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Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.
Subject(s)
Female , Humans , Atrioventricular Block/therapy , Feasibility Studies , Transcatheter Aortic Valve Replacement , Pacemaker, Artificial , Bundle-Branch BlockABSTRACT
@#This study aims to investigate the effect of transmembrane protein angiotensin converting enzyme 2 (ACE2) on the prognosis of breast cancer and its potential mechanism.Public databases were used to analyze ACE2 expression and its relationship with clinicopathological features and prognosis of breast cancer patients, combined with in vitro experiments to analyze the mechanism of action and immune relevance of ACE2 in breast cancer.Results showed that the expression of ACE2 in breast cancer tissues was significantly lower than that in normal breast tissues, and that its expression was negatively correlated with age, M stage and N1mi stage of breast cancer patients (P < 0.05).Patients with Luminal type breast cancer with high ACE2 expression had poor prognosis, while in the triple-negative breast cancer (TNBC) subtype, ACE2 showed different prognostic significance.In addition, ACE2 is closely associated with the metabolic and immune microenvironment of tumor tissue.In vitro experiments have shown that ACE2 is lowly expressed in MDA-MB-231 cells and may inhibit cell progress by downregulating matrix metalloproteinase 2（MMP2）.The results suggest that the low expression of ACE2 in breast cancer is closely associated with patient prognosis as well as metabolic and immune microenvironment, and that ACE2 may inhibit TNBC cell progress through the MMP2 pathway.
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@#In order to mask the bitterness of azithromycin (AZI) and individually regulate the drug release rate to reduce gastrointestinal irritation, immediate-release AZI-AmberliteTM IRP64/HPC and delayed-release AZI-AmberliteTM IRP69/RS100 were prepared by modifying with hydroxypropyl cellulose (HPC) and Eudragit RS100, respectively, and further combined to achieve controlled release.The drug loading and drug utilization rate of AZI-ion exchange resin complexes were measured; the structure of AZI-ion exchange resin complexes was characterized by differential scanning calorimetry and X-ray diffraction; and the wetting humidity, odor masking effects, in vitro dissolution and release behaviors were determined.The results showed that the formation of AZI-ion exchange resin complexes changed the original crystallization state of the drug, that the 2.5% HPC-modified AZI-AmberliteTM IRP64/HPC and the 0.5% RS100-modified AZI-AmberliteTM IRP69/RS100 demonstrated good taste masking effect, and that their combination in the drug content ratio of 13∶67 achieved the expected drug release behavior, i.e.rapid release of AZI in the first 10 min and smooth release in the later 6 h.These results indicated that the AZI-ion exchange resin complexes prepared by surface modification and their composites could mask the bitterness of AZI and realize the flexible adjustment of drug release rate, which lays the foundation for the research and development of new AZI preparations.
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BackgroundInsomnia disorder has become a common disease in the current society. Cognitive Behavior Therapy for Insomnia （CBTI） is one of the non-drug treatment methods for insomnia disorder， but relevant studies of its effect on sleep quality and cognitive function of patients with insomnia disorder are limited. ObjectiveTo explore the effects of CBTI on sleep quality and cognitive function in patients with insomnia disorder， so as to provide references for non-drug treatment of insomnia disorder. MethodsA total of 47 patients with insomnia disorder were recruited as the study subjects. They all met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and have visited Sichuan Mental Health Center from January 2021 to October 2022. The patients underwent CBTI for 6 weeks. Before the treatment， depression and anxiety symptoms were assessed using Hamilton Depression Scale-24 item （HAMD-24） and Hamilton Anxiety Scale （HAMA）. Sleep status and cognitive function were assessed using Pittsburgh Sleep Quality Index （PSQI） and Montreal Cognitive Assessment （MoCA） before and 6 weeks after the treatment. Spearman correlation analysis was used to examine the correlation between the reduction of PSQI score and the increase of MoCA score after treatment. ResultsAfter the 6-week treatment， the factor scores and total score of PSQI across 6 subscales （the sleep quality， sleep onset time， sleep time， sleep efficiency， sleep disorder and daytime dysfunction） were lower than those before the treatment， and the score differences were of statistical significance （t=5.569~15.290， P<0.01）. Both factor and total scores of MoCA across 6 items （visuospatial and executive， naming， attention， language， abstraction and memory） were significantly higher than those before the treatment with score differences reaching statistical significance （t=-11.273~-4.277， P<0.01）. Spearman correlation analysis demonstrated that there was a positive correlation between the decrease in PSQI total score and the increase in MoCA total score after the 6-week CBTI treatment （r=0.323， P=0.027）. ConclusionCBTI may help improve sleep quality and cognitive function in patients with insomnia disorders. The improvement of sleep quality after CBTI intervention may be related to the improvement of cognitive function. ［Funded by Scientific Research Project of Sichuan Provincial Health Commission （number， 19PJ216）］
