A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.     

Influence of immunohematological markers on severity of in vivo hemolysis in human warm autoimmune haemolytic anemia

Autoantibody production in autoimmune haemolytic anemia (AIHA) is the result of the loss of self-immunological tolerance of the host. Here we investigated the various immunohematological markers that may influence the severity of in vivo hemolysis in warm AIHA (WAIHA). Complete direct antiglobulin test (DAT) evaluation and immunohematological characterization were performed in 247 patients of WAIHA following departmental protocols. Clinical and laboratory details of patients were obtained from patient file. The median age of WAIHA patients was 47 years with a female preponderance. Lymphoproliferative diseases were the major underlying causes of secondary WAIHA. The mean haemoglobin (Hb) and reticulocyte count (Retic) were 6.43 gm/dL and 7.58% respectively. Single autoantibody bound to red cells was investigated in 151 patients. The main IgG subclass was IgG1. Multiple autoantibodies like IgG+ C, IgG+IgA and IgG+IgA+C were found in 87 (35.2%) patients. Free autoantibodies were observed in 112 patients with a median indirect antiglobulin test (IAT) reactivity of 2+. Derangement of haematological and biochemical values was statistically significant with increase in DAT reactivity, presence of multiple autoantibodies on red cells, coating of red cells by IgG3 or multiple IgG subclass, higher DAT dilution and increasing IAT reactivity. We conclude that several important but simple immunohematological parameters may influence the degree of in vivo hemolysis in WAIHA. Since a set of common haematological and biochemical test determines the severity of in vivo hemolysis therefore a comprehensive clinical and immunohematological evaluation is advisable for a correct diagnostic and therapeutic workup of WAIHA.     

Secondary alloanti-D immunization post transfusion of “Asia type” DEL red blood cells

Background“Asia type” DEL red blood cells (RBCs) express a very weak D antigen and cannot be detected by routine RhD typing. Thus, it is routinely typed as D-negative (D–) blood group and transfused to D– recipients. Here we described a case of secondary alloanti-D immunization that was associated with transfusion of DEL RBCs to D– recipients and was initially considered as primary alloanti-D immunization.Case presentationA 44-year-old D– woman (G2P2) with adenomyosis and anemia underwent transabdominal hysterectomy. She received four units of D– RBCs before operation. Before transfusion, the alloantibody screening test was negative. Four days after the first transfusion, she needed another RBC transfusion. Unexpectedly, the routine pre-transfusion alloantibody screening test became positive and anti-D (titer, 128-fold) was identified, indicating an alloanti-D immunization. The anti-D developed four days after the first transfusion was unexplained, so alloantibody identification was performed on the sample collected before the first transfusion, and weak anti-D combined with anti-E, which was not detectable during the previous routine pre-transfusion alloantibody screening test with non-enzyme-treated screening cells, was identified using bromelain-treated panel cells. The remaining blood samples of first transfusion in bag tails from two donors were collected for RHD genotyping analysis. One donor was later identified as “Asia type” DEL having RHD* 1227 A/01 N.01 genotype.ConclusionCaution should be applied when we conclude that transfusion of “Asia type” DEL RBCs to true D– recipients could induce primary alloanti-D immunization, especially if the short time interval between transfusion and detection of anti-D is observed.     

Infantile Hepatic Hemangioendothelioma in Comparison with Hepatoblastoma in Children: Clinical and Ultrasound Features

Background

Infantile hepatic hemangioendothelioma (IHH) and hepatoblastoma (HBL) are respectively the most common benign and malignant liver tumors in children.

Objectives

To study the clinical manifestations and the ultrasound features of the pediatric patients for distinguishing IHH from HBL.

Patients and Methods

Between 2002 and 2012, thirteen children with IHH and 38 children with HBL under the age of 10 years were included. We retrospectively reviewed the clinical and the ultrasound features of the two groups, especially including parameters as follows: age at diagnosis, gender, alpha-fetoprotein (AFP) elevation, venous involvement and Doppler ultrasound.

