The Survey of Birth Defects Rate Based on Birth Registration System

Background:To investigate the surveillance trend of birth defects,incidence,distribution,occurrence regularity,and their relevant factors in Xi'an City in the last 10 years for proposing control measur...     

High Killips Class as a Predictor of New-onset Atrial Fibrillation Following Acute Myocardial Infarction: Systematic Review and Meta-analysis

Background:Recent observational studies have shown that patients with higher Killips score (＞Ⅰ) have higher risk of new-onset atrial fibrillation (NOAF) following acute myocardial infarction (AMI),whil...     

A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction

Background:Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address ...     

Effect of Aldehyde Dehydrogenase 2 Gene Polymorphism on Hemodynamics After Nitroglycerin Intervention in Northern Chinese Han Population

Background:Nitroglycerin (NTG) is one of the few immediate treatments for acute angina.Aldehyde dehydrogenase 2 (ALDH2) is a key enzyme in the human body that facilitates the biological metabolism of N...     

Effects of comorbidity and hospital care on 6-month mortality in patients with elevated cardiac troponin T

Objective

To examine the effects of comorbidity and hospital care on mortality in patients with elevated cardiac troponin T.

Design

Observational study.

Setting

A large university hospital with on‐site diagnostic cardiac catheter laboratory.

Patients

All hospitalised patients with elevated cardiac troponin T level (⩾0.01 μg/l) over an 8‐week period.

Main outcome measures

6‐month all‐cause mortality.

Results

Among 313 patients with elevated cardiac troponin T, 195 had acute coronary syndrome and 118 had other conditions. Multivariate analysis showed that among patients with acute coronary syndrome, increasing comorbidity score (odds ratio (OR) 1.23 per point increase, 95% confidence interval (CI) 1.00 to 1.51; p = 0.048), age (OR 1.08 per year, 95% CI 1.04 to 1.13; p<0.001), raised troponin T level (OR 2.22 per 10‐fold increase, 95% CI 1.27 to 3.89; p = 0.005), and ST depression (OR 3.12, 95% CI 1.38 to 7.03; p = 0.006) were independent adverse predictors, while cardiologist care (OR 0.22, 95% CI 0.09 to 0.51; p<0.001) was associated with a better survival. Increasing troponin T level (OR 3.33 per 10‐fold increase, 95% CI 1.24 to 8.91; p = 0.017) was found to predict a worse prognosis among patients without acute coronary syndrome, and cardiologist care did not affect outcome in this group. Among hospital survivors with acute coronary syndrome, increasing comorbidity score, age and a lack of cardiologist care were independently associated with lesser use of effective medications.

Conclusions

Comorbidity was associated with a higher 6‐month mortality in patients having acute coronary syndrome, and lesser use of effective medicines among hospital survivors. Cardiologist care was associated with better 6‐month survival in patients with acute coronary syndrome, but not in those without acute coronary syndrome.Prognostic indices including the original Charlson''s comorbidity index¹ have shown that comorbidity was important in determining the short and long term outcome in patients with various medical conditions, including those with acute myocardial infarction.^2,3,4,5 Among patients admitted to hospital with suspected acute coronary syndrome, an abnormally raised cardiac troponin level can be found in patients with, and also without, acute coronary syndrome.^6,7 An increasing cardiac troponin level was associated with increasing mortality in patients with acute coronary syndrome,⁸ and also those without acute coronary syndrome.⁹ Despite the availability of international management guidelines, care provided for patients with acute coronary syndrome varied in hospitals with or without interventional facilities, and was affected by whether patients received cardiologist care.¹⁰ We examine the effects of comorbid diseases, including a validated comorbidity index,¹¹ and hospital care on the 6‐month outcome among patients with elevated cardiac troponin T, caused by acute coronary syndrome and other conditions.     

Clinical Study of 224 Patients with Hypertriglyceridemia Pancreatitis

Background:Hypertriglyceridenia (HTG) is the most common etiology of acute pancreatitis (AP) after alcohol and gallstone-induced disease.Elevation of serum triglyceride (TG) levels to ≥ 1000 mg/dl in a...     