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@#Objective To analyze the echocardiographic characteristics of above grade 3+ mitral regurgitation (MR) patients by 3D transesophageal echocardiography (3D-TEE) in transcatheter edge-to-edge repair (TEER) and compare the intervention rate of TEER treatment in patients with different risk stratification. Methods We retrospectively analyzed the clinical data of 91 patients with above grade 3+ MR in Anzhen Hospital between June 2021 and April 2022. There were 45 males and 46 females aged 66.5±15.9 years. According to pathogenesis, the patients were divided into different anatomical groups and risk stratification groups. There were 34 patients in a simple degenerative group (simple DMR group), 28 patietns in a complex disease group (Complex group), 14 patients in a simple ventricular functional reflux group (simple VFMR group), 9 patients in a simple atrial functional reflux group (simple AFMR group), and 6 patients in a mixed functional reflux group (mixed FMR group). All patients were examined with a unified standard of transthoracic echocardiography (TTE) and 3D-TEE to compare the characteristic three-dimensional structural changes of the mitral valve in each group. According to the three partition strategy of preoperative anatomical evaluation of TEER, the risk stratification was conducted for the enrolled patients, which was divided into three regions from light to heavy: green area, yellow area, and red area. TEER treatment intervention rate of patients with different risk stratification was calculated. Results Ant leaf angle and post leaf angle were negative in the simple DMR and Complex groups, and non-planar angle, prolapse height and prolapse volume were higher than those of the other groups (P=0.000). Ant leaf angle and post leaf angle were positive in the VFMR group and the mixed FMR group. Anterior and posterior (AP) diameter of valve ring (P=0.036), tenting height and tenting volume were higher than those of other groups (P=0.000). AP diameter, tenting height and tenting volume were changed mildly in patients with simple AFMR. MR patients in red and yellow zone achieved a 28.1% TEER intervention rate. Conclusion Standardized TTE and TEE examinations are crucial for the qualitative and quantitative diagnosis of MR in the echo core-lab. 3D-TEE mitral valve parameter can help determine the exact pathogenesis of MR and to improve the interventional rate of challenging MR patients.
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In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.
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Humans , Exotropia/surgery , Depth Perception/physiology , Strabismus/surgery , Oculomotor Muscles/surgeryABSTRACT
Objective: To assess the prevalence, pattern and outcome of multimorbidity in elderly patients with acute coronary syndrome (ACS). Methods: Secondary analysis was performed based on the data from the BleeMACS registry, which was conducted between 2003 and 2014. We stratified elderly patients (≥65 years) according to their multimorbidity. Multimorbidity was defined as two or more chronic diseases in the same individual. Kaplan-Meier methods were used to estimate 1 year event rates for each endpoint, and comparisons between the study groups were performed using the log-rank test. The primary endpoint was net adverse clinical events (NACE), which is a composite of all-cause mortality, myocardial infarction, or bleeding. Results: Of 7 120 evaluable patients, 6 391 (89.8%) were with morbidity (1 594 with 1, 2 156 with 2, and 2 641 with ≥3 morbidity). Patients with morbidity were older, percent of female sex and non-ST-elevation acute coronary syndromes and implantation rate with drug-eluting stents and blood creatine level were higher compared to patients without morbidity. Compared with the patients without morbidity, the proportion of participants with oral anticoagulant increased in proportion to increased number of morbidities (5.8% vs. 6.4% with 1 morbidity, 7.3% with 2 morbidities, 9.0% with ≥3 morbidities, P trend<0.01) and the proportion of participants with clopidogrel prescription decreased in proportion to increased number of morbidity (91.9% vs. 89.7% with 1 morbidity, 87.9% with 2 morbidities, 88.6% with ≥3 morbidities, P trend = 0.01). During 1 year follow-up, compared with those with no morbidity, the hazard ratio (HR) and 95% confidence interval (CI) of risk of NACE for those with 1, 2, and ≥ 3 morbidities was 1.18 (0.86-1.64), 1.49 (1.10-2.02), and 2.74 (2.06-3.66), respectively (P < 0.01). Multimorbidity was not associated with an increased risk of bleeding of various organs (P>0.05). Conclusion: Multimorbidity is common in elderly patients with ACS. These patients might benefit from coordinated and integrated multimorbidity management by multidisciplinary teams.
