Low vitamin D levels are associated with cognitive impairment in patients with Hashimoto thyroiditis.

BACKGROUND: Cognitive impairment is commonly observed in patients with Hashimoto thyroiditis (HT). Low levels of vitamin D have been correlated with cognitive impairment in non-HT population. We examined the association of vitamin D levels with cognitive impairment in patients with HT. METHODS: We recruited 194 patients with HT and 200 healthy volunteers. Levels of serum 25-hydroxyvitamin D (25(OH)D) were measured using a competitive protein-binding assay. Cognitive funtion was assessed using Montreal Cognitive Assessment score (MoCA). Subjects with a MoCA scores < 26 are considered as having mild cognitive impairment (MCI). Multivariate analysis was performed using logistic regression models. RESULTS: Fifty-five HT patients (28.4%) were diagnosed as having MCI. Patients with MCI had significantly lower 25(OH)D levels when compared with patients without MCI (33.9 ± 6.2 vs. 44.3 ± 9.6 nmol/L, P < 0.001). Significant differences in 25(OH)D quartiles of HT patients were observed between the patients with MCI and the patients without MCI (P < 0.001). In multivariate analyses, serum 25(OH)D levels (≤ 34.0 and ≥ 47.1 nmol/L) were significantly associated with cognitive impairment in patients with HT (OR 6.279, 95% CI 2.673-14.834, P < 0.001; OR 0.061, 95% CI 0.008-0.491, P = 0.009, respectively). CONCLUSION: Our results demonstrate an important association between serum vitamin D levels and cognitive impairment in patients with HT.

[Analgesic and Sedative Effect of Acupuncture Combined with Medicine on Patients Undergiong Cardiac Surgery].

OBJECTIVE: To observe analgesic and sedative effect of acupuncture combined with medicine (ACM) on patients undergiong cardiac surgery. METHODS: A total of 50 patients with cardiac surgery from January 2012 to October 2014 were randomly assigned to the conventional analgesia group (group A) and the ACM analgesia group (group B), 25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine, while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA, Shenting (GV24); Yintang (EX-HN3)] combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed, such as static and dynamic VAS scores, SAS scores, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2). The injection dosage of dexmedetomidine and morphine hydrochloride, analgesia satisfaction rate, sedation satisfaction rate, the incidences of adverse reactions during treatment such as bradycardia and low blood pressure, mechanical ventilation time, ICU time, and hospitalization expense were observed and recorded in the two groups. RESULTS: There was no statistical difference in static and dynamic VAS scores, SAS score, MAP, HR and SpO2 between the two groups at different time points (P > 0.05). The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A (P < 0.05). The analgesia satisfaction rate of patients in group B was much higher than that in group A (P < 0.05). The incidence of bradycardia also obviously decreased more in group B than in group A (P < 0.05). There was no statistical difference in patients' sedation satisfaction rate, incidences of low blood pressure, delirium, vomiting; mechanical ventilation time, ICU time, or hospitalization expense between the two groups (P > 0.05). CONCLUSION: The analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.

Treatment of thoracic hemorrhage due to rupture of traumatic mediastinal hematoma.

Patients in traffic accidents are usually presented with pain and bleeding due to fractures or soft tissue injury. On some occasions, more severe complications may be triggered by the trauma. A review of the published English language literature reveals no survival case once the traumatic mediastinal hematoma is ruptured. In our case, a 54-year-old man suffering motorcycle accident was admitted to emergency department. Computed tomography scan revealed subdural hematoma combined with posterior mediastinal hematoma. The patient was saved and discharged with a satisfactory outcome. Here we hope to share our treatment experience in dealing with the patient with severe multiple trauma.

[Study on the non-and-low response and its determinants to recombinant yeast-derived hepatitis B vaccines among neonates after primary immunization in Shanghai].

OBJECTIVE: To evaluate the non-and-low response to primary immunization of recombinant yeast-derived hepatitis B vaccines (YDVs) among neonates and to probe its determinants, in Shanghai. METHODS: Two thousand and forty-seven infants, born during 2008 - 2009 in three districts of Shanghai and administered with 3 dosages of YDVs according to 0 - 1 - 6 month schedule, were selected as subjects. Anti-HBs titers were evaluated by Chemiluminescence Microparticle Immuno Assay and related information was collected from parents through questionnaires. Univariate analysis and logistic regression model were used to probe the determinants among those infants with non-and-low response. RESULTS: The max-titer of anti-HBs in 2047 subjects was 14 982.7 mIU/ml, whereas the min-titer was 0.52 mIU/ml. The GMC was 408.04 mIU/ml after primary immunization of YDVs. The proportion of infants with titers of < 100 mIU/ml (non-and-low response) was 17%, in which the proportion with titers of < 10 mIU/ml (non response) was 1.86% and the proportion with titers of 10 - 99 mIU/ml (low response) was 15.14%. Data from both univariate analysis and Ordinal logistic regression suggested that gender, age, premature labor, type of vaccines, double positive for both HBsAg and HBeAg were determinants of non-and-low response for infants, with the OR value of 1.365 for male infants, 3.133 for infants with 13 - 18 months old, 2.824 for premature infants, 4.540 for infants administered by 5 µg YDVs and 2.298 for infants whose mother was double positive for both HBsAg and HBeAg. CONCLUSION: Male infants, infants with 13 - 18 months old, premature infants, infants administered by 5 µg YDVs and infants whose mother were double positive for both HBsAg and HBeAg had comparatively worse response for YDVs, suggesting that the anti-HBs titer surveillance programs set for these infants should be strengthened.

An essential tryptophan residue in alkaline phosphatase from pearl oyster (Pinctada fucata).

Alkaline phosphatases are ubiquitous enzymes found in most species including the pearl oyster, Pinctada fucata, where it is presumably involved in nacreous biomineralization processes. In the present study, we have purified alkaline phosphatases from the pearl oyster and modified the tryptophan residues using N-bromosuccinimide (NBS). We show that the resulting inactivation of purified alkaline phosphatase by NBS is dependent on modification of only one of five tryptophan residues in the enzyme. Substrate protection experiments showed that the tryptophan residue was not located at the substrate-binding site but was involved in the catalytic activity.