The predictive value of emergency bedside echocardiography on acute pancreatitis severity by assessing cardiac dysfunction / 中华急诊医学杂志

Objective:To investigate the predictive value of emergency bedside echocardiography on acute pancreatitis (AP) severity by assessing cardiac dysfunction.Methods:The clinical data used in this study was prospectively collected from AP patients in the Emergency Department of Beijing Shijitan Hospital, Capital Medical University from June 2018 to December 2020. According to the Atlanta Classification revised at the 2012 Atlanta International Conference, patients were divided into three groups of mild acute pancreatitis (MAP), moderate-severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). The differences of comprehensive score index, blood-related index, and echocardiography-related index were compared among the three groups. Besides, the predictive factors of SAP were analyzed by Logistic regression, receiving operating characteristic (ROC) curves of subjects were drawn, and the area under the curve (AUC) was analyzed to evaluate the predictive efficiency.Results:A total of 116 patients were enrolled in this study. Compared with the non-SAP group (MAP group+MSAP group), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, Ranson score, procalcitonin, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NTproBNP), EDD, A-peak, E/A, E'/A', and stroke volume (SV) exhibited significant differences (all P<0.05). There was no significant difference in end-systolic diameter, E-peak, and left ventricular ejection fraction among the three groups ( P>0.05). Logistic regression analysis revealed that SOFA score, Ranson score, cTnI, NTproBNP, E'/A', and SV were important predictors of AP severity (all AUC>0.7). Moreover, the predictive value of echocardiography cardiac function assessment index (E'/A' +SV, AUC=0.969) and score index (SOFA score +Ranson score, AUC=0.989) for SAP was better than that of blood index (cTnI+NTproBNP, AUC=0.732). Conclusions:Echocardiographic indicators E'/A' and SV have acceptable predictive values for SAP, providing certain guiding significance for the clinical treatment of AP patients.

Analysis of the pathogenic characteristics of fungal bloodstream infection in severe burn patients / 中华烧伤杂志

Objective@#To retrospectively analyze the diagnosis time, pathogen distribution, and drug resistance of fungal bloodstream infection in severe burn patients.@*Methods@#Blood samples were collected from 55 severe burn patients with fungal bloodstream infection (including 46 males and 9 females, aged 42 (1, 78) years) admitted to the intensive care unit of the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from July 2011 to May 2019 for retrospective analysis. Microbial monitoring system was used to cultivate pathogens, API yeast identification kit and Candida chromogenic medium were used to identify pathogens, and Kirby-Bauer paper disk diffusion method was used to detect drug resistance of fungi to fluconazole, amphotericin B, itraconazole, ketoconazole, and voriconazole. The positive rate of blood fungal culture, mortality rate, distribution of local fungal proliferation sites, the diagnosis time distribution of fungal bloodstream infection, the distribution of fungal species, resistance to commonly-used antifungal drugs, and the use of antibiotics were assessed. The WHONET 5.6 software was applied to analyze the distribution and drug resistance of fungi.@*Results@#(1) Totally 4 839 blood samples were collected during the 9 years, and 122 strains of fungi were isolated, with positive rate of 2.52%. The mortality rate was 14.55% (8 patients) in 55 patients. Catheter fungal proliferation ranked the first among 30 cases of local fungal proliferation. (2) The diagnosis time of fungal bloodstream infection mainly distributed in ≤1 week of hospitalization [32.73% (18/55)]. (3) Among the 55 strains of fungi detected, the detection rate of Candida parapsilosis ranked the first (21.82%, 12 strains), Candida glabrata was the second (18.18%, 10 strains), and Candida tropicalis was tied with Candida albicans in the third place (14.55%, 8 strains). All the detected fungi were sensitive to amphotericin B, and the resistance rates to voriconazole, fluconazole, itraconazole, and ketoconazole were between 4.5% and 9.1%. (4) Droad-spectrum antibiotics were used in all the 55 patients, ≥3 kinds of antibiotics were used in 44 patients, and 37 patients used antibacterial drugs ≥7 days.@*Conclusions@#The diagnosis time of fungal bloodstream infection in the 55 severe burn patients was mainly within 1 week of hospitalization. Candida parapsilosis is the most commonly detected fungal species. Catheter fungal proliferation occurs most commonly among the 30 patients with local fungal proliferation. All the detected fungi were sensitive to amphotericin B, with low drug resistance to voriconazole, fluconazole, itraconazole, and ketoconazole. Broad-spectrum antibiotics were overused in the severe burn patients with fungal bloodstream infection.

