简介：Rapidexpansionofbig-boxstoreindevelopingcountrycausedtypicalarchetypalchangeinmarketstructure:SuccesstotheSuccessful,becausebig-boxstoresarmedwithmodernizedinfrastructureandmanagementcapabilityareabsorbingtheoncecustomersofthetraditionalmarketlikeablackhole.Facingrapidchangeinmarketstructureandsurmountingpleasfromtraditionalmarketmerchants,governmenttookaninevitableinterventionwithlawregulatingthebig-boxstore’sbusinessandimprovingtraditionalmarket’scompetencebuilding.Notsolong,however,didgovernmentconfrontpolicyresistancefrombothsides:Stillongoingpolarizationofbothside’ssales.Thisstudyarticulatesbehaviorovertimeofmarketstructurewithcausalloopdiagramsofwhichcausalitiesareextractedfromliteratures.Thisstudyprovidessignificantcontributiontopolicymakersandtraditionalmarkets’merchantsinotherdevelopingcountrieslikeIndiaandChina,aswellasKorea.

简介：BackgroundCoronaryslowflow(CSF)duringprimarypercutaneouscoronaryintervention(PCI)iscloselyrelatedtotheprognosisofpatientswithacutemyocardialinfarction(AMI).WhetherEnhancedExternalCounterPulsation(EECP)couldimprovethephenomenonandenhancecardiacfunctioninthesepatientshasnotbeenstudied.MethodsSeventy-eightAMIpatientsundergoingprimaryPCIwereenrolledanddividedinto2groups,EECPgroupandshamgroup.InEECPgroup,thepatientsweretreatedwithEECPfor30minaftercoronaryarterystentimplantation;andinshamgroup,thepatientsaftercoronaryarterystentimplantationweretreatedwithcuffswrappedfor30min.HemodynamicsandcorrectedTIMIFrameCount(cTFC)wererecordedatdifferenttimepointsinbothgroups.CRP,HCY,NT-proBNPandKillipclasswerealsodetectedbeforeoperationandaftertreatment.ResultsInEECPgroup,comparedtopre-andpost-EECPtreatment,thesystolicbloodpressure(SBP)wasmuchlower(P<0.05),diastolicbloodpressure(DBP)andmeanarterialbloodpressure(MBP)weremuchhigher(P<0.05).Theheartrate(HR)wasnotchangedduringEECPtreatment(P>0.05).Inshamgroup,SBP,DBP,MBPandHRwerenotsignificantlychangedduringtheseperiod(P>0.05).InEECPgroup,thecTFCofpatientswithCSFdecreasedsignificantlyaftertreatment(P<0.05);andtherewasnodifferenceinshamgroup(P>0.05).Comparedwithpre-EECPtreatment,CRPandHCYwereincreasedinpost-EECPtreatmentofbothgroups(P<0.05),while,theyweremuchlowerinEECPgroup(P<0.05).TheexpressionofNTproBNPwasdecreasedaftertreatmentinbothgroups(P<0.05),anditwasmuchlowerinEECPgroupthaninshamgroup(P<0.05).TheKillipclasswasmuchloweraftertreatmentthanbeforeoperationinEECPgroup(P<0.05),andtherewasnochangeinshamgroup(P>0.05).ConclusionsTheresultssuggestthatEECPishelpfulinashorttimetotheimprovementofCSFandrecoveryofcardiacfunctioninAMIpatientsduringprimaryPCI,andthatCRPandHCYmaybeinvolvedinthispr

简介：Toinvestigatethebenefitsofintracoronaryhigh-dosetirofibanduringprimarypercutaneouscoronaryintervention(PCI)forpatientswithacuteST-segmentelevationmyocardialinfarction(STEMI).MethodsFifty-eightpatientswithSTEMIpresentedwithin12hofsymptomswererandomlyallocatedtostudygroup(n=28,intracor-onaryhigh-dosetirofiban)andcontrolgroup(n=30,intravenoushigh-dosetirofiban).Theculpritvesselsweretarge-tedwithprimaryPCIinallpatients.Clinicalcharacteristics,angiographicfindings,brainnatriureticpeptide(BNP)at7-dayandin-hospitaloutcomeswerecomparedbetweengroups,aswellasleftventricularejectionfraction(LVEF)andmajoradversecardiacevents(MACE,includingdeath,reinfarction,worseningheartfailureandtargetvesselrevascu-larization)at30-dayclinicalfollow-up.ResultsComparedwiththecontrolgroup,thestudygroupshowedbetterthrombolysisinmyocardialinfarction(TIMI)flowgradesimmediatelyafterPCI(96.4%vs76.7%,P=0.02).The30-daycompositemajoradversecardiaceventsratewaslowerinthestudygroup(3.6%vs23.3%,P=0.02),andtheLVEFandBNPinthestudygroupat7dayswasbetterthanthatinthecontrolgroup(P=0.01and0.02,respec-tively).Nosignificantdifferenceinhemorrhagiccomplicationsinhospitalbetweengroupswasnoted(P=0.61).ConclusionsThestudyindicatesthatintracoronaryhigh-dosebolusadministrationoftirofibanforpatientswithSTEMIwhounderwentprimaryPCIcansignificantlyimprovethereperfusionlevelintheinfarctareaandclinicaloutcomesat30daysfollow-up.Itisbetterandsafertoapplyintravenousbolusinjectionforimprovingcoronaryflow,LVEFandshort-termclinicaloutcomes.

