Escore de Risco Clínico Simples para Prever a Mortalidade Pós-Alta Hospitalar em Pacientes Chineses Hospitalizados por Insuficiência Cardíaca / A Simple Clinical Risk Score to Predict Post-Discharge Mortality in Chinese Patients Hospitalized with Heart Failure

Resumo Fundamento Doenças cardiovasculares são a principal causa de morte na China. Entretanto, os esforços atuais para se identificar os fatores de risco de morte em pacientes hospitalizados com insuficiência cardíaca (IC) estão direcionados principalmente para a mortalidade durante a internação e a mortalidade após 30 dias nos Estados Unidos. Dessa forma, é necessário um modelo semelhante ao modelo utilizado para prever o risco considerado para procedimentos cirúrgicos cardiovasculares em pacientes para avaliar o risco de pacientes internados com diagnóstico de IC. Objetivo Identificar variáveis que podem prever a mortalidade por IC um ano após a alta hospitalar, e desenvolver um escore de risco para avaliar o risco de morte no período de um ano. Métodos No presente estudo, 1.742 pacientes chineses com IC foram divididos aleatoriamente em dois grupos: um grupo de amostra de derivação e um grupo de amostra de teste. O método de simulação Monte Carlo via Cadeias de Markov foi usado para identificar variáveis que podem prever a mortalidade um ano após a alta hospitalar. Variáveis com uma frequência >1% na análise bivariada, e que foram consideradas clinicamente significativas, foram qualificadas para análises de modelagens posteriores. A probabilidade posterior de que uma variável estava estatística e significativamente associada ao resultado foi calculada como o número total de vezes em que o IC de 95% da variável não coincidiu com 1 (ou seja, o ponto de referência), dividido pelo número total de iterações. Uma variável com uma probabilidade de 0,9 ou mais alta foi considerado um fator de risco robusto para prever o resultado, e foi incluída na lista final de variáveis. O nível de significância estatística adotado foi 5%. Resultados Cinco variáveis que pudessem prever de maneira robusta a mortalidade um ano após a alta hospitalar foram identificadas: idade, sexo feminino, escore da New York Heart Association (Associação de Cardiologia de Nova Iorque) >3, diâmetro do átrio esquerdo, e índice de massa corporal. Os modelos de derivação e de teste tiveram uma área de curva característica de operação do receptor de 0,79. Essas variáveis selecionadas foram utilizadas para avaliar o escore de risco de mortalidade por IC após um ano, e este foi dividido em três grupos (baixo, moderado e alto). O grupo de alto risco corresponde a aproximadamente 86% das mortes, e o grupo de risco moderado corresponde a 12% das mortes. Conclusão Um escore de risco de 5 variáveis simples pode ser utilizado para avaliar a mortalidade um ano após a alta hospitalar de pacientes internados com IC.

Abstract Background Cardiovascular diseases are the leading causes of death in China. However, present efforts to identify the risk factors for death in patients hospitalized with heart failure (HF) are primarily focused on in-hospital mortality and 30-day mortality in the United States. Thus, a model similar to the model used for predicting the risk in patients considered for cardiovascular surgical procedures is needed to evaluate the risk of the patients admitted with a diagnosis of HF. Objective To identify variables that can predict post-discharge one-year HF mortality and develop a risk score to assess the risk of dying within one year. Methods In the present study, 1,742 Chinese patients with HF were randomly divided into two groups: a derivation sample group and a test sample group. A Markov Chain Monte Carlo simulation method was used to identify variables that can predict the one-year post-discharge mortality. Variables with a frequency of >1% in the bivariate analysis and that were considered clinically meaningful were eligible for further modeling analyses. The posterior probability that a variable was statistically and significantly associated with the outcome was calculated as the total number of times that the variable's 95% CI did not overlap with 1 (i.e., the reference point) divided by the total number of iterations. A variable with a probability of 0.9 or higher was considered a robust risk factor for predicting the outcome, and this was included in the final variable list. The level of statistical significance adopted was 5%. Results Five variables that could robustly predict the one-year post-discharge mortality were identified: age, female gender, New York Heart Association functional classification score >3, left atrial diameter, and body mass index. Both derivation and test models had a receiver operating curve area of 0.79. These selected variables were used to assess the one-year HF mortality risk score, and these were divided into three groups (low, moderate, and high). The high-risk group corresponds to nearly 86% of the deaths, while the moderate group corresponds to 12% of the deaths. Conclusion A simple 5-variable risk score can be used to assess the one-year post-discharge mortality of hospitalized Chinese patients with HF.

