Diagnostic value of FNDC5 in patients with subclinical diabetic cardiomyopathy / 中华心血管病杂志

Objective: To estimate the diagnostic value of fibronectin type Ⅲ-domain containing protein 5 (FNDC5) in subclinical diabetic cardiomyopathy. Methods: A total of 94 patients with type 2 diabetes (T2DM), who were hospitalized from April 2018 to June 2019 in the Third Affiliated Hospital of Soochow University, were enrolled in this study. Patients were divided into T2DM with cardiac dysfunction (subclinical DCM) group (n=47) and T2DM without cardiac dysfunction (non-DCM) group (n=47) according to echocardiography and gated myocardial perfusion imaging results. Basic clinical data and serum FNDC5 level were compared between the two groups. Logistic regression analysis was used to establish predicting models and the diagnostic efficiency of established models was compared by ROC curve analysis. Results: Compared to non-DCM group, patients in subclinical DCM group were older, with longer duration of diabetes, and had higher levels of glycosylated hemoglobin A1c (HbA1c), total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) (all P<0.05). Serum FNDC5 level was significantly lower in subclinical DCM group than in non-DCM group (P<0.001). FNDC5 level was positively correlated with ventricular septal e'(r=0.451,P=0.005), mitral valve e'(r=0.291,P<0.001), the ratio of peak early diastolic trans-mitral flow velocity (E) to peak late diastolic trans-mitral flow velocity (A)(r=0.490,P=0.002), while negatively correlated with A(r=-0.399,P<0.001), the average ratio of E/e'(r=-0.490,P<0.001), tricuspid regurgitation velocity(r=-0.567,P<0.001), left atrial volume index(r=-0.491,P<0.001). Univariate ROC analysis showed that the diagnostic efficacy of FNDC5(AUC=0.940,95%CI 0.897-0.982)was superior to age(AUC=0.639,95%CI 0.523-0.752), diabetic duration(AUC=0.663,95%CI 0.555-0.772), HbA1c(AUC=0.740,95%CI 0.638-0.839), TG(AUC=0.661,95%CI 0.547-0.776), TC(AUC=0.675,95%CI 0.563-0.788)and LDL-C(AUC=0.644,95%CI 0.532-0.756). Model 1 was established with subclinical DCM as dependent variable, age, diabetic duration, TG, TC, LDL-C and HbA1c as independent variables. Model 2 was established by adding FNDC5 as independent variable on the basis of model 1. Diagnostic efficacy for subclinical DCM was compared between the two models by ROC analysis. The diagnostic efficiency was better with model 2 (AUC=0.980) than with model 1 (AUC=0.879, P<0.001). When sensitivity was set at 0.617, the specificity of model 2 was higher than that of model 1(0.979 vs. 0.936). When sensitivity was set at 0.532, the sensitivity of model 2 was higher than that of model 1 (1.000 vs. 0.915). Conclusions: Our findings suggest that serum FNDC5 could be used as a novel biomarker for the diagnosis of subclinical DCM.

Effectiveness analysis and inspirations of rational administration of carbapenem / 中华医院管理杂志

The hospital introduced a multi-department synergy in management of the rational use of carbapenems. Specifically,the medical affairs department conducts training and appraisal of doctors along with a monthly checkup of medical records. The pharmaceutical affairs division conducts prior prescriptions checkup and follow-up comment. The clinical microbiology laboratory and the hospital-acquired infection management department monitors and releases such infection and bacterial resistance information of the whole hospital in real time. The results showed increased prescriptions of imipenem and cilastatin sodium, and decreased prescriptions of biapenem for injection. Drug resistance analysis showed that carbapenem resistant strains increased by 28%,but the total number of patients reduced by 10% and total number of patients with multidrug resistance remained unchanged. It is proposed to further antimicrobial stewardship in the hospital to achieve rational drug use and curb bacterial resistance.