Role of UBE2T gene in the migration and invasion of hepatocellular carcinoma cells and its clinical significance / 肿瘤

Objective: To investigate the expression and clinical significances of ubiquitin conjugating enzyme E2 T (UBE2T) in hepatocellular carcinoma (HCC), and explore the role of UBE2T gene expression in migration and invasion of HCC cells. Methods: The expression of UBE2T mRNA in 54 pairs of HCC tissues and the matched noncancerous liver tissues was analyzed by real-time fluorescent quantitative PCR. The expression level of UBE2T protein in 233 cases of HCC tissues was detected by immunohistochemistry, then the relationship between UBE2T expression and clinicopathological features of HCC patients was analyzed. The recombinant lentiviral vector pWPXL-UBE2T contained UBE2T gene sequences was constructed and further transfected into Hep3B and SMMC-7721 cells. In the other hand, the recombinant lentiviral vector GV248-shUBE2T-1 and GV248-shUBE2T-2 targeted UBE2T gene were transfected into MHCC-LM3 and SK-Hep1 cells. The forced expression and knockdown of UBE2T gene were validated by real-time fluorescent quantitative PCR and Western blotting. Afterwards, the effects of UBE2T gene overexpression and silencing on migratory and invasive abilities of HCC cells were detected by Transwell chamber assays, respectively. Results: The UBE2T mRNA level in HCC tissues was significantly higher than that in the matched noncancerous liver tissues (P < 0.000 1). The expression of UBE2T protein was correlated with intrahepatic metastasis of HCC (P = 0.004) in 233 patients with HCC. Compared with the control group, the forced expression of UBE2T gene markedly promoted both migration and invasion of Hep3B and SMMC-7721 cells (both P < 0.01); while the knockdown of UBE2T gene obviously inhibited the migration and invasion of MHCC-LM3 and SK-Hep1 cells as compared with the negative control group (both P < 0.05). Conclusion: High expression level of UBE2T in HCC tissues is correlated with the presence of intrahepatic metastasis, and the overexpression of UBE2T gene can promote the migration and invasion of HCC cells.

MG53 protein protects against multiorgan ischemia/reperfusion injury: present and future / 中国组织工程研究

BACKGROUND: In recent years, with the progress of shock therapy as well as the establishment and promoted application of arterial bypass grafting, thrombolytic therapy, percutaneous transluminal coronary angioplasty, extracorporeal circulation on cardiac surgery, cardiopulmonary resuscitation, limb replantation, and organ transplantation, blood reperfusion in multiple organs after ischemia has been achieved. However, the organs which undergo a period of ischemia appear to have the performance of damage aggravation.OBJECTIVE: To summarize the research progress of MG53 protein in protecting five organs from ischemia/reperfusion injury, thereby providing reference for further in-depth study.METHODS: A computer-based online search of PubMed, Duxiu Knowledge Search and CNKI databases was performed for relevant literatures puldished between 1986 and 2016. The key words were MG53, TRIM, Mitsugumin53, ischemic, reperfusion, preconditioning, postconditioning, RISK, membrane damage, Connexin43, KChIP2 in English and MG53, ischemia/reperfusion in Chinese. Finally 61 eligible articles were reviewed in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: As a muscle-specific TRIM family protein, endogenous MG53 is involved in the repair of muscle cytomembrane damage, and the protective effects of ischemic preconditioning and postconditioning. Exogenous recombinant human MG 53 protein not only repairs membrane damage of various muscles and non-muscle cells, but also protects the myocardium, skeletal muscle, brain, lung and kidney from ischemia/reperfusion injury.

Efficacy and safety of oral anticoagulants in young ischemic stroke patients with non-valvular atrial fibrillation / 中华全科医师杂志

Seventy two iscbemic stroke patients aged 18-45 years with nonvalvular atrial fibrillation treated in the Second Affiliated Hospital of Xuzhou Medical College from April 2014 to August 2016 were assigned to warfarin group (n =36) and dabigatran group (n =36).In warfarin group the oral warfarin started from small dose and maintained international normalized ratio (INR) as 2.0 to 3.0.In dabigatran group 110 mg dabigatran etexilate was given b.i.d.All patients were followed up for one year after treatment.Medication was discontinued in 10 cases (28％) of warfarin group and 2 cases (6％) of dabigatran group one year after treatment (P =0.02).There were 8 (22％) cases of thromboembolic events in warfarin group and 1 (3％) case in dabigatran group (P =0.03).In warfarin group 233 INR values were recorded with an average of 2.32,and the percentage of time in therapeutic range (TTR) was 75％ (174/ 233).There were 2 deaths in warfarin group and no death in dabiga group.There were 19 (53％) cases of adverse reactions in warfarin group,including 9 cases of bleeding (6 mild bleeding and 3 serious bleeding),5 cases of nausea and vomiting,2 cases constipation or diarrhea,3 cases of headache and dizziness.There were 6 (17％) cases of adverse reactions in dabigatran group,including 2 cases of mild bleeding,2 cases of nausea and vomiting,2 cases of constipation or diarrhea.There was significant difference in the incidence of adverse reactions between the two groups(x2 =13.3,P ＜ 0.01).The results indicate that the efficacy and safety of dabigatran is superior to that of warfarin for young ischemic stroke patients with nonvalvular atrial fibrillation.

