Anemia on the prognosis of elderly patients with acute coronary syndrome: a meta-analysis / 中华老年医学杂志

Objective:To examine the effect of anemia on the prognosis of elderly patients with acute coronary syndrome.Methods:We searched PubMed, Scopus, OVID, the Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, China Biology Medicine Disc, the WanFang and Weipu databases for studies on the association between anemia and the prognosis of acute coronary syndrome in elderly patients.The date range included the period from the establishment of the database to December 10, 2022.Two reviewers independently completed the literature screening and data extraction according to the inclusion and exclusion criteria for the literature.Stata 16.0 software was used to analyze the data.Results:Of 1 399 references retrieved from the initial search, 13 met the inclusion criteria, including a total of 9540 patients with a mean age of 70.3 years.2872 of these patients had concurrent anemia and 6 668 patients had no anemia.In elderly patients with acute coronary syndrome, those with anemia showed significantly increased risk of death, compared with those with no anemia( RR=2.28, 95% CI: 1.74-3.00). Anemia also increased the incidence of ischemia( RR=1.36, 95% CI: 1.13-1.64)and bleeding events( RR=2.18, 95% CI: 1.59-3.01)( P<0.05 for all). Conclusions:Anemia significantly increases the risk of death and is associated with poor prognosis in elderly patients with acute coronary syndrome.

Prognosis of Sacubitril-valsartan on ischemic cardiomyopathy-induced heart failure with reduced ejection fraction in elderly patients / 中华老年医学杂志

Objective:To investigate the efficacy and major adverse cardiovascular events(MACE)in elderly patients with ischemic cardiomyopathy-induced heart failure with reduced ejection fraction(HFrEF)treated with Sacubitril-valsartan at 3 years of follow-up.Methods:This was a single-center retrospective cohort study.The elderly patients with ischemic cardiomyopathy-induced HFrEF aged 60-85 years were diagnosed and treated in Beijing Anzhen Hospital from January 2018 to January 2020.A total of 120 continuously included elderly HFrEF patients treated with sacubitril valsartan were enrolled as the observation group, and 120 age-, gender-and B-type natriuretic peptide-matched elderly HFrEF patients treated with angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB)were enrolled as the control group.Structure and function of the heart were detected at 1-year follow-up.The MACE was observed, including cardiogenic death, readmission due to heart failure worsening and malignant arrhythmia at 3-year follow-up.Results:During follow-up(23.5±11.6)months, the visit of 18 cases was lost.There were no significant differences in the age, medical history, blood pressure between the two groups( P>0.05). Follow-up results showed that the improvement was better in observation group than in control group as follows: the left ventricular ejection fraction(45.8±9.4)% vs.(40.7±8.5)%, left ventricular end-diastolic diameter(56.5±8.3)mm vs.(59.2±7.3)mm, left ventricular end-systolic diameter(42.5±11.2)mm vs.(45.7±9.6)mm, left atrium inner diameter(49.1±8.7)mm vs.(51.2±7.7)mm, and left ventricular mass index(111.3±34.3)g/m 2vs.(119.7±31.5)g/m 2( t=4.41, 2.68, 2.38, 1.98 and 1.98, respectively, P<0.01 or 0.05). The rates of readmission due to heart failure worsening and the incidence of MACE were lower in the observation group than in the control group(21.7% or 26/120 vs.36.7% or 44/120, and 45.0% or 54/120 vs.71.7% or 86/120, χ2=6.54 and 17.55, P<0.05 or 0.01). In patients with the grade Ⅲ and Ⅳ New York Heart Association(NYHA)cardiac function, the incidence of MACE were lower in the observation group than in the control group(75.0% or 9/12 vs.100.0% or 14/14, χ2=5.10, P<0.05). Conclusions:Sacubitril-valsartan can improve cardiac structure and function, and decrease the incidence of MACE in elderly patients with HFrEF induced by ischemic cardimyopathy.

Human umbilical cord mesenchymal stem cells differentiate into neuron-like cells after induction with B27-supplemented serum-free medium / 南方医科大学学报

