Review analysis of reported cases of myocarditis induced by immune checkpoint inhibitors / 中国医师杂志

Objective:To explore the clinical characteristics and influencing factors of myocarditis induced by immune checkpoint inhibitors (ICIs).Methods:Using programmed death receptor-1 (PD-1), nivolumab, pembrolizumab, programmed cell death receptor ligand-1 (PD-L1), atezolizumab, durvalumab, avelumab, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), ipilimumab, tremelimumab as keywords respectively, we combined these words with myocarditis or the corresponding Chinese to search.Results:A total of 49 articles were reported, including 64 patients. Nivolumab was the most reported, followed by pembrolizumab and ipilimumab. The average age was (65.47±13.24)years, mainly elderly patients; 37 cases (57.81%) were male; the overall mortality rate was 31.25%(20/64). The clinical symptoms were diverse and nonspecific, with dyspnea being the most common (39/64, 60.94%). Heart biomarkers were elevated in 94.64%(53/56) of the patients. 35 patients (54.69%, 35/64) developed myocarditis after 1-2 doses and 17 patients died. 60 patients received steroids as initial treatment, and immunosuppressive therapies such as infliximab, intravenous immunoglobulin, antithymic globulin, and/or plasmapheresis were used in 25 patients, symptoms improved in 17 cases (68.00%).Conclusions:ICIs can cause myocarditis, with high mortality, and should be closely monitored and timely treatment. Steroids can be used as initial first-line therapy and immunosuppressants and/or plasmapheresis may improve clinical symptoms and survival rate.

The interaction analysis of genetic and behavioral factors on the occurrence of acute coronary syndrome / 中华行为医学与脑科学杂志

Objective To explore the the interaction analysis of genetic and behavioral factors on the occurrence of acute coronary syndrome. Methods This study consisted of 134 subjects between June 2009 and Dec.2009 from affiliated hospital of Jining Medical University, All subjects underwented selective coronary angiography or coronary artery CT. Coronary artery disease based on the results of coronary angiography or coronary artery CT that at least one coronary artery diameter reduction of more than 50% and fulfilled the diagnostic criteria of ACC/AHA. 84 patients with acute coronary syndrome and 50 controls, and general informations, current disease history,past medical history, related be havioral factors were collected. DNA was extracted from acute coronary syndromepatients and healthy control subjects, stored in -20 ℃. The genotype of CFH Y402H was detected by polymerase chain reaction and restriction fragment length polymorphism(PCR-RFLP) methods in acute coronary syndrome patients and controls. PCR amplification products was verificated by electrophoresis on agarose gel. Deviation of genotype distribution form Hardy-Weinberg equilibrium was assessed using x2 test in each group. Univariate and multivariate conditional logistic analyses were conducted in the end. Results The results showed that smoking history (P=0.000, OR =4.894,OR 95% CI:2.537 ～9.441 ), alcohol drinking history(P= 0.008,OR =2.879,OR 95% CI: 1.499 ～ 5.528 ), hypertension (P = 0.000, OR = 4.222, OR 95% CI: 2.195 ～ 8.123), sports activities (P =0.002,OR =0.333, OR 95% CI:0.188 ～ 0.589 ), salt intake (P= 0.006, OR = 0.457, OR 95% CI:0.287 ～0.727 ), character(P = 0.000, OR = 0.385, OR 95% CI :0.247 ～ 0.600 ) stress of occupations (P = 0.015, OR =2.118, OR 95% CI: 1.278 ～ 3.511 ) were associated with acute coronary syndrome of Northern Chinese Han population. Smoking history(P = 0.010, OR = 6.084, OR 95% CI: 1.543 ～ 23.988), hypertension (P= 0.024, OR =2.821, OR 95% CI: 1.143 ～ 6.595 ), sports activities (P= 0.004, OR = 0.297, OR 95% CI:0.130 ～ 0.678 ), personality(P= 0.011, OR = 0.435, OR 95% CI:0.229 ～ 0.829 ) were significantly associated with acute coronary syndrome in multivariate conditional logistic analyses after adjusting other factors. Conclusions Smoking history,hypertension, personality are risk factors of acute coronary syndrome of Northern Chinese Han population. Butsports activities is protective factors.

Oral glucose tolerance and insulin release test in 52 cases of obese and overweight children / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess the state of glucose metabolism and beta-cell function in obese and overweight children.</p><p><b>METHODS</b>Levels of glucose and insulin were detected during oral glucose tolerance test in 52 obese and overweight children aged 11.3 +/- 1.8 years with body mass index (BMI) 30.2 +/- 19.2 kg/m(2). Insulin resistance index (IR = FIN x FPG/22.5), insulin sensitivity index (IS = 1/FIN x FPG) and ratio of insulin increment to glucose increment at 30' (I(30)-I(0)/G(30)-G(0)) post oral glucose were measured. (FIN = fasting insulin. FPG = fasting plasma glucose). The IR, IS and the ratio post oral glucose were compared among groups with varying BMI and between groups of impaired glucose tolerance (IGT) and control. Serum triglyceride determination and B ultrasonography of liver were performed.</p><p><b>RESULTS</b>(1) one patient with type 2 diabetes (1.9%) and 5 patients with IGT (9.6%) were found. (2) IR (> or = 2.8) was observed in 76.9% of the cases. (3) The IR, IS and their ratio showed no difference between the compared groups. (4) IR and IS did not show significant difference but there was significant difference in ratio between the IGT and control group. (5) Increased serum triglyceride and fatty liver were noted in 36.5% and 53.3% of the cases, respectively.</p><p><b>CONCLUSION</b>The results indicated that insulin resistance and reduced insulin sensitivity in obese and overweight children are common, and these changes seemed not to correlated with the varying degree of BMI. Beta-cells function was obviously impaired in obese children with IGT and disorder of lipid metabolism exists in many obese and overweight children revealed.</p>

