Predictive value of HIT-antibodies detection for new thrombosis in heparin-induced thrombocytopenia / 中华检验医学杂志

Objective To investigate the predictive value of HIT-antibodies(HIT-Ab) detection for new thrombus in suspected Heparin-Induced thrombocytopenia (HIT). Methods Retrospective cohort study. 472 suspected HIT patients were collected from July 2016 to November 2018, and all subjects under-went a 4Ts score and were sent for HIT-Ab tests. According to the results of HIT-Ab, there were four groups:412 cases of negative HIT-Ab (0-0.9 U/ml), 45 cases of weak-positive HIT-Ab (1.0-4.9 U/ml), 12 cases of moderate-positive HIT-Ab (5.0-15.9 U/ml), and 3 cases of strong-positive HIT-Ab (≥16.0 U/ml) respective-ly. Ultrasound or CT examination was used to confirm new thrombosis as a standard to evaluate the value of HIT-Ab for predicting new thrombus. The diagnostic efficacy of HIT-Ab for HIT was evaluated in clinically confirmed HIT. Results The incidence rates of new thrombus in each group were: 15.8％ in Negative HIT-Ab group (62/412), 48.9％in Weak-positiveHIT-Ab group (22/45), 75.0％in Moderate-positive HIT-Ab group (9/12), and100％in Strong-positive HIT-Ab group (3/3)(P<0.00). When HIT-Ab≥1.0 U/ml, the speci-ficity for diagnosing new thrombus was 93.0％, the sensitivity was 34.2％, the negative predictive value (NPV) was 84.2％, and the positive predictive value (PPV) was 56.5％. The diagnostic rates of HIT in each group were:negative 0％(0/412), weak-positive 62.2％(28/45), moderate-positive (12/12) and strong-positive (3/3) were 100％. When HIT-Ab≥ 1.0 U/ml, the specificity for HIT diagnosis was 96.0％, the sensitivity was 100％, NPV was 100％, and PPV was 71.5％. Conclusions In suspected HIT patients, the incidence of new thrombosis increases with the elevated HIT-Ab level. HIT-Ab detection can be used as a crucial tool for new thrombosis prediction and HIT diagnosis in suspected HIT patients. Clinicians can develop treatment strategies based on HIT-Ab levels.

Real-time tissue elastography-based noninvasive prediction model for liver fibrosis in patients with chronic hepatitis B: a prospective study / 中华医学超声杂志（电子版）

Objective To further improve the value of clinical application of a quantitative analysis method called LF-index (LFI) which based on real-time tissue elastography (RTE). Methods We prospectively enrolled 116 consecutive patients with chronic hepatitis B (CHB) and all patients underwent a liver biopsy and RTE between January 2015 and December 2015 at the First affiliated hospital of Wenzhou Medical University. Univariate and multivariate analyses were performed, and the prediction models for predicting significant fibrosis and cirrhosis were derived from independent predictors. Results (1) In multivariate analyses, spleno-portal index (SPI) (OR=13.956, P=0.002) and LFI (OR=6.283, P=0.023) were confirmed as independent predictors of significant fibrosis. In multivariate analyses of patients with and without cirrhosis, we found significant differences in the γ-Glutamyl transferase (GGT) (OR=1.012, P=0.049), SPI (OR=5.676, P=0.002) and LFI (OR=14.102, P=0.001). (2)A novel model called LFI-SPI score (LSPS) for prediction of significant fibrosis was developed (area under receiver operating characteristic curve [AUROC]=0.87), showing the superiority of diagnostic accuracy than LFI (AUROC=0.76, P=0.0109), aspartate aminotransferase to platelet ratio index (APRI) (AUROC=0.64, P=0.0031), fibrosis-4 index (FIB-4) (AUROC=0.67, P= 0.0044) and Fibroscan (AUROC=0.68, P=0.0021). (3) We also developed a LFI-SPI-GGT score (LSPGS) for predicting cirrhosis, with an AUROC of 0.93. The diagnostic accuracy of LSPGS was similar to that of Fibroscan (AUROC=0.85, P=0.134), and was superior to LFI (AUROC=0.81, P=0.0113), APRI (AUROC=0.67, P<0.0001), and FIB-4 (AUROC=0.72, P=0.0005). Conclusions We developed new formulas, LSPS and LSPGS for predicting significant fibrosis and cirrhosis in this prospective study. LSP score was mainly used for screening of significant liver fibrosis, and LSPG score was mainly used to exclude cirrhosis.

p53 gene mutations of familial breast cancer and early-onset breast cancer in part population of southern China / 中南大学学报(医学版)

