Objective To investigate the positive rate of microembolic signal (MES) and the related factors,as well as the correlation between MES and outcomes in patients with cardiogenic cerebral embolism.Methods Patients with cardiogenic cerebral embolism were enrolled.The baseline data of the patients were collected and the MES monitor was conducted.The baseline data of the MES positive group and MES negative group were compared.Multivariatelogistic regression analysis was used to identify the related factors of the positive MES.The patients were followed up regularly.The outcomes of stroke at 6 months and recurrent stroke within 2 years in the MES positive group and MES negative group were compared.Results A total of 165 patients with cardiogenic cerebral embolism were enrolled,including positive MES in 68 patients (41.2％).There were significant difference in the levels of brain natriuretic peptide (BNP),cardiac troponin-I (cTn-I),and D-dimer between the MES positive group and negative group.Multivariate logistic regression analysis showed that the increased levels of baseline BNP (odds ratio [OR] 1.001,95％ confidence interval CI 1.001-1.002;P＜0.001),cTn-I (OR 36.975,95％ CI 1.516-902.0;P=0.027),and D-dimer (OR 1.001,95％ CI 1.000-1.001;P=0.017) were independently associated with the positive MES in cerebral embolism within 48 h after onset.There was no significant difference in the proportion of patients in good outcome (modified Rankin scale score 0-2) and poor outcome (modified Rankin scale score ＞2) after 6 months between the MES positive group and MES negative group.When the average follow-up time was 20.8 months (range,7-24 months),there were 23 patients (33.8％) and 19 (19.6％) had recurrence in the MES positive group and MES negative group,respectively.Kaplan-Meier analysis showed that the recurrence rate of stroke in the MES positive group was significantly higher than that in the MES negative group (log-rank test:P=0.031).COX regression analysis showed that the positive MES was still an independent risk factor for stroke recurrence after adjusting for other confounding factors (OR 0.328,95％ CI 0.142-0.761;P=0.009).Conclusions The positive MES was associated with the increased BNP,cTn-I,and D-dimer levds.The positive MES was not associated with clinical outcomes at 6 month after the onset,but it was associated with the recurrence of stroke within 2 years.

Objective To investigate the effect of antisense telomerase reverse transcriptase (TERT) on 5-hydroxytryptamine (5-HT) induced proliferation and cell cycle of pulmonary artery smooth muscle cells (PASMCs). Methods PASMCs were cultured and divided into four groups: control group (cultured in RPMI-1640 culture medium), 5-HT group (cultured in culture medium containing 5-HT), antisense oligonucleotide (ASODN) group (cultured in culture medium containing 5-HT and ASODN TERT), and sense oligonucleotide (SODN) group (cultured in culture medium containing 5-HT and SODN TERT). The apoptosis of PASMC was observed by fluorescence microscopy with Hoechst staining. Apoptosis and cell cycle was analyzed with flow cytometry. Expression of proliferated cell nuclear antigen (PCNA) was determined by immunohistochemistry staining. Results Hoechst staining showed that apoptosis in 5-HT group (161?33) was significantly higher than that in control group (63?16, P

Objective To research the pathogeny and the electromyographic characteristics of myokymia.Methods The clinical features and electromyography of 42 elderly patients with myokymia were examined. Results Symptomatic myokymia (SM) in 27 cases was caused by low salt syndrome, thyrotoxemia, urinaemia, chronic wasting diseases (such as carcinoma of the stomach or liver), brachial plexus neuropathy, lead poisoning, chronic inflammatory demyelinating polyradiculoneuritis, succinylcholine narcosis, restless leg syndrome or Isaac's syndrome.Symptomatic facial myokymia was caused by neoplasm of the brain stem or in posterior cranial fossa, multiple sclerosis or other causes. Primary myokymia ( PM ) in 15 cases involved idiopathic generalized and benign myokymia.Compared with PM, SM was more constant and powerful. Myokymia potential appeared in the electromyograms of 42 of the patients. The majority of patients with SM had accompanying myotonic discharge. Conclusion The pathogeny and electromyographic characteristics of symptomatic myokymia are different from the primary stage.

Objective To evaluate the detection of membrane neutrophil alkaline phosphatase (NAP)in diagnosis of infection in patients with acute cerebral hemorrhage.Methods A total of 208 patients with acute cerebral hemorrhage,including 1 52 cases without infection (uninfected group)and 56 cases with infection (infected group),admitted in the Second Affiliated Hospital of Nantong University during January 201 0 to July 201 6 were enrolled,30 healthy subjects were also enrolled in the study as control group.The peripheral blood from all subjects were collected,and the counts of white blood cell (WBC), percentage of neutrophil,serum procalcitonin (PCT)and NAP were measured.The value of above 4 indicators in diagnosing infection was determined by receiver operating characteristic (ROC ) curves. ANOVA and t test were used to analyze the data,Pearson correlation was performed to analyze the correlation between NAP and PCT in infected group.Results The levels of WBC,percentage of neutrophil and NAP in both infected and uninfected group were higher than those in healthy control group at admission(F =1 1 7.64, 1 00.69 and 425.09,all P <0.01 ),and the levels of WBC,PCT and NAP were also higher when infection occurred compared with those at admission in infected group (t =3.1 4,34.30 and 36.39,all P <0.01 ). The expression of NAP was positively correlated with PCT in infected group (r =0.762,P <0.05).ROC curve analysis showed that the areas under the curves of NAP and PCT in diagnosis of infection were 0.875 and 0.884,respectively.When 1 0655.28 AB/c and 5.01 mg/L were taken as cut-off values,the sensitivities of NAP and PCT in diagnosis of infection were 85.50% and 87.66%;the specificities were 90.50%和 90.31 %,respectively.The level of NAP in infected patients with gram-positive bacterial infections was higher than that in patients with gram-negative bacterial infections (t =6.29,P <0.01 ). Conclusion The expression of NAP in patients with acute cerebral hemorrhage increases when infection occurs,which may be helpful to the clinical diagnosis of bacterial infection.

