Novel mechanisms driving renal tubulointerstitial fibrosis / 中国临床药理学与治疗学

Renal fibrosis, especially tubulointerstitial fibrosis, is the most common pathway of all chronic kidney diseases progressing to end-stage renal diseases. Several adaptive reactions occur in renal tubular epithelial cells after chronic injury, such as changes in glycolipid metabolism, unfolded protein response, autophagy and senescence, epithelial-to-mesenchymal transition and G2/M cell cycle arrest. Maladaptive repair mechanisms can induce tubulointerstitial fibrosis. This article will discuss the molecular mechanism of these adaptive responses of renal tubular epithelial cells driving renal tubulointerstitial fibrosis, and provide a basis for exploring new drug targets for renal tubulointerstitial fibrosis.

Evaluation of CLIA plus NAT for detecting HBsAg single-ELISA-reactive samples of blood donors / 中国输血杂志

【Objective】 To study the detection performance of HBsAg single-ELISA-reactive samples of blood donors. 【Methods】 Two kinds of ELISA reagents from different manufacturers (named as reagents A and B) were used for HBsAg screening. A total of 276 samples, from January 2017 to May 2021, with HBsAg single-ELISA-reactive results were collected for further nucleic acid detection technology (NAT) and chemiluminescence immunoassay (CLIA) testing, to undergo HBV-DNA and five hepatitis B tests, respectively. The relationship between HBsAg single-ELISA-reactivity, NAT and CLIA was statistically analyzed. 【Results】 Among the 276 HBsAg single-ELISA-reactive samples, 14 were NAT reactive, with the positive rate of 5.07% (14/276). Fisher′s exact test was used to compare the compliance of reagents A and B with NAT reactivity, and the difference was not statistically significant (P<0.05). Among 14 HBsAg+ /NAT+ samples retested by CLIA, 2 were HBsAg reactive(14.29%, 2/14), 13 were anti-HBc reactive (92.86%, 13/14), 9 had the quantitative value of anti-HBs <10 mIU/mL, 5 had the quantitative value of anti-HBs between 10 to 100mIU/ mL. A total of 5 serological patterns were detected, and anti-HBe+ /anti-HBc+ pattern was the dominant. There were 262 cases of HBsAg+ /NAT- samples, but only 1 (0.38%, , 1/262) case was HBsAg reactive by CLIA, 100 were anti-HBc reactive (38.17%, 100/262), 144 (54.96%, 144/262) were anti-HBs reactive, and 1 was HBeAg reactive. A total of 8 serological patterns were detected. 【Conclusion】 Most of HBsAg single-ELISA-reactive results are false, and NAT could effectively reduce the residual risk of transfusion transmitted diseases.

Profile of irregular antibodies among voluntary blood donors: 2018 to 2020 in Jiaxing / 中国输血杂志

【Objective】 To study and analyze the profile of irregular antibodies among voluntary blood donors in Jiaxing area. 【Methods】 The ABO and RhD blood groups of all voluntary blood donors from November 2018 to November 2020 were detected by DIAGAST QWALYS 3 automatic blood group analyzer. According to routine serological screening program of irregular antibody, the samples reactive to O blood cell were sent to the reference laboratory for further identification of the antibody specificity, and the specificity and distribution characteristics of irregular antibodies were analyzed statistically. 【Results】 A total of 79 samples presenting irregular antibodies were yielded out of 90 854 blood samples, with a positive rate of 0.087%. More female samples (n=44) than male (n=35) (P0.05). 【Conclusion】 Female, RhD negative and more than 45 years old blood donors are more likely to present irregular antibodies, regardless of the number of blood donations.

The application value of indocyanine green combined with methylene blue in sentinel lymph node biopsy of breast cancer / 中国医师进修杂志

Objective:To evaluate the potential value of indocyanine green combined with methylene blue and methylene blue alone in the detection of sentinel lymph nodes (SLN) in breast cancer.Methods:The clinical data of 118 patients with early breast cancer from November 2016 to October 2018 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed. Among them, 62 patients underwent SLN biopsy under methylene blue (methylene blue group, 160 SLN), and 56 patients underwent SLN biopsy under indocyanine green combined with methylene blue (combined group, 190 SLN). After SLN biopsy, patients underwent grade Ⅰ and Ⅱ axillary lymph node dissection.Results:There was no significant difference in the positive lymph node rate and accuracy rate between 2 groups ( P>0.05); the SLN dyeing rate and SLN biopsy positive rate in combined group were significantly higher than those in methylene blue group: 97.9% (186/190) vs. 93.1% (149/160) and 28.4% (54/190) vs. 18.1% (29/160), and there were statistical differences ( P<0.05); the false negative rate in combined group was lower than that in methylene blue group: 5.3% (3/57) vs. 14.7% (5/34), but there was no statistical difference ( P>0.05). Conclusions:In breast cancer patients, the dual -tracing method of indocyanine green combined with methylene blue is better than using methylene blue alone in identifying SLN and predicting the status of axillary lymph nodes, and it has a tendency to reduce the false negative rate.

