ABSTRACT
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) for patients with mild to moderate acute ischemic stroke (AIS). MethodsFrom October, 2016 to December, 2019, 321 patients with mild to moderate AIS in Beijing Bo'ai Hospital were collected and divided into SAP group (n = 71) and non-SAP group (n = 250) according to whether they were complicated with SAP. Gender, age, time from symptom onset to admission, systolic pressure, diastolic pressure, scores of National Institutes of Health Stroke Scale (NIHSS) at admission, and medical history were recorded. Laboratory indexes including the count of white blood cell and platelet, levels of D-dimer, hypersensitive C-reactive protein (hs-CRP) and α-hydroxybutyrate dehydrogenase (α-HBDH) were measured. ResultsUnivariate analysis showed that age, NIHSS score, history of hypertension, atrial fibrillation, prior cerebral infarction, the count of white blood cell and platelet, the levels of D-dimer, hs-CRP and α-HBDH were the influencing factors of SAP (P < 0.2). Multivariate Logistic regression showed that age > 70 years old (OR = 7.121, 95%CI 3.493 to 14.514, P < 0.001), NIHSS score > 4 (5 to 10, OR = 4.861, 95% CI 2.412 to 9.797, P < 0.001), the count of platelet > 300×109/L (OR = 6.978, 95% CI 1.864 to 26.128, P = 0.004), and the level of D-dimer > 1.0 mg/L (OR = 3.036, 95% CI, 1.518 to 6.071, P = 0.002) were the risk factors of SAP. The model fitted the original data well (HL = 1.509，P = 0.680) and appeared a good prediction (AUC = 0.847, 95% CI 0.796 to 0.898, P < 0.001). ConclusionAge > 70 years old, NIHSS score > 4 (5 to 10), the count of platelet > 300×109/L and the level of D-dimer > 1.0 mg/L were the risk factors of SAP for patients with mild to moderate AIS.
ABSTRACT
Objective:To observe the changes of serum histone H4 level and its predictive value in patients with septic cardiomyopathy.Methods:A prospective study was conducted. A total of 147 patients with sepsis and septic shock were collected in emergency department. The general data were recorded. Transthoracic echocardiography and plasma histone H4 were conducted within 24 hours and 7 days after admission.The scores of sequential organ failure assessment(SOFA), acute physiology and chronic health evaluationⅡ(APACHEⅡ), and nutritional risk screening 2002 (NRS2002) were evaluated within 24 hours. According to whether septic cardiomyopathy occurred, the patients were divided into two groups, and dynamic changes of histone H4 on the first and seventh day of the two groups were observed. The factors influencing the occurrence of septic cardiomyopathy were analyzed by multivariate logistic regression. The prediction ability of serum histone H4 on septic cardiomyopathy was evaluated by receiver operating curve (ROC).Results:The incidence of septic cardiomyopathy was 28.6% (42 / 147). The level of histone H4 in septic cardiomyopathy group was higher than that in non septic cardiomyopathy group ( Z = 4.449, P < 0.001), and dynamic detection showed that the level of histone H4 on the seventh day was lower than that on admission ( Z=3.057, P=0.002). Multivariate logistic regression showed that the high serum histone H4 level [Odd Ratio( OR)=1.337, 95% confidence interval (95% CI) was 1.173-1.522, P < 0.001], SOFA ( OR= 1.474, 95% CI 1.227-1.769, P < 0.001), older age ( OR = 1.074, 95% CI 1.019-1.132, P = 0.008) were independent risk factors for septic cardiomyopathy. The area of ROC curve for serum histone H4 to predict septic cardiomyopathy was 0.729 ( P < 0.001), the predictive cut-off value was 10.81 ng/ml, which yielded a sensitivity 0.524 and a specificity of 0.914. Conclusions:The level of histone H4 showed dynamic change in septic cardiomyopathy, and high serum histone H4 level has a good predictive value for the occurrence of septic cardiomyopathy.
