Objective To analyze the preoperative risk factors of atrial fibrillation (AF) in patients with coronary artery disease after coronary artery bypass grafting (CABG). Methods From September 2007 to April 2008, the clinical information of 226 patients who underwent onpump coronary artery bypass grafting(CABG)or offpump coronary artery bypass grafting(OPCAB) was collected. The patients were divided into nonAF group and AF group according to whether AF lasted more than 5 mins in 3 days after operation. Ultrasonic cardiography (UCG) and clinical information of preoperation in two groups were analyzed. Results Twentyfour（10.6%） patients had AF after operation. There were more patients whose left atrial diameter gt;35 mm in AF group than that in nonAF group ［41.7%（10）vs. 22.3% (45),χ2=4.380, P=0.036）］, more patients had mitral regurgitation in AF group than that in nonAF group ［37.5%（9） vs. 17.3% (35),χ2=5.568, P=0.018）］, more patients had left main coronary artery involvement in AF group than that in nonAF group ［33.3% (8) vs.12.4% (25),χ2=7.560,P=0.006］, and patients in AF group were older than those in nonAF group ［65.7±9.5 years vs. 60.1±10.1 years,t=-2.724,P=0.010］. In univariate analysis, in terms of preoperative clinical indexs such as the aged, mitral regurgitation, left atrial diameter, left mainm coronary artery involvement, and postoperative clinical indexs such as ventilatory time （χ2=4.190，P=0.040）, electrocardiogram (ECG) monitoring time（χ2=5.948，P=0.015）, hospitalization expense（χ2=4.110，P=0.043）, there were significant differences between 2 groups. Conclusion Risk factors such as the aged, mitral regurgitation, left atrial diameter and left main coronary artery involvement are related to AF after CABG. Clinical index, ECG and echocardiography are helpful to predict AF, and can provide better prevention and treatment, and reduce the rate of AF.
ObjectiveTo analyze the efficacy, hospitalization cost and cost-effect of different treatments for multiple myeloma, so as to provide references for the treatment and development medical insurance payment policy of multiple myeloma.MethodsA total of 60 cases of multiple myeloma patients who were treated in the General Hospital of Shenyang Military Command from January 1st, 2013 to December 31st, 2017 were included. According to the treatment method, they were categorized into the traditional treatment group (n=37) and novel drug treatment group (n=23). The total response rate and hospitalisation expenses for patients with medical insurance of the two groups were calculated and compared, and cost-effectiveness analysis was then performed.ResultsThe overall response rate in patients in traditional treatment group was 56.76% (21/37), and in novel drug treatment group was 82.61% (19/23) (χ2=4.366, P=0.039). The annual average drug fee, annual average novel drug fee, secondary average drug fee, secondary average novel drug fee, annual average total cost, and secondary average total cost of the medical insurance patients in the novel drug treatment group were significantly higher than those in the traditional treatment group (P<0.05). The annual average cost of personal and coordinated payment for the medical insurance patients in the novel drug treatment group were 172 229.53 yuan and 48 237.51 yuan, respectively, which were significantly higher than the traditional treatment group (P<0.01). The cost-effectiveness ratio of the traditional treatment group was 884.44 yuan/%, the novel drug treatment group was 2 821.80 yuan/%, the cost-effective incremental ratio was 7 075.75 yuan/%, the incremental cost-effective ratio was 7 075.75 yuan/%, and the sensitivity analysis was consistent with the results.ConclusionsThe total response rate of novel drug treatment is significantly higher than traditional treatment. However, novel drug treatment costs higher, and patient's economic burden is also higher. The traditional treatment is superior to novel drug treatment in cost-effectiveness analysis.
ObjectiveTo provide experimental data and theoretical support for further studying the maturity of cardiac patches in other in vitro experiments and the safety in other in vivo animal experiments, through standard chemically defined and small molecule-based induction protocol (CDM3) for promoting the differentiation of human induced pluripotent stem cells (hiPSCs) into myocardium, and preliminarily preparing cardiac patches. MethodsAfter resuscitation, culture and identification of hiPSCs, they were inoculated on the matrigel-coated polycaprolactone (PCL). After 24 hours, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and the stemness of hiPSCs was identified by OCT4 fluorescence. After fixation, electron microscope scanning was performed to observe the cell morphology on the surface of the patch. On the 1st, 3rd, 5th, and 7th days of culture, the cell viability was determined by CCK-8 method, and the growth curve was drawn to observe the cell growth and proliferation. After co-cultured with matrigel-coated PCL for 24 hours, hiPSCs were divided into a control group and a CDM3 group, and continued to culture for 6 days. On the 8th day, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and hiPSCs stemness was identified by OCT4 fluorescence, and cTnT and α-actin for cardiomyocyte marker identification. ResultsImmunofluorescence of hiPSCs co-cultured with matrigel-coated PCL for 24 hours showed that OCT4 emitted green fluorescence, and hiPSCs remained stemness on matrigel-coated PCL scaffolds. DAPI emitted blue fluorescence: cells grew clonally with uniform cell morphology. Scanning electron microscope showed that hiPSCs adhered and grew on matrigel-coated PCL, the cell outline was clearly visible, and the morphology was normal. The cell viability assay by CCK-8 method showed that hiPSCs proliferated and grew on PCL scaffolds coated with matrigel. After 6 days of culture in the control group and the CDM3 group, immunofluorescence showed that the hiPSCs in the control group highly expressed the stem cell stemness marker OCT4, but did not express the cardiac markers cTnT and α-actin. The CDM3 group obviously expressed the cardiac markers cTnT and α-actin, but did not express the stem cell stemness marker OCT4. ConclusionhiPSCs can proliferate and grow on matrigel-coated PCL. Under the influence of CDM3, hiPSCs can be differentiated into cardiomyocyte-like cells, and the preliminary preparation of cardiac patch can provide a better treatment method for further clinical treatment of cardiac infarction.