Development and validation of risk prediction model for new-onset cardiovascular diseases among breast cancer patients: Based on regional medical data of Inner Mongolia / 北京大学学报(医学版)

OBJECTIVE@#To develop and validate a three-year risk prediction model for new-onset cardiovascular diseases (CVD) among female patients with breast cancer.@*METHODS@#Based on the data from Inner Mongolia Regional Healthcare Information Platform, female breast cancer patients over 18 years old who had received anti-tumor treatments were included. The candidate predictors were selected by Lasso regression after being included according to the results of the multivariate Fine & Gray model. Cox proportional hazard model, Logistic regression model, Fine & Gray model, random forest model, and XGBoost model were trained on the training set, and the model performance was evaluated on the testing set. The discrimination was evaluated by the area under the curve (AUC) of the receiver operator characteristic curve (ROC), and the calibration was evaluated by the calibration curve.@*RESULTS@#A total of 19 325 breast cancer patients were identified, with an average age of (52.76±10.44) years. The median follow-up was 1.18 [interquartile range (IQR): 2.71] years. In the study, 7 856 patients (40.65%) developed CVD within 3 years after the diagnosis of breast cancer. The final selected variables included age at diagnosis of breast cancer, gross domestic product (GDP) of residence, tumor stage, history of hypertension, ischemic heart disease, and cerebrovascular disease, type of surgery, type of chemotherapy and radiotherapy. In terms of model discrimination, when not considering survival time, the AUC of the XGBoost model was significantly higher than that of the random forest model [0.660 (95%CI: 0.644-0.675) vs. 0.608 (95%CI: 0.591-0.624), P < 0.001] and Logistic regression model [0.609 (95%CI: 0.593-0.625), P < 0.001]. The Logistic regression model and the XGBoost model showed better calibration. When considering survival time, Cox proportional hazard model and Fine & Gray model showed no significant difference for AUC [0.600 (95%CI: 0.584-0.616) vs. 0.615 (95%CI: 0.599-0.631), P=0.188], but Fine & Gray model showed better calibration.@*CONCLUSION@#It is feasible to develop a risk prediction model for new-onset CVD of breast cancer based on regional medical data in China. When not considering survival time, the XGBoost model and the Logistic regression model both showed better performance; Fine & Gray model showed better performance in consideration of survival time.

Preparation of 3D printed metoprolol tartrate chewable tablets and optimization of printing process / 药学学报

With the growing demand of personalized medicine for children, it is especially important to develop medicines for children. In this study, using metoprolol tartrate as model drug, we developed 3D printed chewable tablets suitable for children with automated dosage distribution using semi-solid extruded (SSE) 3D printing technology. Based on the quality by design concept, this study prepared a semi-solid material with good printability using gelatin as the substrate, constructed 3D models and printed tablets with the aid of computer-aided design. The printing parameters were optimized and determined as follows: print temperature of 35-37 ℃, print speed of 25 mm·s-1, fill rate of 15%, and number of outer profile layers of 2. Subsequently, the printing process and the quality uniformity of the tablets were verified, and a linear relationship between the dose and the number of model layers was obtained. Finally, 3D printed chewable tablets were superior in terms of appearance, dose accuracy and compliance compared with traditional split-dose commercially available tablets. In this study, 3D printed metoprolol tartrate chewable tablets with good performance were successfully prepared to address the personalized medication needs of pediatric patients.

Relationship between micronutrients supplementation during periconceptional period and serum concentration of vitamin E in the 1st trimester of gestational period / 北京大学学报(医学版)

