The Red Blood Cell Distribution Width-Albumin Ratio: A Promising Predictor of Mortality in Stroke Patients.

OBJECTIVE: Within this study we attempt to express a correlation between the mortality of stroke and stroke related infection to a novel biomarker represented by the red blood cell width-albumin levels ratio within the patient. We hypothesize that this novel biomarker could be utilized as better predictive tool for stroke associated infections. METHODS: Patient data sets were obtained via the Medical Information Mart for Intensive Care Database iii V1.4 (MIMIC-iii). Data from 1480 patients were obtained to serve the testing for the RA biomarker tests. Clinical endpoints of 30-, 60-, and 365-day all-cause mortality in stroke patients were used as subgroups within the analyzed population. Estimation of hazard ratios (HR) were obtained from Cox regression models for stroke-associated infection and all-cause mortality in relation to RA values. RESULTS: A high-RA was associated with increased mortality in ICU patients suffering from a stroke. After adjusting for age and sex, compared to the reference group (the first quartile), the high-RA group had the highest 30-day (HR, 95% CI: 1.88 (1.36, 2.58)), 90-day (HR, 95% CI: 2.12 (1.59, 2.82)), and one-year (HR, 95% CI: 2.15 (1.65, 2.80)) all-cause mortality. The RA values were independently associated with an increased risk of stroke-associated infection when adjusting for confounders. CONCLUSIONS: Our data suggest RA may be an easily accessible, reproducible, and low-cost biomarker for predicting stroke-associated infections and mortality in patients who have suffered from a stroke.

ATP Binding Cassette Subfamily A Member 2 (ABCA2) Expression and Methylation are Associated with Alzheimer's Disease.

BACKGROUND ABCA2 has been genetically linked to Alzheimer's disease (AD) risk, but its mRNA expression and epigenetics in AD have not been investigated. MATERIAL AND METHODS To explore the diagnosis value of ABCA2 mRNA expression in AD, 2 datasets GES15222 and GSE33000 containing expression profile of brain cortex tissues and 2 datasets GSE63063 (Cohort 1) and GSE63063 (Cohort 2) containing expression profile of blood were downloaded from the NCBI GEO database and analyzed by receiver operating characteristic curve (ROC) analyses and logistic regression. The ABCA2 co-expressed genes were also analyzed by GO annotation to investigate the potential molecular mechanisms. RESULTS The analyses results suggested ABCA2 mRNA expression was upregulated significantly in AD compared with controls in all datasets. ROC analysis suggested that ABCA2 was associated with AD in all datasets, which were also proved by univariate and multivariate analyses. Next, the dataset GSE80970 containing methylation profiles of prefrontal cortex tissues from AD patients were downloaded and analyzed. Methylation of 2 of 36 CpG islands in ABCA2 gene with high diagnostic accuracy of AD from controls in ROC analyses were found to be negatively associated with AD risk in univariate analysis. One was still associated with AD risk after adjustment of confounding factors. Additional analyses indicated that ACBA2 mRNA expression could be used to diagnose mild cognitive impairment (MCI) and Huntington's disease (HD) from controls and to distinguish HD from AD, but not AD from MCI. Furthermore, the genes involved in AD during ABCA2 alteration were analyzed by GO analysis. CONCLUSIONS ABCA2 mRNA expression and methylation is associated AD risk. ABCA2 may be used as a biomarker for AD diagnosis and may be a potential therapeutic target of AD.

[Excision of necrotic and infected tissues combined with induced membrane and external fixator technique for the treatment of chronic osteomyelitis in tibia after fracture operation].

OBJECTIVE: To investigate the clinical efficacy of excision of necrotic and infected tissues combined with induced membrane and external fixator technique to treat chronic osteomyelitis in tibia after fracture operation. METHODS: From June 2011 to June 2014, a total of 13 patients with tibia osteomyelitis were treated with excision of necrotic and infected tissues and external fixator technique in the first stage. There were 8 males and 5 females, ranging in age from 16 to 67 years old with an average of (37.3±14.3) years old. Within 6 to 8 weeks the induced membrane was formed and the induced membrane technique was applied to promote new bone forming in the second stage. RESULTS: Thirteen patients had no reinfection and achieved complete bone healing after 24 to 52 months follow-up. All the patients had satisfactory function. CONCLUSIONS: Excision of necrotic and infected tissues combined with induced membrane and external fixator technique to treat chronic osteomyelitis in tibia after fracture operation can provide satisfactory results.

Integrated analysis of differential gene expression profiles in hippocampi to identify candidate genes involved in Alzheimer's disease.

