Establishment of a rat model of myocardial hypertrophy by a modified abdominal aortic coarctation method / 解剖学报

Objective To compare effectiveness between the modified and traditional pressure-overload myocardial hypertrophy(POMH) model by abdominal aorta coarctation (AAC) method. Methods Totally 45 rats were divided into three groups(n = 15 per group), sham group, traditional group, and modified group. In the traditional group, the diameter ol the abdominal aorta was narrowed to 0. 70 mm through a midline incision for 4 weeks; in the modified group, the diameter of the abdominal aorta was narrowed above the left kidney to 0. 45 mm for 1 week, and then the narrowing was lifted postoperatively. The cardiac index, heart weight (HW) /body weight (BW) and left ventricular index, left ventricular weight (LVW)/BW were measured from the heart specimens, and the cross-sectional area of cardiac myocytes, myocardial collagen area, and myocardial collagen area Iraction were measured in the pathological sections by HE staining and Masson staining. Results Compared with the sham group, the differences in end-systolic interventricular septum thickness (IVSs), left ventricular end-systolic posterior wall thickness (LVPWs), HW/BW, LVW/BW, cardiomyocyte cross-sectional area, myocardial collagen area, myocardial collagen area fraction, and brain natriuretic peptide (BNP) expression levels were statistically significant (P0. 05). Conclusion The modified abdominal aortic constriction method used in this experiment is time-saving, stable, homogeneous and easy to replicate, and is a more ideal approach to establish a rat model of POMH.

Effects of different storage and transportation devices on the temperatures of “internet plus drug delivery”in hospital under high-temperature conditions in summer / 中国药房

OBJECTIVE To explore suitable storage and transportation conditions for “internet plus drug delivery” under high- temperature conditions. METHODS A survey on high-temperature conditions in summer in Beijing was conducted； a retrospective analysis was conducted on “internet plus drug delivery” orders in our hospital from July 2021 to June 2022， summarizing the proportion and delivery range of drugs under different storage and transportation conditions. Additionally， simulation and validation experiments were performed to investigate optimal drug storage and transportation devices for “internet plus drug delivery” in Beijing under high-temperature conditions in summer. RESULTS The monthly average temperature in Beijing from June to August consistently exceeded 25.0 ℃ between 1991 and 2022. From July 2021 to June 2022， a total of 104 drugs were required to be stored below 25.0 ℃， accounting for 31.23% of the 333 drugs listed in our hospital’s “internet plus drug delivery” catalog in Beijing. These drugs were delivered 1 058 times， accounting for 19.63% of the total deliveries. Simulation and validation experiments demonstrated that the average maximum temperature during the next-day delivery process of “carton + foam box + composite aluminum film pearl cotton + 500 g ice bag×2 + gas column bag” was 9.6 ℃， the average minimum temperature was 2.7 ℃， and all the temperatures remained below 15.0 ℃， which could effectively ensure the quality of drugs. CONCLUSIONS Under the high-temperature conditions in summer in Beijing， the storage and transportation device of “carton + foam box + composite aluminum film pearl cotton + 500 g ice bag×2 + gas column bag” can meet the temperature requirements specified in the drug storage instructions for Beijing intra-city drug delivery.

Comparative transcriptomic analysis reveals differences in MADS-box genes of different hypericum in Changbai Mountains.

To explore the differences between the hypericum in the Changbai Mountains, we carried out a transcriptome analysis of two common hypericums in the area, which was Hypericum attenuatum Choisy and Hypericum longistylum Oliv. We screened the MADS-box genes to analyze divergence time and evolutionary selection expression, and determine their expression levels. The results showed that we detected 9287 differentially expressed genes in the two species, of which shared 6044 genes by the two species. Analysis of the selected MADS genes revealed that the species was in an environment adapted to its natural evolution. The divergence time estimation showed that the segregation of these genes in the two species was related to the changes of external environment and genome replication events. The results of relative expression showed that the later flowering period of Hypericum attenuatum Choisy was related to the higher expression of the SVP (SHORT VEGETATIVE PHASE) and the AGL12 (AGAMOUS LIKE 12), while the lower expression of the FUL (FRUITFULL).