Study on development and application of simple constraint mattress for child / 中国医学装备

Objective: To develop a child simple constraint mattress with good permeability,soft,comfort,safe and easily cleanable so as to effectively avoid accidents,such as falling from bed,bump injury,scratch and hurting others.Methods: 70 hospitalized children who need restrictive measures were randomly selected in this research and were divided into observation group(35 cases)and control group(35 cases)according to the time sequence of hospitalization.The constraint mattresses was used for children of observation group,and traditional constraint bands of wrist were used for children of control group.And the effectiveness,safety,comfort,convenience and parental satisfaction of the two constraint tools were observed.Results: The effectiveness,safety,comfort,convenience and satisfaction of constraint measure of observation group were significantly higher than those of control group(x2=10.27,x2=15.97,x2=19.09,x2=3.97,x2=15.88,P＜0.05).Conclusion: The constraint effect of simple constraint mattress is better than that of traditional constraint band of wrist.

Significance of serum adenosine deaminase level in type 1 diabetes patients with acute or chronic diabetes complications / 实用医学杂志

Objective To investigate the significance of serum adenosine deaminase level in type 1 diabe-tes patients(T1DM)with acute or chronic diabetes complications. Methods One hundred and eighty-four cases of type 1 diabetes patients were divided into three groups:T1DM without any complications(n = 55),T1DM with acute diabetes complications(n = 47)and T1DM with chronic diabetes complications(n = 82). We also enrolled 108 healthy persons as the control group.The clinical and biochemical data were collected and the influencing fac-tors of serum ADA were analyzed. Resultes(1)Serum ADA level of T1DM patients was higher than that of the healthy control people.T1DM patients with acute diabetes complications had lower serum ADA level compared with T1DM patients with chronic complications.(2)Results of Pearson correlations analysis showed that serum ADA level had positive correlation with fasting blood glucose.(3)Logistic regression analysis showed that the increase of serum ADA level was an independent risk factor in patients with chronic diabetes complications(OR:1.159,95% Cl:1.044~1.286),while it was a protective factor in patients with acute diabetes complications(OR:0.857,95% Cl:0.748~0.981). Conclusions High serum ADA level was observed in type 1 diabetes patients. The serum ADA level was an independent risk factor for T1DM patients with chronic diabetes complications,while it was a protective factor for T1DM patients with acute diabetes complications.

Effectiveness evaluation of the Thyroid Imaging Report and Data System proposed by American Radiological Society (2017) (ACR-TIRADS) for differential diagnosis in thyroid nodules / 中华超声影像学杂志

Objective@#To evaluate the effect of the Thyroid Imaging Report and Data System proposed by American Radiological Society (ACR-TIRADS) for differential diagnosis in thyroid nodules, and compare ACR-TIRADS to the TIRADS proposed by Kwak et al.(K-TIRADS) and the ultrasound-based risk stratification system evaluated by American Thyroid Association (ATA-Risk Stratification).@*Methods@#The clinical data of 1 760 patients with 1 912 thyroid nodules from 8 hospitals in Jiangsu province were retrospectively analysed. All of them were categorized based on ultrasound-based risk stratification systems. The ROC curve was established to assess and compare the diagnostic value of the systems.@*Results@#The area under the ROC curve (AUC) of ACR-TIRADS was 0.830, with high sensitivity and negative predictive value (86.9% and 87.5%, respectively), and relatively low specificity and positive predictive value (64.1% and 62.9%, respectively). The sensitivity and specificity of K-TIRADS were up to 84.9% and 76.1%, respectively. The AUC of ATA-Risk Stratification was 0.852, with relatively high specificity (83.4%), and low sensitivity (79.4%). There were significant differences in the AUC among the three ultrasound-based risk stratification systems, of which K-TIRADS was the highest (P<0.001). There was no significant difference in sensitivity of ACR-TIRADS and K-TIRADS (P=0.137), but significantly higher than that of ATA-Risk Stratification (P<0.001). There were significant differences in the specificity among the three systems, of which ATA-Risk Stratification was the highest (P<0.001). In addition, there were 109 nodules (5.7%) couldn′t be classified based on ATA-Risk Stratification, with high malignancy rate of 31.2%.@*Conclusions@#The diagnostic efficiency of ACR-TIRADS is good, but lower than K-TIRADS and ATA-Risk Stratification. ACR-TIRADS has the highest sensitivity, and ATA-Risk Stratification has the highest specificity, while the overall diagnostic efficiency of K-TIRADS is the best.

