Effect of emergency heart failure units on readmission and mortality within 6 months after discharge in patients with acute heart failure / 中华急诊医学杂志

Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.

Clinical characteristics and prenatal diagnosis of fetuses with sex chromosomal aneuploidies detected by non-invasive prenatal testing during early and midterm pregnancies / 中华医学遗传学杂志

OBJECTIVE@#To analyze the indication, karyotyping result, ultrasound finding, pregnancy decision and follow-up of fetuses with sex chromosome aneuploidies (SCA) detected by non-invasive prenatal testing (NIPT) during early and midterm pregnancies.@*METHODS@#The results of 225 singleton pregnancies with fetal SCA detected by NIPT were reviewed and analyzed.@*RESULTS@#The 225 cases included 45,X (n=37), 47,XXY (n=74), 47,XXX (n=50), 47,XYY (n=56) and mosaicisms (n=8), among which 121 (53.8%) have opted to terminate the pregnancy, including 45,X (n=31), 47,XXY (n=61), 47,XXX (n=14), 47,XYY (n=12) and 3 mosaicisms. The remainder 104 (46.2%) have elected to continue with the pregnancy, among which three have opted to terminate due to abnormalities detected by ultrasonography, and two had spontaneous abortions.@*CONCLUSION@#NIPT as a first-tier screening method can effectively detect fetal trisomies 21, 13 and 18 as well as SCA. The types of fetal SCA and presence of ultrasound abnormalities are critical factors for the termination of pregnancy.

Analysis of hematological characteristics of patient with different genotypes in lightβ-thalassemia / 实用医学杂志

Objective To investigate the hematological characteristics of patients with light β- thalassae-mia and rapidly identify different mutational genotypes. Methods RBC、Hb、MCV、MCH、MCHC、RDW-CV and HbA2 were studied in the 646 patients,the differences between β0/βN and β +/βN mutations were also compared. Results Most of them were microcytic hypochromic anemia. The most common genotype were β654/βN(33%)、β41-42/βN(32.5%)、β17/βN(14.4%)、β - 28/βN(10%)respectively,β0/βN were relatively higher. The differences in RBC、MCV、MCH、RDW-CV and HbA2 were significant between β0/βN and β +/βN. Compared with β +/βN patients,the MCV and MCH of β0/βN were significantly reduced,RDW-CV and HbA2 were significantly higher. Conclusion Light β- thalassaemia with different genotypes has its own unique hematological features and can be quickly and ef-fectively identified. Clinical efficiency can be improved through hematological analysis.

Risk factors of contrast-induced nephropathy in patients with acute myocardial infarction treated with emergent percutaneous coronary intervention / 中华急诊医学杂志

Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI).Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People's Hospital was reviewed.Exclusion criteria included contrast agent allergy,previous renal diseases,chronic renal failure,heart failure,tumor,acute infection,only one renal function test available during hospitalization and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,laboratory findings,etc,were collected.Patients were divided into CIN group and non-CIN group.The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN.Results A total of 236 patients were enrolled.The incidence of CIN was 10.2％ (24/236).Univariable analysis demonstrated that the risk factors of CIN were age,diabetes mellitus,Killip grade ≥ 3 stage,serum uric acid (SUA) level at admission,blood glucose level at admission.Binary logistic regression analysis showed that SUA ≥ 350 μ mol/L at admission,blood glucos ≥ 11 mmol/L at admission,age ≥ 75 years were independent risk factors for CIN.Conclusion SUA ≥ 350 μ mol/L at admission,blood sugar ≥ 1 1 mmol/L at admission,age ≥ 75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI.

Risk factors of acute kidney injury in patients with acute heart failure / 中华急诊医学杂志

Objective To explore the risk factors for acute kidney injury (AKI) in patients with acute heart failure (AHF).Methods A total of 254 patients with AHF admitted in the emergency department of Peking University People's Hospital from January 2015 to September 2016 were enrolled for retrospective study.Exclusion criteria included:age ＜ 18 years old,end stage renal disease or long-term dialysis,length of hospital stay ＜ 2 days,only one renal function test available during hospitalization,patients discharged by themselves and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,accessory examinations and treatments,etc,were collected.Patients were divided into AKI group and non-AKI group according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Univariate comparison analyses were performed to evaluate the differences between the two groups.Results Of 254 eligible patients,there were 78 (30.7％) in AKI group and 176 (69.3％) in non-AKI group.The mortality rates of AKI group and non-AKI group were 34.6％ and 11.9％ (P ＜ 0.05),respectively.Compared with the non-AKI group,baseline serum creatinine,C-reactive protein,the peak level of B-type natriuretic peptide,the proportion of proteinuria,cardiac function grade Ⅳ,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy in the AKI group were significantly higher;the estimated glomerular filtration rate was significantly lower (P ＜ 0.05).Conclusions The incidence of AKI in patients with AHF was high and the prognosis of patients with AHF developing to AKI was poor.The baseline serum creatinine,estimated glomerular filtration rate,proteinuria,C-reactive protein,cardiac function grade Ⅳ,the peak level of B-type natriuretic peptide,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy were the significant risk factors of AKI in patients with AHF.

