Objective The purpose of this study was to examine the effect of preoperative glucose infusion on glucose transport-4 mRNA ( Glut-4 mRNA) expression in skeletal muscle before and after thoracic operation. Methods Twelve male ASA Ⅰ - Ⅱ patients undergoing elective radical surgery for esophagus cancer were randomly divided into 2 groups : (Ⅰ ) control group; (Ⅱ) glucose infusion group. Patients with hypertension, hyperlipidemia or diabetes mellitus were excluded. The patients in both groups were premedicated with phenobarbitol and atropine. Anesthesia was induced with midazolam 0.1 mg ? kg-1 , propofol 1.5 mg ?kg-1 , fentanyl 4?g?kg-1 and vecuronium 0.15 mg?kg-1 . The patients were mechanically ventilated after trachea! intubatioa Anesthesia was maintained with continuous iv infusion of propofol (80?g ? kg-1? min-1 ) and vecuronium (1.0 ?g?kg-1?min-1) supplemented with droperidol 0.1 mg?kg-1 and fentanyl 6 ?g ?kg-1 given in several boluses. In group Ⅱ 5 % glucose (0.25 g?kg-1) was infused 2 h before operation. Blood samples and 1 g of skeletal muscle were obtained while chest was being opened and closed for determination of plasma glucose and insulin levels and Glut-4 mRNA expression in muscle. The total RNA of the muscle cells was extracted by trizol one-step template. The Glut-4 mRNA amplification products were determined using RT-PCR with ?-action mRNA as an internal control. The Glut-4 mRNA expression was expressed by desired gene/ ?-action? 100% .Results Glut-4 mRNA expression was significantly decreased ( P

Objective To evaluate the effects of butorphanol pretreatment on myocardial damage induced by limb ischemia/reperfusion (I/R) in rats.Methods One hundred and eight male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 3 groups (n =36 each) using a random number table:sham operation group (group S),I/R group and butorphanol pretreatment group (group B).Limb ischemia was induced by occlusion of bilateral hind limbs for 2 h followed by reperfusion in I/R and B groups.At 10 min before ischemia,butorphanol 0.2 mg/kg was injected via the right jugular vein in group B,while the equal volume of normal saline was injected in group I/R.Six rats were chosen randomly before ischemia (baseline,T0) and at 2,6,12,24 and 48 h after reperfusion (T1-5) and blood samples were taken from the abdominal aorta for determination of the serum creatine kinase isoenzyme-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnI) concentration.The animals were then sacrificed and myocardial specimens were obtained for determination of myocardial apoptosis (using TUNEL) and the expression of c-Jun N-terminal kinase (JNK) and extracellular signal-regulated protein kinase (ERK) (using Western blot analysis).Apoptosis index was calculated.Results Compared with group S,the serum CK-MB and cTnI levels were significantly increased at T1-5,and the apoptosis index and expression of JNK and ERK were increased at T2-5 in group I/R (P ＜ 0.05).Compared with group I/R,the pathological changes of myocardium were significantly reduced at T4,the serum CK-MB and cTnI levels were decreased at T2-5,the apoptosis index was decreased at T4,5,the expression of ERK was up-regulated at T2-5,and the expression of JNK was down-regulated at T2-4 (P ＜ 0.05).Conclusion Butorphanol pretreatment can reduce apoptosis in myocardial cells through activating MAPK signal transduction pathway,up-regulating ERK expression and down-regulating JNK expression,thus attenuating myocardial damage induced by limb I/R in rats.

