jccm-aid1066.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Contrast-induced acute kidney injury (CI-AKI) is an important cause of increasing the hospital stay and in-hospital mortality. By increasing intra-renal vasoconstriction, left ventricular ejection fraction (LVEF) can increase the risk of CI-AKI. We sought to investigate whether LVEF can impact the incidence of CI-AKI after cardiac catheterization and whether it can be used to predict CI-AKI.<br /> <strong>Methods:</strong> Patients underwent cardiac catheterization from December 2017 to February 2018 at Jersey Shore University Medical Center were enrolled in the study. Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of &ge; 0.5 mg/dL or an increase of &ge; 25% from the pre-procedure value within 72 hours post-procedure. The maximum allowable contrast dose was calculated using the following formula: (5* (weight (kg)/creatinine level (mg/dL)). A multivariable logistic regression analyses, controlling for potential confounders, were used to test associations between LVEF and CI-AKI.<br /> <strong>Results:</strong> 9.6% had post catheterization CI-AKI. A total of 18 out of 44 (44%) of patients who had CI-AKI also had ongoing congestive heart failure. No statistically significant association found neither with maximum allowable contrast (p = 0.009) nor ejection fraction (p = 0.099) with the development of CI-AKI.<br /> <strong>Conclusion:</strong> In spite of the fact that no statistically significant relationship found between the percentage maximum contrast dose and the ejection fraction with the post-procedure CI-AKI, we heighten the essential of employing Maximum Allowable Contrast Dose (MACD) and ejection fraction in patients undergoing PCI to be used as a clinical guide to predict CI-AKI.</p> 咳血为起搏器植入锁骨下静脉穿刺后:一个案例报告 11/15/2019//m.lakotalakes.com/jccm/jccm-aid1065.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only.<br /> <strong>Case Summary:</strong> A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days.<br /> <strong>Discussion: </strong>Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.</p> 脉冲同步收缩(已经) 11/15/2019//m.lakotalakes.com/jccm/jccm-aid1067.php <h2>Editorial</h2> <p>A key platform underpinning the traditional understanding of the cardiovascular system, with respect to the behavior of large arterial vessels, is Otto Frank&rsquo;s Windkessel Hypothesis [1]. This hypothesis posits simply that the smooth muscle walls of large arteries do not undergo rhythmic contractions in synchrony with the heartbeat but, rather, behave as passive elastic tubes undergoing distension from pulsatile pressure waves. The Windkessel Hypothesis is elegant, well described for over a century, ingrained in the understanding of cardiovascular medicine and physiology, and simply wrong.</p> 系统回顾肥厚性心肌病的心脏性猝死患者心肌纤维化:CMR LGE研究 11/04/2019//m.lakotalakes.com/jccm/jccm-aid1064.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>肥厚性心肌病(HCM)患者对恶性倾向VT / VF因此,心脏性猝死(SCD)。在单中心研究,后期钆增强(LGE)定义VT / VF纤维化有关。然而,尽管无数的调查,SCD尚未完全归因于教育法。解释这些被认为是相关的统计能力不足。你们,br /比;& lt; strong>方法:& lt; / strong>我们执行电子搜索MEDLINE, PubMed:发布的原始数据和CMR抽象或2001年1月至2011年3月。关键搜索词:HCM, LV纤维化SCD和教育法。研究筛选资格根据入选标准:推荐CMR考试与HCM教育法; and follow-up for incidence of VT/VF and SCD. Categorical variables were evaluated between patient groups via Chi-square test.<br /> <strong>Results:</strong> A total of 64 studies were initially identified. Of these, 4 (6.3%) were identified and included (n = 1063 patients). Three prospective and one retrospective study were included. LGE was detected in 59.6% of patients. As expected, the presence of myocardial fibrosis was associated with VT/VF (x2 = 6.5, <em>p</em> &lt; 0.05; OR 9.0, (95% CI 1.2 to 68.7). Moreover, myocardial fibrosis strongly predicted SCD (x2 = 6.6, <em>p</em> &lt; 0.05; OR 3.3 (95% CI 1.2 to 9.7).<br /> <strong>Conclusion:</strong> Despite single center CMR studies, LGE has consistently predicted VT/VF while prediction of SCD has remained paradoxically unlinked. Although the lack of studies meeting our criteria limited our ability to perform a comprehensive meta-analysis, we have been able to demonstrate for the first time that LGE-defined fibrosis is a predictor of SCD in patients with HCM.</p> 做β肾上腺素能受体阻断剂提供相同程度的临床令人信服的发病率和死亡率在慢性心力衰竭患者好处?一个文献综述 11/04/2019//m.lakotalakes.com/jccm/jccm-aid1063.php & lt; h2> Abstract< / h2><p>Chronic heart failure has been extensively characterized as a disorder arising from a complex interaction between impaired ventricular performance and neurohormonal activation. Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of patients with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality benefits of these agents these studies, however did not yield the same results in terms of morbidity and mortality benefits. Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality benefits the current list of approved medicines of the National Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these lifesaving therapeutic agents. The objective of this review was to collate the relevant scientific evidence that will convince the authorities at the National Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines.<br /> A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the benefits of beta adrenoceptor blocking agents in patients with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines.<br /> The search engine yielded several studies that met the predefined inclusion criteria. However, only the Cardiac Insufficiency BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized Intervention Trial (MERIF-HF) because of the clinical relevance of their findings Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of patients with chronic heart failure. However, their efficacy and optimal dose in reducing mortality have not been scientifically established not all beta adrenoceptor blocking agents scientifically studied provide the same degree of clinically meaningful and convincing morbidity and mortality benefits in patients with chronic heart failure.</p> 关键的先天性心脏病的诊断在冰岛2000 - 2014 11/04/2019//m.lakotalakes.com/jccm/jccm-aid1062.php & lt; h2> Abstract< / h2><p>Critical congenital heart defects (CCHDs) are preferably diagnosed prenatally or soon after birth. Late diagnosis has been related to poorer prognosis. The aim of this study is to assess when CCHDs are diagnosed in Iceland and whether late diagnosis is a problem. All live born children in Iceland and foetuses diagnosed with CCHDs during the years 2000-2014 were included. CCHD was defined as a defect requiring intervention or causing death in the first year of life, or leading to abortion.</p> <p>The total number of pre- and postnatal diagnosis of CCHDs was 188. Prenatal diagnosis was made in 69 of 188 (36.7%). Of 69 diagnosed prenatally 33 were terminated due to CCHD. Of the 155 live born children with CCHD, 36 (23.2%) had a prenatal diagnosis and 100 (64.5%) were diagnosed shortly after birth, before discharge from birth facility. 19 children (12.3%) were diagnosed late, that is after discharge from birth facility. Coarctation of the aorta was the most common CCHD diagnosed late (6/19).</p> <p>Prenatal screening and newborn examination give good results in diagnosis of CCHDs in Iceland. Late diagnosis are relatively few, but both the number of prenatally diagnosed CCHDs and CCHDs diagnosed shortly after birth can be further improved.</p> 评价CHA2DS2-VASc分数预测价值的无复流现象的st段抬高心肌梗死患者接受经皮冠状动脉介入 10/28/2019//m.lakotalakes.com/jccm/jccm-aid1061.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>目的:& lt; / strong>本研究的目的是评估的临床预测价值CHA2DS2-VASc得分无复流现象在st段抬高心肌梗死患者肝素)主要应用于经皮冠状动脉介入(PCI)。; / p>& lt; p> & lt; strong>主题和方法:& lt; / strong>三百例STEMI患者接受PCI术后。他们分为:集团(1)包括27个患者无复流和组(2)包括273例没有无复流(控制)。CHA2DS2-VASc风险评分计算为每个病人。;/ p>& lt; p> & lt; strong>结果:& lt; / strong>本研究发现统计上的显著差异(p, lt;0.05)的多变量分析CHA2DS2-VASc分数和无复流现象之间的联系。 The predictive power of individual components in CHA2DS2-VASc score for no-reflow was statistically significant difference (<em>p</em> &lt; 0.05). So, significantly higher CHA2DS2-VASc score is connected with higher risk of no-reflow and in-hospital mortality rate.</p> <p><strong>Conclusion:</strong> Significantly higher CHA2DS2-VASc score is associated with higher risk of no- reflow phenomenon and in-hospital mortality rates in patients with STEMI who underwent primary PCI.</p> 起搏器植入术对TAVR住院治疗后12个月的资源利用率 10/21/2019//m.lakotalakes.com/jccm/jccm-aid1060.php & lt; h2> Abstract< / h2><p><strong>Purpose:</strong> This study reports resource utilization during a Medicare Beneficiary&rsquo;s (MBs) Transcatheter Aortic Valve Replacement (TAVR) index hospitalization and all subsequent encounters for 12 months and compares data between MBs who did or did not receive a pacemaker implantation (PPM) during their index hospitalization.</p> <p><strong>Method:</strong> This retrospective study examined Medicare hospital claims from January 1, 2014 through June 30, 2015. 15,533 MBs who survived for 365 days were studied. Information from all encounters during the study period was combined to compare hospital resource utilization and outcomes.</p> <p><strong>Results:</strong> 14.8% of MBs had a PPM during the index hospitalization. 46.0% of MBs had at least one readmission to a hospital during the 365-day follow-up period. 