Chinese Medicine Regulates NLRP3 Inflammasomes to Treat Diabetic Nephropathy： A Review / 中国实验方剂学杂志

Diabetic nephropathy （DN）， a major cause of chronic kidney disease （CKD）， aggravates the prevalence of end-stage renal disease （ESRD） and threatens human health. The pathogenesis of DN is complex， in which inflammation is a key pathological link in the cascade injury. Therefore， the treatment targeting inflammation helps to delay the progression of DN. NOD-like receptor protein 3 （NLRP3）， a classical proteasome， acts as an inducer of innate immune responses. The activated NLRP3 inflammasomes produce and release inflammatory mediators to trigger pyroptosis and uncontrolled autophagy and mediate the stress signals promoting renal fibrosis， thus participating in the development and progression of DN. The NLRP3 inflammasome as a core site inducing inflammation is widely involved in DN progression and may be a novel target. The active components and compound prescriptions of Chinese medicines are increasingly applied in the prevention and treatment of DN. The latest studies have discovered that Chinese medicines can treat DN by regulating the activation of NLRP3 inflammasomes. Although studies have been conducted to explore the mechanism of Chinese medicines in the treatment of DN via NLRP3 inflammasome， the systematic review remains to be carried out. This paper reviews the relevant publications in recent years and introduces the research progress from the assembly and activation of NLRP3 inflammasomes， the mechanism of NLRP3 inflammasomes in the treatment of DN， and the regulation of NLRP3 inflammasomes by Chinese medicines for the prevention and treatment of DN， aiming to lay a foundation for the relevant studies and provide new targets and strategies for the prevention and treatment of DN.

Traditional Chinese Medicine Against Liver Fibrosis Based on Autophagy： A Review / 中国实验方剂学杂志

Hepatic fibrosis （HF） is a widespread disease caused by various forms of chronic liver injury， significantly impacting human health. HF often has an insidious onset with inconspicuous symptoms， but in its advanced stages， it can progress to cirrhosis or even hepatocellular carcinoma. The pathogenic mechanisms of HF are highly complex， primarily characterized by excessive extracellular matrix （ECM） deposition. Autophagy is a lysosome-mediated degradation system employed by cells to recycle cellular contents， eliminate aggregated proteins， damaged organelles， and invading pathogens （such as viruses and bacteria） to maintain normal cellular function and dynamic balance. Autophagy can regulate various signaling pathways and factors， including mammalian target of rapamycin （mTOR）， adenosine monophosphate-activated protein kinase （AMPK）， and transforming growth factor-β （TGF-β）， to reduce the activation of hepatic stellate cells （HSCs） and hepatocyte necrosis and apoptosis， thereby mitigating ECM deposition and slowing the progression of HF. Numerous studies also suggest that traditional Chinese medicine （TCM） can effectively treat HF， and its mechanism of action may be related to autophagy. This article provides a review by summarizing recent literature in China and abroad on the mechanisms of autophagy， related signaling factors and pathways， as well as the role of TCM in regulating autophagy for the prevention and treatment of HF， aiming to offer insights and references for the development of TCM in the prevention and clinical rational medication in the treatment of HF.

Extracorporeal membrane oxygenation bridging heart transplantation in the treatment of two children with end-stage heart failure / 中国小儿急救医学

Objective:To investigate the application of extracorporeal membrane oxygenation(ECMO)bridging heart transplantation in critically ill children.Methods:The clinical data of two cases of critical infants with venous-arterial ECMO(VA-ECMO)bridging heart transplantation and literature review were retrospectively analyzed.Results:Two cases received orthotopic heart allograft with VA-ECMO support, and were discharged uneventfully without significant postoperative complications.On the 13th day of ECMO assistance, the first child was treated with orthotopic heart transplantation in a hospital qualified for heart transplantation, and the ECMO was evacuated during the operation.After 21 days of the heart transplantation, the patient was discharged from the hospital.The patient was followed up to be healthy after heart transplantation, and had the same development as children of the same age, and had been taking anti-rejection drugs for a long time.On the 10th day of VA-ECMO treatment, the second case received awake ECMO after cardiac function improved.On the 12th day of VA-ECMO treatment, the patient was successfully evacuated from VA-ECMO and waited for heart transplantation.Cardiac orthotopic transplantation was performed after the 17 days after VA-ECMO evacuation.The patient was transferred to the general ward after 6 days of hospitalization in the intensive care unit, and was discharged 23 days after transplantation with conventional anti-rejection therapy.Discharge follow-up in good health, normal school life.Conclusion:When VA-ECMO cannot be withdrawn from the heart of the critically ill children and the end-stage heart, VA-ECMO bridging heart transplantation should be selected at the right time for the children who meet the indications for heart transplantation to create survival opportunity for the previously hopeless children, save the life of the end-stage children, and improve the quality of life.

