Effect of vinyl chloride on liver function and serum sex hormones in male workers / 中国职业医学

OBJECTIVE: To explore the effect of vinyl chloride on the blood sex hormones and liver function of male workers. METHODS: A total of 129 male vinyl chloride workers(exposure group) and 128 male office workers who were not exposed to occupational hazards(control group) were selected as study subjects by judgment sampling method. The time weighted average concentration(C_(TWA)) of vinyl chloride in the workplace air was measured. The level of urine thiodiglycolic acid(TDGA), blood routine, electrocardiogram and liver B-ultrasound were performed on the subjects. The serum levels of liver function and sex hormones were measured. RESULTS: The median of C_(TWA) of vinyl chloride in the workplace was 0.90 mg/m~3, and the geometric mean was 1.40 mg/m~3. The level of urine TDGA in the exposed group was higher than that of the control group(median: 0.68 vs 0.02 mg/g Cr, P<0.01). The abnormal rate of hemoglobin level, erythrocyte count, leukocyte count, hematocrit, mean platelet volume, aspartate transaminase, total bilirubin, indirect bilirubin and liver B-ultrasound increased in the exposure group than that of the control group(P<0.05). The levels of serum prolactin, leuteinizing hormone(LH), follicle-stimulating hormone and estradiol in the exposure group increased, the abnormal rates of prolactin, LH and estradiol increased, and the level of testosterone decreased compared with the control group(P<0.05). The levels of prolactin in the low-, medium-and high-TDGA subgroups in the exposure group increased(P<0.05), and the abnormal rates increased compared with the control group(P<0.017). CONCLUSION: Vinyl chloride can cause liver function damage in male workers and have reproductive toxicity. Prolactin can be used as a biomarker of reproductive toxicity of vinyl chloride.

HPV E6 and E7 mRNA combined with HPV 16 and 18 or 45 genotyping testing as a means of cervical cancer opportunistic screening / 中华妇产科杂志

Objective To evaluate Aptima HPV E6 and E7 mRNA assay (Aptima HPV) combined with Aptima HPV 16 and 18 or 45 (18/45) genotype assay (Aptima HPV-GT) as a means of cervical cancer opportunistic screening. Methods From October 2016 to October 2017, a total of 23 258 women aged 25-65 years were enrolled in the physical examination center and gynecological clinic of Huzhou Maternity and Child Health Care Hospital. All the women had Aptima HPV tested, further Aptima HPV-GT testing for positive women and liquid-based thin layer cytology Thinprep cytologic test (TCT). Women with Aptima HPV (+) or ≥low-grade squamous intraepithelial lesion (LSIL) or obvious clinical symptoms (including vaginal bleeding after intercourse and watery, bloody vaginal discharge) were referred for colposcopy and further biopsy with or without endocervical curettage (ECC) if indicated. Expression of Aptima HPV, HPV 16 and HPV 18/45 with different cytological diagnostic groups and histological diagnosis groups were compared respectively. Sensitivity, specificity, positive predictive value and negative predictive value of Aptima HPV detection and TCT in identifying histological diagnosis of high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL+) were compared. Results (1) The positive rates of Aptima HPV, HPV 16 and HPV 18/45 were 14.00% (3 257/23 258), 1.85% (430/23 258) and 0.86% (199/23 258) respectively.The positive rates of Aptima HPV, HPV 16 and HPV 18/45 increased with cytology grading in squamous epithelium [negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASCUS), LSIL, atypical squamous cell cannot exclude HSIL (ASC-H), HSIL and squamous cell carcinoma (SCC), all P=0.000)]. According to histology results, the positive rates of Aptima HPV, HPV 16 and HPV 18/45 increased with histology grading in squamous epithelium (normal cervical tissue, LSIL, HSIL and SCC, all P=0.000). The positive rate of Aptima HPV was significantly higher in HSIL+group than that in the LSIL or better (LSIL-) group [98.11% (311/317) vs 12.84% (2 946/22 941), P=0.000]. The positive rate of Aptima HPV-GT was significantly higher in HSIL+group than that in LSIL-group [58.36% (185/317) vs 1.91% (439/22 941), P=0.000]. (2) Compared with cytology, Aptima HPV resulted in significant higher sensitivity (98.11% vs 59.62%, P=0.000) and negative predictive value (99.97% vs 99.42%, P=0.000), significant lower specificity (87.16% vs 95.37%, P=0.000) and positive predictive value (9.55% vs 15.10%, P=0.000) when identified HSIL+. Conclusions Women with Aptima HPV positive, especially those with Aptima HPV-GT positive, are more likely to have histological diagnosis of HSIL+. Aptima HPV combined with Aptima HPV-GT is feasible as a means of cervical cancer opportunistic screening in tertiary hospitals.