Association between Tourette Syndrome and the Dopamine D3 Receptor Gene Rs6280

Background:

Tourette syndrome (TS) is a complex, heterozygous genetic disorder. The number of molecular genetic studies have investigated several candidate genes, particularly those implicated in the dopamine system. The dopamine D3 receptor (DRD3) gene has been considered as a candidate gene in TS. There was not any report about the association study of TS and DRD3 gene in Han Chinese population. We combined a case–control genetic association analysis and nuclear pedigrees transmission disequilibrium test (TDT) analysis to investigate the association between DRD3 gene rs6280 single nucleotide polymorphisms (SNPs) and TS in a Han Chinese population.

Methods:

A total of 160 TS patients was diagnosed by the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The DRD3 gene rs6280 SNPs were genotyped by TaqMan SNP genotyping assay technique in all subjects. We used a case–control genetic association analysis to compare the difference in genotype and allele frequencies between 160 TS patients and 90 healthy controls. At the same time, we used TDT analysis to identify the DRD3 gene rs6280 transmission disequilibrium among 101 nuclear pedigrees.

Results:

The genotype and allele frequency of DRD3 gene rs6280 SNPs had no statistical difference between control group (90) and TS group (160) (χ² = 3.647, P = 0.161; χ² = 0.643, P = 0.423) using Chi-squared test. At the basis of the 101 nuclear pedigrees, TDT analysis showed no transmission disequilibrium of DRD3 gene rs6280 SNPs (χ² = 0; P = 1).

Conclusions:

Our findings provide no evidence for an association between DRD3 gene rs6280 and TS in the Han Chinese population.     

Effect of Glutamine Enriched Nutrition Support on Surgical Patients with Gastrointestinal Tumor: A Meta-Analysis of Randomized Controlled Trials

Background:Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy.The purpose of this meta-analysis was to assess the ...     

Use of Platelet Indices for Determining Illness Severity and Predicting Prognosis in Critically Ⅲ Patients

Background:Decreased platelet (PLT) count is one of the independent risk factors for mortality in intensive care unit (ICU) patients.This study was to investigate the relationship between PLT indices a...     

Fractional Flow Reserve Guided Percutaneous Coronary Intervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice

Background:Fractional flow reserve (FFR) is currently considered as the gold standard for evaluating the functional significance of coronary stenosis.However,its potential benefits in real-world practi...     

山羊冠状动脉的观测

The coronary arteries of 50 goats were studied by means of angiography and dissection. The results were as follows: The right coronary artery (RCA) and left coronary artery (LCA) arose from the right and left aortic sinuses respectively. At the beginning, the average external diameter of RCA (2.98 +/- 1.02 mm) was smaller than that of LCA (3.42 +/- 0.74 mm). An independent inter ventricular septal artery (in 94%) supplied the upper two-thirds of the inter ventricular septum. The arterial distributive types were divided into three: The LCA was dominant in 96%, symmetrical in 4%, RCA dominant in 0%. Sixty two percent of the S-A node arteries arose from the RCA, 28% from LCA, 10% from both RCA and LCA. All the A-V node arteries originated from the LCA.     

ESR1基因多态性与新疆胆石症相关性研究

目的 探讨雌激素受体1（estrogen receptor 1, ESR1）基因rs35396879多态性位点基因型与新疆维吾尔族、汉族胆石症之间的关系。方法 采用病例-对照研究方法,收集胆石症患者维吾尔族 87 例、汉族54例; 正常对照组维吾尔族56例,汉族45例,检测及比较其一般临床特征指标。同时采集外周静脉血,提取基因组DNA,运用Sequenom MassARRAY 单核苷酸多态性（SNP）基因型分析技术定量检测ESR1基因rs35396879 位点基因分型,分析基因型分布在维吾尔族、汉族胆石症组和健康对照组间的差异。结果 维吾尔族胆石症组低密度脂蛋白LDL显著高于对照组（P < 0.05）, 性别分布在汉族胆石症组和对照组之间差异有统计学意义（P < 0.05）,汉族人群胆石症组总胆固醇TC显著高于对照组（P < 0.05）;ESR1基因rs35396879 位点在维吾尔族胆石症患者中的基因型和等位基因分布频率与维吾尔族对照组和汉族胆石症组差异均有统计学意义（P < 0.05）。而汉族胆石症患者与汉族对照组、维吾尔族对照组和汉族对照组之间差异无统计学意义。结论 维吾尔族和汉族胆石症患者之间ESR1的rs35396879 位点基因型和等位基因频率分布有差异,这可能是两个民族具有不同胆结石临床表型的潜在分子机制。     

Elimination Rate of Serum Lactate is Correlated with Amyotrophic Lateral Sclerosis Progression

Background:

Mitochondrial dysfunction plays an important role in the pathogenesis of amyotrophic lateral sclerosis (ALS). We aimed to demonstrate mitochondrial dysfunction in ALS using a lactate stress test and to examine the relationship between mitochondrial dysfunction with motor deterioration.