Results

Compared with HBL group, the age of IHH group was much younger (5.8 months vs. 35.1 months, P = 0.000), the AFP elevation was less likely to be detected in IHH group (23.1% vs. 89.5%, P = 0.000). Although the color flow were the same commonly observed (61.5% vs. 52.6%, P > 0.05), the spectral Doppler showed IHH was less likely to appear as arterial flow with resistance index (RI) > 0.7(12.5% vs. 75.0%, P < 0.05), characterized by arterial flow with RI < 0.7 and/or venous flow. Combined the clinical features including age (< 6 months) and normal AFP level yielded high capability in differential diagnosis, with sensitivity, specificity and Youden index of 77% (10/13), 95% (36/38), and 0.72, respectively. When combined clinical features (age and AFP) and spectral Doppler as the diagnostic criterion for distinguishing these cases with positive color flow signals, the sensitivity, specificity, accuracy and Youden Index were 88%, 95%, 89% and 0.83, respectively.

Conclusions

The clinical features are effective indicators for distinguishing IHH from HBL, and the spectral Doppler may be a useful adjunct parameter for differential diagnosis.     

Reduction of RNA A-to-I editing in Drosophila acclimated to heat shock

Although an increasing number of RNA adenosine-to-inosine (A-to-I) editing sites are being discovered, how the editing frequencies of these sites are modulated to fine-tune protein function in adaptive responses is not well understood. A previous study screening for heat tolerance in Drosophila mutants discovered a hypnos-2 mutant strain that was later found to be defective in dADAR, the Drosophila gene encoding the A-to-I editing enzyme. This supports the hypothesis that cells and organisms respond to stressful environments by ADAR (adenosine deaminase acting on RNA)-mediated RNA editing. Here, we investigated changes in the RNA A-to-I editing frequencies of 30 Drosophila nervous system targets in response to heat shock, a stress acclimatization that requires the dADAR function. To our surprise, most of these nervous system editing targets showed reduced editing. Our results suggest that a change in RNA editing pattern is a mechanism by which organisms acclimate to drastic environmental change. However, how RNA editing confers heat resistance is more complicated and requires further investigation.     

强直性脊柱炎病人早期系统性康复训练

[目的]总结50例强直性脊柱炎病人早期进行系统性康复训练的经验.[方法]对50例病人进行包含运动疗法、健康教育及心理护理的系统性康复训练,并采用强直性脊柱炎疾病活动指数（BASDAI）、强直性脊柱炎功能指数（BASFI）、强直性脊柱炎测量学指数（BASMI）进行训练前后评价.[结果]训练6个月后,病人BASDAI、BASFI、BASMI评分均有改善.[结论]对强直性脊柱炎病人进行早期系统性康复训练能改善病人躯体功能.     

Evidences for the regulation of GnRH and GTH expression by GnIH in the goldfish, Carassius auratus

Gonadotrophin-inhibitory hormone (GnIH) plays an important role in regulating of reproduction in teleosts. To clarify the mode of action of GnIH on the synthesis of gonadotropin releasing hormone (GnRH) and gonadotrophin (GtH), three GnIHR cDNAs were cloned from the goldfish brain. In situ hybridization results showed that GnIHRs were localized to the hypothalamus and pituitary. In the hypothalamus, GnIHRs were found in the NPP, NPO and NLT, whereas sGnRH neurons were reported to be located, and potentially regulated by GnIH. In the pituitary, only two GnIHRs were observed and they were localized to the PI instead of the adenohypophysis where GtH-expressing cells are localized, suggesting indirect regulation of GtH by GnIH. In vivo, intraperitoneal (i.p.) injections of synthetic goldfish GnIH-II peptide and GnIH-III peptide significantly decreased sGnRH and FSHβ mRNA levels. Only GnIH-II decreased LHβ mRNA levels significantly. In vitro, both GnIH-II and GnIH-III showed no effect on GtH synthesis, but an inhibition of GnRH-stimulated LHβ and FSHβ synthesis was observed when GnIH-III was applied to primary pituitary cells in culture. Thus, GnIH could contribute to the regulation of gonadotropin in the brain and pituitary in teleosts.     

