Serotype distribution and drug resistance of Streptococcus pneumoniae in hospitalized patients in Yulin, Guangxi / 中国热带医学

@#Abstract: Objective　To analyze the serotype distribution, drug resistance rate and drug resistance gene carrying of Streptococcus pneumoniae isolates in hospitalized patients, and evaluate the coverage of the vaccine to the serotype of Streptococcus pneumoniae in this area, so as to provide reference for the rational use of antibiotics in clinic. Methods　A total of 150 strains of non-repetitive Streptococcus pneumoniae isolated from inpatients from January 2015 to December 2019 were collected for serotyping and antimicrobial sensitivity test. The carrying rates of pbp2b, ermB and tetM were detected by PCR. Results　The PCR classification rate of 150 strains of Streptococcus pneumoniae was 93.1%, and the classification rate of capsular swelling test was 100%, and a total of 19 serotypes were divided, mainly 19F and 6B. Children's serotypes were predominantly 19F, 6B, and 15A; adult serotypes were predominantly 19F, 14, and 23F. The coverage rates of the PCV7, PCV10, PCV13 and PPV23 vaccines were 36.8%, 42.1%, 57.9% and 68.4%, respectively. Strains with serotypes of 19F, 6B, 3, and 23F had higher rates of resistance to antimicrobials. The sensitivity of Streptococcus pneumoniae to penicillin was greater than 96.0%. Antimicrobials with significant differences in resistance rates between invasive and non-invasive strains were penicillin, moxifloxacin, and levofloxacin. The percentage of strains carrying both ermB and tetM resistance genes was 96.0%, and the concordance rate between pbp2b, ermB and tetM resistance genes and the resistance phenotype was >98.0%. A total of 10 multi-resistance combinations were detected, with a multi-resistance rate of 62.6%, and the multi-drug resistance pattern of Streptococcus pneumoniae was mainly concentrated in the 19F and 6B serotypes. Conclusion　There are significant age differences in the serotypes of Streptococcus pneumoniae in this area. The vaccine currently used has low coverage in this region and therefore offer limited protection to the population. The drug resistance rates of Streptococcus pneumoniae varied significantly among serotypes. Erythromycin and tetracycline are not recommended for clinical treatment of Streptococcus pneumoniae. Penicillin can still be used as the first choice for clinical treatment of Streptococcus pneumoniae infection.

Effect of wheat-grain moxibustion on the expression of Beclin-1/GRP78 in spinal dorsal horn in rats with cervical spondylotic radiculopathy / 中国针灸

OBJECTIVE@#To observe the effect of wheat-grain moxibustion at "Dazhui" (GV 14) on the expressions of Beclin-1 and GRP78 in spinal dorsal horn in rats with cervical spondylotic radiculopathy (CSR), and to explore the possible analgesic mechanism of wheat-grain moxibustion for CSR.@*METHODS@#A total of 48 SD rats were randomly divided into a sham operation group, a model group, a wheat-grain moxibustion group and a wheat-grain moxibustion+3-MA group, 12 rats in each group. The CSR model was prepared by spinal cord insertion method. Three days after modeling, the rats in the model group were intraperitoneally injected with 1 mL of 0.9% sodium chloride solution; the rats in the wheat-grain moxibustion group were treated with wheat-grain moxibustion at "Dazhui" (GV 14, 6 cones per time) on the basis of the model group; the rats in the wheat-grain moxibustion+3-MA group were intraperitoneally injected with 3-MA solution and wheat-grain moxibustion at "Dazhui" (GV 14, 6 cones per time). The three groups were intervened for 7 days, once a day. The gait score and mechanical pain threshold were observed before treatment and 7 days into treatment; after the treatment, the expressions of mRNA and protein of Beclin-1 in spinal dorsal horn were detected by real-time fluorescence quantitative PCR and immunohistochemistry; the expression of GRP78 protein in spinal dorsal horn was detected by Western blot method; the autophagosomes and ultrastructure in spinal dorsal horn neurons were observed by electron microscope.@*RESULTS@#After the treatment, compared with the sham operation group, in the model group, the gait score was increased and the mechanical pain threshold was decreased (P<0.01), and the expression of GRP78 protein in spinal dorsal horn was increased (P<0.01). Compared with the model group and the wheat-grain moxibustion+3-MA group, in the wheat-grain moxibustion group, the gait score was decreased and mechanical pain threshold was increased (P<0.01), and the expression of GRP78 protein in spinal dorsal horn was decreased, and the expressions of mRNA and protein of Beclin-1 were increased (P<0.01). Under electron microscope, the ultrastructure of spinal dorsal horn neurons in the wheat-grain moxibustion group was not significantly damaged, and its structure was basically close to normal, and the number of autophagosomes was more than the other three groups.@*CONCLUSION@#Wheat-grain moxibustion at "Dazhui" (GV 14) has analgesic effect on CSR rats. The mechanism may be related to moderately up-regulate the expression of Beclin-1, enhance autophagy and reduce endoplasmic reticulum stress.