Methods:

We enrolled 116 patients and observed clinical variables, including the survival state.

Results:

Patients with a rapid slope of revised ALS functional rating scales (ALSFRS-r) (>20 U/year) exhibited the slowest elimination rate (median −4.67 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation, 590.15%), the shortest duration (0.63 ± 0.28 years) and the worst ALSFRS-r (32.59 ± 4.93). Patients with a moderate slope of ALSFRS-r (10–20 U/year) showed a moderate elimination rate (median −11.33 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation, 309.89%), duration (1.16 ± 0.45 years), and ALSFRS-r (34.83 ± 6.11). The slower progressing (<10 U/year group) patients exhibited a rapid elimination rate (median: −12.00 × 10⁻³ mmol∙L⁻¹∙min⁻¹, coefficient of variation: 143.08%), longer duration (median: 3 years, coefficient of variation: 193.33%), and adequate ALSFRS-r values (39.58 ± 9.44). Advanced-phase ALS patients also showed slower elimination rate (ER, quartiles −17.33, −5.67, 4.00) and worse ALSFRS-r (34.88 ± 9.27), while early-phase patients showed a more rapid ER (quartiles −25.17, −11.33, −3.50) and better ALSFRS-r (39.28 ± 7.59). These differences were statistically significant. Multiple linear regression analysis revealed strong direct associations among ER, ALSFRS-r slope (standard beta = 0.33, P = 0.007), and forced vital capacity (predict %) (standard beta = −0.458, P = 0.006, adjusted for ALSFRS-r, course and onset region). However, the data obtained from 3 years of follow-up showed no statistically significant difference in the survival rates between the most rapid and slowest ER groups.

Conclusion:

There is a potential linear relationship between ER and motor deterioration in ALS. Slower ER might be associated with faster disease progression.     

Cytomegalovirus Pneumonia in Patients with Rheumatic Diseases After Immunosuppressive Therapy: A Single Center Study in China

Background:

Rheumatic diseases involve multiple organs that are affected by immunological mechanisms. Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection. Cytomegalovirus (CMV) is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients. This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.

Methods:

Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated. GraphPad Prism version 5.013 (San Diego, CA, USA) was used to conduct statistical analysis. The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test. Significance between qualitative data was analyzed using Pearson''s Chi-squared test. The cut-off thresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic (ROC) curve analysis.

Results:

One hundred and forty-two patients had positive CMV viral load tests. Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic. The symptomatic group received higher doses of prednisolone (PSL) and more frequently immunosuppressants than the asymptomatic group (P < 0.01). The symptomatic group had lower lymphocyte counts, especially CD⁴⁺ T-cells, than the asymptomatic group (P < 0.01). By ROC curve analysis, when CD⁴⁺ T-cell count was <0.39 × 10⁹/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection. The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients (P < 0.01; threshold viral loads: 1.75 × 10⁴ copies/ml). Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts (P < 0.01), including CD4⁺ and CD⁸⁺ T-cells (P < 0.01).

Conclusions:

When CD⁴⁺ T-cell count is <0.39 × 10⁹/L, patients are at high risk for pulmonary CMV infection. Patients are prone to be symptomatic with CMV-DNA load >1.75 × 10⁴ copies/ml. Lymphopenia (especially CD⁴⁺ T-cells), presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.     

A limited sampling strategy for estimation of the area under the curve (0 to 8 hours) of mycophenolic acid administered three times daily to liver transplant recipients

Objectives

Gastrointestinal side-effects caused by mycophenolic acid (MPA) are frequent in liver transplant recipients, and in these cases a switch from two to three daily doses is usually recommended. However, a limited sampling strategy for the estimation of MPA area under the curve from 0 to 8 hours (AUC_(0–8h)) has not been made.