Objective:To investigate the site and characteristic ofp53 gene mutations in familial or early-onset breast cancer patients in part population of southern China.Methods:A total of 150 patients with familial and early-onset breast cancer in parts population of southern China were enrolled.Genomic DNA was isolated from each peripheral blood sample,and the entire coding sequence and exon and intron splicing region of p53 gene were amplificated by PCR in the 150 patients.The mutation analysis were detected by denaturing high performance liquid chromatography (DHPLC) and confirmed by DNA sequence analysis.Results:In the 150 patients with familial and early-onset breast cancer,6 mutations including one novel pathogenic mutation 869_888 ins20 (insert mutation) and 5 previously reported pathogenic mutations (deletion mutation 643_660de118 and 4 missense mutation 91G＞A,215C＞G,537T＞G,743G＞A) were identified in p53 gene encoding region in 9 patients of breast cancer.Moreover,one same sense mutation 141G＞A in exon 4,one 16 bases deletion in intron 3,and 9 single nucleotide polymorphisms in p53 gene introns were also identified.The total mutation frequency ofp53 gene in 150 patients with familial breast cancer and early-onset breast cancer from part population of southern China was 6.00％,and the mutation frequency of familial breast cancer and early-onset breast cancer was 6.81％ and 6.25％,respectively.Conclusion:The total mutation frequency ofp53 gene in 150 patients with familial breast cancer and early-onset breast cancer from partpopulation of southern China is higher than the frequency previously reported.The pathogenicity of the novel mutations (insert mutation) 869_888ins20 will be confirmed by function analysis in the future study.The deletion mutation 643_660de118 enriches the p53 gene mutation database among Chinese population,which is probably the specific mutation of breast cancer in Chinese population.

PTEN and NBS1 gene mutations in familial breast cancer and early-onset breast cancer from Hunan Province in China / 中南大学学报(医学版)

OBJECTIVE@#To investigate the profile and potential significance of PTEN and NBS1 mutations among patients with familial or at early onset breast cancer in Hunan province.
@*METHODS@#A total of 131 breast cancer patients with familial history or suffered from breast cancer at the age of less than 35 years old were included in this study. A comprehensive phosphatase and tensin homolog (PTEN) and nibrin (NBS1) mutation analysis was performed through denaturing high performance liquid chromatography (DHPLC) and subsequent DNA direct sequencing.
@*RESULTS@#Among 131 patients, a reported mutation IVS4+109insTCTTA in PTEN gene were identified in two patients. The mutation frequency of IVS4+109insTCTTA was 1.15%. Two mutations in PTEN gene, 225 A>C (Thr 160 Pro) and IVS5+13T>C, was firstly discovered. Another reported missense mutation was rs121909229 G>A (Arg 130 Gln). Three mutations were detected in NBS1 gene, of which IVS6+43A>G and IVS6+127A>G were firstly discovered and another reported synonymous mutations was rs1805794 G>C (Glu 185 Gln).
@*CONCLUSION@#The novel mutations in PTEN and NBS1 might be specific to the familial and early-onset breast cancer of Chinese Hunan population.

Comparative study on ultrasonic assessments of left ventricular systolic synchronicity under different cardiac ;pacing modes / 中华超声影像学杂志

Objective To compare left ventricular (LV)synchronization of direct His-bundle pacing (DHBP)and right ventricular apical pacing (RVAP)with two-dimensional speckle tracking imaging (2D-STI)and tissue Doppler imaging (TDI),and discuss the diagnostic value of 2D-STI and TDI in evaluation of left ventricular systolic synchronicity.Methods Twenty-four patients implanted with DHBP and RVAP were observed.Conventional echocardiography examination were undergone both at the mode of DHBP or RVAP respectively.The time to peak radial strain of LV 1 8 segments were derived from the parasternal short-axis views by 2D-STI,then calculated the standard deviations (SD ) and the maximal temporal difference of LV 1 8 segments (Trs-SD and Trs-Dif),and the interval of time to peak radial strain between the anteroseptal wall and the posterior wall (Tas-post).The time to peak systolic velocity of LV 12 segments were derived from the apical axis views by TDI.The SD and the maximal temporal difference of 1 2 segments (Ts-SD and Ts-Dif)were calculated as the LV dyssynchrony index.Results All the systolic synchrony parameters derived from 2D-STI and TDI were more significantly shortened in DHBP than in RVAP (all P <0.01).For DHBP,the detection rate of LV synchronization was higher by 2D-STI than by TDI.For RVAP the detection rate of LV dyssynchronization was also higher by 2D-STI than by TDI with RVAP lead (all P <0.05).Conclusions DHBP is more beneficial than RVAP in LV syschronization and LV function,RVAP may induce left ventricular systolic asynchrony.Both 2D-STI and TDI can assess the LV synchronization quantitatively,but 2D-STI may be more superior on the detection rate than TDI.

