Prognostic value of DCTA scoring system in heart failure.

OBJECTIVE: The aim of this study was to evaluate the prognostic value of a novel scoring system, based on D­dimer, total cholesterol, high-sensitivity cardiac troponin T (hs-cTnT), and serum albumin levels, in patients with heart failure. METHODS: A total of 221 patients diagnosed with heart failure between May 2016 to January 2020 were enrolled in this retrospective study. The prognostic significance of the biomarkers D­dimer, total cholesterol, hs-cTnT, and serum albumin was determined with univariate and multivariate Cox proportional hazard models. A novel prognostic score based on these predictors was established. The Kaplan-Meier method and log-rank test were used to compare the adverse outcomes of patients in different risk groups. RESULT: Results from univariate and multivariate analyses showed that high D­dimer, low serum albumin, high hs-cTnT, and low total cholesterol levels were independent prognostic factors for adverse outcomes (D-dimer >0.63 mg/l, HR = 1.84, 95% CI = 1.16-2.94, p = 0.010; serum albumin >34 g/l, HR = 0.67, 95% CI = 0.45-0.99, p = 0.046; hs-cTnT >24.06 pg/ml, HR = 1.65, 95% CI = 1.08-2.53, p = 0.020; total cholesterol >3.68 mmol/l, HR = 0.63, 95% CI = 0.43-0.92, p = 0.017). Moreover, all the patients were stratified into low-risk or high-risk group according to a scoring system based on these four markers. Kaplan-Meier analyses demonstrated that patients in the high-risk group were more prone to having adverse outcomes compared with patients in the low-risk group. CONCLUSION: D­dimer, total cholesterol, hs-cTnT, and serum albumin levels were independent prognostic factors in the setting of heart failure. A novel and comprehensive scoring system based on these biomarkers is an easily available and effective tool for predicting the adverse outcomes of patients with heart failure.

Prognostic value of D-dimer/fibrinogen ratio in the adverse outcomes of patients hospitalized for heart failure.

Aim: To evaluate the clinical value of plasma D-dimer/fibrinogen ratio (DFR) in patients hospitalized for heart failure (HF). Methods: Clinical data of 235 patients were retrospectively analyzed. Kaplan-Meier method and Cox regression analysis were used to identify significant prognosticators. Results: The Kaplan-Meier analysis showed that a higher DFR level was significantly associated with an increase in the end point outcomes, including HF readmission, thrombotic events and death (log-rank test: p < 0.001). The multivariate Cox regression analysis showed that the high tertile of DFR was significantly associated with the study end points (HR: 2.18; 95% CI: 1.31-3.62; p = 0.003), compared with the low tertile. Conclusion: DFR is a reliable prognostic indicator for patients hospitalized for HF.

Bilateral and symmetric C1-C2 dumbbell ganglioneuromas associated with neurofibromatosis type 1: A case report.

BACKGROUND: Ganglioneuroma (GN) is a rare and benign tumor that originates from autonomic nervous system ganglion cells. The most frequently involved sites are the posterior mediastinum, the abdominal cavity, and the retroperitoneal space. It rarely occurs in the cervical area, compressing the spinal cord. Neurofibromatosis type 1 (NF-1) is an autosomal dominant inheritance disorder, whose prevalence rate approximates one per 3000. CASE SUMMARY: We report an extremely rare case of bilateral and symmetric dumbbell GNs of the cervical spine with NF-1. A 27-year-old man with NF-1 presented with a one-year history of gradually progressive right upper extremity weakness and numbness in both hands. Magnetic resonance imaging showed bilateral and symmetric dumbbell lesions at the C1-C2 levels compressing the spinal cord. We performed total resection of bilateral tumors, and the postoperative histopathological diagnosis of the resected mass was GN. After operation, the preoperative symptoms were gradually relieved without complications. To our knowledge, this is the sixth report of cervical bilateral dumbbell GNs. CONCLUSION: In some cases, cervical bilateral dumbbell GNs could be associated with NF-1. The exact diagnosis cannot be obtained before operation, and pathological outcome is the current gold standard. Surgical resection is the most effective option, and disease outcome is generally good after treatment.

[Effects of altered IFNAR expression on CD4+ CD25+ treg cell dysfunction in patients with systemic lupus erythematosus].

