Preliminary clinical analysis of direct renin inhibitor aliskiren in the treatment of severe coronavirus disease 2019 patients with hypertension / 中华内科杂志

Objective:To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension.Methods:The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension.Results:Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged.Conclusion:Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

StudyoncognitiveimpairmentandriskfactorsinpatientswithWilsondisease / 中国神经精神疾病杂志

Objective To explore cognitive impairment and related factors in patients with Wilson disease (WD) and to screen the risk factors of cognitive impairment in order to provide evidence for clinical intervention. Methods The Chinese Version Addenbrooke＇s Cognitive Examination-III (ACE-III-C) was used to assess the cognitive function. The WD patients with cognitive impairment were analyzed the difference between those with non-cognitive disorders in the Young scale, Baethel scale and biochemical indicators. Risk factors for cognitive impairment in WD patients were analyzed by multiple linear regression. Results Cognitive impairment occurred in 43 (59.7%) of 72 patients with WD. ACE-III-C total score, attention, memory, language fluency, visual spatial factor scores, Young scores, Barthel scores and serum copper levels were significantly different between patients with cognitive impairment and patients with non-cognitive impairment (P＜0.01). Linear regression analysis showed that serum copper levels were the most important risk factors for ACE-III-C total score and cognitive subfields (P＜0.01). Serum zinc levels as a secondary risk factor of language fluency and visual space (P＜0.05). Age-related participation affected language fluency (P＜0.05). Conclusions Serum copper and zinc levels may be the main risk factors of cognitive impairment. Modulation of serum copper and zinc levels may be the key for intervention to treat cognitive impairment in WD patients.

The Early Prognostic Value of Serum Sodium Level in Patients With Acute ST-elevation Myocardial Infarction / 中国循环杂志

Objective: To explore the relationship between serum sodium level and early prognosis in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 7461 STEMI patients within 12h of onset who matched the diagnostic standard of European society of cardiology and American college of cardiology were retrospectively studied. According to serum sodium levels within 24h of admission, the patients were categorized into 3 groups: Serum sodium≥135 mmol/L group, Serum sodium 130-134 mmol/L group and Serum sodium<130 mmol/L group. The baseline condition, 30-day mortality with other adverse events and the effect of neuroendocriology inhibitor treatment were compared among 3 groups; their relationships to serum sodium level were analyzed. Results: Serum sodium<130 mmol/L group had the higher 7-day and 30-day mortality than the other 2 groups, both P<0.001; compared with Serum sodium≥135 mmol/L group, Serum sodium<130 mmol/L group presented the higher occurrence rates of 30-day cardiac shock, heart failure (HF) and life-threatening arrhythmia, P<0.001. With adjusted affecting factors of age, diuretic and reperfusion treatments, serum sodium<130 mmol/L was still related to 7-day and 30-day mortality (OR=1.69 and OR=1.57). Both single and multivariable analysis indicated that serum sodium<130 mmol/L was related to cardiac shock (OR=1.75 and OR=1.64), HF (OR=1.42 and OR=1.30) and life-threatening arrhythmia (OR=1.53 and OR=1.34). In all 3 groups, the patients using ACE inhibitor, β-blocker or both medications had reduced 30-day mortality than those without such medication, allP<0.001; the reduction was more obvious in Serum sodium<130 mmol/L group than the other 2 groups,P<0.001. Conclusion: Serum sodium level<130 mmol/L within 24h of admission was the risk factor for the early stage main adverse events as mortality, cardiac shock, HF and life-threatening arrhythmia in acute STEMI patients.