Effect of standardized PICC training and management on the clinical effect and complication of catheterization / 中南大学学报(医学版)

OBJECTIVE@#To determine the clinical effect of standardized training and management of peripherally inserted central catheter (PICC) and catheter-related complications.@*METHODS@#A total of 610 patients were divided into a control group and an observation group, the control group (n=300) were catheterized by trainees who received "short-term intensive training", the observation group (n=310) by "system standardized training and management". The clinical efficacy of catheterization and the rate of catheter-related complications were compared.@*RESULTS@#There was significant difference in the one-time puncture success rate, one-time cannulation success rate, the time for operation and the pain score between the 2 groups (all P<0.01), and there was also significant difference in the occurrence of catheter extrusion, plug, arrhythmia, catheter-related thrombosis, phlebitis, puncture point effusion and catheter-related infection between the 2 groups (all P<0.05).@*CONCLUSION@#Standardized PICC training and management can improve the effect of catheterization and reduce the incidence of PICC-related complication.

Expression of voltage gated sodium channel Nav1.9 in experimental pulpal lesions in the rats / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between pulpitis pain and voltage-gated sodium channel (Nav1.9) by detecting the expression of Nav1.9 at different time points of the rat pulpal lesion model.</p><p><b>METHODS</b>Thirty-six SD pulpal lesions rat models were divided into three experimental groups, 1 d (n = 12), 3 d (n = 12) and 5 d group(n = 12).Normal SD rats served as control(n = 12). Tumor necrosis factor-α (TNF-α) and Nav1.9 mRNA expressions were evaluated by reverse transcription PCR (RT-PCR) .Nav1.9 protein expressions were analyzed by enzyme-linked immunosorbent assay (ELISA) and Western blotting.</p><p><b>RESULTS</b>The expression of TNF-α in the experimental group (1 d:0.514 ± 0.098, 3 d:0.739 ± 0.104, 5 d:1.238 ± 0.082) was higher than those in the control group (0.147 ± 0.016) (P < 0.01). Nav1.9 mRNA was up-regulated markedly in experimental groups (1 d: 0.296 ± 0.038, 3 d:0.409 ± 0.013, 5 d: 0.487 ± 0.028) , compare with control group (0.223 ± 0.020) (P < 0.05). The ELISA results revealed that the level of Nav1.9 in control pulp tissue was (4.013 ± 0.292) µg/L, in painful pulp tissue of 1 d group was (5.143 ± 0.101) µg/L, in painful pulp tissue of 3 d group was (5.835 ± 0.088) µg/L and in painful pulp tissue of 5 d group was (6.307 ± 0.137) µg/L (P < 0.05). Western blotting showed the expression of Nav1.9 in experimental groups (1 d: 0.106 ± 0.007, 3 d:0.170 ± 0.013, 5 d:0.238 ± 0.004) was up-regulated significantly compared with control group (0.073 ± 0.004)(P < 0.05).</p><p><b>CONCLUSIONS</b>The level of Nav1.9 had a significant increase in painful pulp tissue. Moreover, with the degree of pain aggravation, the expression of Nav1.9 increased in pulp tissue.It suggests that Nav1.9 may play an important role in the development of pulpitis pain.</p>

Clinical value of contrast-enhanced TVS in the assessment of invasion depth of endometrial cancer / 中国基层医药

Objective To discuss the diagnostic value of contrast-enhanced transvaginal sonography TVS in the diagnosis of myometrial invasion grade of endometrial cancer. Methods Total twenty-eight cases were studied by contrast-enhanced TVS,which were proved pathologically endometrial cancer in our hospital. The diagnosis of myometrial invasion grade of endometrial cancer by contrast-enhanced TVS were compared with pathologic results based on FIGO. Results The total coincidence of contrast-enhanced transvaginal sonography in detecting the depth of myometrial invasion was 78.6%. In the evaluation of no myometrial invasion,it showed the sensitivity of 71.4%,specificity of 85.7% and coincidence of 62.5%. In evaluation of superficial myometrial invasion,the sensitivity,specificity and coincidence was 73.7% ,77. 8% ,87. 5% ,respectively. The sensitivity in detecting deep invasion was 100. 0% ,the specificity was 96.0% ,while coincidence was 75.0%.There was no significant difference among the coincidence of various depth of myometrial invasion by contrast-enhanced TVS. Conclusion Contrast-enhanced TVS was valuable in the diagnosis of myometrial invasion grade of endometrial cancer.

