Diagnostic value of aldosterone to renin ratio calculated by plasma renin activity or plasma renin concentration in primary aldosteronism: a meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis.@*METHODS@#We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data.@*RESULTS@#The pooled results showed that ARR (plasma aldosterone concentration [PAC]/PRC) had a sensitivity of 0.82 (95% confidence interval [CI]: 0.78-0.86), a specificity of 0.94 (95% CI: 0.92-0.95), a positive-likelihood ratio (LR) of 12.77 (95% CI: 7.04-23.73), a negative LR of 0.11 (95% CI: 0.07-0.17), and symmetric area under the curve (SAUC) of 0.982, respectively. Furthermore, the diagnostic odds ratio (DOR) of ARR (PAC/PRC) was 180.21. Additionally, the pooled results showed that ARR (PAC/PRA) had a sensitivity of 0.91 (95% CI: 0.86-0.95), a specificity of 0.91 (95% CI: 0.90-0.93), a positive LR of 7.30 (95% CI: 2.99-17.99), a negative LR of 0.10 (95% CI: 0.04-0.26), and SAUC of 0.976, respectively. The DOR of ARR (PAC/PRA) was 155.52. Additionally, we conducted a subgroup analysis for the different thresholds (<35 or ≥35) of PAC/PRC. The results showed that the DOR of the cut-off ≥35 groups was higher than the cut-off <35 groups (DOR = 340.15, 95% CI: 38.32-3019.66; DOR = 116.40, 95% CI = 23.28-581.92).@*CONCLUSIONS@#The research results suggest that the determination of ARR (PAC/PRC) and ARR (PAC/PRA) was all effective screening tools for PA. The diagnostic accuracy and diagnostic value of ARR (PAC/PRC) are higher than ARR (PAC/PRA). In addition, within a certain range, the higher the threshold, the better the diagnostic value.

Semiological characteristics and clinical application value of bilateral asymmetrical tonic seizures / 中华神经科杂志

Objective To illustrate the semiological characteristics of the three sub-types within the broad bilateral asymmetric tonic seizures (BATS),summarize their predictive values on lateralization and localization of seizure onset zone (SOZ),and analyze the difference between BATS and asymmetrical tonic limb posturing (ATLP).Methods A retrospective review of 385 patients who underwent stereotactic electrode implantation in the Sanbo Brain Hospital,Capital Medical University from September 2011 to May 2018 was performed.As long as there was a clinical epileptic seizure in the presence of BATS or ATLP,the patients were classified into the corresponding groups.Postoperative prognosis was assessed using Engel's grading criteria for a follow-up of no less than six months.Seizure descriptions were based on the classification of epileptic seizures introduced by Lüiders,which used arrows to connect the symptoms in chronological order.Results There was no statistically significant difference between the classic BATS and bilateral proximal tonic seizure in terms of whether it could be an independent seizure,as the onset and end of the seizure,with version and generalized tonic-clonic seizure (P＞0.05).Compared with the ATLP,except for whether it could be an independent seizure (P=1.000) and onset before versive seizure (P=0.068),the BATS showed significantly different semiological features (P＜0.05).The classic BATS and secondary motor area epilepsy had a 100.0％ predictive accuracy on the lateralization of SOZ.In the patients with broad BATS,the SOZ distribution was more extensive,but it was rare in the orbitofrontal gyrus,frontal pole and mesial temporal lobe.Compared with the bilateral proximal tonic seizures from the other regions,those originated from supplementary somatosensory motor area and its adjacent areas were rare and showed no statistically significant difference (0/8 vs 40.0％ (18/45),x2=3.226,P=0.072) but a low trend.The predictive value of BATS on lateralization of SOZ was higher than that of ATLP (84.9％ (45/53) vs 57.1％ (24/42),x2=9.086,P=0.003),and BATS was less originated from temporal lobe than ATLP (3.8％ (2/53) vs 23.8％ (10/42),x2=8.523,P=0.004).Conclusion Different from ATLP,the broad BATS are characterized by tonic proximal upper limb posturing,and have a higher predictive value on lateralization and localization of SOZ.