Impact of CYP2C19 genotype and platelet function on clinical outcome in coronary atherosclerotic heart diseases patients received clopidogrel post percutaneous coronary intervention / 中华心血管病杂志

Objective@#To analyze association of CYP2C19 genotype and platelet function phenotype and their impact on clinical outcomes including bleeding events of coronary artery disease(CAD) patients received clopidogrel post percutaneous coronary intervention(PCI).@*Methods@#Coronary atherosclerotic heart diseases patients underwent elective PCI and coronary stent implantation in Fuwai hospital were prospectively enrolled during May 2012 to April 2013. Patients were assigned into groups by genotype of CYP2C19 (extensive metabolizers, intermediate metabolizers, and poor metabolizers) and phenotype of platelet function (clopidogrel responders, semi-responders, and non-responders). The rates of major adverse cardiovascular events, combined cardiovascular events, and bleeding events were recorded during a at least 12 months follow-up period and compared among above defined groups. The association between genotype or phenotype and clinical outcome was assessed using multivariable Cox regression hazards model.@*Results@#Three hundred and eighty patients received coronary stent implantation and met the inclusion criteria of the study, including 157(41.3%) clopidogrel extensive metabolizers, 176(46.3%) intermediate metabolizers, and 47(12.4%) poor metabolizers according to the genotype grouping; 98(25.8%) were responders to clopidogrel, 149(39.2%) were semi-responders, and 133 (35.0%) were non-responders according to the phenotype grouping. Three hundred and seventy-six patients accomplished follow-up. The highest combined cardiovascular events rate was observed in the poor metabolizers (34.0%(16/47)) as compared to the intermediate metabolizers (19.0%(33/174), P=0.026) and the extensive metabolizers (15.5%(24/155), P=0.005). The highest bleeding events rate was observed in the clopidogrel responders (33.7%(33/98)) as compared to the semi-responders (18.9%(28/149), P=0.008) and non-responders (17.7%(23/130), P=0.008). In multivariable Cox regression analysis, the adjusted risk of cardiovascular death, acute myocardial infarction, stent embolism, target lesion revascularization and angina onset was 2.305 times higher in clopidogrel poor metabolizers than in extensive and semi-metabolizers (95%CI=1.208-4.399, P=0.011). The adjusted HR for bleeding events was 0.540 (95%CI=0.321-0.909, P=0.021) among semi-responders vs. responders, was 0.52 (95%CI=0.301-0.905, P=0.021) among non-responders vs. responders during the 12 months follow-up period.@*Conclusions@#Among CAD patients underwent stenting and clopidogrel treatment, poor CYP2C19 metabolizers group carries a significantly higher risk for combined cardiovascular events than in extensive metabolizers group, while clopidogrel responders patients are at significantly higher risk for bleeding as compared to the semi-responders and non-responders.

Effect of endoscopic injection of cyanoacrylate in treatment of acute esophageal and gastric variceal bleeding in children / 临床肝胆病杂志

ObjectiveTo investigate the effect and safety of endoscopic injection of cyanoacrylate in the treatment of esophageal and gastric variceal bleeding (EGVB) in children. MethodsThe clinical data of 35 children with acute EGVB who were treated with endoscopic injection of cyanoacrylate in Children′s Hospital of Baoji Maternal and Child Health Care Hospital from August 2010 to August 2015 were analyzed retrospectively. The emergency response rate, rebleeding rate, and incidence of complications after the treatment were analyzed statistically. ResultsThirty-five patients received 46 times of endoscopic injection of cyanoacrylate in total. The response rate to the initial injection was 95.6% (44/46). The volume of cyanoacrylate injected was 0.2-0.6 ml, with a mean volume of 0.4±0.2 ml. The emergency hemostasis rate was 93.4% (43/46), the rebleeding rate was 11.4% (4/35), and the cycle for 4 patients with the recurrence of bleeding to be cured was 1.2-23.0 months (mean 121±10.9 months). One patient experienced abdominal pain, and no patients experienced ectopic embolism. Two patients died after injection. ConclusionFrequent, small-volume endoscopic injection of cyanoacrylate is an effective and convenient therapeutic method for EGVB in children, has few complications, and holds promise for clinical application.