54.6% of MB&rsquo;s first hospital readmission occurred within 90 days of their TAVR discharge date. Average total Medicare reimbursement for all hospitalizations was $60,638 &plusmn; $28,974 associated with average total hospital length of stay of 11.2 &plusmn; 11.7 days. After adjusting for demographics and 47 comorbid conditions, MBs receiving a PPM during the index TAVR had significantly higher estimated Medicare reimbursement ($5,132) and longer total length of stay (1.8 days) for the entire study period than MBs not receiving a PPM.</p> <p><strong>Conclusion:</strong> Total Medicare reimbursement and hospital LOS were significantly higher among MBs that had a PPM implantation during their index admission; however, there were no significant differences in readmission rates, readmission length of stay, or days to first readmission during the follow-up period between the two study cohorts.</p> 贫血的效果在心力衰竭患者血清hepcidin水平 10/17/2019//m.lakotalakes.com/jccm/jccm-aid1059.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration.</p> <p><strong>Methods:</strong> 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF &le; 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias.</p> <p><strong>Results:</strong> There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (<em>p</em> &lt; 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (<em>p</em> &lt; 0,05).</p> <p><strong>Conclusion:</strong> We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.</p> 斑块形态在糖尿病和非糖尿病患者评估摘要多层ct冠状动脉造影 10/04/2019//m.lakotalakes.com/jccm/jccm-aid1057.php & lt; h2> Abstract< / h2><p><strong>Background and Objectives:</strong> Multi-slice computed tomography (MSCT) provides high accuracy for noninvasive assessment of coronary artery disease (CAD). The introduction of the latest computed tomography technology allows comprehensive evaluation of various aspects of CAD, including the coronary calcium score, coronary artery stenosis, bypass patency, and myocardial function. This study aimed to assess the effect of DM on coronary arteries evaluated by MSCT-CA Comparing Plaque Morphology in Diabetic patients with Non-Diabetic Whoever Controlled or not assessed by HbA1c.</p> <p><strong>Methods:</strong> In this study we randomly assigned 150 adult patients were diagnosed with suspected coronary artery disease underwent MSCT-CA for evaluation their coronaries regarding luminal stenosis, Plaque analysis, Remodeling index, SSS, SIS and Ca score.</p> <p><strong>Results:</strong> There was statistically significant difference between diabetics &amp; non-diabetic groups in LM lesions with (<em>P</em> = 0.029). also, the results of multivariate logistic regression analysis after adjustment for age and sex, diabetics were shown a trend toward more mixed plaque with statistically significant {(OR): 3.422, 95% CI 1.66-7.023, <em>P</em> = 0.001}; whereas, after adjustment for age, sex, history of hypertension, smoking, and hypercholesterolemia, patients with diabetes also shown a trend toward more mixed plaque with statistically significant (OR: 3.456, 95% CI 1.668-7.160, <em>P</em> = 0.001). It means significant differences in coronary atherosclerotic plaque burden and composition between diabetic and non-diabetic patients, with a higher proportion of mixed plaques, a more vulnerable form of atherosclerotic plaque in diabetics (<em>P </em>&lt; 0.001) otherwise No significant difference.</p> <p><strong>Conclusion:</strong> MSCT angiography may be useful for the identification of CAD in diabetic and non-diabetic patients. There were statistically significant differences in coronary atherosclerotic plaque burden and composition, with a higher proportion of mixed plaques, between diabetic and nondiabetic patients. Furthermore, MSCT may give accurate information about plaque characteristics according to different coronary risk factors, thereby identifying high risk features warranting a more intensive anti-atherosclerotic treatment.</p> Scintigraphic心肌病淀粉样蛋白的非侵入性诊断 10/04/2019//m.lakotalakes.com/jccm/jccm-aid1058.php & lt; h2> Introduction< / h2>& lt; p>淀粉样变包括异质群体的疾病,表现为细胞外不溶性淀粉样蛋白聚集异常沉积,由于失败的蛋白质质量控制。心脏淀粉样变性是一种障碍,蛋白质折叠和存款作为淀粉样我¬成bril ini¬ltrate心肌细胞外空间[1]。;/ p>& lt; p>转体基因(ATTR)和轻链(AL)是最常见的类型的心脏淀粉样变。转体基因是一种蛋白质主要由肝脏合成,这可能是遗传或从野生型(ATTRwt)或获得的突变体(ATTRm)淀粉样蛋白[2]。ATTR淀粉样变心肌病是一种常见的表现特别可怜的寿命为2到6年后诊断[3]。虽然被认为是罕见的,这种严重的疾病的患病率可能低估了因为可以非特异性症状,诊断主要依靠检测淀粉样蛋白在组织切片。;/ p> 小学儿童先天性心脏疾病的患病率在尼日利亚,尼日尔三角洲地区的西非 09/26/2019//m.lakotalakes.com/jccm/jccm-aid1056.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>Congenital heart diseases (CHD) are leading causes of childhood morbidity and mortality especially in developing countries. Community-based studies are important in ascertaining the burden of the disease.</p> <p><strong>Objectives: </strong>The study was set out to determine the prevalence and types of CHD among primary school children in Port Harcourt Local Government Area (PHALGA) of Rivers State, Niger Delta, Nigeria.</p> <p><strong>Methods:</strong> A total of 1,712 primary school pupils were selected by multistage sampling from twelve schools in PHALGA. A questionnaire was used to obtain information from pupil&rsquo;s parents on their child&rsquo;s biodata and symptoms suggestive of heart disease. General physical and cardiovascular system examinations were carried out on each selected pupil, following which those with symptoms and/or signs suggestive of heart disease had echocardiographic confirmation of their cardiac status.</p> <p><strong>Results:</strong> The 1,712 subjects were aged 5-14 (mean 8.48 &plusmn; 2.30) years. 874 (51.1%) were females while males were 838 (48.9%). The study revealed that 31 pupils had congenital heart diseases confirmed by echocardiography, giving a prevalence of 18.1 per 1,000 pupils. The commonest cardiac defects seen were acyanotic CHD in 30 (96.8%) pupils while cyanotic CHD was seen in only one (3.2%) pupil. Among the acyanotic CHD, atrial septal defects (83.9%) followed by ventricular septal defects (9.7%) were the commonest. CHD occurred with higher frequency among females (64.5%) and among the younger age group of 5-9 years (61.3%) though these were not statistically significant (p &gt; 0.005).</p> <p><strong>Conclusion:</strong> Cardiac examination as part of compulsory health screening at primary school entry will help detect children with CHD, reduce delay in diagnosis for intervention, avert debilitating morbidity and assure a better quality of life.&nbsp;</p> 小说paclitaxel-coated通过单一逆行球囊成形术腘获得具有挑战性的股浅动脉和髂动脉病变? 09/24/2019//m.lakotalakes.com/jccm/jccm-aid1055.php <h2>Summary</h2> <p><strong>Objectives: </strong>We report our results regarding the use of BioPath&trade; paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access.</p> <p><strong>Methods: </strong>We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath&trade; 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency.</p> <p><strong>Results: </strong>Seventy-two patients (68.6%) had total SFA occlusion and 41 patients (39%) had concomitant external iliac artery involvement, out of whom 31 (29.5%) had total occlusion. Procedural success 90.5% for superficial femoral artery and 85.3% for external iliac artery. One-year patency rates in SFA and EIA were 84.8% and 80.4%, respectively</p> <p><strong>Conclusion: </strong>Single retrograde popliteal access and drug-coated balloon angioplasty may offer a useful alternative to known modalities in treatment of challenging superficial femoral artery and concomitant iliac artery lesions.</p> 心律失常的心脏——计算机分析 09/20/2019//m.lakotalakes.com/jccm/jccm-aid1053.php & lt; h2> Abstract< / h2><p>The problem of synchronization of oscillations of various physical nature is discussed. From the standpoint of the theory of synchronism, a model of the heart is considered as a system of four connected between self-oscillating links: two atria and two ventricles. The synchronous and asynchronous operating modes are considered at sinusoidal and relaxation oscillations. A computer program has been compiled that simulates the fluctuations in the heart using four differential equations. Four examples of calculation according to the program are given for asynchronous and synchronous operation modes. The possibility of evaluating the ablation procedure from the perspective of a computer model is discussed.</p> 冠状microvacsular疾病的小鼠模型使用一个光化学的方法 09/18/2019//m.lakotalakes.com/jccm/jccm-aid1052.php & lt; h2> Abstract< / h2><p>The development of reproducible rodent models of coronary microvascular disease (MVD) is essential for the early detection, treatment, and mechanism study of the pathophysiology. We hypothesized that endothelial dysfunction and subsequent microthrombi in the coronary arterioles, two early events in clinical coronary MVD, could be reproduced by photochemical reaction (PCR) technology in mice hearts. After rose bengal (one of photosensitizers) was administrated systemically, a green light was locally used to activate the photosensitizer, inducing over-production of oxidative stress in the heart. Following PCR, animals demonstrated reproducible endothelial injury, occlusion in arterioles, focal ischemia, and infarct-let with preserved cardiac function. Our technique has proven to be a reliable and reproducible means of creating coronary MVD in mice. We believe that this is an ideal model for developing a novel molecular tracer for earlier detection of coronary MVD, for testing new anti-fibrinolytic drugs, and for investigating the complex pathophysiology of coronary MVD. The protocol for establishing this model takes about thirty to forty minutes.