Subject(s)
Aged , Female , Humans , Acute Coronary Syndrome/epidemiology , Clopidogrel , Hemorrhage , Multimorbidity , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors/adverse effects , Registries , Treatment OutcomeABSTRACT
Objective:To evaluate the effect of driving pressure (ΔP)-guided PEEP titration on lung injury in elderly patients undergoing robot-assisted radical prostatectomy (RARP).Methods:Forty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-28 kg/m 2, with Assess Respiratory Risk in Surgical Patients in Catalonia score assessed as medium to high risk, scheduled for elective RARP, were divided into control group (group C, n=23) and ΔP titration group (group D, n=23) using a random number table method.Volume-controlled mechanical ventilation was used after anesthesia induction and tracheal intubation.In group C, 5 cmH 2O was used to fix PEEP.In group D, the optimal PEEP was titrated after computer-controlled breathing and after establishing Trendelenburg position and pneumoperitoneum, the first titration started from 4 cmH 2O and increased by 1 cmH 2O every 4 min until ΔP reached the minimum value or PEEP increased to 12 cmH 2O, and the second titration was increased in increments as the method described above based on the optimal PEEP of the first titration.At 4 min after completion of the first PEEP titration (T 1, 4 min after mechanical ventilation with fixed PEEP in group C), 2 h after establishment of Trendelenburg position (T 2), 1 min after extubation (T 3) and 2 h after operation (T 4), serum concentrations of Clara cell protein (CC16), surfactant protein D (SP-D), soluble receptor for advanced glycation end-products (sRAGE) and soluble intercellular adhesion molecule-1 (sICAM-1). Pulmonary complications were assessed within 7 days after operation. Results:The serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly higher at T 2-4 than at T 1 in two groups ( P<0.05). Compared with group C, the serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly decreased at T 2-4 ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after operation in group D ( P>0.05). Conclusions:ΔP-guided PEEP titration can reduce lung injury in elderly patients undergoing RARP.
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Objective:To measure serum 25-hydroxyvitamin D (25(OH)D) levels in older adult patients with essential hypertension and correlate serum 25(OH)D levels with target organ damage.Methods:The general data and laboratory test results of 163 older adult patients with essential hypertension who received treatment in Zhejiang Veteran Hospital between January 2019 and April 2021 were collected for this study. The included patients were divided into different groups according to the number of injured target organs, serum 25(OH)D level, and single target organ damage site. Two variables were correlated using the Pearson correlation analysis. The factors that affect target organ damage were analyzed using multivariate logistic regression analysis.Results:There were significant differences in age, course of the disease, serum 25(OH)D level, systolic blood pressure, and diastolic blood pressure among patients with different numbers of damaged target organs ( F = 16.95, 14.39, 14.95, 33.18, 20.88, all P < 0.001). There were significant differences in serum triacylglycerol level and 25(OH)D level among the patients who had different serum 25(OH)D levels ( F = 2.31, 178.48, both P < 0.05). There was a negative correlation between serum 25(OH)D levels and serum triacylglycerol levels. Serum 25(OH)D level was significantly lower in patients with damage to a single target organ heart, kidney, or carotid artery than in patients without target organ damage ( t = 9.24, 6.15, 6.09, all P < 0.05). There was no significant difference in serum 25(OH)D level between patients with damage to a single target organ ( P > 0.05). Older age, long course of disease, high systolic and diastolic blood pressure, and low serum 25(OH)D level were the independent risk factors for target organ damage (all P < 0.05). Conclusion:There is a correlation between serum 25(OH)D levels and target organ damage in older adult patients with essential hypertension. However, the evidence of vitamin D deficiency and target organ damage in essential hypertension is still insufficient, and further investigation is needed. This study is highly innovative and scientific.