Clinical characteristics and prognosis of MLL-AF6 positive patients with acute myeloid leukemia / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical features and prognosis of acute myeloid leukemia (AML) patients with the mixed lineage leukemia (MLL) gene rearrangements AF6 (MLL-AF6) positive.@*METHODS@#In the study, 11 patients who were newly diagnosed with MLL-AF6 positive AML were analyzed retrospectively, related literature was reviewed to clarify the clinical features and prognosis of MLL-AF6 positive patients.@*RESULTS@#Among the 11 patients, there were 6 males and 5 females, with a median age of 36 years. Six patients were diagnosed with AML M5 and five with M4 according to FAB classification (French-American-British classification systems). Gingival swelling and pain occurred in 6 cases and fever occurred in 5 cases. At first diagnosis, the median white blood cells were 55.5×109/L. Immunotype showed the expression of myeloid/monocyte and early stem cell series antigens. The expression level of MLL-AF6 fusion gene (real-time quantitative PCR) was 14.2%-214.5%, and 6/11 cases (54.5%) were associated with high EVI1 gene expression. Mutations of KRAS, TET2, ASXL1, TP53, DNMT3A, and FLT3-ITD were detected by next generation sequencing (NGS) in 4 patients. Chromosome G banding examination showed that 2 cases were t(6;11)(q27, q23) with complex karyotype abnormality, 4 cases with +8 abnormality and 2 cases with normal karyotype. Hematological complete remission (CR) was achieved in 8/11 patients (72.7%) after conventional induction chemotherapy, and primary drug resistance was observed in 3 patients. Two of the eight patients with CR were negative for minimal residual disease (MRD), with a median CR duration of 4.5 months. Two patients with positive MRD and three patients with refractory recurrence underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), but all died due to leukemia progression. At the end of follow-up on December 1, 2019, 2 patients were alive and 9 died, with median survival time of 9 months.@*CONCLUSION@#The AML patients with MLL-AF6 positive were mostly young, the majority of FAB types were M4 and M5, and most of the patients often had fever as the first symptom, with increased white blood cells, accompanied by organ infiltration, and high EVI1 gene expression. The hematological remission rate of routine chemotherapy is not low, but it is difficult to achieve molecular remission, most of which have early recurrence. Early allo-HSCT in a molecular negative state may prolong the CR duration.