OBJECTIVE: To explore the role of type I interferon (IFNalpha) on the function of CD4+ CD25+ regulatory T (Treg) cells in patients with systemic lupus erythematosus (SLE). METHODS: Twenty patients with newly-onset active SLE and 20 healthy controls were recruited in this study. The expressions of type I interferon a receptor (IFNAR) on Treg cells were analyzed using flow cytometry. CD4+ CD25+ Treg cells were purified by magnetic-activated cell sorter (MACS). The function of these cells was assessed in vitro with or without IFNalpha (500 U/mL). The effect of exogenous IFNalpha on the apoptosis of Treg cells and the expression level of FOXP3, CTLA-4, and pAKT in Treg cells were analyzed using flow cytometry. Results The expression levels of IFNAR1 on CD4+ CD25+ Treg cells were significantly higher in the SLE patients than in the healthy controls (P=0.0006). There was a positive correlation between the expression levels of IFNAR on Treg cells and the SLEDAI scores in the SLE patients. Exogenous IFNalpha impaired the suppressive capacity of Treg cells in the SLE patients. However, neither the apoptosis of Treg cells nor the expression levels of FOXP3 and CTLA-4 on Treg cells were influenced by IFNalpha stimulation. IFNalpha enhanced AKT phosphorylation in Treg cells in the SLE patients. CONCLUSION: Altered IFNAR expression may contribute to Treg cell dysfunction in SLE patients through enhancing AKT phosphorylation in Treg cells.

New ideas for teaching electrocardiogram interpretation and improving classroom teaching content.

BACKGROUND: Interpreting an electrocardiogram (ECG) is not only one of the most important parts of diagnostics but also one of the most difficult areas to teach. Owing to the abstract nature of the basic theoretical knowledge of the ECG, its scattered characteristics, and tedious and difficult-to-remember subject matter, teaching how to interpret ECGs is as difficult for teachers to teach as it is for students to learn. In order to enable medical students to master basic knowledge of ECG interpretation skills in a limited teaching time, we modified the content used for traditional ECG teaching and now propose a new ECG teaching method called the "graphics-sequence memory method." METHODS: A prospective randomized controlled study was designed to measure the actual effectiveness of ECG learning by students. Two hundred students were randomly placed under a traditional teaching group and an innovative teaching group, with 100 participants in each group. The teachers in the traditional teaching group utilized the traditional teaching outline, whereas the teachers in the innovative teaching group received training in line with the proposed teaching method and syllabus. All the students took an examination in the final semester by analyzing 20 ECGs from real clinical cases and submitted their ECG reports. RESULTS: The average ECG reading time was 32 minutes for the traditional teaching group and 18 minutes for the innovative teaching group. The average ECG accuracy results were 43% for the traditional teaching group and 77% for the innovative teaching group. CONCLUSION: Learning to accurately interpret ECGs is an important skill in the cardiac discipline, but the ECG's mechanisms are intricate and the content is scattered. Textbooks tend to make the students feel confused owing to the restrictions of the length and the format of the syllabi, apart from many other limitations. The graphics-sequence memory method was found to be a useful method for ECG teaching.

A case of isolated aorta occlusion caused by Takayasu arteritis.

PURPOSE: We report a rare case of Takayasu arteritis causing isolated complete obliteration of the aorta. A 24-year-old woman with night sweats, weight loss, and claudication was hospitalized because of refractory hypertension. Laboratory tests showed increased inflammatory indexes. Imaging studies revealed isolated complete occlusion of thoracic and abdominal aorta. Takayasu arteritis was diagnosed. Glucosteroids and revascularization surgery were given. Clinical symptoms were relieved immediately without relapse after operation. Revascularization surgery was the effective therapy for the patient.

