Role and Mechanism of Chinese Medicinal Materials and Their Compound Formulas with Effects of Replenishing Qi， Activating Blood， and Dispelling Stasis in Prevention and Treatment of Heart Failure / 中国实验方剂学杂志

Heart failure with high prevalence is the endpoint of many cardiovascular diseases. Once diagnosed， patients usually need lifelong medication， which seriously affects their quality of life. The drugs commonly used to treat heart failure include angiotensin-converting enzyme inhibitors， beta-blockers， aldosterone receptor antagonists， and diuretics. However， the long-term use of those drugs can lead to side effects such as hypotension， depletion of body fluid， and electrolyte imbalance and even increase mortality. According to the theory of traditional Chinese medicine （TCM）， Qi deficiency and blood stagnation is the major cause of heart failure and when Qi is not moving， blood is not flowing. Therefore， the TCM clinical treatment of heart failure uses the Chinese medicinal materials which replenish Qi， activate blood， and dispell stasis to treat both internal cause and external symptoms. Recent studies have demonstrated that Chinese herbal medicines such as Astragali Radix， Ginseng Radix et Rhizoma， Notoginseng Radix et Rhizoma， Salviae Miltiorrhizae Radix et Rhizoma， Angelicae Sinensis Radix， as well as the compound formulas such as Buyang Huanwutang， Simiao Yongantang， Qili Qiangxin capsules， and Qishen Yiqi drops， play a significant role in the prevention and treatment of heart failure via replenishing Qi， activating blood， and dispelling stasis. Inhibition of oxidative stress and inflammatory responses， mitigation of myocardial fibrosis， improvement of calcium cycling， and protection of mitochondrial function represent the key mechanisms for the treatment of heart failure with Chinese medicinal materials. Focusing on the pathogenic mechanisms and signaling pathways of heart failure， this paper systematically describes the pharmacological effects， molecular mechanisms， and research progress in the clinical application of Chinese medicinal herbs with effects of replenishing Qi， activating blood， and dispelling stasis and their compound formulas in the prevention and treatment of heart failure， aiming to provide scientific evidence for the development and clinical use of anti-heart failure Chinese medicinal materials.

Caso clínico: Paciente doble heterocigoto para Hemoglobina New York (HB Kaohsiung) y Alfa Talasemia (­α3.7/αα) / Double heterozygous patient for New York Hemoglobin (HB Kaohsiung) and Alpha Thalassemia (­α3.7/αα)

Resumen Se reporta el caso de una paciente adulta, asintomática, sin historial familiar de anemia o enfermedades crónicas, atendida en el Laboratorio Clínico del Área de Salud de Aserrí que acude a control salud por seguimiento a tratamiento de anemia. Se revisa el histórico del expediente médico del propositus, donde se evidencia que el VCM por debajo del límite de referencia normal, hace incurrir al médico tratante en el error de asociar microcitosis con anemia ferropriva. Sin embargo, el Laboratorio Clínico de Aserrí cuenta con un algoritmo de donde se deriva que los índices y la morfología obtenidos en este hemograma son sugestivos de Talasemia, por lo que se envía la muestra al Laboratorio de Estudios Especializados e Investigación del Hospital Nacional de Niños Dr. Carlos Sáenz Herrera para realizar una electroforesis de hemoglobina. En este análisis se detecta una variante de hemoglobina. A nuestro buen saber, no se ha descrito anteriomente un caso de doble heterocigota como el aquí mencionado, por lo que se reporta el primer caso en Costa Rica de un doble heterocigota hemoglobina New York/-3.7 Alfa Talasemia.

Abstract An asymptomatic adult female, with no previous family history of anemia or chronic diseases, goes to consultation at Aserrí ´s Clínic for anemia follow up. A history review of the medical record shows that MCV is below the lower reference range. This MCV value induces the physician to treat the patient for iron deficiency anemia. Using the algorithm of the Clinical Laboratory in Aserrí, such erythrocytic indices are suggestive of Thalassemia. For these reason a blood sample is sent for hemoglobin electrophoresis and molecular analysis at the specialized hematology laboratory at the National Children´s Hospital. A variant hemoglobin is detected. To our knowledge, this is the first case of compound heterozygous for Hemoglobin New York/-3.7 Alfa Thalassemia in Costa Rica.