Objective To study the impact of imported filariasis cases on the elimination program in different areas of Shandong Province. Methods Dezhou was selected as former low endemic area and Yicheng as former high endemic area. Blood examination was carried out for both mobile population and local people for microfilariae(Mf). Mosquitoes were caught in field and dissected to count the ratio of those having laid eggs and the natural filarial infection rate. Mosquitoes reared at different temperatures were fed with Mf-positive blood and dissected after certain time period to observe the development of the larvae. The vectorial capacity and case transmission quantity were calculated and compared with those from different areas. Results The Mf positive rate of inflow population was 3.18% in average. No case was detected from 9 411 local residents after blood exam in Dezhou while 2 out of 692 local residents were found Mf positive in Yicheng. Mosquitoes'natural infection rate was 3.81% but no third stage larva was found. The shortest time period needed for the larva to develop into an infective stage was 16 days in Dezhou and 11 days in Yicheng. The time period from blood meal to egg-laying on average was 4. 95 days in Dezhou and 4.33 days in Yicheng. The ratio of vectorial capacity and case transmission quantity was 1:4.41 and 1:5. 82 respectively in Dezhou and Yicheng. Conclusion Filarial transmission seems unlikely in Dezhou for its low vectorial capacity and low transmission quantity resulted from low and evidently fluctuating temperature in the north. A low level filarial transmission may be possible in former high-endemic area such as Yicheng if there are as many imported cases as in Dezhou.

Objective To investigate the curative effects of dexamethasone in the prevention of delayed encephalopathy after acute carbon monoxide poisoning in the rats.Methods Eighty healthy male Wistar rats were randomly(random number)divided into hyperbaric group(H),dexamethasone group (D),combined treatment group(C)and model control group(M)after carbon monoxide poisoning,twenty rats in each group.Twelve air-modeling rats were selected as normal control group(N).Using eight-arm maze training and testing,the rat's function of cognitive and memory was detected.The serum MBP levels were detected by enzyme-linked immunosorbent assays(ELISA).Magnetic resonance imaging was used for observing the demyelination of the head and the morbidity of delayed encephalopathy.Measured data was analyzed with single factor analysis of variance(one-way ANOVA).Results The result of eight-arm maze showed that there were 6,7,1,1 rats with delayed encephalopathy in groups M,H,C,D,respectively.At 3 days after poisoning,except N group,the serum MBP levels of every groups increased significantly.At 10 days after poisoning,serum MBP levels in groups C and D were significantly decreased,then returned to normal levels at day 18.The serum MBP in groups M and H was higher than normal levels at all the time.Head MRI showed except D group,the rest groups were abnormal signals,which appeared 7 in M group,6in H group and 1 in C group.Conclusions Dexamethasone administrated as soon as possibly after acute carbon monoxide poisoning may reduce the serum MBP levels,prevent demyelination occurs,decrease the pathological damage,eventually play a preventive role in DE.

Objective To explore the effectiveness and safety of temporary immunosuppressant withdrawal for the management of severe infection after liver transplantation.Methods Fifty-one patients with severe infection after liver transplantation were divided into control group (24 cases) and withdrawal group (27 cases ) according to the immunosuppression protocol.In the withdrawal group, the immunosuppressive drugs were temporarily suspended according to ATP values of CD4 + T cell and CD4 + T lymphocyte subsets counting until infection was controlled.The liver function,the incidence of acute rejection and the graft survival rate were monitored during the process.The side effects were observed.Result Severe infection was cured in 39 patients.There were 9 deaths in the control group in which the immunosuppressant was continued during the course of infection and 3 in the withdrawal group,respectively.The median suspension of immunosuppressant in trial group was ( 15.5 ± 4.8 ) d ( 6 ～ 22 d) ; CD4 + T lymphocyte subsets counting rose from (65.60 ± 32.58)/μl to (103.04 ± 12.39)/μl,ATP values of CD4 + T cell rose from (79 ±23) μg/L to ( 112 ± 11 ) μg/L; meanwhile,the temperature dropped from (38.3 ± 1.2) ℃ to (36.4 ± 1.1) ℃,WBC dropped from (15.7 ± 4.4) × 109/L to (6.3 ± 3.8) × 109/L,CRP dropped from ( 153.4 ± 37.1 ) mg/L to ( 16.5 ± 4.8) mg/L.During the course of treatment and follow-up,liver function of patients in the trial group remained normal and no acute rejection occurred.Compared with the control group,the temperature recovery time in the trial group was shorter ( respectively F =5.32,8.37,9.12,all P ＜ 0.05) and the therapeutic outcome was better.Conclusions The cellular immune function test could be evaluated according to the ATP values of CD4 + T cell and CD4 + T lymphocyte subsets counting.For severe infection after liver transplantation, anti-infection treatment and simultaneously withdrawing immunosuppressants help to control the infection.

