ABSTRACT
Weightlessness in the space environment affects astronauts' learning memory and cognitive function. Repetitive transcranial magnetic stimulation has been shown to be effective in improving cognitive dysfunction. In this study, we investigated the effects of repetitive transcranial magnetic stimulation on neural excitability and ion channels in simulated weightlessness mice from a neurophysiological perspective. Young C57 mice were divided into control, hindlimb unloading and magnetic stimulation groups. The mice in the hindlimb unloading and magnetic stimulation groups were treated with hindlimb unloading for 14 days to establish a simulated weightlessness model, while the mice in the magnetic stimulation group were subjected to 14 days of repetitive transcranial magnetic stimulation. Using isolated brain slice patch clamp experiments, the relevant indexes of action potential and the kinetic property changes of voltage-gated sodium and potassium channels were detected to analyze the excitability of neurons and their ion channel mechanisms. The results showed that the behavioral cognitive ability and neuronal excitability of the mice decreased significantly with hindlimb unloading. Repetitive transcranial magnetic stimulation could significantly improve the cognitive impairment and neuroelectrophysiological indexes of the hindlimb unloading mice. Repetitive transcranial magnetic stimulation may change the activation, inactivation and reactivation process of sodium and potassium ion channels by promoting sodium ion outflow and inhibiting potassium ion, and affect the dynamic characteristics of ion channels, so as to enhance the excitability of single neurons and improve the cognitive damage and spatial memory ability of hindlimb unloading mice.
Subject(s)
Animals , Mice , Transcranial Magnetic Stimulation , Hindlimb Suspension , Neurons , Cognitive Dysfunction , BrainABSTRACT
OBJECTIVES@#To investigate the clinical characteristics, pathology, and prognosis of children with diffuse endocapillary proliferative Henoch-Schönlein purpura nephritis (DEP-HSPN).@*METHODS@#A retrospective analysis was performed on the clinical, pathological, and prognosis data of 44 children with DEP-HSPN and 765 children without DEP-HSPN. The children with DEP-HSPN were diagnosed by renal biopsy in Jiangxi Provincial Children's Hospital from January 2006 to December 2021.@*RESULTS@#Among the 809 children with purpura nephritis, 44 (5.4%) had DEP-HSPN, with a mean age of (8±3) years, and there were 29 boys (65.9%) and 15 girls (34.1%). Compared with the non-DEP-HSPN group, the DEP-HSPN group had a significantly shorter time from onset to renal biopsy and a significantly higher proportion of children with respiratory infection or gross hematuria, and most children had nephrotic syndrome. The DEP-HSPN group had significantly higher levels of 24-hour urinary protein, urinary protein grading, microscopic hematuria grading, serum creatinine, and blood urea nitrogen and significantly lower levels of serum albumin and complement C3 (P<0.05). The DEP-HSPN group had a higher pathological grading, with predominant deposition of IgA in the mesangial area and capillary loops, and higher activity scores in the modified semi-quantitative scoring system (P<0.05). The Kaplan-Meier survival analysis showed that there was no significant difference in the renal complete remission rate between the two groups (P>0.05).@*CONCLUSIONS@#Children with DEP-HSPN have a rapid onset, severe clinical manifestations and pathological grading, and high activity scores in the modified semi-quantitative scoring system. However, most of the children with DEP-HSPN have a good prognosis, with a comparable renal complete remission rate to the children without DEP-HSPN.
