Long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion / 中华医学杂志(英文版)

BACKGROUND@#The development of the technique has improved the success rate of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). However, long-term outcomes remain unclear. The present study sought to investigate long-term outcomes of PCI for IS-CTO.@*METHODS@#A total of 474 IS-CTO patients were enrolled at two cardiac centers from 2015 to 2018 retrospectively. These patients were allocated into either successful or failed IS-CTO PCI groups. The primary endpoint (major adverse cardiac events [MACE]) consisted of recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) at follow-up. Multivariable Cox regression analysis was used to investigate the association between treatment appropriateness and clinical outcomes.@*RESULTS@#A total of 367 patients were successfully treated with IS-CTO PCI while 107 patients had failed recanalization. After a median follow-up of 30 months (interquartile range: 17-42 months), no significant difference was observed between the two groups for the following parameters: cardiac death (successful PCI vs. failed PCI: 0.9% vs. 2.7%; adjusted hazard ratio [HR]: 1.442; 95% confidence interval [CI]: 0.21-9.887; P = 0.709), RAP (successful PCI vs. failed PCI: 40.8% vs. 40.0%; adjusted HR: 1.025; 95% CI: 0.683-1.538; P = 0.905), heart failure (successful PCI vs. failed PCI: 6.1% vs. 2.7%; adjusted HR: 0.281; 95% CI: 0.065-1.206; P = 0.088), target-vessel related MI (successful PCI vs. failed PCI: 1.5% vs. 2.7%; adjusted HR: 1.150; 95% CI: 0.221-5.995; P = 0.868), MACE (successful PCI vs. failed PCI: 44.2% vs. 45.3%; adjusted HR: 1.052; 95% CI: 0.717-1.543; P = 0.797). More patients were free of angina in the successful IS-CTO PCI group compared with failed PCI in the first (80.4% vs. 60%, P 18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of TVR (HR: 2.682; 95% CI: 1.295-5.578; P = 0.008) or MACE (without TVR) (HR: 1.898; 95% CI: 1.036-3.479; P = 0.038) in successful IS-CTO PCI.@*CONCLUSIONS@#After a median follow-up of 30 months, the successful IS-CTO PCI group had MACE similar to that of the failed PCI group. However, the successful IS-CTO PCI group had improved angina symptoms and were free from requiring coronary artery bypass grafting in the first or second years. To decrease MACE, DAPT was found to be essential and recommended for at least 18 months for IS-CTO PCI.

Protective effect of ulinastatin on myocardial injury after cardiopulmonary resuscitation in pigs / 中华急诊医学杂志

Objective To evaluate the protective effect of ulinastatin (UTI) on myocardial injury after post-cardiac arrest syndrome (PCAS) of cardiopulmonary resuscitation in pigs.Methods Twelve male 3-4 months pigs were randomly divided into two groups,UTI group and control group.The ventricular fibrillation (VF) animal model was replicated by programmed stimulation method.Among the 12 pigs,11 pigs were successfully resuscitated by CPR after 5 min VF,of which,6 pigs were in the UTI group and 5 pigs in the control group.Immediately after resuscitation,pigs in the UTI group was given 100 kU dissolved in 5 mL normal saline with slowly injection every 3 h until 24 h after recovery (no drug was given at 24 h).In the control group,5 mL normal saline was given with same delivery time and frequency as that in the UTI group.The venous blood of the pigs was collected at VF,2,4,6,12,and 24 h after ROCS,and tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),superoxide dismutase (SOD),malondialdehyde (MDA),and ischemia modified albumin (IMA) were measured by enzymelinked immunosorbent assay (ELISA) method.Because IMA was sensitive and increased rapidly,venous blood was detected at 1 h after ROSC,and the rest test time were same with the rest of the blood factors.Statistical analysis was performed using LSD-t test and variance analysis.The pigs were sacrificed 24 h after ROSC,and specimens from heart tissue were taken for HE staining.Results Before ventricular fibrillation in three groups,there was no significant difference in serum levels of inflammatory cytokines,oxidative stress indexes,and myocardial ischemia markers between the two groups (P＞0.05).At 2 h after ventricular fibrillation,the levels of TNF-α and IL-6 level in the UTI group was significantly lower than those in the control group.At 4 h,MDA level in the UTI group was significantly lower than that in the control group (P＜0.05);IMA was significantly increased at 1 h after ROSC,and the level of 1 h in the UTI group was significantly lower than that in the control group (P＜0.05),but was not statistically significant at 12 h between the two groups (P＞0.05).HE staining results showed that the damage degree of myocardial tissue in the UTI group was significantly lower than that in the control group at 24 h after ROSC.Conclusions UTI can significantly antagonize inflammatory response,reduce oxidative stress,and improve the myocardial tissue injury after resuscitation.It can protect myocardial injury after cardiopulmonary resuscitation.