An analysis of risk factors for stroke in atrial fibrillation and hypertension patients / 中华内科杂志

Objective To explore the independent risk factors for the 1 year stroke event in Chinese patients with atrial fibrillation (AF) and hypertension (HT).Methods Data of AF and HT patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed.The eligible patients were divided into the stroke group and the non-stroke group according to the result of 1 year follow-up.The predictors for the 1 year stroke event were identified by uni-and multi-variate Cox regression analysis with the baseline and therapeutic variables.Results A total of 1 118 AF and HT patients were enrolled in the study with the incidence of 1 year stroke event of 8.7％.All patients were divided into the stroke group (n =97) and the non-stroke group (n =1 021).Compared with the non-stroke group,more female patients were in the stroke group (68.0％ vs 54.5％,P ＜ 0.05) and the patients in the stroke group were older [(76.0 ± 9.4) years vs (71.9 ± 10.6) years,P ＜ 0.01] with higher proportion of previous history of stroke (38.1％ vs 23.8％,P ＜0.01).More patients were observed on the antihypertensive treatment in the non-stroke group (91.6％ vs 85.6％,P ＜ 0.05),while more patients on statins in the stroke group(45.4％vs 34.5％,P ＜ 0.05).Multi-variate Cox regression analysis showed that age (HR =1.036,95％ CI 1.010-1.062),female (HR =1.908,95％ CI 1.170-3.110),previous stroke history (HR =1.680,95％ CI 1.084-2.603),and no antihypertensive treatment (HR =1.955,95％ CI 1.008-3.791) were independent risk factors for the 1 year stroke event in patients with AF and HT.Conclusion Age,female,previous stroke history and no antihypertensive treatment are the independent risk factors for the 1 year stroke event in patients with AF and HT.

Association between Glutathione S-Transferase T1, M1, and P1 Genotypes and the Risk of Colorectal Cancer

Glutathione S-transferases (GSTs) are enzymes which play an important role in the neutralization of toxic compounds and eradication of electrophilic carcinogens. Genetic polymorphisms within the genes encoding for GSTs may therefore cause variations in their enzyme activity, which may in turn influence the interindividual susceptibility to cancers. In this study, we aimed to investigate the association between genetic polymorphisms of GSTT1, GSTM1, and GSTP1 and the risk of colorectal cancer (CRC) in 264 cases and 317 controls in a Chinese population. Genotyping was performed by using multiplex PCR (for GSTT1 and GSTM1) and PCR-RFLP (for GSTP1) methods. The association between the polymorphic genotypes and CRC risk was evaluated by deriving odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis. Our results showed that individuals with GSTT1 and GSTM1 null genotypes exhibited a higher risk of CRC (GSTT1, OR,1.66; 95% CI, 1.20-2.31, P=0.003; GSTM1, OR,1.57; 95% CI,1.13-2.18, P=0.007), while no association was observed for GSTP1 (P(heterozygous)=0.790 or P(variant)=0.261). Furthermore, individuals who simultaneously carried the null genotypes for both GSTT1 and GSTM1 showed a stronger risk association (OR, 1.95; 95% CI, 1.33-2.85; P<0.001). In conclusion, the GSTT1 and GSTM1 polymorphisms, but not GSTP1, may modulate the CRC risk among Chinese.

Simultaneous Determination of Clozapine, Quetiapine and Risperidone in Human Serum with Online Solid Phase Extraction-High Performance Liquid Chromatography / 分析化学

A method was developed for simultaneous determination of Clozapine, Quetiapine and Risperidone in human serum by fully automated online solid phase extraction ( SPE )-high performance liquid chromatography. With Capcell MF Ph-1 column as SPE cartridge and Acclaim C18 as analytical column, high selectivity could be achieved by this method according to the selective complementarity of the two columns. In the experiment, ACN-H2 O was used as the SPE mobile phase with a flow rate of 1 mL/min and ACN-10 mmol/L NH4 Ac was used as the analytical mobile phase with a flow rate of 1 mL/min. Serum samples were injected directly into the SPE column and the biological matrix was washed out with the loading solvent. By rotation of the switching valve, Clozapine, Quetiapine and Risperidone were eluted from the SPE cartridge in the back-flush mode and transferred to the analytical column by the chromatographic mobile phase. The whole time of the online SPE purification and chromatographic separation of the analytes was 18 min. Calibration curve of Clozapine with good linearity ( r=0 . 9996 ) was obtained in the range of 10-1800 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 118. 4%, 105. 0% and 105 . 4%. Calibration curve of Quetiapine with good linearity ( r=0 . 9997 ) was obtained in the range of 3 . 6-640 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 112. 8%, 101 . 1% and 101 . 5%. Calibration curve of Risperidone with good linearity ( r=0 . 9995 ) was obtained in the range of 0. 71-128 μg/L in human serum, and the recoveries at low, medium and high concentration levels were 100. 7%, 97. 2% and 98. 8%. In conclusion, the established automated online SPE-HPLC-UV method demonstrated good performance in terms of linearity, specificity, limits of quantification, and was successfully utilized to quantify Clozapine, Quetiapine and Risperidone in human serum.