Correlation of TUBB3 expression with chemotherapy sensitivity and clinical outcome of advanced gastric cancer treated with paclitaxel-based chemotherapy / 中国肿瘤临床

Objective:To investigate the expression of class IIIβ-tubulin (TUBB3) in advanced gastric cancer and analyze its correlation with the chemotherapeutic effect of paclitaxel and the prognosis of patients. Methods:This study reviewed 49 cases with advanced gastric cancer, diagnosed from December 2008 to December 2011 at Shaoyang Central Hospital. All patients were treated with paclitax-el or docetaxel-based chemotherapy. TUBB3 expression was determined using immunohistochemistry. Relationships of the expression of TUBB3 protein with chemotherapy response, progression-free survival (PFS), and overall survival (OS) were analyzed. Results:Among the 46 valid cases treated with paclitaxel or docetaxel-based regimen, treatment response was as follows:complete response (CR) in 1 patient, partial response (PR) in 17 patients, stable disease (SD) in 22 patients, and progression disease (PD) in 6 patients. The overall response rate (CR+PR) was 39.13％(18/46). The chemotherapy response rates in low and high TUBB3 expression groups were 54.17％(13/24) and 22.73％(5/22), respectively (χ2=4.736, P=0.029). The patients with low TUBB3 expression had significantly longer median PFS and OS than those with high TUBB3 expression (PFS 5.9 vs. 3.9 months, P=0.032;OS 11.6 vs. 7.9 months, P=0.001). Univar-iate analysis and multivariate Cox regression analysis showed that the expression of TUBB3 was an independent prognostic factor in advanced gastric cancer. Conclusions:The present study demonstrates that TUBB3 expression in advanced gastric cancer is associated with chemotherapy response and prognosis;especifically, the low expression group had a better chemotherapy response and progno-sis than the high expression group. The result of this study may provide a new sight for tailored chemotherapy and for predicting prog-nosis of individuals with advanced gastric cancer.

Correlation between the level of the urinary 11-dehydrothromboxane B2 and the clinical efficacy of aspirin in patients with type 2 diabete and coronary artery disease / 北京大学学报(医学版)

Objective:To elucidate the correlation between urinary 11-dehydro-thromboxane B2 ( 11 dhTxB2 ) and clinical efficacy of aspirin treatment in patients with type 2 diabete and coronary artery disease ( CAD) . Methods:In this prospective cohort study, 169 aged patients with type 2 diabete accom-panying CAD in Peking University First Hospital were enrolled. The level of urinary 11dhTxB2 was detec-ted using enzyme-linked immuno-sorbent assay. Low aspirin response or high on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1 500 ng/g. All the included patients were divided into two groups based on the results, HAPR group and No-HAPR group. Results:Baseline urinary 11dhTxB2 of the patients with type 2 diabete accompanying CAD was ( 3 687 ± 3 052 ) ng/g, while the urinary 11dhTxB2 was (1 954 ± 859) ng/g in patients after 100 mg/d aspirin treatment (P<0. 001). Preva-lence of HAPR in patients with type 2 diabete accompanying CAD were 32 . 5%. Within a mean follow-up time of 12 months, the outcomes occurred more frequently in HAPR group than in No-HAPR group ( P<0 . 05 ) . Conclusion:Urinary 11 dhTxB2 can be recognized as an effective indicator in evaluating aspirin clinical efficacy of patients with type 2 diabete accompanying CAD.

