Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective

Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion.

Methods

Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system.

Results

Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization.

Conclusions

Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.     

A Comparative Study of Sources of Health Information and Access to Preventive Care Among Low Income Chronic Drug Users

Much of health research that examines patterns of health utilization for chronic drug users fails to account for the role of media use and health information seeking. This paper suggests that the nature of drug use is associated with a decreased health orientation that is manifested in media selection and consumption. A comparative analysis was conducted to examine: (1) the differential health perceptions as a function of drug use, (2) the sources of information used, and (3) the relationship between sources of information and primary health care access among chronic users of illicit drugs and socio-demographically similar persons who are not chronic drug users. Results point to both common as well as differential patterns of health information sources. Logistic regression analysis found that medically related sources such as doctors and pamphlets are important sources associated with increased primary care. Important implications are discussed.     

羌医药浸酒外搽配合局部推拿理疗对慢性运动性闭合性软组织损伤康复效果的观察

目的：观察分析羌族民间传统药方浸酒外搽配合局部推拿理疗对慢性运动性闭合性软组织损伤的临床疗效。方法：选取2012年1月至2013年12月因慢性运动性闭合性软组织损伤而就诊的患者共110例,随机分为推拿理疗组、推拿理疗＋内服中药组和推拿理疗＋羌族药方浸酒外搽组。对比三组患者治疗前和治疗2个月后的临床病状积分和运动后各时段酸痛等级,对比三组患者治疗前和治疗2个月后的VAS疼痛评分和Oswestry评分,同时对比三组患者治疗2个月后的临床疗效。结果：三组患者治疗2个月后的各项临床病状积分、运动后各时段酸痛等级、VAS疼痛评分和Oswestry评分均显著低于治疗前,且推拿理疗＋羌族药方浸酒外搽组治疗2个月后的各项临床病状积分、运动后各时段酸痛等级、VAS疼痛评分和Oswestry评分均显著低于其他两组,P〈0.01。推拿理疗＋羌族药方浸酒外搽组治疗2个月后的临床疗效显著优于其他两组,P〈0.05。结论：羌族药方浸酒外搽配合局部推拿理疗可显著改善慢性运动性闭合性软组织损伤患者的临床症状和生活质量,具有良好疗效,值得临床推广。     

谁的意志 谁的利益——传统法视野下法律统治阶级意志论新辨

传统中国君主专制的政治形态下,君主权力几近不受约束,立法者尤其是最高立法者个人之偏见、情感、私利可毫无阻碍地作用于立法活动,法律背离统治阶级整体意志,遂成寻常之事。传统中国法律经常背离统治阶级意志的历史事实说明,法律反映统治阶级意志这一马克思主义法学基本命题,具有实然与应然双重意义,近代以前其意义多为应然,近代以后随着民主政治的建立、完善,其意义则由应然逐渐转为实然。近代民主政治的建立,是法律反映统治阶级意志成为实然之根本前提。     

The Assessment of Oxidative Stress on Patients with Chronic Renal Failure at Different Stages and on Dialysis Patients Receiving Different Hypertensive Treatment

The aim of this study is to evaluate the oxidative stress in predialysis, hemodialysis (HD) and peritoneal dialysis patients and to test the effects of antihypertensive drugs and volume control on oxidative stress parameters. The study was composed of five groups as follows: control group (n = 30), predialysis group (n = 30), peritoneal dialysis group (n = 30), hemodialysis group, (normotensive with strict volume control, n = 30), hemodialysis group (normotensive with medication, n = 30). Plasma malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx) and routine biochemical parameters were studied in all patients. Hemodialysis patients with strict volume control (HD_vc) had lower levels of MDA than other patient groups (p < 0.001), and CAT, SOD values had highest level other patient groups (p < 0.001). The treatment of hypertension with strict volume control in chronic renal failure patients causes less damage to the antioxidant capacity.     

The Uncertainty of the eGFR

The estimated glomerular filtration rate (eGFR) is a parameter derived from the serum creatinine, patient age and gender and is used to ascertain renal function. It is subject to variation because of the analytical error of the creatinine measurement and biological variation. The widespread use of the eGFR to classify renal disease has led to the identification of more patients with marginal chronic kidney disease but because of the uncertainty of the eGFR it has also led to over-diagnosis of some kidney disease. There is a well described age relation with eGFR.The uncertainty of the eGFR at the critical decision level of 60 mL/min/1.73 m² is calculated to be 11. Caution needs to be exercised when interpreting an eGFR between 49 and 71 mL/min/1.73 m².     

Current status of percutaneous coronary intervention of chronic total occlusion

This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%–20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient’s angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.     

针灸治疗慢性踝关节扭伤145例疗效观察

145例患随机分成傍刺温针灸组83例和单一针刺组62例，治疗2个疗程，观察比较2组的疗效。结果显示：傍刺温针灸组的总有效率为98.8％，治愈率80．72％，单一针刺组为88．7％，51．61％，经统计检验，差异显或极显(P＜0．05，P＜0．01)。傍刺温针灸治疗该病的临床疗效优于单一针刺疗法。     

Communicating About Chronic Caregiving in the Workplace: Employees’ Disclosure Preferences,Intentions, and Behaviors

A growing number of Americans are living with chronic health conditions that require informal, ongoing care from family members who are also in the paid labor force. In this exploratory study, communication privacy management is used to make sense of chronic caregiving (N = 48–64) and noncaregiving (N = 174–178) employees’ disclosure preferences, intentions, and behaviors in the workplace. We find that workers in general anticipate that they would disclose to many individuals at work about their caregiving, but employees actually disclose much less information to far fewer people at work when they occupy the chronic caregiver role. For chronic caregivers, positive perceptions about coworker supportiveness predict increased disclosure behaviors. Finally, future research directions as employers, workers, and policy makers prepare for the complex challenges associated with negotiating paid work and unpaid chronic caregiving are provided.