OBJECTIVE@#To evaluate the capacity and efficiency of human umbilical cord mesenchymal stem cells (HUCMSCs) to differentiate into neuron- like cells after induction with B27- supplemented serum- free medium.@*METHODS@#HUCMSCs at passage 4 were cultured for 14 days with serum-containing medium (SCM) (group A), SCM supplemented with 20 ng/mL nerve growth factor (NGF) and 10 ng/mL basic fibroblast growth factor (bFGF) (group B), serum-free medium (SFM) (group C), or SFM supplemented with 20 ng/mL NGF and 10 ng/mL bFGF. The culture medium were changed every 3 days and the growth of the neurospheres was observed using an inverted microscope. The cell markers were analyzed with flow cytometry and the expressions of nestin, neuron- specific enolase (NSE), neurofilament heavy polypeptide (NEFH), and glial fibrillary acidic protein (GFAP) were quantified by quantitative real-time PCR (qRT-PCR) and Western blotting.@*RESULTS@#Before induction, HUCMSCs expressed abundant mesenchymal stem cell surface markers including CD29 (99.5%), CD44 (49.6%) and CD105 (77.7%). Neuron-like cells were observed in the cultures on days 7, 10, and 14, and the cell differentiation was the best in group D, followed by groups C, B and A. In all the 4 groups, the cellular expressions of nestin and GFAP gradually lowered while those of NEFH and NSE increased progressively. The expressions of GFAP, NEFH, nestin and NSE were significantly different between group A and the other 3 groups ( < 0.001 or 0.05).@*CONCLUSIONS@#B27-supplemented SFM effectively induces the differentiation of HUCMSCs into neuron- like cells, and the supplementation with cytokines (NGF and bFGF) strongly promotes the cell differentiation.

Effect of low-frequency pulsed electromagnetic fields on activity of rat calvarial osteoblasts through IGF-1R/NO signaling pathway / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of low-frequency pulsed electromagnetic fields (PEMF) on the maturation and mineralization of rat cranial osteoblasts and its relation to IGF-1R/NO signaling pathway.@*METHODS@#The rat osteoblasts were isolated and cultured and randomly divided into blank control group, PEMF group, GSK group (IGF-1R blocker) and PEMF+GSK group. The cells were treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. After 3 d of PEMF treatment, the expressions of protein kinase (AKT), inducible nitric oxide synthase (iNOS) and cGMP-dependent protein kinase (PKG) were detected by Western blotting; on 6 d of PEMF treatment alkaline phosphatase (ALP) activity was determined; on 12 d of PEMF treatment the calcification nodule formation was demonstrated by Alizarin red staining.@*RESULTS@#NO level was significantly increased in rat osteoblasts treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. Western blot analysis showed that the expressions of AKT, iNOS and PKG protein in PEMF group were higher than those in the control group (all <0.01); the ALP activity was increased(<0.05), and the PEMF group had the largest area of Alizarin red staining (<0.01). The expressions of AKT, iNOS and PKG protein in GSK group were lower than those in the control group; the ALP activity was decreased (<0.05), and the GSK group had the least area of Alizarin red staining (<0.01). The expressions of AKT, iNOS, PKG protein, the ALP activity and the area of Alizarin red staining in PEMF+GSK group were between PEMF group and GSK group.@*CONCLUSIONS@#PEMF may enhance the maturation and mineralization of rat cranial osteoblasts through IGF-1R/NO signaling pathway.

The relationship between fragmented QRS complexes and severity of coronary artery lesion in elder patients with complex coronary artery lesions / 中华老年医学杂志

Objective To investigate the relationship between fragmented QRS (fQRS) complexes and the severity of coronary artery lesions in elder patients with complex coronary artery lesions.Methods Two-hundred and one elder patients with complex coronary lesions undergone coronary angiography in Beijing Anzhen Hospital from January 2013 to July 2016 were enrolled.Based on the coronary lesions,patients were divided into the complex coronary lesions group and the simple coronary lesions group.The clinical features and coronary scores were compared between groups.Logistic regression analysis was used to evaluate the risk factors of complex coronary lesions.Results Compared with simple coronary lesions group,the complex coronary lesions group was associated with higher rate of fQRS (31.3％ vs.17.2％,x2 =9.68,P＜0.01),more number of fQRS leads [(1.0±1.5) vs.(0.5±0.8),t=-4.04,P＜0.01],longer duration of QRS [(87.2±10.7) ms vs.(84.1±8.9) ms,t=-3.09,P＜0.01].Moreover,patients with fQRS had a lower level of high density lipoprotein cholesterol (HDL-C) [M(Q25,Q75),0.9 (0.8,1.1) mmol/L vs.1.0 (0.9,1.2) mmol/L,t=-2.84,P＜0.01] and a higher Gensini score [40 (8-76) vs.22 (16-2),t=8.63,P＜0.01] compared with those without fQRS.Furthermore,Logistic regression analysis showed that HDL C (OR=0.346,95％CI:0.163 0.674,P＜0.05),fQRS (OR=2.215,95％ CI:1.381-3.725,P＜0.05) and the number of fQRS leads (OR=4.613,95％ CI:2.412-9.578,P＜0.05) were independent risk factors for patients with high Gensini score,and there was a positive correlation between fQRS and Gensini scores (=0.624,P＜0.01).Conclusions fQRS might be a noninvasive indicator of severity of coronary artery lesions for elder patients with complex coronary lesions.