Protective effect of ulinastatin on myocardial injury after cardiopulmonary resuscitation in pigs / 中华急诊医学杂志

Objective@#To evaluate the protective effect of ulinastatin (UTI) on myocardial injury after post-cardiac arrest syndrome (PCAS) of cardiopulmonary resuscitation in pigs.@*Methods@#Twelve male 3-4 months pigs were randomly divided into two groups, UTI group and control group. The ventricular fibrillation (VF) animal model was replicated by programmed stimulation method. Among the 12 pigs, 11 pigs were successfully resuscitated by CPR after 5 min VF, of which, 6 pigs were in the UTI group and 5 pigs in the control group. Immediately after resuscitation, pigs in the UTI group was given 100 kU dissolved in 5 mL normal saline with slowly injection every 3 h until 24 h after recovery (no drug was given at 24 h). In the control group, 5 mL normal saline was given with same delivery time and frequency as that in the UTI group. The venous blood of the pigs was collected at VF, 2, 4, 6, 12, and 24 h after ROCS, and tumor necrosis factor -α (TNF-α), interleukin-6 (IL-6), superoxide dismutase (SOD), malondialdehyde (MDA), and ischemia modified albumin (IMA) were measured by enzyme-linked immunosorbent assay (ELISA) method. Because IMA was sensitive and increased rapidly, venous blood was detected at 1 h after ROSC, and the rest test time were same with the rest of the blood factors. Statistical analysis was performed using LSD-t test and variance analysis. The pigs were sacrificed 24 h after ROSC, and specimens from heart tissue were taken for HE staining.@*Results@#Before ventricular fibrillation in three groups, there was no significant difference in serum levels of inflammatory cytokines, oxidative stress indexes, and myocardial ischemia markers between the two groups (P>0.05). At 2 h after ventricular fibrillation, the levels of TNF-α and IL-6 level in the UTI group was significantly lower than those in the control group. At 4 h, MDA level in the UTI group was significantly lower than that in the control group (P<0.05); IMA was significantly increased at 1 h after ROSC, and the level of 1 h in the UTI group was significantly lower than that in the control group (P<0.05), but was not statistically significant at 12 h between the two groups (P>0.05). HE staining results showed that the damage degree of myocardial tissue in the UTI group was significantly lower than that in the control group at 24 h after ROSC.@*Conclusions@#UTI can significantly antagonize inflammatory response, reduce oxidative stress, and improve the myocardial tissue injury after resuscitation. It can protect myocardial injury after cardiopulmonary resuscitation.