Therapeutic effect of acupuncture combined with wheat-grain moxibustion on perimenopausal depression with kidney deficiency and liver depression / 中国针灸

OBJECTIVE@#To compare the therapeutic effect of acupuncture combined with wheat-grain moxibustion and oral fluoxetine hydrochloride capsule on perimenopausal depression with kidney deficiency and liver depression.@*METHODS@#A total of 60 patients of perimenopausal depression with kidney deficiency and liver depression were randomized into an observation group and a control group, 30 cases in each one. Acupuncture combined with wheat-grain moxibustion were adopted in the observation group. Acupuncture was applied at Baihui (GV 20), Yintang (GV 29), Fengchi (GB 20), etc. for 30 min. Wheat-grain moxibustion was applied at Ganshu (BL 18), Shenshu (BL 23), Mingmen (GV 4) and Yongquan (KI 1), 3 moxa-cones for each acupoint. The treatment in the observation group was given once every 2 days, 3 times a week. Fluoxetine hydrochloride capsule was given orally in the control group, 20 mg each time, once a day. Treatment for 8 weeks was required in the both groups. The scores of Hamilton depression scale (HAMD) and modified Kupperman scale were observed in the both groups before and after treatment, and at 1, 3, 6-month follow-up. The therapeutic efficacy was evaluated after treatment.@*RESULTS@#Compared before treatment, the scores of HAMD and modified Kupperman scale after treatment and at each time point of follow-up were decreased in the both groups (@*CONCLUSION@#Acupuncture combined with wheat-grain moxibustion can effectively treat perimenopausal depression with kidney deficiency and liver depression, and have more stable and sustained therapeutic effect compared with oral fluoxetine hydrochloride capsule.

Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features.@*METHODS@#This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSI@*RESULTS@#Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSI@*CONCLUSIONS@#There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.

Clinical Efficacy of Modified Shenling Baizhu San in Treatment of Hashimoto's Thyroiditis / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of modified Shenling Baizhu San combined with thyroxine tablets in the treatment of Hashimoto's thyroiditis (HT). Method:The 68 patients with HT were randomly divided into treatment group and control group, with 34 patients in each group. Control group was treated with thyroxine tablets alone, while treatment group was treated with modified Shenling Baizhu San in addition to the therapy of control group. Free triiodothyronine (FT3), free Thyroxine (FT4), thyroid stimulating hormone (TSH), serum thyroid peroxidase antibody (TPOAb) and thyroglobulin were observed before and after treatment in the two groups of HT patients. The changes of thyroglobulin antibody (TgAb) and traditional Chinese medicine (TCM) syndrome score, and the safety of TCM prescription were observed. Result:After 3 months of treatment, the effective rate of treatment group was 91.2%, which was significantly higher than 70.6% of control group, with statistically significant difference (PPP3 and FT4 in treatment group and control group increased significantly after 3 months of treatment (PPPPConclusion:Modified Shenling Baizhu San combined with thyroxine tablets in the treatment of HT is more effective than simple thyroxine tablets, which is worthy of further clinical and experimental study.

The study of salivary pepsin content and laryngopharyngeal reflux scale in 91 asymptomatic volunteers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the content of pepsin in salivary, and to assess the laryngophargeal lesions based on the reflux founding score (RFS) scale in asymptomatic volunteers, in order to provide a reference for the diagnosis of laryngopharyngeal reflux.@*METHODS@#A total of 91 asymptomatic subjects were recruited in this study. Participants provided a fasting saliva specimen for pepsin measurement using enzyme-linked immunoadsorbent assay, completed the reflux symptom index (RSI) assessment and underwent laryngostroboscopic examination using a rigid endoscope. Their RFS were graded according to the laryngeal findings.@*RESULTS@#The median concentration of pepsin in 91 asymptomatic volunteers was 55.5 μg/L (range 3.53-191.64 μg/L). The mean individuals RSI was 2.24±2.34, and the mean individuals RFS was 5.78±1.74.@*CONCLUSIONS@#Our data demonstrate that certain concentration of pepsin was detected and showed a higher RFS score in asymptomatic volunteers.