Variations of sacral slope at the early stage after posterior lumbar interbody fusion and its clinical significance / 中国组织工程研究

BACKGROUND: Loss of sacral slope has been shown to be an important anatomic basis for low back pain. The effect of sacral slope changes after lumbar fusion on pain relief remains unclear.OBJECTIVE: To analyze the variations of sacral slope and clinical significance at the early stage after posterior lumbar interbody fusion at L4-5.METHODS: Sixty patients with herniation at disc levels L4-5 and spinal stenosis (n=38) or lumbar spondylolisthesis at L4 (n=22) undergoing posterior lumbar interbody fusion were enrolled. All patients were followed up for 12-24 months to compare the sacral slop at baseline and postoperatively. The clinical outcomes were evaluated by MacNab criteria, and its correlation with age, sex and sacral slop variations was analyzed.RESULTS AND CONCLUSION: At 12-24 months postoperatively, the sacral slope in the two groups was significantly improved than that at baseline (P 0.05). The age, sex and sacral slop variations showed no significant effects on the early clinical outcomes (P > 0.05).These results suggest that posterior lumbar interbody fusion can markedly improve the sacral slope in patients with spinal stenosis and lumbar spondylolisthesis at early period. Furthermore, age, sex, and sacral slope variations all show no obvious effect on postoperative early functional recovery.

Correlation between serum homocysteine level、 serum uric acid level and coronary lesion severity in coronary artery disease patients / 中华急诊医学杂志

Objective To evaluate the correlation between serum homocysteine (Hcy) level,serum uric acid level and coronary lesion severity in patients with coronary artery disease (CAD).Methods A total of 622 patients receiving coronary angiography from January 2015 to December 2015 were retrospectively studied.They were divided into two groups according to the findings on coronary angiography.Those with ≥ 50％ stenosis were defined as coronary artery disease.According to SYNTAX score,CAD patients were divided into three groups:low risk group (1-22),moderate risk group (23-32) and high risk group (＞ 33).Fasting serum Hcy levels,fasting serum uric acid levels,fasting blood lipids including total cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined.Then,patients were divided into two groups according to the serum Hcy level for observing the relationship between the serum Hcy and the SYNTAX score.Results TC,LDL-C were significant higher in SYNTAX score high-risk group and moderate risk group compared with normal group.There were no statistically significant differences in TC and LDL-C between the normal group and the low-risk group (P ＞ 0.05).Compared with normal coronary group,Hcy in high risk group and moderate risk group was significant higher.There were no statistically significant differences in age,sex,TC,TG,HDL-C,LDL-C between normal Hcy group and high Hcy group (P ＞ 0.05).The SYNTAX score was significantly higher in high Hcy group than that in normal group (P ＜ 0.05).Multivariate logistic regression analysis suggested that serum Hcy was associated with coronary lesion severity.Compared with normal coronary group in the same gender,uric acid level in high risk group and moderate risk group was significant higher (P ＜ 0.05).Multivariate logistic regression analysis showed that serum uric acid was associated with coronary lesion severity.(P ＜ 0.05) Conclusions Serum Hcy and high uric acid level are the risk factors of coronary lesion severity.With the increased Hcy level and uric acid level,the increase in the severity degree of coronary artery lesions represents a greater cardiovascular risk.

The efficiency of Ivabradine therapy in heart failure in elderly patients / 中华老年医学杂志

