Objective To figure out the preliminary clinical value of real-time three-dimensional echocardiography(RT-3DE) in evaluating the systolic dyssynchrony in patients with coronary artery heart disease(CAD).Methods Eighty patients who were suspected as CAD were included in this study.RT-3DE was performed first.After the analysis,we got the data:ejection fraction (EF),16 segments systolic dyssynchronic index (SDI 16).All subjects should take the coronary angiography.According to coronary angiography results,the patients with the vascular stenosis rate ≥50% were defined as the CAD group,and the patients with the vascular stenosis rate <50% were defined as the coronary atherosclerosis group,the patients with the completely normal angiographic results were included in the control group according to the results of angiography.The parametric differences among the groups were compared.Results There was no significant difference in LVEF among the three groups.SDI 16 had no significant difference between the control group and the coronary atherosclerosis group (t=-1.03,P>0.05).However,SDI 16 had significant difference between the control group[(3.72±2.68)%]and the CAD group[(7.14±3.10)%],the same between coronary atherosclerosis group[(5.12±3.46)%]and the CAD group[(7.14±3.10)%](t=-3.71,-2.34,all P<0.05).ROC curve analysis revealed that a cut-off value for SDI of 5.49%,yielded a sensitivity of 81.8%,with a specificity of 73.1% to predict coronary atherosclerosis to CAD(AUC=0.743).Conclusion SDI 16 >5.49% has a higher value in evaluating systolic dyssynchrony in patients with CAD with RT-3D of Siemens Acuson SC2000 ultrasonic diagnostic instrument.

Objective To investigate the clinical value of anatomic M-mode echocardiography (AMM)for pristine diagnosis of myocardial ischemia in patients with coronary heart diseases (CAD).Methods 44 inner patients who were suspected as CAD were detected.Ordinary ultrasound was performed first.The ventricular segmental wall thickness and amplitude were measured by AMM.Then,we got the ventricular wall thickening fractions.All subjects should take the coronary angiography after the ultrasound examination in 1 -3 days.Patients with the vascular stenosis rate≥50% were defined as the CAD group,patients with the completely normal angiographic results were included in the normal control group according to the results of angiography.The parametric differences between the patients and the normal control subjects were compared.Results In the normal control subjects,the ventricular segmental wall amplitude >5mm accounted for 78.67%,the ventricular wall thickening fractions >30% accounted for 99.13%.But in CAD group,the ventricular segmental wall amplitude <4mm accounted for 61.14%,<5mm accounted for 93.47%,the abnormal ventricular wall thickening fractions <30% accounted for 88.43%.The sensitivity, specificity,accuracy of AMM were 77.47%,90.00%,77.39% respectively.Conclusion The ventricular wall thickening fractions of AMMhas quite significant correlation with morbid blood vessel in patients with CAD,they are effective reference indicators to evaluate the left ventricular wall motion quantitatively.

Objective To evaluate the effect of oxidative injury induced by peroxide oxidase on Klotho expression in mouse renal tubular epithelial cells (TCMK-1) and to explore the possible pathway.Methods TCMK-1 cells were exposed to H2O2 of different concentrations.Reactive oxygen species (ROS) was examined byflow cytometrry.Cell viability was assessed by CCK-8.Cell apoptosis was evaluated by flow cytometry and Hoechst 33258 staining.The expression of Klotho,apoptosis-associated proteins and anti-oxidant enzymes were determined by Western blotting.Results Compared with control group,after H2O2 stimulating TCMK-1 cell,ROS was dramatically elevated (all P ＜ 0.05) and the expression of anti-oxidant enzymes,SOD2 and CAT went down (all P ＜ 0.05);the expression of Klotho was inhibited (all P ＜ 0.05);cell viability of TCMK-1 cells was decreased (all P ＜ 0.05) in a dose-dependent manner (0.3 to 0.9 mmol/L);cell apoptosis was significantly increased in TCMK-1 cells following the concentration of H2O2 (all P ＜ 0.05);Bax/Bcl-2 and the phosphororation of JNK and p38 were obviously elevated in TCMK-1 by H2O2 induction (all P ＜ 0.05).Conclusion Oxidative injuries induced by H2O2 significantly suppresses the expression of Klotho in TCMK-1 cells.And cell apoptosis was increased,p38 and JNK pathway was activated.

