Coronary Stenosis ; diagnostic imaging ; Fractional Flow Reserve, Myocardial ; Humans ; Tomography, X-Ray Computed ; methods

Angiography ; Aortic Valve Stenosis ; Heart Valve Prosthesis ; Humans ; Tomography

Objective To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. Methods The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. Results The prevalence of placenta previa was 4.84% (3 840/79 304) in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76% (106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy (P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section (OR=12.9,95%CI:6.3-26.3), two or more prior cesarean sections (OR=14.4, 95%CI:3.9-53.2), anterior placenta (OR=4.8, 95%CI:2.1-10.7), complete placenta previa (OR=5.9, 95%CI:1.8-42.5), placenta accreta (OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L (OR=1.7, 95%CI:1.0-2.8) and delivery before 34 gestational weeks (OR=3.2, 95%CI:1.6-6.3) were independent risk factors of peripartum hysterectomy in patients with placenta previa (P<0.05). Conclusions Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.

Objective To evaluate the efficacy of probiotics to treat irritable bowel syndrome (IBS).Methods Publications from database including PubMed,the Cochrane Library,Embase,CNKI,CBM and WanFang Data were searched up to August 31,2014.The randomized controlled trials (RCTs) on probiotics to treat IBS were eligible.The related articles were extracted and cross-checked independently by two reviewers.Methodological quality of trials was evaluated according to Cochrane Handbook 5.1.0 criteria.Meta-analysis was conducted using RevMan 5.2 software.Results A total of 17 RCTs involving 1 700 patients were included.Results of meta-analyses showed that compared with the placebo,probiotics was statistically better in improving the overall symptoms integral (SMD =-0.20,95％ CI-0.33--0.07,P =0.002),alleviating abdominal pain/discomfort (SMD =-0.19,95％ CI-0.29--0.09,P ＜ 0.001),relieving abdominal distention (SMD =-0.16,95％ CI-0.28--0.03,P =0.020),and defecation discomfort (SMD =-0.22,95％ CI-0.42--0.02,P =0.030).There was no statistical significance in the overall quality of life (SMD =-0.08,95％ CI-0.07-0.23,P =0.290) and adverse effect ratio (RR =1.08,95％CI0.79-1.49,P=0.630).Conclusion Probiotics have beneficial effects on IBS,which can improve the patients' symptoms and with less adverse reaction.Due to the bias,further large-scale,multicenter and high-quality RCTs are required to unify outcome indicators,further define sensitive strain,and standardize its usage,dosage and course of treatment.

Objective To measure HPSE and VEGF-C expression in pancreatic cancer tissues and to observe the effect of small interfering RNA targeting heparanase gene on VEGF-C expression and malignant biological behavior of pancreatic cancer cell lines BxPC-3.Methods We measured the relative mRNA levels of HPSE and VEGF-C in 34 pancreatic ductal cell adenocarcinoma(PDAC) specimens by RT-qPCR.The recombinant plasmid GV230/HPSE was constructed.BxPC-3 was transiently transfected with GV230/HPSE and HPSE-siRNA.The expression levels of HPSE and VEGF-C were measured by performing florescent real-time quantitative PCR (RT-qPCR) and immunoblotting.The invasion and migration potential of treated BxPC-3 was evaluated by transwell invasion assay and Scratch-wound assay.Results Spearman rank correlation analysis indicated a positive correlation between HPSE and VEGF-C (r =0.812,P ＜0.01)in pancreatic cancer tissues.HPSE and VEGF-C overexpression was correlated with tumor differentiation,lymph node metastasis and TNM stage(all P ＜0.01).RT-qPCR and Western blot showed high expression of HPSE mRNA and VEGF-C mRNA in GV230/HPSE group than that in control group,compared to low expression of HPSE mRNA and VEGF-C mRNA in siRNA group (all P ＜ 0.01).Invasion chamber assay and Scratch-wound assay showed higher invasion in GV230/HPSE group than that in control group,while lower invasion in siRNA group (all P ＜ 0.01).Conclusions Joint detection of HPSE and VEGF-C may be of significance in predicting prognosis of patients with pancreatic cancer.HPSE regulates the expression of VEGF-C and facilitates invasion and migration of BxPC-3 in vitro.