</p> 冠状动脉起源异常:关于两种情况 09/13/2019//m.lakotalakes.com/jccm/jccm-aid1051.php & lt; h2> Introduction< / h2><p>Anomalies of coronary artery origin are congenital malformations characterized by the abnormal birth of a coronary artery from the controlateral coronary aortic sinus (birth of the left coronary artery from the right sinus or birth of the right coronary artery from the left sinus).The artery concerned has an abnormal initial path between the aorta and the pulmonary artery; this segment is most often intramural, in the aortic wall. They are rare with a prevalence (0.1% to 0.3% of the population).</p> 多久是Klippel-Feil综合症与先天性心脏病的五位和文献之回顾 09/03/2019//m.lakotalakes.com/jccm/jccm-aid1050.php <强>简介:< /强> Klippel-Feil综合症(kf),是一种骨疾病的特点是异常加入(融合)的两个或两个以上的颈部脊髓骨(颈椎),从出生就是礼物。三大特性结果从这个异常:短脖子,颈部的活动范围有限,和低的发际线。在某些个人、kf可以与各种额外的症状和身体异常造成的状况恶化和并发症的孩子。<强>的目的表示:< /强>在这里,我们报告五个孩子从科索沃kf与不同的心脏异常有关,临床表现,诊断,管理和资源有限的设置选择条件的结果。<强>方法:< /强>我们回顾性分析了医学报告的五个孩子,在不同的年龄与先天性疾病诊断和临床和实验室Klippel-Feil综合症的迹象。<强>结论:< /强>基于我们的情况下,在一个小国家所有确诊科索沃,我们可以得出结论,kf不是这样一个罕见的疾病。此外,这种综合症是很少与不同的先天性心脏病。四例心脏手术表示,成功完成国外科索沃在科索沃缺乏这样的服务。 小说paclitaxel-coated通过单一逆行球囊成形术腘获得具有挑战性的股浅动脉和髂动脉病变? 09/24/2019//m.lakotalakes.com/jccm/jccm-aid1055.php <h2>Summary</h2> <p><strong>Objectives:</strong> We report our results regarding the use of BioPath&trade; paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access.</p> <p><strong>Methods</strong>: We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath&trade; 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency.</p> 小说心脏标志物的诊断、风险stratifi阳离子,预测心力衰竭患者 08/22/2019//m.lakotalakes.com/jccm/jccm-aid1049.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>目前的诊断和指导方针管理心力衰竭(HF)依靠临床表现和利钠肽值,但证据表明,最近发现心脏生物标记物可能有助于心衰的早期检测和改善风险分层。本研究的目的是评估多个生物标志物的诊断和预后效用心力衰竭患者左心室收缩功能不全(LVSD)。; / p>& lt; p> & lt; strong>方法:& lt; / strong>高灵敏度心肌肌钙蛋白I (cTnI),氨基端pro b型利钠肽(中位数水平以上病人)、白细胞介素- 6 (il - 6)、endothelin-1 (ET-1) pro-matrix metalloproteinase-9 (pMMP-9)和肿瘤坏死因子-α(TNF及;α)测量使用单分子计算技术在200年患者不同阶段的高频。等离子体生物标志物的检测与横断面协会所有高频阶段,和advanced-therapy transplant-free生存评估使用多变量分析和Cox回归分析,分别为。;/ p>& lt; p> & lt; strong>结果:& lt; / strong>NTproBNP pMMP-9, il - 6在早期升高,高频的无症状的阶段,并与心力衰竭严重程度增加。体内循环的联合il - 6水平更高,NTproBNP cTnI预测明显恶化生存在1500天的随访。 Cox regression analysis adjusted for ACC/AHA HF stages demonstrated that a higher concentration of IL-6 and cTnI conferred greater risks in terms of time to death, implantation of left ventricular assist device (LVAD), or heart transplantation.</p> <p><strong>Conclusion:</strong> Biomarkers of inflammation, LV remodeling, and myocardial injury were elevated in HF and increased with HF severity. Patients had a significantly higher risk of serious cardiac events if multiple biomarkers were elevated. These findings support measuring NTproBNP, cTnI and IL-6 among patients with HF and LVSD for diagnostic and prognostic purposes.</p> 晚发现创伤性心脏损伤的病例报告 08/19/2019//m.lakotalakes.com/jccm/jccm-aid1048.php & lt; h2> Abstract< / h2><p>Blunt chest trauma leads to a wide range of lesions, relatively minor parietal injuries to potentially fatal cardiac lesions, making diagnosis and management difficult. The diagnosis is currently facilitated by imaging, however, these lesions may go unnoticed and be discovered late through complications.</p> <p>We report the case of a neglected heart wound revealed by a heart failure. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion and the absence of cardiac symptoms, and a long delay from injury to appropriate treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate the anterior mitral leaflet.</p> 心脏手术的时机和其他干预与先天性心脏病儿童:一个评论文章 08/09/2019//m.lakotalakes.com/jccm/jccm-aid1047.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>早期诊断和改善设备是必要的,以确定最佳的手术时机和其他干预儿童先天性心脏疾病在尼日利亚。这是因为后期表现,诊断和后期延迟手术会导致死亡率和影响这些孩子。你们之间的生活质量;/ p>& lt; p> & lt; strong>目标:& lt; / strong>这篇评论文章旨在列举心脏手术的时机和其他干预措施和寻求如果有任何因素与心脏手术的时机灵活;/ p>& lt; p> & lt; strong>方法:& lt; / strong>搜索PubMed数据库,世界卫生组织库,谷歌学术搜索、访问数据库,并参考列表所选文章儿童心脏手术的时机。Cochrane系统评价也是搜索的数据库。我们注意到一些来自非洲设置的数据。 Key words such as timing of cardiac surgery; children, congenital heart defect were used.</p> <p><strong>Conclusion:</strong> Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality.</p> 经前焦虑障碍患者P波色散 07/31/2019//m.lakotalakes.com/jccm/jccm-aid1046.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>Growing evidence has revealed that fear and anxiety related situations could affect cardiac parameters. P wave dispersion (Pd) is an important index. In the present study, we aimed to evaluate Pd values in patients with premenstrual dysphoric disorder.</p> <p><strong>Methods:</strong> The study was composed of twenty-five female patients with premenstrual dysphoric disorder and same number of healthy controls. Pd, Pmin and Pmax values were determined by electrocardiogram (ECG) in the subjects.</p> <p><strong>Results:</strong> It was found that patients with premenstrual dysphoric disorder had considerably higher Pmax and Pmin values compared to those of healthy subjects. Pd was also significantly higher in patients with premenstrual dysphoric disorders than that of healthy subjects.</p> <p><strong>Conclusion:</strong> Study suggests that patients with premenstrual dysphoric disorder seems to have increased Pd, as can be seen in anxiety and fear related clinical conditions, considering that this group of patients have an increased trend to cardiac abnormalities, particularly cardiac arrythmias. To access strong conclusion, it is required novel studies with larger samples.</p> 临床前僵硬的心是心血管morbimortality看似健康的人口的一个标志 07/31/2019//m.lakotalakes.com/jccm/jccm-aid1045.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>The prognostic signifi cance of impaired left ventricular (LV) relaxation and increased LV stiffness as precursor of heart failure with preserved ejection fraction and death is still largely unknown in apparently healthy subjects.</p> <p><strong>Methods:</strong> We constituted a cohort of 353 patients with normal ejection fraction (&gt;45%) and no significant heart disease, based on a total of 3,575 consecutive left-sided heart catheterizations performed. We measured peak negative first derivative of LV pressure (-dP/dt) and operating chamber stiffness (&Kappa;) using a validated equation. Patients were categorized as having: 1) normal diastolic function, 2) isolated relaxation abnormalities (-dP/dt &gt; 1860mm Hg/sec and K &lt;0.025mm Hg/ml), or 3) predominant stiff heart (K &ge;0.025mm Hg/ml).</p> <p><strong>Results:</strong> During a follow-up of at least 5 years, the incidence of the primary composite endpoint (death, major arterial event, heart failure, and arrhythmia) was 23.2% (82 patients). Compared to isolated relaxation abnormalities, predominant stiff heart showed stronger prognostic significance for all events (p=0.002), namely heart failure (HR, 2.9; p=0.0499), cardiac death (HR, 5.8; p=0.03), and heart failure and cardiac death combined (HR, 3.7; p=0.003).</p> <p><strong>Conclusion: </strong>In this apparently healthy population referred to our center for cardiac catheterization, the prevalence of diastolic dysfunction was very high. Moreover, predominant stiff heart was a better predictor of cardiovascular outcomes than isolated relaxation abnormalities.</p> 严重的小儿密集和中期威廉斯综合症的主动脉瓣狭窄 07/30/2019//m.lakotalakes.com/jccm/jccm-aid1044.php & lt; h2> Abstract< / h2><p>We report a challenging patient with Williams syndrome and severe coarctation of the aorta. As in a few similar cases reported, several surgical and catheter interventions for recoarctation, intrastent intimal proliferation and stenosis of the left sub-clavian artery were required. Aortic patch angioplasty is planned for the future in a grower child.</p> 对献血者的脂质和血液学的评估在欧洲加沙医院,巴勒斯坦 07/16/2019//m.lakotalakes.com/jccm/jccm-aid1043.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>There is an important shortage of blood in the greatest blood banks worldwide to meet up with requirements for numerous medical interventions. Limited studies have associated regular blood donation to the lowering of lipid function parameters. Assessing the lipid function is a classical method of evaluating an individual&rsquo;s risk for coronary heart disease.</p> <p><strong>Objective:</strong> The general goal of the study is to determine lipid and hematological profile among blood donors in European Gaza Hospital, Palestine.</p> <p><strong>Materials and Methods:</strong> This study was a case-control study that involved 120 male, 40 of whom were regular blood donors (study group), 40 first time donors and 40 non- donors (control group) aged between 18-60 years. A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw-capped tube. This was allowed to clot and the serum was used to determine total cholesterol (TC), triglycerides, High-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (HDL-C), while HDL-C/LDL-C and TC/LDL ratio were calculated by using the following formula. Anthropometric parameters (weight, height) of donors were measured using standard protocol. The height (in meter), weight (in kilogram) were used to calculate the body mass index (BMI) using the following formula. BMI= weight (kg)/ (height in meter)&sup2; and blood was collected from each participant in EDTA (for hematocrit, ESR). Three groups were matched for age and BMI. Data were analyzed using SPSS version 23. Chi-square (&chi;&sup2;) was used to compare the relationship between categorical variables, ANOVA was used to measure the difference between means. Data were summarized using tables, pie charts, histograms. A P-value &lt; 0.05 was considered to be statistically significant for all tests conducted.