Ying-g Shen

Diagnostic performance of mean platelet volume for patients with acute coronary syndrome visiting an emergency department with acute chest pain: the Chinese scenario

Objectives To assess the ability of mean platelet volume (MPV) to detect acute coronary syndromes (ACS) in Chinese patients within 4 h of chest pain onset. Methods Consecutive adult Chinese patients who arrived at an emergency department (ED) with acute chest pain (onset within 4 h) between May and August 2009 were recruited. The MPV was checked for all enrolled patients on arrival at the ED, and further comparisons between the patients in different groups were made. Results 282 patients (136 men and 146 women) were enrolled and 69 were diagnosed as having ACS (24.5%). As compared with the non-ACS group, the ACS group had significantly higher MPV values (10.8±0.86 fl vs 9.8±0.76 fl, p<0.001). Moreover, we found that the MPV values were higher in patients with acute myocardial infarction (AMI) (n=28) as compared with patients with unstable angina (UA) (n=41) (11.0±0.79 fl vs 10.6±0.87 fl, p=0.027). Multiple logistic regression analysis yielded the fact that the initial MPV was an independent predictor of ACS attack in patients with acute chest pain (OR 8.866). The corresponding area under the receiver operating characteristic curve (ROC) for MPV in predicting ACS in patients with acute chest pain was 0.800 (95% CI 0.736 to 0.864) and the best cut-off value was 10.35 fl (sensitivity 78.3%; specificity 74.6%). Conclusions MPV is significantly associated with ACS in patients with acute chest pain and is an early and independent predictor.

Postresuscitation autonomic nervous modulation after cardiac arrest resembles that of severe sepsis

INTRODUCTION This study explored whether post-resuscitation status resembles severe sepsis in terms of autonomic nervous modulation by using heart rate variability (HRV) analysis. METHODS Successfully resuscitated nontraumatic out-of-hospital cardiac arrest (OHCA) adult patients in an emergency department were prospectively enrolled as the study group. Age- and sex-matched patients with severe sepsis with and without mechanical ventilation were included as positive controls, while sepsis patients and healthy volunteers were included as negative controls. The HRV measures obtained from 10-minute electrocardiogram were compared among 5 groups of subjects. RESULTS Sixty-four successfully resuscitated OHCA patients were studied. There were no significant differences in all HRV measures (standard deviation of R-R intervals [SD(RR)], coefficient of variation of R-R intervals [CV(RR)], total power [TP], very-low-frequency component [VLF], low-frequency component [LF], high-frequency component [HF], normalized LF [LF%], normalized HF [HF%], and LF/HF) among the successfully resuscitated OHCA patients and severe sepsis patients with and without mechanical ventilation. Also, no significant differences in all HRV measures were found between nonsurvivors of OHCA group and nonsurvivors of severe sepsis group. In the nonsurvivors of OHCA group and severe sepsis group, the LF% and LF/HF were significantly lower, whereas the HF and HF% were significantly higher, as compared with the survivors of these 2 groups. CONCLUSIONS The autonomic nervous modulation in the initial phase of OHCA patients resembles that of severe sepsis in that both groups of patients have decreased global HRV (TP, SD(RR), and CV(RR)), sympathovagal balance (LF% and LF/HF), and renin-angiotensin-aldosterone modulation (VLF), as compared to healthy subjects.

Circadian variation of acute myocardial infarction in young people

AIMS The aim was to investigate the circadian and weekly variation in Chinese young patients with acute myocardial infarction (AMI). METHODS This was a 10-year retrospective cohort study. We studied patients (>18 to <45 years of age) with a first attack of AMI from the emergency departments of 3 university teaching hospitals in Taiwan from January 1, 2001, to December 31, 2010. We analyzed patients in the standard circadian fashion using 6-hour intervals (00:01-06:00, 06:01-12:00, 12:01-18:00, and 18:01-24:00). We also did an analysis by day of week. RESULTS The database had 505 patients with AMI with complete data. The percentage of total AMIs that occurred in the 6-hour intervals were as follows: 00:01 to 06:00, 30.9%; 06:01 to 12:00, 23.4%; 12:01 to 18:00, 25.9%; and 18:01 to 24:00, 19.8%. The percentage of AMIs between 00:01 and 06:00 was significant higher compared with that in the other three 6-hour intervals (df = 3, χ(2) = 91.7, P < .001). However, there was no significant weekly variation for these patients in the present study. CONCLUSIONS There was a significant circadian variation with a peak from 00:01 to 06:00 in Chinese young patients with AMI. However, there was no significant weekly variation in these patients. The circadian periodicity may create new possibilities for disease prevention and medication prescription.