Nutritional evaluation and implementation of enteral nutrition in PICU / 中国小儿急救医学

Most critically ill children are in a state of severe stress and prone to malnutrition, which lead to a decline in the body′s resistance to disease and repair ability, thus aggravating the condition of children.After the initial support treatment of multiple organ functions, nutritional support should be considered as soon as possible to improve the metabolic status and supplement the metabolic needs of children, which can improve the nutritional status of children.Reasonable nutritional support treatment can not only improve nutritional status of the body, but also benefit the recovery and prognosis of the disease.Enteral nutrition is highly valued because it conforms to the gastrointestinal physiology and improves the mucosal barrier function of gastrointestinal tract.

Mechanism of Qingre Lishi Huazhuo Method（Modified Simiaosan） on Chronic Gouty Arthritis of Dampness-heat Obstruction Syndrome Based on NLRP3/IL-1β Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo study the clinical efficacy of the Qingre Lishi Huazhuo method on patients with chronic gouty arthritis of dampness-heat obstruction syndrome and the effect on nucleotide-binding oligomerization domain-like receptor 3（NLRP3）/interleukin-1β （IL-1β） signaling pathway to preliminarily explore its mechanism. MethodSixty patients with chronic gouty arthritis of dampness-heat obstruction syndrome were enrolled and divided into a treatment group （30 cases） and a control group （30 cases） according to the random number table method. Thirty people were assigned to the healthy group. Patients in the control group were treated with oral Febuxostat， while those in the treatment group were treated with modified Simiaosan combined with Febuxostat. Treatment lasted four weeks. The general clinical data， traditional Chinese medicine （TCM） syndrome scores， serum uric acid （UA）， serum creatinine （SCr）， blood urea nitrogen （BUN）， fasting blood glucose （FPG）， low-density lipoprotein （LDL）， triglyceride （TG）， total cholesterol （TC）， erythrocyte sedimentation rate （ESR）， and C-reactive protein （CRP） of patients were recorded. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of IL-1β，TNF-α， and IL-6，and the levels of NLRP3，cysteinyl aspartate-specific protease-1 （Caspase-1）， and apoptosis-associated speck-like protein containing a CARD （ASC） were detected by Western blot. ResultBefore treatment， the levels of body mass index （BMI）， systolic blood pressure （SBP），diastolic blood pressure （DBP），UA，SCr，BUN，FPG，LDL，TG，and TC in both groups significantly increased （P<0.05，P<0.01），and the levels of HDL significantly decreased as compared with those in the healthy group（P<0.05）. Additionally， the levels of IL-1β， TNF-α， and IL-6 in both groups significantly increased before treatment （P<0.01）. Compared with the results before treatment， patients in the two groups had significant reductions in tube pain， joint tenderness， joint swelling，joint fever， activity disorders， body fatigue， sliminess， bitter mouth， yellow and red urine， and tongue manifestation scores （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had a significant decrease in joint fever， body fatigue， sliminess， bitter mouth，sticky stool，yellow and red urine， tongue manifestation score， and pulse score （P<0.05）. The total effective rate in the treatment group was 80.0% （24/30）， higher than 56.7% （17/30）in the control group（χ2=11.916，P<0.05）. Compared with the results before treatment， BMI， SBP， DBP， UA， SCr， BUN， FPG， LDL， TG， TC， ESR，CRP， IL-1β， TNF-α， IL-6 levels， and VAS score in both groups significantly decreased （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had decreased DBP，ESR， IL-1β levels， and VAS score （P<0.05）. Western blot results showed that before treatment， the protein expression of NLRP3， Caspase-1， and ASC in peripheral blood mononuclear cells （PBMCs） of patients in both groups were higher than those in the healthy group （P<0.01）. Compared with the results before treatment， the protein expression of NLRP3， Caspase-1， and ASC in PBMCs in patients of both groups after treatment decreased （P<0.05，P<0.01）. Compared with the control group after treatment， the treatment group showed decreased expression levels of NLRP3 and Caspase-1（P<0.05）. ConclusionThe Qingre Lishi Huazhuo method can effectively improve the clinical symptoms and reduce inflammation of chronic gouty arthritis of dampness-heat obstruction syndrome with good safety. The mechanism may be related to the inhibition of the NLRP3/IL-1β signaling pathway.