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简介：AbstractBackground:It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the "Heart and Brain Green Channel" app.Results:Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05).Conclusions:This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.

简介：BackgroundCreatinekinase-MB(CK-MB)elevationafterpercutaneouscoronaryintervention(PCI)hasbeenassociatedwithincreasedriskformortality.Althoughmoststudieshavedefinedperiproceduralmyocardialinfarction(pMI)asanelevationinCK-MB>3×upperlimitofnormal(ULN),useofdifferentCK-MBassaysandvariationinsite-specificdefinitionsoftheULNmaylimitthevalueofsuchrelativethresholds.MethodsandResultsWeuseddatafromthemulticenterEvaluationofDrug-ElutingStentsandIschemicEvents(EVENT)registrytoexaminetheimpactofvariationsinsite-specificthresholdsforCK-MBelevationontheincidenceofpMIaswellastherelationshipbetweenabsolutepeaklevelsofCK-MBafterPCIand1-yearmortality.Thestudycohortconsistedof6347patientswhounderwentnonemergentPCIandhadnormalCK-MBatbaseline.Acrossthe59studycenters,theULNforCK-MBrangedfrom2.6to10.4ng/mL(median,5.0ng/mL),andtherewasaninverserelationshipbetweenthesite-specificULNandtheincidenceofpMI(definedasCK-MBelevation>3×ULN).AlthoughanypostprocedureelevationofCK-MBwasassociatedwithanadverseprognosis,incategoricalanalyses,onlyCK-MB≥50ng/mLwasindependentlyassociatedwithincreased1-yearmortality(hazardratio,4.71;95%confidenceinterval,2.42to9.13;P<0.001).SplineanalysisusingpeakCK-MBasacontinuousvariablesuggestedagraded,nonlinearrelationshipwith1-yearmortality,withaninflectionpointat≈30ng/mL.ConclusionsAmongunselectedpatientsundergoingPCI,thereisagradedrelationshipbetweenCK-MBelevationafterPCIand1-yearmortalitythatisparticularlystrongforlargeCK-MBelevations(>30to50ng/mL).FuturestudiesthatincludepMIasaclinicalendpointshouldconsiderusingacorelaboratorytoassessCK-MB(toensureconsistency)andraisingthethresholdfordefiningpMIabovecurrentlevels(toenhanceclinicalrelevance).

简介：摘要：新时代下的大学生往往比过去的大学生拥有更优质的物质生活和更便利的学习条件，但同时也承受着更多的生活压力和学业压力，逐渐表现出不同程度的心理问题，甚至出现了严重的心理危机。本文就大学生心理危机行为的内涵和特征进行了简要分析，总结了大学生心理危机行为产生的具体原因以及在学习和生活中的表现，并提出了有针对性的干预策略，希望有助于更好地解决大学生可能出现的心理问题，减少大学生心理危机行为的出现，引导大学生养成健康的心理状态，帮助他们形成健全的人格和正确的价值观念，让他们逐渐成长为符合时代要求和社会发展的优秀青年。

简介：BackgroundItiswellknownthattherewasasignificantlinkbetweenpreproceduralbloodglucoselevelsandshort-termandlong-termadverseoutcomesinpatientsundergoingelectivePCI.However,theroleofpre-proceduralbloodglucoselevelsasapredictorofadverseeventsinCKDpatientswhounderwentPCIoutofestablisheddiabeteshasyettobeidentified.MethodsInourstudy,weconductedaprospectivestudyof331acutecoronarysyndrome(ACS)patientswithCKDwhounderwentPCIoutofestablisheddiabetes.Patientsweredividedintotwogroupsbasedonpre-proceduralglucoselevels(hypoglycemia<7.0mmol/L;hyperglycemia≥7.0mmol/L).Allpatientswerefollowedupprospectivelyformajoradversecardiovascularevents(MACEs)andmortalityfor6months.ResultsInourcohort,hyperglycemiapatientsreportedahigherincidenceofin-hospitalmortalitythanhypoglycemiapatients(7.5%vs.0%,P<0.001).Hyperglycemiapatientsreportedasignificantlyhigherrateof6-monthMACEs(10%vs.2.4%,P=0.007),allcausemortality(7.5%vs.1.6%,P=0.015),andcardiovascularmortality(6.2%vs1.6%,P=0.041)comparedwithhypoglycemiapatientswithpre-proceduralglucoselevels<7.0mmol/L.Multivariateanalysisdisclosedthatapre-proceduralglucoselevel≥7.0mmol/LwasasignificantindependentpredictorofMACEs(OR=2.53,95%CI1.68-17.15,P=0.004),allcausemortality(OR=4.6,95%CI1.10-18.84,P=0.036),andcardiovascularmortality(OR=6.2,95%CI1.53-24.94,P=0.011)at6monthsinpatientsafterPCI.ConclusionThestudysuggestedthatpre-proceduralglucoselevelsareassociatedwithshort-termcardiovascularoutcomeCKDpatientswhounderwentPCIwithoutestablisheddiabetesinthesettingofACS.