ABSTRACT
Objective:To establish a clinical diagnostic scoring system for septic cardiomyopathy (SCM) and evaluate its diagnostic efficacy.Methods:A prospective cohort study was performed. Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020. The baseline information, medical history, heart rate (HR), mean arterial pressure (MAP), body temperature and respiratory rate (RR) on admission were recorded. Laboratory indexes such as white blood cell count (WBC), hypersensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood lactic acid (Lac) were measured. Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission. Sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and nutritional risk screening 2002 scale (NRS2002) were also assessed. The patients were divided into two groups according to whether SCM occurred or not. The risk factors of SCM were screened by univariate and multivariate Logistic regression. The cut-off value of continuous index was determined by receiver operator characteristic curve (ROC curve) and discretized concerning clinical data. The regression coefficient β was used to establish the corresponding score, and the clinical diagnostic score system of SCM was established. The diagnostic value of the model was evaluated by ROC curve.Results:In total, 147 patients were enrolled in the study and the incidence of SCM was 28.6% (42/147). Univariate Logistic regression analysis showed the risk factors of SCM included: ① continuous indicators: age, NT-proBNP, RR, MAP, Lac, NRS2002, SOFA, APACHEⅡ; ② discrete indicators: shock, use of vasoactive drugs, history of coronary heart disease, acute kidney injury (AKI). Multivariate Logistic regression analysis after discretization of above continuous index showed that age≥87 years old, NT-proBNP≥3 000 ng/L, RR≥30 times/min, Lac≥3 mmol/L and SOFA≥10 points were independent risk factors for SCM [age ≥87 years: odds ratio ( OR) = 3.491, 95% confidence interval (95% CI) was 1.371-8.893, P = 0.009; NT-proBNP≥3 000 ng/L: OR = 2.708, 95% CI was 1.093-6.711, P = 0.031; RR≥30 times/min: OR = 3.404, 95% CI was 1.356-8.541, P = 0.009; Lac≥3 mmol/L: OR = 3.572, 95% CI was 1.460-8.739, P = 0.005; SOFA≥10 points: OR = 8.693, 95% CI was 2.541-29.742, P = 0.001]. The clinical diagnostic score system of SCM was established successfully, which was composed of age≥87 years old (1 point), NT-proBNP ≥ 3 000 ng/L(1 point), RR≥30 times/min (1 point), Lac≥3.0 mmol/L (1 point), SOFA≥10 points (2 points), and the total score was 6 points. ROC curve analysis showed the cut-off value of the scoring system for diagnosing SCM was 3 points, the area under ROC curve (AUC) was 0.833, 95% CI was 0.755-0.910, P < 0.001, with the sensitivity of 71.4%, and specificity of 86.7%. Conclusion:The clinical diagnostic scoring system has good diagnostic efficacy for SCM and contributes to early identification of SCM for clinicians.
ABSTRACT
Objective To explore the risk factors and outcome of stroke-associated pneumonia (SAP) in emergency ward. Methods The baseline characteristics and laboratory data of 306 patients with stroke in emergency ward of our hospital from April, 2014 to December, 2016 were reviewed. Patients were allocated into SAP group (n=120) and non-SAP group (n=186). The multivariable Logistic regression was applied to investigate risk factors for the progression and death of SAP. Results Totally, 120 (39.2%) patients developed SAP, in which 34 (28.3%) cases died. There were significant differences in age, the scores of Glasgow Coma Score (GCS), Sequential Organ Failure As-sessment (SOFA) and National Institute of Health Stroke Scale (NIHSS), and mechanical ventilation, dysphagia, antiacid and tube feeding (P15 and mechanical ventilation were the risk factors for 30-day mortality in SAP group. Conclusion SAP is a severe complication of stroke, it is associated with a variety of risk factors that affect its out-come in emergency ward.
ABSTRACT
Objective To compare the clinical effect of minimally invasive plate osteosynthesis (MIPO) and open reduction internal fixation(ORIF)for treating proximal humeral fractures.Methods The clinical data of 65 patients with proximal humeral fractures treated by surgery from February 2011 to January 2013 were collected.The patients were divided into MIPO group (26 cases) and ORIF group (39 cases) according to the surgery mode.The situation of operation and hospitalization was compared between the two groups.The patients were followed up by clinic and telephone modes.The Neer scores and EuroQol 5 dimensions scores (EQ-5D) were adopted to evaluate the function of shoulder joint and quality of life after discharge.The visual analogue scale (VAS) was adopted to evaluate the pain degree.Results Compared with the ORIF group,the MIPO group had less intraoperative bleeding,short operation time and hospital duration,while the incidence rate of complications showed no statistically significant difference between the two groups (P＞0.05).All cases in both groups were followed up for more than 3 years and the mean follow-up period was (47.2±6.1) months.The shoulder joint function scores at last follow up in the MIPO group and ORIF group were (84.1±9.3) points and (82.8+11.5) points,the living quality scores were (0.91+0.09) points and (0.89+0.10) points and the VAS scores were (0.9±0.8) points and (1.2+0.7) points respectively.The scores of various items showed no statistically significant difference (P＞0.05).Conclusion Both MIPO and ORIF obtain the good clinical effect in treating proximal humeral fracture,and the MIPO technique has the advantages of small trauma and rapid recovery.