Multicenter Randomized Controlled Clinical Trial of Longmu Zhuanggu Granule in Treatment of Children Recurrent Respiratory Infection with Lung-Spleen Qi Deficiency Syndrome / 中国实验方剂学杂志

Objective:To evaluate the clinical efficacy and safety of Longmu Zhuanggu granule for the treatment of children recurrent respiratory infection due to lung-spleen Qi deficiency. Method:This multicenter stratified， block-randomized， double-blind， double-dummy， positive drug （pidotimod granule） parallel controlled， and non-inferiority trail intended to included 240 children patients and divided them into the experimental group （<italic>n</italic>=120） and the control group （<italic>n</italic>=120） at the ratio of 1∶1. Patients in both groups were treated for eight successive weeks and followed up for 12 months. The cure rates， numbers of respiratory infections， average courses of disease， curative effects of traditional Chinese medicine （TCM） syndrome， curative effects of individual symptoms， curative effects of immune indexes， and safety indexes between the two groups were observed and compared. Result:A total of 237 subjects were collected from 10 research centers， including 119 cases in the control group and 118 in the experimental group. There were 236 cases enrolled into the full analysis set （FAS）， 210 into the per-protocol set （PPS）， and 236 into the safety set （SS）. The baseline data of the two groups were not significantly different from each other， indicating that they were comparable. The cure rates of the experimental group and control group were 75.21% （88/117） and 73.95%（88/119）， respectively， with the 95% confidence interval （CI） of difference between the two groups being 1.26% （-9.85%，12.37%） for FAS and 3.81% （-6.28%，13.90%） for PPS. The 95% CI fell within the 10% non-inferiority margin， implying that non-infertility test of the cure rate in the treatment of endpoint disease was valid， and the conclusions of FAS and PPS analysis were consistent. There was no significant difference in the number or course of upper respiratory infection， bronchitis， and pneumonia. The difference in curative effects of TCM syndrome between the two groups after four weeks of treatment was not remarkable. After eight weeks of treatment， the total effective rate of the experimental group was 84.62%（99/117）， statistically higher than 78.15%（93/119） of the control group（<italic>χ</italic>²=-3.26，<italic>P</italic><0.05）. There were no significant differences in the disappearance rates of individual symptoms between the two groups after four weeks of treatment. After eight weeks of treatment， the experimental group and control group exhibited the disappearance rates of 67.50%（54/80） and 47.37%（36/76） for shortness of breath and laziness to speak， 75.00%（54/72） and 53.33%（40/75） for poor appetite， 54.55%（60/110） and 37.84%（42/111） for hyperhidrosis， respectively， with obviously better outcomes observed in the experimental group （<italic>P</italic><0.05，<italic>P</italic><0.01）. The inter-group comparison revealed significant differences in immune indexes after eight weeks of treatment. As demonstrated by comparison with the situations before treatment， IgA， IgG， IgM， and CD4 did not change significantly after treatment. Except for CD8 in the experimental group (<italic>P</italic><0.05), there was no significant difference in other immune indexes before and after treatment There was no significant difference in the incidence of adverse reactions. Conclusion:Longmu Zhuanggu granule is not inferior to pidomod granule in the treatment of children recurrent respiratory infection due to lung-spleen Qi deficiency， and it exhibits good safety， implying its promising clinical application value.