Risk factors of acute kidney injury in patients with acute heart failure / 中华急诊医学杂志

Objective To explore the risk factors for acute kidney injury (AKI) in patients with acute heart failure (AHF).Methods A total of 254 patients with AHF admitted in the emergency department of Peking University People's Hospital from January 2015 to September 2016 were enrolled for retrospective study.Exclusion criteria included:age ＜ 18 years old,end stage renal disease or long-term dialysis,length of hospital stay ＜ 2 days,only one renal function test available during hospitalization,patients discharged by themselves and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,accessory examinations and treatments,etc,were collected.Patients were divided into AKI group and non-AKI group according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Univariate comparison analyses were performed to evaluate the differences between the two groups.Results Of 254 eligible patients,there were 78 (30.7％) in AKI group and 176 (69.3％) in non-AKI group.The mortality rates of AKI group and non-AKI group were 34.6％ and 11.9％ (P ＜ 0.05),respectively.Compared with the non-AKI group,baseline serum creatinine,C-reactive protein,the peak level of B-type natriuretic peptide,the proportion of proteinuria,cardiac function grade Ⅳ,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy in the AKI group were significantly higher;the estimated glomerular filtration rate was significantly lower (P ＜ 0.05).Conclusions The incidence of AKI in patients with AHF was high and the prognosis of patients with AHF developing to AKI was poor.The baseline serum creatinine,estimated glomerular filtration rate,proteinuria,C-reactive protein,cardiac function grade Ⅳ,the peak level of B-type natriuretic peptide,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy were the significant risk factors of AKI in patients with AHF.

The effect of A375 cells corylin melanin synthesis / 国际中医中药杂志

Objective To study the effect of Corylin on A375 cells melanin synthesis,and explore its mechanism.Methods The cells were randomly divided into the control group, the estradiol group, and corylin group including 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L. Estradiol estradiol intervention group were given 10-3 mol/L. Corylin group (10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L,100μmol/L) were given 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L corylin intervention. The activity of proliferation were detected by MTT, NaOH method, dopa oxidation , both melanin content and tyrosinase activity (tyrosinase, TYR). TYR, yrosinase related protein (tyrosinase related protein, TRP)-1 and TRP-2 expression levels of mRNA were determined by RT-PCR.Results Compared with the control group, 10, 100μmol/L of Corylin group cell proliferation rate significantly decreased (P<0.01). The 1μmol/L, 10-1μmol/L, 10-2μmol/L of Corylin group cell melanin content, TYR significantly decreased (P<0.01 or P<0.05). The 1μmol/L corylin group TYR (0.303 ± 0.003vs. 0.628 ± 0.012), TRP-1 (0.313 ± 0.008 vs. 0.677 ± 0.022), TRP-2 (0.456 ± 0.028vs. 0.687 ± 0.020) mRNA expression level significantly decrease (P<0.01).Conclusions The results showed that Corylin could inhibit melanin synthesis, which worked probably through inhibiting the activity of TYR and cutting the mRNA expressions of TYR,TRP-1/2.

Study of the anemia status and genotype of thalassemia in preschool children in Shenzhen / 实用医学杂志

Objective To study the anemia status and genotype of thalassemia in preschool children in Shenzhen. Methods 658 preschool with anemia hospitalized in Shenzhen Longgang Maternal and Child Health Hospital from October 2012 to September 2015 were screened by complete blood analysis . The most common mutations of thalassemia genotype (17 β thalassemia genotype mutation,3 α thalassemia genotype mutation and 3α thalassemia genotype absence change) in Chinese population were detected. Results All cases have microcytic hypochromic anemia. 426 cases were identified to be thalassemia (64.7%). 23 genotypes and 13 gene mutation type were detected. The most common genotype type were SEA/αα(46%),β654/βN(15%),β41?42/βN(12.7%). And the most common allele gene mutation type were SEA (49.1%),IVS?Ⅱ?654( C→T)(14.4%),CD41?42(?TTCT)(12.4%) re?spectively. MCV and MCH of thalassemia children was significantly lower than that of children diagnosed as without thalassemia. The differences of RBC,Hb,MCV,MCH,MCHC,RBC?SD between the two groups were statistical?ly significant. Conclusion The proportion of thalassemia among preschool anemia children in Shenzhen area was high,and it is necessary to strengthen the local thalassemia prevention and decrease anemia effect on preschool children′s health.

