Association between public media and trends in new acute coronary syndrome presentations during the first COVID‑19 wave in the Netherlands

BackgroundWe aimed to evaluate the association between public media and trends in new presentations of acute coronary syndrome (ACS) during the first wave of the coronavirus disease 2019 (COVID‑19) in the Netherlands.MethodsNew ACS presentations per week in 73 hospitals during the first half of 2019 and 2020 were retrieved from the national organisation Dutch Hospital Data and incidence rates were calculated. Stratified analyses were performed by region, type of ACS and patient characteristics.ResultsAfter the first confirmed COVID‑19 case and during lockdown, numbers declined by up to 41% (95% confidence interval (CI): 36–47%) compared to 2019. This reduction was more pronounced for non-ST-segment elevation myocardial infarction (NSTEMI) (48%; 95% CI: 39–55%) and unstable angina (UA; 50%; 95% CI: 40–59%) than for STEMI (34%; 95% CI: 23–43%). There was no association between ACS and COVID‑19 incidence rate per region. After the steep decline, a public campaign encouraged patients not to postpone hospital visits. Numbers then increased, without a rebound effect. Trends were similar irrespective of sex, age or socio-economic status. During the outbreak, compared to coronary artery bypass graft procedures, relatively more (acute) percutaneous coronary interventions for NSTEMI and UA were performed.ConclusionNew ACS presentations decreased by up to 41%. Lockdown measures and public campaigns, rather than COVID‑19 incidence, were associated with significant changes in new ACS presentations. Even though causality cannot be established, this emphasises the role of the public media and healthcare organisations in informing patients to prevent underdiagnoses of ACS and associated health damage.Supplementary InformationThe online version of this article (10.1007/s12471-021-01603-5) contains supplementary material, which is available to authorized users.     

Modeling diseases of noncoding unstable repeat expansions using mutant pluripotent stem cells

Pathogenic mutations involving DNA repeat expansions are responsible for over 20 different neuronal and neuromuscular diseases. All result from expanded tracts of repetitive DNA sequences (mostly microsatellites) that become unstable beyond a critical length when transmitted across generations. Nearly all are inherited as autosomal dominant conditions and are typically associated with anticipation. Pathologic unstable repeat expansions can be classified according to their length, repeat sequence, gene location and underlying pathologic mechanisms. This review summarizes the current contribution of mutant pluripotent stem cells (diseased human embryonic stem cells and patient-derived induced pluripotent stem cells) to the research of unstable repeat pathologies by focusing on particularly large unstable noncoding expansions. Among this class of disorders are Fragile X syndrome and Fragile X-associated tremor/ataxia syndrome, myotonic dystrophy type 1 and myotonic dystrophy type 2, Friedreich ataxia and C9 related amyotrophic lateral sclerosis and/or frontotemporal dementia, Facioscapulohumeral Muscular Dystrophy and potentially more. Common features that are typical to this subclass of conditions are RNA toxic gain-of-function, epigenetic loss-of-function, toxic repeat-associated non-ATG translation and somatic instability. For each mechanism we summarize the currently available stem cell based models, highlight how they contributed to better understanding of the related mechanism, and discuss how they may be utilized in future investigations.     

Alternative (un)stable states in a stochastic predator–prey model

Stochastic models sometimes behave qualitatively differently from their deterministic analogues. We explore the implications of this in ecosystems that shift suddenly from one state to another. This phenomenon is usually studied through deterministic models with multiple stable equilibria under a single set of conditions, with stability defined through linear stability analysis. However, in stochastic systems, some unstable states can trap stochastic dynamics for long intervals, essentially masquerading as additional stable states. Using a predator–prey model, we demonstrate that this effect is sufficient to make a stochastic system with one stable state exhibit the same characteristics as an analogous system with alternative stable states. Although this result is surprising with respect to how stability is defined by standard analyses, we show that it is well-anticipated by an alternative approach based on the system's “quasi-potential.” Broadly, understanding the risk of sudden state shifts will require a more holistic understanding of stability in stochastic systems.     

氨氯地平、比索洛尔对高血压合并心绞痛患者CAP及IMT 的影响

目的:比较氨氯地平、比索洛尔对高血压合并心绞痛患者中心动脉压(central artery pressure,CAP)及颈动脉内中膜厚度(intima-media thickness,IMT)的影响。方法:选择我院2013年8月-2014年9月收治的高血压合并心绞痛患者76例,随机分为观察组和对照组,各38例。观察组给予氨氯地平5 mg/d,对照组给予比索洛尔2.5 mg/d,疗程均为1年。测定并对比两组治疗前后血压、CAP、IMT变化情况以及心绞痛的治疗效果。结果:观察组治疗后CAP收缩压、舒张压、IMT分别为(130.36±5.09)mm Hg、(73.38±5.76)mm Hg、(0.89±0.08)mm,均明显低于对照组的(144.82±6.54)mm Hg、(84.89±6.14)mm Hg、(1.01±0.12)mm,差异均有统计学意义(P0.05)。观察组治疗总有效率为89.47%,高于对照组的76.32%,但差异无统计学意义(P0.05)。结论:氨氯地平与比索洛尔治疗高血压合并心绞痛的临床疗效相当,但氨氯地平在降低高血压合并心绞痛患者CAP、IMT方面的效果优于比索洛尔。     

Population dynamics of houseflies,Musca domestica,on experimentally accumulated refuse

The population dynamics of the housefly, Musca domestica, on patchy and unstable habitats consisting of refuse was investigated at a waste disposal site by using sticky flypaper and mark-release-recapture technique (Jolly-Seber 's method). The newly disposed garbage was favorable for breeding of the flies for about one month after being disposed, while a mixture of garbage and ash from incinerated refuse was less favorable. On the garbage under favorable conditions, the rates of population increase was 1.25–2.82 per day, and approximately 1300–1500 flies were produced per square meter within the available period of one month. The rapid decrease in the fly density was observed just after the appearance of high density peaks. The mark-release-recapture study suggested that this rapid decrease would be mainly due to the density-dependent emigration of adult flies from the patchy habitats. The emigration was also activated when the time after garbage disposition became long.     