Evaluation for the Usability of Carelink Remote Monitoring System by Clinical Physicians / 中国循环杂志

Objective: To conduct a preliminary evaluation for the usability of Carelink remote monitoring system by clinical physician. Methods: A total of 215 patients received cardiovascular implantable electronic devices (CIED) with Carelink remote monitoring function from 12 hospitals in China between 2012-01 and 2013-10 were prospectively enrolled. The patient's mean age was (62.3±14.3) years including 108 male and 107 female. There were 54 physicians completed questionnaire survey. Based on the type of CIED, the patients were divided into3 groups: PM (pace maker) group,n=110, ICD (implantable cardioverter defibrillator) group,n=54 and CRT (cardiac resynchronization therapy) group,n=51. The patients received routine hospital visit at 3 months of CIED implantation and meanwhile, they performed device data transmission at 3 and 6 months of Carelink remote monitoring. The time physician spent to evaluate data was collected at 3 months and the questionnaire survey was completed by physician at 6 months after CIED implantation. Results: All 54 physicians felt that Carelink remote monitoring system was simple to operate and easy to use. There were 147 patients ifnished hospital visit at 3 months after CIED implantation, the mean time for physician to evaluate data was (14.8±8.4) min; 150 patients ifnished Carelink remote monitor at 3 months after CIED implantation, the mean time for physician to evaluate data was (8.2 ±4.6) min,P<0.0001.Conclusion: Carelink remote monitoring system was easy to use, it may save time in follow-up study which with high satisfaction in clinical practice.

Evaluation of Safety and Efficacy of Qinming8631 DR Implantable Cardiac Pacemaker in Chinese Patients: A Prospective, Multicenter, Randomized Controlled Trial of the First Domestically Developed Pacemaker of China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High cost of imported pacemakers is a main obstacle for Chinese patients suffering from bradyarrhythmia, and a domestically developed pacemaker will help lower the burden. This study aimed to evaluate the safety and efficacy of Qinming8631 DR (Qinming Medical, Baoji, China), the first domestically developed dual-chamber pacemaker of China, compared with a commercially available pacemaker Talos DR (Biotronik, Berlin, Germany) in Chinese patients.</p><p><b>METHODS</b>A prospective randomized trial was conducted at 14 centers in China. Participants were randomized into trial (Qinming8631 DR) and control (Talos DR) groups. Parameters of the pacing systems were collected immediately after device implantation and during follow-ups. The effective pacing rate at 6-month follow-up was recorded as the primary end point. Electrical properties, magnet response, single- and double-pole polarity conversion, rate response function, and adverse events of the pacing system were analyzed. The Cochran-Mantel-Haenszel Chi-square test, paired t-test, and Wilcoxon signed-rank test were used for measuring primary qualitative outcomes and comparing normally and abnormally distributed measurement data.</p><p><b>RESULTS</b>A total of 225 patients with a diagnosis of bradyarrhythmia and eligible for this study were randomly enrolled into the trial (n = 113) and control (n = 112) groups. They underwent successful pacemaker implantation with acceptable postoperative pacing threshold and sensitivity. Effective pacing rates of trial and control groups were comparable both in the full analysis set and the per protocol set (81.4% vs. 79.5%, P = 0.712 and 95.4% vs. 89.5%, P = 0.143, respectively). In both data sets, noninferiority of the trial group was above the predefined noninferiority limit(-9.5%).</p><p><b>CONCLUSIONS</b>This study established the noninferiority of Qinming8631 DR to Talos DR. The safety and efficacy of Qinming8631 DR pacemaker were comparable to those of Talos DR in treating patients with cardiac bradyarrhythmia.</p>

The correlation between serum bilirubinlevels and instent-restenosis for coronary heart disease: an angiographic study / 中华急诊医学杂志

Objective To study the correlation between serum bilirubin and restenosis after stent implantation of coronary heart disease (CHD).Methods Two hundred and fourtynine patients with CHD were divided into Instent-restenosis (ISR) of CHD group and non-ISR of CHD group according to their angiography findings.Theirserum bilirubin levels were compared and correlation between serum bilirubin level and ISR of CHD was studied.Results The serum bilirubin level was significantlylower in ISRof CHD group than in non-ISR group (P ＜ 0.05),in TBIL (9.9322 ± 3.8748μmol/L) to (12.08 ±4.6679μmol/L)、DBIL (3.1744 ± 1.60μmol/L) to (3.8949 ± 1.825μmol/L)、IBIL (6.757 ±2.822μmol/L) to (8.174 ± 3.388μmol/L).Conclusions The serum bilirubinlevel is lower in CHD patients with ISR than in CHD patients with non-ISR,which is an indepent risk factor for ISR of CHD.