Risk factors of acute kidney injury in patients with acute myocardial infarction / 中华急诊医学杂志

Objective To explore the risk factors for acute kidney injury (AKI)in patients with acute myocardial infarction (AMI).Method The medical data of hospitalized patients with AMI admitted from October 2013 to May 2014 were reviewed.All patients were divided into AKI group and non-AKI group.The univariate comparison analysis were performed to obtain the AKI risk factors.Results A total of 565 patients were enrolled.The incidence of AKI (n =91 )was 16.1% and there were 474 non-AKI patients.The mortality of AKI group was 19.8% and mortality of non-AKI group was 0.4% (P <0.01). Univariate analysis demonstrated that the risk factors of AKI were age,hypertension,previous myocardial infarction,heart failure history,chronic kidney disease,cerebral infarction history,peripheral vascular disease;ventricular fibrillation,heart rate,Killip grade ≥3 stage,left ventricular ejection fraction,serum creatinine,eGFR,hemoglobin,blood urea nitrogen,troponin I,B-type natriuretic peptide and C-reactive protein,fasting glucose,albumin,maximum daily dose of furosemide,non-use of ACEI /ARB and statins, the use of intra-aortic balloon pump, temporary pacemaker and pulmonary mechanical ventilation, implementation of PCI and coronary artery bypass graft surgery.Conclusions These risk factors for AKI after AMI were found to identify high-risk patients,helping the clinicians to make decision for preventive intervention.

Clinical analysis of suspected acute aortic dissection with ST-segment elevation detected by inferior leads / 中华急诊医学杂志

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

Effects of IL-6 and AG490 on Burkitt lymphoma cell growth / 中国病理生理杂志

AIM:To observe the influences of IL-6 and AG490 on the growth of Raji cell line ( Burkitt lym-phoma cell, BL).METHODS:Raji cells were cultured.IL-6, an activator of signal transducer and activator of transcrip-tion 3 (STAT3), and AG490, a specific inhibitor of STAT3 were added into the medium respectively .The expression of STAT3 and survivin at mRNA and protein levels was detected by real-time PCR and Western blot .The cell viability was measured by MTT assay .Apoptosis and cell cycle were examined by flow cytometry .RESULTS:IL-6 or AG490 affected the growth of Raji cells significantly in a dose-dependent manner (P<0.05).The mRNA expression of STAT3 and sur-vivin in Raji cells was higher in IL-6 group, and lower in the AG490 group than that in the corresponding control group . The statistical differences were found in the mRNA expression of STAT 3 and survivin among different IL-6 or AG490 groups (P<0.05).The concentration dependent relationship was also presented in IL-6 and AG490 groups by the regression a-nalysis.The results of Western blot showed that the protein levels of phosphorylated STAT 3 (p-STAT3), STAT3 and sur-vivin were increased in IL-6 group, and decreased in AG490 group.The apoptotic rate of Raji cells was gradually reduced with the increasing concentration of IL-6.The opposite results were detected in the Raji cells treated with AG 490.There was significant difference in constitute of the cell cycle between the groups treated with IL -6 or AG490 and corresponding control group.The cells at G1-phase and G1/S were significantly increased , while those at S-phase had no obvious change under treating with AG490.The cells at S-phase decreased obviously in the Raji cells treated with IL-6.CONCLUSION:IL-6 and AG490 distinctly affect the growth of Raji cells .The mechanism may be associated with the activation of STAT 3 and survivin.

The related study of α-klotho and obesity related glomerulonephritis / 中华肾脏病杂志

Objective To investigate the relationship of α-klotho protein and obesity related glomerulonephritis.Methods The chronic kidney disease (CKD) patients with or without ORG were diagnosed by renal biopsy.The normal and abdominal obesity control people were enrolled from the physical examination center.Propensity scoring analysis was done to balance the four groups of people in important clinical characteristics.The α-klotho levels in blood and urine were detected by ELISA.ORG mouse model was established and the mRNA and protein expression of klotho protein were detected by real-time quantitative PCR and Western blotting.Results (1) The plasma α-klotho levels decreased in ORG patients,CKD patients and abdominal obesity control people compared with normal control people [(251.7 ± 124.1) ng/L,(336.3 ± 126.1) ng/L,(377.1 ± 120.4) ng/L vs (472.3 ± 204.2)ng/L,all P ＜ 0.05].The ORG patients had the lowest plasma α-klotho levels (P ＜ 0.05).(2) ORG patients also had the lowest urine α-klotho levels compared with CKD patients,abdominal obesity and normal control people [(24.7±11.4) mg/mol vs (82.5±33.8) mg/mol,(74.5±32.5) mg/mol,(100.8±51.1)mg/mol,all P ＜ 0.05].There was no difference in urine α-klotho levels of CKD patients,abdominal obesity and normal control people.(3) Compared with the normal control mouse,ORG model mouse showed decreased mRNA and protein expression of α-klotho protein in renal tissue.Conclusion The lower plasma and urine α-klotho levels in ORG patients may be due to the reduced expression of α -klotho protein in kidney.

