Factors influencing of the clinical outcome of interventional therapy for complex high-risk indicated coronary artery disease assisted by extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective:To explore the factors influencing the clinical outcome of complex high-risk indicated patients percutaneous coronary intervention (CHIP-PCI) assisted by extracorporeal membrane oxygenation (ECMO).Methods:The clinical data of patients with CHIP-PCI assisted by ECMO in the First Affiliated Hospital of Zhengzhou University from April 2018 to April 2022 were retrospectively collected and analyzed. Patients were divided into the survival and death groups according to the in-hospital survival status. The baseline characteristic, the results of coronary angiography, and the use of ECMO, blood products and drug were compared between the two groups. The 24-h rate of change of biochemical test indicators after the use of ECMO were calculated and the univariate analysis was analyzed using rank sum test. According to the univariate analysis, the variables ( P<0.05) were included in multivariate logistic regression to analyze the factors affecting the clinical outcomes of patients. Results:A total of 67 CHIP patients who completed PCI with ECMO were included. In the survival group ( n=36), the duration of ECMO treatment was 59 (41, 87) h, 9 cases received continuous renal replacement therapy, and 11 cases received IABP. In the death group ( n=31), the duration of ECMO treatment was 31 (19, 80) h, 12 cases received continuous renal replacement therapy and10 cases received IABP. The proportion of patients with chronic total occlusion lesions (CTOs) in the survival group was lower than that in the death group, the duration of ECMO of the survival group was longer than that of the death group ( P<0.05). Multivariate logistic regression analysis showed that 24-h lactate change rate ( OR=2.864, 95% CI: 1.185-6.918, P=0.019), 24-h eGFR change rate ( OR=0.050, 95% CI: 0.003-0.871, P=0.040), 24-h D-dimer change rate ( OR=1.497, 95% CI: 1.044-2.146, P=0.028) and 24-h direct bilirubin change rate ( OR=2.617, 95% CI: 1.121-6.111, P=0.026) were associated with in-hospital mortality. Conclusions:Within 24 h after CHIP-PCI assisted by ECMO, the rapid decline in lactic acid, D-dimer and direct bilirubin, and the rapid recovery of eGFR, are associated with the decreased risk of hospital mortality from CHIP.

The efficacy and safety of a novel domestic pulmonary artery thromoectomy system in the treatment of acute pulmonary embolization / 中华放射学杂志

Objective:To evaluate the efficacy and safety of a novel domestic pulmonary thromoboectomy system Tendvia TM in the treatment for high-risk patients complicated with acute pulmonary embolization (APE). Methods:The study was designed as a prospective single-center clinical trial. Twenty-four high-risk patients with APE were recruited and underwent percutaneous mechanical thromoectomy (PMT) with the Tendvia TM pulmonary thromoboectomy system. The primary efficacy endpoint was the reduction of RV/LV ratio at the post-operative 48 h. The secondary efficacy endpoints included technical success rate, mean pulmonary arterial pressure (mPAP), arterial PaO 2 and the instant post-operative thrombus clearance rate. The evaluation of the safety included the intraoperative complications and related complications during the follow-up period associated with the PMT operation and the major adverse event (MAE) rate within the post-operative 48 h. The pre-and post-operative data were compared with paired sample t-test or Wilcoxon rank sum test to evaluate the efficacy and safety of Tendvia TM pulmonary thromoboectomy system. Results:The technical success rate of PMT with Tendvia TM pulmonary thromoboectomy system was 100% (24/24). The 48 h pre-operative RV/LV ratio was 1.19±0.25 and the post-operative RV/LV ratio was 0.82±0.16. The mean RV/LV ratio of the patients was decreased by 0.37±0.25 at post-operative 48 h with significant statistical difference ( t=7.03, P<0.001). The 48 h pre-operative mPAP was (31.09±6.09) mmHg and the post-operative mPAP was (25.91±4.36) mmHg. The mPAP of the patients was reduced by 5.18 mmHg at post-operative 48 h with significant statistical difference ( t=6.73, P<0.001). The pre-operative PaO 2 was (74.66±11.28) mmHg and the post-operative PaO 2 was (88.01±10.57) mmHg. The pressure of oxygen in artery was increased by 13.36 mmHg. The differences were statistically significant( t=-4.08, P<0.001). The rate of thrombus removal was 68.17%±22.66%. 87.5% (21 cases) of patients achieved a thrombus removal greater than grade Ⅱ. One patient underwent catheter directed thrombolysis (CDT) after PMT based on the evaluation of operator. The patient′s thrombus removal achieved grade Ⅲ after 48 h and the CDT was ceased. Hemoptysis occurred intra-operatively in one case underwent PMT and the symptom of the patient was alleviated with conservative medication. The MAE incidence within the post-operative 48 h was 4.17% (1/24). No device-related mortality or all-cause mortality occurred in the trial. Conclusions:The Tendvia TM pulmonary thromoboectomy system is a safe and effective device to remove the pulmonary arterial thrombus for the treatment of patients with APE. The Tendvia TM pulmonary thromoboectomy system can be a new choice in the treatment for the patients with APE.