Association between mortality rate of hepatic carcinoma and the distance from Suihe River in Lingbi county, Anhui province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the association between mortality rate of hepatic carcinoma and the distance from Suihe River in Lingbi county, Suzhou, Anhui province.</p><p><b>METHODS</b>Using the disease mapping and spatial statistical analysis techniques,we described the spatial distributions of the mortality rate of hepatic carcinoma from 2005 to 2010 in Lingbi county. Taking the distance between villages and polluted rivers as proxy variable of environmental exposure, mortality rate of hepatic carcinoma in each village as dependant variable, and using the Glimmix model and Bayesian spatial model (BYM) to undertake the univariate and multivariate analysis, we investigatived the association between mortality rate of hepatic carcinoma and the water pollution of Suihe River in Lingbi county.</p><p><b>RESULTS</b>Obvious clustering of high mortality rate of hepatic carcinoma along the polluted river was observed in Lingbi county. Results of Glimmix model showed that whether spatial autocorrelation was considered or not, closer to the polluted river has higher mortality rate of hepatic carcinoma. Results of univariate analysis of the BYM model showed that, compared with the villages far from the polluted river more than 12 km (the mortality rate of hepatic carcinoma was 33.12/100 000(1068/3 224 562) ), the RR values of the hepatic carcinoma mortality was 1.38(95%CI:1.06-1.82) for the villages apart from the polluted river within 6 km (the mortality rate of hepatic carcinoma was 42.48/100 000(777/1 829 064)), and 1.13 (95%CI:0.92-1.39) for villages apart from the river between 6 and 12 km (the mortality rate of hepatic carcinoma was 35.65/100 000(651/1 825 848)). In the BYM model multivariate analysis, adding the volume of fertilizer and pesticides used per cultivated area, GDP per capita to do multivariate analysis were, the relation between mortality rate of hepatic carcinoma and distance from polluted rivers remains unchanged.</p><p><b>CONCLUSION</b>The mortality rate of hepatic carcinoma was associated with the exposure to the polluted river in Lingbi county. The polluted river may increase the hepatic carcinoma mortality of nearby residents.</p>

Survival analysis of late-onset systemic lupus erythematosus: a cohort study in China.

The aim of this study is to explore the survival rate and risk factors of mortality in patients with late-onset systemic lupus erythematosus (SLE) in a large cohort. Clinical presentations, disease activity, organ damage scores, autoantibody profile, and mortality data were obtained retrospectively from late-onset SLE patients (onset age ≥50 years) diagnosed between 1995 and 2009. The risk factors of organ damage were evaluated by the chi-square test and logistic regression. The cumulative rate of survival was calculated by Kaplan-Meier method, and factors predictive of mortality were studied by Cox proportion hazard regression model. A total of 158 patients (132 female and 26 male) were studied. The average onset age was 58.66 ± 6.38 years and mean disease duration was 63.85 ± 48.17 months. One hundred and four patients had organ damage at the time of data analysis. Hematological system and kidney involvement were most common. Central nervous system involvement was relatively rare. In univariate logistic analysis, associations were found between SLE disease activity index (SLEDAI) at diagnosis (OR = 1.133, P = 0.001); renal involvement (OR = 2.441, P = 0.009) and edema (OR = 2.812, P = 0.003) were associated with organ damage. And SLEDAI at diagnosis (OR = 1.103, P = 0.034) was independent factor for organ damage in multivariate logistic regression. During the follow-up, 64 patients (51 female and 13 male) died. Five-, 10-, and 15-year survival rates were 80.4, 56.5, and 31.7 %, respectively. Median survival time was 123 months. The analysis of Cox proportion hazard regression model showed that age at disease onset (OR = 1.069, P = 0.002), compliance of medical care (OR = 3.282, P = 0.001), and SLEDAI at diagnosis (OR = 1.091, P = 0.003) were independent risk factors of mortality. Late-onset SLE has a poor long-term prognosis. Infection is the major cause of death in patients with late-onset lupus. Disease activity, medical care, and onset age are strongly related to death of late-onset SLE.

Neutrophil extracellular traps in sterile inflammation: the story after dying?

Evidences accumulated that the death of neutrophils are not the end of their missions. The neutrophil extracellular traps (NETs), web-like structure, formed after neutrophils dying contribute greatly to immune defense, in both innate and adaptive immunity. Interestingly, previous studies revealed that the generation and activation of NETs do not only rely on bacteria induction, but also in patients with sterile inflammatory diseases, implying an undeniable correlation between NETs and these diseases. This review summarized the latest findings that the crucial roles of NETs in sterile inflammatory diseases, as well as novel targeted therapy based on these new discoveries.

