Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.

BACKGROUND: Chronic congestive heart failure occurs at the late stage of many heart diseases. Cognitive disability exists in chronic congestive heart failure which has been reported in most clinical studies, and measures that can successfully improve heart function can improve cognitive function.OBJECTIVE: To probe into the effect of chronic congestive heart failure after myocardial infarction on spatial learning and memory ability,and to observe the correlation between heart failure and cognitive function.DESIGN: A randomized controlled observation based on the experimental animals.SETTING: Key Laboratory of Traditional Chinese Medicine (Beijing University of Chinese Medicine), Ministry of Education.MATERIALS: This experiment was performed at the Key Laboratory of Traditional Chinese Medicine (Beijing University of Chinese Medicine),Ministry of Education. in November 2001. Totally 100 healthy male rats aged 10 to 12 weeks, weighing 200 g to 220 g purchased from Beijing Weitong Lihua Experimental animal Technical Co. Ltd were enrolled and randomly divided into the operation group (n=60) and sham-operation group (n=40).METHODS: Model rats in the operation group were infarcted by ligation of the left anterior descending coronary arteries to produce acute myocardial infarction models. Those in the sham-operation group left a loose tie without ligation. The rats that showed myocardial infarction-like changes through electrocardiogram were taken as the rats for operation (n=38), and those survived rats without abnormal changes and without ligation were taken as the sham-operation group (n=25). The two groups were subdivided into 10-day gro up, 30-day group and 60-day group. Morris water maze test was performed 10, 30 and 60 days after the operation followed by hemodynamic monitoring. Among the 10-day group, 30-day group and 60-day group, rats that did not complete the whole Morris swimming test due to heart failure with poor power and died 2 days after the operation or after hemodynamic monitoring were set as heart failure end period group.Rats in the same group as those died with similar body mass were set as the control group.MAIN OUTCOME MEASURES: ① Escape logarithm latency and the good rate if cognitive ability; ② stroke volume, cardiac output per minute,heart rate and cardiac index of hemodynamics, in which cardiac index was the main index for responding heart functionRESULTS: Totally 33 rats met the criteria in the operation group and 25rats in the sham-operation group. All the animals entered the stage of result analysis. ①Results of hymodynamic index: Stroke volume, cardiac output per minute and cardiac index of the rats in the 10-day group, 30-day group and 60-day group were significantly lower than those of the homochronous sham-operation group (P ＜ 0.01), and those indexes were significantly lower in the heart failure end period group than in the end period control group and each period of the operation (P ＜ 0.01-0.05). As compared with homochronous control group, the cardiac index in 10-day group, 30-day group, 60-day group and end period group was 51.21%,50.58%,55.84% and 33.91% respectively, and all were 60% lower than the normal value. ② Results of Morris water maze: Logarithm latency of 10-day operation group after training of 8 times was obviously longer than that of the 10-day sham-operation group [F(1,28) =5.997,P=0.021]. As for cognitive function, it was obviously worse in the 10-day operation group than that of the 10-day sham-operation group (x2=8.142 ,P ＜ 0.005). There was no significant difference between the 30-day operation group and the 30-day sham-operation group, and there was no significant difference in the logarithm latency as well between the 60-day operation group and the 60-day sham-operation group. As for searching strategies, the good rate of general cognitive ability in the 60-day operation group was worse than that in the 60-day sham-operation group (x2=4.988 ,P ＜ 0.05). Logarithm latency prolonged significantly in the heart failure end period group than in the end period control group [F( 1,6)=19.567 ,P=0.004], and the good rate of general cognitive ability was worse in the heart failure end period than that in the end period control group(x=1 1.82,P ＜ 0.01).CONCLUSION: Spatial learning and memory ability after heart failure in rats with myocardial infarction was injured obviously 10 days after the operation, and it recovered to the normal level 30 days after the operation.Cognitive injury occurred to some extent 60 days after the operation, and the cognitive function was obviously worse at the end period of congestive heart failure.

Objective To analyze the types and risk factors of community-acquired infections (CAI)in diabetic patients by system analysis method of evidence-based medicine.Methods China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database were searched by computer,domestic published researches on CAI and related risk factors in dia-betic patients were aggregated,Meta-analysis was conducted by stata 1 1 .0 software.Results A total of 1 2 literatures were included in the study .The average rate of CAI in diabetic patients was 39.55% (22.12%-55.86%).The major infec-tions were respiratory system infection(40.74%),urinary tract infection(27.35%),tuberculosis(10.80%),skin and soft tissue infection(9.19%),and hepatobiliary system infection (5.57%).Stratified analysis on risk factors revealed that OR and OR95%CI of chronic complication,age,disease course,glycemic control,gender,type of diabetes,subtype of ketoac-idosis was 1.63(1.45,1.82),1.30(1.19,1.42),1.47(1.35,1.61),0.68(0.61,0.76),0.69(0.64,0.75),1.37 (1.13,1.66 )and 0.87(0.62,1.23),respectively.There was no publication bias and combined results were stable. Conclusion The main CAI in diabetic patients are respiratory system infection,urinary tract infection,tuberculo-sis,skin and soft tissue infection,and so on ;several factors,such as female,older age,long-term disease course, poor glycemic control,and complication,can contribute to the increase of CAI in diabetic patients.