Association between CMTM5 gene rs723840 single nucleotide polymorphism and high on asprin platelet reactivity / 北京大学学报(医学版)

Objective: To elucidate the correlation between the single nucleotide polymorphism of CKLF-like MARVEL transmembrane member 5 ( CMTM5 ) gene rs723840 and the occurrence of high on aspirin platelet reactivity ( HAPR) . Methods:The present study is a case-control study. A total of 210 hospitalized patients in Peking University First Hospital were enrolled. Aspirin response was assessed by 0. 5 g/L arachidonic acid (AA)-induced platelet aggregation ratio (PR), and ≥3/4 quartile of PR of the population was defined as HAPR. Accordingly all the enrolled 210 coronary artery diseases ( CAD) patients were divided into HAPR group and No-HAPR group. The genotypes were determined by poly-merase chain reaction ( PCR) and sequencing analysis for rs723840 of CMTM5 gene. Results:The geno-type frequencies in rs723840 C>T of CMTM5 gene conformed well to the Hardy-Weinberg equilibrium in both HAPR group and No-HAPR group. Between the two groups, the genotypes frequencies in HAPR and No-HAPR groups were 48 . 4%, 51 . 6%, 0 . 0% and 73 . 7%, 22 . 9%, 0 . 034%, respectively ( P=0. 004). The C, T allele frequencies were significantly different in the two groups (P =0. 031,OR =0 . 501 , 95%CI:0 . 264-0 . 947 ) . Conclusion:Our study finds a significant correlation between CMTM5 gene rs723840 polymorphism and high on aspirin platelet reactivity.

Latent Structure Analysis and Syndrome Differentiation for Integration of Traditional Chinese Medicine and Western Medicine (III)：Establishment of Classification Rules / 世界科学技术-中医药现代化

Objective: In China, doctors at TCM hospitals and clinics often divide patients with a Western medicine (WM) disease into several syndrome classes from the TCM perspective and treat patients in different classes using different principles. A key problem is how to carry out the classification properly. We propose an evidence-based ap-proach for solving the problem where evidence is obtained by analyzing unlabeled symptom data using latent tree models.Method: In previous work, we have shown how latent tree analysis of symptom data can be used to identify TCM syndrome classes among patients with a WM disease. In the paper, we investigate how to establish classification rules for distinguishing between the classes.Results: We have applied the method to a data set about Vascular Mild Cognitive Impairment that involves 93 symptoms and 803 patients. Nine syndrome types are identified, along with the corresponding classification rules. Conclusions: An evidence-based approach to the TCM patient classification prob-lem has been developed. The approach can be used to answer the following questions about a WM disease: What TCM syndrome classes are there? What are the sizes of the classes? What are the statistical characteristics of each class? How can one differentiate between the different classes?

Effect of Cyclosporine A on stable established lymphoma models induced by Epstein-Barr virus / 中国免疫学杂志

Objective:To study the effect of Cyclosporine A(CSA) on inhibiting graft versus host reaction(GVHR) occured in hu PBL/SCID chimeras and to stably establish EBV induced lymphoma models.Methods:Human peripheral blood lymphocyts were isolated and were inoculated intraperitoneally into SCID mice.Mice were infected with EBV and injected intraperitoneally with CSA.Human sIL 2R in the serum of hu PBL/SCID chimeras were analyzed by ELISA.Results:No mouse was dead in CSA group,whereas 15 mice of the other three groups died of GVHR.The medium life span of no CSA administration mice was 17 days,and motalities were 55.56%(5/9),30.43%(7/23),42.86%(3/7)respectively.The difference was statistically significant between CSA group and the other groups.The levels of human sIL 2R were stable in CSA group while increased gradually in experimental infertion the groups without CSA.Difference was significant at day 15 and day 22 between the EBV infection group without CSA and with CSA administration.Of 38 survival SCID mice,24 mice developed tumors in their body cavities.Conclusion:CSA can strikingly inhibit GVHR that may occur in hu PBL/SCID mice,that could help practical to stably establish the lymphoma models.

Construction of evolutionary tree model for esophageal carcinogenesis based on comparative genome hybridization data / 中国病理生理杂志

AIM:Based on comparative genomic hybridization(CGH) data,to construct tree model of esophageal carcinoma and to explore mechanism of multigene involved,multistep development and multipathway progression during esophageal carcinogenesis.METHODS:Using the software developed by Desper et al,tree models of esophageal carcinoma were constructed according to the CGH data of 78 esophageal carcinoma patients.RESULTS:Tree models for esophageal carcinoma suggested that there were-4p,-9p,-18q,+7p,+8q,+17p,+17q,+20p,+20q nine nonrandom genetic events,and +7p、+8q and +20q might be important early events in esophageal carcinogenesis,indicating that there might be cancer-related genes in these chromosomal arms.CONCLUSION:Tree models based on CGH data of esophageal carcinoma imply the process of multigene involved,multistep and multipathway progression.The tree models also give the direction to search for esophageal cancer-related genes.