Comparison of diagnostic value between TIRADS and ultrasound patterns of ATA (2015) guidelines in the differentiation of benign and malignant thyroid nodule / 中华内分泌代谢杂志

To compare the diagnostic value between the thyroid imaging reporting and data system ( TIRADS) and ultrasound ( US ) patterns of 2015 American Thyroid Association ( ATA ) guidelines in the differentiation of benign and malignant thyroid nodules. 639 patients in Jiangsu province who were scheduled for ultrasound-guided fine-needle aspiration biopsy or thyroidectomy were recruited for the retrospective study. All of them were categorized based on TIRADS and ultrasound patterns of ATA ( 2015 ) guidelines. The receiver operating characteristic curve was established to assess and compare the diagnostic value of the two models. Results:( 1 ) 639 patients with 847 thyroid nodules were included in this study, 510 females and 129 males. The mean age was (46. 77 ±12.98)yearsold. (2)818nodulescouldbeclassifiedaccordingtoTIRADS. ThemalignancyratesofTIRADS2,3, 4A, 4B, 5 were 0, 15. 9%, 49. 1%, 78. 8% ,and 100%, respectively. (3) Ultrasound patterns of ATA could be assigned to 793 nodules. The malignancy rates of nodules with very low, low, intermediate, high suspicion for malignancy were 6. 2%, 10. 3%, 24. 9% and 70. 1%, respectively. (4) Ultrasound patterns of ATA had higher specificity (77. 9%) compared to TIRADS. The sensitivity and area under curve of ultrasound patterns of ATA were lower than those of TIRADS, though, not significant. Ultrasound patterns of ATA(2015) guidelines may yield higher specificity in the differential diagnosis of benign and malignant thyroid nodules, while TIRADS classification may offer a relatively higher sensitivity and area under curve.

The impact of obstructive sleep apnea-hypopnea syndrome on early renal damage among patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

[Summary] The aim of this study was to examine the association between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and microalbuminuria in type 2 diabetes mellitus patients. We found that severe OSAHS significantly increases the risk of early renal damage in type 2 diabetes mellitus patients with HbA1C<7% ( lowest oxygen saturation:OR=2. 41, 95% CI 1. 19-8. 08; apnea hyponea index: OR=2. 91, 95% CI 1. 50-9. 11), suggesting that OSAHS may increase the risk for early renal damage in type 2 diabetes mellitus, especially in those with successful control of glucose.

Role of AMPK-dependent autophagic signaling pathway in ketamine-induced reduction of diabetic neuropathic pain in rats / 中华麻醉学杂志

Objective To evaluate the role of AMP-activated protein kinase (AMPK)-dependent autophagic signaling pathway in ketamine-induced reduction of diabetic neuropathic pain (DNP) in rats.Methods Sixty male Wistar rats,aged 3 months,weighing 200-250 g,were equally randomized into 5 groups using a random number table:control group (C group),normal saline group (NS group),ketamine group (K group),ketamine + Compound C group (KC group),and ketamine + 3-methyladenine (3-MA) group (KM group).DNP model was established by intraperitoneal injection of streptozocin (STZ)65 mg/kg in anesthetized rats.Four weeks later,the equal volume of normal saline,ketamine 10 mg/kg,ketamine 10 mg/kg + Compound C1 mg/kg,and ketamine + 3-MA 2 μl were injected intraperitoneally once a day for 7 consecutive days in NS,K,KC and KM groups,respectively.The mechanical paw withdrawal threshold (MWT) was measured on 8th day.The rats were then sacrificed,and the lunbar segment (L1-5) of the spinal cord was removed for determination of the expression of AMPKαt,Beclin-1,microtubule-associated protein 1 light chain (LC) 3B (by Western blot) and dendritic spine density in the dorsal root ganglia.Results Compared with group C,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in group NS (P＜0.05).Compared with group NS,the MWT,expression of AMPKαt,Beclin-1,and LC3B,and dendritic spine density were significantly increased in group K (P＜0.05).Compared with group K,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in KC and KM groups (P＜0.05).Conclusion Activation of AMPK-dependent autophagic pathway is involved in ketamine-induced reduction of DNP in rats.

Experimental research on the prevention of rabbit postoperative abdominal cavity adhesion with PLGA membrane / 生物医学工程学杂志

The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factor β1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group 1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.