Analysis of the group A rotavirus infection in children with diarrhea in Shenzhen / 国际检验医学杂志

Objective To investigate the epidemiological characteristics of the group A rotavirus (RV) among the children with diarrhea in Shenzhen ,in order to provide reference for clinical diagnosis and treatment .Methods Stool samples were collected for RV detection from children with diarrhea .The results were analyzed .Results A total of 3 509 cases of children with RV infection were checked out from 14 511 cases of children with diarrhea ,with the infection rate accounting for 24 .18% .RV infection occurred all year around ,and the infection peak was November ,December and January .RV infected children mainly distributed in the age group of 6 months to 2 years .Conclusion RV infection in children is a universal problem in Shenzhen .Clinic should pay attention to it .

Relation between Caspase recruitment domain-containing membrane-associated guanylate kinase protein 1, clinicopathological features of gastrointestinal lymphoma also and Helicobacter pylori infection / 中华消化杂志

Objective To investigate the relation between the expression of Caspase recruitment domain-containing membrane-associated guanylate kinase protein 1 (CARMA1),clinicopathological features of gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma,diffuse large B cell lymphoma (DLBCL),and Helicobacter pylori (H.pylori) infection.Methods From January 1999 to March 2011,34 patients with DLBCL and 20 patients with MALT lymphoma were selected,and at same period 21 cases with reactive hyperplasia of gastrointestinal lymphoid tissue were enrolled in as control.The expression of CARMA1,Ki-67 and cytotoxin-associated gene A (CagA) at protein level were examined by immunohistochemistry.The relative expression quantity of CARMA1 mRNA was detected by real-time polymerase chain reaction (PCR).The condition of H.pylori infection in 25 gastric lymphoma and 10 controls was detected by methylene boric acid and blue staining or semi-nested PCR.Chi-square test was used for counting data analysis,t test for measurement data.Multivariate COX regression analysis was implemented for survival analysis.Survival curve was drawn by Kaplan-Meier method and analyzed by Log-rank test.Results The relative expression quantity of CARMA1 mRNA of 28 patients with DLBLC (3.073±1.846) was higher than that of 14 patients with MALT lymphoma,and the difference was statistically significant (F 0.975,P＜ 0.05).The positive rate of CARMA1 expression at protein level of gastrointestinal lymphoma group (75.9 ％,41/54) was higher than that of control group (47.6％,10/21),and the difference was statistically significant (x2 =5.568,P＜0.05),and the positive rate of CARMA1 expression of MALT lymphoma group (11/20) was lower than that of DLBCL group (88.2％,30/34),and the difference was statistically significant (x2 =5.900,P＜0.05).Among 42 patients with gastrointestinal lymphoma who received surgery,the relative expression quantity of CARMA1 mRNA in cases with high proliferation (2.885±1.837) was higher than that in cases with low proliferation.The expression of CARMA1 mRNA in the cases at advanced stage of the disease (4.416± 1.010) was higher than that in cases at early stage,and the difference was statistically significant (F=3.317 and 2.972,both P＜0.05).Among 54 patients with gastrointestinal lymphoma,the positive rate of CARMA1 expression at protein level of patients with high proliferation (88.6％,31/35) was higher that that of patients with low proliferation (10/19),and the difference was statistically significant (x22 ＝ 6.847,P＜0.05).There were no significant differences in relative expression quantity of CARMA1 mRNA and the positive rate of CARMA1 expression at protein level between 11 gastric lymphoma patients without H.pylori infection and 14 gastric lymphoma patients with H.pylori infection (both P＞0.05).The positive rate of CARMA1 expression at protein level of CagA positive and CagA negative H.pylori infected gastric lymphoma patients was 11/11 and 2/3.The expression of CARMA1 at protein level was correlated with the prognosis of gastrointestinal lymphoma (RR＝4.160,P＜0.05).In the 29 cases of patients with gastrointestinal MALT lymphoma and 18 cases of patients with DLBCL who were followed up,the survival situation of gastrointestinal lymphoma patients with CARMA1 positive expression rate over 50％ was worse than that of patients with the rate less than 50％,and the difference was statistically significant (x2=5.383 and 4.028,both P＜0.05).Conclusions CARMA1 might be involved in the pathogenesis and progression of MALT and DLBCL; and it might be a related factor of poor prognosis.There was no correlation between the expression of CARMA1 and H.pylori infection in these two lymphomas.