The protective effects of ulinastatin on brain tissue after CPR in swine / 中华急诊医学杂志

Objective To study the protective effects of ulinastatin on brain tissue from pathomorphism and the changes of serum IL-6,Ngb (neuroglobin of brain),S100B protein and superoxide dismutase (SOD) after cardiopulmonary resuscitation (CPR) in swine.Methods The CPR model of swine was made by a programmed electric stimulation given to myocardium to produce a ventricular fibrillation and then a CPR was given.A flock of 16 male healthy Beijing landraces pigs of 3-4 months old were divided in random number method into control group (n =6) and ulinastatin group (n =6),because there were 12 swine survived from ventricular fibrillation.The t-test was used for the statistical analysis.ELISA was used to detect the changes in levels of those biomarkers in serum at each interval as well as the pathomorphological changes in brain tissues were observed under the light microscope after HE staining.Results (1) Before ventricular fibrillation,there were no distinct differences in levels of various biomarkers in porcine serum between two groups.After ventricular fibrillation,serum IL-6,S100B protein and Ngb levels in both groups gradually increased as time elapsed,and the levels of those biomarkers in the control were significantly higher than those in the ulinastatin group (P ＜ 0.05).Serum SOD in both groups gradually reduced,and more distinct decline of biomarkers was found in the ulinastatin group (P ＜ 0.05).(2) HE staining showed the porcine brain tissues in control group had significant ischemia,degeneration and necrosis and the degree of those pathological changes in the ulinastatin group were significantly moderated.Conclusion The immediate administration of ulinastatin as CPR initiated can alleviate porcine brain tissue damage after ischemia/reperfusion (I/R).This showed a protective effect of ulinastatin against I/R injury on porcine brain.

Role of axl in preeclamptic EPCs functions / 华中科技大学学报（医学）（英德文版）

Axl encodes the tyrosine-protein kinase receptor, participating in the proliferation and migration of many cells. This study examined the role of Axl in functions of endothelial progenitor cells (EPCs). Axl was detected by RT-PCR and Western blotting in both placentas and EPCs from normal pregnancy and preeclampsia patients. The Axl inhibitor, BMS777-607, was used to inhibit the Axl signalling pathway in EPCs. Cell proliferation, differentiation, migration and adhesion were measured by CCK-8 assay, cell differentiation assay, Transwell assay, and cell adhesion assay, respectively. Results showed the expression levels of Axl mRNA and protein were significantly higher in both placentas and EPCs from preeclampsia patients than from normal pregnancy (P<0.05). After treatment with BMS777-607, proliferation, differentiation, migration and adhesion capability of EPCs were all significantly decreased. Our study suggests Axl may play a role in the function of EPCs, thereby involving in the pathogenesis of preeclampsia.

Efficacy of rituximab combined with CHOP chemotherapy for 35 patients with aggressive B cell non-Hodgkin’s lymphoma / 中国生化药物杂志

Objective To analyze efficacy of rituximab combined with chemotherapy for 35 patients with aggressive B cell non-Hodgkin’s lymphoma.Methods 70 patients with aggressive B cell non-Hodgkin’s lymphoma were chosen from Hematology Department of First Affiliated Hospital of Liaoning Medical University and divided into observation group and control group at random, each group with 35 cases.The control group were treated with CHOP chemotherapy, and the observation group were treated with anti-CD20 monoclonal antibody rituximab combined with CHOP chemotherapy. The efficacy and toxicity of two group were compared.Results The total effective rate of observation group was significantly higher than that of control group (80.0%vs.37.1%;χ2 =13.246,P<0.001).Fever cases of observation group were significantly more than those of control group (15vs.4;χ2 =8.741,P=0.003), while the other adverse reactions of leucopenia and gastrointestinal reaction between two groups were not significantly different. Conclusion For patients with aggressive B cell non-Hodgkin’s lymphoma, rituximab combined with CHOP chemotherapy has better short-term effects and its adverse reactions are tolerable, which helps patients to improve the quality of life.