Experiences of applying home monitoring for cardiac implantable electronic devices / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the results of remote home monitoring for cardiac implantable electronic devices (CIED).</p><p><b>METHODS</b>From November 2009 to July 2014, 37 patients implanted with home monitoring system CIED were enrolled, and 31 cases were implanted with dual chamber pacemakers, 2 with cardiac resynchronization therapy(CRT) and 4 with implantable cardioverter defibrillator (ICD). All patients received clinical routine follow-up.Data was automatic transmitted daily by remote home monitoring system, while special alarm events were transmitted at any time.The success rate of data transmission, abnormal events monitoring and pacing parameter changes were analyzed.</p><p><b>RESULTS</b>A total of 37 patients (24 males, mean age (70.0±9.6) years) were enrolled.Average follow-up time was (902±404) days.Success rate of data transmission was 97.6% (32 574), failed data transmission rate was 2.4% (801). Ninth-nine alerts were transmitted from 28 patients (75.7%), including 80 (80.8%) disease-related alerts and 19 (19.2%) system-related alerts.Average detection time of atrial fibrillation by remote home monitoring system to last clinical routine follow-up was 62 (19-120) days.There was no significant change in ventricular threshold, atrial and ventricle sensing during acute, subacute and chronic phases post the application of the steroid-eluting leads(all P>0.05).</p><p><b>CONCLUSIONS</b>The success rate of data transmission for CIED with remote home monitoring system is efficient, abnormal events can be timely detected.Meanwhile, remote home monitoring system also verified the stability of pacing parameters during acute, subacute and chronic phases post the application of the steroid-eluting leads.</p>

Endoplasmic reticulum stress-mediated aldosterone-induced apoptosis in vascular endothelial cells / 华中科技大学学报（医学）（英德文版）

The aim of this study was to examine the effects of endoplasmic reticulum (ER) stress on aldosterone (Aldo)-induced apoptosis of endothelial cells. Glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP, a hallmark of ER-associated apoptosis) were used to evaluate ER stress. Western blotting and real-time PCR were used to analyze indicators of ER molecule. Apoptosis was detected by annexin V/propidium iodide staining and flow cytometry. Human umbilical vein endothelial cells (HUVECs) were stimulated with different concentrations of Aldo for different durations. Aldo promoted apoptosis of HUVECs and induced ER stress, as evidenced by increased expression of GRP78 and CHOP. siRNA knockdown of CHOP attenuated Aldo-mediated apoptosis. These results indicate that ER stress may be involved in Aldo-induced apoptosis of HUVECs.

Efficacy of intravascular ultrasound guided rotational atherectomy for heavily calcified coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy (RA) followed by drug eluting stent (DES) implantation in treating patients with heavily calcified coronary lesions.</p><p><b>METHODS</b>Clinical characteristics, coronary angiogram, intravascular ultrasound images, peri-procedure and follow-up data (including death , myocardial infarction and target lesion revascularization) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed. IVUS examination was carried out before RA, after RA and stent implantation to guide whether further RA or post dilatation was needed. According to the arc of calcification, the patients were divided into group A (90°-270°, 18 cases) and group B (271°-360°, 26 cases).</p><p><b>RESULTS</b>In A and B group, the arc of calcification was (195 ± 71)° in group A and (345 ± 23)° in group B (P < 0.01) , length of calcification was (34.4 ± 11.8) mm in group A and (20.0 ± 6.6) mm in group B (P < 0.05). Number of burrs used and size of largest burr used were similar between 2 groups (both P > 0.05). Acute cross sectional area gain after RA was (0.43 ± 0.32) mm in group A and (0.53 ± 0.38) mm² in group B (P > 0.05). After RA, there was significant decrease in the arc of calcification in group B compared with baseline ((324 ± 52)° vs. (345 ± 23)°, P < 0.05). The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups (all P < 0.05). The final minimal lumen area after stenting were similar between 2 groups (P > 0.05). Procedure success rate was 100% (44/44) without any major complications such as death, acute myocardial infarction and coronary perforation. During the (16.6 ± 6.3) months follow-up, there was 1 death in group A, 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.</p><p><b>CONCLUSION</b>Heavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.</p>