Objectives To evaluate the efficacy and safety of administering Ivabradine in the elder patients with chronic heart failure(HF).Methods Totally 52 outpatients with chronic stable HF in Fuwai Hospital and Anzhen Hospital from August 2015 to February 2016,with heart rates (HR)of ＞70 bpmafter optimized medical therapy were selected and administrated Ivabradine for 3 months(Ivabradine group).50 patients who received optimized medical therapy except Ivabradine for economic or other reasons were recruited as control group during the same period.Initial dose of Ivabradine was 2.5 mg two times a day,up to a maximum of 7.5 mg two times a day,adjusting the dose according to HR.Resting HR of the patients was maintained around 60 beats/min and not lower than 55 beats/min.HR,N-terminal pro-brain natriuretic peptide (NT-proBNP),6-minute walk distance,Minnesota heart failure quality of life(MLHFQ),left ventricular ejection fraction(LVEF) and adverse effects were recorded.Results At baseline,no significant differences were found in HR,NT-proBNP,the scores of MLHFQ,6-minute walk distance (all P＞ 0.05) between Ivabradine group and control group.After 3 months of treatment,compared with control group,Ivabradine group showed significantly decreased levels of HR,the scores of MLHFQ and NT-proBNP(allP＜0.01),and significantly increased 6-minute walk distance and LVEF(all P＜0.01).Compared with baseline data,Ivabradine treatment showed the decreased levels of HR [(69.5 ± 10.2)bpm vs.(80.2 ± 7.8)bpm,P＜0.05],the scores of MLHFQ [(14.9±4.3)scores vs.(23.5±6.2)scores(P＜0.05)]and NT-proBNP [1 682 ng/L (212-3 628) vs.2 450 (254-5 344) ng/L,P ＜ 0.05] significantly,and showed the significantly increased levels of 6-minute walk distance [(386.4 ± 101.8)m vs.(282.9 ± 86.3)m,P＜ 0.05]and LVEF [(40.0±6.0)％vs.(31.0±7.0)％ (P＜0.05)].Few adverse effects were recorded.Conclusions In elderly outpatients with stable HF,Ivabradine treatment is effective and safe.

Correlation between red blood cell distribution width and in-stent restenosis after percutaneous coronary intervention in patients with coronary heart disease after PCI / 中国综合临床

Objective To investigate the correlation between red blood cell distribution width(RDW) and in-stent restenosis(ISR)in patients with coronary heart disease after PCI.Methods A total of nine hundred and seventy-eight patients with coronary heart disease treated in Beijing Anzhen Hospital,Capital Medical University with DES stent implantation from March 2015 to March 2016 were enrolled in the study.Among them,493 patients(50.41%)underwent coronary angiography in the hospital at 6-12 months after the operation.According to the results of the angiography,the patients were divided into two groups: the ISR group and the non-ISR group.The basic data of the patients,the laboratory indexes and the coronary interventional procedures record were collected to analyze the factors that could lead to in-stent restenosis.Results 51 cases(10.34%)in the ISR group and 442 cases(89.66%)in the non-ISR group.The baseline characteristics of the two groups were similar,and there was no significant difference in gender,age, body mass index,combined with hypertension,family history of coronary heart disease,long-term administration of statin and follow-up interval(P>0.05).The proportion of patients with diabetes was significantly higher than that of the non-ISR group(37.3% vs.22.6%,P=0.021);the smoking rate was significantly higher in the ISR group(52.9% vs.35.7%,P=0.016).In terms of laboratory examination,there were no significant differences between the two groups in blood lipid levels and WBC,RBC,Hb and PLT counts between the two groups(P>0.05).The levels of serum RDW(13.4(13.00,13.80)vs.12.7(12.40,13.10),P<0.01)and hs-CRP (3.15(2.32,4.63)vs.1.33(0.63,3.16),P<0.01)were significantly increased in the patients with ISR.The stent length was longer in the ISR group((21.87 ± 5.20)mm vs.(19.14 ± 4.87)mm,P<0.01),the stent diameter was smaller((2.87±0.38)mm vs.(3.09±0.36)mm,P<0.01),the number of cases with serial stents in ISR group was higher than that in non-ISR group(45.1 % Vs 30.8%,P=0.038).Multivariate logistic regression analysis showed that RDW(OR=2.396,95%CI 1.655-3.471;P<0.01),hs-CRP(OR=1.052, 95%CI:1.001-1.105;P=0.044),DM(OR=2.029,95%CI:1.004-4.100;P=0.049),smoking(OR=2.252,95%CI:1.060-4.783;P=0.035),stent length(OR=1.149,95%CI:1.072-1.230;P<0.01),stent diameter(OR=0.210,95%CI:0.079-0.558;P=0.002)and serial stents(OR=2.306,95%CI:1.162-4.575;P=0.017)were independent risk factors for in-stent restenosis.Conclusion Red blood cell distribution width is an independent predictor of in-stent restenosis after PCI in patients with coronary heart disease.Chronic inflammation and oxidative stress may be the most important pathogenesis of ISR.

