Effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction patients / 中国胸心血管外科临床杂志

@#Objective    To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods    This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results     The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min   (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion    The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.

Role of T cells in acute kidney injury / 中国免疫学杂志

Acute kidney injury (AKI) refers to the clinical syndrome of rapid loss of renal function caused by various causes.AKI increases the risk of developing chronic kidney disease (CKD) and the mortality of patients.The increase in the rate has caused a great economic burden on the family and society.The pathogenesis of mediating AKI is numerous,and it is currently believed that innate and adaptive immune-mediated inflammatory reactions are involved in the initiation,progression and repair stage of AKI.T lymphocytes play a key role in it.This article will review the progress of the role of T cells in AKI.

Research progress of role of NLRP3 inflammasome in lupus nephritis / 中国免疫学杂志

Systemic lupus erythematosus (SLE)is an autoimmune disease whose pathogenesis is extremely complicated.With the further research,the role of inflammasome in the pathogenesis of Lupus nephritis has also been gradually emphasized.Among them,the nucleotide-binding oligomerization domain-like receptors family pyrin domain containing 3 (NLRP3) inflammasome is the most exhaustive inflammasome.We summarize the related studies on the role of NLRP3 inflammasome in Lupus nephritis in recent years.We found that NLRP3 inflammasome not only plays an important role in the pathogenesis of Lupus nephritis,but also participates in the process of kidney injury by circulating immune cells and renal innate cells.Finally,we introduced two specific inhibitors of NLRP3 inflammasome,β-hydroxybutyrate and MCC950,which provided a new strategy for the treatment of Lupus nephritis.

Pattern-specific physiotherapy for chronic neck pain based on functional impairment / 中华物理医学与康复杂志

Objective To explore the effect of pattern-specific physical therapy based on functional impair-ment on chronic neck pain ( CNP ) . Methods Ninety-three CNP patients treated in the outpatient department of our hospital between March 2016 and November 2017 were randomly divided into a study group ( n=46) and a control group ( n=47) . The control group received routine physical treatment, while the study group was treated with pattern-specific physical therapy involving local pain management, traction, soft tissue relaxation, mobilization, strength training, posture control training and active exercise as well as health education. Each was based on a physical exami-nation and pattern classification by doctors and therapists. The subjects in both groups were required to complete 3 to 6 ninety-minute sessions of outpatient treatment and 6 thirty-minute sessions of self-training at home over 2 weeks. Pain intensity and cervical dysfunction were rated using a visual analogue scale ( VAS) and a neck disability index ( NDI) before and after the two-week intervention and one month later. Before the intervention and during the follow-up, postural analyses for the head and neck in a standing position were performed. The cranial vertebral angle ( CVA) , protracted shoulder angle ( PSA) and sagittal head elevation were measured. Results Eighty-seven par-ticipants completed the treatments and follow-up. After the 2-week intervention, the average VAS rating at the end of cervical anteflection in the study group was significantly lower than that in the control group ( P≤0.05) . Significantly greater improvement in the NDI scores was observed in the study group than the control group ( P≤0.05) . During the follow-up, it was found that the average CVA score had improved more significantly in the study group than with the control group ( P≤0.01) , but there were no significant differences in the other measurements between the two groups.Conclusion This pattern-specific physical therapy process is more effective for relieving the end pain during cervical anteflection quickly. It can improve functioning and ability in daily activities to some degree, as well as correct head and neck posture in the long term. It may be helpful in regulating physical therapy for neck pain and for developing a standardized treatment protocol for CNP .

Long-term follow-up of a patient since the acute phase of Chagas disease (South American trypanosomiasis): further treatment and cure of the infection

ABSTRACTA woman had been followed since 1957 for acute phase Chagas disease. Parasitological and serological tests were positive, and treatment included benznidazole in 1974. Following treatment, parasitological test results were negative and conventional serology remained positive until 1994, with subsequent discordant results (1995-1997). The results became consistently negative since 1999. She had an indeterminate chronic form until 1974. Only two minor and transitory nonspecific alterations on electrocardiogram were noted, with the last nine records normal until June 2014. This case confirms the possibility of curing chronic disease and suggests the benefit of specific treatments for preventing long-term morbidity.

Specific schistosomiasis treatment as a strategy for disease control

The great hope for schistosomiasis treatment began with the development of oxamniquine and praziquantel. These drugs can be administered orally in a single dose and have a high curative power with minor side effects. In this study, we carried out a field experiment involving a population of 3,782 people. The population was examined at four localities in Minas Gerais within the valleys of the Doce and Jequitinhonha Rivers. In this cohort, there were 1,790 patients infected with Schistosoma mansoni (47.3 percent) and we showed that only 1,403 (78.4 percent) could be treated with oxamniquine in a single dose of 12.5-20 mg/kg orally. The other 387 (21.6 percent) were not treated during the first stage because of contraindications (pregnancy or impeditive diseases), absences or refusals. It was observed that, on average, 8.8-17 percent of the infected patients continued to excrete S. mansoni eggs at the end of the 2nd month after treatment and 30-32 percent of the cohort was infected by the end of the 24th month. In one of the areas that we followed-up for a total of 30 years, the prevalence of the infection with S. mansoni fell from 60.8-19.3 percent and the hepatosplenic form of the disease dropped from 5.8-1.3 percent. We conclude that specific treatment of schistosomiasis reduces the prevalence of infection in the short-term and the morbidity due to schistosomiasis in medium to long-term time frames, but does not help to control disease transmission.

Treatment and Management of Senile Dementia

There are about sixty to seventy diseases which develop dementia until now. These include degenerative disease, vascular disease, infectious disease, hydrocephalus, toxic condition, head trauma, tumor , metabolic disease, and demyelinating disease etc. 20% of dementing illness is reversible to treatment. Treatment strategies of dementia can be classified as disease-specific treatment, pharmacotherapy with neurocognitive activators or psychopharmacologic agents, and nonpharmacologic intervention such as neurocognitive rehabilitation, reminiscence therapy, occupational or physical therapy, and psychosocial approach. But medical approach is necessary to prevent disability stemming from pneumonia, dehydration, malnutrition, decubitus ulcer, and other complication. These treatment strategies must be administered comprehensibly due to characteristics of the dementia patients.

Psychiatric care for patients with breast cancer

Psychiatric management of patients with breast cancer, as well as women's emotional reactions to all phases of breast cancer, were reviewed. These patients face two major losses; one is the physical loss of part of the body and a threat to life, and the other is the loss of femininity. The patients are also likely to suffer from various psychiatric problems including anxiety and depression. Oncologists should be alert to each patient's emotional reactions and potential psychiatric problems, and if necessary, should refer them to a psychiatrist. A combination of psychotherapeutic, behavioural, and pharmacologic techniques is available for the care of patients with breast cancer. Psychotherapeutic modalities include individual therapy, family therapy, group therapy, and self-help treatment. The author divided individual therapy into general and specific treatment. General treatment deals with a crisis-intervention and cognitive-behavioral approach, whereas specific treatment deals with issues relevant to patients with breast cancer. Some of the therapeutic processes were illustrated in a case report. These guidelines will contribute to the relief and prevention of emotional suffering stemming from an encounter with the most common form of cancer in women. Also, proper and effective care for patients with breast cancer requires combined use of a variety of therapeutic modalities as well as a multi-disciplinary approach including psychiatric care.