Comparison of the predictive value of the modified CADILLAC, GRACE and TIMI risk scores for the risk of short-term death in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention / 中华危重病急救医学

Objective:To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI.Results:In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade Ⅲ, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95% CI) was 0.702-0.923], 0.725 (95% CI was 0.666-0.812) and 0.882 (95% CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. Conclusions:The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.

Research on mechanism of opioid receptors in pharmacological effects of ketamine / 中国药理学通报

Ketamine has been used clinically as an analgesic and anesthetic since 1970. Recently, it has been concerned due to its rapid and effective antidepressant effect. However, the psychiatric adverse reactions caused by ketamine such as addiction and hallucination limit its clinical application, yet the mechanism of the adverse reactions is still unclear. At present, it is generally believed that the pharmacological effects of ketamine are mainly mediated by N-methyl-D-aspartate acid (NMDA) receptors, but increasing numbers of research evidences suggest that the opioid receptor also play an important role in the pharmacological effects of ketamine. This review, based on the relevant literature published publicly in the past 20 years, summarizes the mechanisms of opioid receptors in the pharmacological effects of ketamine, such as anesthesia, analgesia, anti-depressant, anti-addiction and addiction, providing reference for revealing the mechanism of ketamine, and making beneficial exploration for solving the clinical side effects of ketamine.

Multicentric reticulohistiocytosis: A case report / 北京大学学报(医学版)

A 65-year-old woman developed erythema, papules and nodules over the body. Some nodules of her auricles and hands like string beads. Besides, she suffered from symmetrical swelling and pain of multiple joints, morning stiffness with deformity of joints; She had elevated erythrocyte sedimentation rate and C reactive protein levels; Her rheumatoid factor and antinuclear antibody were positive; Joints destruction was found with X-ray imaging; Skin pathology showed Dermal infiltrate of abundant histiocytes, part of them with a ground-glass appearance; A CD68 immunohistochemical stain was positive and the cells were negative for S100, CD1a. These findings were diagnostic evidences of multicentric reticulohistiocytosis (MRH). The patient received high-dose of glucocorticoids combinated with immunosuppressive agents, and achieved a satisfactory effect. MRH was a rare multisystem disease characterized by papulonodular mucocutaneous and destructive arthritis, and its pathogeny was not yet completely understood. The typical lesions of MRH were hard papules or nodules that usually occured on the hands, face and arms. Classic coral bead appearance from periungual cutaneous nodules that were characteristic of MRH. MRH was an inflammatory joint disease, affecting almost all the appendicular joints and characterized by joint multiple, symmetrical, destructive, progressive disability. Joints destruction of the distal interphalangeal joints was a unique feature of MRH. In addition to skin and joints, it could also involve other systems. There were no diagnostic laboratory markers for MRH. Laboratory examinations had often been found to be non-specific. Imageological examination mainly showed bone and joint destruction. Skin biopsy was the best test to diagnose MRH, the typical histopathological findings included an infiltrate with histiocytes and multinucleated giant cells with a ground-glass appearing in eosinophilic cytoplasm, and the immunohistochemical stain was positive for CD68. The diagnosis was typically made based on the clinical presentation, supportive radiographic findings and skin biopsy. MRH was easily possible to mistake for other more common autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and dermatomyositis, but the distinctive clinical, radiographic, and histologic features could aid in differentiating these diseases. MRH could mimic other rheumatic diseases, besides, it could also coexist with cancer or other autoimmune disorders. There was no standardized treatment for MRH. However, Nonsteroidal anti-inflammatory drugs, glucocorticoid, Immunosuppressant, biologic medications, and bisphosphonates had been used with varying degrees of curative effect. Treatment with glucocorticoid combined with immunosuppressants were effective for rash and arthritis, early use of them should be strongly considered, and refractory cases could be treated with biological agents. By reporting a MRH case and reviewing literature, this paper aims to help the clinicians improve the understanding of this rare disease, and suggests that when one diagnosis cannot explain the whole picture of the disease, and further evidence should be sought to confirm the diagnosis.

Effect and mechanism of aspirin combined with vinorelbine on non-small cell lung cancer / 中国中药杂志

