Kidney-tonifying and Blood-activating Prescription Regulates Wnt/β-catenin Signaling Pathway to Improve Uterine Spiral Artery Remodeling in Mouse Model of Recurrent Miscarriage / 中国实验方剂学杂志

ObjectiveTo observe the effects of the kidney-tonifying and blood-activating prescription on the Wnt/β-catenin signaling pathway and uterine spiral artery remodeling in a mouse model of recurrent miscarriage and to explore its underlying mechanism. MethodA mouse model of normal pregnancy was established by mating CBA/J mice with BALB/c mice. A mouse model of recurrent miscarriage was established by mating CBA/J mice with DBA/2 mice. The modeled mice of recurrent miscarriage were randomized into model， dydrogesterone， and low- and high-dose Chinese medicine groups. The mice in normal pregnancy were used as the control group. Each group consisted of 10 mice， and the drug administration lasted for 14 days. After the treatment， the embryo absorption rate of each group was recorded. Hematoxylin-eosin （HE） staining was employed to observe the pathological morphology of the uterine decidua， and the physiological transformation rate of spiral arteries （SPA） was evaluated. Real-time polymerase chain reaction （Real-time PCR） and Western blot were performed to determine the mRNA and protein levels， respectively， of matrix metalloproteinases （MMP）-2， MMP-9， vascular endothelial growth factor （VEGF）， and Wnt/β-catenin signaling pathway. ResultCompared with the control group， the model group presented increased embryo absorption rate （P<0.05）， decreased physiological transformation rate of uterine SPA （P<0.05）， cellular swelling， degeneration， and disordered arrangement in the uterine decidua tissue， and down-regulated mRNA and protein levels of key factors involved in SPA remodeling （MMP-2， MMP-9， VEGF） and the Wnt/β-catenin signaling pathway （Wnt2， β-catenin， Cyclin D1， c-Myc） （P<0.05）. Compared with the model group， both the low- and high-dose Chinese medicine reduced embryo absorption rate （P<0.05）， increased SPA physiological transformation rate （P<0.05）， improved uterine decidua tissue morphology， and increased decidua vessel count. Furthermore， they up-regulated the mRNA and protein levels of MMP-2， MMP-9， VEGF， and proteins in the Wnt/β-catenin signaling pathway （P<0.05）. ConclusionRecurrent miscarriage is associated with impaired uterine spiral artery remodeling. The kidney-tonifying and blood-activating prescription can promote uterine spiral artery remodeling by activating the Wnt/β-catenin signaling pathway and promoting the expression of VEGF， MMP-2， and MMP-9， thus treating recurrent miscarriage.

Research progress on liquid biopsy and its combination of radiology in diagnosis of pulmonary nodules / 中国胸心血管外科临床杂志

@#Lung cancer is a malignant tumor with the highest mortality worldwide, and its early diagnosis and evaluation have a crucial impact on the comprehensive treatment of patients. Early preoperative diagnosis of lung cancer depends on a variety of imaging and tumor marker indicators, but it cannot be accurately assessed due to its high false positive rate. Liquid biopsy biomarkers can detect circulating tumor cells and DNA in peripheral blood by non-invasive methods and are gradually becoming a powerful diagnostic tool in the field of precision medicine for tumors. This article reviews the research progress of liquid biopsy biomarkers and their combination with clinical imaging features in the early diagnosis of lung cancer.

Application value of radiomics-based machine learning model in identifying the degree of pulmonary ground-glass nodule infiltration / 中国胸心血管外科临床杂志