Subject(s)
Male , Female , Humans , Child , Child, Preschool , Hematuria , IgA Vasculitis , Retrospective Studies , Prognosis , NephritisABSTRACT
OBJECTIVE@#To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle anddistal tibia fractures.@*METHODS@#The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022, were retrospectively analyzed. These patients were categorized into external fixation group (n=30) and internal fixation group (n=30). There were 18 males and 12 females in the external fixation group, with an average age of (49.29±2.35) years old. Among them, 14 patients presented with fractures on the left side, and 16 patients presented with fractures on the right side. Closed reduction, arched wire, and semi-circular external fixator were used for treatment. There were 20 males and 10 females in the internal fixation group, with an average age of (48.96±1.87) years old. Among them, 15 patients presented with fractures on the left side, and 15 patients presented with fractures on the right side. MIPPO technique was used for the treatment. Perioperative parameters, including time injury to surgery, surgical duration, incision length, intraoperative bleeding, time to active activity, and incision healing level, were compared between the two groups. Clinical outcomes were also assessed, including Johner-Wruhs scores, time to minimum pain-adapted full weight-bearing, visual analog scale (VAS), SF-36 scale, and complications.@*RESULTS@#The external fixation group exhibited a significantly shorter incision length (1.36±0.86) cm and lower intraoperative bleeding (10.83±5.73) ml compared to the internal fixation group (12.74±3.12) cm and (86.47±8.90) ml, respectively(P<0.05). The postoperative active activity time (1.50±0.54) days and minimum pain-adapted full weight-bearing activity time(108.87±3.43) days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98) days and (105.27±3.68) days, respectively(P<0.05). Over a mean postoperative follow-up duration of (6.23±1.89) months, both groups showed improved VAS and SF-36 scale scores. There were no statistically significant differences in VAS and SF-36 scale scores 1, 3, 6 months post-operatively between the two groups(P>0.05). The intraoperative surgical time in the external fixation group (35.42±9.31) minutes was shorter than that in the internal fixation group(74.22±7.81) minutes (P<0.05). There was no intraoperative vascular or nerve injury, nor postoperative skin necrosis in the external fixation group. However, skin necrosis was observed in 6 patientsin the internal fixation group, representing a statistically significant difference (P<0.05).@*CONCLUSION@#Both external fixation and plate internal fixation are effective methods for the treatment of middle and distal tibia fractures. External fixation exhibits the advantage of less surgical trauma and a lower incidence of complications.
Subject(s)
Female , Male , Humans , Middle Aged , Retrospective Studies , Tibia , Treatment Outcome , Ankle Fractures , Tibial Fractures/surgery , External Fixators , Pain , NecrosisABSTRACT
Objective:To investigate the indication, effectiveness, tolerance, and safety of levosimendan in patients with acute heart failure (AHF) in 20 hospitals in Beijing, China.Methods:This prospective, observational, and multicenter study consecutively enrolled AHF patients who were treated with levosimendan at 20 hospitals in Beijing from April 2020 to March 2022. Baseline demographics, laboratory parameters, clinical presentation, concomitant diseases and medications were collected. After initiation of levosimendan, levosimendan administration, laboratory parameter pre- and post-administration, symptoms improvement, and adverse events were also collected.Results:Totally 800 AHF patients were included, 67% of whom were male, aged (65 ±17) years, 50% of whom had ischemic heart disease, and the left ventricular ejection fraction (LVEF) was (36±11)%. The dose of levosimendan was (11.84 ±2.11) mg and the mean infusion time was (1 450±307) min. Dyspnea was improved in 83.4% of AHF patients at 24 h after treatment. The level of B-type natriuretic peptide (BNP) significantly decreased from 689 (406-1509) pg/mL to 410 (156-697) pg/mL in all patients at 24-72 h after treatment ( P<0.001), and the level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) decreased from 6910 (3 715-13 914) pg/mL to 2 851 (1 288-6 191) pg/mL ( P<0.001). Meanwhile, LVEF level also improved significantly [(40±11)% vs. (36±11)%, P<0.001]. During levosimendan administration, adverse events occurred in 74 (9.3%) patients, including hypotension (5.9%), arrhythmia (1.9%), and other symptoms (1.1%). Among them, 7 patients ( 2 patients with hypotension and 5 patients with ventricular tachycardia) interrupted levosimendan administration. Conclusions:The use of levosimendan is safe, and can improve symptoms reduce BNP or NT-pro BNP levels and increase LVEF level in AHF patients.
ABSTRACT
Transcranial magnetic stimulation (TMS) as a noninvasive neuromodulation technique can improve the impairment of learning and memory caused by diseases, and the regulation of learning and memory depends on synaptic plasticity. TMS can affect plasticity of brain synaptic. This paper reviews the effects of TMS on synaptic plasticity from two aspects of structural and functional plasticity, and further reveals the mechanism of TMS from synaptic vesicles, neurotransmitters, synaptic associated proteins, brain derived neurotrophic factor and related pathways. Finally, it is found that TMS could affect neuronal morphology, glutamate receptor and neurotransmitter, and regulate the expression of synaptic associated proteins through the expression of brain derived neurotrophic factor, thus affecting the learning and memory function. This paper reviews the effects of TMS on learning, memory and plasticity of brain synaptic, which provides a reference for the study of the mechanism of TMS.