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Objective:To study the diagnostic value of the artificial intelligence (AI) diagnostic system, ACR TI-RADS classification and AI+ ACR TI-RADS combined diagnostic performance in benign and malignant thyroid nodules and its guiding significance for surgical treatment.Methods:From Nov. 1, 2021, to Feb. 26, 2022, 349 patients with 605 thyroid nodules who received surgical treatment in Department of Thyroid (Hernia) Surgery, Department of General Surgery, the First Medical Center of the PLA General Hospital, were selected. There were 95 males and 254 females, male: female=1:2.67, aged 16-78 years, and the nodule diameter was 0.2-5.6 cm. SPSS 26.0 and R studio software were used for data processing. AI diagnostic system, ACR TI-RADS grading and AI+ ACR TI-RADS combined diagnostic efficacy were statistically analyzed, respectively. ROC curve analysis was performed in parallel.Results:The AUC value of AI+ ACR TI-RADS combined diagnosis was 0.900, greater than 0.857 of AI diagnostic system and 0.788 of ACR TI-RADS, and the difference was statistically significant ( Z= 7.631, both P<0.001) . The sensitivity of the combined diagnosis was 95.32%, the specificity was 84.61%, the accuracy was 92.56%, the positive predictive value was 94.69%, the negative predictive value was 86.27%, the missed diagnosis rate was 4.68%, and the misdiagnosis rate was 15.38%, which were better than the other two diagnostic methods. With an excellent coincidence rate with postoperative pathological results ( Kappa=0.804, P<0.001) . The accuracy of combined diagnosis in identifying the maximum diameter of different tumors was 89.58% for d≤0.5 cm, 96.09% for 0.5<d≤1.0 cm, 95.45% for 1.0<d≤2.0 cm, 87.88% for 2.0<d≤4.0 cm, and 85.71% for d>4.0 cm, better than the other two diagnostic methods. Conclusions:The combined application of AI+ACR TI-RADS has a certain primary screening value in evaluating thyroid nodule properties. The combined diagnosis of the two can more effectively determine the benign and malignant thyroid nodules.
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Objective:To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF) and concomitant heart failure with preserved ejection fraction (HFpEF).Methods:The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019. Right ventricular functional parameters were measured before and 5 days, 1, 3, 6 and 12 months after the ablation by transthoracic echocardiography, respectively, including the right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid annular diameter (TVAD), tricuspid annular peak systolic speed(TDI-S′) and longitudinal strain of right ventricular free wall (RVFLS). Meanwhile, routine ECG and Holter recordings were performed at each follow-up time point.Results:In this study, atrial fibrillation (AF) recurrence occurred in 4 patients at the 3rd month after ablation, and 7 patients failed to follow up due to the Covid-19. Finally, 19 patients were followed up for the evaluation of cardiac function after catheter ablation. Compared with pre-ablation, right ventricular structural and functional paramters(RVFAC, TAPSE, TVAD, TDI-S′, RVFLS) improved significantly at all stages of follow-up( all P<0.05). Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′ at the baseline( P=0.039, P=0.019). Conclusions:Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.
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@#Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.