简介：【摘要】目的：研究探讨综合护理干预应用在产妇分娩方式及产后出血中的影响效果。方法：研究随机挑选医院2023年1月-12月收治的100例产妇当作研究对象，并运用抽签法将产妇分成对照组及研究组，对照组实施常规护理，研究组实施综合护理，观察效果。结果：研究组自然分娩率高于对照组，且研究组产后出血量及产后出血发生率低于对照组，P<0.05。结论：综合护理干预可以有效提高产妇自然分娩率，预防产后出血。

简介：摘要：目的：本研究旨在探讨护理干预对CAD合并糖尿病治疗中的作用，实施并推行护理干预模式，开展有效的护理方案。方法:通过收治CAD合并糖尿病患者168例，随机分为观察组和对照组各84例，观察组给予人性化护理，对照组给予一般护理，观察两组的护理效果。结果：对照组并发症明显大于观察组。结论：CAD合并糖尿病患者并发症进行有针对性护理干预，正确有效的控制血糖，它不仅能使患者血糖控制在满意水平还可以有效改善患者血脂水平，提高患者生活质量，也能有效预防各类并发症的出现，减轻病人的身心疼痛，促进病人的身心健康。

简介：BackgroundPriorrandomizedtrialshaveshownreducedbleedingwithbivalirudincomparedwithunfractionatedheparin(UFH)inpatientsundergoingpercutaneouscoronaryintervention(PCI).However,itisnotknownifthisbenefitisalsopresentwhenUFHdosesaremoretightlycontrolled(asmeasuredbyactivatedclot-tingtime,ACT).MethodsandResultsPatientsenrolledintheEVENT(EvaluationofDrug-ElutingStentsandIschemicEvents)registry,weredividedinto3groups,basedontheantithromboticdrugusedduringPCI(UFHmonotherapy,UFH+glycoproteinIIb-IIIareceptorinhibitor[GPI],orbivalirudinalone).Propensityscorematchingwasusedtoadjustformeasuredcovariates(89variables)andtocomparebivalirudinversusUFHmonotherapyandbivalirudinversusUFH+GPIgroups.TheUFHgroupswerestratifiedbasedonACTachieved(optimalACTdefinedas250-300forUFHmonotherapyand200-250whenGPIwasalsoused).Theprimarybleedingoutcomewasin-hospitalcompositebleeding,definedaseventsofaccesssitebleeding,ThrombolysisInMyocardialInfarctionmajor/minorbleeding,ortransfusion.Primary(in-hospitaldeath/myocardialinfarction)andsecondaryischemicoutcomes(death/MI/unplannedrepeatrevascularizationat12months)werealsoevaluated.Propensityscorematchingyielded3022patientsfortheUFHmonotherapyversusbivalirudincomparisonand3520patientsfortheUFH+GPIversusbivalirudincomparison.BivalirudinusewasassociatedwithnumericallylowerbleedingratesatallcategoriesofachievedACTwhencomparedwithUFH(low,optimal,highACT:2.5%versus4.7%,1.9%versus6.0%,3.1%versus4.8%,respectively)orheparin+GPIgroups(low,optimal,highACT:0.0%versus2.7%,2.7%versus5.2%,2.4%versus6.1%,respectively)andwasnotassociatedwithanystatisticallysignificantincreaseineitherprimaryorsecondaryischemicoutcomes.ConclusionsAmongunselectedpatientsundergoingPCI,bivalirudinuseduringPCIwasassociatedwithalowerriskofbleedingatall

简介：Thepresentstudywasdesignedtosynthesize2-Cyano-3,12-dioxooleana-1,9(11)-en-28-oate-13β,28-olide(1),alactonederivativeofoleanolicacid(OA)andevaluateitsanti-inflammatoryactivity.Compound1significantlydiminishednitricoxide(NO)productionanddown-regulatedthemRNAexpressionofiNOS,COX-2,IL-6,IL-1β,andTNF-αinlipopolysaccharide(LPS)-stimulatedRAW264.7cells.FurtherinvivostudiesinmurinemodelofLPS-inducedacutelunginjury(ALI)showedthat1possessedmorepotentprotectiveeffectsthanthewell-knownanti-inflammatorydrugdexamethasonebyinhibitingmyeloperoxidase(MPO)activity,reducingtotalcellsandneutrophils,andsuppressinginflammatorycytokinesexpression,andthusamelioratingthehistopathologicalconditionsoftheinjuredlungtissue.Inconclusion,compound1couldbedevelopedasapromisinganti-inflammatoryagentforinterventionofLPS-inducedALI.