Detection and analysis of HAV-HEV, HGV infection in patients with viral hepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the simple infection and super/co-infection of HAV-HEV, HGV in patients with viral hepatitis.</p><p><b>METHODS</b>Using EIA method to detect anti-HAV IgM, HBV serum markers, anti-HCV IgM, anti-HDV IgM, anti-HEV IgM, anti-HGV IgM in viral hepatitis patients with different clinical types.</p><p><b>RESULTS</b>Seventy-three percent patients (154/210) had HBV infection markers, twenty-nine percent patients (61/210) had HAV infection marker, eight percent patients (17/210) had HCV, HDV infection markers, ten percent patients (21/210) had HEV infection and seven percent patients (15/210) had HGV infection. Only nine percent patients (20/210) had viral hepatitis serum markers negative. In all clinical types, sixty-one percent patients had only one type hepatitis virus infection, thirty-two percent patients had two types of hepatitis virus super/co-infection, six percent patients had three types of hepatitis virus super/co-infection. Super/co-infection often occurred in patients who had cirrhosis or hepatic failure.</p><p><b>CONCLUSION</b>HBV and HAV infection is very common in viral hepatitis patients, whereas HCV, HDV, HEV and HGV infection is relatively low; double super/co-infection of HAV-HEV, HGV frequently occurs in severe patients with viral hepatitis.</p>

Prader-Willi syndrome and genomic imprinting / 中华儿科杂志

<p><b>OBJECTIVE</b>Prader-Willi syndrome (PWS) is an example of a human genetic disorder that involves imprinting genes on the proximal long arm of chromosome 15 and SNRPN gene as a candidate gene for this syndrome. The purpose of this study was to show the molecular genetic defects and genomic imprinting basis in Chinese PWS patients and to evaluate the clinical applications of a differential diagnostic test for PWS.</p><p><b>METHODS</b>Fluorescence in situ hybridization (FISH) and methylation-specific PCR (MSPCR) techniques were applied for 4 clinically suspected PWS patients. Using three probes, including SNRPN probe for identification of the critical locus in PWS region, D15Z1 and PML control probes for identification of the 15p arm and 15q arm, the authors detected the deletions 15q in PWS. MSPCR was based on sodium bisulfite treatment of DNA and PCR primers specific for the maternal and paternal allele.</p><p><b>RESULTS</b>When hybridized with mixed probes, it was found in 2 patients that the central specific signal was absent, but both the flanking control signals were retained, indicating SNRPN gene deletion of chromosome 15q11-13. Bisulfite-modified DNA from all PWS children amplified with methylated allele-specific primer pair showed only maternal 131bp PCR product, indicating the maternal uniparental disomy (UPD15).</p><p><b>CONCLUSION</b>Genomic imprinting plays an important role in the molecular pathogenesis of PWS that caused by paternal microdeletions of 15q11-q13 or maternal UPD of chromosome 15. The basic defect seemed to be an absence of function of PWS genes that are normally expressed only from the paternal chromosome 15. MSPCR is a rapid and simple PCR-based assay compared with other cyto-molecular tests and its results were consistent with the clinical diagnosis of PWS, so it seems to be a reliable diagnostic method for PWS patients who show abnormal methylation at SNRPN. The genetic differential tests for PWS are important in determining familial recurrence risk.</p>

Levonorgestrel-releasing intrauterine system for treatment of dysmenorrhea associated with adenomyosis / 中华妇产科杂志

Objective To evaluate the efficacy and safety of a levonorgestrel-releasing intrauterine system(LNG-IUS)for the treatment of dysmenorrhea associated with adenomyosis.Methods We recruited 48 women with moderate or severe dysmenorrhea associated with adenomyosis.All women were inserted of LNG-IUS into their uterine cavity from days 5-7 of their periods and maintained for 12 months.We compared the visual analogue scale(VAS)scores and verbal rating scale(VRS)scores of their dysmenorrhea and dyspareunia at baseline and 12 monthes follow-up.Results Forty-four women completed the study. There were significant differences between mean VAS and VRS scores changes of dysmenorrhea and dyspareunia at baseline and 12 monthes follow-up,those of dysmenorrhea dropping from 75?13 to 11?11 and 2.3?0.4 to 0.4?0.3,those of dyspareunia dropping from 54?19 to 4?4 and from 1.6?0.8 to 0.2?0.2 respectively.Overall 29 women(66%)were very satisfied or satisfied with the one-year treatment. Conclusion Insertion of LNG-IUS alleviates moderate or severe dysmenorrhea associated with adenomyosis remarkably.