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This paper aims to analyze the clinical efficacy of cognitive behavioral therapy for insomnia （CBTI） in chronic insomnia treatment， with a view to providing a theoretical basis for promoting the clinical use of CBTI and providing a reference for the non-pharmacological treatment of chronic insomnia patients in China. Chronic insomnia is a common disorder， and CBTI has emerged as the first approach to treating chronic insomnia， so this review focuses on the current status， clinical efficacy， adverse effects， existed problems and management strategies of CBTI for chronic insomnia treatment from the perspectives of physiological mechanisms and neuroimaging.
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@#Abstract: Objective To explore the effects of continuous light and benzene exposure on peripheral blood erythrocyte - Methods parameters and expression of miR 144/451 in the bone marrow of mice. This was a 2×2 factorial design. Photoperiod ， ， factor was set as normal and continuous light levels and mice were treated for 12 hours/12 hours light/dark or 24 hours light - respectively. The benzene exposure factor was set as non exposure and exposure levels. Mice were exposed to benzene by static 3 ， inhalation with a mass concentration of 0.0 and 32.5 mg/m for three hours per day five days per week for a total of four weeks. ， ， Specific pathogen free male C57BL/6 J mice were randomly divided into negative control group simple continuous light group - - ， ， simple benzene exposure group and combined exposure group with 12 mice per group. After benzene exposure peripheral ， blood was collected for the detection of erythrocyte parameters in four periods. After the mice were sacrificed the expression of - - - - miR 451a and miR 144 5p was detected by real time fluorescence quantitative polymerase chain reaction in bone marrow Results （ ）， ， tissues. The hematocrit volume HCT mean corpuscular volume mean corpuscular hemoglobin concentration （ ） - MCHC and mean corpuscular hemoglobin in peripheral blood and the relative expression of miR 451a in bone marrow tissue （ P< ） ， were statistically significant only in mice with benzene exposure all 0.05 . Among them the MCHC of benzene exposed （P< ）， （ P< ） - mice increased 0.05 but the other four indexes decreased all 0.05 compared with non benzene exposed mice. In thenegative control group the change of red blood cells count hemoglobin level and HCT in peripheral blood were rhythmical all P < ） ， （ P > ） rhythmical 0.05 . However the indexes above were out of rhythm all rhythmical 0.05 in the simple continuous light group and the - （ P > combined exposure group. The change of hemoglobin level and HCT of peripheral blood were also out of rhythm all rhythmical ） - - 0.05 in the simple benzene exposure group. The relative expression of miR 451a in bone marrow tissues of negative control （ P < ）， - group and simple continuous light group was rhythmical all rhythmical 0.05 while the relative expression of miR 451a in simple - - （ P > ）Conclusion benzene exposure group and combined exposure group was out of rhythm all rhythmical 0.05 . Benzene exposure ， induced changes in erythrocyte parameters of mice are independent effect and its mechanism may be related to the rhythmic - ， expression disorder of miR 451a in bone marrow tissues. Continuous light exposure benzene exposure and their interactions can ， interfere with the circadian rhythm of erythrocyte parameters such as red blood cell count hemoglobin and HCT to some extent.