Design and methods

In 22 liver transplant patients who were administered MPA three times daily, the trapezoidal extrapolated MPA AUC_(0–8h) values using a sampling time from 0 to 2 hours were calculated.

Results

A tentative therapeutic range for MPA AUC_(0–8h) of about 20–40 μg.h/mL is proposed, and in the 13 patients with supratherapeutic values the total leukocyte blood count was significantly lower than in the 9 patients with AUC_(0–8h) ≤ 40 μg.h/mL (P < 0.001). Significant negative correlations were found between the total leukocyte blood count and the MPA trough levels (r = −0.458; P < 0.05), AUC_(0–8h) (r = −0.479; P < 0.05), and AUC_(0–2h) (r = −0.437; P < 0.05). A significant correlation was found between the trapezoidal extrapolated AUC_(0–8h) and trapezoidal AUC_(0–2h) results (r = 0.850; P < 0.001).

Conclusions

The trapezoidal extrapolated AUC_(0–8h), and possibly trapezoidal AUC_(0–2h), may be useful for routine therapeutic MPA monitoring in liver transplant recipients in which the dosing frequency is increased from twice to three times a day.     

Protective Effect of Low-dose Sevoflurane Inhalation and Propofol Anesthesia on the Myocardium after Carotid Endarterectomy: A Randomized Controlled Trial

Background:Myocardial infarction is an important cause of mortality after carotid endarterectomy (CEA).Sevoflurane provides myocardial protection to patients undergoing coronary surgery,but whether it ...     

Variants of Interleukin-7/Interleukin-7 Receptor Alpha are Associated with Both Neuromyelitis Optica and Multiple Sclerosis Among Chinese Han Population in Southeastern China

Background:

Neuromyelitis optica (NMO) and multiple sclerosis (MS) are autoimmune demyelinating diseases of the central nerve system. Interleukin-7 (IL-7) and interleukin-7 receptor alpha (IL-7Rα) were proved to be important in the pathogenesis of both diseases because of the roles they played in the differentiations of autoimmune lymphocytes. The variants of both genes had been identified to be associated with MS susceptibility in Caucasian, Japanese and Korean populations. However, the association of these variants with NMO and MS has not been well studied in Chinese Southeastern Han population. Here, we aimed to evaluate the association of six IL-7 variants (rs1520333, rs1545298, rs4739140, rs6993386, rs7816065, and rs2887502) and one variant of IL-7RA (rs6897932) with NMO and MS among Chinese Han population in southeastern China.

Methods:

Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MassARRAY system) and Sanger sequencing were used to determine the variants of IL-7 and IL-7RA in 167 NMO patients, 159 MS patients and 479 healthy controls among Chinese Han population in southeastern China. Samples were excluded if the genotyping success rate <90%.

Results:

Statistical differences were observed in the genotypes of IL-7 rs1520333 in MS patients and IL-7RA rs6897932 in NMO patients, compared with healthy controls (P = 0.035 and 0.034, respectively). There was a statistically significant difference in the genotypes of IL-7 rs2887502 between MS and NMO patients (P = 0.014). And there were statistically significant differences in the rs6897932 genotypes (P = 0.004) and alleles (P = 0.042) between NMO-IgG positive patients and healthy controls.

Conclusions:

The study suggested that among Chinese Han population in southeastern China, the variant of IL-7RA (rs6897932) was associated with NMO especially NMO-IgG positive patients while the variant of IL-7 (rs1520333) with MS patients. And the genotypic differences of IL-7 rs2887502 between MS and NMO indicated the different genetic backgrounds of these two diseases.     

Long term clinical outcome and bleeding complications among hospital survivors with acute coronary syndromes

Objective

To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non‐ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti‐thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone.

Design

Observational study.

Setting

A large university hospital.

Patients

224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002.

Main outcome measures

Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge.

Results

Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p<0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were <1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS).

Conclusions

Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups.     

Baseline Hepatitis B Virus DNA Level is a Promising Factor for Predicting the 3rd Month Virological Response to Entecavir Therapy: A Study of Strict Defined Hepatitis B virus Induced Cirrhosis

Background:Cirrhosis is a common complication of chronic hepatitis B.It remains unclear if viral and biochemical parameters at baseline affect virological response to entecavir and therefore warrant in...