Alzheimer's disease (AD) is a complex neurodegenerative disorder with largely unknown genetic mechanisms. Identifying altered neuronal gene expression in AD may provide diagnostic or therapeutic targets for AD. The present study aimed to identify differentially expressed genes (DEGs) and their further association with other biological processes that regulate causative factors for AD. The present study performed an integrated analysis of publicly available gene expression omnibus datasets of AD hippocampi. Gene ontology (GO) enrichment analyses, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Protein­Protein interaction (PPI) network analysis were performed. The present study detected 295 DEGs (109 upregulated and 186 downregulated genes) in hippocampi between AD and control samples by integrating four datasets of gene expression profiles of hippocampi of patients with AD. Respiratory electron transport chain (GO: 0022904; P=1.64x10­11) was the most significantly enriched GO term among biological processes, while for molecular functions, the most significantly enriched GO term was that of protein binding (GO: 0005515; P=3.03x10­29), and for cellular components, the most significantly enriched GO term was that of the cytoplasm (GO: 0005737; P=8.67x10­33). The most significant pathway in the KEGG analysis was oxidative phosphorylation (P=1.61x10­13). PPI network analysis showed that the significant hub proteins contained ß-actin (degree, 268), hepatoma-derived growth factor (degree, 218) and WD repeat­containing protein 82 (degree, 87). The integrated analysis performed in the present study serves as a basis for identifying novel drug targets to develop improved therapies and interventions for common and devastating neurological diseases such as AD.

Efficacy and safety of Wuling capsule, a single herbal formula, in Chinese subjects with insomnia: a multicenter, randomized, double-blind, placebo-controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Wuling Capsule is a single herbal formula from mycelia of precious Xylaria nigripes (Kl.) Sacc and its pharmacological function have a tranquilizing effect on the central nervous system. The aim of the study to evaluate the efficacy and safety of Wuling capsule in treatment of insomnia. MATERIALS AND METHODS: We performed a multicenter, randomized, double-blind, placebo-controlled study. The participants received either placebo (n=92) or Wuling capsule (n=94) for 4 weeks and a follow-up period for 2 weeks. RESULTS: Compared between pre-treatment and post-treatment, the global Pittsburgh sleep quality index (PSQI) scores in both Wuling capsule group and placebo group improved significantly (P<0.01). However, there was no significant difference between Wuling capsule group and placebo group (P>0.05). Scores of clinical global impressions scale (CGI-I) at each week in Wuling capsule group was similar to those in placebo group (P>0.05). Compared between pre-treatment and post-treatment, scores of the four components of world health organization on quality of life brief scale (WHOQOL-BREF) in both Wuling capsule group and placebo group improved significantly (P<0.01). However, there were no difference between the two groups (P>0.05). The rate of adverse events was 10.10% in Wuling group, and 6.73% in placebo group (P>0.05). CONCLUSIONS: Wuling capsule can improve insomnia when compared with pre-treatment for 4 weeks and be a well tolerated by all the patients at the 6 weeks of study period. However, there are no significant in the results of the variables tested when compared with placebo control. Further additional rigorous randomized clinical trials are still required.

[Clinical study on intervention of spleen-restoring decoction integrating with dormancy hygiene education on subhealthy insomnia of deficiency of both heart and spleen pattern].

OBJECTIVE: To appraise the clinical efficacy, safety and compliance of the intervention of spleen-restoring decoction combined with dormancy hygiene education and the intervention of spleen-restoring decoction alone on sub-healthy insomnia of deficiency of both the heart and spleen pattern. METHOD: Study design took multi-centers, blind and randomized control trial, 107 participants with sub-healthy insomnia of deficiency of both the heart and spleen pattern were assigned to A group (52 cases) which was treated with the intervention of spleen-restoring decoction combined with dormancy hygiene education and B group (55 cases) which was treated with the intervention of spleen-restoring decoction single, compared by efficacy, PSQI score, CGI score, WHOQOL-BREF score and security. RESULT: The efficacy of two group was 79.58%. There was no significant different between them. The PSQI scores before treatment was (11.80 +/- 2.08) and which afer treatment was (6.78 +/- 2.84) of A group. The PSQI scores before treatment was (11.61 +/- 2.00) and which afer treatment was (6.73 +/- 2.27) of B group. There was significant difference in PSQI scores both A group and B group after treatment (P < 0.01); the results of CGI score and WHOQOL-BREF score before and after measurement showed the same as PSQI. There were no significant difference between two groups in all scores after treatment and there was no interaction between time pots and treatment factors . Withdrawal reaction analysis: comparing CGI after withdraw 2 weeks and at the end of treatment course, there was no significant difference between two groups. The same result was in comparison among groups. CONCLUSION: Both the intervention of spleen-restoring decoction integrating with dormancy hygiene education and spleen-restoring decoction had obvious clinical efficacy on treating subhealthy insomnia of deficiency of both the heart and spleen pattern, and had high compliance and safety. The intervention of spleen-restoring decoction integrating with dormancy hygiene education showed no better clinical efficacy than spleen-restoring decoction did.