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Background Arsenic is recognized as a kind of developmental toxicant, which can pass through the placenta barrier and induce health defects in offspring. However, the effects of environmental levels of arsenic exposure during gestation on the reproductive system of adult male offspring remain unclear. Objective To investigate the impact of environmental levels of arsenic exposure during gestation on testosterone synthesis and sperm quality in F1 adult male rats. Methods Forty sexually mature Wistar female rats were randomly divided into four groups according to body weight, namely control group, low-dose sodium arsenite (NaAsO2) group, middle-dose NaAsO2 group, and high-dose NaAsO2 group. They were mated with sexually mature Wistar male rats in a ratio of 2:1, and the day with presence of a vaginal plug or spermatozoa in the vaginal smear was designated as gestational day 0 (GD0). Pregnant rats were provided drinking water containing 0, 1, 5,, or 25 mg·L−1 NaAsO2 until delivery. At postnatal day 70, the F1 male rats were euthanized. Anogenital distance was measured, testis and epididymis were weighed, and associated organ coefficients were calculated. Epididymal sperm quality was evaluated. The histological changes of testis were observed. The levels of testosterone and estradiol in serum were determined with ELISA kit. The testicular mRNA relative expression levels of key steroidogenic enzymes were determined by quantitative real-time PCR. The protein relative expression levels of key steroidogenic enzymes were determined by Western blotting. Results Compared with the control group, the testicular coefficients and epididymis coefficients were increased in the low- and middle-dose groups (P<0.05), and the epididymis coefficient was also increased in the high-dose group (P<0.05). As for the percentage of sperm motility, compared to the control group, grade Ⅰ sperm cells were increased in the low-dose group, but significantly decreased in the middle- and high-dose groups; grade Ⅱ and Ⅲ sperm cells were decreased in the low- and high-dose groups; grade Ⅳ sperm cells were significantly increased in the middle- and high-dose groups; all the differences above were statistically significant (P<0.05). Compared with the control group, there was a significant increase in serum testosterone levels in all treated groups (P<0.05), and the serum estradiol levels were significantly decreased in the high-dose group (P<0.05). Meanwhile, compared with the control group, the relative mRNA expression levels of Hsd3β1 and Cyp19a1 were decreased (P<0.05), while those of StAR and Cyp11a1 were increased in the high-dose group (P<0.05). In addition, the relative protein expression levels of CYP11A1 were significantly increased in all treated groups compared with the control group (P<0.05). Conclusion Environmental levels of arsenic exposure during gestation can up-regulate testosterone level and reduce sperm quality, and is a potential risk for reproductive dysfunction in adult male offspring.
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The method of homogeneity evaluation for active pharmaceutical ingredient (API) spatial distribution in lyophilized product was investigated for the first time with confocal micro-Raman spectroscopy mapping, using pemetrexed disodium for injection as a model drug. Certain areas of the lyophilized product were scanned to obtain Raman spectra. The classical method ("peak clipping" method) was employed for mapping with characteristic Raman peaks of the API and the excipient. Due to the API being finely dispersed in the excipient in lyophilized products, the classical method cannot discriminate between the two ingredients making the distribution homogeneity difficult to evaluate. The "ratio of characteristic peak intensities" method was then utilized. Using this method, the relative intensity of the characteristic Raman peaks of the API to the excipient was applied for mapping and the relative content of API to excipient was calculated for a homogeneity evaluation of the drug distribution. The validation of this method showed a good linear relationship between the relative intensity and the relative content of API to excipient (r2 > 0.99), and the precision and recovery were adequate for homogeneity evaluation of API by Raman spectroscopy mapping. Five products of pemetrexed disodium for injection from different manufacturers were tested through Raman maps applying this method and the histograms of relative Raman intensity were also plotted by frequency to help the homogeneity evaluation of drug distribution. The results showed that there were obvious differences in the drug distribution homogeneity from different products, where a more homogeneous API distribution was found in the brand product. This research provides a reliable method for the homogeneity evaluation of API distribution, which facilitates quality evaluation and process optimization of lyophilized products.
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Objective To investigate the distribution and density of Culex mosquito populations and the resistance of Culex pipiens pallens to insecticides in Jiangsu Province in 2018 and 2019. Methods During the period from June to October in 2018 and 2019, six counties (districts, cities) were sampled in southern, northern and central Jiangsu Province as surveillance sites. The density of Culex mosquitoes was measured overnight using the light trapping technique. In addition, Culex pipiens pallens mosquitoes were collected from Hai’an of Nantong City and Yandu District of Yancheng City, central Jiangsu Province, and the sensitivity of female first filial generations to dichlorodiphenyltrichloroethane (DDT), malation, proposur, beta cypermethrin and deltamethrin was tested using the standard WHO insecticide susceptibility test assay. Results A total of 104 423 Culex mosquitoes were captured in six surveillance sites of Jiangsu Province in 2018 and 2019, and Culex quinquefasciatus (49.11%), Culex pipiens pallens (28.38%), and Culex tritaeniorhynchus (21.04%) were predominant species. The density of Culex mosquitoes started to increase since early June, peaked in July and tended to be low in late October. Culex pipiens pallens mosquitoes captured from Hai’an was susceptible to malation, while those from Yandu District were moderately resistant to malation. Culex pipiens pallens mosquitoes from both Yandu and Hai’an were moderately resistant to proposur, and were resistant to DDT, beta cypermethrin and deltamethrin. Conclusions Culex quinquefasciatus, Culex pipiens pallens and Culex tritaeniorhynchus are predominant Culex species in Jiangsu Province. Culex pipiens pallens is resistant to DT, beta cypermethrin and deltamethrin in central Jiangsu Province.