Objective: To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF). Methods: This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis. Results: There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS₂ score and CHA₂DS₂-VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%). Conclusions RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.

OBJECTIVETo study the relationship between compliance with anti-hypertension therapy and assessment of quality of health care in hypertensive patients in community.

METHODSAccording to multi-stage cluster random sampling, we selected two communities from 36 streets in certain areas of Shanghai respectively using random number method on May, 2013, 72 communities in total, then we randomly selected 25 patients who were archived in the community health center from each community of the street.We conducted 1 800 questionnaires in total in which 1 172 patients were under medication study. The Morisky Medication Adherence Scale was used to evaluate medication compliance while the Patient Assessment of Chronic Illness Care Scale was applied to measuring the quality of patient's self-reported health service. The Spearman rank correlation analysis was used to evaluate the relationship between assessment of quality of health care for chronic illness and compliance with anti-hypertension therapy. Binary logistic analysis was applied to evaluate the factors which influenced patient's medicine compliance.

RESULTSThere were 567(48.4%) respondents with good compliance. Age less than or equal to 65 accounted for 43.3% (245 people) while age greater than 65 accounted for 56.7% (321 people). The average scores of total and difference dimensions remained at a low level, ranging from 1.97 to 2.67 out of 5. The Assessment of quality of health care score was (2.67 ± 1.33)scores, in which the highest score of the dimensions was patient activation which was (2.56 ± 1.41)scores and the lowest was follow-up / collaboration which was (1.97 ± 1.49)scores. The Spearman rank correlation analysis showed that negative association between accumulate points of patient medicine compliance and patient activation was found (rs = -0.09, P < 0.01). The result of binary logistic analysis indicated that medication adherence of age greater than 65 was 1.49 times (95%CI: 1.11-2.00) higher than age less than or equal to 65. The patient activation was a protective factors of good medicine adherence (OR = 1.35, 95%CI:1.14-1.59).

CONCLUSIONSThe medicine adherence of hypertension patients in community medication compliance is not very good at the moment. The self-rated quality of health care is still relative poor. Positive activation from interaction of physicians and patients can help enhancing patient's medicine compliance.

China ; Chronic Disease ; Humans ; Hypertension ; drug therapy ; Medication Adherence ; Patient Compliance ; Quality of Health Care ; Surveys and Questionnaires

OBJECTIVETo evaluate the safety of percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) complicating chronic kidney disease (CKD).

METHODSWe retrospectively evaluated the medical data of 335 patients hospitalized in our hospital with a diagnosis of ACS and CKD between 1 January 2011 and 30 May 2014. Patients were divided into two groups: PCI group who received PCI treatment during hospitalization (n = 135) and non-PCI group who did not receive PCI treatment (n = 200). Multivariable logistic regression analysis was performed to evaluate the connection between PCI and in-hospital death and acute renal insufficiency.

RESULTSThe median GFR level of 335 patients was 36.26 (25.09-47.65) ml · min⁻¹ · 1.73 m⁻². GFR level was similar between the two groups (P = 0.205). Multivariable logistic regression analysis showed that PCI did not increase the risk of in-hospital death (OR = 0.465, 95% CI: 0.190-1.136, P = 0.093) and in-hospital acute renal insufficiency (OR = 0.830, 95% CI: 0.375-1.836, P = 0.669). In patients of 45 ml · min⁻¹ · 1.73 m⁻² ≤ GFR < 60 ml · min⁻¹ · 1.73 m⁻², 30 ml · min⁻¹ · 1.73 m⁻² ≤ GFR < 45 ml · min⁻¹ · 1.73 m⁻² and GFR < 30 ml · min⁻¹ · 1.73 m⁻², the OR of in-hospital death in PCI group were 0.235 (95% CI: 0.024-2.301, P = 0.213), 0.640 (95% CI: 0.112-3.649, P = 0.616) and 0.919 (95% CI: 0.159-5.307, P = 0.925), and the OR of in-hospital acute renal insufficiency were 0.436 (95% CI: 0.120-1.587, P = 0.208), 2.209 (95% CI: 0.394-12.391, P = 0.368) and 0.724 (95% CI: 0.127-4.117, P = 0.716) indicating that PCI did not increase above events in ACS patients complicating CKD.