@#Objective    To establish a machine learning model based on computed tomography (CT) radiomics for preoperatively predicting invasive degree of lung ground-glass nodules (GGNs). Methods    We retrospectively analyzed the clinical data of GGNs patients whose solid component less than 3 cm in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from March 2021 to July 2021 and the First Hospital of Lanzhou University from January 2019 to May 2022. The lesions were divided into pre-invasiveness and invasiveness according to postoperative pathological results, and the patients were randomly divided into a training set and a test set in a ratio of 7∶3. Radiomic features (1 317) were extracted from CT images of each patient, the max-relevance and min-redundancy (mRMR) was used to screen the top 100 features with the most relevant categories, least absolute shrinkage and selection operator (LASSO) was used to select radiomic features, and the support vector machine (SVM) classifier was used to establish the prediction model. We calculated the area under the curve (AUC), sensitivity, specificity, accuracy, negative predictive value, positive predictive value to evaluate the performance of the model, drawing calibration and decision curves of the prediction model to evaluate the accuracy and clinical benefit of the model, analyzed the performance in the training set and subgroups with different nodule diameters, and compared the prediction performance of this model with Mayo and Brock models. Two primary thoracic surgeons were required to evaluate the invasiveness of GGNs to investigate the clinical utility of the mode. Results    A total of 400 patients were divided into the training set (n=280) and the test set (n=120) according to the admission criteria. There were 267 females and 133 males with an ……

Circulating tumor cells-based model for pulmonary solid nodules diagnosis: a multicenter study / 中华胸心血管外科杂志

Objective:To evaluate the clinical radiological features combined with circulating tumor cells in the diagnosis of benign and malignant pulmonary solid nodules.Methods:Clinical data of 437 patients from Shanghai Pulmonary Hospital(SPH cohort) from January to April 2021 and 82 patients from Lanzhou University First Hospital (LZH cohort) from August 2019 to May 2022 were retrospectively included. Patients in Shanghai pulmonary hospital were randomly divided into training set and internal validation set in a ratio of 4∶1 by random number table method and patients in Lanzhou University First Hospital were as external validation set. Independent risk factors were selected by regression analysis of training set constructed a Nomogram prediction model. The performance of the Nomogram prediction model was estimated by applying receiver operating curve( ROC) analysis, tested in different nodules size and intermediate risk IPSNs and tested by calibration curve. Results:Independent risk factors selected by regression analysis for solid pulmonary nodules were age, the level of CTC, pleural Indentation, lobulation, spiculation. The Nomogram prediction mode provided an area under ROC( AUC) of 0.888, 0.833 in internal validation set and external validation set, outperforming radiological features model(0.835, P=0.007; 0.804, P=0.043) Mayo clinical model(0.781, P=0.019; 0.726, P=0.033) and CTCs(0.699, P=0.002; 0.648, P=0.012) in both two validation sets, C-index of 0.888, 0.871 and corrected C-index of 0.853, 0.842 in both two validation sets . The AUC of the prediction model with internal validation set was 0.905 and 0.871 for nodule diameter of 5-20 mm and intermediate risk probability. Conclusion:The prediction model in this study has better diagnostic value and practicability, and is more effective in clinical diagnosis of diseases.

Effect of goal-directed fluid therapy based on permissive high stroke volume variation guidance on residual liver function in elderly patients undergoing laparoscopic hepatectomy / 中华麻醉学杂志

Objective:To evaluate the effect of goal-directed fluid therapy (GDFT) based on permissive high stroke volume variation (SVV) guidance on residual liver function in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, aged 65-80 yr, with body mass index of 18.5-24.9 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) by the random number table method: SVV-guided GDFT group (group SG) and CVP-guided fluid replacement group (group C). Intraoperative fluid management was divided into 2 stages.The first stage was from the start of surgery to the completion of liver resection, the SVV was maintained at 13%-20% in group SG, and the low CVP was maintained at 0-5 cmH 2O in group C. The second stage was from completion of liver resection to the end of the operation, SVV was maintained at 9%-13%, additional hydroxyethyl starch 3 ml/kg was given or repeatedly administered when SVV>13% (for 5 min) or when the response to previous fluid replacement was positive (SVV increased by more than 10%), and the infusion rate was slowed down when the SVV was 9%-13% in group SG, and CVP was maintained at 5-12 cmH 2O in group C. Mean arterial pressure and heart rate were recorded on admission to the operating room, at skin incision (T 1), at the start of liver resection (T 2), at completion of liver resection (T 3) and at the end of operation (T 4). The operation time, intraoperative blood loss, transfusion volume, urine volume and levels of serum lactic acid before operation and at the end of operation were recorded.Blood samples from the median cubital vein were collected at T 0-4 to measure blood glucose and cortisol concentrations.The concentrations of serum aspartate aminotransferase, alanine aminotransferase, total bilirubin and albumin were measured before operation, at 1, 3 and 5 days after operation, and prothrombin time, activated partial thromboplastin time, thrombin time and Fib were recorded.The concentrations of serum interleukin-6, tumor necrosis factor-alpha and C-reactive protein were measured by enzyme-linked immunosorbent assay before operation and at the end of operation, and the postoperative complications and length of hospital stay were recorded. Results:Compared with group C, mean arterial pressure and heart rate were significantly decreased at T 2, 3, blood loss was reduced, transfusion volume and urine volume were increased, prothrombin time and activated partial thromboplastin time were shortened at the end of operation, serum concentrations of interleukin-6 and lactic acid and concentrations of aspartate aminotransferase and alanine aminotransferase in serum at 5 days after operation were decreased, and the length of hospital stay was shortened in group SG ( P<0.05). Conclusions:GDFT based on permissive high SVV guidance can improve residual liver function in elderly patients undergoing laparoscopic hepatectomy.