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@#This study sought to assess the therapeutic effect of celecoxib (CEL)-loaded polylactic acid-glycolic acid copolymer (PLGA) microspheres on rheumatoid arthritis in rats after intra-articular injection.The celecoxib-loaded microspheres (CEL-MS) were prepared by the O/W solvent volatilization method with PLGA as carrier.In order to investigate the therapeutic effect of CEL-MS on rheumatoid arthritis in rats after intra-articular injection, a rat model of adjuvant arthritis (AA) was constructed by complete Freund''s adjuvant, and the evaluation indicators of the therapeutic effect were rat paw swelling, arthritis index,spleen index and joint synovial histopathological examination. The results showed that the microspheres had a smooth spherical morphology with a particle size of (2.1 ± 0.3) μm and a drug loading efficiency of (20.8 ± 0.6)%.The results of the in vivo efficacy test showed that intra-articular injection of CEL-MS compared to the CEL suspension oral and the celecoxib suspension intra-articular injection in adjuvant arthritis rat model can significantly reduce joint swelling and arthritis index, thus effectively inhibiting synovial inflammation.The above results indicate that intra-articular injection of CEL-MS has a good therapeutic effect on rheumatoid arthritis in rats.
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OBJECTIVE@#To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-KoyanagiHarada (VKH) disease.@*METHODS@#Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging.SDOCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission.@*RESULTS@#VKH disease involved both eyes in 11 patients (91.7%).Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%).IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment.Hyperauto fluorescence was a common finding in FAF imaging (100%), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging.Ten eyes (43.5%) showed patches of relative hypoautofluorescence in the hyperauto fl uorescence areas, and granular hyperauto fl uorescence was found in the lesions in 4 eyes (17.4%).During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5%) of hyperautofluorescence in 9 eyes (39.1%).In 6 eyes (26.1%), only a few hyperautofluorescent spots scattered in the macula were observed.SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes.The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT (@*CONCLUSIONS@#The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease.FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.
Subject(s)
Humans , Acute Disease , Fluorescein Angiography , Follow-Up Studies , Retinal Detachment/diagnostic imaging , Tomography, Optical Coherence , Uveomeningoencephalitic Syndrome/diagnostic imagingABSTRACT
Objective:To evaluate the effectiveness of interventional treatment for neonatal critical pulmonary stenosis(NCPS).Methods:Clinical data of 12 neonates with NCPS who received percutaneous balloon pulmonary valvuloplasty (PBPV) from January 2016 to December 2019 in Department of Cardiology, Shenzhen Children′s Hospital were summarized and analyzed.The collected data included transthoracic echocardiography (TTE), percutaneous oxygen saturation (SPO 2), relevant data on interventional surgery, and follow-up results. Results:All 12 neonates with NCPS received PBPV successfully.The postoperative pressure difference between the right ventricle and the pulmonary artery ranged from 8 to 35 mmHg[(20±7) mmHg, 1 mmHg=0.133 kPa]. The postoperative SPO 2 ranged from 74%-100%[(93.0±5.9)%]. Three neonates with NCPS received Blalock-Taussig (B-T) shunt.One neonate with NCPS developed supraventricular tachycardia during the operation.There was no death for these 12 neonates with NCPS. Conclusions:Interventional treatment of neonates with NCPS could achieve a better effect and be employed as the first treatment option.Some neonates with NCPS would require cardiac B-T shunt or patent ductus arteriosus stent implantation.