Soft corneal contact lens for postoperative comfort in patients with recurrent pterygium function / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the effect of soft contact lens on the comfort of postoperative patients with recurrent pterygium. <p>METHODS: For 100 eyes of 98 patients after recurrent pterygium excision, the conjunctival implant with limbal stem cells from the upper part of the cornea was used, and the scleral surface of the operation area was transferred and covered. Fifty eyes were treated with corneal bandage lens for 5d(Group A)and 50 eyes were conventionally ensheathed(Group B). The time of corneal wound healing and various symptoms and signs were observed after operation. <p>RESULTS: Compared with Group B, 1d after pterygium, the symptoms and signs of corneal irritation in Group A were significantly less(<i>P</i><0.05), and the corneal epithelial healing was significantly faster and better(<i>P</i><0.05). <p>CONCLUSION: The corneal contact lens can obviously improve the early postoperative corneal irritation in patients with pterygium, promote corneal wound healing and relieve postoperative discomfort.

Interferon regulatory factor-1 mediates the release of high mobility group box-1 in endotoxemia in mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The extracellular release of the danger signal high mobility group box-1 (HMGB1) has been implicated in the pathogenesis and outcomes of sepsis. Understanding the mechanisms responsible for HMGB1 release can lead to the identification of targets that may inhibit this process. The transcription factor interferon regulatory factor-1 (IRF-1) is an important mediator of innate immune responses and has been shown to participate in mortality associated with endotoxemia; however, its role in mediating the release of HMGB1 in these settings is unknown.</p><p><b>METHODS</b>Male IRF-1 knockout (KO) and age matched C57BL/6 wild type (WT) mice were given intraperitoneal (IP) injections of lipopolysaccharide (LPS). In some experiments, 96 hours survival rates were observed. In other experiments, mice were sacrificed 12 hours after LPS administration and sera were harvested for future analysis. In in vitro study, RAW 264.7 murine monocyte/macrophage-like cells or primary peritoneal macrophage obtained from IRF-1 KO and WT mice were cultured for LPS mediated HMGB1 release analysis. And the mechanism for HMGB1 release was analyzed by immune-precipitation.</p><p><b>RESULTS</b>IRF-1 KO mice experienced less mortality, and released less systemic HMGB1 compared to their WT counterparts. Exogenous administration of recombinant HMGB1 to IRF-1 KO mice returned the mortality rate to that seen originally in IRF-1 WT mice. Using cultures of peritoneal macrophages or RAW264.7 cells, in vitro LPS stimulation induced the release of HMGB1 in an IRF-1 dependent manner. And the janus associated kinase (JAK)-IRF-1 signal pathway appeared to participate in the signaling mechanisms of LPS-induced HMGB1 release by mediating acetylation of HMGB1.</p><p><b>CONCLUSION</b>IRF-1 plays a role in LPS induced release of HMGB1 and therefore may serve as a novel target in sepsis.</p>

Pathogen distribution and antibiotic resistance for hospital aquired pneumonia in respiratory medicine intensive care unit / 中南大学学报(医学版)