ABSTRACT
Objective To compare the clinical effect of minimally invasive plate osteosynthesis (MIPO) and open reduction internal fixation(ORIF)for treating proximal humeral fractures.Methods The clinical data of 65 patients with proximal humeral fractures treated by surgery from February 2011 to January 2013 were collected.The patients were divided into MIPO group (26 cases) and ORIF group (39 cases) according to the surgery mode.The situation of operation and hospitalization was compared between the two groups.The patients were followed up by clinic and telephone modes.The Neer scores and EuroQol 5 dimensions scores (EQ-5D) were adopted to evaluate the function of shoulder joint and quality of life after discharge.The visual analogue scale (VAS) was adopted to evaluate the pain degree.Results Compared with the ORIF group,the MIPO group had less intraoperative bleeding,short operation time and hospital duration,while the incidence rate of complications showed no statistically significant difference between the two groups (P＞0.05).All cases in both groups were followed up for more than 3 years and the mean follow-up period was (47.2±6.1) months.The shoulder joint function scores at last follow up in the MIPO group and ORIF group were (84.1±9.3) points and (82.8+11.5) points,the living quality scores were (0.91+0.09) points and (0.89+0.10) points and the VAS scores were (0.9±0.8) points and (1.2+0.7) points respectively.The scores of various items showed no statistically significant difference (P＞0.05).Conclusion Both MIPO and ORIF obtain the good clinical effect in treating proximal humeral fracture,and the MIPO technique has the advantages of small trauma and rapid recovery.
ABSTRACT
Aim To investigate whether EGCG regu-lates ABCA1 expression by influencing the expression of miR-33 a to promote cholesterol efflux from macro-phages. Methods THP-1 macrophage-derived foam cells were established by co-incubated with oxLDL, and then treated with EGCG, and miR-33a expression was detected with Real-time PCR. THP-1 macrophage-derived foam cells were randomly divided into the fol-lowing groups: control group, 50 μmol · L-1 EGCG treatment group, 50 μmol · L-1 EGCG +80 nmol · L-1 miR-33a mimic treated group. Real-time PCR and Werstern blot was used to detect ABCA1 mRNA and protein expression, Oil Red O staining and high per-formance liquid chromatography were used to detect in-tracellular lipid content, and [3H] assay was used to determine cellular cholesterol efflux. Results EGCG could downregulate miRNA33 a expression in a dose-and time-dependent fashion within safe doses. EGCG significantly upregulated ABCA1 mRNA and protein expression, which could be inhibited after miRNA33 mimic transfected into cells, however. EGCG may re-duce lipid accumulation in THP-1 macrophage-derived foam cells, and this effect could also be weakened after miRNA33 mimic transfected. EGCG could reduce the accumulation of intracellular cholesterol,which was re-lated with EGCG promoting intracellular cholesterol ef-flux , and excess miRNA33 a transfected into cells could inhibit intracellular cholesterol efflux. Conclusion EGCG may upregulate ABCA1 expression by reducing miRNA33a generation, resulting in the promotion of cholesterol efflux from macrophages, which may be one of the molecular mechanisms of EGCG anti-atheroscle-rotic effect.