[Analysis of symptom compositions in sub-health insomnia patients of Yin deficiency fire hyperactivity syndrome and Xin-Pi deficiency syndrome].

OBJECTIVE: To study Chinese medicine syndrome features in sub-health insomnia patients, and to make clear the symptom compositions of each syndrome, thus providing references for main and minor symptoms selection, and establishing a syndrome differentiation system in clinical testing. METHODS: Chinese medicine syndrome information was collected by multi-centered large-sample clinical data. The information was statistically managed to get common syndrome types, symptoms compositions, and the Pittsburgh Sleep Quality Index (PSQI) scores of sub-health insomnia patients. RESULTS: The most common symptoms of sub-health insomnia patients of yin deficiency fire hyperactivity syndrome and Xin-Pi deficiency syndrome cover difficulties in falling asleep, early awakening, dreaminess, sometimes sleeping sometimes awake, failing in falling into sleep when wake up, failing in sleep all night. There was insignificant difference between the two syndrome types (P>0.05). Some unique symptoms occurred in the two syndrome types as minor symptoms. Fatigue, abdominal distension after eating occurred in patients of Xin-Pi deficiency syndrome. Burning sensation of five centers, irritability, etc. occurred in patients of yin deficiency fire hyperactivity syndrome. Significant difference was shown in minor symptoms (except irritability, vexation, frequent urine) (P<0.05, P<0.01). No significant difference was shown in PSQI score between the two syndrome types (P>0.05). But significant difference was shown in sleep disturbance factors (P<0.05). Patients of yin deficiency fire hyperactivity syndrome had severe sleep disturbance factors. CONCLUSION: There was no significant difference in main symptoms between the two syndrome types. Some unique symptoms occurred in the two syndrome types as minor symptoms. There was difference in sleep quality compositions.

[Clinical contrast of percutaneous pinning with plaster splint and open reduction and pulling out wire in the treatment of mallet fingers].

OBJECTIVE: To compare differences in the clinical outcomes between percutaneous pinning with plaster splint and open reduction and pulling out wire in the treatment of mallet fingers. METHODS: From December 2002 to September 2007, 72 patients with mallet fingers were treated. They were divided into two groups: group A and group B. In group A, 38 patients were treated by open reduction and pulling out wire, 34 males and 4 females, aged (26.0 +/- 8.5) years. Among them, 2 patients were injured in the index finger, 11 in the middle finger, 18 in the ring finger and 7 in the little finger. Thirty-three patients suffered from sports injuries, 5 from falling wounds. The average time between the injury and the surgery was (6.1 +/- 3.1) days. In group B, 34 patients were treated by percutaneous pinning with plaster splint, 26 males and 8 females, aged (28.1 +/- 10.7) years. Among them, 1 patient was injured in the index finger, 9 in the middle finger, 15 in the ring finger and 9 in the little finger. Thirty-one patients suffered from sports injuries, 3 from falling wounds. The average time between the injury and the surgery was (6.3 +/- 3.6) days. All the fingers had typical mallet malformation, and X-ray films showed avulsed fractures of distal-segment phalanxes at the dorsal basilar part. RESULTS: The operation time was (61.8 +/- 12.8) minutes in group A and (7.0 +/- 2.6) minutes in group B. All patients in both groups were followed up for 6-24 months (11.9 months on average in group A and 13.2 months in group B). In group A, apart from 3 patients who had flap necrosis and infection, all the other patients obtained healing by first intention. One patient had palmar skin ulcer at 6 days after the operation and healed after proper treatment. Thirty-six patients gained bone union at (47.6 +/- 8.7) days postoperatively and 2 patients had pseudarthrosis, which improved after reconstruction of the extensor tendon attachment point. According to the total active movement (TAM) functional assessment system, 10 cases were excellent, 18 good, 8 fair and 2 poor, with the choiceness rate of 73.7%. In group B, all incisions obtained healing by first intention without pin-track infection, flap necrosis and migration of the pins and gained bone union at (27.7 +/- 3.9) days after the operation. According to the TAM functional assessment system, 19 cases were excellent, 13 good and 2 fair, with the choiceness rate of 94.1%. There were significant differences between the two groups in operation time, complications, healing time and choiceness rate (P < 0.05). CONCLUSION: Percutaneous pinning with plaster splint is simple in operation and has smaller incisions and fewer complications compared withopen reduction and pulling out wire, and proves to be a useful way in the treatment of mallet fingers.