CYP2C19 genotype-guided antiplatelet therapy in elderly patients with acute coronary syndrome after percutaneous coronary intervention / 中华老年医学杂志

Objective:To investigate optimal antiplatelet therapy options based on the CYP2C19 genotype in elderly patients with acute coronary syndrome(ACS).Methods:Elderly patients with ACS admitted to our hospital from January 2018 to March 2019 were enrolled and received CyP2C19 gene testing.Patients with the intermediate metabolic genotype of CYP2C19 were randomly divided into two groups: the Ticagrelor group and the double-dose Clopidogrel group.After a one-year follow-up, the risk of bleeding and incidences of cardiovascular events in the two groups were analyzed.Results:468 elderly patients meeting the criteria, 214 had the intermediate metabolic genotype of CYP2C19, accounting for 45.7% of the total, and were randomly divided into the ticagrelor treatment group( n=107)and the double-dose Clopidogrel treatment group( n=107). There were significant differences between the Ticagrelor treatment group and the double-dose Clopidogrel treatment group in incidences of minor bleeding, massive hemorrhage, recurrent angina and recurrent acute myocardial infarction(11.2% vs.22.4%, 2.8% vs. 9.4 %, 4.7% vs.13.1%, 3.7% vs. 11.2%, P<0.05). The double-dose Clopidogrel group not only had a higher risk of cardiovascular events, but also a higher risk of bleeding. Conclusions:For elderly ACS patients with the intermediate metabolic genotype of CYP2C19, a standard dose of ticagrelor is recommended.

The association between plasma levels of 20 amino acids and risk of diabetes / 中华内科杂志

Objective To investigate the association between the plasma levels of 20 amino acids and the risk of diabetes in middle-aged and elderly population.Methods This study was a part of the Chinese multi-provincial cohort study conducted in communities of Shougang.In 2007 and 2012,the population was investigated for diabetes and other risk factors.Blood samples collected from 475 people were tested for various amino acid levels by liquid chromatography-tandem mass spectrometry.A multivariate logistic regression analysis was used to analyze the association between plasma amino acid levels and diabetes risk.Results The age of the selected population at baseline was (58.7±6.3) years,and the blood glucose level at baseline was (5.68 ± 1.34) mmol/L.Among them,56 (11.79％) subjects were diabetes.Multivariate logistic regression analyses showed that after adjusting for age,gender,body mass index,systolic blood pressure and dyslipidemia,individuals with plasma branched-chain amino acid (valine,leucine and isoleucine) and cysteine in the highest tertile levels were at high risk of diabetes with the ORs of 3.61 (95％ CI 1.48-8.80),3.27 (95％ CI 1.34-7.99),2.46 (95％ CI 1.04-5.84) and 2.09 (95％ CI 1.02-4.27),respectively.After 5 years' followed up,5.73％ (24/419) subjects developed diabetes.Compared with those in the lowest tertile,individuals with plasma branched-chain amino acid (total concentration),phenylalanine,and tyrosine levels at baseline in the highest tertile had 3.69 times,3.61 times and 4.14 times higher risk to develop new diabetes,respectively.In contrast,individuals with plasma glycine level in the highest tertile had only 76％ (OR 0.24,95％ CI 0.06-0.91) risk for the development of diabetes compared with those with plasma glycine level in the lowest tertile.Conclusions The increase in plasma branched-chain amino acid and cysteine levels is significantly associated with an increase in incident diabetes.Subjects with higher levels of branched-chain amino acids and aromatic amino acids (phenylalanine,tyrosine) had a significantly higher risk of developing new-onset diabetes,while those with higher glycine levels had a significantly lower risk of developing diabetes in 5 years.