Objective To study the value of the intervention of Nitroglycerin(NTG) on ~(99m)Tc-MIBI myocardial tomography imaging in the estimation of myocardial viability.Method According to the analysis of autologous electrocardiogram(ECG),a total of 66 patients with unstable angina(UA) was divided into group A and group B.The patients in group A were without old myocardial infarction and those of group B were with old myocardial infarction.The patients in the two groups were respectively underwent the resting ~(99m)Tc-MIBI myocardial tomography imaging and the NTG administration intervened the next day.The imaging was collected and tested by the computer.Results Of 594 myocardial segments in the 66 cases,242 segments(40.7%) in testing myocardial imaging were proved to be perfusion abnormal,while after the intervention of NTG administration,the perfusion of 114 segments(47.1%) had been improved according to the imaging.Conclusion The intervention of NTG administration on ~(99m)Tc-MIBI myocardial tomography imaging for myocardial viability is simple,safe,objective and accurate,which provides a forceful means for the post-operative evaluation and the selection of indication before the rebuilding of coronary artery of the UA patients.

Objective: To explore the association between the 21-gene recurrence score (RS) and clinicopathologic characteristics as well as prognosis in patients with axillary lymph node negative, hormone receptor (HR) positive breast cancer. Methods: The clinicopathologic data of 439 early breast cancer patients who underwent 21 gene RS testing was retrospectively analyzed. According to the 21 gene RS, the patients were divided into low risk (295 cases), intermediate risk (111 cases) and high-risk (33 cases) group. The relationship between the 21 gene RS and clinicopathological characteristics, treatment, recurrence and metastasis was analyzed. Univariate and multivariate statistical analyses were used to analyze the risk factors for relapse free survival (RFS). Results: Tumor grade, estrogen receptor (ER), progesterone receptor (PR) and Ki-67 index were significantly different among the 3 risk cohorts (P<0.001 for all). After a median follow-up of 32 months, the recurrence rate in low risk group (3.7%) was significantly lower than that in the intermediate-high risk group (9.0%), the locoregional recurrence (LRR) rate of low, intermediate and high risk group was 2.4%, 6.3% and 9.1%; and the distant metastasis (DM) rate in low risk group was 1.4% and 2.1% in the intermediate-high risk group. Univariate analysis showed RS, ER status and endocrine therapy were prognostic factors for RFS (P<0.05 for all). Multivariate analysis showed that RS was an independent significant predictor for RFS (P=0.04). Conclusions The 21-gene RS is related to tumor grade, ER, PR and Ki-67 index. RS is an independent risk factor for RFS in patients with hormone receptor positive early-stage breast cancer.

OBJECTIVETo investigate the safety and efficacy of trastuzumab administered concurrently with anthracycline-containing adjuvant regimen for breast cancer.

METHODSIt is a prospective, randomized and controlled trial. Participants were randomized to receive trastuzumab administered concurrently or sequentially with anthracycline-containing adjuvant regimen. The primary endpoint was cardiac safety. The second endpoints were disease-free survival (DFS) and overall survival (OS).

RESULTSOne hundred and nine breast cancer patients were enrolled and randomized in this trial. Fifty-five participants received trastuzumab administered concurrently with anthracycline-containing adjuvant regimen and 54 patients received trastuzumab administered sequentially with anthracycline. The primary cardiac event was asymptomatic decrease in the left ventricular ejection fraction (LVEF). There was no significant difference between concurrent and sequential groups in cardiac event rates (9.1% vs13.0%, P = 0.556), neither of LVEF values at basline or at 3, 6, 9 and 12 months during trastuzumab treatment (P > 0.05). Four patients (7.3%) in the concurrent group suffered local recurrences or distant metastases, and 6 participants (11.1%) in the sequential group had distant metastases. There was no significant difference between the two groups in DFS (P = 0.724). There was no death in both groups.

CONCLUSIONSTrastuzumab administered concurrently with anthracycline is a safe adjuvant regimen for breast cancer and does not increase cardiac events. Further research is needed to determine the efficacy of this treatment regimen.