Down-regulation of miR-488 targeting to promote Jag1 expression inhibits hypoxia-reoxygenation myocardial H9c2 cell damage / 中华医学遗传学杂志

OBJECTIVE@#To study the effect of down-regulating miR-488 targeting Jag1 on the injury of hypoxia-reoxygenation myocardial H9c2 cells.@*METHODS@#A hypoxic-reoxygenated myocardial H9c2 cell injury model was constructed. miR-488 inhibitor was used to transfect the cells. CCK-8 method and flow cytometry were used to detect cell proliferation and apoptosis in each group. Lactate dehydrogenase (LDH), superoxide dismutase (SOD), malonaldehyde (MDA), catalase (CAT) levels were detected. Western blotting was used to detect the expression of Bcl-2 associated X Protein (Bax) and B cell lymphoma/lewkmia-2 (Bcl-2). Target genes of miR-488 were predicted, and a luciferase reporter system was used to verify the targeting relationship between the two. Myocardial H9c2 cells were co-transfected with miR-488 inhibitor and Jag1 siRNA, and treated with hypoxia and reoxygenation, cell proliferation, apoptosis, LDH, SOD, MDA, CAT levels, and Bax, Bcl-2 protein expression were detected.@*RESULTS@#The expression of miR-488 in the hypoxia-reoxygenated myocardial H9c2 cells was increased, along with reduced cell proliferation, increased apoptosis, increased Bax protein expression, decreased Bcl-2 protein expression, increased MDA, decreased CAT and SOD, and increased LDH level in the supernatant of cell culture. When myocardial H9c2 cells were transfected with miR-488 inhibitor and treated with hypoxia and reoxygenation, the expression of miR-488 was decreased, along with increased cell proliferation, decreased apoptosis, decreased Bax protein expression, increased Bcl-2 protein expression, decreased MDA, increased CAT and SOD, and decreased LDH level in the supernatant of cell culture. Down-regulation of miR-488 could target and down-regulate Jag1 expression. And Jag1 siRNA could reverse the effect of miR-488 inhibitor on the proliferation, apoptosis, LDH, SOD, MDA, CAT levels and the expression of Bax and Bcl-2 of hypoxic-reoxygenated myocardial H9c2 cells.@*CONCLUSION@#Down-regulating miR-488 targeted Jag1 can attenuate hypoxia-reoxygenation induced myocardial H9c2 cell injury.

Deep brain stimulation for treatment of pediatric dystonia / 中华实用儿科临床杂志

Objective:To summarize the therapeutic effect of deep brain stimulation (DBS) for dystonia.Methods:Detailed clinical information and peripheral blood of children with dystonia at Peking University First Hospital from April 2017 to July 2020 were collected.The motor scores of Burke-Fahn-Marsden Dystonia Rating Scale were recorded of the dystonia before and after the treatment of DBS.Whole-exome sequencing was performed on children with dystonia.Then the effect of DBS was evaluated.Results:A total of 32 cases of patients with dystonia treated with DBS were enrolled, including 16 males and 16 females.Twelve cases were treated with globus pallidus internus DBS, and 20 cases were treated with subthalamic nucleus DBS.Twenty cases (62.5%) with pathogenic gene mutations were detected.Pathogenic variants in PANK2 (9 cases), KMT2B(3 cases), GNAO1 (2 cases), GCDH (2 cases), PINK1(1 case), NDUFAF6(1 case), DYT27(1 case) and ADCY5(1 case) were found.The follow-up period was 1 month to 3 years and 8 months.Only 1 case had local infection due to improper home care.The postoperative improvement was 5.66%-95.92%. Conclusions:All patients have a certain degree of relief after DBS without obvious adverse reactions.DBS is an effective treatment for pediatric dystonia.