</p> <p><strong>Results:</strong> The mean total cholesterol (169&plusmn;10.85 mg/dl), triglycerides (116&plusmn;9.73 mg/dl), HDL (54&plusmn;2.5 mg/dl ), LDL (92&plusmn;11.4mg/dl), LDL/HDL ratio (1.73&plusmn;0.25) and TC/HDL ratio (3.16&plusmn;0.26) were lower in the regular blood donors than the first time donors(198&plusmn;10.13, 179&plusmn;5.82, 42.33&plusmn;1.6, 120&plusmn;11.2, 2.85&plusmn;0.36, 4.7&plusmn;0.40) and non- donors (202&plusmn;10.19, 180&plusmn;12.68, 41.75&plusmn;1.4, 125&plusmn;11.7, 2.99&plusmn;0.33, 4.86&plusmn;0.32) respectively and statistically significant (P &lt; 0.05).The mean ESR (6.63&plusmn;0.87mm/hr) was lower statistically significant in the regular blood donors than the first time donors (7.40&plusmn;1.17) and non- donors (7.60&plusmn;1.48) respectively (P &lt; 0.05). The mean HCT (42.98&plusmn;0.86%) was lower statistically significant in the regular blood donors than the first time donors (44.63&plusmn;0.90) and non- donors (44.75&plusmn;0.74, P &lt; 0.05).</p> <p><strong>Conclusion:</strong> Regular donors have reduced risk of developing coronary heart disease as reflected by the low total cholesterol, triglycerides, LDL-c, LDL-c/HDL-c ratio, TC/HDL-c ratio and HCT and high HDL. BMI in regular donor was less than the donor for the first time and did not donate, but did not reach the statistical significance. Also in our study regular donors have reduced risk of developing inflammation as reflected by low ESR.</p> 单跨顶端访问双主动脉瓣和二尖瓣valves-in-valves程序高血栓栓塞的风险 07/16/2019//m.lakotalakes.com/jccm/jccm-aid1042.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>Persistent left atrial thrombus remains a contra indication to transeptal valves in valves procedure. We aimed to perform a double valves in valves replacement through transapical access with cerebral angiography control during the procedure just after implantation. Our case shows the feasibility of this strategy and the management of right ventricle laceration successfully treated after extra corporeal membrane oxygenation implantation and local hemostasis. We reported a feasibility case report of successful double valves in valves implantation through transapical access with 6 months of clinical and computed tomography follow up.</p> 心肌炎和心肌病——特殊实体全身心肌病 07/01/2019//m.lakotalakes.com/jccm/jccm-aid1041.php & lt; h2> Introduction< / h2><p>Cardiomyopathy is a heart muscle disease with structural and functional myocardial abnormalities in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease. However, it has become clear that diverse etiologies and clinical manifestations (e.g. arrhythmogenic right-ventricular cardiomyopathy/dysplasia (ARVC/D), ARVD/C, left-ventricular non-compaction cardiomyopathy (LVNC)) are responsible for the clinical picture of dilated cardiomyopathy (DCM).</p> c反应蛋白与代谢综合症患者心室复极化色散 06/27/2019//m.lakotalakes.com/jccm/jccm-aid1040.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>An increasing body of evidence indicates that inflammatory activation profoundly impacts the electrophysiological properties of cardiomyocytes. A marker of systemic inflammation such as C-reactive<br /> protein(CRP), is associated with all parameters of the Mtabolic syndrome(MetS) and that may result in adverse cardiac events via multiple effects, ultimately resulting in a prolongation of Action Potential duration (APD), and thereby of the QTC (QT corrected) interval on ECG.</p> <p><strong>Objective:</strong> We sought to investigate the influence of CRP levels on the prevalence of prolonged QT-dispersion and prolonged Tpeak-Tend &ndash;dispersion in the patients with MetS.</p> <p><strong>Methods:</strong> We conducted a multicenter observational cross-sectional study. The study population consisted of 200 patients with MetS, stratified in two groups:103 participants (50 females and 53 males) with level of CRP&gt;3mg/l, and 97 participants (47 females and 50 males) with level of CRP&lt;3mg/l), who attended outpatient visits at general cardiology Health Care Clinics during 1 calendar year. For the analysis of the ECG, we performed a manual measurement of the values using a digital caliper with measuring range of 0-150 mm, 0.01 mm resolution, and 0-100 &plusmn; 0.02 mm accuracy. QT interval dispersion was obtained by the difference between the maximum and the minimum QT intervals found in the 12-lead electrocardiogram. The Tpeak-Tend interval was obtained from the difference between QT interval and QTpeak interval.</p> <p><strong>Results:</strong> Prolonged QTC. dispersion, was found in 51.4% of participants with level of CRP&gt;3mg/l and in 32.9% of with level of CRP&lt;3mg/l, the differences were statistically significant. (p=0.004). The results showed that 51.4% participants with level of CRP&gt;3mg/l had a prolonged Tpeak-Tend interval, and 32.9% of participants with level of CRP&lt;3mg/l had prolonged Tpeak-Tend interval. Difference were statistically significant.( p=0.04). There were significant association of increased levels of CRP and QTC-dispersion (OR = 2.486, 95% CI 1.389-4.446).There were significant association of increased levels of CRP with Tpeak-Tend Dispersion (OR=2.239,95%CI 1.262-3.976). Prolonged QTC max. Interval OR=2.236,%CI 1.246-4.014),Prolonged Tp-Te-interval. (OR=2.367, 95%CI 1.327-4.222), also there were significant association of increased levels of CRP with BMI. (OR=1.154, 95%CI 1.095-1.227) and significant association of increased levels of CRP with presence of uncontrolled glicemia.(OR=1.779, 95%CI 1.014-3.12).</p> <p><strong>Conclusion:</strong> We think we proved the hypothesis that patients with MetS and high level of CRP have higher prevalence of QT- dispersion and Tpeak-Tend dispersion than patients with MetS and lower level of CRP. These findings have both epidemiological and clinical relevance, also these findings might lend further insight into potential mechanisms by which MetS is associated with adverse cardiac events.</p> 由于流感病毒H3N2感染类似急性病毒性心肌炎急性冠状动脉综合症:一个案例报告 06/20/2019//m.lakotalakes.com/jccm/jccm-aid1039.php <h2>Case Presentation</h2> <p>A 16-year-old man with history of two weeks-flu like symptoms with intermittent fever. He came to the emergency department with 2 hours-chest pain that radiates to the back and upper extremities. At the admission he was hemodynamically stable with normal blood pressure The ECG showed sinus rhythm and ST segment elevation of 0.5 mV in all leads (Figure 1A).The cardiac enzymes were elevated (Troponin 12.19 ng/mLland creatine kinase-MB fraction 63.25 U/L). He was admitted to the Intensive Care Unit and later transferred to our medical unit to continue with study protocol. The transthoracic echocardiogram (Figure 1B) reported normal left ventricular systolic function with left ventricular ejection fraction (LVEF) 68%, global longitudinal strain -18%, TAPSE 30 mm, and normal systolic pulmonary artery pressure (30 mmHg).</p> Not-motorized移植心脏援助(NICA):血流动力学的概念和临床的角度 06/13/2019//m.lakotalakes.com/jccm/jccm-aid1038.php & lt; h2> Abstract< / h2>& lt; p>相当大的改善心脏支持系统技术直到现在还没有解决的问题连接心脏辅助装置(CAD)外部能源,这使得这些患者的危险致命的感染和依赖外部电池几个小时的自主权。作者说明和讨论血流动力学的概念和临床,基础的力学第一not-motorized移植心脏辅助装置(NICA)。你们;/ p> 以色列袭击的影响在2014年在加沙STEMI的发生率 06/07/2019//m.lakotalakes.com/jccm/jccm-aid1037.php <h2>Background</h2> <p>For 51 days, Gaza was pummeled down by the Israeli military in a war known as Operation Protective Edge. During the 50 days (7-7-204 to 28-8-2014) of the Israeli campaign, 2104 Palestinians were killed, including 253 women (12%) and 495 children (24%). According to the UN, at least 69% of Palestinians killed were civilians. It is estimated that 10,224 Palestinians, including 3,106 children (30%) and 1,970 women (19%) were injured.</p> 只有现实世界的经验Mynx股关闭设备的病人接受经皮冠状动脉介入 06/04/2019//m.lakotalakes.com/jccm/jccm-aid1036.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Vascular closure devices are routinely used following femoral artery access to perform percutaneous coronary interventions (PCI). A number of devices are available on the market. We have reported previously on our experience of the Mynx device following diagnostic coronary angiography.</p> <p><strong>Aims:</strong> To assess the success and complication rates of the Mynx device used in all-comers in the context of PCI within a single cardiac centre.</p> <p><strong>Methods:</strong> Retrospective analysis of data available for patients who underwent PCI via the femoral route and received a Mynx device at a single tertiary centre.