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Objective:To compare the differences of fluoroscopy time and dose between HIS bundle pacing and right ventricle apex pacing.Methods:This study includes thirty patients undergoing HIS bundle pacing (HIS group) and 32 patients undergoing right ventricular apex pacing (RVA group). The fluoroscopy time and cumulative dose (CD) to patients during surgery were recorded and analyzed.Results:The operation time for patients in HIS group and RVA group were (76.8±13.1) and (66.0±10.8) min ( t=3.386, P<0.001), respectively. The fluoroscopy time was (698.2±113.7) and (293.3±63.9) s ( t=14.709, P<0.001) and the CD were (391.3±70.0) and (162.3±40.5) mGy ( t=13.694, P<0.001) in HBP group and RVA group, respectively. In comparison, the fluoroscopy time and CD for HIS bundle electrode implantation were (501.2±112.3) s and (279.9±65.0) mGy, respectively, significantly higher than in the case of RVA, where the values were (103.4±30.6) s and (57.3±13.8) mGy ( t=15.864, Z=-6.524, P<0.001). Conclusions:Compared with right ventricular apical pacing, the HIS bundle pacing takes longer operation time, leading to higher radiation dose, which should be prudently selected.
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Objective:To investigate the diagnostic values of interleukin-22 (IL-22), interferon-γ(IFN-γ)and macrophage migration inhibition factor (MIF) in pleural effusion for tuberculosis pleurisy.Methods:From April 2018 to May 2019, a total of 77 patients including 45 cases of tuberculous pleurisy, 19 cases of malignant pleurisy, 13 cases of parapneumonia and 13 cases of healthy control in Wuxi Fifth People′s Hospital were enrolled. The levels of IL-22, IFN-γ and MIF in plasma and pleural effusion were detected by enzyme linked immunosorbent assay (ELISA). Mann-Whitney U test was used for statistical analysis.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of IL-22, IFN-γ and MIF for tuberculous pleurisy. Results:The median levels of IL-22, IFN-γ, MIF and adenosine deaminase in 45 cases with pleural effusion in tuberculosis pleurisy group were 396.8 ng/L, 2 200.0 ng/L, 241.3 μg/L and 70.8 U/L, respectively, which were all significantly higher than 32 cases with non-tuberculosis pleurisy group, including 19 cases with malignant pleurisy and 13 cases with parapneumonia (52.8 ng/L, 232.3 ng/L, 179.6 μg/L and 17.0 U/L, respectively). The differences were all statistically significant ( U=179.000, 118.500, 287.000, 162.000, respectively, all P<0.05). The median levels of IL-22 and IFN-γ in plasma of tuberculosis pleurisy group were 20.0 ng/L and 45.9 ng/L, respectively, which were both higher than healthy control group (14.3 ng/L and 33.4 ng/L, respectively). The level of MIF was 96.2 μg/L, which was lower than healthy control (159.5 μg/L). The differences were all statistically significant ( U=74.000, 13.000 and 73.000, respectively, all P<0.05). The areas under ROC curve (AUC) of IL-22, IFN-γ and MIF in pleural effusion for the diagnosis of tuberculosis pleurisy were 0.876, 0.917 and 0.682, respectively.The sensitivities were 93.75%, 100.00% and 63.64%, respectively; the specificities were 82.22%, 91.11% and 65.85%, respectively. The median levels of IL-22 and IFN-γ in plasma in tuberculosis pleurisy group at two months of follow-up after anti-tuberculosis therapy were 16.0 ng/L and 33.9 ng/L, respectively, which were both lower than baseline (20.0 ng/L and 44.7 ng/L, respectively). The differences were both statistically significant ( U=2.156 and 2.221, respectively, both P<0.05). Conclusion:IFN-γ and IL-22 in pleural effusion could be used as effective indicators to identify tuberculous pleurisy, and the dynamic monitoring of IL-22 in patients′plasma could be an important biomarker in evaluating the efficacy of anti-tuberculosis treatment.