Subject(s)
Humans , Brain , Learning , Neuronal Plasticity , Transcranial Magnetic StimulationABSTRACT
BACKGROUND@#There were few studies on real-world data about autologous hematopoietic stem cell transplantation (auto-HSCT) or allogeneic HSCT (allo-HSCT) in peripheral T-cell lymphoma (PTCL). This study aimed to investigate the clinical outcomes of patients who received auto-HSCT or allo-HSCT in China.@*METHODS@#From July 2007 to June 2017, a total of 128 patients who received auto-HSCT (n = 72) or allo-HSCT (n = 56) at eight medical centers across China were included in this study. We retrospectively collected their demographic and clinical data and compared the clinical outcomes between groups.@*RESULTS@#Patients receiving allo-HSCT were more likely to be diagnosed with stage III or IV disease (95% vs. 82%, P = 0.027), bone marrow involvement (42% vs. 15%, P = 0.001), chemotherapy-resistant disease (41% vs. 8%, P = 0.001), and progression disease (32% vs. 4%, P < 0.001) at transplantation than those receiving auto-HSCT. With a median follow-up of 30 (2-143) months, 3-year overall survival (OS) and progression-free survival (PFS) in the auto-HSCT group were 70%(48/63) and 59%(42/63), respectively. Three-year OS and PFS for allo-HSCT recipients were 46%(27/54) and 44%(29/54), respectively. There was no difference in relapse rate (34%[17/63] in auto-HSCT vs. 29%[15/54] in allo-HSCT, P = 0.840). Three-year non-relapse mortality rate in auto-HSCT recipients was 6%(4/63) compared with 27%(14/54) for allo-HSCT recipients (P = 0.004). Subanalyses showed that patients with lower prognostic index scores for PTCL (PIT) who received auto-HSCT in an upfront setting had a better outcome than patients with higher PIT scores (3-year OS: 85% vs. 40%, P = 0.003). Patients with complete remission (CR) undergoing auto-HSCT had better survival (3-year OS: 88% vs. 48% in allo-HSCT, P = 0.008). For patients beyond CR, the outcome of patients who received allo-HSCT was similar to that in the atuo-HSCT group (3-year OS: 51% vs. 46%, P = 0.300).@*CONCLUSIONS@#Our study provided real-world data about auto-HSCT and allo-HSCT in China. Auto-HSCT seemed to be associated with better survival for patients in good condition (lower PIT score and/or better disease control). For patients possessing unfavorable characteristics, the survival of patients receiving allo-HSCT group was similar to that in the auto-HSCT group.
Subject(s)
Humans , China , Hematopoietic Stem Cell Transplantation , Lymphoma, T-Cell, Peripheral/therapy , Neoplasm Recurrence, Local , Retrospective Studies , Transplantation, Autologous , Transplantation, Homologous , Treatment OutcomeABSTRACT
As a noninvasive neuromodulation technique, transcranial magnetic stimulation (TMS) is widely used in the clinical treatment of neurological and psychiatric diseases, but the mechanism of its action is still unclear. The purpose of this paper is to investigate the effects of different frequencies of magnetic stimulation (MS) on neuronal excitability and voltage-gated potassium channels in the
Subject(s)
Animals , Mice , Action Potentials , Magnetic Phenomena , Mental Disorders , Neurons , Patch-Clamp Techniques , Potassium Channels, Voltage-GatedABSTRACT
The chemical constituents from the extract of the twigs of Euscaphis konishii with anti-hepatoma activity were investigated, twelve compounds by repeated chromatography with silica gel, Sephadex LH-20 and preparative-HPLC. The structures of the chemical components were elucidated by spectroscopy methods, as konilignan(1),(7R, 8S)-dihydrodehydrodico-niferylalcohol-9-O-β-D-glucopyranoside(2),illiciumlignan B(3),threo-1-(4-hydroxy-3-methoxyphenyl)-2-[4-(3-hydroxypropyl)-2-methoxyphenoxy]-1,3-panediol(4),erythro-1-(4-hydroxy-3-methoxyphenyl)-2-[4-(3-hydroxypropyl)-2-methoxyphenoxy]-1,3-panediol(5), matairesinol(6), wikstromol(7), isolariciresinol(8),(+)-lyoniresinol(9), 4-ketopinoresinol(10), syringaresin(11), and vladinol D(12). Among them, compound 1 is a new lignan. Compounds 10 and 12 had moderate inhibitory activity on HepG2 cells, with IC_(50) values of 107.12 μmol·L~(-1) and 183.56 μmol·L~(-1), respectively.