</p> <p><strong>Results:</strong> The device was used to achieve haemostasis in 113 patients following PCI. In all cases weight-adjusted Heparin as well as dual antiplatelet therapy (Aspirin and Clopidogrel/ Ticagrelor) was administered as per PCI protocol. The device was successfully deployed in 111 cases (98.2%). The were 2 cases of device failure, one due to operator error and the other due to Mynx grip balloon bursting during device deployment. In 15 cases (13.2%; 9 male and 6 female) there were reports of small haematomas (&lt;2cm) or oozing resulting in application of manual pressure or Femstop (St. Jude). A further patient required ultrasound-guided compression of the artery due to a large retroperitoneal bleed resulting from access complications. A larger proportion of the cases with complications were done as PPCI (44% vs 33%). The group with complications had higher systolic BP (140mmHg vs 128mmHg; P&lt;0.05) and MABP (97mmHg vs 75mmHg; P&lt;0.05) as compared with the group without any complications.</p> <p><strong>Conclusion:</strong> The Mynx closure device is safe and easy to use in the context of PCI, in both the elective and emergency (PPCI) settings. Complication rates, predominately minor, can be minimised in experienced hands.</p> 是二级预防冠状动脉内介入治疗后放电之前足够的信息? 05/08/2019//m.lakotalakes.com/jccm/jccm-aid1034.php <h2>Summary</h2> <p><strong>Introduction:</strong> Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches.</p> <p><strong>Aims:</strong> To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used.</p> <p><strong>Methods:</strong> This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed.</p> <p><strong>Results:</strong> There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet.</p> <p>During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling.</p> <p><strong>Conclusion:</strong> Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach.</p> 是S-Klothoa€™s最大浓度依赖在年轻的成年男性运动强度和时间吗? 03/08/2019//m.lakotalakes.com/jccm/jccm-aid1033.php & lt; h2> Abstract< / h2><p>The purpose of the present study was to define the period of time in which aerobic training does not increase further serum S-Klotho levels in untrained young adult males, and to examine the relation between plasma S-Klotho concentration and maximal oxygen uptake (VO2max).</p> <p><strong>Methods:</strong> Sixty (60) untrained subjects (27.05&plusmn;1.1 years) were divided into 2 groups, both exercised six months 4&times;wk-1 for the duration of 45 min&times;session. One group (LTI) exercised below the anaerobic threshold at 40-50% of VO2max, while the second group (HTI) worked above the anaerobic threshold at 65-70% of VO2max. Testing sessions were performed at 0, 2, 4, and 6 months. Blood samples were drawn after overnight fasting; S-Klotho was analyzed using an ELISA kit.</p> <p><strong>Results:</strong> Following 2 and 4 months, significant (p&le;0.05) increases were noted in the HTI group, at the fourth testing session, S-Klotho leveled off. In the LTI group, S-Klotho remained almost unchanged. Findings of the present study, support emerging evidence suggesting that a relation between plasma S-Klotho concentration and VO2max exists.</p> <p><strong>Conclusion:</strong> Data suggest that increases in S-Klotho is tidally associated with VO2max levels. In addition, the S-Klotho increase levels-off following 4 months of aerobic training. Exercising below the anaerobic threshold does not increase VO2max and thus, does not increase S-Klotho.</p> 诊断的准确性TIMI与恩典分数预测死亡的患者急性Non-ST抬高心肌梗死(NSTEMI) 02/22/2019//m.lakotalakes.com/jccm/jccm-aid1032.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong> Background< / strong>:急性冠脉综合征描述一系列的疾病从通过non-ST-Elevation不稳定性心绞痛心肌梗死(NSTEMI) st段抬高心肌梗死肝素)。早死在NSTEMI通常是由于心律失常。病人应该立即承认医院,最好是心脏保健单位因为有明显死亡的危险。;/ p>& lt; p> & lt; strong>目的:& lt; / strong>比较TIMI与优雅的诊断精度预测死亡的患者急性Non-ST海拔心肌梗塞。你们;/ p>& lt; p> & lt; strong>材料,amp;方法:& lt; / strong>现在在心内科横断面研究,运营,木尔坦。所有患者评估根据给定的分数在两个评分系统即TIMI危险评分和优雅得分。 Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients.</p> <p><strong>Results:</strong> In our study the mean age of the patients was 55.73&plusmn;9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%.</p> <p><strong>Conclusion:</strong> Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.</p> 有一个理想的血压在心肺旁路,以防止术后脑损伤吗?€”最近的证据说什么? 11/21/2018//m.lakotalakes.com/jccm/jccm-aid1031.php <h2>Background</h2> <p>Post cardiac surgery stroke is a devastating complication with an incidence as high as 50%1. The association between intra-operative mean arterial blood pressure (MAP- better called linear blood pressure) during cardiopulmonary bypass (CPB) and the development of postoperative stroke-as diagnosed by neuroimaging- and of cognitive dysfunction (POCD) is controversial. This is due to differences in the study populations, stroke assessment tools, operation and conduction of MAPs, variations in neurocognitive testing and duration of follow up. As a result there is a gap in the knowledge on an ideal MAP as a preventive measure of post CPB stroke and POCD.</p> 组氨酸对收缩性和肾上腺素收缩效果的影响的实验与右心室心肌非怀孕和怀孕的老鼠 11/19/2018//m.lakotalakes.com/jccm/jccm-aid1030.php & lt; h2> Abstract< / h2><p>It was investigated contractility and adrenoreactivity of intact myocardium strips of right ventricular in experiment with 60 rats. They were assessed by the force of induce contraction and its changes under the influence of adrenaline (10-9 or 10-5 g / ml). Found that these indicators do not depend on the phases of the estrous cycle and the presence of pregnancy. Histidine (10-10-10-4 g / ml) did not increase the response to adrenalin (10-9 g / ml), but increased the force of the contractions in rats in progesterone dominance (trend) and pregnancy (statistically significant). Against the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5 g / mL) instead of increasing the force of contraction reduced it (probably due to activation of beta3-, alpha1 - and alpha1 a2- adrenergic receptors), and histidine (10-4 g / mL) prevented this reduction, but does not restore full ability of adrenaline to exert a positive inotropic effect. On the background of nicergoline (10-8 g / mL or nicergoline and propranolol (10-8 g / mL), adrenaline (10-5 g / mL) did not alter the force of contraction, and histidine (10-4 g/mL) restore ability of adrenaline to exert a positive inotropic effect but only in the experiments with nicergoline. Concluded that histidine increases the efficiency of the activation of all three (beta1-, beta2- and beta3-) populations of myocardial beta-adrenoceptoprs, including at lower by adrenergic blockers. Therefore, histidine proposed as an antagonist of beta-adrenergic blockers and as resensitizator of these receptors.&nbsp;</p> <p><strong>Core Tip:</strong> In the experiments with strips of the right ventricle of 40 nonpregnant and 20 pregnant rats histidine (10-10-10-4 g /mL) did not increase the response to adrenaline (10-9 g / ml), but increased the force of contractions in pregnant rats. On the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5g/mL) showed a negative inotropic effect, and histidine (10-4 g / mL) prevented it, but does not restore the ability of adrenaline to show positive inotropic effect,. i.e histidine exhibits the properties of the antagonist of beta-blockers and of resensitizator of beta-adrenoceptors.</p> 血钾过高:急诊医学的大敌。描述两个病例报告 11/06/2018//m.lakotalakes.com/jccm/jccm-aid1029.php & lt; h2> Abstract< / h2><p>Potassium is an important ion capable to maintain intra-extracellular electric gradient. Variations in the intra-extracellular ionic flow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells.</p> <p>In this study we demonstrated that high level of serum potassium may be associated with cardiac and neurological life-threatening diseases.</p> <p>We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy.</p> <p>Emergency haemodialysis was performed with a complete remission of the clinical manifestations.</p> <p>Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.</p> <p>We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy.</p> <p>Emergency haemodialysis was performed with a complete remission of the clinical manifestations.</p> <p>Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.</p> 该项受体的内源性敏化剂(ESBAR)及其类似物(审查) 10/29/2018//m.lakotalakes.com/jccm/jccm-aid1028.php & lt; h2> Abstract< / h2>& lt; p> 20年的研究结果出现在血清和其他体液的内生调节器的肾上腺素能和M-cholinergic影响体液链接的自主神经系统的一个组成部分。本文致力于该项受体的内源性敏化剂(ESBAR) -水溶性低分子量物质,类似物的组氨酸,色氨酸、酪氨酸、mildronat preductal。它显示,单独的人类血清稀释和动物(作为ESBAR来源)和类似物的ESBAR方法提高beta-adrenoceptors激活的有效性(AR)平滑肌(子宫、冠状动脉和肾动脉、气管、胃),心肌,红细胞和血小板(分别组氨酸和色氨酸)的影响。据报道,内容ESBAR在人类血清(根据其稀释的浓度)取决于性和躯体疾病的存在,和女性也在舞台上讨论的繁殖和产科并发症的可能机制ESBAR行动,它的生理作用,包括组件的beta-adrenoceptor抑制子宫肌层的机制,以及使用的前景ESBAR的对应物,包括早产的预防,对支气管哮喘的治疗,冠心病、高血压和心脏衰竭。你们;/ p> 一项观察性研究出现的焦虑、抑郁和自我报告的心肌梗死后2年的生活质量 10/17/2018//m.lakotalakes.com/jccm/jccm-aid1027.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena.</p> <p><strong>Aims:</strong> To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI.</p> <p><strong>Methods:</strong> This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires.</p> <p><strong>Results:</strong> Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009).</p> <p>Most patients had &ldquo;no problems&rdquo; with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least &ldquo;some problems&rdquo; with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p&lt;0.001) and female sex (p&lt;0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80).