Analysis of TGFBI gene mutation in a pedigree affected with corneal dystrophy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To detect potential mutation in a large Chinese pedigree affected with congenital corneal dystrophy.</p><p><b>METHODS</b>Two patients from the pedigree were subjected to whole exome sequencing to determine the candidate gene. Suspected mutation was verified in 13 additional members by directional Sanger sequencing. Ccorrelation between genotype and phenotype was explored.</p><p><b>RESULTS</b>A missense mutation, c.1877A>C (p.His626Pro), was detected in exon 14 of the TGFBI gene in 8 patients from the pedigree, but not in five unaffected members and 100 unrelated healthy controls. Respectively, the mutation was predicted as "affecting protein function", "probably damaging" and "disease causing" by SIFT, PolyPhen-2 and MutationTaster.</p><p><b>CONCLUSION</b>The c.1877A>C mutation of the TGFBI gene probably underlies the disease in this pedigree.</p>

Association between long-term blood pressure change and the incidence of cardiovascular diseases: a population-based cohort study / 中华心血管病杂志

Objective@#To explore the association between long-term changes in blood pressure (BP) levels and the incidence of cardiovascular diseases (CVD).@*Methods@#A total of 5 752 participants, who participated baseline examination in 1992-1993 and re-examination in 2007, were followed up till December 31, 2013 according to the study protocol of the Chinese Multi-provincial Cohort Study. Participants were stratified by baseline BP and re-examination BP and cross-combined into 9 subgroups. The 20-year incidence of acute cardiovascular events, acute coronary heart disease (CHD) and acute stroke events were analyzed and association between disease incidence and 15-year changes in BP were determined using the competing risk regression model.@*Results@#(1) There were 523 CVD events (170 CHD, 373 stroke) during the 20 years follow up. The number of participants with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) of <130/80 mmHg (1 mmHg=0.133 kPa), 130-139/80-89 mmHg, and hypertension were 2 892 (50.3%), 1 328 (23.1%) and 1 532 (26.6%), respectively. (2) Among participants with baseline SBP of 130-139 mmHg or DBP of 80-89 mmHg, 870 (65.5%) progressed to hypertension and 279 (21.0%) maintained at the same stratum over a 15-year follow up period. (3) After adjustment for age, sex, body mass index, smoking status, diabetes, total cholesterol, and high-density lipoprotein cholesterol at baseline, participants maintained SBP/DBP at 130-139/80-89 mmHg had a higher risk of developing acute cardiovascular events, CHD and stroke with the hazard ratios (HR) and 95% confidence interval (95%CI) of 2.04 (1.16, 3.57), 3.29 (1.30, 8.35) and 1.63 (0.80, 3.33), compared with those who maintained their SBP < 130 mmHg and DBP <80 mmHg. Participants whose BP increased from 130-139/80-89 mmHg to hypertension over the follow up period had 2.81-fold (1.84, 4.29), 3.17-fold (1.43, 7.03) and 2.71-fold (1.65, 4.44) higher risk for the incidence of acute cardiovascular events, CHD, and stroke, respectively, compared with participants who maintained their SBP <130 mmHg and DBP <80 mmHg.@*Conclusions@#Participants with SBP/DBP of 130-139/80-89 mmHg have a high long-term risk for progression to hypertension. Sustained exposure to SBP/DBP of 130-139/80-89 mmHg or higher increases the risk of CVD incidence, and our results highlight the importance of early prevention for participants with this BP stratum.

Impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome / 中华心血管病杂志

Objective@#To evaluate the impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome (ACS).@*Methods@#This multi-center cross-sectional study collected data from 34 hospitals covering 22 provinces in China. Hospitals were randomly divided into four groups: control group(routine treatment and care), promotional calendar group (routine treatment and care plus giving propaganda desk calendar to patients), education group (routine treatment and care add patients education by nurses) and combined intervention group (promotional calendar and education).At least 90 patients with ACS were consecutively enrolled from each involved hospital from April 15, 2012 to June 30, 2013. To reduce the impact of uneven distribution of inter-group variables on the results, 1∶1∶1∶1 propensity score matching method was used. The drug usage for secondary prevention and prognosis wasobtainedat 6 months after hospital discharge.@*Results@#(1) A total of 3 391 patients were selected and 2 244 patients were included for the final analysisafter propensity score analysis. (2) At 6 months after discharge, the adherence rates of antiplatelet, statins, angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB), β-blocker and the combination of 4 medications were similar between control group and promotional calendar group (all P>0.016).The adherence rates of antiplatelet and statins were 97.0% (526/542) and 91.0% (493/542) in the education group, 3.7% and 5.5% higher than in the control group (both P<0.016). The adherence rates of statins,ACEI/ARB and combined medication were 91.0% (496/545), 68.3% (372/545) and 53.2% (290/545) in the combined intervention group,significantly higher than in the control group (5.5%,8.3% and 9.6%, all P<0.016). (3) Poisson regression analysis showed that the adherence of antiplatelet drugs in the education group was 3.4%(OR=1.034, 95%CI 1.007-1.060,P<0.05) and 3.5%(OR=1.035, 95%CI 1.007-1.063, P<0.05) higher than in the control group and the promotional calendar group, and the statins adherence rate was 5.5%(OR=1.055, 95%CI 1.012-1.101,P<0.05) higher than in the control group. The antiplatelet drug adherence rates in the combined intervention group were 3.0% (OR=1.030, 95%CI 1.002-1.058,P<0.05) and 3.1% (OR=1.031, 95%CI 1.003-1.060,P<0.05) higher than in the control group and the promotional calendar group, respectively, and statin adherence was 6.1% (OR=1.061, 95%CI 1.017-1.107,P<0.01) higher than in the control group. The adherence rates of ACEI/ARB in combined intervention group were respectively 15.4%(OR=1.154, 95%CI 1.057-1.259, P<0.01),20.0%(OR=1.200, 95%CI 1.096-1.314, P<0.01) and 25.5%(OR=1.255, 95%CI 1.142-1.380, P<0.01) higher than in the control group, promotional calendar group and education group. The adherence rates of combined medication in combined intervention group were respectively 21.6%(OR=1.216, 95%CI 1.079-1.371, P<0.01),21.5%(OR=1.215, 95%CI 1.077-1.371, P<0.01) and 27.8%(OR=1.278, 95%CI 1.126-1.450, P<0.01) higher than in the control group, promotional calendar group and education group. (4) At 6 months after discharge, the control rates of blood pressure (<140/90 mmHg,1 mmHg=0.133 kPa) in the education group were significantly higher than in the control group and promotional calendar group (78.7% (398/506) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016),and the control rates of blood pressure in combined intervention group were higher than in the control group and promotional calendar group (78.2% (376/481) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016).The rehospitalization rates were 7.0% (39/561) in the promotional calendar group, and 7.6% (42/561) in the education group, both significantly higher than in the control group (3.8% (21/561), all P<0.016).The rate of the low density lipoprotein cholesterol<2.07 mmol/L and the rate for all-cause mortality were similar among groups (all P>0.016) .@*Conclusion@#Post-discharge medication adherence in ACS patients can be enhanced by either promotional calendaror nurses education strategy, and the efficacy is better by nurse education as compared with promotional calendar, the combination of both methods can further increase the post-discharge medication adherence rates in ACS patients.

Trends in 30-day case fatality rate in patients hospitalized due to acute myocardial infarction in Beijing, 2007-2012 / 中华流行病学杂志

Objective To understand the distribution and trends in 30-day coronary heart disease (CHD) case fatality rate in patients hospitalized due to acute myocardial infarction (AMI) in Beijing during 2007-2012.Methods The clinical data of patients hospitalized due to AMI in Beijing from 1 January 2007 to 31 December 2012 were collected from "The Cardiovascular Disease Surveillance System in Beijing".A total of 77 943 local patients aged ≥25 years were hospitalized due to AMI in Beijing during the this period.After excluding duplicate records and validation for the completeness and accuracy of the records,the clinical characteristics of the patients and 30-day CHD case fatality rate in the patients were analyzed.Trends in 30-day CHD case fatality rate in the patients were analyzed with Poisson regression models.Results The age-standardized average 30-day CHD case fatality rate was 9.7％ in the 77 943 patients.During this period,a decreasing trend was observed in 30-day CHD case fatality rate after adjusting for age and gender (P＜0.001).The age-standardized 30-day CHD case fatality rate decreased by 16.0％,from 10.8％ in 2007 to 9.0％ in 2012.The decreases of 30-day CHD case fatality rates were noted in both men and women,whereas 30-day CHD case fatality rate was higher in women (14.1％) than in men (7.6％) after adjusting for age.During this period,the proportion of ST-segment elevation myocardial infarction (STEMI) decreased,while the proportion of non-ST-segment elevation myocardial infarction (NSTEMI) increased with year.A significant decline (20.1％) in 30-day case fatality rate of STEMI was found,but no decline was found for 30-day mortality rate of NSTEMI.Conclusion A decreasing trend in 30-day CHD case fatality rate was observed in the patients aged ≥25 years and hospitalized due to AMI in Beijing during 2007-2012,indicating the improvement in short-term prognosis of patients hospitalized due to AMI.Our findings highlight the urgent need to improve the treatment for woman and NSTEMI patients.