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Objective To investigate the effect of caveolin-1 scaffolding domain (CSD) peptides on heme oxygenase-1 (HO-1) activity increasing and M1/M2 phenotype polarization in rat alveolar macrophages (AMs) induced by lipopolysaccharide (LPS).Methods Bioinformatics was used to analyze the binding of full-length wild-type CSD polypeptide and 101 amino acid deleted truncated mutant CSD polypeptide (Δ101CSD) to HO-1. Primary AMs were isolated from rats, when cell fusion reached 80％, they were synchronized with serum-free medium and divided into five groups: no treatment was given to the blank control group; LPS group was treated with 100μg/L LPS for 16 hours;LPS+ hemin group was treated with 100μg/L LPS and 20μmol/L hemin for 16 hours; wild-type CSD polypeptide+ LPS+hemin group was pretreated with 10μmol/L wild-type CSD polypeptide 6 hours before LPS treatment; Δ101CSD+ LPS+hemin group was pretreated with 10μmol/L Δ101CSD polypeptide 6 hours before LPS treatment. After treatment for 16 hours, the co-localization between caveolin-1 (Cav-1) and HO-1 was displayed by confocal microscope; the mRNA expressions of inflammatory cytokines interleukin-1β (IL-1β) and monocyte chemoattractant protein-1 (MCP-1) and M1/M2 polarization cytokines tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS), leukocyte differentiation antigen 206 (CD206) and IL-10 were determined by real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-qPCR); the HO-1 activity and nitric oxide (NO) production were determined by spectrophotometry.Results Bioinformatics analysis showed: both wild-type CSD and Δ101CSD peptides could bind to HO-1, and there was no significant difference in the binding ability between the two peptides, but the deletion of 101 Arg resulted in the disappearance of part of the binding region between Δ101CSD and HO-1. The results of laser confocal microscopy showed: the expressions of Cav-1 and HO-1 were lowed in the blank control group, and Cav-1 was bound to HO-1 in LPS group and LPS+ hemin group. Both wild-type CSD and Δ101CSD peptides pretreatment could significantly reduce the binding of HO-1 to Cav-1 induced by LPS. HO-1 activity analysis showed: after LPS stimulation, the activity of HO-1 was significantly higher than that of the blank control group; the activity of HO-1 induced by LPS was increased by hemin; after pretreatment with two kinds of CSD peptides, the activity of HO-1 was further increased, and the effect of wild-type CSD peptide was more significant, which showed a statistically significant difference as compared with that of LPS+ hemin group (pmol·mg-1·h-1: 3683±266 vs. 2408±132,P < 0.05). RT-qPCR results showed: LPS could induce elevation of cytokines and M1 markers and decrease of M2 markers, while hemin could inhibit LPS-induced inflammatory response and M1/M2 phenotypic polarization. Compared with LPS+ hemin group, after pretreatment with wild-type CSD peptide, the levels of inflammatory factors in AMs were decreased, and the mRNA expression levels of TNF-α and iNOS, M1 markers, were decreased [TNF-α mRNA (2-??Ct): 6.82±0.05 vs. 8.70±0.24, iNOS mRNA (2-??Ct): 331.50±32.05 vs. 506.70±0.10, bothP < 0.05], and IL-10 mRNA expression level was increased (2-??Ct: 269.09±6.54 vs. 119.05±3.30,P < 0.05). The deletion of 101 site partially weakened the inhibitory effect of CSD peptides on inflammatory factors and only reduced the expression of iNOS mRNA (2-??Ct: 429.11±8.92 vs. 506.70±0.10,P < 0.05), indicating that its ability to transform AMs from M1 phenotype to M2 phenotype was poor. The two peptides had no effect on the expression of CD206.Conclusion Wild-type CSD had beneficial effects of anti-inflammation by reducing Cav-1 binding to HO-1 induced by LPS, restoring the HO-1 activity and driving M2 phenotype in alveolar macrophages.
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Objective To explore the value of T-SPOT.TB test in diagnosis of tuberculous pleurisy by comparing the T-SPOT.TB test, adenosine deaminase (ADA) of hydrothorax and tuberculosis antibody (TB-Ab). Methods 62 pleural effusion patients are included in the research , of which 32 cases have tuberculosis and 30 cases have no tuberculosis. All patients underwent T-SPOT.TB, pleural effusion ADA, and TB-Ab test. The results were compared with final clinical diagnosis for sensitivity and specificity evaluation. Results The sensitivity of T-SPOT.TB, ADA, TB-Ab were 90.6%, 71.9% and 62.5% respectively. The specificity of T-SPOT. TB, ADA, TB-Ab were 90.0%, 83.3% and 86.7% respectively. The sensitivity of T-SPOT.TB was the highest one among the three methods. The sensitivity of T-SPOT.TB has statistically significant difference compared with TB-Ab (P 0.05). Conclusions The T-SPOT.TB test had higher sensitivity and specificity for the diagnosis of tuberculous pleurisy , and had important reference value in early diagnosis of patients with tuberculous pleurisy. The T-SPOT.TB and TB-Ab combination examination had a complementary effect.