The study aimed to investigate the effect and mechanism of aspirin combined with vinorelbine on the proliferation and apoptosis of non-small cell lung cancer cells. 3-(4-dimethylthiazolyl-2)-2-diphenyltetrazolium bromide(MTT) was used to detect the cytotoxic effect of aspirin and vinorelbine on H460 and A549 cells, and half of inhibitory concentration(IC_(50)) value of drugs as well as synergistic effect were calculated. The results showed that both aspirin and vinorelbine inhibited the cancer cells proliferation by a concentration-dependent manner with IC_(50 )values of 1.553 mmol·L~(-1) and 0.033 μmol·L~(-1) in H460 cells, respectively. The IC_(50 )values of aspirin and vinorelbine were 1.70 mmol·L~(-1)and more than 20 μmol·L~(-1) in A549 cells. The combination index(CI) value was used to evaluate the combined effect of two drugs. Aspirin combined with vinorelbine had synergistic effects at the ratio of 100∶1 on H460 cells and 1∶10 on A549 cells(CI<1). Clone formation and 4',6-diamidino-2-phenylindole(DAPI)/propidium iodide(PI) staining assays were used to verify the effect of the combination of two drugs on proliferation of H460 cells. Compared with the aspirin single group, the combination group had stronger inhibitory effect on the proliferation of H460 cells and the clone formation rate was 49.5%(P<0.05). Furthermore, apoptosis, mitochondrial membrane potential, reactive oxygen species and Western blot experiments were used to explore the synergistic mechanism of aspirin combined with vinorelbine in inhibiting cell proliferation. The results showed that the cancer cell apoptosis rate was 52.8%, the mitochondrial membrane potential was decreased to 33.1%, and the levels of reactive oxygen species was increased to 73.3% in combination group, which were significantly different from those of the single drug treatment groups(P<0.05). Western blot showed that combination group significantly up-regulated the expressions of Bax, p53, cleaved caspase-3 and cytochrome C, while down-regulated the expression of anti-apoptosis proteins such as Bcl-xL and Bcl-2 when compared with single groups. Our results suggested that aspirin combined with vinorelbine could synergistically inhibit the proliferation of H460 cells by inducing the cell apoptosis through the mitochondrial pathway.

Pedicle fixation combined with intervertebral fusion for lumbar spondylolithesis:whether restoring disc height affects the biomechanics and spinal function / 中国组织工程研究

BACKGROUND: According to the current most prevailed posterior pedicle screw reduction and Cage fusion for spondylolisthesis, the previous focus is to restore the vertebral sagittal displacement, and whether restoring disc height is needed and the degree of recovery remain unclear. Moreover, there is still a lack of better quantitative indicators to restore the disc height.OBEJCTIVE: By comparing the surgery of lifting reduction, to study the clinical effect of distraction and lifting reduction combined with posterior intervertebral fusion in the treatment of lumbar spondylolisthesis. METHODS: Sixty patients with L5 spondylolisthesis located in L5/S1 were selected, and were divided into two groups based on the surgery methods (n=30 per group): group A (single lifting reduction group) and group B (lifting and distracting reduction group). The patients in the group B were given distracting reduction amid insertion of 12 mm-height Cage; while the patients in the group A were subjected to lifting reduction, and intervertebral fusion with 8 mm-height Cage. The general information and the Visual Analogue Scale, Japanese Orthopaedic Association and Oswestry Disability Index scores at baseline, postoperative 1 month and last follow-up, as well as the postoperative correction and bone fusion were recorded. Additionally, the clinical effectiveness was assessed by Macnab score. RESULTS AND CONCLUSION: (1) At postoperative 1 month and last follow-up, the disc height, disc height/vertebral height, neuroforamen height and clinical effectiveness in the group B were superior to those in the group A (P < 0.05). (2) To conclude, the pedicle screw system combined with posterior intervertebral cage fusion for spondylolisthesis, can rapidly restore the disc height, contribute to restructure better biomechanics of spine. Furthermore, it significantly improves clinical systems, is easy to operate, and achieves better efficacy; therefore, it is recommended firstly.

Deferoxamine suppresses microglia activation and protects against secondary neural injury after intracerebral hemorrhage in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of the iron chelator deferoxamine (DFA) in suppressing microglia activation and protecting against secondary neural injury in a rat model of intracerebral hemorrhage (ICH).</p><p><b>METHODS</b>SD rats were randomly divided into sham-operated group, ICH group and DFA treatment group. ICH model was established by infusion of type IV collagenase into the right basal ganglia, and starting from 1 h after the operation, the rats received intraperitoneal DFA injections every 12 h for 7 days. The iron content in the perihematoma brain tissue was determined at different time points after DFA administration, and OX42 immunohistochemistry was used to observe the changes in the microglia. The contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the brain tissue were detected by ELISA. The neural death and neurological deficiency were measured using Nissl staining and neurological scores, respectively.</p><p><b>RESULTS</b>The iron content in the brain tissues around the hematoma was significantly increased 3 days after ICH and maintained a high level till 28 days, accompanied by a marked increase of microglial cells as compared to the sham-operated group. DFA injection caused significantly decreased iron content in the brain tissue, reduced number of microglial cells, and lowered levels of IL-1β and TNF-α. Neuronal loss around the hematoma was obviously reversed after DFA injections, which resulted in improved neurological deficiency.</p><p><b>CONCLUSION</b>DFA can suppress microglia activation by removing iron overload from the perihematoma brain tissue, thus reducing secondary neuronal death and neurological deficiency in rats with ICH.</p>