Effect of permissive high SVV on postoperative delirium in elderly patients undergoing laparoscopic hepatectomy / 中华麻醉学杂志

Objective:To evaluate the effect of permissive high stroke volume variability (SVV) on postoperative delirium (POD) in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, with body mass index of 18.5-24.9 kg/m 2, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) using a random number table method: permissive high SVV group (group S) and control group (group C). Group S was given goal-directed fluid infusion with a target of high SVV (13%-20%), and fluid replacement was performed according to the intraoperative CVP in group C. Oxygen extraction ratio was calculated on admission to the operating room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), completion of liver resection (T 3) and at the end of operation (T 4). Intraoperative blood loss, volume of fluid infused and urine volume were recorded.Lactic acid concentrations were measured at T 0 and T 4.Regional cerebral oxygen saturation (rSO 2) was continuously recorded, and the maximum percentage of decrease in rSO 2 from baseline (rSO 2max%) was calculated.Peripheral venous blood samples were collected at 1 day before operation, at the end of operation, and at 1 and 3 days after operation to determine the concentrations of serum S100β and neuron-specific enolase.POD was evaluated at 1, 3 and 7 days after operation, and the hospitalization time was recorded. Results:Compared with group C, the intraoperative blood loss was significantly decreased, the volume of fluid infused and urine volume were increased, the lactic acid concentration at T 4, rSO 2max%, oxygen extraction ratio at T 2-4, serum S100β and neuron-specific enolase concentrations and incidence of POD at 1 and 3 days after operation were decreased, and the hospitalization time was shortened in group S ( P<0.05). Conclusion:Permissive high SVV can decrease the development of POD in elderly patients undergoing laparoscopic hepatectomy, which is related to reduction of cerebral oxygen metabolism.

Mitochondrial aldehyde dehydrogenase 2 protects against high glucose-induced injury in neonatal rat cardiomyocytes by regulating CaN-NFAT3 signaling pathway / 南方医科大学学报

OBJECTIVE@#To investigate whether CaN-NFAT3 pathway mediates the protective effects of aldehyde dehydrogenase (ALDH) 2 in high glucose-treated neonatal rat ventricular myocytes.@*METHODS@#The ventricular myocytes were isolated from the heart of neonatal (within 3 days) SD rats by enzyme digestion and cultured in the presence of 5-Brdu. After reaching confluence, the cultured ventricular myocytes were identified using immunofluorescence assay for -SA protein. The cells were then cultured in either normal (5 mmol/L) or high glucose (30 mmol/L) medium in the presence of ALDH2 agonist Alda-1, ALDH 2 inhibitor Daidzin, or Alda-1 and NFAT3 inhibitor (11R-VIVIT). Fluorescent probe and ELISA were used to detect intracellular Ca concentration and CaN content, respectively; ALDH2, CaN and NFAT3 protein expressions in the cells were detected using Western blotting.@*RESULTS@#Compared with cells cultured in normal glucose, the cells exposed to high glucose showed a significantly decreased expression of ALDH2 protein ( < 0.05) and increased expressions of CaN ( < 0.05) and NFAT3 proteins with also increased intracellular CaN and Ca concentrations ( < 0.01). Alda-1 treatment significantly lowered Ca concentration ( < 0.05), intracellular CaN content ( < 0.01), and CaN and NFAT3 protein expressions ( < 0.05), and increased ALDH2 protein expression ( < 0.05) in high glucose- exposed cells; Daidzin treatment significantly increased Ca concentration ( < 0.01) and intracellular CaN content ( < 0.05) in the exposed cells. Compared with Alda-1 alone, treatment of the high glucose-exposed cells with both Alda-1 and 11R-VIVIT did not produce significant changes in the expression of ALDH2 protein (>0.05) but significantly reduced the expression of NFAT3 protein ( < 0.05).@*CONCLUSIONS@#Mitochondrial ALDH2 protects neonatal rat cardiomyocytes against high glucose-induced injury possibly by negatively regulating Ca-CaN-NFAT3 signaling pathway.