Treatment of lumbar intervertebral disc herniation and sciatica with percutaneous transforaminal endoscopic technique / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical effects of percutaneous transforaminal endoscopic technique in treating lumbar intervertebral disc herniation and sciatica.</p><p><b>METHODS</b>From June 2011 to January 2012,the clinical data of 46 patients with lumbar intervertebral disc herniation and sciatica underwent percutaneous transforaminal endoscopic technique were retrospectively analyzed. There were 28 males and 18 females,ranging in age from 11 to 77 years old with an average of (39.7_ 15.3) years old,20 cases were L5S1 and 26 cases were L4,5. All patients had the symptoms such as lumbago and sciatica and their straight-leg raising test were positive. Straight-leg raising test of patients were instantly repeated after operation;operative time,volume of blood loss,complication, length of stay and duration of back to work or daily life were recorded. The clinical effects were assessed according to the VAS,JOA and JOABPEQ score.</p><p><b>RESULTS</b>All operations were successful,postoperative straight-leg raising test were all negative. Operative time,volume of blood loss,length of stay,duration of back to work or daily life,follow-up time were (93.0+/-28.0) min, (20.0+/-9.0)ml, (3.1+/-1.5) d, (11.6+/-4.2) d, (13.9+/-1.6) months,respectively. VAS score of lumbar before operation and at the 1st and 3rd,6th,12th month after operation were 5.3+/-1.2,1.9+/-1.1,1.0+/-0.8,0.9+/-0.8,0.8+/-0.6,respectively;VAS score of leg before operation and at the 1st and 3rd,6th,12th month after operation were 7.2+ 1.2,0.8+/-1.2,0.5+/-0.8,0.5+/-0.8,0.3+/-0.8,respectively. Five factors of JOABPEQ score,including lumbar pain,lumbar function, locomotor activity,social life viability and mental status,were respectively 27.0+/-30.6,37.3+/-27.4,38.5+/-26.6,33.0+/-13.7,55.4+/-19.0 before operation and 83.6+/-24.8,89.4+/-15.7,87.0+/-17.9,58.4+/-14.6,79.5+/-13.4 at final follow-up. Preoperative and postoperative JOA score were 9.1+/-2.6 and 27.3+/- 1.7, respectively. The postoperative VAS,JOA and JOABPEQ score had significantly improved (P<0.05).</p><p><b>CONCLUSION</b>Percutaneous transforaminal endoscopic technique is safe and effective method in treating lumbar disc herniation and sciatica,it can fleetly relieve pain and the patient can recover daily life and work after treatment.</p>

The mitochondrial tRNA(Thr) A15951G mutation may be associated with Leber's hereditary optic neuropathy in two Chinese families / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore clinical, genetic and molecular features of two Chinese Han families with Leber's hereditary optic neuropathy (LHON).</p><p><b>METHODS</b>Ophthalmologic examinations revealed variable severity and age-at-onset of visual loss among probands and other matrilineal relatives of both families. The families exhibited extremely low penetrance of visual impairment. The entire mitochondrial genome of two probands was amplified by PCR in 24 overlapping fragments using sets of oligonucleotide primers.</p><p><b>RESULTS</b>Sequence analysis of complete mitochondrial genome in the pedigrees excluded three common LHON associated mutations G11778A, G3460A and T14484C, but revealed the presence of a known homoplasmic tRNA(Thr) A15951G mutation. It also showed distinct sets of mtDNA polymorphisms belonging to Eastern Asian haplogroup D4b1. The A15951G mutation is located at the extremely conserved nucleotide (conventional position 71) of tRNA(Thr). Thus, this mutation may alter the structure and stability of mitochondrial tRNA(Thr), thereby leading to a failure in the tRNA metabolism and mitochondrial dysfunction, causing visual impairment.</p><p><b>CONCLUSION</b>The results suggested that the A15951G mutation might be involved in the pathogenesis of Leber's hereditary optic neuropathy in the two families.</p>