Rapamycin-induced posterior reversible encephalopathy in a kidney transplantation patient.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by abnormalities in cerebral white matter and neurologic symptoms. It can be caused by immunosuppressive drugs or autoimmune diseases. We describe a case of PRES in a kidney transplantation patient treated with rapamycin. CASE: A 24-year-old woman, who received kidney transplantation 8 years ago, presented hypertension (220/120 mmHg), blindness, paralysis of left extremities, vomiting, convulsions and unconsciousness after rapamycin treatment. Magnetic resonance imaging (MRI) showed brain lesions suggestive of PRES. Rapamycin was withdrawn, and repeated MRI indicated progressive resolution within 2 months. CONCLUSION: Although neurotoxicity of rapamycin is relatively low, it can induce PRES in kidney transplantation patients.

[Essence of meridians based on neural electric field].

The physiological and pathological phenomenon along the running courses of meridians such as enrichment of small charged molecular, low-resistance, isotope migration, electromyography phenomenon, acoustical conductivity, thermal radiation, magnetic phenomenon and optical-electrical characteristics, etc. are explored in this article. And based on the above mentioned studies, it is concluded that as a physiological sensation along meridians, propagated sensation could only be the result of the reflection of nerve excitation. The direct stimulator of the neural electrical activities of the propagated sensation is the enrichment of charged small biological molecular at the corresponding site of the organism. The root cause of the enrichment is the unique electrophysiological mechanism and distribution discipline of the human nerve fiber, which formed an electric field of biological source for the concentration of the small molecular. Thus, it is concluded that the electric field along the running courses of meridians is an isopotential balanced line formed by multiple neural bioelectrical activities in different spaces closed to meridians.

Atrial myxoma with metastasis misdiagnosed as Takayasu arteritis.

The objective of the study is to report a case of atrial myxoma with bloodstream metastasis misdiagnosed to be Takayasu arteritis. A 23-year-old woman manifested with fever, repetitive vasocerebral events and extremities ischemic signs (claudication, difference of BP in arms and absence of pulse) for 5 years. Imaging studies revealed multiple cerebral infarction, bilateral iliac artery stenosis and as thrombosis formation. Takayasu arteritis was diagnosed according to American College of Rheumatology criteria. Glucosteroids and immunosuppressants were given; however, symptoms were not relieved even after treatment. Echocardiography suggested a mass in left atrium, which was surgically removed and pathologically confirmed to be atrial myxoma. Clinical symptoms completely relieved after operation. In conclusion, atrial myxoma with bloodstream metastasis sometimes presented with similar clinical symptoms of Takayasu arteritis and may lead to misdiagnosis of these two diseases. Usually, accepted diagnosis criteria are not enough in distinguishing these diseases. Echocardiography should be considered in these patients.

Diffuse lupus encephalopathy in a case of rhupus syndrome.

"Rhupus syndrome" is a rare clinical condition, which is related to anti-CCP antibody, characterized by overlapping clinical and immunologic features of rheumatoid arthritis and systemic lupus erythematosus. Previous reports mentioned that patients have more RA-associated damage, and little organic damage associated with SLE. The severe organ damage, especially central nervous system involvement has been reported to be rare in patients with rhupus syndrome. Here, we report a very rare concurrence of RA, SLE and diffuse lupus encephalopathy in a Chinese woman.

[Analysis of the risk factors of community-acquired pneumonia in patients with primary Sjogren's syndrome].

OBJECTIVE: To investigate the risk factors of community-acquired pneumonia (CAP) in patients with primary Sjogren's syndrome (pSS). METHODS: The clinical data were collected from 121 inpatients with pSS and univariate analysis and logistic regression were conducted to analyze the risk factors of CAP. RESULTS: The incidence of CAP in the 121 patients with pSS was 27.3%. Age, disease course, low while blood cells, low complement levels, liver and kidney dysfunction, low albumin, hyperglobulinaemia, renal tubule acidosis, interstitial lung disease (ILD) and immunosuppressive agents were closely related to CAP in these patients. Logistic regression analysis identified ILD, low complement levels and hyperglobulinemia as the risk factors for CAP in patients with pSS. CONCLUSION: Vigorous control of pSS and minimizing the risk factors may prove effective to lower the incidence of CAP in patients with pSS.