Ultrasonographic diagnosis of acute superior mesenteric venous thrombosis / 中国基层医药

ObjectiveTo investigate the diagnosis of acute superior mesenteric venous thrombosis(MVT) by ultrasonography. MethodsSeventeen patients with MVT were confirmed by operation or CT scanning and followed-up, whose ultrasonographic features were analyzed retrospectively. ResultsUltrasonographic features of seventeen patients with MVT were enlarged superior mesenteric vein filled with hypoecho without flow signals( n =9) ,portal vein and(or) splenic vein filled with hypoecho without flow signals (n =4), intestine wall thickening and intestine distension( n =2) and ascites( n =2). The accuracy of ultrasonographic examination for SMV was 65％ (11/17). According to MVT with or without splenic or portal vein involvement,MVT were been classified as two type:large vessel type(n =10) and small vessel type(n =7). The accuracy of ultrasonographic examination for large vessel type and small vessel type were 90％ (9/10) and 29％ (2/7) ,respectively. Patient with large vessel type of MVT were easy to be diagnosed by ultrasonography than those with small vessel type( x2 =3.41, P ＜ 0. 05 ). ConclusionUltrasonography was valuable in diagnosis of MVT, and it played more important role in diagnosis of large vessel type of MVT.

Dynamic observation the change of reversed diastolic flow in renal allografts with ultrasound / 中华泌尿外科杂志

Objective To retrospectively analyze the change of reversed diastolic flow in renal allografts with ultrasound and its association with clinical outcomes.Methods 17 patients with reverse diastolic flow of renal allograft were reviewed. According to the waveform morphology changes of RDF,17 cases of RDF were classified as two types: typeⅠ(total RDF changing type: continuous total RDF or non-total RDF transformed into total RDF,n=6)and type Ⅱ (non-total RDF changing type: continuous non-total RDF or total RDF transformed into non-total RDF or disappeared,n=11).Meanwhile,they were compared with clinical outcome.Results In typeⅠ, transplanted kidney resection were performed in five cases, but 10 cases in type Ⅱ were recovered. TypeⅠwas associated with lower likelihood of renal allografts survival(Fisher exact test, P=0.005).Conclusions Dynamic observation the change of RDF may help to judge the prognosis in renal allograft.TypeⅠmay predict of an unfavorable outcome in renal allograft with RDF.

Improved resistance index in renal allograft with reversed diastolic flow / 中华器官移植杂志

Objective To study the accuracy of improved resistance index (RI) in judging the prognosis in renal allograft with reversed diastolic flow. Methods According to the transplant nephrectomy, patients with reversed diastolic flow in renal allograft were classified into two groups:surgical group (n = 5) and nonsurgical group (n = 19). The differences in improved RI between two groups were compared by using Student's t test. Improved RI was defined as a ratio of peak systolic velocity plus peak diastolic velocity divided by peak systolic velocity. Receiver operating characteristic (ROC) curve was constructed for improved RI to evaluate diagnostic accuracy in judging the prognosis in renal allograft with reversed diastolic flow. Results Improved RI in surgical group ( 1.57 ± 0. 26)was higher than in nonsurgical group (1.22 ± 0. 08) (P＜＜0. 05). Areas under ROC curve for improved RI was 0. 979. An improved RI threshold of 1.31 had 100 % sensitivity, 90 % specificity, 71%positive predictive value, and 100 % negative predictive value for renal allograft with reversed diastolic flow loss as the maximum Youden index was 90 %. Applying this cutoff value to predict the function of renal allograft with reversed diastolic flow recovery, the accuracy was 92 % (maximum) or 83 %(minimum). Conclusion Improved RI can not only serve as a useful noninvasive index to predict renal allograft with reversed diastolic flow loss, but also to predict the function of renal allograft with reversed diastolic flow recovery.

Reversed diastalic flow in abdominal and peripheral vascularity and its value of clinical application / 中国医师进修杂志

Objective To study the reversed diastolic flow in abdominal and peripheral vascularity and its value of clinical application.Methods A review of Doppler sonograms was performed in abdominal and peripheral vascularity obtained over a 9-year period.And if the patients with reversed diastolic flow were found,their clinical feature were recorded and evaluated.Results Sixty-eight patients with reversed diastolic flow were found including subelavian steal syndrome(21 cases),complications of renal transplant (22 cases),thrombosis in arteriovenous fistulas (20 cases),preeclampsia in pregnancy (3 cases) and others (2 cases).The causes of reversed diastolic flow in abdominal and peripheral vascularity might be divided into four types: vessels type(41 cases),organ type (22 cases),pregnancy type (3 cases) and others (2 cases).Conclusion The causes of patients of reversed diastolic flow in abdominal and peripheral vascuhrity are different depending on its site,and the typing of causes of reversed diastolic flow may aid to enhance the recognition of reversed diastolic flow.