OBJECTIVE@#To explore the association of maternal periconceptional folic acid or multiple micronutrients supplementation during periconceptional period and the serum vitamin E (Vit.E) concentration in the 1st trimester of gestational period.@*METHODS@#A retrospective cohort study was conducted based on the prenatal health care system and clinical laboratory information system. Totally, 22 171 pregnant women who had their prenatal health care and gave birth in Tongzhou Maternal & Child Health Hospital of Beijing from Jan. 2016 to Dec. 2018 were recruited. The usage patterns of nutritional supplements [folic acid (FA) or multiple micronutrients (MM)] during periconceptional period were independent variables, and serum Vit.E concentration and serum Vit.E concentration≥11.2 mg/L in the 1st trimester of gestational period were outcome variables for generalized linear regression model and Logistic regression model, respectively, to analyze the relationships between the independent and outcome variables.@*RESULTS@#The range of the serum Vit.E concentration in the 1st trimester of gestational period was 5.2-24.0 mg/L, and the median concentration was 10.1 (8.8-11.6) mg/L; the excess rate of the serum Vit.E of those who took MM supplementation was 0.3%, and the rates for the groups of FA only or no nutritional supplements used were both 0.1%. Compared with women without nutritional supplement or the women taking FA, the women who took MM had higher serum Vit.E levels in the 1st trimester of gestational period (both P < 0.05). The women taking FA or MM initiated before the conception showed that the serum Vit.E concentration in the 1st trimester of gestational period was higher than that after the conception (P < 0.05), and the serum Vit.E concentration of women who took regularly was higher than that of irregular taking (P < 0.05); with taking compliance elevated, the serum Vit.E concentration of the two groups of women taking FA or MM increased (P < 0.05). The risk of serum Vit.E concentration≥11.2 mg/L among the women taking MM was higher than that of the women without nutritional supplements or taking FA only [odds ratio (OR)=1.36, 95% confidence interval (95%CI): 1.21-1.53; OR=1.39, 95%CI: 1.31-1.48)]; women who took FA or MM showed a lower risk for serum Vit.E concentration≥11.2 mg/L of taking it after the conception than before, the ORs (95%CI) were 0.86 (95%CI: 0.77-0.96) and 0.88 (95%CI: 0.81-0.95), respectively; the women taking the two supplements regularly had higher risk for serum Vit.E concentration≥11.2 mg/L than irregular taking, the ORs (95%CI) were 1.16 (95%CI: 1.05-1.29) and 1.13 (95%CI: 1.04-1.22) for FA and MM users, respectively; with the compliance increasing, the women taking MM had a higher risk of serum Vit.E levels≥11.2 mg/L in the 1st trimester [OR (95%CI) was 1.10 (1.07-1.14)], but for FA users, the OR (95%CI) was 1.04(1.00-1.08).@*CONCLUSION@#Vit.E nutritional status in women in early gestational period in Beijing was generally good, and the excess rate of serum Vit.E was higher in women who took MM during periconceptional period than those without nutritional supplement or taking FA only, suggesting that women need to consider their own Vit.E nutritional status to choose the type of nutritional supplements during periconceptional period, so as to avoid related health hazards.

Accelerated stability test of sustained-release thienorphine loaded microspheres for injection / 药学学报

In order to meet the clinical needs of long-acting sustained-release thienorphine, injectable thienorphine loaded microspheres were developed, and the accelerated stability study was carried out to explore the suitable storage and transportation conditions of the microspheres. Using poly(lactic-co-glycolic acid) (PLGA) as carrier material, 3 batches of microspheres were prepared in pilot scale with emulsion solvent evaporation method. By investigating the in vitro release of thienorphine loaded microspheres at 37, 45, 52, and 60 ℃, and applying the Arrhenius equation, the linear relationship between the release rate constant (lgk) and the temperature (1/T) was established to obtain the equation: lgk = -8.073/T + 24.35 (R2 = 0.985 3), which showed that the release of microspheres at high temperature can be used to predict the release in vitro at 37 ℃, and 52.0 ± 0.5 ℃ was selected as the accelerated release condition in vitro. The quality research methods were established to investigate the changes of critical quality attributes such as microsphere morphology, drug loading, particle size and distribution, polymer molecular weight, and the related substances under accelerated conditions. The difference factor f1 and similarity factor f2 were used to assess the similarity of release behavior under accelerated conditions. The results showed that under the accelerated experimental conditions of 25 ± 2 ℃ and relative humidity (RH) 60% ± 5%, the critical quality attributes of injectable thienorphine loaded microspheres had no significant change in 6 months, suggesting that the long-term storage condition could be 5 ± 3 ℃.