Prediction of all-cause mortality and cardiovascular mortality by albuminuria in middle-to-old-aged Chinese population / 中华肾脏病杂志

Objectives To investigate the relationship between albuminuria and all-cause mortality and cardiovascular mortality in middle-to-old-aged Chinese population. Methods A total of 2500 residents aged more than 40 years old were selected using random cluster sampling in Shougang community, Beijing, and 2315 of them took part in the survey finally. Morning urinary samples were collected. Urinary albumin and creatinine were measured. Albumin to creatinine ratio (ACR) was calculated and used as an index of albuminuria. The subjects were grouped according to ACR: normoalbuminuria (NO, ACR＜ 30 mg/g), microalbuminuria (MI, ACR 30-299 mg/g), and macroalbuminuria (MA, ACR ≥ 300 mg/g). Albuminuria (AL) group consisted of MI group and MA group. Cardiovascular risk factors were also investigated. Then all-cause mortality and cardiovascular mortality were collected after 4 years. The Cox model was used to analyze the relationship between albuminuria and all-cause mortality after adjusting for confounders. Results The prevalence of microalbuminuria and macroalbuminuria was 7.6% and 1.4% respectively. After 4 years follow-up,the cardiovascular mortality was 2.7/1000 person-years in NO group, 19.9/1000 person-years in MI group, and 11.5/1000 person-years in MA group and the all-cause mortality was 6.6/1000,25.9/1000 and 57.5/1000 person-years respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, hypertension, diabetes mellitus, cardiovascular disease at baseline and serum creatinine, the hazard ratio (HR) of cardiovascular mortality in AL group was 5.26 [95% confidence intervals (CI) 2.26-12.24] compared with NO group; the HR of all-cause mortality was 3.34 (95% CI 1.82-6.15). Among patients without cardiovascular disease at baseline, the corresponding HRs were 6.92 (95%CI 1.80-26.58) and 2.85 (95%CI 1.22-6.65) respectively.Conclusion In the population studied, albuminuria is an independent risk factor for all-cause mortality and cardiovascular mortality.

Outcome and influencing factors of integrated intensive intervention in participants with impaired glucose regulation for two years / 中华内分泌代谢杂志

Objective To investigate the outcome and related risk factors of integrated intensive intervention in participants with impaired glucose regulation (IGR) after two years by the criteria of American Diabetes Association 2003. Methods The subjects who remained to be IGR at the end of first year following 75 g oral glucose tolerance test were randomly assigned to either a routine care control group or to an intensive integrated intervention group. The control group received general dietary and exercise advice at baseline and was followed up. In addition to dietary control and exercise advice, mefformin or acarbose were administrated in the intervention group. The latter group was also advised to take antihypertensive agents, lipid-regulating agents if necessary, as well as aspirin. Results The proportion of patients who fulfilled the assigned goals of blood glucose, blood pressure, body mass index or triglycerides was significantly higher in the intensive group than those in the control group. None in the intensive group developed overt diabetes mellitus, while 8 (9.3%) in the control group did. The proportion of patients who reverted to normal glucose tolerance (NGT) was slightly higher in the intensive group than in the control group (29.5% vs 22.1%, P>0.05). Logistic analysis showed that increase of waist circumference and systolic blood pressure was positively while the improvement of islet β-cell function was negatively correlated with the development of diabetes mellitus. Conclusions The intensive integrated intervention could significantly decrease the conversion rate of IGR to diabetes mellitus, and increase the chance of reversion to NGT. The increase of waist circumference or systolic blood pressure, the deterioration of islet β-ccll function were the influencing factors of the conversion of IGR to diabetes mellitus.