Establishment of a rabbit model of facial skin lifting and application of the absorbable soft tissue plastic belt / 中国比较医学杂志

Objective To establish a rabbit model of facial skin lifting and to evaluate the skin lifting effects of absorbable soft tissue plastic belt, and to provide experimental basis for clinical application of this plastic belt.Methods 36 Japanese white rabbits were randomly divided into model control group (n=6) and plastic belt lifting group (n=30). The model control group received only facial skin resection surgery, while the plastic belt lifting group had facial skin resection and plastic belt implantation.The changes of rabbit general status, skin lifting effects, performance of plastic belt and pathological changes of subcutaneous tissue after implantation were determined during the 4 weeks after surgery. Results The rabbit skin wound was healed within 3-7 days after surgery without infection.Meanwhile, the plastic belts did not show shifting or rupture, and only whitening around the perforations was observed in the two groups.Compared with the model control group, the MA and MB distances in the plastic belt lifting group were significantly lower ( P0.05 ) .Moreover, the molecular weight ( Mw ) , peak molecular weight ( Mp ) , Z molecular weight (Mz) and viscosity were gradually decreased along with the time passing after implantation (P<0.01), and its dispersion Mz/Mw ratio was also gradually decreased from 2 weeks after implantation (P<0.01), and no obvious pathological changes were found after subcutaneous implantation of the plastic belts.Conclusions We have successfully established a facial skin lifting rabbit model, and the plastic belt can obviously lift the facial skin fascia system and keep intact more than 4 weeks in the body.Therefore, this plastic belt can be applied for anti-wrinkle facial soft tissue lifting against the skin damage caused by aging.

Development and systematical evaluation of an up-converting phosphor technology based lateral flow assay for quantitative detection of Burkholderia pseudomallei / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop an up-converting phosphor technology-based lateral-flow (UPT-LF) assay for rapid quantitative detection of Burkholderia pseudomallei on site.</p><p><b>METHODS</b>The strip Bps-UPT-LF strip was prepared with up-converting phosphor (UCP) particles as the bio-label using double-antibody sandwich method. Detection performance, including sensitivity, quantitative accuracy, precision, and specificity, were first evaluated using bacterial suspensions of Burkholderia pseudomallei, the related species and the strains which had similar routes of transmission with serial standard concentrations diluted by phosphate buffer, then biological and chemical reagents and simulated samples with series concentrations were employed for sample tolerance evaluation, while the operation error during on site detection was also evaluated through adjusting liquid measure.</p><p><b>RESULTS</b>The whole detection was accomplished within 20 minutes, and the sensitivity was 10(4) CFU/ml with linear quantitative range from 10(4) CFU/ml to 10(7) CFU/ml, which covered four orders of magnitude. Bps-UPT-LF strip demonstrated high specificity with the absence of any false-positive result even at 10(7) and 10(8) CFU/ml of non-specific bacterial contamination. Not only Bps-UPT-LF strip could tolerate to high concentration of the extreme acid and basic matter (pH 1-12), saline matter (≤ 2 mol/L mixture of NaCl and KCl), viscous materials (≤ 50 g/L of PEG 20000 and ≤ 20% of glycerol) and bio-macromolecule (≥ 400 g/L of bovine serum albumin or ≥ 80 g/L of casein), but also it can directly detect animal, environmental and powder specimen, such as ≥ 400 g/L of milk powder, flour powder, fruit juice, fresh and decomposed viscera, and ≤ 200 g/L of putty powder, sucrose, gourmet powder, and soil. Operation errors of liquid measure had few effects on sensitivity and specificity, including -50%-200% of sample, -22%-44% of sample-treating buffer and -30%-30% of loading mixture.</p><p><b>CONCLUSION</b>The good detection performance and tolerance performance bring the bright future for Bps-UPT-LF strip to detect Burkholderia pseudomallei on site rapidly and quantitatively for nature foci surveillance and anti-bioterrorism.</p>