Subject(s)
Chromatography, High Pressure Liquid , Lignans/pharmacology , Plant Extracts/pharmacologyABSTRACT
Objective:To evaluate the effect and influence of exchange transfusion on neonatal ABO hemolysis by comparing the changes of indirect bilirubin in serum and internal environment before and after exchange transfusion.Methods:A retrospective analysis of 242 cases with neonatal ABO hemolytic disease from January 2017 to October 2018 in the Children's Hospital of Jiangxi Province was carried out.According to whether the parents signed or agreed to exchange transfusion, they were divided into two groups.The exchange group (126 cases) received routine treatment + exchange of blood, and the control group (116 cases) was only given conventional therapy(blue light + probiotics + gamma globulin). In the exchange group, peripheral venous blood was collected half an hour before the exchange of blood(T1) and half an hour after the exchange of blood(T2), while in the control group, the indirect bilirubin, platelet and blood sugar were measured at two time points of parents signing disapproval of exchange of blood(T1) and disapproval of exchange of blood and one day after the treatment(T2).Results:The indirect bilirubin levels in serum of the exchange group and the control group were decreased, and the difference was statistically significant[(194.010±41.065)μmol/L vs.(390.048±39.058)μmol/L, t=1507.604, (292.014±39.998)μmol/L vs.(383.452±42.820)μmol/L, t=306.820, all P<0.05]. The decrease of serum indirect bilirubin in the exchange group was more significant than that in the control group, and the difference was statistically significant.[(194.010±41.065)μmol/L vs.(292.014±39.998)μmol/L, t=368.267, P<0.05]. After exchange transfusion, the levels of platelet and blood sugar were decreased significantly, and the differences were statistically significant[(91.370±24.766)×10 9/L vs.(350.660±32.564)×10 9/L, t=5061.203, (2.965±0.593)mmol/L vs.(5.490±0.876)mmol/L, t=717.817, all P<0.05]. Decreased platelets and blood sugar could return to normal within 3 days. Conclusion:Exchange therapy can significantly reduce the level of bilirubin and the incidence of bilirubin encephalopathy in neonates with ABO hemolysis.Exchange therapy has certain effect on the internal environment of neonatal ABO hemolytic patients, which is easy to cause thrombocytopenia and blood sugar reduction.But the change of internal environment is temporary and reversible.
ABSTRACT
Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK(+) and 9 ones (27.3%) ALK(-). Of them, 25 patients (19 ALK(+) and 6 ALK(-)) underwent auto-HSCT and 8 cases (5 ALK(+) and 3ALK(-)) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion: ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Hematopoietic Stem Cell Transplantation , Lymphoma, Large-Cell, Anaplastic/therapy , Neoplasm Recurrence, Local , Retrospective Studies , Transplantation, Autologous , Transplantation, Homologous , Treatment OutcomeABSTRACT
Objective:To investigate the correlation among clinical manifestations, pathological changes and immunofluorescence in children with primary IgA nephropathy (IgAN).Methods:The data of a total of 222 cases diagnosed with IgAN by the Department of Nephrology, Jiangxi Children′s Hospital in recent 10 years were collected for the analysis of clinical and pathological features and their correlation.Results:(1)Immunofluorescence showed that 115 cases (51.8%) IgA patients had only mesangial deposition, and 107 cases (48.2%) IgA patients had both mesangial deposition and capillary loop deposition.Most IgA patients (122 cases, 55.0%) had immunofluorescence intensity+ + .In IgA patients, IgM deposition was the most common [168 cases (75.7%)], followed by C 3 deposition [160 cases (72.1%)]. Patients with C 4 deposition were the least[7 cases (3.2%)]. (2) Hypertension were positively correlated with IgM, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hyperuricemia was positively correlated with IgM deposition, IgG deposition, C 3 deposition and IgA with vascular loop deposition(all P<0.05); hypoalbuminemia was negatively correlated with IgM deposition, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hypercholesterolemia were positively correlated with C 3 deposition and IgA with vascular loop deposition(all P<0.05). Urine protein quantification were positively related to IgM, IgG and IgA with vascular loop deposition (all P<0.05). The estimated glomerular filtration rate(eGFR)was negatively related to IgA with vascular loop deposition( P<0.05). (3) Lee′s grade were positively correlated with IgM and C 3 deposition, IgA deposition intensity and IgA with capillary loop deposition(all P<0.05). (4) Oxford type mesangial hypercellularity(M1)were positively correlated with C 3 deposition and IgA deposition intensity(all P<0.001). Endocapillary hypercellularity(E1)lesions were positively correlated with IgA deposition intensity and IgA with capilla-ry loop deposition(all P<0.05). Segmental glomerulosclerosis(S1)lesions had no correlation with immunofluorescence pathology.Tubular atrophy and interstitial fibrosis(T1)was positively correlated with IgG and C 3 deposition(all P<0.05). (5) There was no correlation between glomerulosclerosis and immunofluorescence pathology.Crescent was positively correlated with IgM deposition, IgG deposition, C 3 deposition, IgA deposition intensity and IgA capillary loop deposition(all P<0.05). Renal artery thickening was positively correlated with IgG deposition and IgA capillary loop deposition(all P<0.05). Conclusions:IgA intensity of + + and IgM deposition are most commonly found in immunofluorescence of children with primary IgAN.IgA patients with capillary loops or C 3 deposition have more severe clinical manifestations and light microscopy results.