Mechanism of Zhenwu Decoction in improving renal inflammatory injury in mice with DN of spleen-kidney Yang deficiency syndrome by regulating ROCK/IKK/NF-κB pathway / 中国中药杂志

To investigate the intervention effect and mechanism of Zhenwu Decoction on diabetic nephropathy(DN) mice of spleen-kidney Yang deficiency syndrome based on the Rho-associated coiled-coil kinase(ROCK)/IκB kinase(IKK)/nuclear factor-κB(NF-κB) pathway. Ninety-five 7-week-old db/db male mice and 25 7-week-old db/m male mice were fed adaptively for one week. The DN model of spleen-kidney Yang deficiency syndrome was induced by Dahuang Decoction combined with hydrocortisone by gavage, and then the model was evaluated. After modeling, they were randomly divided into a model group, high-dose, medium-dose, and low-dose Zhenwu Decoction groups(33.8, 16.9, and 8.45 g·kg~(-1)·d~(-1)), and an irbesartan group(25 mg·kg~(-1)·d~(-1)), with at least 15 animals in each group. The intervention lasted for eight weeks. After the intervention, body weight and food intake were measured. Serum crea-tinine(Scr), blood urea nitrogen(BUN), fasting blood glucose(FBG), urinary albumin(uALb), and urine creatinine(Ucr) were determined. The uALb/Ucr ratio(ACR) and 24 h urinary protein(UTP) were calculated. Renal pathological morphology was evaluated by HE staining and Masson staining. The levels of key molecular proteins in the ROCK/IKK/NF-κB pathway were detected by Western blot. Enzyme-linked immunosorbent assay(ELISA) was used to detect interleukin-1β(IL-1β), interleukin-6(IL-6), interleukin-8(IL-8), interleukin-10(IL-10), and tumor necrosis factor-α(TNF-α). Compared with the blank group, the model group showed increased content of BUN, uALb, and SCr, increased values of 24 h UTP and ACR, decreased content of Ucr(P<0.05), enlarged glomeruli, thickened basement membrane, mesangial matrix proliferation, inflammatory cell infiltration, and collagen fiber deposition. The protein expression of ROCK1, ROCK2, IKK, NF-κB, phosphorylated IKK(p-IKK), phosphorylated NF-κB(p-NF-κB), and phosphorylated inhibitor of NF-κB(p-IκB) increased(P<0.05), while the protein expression of inhibitor of NF-κB(IκB) decreased(P<0.05). The levels of inflammatory factors IL-1β, IL-6, IL-8, and TNF-α increased(P<0.05), while the level of IL-10 decreased(P<0.05). Compared with the model group, the groups with drug treatment showed decreased levels of BUN, uALb, SCr, 24 h UTP, and ACR, increased level of Ucr(P<0.05), and improved renal pathological status to varying degrees. The high-and medium-dose Zhenwu Decoction groups and the irbesartan group showed reduced protein expression of ROCK1, ROCK2, IKK, NF-κB, p-IKK, p-NF-κB, and p-IκB in the kidneys(P<0.05), increased protein expression of IκB(P<0.05), decreased levels of serum inflammatory factors IL-1β, IL-6, IL-8, and TNF-α(P<0.05), and increased level of IL-10(P<0.05). Zhenwu Decoction can significantly improve renal function and renal pathological damage in DN mice of spleen-kidney Yang deficiency syndrome, and its specific mechanism may be related to the inhibition of inflammatory response by down-regulating the expression of key molecules in the ROCK/IKK/NF-κB pathway in the kidney.

Discussion on the possibility of multi-layer intelligent technologies to achieve the best recover of musculoskeletal injuries: Smart materials, variable structures, and intelligent therapeutic planning.

Although intelligent technologies has facilitated the development of precise orthopaedic, simple internal fixation, ligament reconstruction or arthroplasty can only relieve pain of patients in short-term. To achieve the best recover of musculoskeletal injuries, three bottlenecks must be broken through, which includes scientific path planning, bioactive implants and personalized surgical channels building. As scientific surgical path can be planned and built by through AI technology, 4D printing technology can make more bioactive implants be manufactured, and variable structures can establish personalized channels precisely, it is possible to achieve satisfied and effective musculoskeletal injury recovery with the progress of multi-layer intelligent technologies (MLIT).

Large-Scale Production of Rectorite Nanosheets and Their Co-Assembly with Aramid Nanofibers for High-Performance Electrical Insulating Nanopapers.