Etiological profile in patients with heart failure

Background: The incidence and prevalence rates of heart failure (HF) are increasing worldwide. The prevalence of HF rises exponentially with increasing age and affects 4% to 8% of people older than 65. The leading causes of HF in India include coronary artery disease (CAD), diabetes, hypertension, rheumatic valvular heart diseases and primary cardiac muscle diseases. Rheumatic heart disease (RHD) is still a common cause of HF in India. Epidemiological studies have estimated that 1.5% to 2% population experience HF and it is the main reason for hospital admission of elderly patients. The objective of this study was to establish the etiological factors of heart failureMethods: A cross sectional study of 150 patients above the age of 18 years presented with heart failure diagnosed clinically on the basis of Framingham heart failure criteria and echocardiography, done over a period of one year in department of medicine in BRD medical college Gorakhpur Uttar Pradesh.Results: A total of 150 patients were include in this analysis the majority of patients were male (57.3%). Age of patients ranged from 18 - 70 years and 84% patients were above the age of 40 years.Conclusions: Heart failure was more prevalent in elderly male above 40 years of age. Myocardial infarction, DCMP, rheumatic heart disease and hypertensive heart failure are the common etiology leading to heart failure.

Study of spectrum of cardiac disease complicating pregnancy and the maternal and foetal outcome

Background: Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy, accounting for almost 10% of maternal deaths. They complicate 1-3% of all pregnancies.Methods: The study was conducted at Cheluvamba Hospital from January 2015 till July 2016. All pregnant women with cardiac disease were included in the study. Pregnant women with cardiac disease were followed up during antenatal period, evaluated and maternal and foetal outcome was studied.Results: Total number of deliveries in the one and half year study period was 18,803 cases and the total number of women with cardiac disease was 90. Most of the subjects belonged to NYHA grade I and II (95.5%), whereas NYHA grade III and IV constituted only 4.4% of cases. Rheumatic heart disease was the principal cardiac lesion (62.22%) among the pregnancies, while congenital heart disease (33.33%) was the second most common cause. 16.7% had cardiac complications and there were 2(2.22%) maternal mortality. 91.86% were live births with 5.88% IUDs and 2.35% neonatal deaths. 15.29% of the babies were Preterm, 8.14% were IUGR babies and 2.35% had congenital anomalies. It was noted NYHA grade III/IV cases had more preterm babies compared to NYHA grade I/II. NICU admissions were also more with NYHA grade III/IV.Conclusions: The results suggest the need for pre-pregnancy counselling, early diagnosis, correction of cardiac lesions where indicated, close surveillance during pregnancy and a team approach comprising of obstetricians, cardiologists, neonatologists and nursing personnel for a successful pregnancy outcome.

Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study / 한국역학회지

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Assessment of pressure-volume loop in patients with pulmonary hypertension and the correlation with New York Heart Function Classification / 中国介入心脏病学杂志

Objective To analyze the correlation between the pressure volume parameters and cardiac function in terms of New York Heart Association(NYHA) classification in patients with pulmonary arterial hypertension. Methods Among 36 patients with pulmonary hypertension admitted in our center between April 2015 to June 2016, right heart catheterization recording right atrial pressure curve,right ventricular pressure curve,pulmonary arterial pressure and oxygen saturation curve in different parts was performal.All patients recived underwent cardiac MRI examination to obtain a single cardiac cycle and the use of Mass software to measure right ventricular volume continuously and right ventricular pressure-volume loop parameters were then obtained. Patients were divided into different groups according to the NYHA functional classification, and the correlation between the parameters of each group and the cardiac function classes a were analyzed. Results Compare to patients with NYHA class Ⅰheart function,patients with NYHA heart function class Ⅱ and class Ⅲ had significantly higher right ventricular end diastolic pressure(P < 0.05)and higher right ventricular systolic pressure (P < 0.01). Spearman correlation analysis showed that cardiac function of NYHA classⅠ,Ⅱ and Ⅲhad position correlation with RVESV,RVEDP and RVESP wheras negative correlation with RVEDV. ROC curve analysis showed that,when the patients were divided into 2 groups as NYHAⅠvs. NYHA class Ⅱ + Ⅲ,NYHA classification for predicting the outcome of the NYHA class Ⅱ + Ⅲ level, pulmonary artery elasticity and right ventricular end systolic pressure had larger area under curves respectively. Conclusions Pressure-volume parameters of right ventricles are more objective indicators for cardiac function assessment for pulmonary hypertension patients and evaluation of disease progression especialy in patients with mild symptoms.