Molecular insights into AabZIP1-mediated regulation on artemisinin biosynthesis and drought tolerance in Artemisia annua

Artemisia annua is the main natural source of artemisinin production. In A. annua, extended drought stress severely reduces its biomass and artemisinin production while short-term water-withholding or abscisic acid (ABA) treatment can increase artemisinin biosynthesis. ABA-responsive transcription factor AabZIP1 and JA signaling AaMYC2 have been shown in separate studies to promote artemisinin production by targeting several artemisinin biosynthesis genes. Here, we found AabZIP1 promote the expression of multiple artemisinin biosynthesis genes including AaDBR2 and AaALDH1, which AabZIP1 does not directly activate. Subsequently, it was found that AabZIP1 up-regulates AaMYC2 expression through direct binding to its promoter, and that AaMYC2 binds to the promoter of AaALDH1 to activate its transcription. In addition, AabZIP1 directly transactivates wax biosynthesis genes AaCER1 and AaCYP86A1. The biosynthesis of artemisinin and cuticular wax and the tolerance of drought stress were significantly increased by AabZIP1 overexpression, whereas they were significantly decreased in RNAi-AabZIP1 plants. Collectively, we have uncovered the AabZIP1-AaMYC2 transcriptional module as a point of cross-talk between ABA and JA signaling in artemisinin biosynthesis, which may have general implications. We have also identified AabZIP1 as a promising candidate gene for the development of A. annua plants with high artemisinin content and drought tolerance in metabolic engineering breeding.

Leiomyomatosis peritonealis disseminata during pregnancy: a case report and literature review / 中华围产医学杂志

Objective:To review the clinical and pathological features, pathogenesis, and differential diagnosis of leiomyomatosis peritonealis disseminata (LPD) during pregnancy.Methods:We report the diagnosis and treatment of LPD in a pregnant woman admitted to Jiaozhou Central Hospital of Qingdao. We retrieved relevant literature from China and abroad to review the clinical characteristics and outcomes.Results:(1) Case report: The 33-year-old pregnant woman who had had previous cesarean sections was admitted at 37 +2 weeks gestation due to premature rupture of membranes 30 minutes before arriving at the hospital with a pelvic mass which was first diagnosed seven months earlier, in the first trimester. A lower segment cesarean section was performed, and the pelvic mass was removed on admission. No relapse was reported during the postoperative follow-up for 26 months. (2) Literature review: thirteen papers involving 15 cases, including the present case, were retrieved. The age at onset was 32 years old (19-47 years old); five of them had a history of myomectomy. Twelve cases had no significant symptoms, and the diagnosis was made at delivery or postpartum; the other three had noticeable features, mainly with abdominal pain. Six had obstetrical complications, including hypertensive disorders of pregnancy, premature rupture of membrane, abnormal fetal position, and oligohydramnios. Two cases had a history of assisted reproductive technology. Eleven cases delivered after 32 gestational weeks, three before 28 weeks, one aborted at ten gestational weeks due to severe complications. Twelve had cesarean section and myomectomy and the uterus and appendages were preserved. Three cases had a cesarean hysterectomy and two of them also had bilateral salpingo-oophorectomy. The pathological manifestations of seven cases were extensive and massively distributed small fibroids, similar to malignant tumor infiltration, with the diameter of 0.5 to 1.0 cm; five cases had multiple large fibroids, accompanied by scattered small fibroids. Conclusion:LPD during pregnancy is rare, and usually benign, with no obvious clinical symptoms. LPD is more likely to be misdiagnosed as a malignant tumor before the operation, and the diagnosis is usually confirmed by postoperative histopathology. A common surgical strategy is a cesarean section combined with pelvic mass resection.

Associations of Sarcopenia, Handgrip Strength and Calf Circumference with Cognitive Impairment among Chinese Older Adults / 生物医学与环境科学（英文）

Objective@#To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults.@*Methods@#Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment.@*Results@#The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( @*Conclusion@#Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.

Safety of two ventilator weaning strategies after high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVE@#To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants.@*METHODS@#A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32@*RESULTS@#There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, @*CONCLUSIONS@#For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.