Compared with raw rectorite microplatelets (RMs), rectorite nanosheets (RNs) have considerably greater application prospects in the preparation of advanced composite materials because of their larger aspect ratio, higher surface reactivity, and intrinsically superior mechanical and physical properties. However, the difficulty in the efficient preparation of RNs significantly limits their large-scale applications. Here, a scalable poly(vinylpyrrolidone)-assisted stirring approach is developed to prepare ultrathin RNs from the abundant natural RMs. A higher production rate (≈0.675 g h-1 ) is achieved compared with that of most other nanosheets. Additionally, instead of using conventional time- and energy-consuming high-speed centrifugation, an efficient poly(dienedimethylammonium chloride)-assisted sedimentation strategy is proposed here to rapidly separate the exfoliated RNs from the RN dispersion. Then, the RNs are co-assembled with aramid nanofibers (ANFs) into large-scale nacre-mimetic ANF-RN nanopapers with considerably enhanced mechanical, electrical insulating, and high-temperature-resistant properties compared with pure ANF nanopapers and ANF-RM micropapers. Moreover, these properties are superior to those of previously reported ANF-based nanopapers and commercial insulating micropapers.

Risk assessment of carbofuran residues in fruits and vegetables at the Chinese market: A 7-year survey.

The United Nations designated 2021 as the International Year of Fruits and Vegetables (IYFV), with the goal of educating populations regarding the role of such produce in nutrition, food safety, and overall health. Carbofuran is a highly toxic insecticide and nematocide, and its use to treat fruit trees, vegetables, tea, and medicinal herbs is thus prohibited. However, carbofuran residues are still detectable via LC-Q-TOF/MS in fruit and vegetable samples collected from 138 sites in 31 regions. In the present study, carbofuran levels were sampled at 1388 sampling sites in 31 regions (provinces, autonomous regions, and municipalities) not including Hong Kong, Macao, or Taiwan. In total, over 36,000 samples (including 12,547 samples of 41 kinds of fruits and 23,785 samples of 83 kinds of vegetables) were randomly collected from supermarkets and farmer's markets. These data were used to conduct a risk assessment pertaining to dietary carbofuran exposure through the consumption of fruits and vegetables. In total, carbofuran residues were detectable in 2.0% of fruits and 2.3% of vegetables. Risk assessments indicated that the intake of fruits and vegetables harboring carbofuran residues did not pose a chronic health risk. However, peaches, grapes, sweet peppers, celery, Chinese chives, leaf lettuce, spinach, small rape, mustard greens, cucumbers, watermelons, Chinese wolfberry leaves, wax gourds, snap beans, bitter melons, green Chinese vegetables, lettuce, shallot, cowpeas, eggplants, tomatoes, tangerines, summer squash, oranges, lemons, Chinese cabbage, peppers, and strawberries were associated with an unacceptable acute risk to both children and adults. Moreover, crown daisies, nectarines, citrus fruits, pitayas, melons, kale, cabbages, milk Chinese cabbage, carrots, and melons were associated with an unacceptable acute risk to children. Substantial acute risk to children and adults was observed for fruits and vegetables from surveyed regions other than Inner Mongolia, Yunnan, Liaoning, Fujian, Xinjiang, and Hubei. Together, these data provide a foundation for future research aimed at the management of carbofuran residues in fruits and vegetables in an effort to better protect consumer health.

Vortex-assisted dispersive liquid-liquid microextraction based on the solidification of sedimentary deep eutectic solvents for the determination of triazine and phenylurea herbicides in milk samples.

Vortex-assisted dispersive liquid-liquid microextraction based on the solidification of sedimentary deep eutectic solvents was developed and applied to the extraction of triazine and phenylurea herbicides in milk samples. In this study, a series of novel hydrophobic deep eutectic solvents were prepared using tetrabutylammonium chloride as the hydrogen bond acceptor and perfluorooctanol as the hydrogen bond donor, and their structures, viscosities, densities and melting points were determined. The deep eutectic solvent was used as the extraction solvent and dispersed in the sample solution with the assistance of vortex. After extraction, through centrifugation and subsequent cooling in an ice bath, the deep eutectic solvent was solidified and deposited on the bottom of the centrifuge tube. Subsequently, the deep eutectic solvent combined with the target analytes was diluted and used for chromatographic analysis. Some parameters, including the extraction temperature, type and volume of the deep eutectic solvent, amount of NaCl, vortex time and pH of the sample solution, were optimized by the single-factor experiment, Plackett-Burman design and Box-Behnken design. The limits of detection and quantification were in the range of 0.41-0.59 µg L-1 and 1.37-1.95 µg L-1, respectively. The intra-day precision and inter-day precision were in the range of 0.28-2.14% and 2.02-7.99%, respectively. The present method was successfully applied to the determination of triazine and phenylurea herbicides in milk samples.