Analysis of gene characteristics and therapeutic effect of cblC type methylmalonic acidemia with hydrocephalus / 中华实用儿科临床杂志

Objective:The clinical manifestations, types of gene mutations, therapeutic effects and prognostic characteristics of 15 children with cblC type methylmalonic acidemia (MMA) and hydrocephalus were analyzed to improve the clinical understanding of the disease, so as to provide a basis for the treatment of the disease.Methods:From April 2015 to January 2019, 15 patients with MMA and hydrocephalus in Department of Pediatric Surgery, Peking University First Hospital were enrolled, and all gene detection showed clbC type.All the 15 patients underwent ventriculoperitoneal shunt.After surgery, the clinical manifestations and imaging findings were applied as the basis to adjust the pressure of the diverter valve appropriately.Clinical data and gene mutation characteristics of 15 children with cblC type and hydrocephalus were retrospectively analyzed, and the therapeutic effects and prognosis were summarized and analyzed as well.Results:There were 8 males (53.3%) and 7 females (46.7%), aged from 2 to 33 months.All the cases were followed up from 11 to 55 months, without death case and serious postoperative complications of hydroce-phalus.The head circumference of 3 cases (20.0%) was in the normal range, 1 case (6.7%) was greater than the normal range, and 11 cases (73.3%) were less than the normal range.Four patients (26.7%) were transferred to the pediatric intensive care unit after surgery.c.609G>A mutation was the most common in this study, with 7 cases (46.7%) of c. 609G>A homozygous mutation, and 5 cases (33.3%) of c. 609G>A heterozygous mutation.Clinical symptoms of intracranial hypertension were relieved or disappeared.The head circumference progressive enlargement was stopped.The anterior fontanelle tension greatly decreased, all " setting-sun" sign of eyes disappeared, and vision loss and hearing loss were better compared with the pre-operation.Four cases (26.7%) displayed normal intelligence and exercise, and 11 cases (73.3%) were left with mild to severe psychomotor retardation.During the follow-up pe-riod, the head CT showed that the ventricle was remarkably narrowed, and interstitial brain edema obviously improved.Conclusions:Ventriculoperitoneal shunt in the treatment of cblC type MMA with hydrocephalus has positive effects.The head circumference of most cblC type MMA with hydrocephalus is less than the normal range.c.609 G>A is the most common mutation in cblC type MMA with hydrocephalus.Perioperative " metabolic crisis" can result in serious complications.

Surgical treatment of deep brain stimulation for pediatric hereditary dystonia / 中华实用儿科临床杂志

In the past 30 years, with the advancement of functional neurosurgery, neuroelectrophysiology and neuroimaging, deep brain stimulation (DBS), as a new tool for the treatment of dyskinesia, has been considered to have underwent the fastest development in this field.Many patients with dyskinesias have significantly improved their main clinical symptoms after treatment with DBS, some of the improvement are even dramatic.Due to its minimally invasive characteristics, reversibility and adjustability, DBS therapy has been increasingly used in the treatment of dystonia in children.Hereditary dystonia is the most common type of dyskinesia in children, and there is no effective treatment yet.Recently, some dyskinesia at home and abroad centers have carried out DBS treatment for pediatric hereditary dystonia and achieved some encouraging results.Now, the effect of DBS in the treatment of hereditary dystonia in children and the main process of DBS treatment were mainly discussed, and shared the experience based on the clinical practices of Multidisciplinary Collaborative Diagnosis and Treatment Center for Children′s Motor Disorders, Peking University First Hospital.