Immunoregulatory Effect of Chaihu Jia Longgu Mulitang Modified with Bupleuri Radix on Hippocampal NLRP3 Pathway in Depressed Rats / 中国实验方剂学杂志

Objective:To investigate the effect and mechanism of Chaihu Jia Longgu Mulitang （CJLM） on hippocampal NOD-like receptor protein 3 （NLRP3）inflammasome pathway in rats with depression. Method:Sixty male SD rats were randomly divided into a normal group，a model group， a MCC950 （1 mg·kg^-1） group， and high- （13 g·kg^-1）， medium- （6.5 g·kg^-1）， and low-dose （3.25 g·kg^-1） Chaihu Jia Longgu Mulitang groups， with 10 rats in each group．The depression model was induced by isolation combined with chronic unpredictable mild stimulation（CUMS） in rats except for those in the normal group. Rats were treated correspondingly for 21 days by intraperitoneal injection in the MCC950 group and gavage in other groups. The normal group and the model group received an equal volume of normal saline. The depression-like behaviors of rats were observed by sucrose preference test （SPT） and novelty-suppressed feeding test. Enzyme-linked immunosorbent assay （ELISA） was used to determine the levels of interleukin-1<italic>β </italic>（IL-1<italic>β</italic>） and IL-18 in the hippocampus of depressed rats. Western blot was used to detect the protein levels of NLRP3， apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain （ASC）， and Caspase-1. Result:Compared with the normal group， the model group showed decreased sucrose preference rate （<italic>P</italic><0.01）， prolonged novelty-suppressed feeding time （<italic>P</italic><0.01）， enhanced protein expression of NLRP3，ASC， and caspase-1<italic> </italic>（<italic>P</italic><0.05， <italic>P</italic><0.01）， and elevated expression of IL-1<italic>β</italic> and IL-18 （<italic>P</italic><0.01）. Conclusion:CJLM can alleviate depression-like behaviors in CUMS-induced model rats， and the underlying mechanism is related to the inhibition of the NLRP3 inflammasome pathway．

Effect of Drought Stress on Growth and Photosynthetic Physiological Parameters of Acanthopanax senticosus / 中国实验方剂学杂志

Objective:To study the effects of different drought conditions on the growth and photosynthetic physiological parameters of Acanthopanax senticosus，in order to provide the theoretical basis for standardized planting and rational development and utilization of A. senticosus. Method:In this study，three-year-old A. senticosus was used as experimental samples. The growth parameters，photosynthetic parameters，and photosynthetic physiological parameters were determined to study the effects of different drought conditions on the growth and photosynthesis of A. senticosus. Result:The plant height and leaf number were significantly lower than the control group under drought stress conditions，and the leaf area was higher than the control group under drought stress. Net photosynthetic rate，stomata conductance and transpiration rate were not significantly different between the control group and the moderate drought stress group. They were significantly decreased in the severe drought stress group，while the intercellular carbon dioxide concentration increased with the severity of drought stress. With the treatment time，the initial fluorescence was higher in the severe drought stress group than in the control group，and the moderate drought stress group was lower than the control group，the maximum fluorescence was significantly lower in the severe drought stress group than in the control group， potential photochemical efficiency and maximum photochemical efficiency were significantly elevated in the moderate drought stress group. Conclusion:Drought stress can significantly inhibit the growth of A. senticosus. Severe drought conditions can significantly inhibit the photosynthesis of A. senticosus leaves. This effect is related to the regulation of stomatal size，but not related to the activity of photoreaction center.

Food safety risk monitoring ability of institutions for disease control and prevention in a province / 上海预防医学

Objective:To determine the current situation of food safety risk monitoring ability of centers for disease control and prevention （CDCs） in a province， and provide reference for strengthening the construction of food safety monitoring ability in the future. Methods:A self-administered questionnaire survey was conducted among 14 CDCs who are responsible for food safety risk monitoring in the province in 2018. Results:The ratio of food inspection staff with senior， middle， and primary professional titles was 1∶1∶1. The educational background of food inspection staff at the provincial and municipal levels was mainly bachelor degree or above， while that of county level directly under the administration of the province was mainly college degree. The age composition of the staff at the provincial level tended to be elder； however， there were more staff with less working experience at the county level. The qualification proportion of laboratory area was 50%. The distribution proportion of food inspection equipment in the CDC at all levels was 83.3%， 79.5% and 36.3%， respectively. In total， 14 CDCs completed the monitoring task as required. They were all accredited with laboratory qualifications； however， one CDC did not conduct re-evaluation after the certification of food inspection qualification expired. Each CDC ensured the accuracy and reliability of monitoring data through the supervision in food testing. Conclusion:The food safety risk monitoring ability of the CDCs in the province is continuously improved， which can meet the needs of routine monitoring. However， the composition of professional titles of food inspection staff is not very reasonable. There is still a gap between the equipment configuration and the national requirements. The ability of food inspection needs to be improved， in which quality management and laboratory qualification should be further strengthened.

Effect of Plant-Soil Feedback on Secondary Metabolites of Acanthopanax senticosus Seedlings / 中国实验方剂学杂志

Objective::To investigate the effects of plant-soil feedback on secondary metabolites in roots, stems and leaves of Acanthopanax senticosus seedlings. Method::One-year-old seedlings of A. senticosus were planted in the soil where no A. senticosus had been planted before (group 1), soil where A. senticosus had been planted for 3 years (group 2), and soil where A. senticosus had been planted for many years in the greenhouse pot experiment, and the secondary metabolites of its roots, stems and leaves were then analyzed. Result::L-Phenylalanine, 3, 4-dihydroxybenzoic acid, syringin, chlorogenic acid, caffeic acid, eleutheroside E, isofraxidin, rutin, hyperoside, and quercetin had significant differences in leaves and roots of A. senticosus seedlings in the soil of group 3, but there was no significant difference in chlorogenic acid and eleutheroside E in stem. Eleutheroside E, isofraxidin, rutin and hyperoside were not detected in the leaves of seedlings planted in group 3.Most of the secondary metabolites in the roots of A. senticosus seedlings showed positive feedback, while in the stems of Acanthopanax senticosus seedlings, caffeine, A. senticosus glycosides, hypericin and quercetin showed negative feedback, and most of the secondary metabolites in the leaves of A. senticosus seedlings showed positive feedback. Conclusion::The plant and soil showed different feedback in different parts of the growth process of A. senticosus seedlings, and the soil where A. senticosus had not been planted was more advantageous to the secondary metabolites of A. senticosus seedlings. The results of the study provide a basis for the study of the effect of plant-soil feedback on the A. senticosus, and provide the theoretical basis and technical support for the artificial cultivation of A. senticosus.

Effect of Shading on Growth and Photosynthetic Physiological Parameters of Acanthopanax senticosus / 中国实验方剂学杂志

Objective:To study the effect of different shading conditions on the growth and photosynthetic physiological parameters of Acanthopanax senticosus，and provide a theoretical basis for standardized planting and rational development and utilization of A. senticosus. Method:Three-year-old A. senticosus was used as the experimental sample.The growth parameters and photosynthetic physiological parameters of plant height，leaf number and leaf area were determined to study the effects of different shading conditions on the growth and photosynthesis of A. senticosus. Result:Plant height，leaf number，and leaf area were significantly higher in the shading treatment than in the control group，and highest under moderate shading conditions.The net photosynthetic rate，stomatal conductance，and transpiration rate were significantly higher in the moderate shading group than in the control group，and decreased in the severe shading group，while the intercellular carbon dioxide concentration was significantly lower in the moderate shading group than in the other treatment groups.As the treatment time progressed，the initial fluorescence was not significantly higher in the moderate shading group than in the control group，but significantly higher in the severe shading group；the maximum fluorescence was significantly higher in the shading group than in the control group，in the moderate shading group.The potential photochemical efficiency and maximum photochemical efficiency were not significantly different between the moderate shading group and the control group and decreased in the severe shading group，which was significantly lower than other treatment groups. Conclusion:Shading treatment is beneficial to the growth of A. senticosus.The moderate shading condition can significantly improve the photosynthesis of A. senticosus.Severe shading treatment can significantly inhibit the photosynthesis of A. senticosus leaves.This effect is related to the regulation of stomatal regulation. The activity of the photoreaction center is related.

Relationship between serum vitamin E concentration in first trimester and the risk of developing hypertension disorders complicating pregnancy / 北京大学学报(医学版)

OBJECTIVE@#To investigate the incidence of hypertension disorders complicating pregnancy (HDCP) and vitamin E (VE) nutritional status among pregnant women in Beijing, and to determine the relationship between serum VE concentration in the first trimester of pregnancy and the risk of developing HDCP.@*METHODS@#A retrospective cohort study was performed including 22 283 cases of pregnant women who underwent singleton deliveries in Tongzhou Maternal & Child Health Hospital of Beijing from January 2016 through December 2018 and received tests of serum VE concentrations in the first trimester of pregnancy. Nonconditional Logistic regression model was used to analyze the association between serum VE concentration levels and the risk of developing HDCP.@*RESULTS@#The total incidence of HDCP was 5.4%, with the incidence of gestational hypertension around 2.1% and the incidence of preeclampsia-eclampsia around 3.3%. The median concentration of serum VE in early pregnancy was 10.1 (8.8-11.6) mg/L, and 99.7% of the participants had normal serum VE concentrations. The incidence of gestational hypertension and that of preeclampsia-eclampsia had been annually increasing in three years; a linear-by-linear association had also been observed between the serum VE concentrations and the years of delivery. According to the results of the univariable and the multivariable Logistic regression analyses, higher risks of developing HDCP had been observed among women with higher serum VE concentrations. Compared to those with serum VE concentrations in interquartile range (P25-P75) of all the participants, the women whose serum VE concentrations above P75 were at higher risks to be attacked by HDCP (OR = 1.34, P < 0.001), gestational hypertension (OR = 1.39, P = 0.002), or preeclampsia-eclampsia (OR = 1.34, P = 0.001), as suggested by the results of the multivariable Logistic regression model analyses. In addition, the women with serum VE concentrations of 11.2 mg/L or above had a significantly higher risk of developing HDCP than those whose serum VE concentrations of P40-P60 of all the participants, and this risk grew higher as serum VE concentrations in the first trimester of pregnancy increased.@*CONCLUSION@#Women in Beijing are at good nutritional status. From January 2016 to December 2018, the incidence of HDCP increased with serum VE concentration level, and serum VE concentration of 11.2 mg/L is an indicator of an increased risk of developing HDCP, suggesting that pregnant women should take nutritional supplements containing VE carefully.

Research advances in the methods for weaning from high-frequency oscillatory ventilation in neonates / 中国当代儿科杂志

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.

Myocardial Blood Flow Quantified by Low-Dose Dynamic CT Myocardial Perfusion Imaging Is Associated with Peak Troponin Level and Impaired Left Ventricle Function in Patients with ST-Elevated Myocardial Infarction

OBJECTIVE: To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI). MATERIALS AND METHODS: Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark. RESULTS: The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = −0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = −0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001). CONCLUSION: MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.

Prevalence of Decreased Myocardial Blood Flow in Symptomatic Patients with Patent Coronary Stents: Insights from Low-Dose Dynamic CT Myocardial Perfusion Imaging

OBJECTIVE: To study the prevalence and clinical characteristics of decreased myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) in symptomatic patients without in-stent restenosis. MATERIALS AND METHODS: Thirty-seven (mean age, 71.3 ± 10 years; age range, 48–88 years; 31 males, 6 females) consecutive symptomatic patients with patent coronary stents and without obstructive de novo lesions were prospectively enrolled to undergo dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used to image the complete left ventricle. A bolus of contrast media (50 mL; iopromide, 370 mg iodine/mL) was injected into the antecubital vein at a rate of 6 mL/s, followed by a 40-mL saline flush. The mean MBF value and other quantitative parameters were measured for each segment of both stented-vessel territories and reference territories. The MBFratio was defined as the ratio of the mean MBF value of the whole stent-vessel territory to that of the whole reference territory. An MBFratio of 0.85 was used as the cut-off value to distinguish hypoperfused from non-hypoperfused segments. RESULTS: A total of 629 segments of 37 patients were ultimately included for analysis. The mean effective dose of dynamic CT-MPI was 3.1 ± 1.2 mSv (range, 1.7–6.3 mSv). The mean MBF of stent-vessel territories was decreased in 19 lesions and 81 segments. Compared to stent-vessel territories without hypoperfusion, the mean MBF and myocardial blood volume were markedly lower in hypoperfused stent-vessel territories (77.5 ± 16.6 mL/100 mL/min vs. 140.4 ± 24.1 mL/100 mL/min [p < 0.001] and 6.4 ± 3.7 mL/100 mL vs. 11.5 ± 4 mL/100 mL [p < 0.001, respectively]). Myocardial hypoperfusion in stent-vessel territories was present in 48.6% (18/37) of patients. None of clinical parameters differed statistically significantly between hypoperfusion and non-hypoperfusion subgroups. CONCLUSION: Decreased MBF is commonly present in patients who are symptomatic after percutaneous coronary intervention, despite patent stents and can be detected by dynamic CT-MPI using a low radiation dose.

MSCTimagingfeaturesofcoronaryarteryfistulawithsurgicalindicationsanditsclinicalvalue / 实用放射学杂志

Objective ToinvestigatetheMSCTfeaturesanditsclinicalvalueofcoronaryarteryfistula(CAF)withsurgicalindication. Methods CTfindingsof36patientswithluminaltumorGlikedilationCAFprovedbysurgerywereanalyzedretrospectively.Bymeans ofMIP,CPR,MPRandVRreconstruction,wearrangedtheabnormalvesselsintogroupsaccordingtoitscharacteristics,andmeasured thediameterofdilatation.ThediagnosticaccuracyofMSCTforCAFwascomparedwithtransthoracicechocardiography.Results Among the36cases,drainagesitesof8caseswererightatrium,14casesrightventricle,2casespulmonaryartery,1caseleftatrium,9cases leftventricle,and2casescoronarysinus.Amongallcases,4casesoriginatedfromleftmainartery,2casesfromleftanteriordescending, 5casesfromcircumflexartery,and25casesfromrightCAF.Ofwhich,24casesunderwentfistulaligationwithextracorporealcirculation. 12casesweretreatedwithminimallyinvasivesurgery.ThediagnosticaccuracyofMSCTbeforesurgerywas100%(36/36),andthat ofechocardiographywasabout80.6%(29/36).Conclusion ReconstructiontechniqueofMSCTcanprovidetheinformationofthe CAFvesselsanditsorigin,courseandshapeoffistulaorificium.MSCTcanaccuratelylocateandguidethesurgicalapproach,especially forpreGinvasivesurgery,providingimportantinformationfortreatment.MSCTshouldbethebestimagingmethodforCAF.

Pretreatment Serum Amyloid A and C-reactive Protein Comparing with Epstein-Barr Virus DNA as Prognostic Indicators in Patients with Nasopharyngeal Carcinoma: A Prospective Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The measuring Epstein-Barr virus (EBV) DNA is an important predictor of nasopharyngeal carcinoma (NPC). This study evaluated the predictive value of pretreatment serum amyloid A (SAA) and C-reactive protein (CRP) comparing with EBV DNA in patients with NPC. MATERIALS AND METHODS: In an observational study of 419 non-metastatic NPC patients, we prospectively evaluated the prognostic effects of pretreatment SAA, CRP, and EBV DNA on survival. The primary end-point was progress-free survival (PFS). RESULTS: The median level of SAA and CRP was 4.28 mg/L and 1.88 mg/L, respectively. For the high-SAA group (> 4.28 mg/L) versus the low-SAA (≤ 4.28 mg/L) group and the high-CRP group (> 1.88 mg/L) versus the low-CRP (≤ 1.88 mg/L) group, the 5-year PFS was 64.5% versus 73.1% (p=0.013) and 65.2% versus 73.3% (p=0.064), respectively. EBV DNA detection showed a superior predictive result, the 5-year PFS in the EBV DNA ≥ 1,500 copies/mL group was obviously different than the EBV DNA < 1,500 copies/mL group (62.2% versus 77.8%, p < 0.001). Multifactorial Cox regression analysis confirmed that in the PFS, the independent prognostic factors were including EBV DNA (hazard ratio [HR], 1.788; p=0.009), tumour stage (HR, 1.903; p=0.021), and node stage (HR, 1.498; p=0.049), but the SAA and CRP were not included in the independent prognostic factors. CONCLUSION: The results of SAA and CRP had a certain relationship with the prognosis of NPC, and the prognosis of patients with high level of SAA and CRP were poor. However, the predictive ability of SAA and CRP was lower than that of EBV DNA.

Protective effects of ranolazine preconditioning on myocardial ischemia reperfusion injury in rats / 心血管康复医学杂志

Objective:To study protective effects of ranolazine preconditioning on myocardial ischemia reperfusion in-jury(MIRI)in rats.Methods:A total of 32 SD rats were randomly and equally divided into sham operation group, ischemia/reperfusion(I/R)group,low dose ranolazine group(low dose group)and high dose ranolazine group (high dose group).HR,SBP,DBP,left ventricular systolic pressure(LVSP),left ventricular diastolic pressure (LVDP),left ventricular pressure maximum rate of rise(+dp/dtmax),left ventricular pressure maximum rate of de-cline(-dp/dtmax),levels of CK-MB,LDH and cTnI,severity of myocardial infarction and ATP concentration were measured and compared among all groups.Results:Compared with sham operation group,there were significant re-ductions in LVSP[(119.35 ± 5.00)mmHg vs.(92.68 ± 2.95)mmHg vs.(100.60 ± 3.12)mmHg vs.(112.22 ± 3.69)mmHg],LVDP[(24.78 ± 1.71)mmHg vs.(17.26 ± 1.69)mmHg vs.(19.25 ± 1.05)mmHg vs.(22.18 ± 1.55)mmHg],+dp/dtmax[(3736 ± 102.37)mmHg/s vs.(3115 ± 112.72)mmHg/s vs.(3338 ± 51.88)mmHg/s vs.(3446 ± 37.99)mmHg/s],-dp/dtmax[(3634 ± 102.51)mmHg/s vs.(3015 ± 127.00)mmHg/s vs.(3239 ±37.36)mmHg/s vs.(3349 ± 45.49)mmHg/s]and ATP concentration[(22.54 ± 1.52)nmol/mg vs.(14.08 ± 1.80) nmol/mg vs.(16.88 ± 0.74)nmol/mg vs.(19.34 ± 0.88)nmol/mg],and significant rise in levels of CK-MB [(490.88 ± 168.04)U/L vs.(1259.0 ± 78.02)U/L vs.(1127.9 ± 127.23)U/L vs.(956.62 ± 105.22)U/L], LDH[(1494.9 ± 174.84)U/L vs.(2657.6 ± 104.33)U/L vs.(2293.9 ± 99.58)U/L vs.(1932.6 ± 134.25)U/L]and cTnI[(1.03 ± 0.14)ng/ml vs.(10.62 ± 1.34)ng/ml vs.(6.97 ± 1.32)ng/ml vs.(4.87 ± 0.79)ng/ml] in I/R group,low dose group and high dose group,P<0.01 all.Compared with I/R group,there were significant rise in LVSP,LVDP,+ dp/dtmax,-dp/dtmaxand ATP concentration,and significant reductions in levels of CK-MB,LDH and cTnI and MI severity[(0.5289 ± 0.0223)vs.(0.4887 ± 0.0089)vs.(0.4438 ± 0.0154)]in low dose group and high dose group(P<0.05 or <0.01),and those of high dose group were significantly better than those of low dose group(P< 0.05 or < 0.01).Conclusion:Ranolazine preconditioning possesses significant protective effect on MIRI,and it's dose-dependent.