Application of distraction before discectomy in anterior cervical surgery / 吉林大学学报(医学版)

Objective:To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space,and to explore its feasibility in restricting the over distraction.Methods:A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF).During surgery,the intervertebral space was distracted before discectomy,the procedure was defined as DBD technique.Before surgery,the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (H0).The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hd),and the mean value of Hp and Hd,H,was regarded as a referential height that the index intervertebral space should be restored.During operation,the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured withthe aforementioned method.The pre-and post-operation index segment heights AB and A'B'were measured respectively.The change of index segment height was defined as △H (A'B'-AB),the index intervertebral space height after operation was defined as Hs (H0 +△H).The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores.The radiographic data of the patients in two groups was analyzed and compared with statistical methods.Results:The post-operative neck pain incidence rate was 19.35％.During operation,after DBD,the intervertebral space height change △H1 was (1.19±0.51) mm.In non-neck pain group,the difference between H1 (6.95 mm±0.84 mm) and H (6.98 mm±0.70 mm) was not significant (P=0.80),and the difference between H2 (7.31 mm±0.90 mm) and H1 (6.95 mm± 0.84 mm) was significant (P＜0.01).In neck pain group,the difference between H2 (8.33 mm± 1.39 mm) and H1 (7.87 mm±1.35 mm) was significant (P＜0.01).In neck pain group,the △H was (3.04±0.42) mm;in non-neck pain group,the △H was (1.70±0.51) mm;the difference between two groups was significant (P＜0.01).In nonneck pain group,H1,H2 and H3 had good consistency with H.Conclusion:DBD can effectively control the distraction height of the index intervertebral space within 2 mm,also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.

Risk factors affecting prognosis in post-traumatic hydrocephalus patients after traumatic brain injury / 中华创伤杂志

Objective To investigate the risk factors affecting the prognosis of patients with hydrocephalus after traumatic brain injury (TBI).Methods A retrospective case control study was performed to analyze the clinical data of 70 patients with hydrocephalus after TBI admitted to the Lianyungang Hospital of Xuzhou Medical University from March 2012 to October 2017,including 54 males and 16 females.The Glasgow Outcome Score (GOS) was used as an indicator to evaluate the prognosis of patients after 3 months of treatment.According to the GOS,the patients were divided into good prognosis group (GOS ＞ 3 points,27 patients) and poor prognosis group (GOS ≤3 points,51 patients).A total of 18 factors including gender,age,Glasgow Coma Score (GCS) on admission,platelet count,coagulation function,plasma fibrinogen levels,D-Dimer concentration,brain contusion,subarachnoid hemorrhage,subdural hygroma,subdural hemorrhage,cerebral hernia,cisterna ambiens disappearance,decompressive craniectomy,cranioplasty,ventriculo-peritoneal (V-P) shunt implantation,intracranial infection,and duration of coma were first analyzed using univariate analysis.Multivariate logistic regression analysis was then performed on the statistically significant factors generated by univariate analysis.Results The univariate analysis indicated that the GCS at admission ≤ 8 points,cerebral hernia,subarachnoid hemorrhage,subdural hygroma,intracranial infection,cisterna ambiens disappearance,plasma fibrinogen increase,and duration of coma ＞ 2 months were associated with the prognosis of hydrocephalus after TBI (P ＜ 0.05).The multivariate analysis showed that cistema ambiens disappearance,duration of coma ＞ 2 months,and plasma fibrinogen increase were significantly related to the adverse outcomes of hydrocephalus (P ＜ 0.05).The total consistence rate of the logistic regression equation for prognosis precliction was 89％.Conclusions The cisterna ambiens disappearance,duration of coma ＞ 2 months and plasma fibrinogen increase are the most important factors affecting the prognosis of hydrocephalus after TBI.Clinically,we should strictly control the indications of TBI and hydrocephalus after TBI,take active treatment measures,shorten the duration of coma,and timely monitor the changes in blood coagulation indexes such as plasma fibrinogen,thereby to improve the prognosis of patients with hydrocephalus after TBI.