Preliminary experimental study on hypofibrinogenemia in the long-term administration of hemocoagulase / 国际检验医学杂志

Objective To study the effect of the long-term administration of hemocoagulasein vitro and in vivo,whether it may cause hypofibrinogenemia and changes of cytokine interleukin-6(IL-6) expression level which related to fibrinogen synthesis.Methods Totally 50 healthy subjects pooled plasma was chose in vitro experiments,which was divided into 7 groups.After that,added various of dilutions of injection hemocoagulase and incubated at 37 ℃,detected FIB concentration every 12 h.In vivo experiments,80 rats with six-week old were randomly divided into 4 groups:negative control group,high-dose group,middle-dose group,low-dose group,After 3 weeks administration,the serum level of Ⅴfactor,Ⅷ factor,PT,activated partial thromboplastin time (APTT),FIB,IL-6 was detected.Results Hemocoagulase in vitro had a strong role to reduce fibrin,and showed a significant dose-dependent and time-dependent;Hemocoagulase prolonged low-dose use might reduce the concentration of FIB in mice,but theⅤfactor,Ⅷ factor,PT,APTT,TT were not significantly affected.Compared with the negative control group,FIB and IL-6 concentration decreased in high-dose group,middle-dose group,low-dose group and had statistically significant differences (P<0.05);The level of FIB among the groups had statistically significant differences (P<0.05).The APTT of the middle and high dose groups was slightly prolonged,which was significantly different from that of the negative control group (P<0.05).Conclusion Hemocoagulase has a strong effect to reduce the concentration of fibrin,when there is a long-term medication,fibrin concentration of the patient should be closely monitored,hemocoagulase not only directly decomposed fibrin,but also may affect the synthesis of IL-6,the specific mechanism needs further study.

Erythropoietin protects rats with heart failure in hypothermia by activating PI3K/Akt pathway and upregulating the expression of HSP70 / 中国病理生理杂志

AIM: To investigate the effect oferythropoietin (EPO) on the rats with heart failure (HF) in hypothermia and to explore its underlying mechanism.METHODS: The Sprague-Dawley rats (n=80) were randomly divided into five groups: control group (CON group), HF in low-temperature group (HFLT group), HF in normal temperature group (HFNT group), HF with EPO in low temperature group (HFLT+EPO group), and HF with EPO and LY2940002 in low temperature group (HFLT+EPO+LY group).All rats were housed in artifitial climate chamber.The animals in CON, HFLT, HFLT+EPO and HFLT+EPO+LY groups were under the low-temperature environment, while those in HFNT group were under normal temperature.The heart function was evaluated by echocardiography.The rats were then executed and the hearts were harvested.The apoptosis of myocytes was assessed by TUNEL method.The mRNA expression of Fas and PI3K was detected by fluorescence quantitative PCR (qPCR) and the protein levels of HSP70, Akt and p-Akt in the myocardial tissues were determined by Western blot.RESULTS: The rat cardiac functions in HFLT group were significantly deteriorated compared with HFNT group.The cardiac functions in HFLT+EPO group were improved compared with HFLT group.The cardiac functions in HFLT+EPO+LY group were significantly pejorated compared with HFLT+EPO group.The apoptotic index of the myocardium in HFLT group and HFNT group was significantly higher than that in CON group (P<0.01).The apoptotic index of the myocardium in HFLT group was significantly higher than that in HFNT group (P<0.05).The apoptotic index of the myocardium in HFLT+EPO group was significantly lower than that in HFLT group (P<0.01).The mRNA expression of Fas in HFLT group was significantly higher than that in HFNT group, and no obvious difference of the mRNA expression level of PI3K between HFLT group and HFNT group was observed.The mRNA expression of PI3K in HFLT+EPO group was significantly lower than that in HFLT group and HFLT+EPO+LY group (P<0.05), and that in HFLT+EPO group was significantly higher than that in HFLT group and HFLT+EPO+LY group (P<0.05).The protein levels of p-Akt and HSP70 in HFLT+EPO group was also higher than those in HFLT group and HFLT+EPO+LY group (P<0.05), and no obvious difference of the protein levels of p-Akt and HSP70 in CON, HFLT and HFNT groups was found.The protein level of Akt had no significant difference in each group.CONCLUSION: The pathway of PI3K/Akt may be one of the cardioprotective ways of EPO.EPO activates the PI3K/Akt pathway, upregulates the experssion of HSP70 (an endogenous protective factor) and inhibits the apoptosis, thus protecting the cardiac functions in the rats with HF in hypothermia.