Relationship between HLA-DQB1 allele as well as expression level of Th1/Th2 cytokines with familial clustering of hepatocellular carcinoma in Guangxi yao / 中国免疫学杂志

Objective:To elucidate the relationship between HLA-DQB1 allele polymorphism as well as the expression level of Th1/Th2 cytokines with familial clustering of hepatocellular carcinoma ( HCC) to provide some evidence for the seeking susceptibility gene or resistant gene of HCC in Guangxi yao,China.Methods:With the same sexuality,age ±5 year,40 members whose families have had two or more HCC patients( high-occurrence families) were selected as the case group,and 40 members whose families have no any cancer patient were selected as the controls.Peripheral blood samples were collected to extract DNA,PCR-SSP was used to detect HLA-DQB1 alleles and ELISA was used to detect IL-2,IL-4 and IL-10.Results:(1) The gene frequency of the HLA-DQB1*02/09 alleles in the case group was higher than that in the controls(P0.05 ).( 2 ) The gene frequency of alleles HLA-DQB1 in HBsAg positive group and HBsAg negative group were never significant difference (P>0.05).(3)The expression levels of IL-4,IL-10 in the case group was higher than that in the control ( P<0.05 ).( 4 ) The expression level of IL-10 in the positive group of the HLA-DQB1*02 allele was higher than that in the negative group of the HLA-DQB1*02 allele ( P<0.05 ).( 5 ) The expression level of IL-4 in the positive group of the HLA-DQB1*09 allele was higher than that in the negative group of the HLA-DQB1*09 allele( P<0.05) .Con-clusion:(1) HLA-DQB1*02/09 seem to be susceptibility genes of hepatocellular carcinoma in high HCC incidence areas of Guangxi yao.(2) There may be not significant correlation bewteen HLA-DQB1 alleles and the susceptibility of HBV infection in high HCC incidence areas of Guangxi yao.( 3 ) The imbalance of IL-4, IL-10 might be associated with familial clustering of hepatocellular carcinoma in Guangxi yao.(4)The imbalance of IL-10 might be due to the carrying of HLA-DQB1*02;the imbalance of IL-4 might be due to the carrying of HLA-DQB1*09.Through the same approaches,these might lead to the phenomenon of familial aggregation of HCC in Guangxiyao.

Palmaris longus tendon versus iliotibial tract fascia graft for coracoclavicular ligament reconstruction combined with hook plate fixation in treatment of acromioclavicular joint dislocation / 中华创伤骨科杂志

Objective To compare the clinical outcomes of palmaris longus tendon (PLT) and iliotibial tract fascia graft (ITFG) for coracoclavicular ligament (CCL) reconstruction combined with hook plate fixation in the treatment of acromioclavicular joint (ACJ) dislocation.Methods A retrospective study was conducted to evaluate the outcomes of 68 patients with ACJ dislocation of Rockwood type Ⅲ and above who had been treated in our department with CCL reconstruction using PLT or ITFG in addition to hook plate fixation from January 2008 to January 2014.They were 57 males and 11 females,with an average age of 36.1 years (range,from 19 to 55 years).The patients were divided into 2 groups according to their grafts used in CCL reconstruction:36 cases in PLT group and 32 in ITFG group.They were firstly treated with CCL reconstruction followed by hook plate fixation.The hook plates were removed at 6 months after operation.The acromioclavicular and coracoclavicular distances were measured on the postoperative anteroposterior radiographs of the injured shoulders.The outcomes were assessed at the final follow-ups according to Constant-Murley shoulder score and Karlsson criteria.The 2 groups were compatible without significant differences in preoperative general data (P ＞ 0.05).Results The 68 patients were followed up for an average of 18 months (range,from 16 to 22 months).The acromioclavicular and coracoclavicular distances measured in PLT group at 12 months after operation were significantly larger than those measured in ITFG group (P ＜ 0.05).At the final follow-ups,the Constant-Murley shoulder score (92.1 ±7.2) and Karlsson excellent to good rate (83.3％,30/36) in ITFG group were insignificantly higher than those in TIR group (88.3 ± 9.8;81.3％,26/32) (P ＞ 0.05).Conclusion In the treatment of ACJ dislocation of Rookwood type Ⅲ and above,CCL reconstruction using ITFG may lead to better radiographic outcomes than that using PLT,though the 2 grafts lead to similar functional recovery of the injured shoulders.

Genic and non-genic regulation of low frequence pulsed electromagnetic fields on osteoblasts differentiation / 浙江大学学报·医学版

To study the genic and non-genic regulation of 50 Hz 0.6 mT pulsed electromagnenic fields (PEMF) on rat calvarial osteoblasts (ROB) differentiation.ROBs were achieved by enzyme digestion, and treated with 50 Hz 0.6 mT PEMFs for 1.5 hours after subculture. The alkaline phosphatase (ALP) activity, mRNA transcription of ALP, Runx2 and OSX and protein expression of Runx2 and OSX were detected at 0, 3, 6, 9 and 12 hours after PEMF treatment.The ALP activity at 3 hours after treatment was significantly higher than that in the control(<0.01), while the mRNA transcription of ALP began to increase at 6 hours after treatment. The mRNA transcription of Runx2 increased immediately after treatment and regressed at 6 hours, then increased again. The protein expression of it corresponded but with a little lag. The mRNA transcription of OSX also raised instantly after treatment, then returned to the level of control at 6 hours, and lower than control at 12 hours significantly. The protein expression of it also corresponded but with a bit delay.There are genic regulation for the protein expression of Runx2 and OSX, and non-genic regulation for the ALP activity on the process of 50 Hz 0.6 mT PEMFs prompts ROBs differentiation.