Objective To investigate the role of integrin-linked kinase (ILK) on migration and invasion of lung cancer cell by upregulating matrix metalloproteinase-9 through nuclear factor-κB (NF-κB) pathway.Methods A549 cell line were overexpressed ILK and matrix metalloproteinase-9 (MMP-9) confirmed by cell transfection,siRNA interference,cell scratch test,real-time quantitative PCR and Western Blot.Results Over-expression of ILK stimulated MMP-9 expression in lung cancer cells(P ＜ 0.01).The addition of MMP-9 inhibitor doxycycline and anti-MMP-9 neutralizing antibody significantly impaired the wound healing capacity of ILK-transfected cells(P ＜ 0.01),as well as by in vitro matrigel invasion assay (P ＜ 0.01).In addition,overexpression ILK induced phosphorylation and nuclear translocation of nuclear factor-κB subunit p65.Upregulation of MMP-9 was severely abolished by either BAY 11-7028,a specific NF-κB inhibitor,or siRNA targeted to NF-κB p65 in ILK over-expression cells.Conclusion The finding indicate that over-expression of ILK can promote the migration and invasion of lung cancer cell,and upregulate MMP-9 through the NF-κB pathway.

A survey on smoking status and risk factors was conducted among 3373 residents in two districts of Shen yang city during November 2008 and September 2009 ; the pulmonary function tests were also performed for all subjects.A logistical regression model was used to evaluate the risk factors of smoking,and the knowledge about diseases caused by smoking was evaluated by chi-square test.The overall smoking rate was 50.7％ ( 1710/3373 ) ; 86.8％ (1458/1680) for males a(un)14.9％ (252/1693)for females.The risk factors of smoking ( P ＜ 0.05 ) in order of OR value were as follows:drinking,work environment and underlying diseases ; the protective factors were:female,educational level,overweight ( BMI ≥ 24) and old age.The survey on knowledge of smoking-related disease was conducted in 2478 residents including 815 smokers and 1663 non-smokers. The awareness levels about whether smoking can cause COPD,asthma,birth defects,malignant tumor,abortion,growth retardation,fetal death and myocardial infarction were significantly different between smokers and non-smokers.

Objective To evaluate the influences of abnormal glucose challenge test (GCT) on pregnancy outcomes and neonatal anthropometric data in women with normal oral glucose tolerance test (OGTT).Methods Totally 214 women who delivered in the First Affiliated Hospital of Sun Yat-sen University from November 2006 to December 2007 were enrolled.50 g GCT was performed at 24-28 weeks of gestation and 75 g OGTT would be followed if GCT≥7.8 mmol/L.Those patients,whose OGTT results below the following criteria (5.3 mmoL/L,10.0 mmol/L,8.6 mmol/L,7.8 mmol/L),were classified as normal OGTT.Altogether,116 of the 214 women with abnormal GCT and normal OGTT were collected as the study group and the rest 98 women with normal GCT as the control group.The pregnant outcomes of the two groups were analyzed.The neonatal anthropometry,including birth weight,body length,head circumference and shoulder circumference,were recorded.Other neonatal anthropometric data,such as upper arm circumference,tricep skinfold thickness and hypodermic fat thickness of abdomen were measured by a tape measure within 24 hours after birth.Results (1) Pregnant outcomes:No significant difference was found in the rate of assisted vaginal delivery,polyhydramnios,premature rupture of membranes and fetal distress between the study and control group[10.3% (12/116) vs 4% (4/98),5.2% (6/116) vs 10% (10/98),13.8% (16/116) vs 17% (17/98),20.7% (24/116) vs 13% (13/98),P ＞0.05,respectively],but the rate of cesarean section,spontaneous vaginal delivery and large for gestational age babies in the study group were different from those of the control[72.4% (84/116) vs 51% (51/98),17.2%(20/116) vs 45% (44/98),25.9% (30/116) vs 6% (6/98),P ＜0.05,respectively].(2)Neonatal anthropometry:The birth weight of the study group was significantly higher than that of the control group[(3.4 ±0.4) kg vs (3.3±0.4) kg,P ＜0.05],but no significant difference was shown in any other neonatal anthropometric results between the study and control group,including body length[(49.9 ±1.3)cm vs (49.7±1.4) cm],head circumference[(33.4±1.5)cm vs (33.8±1.7) cm],shoulder circumference [(35.4±2.3)cm vs (35.0±2.3)cm],upper arm circumference[(11.0±0.7)cm vs (10.9±0.8)cm],tricep skinfold thickness[(9.7±1.0)mm vs (9.9± 1.4)mm]and hypodermic fat thickness of abdomen[(7.2±1.2)mm vs (7.2+1.0)mm;all P＞0.05].Conclusion Women with abnormal GCT alone may have no significant influences on neonatal anthropometric data,but might have more cesarean section,large for gestational age babies,and neonatal birth weight than those women with normal GCT.