Assessment of pressure-volume loop in patients with pulmonary hypertension and the correlation with New York Heart Function Classification / 中国介入心脏病学杂志

Objective To analyze the correlation between the pressure volume parameters and cardiac function in terms of New York Heart Association(NYHA) classification in patients with pulmonary arterial hypertension. Methods Among 36 patients with pulmonary hypertension admitted in our center between April 2015 to June 2016, right heart catheterization recording right atrial pressure curve,right ventricular pressure curve,pulmonary arterial pressure and oxygen saturation curve in different parts was performal.All patients recived underwent cardiac MRI examination to obtain a single cardiac cycle and the use of Mass software to measure right ventricular volume continuously and right ventricular pressure-volume loop parameters were then obtained. Patients were divided into different groups according to the NYHA functional classification, and the correlation between the parameters of each group and the cardiac function classes a were analyzed. Results Compare to patients with NYHA class Ⅰheart function,patients with NYHA heart function class Ⅱ and class Ⅲ had significantly higher right ventricular end diastolic pressure(P < 0.05)and higher right ventricular systolic pressure (P < 0.01). Spearman correlation analysis showed that cardiac function of NYHA classⅠ,Ⅱ and Ⅲhad position correlation with RVESV,RVEDP and RVESP wheras negative correlation with RVEDV. ROC curve analysis showed that,when the patients were divided into 2 groups as NYHAⅠvs. NYHA class Ⅱ + Ⅲ,NYHA classification for predicting the outcome of the NYHA class Ⅱ + Ⅲ level, pulmonary artery elasticity and right ventricular end systolic pressure had larger area under curves respectively. Conclusions Pressure-volume parameters of right ventricles are more objective indicators for cardiac function assessment for pulmonary hypertension patients and evaluation of disease progression especialy in patients with mild symptoms.

Use of Protective Gloves in Nail Salons in Manhattan, New York City / 예방의학회지

OBJECTIVES: Nail salon owners in New York City (NYC) are required to provide their workers with gloves and it is their responsibility to maintain healthy, safe working spaces for their employees. The purpose of this study was to determine the frequency with which nail salon workers wear protective gloves. METHODS: A Freedom of Information Law request was submitted to New York Department of State's Division of Licensing Services for a full list of nail salons in Manhattan, NYC. A sample population of 800 nail salons was identified and a simple random sample (without replacement) of 30% (n=240) was selected using a random number generator. Researchers visited each nail salon from October to December of 2015, posing as a potential customer to determine if nail salon workers were wearing gloves. RESULTS: Among the 169 salons in which one or more workers was observed providing services, a total of 562 workers were observed. For 149 salons, in which one or more worker was observed providing services, none of the workers were wearing gloves. In contrast, in six of the salons observed, in which one or more workers was providing services, all of the workers (1 in 2 sites, 2 in 1 site, 3 in 2 sites, and 4 in 1 site) were wearing gloves. Almost three-quarters of the total number of workers observed (n=415, 73.8%) were not wearing gloves. CONCLUSIONS: The findings of this study indicate that, despite recent media attention and legislation, the majority of nail salon workers we observed were not wearing protective gloves when providing services.

A study of media image of traditional Chinese medicine on New York Times / 国际中医中药杂志

Objective To summarize the media image of traditional Chinese medicine (TCM) by analyzing the TCM-related reports onNew York Times.Methods A total of 113 pieces of TCM-related reports onNew York Times during the 1980-2015 period collected and analyzed from the aspects of the amount, genres, coverage resources, reporting attitudes and main issues under the framework of content analysis.Results①The amount of TCM-related reports has been on the rise since 1980s. There was a wide variety in the genres of the reports and the American local resources account for a large proportion.②The reporting attitude in general tended to be relatively positive, though a major difference can be found in the attitude toward acupuncture and herbs.③ Eleven main issues can be categorized in the reports.Conclusion Changes could be seen in the TCM-related reports over time. Despite the fact that the media image of TCM tends to be relatively positive, the negative attitude toward herbs may hamper their development in the US. External communication of TCM is to be strengthened so as to promote the media image of TCM.