OBJECTIVE@#To investigate the change of pathogen distribution and antibiotic resistance of pathogens isolated from in-patients with hospital acquired pneumonia (HAP) in the Department of Respiratory Medicine Intensive Care Unit (RICU) of Xiangya Hospital in 2005 and in 2011, and to provide reasonable anti-infectious strategy.@*METHODS@#The positive susceptibility test of sputum (bronchial secretions) culture was done in patients with HAP in RICU of Xiangya Hospital in 2005 and in 2011, and the distribution feature and antibiotic resistance were compared.@*RESULTS@#1) In the two years, the main pathogen in HAP patients was Gram negative bacteria (infection rate was 68.07% and 65.21% in 2005 and in2011 respectively). The primary pathogenic bacteria were changed, and Acinetobacter baumanii became the most common Gram negative bacterium which replaced Pseudomonas aeruginosa, with infection rate 6.81% in 2005 to 40.87% in 2011. The infection rate of Pseudomonas aeruginosa reduced from 20.42% in 2005 to 15.60% in 2011. Haemophilus influenzae was rare. Staphylococcus aureus became the primary Gram positive bacteria, and its infection rate increased from 1.57% in 2005 to 4.83% in 2011, all of which were methicillin-resistant Staphylococcus aureus (MRSA). Saccharomyces albicans' positive culture rate increased significantly. 2) Compared with in 2005, the antibiotic resistance of pathogen isolated from the HAP pationts changed a lot in 2011: increased antibiotic resistance rate and decreased sensitivity to many antibiotics. Pseudomonas aeruginosa was only relatively susceptible to meropenem, cefoperazone sulbactam, ceftazidime, cefpodoxime, and andamicaxin in 2011. The resistance rate of Pseudomonas aeruginosa to levofloxacin, cyclopropane, amicacin, gentamicin, meropenem, cematrixone, and piperacilintazobactam increased obviously (P<0.05). Compared with 2005, Acinetobacter baumanii was totally susceptible to polymyxin and relatively susceptible to sulbactam, but it was almost completely resistant to Aminoglycoside antibiotics in 2011, with significant difference (P<0.01).@*CONCLUSION@#The main pathogen of HAP patients in RICU was Gram negative bacteria, with increased infection rate of Staphylococcus aureus and fungus. There is change pathogen distribution and antibiotic resistance, and the clinical initial experimental antibiotic therapy may be influenced. It is important to use antibiotics more rationally to delay the antibiotic resistance.

Effects of autophagy on quercetin-induced death of SMMC-7721 cell / 中国药学杂志

OBJECTIVE: A im To investigate the role of qercetin(Que) -induced autophagy in the death of hepatocellular carcinoma cell line SMMC-7721 cells. METHODS: After treatment with different concentration of Que, the growth inhibition of the SMMC-7721 cells were assessed by MTT colorimetric assay. The fluorescent staining was applied to identify the autophagy after Que treatment. Lactate dehydrogenase (LDH) leakage and Western blot analysis were used to study the autophagic mechanisms involved in death of SMMC-7721 cells. RESULTS: The proliferation of SMMC-7721 cells were significantly inhibited in a dose and time-dependent manner after Que treatment. Autophagy was also induced in MCF-7 cells as detected by MDC staining and Fluorescent staining in the early phase. The autophagy specific inhibitor 3-MA or chloroquine potentiated Que's cytotoxicitiy in SMMC-7721 cells when administered 1h before Que; The expression of cathepsin B increased after Que treatment. CONCLUSION: Que can significantly inhibit the growth of the SMMC-7721 cells by inducing the autophagy, which is a protection mechanism that can reduce the cytotoxicity induced by Que in SMMC-7721 cells. The activation of Cathepsin B is considerable in autophagy process.

Significance of plasmic homocysteine, folate and Vitamin B(12) in ulcerative colitis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of plasmic homocysteine (Hcy), folate (FA) and Vitamin B(12) (VitB(12)) in patients with ulcerative colitis (UC).</p><p><b>METHODS</b>Plasmic Hcy in 112 cases of UC patients and 110 controls were detected by HPLC-FD method. Plasmic FA, VitB(12) in 76 cases of UC patients and 12 controls were detected by enzyme-linked immunosorbent assay (ELISA) method.</p><p><b>RESULTS</b>The level of plasmic Hcy in UC patients was(11.27±7.26) μmol/L, significantly higher than that in controls[(8.19±4.81) μmol/L, P<0.05], and was not significantly correlated with disease index, extent and duration of UC(P>0.05). The level of FA and VitB(12) in UC patients were (7.64±1.95) nmol/L and (108.64±32.22) pmol/L respectively, lower than those in controls[(9.14±1.23) nmol/L and (112.64±33.33) pmol/L, P<0.05]. The level of plasmic Hcy was negatively correlated with the level of FA and VitB(12) in UC patients(P<0.05). The level of plasmic FA decreased to some extent with UC disease duration.</p><p><b>CONCLUSION</b>Plasmic Hcy is elevated in UC patients, which may be related to the decrease of FA and VitB(12).</p>