Clinical application of short-segment nail-stick system combined with annular fusion in lumbar spondylolisthesis / 重庆医学

Objective To investigate the clinical effect of the bone graft fusion of the posterior lumbar interbody fusion (PLIF) combined with posterolateral fusion(PLF) in treating lumbar spondylolisthesis .Methods 63 cases of lumbar spondylolisthesis were performed the posterior unilateral or bilateral vertebral plate resection ,nerve root canal decompression ,clearing the slippage space , reduction ,fixation short-segment vertebral pedicle nail-stick system for reduction and fixation ,bone graft fusion with the interverte-bral space Cage and posterior-lateral bone graft fusion ,vertebral pedicle isthmus cracking was performed the clearance and bone graft fusion(PLIF combined with PLF ) .The JOA scores ,lumbar lordosis ,segment lordosis ,intervertebral space height ,slippage rate and complications were recorded before operation ,in postoperative 1 week ,6 ,12 months .Results All cases had no serious complications .The JOA scores were increased to some different degrees from the beginning of postoperative 1 week ,with the reha-bilitation time extension ,the JOA scores were gradually increased ,the improvement rate of the postoperative JOA score averaged 85 .00% .The lumbar lordosis ,segment lordosis ,intervertebral space height and slippage rate after operation were significantly im-proved compared with before operation ,the fusion failure rate was 4 .76% .Conclusion The bone graft fusion of PLIF combined with PLF is one of ideal methods to treat lumbar spondylolisthesis .

Impact of six genetic polymorphisms on Warfarin maintenance dose variation in Chinese Han population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of VKORC1, CYP2C9, GGCX, PROC, EPHX1 and CYP4F2 gene polymorphisms on Warfarin maintenance dose variation in Chinese Han Population.</p><p><b>METHODS</b>Four hundred eighty-eight patients with prosthetic heart valves, atrial fibrillation or pulmonary thromboembolism and achieved stable Warfarin dose were enrolled. TaqMan probe or direct sequencing were used to genotype Y9VKORC1, CYP2C9, GGCX, EPHX1 and CYP4F2 gene polymorphisms. Demographic characteristics, stable therapeutic dose of Warfarin and concomitant medications were collected for all patients. The effect of VKORC1, CYP2C9, GGCX, PROC, EPHX1 and CYP4F2 gene polymorphisms, demographic characteristics and concomitant medications on Warfarin daily maintenance dose were analyzed with statistical method.</p><p><b>RESULTS</b>VKORC1 and CYP2C9 gene polymorphisms could explain more than 50% Warfarin maintenance dose variation in recruited patients, while CYP4F2 gene polymorphisms could only explain 1%. GGCX, PROC and EPHX1 gene polymorphisms had no impact no Warfarin maintenance dose. VKORC1 and CYP2C9 gene polymorphisms have a greater impact on Warfarin maintenance dose compared with demographic characteristics and concomitant medications.</p><p><b>CONCLUSION</b>VKORC1 and CYP2C9 gene polymorphisms have a significant impact on Warfarin maintenance dose in Chinese Han population.</p>

Establishment and preliminary validation of warfarin maintenance dose algorithm in Chinese Han Population / 中华心血管病杂志

<p><b>OBJECTIVES</b>To establish an algorithm to predict the warfarin maintenance dose in Chinese Han population and validate the accuracy of this algorithm.</p><p><b>METHODS</b>A total of 488 Chinese Han patients, hospitalized in Fuwai hospital and had a stable dose of warfarin and a target international normalized ratio (INR) of 1.5 to 3.0, were recruited. Indications for warfarin use included prosthetic heart valve, atrial fibrillation and pulmonary embolism. These patients were divided into derivation group (n = 323) and validation group (n = 165) according to the enrollment time. A warfarin maintenance dose algorithm was established based on genetic information, demographic characteristics and concomitant medications by multiple linear regression analysis in derivation group. In the validation group, we evaluated the accuracy of our algorithm by comparing the predicted dose with the actual dose.</p><p><b>RESULTS</b>Our algorithm included VKORC1-1639G > A, CYP2C9*3 and CYP4F2 genotype, age, Body hight, body weight, amiodarone and digoxin use (R(2) = 0.652, P < 0.001) .In the validation group, the average predicted dose by our algorithm had no statistical difference with the actual dose [(3.51 ± 1.03) mg vs. (3.53 ± 1.41) mg, P = 0.779]. Our algorithm identified 100 out of 165 (60.6%) patients in the validation group, whose predicted dose of warfarin was within 20% of the actual dose, and predicted warfarin dose was underestimated in 17.6% (29/165) patients and overestimated in 21.8% (36/165) patients.</p><p><b>CONCLUSION</b>Our algorithm based on VKORC1, CYP2C9 and CYP4F2 polymorphisms can help to predict the warfarin maintenance dose in Chinese Han Population.</p>

