BACKGROUND: Bone marrow stem cells can be induced to differentiate into vascular endothelial cells and facilitate establishment of compensatory circulation, so as so improve blood supply of ischemic tissues. OBJECTIVE: To observe the clinical efficacy of autologous peripheral blood stem cells (PBSCs) transplantation in the treatment of diabetic vascular disorder in the lower extremities and diabetic feet. DESIGN: Wuhan Central Hospital, Wuban, Hubei Province, China. PARTICIPANTS: A total of 89 patients with type 2 diabetic vascular disorder in the lower extremity were enrolled from Department of Endocrinology in Wuhan Central Hospital from July 2005 to may 2007. All cases matched the criteria of diabetes by WHO in 1999, and complicated with diabetic peripheral angiopathy and diabetic feet. They included 61 males and 28 females, aged 45-90 years, with an average age of 67. Lesion was mainly located in lower extremities, 54 patients with foot ulcers while 8 patients with gangrene. All the patients signed the informed consents, and the experiment was approved by the hospital ethics committee. Recombinant human granulocyte colony stimulating factor was purchased from China Kunpeng Bio-Pharmaceutical Co., Ltd.METHODS: Stem cell mobilization: 89 patients all received recombinant human granulocyte colony stimulating factor, 500-600 μg per day by hypodermic injection for 5 days to mobilize stem cells. On the fifth day. PBSCs were collected with a total amount of 83-103mL. The number of mononuclear cells was (1.86-3.39)×1011L-1,while the proportion of CD34 positive cells was 0.55%-1.36%. PBSCs transplantation: After patients were treated with intravenous anesthesia, PBSCs were injected into the ischemic lower extremity and foot intramuscularly at 3cm×3cm distance. The clinical and laboratory findings were monitored from the first day to the sixth month.MAIN OUTCOME MEASURES: The patients were evaluated before transplantation, and in the first, third and sixth months after transplantation, including affected limb pain, cool feeling, intermittent claudication, ankle brachial index (ABI), limb skin temperature and deep feeling. Color Doppler. CT and digital subtraction angiography were applied to detect lower extremities morphous.RESULTS: All 89 included patients were involved in the result analysis. Scores of clinical symptom: The affected limb pain, cool feeling, and intermittent claudication were all improved significantly after PBSCs transplantation (P<0.05),and the improvement was more evident with time extension. ABI: After PBSCs transplantation, ABI in patients increased significantly by different degrees with the time extension(P0.05). Skin temperature and deep feeling: Limb skin temperature increased significantly after transplantation (P<0.05), and deep feeling seemed to be improved, but the change was not significant(P0.05). Imaging determination: There was no obvious change after transplantation checking of lower extremity by color Doppler. But CT and digital subtraction angiography results showed lower extremities in 23 patients had new collateral vessels formation with different degrees.CONCLUSION: Autologous PBSCs transplantation can increase blood flow of lower extremities in patients with diabetic vascular disorder in the lower extremities and diabetic feet, and promote the angiogenesis in lower extremity of partial patients.

To investigate the relationship between the effects of arecoline hydrobromide on contraction of the smooth muscles in oncomelania foot, and explore the mechanism of arecoline hydrobromide in decreasing climbing adhesion and increasing snail－killing. 　Method: The in vitro experiment was used to observe the effects of arecoline hydrobromide on contraction activitive of foot smooth muscles of oncomelania. 　Results: With a concentration of 3×10-6mol*L-1, arecoline hydrobromide strengthened the contraction and increased the frequency of the contraction of the foot smooth muscles of oncomelania, which was antagonized by verapamil. The same concentration of arecoline hydrobromide enhanced the contraction of smooth muscles in Ringer's solution with ECTA but Ca2+, and this effect was antagonized by caffeine. The concentrations of 10－5 and 3×10－5mol*L-1 of arecolin hydrobromide blocked the effect of Bay K8644 in enhancing foot smooth muscle contraction, with a characteristic of concentration－dependence. 　Conclusion:Arecoline hydrobromide may block the calcium channel of the smooth muscles in oncomelania foot. This could provide an explanation why arecoline hydrobromide decreases the rate of oncomelania climbing adhesion and enhances snail－killing.