Objective To observe the influence of insulin therapy on the short-term prognosis of patients with acute ST-elevation myocardial infarction (ASTEMI) complicated with hyperglycaemia.Methods A total of 128 patients with ASTEMI complicated with hyperglycaemia were randomized into 2 groups:treatment group and control group.There were 64 patients(50.0％ )in the treatment group and 64 patients(50.0％ ) in the control group.All of the patients were given anticoagulants,antiplatelet drugs,statins,beta-receptor blockers,nitrates and angiotensin-converting enzyme inhibitors (ACEI)or angiotensin receptor blocker (ARB) Moreover,the patients in the treatment group were given extra 50 U insulin ( Novolin R) in 50 ml saline by venous infusion.In the treatment group,Venous blood samples were obtained before and 7 days after treatment to determine the fasting blood glucose and hs-CRP in serum; the levels of fasting blood glucose and hs-CRP and short-term prognosis were compared between the 2 groups.ResultsThe levels of fasting blood glucose in the treatment group were decreased significantly after treatment ( [ 5.4 ± 0.8 ] mmol/L vs [ 11.6 ± 2.3 ] mmol/L,P ＜0.01),but there was no significant change in the control group( [ 10.7 ± 2.1 ] mmol/L vs [ 11.2 ± 2.7]mmol/L,P ＞ 0.05 ).The levels of hs-CRP in both groups were decreased significantly after treatment (P ＜0.05),but it was much more obvious in the treatment group( [ 6.2 ± 1.5 ] mg/L vs [ 8.7 ± 1.8 ] mg/L,P ＜0.05).The incidence of major adverse cardiac events(MACE) during a 3 months′ follow-up in the treatment group was significantly lower than that in the control group ( 12.50％ vs 34.38％,P ＜ 0.05 ).Conclusion Insulin therapy can improve the short-term prognosis in patients with ASTEMI complicated with hyperglycaemia.

Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are relat?ed to many special departments,such as gastroenterology,general surgery,neurology,endocrinology,radiology,traditional Chinese medicine,blood purification,endoscopy,intervention,and ICU. It is necessary to apply a multidisciplinary treatment (MDT)mode. However,the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team,formulate the formal working procedures,and standard?ize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.

Objective:To explore the serum tenascin-C levels in patients with acute ST-segment elevation myocardial infarction (STEMI) and its impact on the long-term prognosis.Methods:One hundred and thirteen STEMI patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Dalian Medical University and successfully underwent emergency PCI from June 2015 to June 2016 were included in this prospective study. The serum tenascin-C levels were measured during hospitalization, and the patients were divided into tenascin-C ≥ 120 μg/L group and tenascin-C<120 μg/L group according to the serum tenascin-C level. Major adverse cardiovascular events (MACE) were observed during the 5 years follow up in all patients. According to the incidence of MACE, the patients were divided into MACE group and non-MACE group, and the predictive factors of MACE were analyzed. Continuous variables were presented as the mean±standard deviation and compared with the Student′s t-test. Categorical variables were presented as percentages and compared with the Chi-square test or Fisher′s exact test. Receiver operating characteristic (ROC) curve was used to analyze the value of serum tenascin-C level in predicting MACE in STEMI patients. Kaplan Meier survival analysis was used to compare the incidence of MACE between two groups. Cox proportional hazards regression model was used to analyze the risk factors of MACE during the 5 years follow up.Results:The serum tenascin-C levels in the STEMI patients increased on the first day after the onset of disease (46.5±24.8 μg/L), peaked on the third day (97.5±41.2 μg/L), and then gradually decreased. All patients were followed up for 5 years. There were 37 cases of MACE, including 4 cases of cardiac death (3.5%), 14 cases of heart failure (12.4%), 14 cases of recurrent myocardial infarction or revascularization (12.4%), and 5 cases of stroke (4.4%). For prediction of MACE, the area under the curve of the serum TN-C level was 0.953 (95% CI 0.918-0.988, P<0.05), which was thus a valuable biomarker in predicting MACE for STEMI patients. The incidence of MACE in the group of tenascin-C≥120 μg/L group was higher than that in the group of tenascin-C<120 μg/L group (86.4% [19/22] vs 19.8% [18/91]), and Kaplan-Meier survival analysis showed that the difference was statistically significant ( P<0.05). Cox proportional hazards model analysis showed that serum tenascin-C level was an independent predictor of MACE for STEMI patients during the 5 years follow-up ( HR=1.007, 95% CI 1.001-1.012, P<0.05). In addition, other variables including high sensitivity C-reactive protein ( HR=1.028, 95% CI 1.007-1.049, P<0.05), and cardiac troponin Ⅰ ( HR=1.004, 95% CI 1.000-1.008, P<0.05) were also found to be the independent predictors of MACE. Conclusions:The serum tenascin-C levels in STEMI patients increased significantly during the acute disease phase. Detecting the serum tenascin-C levels is valuable for predicting MACE in STEMI patients, and serum tenascin-C is an independent predictor of MACE in STEMI patients during the long-term follow-up period after acute myocardial infarction.

BACKGROUND: Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes. METHODS: A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome. RESULTS: At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046). CONCLUSIONS For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
Humans ; Treatment Outcome ; Percutaneous Coronary Intervention/methods* ; Coronary Occlusion/surgery* ; Prognosis ; Angina, Unstable/surgery* ; Chronic Disease ; Risk Factors