Analysis of Risk Factors of Drug Resistance in Patients With Helicobacter pylori Infection / 胃肠病学

Background: The increasing in antibiotic resistance of Helicobacter pylori (Hp) has become the main cause leading to the decreasing of the eradication rate for Hp treatment. Aims: To investigate the risk factors of drug resistance of Hp. Methods: Data on 396 patients with Hp infection from Dec. 2016 to Mar. 2021 at Army Medical University were retrospectively analyzed. Drug susceptibility test was used to evaluate the resistance of 6 antibacterial drugs (metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone). Unconditional Logistic regression was used to investigate the risk factors affecting Hp antibiotic resistance. Results: In 396 patients with Hp infection, the resistance rates of metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone were 96.5%, 45.5%, 41.9%, 0.3%, 0.3% and 0, respectively. Multivariate analysis showed that previous regimen containing clarithromycin was a risk factor for clarithromycin resistance (P 40 years old was a risk factor for levofloxacin resistance (P< 0.001). Conclusions: The resistance rates of metronidazole, clarithromycin and levofloxacin are relatively high, and regimens containing these antibiotics should be avoided without the support from drug susceptibility results, especially in patients who have accepted clarithromycin‑containing regimen or more than 40 years old. Amoxicillin, tetracycline and furazolidone should be recommended preferentially for Hp treatment empirically.

Loss of O-GlcNAcylation on MeCP2 at Threonine 203 Leads to Neurodevelopmental Disorders / 神经科学通报·英文版

Mutations of the X-linked methyl-CpG-binding protein 2 (MECP2) gene in humans are responsible for most cases of Rett syndrome (RTT), an X-linked progressive neurological disorder. While genome-wide screens in clinical trials have revealed several putative RTT-associated mutations in MECP2, their causal relevance regarding the functional regulation of MeCP2 at the etiologic sites at the protein level requires more evidence. In this study, we demonstrated that MeCP2 was dynamically modified by O-linked-β-N-acetylglucosamine (O-GlcNAc) at threonine 203 (T203), an etiologic site in RTT patients. Disruption of the O-GlcNAcylation of MeCP2 specifically at T203 impaired dendrite development and spine maturation in cultured hippocampal neurons, and disrupted neuronal migration, dendritic spine morphogenesis, and caused dysfunction of synaptic transmission in the developing and juvenile mouse cerebral cortex. Mechanistically, genetic disruption of O-GlcNAcylation at T203 on MeCP2 decreased the neuronal activity-induced induction of Bdnf transcription. Our study highlights the critical role of MeCP2 T203 O-GlcNAcylation in neural development and synaptic transmission potentially via brain-derived neurotrophic factor.

A long-term ischemic stroke risk score model in patients aged 60 years and older with obstructive sleep apnea: a multicenter prospective cohort study / 南方医科大学学报

OBJECTIVE@#To analyze the independent risk factors of long-term ischemic stroke and establish a nomogram for predicting the long-term risks in elderly patients with obstructive sleep apnea (OSA).@*METHODS@#This multicenter prospective cohort study was conducted from January, 2015 to October, 2017 among consecutive elderly patients (≥60 years) with newly diagnosed OSA without a history of cardio-cerebrovascular diseases and loss of important clinical indicators. The follow-up outcome was the occurrence of ischemic stroke. The baseline demographic and clinical data, sleep parameters, laboratory and ultrasound results were collected from all the patients, who were randomized into the modeling group (n=856) and validation group (n=258) at a 3∶1 ratio. LASSO regression was used for variable reduction and dimension screening, and the risk score prediction model of ischemic stroke was established based on Cox proportional hazard regression.@*RESULTS@#In the total of 1141 patients enrolled in this study, 58 (5.08%) patients experienced ischemic stroke during the median follow-up of 42 months (range 41-54 months). The cumulative incidence of ischemic stroke was 5.14% in the model group and 4.91% in the verification group (P < 0.05). Age (HR=3.44, 95% CI: 2.38- 7.77), fasting blood glucose (FPG) (HR=2.13, 95% CI: 1.22-3.72), internal diameter of the ascending aorta (HR=2.60, 95% CI: 1.0- 4.47), left atrial anteroposterior diameter (HR=1.98, 95% CI: 1.75-2.25) and minimum oxygen saturation (LSpO2) (HR=1.57, 95% CI: 1.20-1.93) were identified as independent risk factors for ischemic stroke (P < 0.05 or 0.01). A long-term ischemic stroke risk score model was constructed based the regression coefficient ratios of these 5 risk variables. Before and after the application of the Bootstrap method, the AUC of the cohort risk score model was 0.84 (95% CI: 0.78- 0.90) and 0.85 (95% CI: 0.78- 0.89) in the model group and was 0.83 (95% CI: 0.73-0.93) and 0.82 (95%CI: 0.72-0.90) in the verification group, respectively, suggesting a good prediction efficiency and high robustness of the model. At the best clinical cutoff point, the cumulative incidence of ischemic stroke was significantly higher in the high-risk group than in the low-risk group (P=0.021).@*CONCLUSION@#This model can help to identify high-risk OSA patients for early interventions of the risks of ischemic stroke associated with OSA.