The role of prehealth student volunteers at a student-run free clinic in New York, United States / 보건의료교육평가

PURPOSE: The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. METHODS: We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. RESULTS: A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. CONCLUSION: After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.

Análisis comparativo de angioplastia versus cirugía en la coronariopatía multivaso; perspectiva de un hospital comunitario / Comparative analysis of angioplasty versus surgery in multivessel coronary artery disease: A community hospital perspective

Introducción: Hasta 60% de los casos tratados con intervención coronaria percutánea (ICP) o cirugía (CRVC) tienen enfermedad coronaria de múltiples vasos (ECMV). Objetivo: Comparar la evolución clínica de estos pacientes después de su comparativo, de una cohorte tratada por ECMV con CRVC o ICP más stents farmacoactivos o bioactivos entre enero de 2004 a julio de 2011. Se utilizó expediente clínico, consignando eventos cardiovasculares adversos. Resultados: Ingresaron 134 pacientes, predominando varones con enfermedad trivascular y angina estable con un seguimiento de 35.7 ± 20.4 meses. El grupo quirúrgico tuvo más dislipidemia (41.9 vs 36.7%), diabetes (59.5 vs 38.3%), hipertensión arterial (67.6 vs 60%), infarto del miocardio antiguo (37.8 vs 23.3%) y lesión tipo C en la arteria descendente anterior (63.9 vs 30.4%), p < 0.05 para todas. Los tratados con ICP tuvieron más necesidad de revascularización repetida (30.50 vs 2.73%) p < 0.01, recurrencia de angina (44 vs 20%), ergometrías positivas (39 vs 18%), hospitalizaciones (25 vs 9%) y deterioro funcional según la New York Heart Association III o IV (22 vs 11%), p < 0.05 para todos. Conclusión: En pacientes de un hospital comunitario con ECMV, la ICP presenta una recurrencia superior de isquemia y revascularización repetida comparada con la CRVC.

Introduction: 60% of the patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) suffer from multivessel coronary artery disease. Objective: Our objective was to compare the clinical course of patients with this diagnosis after revascularization. Methods: We‚ consulted and compared the clinical records‚ of‚ a multivessel coronary artery disease cohort treated with either coronary artery bypass grafting or angioplasty with drug eluting stents or bioactive stents between January 2004 and July 2011, consigning adverse cardiovascular events. Results: 134 patients, mostly male, with‚ 3-vessel disease and stable angina, were followed up for‚ 35.7 ± 20.4 months. Dyslipidemia‚ (41.9 vs 36.7%),‚ diabetes mellitus type 2‚ (59.5 vs 38.3%), hypertension (67.6 vs 60%),‚ old myocardial infarction‚ (37.8 vs 23.3%) and type C lesion in left anterior descendent artery (63.9 vs 30.4%) were all more frequent in the surgery group (p < 0.05). On the other hand, the angioplasty treated patients needed more frequently revascularization (30.50 vs 2.73%; p < 0.01) and hospitalization (25 vs 9%) and had more often angina‚ (44 vs 20%), positive ergometry (39 vs 18%), and functional impairment type New York Heart Association III/IV‚ (22 vs 11%) (p < 0.05). Conclusion: In patients at a community hospital with multivessel coronary artery disease, PCI has a higher recurrence of ischemia and repeated revascularization compared to CABG.