Comparison of loading with maintenance dose of clopidogrel on platelet reactivity in Chinese with different CYP2C19 genotypes prior to percutaneous coronary intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention (PCI): a 300 mg loading dose (LD) in clopidogrel naїve patients and a 75 mg maintenance dose (MD) once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown. We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype.</p><p><b>METHODS</b>Chinese patients undergoing PCI (n = 840) were assigned to 2×2 groups in the trial according to different clopidogrel pretreatment strategies (470 patients in LD, 370 patients in MD) and CYP2C19 genotypes (494 carriers of any CYP2C19 *2 or *3 loss-of-function allele, 346 non-carriers). The primary outcome was platelet aggregation (PA) as measured by the 10 µmol/L adenosine diphosphate induced light transmission aggregation.</p><p><b>RESULTS</b>Compared with MD group, LD strategy showed a significantly higher PA-((59.22 ± 11.67)% vs. (52.83 ± 12.17)%, P < 0.01), similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers ((59.41 ± 10.91)% vs. (52.10 ± 12.90)%, P < 0.01). LD patients in either the CYP2C19 loss-of-function allele carrier or non-carrier group showed a significantly higher PA compared with MD group ((61.50 ± 10.61)% vs. (56.84 ± 10.74)%, P < 0.01; (56.06 ± 12.34)% vs. (46.88 ± 11.78)%, P < 0.01, respectively). A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype (P = 0.001).</p><p><b>CONCLUSION</b>The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI, especially in the CYP2C19 2 or 3 loss-of-function allele non-carriers. (ClinicalTrials.gov number NCT01710436)</p>

Selection and curative effect of surgical approach for thoracolumbar fractures / 中华创伤杂志

Objective To investigate the selection and curative effect of surgical approach for thoracolumbar fractures. Methods A retrospective analysis was conducted on 212 patients with thoracolumbar fractures treated surgically from January 1995 to January 2009 to observe the spinal column and the neurological function recovery. Results Anterior surgery was performed in 73 patients and posterior surgery in 139. The patients were followed up for average 23.7 months ( range, 12-52 months). The height of injury vertebral, the Cobb' s angle and the volume of vertebral canal were improved significantly (P <0.01 ). The patients with incomplete paralysis all got nerve function recovery at different extents ( from one grade to three grades). Conclusions Surgical treatment for thoracolumbar fractures can effectively recover the spine structure and promote the nerve function recovery. The surgical approach should be selected based on the fracture type.

Early clinical outcomes of arthroscopic capsular release for the treatment of idiopathic frozen shoulder / 中国矫形外科杂志

[Objective]To evaluate the results of arthroscopic capsular release for the treatment of idiopathic frozen shoulder.[Method]From January 2004 to April 2005,7 patients with diagnosis of idiopathic frozea shoulder,who had symptoms for an average of 8.0 months(5 to 13months)with failed conservative treatment for at least 4 months,were treated with arthroscopic capsular release combined with rehabilitaticon exercises after operation.Under general anesthesia,all the patients underwent arthroscopic capsular release and manipulation.All patients were strictly evaluated by Constant score,normalized Constant score and the Visual Analog Scale(VAS 1 to 15 points,1 = no pain),before operation,at 3 weeks after operation,3 months after operation and 17.2 months after operation respectively.[Result]All patients were followed up with a mean of 17.2 months(8 to 23 months).The average in-hospital day was 8.1 days(7 to 10 days).All patients had significant improvement in terms of functional gain and pain relief after operntion.The preoperative pain score improved from(5.2?2.4)points to(11.2?2.0),(14.6?0.4)and(14.7?0.4)points at 3 weeks after operation,3 months after operation end 17.2 months after operation respectively.The Constant score improved from(24.5?14.2)to(47.0?18.8),(68.9?9.4)and(70.1?7.9),and the normalized Constant score improvad from(31.0%?17.3%)to(60.1%?24.9%),(87.1%?14.5%)and(89.7%?12.1%).There was no complication in the treatment procedures.[Conclusion]Arthrosenpic capsular release is a safe and effective surgical procedure in the management of idiopathic frozen shoulder unresponsive to conservative treatment.It has advantages of little invasive,better recovery,less operation time and less complications.