A case-control study on the risk factors for attempted suicide in patients with major depression / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the environmental risk factors on attempted suicide in patients with major depression, and to study the interaction between factors as single nucleotide polymorphism(SNP) of TPH2 gene rs7305115 associated to attempted suicide in major depression.</p><p><b>METHODS</b>Paired case-control study on 215 suicide attempters with major depression (92 male, 123 female) and molecular biological techniques were used to study the relation between TPH2 gene rs7305115 SNP,interrelated environmental factors and the rate of attempted suicide. Controls were paired with cases according to the same gender, similar age (no more than 3 years) and from the same district.</p><p><b>RESULTS</b>There were remarkably significant differences in gene types and gene frequency between case and control groups (P < 0.001). Data from multivariate conditional logistic regression model analysis showed that hopelessness, negative life-events and family history of suicide were relationship of attempted suicide in patients with major depression with OR values as 0.33 (95% CI: 0.22-0.99), 7.68 (95% CI: 5.79-13.74), 6.64 (95% CI: 2.48-11.04), 2.98 (95% CI: 1.17-5.04) respectively. There was no first level interaction between any of the two risk factors.</p><p><b>CONCLUSION</b>Results from the study supported the idea that hopelessness, negative life-events and family history of suicide were risk factors of attempted suicide in major deprbssion while TPH2 gene rs7305115 A/A might be the protective factor.</p>

Detection of SARS-CoV and RNA on aerosol samples from SARS-patients admitted to hospital / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the risk of aerosol transmission in severe acute respiratory syndrome (SARS) patients admitted to Hospital through testing the air samples.</p><p><b>METHODS</b>Air samples were collected from 7 wards and 1 balcony of the Hospital, 3 times a day for 3 continuous days, using bioaerosol sampler type FA-2. Bioaerosol particles were then washed down from the samples by serum-free Dulbecco's Modified Eagle Medium (DMEM) culture medium. Nested-reverse transcription-polymerase chain reaction (RT-PCR) was used to amplify the N protein gene of the SARS associated coronavirus (SARS-CoV) from these washing solutions. The residual solutions were inoculated into prepared cell cultures to isolate live virus. The positive samples were then identified by indirect immunofluorescence assay and sequence analysis of the PCR products.</p><p><b>RESULTS</b>Positive rates of RT-PCR test on air samples were 29.03% in the wards and 20.0% in balcony respectively. Results from sequential analysis showed that the homology of amplified cDNA fragments to previously known SARS-CoV stains was 98%. A strain of live pathogen was isolated from one of the 36 samples. The isolate could cause typical cytopathic effects, similar to those SARS-CoV on Vero-E6 cells and the effects could be stably passed. Indirect immunofluorescence assay showed positive from serum of a SARS patient.</p><p><b>CONCLUSION</b>SARS-CoV existed in the air hospital, where SARS patients were admitted to, but the activity of SARS-CoV in air samples was rather low. SARS patients could still shed SARS-CoV even during the recovery phase. Potential possibility of aerosol transmission might exist within 1 meter square area around SARS patients.</p>

Associations between six functional genes and schizophrenia / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the associations between schizophrenia and six functional genes: dopamine D2 receptor gene (DRD2), dopamine D4 receptor gene (DRD4), 5-hydroxytryptamine 2A receptor gene (5-HT2A), 5-HT6 receptor gene (5-HT6), catechol-O-methyltransferase gene (COMT) and dopamine transporter gene (DAT1).</p><p><b>METHODS</b>With the techniques of Amp-RFLP and Amp-FLP, association analysis was made between schizophrenia and the six genes in 67 schizophrenic patients from Chinese Han population.</p><p><b>RESULTS</b>(1) Neither genotypes nor alleles of DRD2, 5-HT2A, 5-HT6 and COMT gene showed significant differences between patients and controls (P>0.05). (2) Six repeats (6R) in DRD4 gene, the allele of 480 bp and the genotype of 480/520 in DAT1 gene were found to be of significant differences between the two groups (P<0.05). (3) Only one negative association was observed between the 480 bp allele of DAT1 gene and schizophrenia (OR=0.441, 95% CI:0.202-0.963, Z=2.05, P<0.05).</p><p><b>CONCLUSION</b>The 480 bp allele of DAT1 gene is negatively associated with schizophrenia in Chinese Han population, which stands for the dopamine hypothesis of schizophrenia.</p>