Treatment of choroidal neovascularization with Chinese medicine huangban bianxing recipe / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of Chinese medicine Huangban Bianxing Recipe (HBR) for treatment of choroidal neovascularization (CNV).</p><p><b>METHODS</b>Eighty patients (97 eyes) suffered from CNV were assigned to two groups, the treated group treated by HBR orally taken one dose every day and the control group treated with ginkgo leaf tablet 1 tablet (19.2 mg) thrice a day, all for 3 months. The best corrected visual acuity (BCVA), fundus hemorrhagic area were measured; the neo-genetic vascular leakage area determined by fluorescent fundus angiography (FFA); and the out-layer high reflective band thickness (OHRBT) estimated by optical coherent tomography (OCT) were recorded before and after treatment.</p><p><b>RESULTS</b>After treatment, in the treated group, BCVA was improved, with an effective rate of 67.12%, while in the control group, it was 33.33%, the former was better than the latter significantly (P < 0.05). The effective rate in reducing fundus hemorrhagic area in the two groups (85.11% vs 47.62%) and that in the CNV closure showed by FFA (67.50% vs 37.50%) were also superior in the treated group (P < 0.05). Besides, OCT showed that the OHRBT reduced significantly after treatment in the treated group (P < 0.01).</p><p><b>CONCLUSION</b>HBR can improve the vision, reduce the CNV leakage in the macular region, and advance the absorption of fundus hemorrhage in CNV patients.</p>

Observation on Therapeutic effect of Urapidil Hydrochloride in Control of Blood Pressure at the Perioperative Stage of Hemorrhagic Apoplexy / 中国药房

OBJECTIVE:To observe the efficacy of urapidil hydrochloride in control of blood pressure at the perioperative stage of hemorrhagic apoplexy.METHODS:All80patients with hypertensive cerebral hemorrhage were managed with seda?tive,dehydration,hemostasis,and cerebral nerve nourishment,then when the blood pressure still remained high,or the blood pressure was hard to control after the intubation,urapidi hydrochloride was administered by intravenous infusion at the dose of250mg added with250ml of5%glucose infusion,the infusion drip was set at constant speed,with2mg/min as its starting speed,while at the same time the blood pressure and heart rate were monitored and infusion speed was adjusted every10to15min,after the target blood pressure21.2/13.2kPa was obtained,the infusion speed was kept at0.1～0.4mg/min.The blood pressure and heart rate were observed separately before the administration of urapidil hydrochloride and2,5,10,15,20and30min after the administration as well as after the operation.RESULTS:5min after the administration,blood pres?sure decreased remarkably but not to the extent to cause low blood pressure,and the heart rate increased slightly at the same time,generally not over10beats each minute.CONCLUSION:Urapidil hydrochloride decreases blood pressure steadily and safely at a manageable dosage.It can be used to control blood pressure during hemostasis and clearance of hematoma,which reduces the possibility of rehemorrhagia caused by high blood pressure during and after the operation.

Antisense oligonucleotide inhibition of coxsackievirus B3 gene expression in HeLa cells and dose-response experiments / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>In this study, the authors investigated inhibition of coxsackievirus B (CVB) gene expression using antisense oligonucleotides complementary to the 5' NCR, translation initiation codon and structural protein coding sequences and also observed the dose-response of the sequence specific inhibition of CVB plaque formation by antisense oligonucleotides.</p><p><b>METHODS</b>Antiviral activities of these oligonucleotides were evaluated by using plaque reduction assay, yield reduction assay, cytopathic effect (CPE) and Western blot analysis. The cells were treated with random oligonucleotides as a specificity control.</p><p><b>RESULTS</b>At a screening concentration of 5 micromole, 6 of the phosphorothioate oligonucleotide demonstrated some reduction of virus replication relative to untreated cells. 70%-90% inhibition of virus at 0.1 MOI (multiplicity of infection), 50% inhibition of virus infection at 10 MOI. The levels of the VP1 were reduced in CVB-infected cells treated with Scb561 and Scb733. VP1 was significantly reduced after treatment with 0.625 micromole Scb561 and almost undetectable in cells treated with 2.5 micromole Scb561. Dose response experiments implied that sequence specific oligonucleotide doses were related to effect on inhibition of CVB3 infection. When oligonucleotide doses were increased from 1.25 to 5 micromole, 75% to 90% inhibition were observed with Scb561 and 65% to 80% inhibition with Scb733, whereas random control failed to inhibit CVB replication (8% inhibition for each). CONCLUSION The present studies showed that antisense oligonucleotides against internal ribosome entry site (IRES) and translation initiation codon were capable of specifically inhibiting the synthesis of viral protein and subsequent productive CVB replication.The selective inhibition using antisense oligonucleotide might lead to development of an effective antiviral agent for future clinical evaluation.</p>