Determination of Clinical Cut-Off Values for Serum Cystatin C Levels to Predict Ischemic Stroke Risk

Background: The association between cystatin C and risk of ischemic stroke is inconsistent and the cut-off values of cystatin C are diverse in different articles. We aimed to investigate the association between cystatin C levels and the development of ischemic stroke and to explore the clinical cut-off values of serum cystatin C levels for ischemic stroke. Methods: This prospective cohort study included 7658 participants from the China Health and Retirement Longitudinal Study who were free of cardiovascular diseases and cancer at baseline. A decision-tree model was used to find reasonable cut-off values for cystatin C levels. Logistic regression models were used to analyze the association between different levels of cystatin C and the risk of ischemic stroke. Results: The whole cohort was divided into the following 3 groups according to the decision tree: group-low (<.901 mg/L), group-moderate (.901～1.235 mg/L), and group-high (>1.235 mg/L). After 4 years of follow-up, we identified 156 cases of ischemic stroke. After adjusting for potential confounding factors, the odds ratios (95% confidence intervals) of ischemic stroke were 1.637 (1.048-2.556) for group-moderate and 2.326 (1.285-4.210) for group-high) compared with the low group of cystatin C. Subgroup analyses showed that the association between cystatin C levels and the incidence of ischemic stroke was more pronounced in males or old people than in females or young people. Conclusions: We found 2 suitable cut-off values for serum cystatin C levels and found that high levels of cystatin C were associated with an increased risk of ischemic stroke.     

Atypical somatosensory-motor cortical response during vowel vocalization in spasmodic dysphonia

ObjectiveSpasmodic dysphonia (SD) is a debilitating voice/speech disorder without an effective cure. To obtain a better understanding of the underlying cortical neural mechanism of the disease we analyzed electroencephalographic (EEG) signals of people with SD during voice production.MethodTen SD individuals and 10 healthy volunteers produced 50 vowel vocalization epochs of 2500 ms duration. Two EEG features were derived: (1) event-related change in spectral power during vocalization relative to rest, (2) inter-regional spectral coherence.ResultsDuring early vocalization (500–1000 ms) the SD group showed significantly larger alpha band spectral power over the left motor cortex. During late vocalization (1000–2500 ms) SD patients showed a significantly larger gamma band coherence between left somatosensory and premotor cortical areas.ConclusionsTwo atypical patterns of cortical activity characterize the pathophysiology of spasmodic dysphonia during voice production: (1) a reduced movement-related desynchronization of motor cortical networks, (2) an excessively large synchronization between left somatosensory and premotor cortical areas.SignificanceThe pathophysiology of SD is characterized by an abnormally high synchronous activity within and across cortical neural networks involved in voice production that is mainly lateralized in the left hemisphere.     

Hesperidin Shows Protective Effects on Renal Function in Ischemia-induced Acute Kidney Injury (Sprague-Dawley Rats)

ObjectiveHesperidin is a well-known flavanone glycoside copiously found in sweet orange and lemon, which was recently reported to possess significant anti-inflammatory, analgesic, antifungal, antiviral, antioxidant, and anticancer activities. Ischemia-reperfusion (I/R) injury is a major problem after renal transplantation. Furthermore, inflammatory responses to I/R exacerbate the resultant renal injury. In the present study, we investigated whether hesperidin exhibits renoprotective effects against I/R-induced acute kidney injury in a rat model.MethodsWe fed Sprague-Dawley rats either hesperidin (100 mg/kg/d) or saline. One week later, ischemia was induced by bilateral renal pedicle occlusion for 30 minutes followed by reperfusion. The rats were randomly divided into 3 groups, which were treated as follows: 1. the sham operated group; 2. the I/R group; 3. the I/R-hesperidin groupResultsCompared to the sham group, the I/R group had higher expression of blood urea nitrogen and serum creatinine and lower expression of catalase, superoxide dismutase, glutathione peroxidase, antioxidants, and nitric oxide. Compared to the I/R group, the I/R-hesperidin group had higher expression of catalase, superoxide dismutase, glutathione peroxidase, antioxidant, and nitric oxide and lower expression of blood urea nitrogen and serum creatinine.ConclusionsHesperidin improved acute renal I/R injury through its antioxidant effects. These findings suggest that hesperidin is a potential therapeutic agent for acute ischemia-induced renal damage.     