单侧全髋关节置换术后患者下肢三维运动力学特征分析

目的:分析单侧全髋关节置换术(THR)恢复期患者平地步行中下肢关节的三维运动学和动力学特征,指导后续和早期康复.方法:采用运动重建实验室检测病例数据库资料分析的方法,选择在本院关节外科行THR后5-10年的患者14例为实验组,14例相匹配的健康人为对照组.采用Vicon Nexus、AMTI检测下肢三维运动学和动力学,应用Polygon分析步态周期中髋、膝、踝关节三维运动学和动力学特征.结果:和对照组右侧下肢比较,术侧髋关节屈曲峰值力矩减小(P＜0.05),膝、踝关节屈曲峰值力矩增大(P＜0.05);峰值角度方面,术侧髋关节内收、内旋、外旋、后伸和膝关节内收以及踝关节内收、外展、内旋、外旋,差异有显著性意义(P＜0.05).术侧和健侧比较无显著性差异(P＞0.05).结论:髋关节置换术后恢复期患者,通过同侧膝关节和踝关节屈曲力矩增加代偿患髋屈曲力矩的降低;同时为防止植入物松动和向外脱位,步行中患髋过度外旋并发踝关节过度内旋.另外,健侧下肢产生了与患侧下肢相似的运动力学变化.     

虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响

摘要 目的：评估亚急性期脑梗死患者虚拟现实同步减重训练（VR+BWSTT）后步态对称性的远期变化及其神经机制。 方法：8例亚急性期脑梗死患者在3周VR+BWSTT前后各做一次三维步态检查及弥散张量成像（DTI）,其中7例患者训练后3个月复查了三维步态和DTI。对以下参数进行前后对比：单腿支撑时间不对称性、步长不对称性、下肢各关节活动范围不对称性、下肢Fugl-Meyer评分、病灶中心的各向异性分数（FA）值、表观扩散系数（ADC）和FA指数（病灶中心FA值/健侧对应区FA值）、ADC指数（病灶中心ADC值/健侧对应区ADC值）。对FA指数、ADC指数与下肢Fugl-Meyer评分做相关性分析。 结果：单腿支撑时间不对称性和下肢Fugl-Meyer评分在训练后改善（P＜0.05）,且持续至训练后3个月。步长不对称性和下肢各关节活动范围不对称性在训练后无改善（P＞0.05）。训练前ADC指数与训练前后下肢Fugl-Meyer评分的变化值有相关性（P＜0.05）。 结论：VR+BWSTT可改善亚急性期脑梗死患者步态的时间不对称性和下肢Fugl-Meyer评分。ADC指数可预测患者下肢运动功能康复潜能。     

口服复方聚乙二醇-4000前吞服比沙可啶对简化CT结肠镜肠道清洁准备的作用

目的 探讨口服复方聚乙二醇-4000前吞服比沙可啶对简化CT结肠镜肠道清洁准备的作用。 方法 将40例接收CT结肠镜检查的患者随机均分成试验组、对照组。 检查前1天,试验组三餐前口服40% W/V硫酸钡20 ml,晚餐后将60%泛影葡胺20 ml溶于250 ml水并服完,口服2 L复方聚乙二醇-4000电解质液之前1 h吞服10 mg比沙可啶肠溶片;对照组不吞服比沙可啶,其余同试验组。统计分析两组结直肠存留肠液评分、存留肠液CT值及存留粪块评分。 结果 试验组存留肠液平均评分(1.50±0.06)低于对照组(1.78±0.08),差异有统计学意义(P=0.024)。试验组、对照组存留肠液平均CT值分别为(729±29)HU、(597±27)HU,差异无统计学意义(P>0.05)。试验组存留粪块评分(1.96±0.11)低于对照组(2.63±0.12),差异有统计学意义(P=0.001)。 结论 口服复方聚乙二醇-4000前吞服比沙可啶既可增强对肠液的清洁能力,又不影响存留肠液CT值,同时可增强对肠道粪块的清洁能力,较单独口服复方聚乙二醇-4000的肠道清洁效果好,是CT结肠镜前较好的简化肠道准备方法。