Application of distraction before discectomy in anterior cervical surgery / 吉林大学学报(医学版)

Objective: To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space, and to explore its feasibility in restricting the over distraction. Methods: A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF). During surgery, the intervertebral space was distracted before discectomy, the procedure was defined as DBD technique. Before surgery, the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (Ho). The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hj), and the mean value of Hp and H,i, H, was regarded as a referential height that the index intervertebral space should be restored. During operation, the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured with the aforementioned method. The pre- and post-operation index segment heights AB and A' B' were measured respectively. The change of index segment height was defined as δH (A' B'-AB), the index intervertebral space height after operation was defined as H3 (H0+δH). The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores. The radiographic data of the patients in two groups was analyzed and compared with statistical methods. Results: The post-operative neck pain incidence rate was 19. 35%. During operation, after DBD, the intervertebral space height change δH1 was (1. 19 ± 0. 51) mm. In non-neck pain group, the difference between H1 (6. 95 mm ± 0. 84 mm) and H (6. 98 mm ±0. 70 mm) was not significant (P=0. 80), and the difference between H2 (7. 31 mm ±0. 90 mm) and H1 (6. 95 mm ±0. 84 mm) was significant (P<0. 01). In neck pain group, the difference between H2 (8. 33 mm ±l. 39 mm) and H1 (7. 87 mm ± 1.35 mm) was significant (P<0.01). In neck pain group, the δH was (3.04 ± 0.42) mm; in non-neck pain group, the δH was (1. 70 ± 0. 51) mm; the difference between two groups was significant (P<0. 01). In nonneck pain group, H1, H2 and Ha had good consistency with H. Conclusion: DBD can effectively control the distraction height of the index intervertebral space within 2 mm, also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.

Influence of polishing and glazing on the wear of zirconia and enamel / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of different surface treatment of zirconia and to find the best way to reduce the wear of its antagonist.</p><p><b>METHODS</b>Twenty-five plates(5 mm×10 mm×15 mm) made of zirconia were divided into five equal groups. Group A was only ground, group B was ground and polished, group C was ground and polished then polished by prophylaxis paste, group D was ground and glazed, group E was ground, polishsed, and then reglazed. Five central incisors were embedded in autopolymerizing acrylic resin with a size of 5 mm×10 mm×15 mm as the control group F. Thirty upper premolars buccal cusps were prepared as the antagonist. Cusps were embedded in autopolymerizing acrylic resin with a shape of circular column whose diameter were 3.1 mm. The wear test was performed in the universal micro-tribotester in artificial saliva. The roughness of each group was measured with rough meter before the wear test. The volume loss of the antagonist was measured using a 3D scanner. The wear surface was observed with scanning electron microscopy to determine the wear characteristics. Data were analyzed using one-way analysis of variance.</p><p><b>RESULTS</b>Each group of surface roughness and mass loss of antagonist showed significant statistical difference (P<0.05). Antagonist of group D showed the maximum volume loss([0.905±0.018] mm3). Antagonist of control group showed the least volume loss([0.235±0.017] mm3). Antagonist of group C showed less volume loss than antagonist of control group did([0.413±0.017] mm3). Wear type of enamel of control group and the antagonist of the groups in which the samples were polished with prophylaxis paste was fatigue wear, and the other groups showed abrasive and adhesive wear.</p><p><b>CONCLUSIONS</b>In the surface treatment methods of zirconia, polishing is better than glazing. Ground and polishing and then polishing with prophylaxis paste can decrease the wear of the antagonist.</p>