Ganoderic acid A suppresses proliferation and invasion and induces apoptosis in human osteosarcoma cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of ganoderic acid A (GA-A) on the biological behaviors of human osteosarcoma cells in vitro.</p><p><b>METHODS</b>MG63 and HOS cells were treated with 0.1, 0.25, and 0.5 mmol/L GA-A, and the changes in cell proliferation, apoptosis and migration were evaluated using MTT assay, flow cytometry, and Transwell assay, respectively. The expressions of STAT3, p38, and NF-κB1 in the cells were analyzed by Western blotting.</p><p><b>RESULTS</b>GA-A effectively inhibited the proliferation of human osteosarcoma HOS and MG-63 cells in a dose-dependent manner, and induced obvious cell apoptosis in both cells. Treatment with 0.5 mmol/L GA-A also resulted in significant inhibition of the invasion of both cells. The results of Western blotting showed that GA-A down-regulated the expression level of phosphorylated STAT3 and increased the phosphorylation level of p38 and NF-κB1 expression in both cells.</p><p><b>CONCLUSION</b>GA-A can induce proliferation inhibition, apoptosis and suppression of invasion in human osteosarcoma HOS and MG-63 cells.</p>

Differentiation of mesenchymal stem cells derived from human umbilical cord / 中国病理生理杂志

AIM:To explore an ideal method to induce the differen-tiation of human umbilical cord mesenchy-mal stem cells (hUCMSCs) into neuron-like cells and to provide some evidence for the transplantation of hUCMSCs for spi-nal cord injury .METHODS:The hUCMSCs were isolated from human umbilical cord digested with collagenase Ⅱ.The hUCMSCs was verified by flow cytometry analysis .The passage 5 cells were randomly divided into 4 groups.The differentiation of hUCMSCs was induced by bFGF in group A , bFGF and BDNF in group B, or BHA, bFGF and BDNF in group C, while the cells in group D served as a control group cultured with DMEM-F12 and 10%FBS.Two weeks later , the expression of nestin , neurofilament protein H ( NEFH) and glial fibrillary acidic protein ( GFAP) was detected by real-time PCR and immunocytochemistry .The morphological changes of cells were observed under an atomic force microscope . RESULTS:Mesenchymal stem cells were isolated and cultured from human umbilical cord by enzyme digestion .hUCMSCs expressed CD29, CD44 and CD105, but no CD34, CD45 or HLA-DR.After cultured with inducing medium for 2 weeks, the cells were successfully induced into neuron-like cells.The appearance of the cells had great change .The induced hUC-MSCs developed round cell bodies with multiple neurite-like extensions observed under an atomic force microscope .The re-sult of real-time PCR showed that nestin was positive in A , B and C groups , and NEFH was positive in A and B groups , but GFAP was negative in 4 groups.The difference of nestin and NEFH expression among the induced groups was signifi -cant (P<0.05).CONCLUSION:Mesenchymal stem cells were isolated and cultured from human umbilical cord by en-zyme digestion in vitro, and all the hUCMACs presented stable biological properties .Moreover, hUCMSCs were induced to differentiate into neuron-like cells in vitro via bFGF combined with BDNF .

A two-year follow-up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations. The cardiovascular risk factors influencing postoperative outcome have been also reported. Until recently, little has been known about the prognosis in this patient cohort in the Chinese population. We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.</p><p><b>METHODS</b>A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years). Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without. A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes. The primary outcomes were death from any cause, the pre-specified morbidity was re-hospitalization for pulmonary conditions, congestive heart failure, angina, ischemic/hemorrhagic stroke.</p><p><b>RESULTS</b>During the two-year follow-up, 34 patients died and 65 experienced re-hospitalization with pulmonary conditions, congestive heart failure, angina, or ischemic/hemorrhagic stroke. Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P = 0.35 and P = 0.40, respectively). Cox proportional hazards regression analysis showed that level of lowdensity lipoprotein (HR, 4.06; 95% CI: 1.19-18.7, P = 0.027) and AAA size (HR, 2.18; 95% CI: 1.28-11.65, P = 0.036) were independently associated with the incidence of overall mortality. Long-term use of angiotensin converting enzyme inhibitors, statins, AAA size and systolic blood pressure were independent predictors of the secondary pre-specified outcomes.</p><p><b>CONCLUSIONS</b>Coronary artery revascularization following the guideline recommendations did not increase the mortality and morbidity of Chinese with AAA who were undergoing repair. Absence of angiotensin converting enzyme inhibitors and statins, AAA size, and systolic blood pressure were powerful predictors of the clinical events.</p>