Objective To investigate the efficacy and safety of low-dose prednisone combined with methotrexate (MTX) and hydroxychloroquine (HCQ) in the treatment of rheumatoid arthritis (RA).Methods In this 12-week study,150 patients with active rheumatoid arthritis were randomly divided into two groups:prednisone group (70 cases who were received prednisone 5 ～ 10 mg/d + MTX 10 mg/w +HCQ 0.2 g/d) and control group (80 cases who were treated by Meloxicam 7.5 mg/d + MTX 10 mg/w +Leflunomide (LEF) 20 mg/d).The primary end-points were tender and swollen joint counts,visual analogue scales (VAS),and global physician and patients assessments of disease.The secondary end-points were morning stiffness time,C-reactive protein,erythrocyte sedimentation rate,the Health Assessment Questionnaire (HAQ),DAS28 and ACR20,ACR50.Results After 12 weeks,in terms of primary endpoints,tender and swollen joint counts,VAS and global physician assessments in the prednisone group were improved significantly [(4.5 ± 2.5),(3.2 ± 3.36),(21 ± 15),(24.2 ± 16.4),(20.2 ± 10.4) vs (6.4 ±5.84),(6.6±5.5),(46±14),(37.9±19.7),(34.1±12.4),P ＜0.05orP ＜0.01].In terms of secondary end-points,the prednisone group produced higher response rates [HAQ score (0.93 ± 0.52),CRP(10.2 ± 5.8) mg/L,ESR(30 ± 14) mm/h,morning stiffness time (32.0 ± 32.3) min,DAS 28 score (3.1±0.9) vs (1.22 ±0.81),(16.3±10.1)mg/L,(33±29)mm/h,(54.7±45.4)min,(4.9±1.9),P ＜0.05 orP ＜0.01].The incidence of adverse events was similar between two groups (43％ vs 49％,P ＞ 0.05).Conclusions Low-dose prednisone combined with MTX and HCQ produced rapid and relevant improvements in RA signs and symptoms.

Objective To study the value of deferred stent implantation in patients with high thrombus burden of acute ST-segment elevation myocardial infarction (STEMI). Methods Select 106 cases with a high thrombus burden within 12 hours of onset in patients with STEMI ,the infarct-related artery thrombus aspiration after antegrade flow of TIMI 2-3 and≤2 points of the thrombus aspiration(TS)patients were randomly divided into immediate stenting group(n = 43)and deferred stenting group(n = 40). Two groups of patients were compared with the myocardial blush grade(MBG),the incidence of slow-/no-reflow ,the incidence of compound endpoints in 6 months and the cardiac function after PCI for 6 months. Results After stenting,the MBG of deferred group was significantly higher than that of immediate group ,the incidence of slow-/no-reflow and the compound endpoints events within 6 months in deferred group was significantly lower than that in the immediate group. After PCI for 6 months,the improvement of LVEF in the deferred group was significantly higher than that in the immediate group, the left ventricular end diastolic dimension(LVEDD)in deferred group was significantly lower than that in immedi-ate group,and the differences were statistically significant(P < 0.05). Conclusions The high thrombus burden in patients with acute STEMI after thrombus aspiration ,deferred stent implantation can significantly reduce the rate of slow-/no-reflow ,improve myocardial perfusion ,reduce the incidence of compound endpoints events ,im-prove cardiac function in patients.

OBJECTIVE: To study the clinical characteristics of invasive fungal infection secondary to systemic lupus erythematosus (SLE). METHODS: We observed the clinical features and experimental examination in 91 patients treated in Xiangya Hospital in recent years, of which 48 patients with invasive fungal infection and 41 patients without invasive fungal infection. RESULTS: The invasive fungal infection secondary to SLE mainly occurred in the lungs, nervous system, and urinary system. The fungi were mainly Candida albins and Aspergillus. The rate of invasive fungal infection in SLE patients and the level of CRP and TNF-α in these patients were significantly increased. The occurrence of invasive fungal infection was positively correlated with the prolonged course of disease, long-term use of immunosuppressants and antibiotics, and occurrence of complications, such as hypoproteinemia, leukocytopenia, and so on. The levels of C-reactive protein (CRP) and tumor necrosis factor-α(TNF-α) were increased in SLE patients with invasive fungal infection. CONCLUSION The clinical features of SLE patients with invasive fungal infections are long course of disease, long-time use of immunosuppressants or antibiotics, and occurrence of complications, such as hypoproteinemia or leukopenia. The level of CRP and TNF-α can be used as an important reference index for diagnosing invasive fungal infections.
Adolescent ; Adult ; Aspergillus ; isolation & purification ; C-Reactive Protein ; metabolism ; Candida albicans ; isolation & purification ; Central Nervous System Fungal Infections ; epidemiology ; Child ; China ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; Lupus Erythematosus, Systemic ; microbiology ; Male ; Middle Aged ; Mycoses ; complications ; Tumor Necrosis Factor-alpha ; blood ; Young Adult

OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
Collateral Circulation ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity