The predictive value of platelet-to-lymphocyte ratio for weaning failure in septic patients receiving mechanical ventilation / 中华预防医学杂志

Objective: To determine the ability of the ratio of platelet to lymphocyte (PLR) for predicting extubation failure in septic patients receiving invasive mechanical ventilation (IMV). Methods: The retrospective cohort study was conducted in ICU at Beijing Chao-Yang Hospital Shijingshan District, Capital Medical University in China from January, 2010 to December, 2019, including patients with sepsis who received IMV. 180 patients were enrolled in the study, including 111 male and 69 female, with the age range of 23-93 years and the median age of 76 years, and with an average age of 71.22 years. The medical records were reviewed, such as age, sex, acute physiology and chronic health evaluation II (APACHEII), sequential organ failure assessment (SOFA), spontaneous breathing trial (SBT) outcome, weaning outcome, complete blood count before SBT. According to weaning outcome, patients were divided into weaning failure and weaning success group. The difference of PLR, white blood cell(WBC), C-reaction protein (CRP) and procalcitonin (PCT) were compared between weaning failure and success group. Receiver-operating characteristics (ROC) curves and multivariate logistical regression analysis were employed to analyze the performance of these inflammatory markers for predicting weaning failure in patients with sepsis. Results: 180 patients with sepsis were included in the study and 37 patients (20.5%) experienced weaning failure (31 SBT failure and 6 extubation failure after successful SBT). PLR was higher in weaning failure group than that in weaning success group (Z=-5.793,P<0.001). Other inflammation biomarkers such as WBC, CRP and PCT were also higher in weaning failure group than that in weaning success group(Z=-4.356, -3.118 and -2.743, P<0.001, 0.002 and 0.006, respectively). According to ROC curves, PLR has a better predictive ability for weaning failure (AUC=0.809,95%CI 0.733-0.885) when compared to WBC (AUC=0.773,95%CI 0.648-0.817), CRP (AUC=0.666,95%CI 0.577-0.755) and PCT (AUC=0.603,95%CI 0.508-0.698). The cutoff value of PLR for predicting weaning failure was 257.69 with sensitivity 78.38%, specificity 76.22%, and diagnostic accuracy 71.66%. According to multivariate logistic regression analyses, PLR>257.69 was an independent risk factor for predicting weaning failure in patients with sepsis. Conclusions: PLR may be a valuable biomarker for predicting weaning failure in septic patients receiving IMV, and the patients with higher PLR should be handled with caution since they are at higher risk of weaning failure, and some more effective treatment should be in consideration after extubation.

Study on the effect of histone deacetylase gene polymorphism and environmental factors on type 2 diabetes mellitus / 中华疾病控制杂志

@#Objective To examine whether polymorphisms of histone deacetylase( HDACs) and environment factors can be implicated in type 2 diabetes mellitus ( T2DM) ，and to provide evidence for the prevention and treatment of T2DM． Methods In 2017，T2DM patients and controls were selected from 17 villages in Huadu District，Guangzhou． According the Diagnostic criteria for T2DM，the case group of T2DM was matched with control group from the population diagnosed as normal by gender，age no more than 5 years old，and from the same natural village． Conditional logistic regression model was used to analyze the effect of gene and environment and their interaction on T2DM． Results The average age of 499 cases group were ( 61．53±13．08) years old，and the average age of 499 controls group were ( 61．48±13．09) years old． There were no statistic difference between two groups． Furthermore，the two groups were gender－balanced too． In conditional logistic regression model，we found that glycerin trilau- rate ( TG) abnormalities ( OR= 2．410，95% CI: 1．755－3．310，P＜0．001) and cholesterol total ( TC) ab- normalities ( OR= 1．436，95% CI: 1．046－1．972，P = 0．025) were risk factors for T2DM． The subjects carries rs72792338 TC+TT genotype ( OR= 0．526，95% CI: 0．349－0．793，P= 0．002) had lower the risk to develop T2DM． Conclusions Abnormal TG and TC are risk factors for T2DM． Rs72792338 TT and TC genotype carryings decrease the risk of T2DM．

The difference of IL-28B polymorphisms between hepatitis C patients with and without cryoglobulinemia / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To determine whether patients infected with chronic hepatitis C (CHC) show a differential distribution profile of IL-28B polymorphisms according to the presence of concomitant cryoglobulinemia.</p><p><b>METHODS</b>Sixty-two consecutive CHC patients were enrolled in the study between December 2008 and December 2010. All patients received combination therapy of pegylated interferon alpha-2a (weekly, 180 g, subcutaneous injection) plus ribavirin (daily, 10to15 mg/kg body weight, oral) for 48 weeks, with individualized dosage adjustments according to the patient's clinical situation. Cryoglobulins were detected visibly by separation of cryoprecipitates in patient serum samples. Three IL-28B SNPs (rs8099917, rs12979860, and rs12980275) were detected by sequencing. Response to treatment was assessed by measuring serum levels of HCV RNA by quantitative PCR at baseline (prior to treatment initiation), during treatment (4 and 12 weeks after treatment initiation), end of therapy (48 weeks after treatment initiation), and post-treatment (24 weeks after end of therapy). The significance of between-group differences were assessed by the Chi-square and Fisher's exact tests.</p><p><b>RESULTS</b>Cryoglobulinemia was detected in 43.5% (27/62) of the CHC patients and showed a female bias (59.3% vs. males: 34.3%, P = 0.05). Compared to CHC patients without cryoglobulinemia, the CHC patients with cryoglobulinemia showed significantly higher levels of HCV RNA at baseline (5.64+/-1.20 vs. 6.37+/-0.67, P less than 0.05) but lower frequencies of the IL28B rs8099917 TT genotype (94.3% vs. 63.0%, P = 0.002), rs8099917 T allele (97.1% vs. 81.5%, P = 0.003), and rs12979860 C allele (94.3% vs. 83.3%, P = 0.048). CHC patients with cryoglobulinemia and having the rs8099917 TT, rs12979860 CC, or rs12980275 AA genotype achieved a higher rate of sustained virological response.</p><p><b>CONCLUSION</b>Cryoglobulinemia in CHC patients is associated with a differential distribution of IL-28B polymorphisms, and certain polymorphisms may be related to anti-viral treatment response.</p>

Efficacy of pegylated interferon-alpha-2a plus ribavirin for patients aged at least 60 years with chronic hepatitis C / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In China, patients with hepatitis C virus (HCV)-associated liver disease are getting older, and thus the number of deaths due to such disease is increasing. The efficacy of combination therapy with ribavirin and interferon for chronic HCV infection in elderly patients has not been fully clarified. The aim of the present study was to evaluate the efficacy and tolerability of the combination therapy in the elderly patients.</p><p><b>METHODS</b>Sixty-eight chronic hepatitis C patients, who received the combination therapy, were classified into two age groups: elderly group ((3)60 years, n = 25) and non-elderly group (< 60 years, n = 43). Rapid virological response, complete early virological response, sustained virological response, relapse, non-response rate, and safety were compared between the elderly group and non-elderly group.</p><p><b>RESULTS</b>Overall sustained virological response was lower in the elderly group than non-elderly group (44% vs. 75%, P = 0.012, OR = 0.270, and 95%CI 0.095 - 0.768). Among patients with HCV genotype 1, sustained virological response was lower in the elderly group than non-elderly group (45% vs. 77%, P = 0.015, OR = 0.247, 95%CI 0.078 - 0.781). The proportions of dose reduction due to laboratory abnormalities were significantly higher in the elderly group than non-elderly group (60.0% vs. 32.6%, P = 0.027). Multiple binary Logistic regression analysis confirmed that patient age was an associated factor for sustained virological response.</p><p><b>CONCLUSION</b>Among patients with HCV genotype 1, the elderly patients had lower sustained virological response than non-elderly patients during pegylated interferon-alpha-2a plus ribavirin combination therapy.</p>

Cryoglobulinemia is an independent factor negatively associated with sustained virological response in chronic hepatitis C patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Mixed cryoglobulinemia (MC) is one of the most common and severe symptoms in chronic hepatitis C patients. The aim of this study was to investigate whether mixed cryoglobulinemia is a factor associated with sustained virological response in chronic hepatitis C patients treated with combination therapy of pegylated interferon alpha-2a and ribavirin.</p><p><b>METHODS</b>This is a single-center study including 57 chronic hepatitis C patients who received combination treatments of pegylated interferon alfa-2a and ribavirin. Serum cryoglobulin was detected by cryoprecipitation prior to treatment. Serum hepatitis C virus (HCV) RNA levels were checked before treatment, during the fourth and 12th week of treatment, and during the 24th week after cessation of treatment. The genotype of HCV was determined at baseline. Logistic regression analysis was used to assess the factors associated with sustained virological response.</p><p><b>RESULTS</b>Twenty-five patients were with MC (43.9%). Twenty-four weeks after cessation of antiviral treatment, sustained virological response achievement in MC(+) patients was significantly lower than that in MC(-) patients (32.0% vs. 75.0%, P = 0.001). Univariate Logistic regression analysis and multivariate Logistic regression analysis found that only MC (odds ratio: 6.375; 95% CI: 1.998- 20.343, P = 0.002) was negatively associated with sustained virological response achievement.</p><p><b>CONCLUSION</b>MC is an independent factor negatively associated with sustained virological response in chronic hepatitis C patients treated with pegylated interferon alpha-2a and ribavirin.</p>

Anti-cicatricial effect of tetrandrine drug delivery system in glaucoma filtration surgery in rabbit / 中华实验眼科杂志

Background Scarring of the filtering bleb is a main cause of filtering surgical failure in glaucoma.It has been reposed that tetrandrine could suppress the proliferation of cultured human fibroblast of Tenons capsule in vitro and thus has the potential effect to prevent scarring after the filtering surgery. Objective Present study was to investigate the anti-cicatricial effect of tetrandrine drug delivery system(Tet DDS)during filtration surgery. Methods Filtration surgery was performed in bilateral eyes of 18 New Zealand white rabbits.The Tet DDS with 0.3 mg Tet,0.2 mg Tet or free-Tet were implanted subcunjunctially during the surgery.The filtering blebs were scored in 1 day,4,7,10,14 days after referring to the corneal thickness and bleb range under the slit-lamp biomicroscopy.The morphology of filtering bleb was assessed by in vivo confocal microscopy in 7 and 14 days after operation.The filtering bleb specimen was prepared in 7 and 14 days for the histopathological examination. Results The filtering bleb scores in Tet DDS implantation groups were significantly higher than those in free-Tet DDS group from 4 days through 14 days after trabeculectomy(P＜0.01),and the scores showed a considerably increase in 0.3 mg Tet DDS group compared with 0.2 mg Tet DDS group from 7 days through 14 days after trabeculectomy(P＜0.05).The filtering blebs of Tet DDS implantation groups were found with distinct subepithelial cystic spaces under the light microscopy and in vivo confocal microscopy on the 7th day and 14th day after surgery.Compared with free-Tet DDS group,the numbers of subepithelial mierocysts were much more(P＜0.01)and the area of microcysts was larger(P＜0.01)in Tet DDS group.The filtering tissue presented with more subepithelial microcysts and larger microcysts range in 0.3 mg Tet DDS group than 0.2 mg Tet DDS group in 7 and 14 days after operation(P＜0.05).The inflammatory cell infiltration wag milder in 0.3 mg Tet DDS group in comparison with 0.2 mg Tet DDS group and free-Ted DDS group.Conclusion Tet DDS has strong inhibitory effects on inflammatory cells activity and fibroblagt activity the early stage after filtering surgery and therefore improve the surgery success rate.

Association of ankle-brachial index and pulse wave velocity with stroke in Han, Uighur, and Kazakh population of Xinjiang / 中华流行病学杂志

Objective To investigate the relationship between stroke and ankle-brachial index (ABI), pulse wave velocity (PWV) in Han, Uighur, and Kazakh populations of Xinjiang. Methods Data was from the investigation of cardiovascular risk survey (CRS) program among different nationalities in Xinjiang from October 2007 to March 2010. A total of 14 618 samples aged over 35 with complete data dimension were surveyed. Results ( 1 ) There were 633 patients with stroke, including 258 Hans (4.48%), 247 Uighurs (5.18%), and 128 Kazakhs (3.13%). The incidence of stroke was significant different in the three ethnic groups (P＜0.001). (2)Compared to the Han population, the incidence of stroke was higher ( OR= 1.304) in Uighur but lower (OR=0.794) in Kazakh. (3) PWV was significant different between stroke and non-stroke patients. After adjustment for age, body mass index, systolic blood pressure, triglyceride, total cholesterol and other risk factors, the difference remained significant, indicating that PWV (OR=1.001, P＜0.001) might associate with the occurrence of stroke. Conclusion The results of this study showed that the incidence of stroke was significantly different in the three ethnic groups. PWV might associate with the occurrence of stroke.