Efficacy of intramedullary and extramedullary decompression on cervical ossification of the posterior longitudinal ligament with spinal cord signal change / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical effect of different surgical approaches for treating cervical ossification of the posterior longitudinal ligament (OPLL) with spinal cord signal change.</p><p><b>METHODS</b>Thirty-eight patients with OPLL with spinal cord signal change were treated from January 2005 to January 2011. Surgical removal via an anterior approach or partial decompression was performed in 10 cases (group A), posterior approach open-door laminoplasty with decompression, bone grafting and internal fixation was performed in 12 cases (group B), and opening the cervical spinal meninges to relieve the pressure was performed in 16 cases (group C) on the basis of the procedures in group B. All the patients were followed up and the pre- and postoperative JOA scores, improvement ratio and inter-body implant fusion were evaluated. Imaging examinations including X-rays, CT and MRI were also performed pre- and postoperatively, and the surgical complications were recorded.</p><p><b>RESULTS</b>At 12 months postoperatively, the mean improvement rates in groups A, B, and C were 52.39%, 55.15%, and 60.32%, respectively, with the mean JOA scores of 13.54∓0.56, 13.56∓1.26, and 14.70∓1.41, respectively. The JOA scores and improvement rates significantly increased after the surgeries. One patient in group A became paraplegic after the operation with cerebrospinal fluid leakage, and one patient in group B and one in group C reported numbness of the upper limb. Group C showed a shorter postoperative recovery time without severe complications.</p><p><b>CONCLUSION</b>Posterior open-door laminoplasty, decompression, bone grafting and internal fixation can be an effective approach for treatment of cervical OPLL with spinal cord signal change and requires shorter rehabilitation time after the operation.</p>

A study of nontraumatic acute chest pain risk stratification in emergency department / 中华急诊医学杂志

ObjectiveTo investigate the independent risk factors of 30-day mortality of nontraumatic acute chest pain in emergency department so as to get non - traumatic acute chest pain risk score,MethodsThe clinical data of 532 patients with non - traumatic acute chest pain were reviewed.The independent risk factors of 30 - day mortality were identified after analysis of medical history,symptom and sign,laboratory findings by uuivariate analysis and logistic regression.Non- traumatic acute chest pain risk score was made as per the odds ratios of these risk factors. ResultsThe average age of the patients was (55.7 + 12.7 ) years,and 45 patients ( 8.4％ ) died after 30 days.In patients with non - traumatic acute chest pain,history of hypertension (OR:4.28; 95％ CI:1.59-11.55 ),prolonged chest pain (OR:1.1; 95％ CI:1.05-1.15),dyspnea (OR:6.61; 95％CI:2.40-18.10) and tachycardia (OR:1.02; 95％CI:1.00-1.04),high leucocyte count (OR:1.18; 95％CI:1.06-1.31) and D - Dimer ( OR:1.002; 95％ CI:1.001-1.002 ) predicted 30 - day mortality independently,whereas chest pain relieved by medicine (OR:0. 15; 95％ CI:0.04-0.65),high blood oxygen saturation (SaO2) (OR:0.89; 95％CI:0.83-0.98) and normal hematocrit (OR:0.92; 95％CI:0.86-0.99) were good markers to predict optimistic prognosis.Non - traumatic acute chest pain risk score was higher in 30 - day dead group than those in survival group significantly ( P ＜ 0.01 ),and mortality was significantly different between groups with various risk stratification (P ＜ 0. 01 ).Conclusions Clinical physician can predict 30 - day mortality and evaluate prognosis in patients with acute chest pain by using non - traumatic acute chest pain risk score quickly and effectively.