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Objective To compare the X-ray radiation dose from atrial fibrillation (AF) ablation guided by magnetic navigation system (MNS) and manual procedure (CON).Methods 94 AF patients were randomly divided into MNS group (34 cases) and CON group(60 cases).The dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time of patients,the X-ray exposure time and dose of operators were recorded and analyzed.Results The results from the patients in MNS group and CON group were CD values (0.54 ±0.45) and (1.61 ±0.89) Gy (t =2.44,P ＜0.05),DAP values (46.86 ±27.09) and (139.71 ±76.69) Gy·cm2(t =3.89,P ＜0.05) and fluoroscopy time (15.60 ±7.52) and (39.50 ± 8.82) min (t =1.96,P ＜ 0.05),respectively.The X-ray exposure dose in both groups were (22.68 ± 6.87) and (62.74 ± 20.92) μSv (t =2.02,P ＜ 0.05) for operation doctor (19.38 ± 5.64) and (49.42 ± 10.67) μ Sv (t =3.58,P ＜ 0.05) for operation assistant and (18.98 ± 4.99) and (47.77 ± 13.65) μ Sv (t =3.17,P ＜ 0.05) for nurse,respectively.The X-ray exposure time experienced in both groups were (11.48 ±7.59) and (30.50 ±14.82) min (t =2.75,P ＜0.05) for operation doctor,(8.96 ±5.88) and (24.49 ±9.09) min (t =4.20,P ＜0.05) for operation assistant and (8.33 ±6.35) and (22.99 ± 13.36) min(t =2.76,P ＜ 0.05) for nurse,respectively.Conclusions Compared with manual procedure,the MNS applied in AF ablation has the potential to decrease X-ray exposure dose.
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Objective To analysis the changes of heart function in early stage after lung transplantation,and to explore its relationship with decreased pulmonary artery pressure.MethodsFrom 2002 to 2010,echocardiography results of 90 patients before and after lung transplantation in Wuxi People's Hospital were collected, 20caseshadcompletedateofpreoperativeandpostoperative echocardiography.Echocardiographic changes had been analyzed.Pearson linear correlation analysis was applied to determine the relationship between the early postoperative changes in cardiac structure and function and decreased pulmonary artery systolic pressure.ResultsPostoperative pulmonary artery systolic pressure ([38.30 ± 8.92]mm Hg) compared with preoperative([60.05 ± 29.10]mm Hg) was significantly lower(t =3.120, P = 0.006) , Postoperative right ventricular diameter was significantly reduced compared with the preoperative(t = 36.000, P = 0.008) , tricuspid and pulmonary valve regurgitation significantly reduced (t =57.000 and 66, Ps ＜ 0.05) .Postoperative left atrial diameter and left ventricular end diastolic diameter ([35.15± 5.73]mm and [43.25 ± 5.56]mm) compared with preoperative([32.40 ± 7.29]mm and [40.15 ± 6.20]mm)were significantly expanded (t =-2.384 and t =-2.153, Ps ＜ 0.05) .Although postoperative stroke volume ([59.54 ± 14.97]ml)compared with preoperative ([44.18 ± 15.85]ml)significantly increased (t =-3.918, P = 0.004) , but the postoperative left ventricular ejection fraction ([63.10 ± 8.48]％)compared with preoperative ([71.75 ± 8.10]％)was significantly decreased (t =3.742, P = 0.001) .Pearson linear correlation analysis showed the greater degree of decreased systolic pulmonary artery pressure after lung transplantation, the larger rate of increased postoperative left atrial diameter and left ventricular end diastolic diameter, and the bigger range of decreased postoperative LVEF (r = 0.642,0.737 and 0.448, P ＜ 0.05) .ConclusionIn early stage after lung transplant, right heart structure was normalization, right heart function improved,left heart enlarged, stroke volume increased, but left ventricular function reduced.There were a linear correlation between those changes and reduced systolic pulmonary artery pressure.
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Objective To evaluate the value of N-terminal prohormone brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) in patients with left ventricular diastolic dysfunction.Methods Forty-three patients with diastolic heart failure were enrolled. Pulsed wave (PW) Doppler technology was used to detect early diastolic mitral velocity (E) and TDI was performed to determine the mitral annulus velocity of early diastolic phase (Em). According to the E/Em, patients were divided into three groups: group Ⅰ (E/Em ＜8),group Ⅱ (E/Em 8-15) and group Ⅲ (E/Em ＞ 15). The plasma NT-proBNP was measured. Results The plasma NT-proBNP in group Ⅲ [( 1119 ± 3123) ng/L] was higher than that in group Ⅱ [(684± 1742) ng/L] and group Ⅰ [(276±438) ng/L] (P＜0.01),and the plasma NT-proBNP in group Ⅱ was higher than that in group Ⅰ (P ＜ 0.01 ). The plasma NT-proBNP had positive correlation with E/Em (r = 0.438,P ＜ 0.01 ). Conclusion The plasma NT-proBNP and TDI are useful to evaluate the left ventricular diastolic dysfunction.
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Objective To explore the pre-requisite "highlight" of information system in a new outpatient building and its significance on outpatient information construction.Methods The importance of new outpatient information system for improving the treatment of the environment and optimizing the outpatient treatment processes were analyzed from information dissemination system,self-service system and intelligent queuing system.Results The systemic design plan and actual role of the three systems were given by combining actual situation of the new outpatient building construction.Conclusion Having greatly improving for the outpatient information construction and the new outpatient building will have a positive impact on hospital management model,medical model and informationation construction.