ABSTRACT
Aim To investigate the mechanism for the inhibitory effect of hydrogen sulfide on the expression of tissue factor(TF)induced by oxidative low-density lipoprotein(ox-LDL)in endothelial cells.Methods Human umbilical vein endothelial cells (HUVECs ) were treated with 50 mg·L-1 ox-LDL in the absence or presence of different concentrations of NaHS (25 , 50,100 and 200 μmol·L-1 )for 24 h.The mRNA expression and protein content of TF in HUVECs were determined by reverse transcription PCR and ELISA, respectively.The content of intracellular reactive oxy-gen species (ROS)was determined by DCFH,an oxi-dative sensitive fluorescent indicator.The activation of nuclear factor-kappaB (NF-κB)was estimated by its expression in nuclear extracts analyzed by Western blot.Results Ox-LDL induced TF mRNA expression and increased TF protein content in HUVECs.The in-crease in intracellular ROS production and the activa-tion of NF-κB were observed in HUVECs treated with ox-LDL.However,NaHS could markedly inhibit the increases in TF mRNA and protein levels induced by ox-LDL.Also the elevation of intracellular ROS pro-duction and the activation of NF-κB elicited by ox-LDL were significantly suppressed by pretreatment with NaHS.In addition,pretreatment with BAY 1 1-7082 (10 μmol·L-1 ),the inhibitor of NF-κB or N-acetyl-L-cysteine(1 mmol·L-1 ),an antioxidant,could also decrease the TF mRNA and protein level as well as ROS production and NF-κB activation induced by ox-LDL in HUVECs,similar to the effects of 200 μmol· L-1 NaHS.Conclusion The mechanism for the in-hibitory effect of H2 S on the ox-LDL- induced TF ex-pression in endothelial cells may be related to inhibi-ting intracellular ROS production and subsequently NF-κB activation.
ABSTRACT
AIM: To study the effects of apolipoprotein (apo) A-Ⅰon ATP binding cassette transporter A1 (ABCA1) degradation and cholesterol efflux in THP-1 macrophage-derived foam cells. METHODS: After exposure of the cultured THP-1 macrophage-derived foam cells to apolipoprotein A-Ⅰ for different time, cholesterol efflux, ABCA1 mRNA and protein level were determined by liquid scintillation counting, reverse transcriptase-polymerase chain reaction and Western blotting, respectively. The mean ABCA1 fluorescence intensity on THP-1 macrophage-derived foam cells was detected by flow cytometry. RESULTS: ApoA-Ⅰ markedly increased ABCA1-mediated cholesterol efflux from THP-1 macrophage-derived foam cells. This was accompanied by an increase in the content of ABCA1. ApoA-Ⅰ did not alter ABCA1 mRNA abundance. Thiol protease inhibitors increased the level of ABCA1 protein and slowed its decay in THP-1 macrophage-derived foam cells, whereas none of the proteosome-specific inhibitor lactacystin, other protease inhibitors, or the lysosomal inhibitor NH_4Cl showed such effects. The apoA-Ⅰ mediated cellular cholesterol efflux was enhanced by thiol protease inhibitors. CONCLUSION: Thiol protease inhibitors might provide an alternative way to upregulate ABCA1 protein. This strategy is especially appealing since it may mimic the stabilizing effect of the natural ligands apoA-Ⅰ.
ABSTRACT
Objective To investigate whether emergency percutaneous coronary intervention(PCI) could influence the BNP level in patients with ST-segment elevation myocardial infarction(STEMI).Methods We enrolled 193 patients who were admitted with STEMI.The BNP levels were measured at admission.All patients underwent routine clinical laboratory tests in the first day of hospitalization.Ninety-two patients underwent emergency PCI and the other 101 patients received conservative medicine treatment.The patients who had emergency PCI were divided into two subgroups according to the time between symptom onset and PCI started(ictus time 0-3 h,n=42;ictus time 3-6 h,n=50) for analysis.Results BNP levels were significantly lower in patients undergoing PCI when compared with conservative medicine treatment(261.0?410.9 ng/L vs 921.5?1126.7 ng/L,P
ABSTRACT
AIM: Anti-atherosclerosis effects of Momordica charantia L was further studied in a New Zealand rabbit atherosclerotic model at the basis of anti-inflammation and antioxidant effects. METHODS: Animals were divided into 3 groups: normal group (normal rabbit diet), atherosclerosis group(diet containing 2% cholesterol), and Momordica charantia L group(diet containing 2% cholesterol and 1 5% sarcocarp of Momordica charantia L ). Ninety days later, all animals were sacrificed. The effect of Momordica charantia L on atherosclerosis was evaluated by measuring serum lipid and total cholesterol content of artery wall, observing fatty liver degree, aorta arteriosclerotic area, and the thickness of intima. RESULTS: The level of total serum cholesterol and LDL-C in Momordica charantia L treatment group were obviously lower than those in atherosclerosis group, so were the total cholesterol content of artery wall, fatty liver degree, atherosclerotic area, intima thickness and I/M ratio, but no significantly difference was found between the two groups in TG level. The level of HDL-C in Momordica charantia L treatment group was evidently lower than that in normal control group. CONCLUSION: Momordica charantia L has an anti-atherosclerosis action in rabbits.