Endoplasmic reticulum stress-mediated aldosterone-induced apoptosis in vascular endothelial cells / 华中科技大学学报（医学）（英德文版）

The aim of this study was to examine the effects of endoplasmic reticulum (ER) stress on aldosterone (Aldo)-induced apoptosis of endothelial cells. Glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP, a hallmark of ER-associated apoptosis) were used to evaluate ER stress. Western blotting and real-time PCR were used to analyze indicators of ER molecule. Apoptosis was detected by annexin V/propidium iodide staining and flow cytometry. Human umbilical vein endothelial cells (HUVECs) were stimulated with different concentrations of Aldo for different durations. Aldo promoted apoptosis of HUVECs and induced ER stress, as evidenced by increased expression of GRP78 and CHOP. siRNA knockdown of CHOP attenuated Aldo-mediated apoptosis. These results indicate that ER stress may be involved in Aldo-induced apoptosis of HUVECs.

Inducing-apoptosis effect of brucine on human monocytic leukemia cell line THP-1 and its mechanism / 中国实验血液学杂志

This study was aimed to investigate the inducing-apoptosis effect of brucine on human monocytic leukemia cell line THP-1 cells and its possible mechanism. The inhibition effect of brucine on growth of THP-1 cells was measured by CCK-8 method. Morphological changes of THP-1 cells treated with brucine was detected by acridine orange/ethidium bromide (AO/EB)double staining. Annexin-V/PI double labeling method was used to assay the apoptosis rate of THP-1 cells. The effect of brucine on THP-1 cell cycle distribution was detected by PI single staining. RT-PCR was used to detect the expression of BCL-2 and BAX. The results showed that the brucine could inhibit the THP-1 cell growth in concentration and time-dependent manners at the range of 50 to 400 µg/ml. The cells stained with AO/EB revealed that the brucine induced the nuclear chromatin condensation. After the THP-1 cells were treated with brucine of 400µg/ml for 48 hours, most nucleic were stained as orange-red, and condensed, displaying the late apoptotic cell morphology. Annexin-V/PI detection showed that brucine could induce apoptosis of THP-1 cells in a concentration-dependent manner. Compared with the control group, more cells in brucine-treated group were arrested at G0/G1 phase in a concentration-dependent manner. RT-PCR detection revealed that the expression of BCL-2 was down-regulated strikingly and BAX was up-regulated. It is concluded that brucine can efficiently inhibit cell growth and block THP-1 cells in G0/G1 phase. The mechanism of THP-1 cell apoptosis induced by brucine may be related to the inhibition of BCL-2 and activation of BAX.