Objective To test the reliability and validity of CRIES-13(Chinese edition). The Children Revised Impact of Event Scale (CRIES-13) was recommened for diagnosing PTSD of children. Methods In the last third of the September 2008,according to the suffering condition,600 students were choosed who were fit for the research standard as subjects in two middle schools randomly. The viability of CRIES-13 was weighted by testretest reliability,Cronbach' s alpha,Split half reliability. The validity of CRIES-13 was analysed by content validity ,criterion validity,construction validity. Results In the test-retest reliability of CRIES-13, the Spearman correlation coefficient of total,intrusion factor,avoid factor,high warkening factor were 0.79, 0.75, 0.71, 0.75. Significant correlation were found among these scores. The Cronbach' s alpha of population was 0. 81. The Cronbach' s alpha of three factors was 0. 79 ( intrusion factor) , 0. 71 ( avoid factor), 0. 65 ( high awarkening factor). CRIES-13's split-half reliability was 0. 85. In the content validity test,the Spearman rank correlation coefficient between total score and each item was 0. 83 (intrusion factor), 0. 75 (avoid factor), 0. 85 (high awarkening factor). The correlation between intrusion factor and avoid factor was 0.63. The correlation between avoid factor and high awarkening factor was 0.41. The correlation between intrusion factor and high awarkening factor was 0.41. In struction validity, variance orthogonal rotation factor analysis was adopted and got three general factors. Their cumulative contribution to total variance was 55.52%. In the criterion validity test,significant correlation was found between intrusion factor and SDQ emotional factor and depression scale total score. Significant correlation was found between high awakening factor and SDQ emotional factor and depression scale total score. Conclusion The reliability and validity of CRIES-13 was good. It could be used extensively.

Objective The Children's Revised Impact of Event Scale (CRIES-13) is used for Screening PTSD of children. The reliability and validity of CRIES-13 is good. To research the demarcation points of CRIES-13 (Chinese version) based on the reliability and validity analysis,and to improve the useful value of the scale.Methods In late September 2008, according affected condition, students were choosed who were fit for the research standard as subjects in two middle schools. First,general questionnaire (self-writing) and CRIES-13 were applied to the subjects. Second, according to K-SADS-PL, physician carried out diagnosis meeting and evaluation to 310 students who were classified by stratified rand sampling. Critical point of CRIES-13 was divided by K-SADSPL. The assessment value of it were sensitivity, specificity, veracity, PPV, NPV. The right choice of division was measured by ROC curve. Results When the critical score was higher than 30, the score of Se ( 0. 833 ), Sp(0. 836) and NPV (0.97) was in the high level. Conclusion When the critical score is higher than 30, the scale have a good discrimination for PTSD, non-PTSD and it can be used extensively.

OBJECTIVETo investigate the effect of adenosine and its agonist on hypoxia-induced right ventricular hypertrophy (RVH) and explore the underlying mechanism.

METHODSFifty-six rats were randomly divided into normoxia group, hypoxia group, and treated hypoxia groups (with different treatments with adenosine, A1 receptor agonist CPA, A2 receptor agonist NECA, CPA plus A1 receptor inhibitor DPCPX, or NECA plus A2B receptor inhibitor MRS1754). The rats except for those in normoxia group were exposed to normobaric chronic hypoxia (9.5%-10.5% oxygen) for 21 days, and the corresponding treatments were administered since the 7th day of hypoxia till day 21 via implantable capsule with a pressure pump. After the treatments, the right ventricles were then removed and weighed for evaluation of hypertrophy, and the expressions of NHE-1 and CnAβ mRNA in the myocardial tissue were detected using RT-PCR.

RESULTSAfter a 21-day hypoxia, the rats showed significantly increased RV/(LV+S) ratio (0.369∓0.033) and RV/BW ratio (0.75∓0.095) compared to those in normoxia group (0.271∓0.010 and 0.59∓0.039, respectively; P<0.001), adenosine treatment group (0.281∓0.022 and 0.65∓0.077, respectively; P<0.001, P=0.025), hypoxia with CPA group (0.313∓0.021 and 0.66∓0.067, respectively P<0.001), and hypoxia with NECA group(0.333∓0.019, and 0.68∓0.074, respectively P<0.001). The NHE-1 and CnAβ mRNA levels in hypoxia group were significantly higher than those in normoxia group, adenosine treatment group, hypoxia with CPA group, and hypoxia with NECA group(P<0.001).

CONCLUSIONAdenosine and its agonist can inhibit hypoxia-induced RVH in rats through the NHE-1/CaN signal pathway.

Adenosine ; agonists ; pharmacology ; Animals ; Hypertrophy, Right Ventricular ; metabolism ; Hypoxia ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; drug effects ; Sodium-Hydrogen Exchangers ; metabolism