ABSTRACT
Objective@#To identify the independent risk factors of esophageal varices (EV) in cirrhosis by endoscopic ultrasonography (EUS), and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model.@*Methods@#A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker (NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model.@*Results@#A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV (the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores: no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm (1 point), the number of peri-ECV≥5 (3 points), the diameter of para-ECV≥5 mm (4 points), and the number of para-ECV≥5 (4 points). (2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0.003 to 1.000 with the increase of the score. (3) In the risk assessment model, the total risk score ≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2.78% in the low-risk group, 36.36% in the medium-risk group and 93.91% in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0.947 (P<0.05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0.450, suggesting that the model fitted well.@*Conclusion@#The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.
ABSTRACT
Objective To identify the independent risk factors of esophageal varices ( EV) in cirrhosis by endoscopic ultrasonography ( EUS) , and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model. Methods A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker ( NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model. Results A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV ( the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores:no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm ( 1 point) , the number of peri-ECV≥5 ( 3 points) , the diameter of para-ECV≥5 mm ( 4 points) , and the number of para-ECV≥5 ( 4 points) . ( 2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0. 003 to 1. 000 with the increase of the score. ( 3) In the risk assessment model, the total risk score≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2. 78％ in the low-risk group, 36. 36％ in the medium-risk group and 93. 91％ in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0. 947 (P<0. 05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0. 450, suggesting that the model fitted well. Conclusion The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.
ABSTRACT
BACKGROUND@#Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients.@*METHODS@#We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups.@*RESULTS@#Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107).@*CONCLUSIONS@#Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.@*TRIAL REGISTRATION@#www.clinicaltrials.gov (No. NCT01874691).
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac , Pathology , China , Electrocardiography , Methods , Hospital Mortality , Myocardial Infarction , Pathology , Odds Ratio , Registries , Risk Factors , ST Elevation Myocardial Infarction , PathologyABSTRACT
BACKGROUND@#Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their "high-risk" angiographic characteristics.@*METHODS@#We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.@*RESULTS@#The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02-1.83).@*CONCLUSIONS@#Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics.@*CLINICAL TRIAL REGISTRATION@#NCT01874691, https://clinicaltrials.gov.
ABSTRACT
Background@#Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their "high-risk" angiographic characteristics.@*Methods@#We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.@*Results@#The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ2 = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ2 = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02–1.83).@*Conclusions@#Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics.@*Clinical trial registration@#NCT01874691, https://clinicaltrials.gov.
ABSTRACT
Objective To compare the accuracy of three classification systems [determinant based classification (DBC),Revision of the Atlanta classification (RAC),and Atlanta classification (AC)] to stratify severity of acute pancreatitis (AP),and to analyze the association between different severity categories and clinical outcomes.Methods In this retrospective study,we reviewed the clinical data of 458 patients with AP admitted to our unit from January 2015 to December 2017.AP severity was stratified according to the three classification systems (DBC,RAC,and AC) respectively.The classification accuracy of three classification systems was analyzed.Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification.Multi-factors logistic regression analysis identified the independent risk fators for mortality of AP.Results Among the three classification systems,there were significant differences in the mortality rate,invasive treatment rate,ICU monitoring rate and the average hospitalization time among the three subtypes (P＜0.001).The RAC and DBC were comparable,but performed better than AC in predicting mortality (AUC 0.94 and 0.95 vs.0.63,P＜0.001),ICU admission (AUC 0.90 and 0.88 vs 0.60,P＜0.001).The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.88 vs 0.69 and 0.68,P＜0.001).Persistent organ failure (OR=13.131,P=0.003) and infected necrosis(OR=9.424,P=0.014) were independent risk factors for mortality.Conclusion The accuracy of DBC and RAC to stratify the severity of AP was significantly higher than that of AC.The accuracy of DBC in predicting clinical outcome was genarally higher than that of RAC and AC.Infectious necrosis and persistent organ failure were the independent risk fators for mortality.