Relationship between carbon dioxide combining power and contrast- induced acute kidney injury in patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the relationship between carbon dioxide combining power(CO₂-CP) and contrast-induced acute kidney injury (CI-AKI) in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.</p><p><b>METHODS</b>We retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention. Patients were divided into three tertiles according to pre-operative CO₂-CP: T1 (CO₂-CP < 22.62 mmol/L), T2(CO₂-CP 22.62-24.30 mmol/L), T3(CO₂-CP > 24.30 mmol/L). Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups. An increase in serum creatinine of >26.4 µmol/L and/or >50% from baseline within 48 hours after contrast exposure was defined as CI-AKI. Univariate logistic regression analysis was used to identify the risk factors of CI-AKI. The relationship between CO₂-CP and CI-AKI was assessed by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify the optimal cutoff of the CO₂-CP for predicting CI-AKI.</p><p><b>RESULTS</b>CI-AKI occurred in 25 (14.4%) patients, and lower CO₂-CP was related to higher incidence of CI-AKI (27.6% (16/58) in group T1, 5.3% (3/57) in group T2, 1.7 % (1/59) in group T3, P = 0.002) and higher in-hospital mortality (10.3% (6/58) vs. 0 and 1.7% (1/59), P = 0.010). Dialysis rate was similar among 3 groups (5.2% (3/58) vs. 0 and 1.7% (1/59), P = 0.168). The incidence of CI-AKI was significantly associated with CO₂-CP < 22.00 mmol/L in univariate analyses (OR = 6.767, 95% CI 2.731-16.768, P < 0.001). After adjusting for potential confounding risk factors, CO₂-CP < 22.00 mmol/L remained significantly associated with the incidence of CI-AKI (OR = 5.835, 95%CI 1.800-18.914, P = 0.003) in multivariate logistic regression. ROC analysis revealed that the optimal cutoff of CO₂-CP to predict CI-AKI was 22.00 mmol/L (sensitivity 64.0%, specificity 79.1%, AUC = 0.714).</p><p><b>CONCLUSIONS</b>Pre-percutaneous coronary intervention CO₂-CP in patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention is related to CI-AKI. CO₂-CP < 22.00 mmol/L predicts higher risk of CI-AKI in this patient cohort.</p>

Potential biomarkers predicting risk of pulmonary hypertension in congenital heart disease: the role of homocysteine and hydrogen sulfide / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary hypertension (PH) is a common complication of congenital heart disease (CHD). Although risk stratification is vital for prognosis and therapeutic guidance, the need for understanding the role of novel biomarkers cannot be overlooked. The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.</p><p><b>METHODS</b>Between September 2012 and April 2013, we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution. Standard right heart catheterizations were performed in all cases. Seventy-seven cases were associated with PH. The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode, respectively. Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase (MTHFR), cystathionine β-synthase (CBS), and cystathionine gamma-lyase (CSE). Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.</p><p><b>RESULTS</b>The difference in the levels of homocysteine, folic acid, vitamin B12, hydrogen sulfide, as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant (all P < 0.05). Homocysteine had the best sensitivity and specificity to predict PH (P < 0.001). Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide, and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different (all P < 0.05). Based on the ROC curve, homocysteine had the best sensitivity and specificity to predict obstructive PH (P = 0.032), while CSE had the most significant sensitivity and specificity to predict the dynamic PH (P = 0.008).</p><p><b>CONCLUSIONS</b>Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD. The underlying mechanism involved the decreased expression of MTHFR and CSE along with vitamin B12 deficiency. Homocysteine and hydrogen sulfide are potential biomarkers to predict PH.</p>

Brief analysis on slow needle insertion / 中国针灸

The sources of clinical efficacy of slow needle insertion is discussed. From the basic factors of slow needle insertion, the requirements of this manipulation, main points of 4 steps (to straight the needle, to press softly, to twirl the needle and to hold without brute force), keys of operation and its significance are analyzed. Slow needle insertion is not only beneficial to the management and regulation of Shen (spirit) and induction of qi in the process of the spirit unity of doctor and patient, but also accumulates the needling sensation among three levels of the superficial, middled and deep layers of an acupoint, which could promote the curative effect.