Trends in 30-day case fatality rate in patients hospitalized due to acute myocardial infarction in Beijing, 2007-2012 / 中华流行病学杂志

Objective To understand the distribution and trends in 30-day coronary heart disease (CHD) case fatality rate in patients hospitalized due to acute myocardial infarction (AMI) in Beijing during 2007-2012.Methods The clinical data of patients hospitalized due to AMI in Beijing from 1 January 2007 to 31 December 2012 were collected from "The Cardiovascular Disease Surveillance System in Beijing".A total of 77 943 local patients aged ≥25 years were hospitalized due to AMI in Beijing during the this period.After excluding duplicate records and validation for the completeness and accuracy of the records,the clinical characteristics of the patients and 30-day CHD case fatality rate in the patients were analyzed.Trends in 30-day CHD case fatality rate in the patients were analyzed with Poisson regression models.Results The age-standardized average 30-day CHD case fatality rate was 9.7％ in the 77 943 patients.During this period,a decreasing trend was observed in 30-day CHD case fatality rate after adjusting for age and gender (P＜0.001).The age-standardized 30-day CHD case fatality rate decreased by 16.0％,from 10.8％ in 2007 to 9.0％ in 2012.The decreases of 30-day CHD case fatality rates were noted in both men and women,whereas 30-day CHD case fatality rate was higher in women (14.1％) than in men (7.6％) after adjusting for age.During this period,the proportion of ST-segment elevation myocardial infarction (STEMI) decreased,while the proportion of non-ST-segment elevation myocardial infarction (NSTEMI) increased with year.A significant decline (20.1％) in 30-day case fatality rate of STEMI was found,but no decline was found for 30-day mortality rate of NSTEMI.Conclusion A decreasing trend in 30-day CHD case fatality rate was observed in the patients aged ≥25 years and hospitalized due to AMI in Beijing during 2007-2012,indicating the improvement in short-term prognosis of patients hospitalized due to AMI.Our findings highlight the urgent need to improve the treatment for woman and NSTEMI patients.

The present status of aspirin use for primary prevention among hypertensive outpatients in China / 中华内科杂志

Objective To evaluate the current status of aspirin for primary prevention in hypertensive outpatients in China,and the gap between aspirin use and guidelines.Methods This was a multi-center cross-sectional study and carried out in hypertensive patients from 46 hospitals of twenty two cities in China from June to December in 2009.At least 100 essential hypertensive outpatients were consecutively recruited from each participant hospitals according to the consistent inclusion criteria.The patients underwent physical examinations and biochemical analyses,and answered questionnaires.Based on the relevant guidelines,the risk assessment of cardiovascular disease (CVD) is a prerequisite for the proper use of aspirin in primary prevention.Results A total of 5 206 hypertensive outpatients were included.Among them,1 324 (25.4％) were with a history of CVD.Among those with no history of CVD,2 705 patients (69.7％) were at high risk of CVD,and the aspirin utilization rate for primary prevention was 29.2％,with 32.2％ patients at high risk and 22.4％ patients at low-medium risk of CVD,respectively.In the application of aspirin for CVD primary prevention,the inappropriate aspirin use rate in patients at lowmedium risk was 23.3％.Conclusions The proportion of subjects at high risk for CVD is high in hypertensive outpatients suggesting a wide range of application space for aspirin.There exists underutilization for high risk and overutilization for low-medium risk patients in current aspirin primary prevention application.