Clinical analysis on replantation of severed palm in 45 patients / 中国骨伤

<p><b>OBJECTIVE</b>To explore methods and clinical outcomes of microsurgical technique in treating patients with severed palm.</p><p><b>METHODS</b>From January 2009 to December 2012,45 patients with severed palm were treated by replantation through microsurgical technique, included 37 males and 8 females, aged from 13 to 45 years old with an average of 25. Postoperative survival rate and evaluation standard of upper limb replantation function posposed by Chinese Medical Association were applied for evaluate clinical outcomes after operation.</p><p><b>RESULTS</b>Forty-five patients with severed plam were treated by replantation. Thirty-nine patients (121 fingers) were survived,and survival rate was 87%. All patients were followed up 3 to 15.5 months with an average of 11.5 months. According to evaluation standard of upper limb replantation function posposed by Chinese Medical Association, the total score was 80.27 +/- 1.93, and 27 cases got excellent results, 8 good and 4 poor.</p><p><b>CONCLUSION</b>The success of replantation of severed palm depends on grasping operation indication strictly, knowing complexity and local anatomic relationship, debridement completely during operation, making full use of remaining organization, arteriovenostomy through microsurgical technique as early as possible, constructing circulation and repairing injuried nerve rationally.</p>

Effects of PLGA absorbable membrane on preventing postoperative abdominal adhesion in rabbits / 中国医疗器械杂志

<p><b>OBJECTIVE</b>To investigate the effects of PLGA absorbable membrane in prevention of postoperative abdominal adhesion in rabbits.</p><p><b>METHODS</b>66 Japanese white rabbits were randomly divided into three groups: the normal control group n = 6, model control group n = 30 and PLGA group n = 30. Rabbits were received multifactor methods to establish postoperative abdominal adhesion models except for normal control group. The cecum wound was covered PLGA membrane in the PLGA group. At postoperative 1, 2, 4, 6 and 12 weeks, the abdominal cavities were reopened and the adhesive severity was graded blindly, and the hydroxyproline level in cecum tissue was measured and the cecum histopathology was observed.</p><p><b>RESULTS</b>(1) the degree of adhesion and hydroxyproline level in model control group were significantly higher than those of normal control group (P < 0.05, P < 0.01), while the degree of adhesion and hydroxyproline level in PLGA group were significantly lower than those of model control group (P < 0.05). (2) HE staining showed that cecum serosa had obviously inflammatory cell infiltration and fibroblast proliferation, while PLGA could inhibit fibroblast proliferation and reduce the inflammatory cell infiltration and collagen.</p><p><b>CONCLUSION</b>PLGA absorbable membrane can inhibit fibroblast proliferation and collagen to prevent the experimental postoperative peritoneal adhesions.</p>

A new β-carboline alkaloid from the seeds of Griffonia simplicifolia / 中国天然药物

AIM@#To study the chemical constituents from the seeds of Griffonia simplicifolia Baill.@*METHODS@#The chemical constituents were isolated and purified by a combination of chromatographic materials including silica gel, Sephadex LH-20, and preparative TLC. Their structures were elucidated on the basis of MS and NMR data analysis. The cytotoxic activities were evaluated against HepG2 cancer cell line using the MTT colorimetric method.@*RESULTS@#A new β-carboline alkaloid, griffonine (1), together with seven known alkaloids, hyrtioerectine B (2), 3-carboxy-6-hydroxy-β-carboline (3), hyrtiosulawesine (4), 5-hydroxyindole-3-carbaldehyde (5), 5-hydroxy-3-(2-hydroxyethyl) indole (6), trigonelline (7), and 5-hydroxytryptamine (8) were isolated and identified. Alkaloids 1, 2 and 4 showed growth inhibitory effects on the HepG2 cell line with IC50 values of 23.5, 9.6 and 19.3 μmol·L(-1), respectively.@*CONCLUSION@#Alkaloid 1 is new and was named griffonine. Alkaloids 2-7 were isolated from this plant for the first time. Alkaloids 1, 2 and 4 were potentially cytotoxic.