The impact of admission blood glucose level on the prognosis of ST-segment elevation myocardial infarction / 中华内科杂志

Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose>10 mmol/L) and known diagnosis of diabetes mellitus (DM) ,these patients were divided into four groups, Ⅰ :no DM and normal glucose group (control group) ; Ⅱ : DM but normal glucose group; Ⅲ : no DM and hyperglycemia group; and Ⅳ: DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group Ⅲ 17. 1% vs group I 8.6%, group Ⅳ 18.6% vs group Ⅰ 8. 6%, P<0.001) and also an increased incidence of MACE (group Ⅲ36. 3% vs group Ⅰ 21.6%, group Ⅳ 38. 8% vs group Ⅰ 21.6%, P<0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group Ⅱ 11.6% vs group Ⅰ 8. 6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold(OR 1.51,95% CI 1.22-1.87,P<0.001) and 1.83 fold(OR 1.83,95% CI 1.40-2. 39, P<0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05,95% CI 1.04-1.07,P<0.001), but DM without hyperglycemia was not so (OR 1.11,95% CI 0. 87-1.42, P =0. 412). Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia isv not associated with the short-term mortality.

Waist circumference cutoff points for Chinese adults with metabolic syndrome defined by the International Diabetes Federation / 老年心脏病学杂志（英文版）

Objective To investigate the appropriate waist circumference (WC) cutoff points for central obesity in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of the International Diabetes Federation (IDF). Methods A total of 2,344Beijing residents aged ≥40 years were investigated. They answered questionnaires, received physical examinations, and underwent plasma glucose and lipid profile measurement. Those non-diabetic subjects underwent a 75g oral glucose tolerance test. All data were analyzed to calculate the appropriate WC cutoff points for central obesity reaching the diagonsis of MS. Results 1) Both in males and females, the triglyceride (TG), systolic blood pressure, diastolic blood pressure and fasting plasma glucose (FPG) increased linearly with WC, and the high density lipoprotein cholesterol (HDL-C) decreased linearly with WC (P＜0.05). 2)The prevalence of elevated TG,reduced HDL-C, elevated blood pressure, elevated FBG, or ≥ 2 of these factors increased with WC (P＜0.05). 3) Based on the receiver operating characteristic (ROC) curve analysis and Youden index, the WC values for central obesity and for detecting BMI ≥ 25 kg/m2were about 90 cm for men and 80 cm for women. 4) The odds ratio for the presence of two or more metabolic risk factors increased abruptly in men with WC ≥ 90 cm and in women with WC ≥ 80 cm. Conclusions The appropriate WC cutoff point for central obesity was determined to be 90 cm for men and 80 cm for women in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of IDF.

Two-year outcomes in patients admitted with non-ST elevation acute coronary syndrome: results of the OASIS registry 1 and 2.

BACKGROUND: Acute coronary syndrome continues to have significant long-term morbidity and mortality. This study sought to compare baseline characteristics, practice patterns and clinical outcomes for patients with non-ST elevation acute coronary syndrome from a broad range of low-, middle- and high-income countries. METHODS AND RESULTS: We compared the data from a prospective registry of patients with non-ST elevation acute coronary syndrome involving 4615 patients from 65 centers in 8 low and middle income countries (OASIS registry 2) with those obtained from 7987 patients from 95 centers in 6 middle and high income countries (OASIS registry 1). Patients in the OASIS registry 2 were younger, were more often males and smokers, presented later to the hospital after symptom onset and had a lower prevalence of diabetes at admission [with the exception of India, which had the highest age-adjusted prevalence (39.1%)]. There were marked variations in the angiography and intervention rates during the hospital stay, but the uses of proven pharmacological therapies were comparable. The two-year mortality rates adjusted for baseline covariates ranged from 6.9% to 15%. Patients from China had the lowest two-year mortality rate (6.9%) and patients from India had the highest rate (15%). Combining the two registries, the covariate-adjusted rate of death or myocardial infarction did not differ across countries with in-hospital angiographic rates of > or = 50% (17.1%), 25-49% (16.7%) or < 25% (16.5%). However, the covariate-adjusted rates for subsequent myocardial infarction (7.6%, 9.2% and 10.8% respectively, p < 0.0001), refractory angina (21.3%, 27.7% and 35.4% respectively, p < 0.0001) and the composite of death, myocardial infarction or refractory angina (34.9%, 40.7% and 46.8% respectively, p < 0.0001) differed depending on the angiographic rates. CONCLUSIONS: Among the participating countries there was a marked heterogeneity in patient characteristics, coronary interventions, resulting in differences in the two-year composite rates of death, myocardial infarction and refractory angina among patients admitted with non-ST elevation acute coronary syndrome.