Relationship between leukocyte count and risk of hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the association between the leukocyte count and blood pressure value and hypertension risk in a Chinese community-based population.</p><p><b>METHODS</b>A total of 4 188 participants who took part in the baseline examination in 1992 and the follow-up survey in 2007 from the Chinese Multi-Provincial Cohort Study were included in this study. The relationship of leukocyte and blood pressure value and hypertension risk were evaluated by cross-sectional analyses.The prospective association between baseline leukocyte count and blood pressure changes and risk of hypertension were analyzed in 2 954 normotensive individuals at baseline examination.The associations between leukocyte count and blood pressure was evaluated with Spearman's rank correlation analyses and linear regression models,and the associations between leukocyte count and risk of hypertension was evaluated with logistic regression models.</p><p><b>RESULTS</b>(1) The cross-sectional study results showed that the correlation coefficient of leukocyte count and systolic blood pressure and diastolic blood pressure was 0.208 and 0.154 (both P < 0.001), respectively.Multiple linear regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with 1.41 mmHg (1 mmHg = 0.133 kPa) systolic blood pressure increase (95% CI: 1.20-1.63 mmHg, P < 0.001) and 0.63 mmHg diastolic blood pressure increase (95% CI: 0.51-0.76 mmHg, P < 0.001). Multivariable logistic regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with a 15% increased risk of hypertension (OR: 1.15, 95% CI: 1.12-1.19, P < 0.001). (2) During 15 years of follow-up, 47.2% (1 394/2 954) normotensive individuals progressed to hypertension. Spearman's rank correlation analyses showed that, the correlation coefficient of leukocyte count and systolic blood pressure change and diastolic blood pressure change was 0.062 (P = 0.003) and 0.102 (P < 0.001), respectively.Multiple linear regression analyses showed that every 1×10(9)/L increment in baseline leukocyte count was associated with 1.03 mmHg systolic blood pressure increase (95% CI: 0.74-1.32 mmHg, P < 0.001) and 0.64 mmHg diastolic blood pressure increase (95% CI: 0.48-0.80 mmHg, P < 0.001). Multivariable logistic regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with a 9% increased risk of incident hypertension (OR: 1.09, 95% CI: 1.06-1.13, P < 0.001).</p><p><b>CONCLUSION</b>Elevated leukocyte count is associated with increased blood pressure value and hypertension among Chinese community-based population, suggesting that inflammation may participate in the pathogenesis of hypertension.</p>

Association between very low density lipoprotein cholesterol and cholesterol absorption/synthesis markers in patients with moderate and high risk of coronary heart disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the association between very low density lipoprotein cholesterol (VLDL-C) and cholesterol absorption and synthesis markers in patients with moderate and high risk of coronary heart disease.</p><p><b>METHODS</b>A total 363 statin-naïve patients with moderate and high risk of coronary heart disease were consecutively recruited from two hospitals in Shanxi and Henan provinces between October 2008 and June 2009. A standard questionnaire and physical examination were performed at baseline. Atorvastatin (20 mg/day) was administered to patients for 4 weeks. Venous blood samples after an overnight fast were collected before and after treatment for measuring VLDL-C and cholesterol absorption and synthesis markers. In qualitative analyses, the baseline level of cholesterol absorption and synthesis markers and their reduction after atorvastatin treatment were categorized into 3 tertile groups.</p><p><b>RESULTS</b>(1) Of 363 patients, 283 patients with mean age of (55.43±9.01)years old with complete data were finally analyzed. The median level of baseline VLDL-C was 1.06 (0.65, 1.86) mmol/L. The median level of baseline cholesterol absorption marker (Campesterol) and cholesterol synthesis marker (Lathosterol) was 6.01 (3.78, 9.45) mg/L and 13.46 (8.30, 21.07) mg/L, respectively. (2) Partial correlation analysis and multiple regression showed the baseline level of VLDL-C was positively correlated with Campesterol (r=0.153, P<0.05) but not with Lathosterol(r=0.182, P=0.173). Furthermore, baseline VLDL-C level significantly increased with tertile of the baseline level of Campesterol in the qualitative analyses(P for trend=0.035). (3) Mean reduction in VLDL-C levels was 38.0% after 4 weeks atorvastatin treatment. VLDL-C reduction was positively correlated with Campesterol reduction (r=0.331, P<0.001). VLDL-C reduction significantly increased with the tertile of Campesterol reduction (P for trend=0.032). But this trend was not observed between VLDL-C level and Lathosterol (P for trend=0.798).</p><p><b>CONCLUSION</b>The level of VLDL-C was closely related to cholesterol absorption marker, and further studies are needed to validate if inhibitor of cholesterol absorption (for example by Ezetimibe) could bring about more effective VLDL-C lowering effect in this patient cohort.</p>