Observation on the treatment of infants with isolated congenital third-degree atrioventricular block by epicardial pacemaker / 中国小儿急救医学

Objective:To summarize the experience of transthoracic epicardial insertion pacemaker for isolated congenital third-degree atrioventricular block (CAVB), and explore the necessity and feasibility of permanent pacemaker in the treatment of CAVB in neonates and infants.Methods:The clinical data and follow-up of four children with CAVB admitted to the Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital from September 2010 to February 2022 were analyzed retrospectively.Two patients were implanted with permanent cardiac pacemakers during an early stage (less than one year old), and two patients were implanted during the non-early stage (one year old and above). All patients were diagnosed based on clinical symptoms, electrocardiogram and echocardiographic examination.After treatment, the pacing threshold, atrial sensing function, clinical symptoms, electrocardiogram and echocardiography examination of four patients were followed up.Results:All patients were successfully implanted with permanent cardiac pacemakers.One patient of non-early implantation was died of severe pneumonia and sepsis.During the follow-up period, pacing threshold, amplitude, impedance, minute ventilation and sensor function indicated pacemakers worked well in other three patients.Heart rates in these patients were significantly recovered, and showed growth trends in line with percentile curves for Chinese children and good movement skills.Conclusion:A pacemaker implantation performed by an experienced operator is a safe and feasible treatment for children with CAVB diagnosed in neonates and infants period with good prognosis.

Efficacy of wrist arthroscopic transosseous footprint repair technique for the treatment of triangular fibrocartilage complex injury / 中华创伤杂志

Objective:To investigate the clinical efficacy of wrist arthroscopic transosseous footprint repair technique for treating triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with TFCC injury admitted to Shenzhen Second People′s Hospital from July 2017 to September 2020, including 38 males and 18 females, aged 17-45 years [(33.5±3.6)years]. All patients had unilateral injury. Physical examination showed instability of the distal radioulnar joint, and MRI and arthroscopy confirmed deep ligament injury of TFCC. All patients underwent repair of deep insertion of the TFCC by using wrist arthroscopic transosseous footprint. The operation time, intraoperative blood loss, wound healing and postoperative complications were recorded. The flexion and extension range of motion of the wrist, radial and ulnal deviation of the wrist, rotation range of motion of the forearm, patient related wrist evaluation (PRWE) score, modified Mayo wrist score, visual analogue scale (VAS), and percentage of grip strength between the affected side and unaffected side were compared preoperatively, at 3 months postoperatively and at 1 year postoperatively.Results:All patients were followed up for 12-18 months [(13.4±5.2)months]. The operation time was (61.3±8.9)minutes, with the intraoperative blood loss of (2.4±1.2)ml. All wounds were healed by first intension. There was no wound infection or ulnar nerve irritation symptom after operation. Four patients experienced clicking on the ulnar side of the wrist in a short period of time post-operation, with spontaneous disappearance of the symptom. At 3 months postoperatively, the radial and ulnar deviation of the wrist was decreased from (52.5±5.9)° preoperatively to (42.6±5.9)°, and rotation range of motion of the forearm was decreased from (94.9±8.4)°preoperatively to (84.6±5.9)° (all P<0.01). The flexion and extension range of motion of the wrist was (93.1±17.4)° preoperatively, with insignificant difference compared with (89.4±5.8)° at 3 months postoperatively ( P>0.05). At 1 year postoperatively, the flexion and extension range of motion of the wrist, radial and ulnar deviation range of motion of the wrist, and rotation range of motion of the forearm were significantly increased to (101.3±13.6)°, (52.4±6.6)°, and (116.4±16.4)° when compared with those at 3 months postoperatively (all P<0.01). At 3 months postoperatively, the PRWE score was increased to (17.1±3.8)points from (10.6±3.2)points preoperatively ( P<0.01), modified Mayo wrist score was decreased to (70.3±6.7) points from (78.1±12.7)points preoperatively ( P<0.01), VAS was decreased to (4.4±1.7)points from (6.2±1.5)points preoperatively ( P>0.05), and percentage of grip strength between the affected side and unaffected side was decreased to (55.7±8.7)% from (74.4±15.2)% preoperatively ( P<0.01). At 1 year postoperatively, the PRWE score was increased to (2.0±0.9)points, modified Mayo wrist score was increased to (94.8±3.3)points, VAS was decreased to (2.1±1.1)points, and percentage of grip strength between the affected side and unaffected side was increased to (93.2±8.7)% when compared with those at 3 months postoperatively (all P<0.01). Conclusion:Wrist arthroscopic transosseous footprint repair technique can effectively treat deep ligament injury of TFCC, with advantages of significantly improving postoperative joint range of motion and functional score, relieving the pain on the ulnar side of the wrist and enhancing grip strength.