脊柱结核患者血常规参数的变化及其临床意义

目的 研究脊柱结核患者血常规中各项参数的变化及其临床意义。方法 选取宁夏医科大学总医院2017年1月~2018年6月收治的脊柱结核患者70例为研究组,对照组为同期该院体检中心体检的健康人员70例。统计两组血常规中的参数值,比较两组之间的差异。结果 与对照组相比,研究组的白细胞总数（WBC）无明显变化（P＞0.05）,中性粒细胞计数（NEU）、单核细胞计数（MXD）增加,淋巴细胞计数（LYM）减少,单核细胞/淋巴细胞比例（M/L）增加（P＜0.05）;研究组存在轻度贫血,表现为红细胞计数（RBC）、血红蛋白含量（HGB）、平均红细胞HGB含量（MCH）、平均红细胞HGB浓度（MCHC）、红细胞压积（HCT）下降,红细胞分布宽度（RDW）增加（P＜0.05）;研究组的血小板计数（PLT）和血小板压积（PCT）明显增加（P＜0.05）。结论 与健康体检人员相比,脊柱结核患者的血常规中某些参数值存在异常,可能为脊柱结核的早期诊断提供依据。     

夜班急诊血常规、生化、血气及凝血四项TAT时间分析

目的 探讨夜班急诊血常规、生化、血气及凝血四项的结果回报流程中各阶段所需时间,做好检验科质量持续性改进。方法 记录2018年8月3日~22日我院连续20次夜班临床医师急诊项目申请时间、检验科样本接收时间及检验报告审核时间,计算项目申请至样本接收时间（TAT-T1）、样本接收至报告审核时间（TAT-T2）及项目申请至报告审核时间（TAT-T总）。结果 共统计732份急诊样本,其中血常规231份,生化299份,血气109份,凝血四项93份。①血常规TAT-T1、TAT-T2、TAT-T总分别为（138.82±125.80）min、（24.80±20.91）min、（163.81±128.43）min;②生化TAT-T1、TAT-T2、TAT-T总分别为（150.71±125.94）min、（48.23±16.72）min、（198.93±124.86）min;③血气TAT-T1、TAT-T2、TAT-T总分别为（109.76±98.91）min、（22.32±19.90）min、（132.02±98.32）min;④凝血四项TAT-T1、TAT-T2、TAT-T总分别为（114.42±86.80）min、（46.21±25.91）min、（160.60±90.81）min;⑤其中TAT-T2占用了TAT流程中所需时间的21.72%,而TAT-T1占78.33%。结论 TAT整个流程时间较长,TAT-T2是TAT中的核心阶段,占流程中所需时间的1/5左右,而TAT-T1却占用了整个流程4/5左右的时间。检验科TAT持续性改进除了加强值班人员责任心、工作方式的调整外,临床科室、护工组和检验科之间只有相互协调,相互改进,才能在持续性质量改进工作中,达到真正的质量改进。     

应用六西格玛评价陕西省临床检验质量

应用六西格玛（6σ）评价陕西省15项临床检验质量指标调查数据,发现实验室质量管理方面存在的不足,并提出改进建议。方法实验室在线填报质量指标数据,将数据转化为σ值进行评价。结果参加调查的临床实验室256家。15项质量指标中,对于标本可接受性指标（7项）和检验报告适当性指标（3项）,90.0%以上的实验室数据可接受（σ≥3）;而室内质控与室间质评指标（5项）的数据可接受比率较低。室内质控项目开展率、室内质控项目变异系数不合格率、室间质评项目参加率、实验室间比对率的实验室数据不可接受（σ＜2）的比率分别是60.7%、7.1%、16.2%、94.9%。结论陕西省临床实验室参与调查的积极性尚待提高。实验室应加强信息系统建设,积极开展检测项目的室内质控,参加室间质评,以提高临床实验室检验质量。     

ER+/HER2+ Breast Cancer Has Different Metastatic Patterns and Better Survival Than ER−/HER2+ Breast Cancer

BackgroundHuman epidermal growth factor receptor 2–positive (HER2⁺) breast cancer is generally treated with HER2-targeted therapy combined with chemotherapy. Patients with HER2⁺ and estrogen receptor–positive (ER⁺) cancer are additionally treated with long-term hormone therapy. This study examined the metastatic pattern and prognosis of both ER⁺/HER2⁺ and ER^?/HER2⁺ breast cancer.Patients and MethodsA total of 54,147 patients with HER2⁺ breast cancer from the National Cancer Data Base (NCDB, 2010-2013) and 31,946 patients with HER2⁺ breast cancer from the Surveillance, Epidemiology, and End Results Program (SEER, 2010-2014) were examined. Sites of metastasis and overall survival (OS) were examined in the NCDB, while OS and breast cancer–specific survival were examined in the SEER database.ResultsCompared to ER^?/HER2⁺ breast cancer, ER⁺/HER2⁺ breast cancer was more likely to metastasize to bone but less likely to brain, liver, and lung and less likely to result in multiple metastases. In univariate analysis based on the NCDB, patients with ER^?/HER2⁺ breast cancer had worse OS in all metastasis subsets, including patients who received HER2-targeted therapy. This poor survival for ER^?/HER2⁺ persisted in patients with metastasis to bone and lung, and multiple metastases. In multivariate analysis adjusting for age, tumor grade, surgery, chemotherapy, HER2-targeted therapy, and hormone therapy, ER^?/HER2⁺ patients with bone metastasis still had worse OS. In the SEER, ER^?/HER2⁺ patients had both worse OS and breast cancer–specific survival in univariate analysis.ConclusionThis large study showed patients with ER⁺/HER2⁺ and ER^?/HER2⁺ breast cancers had different metastatic patterns. Patients with ER^?/HER2⁺ breast cancer may require more aggressive treatment.