Changes and significance of serum total bilirubin,gamma glutamyltransferase in patients with type 2 diabetes / 中国医师进修杂志

Objective To analyze the changes of serum total bilirubin (TBil) and gamma glutamyltransferase (GGT) in patients with type 2 diabetes newly diagnosed without complications and explore their relationship with vascular complications of type 2 diabetes.Methods The levels of serum TBil and GGT were determined by automatic biochemical analyzer in 42 healthy person (control group),64patients with type 2 diabetes without complications (diabetes without complications group) and 81 patients with type 2 diabetes with vascular complications (diabetes with complications group).Results The levels of serum TBil and GGT were (7.89 ± 4.81) μ mol/L and (29.81 ± 14.97) U/L in diabetes with complications group.The level of serum TBil was (10.42 ± 3.55) μ mol/L in control group.The levels of serum TBil and GGT were (11.30 ± 4.16) μ mol/L and (47.00 ± 38.57) U/L in diabetes without complications group.The level of serum TBil in diabetes with complications group was lower than that in control group and diabetes without complications group (P ＜ 0.05).The level of serum GGT in diabetes with complications group was lower than that in diabetes without complications group (P ＜ 0.05).Pearson correlation analysis showed that 24-hour urinary protein excretion,urinary albumin creatinine ratio had negative correlation with serum TBil (P ＜0.05).Logistic regression analysis showed that GGT was the protective factor of diabetic vascular complications (OR =0.965).Conclusion The levels of serum TBil and GGT may be associated with the occurrence and development of vascular lesions in patients with type 2 diabetes.

Diagnosis and treatment of apical ballooning syndrome complicated with asthma: A case report and literature review / 第二军医大学学报

Objective To improve our knowledge on the clinical characteristics, diagnosis, and treatment of apical ballooning syndrome (ABS) complicated with asthma. Methods and results A 73 year-old female patient, with a 10-year history of asthma and a 4-year history of recurrent chest distress, was admitted due to chest distress, cough for 15 days and chest pain for 7 hours. Coronary arteriography during emergent percutaneous coronary intervention (PCI) showed a 40% stenosis in the anterior descending artery, and stenosis was not found in other vessels. Left ventriculographic showed apical ballooning, echocardiography showed a 3 5% left ventricular ejection fraction, and the patient was diagnosed as having ABS with asthma. The cardiac function gradually recovered after symptomtargeted treatment. Literatures showed that it was difficult to distinguish between ABS and acute myocardial infarction i the treatments and prognoses of them were very different. When acute lett ventricular failure was complicated withABS and asthma, it was difficult to distinguish from pulmonary asthma and the treatment was very different. Conclusion Clinicians should improve the knowledge of ABS and put more emphasis on differential diagnosis so as to make the right treatment decision.

Diagnosis and treatment of apical ballooning syndrome complicated with asthma: A case report and literature review / 第二军医大学学报

Objective To improve our knowledge on the clinical characteristics, diagnosis, and treatment of apical ballooning syndrome (ABS) complicated with asthma. Methods and results A 73 year-old female patient, with a 10-year history of asthma and a 4-year history of recurrent chest distress, was admitted due to chest distress, cough for 15 days and chest pain for 7 hours. Coronary arteriography during emergent percutaneous coronary intervention (PCI) showed a 40% stenosis in the anterior descending artery, and stenosis was not found in other vessels. Left ventriculographic showed apical ballooning, echocardiography showed a 3 5% left ventricular ejection fraction, and the patient was diagnosed as having ABS with asthma. The cardiac function gradually recovered after symptomtargeted treatment. Literatures showed that it was difficult to distinguish between ABS and acute myocardial infarction i the treatments and prognoses of them were very different. When acute lett ventricular failure was complicated withABS and asthma, it was difficult to distinguish from pulmonary asthma and the treatment was very different. Conclusion Clinicians should improve the knowledge of ABS and put more emphasis on differential diagnosis so as to make the right treatment decision.