Factors Affecting the Initial Eradication Rate of Helicobacter pylori Infection / 胃肠病学

Background: Helicobacter pylori (Hp) infection is related to the occurrence of many upper digestive tract diseases, and the eradication rate has been decreasing year by year. Aims: To investigate the risk factors affecting initial eradication rate of Hp infection. Methods: Clinical data of 428 patients with Hp infection were retrospectively analyzed. Four regimens (14-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 10-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 14-day esomeprazole 20 mg + amoxicillin 1 000 mg, tid; 14-day esomeprazole 20 mg + bismuth 220 mg + amoxicillin 1 000 mg + clarithromycin 500 mg, bid) were given, and effect of antibiotic resistance on Hp eradication was analyzed, the relevant risk factors affecting the eradication rate of Hp were investigated. Results: The eradication rate of ITT analysis was 86.4%, PP analysis was 87.6%. The eradication rates of 4 regimens for ITT analysis were 90.8%, 79.8%, 82.7%, 91.9%, respectively, and were 90.8%, 81.2%, 85.1%, 92.7% for PP analysis, respectively. The antibiotic resistance rate was 30.3%, 97.4% and 36.8% for clarithromycin, metronidazole and levofloxacin, respectively. The recurrence rate of 116 patients was 4.3% after one year of eradication. Smoking, poor compliance, CYP2C19 gene polymorphism were risk factors for eradication rate of Hp (P<0.05). Conclusions: Smoking, poor compliance and ultra-rapid metabolizers, extensive metabolizers of CYP2C19 gene polymorphism can reduce Hp eradication rate. In clinical practice, patient education should be strengthened to urge patients to quit smoking. The quality of follow-up should be improved and proton pump inhibitor that has less impact on CYP2C19 gene polymorphism should be used, thereby increase the Hp eradication rate.

Gait analysis of knee osteoarthritis based on depth camera / 中华骨科杂志

Objective:In this study, a gait acquisition and analysis system is developed to provide a cheap, easy-to-use solution for quantitative recording and analysis of patients' gaits.Methods:From April 2017 to October 2018, we collected the gait data of 19 patients with knee osteoarthritis and 19 healthy volunteers in the orthopaedic outpatient department. Among 19 patients, there were 9 males and 10 females, aged 50.1±9.4 years old. Among 19 healthy volunteers, there were 8 males and 11 females, aged 50.7±10.3 years old. Then, from the collected gait data, the static gait features such as gait speed, step length, stride, and dynamic gait features were automatically calculated, and the statistical difference analysis was finished to determine the correlation between these quantitative gait features and knee osteoarthritis.Results:Firstly, the gait data collected by the depth camera was compared with the data from the multi infrared camera-based motion analysis system (gold standard). The average angle error of the collected knee joint angle was 0.98 degrees, which proved the correctness of the gait data recorded by the depth camera. The statistical difference analysis of gait characteristics between the patient group and the healthy group showed that the gait characteristics with P<0.05 included: gait speed ( r=-0.922, P<0.001), step length ( r=-0.897, P=0.004), stride ( r=-0.914 , P<0.001), dynamic characteristics of angle of knee joint ( r=0.775, P=0.001). Conclusion:The gait acquisition and analysis system based on the depth camera can accurately record and store the gait data of the patients with knee osteoarthritis. Moreover, the extracted quantitative gait features have statistical differences between the patients and the healthy group, which is helpful for the gait analysis of bone joint.