Serum total cholesterol change from 1992 to 2007 in the general population from Chinese multi-provincial cohort study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To describe the changes of serum total cholesterol (TC) and the prevalence of hypercholesterolemia from 1992 to 2007 in the general population from Chinese multi-provincial cohort study (CMCS).</p><p><b>METHODS</b>CMCS database were established on participants aged 35-64 years from 11 provinces during the baseline examination on cardiovascular risk factors in 1992. Participants were followed up and invited to re-examine risk factors in 2007. Five thousand seven hundred and forty participants with complete data from these two examinations were included in this study for investigating the changes of serum TC level.</p><p><b>RESULTS</b>(1) From 1992 to 2007, the mean level of TC increased from 4.65 mmol/L to 4.96 mmol/L for men, and from 4.40 mmol/L to 5.35 mmol/L for women. The prevalence of hypercholesterolemia increased from 5.1% (141/2 791) to 8.5% (237/2 791) in men, and from 4.9% (143/2 949) to 20.0% (590/2 949) in women. (2) Stratified by sex and age, the maximum increase in TC of 0.95 mmol/L was observed in women aged 35-44 years. Stratified by district, the maximum increase in TC of 0.88 mmol/L was observed in participants who had low baseline TC level living at rural area. Furthermore, baseline TC level was categorized into quintiles, the increases in TC level were highest in the lowest quintile both in men and women (0.93 mmol/L and 1.45 mmol/L, respectively). (3) Thirty-six point five percent (302/827) participants with hypercholesterolemia in 2007 developed from those with baseline TC 5.18-6.21 mmol/L, and 49.6% (410/827) developed from those with baseline TC < 5.18 mmol/L.</p><p><b>CONCLUSIONS</b>From 1992 to 2007, the mean level of TC increased in both men and women. The greatest increases in TC were observed in the participants with the lowest quintile of baseline TC and those living in the rural area.</p>

Changes in the diagnosis and treatment of hospitalized patients with acute coronary syndrome from 2006 to 2012 in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the changes in the diagnosis and treatment of hospitalized patients with acute coronary syndrome (ACS) from 2006 to 2012 in China.</p><p><b>METHODS</b>Hospitalized patients with ACS in 2006 from 65 hospitals distributed in 31 provinces, autonomous regions, and municipalities (data derived from the BRIG project phase I study, n = 3 323) and hospitalized in 2012 from 34 hospitals distributed in 21 provinces, autonomous regions, and municipalities (data derived from the BRIG project phase III study, n = 3 391) were included. Patients with susceptible ACS, patients admitted to hospital due to trauma, or patients participated in any drug clinical trials were excluded. Only patients with complete data were analyzed. Data between 3 124 ACS patients from BRIG project-I and 3 124 ACS patients from BRIG project-III were compared.</p><p><b>RESULTS</b>(1) The ACS patients hospitalized in 2012 were younger than those hospitalized in 2006 ((61.9 ± 11.2) years vs. (64.7 ± 11.5) years, P < 0.01), and the percentage of patients ≤ 60 years was higher in patients hospitalized in 2012 ((42.5% (1 327/3 124)) compared with those hospitalized in 2006 (32.1% (1 004/3 124), P < 0.05).(2) The percentages of ACS patients complicated with hypertension ((61.2% (1 853/3 124) vs. 53.0% (1 655/3 124)), diabetes (24.3% (760/3 124) vs. 16.4% (513/3 124)), and hypercholesterolemia (20.3% (633/3 124) vs. 6.3% (197/3 124)) were consistently higher in ACS patients hospitalized in 2012 than in hospitalized ACS patients in 2006 (all P < 0.01).(3) The rate of coronary angiogram examination increased from 28.6% (894/3 124) in 2006 to 68.6% (2 144/3 124) in 2012 (P < 0.01) . Moreover, the rate of intervention treatment was increased from 24.6% (770/3 124) in 2006 to 51.0% (1 594/3 124) in 2012 (P < 0.01). (4) The administration rate of aspirin (95.2% (2 975/3 124) vs. 91.7% (2 864/3 124) ), clopidogrel (85.6% (2 673/3 124) vs. 42.2% (1 318/3 124) ), and statins (90.0% (2 812/3 124) vs. 69.8% (2 180/3 124) ) was significantly higher in 2012 than in 2006 (all P < 0.01).</p><p><b>CONCLUSION</b>Compared with 2006, there is a trend of younger onset age for ACS and higher proportions of complicated cardiovascular diseases, as well as improved diagnosis and treatment strategies for Chinese ACS patients in 2012.</p>