Effects of Purple frutescens Leaves Polysaccharides on Oxidative Stress and PI 3K/AKT/GLUT4 Signaling Pathway of Pancreatic Tissues in Diabetes Mellitus Model Mice / 中国药房

OBJECTIVE：To study the effects of Purple frute scens leaves polysaccharides （PPLPs）on oxidative stress and PI3K/AKT/GLUT4 signaling pathway of pancreatic tissues in diabetes mellitus （DM）model mice. METHODS ：Totally 60 mice were given intraperitoneal injection of STZ （60 mg/kg）to induce DM model. The 40 successful modeling mice were randomly divided into model group ，metformin group （positive control ，200 mg/kg），PPLPs high-dose and low-dose groups （400，200 mg/kg），with 10 mice in each group. Another 10 healthy mice were selected as the normal group （normal saline ）. They were given relevant medicine intragastrically ，once a day ，for consecutive 28 days. During the experiment ，general information and body weight of mice were observed ；oral glucose tolerance （OGTT）test（determining FBG at 0，30，60，120 min after giving 40％ glucose solution ）was conducted. After last medication ，the changes of related blood glucose indexes （FBG，FINS，ISI，IRI）， blood lipid indexes （HDL-C，LDL-C，TC，TG）and oxidant stress indexes （MDA content and the activities of SOD ，CAT， GSH-Px）as well as the protein expressions of PI 3K，p-AKT and GLUT 4 in pancreatic tissue were determined. RESULTS ：During the experiment ，compared with normal group ，the mice were slow in action ，the feed consumption and water consumption increased，and body weight significantly increased in model group （P＜0.05）. 0，30，60，120 min after giving glucose ，the FBG content of mice were all increased significantly （P＜0.05）. After last medication ，the contents of FINS and HDL-C in serum as well as ISI ，the activities of SOD ，CAT and GSH-Px as well as the protein expressions of PI 3K，p-AKT and GLUT 4 in pancreatic tissue were all decreased significantly （P＜0.05）；the contents of FBG and LDL-C ，TC and TG in serum as well as IRI ， 疗。E-mail：sunguangping83@163.com MDA content in pancreatic tissue were all increased significantly（P＜0.05）. Compared with model group ，the general condition and OGTT of mice in each administration group was improved；the contents of FINS and HDL-C in serum as well as ISI ，the activities of SOD ，CAT and GSH-Px as well as the protein expressions of PI 3K，p-AKT and GLUT 4 in pancreatic tissue were all increased significantly （P＜0.05）；the contents of FBG，LDL-C，TC and TG in serum as well as IRI ，MDA content of pancreatic tissue were decreased significantly （P＜0.05）. CONCLUSIONS：PPLPs has anti-diabetic effects ，which are related to reducting oxidative stress level and promoting the activation of PI 3K/AKT/GLUT4 signaling pathway.

Effect of miR-125a-5p targeting Scarb1 gene on hypoxia/reoxygenation injury of cardiomyocytes and its mechanism / 中华医学遗传学杂志

OBJECTIVE@#To explore the effect and mechanism of miR-125a-5p targeted regulation of scavenger receptor B1 (Scarb1) gene on anoxia/reoxygenation injury of rat cardiomyocytes.@*METHODS@#H9c2 rat cardiomyocytes were randomly divided into blank control group, hypoxia/reoxygenation group, transfection control group and mir-125a-5p transfection group. The expression of miR-125a-5p, cardiomyocyte viability, apoptosis rate, ATP content and the expression of Scarb1, Cyt C, Bax, Bcl-2 and NF-κB signaling pathway related proteins were determined. Target gene of miR-125a-5p was predicted with Targetscan software, and the targeting of miR-125a-5p on Scarb1 was verified by double luciferase reporter gene experiment.@*RESULTS@#Compared with the blank control group, the expression of miR-125a-5p, Bax, Cyt C and the apoptotic rate of cardiomyocytes in the hypoxia/reoxygenation group were significantly increased (P<0.05), while the expression of Scarb1, Bcl-2 and the content of ATP were significantly decreased (P<0.05). Compared with the control group, the situation of mir-125a-5p transfection group was just the opposite. Double luciferase reporter gene experiment has confirmed Scarb1 to be the target of miR-125a-5p. Hypoxia/reoxygenation can promote the expression of NF-κB p65, C-myc and Cyclin D1 in cardiomyocytes, while down-regulating the expression of miR-125a-5p can inhibit the expression of such proteins.@*CONCLUSION@#Hypoxia/reoxygenation can induce the expression of miR-125a-5p in rat cardiomyocytes. Inhibition of miR-125a-5p can protect cardiomyocytes from hypoxia/reoxygenation by up-regulating the expression of Scarb1. The mechanism may be related to the inhibition of activation of NF-κB signaling pathway.

