简介：BackgroundPostoperativewoundinfectionwasfrequentlyreportedinpatientsundergoingheartvalvereplacementandcoronaryarterybypasssurgery(CABG)duetomajortrauma,long-termbedrest,malnutritionandcompromisedimmunesystem.Infectedpatientswereusuallyhousedinthesameairborneinfectionisolationrooms.Aseriesofairmonitoringandcontrolstrategiesshouldbestrictlyenforcedtoaimatavoidingairbornefungalcontaminationandachievinghighercurerateininfectedpatients.TheefficacyofAirinspaceplasmairsysteminreducingairbornefungalcontaminationincardiacpostoperativeinfectionwardshasnotbeenclearlydetermined.MethodsAsurveyofaircontaminationwasconductedinthecardiacpostoperativeinfectionwardusingAirinspaceplasmairsystem.Laserparticlecounterwasusedtodeterminetheairborneparticlesof0.3μm?and0.5μm?insize.Airsampleswereincubatedandexaminedforfungaldevelopment.AirborneparticlecountsandfungalloadsofairsamplescollectedbeforeandaftertreatmentwithAirinspaceplasmairsystemwerecompared.ResultsTheparticlecountsin0.3μmrangecollectedbefore(52206<2345)andafter(9408<4317)treatedwithAirinspaceplasmairsystemdifferedsignificantly(P<0.01).Theparticlecountsin0.5μmrangebefore(12995<422)andafter(2016<915)treatmentwithAirinspaceplasmairsystemalsodifferedsignificantly(P<0.01).ThefungalloadsbeforeandafterusingAirinspaceplasmairsystemshowedsignificantdifference[(1975.3<356.1)cfu/m3vs.(193.83<29.5)cfu/m3,P<0.01].ConclusionAirinspaceplasmairsystemusedincardiacpostoperativeinfectionwardshasshownremarkableefficacyinreducingairborneparticlesandfungalcontaminationandhelpespreventcrossinfection.

简介：Permanentpacemakerimplantisacommonlyperformedcardiacprocedurefortreatmentofbradycardiaorconductionsystemabnormality.Withconventionalrightventricular(RV)pacingaleadisimplantedattheRVapexorontheRVseptum.However,RVapicalorRVseptalpacingcausesiatrogenicleftbundle-branchblockandventriculardyssynchronyandcanleadtoadversecardiacremodeling,apacing-mediatedcardiomyopathy,andcongestiveheartfailure.Alternatively,permanentHis-bundlepacingusestheintrinsicrapidly-conductingHis-Purkinjesystemtoactivatetheventricle,therebymaintaining(orsometimesevenrestoring)ventricularsynchrony.ManypatientsmayderivebenefitfrompermanentHis-bundlepacing.

简介：Introduction:Congestiveheartfailure(CHF)accountsforover$32billioninhealthcarecostsperyearandisattheepicenterofhealthcarereform.CHFremainsamajorcauseofhospitalizations.Itisknownandhasbeenreportedthatmisseddiagnosisofandmissedopportunitiestotreatheartfailureareassociatedwithhighermortalityandmorbidity.CHFdiseasemanagementprogramshaveemergedasapotentialsolutiontotheCHFepidemic.TheparadoxremainsthatCHFdiseasemanagementprogramsstillclusterintertiaryhospitalsystems.Theimpactofheartfailurespecialistsandspecialtyteamsincommunityhealthsystemsislesswellunderstood.CurrentlytherearenotenoughCHF-trainedteamsinthecommunitysettingtoaddressthisunmethealthneed.Methods:WeexploredtheimpactofCHFclinicsinacommunity-basedhospitalsystemonreadmissionrates,mortality,andsymptomaticrelief.Atotalof384patientswereenrolledintheclinicbetween2012and2015.Datacollectedincludedage,sex,typeofheartfailure,NewYorkHeartAssociationclass,ejectionfraction,serumcreatinineandbrainnatriureticpeptidevalues,andreadmissionandmortalityrateswithin30days,3months,6months,and1year.WealsocomparedreadmissionratesbetweenpatientswhowerefollowedupintheCHFclinicversusthosewhowerenotseenintheCHFclinic.Results:AstatisticallysignificantdifferencewasdemonstratedinreadmissionratesbetweenpatientswhowerefollowedupintheCHFclinicversusthosewhodidnotvisittheCHFclinicforupto1yearoffollow-up.Conclusion:CHFcommunityhospitalclinicsthatusearapidandfrequentfollow-upformatwithCHF-trainedteamseffectivelyreducerehospitalizationratesupto1year.

简介：ObjectivesToinvestigatetheeffectandmechanismofendovaseularbraehytherapywith^192IronexpressionoftypeIcollagen,metalloproteinases-1(MMP-1)andthetissueinhibitor(TIMP-1)afterangioplasty.MethodsRestenotiemodelofdomesticmieroswinewasemployedandtheiliaearterieswererandomizedtoradiationgroup(n=12),whichweretreatedwith20-25Gyof^192Ir,andnon-radiationgroup(n=36)afterangioplasty.Thetargetvesselswereharvestedintheendof3monthsand6monthsafterangioplasty.Im-munohistochemistryandinsituhybridizationwereusedtodetectproteinsoftypeIcollagen,MMP-1andTIMP-1,andmRNAexpressionoftypeIcollagen.ResultsTheproteinandmRNAoftypeIcollagen,theratiosofTIMP-1/MMP-1weresignificantlylowerinradiationgroupthaninnon-radiationgroup(P<0.05or0.01).ThepeakoftranscriptionoftypeIcollagenmRNAwasat6monthsand3monthsinnon-radiationgroupandradiationgrouprespectively.ConclusionsEndovascularbrachytherapywith^192IrmightmodifythemetabolismofextracellularmatrixafterangioplastybyinhibitingthesynthesisoftypeIcollagenandtheactivitiesofMMP-1andTIMP-1.

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简介：Objective:Therandomizedcontrolledtrial(ClinicalTrials.govidentifierNCT02990741)willinvestigatewhethermorefrequentelectrocardiographic(ECG)recordingsandanalyseswithanautomatedECGsystemwouldimprovedetectionofatrialfibrillationcomparedwithasingleannualECGscreeninelderlyChineseincommunityhealthcenters.Design:Menandwomen(≥65years)willberandomizedintointensive(n=3500)andusual(n=3500)screeninggroups,andwithintheintensivescreeninggroupintointensivescreening(n=2625)andmoreintensivescreening(n=875)subgroups.ECGrecordingswillbeperformedwithanautomatedECGanalysissystem(AliveCorheartmonitor)at1yearintheusualscreeninggroup,at3,6,9,and12monthsintheintensivescreeningsubgroup,andat1,2,3,and4weeksand3,6,9,and12monthsinthemoreintensivescreeningsubgroup.Theprimaryoutcomeisthedetectionrateofatrialfibrillationbetweentheusualscreeninggroupandtheintensivescreeninggroup.Samplesizeestimationwasbasedonaprojecteddetectionrateofatrialfibrillationof2.0%byasingleECGrecordingat12months,animprovementof50%withmorefrequentECGrecordings,α=0.05,powerof80%,andaone-sidedtest.Conclusions:ThetrialwillprovideevidenceontheclinicaleffectivenessofmorefrequentECGrecordingsbyahandheldautomatedanalysissysteminthedetectionofatrialfibrillation.