ABSTRACT
Objective To evaluate the value of bedside ultrasound-measured antral cross-sectional area (CSA) in diagnosing an empty stomach in patients with chronic hepatitis B.Methods One hundred and fifty-nine patients with chronic hepatitis B,aged 18-64 yr,with body height＞150 cm,weighing 45-110 kg,were enrolled in this study.The antero-posterior diameter and craniocaudal diameter of the gastric antrumn were measured by bedside ultrasound when patients were in the supine position,and CSA was calculated.Gastroscope negative pressure was used to suction fluid from stomach at the end of gastroscopy,and the fluid volume was recorded,and gastric fluid volume ≤0.8 ml/kg was defined as the standard for empty stomach.Results The cut-off value of CSA measured by bedside ultrasound in diagnosing an empty stomach was 440 mm2,with sensitivity 85.07％,specificity 80.95％,positive predictive value 96.61％,negative predictive value 45.95％,coincidence rate 84.52％.Conclusion The cut-off value of bedside ultrasound-measured CSA in diagnosing an empty stomach is 440 mm2 for the patients with chronic hepatitis B.
ABSTRACT
Objective: To evaluate clinical outcomes of autologous (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for angioimmunoblastic T-cell lymphoma (AITL) . Methods: From June 2007 to June 2017, clinical data of AITL patients who underwent HSCT in eight hospitals were assessed retrospectively. Results: Of 19 patients, 13 male and 6 female with a median age of 50 (32-60) years old, 12 auto-HSCT and 7 allo-HSCT recipients were enrolled in this study, all donors were HLA-identical siblings. Two of allo-HSCT recipients were relapsed auto-HSCT ones. There were 5 patients (5/12) in complete response (CR) status and 7 (7/12) in partial remission (PR) status before transplantation in auto-HSCT group, and 2 (2/7) in PR status and 3 (3/7) in progression disease (PD) status before transplantation in allo-HSCT group. The median follow-up for the surviving patients was 46.5 months (range, 1-100 months) for the whole series, two patients lost in auto-HSCT group. Three patients developed acute graft-versus-host disease (aGVHD) and 5 chronic graft-versus-host disease (cGVHD) after allo-HSCT. Three patients died of primary disease and 1bleeding in auto-HSCT group. One patient died of primary disease and 2 transplantation-related mortality in allo-HSCT group. The 3-year cumulative overall survival (OS) were 56% (95%CI 32%-100%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.979) . The 3-year cumulative progression-free survival (PFS) were 34% (95%CI 14%-85%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.451) . Conclusion: Both auto-HSCT and allo-HSCT were optimal choices for AITL. In clinical practice, which HSCT was better for AITL patients should be based on comprehensive factors including sensitivity to chemotherapy, risk stratification and disease status at transplantation.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Lymphoma, T-Cell/therapy , Retrospective Studies , Transplantation, Autologous , Transplantation, Homologous , Treatment OutcomeABSTRACT
Objectives: To investigate the association between acquired thrombocytopenia and long-term clinical outcome among stable coronary artery disease patients undergoing elective percutaneous coronary intervention (PCI). Methods: We analyzed clinical data of 8 271 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Acquired thrombocytopenia was defined as platelet count <150×109/L after PCI in patients with normal baseline platelet count value. We compared data on demographic, clinical, laboratory, and 30-month outcome between non-thrombocytopenic and thrombocytopenic patients and identified the independent predictors of acquired thrombocytopenia post PCI. Results: Acquired thrombocytopenia developed in 654 (7.91%) patients (634 [7.67%] patients had mild thrombocytopenia, 20 [0.24%] patients had moderate or severe thrombocytopenia). Patients who developed thrombocytopenia had higher 30-month rate of all cause death (2.3% vs 1.0%, P=0.0086) and cardiogenic death (1.2% vs 0.5%, P=0.0261). Moderate or severe thrombocytopenia was associated with a 13-fold increased risk for cardiogenic death, 7-fold increased risk for stent thrombosis,11-fold increased risk for myocardial infarction compared with patients without thrombocytopenia. Conclusions: Acquired thrombocytopenia after PCI is common in stable coronary artery disease patients and is independently associated with increased risk of long-term adverse outcome in these patients.