</p> 使用Rivaroxaban和Apixaban Non-Vitamin K拮抗剂口服抗凝血剂(NOACs),肾功能受损的患者,我们的知识的局限性 10/11/2018//m.lakotalakes.com/jccm/jccm-aid1026.php <h2>Opinion</h2> <p>Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin. However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3].</p> Microdialysis技术已监测的€¢哦一代大鼠的心肌损伤 08/05/2018//m.lakotalakes.com/jccm/jccm-aid1025.php & lt; h2> Abstract< / h2><p>The micro dialysis procedure is a technique that has been established for some years. Although free radical reaction is a part of normal metabolism, sustained elevation of noradrenaline (NA) in the extracellular fluid can be autoxidized, which in turn leads (possibly by an in direct mechanism) to the formation of cytotoxic free radicals. Reactive oxygen causes excessive Na+ entry through the fast Ca2+ channel, leading to intracellular Ca2+ overload through the Na+-Ca2+ exchange system. However, the interaction between intracellular Ca2+ overload and oxygen free radicals in myocardium is not clear. Angiotensin converting enzyme (ACE) inhibitor is associated with cardioprotective effect due to suppression of NA-induced hydroxyl radical (&bull;OH) generation in the heart. Low-density lipoprotein (LDL) oxidation may be related to NA induced &bull;OH generation. Although the neuroprotective effects of nitric oxide (NO) is discussed, NO contributes to the extracellular potassium concentration ([K+]o)-induced &bull;OH generation via NO synthase (NOS) activation. Opening of ATP sensitive K+ channel (KATP) channel may cause &bull;OH generation. These finding may be useful in elucidating the actual mechanism of free radical formation in the pathogenesis of heart disorders.</p> 心血管损害在非洲黑人狼疮科目 07/16/2018//m.lakotalakes.com/jccm/jccm-aid1024.php <h2>Summary</h2> <p><strong>Introduction</strong>: Systemic lupus is a disseminated inflammation of the conjunctive tissue. Cardiovascular lesions are the first cause of morbidity and mortality in the course of that disease. These lesions are prevalent in 30 to 62% of cases, depending on whether the diagnostic tool is clinical, echocardiographic, or autopsic. Any part of the heart can be affected, yielding manifestations of pericarditis, endocarditis, coronary heart disease, conduction disorders, and rarely myocarditis.</p> <p><strong>Objective:</strong> Describe cardiac manifestations during the follow up of patients diagnosed with systemic lupus.</p> <p><strong>Patients and Methods:</strong> We conducted a transversal descriptive study over a period of 27 months, in the departments of Internal Medicine, Dermatology, and Cardiology of Yalgado Ouedraogo University Hospital of Ouagadougou. All patients diagnosed with systemic lupus according to the American College of Rheumatology criteria, and having done an EKG, a Holter EKG, or a transthoracic echocardiography, were included in the study. Data were collected from inpatient medical records, outpatient follow up registry and booklets.</p> <p><strong>Results:</strong> Cardiovascular lesions were prevalent in 7 cases (43.75%) out of 16 patients diagnosed with systemic lupus. Mean age of patients was 36 years, with extremes of 23 and 51 years. Only female patients were affected in our study. Cardiac manifestations were mainly benign pericarditis, heart failure, and conduction disorders.</p> <p><strong>Conclusions:</strong> Cardiovascular manifestations are frequent during the course of systemic lupus, and occur after few years of disease progression. Transthoracic echocardiography and EKG remain useful non-invasive explorations for the assessment of cardiovascular lesions, despite minor shortcomings.</p> 阻挡和评估风险因素和梅斯率non-occluded NSTEMI患者接受冠状动脉造影:一项回顾性crosssectional研究在木尔坦,巴基斯坦 05/30/2018//m.lakotalakes.com/jccm/jccm-aid1023.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>目标:& lt; / strong>The prime focus of the present study was to evaluate the most occluded coronary artery (OCA) among non-ST elevated myocardial infarction (NSTEMI) patients, and risk factors associated with occluded and non-occluded NSTEMI. Also, major adverse cardiovascular event (MACE) were evaluated among patients during index hospitalization.</p> <p><strong>Methods:</strong> A retrospective, cross-sectional study was conducted in Multan Institute of Cardiology, Pakistan between 1st February, 2017, and 31st September, 2017. The data were collected from medical records of the outpatients and inpatients who were index hospitalized. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) And Microsoft Excel (MS Office 2010).</p> <p><strong>Results:</strong> Among 624 patients, angiographic findings revealed that 63.9% were suffering from non-occlusive NSTEMI while 36.1% of the patients had occluded NSTEMI. In occluded NSTEMI patients, 30.3% were having single vessel occlusion while 5.8% were having multi-vessel occlusion. Also, 49.8% were having occlusion of right coronary artery (CA) while 44% were having occluded left anterior descending (LAD) artery. Multivariate analysis revealed that age (p=0.001) and left ventricular ejection fraction (LVEF) (p=0.001) had a statistically significant association. The incidence of MACE was high among non-OCA patients as compared to OCA patients but no statistically significant association was found (p=0.44).</p> <p><strong>Conclusions:</strong> Angiography confirmed that most of the NSTEMI patients had OCA. But the MACE rate was not significantly differ among OCA and non-OCA patients. The risk factors associated with OCA were low LVEF and age.</p> 一个索引的设计和验证预测高血压心脏病的发展 02/16/2018//m.lakotalakes.com/jccm/jccm-aid1022.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>高血压心脏病的发病率和死亡率高需求的建设和验证工具的风险分层发展这个条件灵活;/ p>& lt; p> & lt; strong>目的:& lt; / strong>设计和验证索引、基于风险因素,允许预测高血压患者心脏病诊断的发展基本动脉高血压。你们;/ p>& lt; p> & lt; strong>方法:& lt; / strong>前瞻性队列研究是在专门的动脉高血压高血压患者辅助physicians&,办公室,宝贝,Carlos Manuel de C&餐厅;spedes&”,专业一般大学医院门诊部,一种强风市格拉玛省,古巴从1月1日,2010年到2016年12月31日。内部和外部效度和内部一致性指数测定。;/ p> <p><strong>Results:</strong> The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p&lt;0.0005) and calibration (p=0.751) were adequate.</p> <p><strong>Conclusions:</strong> The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk.</p> 心电图描记的创始者突变Arrhythmogenic心肌病相关的标准 02/02/2018//m.lakotalakes.com/jccm/jccm-aid1021.php <h2>Background</h2> <p>Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women&gt;30 years for sudden cardiac death prevention.The mutation increases the stiffness of the cell nucleus thus producing the massive loss of cardiomyocytes [2]. P.Arg14del phospholamban mutations cause biventricular arrhythmogenic cardiomyopathy with predominant heart failure, and in some cases, secondary sudden cardiac death [3]. Both founder mutations have characteristic electrocardiographic appearance, together with typical ECG manifestations of arrhythmogenic cardiomyopathy like right precordial T-wave inversions, terminal activation delay and epsilon waves in right precordial leads. Typical ECG manifestations in TMEM43 mutations are poor R-wave progression in right precordial leads (Figure 1), often associated with T-wave inversions in lateral leads [4]. Typical ECG manifestations in phospholamban mutations are low voltage ECG [5], more than complete right bundle branch block [6], epsilon waves in right precordial leads and in lead aVR [7] and right precordial T-wave inversions (Figure 2). Atrial fibrillation occurs frequently.</p> 心脏病的新假说:在内源性毒性方面 01/22/2018//m.lakotalakes.com/jccm/jccm-aid1020.php & lt; h2> Introduction< / h2><p>In order to suggest new pathogenetic hypotesys in some heart disease we think is interesting to observe some biomedical literature: Can we think some endogenus toxicologic movens in some heart pathologies?</p> <p>Activated platelet can trigger coronay artery spasm in some patients, and in SCD many patients not show Anatomic abnormalities and this can be involved sudden vigorous exertion untrained subjects (also in young) in seems to show an inadeguate methabolic response. Also severe artmia can be due by electrolyte umbalance.</p> 数值模拟在曲折的小动脉血栓性闭塞 12/06/2017//m.lakotalakes.com/jccm/jccm-aid1019.php & lt; h2> Abstract< / h2><p>Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles.&nbsp;</p> Lipid-induced心血管疾病 12/28/2017//m.lakotalakes.com/jccm/jccm-aid1018.php & lt; h2> Abstract< / h2><p>Cardiovascular diseases are the leading cause of death worldwide. There are many evidences that the dysfunctioning lipotoxicity is the one of major factors of cardiovascular diseases such as, atherosclerosis, hypertension, and coronary heart disease. Obesity and diabetes increase circulating lipids that are likely with more generation of toxic intermediates, which leading to the complications associated with cardiovascular diseases. Indeed, lipotoxicity is a metabolic syndrome caused by abnormal lipid accumulation, which leads to cellular dysfunction and necrosis. Here we review the factors that induced pathogenesis of cardiovascular diseases by lipid accumulation and the mechanisms underlying the lipotoxicity.&nbsp;</p> Non-hemodynamic患高血压心脏病的风险相关的因素 09/20/2017//m.lakotalakes.com/jccm/jccm-aid1017.php & lt; h2> Abstract< / h2><p><strong>Introduction</strong>: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development.&nbsp;</p> <p><strong>Objective</strong>: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy.</p> <p><strong>Methods</strong>: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians&rsquo; office of the &ldquo;Carlos Manuel de C&eacute;spedes&rdquo; Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1.</p> <p><strong>Results</strong>: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p&lt;0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p&lt;0.005). The area under the model ROC curve was 0.887 (p&lt;0,005).</p> <p><strong>Conclusions</strong>: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors.</p> 新心:描绘生理anatomo-functional重建在缺血性心肌病 09/15/2017//m.lakotalakes.com/jccm/jccm-aid1016.php <h2>Summary</h2> <p>Fiber-based model of the left ventricle is known since 1628 but the complex 3D structure of myocardial fibers has not taken into account in normalcy or in disease until the last decade. We here present the case of a 60-year-old female patient affected by ischemic cardiomyopathy and severe left ventricular dysfunction. Left ventricle was reconstructed according to a novel surgical technique aimed at rebuilding an elliptical ventricular chamber and redirecting myocardial bundles of fibers in a near-normal orientation, by means of an original suturing technique. Left ventricular torsion was restored, proving the reorientation of myocardial fibres&rsquo; bundles. The restored physiologic shape was maintained along the years, gradually improving global ejection fraction and diastolic indices, showing a positive remodeling induced by the optimised geometrical and functional parameters.</p> <p>The unexpected and never proven before renewal of ventricular torsion is an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical mechanics. A new fiber-based reading of heart function could improve clinical and functional outcomes and address some unsolved issues in the surgical treatment of ischemic cardiomyopathy as well as in medical approaches to the diseased myocardium.</p> 价值有心电图T波倒置在铅aVL中期预测左前降枝冠状动脉狭窄患者的稳定 08/18/2017//m.lakotalakes.com/jccm/jccm-aid1015.php & lt; h2> ABSTRACT< / h2><p><strong>Background</strong>: The electrocardiogram (ECG) is a simple and noninvasive bedside diagnostic tool with a well-established role in the diagnosis of coronary artery disease (CAD). We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina.&nbsp;</p> <p><strong>Patients and Methods</strong>: study was conducted on 156 patients referred for invasive coronary angiography with history of stable CAD as proved by non- invasive tests, 12 lead ECG was recorded and fully interpreted with more focus on T wave direction in aVL lead. T waves in aVL were categorized into one of three groups: upright, flat or inverted.</p> <p><strong>Results</strong>: regarding T wave in lead aVL, inverted T wave was reported in 71(45.5%) patients, 58 (37.2%) patients were with upright T wave in lead aVL and 27(17.3%) patients were with flat T wave in lead aVL, and we found that inverted T wave in lead aVL was most evident in 56(73.7%) patients with mid LAD with (highest &kappa; value equal to 0.550[moderate agreement], and p value&lt;0.001.</p> <p><strong>Conclusions</strong>: This study confirmed the diagnostic value of T wave inversion in lead aVL in prediction of mid left anterior descending artery lesions in patients with stable coronary artery disease.</p> 亚急性感染性endocarditisassociated membranoproliferative肾小球肾炎:病例报告和审查 08/17/2017//m.lakotalakes.com/jccm/jccm-aid1014.php & lt; h2> ABSTRACT< / h2><p>We experienced a case of membranoproliferative glomerulonephritis (MPGN) caused by subacute infectious endocarditis (SIE). A 57-year-old male farmer complained of fatigue, lack of appetite and gross haematuria for a month; he had no cough, chest pain, or exertion dyspnea. After admission, lab tests showed mild proteinuria(1.04g/d) and heavy dysmorphic red blood cells(RBC) (543/HP), with serum creatinine(Scr) slightly elevated(1.46mg/dl) and anemia(hemoglobin Hb 85g/L). A renal biopsy revealed MPGN lesion with 16.6% cellular crescents. The echocardiogram test revealed mitra valve prolapse with perforation of the anterior lobe, vegetation, and severe regurgitation. He was diagnosed as SIE induced MPGN. Then he underwent mitral valve replacement after systemic antibiotic treatment without immunosuppressive agents. Follow-up showed that he dramatically regained normal kidney function in total 1 year after the operation. Thus, antibiotic administration and valve replacement may be efficient enough for some of SIE induced MPGN. We did a brief review of the literature on SIE induced MPGN, which was sometimes misdiagnosed due to its silent characteristics; some SIE patients may initially have other organs involved.</p> 一种罕见的先天性冠状动脉异常:编织右冠状动脉和心肌梗死有关 07/07/2017//m.lakotalakes.com/jccm/jccm-aid1013.php <h2>CASE PRESENTATION</h2> <p>Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1].&nbsp;Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2].</p> <p>Recently, we have encountered a case of WCA associated with myocardial infarction. A 46-year-old man presented cardiology department with stable angina pectoris. An electrocardiography (ECG) showed Q waves in the inferior leads. Echocardiography examination showed akinesis of the inferior wall and left ventricle ejection fraction was 50%. The coronary angiograms showed a 70% stenosis of left anterior descending artery (LAD), 99% stenosis of circumflex artery and a twisting course of the right coronary artery lumen after it divided into multiple channels (woven right coronery artery) (Figure 1, Video1). He was transferred to the cardiovascular department for the bypass surgery.</p> 视网膜微血管的调查发现患者的冠状动脉疾病 07/07/2017//m.lakotalakes.com/jccm/jccm-aid1012.php & lt; h2> ABSTRACT< / h2>& lt; p> & lt; strong>目标:& lt; / strong>Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease.</p> <p><strong>Material and Method:</strong> Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated.</p> <p><strong>Results:</strong> This study enrolled 100 patients (male: 72 (72%), mean age: 58.25&plusmn;7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p&lt;0.001).</p> <p><strong>Conclusions: </strong>Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions.</p> 发病率患者冠状动脉血管造影程序post-drug-eluting气球治疗冠状动脉drugeluting支架支架内Restenosis-does这有关系吗? 06/29/2017//m.lakotalakes.com/jccm/jccm-aid1011.php & lt; h2> ABSTRACT< / h2><p><strong>Objectives: </strong>The clinical impact of drug-eluting balloon (DEB) coronary intervention for drug-eluting in-stent restenosis (DES-ISR) is not fully known. To further evaluate this impact, we aimed to describe the incidence of symptom-driven coronary angiography (SDCA), an under-reported but potentially informative outcome metric in this cohort of patients.</p> <p><strong>Methods</strong>: We retrospectively identified all patients (n=28) who had DEB-treated DES-ISR at University Hospital Limerick in between 2013-2015 and evaluated the incidence of subsequent SDCA as the primary endpoint. Data were expressed as mean &plusmn; SD and %.</p> <p><strong>Results</strong>: Baseline demographics demonstrate a mean age 63&plusmn;9 years with 61% of DEB-treated DES-ISR presenting with acute coronary syndrome. Mean number of ISR per patient and number of DEB per lesion was 1.2&plusmn;0.6 lesions and 1.2&plusmn;0.6 balloons, respectively. The incidence of SDCA was 54% after mean follow-up duration of 179&plusmn;241 days. 67.8% of patients had follow-up data beyond 12 months. Within the first year of follow-up, the incidence of SDCA with and without target lesion revascularization (TLR) was 11% and 36% respectively. Among patients with SDCA without TLR, 30% had an acute coronary syndrome not requiring percutaneous coronary intervention.</p> <p><strong>Conclusions</strong>: A high incidence of SDCA was observed, particularly within the first 12 months after DEB-treated DES-ISR. This under-reported metric may represent a cohort at higher cardiovascular risk but requires further confirmation in larger studies.</p> 溶栓,唯一最优快速再灌注治疗 06/23/2017//m.lakotalakes.com/jccm/jccm-aid1010.php & lt; h2> ABSTRACT< / h2><p>Thrombolysis with tissue plasminogen activator (tPA) has been plagued by inadequate efficacy and a high risk of intracranial hemorrhage (ICH), which led to its replacement by procedures like percutaneous coronary intervention (PCI) whenever possible. Since this requires hospitalization, it is time-consuming, and compromising salvage of brain tissue and myocardium. Thrombolysis is the only first-line treatment that can provide sufficiently timely treatment for optimal recovery of organ function. However, for this potential to be realized, its efficacy and safety must be significantly improved over the current method. By adopting the sequential, synergistic fibrinolytic paradigm of the endogenous system, already verified by a clinical trial, this becomes possible. The endogenous system&rsquo;s function is evidenced by the fibrinolytic product D-dimer that is invariably present in blood, and which increases &gt;20-fold in the presence of thromboembolism. This system uses tPA to initiate lysis, which is then completed by the other fibrin-specific activator prourokinase (proUK). Since tPA and proUK in combination are synergistic in fibrinolysis, it helps explain their efficacy at their low endogenous concentrations.