Effect of Pseudomonas aeruginosa on the expressions of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in the airway of bronchiectasis patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the airway of bronchiectasis (BE) patients, and evaluate the effect of pseudomonas aeruginosa (PAE) on the expression of TIMP-1 and MMP-9.</p><p><b>METHODS</b>In this case-control study, subjects were divided into BE group and control group, and the BE group was further divided into PAE group and other bacteria group based on the culture results of bronchoalveolar lavage fluid (BALF). BALF was obtained by bronchoscopy, the expressions of MMP-9 and TIMP-1 were determined by ELISA, then the ratio of TIMP-1/MMP-9 was calculated. Furthermore, the tissue of bronchic endomembrane was obtained by transbronchial biopsy and the expressions of MMP-9 and TIMP-1 were determined using immunohistochemical method.</p><p><b>RESULTS</b>The levels of MMP-9 in the BALF of PAE group and other bacteria group were significantly higher than that in control group (P=0.0000 both), and the expressions of MMP-9 in bronchic endomembrane of PAE group and other bacteria group were also significantly higher (P=0.0421 and 0.0003, respectively). The level of TIMP-1 in BALF of PAE group was significantly lower than that in other bacteria group (P=0.0324). The ratio of TIMP-1/MMP-9 in BALF of BE group was significantly lower than that in control group(P=0.0000), and this ratio of PAE group was significantly lower than those in both other bacteria group and control group (P=0.0026 and 0.0000, respectively).</p><p><b>CONCLUSION</b>PAE infection in BE patients can suppress the expression of TIMP-1 and stimulate the expression of MMP-9, and thus make the disease even worse.</p>

Safety and efficacy of tramadol hydrochloride with behavioral modification in the treatment of premature ejaculation / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of tramadol hydrochloride with behavioral modification in delaying ejaculation in patients with premature ejaculation.</p><p><b>METHODS</b>Seventy-two potent men with premature ejaculation were equally and randomly assigned to a treatment group and control group, the former received 50 mg tramadol hydrochloride with behavioral modification approximately 2 hours before planned sexual activity, while the latter underwent behavioral therapy only, both treated for 8 weeks. Intravaginal ejaculatory latency time (IELT), intercourse satisfaction of the partners, total therapeutic effectiveness, adverse reactions, and hepatic and renal function of the patients were recorded and compared before and after the treatment.</p><p><b>RESULTS</b>Both the treatment and the control groups showed significant differences from pretreatment in the mean IELT and intercourse satisfaction domain values (P < 0.01). The total rate of effectiveness was 72.2% in the treatment group and 47.2% in the control. The former exhibited even more significant improvement than the latter in the mean IELT, intercourse satisfaction domain values and total rate of effectiveness (P < 0.05). Adverse reactions occurred in 10 cases (27.8%), and no statistically significant differences were found in hepatic and renal function before and after treatment (P > 0.05).</p><p><b>CONCLUSION</b>Tramadol hydrochloride with behavioral modification showed positive effects in prolonging IELT and improving partners' intercourse satisfaction. Yet more multicenter and double-blind studies are required to evaluate its efficacy and safety as a routine therapy for premature ejaculation.</p>

The application of triple branches aortic arch stent-graft placement in the surgical treatment of acute Stanford type A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up the experience of performing ascending aorta replacement combined triple-branched stent graft implantation for acute Stanford type A aortic dissection.</p><p><b>METHODS</b>From January 2010 to December 2010, 14 patients with acute Stanford type A aortic dissection underwent the procedure of performing ascending aorta replacement combined triple-branched stent graft implantation. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. When the body temperature drops below 18°C, the ascending aorta was transected near the base of the innominate artery. From the incision, the triple-branched stent graft was implanted into the true lumen of the arch, descending aorta and the aorta bifurcation vessel. The transected stump of the ascending aorta was anastomosis to the proximal of the branched blood vessel prosthesis.</p><p><b>RESULTS</b>Cardiopulmonary bypass time was (186 ± 38) min, cross clamp time was (101 ± 27) min, and average selective cerebral perfusion and lower body arrest time was (39 ± 11) min. The in-hospital mortality was zero. One patient of transient postoperative neurologic dysfunction, one of acute renal failure, one of transient limbs disturbance, one of secondary thoracotomy operation, one of gastrointestinal hemorrhage and one of postoperative chylothorax were observed. CT angiography rechecked showed the position of the vascular stent were satisfactory and the blood flow of arterial branches stents were lucid. The false lumen of the aortic arch and descending aorta closed with thrombus or shrinked.</p><p><b>CONCLUSIONS</b>The patients required aortic arch to be reconstructed which had no main tearing of intima in the arch may be best candidates for this technique. Open triple-branched stent graft placement combined ascending aorta replacement is an effective means for aortic arch reconstruction in acute Stanford type A aortic dissection.</p>