Adult ; Anthracyclines ; administration & dosage ; Antibodies, Monoclonal, Humanized ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; surgery ; Carcinoma, Ductal, Breast ; drug therapy ; pathology ; surgery ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Prospective Studies ; Stroke Volume ; Trastuzumab

Objective To explore the safety and cosmetic effect of nipple-sparing modified radical mas tectomy and immediate tissue expander implantation with single circumaereolar incision.Methods 30 patients were enrolled in Peking Union Medical College Hospital between Jan.2014 and Dec.2015.All the patients were categorized according to surgical incision (single circumaereolar incision group vs double incisions group).Data on clinicopathological parameters,average hospital stay,complications and overall cosmetic effect were retrospectively collected.Data was performed with Chi-square test,Fisher exact test and t-test.Statistical significance was defined as P＜0.05.Results 19 patients were enrolled in single circumaereolar incision group,and 11 patients in double incisions group.There was no significant difference for operation duration (P=0.093) and average hospital stay (P=0.339).After follow-up for 19.1 months,ranging from 8 to 31 months,no patients developed seroma or arm lymphedema.There was no statistical significance between the two groups in terms of sensation in nippleaereolar area (P=0.973),bilateral symmetry (P=0.650) and overall cosmesis (P=0.483).Conclusion single circumaereolar incision nipple-sparing modified radical mastectomy and immediate tissue expander implantation can be one of the preferable surgical procedures with benefits of minimal invasiveness,reliable oncological safety and decent cosmetic effect.

Objective:To explore the cognition of community health care workers and the elderly on frailty, and attitudes towards frailty management.Methods:The semi-structured interview was conducted with 14 community health care workers and 17 community elderly in 3 communities in Beijing with the method of phenomenological research. We interviewed respondents' cognition on frailty management and attitudes towards frailty management. Colaizzi 7-step method was used for data analysis.Results:Three themes of cognition on elderly frailty were extracted including that the elderly in the community had different cognition and understandings of elderly frailty; community health care workers had a comprehensive understanding of the concept of elderly frailty, but not much contact with this concept; there were several misunderstandings about the cognition of elderly frailty. Four themes of attitudes towards frailty management were extracted including that the elderly want scientific frailty management; the elderly in the early stage of frailty did not agree with frailty management; community health care workers affirmed the importance of frail management; there were many obstacles to the frailty management in Beijing communities.Conclusions:It is necessary to strengthen education and publicity for the elderly frailty, speed up the formulation of evidence-based frailty management plans, guide community practice, and improve the quality of life of the elderly.

OBJECTIVE To analyze the factors affecting the inclusion of Chinese patent medicines in China’s National reimbursement drug list （NRDL）， and assist these medicines in fully reflecting their actual value in the reimbursement admission process. METHODS From the official website of the China’s National Healthcare Security Administration， the application materials of Chinese patent medicines outside the list that passed the formal review from 2021 to 2023 were obtained， including basic information on the medicines， safety， efficacy， innovation and heritage information， and supplemented with references from the pharmacopeia and the Yaozhi Database. Economic information and enterprise information were obtained through websites such as the Yaozhi Database. Univariate analysis， multivariate Logistic regression analysis and stepwise regression analysis were conducted on the initial application information and admission outcomes of the medicines. Sensitivity analysis was also performed on medicines that applied multiple times in different years as independent samples. RESULTS & CONCLUSIONS There were 27 Chinese patent medicines that passed the formal review from 2021 to 2023， involving 37 applications. The univariate analysis results showed that medicines with descriptions of traditional Chinese medicine （TCM） syndrome types， clear adjustment information for medication plans for specific population groups， short time to market in the indications of the package insert， registered as Class 1 to 6 following or class Ⅰ innovative TCM/class Ⅲ ancient classic prescription compound TCM registered， and those produced by enterprises listed in the “Top 100 Chinese Pharmaceutical Industry Enterprises” list for the current year were more likely to be included in the NRDL （P＜0.05）. The results of the multivariate Logistic regression analysis were not statistically significant， but the stepwise regression results indicated good consistency with the univariate analysis. The results of the sensitivity analysis were consistent with the trend of basic analysis. It is recommended that Chinese patent medicine enterprises further clarify the description of product instructions， expand innovation capabilities， inherit and develop ancient classic prescriptions， and promptly complete clinical trial evidence.