Efficacy and safety of ibutilide for conversion of atrial fibrillation/flutter / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation (AF) and flutter (AFL) to sinus rhythm.</p><p><b>METHODS</b>Ninety-nine consecutive patients aged 18-75 y with AF/AFL were included. The duration of arrhythmia was <90 d (1 h-90 d) and ventricular rate was >60 beats/min. Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg, then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg, then repeated if AF/AFL persisted after 10 min. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min.</p><p><b>RESULTS</b>Ventricular rates were decreased in both groups. AF/AFL were converted in 34 of 49 patients (69.4 % ) in ibutilide group and in 22 of 50 patients (44.0 %) in propafenone group (P <0.05). The converting time of ibutilide was significantly shorter than that of propafenone [(16.79 ± 12.31) min compared with (36.92 ± 11.38)min, P <0.01]. The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia (3/49,6.12 %). Transient hypotension and heart pause were the main adverse events in patients who received propafenone, acute left heart failure occurred in one patient of propafenone group.</p><p><b>CONCLUSION</b>Intravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL. Furthermore,strict processing under electrocardio-monitoring is important.</p>

Status of glucose metabolism in Chinese essential hypertensive patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate glucose metabolism status and its relationship with blood pressure, obesity, renal function and cardio-cerebral vascular events in Chinese essential hypertensive patients.</p><p><b>METHODS</b>Essential hypertensive patients without diabetic history were enrolled in this cross-sectional survey. All patients filled in questionnaires and received physical examination and laboratory tests. Oral glucose tolerance test (OGTT, fasting and 2 hours glucose level after drinking the 75 g glucose solution) was performed in patients who signed the informed consent.</p><p><b>RESULTS</b>(1) The control rate of systolic BP was lower in patients with dysglycemia than in patients without dysglycemia (41.0% vs. 46.4%, P = 0.000). (2) The albuminuria detection rate and the abnormal rate of estimated glumerular filtration rate (eGFR) increased significantly with the deterioration of glucose metabolism. (3) Multifactor-analysis showed that abnormal waist circumference, decreased eGFR and presence of albuminuria were independent risk factors for abnormal glucose metabolism. Cardiovascular events was significantly higher in patients with abnormal glucose metabolism than patients with normal glucose metabolism.</p><p><b>CONCLUSION</b>Abnormal glucose metabolism is common in Chinese essential hypertensive patients. When complicated with abnormal glucose metabolism, essential hypertensive patients had poor blood pressure control rate and were related to higher cardiovascular risk.</p>

Iodine deficiency disorders in Sanya in 2011: an analysis of a survey results / 中国地方病学杂志

Objective In order to understand the Sanya of iodine deficiency disorders(IDD) prevention and cure,and to provide a scientific basis for formulating corresponding control measures.Methods According to the requirements of Iodine Deficiency Disorders Monitoring Program,one townships(districts) in Sanya of Hainan in 2011 were selected based on their positions of east,south,west,north and center,respectively.Four administrative villages in each township(district) were selected in the same way.Fifteen salt samples,8 urine samples of women of childbearing age and 1 drinking water sample from each adninistrative village were collected.In the primary school of each township(district),40 students aged 8 to 10 were selected to check up their thyroid,test their intelligence quotient (IQ) and urinary iodine.Thirty three fifth-grade students in each of the primary schools were selected to launch a questionnaire survey of health education knowledge and test(semiquantitative test) their household edible salt.Salt iodine was detected by direct titrimetry; urinary iodine and water iodine were detected by As-Ce catalytic spectrophotometry; and children's IQ values were measured using the Combined Raven Test (CRT) in rural edition.Results Totally 300 salt samples were tested,and the median salt iodine was 31.0 mg/kg.The iodized salt coverage rate was 96.67％ (290/300),and the consumption rate of qualified iodized salt was 96.00％ (288/300).Totally 200 urine samples were tested,and the median urinary iodine was 194.6 μg/L;and the range of urinary iodine was between 18.50 μg/L and 655.10 μg/L,the proportions of less than 50 μg/L and between 50 μg/L and ＜ 100 μg/L were 4.00％ (8/200) and 13.50％ (27/200),respectively.A total of 200 children were examined by palpation,and the goiter rate was 1.00％(2/200).Mean IQ value of the students was 97.66 and there were 8 students whose IQ values were lower than 69 and 20 students whose IQ values were between 70 and 79.The average score was 3.24 of the 165 students who took part in the questionnaire survey of health education knowledge.There were 43 students who failed in the exam,and the failed rate was 26.06％.The coverage rate of iodized salt in household was 96.36％ (159/165).The median of urinary iodine of the 160 women of childbearing age was 162.95 μg/L,the range of urinary iodine were between 9.50 μg/L and 908.80 μg/L,and the proportion of less than 100 μg/L was 19.38％ (31/160).The consumption rate of eligible iodized salt was 96.90％ (155/160).The levels of water iodine of the 20 water samples from the 5 townships(districts) were all less than 10.0 μg/L.Conclusions Sanya is still in the area lack of iodine in the environment.In general Sanya has reached the goals of elimination of iodine deficiency disorders,but there are still some of the children and women of childbearing age who are iodine deficient.