</p> 自发的一个巨大的冠状动脉动脉瘤破裂后急性心肌梗塞 06/21/2017//m.lakotalakes.com/jccm/jccm-aid1009.php <h2>CASE PRESENTATION</h2> <p>Coronary artery aneurysm is commonly defined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2].Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood flow within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction.</p> 程序利用率、延迟和死亡率:周末和工作日为心肌梗死的承认 05/19/2017//m.lakotalakes.com/jccm/jccm-aid1008.php & lt; h2> ABSTRACT< / h2>& lt; p> & lt; strong> Background< / strong>:由于医院协议和人员的可用性变化,心肌梗死患者承认在周末可能不太可能接受侵入性程序,也可能收到比承认他们具有更大的延迟一周。是否发生这种情况,转化为结果的差异并不是建立灵活;/ p>& lt; p> & lt; strong> Method< / strong>:使用全国住院病人样本数据库(2008 - 2011),我们发现所有的病人承认原则急性心肌梗死的诊断。他们被周末或工作日分层入学。基线临床特点、手术利用和延迟过程比较,构造和逻辑回归模型来评估这些变量之间的关系和住院死亡率。;/ p>& lt; p> & lt; strong> Results< / strong>:病人人口和provider-related特征(医院类型、地理)类似的周末和工作日之间为心肌梗死的承认。协变量调整后,我们发现周末入院死亡率是5%的几率大于工作日入学(OR: 1.05;95%置信区间:1.01,1.09,p = 0.009)。利用入侵过程中,我们发现,周末接收程序录取的几率不到12%的几率工作日承认,调整其他协变量(OR: 0.88; 95% CI: 0.86, 0.91, p&lt;0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p&lt;0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87).</p> <p><strong>Conclusion</strong>: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality.</p> 在塞内加尔的迹象和结果Coronarography糖尿病患者:大约45例 02/20/2017//m.lakotalakes.com/jccm/jccm-aid1007.php & lt; h2> ABSTRACT< / h2>& lt; p> & lt; strong>简介:& lt; / strong>Coronary disease accounts for 75% of diabetic mortality. Coronary angiography reveals lesions that are often diffuse, staggered and multi-truncated. The objective of this study was to determine the indications and results of coronary angiography in diabetic patients.</p> <p><strong>Method:</strong> This is a cross-sectional, descriptive and analytical study which took place from May 2013 to July 2015 at the cardiology clinic of the Aristide Le Dantec hospital. We have included all diabetics who have benefited from coronary angiography by studying clinical and paraclinical data, particularly coronary angiography ones.</p> <p><strong>Results:</strong> During this period, 400 patients had coronary angiography, including 45 diabetics, a hospital prevalence of 11.25%. The average age of our patients was 62.27 y/o with extremes of 44 and 85 y/o. The sex ratio was 1.6 in favor of men. Diabete was revealed in 42 patients. Almost all patients were type II diabetics (44 patients) since 9.94 years in average. The associated cardiovascular risk factors were hypertension 66.7% and dyslipidemia 49.6%. Only 4 patients had typical chest pain. The electrocardiogram was abnormal in 84.4% of cases with 26 cases of SCA ST +. Coronary angiography was abnormal in 37 patients with significant stenosis in 30 patients. A single-truncular lesion was found in 14 cases, 8 had bi-truncular and other 8 had tri-truncular one. The anterior interventricular artery and the segment II of the right coronary were the most affected branches. Concerning the management, 14 patients had angioplasty with an active stent, 8 patients had medical treatment alone and 9 patients had coronary artery bypass surgery. Accidents occured for 4 patients, two of whom had arterial spasm, one of a vagal discomfort and another had an occlusion of the circumflex that led to the implantation of a stent.</p> <p><strong>Conclusion:</strong> Diabetes is accompanied by progressive coronary atherosclerosis, which has an adverse effect on patients&#39; prognosis. Tri-truncal affection and indications for coronary artery bypass surgery are common.</p> 短期和中期评估的患者在冠状动脉的患者:PrA©开头的结果阿里斯蒂德医院的心脏科大学Le Dantec达喀尔(塞内加尔):研究38例 02/20/2017//m.lakotalakes.com/jccm/jccm-aid1006.php & lt; h2> ABSTRACT< / h2>& lt; p> & lt; strong> Introduction< / strong>:冠心病冠状动脉血管成形术是一种安全的治疗方法。然而,其主要障碍仍然存在发生支架血栓形成(ST)和支架内再狭窄(ISR)。本研究的目的是评估冠状动脉血管成形术患者的短期和中期结果阿里斯蒂德达喀尔Le Dantec医院的心脏病学部门。amp;, & lt; / p>& lt; p> & lt; strong> Methodology< / strong>:纵向,描述性和分析研究的12个月(2014年4月至2015年4月),随访6个月。包括任何病人冠状动脉血管成形术和支架放置灵活;/ p>& lt; p>结果:38例被包含在一个男性主导地位和性别比例为5.32。平均年龄为57.94岁。心血管风险因素主要是吸烟(57.9%)和冠状动脉遗传(42.1%),其次是高血压(39.5%)、糖尿病(34.2%)。血管成形术的适应症急性冠脉综合征TS(+)和(-)分别为(50%)和(23.7%)和稳定心绞痛(26.3%)。 The right femoral approach was almost exclusive (97.4%). Coronary angiography revealed a predominance of anterior interventricular affection (84.2%). Type B lesions were the most frequent (68.4%). The single-truncal valve affection was predominant (76.3%). Direct stenting accounted for 63.2% of procedures. Twenty-one bare stents (55.3%) and 17 active stents (44.7%) were implanted. The results were excellent (94.7%). One case of acute stent thrombosis was noted. Echocardiography of dobutamine stress during follow-up was positive in 04 patients (12.5%). The control coronary angiography performed in two patients revealed an ISR. The predictive factors for restenosis were dominated by a deterioration in the segmental kinetics (p=0.009), in the diastolic function (p=0.002), the systolic function (p=0.003), a high post angioplasty troponin (p=0.004), the presence of calcifications (p=0.004) and a high SYNTAX score (p=0.021).</p> <p><strong>Conclusion</strong>: According to these results, Angioplasty is an effective therapy for coronary disease. However, a correct intake of double platelet antiaggregants and clinical and non-invasive screening are required for follow-up to avoid stent thrombosis or restenosis.</p> 先天性Quadricuspid主动脉瓣、主动脉瓣闭锁不全的一种罕见病因成年人:病例报告 01/23/2017//m.lakotalakes.com/jccm/jccm-aid1005.php <h2>INTRODUCTION</h2> <p>Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases [5].QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies [3]. Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery.</p> 间歇性左束支阻滞:机制是什么? 01/20/2017//m.lakotalakes.com/jccm/jccm-aid1004.php <h2>CASE PRESENTATION</h2> <p>A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic finding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities.<br /> <br /> 12-lead Holter ECG showed constant sinus rhythm, preserved AV conduction (PR at the upper normal limit) and no brady/tachyarrhythmias. Complete LBBB was observed during prolonged phases of the recording, but occasionally it was intermittent (Figure 1). What is the most likely mechanism of the intermittent LBBB showed in this figure?</p> 浓差极化的Ox-LDL及其对细胞增殖的影响和人类内皮细胞凋亡 12/30/2016//m.lakotalakes.com/jccm/jccm-aid1003.php & lt; h2> ABSTRACT< / h2>& lt; p> & lt; strong>背景:& lt; / strong>Flow-dependent concentration polarization of native LDL is important in the localization of atherogenesis. However, ox-LDL plays a more important role than n-LDL in atherogenesis by inducing cell proliferation and apoptosis. We hypothesized that concentration polarization of ox-LDL may adversely affect vascular beds due to its toxicity to endothelial cell (EC) lining.<br /> <br /> <strong>Methods:</strong> Using a parallel-plate flow chamber technique, we studied water filtration rate and wall concentration of ox-LDLs EC monolayers cultured on permeable or non-permeable membranes. ECs cultured on permeable and non-permeable membranes were examined in terms of cell viability, ox-LDL uptake, LOX-1 expression and cell apoptosis (Cytochrome c and Bcl-2 expression). We observed that the wall concentration of ox-LDL was about 16% higher in the permeable group than in the permeable group (P&lt;0.05). Cell proliferation (MTT assay) increased in response to low concentration of ox-LDL (1-5 &mu;g/ml), and fell drastically in response to higher concentration; all these changes were more pronounced in the permeable group than in the non-permeable group. The uptake of ox-LDL and LOX-1 expression by ECs were also significantly higher in the permeable group than in the non-permeable group of cultured cells.<br /> <br /> <strong>Conclusions:</strong> These observations suggest that concentration polarization of ox-LDL occurs in an artery that is permeable to water, and ox-LDL concentration polarization can enhance ox-LDL accumulation into the arterial wall and accelerate EC proliferation at low concentrations and apoptosis at high concentrations, possibly via LOX-1 expression.</p> Mid-Ventricular膨胀在动脉粥样硬化和冠状动脉左前降枝的种非异常 12/30/2016//m.lakotalakes.com/jccm/jccm-aid1002.php <h2>Letter to Editor</h2> <p>Myocardial coronary bridging [1], encasement [2], and mid-LAD rigid straightening [3-5] appears to be epiphenomenon of takotsubo syndrome [6], rather than causing the disease. Typical takotsubo syndrome usually lasts only a few weeks, but chronic takotsubo cardiomyopathy is reported [7].<br /> <br /> In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case [4]. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography [3]. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents [8].</p> 左心房重构与Reperfused急性心肌梗塞患者的左室重构 12/07/2016//m.lakotalakes.com/jccm/jccm-aid1001.php & lt; h2> ABSTRACT< / h2><p><strong>Background: </strong>Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied.</p> <p><strong>Methods: </strong>We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling.</p> <p><strong>Results: </strong>LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5- 31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariateanalysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001).</p> <p><strong>Conclusions: </strong>Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term reflects better than standard echocardiographic indices LV diastolic filling impairment.</p>