Objective To evaluate the efficacy of levofloxacin-based triple therapy and bismuthbased quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens.Methods Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed,Cochrane Library,SPRINGER,VIP database,WanFang database and CKNI database.The literature quality was evaluated by the improved Jadad criterion.RevMan5.3 sofeware was applied to data analysis.The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis.Publication bias assessed with funnel plots.Results Ultimately seventeen literatures were included for meta-analysis,the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant (77.0％ vs 68.7％,OR =1.52,95％ CI 0.96-2.42,P =0.34).In European countries,levofloxacin-based triple therapy was more effective than quadruple therapy(80.6％ vs 68.5％,OR =2.18,95％ CI 1.25-3.81,P ＜ 0.05),while eradication rates of two groups in Asian countries were similar.The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy,whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy (87.7％ vs 61.3％,OR =4.92,95％ CI 3.09-7.82,P ＜ 0.05).The efficacy was not influenced by the dose of levofloxacin.The adverse effects were significantly lesser(19.1％ vs 29.5％,OR =0.47,95％ CI 0.26-0.82,P ＜ 0.05),whereas the compliance rate was significantly higher in levofloxacin group (96.0％ vs 89.9％,OR =2.27,95％ CI 1.33-3.87,P ＜ 0.05).Conclusions Comparing with bismuth-based quadruple therapy,levofloxacinbased triple therapy has higher eradication rate,compliance rate and lesser side effects,so we recommend it as a second-line rescue therapy after front-line Hp eradication failure.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.

Objective To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms.Methods PubMed,CENTRAL,Embase,CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H.pylori eradication treatment and those without treatment.The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring.A Meta-analysis was conducted by using RevMan 5.20 software.Results Twenty RCTs involving 6 575 cases were included.Meta-analysis showed that:(1) There was a positive link between H.pylori eradication and endoscopic reflux esophagitis.The diagnostic rate of endoscopic reflux esophagitis after H.pylori eradication therapy was higher than that of control group(7.25％ vs 4.20％;OR =1.62,95 ％ CI 1.20-2.19,P =0.002).Subgroup analysis found that Asian patients,40 to 50 years old,followup time more than 1 year,and peptic ulcer had higher incidence of endoscopic reflux esophagitis;(2) The incidence of reflux symptoms was not significantly different between H.pylori eradication group and control group (25.2％ vs 24.6％;OR =1.03,95％ CI 0.87-1.21,P =0.76).Further analysis indicated that reflux symptoms were not related to some relevant factors,such as races,age at diagnosis,follow-up time and underlying diseases.Conclusions The eradication of H.pylori is considered as one of risk factors for GERD,especially in Asian populations,long time follow-up,40 to 50 years old and patients with peptic ulcer.Meanwhile,the eradication of H.pylori does not suggest the correlation with reflux symptoms.H.pylori eradication therapy should be administrated according to patients' individual conditions.

Objective To develop a new type of lumbar puncture needle to facilitate to measure intracranial pressure,decrease the risks for intracranial infection and brain hernia.Methods The needle was composed of a body,no.1 and no.2 sleeves,a stylet,a needle base,a catheter,joints and etc.The needle had body and stylet made of stainless steel,the catheter manufactured with medical silicone tube,the joints produced by medical rubber and the remained components by medical plastics.Results The developed needle executed pressure measuring,cerebrospinal fluid collection and medication injection with no extracting the stylet.The outflow velocity of cerebrospinal fluid was limited,and the incidences of the complications were decreased including infection,brain hernia and etc.Conclusion The lumbar puncture needle has simple structure,easy operation and high safety,and thus is worthy promoting practically.

Aim To investigate the effects of silencing MALAT1 gene on cell proliferation inhibition and apop-tosis induced by Melittin in human hepatocellular car-cinoma HepG2 cells. Methods The inhibitory rate of cell proliferation treated with Melittin in HepG2 cells was examined by MTT assay. Apoptotic rate was detec-ted by flow cytometry. The MALAT1 expression level in HepG2 cells was measured by qPCR. Specific siR-NAs were utilized to silence MALAT1 expression. The rates of cell proliferation inhibition and apoptosis in HepG2 cells treated with siRNA and Melittin were compared with those of Melittin alone. Results Melit-tin significantly suppressed the growth of HepG2 and induced cell apoptosis in a dose-dependent manner. Compared with normal liver cell lines, MALAT1 was highly expressed in HepG2 cells ( P<0. 05 ) . The ex-pression of MALAT1 in HepG2 cells was inhibited by Melittin, and the inhibitory rate increased with the in-crease of concentration. The rates of cell proliferation inhibition and apoptosis in HepG2 cells treated with siRNA and Melittin were significantly higher than those treated merely with Melittin. Conclusion Melittin can reduce the expression of MALAT1 and silencing MALAT1 can effectively promote proliferation inhibi-tion and apoptosis in HepG2 cells induced by Melittin.