Biomechanical study on restorative methods of unilateral maxilla based on finite element analysis / 生物医学工程学杂志

This paper is to report our study in which the differences between prosthetic restoration and surgical reconstruction using traditional clasp retention technology were analyzed based on three-dimensional finite element methods in our laboratory. Firstly, the maxillary unilateral defect model was developed using medical image processing software MIMICS. Secondly, the prosthesis was generated by mirroring technology. The clasp was designed according to the methods raised by Aramany. Then, the stress distribution of maxilla was calculated by simulating occlusion. According to the results, after osseointegration of surgical reconstruction, stresses of unaffected abutments were reduced significantly, and less stress of junction occurred near zygoma of affected side, which were all less than stresses of prosthesis restoration. Thus, removing the clasp of surgical reconstruction increased the stresses of unaffected abutments. The stress trends of maxillary components were different between prosthetic restoration and surgical reconstruction. Surgical reconstruction is better than prosthesis restoration in protection of the abutments. Clasp can alleviate the occlusal burden of maxilla. Varieties of retentive technologies can be considered in prosthesis restoration. The surgical reconstruction is more conducive to rehabilitate unilateral maxilla biomechanically in clinic.

The prevalence of risk factors and status of clinical practice patterns among hospitalized patients with acute coronary syndromes / 中华内科杂志

Objective To analyze the distribution of multiple risk factors for hospitalized patients with acute coronary syndromes (ACS) and explore the status and determinants of drug usage recommended by the guideline.Methods This was a multi-center cross-sectional study in 34 hospitals from 22 provinces in China.About ninety ACS patients were consecutively enrolled from each hospital since April 15,2012 according to a standard protocol.Totally,3 253 patients with complete data were analyzed in this study.Results (1) The average age of male patients with ACS was lower than that of female patients (60.4 years vs 66.2 years,P ＜0.01).Nearly 60％ of ACS patients were under the age of 65 years.Early onset of ACS accounted for one-third of male (＜ 55 years of age) and two-fifthes of female patients (＜ 65 years old).(2) Among the four ACS major risk factors (hypertension,hyperlipidemia,smoking and diabetes),hypertension was with the highest prevalence (68.4％).More than 90％ of ACS patients had at least one risk factor and about two-thirds of them had at least two.(3) As for the application of evidence-based drugs,the top one was aspirin with 95.3％ of ACS patients reseiving it.The second was statins (90.1％).Angiotensin converting enzyme inhibitors (ACEI) or angiotension Ⅱ receptor blocker(ARB) was the lowest (53.6％).Multivariable analysis indicated that,in contrast to that in ACS patients without percutaneous coronary intervention(PCI),the drug usage rates were increased by more than 30％ for ACEI or ARB and β receptor blockers,by more than 50％ for statins,and by 4-7 times for antiplatelet agents among ACS patients with PCI.Conclusions In China,more than 90％ of hospitalized patients with ACS carried at least one major risk factor.There is still room for improving in the application of drugs recommended by the guidelines,especially for ACS patients without PCI.

The epidemiology of out-of-hospital deaths due to acute coronary events in young Beijing adults / 中华内科杂志

Objectives To explore the characteristics of status and different populations of prehospital death associated with acute coronary events among young adults in Beijing.Methods Data of acute coronary events of hospitalization or death were obtained from the Hospital Discharge Information System from Beijing Public Health Information Center and Death Register System from Beijing Center for Disease Control in Beijing.The total case fatality rate of acute coronary events and proportion of prehospital coronary heart disease (CHD) death were compared upon gender,area,occupation and marital status among people aged between 25-45 years old.Results A total of 3489 cases were identified during 2007 to 2009 with acute coronary events ( male:3183,female:306),with a mean age of (40.5 ± 4.3 ) years old.The 3-years' overall mortality was 26.0％,with female's higher than male's (51.0％ vs 23.6 ％,P ＜ 0.05 ) ; and it was higher in rural area than in urban areas (28.9％ vs 22.9％,P ＜0.05).Ninety-five percent of death due to acute coronary events occurred prehospital,with the proportion of 95.2％ in male and 94.2％ in female. Among the people with different occupations, self-employed people had the highest rate of prehospital death.Majority of prehospital deaths (64.8％ ) occurred at home.Conclusion More than 90％ of deaths caused by acute coronary events among young adults aged between 25-45 years old occurred before been admitted into hospital,and the site of prehospital deaths was mainly at home.