T型锁定接骨板治疗老年桡骨远端不稳定性骨折的临床疗效

目的:探讨老年桡骨远端不稳定性骨折采用桡骨远端T型锁定接骨板治疗的临床疗效及安全性。方法:选择2013年7月-2015年4月在我院接受治疗的老年桡骨远端不稳定性骨折患者80例,根据手术方式不同分为观察组和对照组。观察组患者采用桡骨远端T型锁定接骨板治疗,对照组采用外固定支架治疗。观察并比较两组患者的临床疗效及手术安全性。结果:观察组骨性愈合时间少于对照组,掌倾角及尺偏角大于对照组,差异有统计学意义(P0.05)。观察组治疗后腕关节功能优于对照组,差异有统计学意义(P0.048)。观察组患者腕关节慢性疼痛、骨折感染的发生率低于对照组,差异有统计学意义(P0.05)。结论:桡骨远端T型锁定接骨板治疗老年桡骨远端不稳定性骨折具有复位效果好、创伤小且安全性高的特点,有一定的临床推广价值。     

实验性神经起步点的不规则节律中的非稳定周期轨道

在大鼠坐骨神经结扎模型中,记录到放电节律以周期加方式相互转化,在确认了周期二与周期三之间的不规则节律具有混性质后,借助峰峰间期序列的回归映象方法,使用了一种测度增强算法,确认了此混沌放电中的非稳定周期轨道结构,提示出非稳定周期轨道在神经不规则放电节律的动力学之中起着重要作用。     

Characteristics of circulating CD31+ cells from patients with coronary artery disease

Recently, we reported the properties of CD31‐expressing cells in healthy individuals. However, the characteristics of CD31‐expressing cells derived from coronary artery disease (CAD) patients remain unknown. This study aimed to investigate the relationship between circulating CD31⁺ cells and CAD as well as their biological characteristics. Analysis with flow cytometry revealed that CD31⁺ cells (C‐CD31) from the peripheral blood (PB) of CAD patients exhibited low levels of T‐cell marker and high levels of macrophage marker compared with the PB‐CD31⁺ cells from healthy individuals (H‐CD31). In addition, the expression levels of multiple pro‐angiogenic and chemokine genes were significantly down‐regulated in C‐CD31. However, inflammatory gene IL‐1α was highly up‐regulated in C‐CD31. Patients with unstable angina (UA) had significantly more CD31⁺ cells in the PB than healthy control group (P < 0.001). Moreover, there were significant correlations between the number of CD31⁺ cells and cardiovascular (CV) disease activity (R = 0.318, P = 0.006) and the number of diseased coronaries (R = 0.312, P = 0.005). For the diagnostic category of UA, the area under curve was 0.803 (P < 0.001). In conclusion, C‐CD31 have impaired angiogenic potential and the number of circulating CD31⁺ cells were correlated with CV risk. These findings may contribute to the understanding of the pathogenesis of CAD.     

曲美他嗪与稳心颗粒联合治疗不稳定性心绞痛疗效观察

目的:探讨曲美他嗪与稳心颗粒联合治疗不稳定性心绞痛临床疗效。方法:选取我院2011年6月-2012年6月不稳定性心绞痛患者150例,随机分为治疗组和对照组。对照组仅给予曲美他嗪治疗;治疗组给予曲美他嗪与稳心颗粒联合治疗。观察两组临床疗效、治疗前后心绞痛持续时间及发作次数、心电图改善情况及不良反应。结果:治疗组总有效率为86.8%,对照组总有效率为49.3%,两组疗效比较,差异具有统计学意义(P0.05);治疗组心电图总有效率为89.33%,对照组总有效率为72.00%,两组疗效比较,差异具有统计学意义(P0.05);治疗组心绞痛发作次数、持续时间、血液流变学指标较治疗前有显著下降(P0.05),较对照组有明显差异(P0.05)。两组患者治疗期间尿常规、血常规、肾功能、肝功能及电解质均未见明显变化,且两组患者不良反应差异无统计学意义(P0.05)。结论:曲美他嗪与稳心颗粒联合治疗不稳定性心绞痛临床疗效确切,具有很大临床意义。     

锁定型gamma钉与普通型gamma钉、动力髋螺钉治疗不稳定性股骨粗隆间骨折的 临床疗效比较

目的:比较锁定型γ钉(Locking Gamma Nail,LGN)、普通型γ钉(Traditional Gamma Nail,TGN)和动力髋螺钉(Dynamic Hip Screw,DHS)治疗不稳定性股骨粗隆间骨折的临床疗效和安全性。方法:选择2009年1月至2011年1月在我院分别接受锁定型γ钉(A组)、普通型γ钉(B组)和动力髋(C组)内固定治疗的随访资料完整的患者共92例。记录和比较三组患者的手术时间、术中出血量、骨折愈合时间及末次髋关节功能评分等相关数据。结果:A组、B组和C组的手术时间、术中出血比较有统计学差异(均P<0.01),但A、B组之间无明显统计学差异;A组和B组、C组的骨折愈合时间、髋关节功能评分比较差异均有统计学意义(均P<0.01),B、C组之间无明显统计学意义。结论:LGN的固定效果和生物力学性能良好,操作简便,固定牢固,整体治疗效果优于TGN和DHS,可作为临床治疗不稳定性股骨粗隆间骨折的首选。