New York state of mind: culture, history, and psychology in New York City

Place is important for understanding knowledge and scientific practices. In turn, knowledge and practice influence the place they occur. Place is not simply the stage where the real action happens, but it is itself constitutive of systems of human interaction, thus ideas are produced and shaped in resonance with their environments. Here the author argues that New York City was an important site for the growth and diversification of application of psychology during the decade of the 1920s. The city both shaped the science and practice that grew there and was shaped by it.(AU)

A ordem do caos: epistemologia de um tempo e experiências de ruptura na obra a trilogia de Nova York / The order of chaos: epistemology of a time and experiences of rupture/discontinuity at the masterpiece the New York trilogy

A Trilogia de Nova York é um romance policial pós-moderno. Obra de seu tempo, traz questões pertinentes à contemporaneidade, como a intensificação das experiências de ruptura. Do encontro com o novo num espaço-tempo cada vez mais comprimido, seguem-se esvaziamentos das categorias que nos remetem a ordens, unidades, certezas. Contudo, imersa na realidade da ficção - e na nossa -, escolhi o caminho, não dos que lamentam saudosamente uma modernidade das seguranças, e sim dos que não consideram preencher os inúmeros vazios restantes, mas conservá-los como aberturas que são, como torção própria de paradigma - que nos lega não outra coisa senão outro paradigma. Desta imanência entre o ser/estar e o conhecer (não esqueçamos o detetive como sujeito de um ato epistêmico), lançarei ao interesse questões em três diferentes frentes: (i) sobre a contemporaneidade, análise da própria obra; (ii) na contemporaneidade, análise do discurso e da autoria; (iii) na e sobre a contemporaneidade

The New York Trilogy is a post-modern detective fiction and as well comes up with some contemporary issues as the intensification of the experiences of rupture/discontinuity (once begun in Modernity). Once the disconcerting encounters with new are happening in a space-time each time more constricted, the categories related to an order, unities, certainties are being “replaced” by non-spaces, nothingnesses. However, looking from an inside’s perspective, I chose to take the way not of those who miss modernity (and the “safety” that comes with it), but of those who consider not to fill the innumerable remaining emptinesses in order to conserve them as the true openings that they are, to accept them as the very twist of paradigm - and the fate of gaining not other thing than another paradigm. From this immanent bond between the being and the knowing, I will launch questionings in three different trails: (i) about the contemporary days, analysis of the novel itself; (i) in the contemporary days, analysis of discourse and authorship; (iii) about and in the contemporary days

The Risk Factors for Severe Thyroid-Associated Orbitopathy

PURPOSE: To determine risk factors for severe Thyroid-Associated Orbitopathy (TAO). METHODS: We retrospectively studied the clinical data of 385 patients of the New York City area diagnosed with TAO from January 1990 to December 2000. We reviewed clinical characteristics and tried to identify several risk factors. The statistical analysis was applied to the collected data. RESULTS: Men more frequently had proptosis, restrictive myopathy, and optic neuropathy than women. Patients older than 50 years presented more frequently with proptosis, restrictive myopathy, and optic neuropathy than younger than 50 years. Patients with a family history of thyroid disease had similar clinical characteristics compare to those without family history. Smokers more often had proptosis, restrictive myopathy, and compressive optic neuropathy than nonsmokers. Patients who had received radioactive iodine (RAI) treatment were older, and were more frequently smokers. If patients were smokers and treated with radioactive iodine treatment, they were more likely to have proptosis, restrictive myopathy, and compressive optic neuropathy than if not treated with radioactive iodine. However, the RAI treatment did not seem to be associated with severe characteristics of TAO in non-smokers. CONCLUSIONS: The risk factors for severe TAO are: male, age older than 50, smoking, treated with RAI in smokers.

Proportional mortality ratios among Korean immigrants to New York City, 1986-1990

BACKGROUND: About 13,000 people immigrated to New York City from the Republic of Korea between 1986 and 1990, creating an important ethnic minority. METHODS: Using US-born Whites as a reference, age-adjusted proportional mortality ratios were computed for 314 men and 248 women of Korean ancestry born abroad who died in New York City in 1986-90. RESULTS: Males had a significant excess of viral hepatitis, cancer, stroke, and external causes: accidents, suicide, and homicide. They had significantly reduced proportional rates of AIDS and heart disease. Mortality patterns were similar for Korean women, who had significantly increased proportional rates of stroke and accidents, and reduced heart disease. Stomach and liver cancers were significantly elevated in both sexes, while female breast cancer was low. There were two male and one female tuberculosis deaths (4 to 7 fold increase), and one Korean woman died of childbirth complications (59-fold increase). CONCLUSIONS: Except for violent deaths, these observations resemble known mortality patterns in Korea.