CONCLUSIONPCI does not increase the risk of in-hospital death and in-hospital acute renal insufficiency in ACS patients complicating CKD.

Acute Coronary Syndrome ; Acute Kidney Injury ; Hospitalization ; Humans ; Percutaneous Coronary Intervention ; Renal Insufficiency, Chronic ; Retrospective Studies

Objective: To investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) on all-cause mortality in heart failure patients with preserved ejection fraction (HFpEF) at real world scenarios. Methods: Patients who met the diagnostic criteria of HFpEF in the China National Heart Failure Registration Study (CN-HF) were divided into death and survival groups. The demographic data, physical examination, results of the first echocardiography, laboratory results at admission, complications, drug use and clinical outcomes were obtained from CN-HF. The univariate Cox proportional hazard model was used to screen the variates that might predict prognosis, and then the covariates with statistical significance were included in the multivariate Cox regression model to analyze the predictive value of baseline NT-proBNP on all-cause death. Spearman correlation analysis was used to evaluate the relationship between NT-proBNP and estimated glomerular filtration rate (eGFR), so as to further explore the predictive value of the interaction between renal dysfunction and NT-proBNP on death. Since NT-proBNP did not obey the binary normal distribution, it was expressed by the natural logarithm of NT-proBNP (LnNT-proBNP). Results: A total of 1 846 HFpEF patients were enrolled in this study, with an average age of 71.5 years, 1 017 males(55.1%), median NT-proBNP 860 ng/L, and median eGFR 73.9 ml·min^-1·1.73m^-2. After a median follow-up of 34 months, 213 (11.5%) patients died. Patients in the death group were older, with higher NYHA classification Ⅲ-Ⅳ ratio, longer hospital stay, higher serum potassium and NT-proBNP level, prevalence of complications of diabetes mellitus, arrhythmia and atrial fibrillation, use of angiotensin receptor antagonist(ARB), mineralocorticoid receptor antagonists (MRA), diuretic and digoxin was significantly higher in death group than in survival group. Body mass index (BMI), diastolic blood pressure, left ventricular ejection fraction (LVEF), hemoglobin, serum cholesterol(TC), serum triglycerides (TG) and eGFR, and use of angiotensin converting enzyme inhibitors (ACEI), statins and aspirin were lower in death group than in survival group. Univariate Cox regression analysis showed that NT-proBNP was a predictor of all-cause death in HFpEF patients (HR=2.522, 95%CI 2.040-3.119, P<0.001). Multivariate Cox regression analysis showed that the elevated NT-proBNP remains as the independent predictor of all-cause death in patients with HFpEF (HR=1.230, 95%CI 1.049-1.442, P=0.011) after adjusting for age, BMI, diastolic blood pressure, LVEF, hemoglobin, serum potassium, serum sodium, TC, serum high-density lipoprotein cholesterol (HDL-C), TG, eGFR, atrial fibrillation, as well as the treatment of ACEI/ARB, MRA, diuretics and digoxin. Spearman correlation analysis showed that LnNT-proBNP was negatively correlated with eGFR (r=-0.361, P<0.001), but there was no interaction between NT-proBNP and renal dysfunction in predicting death in HFpEF patients (P>0.05). Conclusion The elevated level of NT-proBNP at admission is an independent predictor of all-cause mortality in HFpEF patients.