Meta analysis of atorvastatin combined with trimetazidine in the treatment of angina pectoris of coronary heart disease / 中国医师杂志

Objective To evaluate efficacy and safety of Atorvastatin combined with trimetazidine Sibutramine treating angina pectoris of coronary heart disease.Methods Of computer retrieval China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database and search atorvastatin statins combined with trimetazidine trimetazidine in the treatment of angina pectoris of coronary heart disease:a randomized controlled trial,according to Jadad scale to evaluate the quality of the included studies and extracted data.Meta analysis was performed using RevMan 5.3.Results In accordance with the inclusion criteria were included in the 18 study,a total of 1 848 patients.The software of RevMan 5.3 on cardiovascular events incidence,clinical curative effect,angina pectoris,blood lipid [total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C)],the improvement of cardiac function [including cardiac index left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD)] and the adverse reactions of meta analysis showed that compared with pure atorvastatin,atorvastatin combined with trimetazidine can reduce the incidence of cardiovascular events [OR =0.19,95％ Cl (0.11,0.35),P＜0.01],reduce seizure frequency and duration of angina [WMD =-1.52,95％ CI (-1.84,-0.99),P ＜ 0.01;WMD =-1.80,95％ CI (-2.20,-1.50),P ＜0.01],improve the clinical efficiency of [OR =4.78,95％ Cl (3.54,6.47),P ＜ 0.01] display.Blood lipid and cardiac ultrasound index show that atorvastatin combined with trimetazidine can better improve the patient's LVEDD [WMD =-2.69,95％ CI (-4.39,-0.98),P ＜ 0.01] LVESD [WMD =-6.92,95 ％ CI(-11.82,-2.02),P ＜ 0.01].The decrease of serum level of TC,TG,LDL-C was better than atorvastatin monotherapy,but there were no statistically significant differences in the improvement level of serum HDL-C in the included patients (P =O.17).In the included studies,atorvastatin combined with trimetazidine can effectively reduce the incidence of adverse reactions in patients [0R=0.33,95％ CI (0.13,0.85),P=0.02].Conclusions Atorvastatin combined with trimetazidine is safer and more effective than atorvastatin alone in the treatment of coronary heart disease angina pectoris.

Cinnamaldehyde attenuates lipopolysaccharide induced inflammation and apoptosis in human umbilical vein endothelial cells / 中华心血管病杂志

Objective@#To investigate the effect of cinnamaldehyde (CIN) on the inflammation and apoptosis on human umbilical vein endothelial cells (HUVECs) induced by lipopolysaccharide (LPS), and to explore the potential mechanisms.@*Methods@#HUVECs were divided in to 8 groups: blank control group, LPS group, LPS+(low, medium, high) dose CIN groups and (low, medium, high) CIN groups. Cell cytotoxicity was determined by trypan blue staining, mRNA expression of the inflammatory factors was determined by RT-PCR,apoptosis was determined by TUNEL staining,the signal pathway was determined by Western blot.@*Results@#(1) Cell viability:compared with the control group,cell survival rate was significantly lower in the LPS group (P<0.01), while the survival rates were all significantly higher in the 3 LPS+CIN groups than in the LPS group (all P<0.01) in a concentration-dependent manner. (2) The mRNA expression of the inflammation factors: compared with the control group, mRNA expression of the inflammation factors were all increased in the LPS group (all P<0.01),while the effect of LPS could be significantly reversed by cotreatment with CIN in a concentration-dependent manner (all P<0.01). Compared with control group, the mRNA expression of the inflammation factors in the LPS group were all enhanced in a time-dependent manner (0,6,12,24 h),which could be significantly downregulated by cotreatment with LPS+CIN (high dose) in a time-dependent manner. (3) Cell apoptosis: compared with the control group, the apoptosis rate was significantly higher in the LPS group (P<0.01), while this effect could be significantly reversed by the cotreatment with CIN (high dose) (P<0.01). (4) Signaling pathway: compared with the control group, the phosphorylation of iκBα, p65 in HUVECs treated with LPS were rapidly up-regulated compared with their corresponding total proteins and the expression of TLR4 (all P<0.01), while the degree of p-iκBα/iκBα, p-p65/p65 and TLR4 could be significantly suppressed by cotreatment with CIN (high dose) (all P<0.01).@*Conclusion@#CIN can attenuate LPS induced inflammation and apoptosis in HUVECs, possibly by inhibiting the activation of NF-κB signaling pathway.