Initial salivary α-amylase activity predicts malignant ventricular arrhythmias and short-term prognosis after ST-segment elevation myocardial infarction

Background Ventricular arrhythmias (VA), including ventricular tachycardia and ventricular fibrillation, are the most common remediable cause of death in patients with acute myocardial infarction. Augmented sympathetic neural activity to the heart and myocardial catecholamine release may be the primary factors in the generation of VA. The aim of this study was to assess the predictive value of salivary α-amylase (sAA) activity, an indicator of sympathetic activity, for malignant VA occurrence and for short-term outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods Patients with STEMI (n=91) were recruited from the Emergency Department during the period 1 December 2008 to 31 April 2010. Correlations of initial sAA activity at presentation with VA, as well as 1-month prognosis were analysed. Results sAA activity was significantly increased in the VA group (395±173.7; n=9) as compared with the non-VA group (283±89.3; n=82) (p=0.014). The adjusted OR for malignant ventricular arrhythmia occurrence was 1.010 (95% CI 1.001 to 1.018). Eight patients (8.8%) died and 24 (26.4%) had at least one short-term adverse event within the first month after STEMI. Simple logistic regression analysis showed that sAA is an independent predictor for short-term prognosis (p=0.049, OR 1.005, 95% CI 1.000 to 1.009). Conclusions Although a prospective study with a large cohort is required, the present results suggest that high initial sAA activity is associated with increased risk of malignant VA and predicts short-term prognosis in patients with STEMI.

Painless acute aortic dissection presenting as intermittent syncope

Syncope is commonly encountered in emergency department patients. The causes are numerous and include certain life-threatening illnesses that must be rapidly considered and excluded from the differential diagnosis. This article reports on a case of a painless acute aortic dissection and having collapsed 3 times within 1 day. The rupture of the patients proximal dissection (ascending aorta) into the pericardial space with low cardiac output may have lead to his intermittent syncope (especial during postural change). This patient underwent immediate surgery and, ultimately, had a successful outcome. A 57-year-old previously healthy man was presented urgently by emergency medical services vehicle to our emergency department (ED), having collapsed 3 times within 1 day. Witnesses to the first event said that he had been perfectly well until he complained of feeling mild chest tightness and then abruptly lost consciousness for 1 minute. About 3 hours later, he had a second episode of syncope without any cardiac symptoms. About 8 hours after first episode, he had a third syncopal episode while standing up. When the paramedics arrived at the scene, he was conscious but his blood pressure could not be measured. On arrival in the ED, his blood pressure was 76/47 mm Hg in the right arm, his heart rate was 78 beats per minute, and his respiratory rate was 19 breaths per minute. He was afebrile and conscious but slightly irritable and diaphoretic. He denied any pain or discomfort. Physical examination revealed prominent jugular veins and distant heart sounds. Auscultation indicated the chest was clear, with equal breath sounds. Abdominal and neurologic examinations were unremarkable. An electrocardiogram showed a normal sinus rhythm and no ST-segment abnormalities. The anteroposterior supine x-ray of the chest showed enlarged mediastinal and cardiac silhouettes, but the lung fields were clear (Fig. 1). Computed tomography of the chest showed an acute aortic dissection (AAD) (Stanford type A, DeBakey type 1) with pericardial effusion and left renal 0735-6757/

Sarcoidosis with Bilateral Epididymal Involvement Leading to Oligo-Asthenospermia

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Diagnostic Performance of Initial Salivary Alpha-Amylase Activity for Acute Myocardial Infarction in Patients with Acute Chest Pain

Sarcoidosis is a multisystemic, chronic granulomatous disorder. The incidence of urogenital system involvement is 0.2% in clinically diagnosed cases and 5% in autopsy cases. We report a rare case of pulmonary sarcoidosis with bilateral epididymal involvement leading to oligo-asthenospermia. A 20-yearold man presented with bilateral epididymal swelling for two weeks. Chest radiography and computed tomography (CT) showed multiple ill-defined nodules in the bilateral lung fields with mediastinal and hilar lymphadenopathies. Pathology confirmed the diagnosis of sarcoidosis. Presnisolone 40 mg daily was administered orally. After ten days of therapy, chest radiography revealed resolution of the nodular lesions and the bilateral epididymal enlargement subsided.