Clinical risk factors and coronary angiographic features in young men with acute myocardial infarction / 中华急诊医学杂志

ObjectiveTo investigate clinical risk factors and coronary angiographic features in young men with acute myocardial infarction (AMI).MethodsWe retrospectively studied 200 young men with AMI and compared with 104 non-CHD men,89 old men with AMI.All patients were admitted to hospital from January 2009 to December 2010 and undergone coronary angiography,and the clinic and coronary angiographic features were assessed.The relation between body mass index (BMI),smoking history,familial history of early coronary artery disease,essential hypertension,type 2 diabetes mellitus,hyperlipidemia,serum uric acid ( UA),lipids,hemoglobin (Hb),fasting blood glucose (FBG) with coronary artery disease and its severity was observed.The severity of CAD was diagnosed by the number of diseased vessel.Results In young men with AMI group,the factors such as smoking history,obesity,essential hypertension,type 2 diabetes mellitus,familial history of early coronary artery disease were remarkably different ( P ＜ 0.05 ) ; body mass index,fasting blood glucose,total cholesterol,triglyceride,low density lipoprotein cholesterol were higher than the control group ( P ＜ 0.05 ),hemoglobin was lower than the control group ( P ＜ 0.05 ).Applying Logistic regression analysis,obesity ( OR =11.020),type 2 diabetes mellitus ( OR =5.805 ),essential hypertension ( OR =4.428 ),familial history of early coronary artery disease ( OR =2.883 ),smoking history ( OR =2.153 ) and lower concentration hemoglobin ( OR =1.034) are independent risk factors (P ＜ 0.05) for young men with AMI. According to coronary angiography in young men with AMI,there were 14 cases with zero-vessel disease,109 cases with singlevessel disease (54.50％,69 cases involved with left anterior descending artery) and 42 cases with twovessel disease,35 cases with three-vessel disease.The ratio of single vessel disease involved left anterior desending artery in young men was higher than that of old men with AMI ( P ＜ 0.05 ).Conclusions Obesity,type 2 diabetes mellitus,essential hypertension,familial history of early coronary artery disease,smoking history and lower concentration of hemoglobin are risk factors of young men with AMI ; Single vessel coronary disease is seen more frequently in young men with AMI.

Vertebroplasty with bone cement in the treatment of osteoporotic vertebral compression fractures A 6-year follow-up / 中国组织工程研究

BACKGROUND: Percutaneous vertebroplasty for osteoporotic vertebral compression fractures has achieved very good results, but its long-term efficacy as well as impact on patients has been rarely reported so far.OBJECTIVE: To investigate the long-term effect of vertebroplasty with bone cement on osteoporotic vertebral compression fractures through a follow-up.METHODS: Thirty-four patients with osteoporotic vertebral compression fractures who had undergone percutaneous vertebroplasty were recruited. Visual analogue scale scoring was measured and compared as well as lesioned vertebral height and kyphosis angle shown on lateral X-ray examination prior to, 1 week and 6 years after percutaneous vertebroplasty.RESULTS AND CONCLUSION: The kyphosis angle was improved 1 week and 6 years after percutaneous vertebroplasty, and it changed insignificantly during the follow-up period. The vertebral height was also improved significantly after percutaneous vertebroplasty (P < 0.01); however, there was no obvious variation in the vertebral height at 1 week and 6 years after percutaneous vertebroplasty. The visual analogue scale exhibited an improvement after percutaneous vertebroplasty (P < 0.01); however, with time going by, the scoring on the visual analogue scale had an increased tend. All the parameters remained stable and had no large fluctuations. It is proved that the percutaneous vertebroplasty is effective and safe to treat osteoporotic vertebral compression fractures with an excellent long-term effect.

VAD implantation in cardiac failure patients with prosthetic valves / 中华胸心血管外科杂志

ObjectiveAn increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves.The operative and peri-operative management of these patients has been varied.MethodsA retrospective study of VADs between Jan 1994 and June 2008 revealed 10 patients with previous prosthetic valves requiring management during and after VAD placement.Three patients were supported post-cardiotomy after valve surgery.Two patients were supported due to cardiogenic shock postopera-tively.Four patients were supported as a bridge to transplantation.One patient was supported as a destination therapy.ResultsThe mitral valve was left untreated during VAD implantation regardless of valve repair or replacement.For aortic valves,the mechanical aortic valve was replaced with tissue valve in two patients and left untreated in one case.One patient had tricuspid valve repair previously and was left untouched.All patients with prosthetic valves in aortic,mitral and tricuspid position during VAD support received anticoagulation therapy.There were 4 deaths,and 4 went on to transplantation.One patient weaned from VAD and discharge from hospital.One patient received HeartMate Ⅰ as destination therapy.The most common causes of death were multisystem organ failure and sepsis.One patient had a thromboembolic event.ConclusionThe survival rate of 60% is encouraging when compared to overall survival rates.The most common cause of death was multisystem organ failure.Patients with prosthetic valves may be safely managed during VAD support.