One-stop hybrid cardiac surgery for adults with complex heart disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of adult patients with complex heart disease.</p><p><b>METHODS</b>From November 2011 to March 2012, a total of 5 patients [4 male, mean age: (58.8 ± 14.7) years] underwent one-stop hybrid approach in the hybrid operating room. Two patients suffered from multi-coronary lesions, 2 patients were diagnosed with both valvular heart disease and coronary disease, and another 1 patient had valve disease and congenital heart disease (patent ductus arteriosus). Minimally invasive cardiac surgery (coronary artery bypass grafting for the left anterior descending or valvular surgery) and percutaneous intervention were performed in an enhanced operative unit. The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure.</p><p><b>RESULTS</b>The one-stop hybrid procedure was successful in all patients. Left internal mammary artery grafts were unobstructed. A total of 6 non-left anterior descending coronary lesions were treated by percutaneous coronary intervention and 6 drug-eluting stents were implanted. There was no death, perioperative myocardial infarction, heart failure, prosthetic valve dysfunction, respiratory failure, stroke or repeat surgery during the procedure period. All patients remained free from angina, prosthetic valve dysfunction and patent ductus arteriosus recanalisation during the 3.2 months (rang 1 to 5 months) follow-up period.</p><p><b>CONCLUSION</b>One-stop hybrid cardiac surgery provides a reasonable, feasible and safe alternative for treating adult patients with complex heart disease.</p>

Expression of heparanase and its coagulation proteins on the surface of leukemic cells / 白血病·淋巴瘤

Objective To explore whether the expression level of heparanase (HPA) and its coagulation proteins on leukemic blast membrane could determine the hemostatic balance on the surface of leukemia cells.Methods Forty patients of leukemia were studied,and 20 patients with iron dificient anemia as the control group.Expression of tissue factor (TF),heparanase (HPA),tissue factor pathway inhibitor (TFPI),and urokinase plasminogen activator receptor (UPAR) on leukemic blast surfaces were analyzed by flowcytometry.Results The expression of TF,UPAR,and HPA in AML,ALL,CML,CLL and CRAL groups were significantly higher compared with the control group (t =.3.289,3.507,2.701,P ＜0.05; t =2.498,0.802,3.090,P ＜0.05; t =2.642,3.308,2.696,P ＜0.05; t =3.417,3.434,2.382,P ＜0.05; t =2.193,2.272,2.263,P ＜0.05).There were no significantly differences between the leukemic cell expression of TFPI and the control group (P ＞0.05).Expression of TF,UPAR,HPA in AML patients were significantly higher than ALL,CML and CLL groups (t =2.463,2.179,2.276,P ＜0.05; t =2.637,2.402,2.095,P ＜0.05; t =2.548,2.425,2.412,P ＜0.05).The levels of TF,UPAR and HPA in M3,M4 and M5 patients were higher than that of M1,M2 groups (P ＜0.05).There were no significantly differences among M3,M4 and M5 (P ＞0.05).Conclusions These results suggest that TF,UPAR and HPA are predominately expressed on leukemic blast surface,particularly in M3and M4,5 subtypes.The expression of coagulation proteins on blast membrane might determine the hemostatic balance on the surface of leukemia cells.