Combined Acupuncture and Functional Exercises for Infantile Cerebral Palsy in 45 Cases / 针灸推拿医学（英文版）

Sishencong (Ex-HN 1), Niesanzhen, Shenting (GV 24), Benshen (GB 13), Naohu (GV 17), Naokong (GB 19), Quchi (LI 11), Hegu (LI 4), Biguan (ST 31),Zusanli (ST 36), Zuyunganqu (Foot-Motor-Sensory area),Yundongqu (Motor area), Pinghengqu (Equilibrium area),Shousanli (LI 10), Sanjian (LI 3), Huantiao (GB 30) and Yanglingquan (GB 34) were needled in combination with Vojta and Bobath methods to treat 45 children with cerebral palsy. Results showed that 12 cases got marked effectiveness, 22 cases got effectiveness and 11 cases failed.

Knowledge on hypertension and the effect of management on hypertension in patients attending hospital clinics / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the current knowledge on hypertension and the effect of management on hypertension in patients attending hospital clinics.</p><p><b>METHODS</b>A cross-sectional survey was used in the outpatients over the age of 35 years in 18 general hospitals (provincial, district and community) which represented the different levels of medical care in 8 major cities covering Northern and Southern China including an interview with two blood pressure measurements and one questionnaire in one clinical visit.</p><p><b>RESULTS</b>A total of 9 703 subjects participated in this project, who were similarly distributed by gender and age in the hospitals at different levels. Of all the 9 703 subjects, 4 510 (46.5%) were found to be hypertensive. 6.4%, 12.1%, 25.5%, 41.1% and 14.6% of all the participants were categorized into knowledge on hypertension grade 0, 1, 2, 3, 4 respectively. The classification was based on the number of correct answers to four questions about knowledge of hypertension. The higher the grade of hypertension knowledge the more response to higher rate of awareness, treatment, and control in this hypertensive population was noticed. There was significantly positive correlation between the grade of hypertension knowledge and treatment compliance. The major cause of poor treatment compliance was due to lack of hypertension knowledge.</p><p><b>CONCLUSION</b>There was poor knowledge on hypertension in the investigated participants, which would influence on the management of hypertension. Data suggested that health education on the knowledge of hypertension in the population needs to be improved.</p>

INHIBITION OF TETRANDRINE AND DEMETHYL TETRANDRINE ON DNA, RNA AND PROTEIN SYNTHESES OF LEUKEMIA 7712 AND SARCOMA 180 CELLS / 中国药理学通报

The 50% inhibition doses ( ID50 ) of tetrandrine and demethyl tetrandrine on DNA synthesis in L7712 and Sl80 cells are 2.6, 3 .5mg/ L and 27.5, 24.5mg/L respectively. The DNA synthesis inhibition is likely due to DNA template damage caused by both natural products. The inhibition of DNA, RNA and protein syntheses by tetrandrine or demethyl tetrandrine increased with incubating time. The inhibiting activities of two natural products on DNA and RNA synthesis are s-tronger than on protein. There are no differences either in inhibiting activity or in inhibiting mechanism between two natural products.