BACKGROUND:Legacy posterior stabilized prosthesis has advantages in theoretic design,in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes for vaglus knee deformity are better than Legacy constrained condylar knee prosthesis. OBJECTIVE:To explore the midterm folow-up effect of Legacy posterior stabilized prosthesis in total knee arthroplasty in patients with valgus knee deformity. METHODS: From February 2006 to November 2013 in Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical Colege, total knee arthroplasty was used to treat valgus knee deformity in 33 cases (35 knees). Parapatelar medial approach was used. Precise osteotomy was utilized to correct limb alignment. Lateral soft tissue received selective release. Finaly, an equal type of Legacy posterior stabilized prosthesis (Zimmer, USA) was implanted and fixed with antibiotic bone cement. The differences in hospital for special surgery knee score, range of motion of knee, femoral tibial angle, and maximum flexion and extension angle, as wel as X-ray film results were compared and analyzed before and after replacement. The complications including deep vein thrombosis, peri-prosthetic infection, patelar clicking, unstable knee, and common peroneal nerve injury were recorded after surgery. RESULTS AND CONCLUSION: Al patients were folowed up for 24-50 months. The incision was healed in one-stage. No complications such as peri-prosthetic infection appeared. Three patients suffered from common peroneal nerve palsy, which was cured at half a year after surgery by expectant treatment such as trophic nerve. Two cases suffered from knee instability after replacement, which was improved at 1 month after external fixation with a brace. One case experienced deep vein thrombosis in the lower extremity, which was improved after treatment with low molecular weight heparin anticoagulation. During final folow-up, hospital for special surgery knee score increased from (51.85±4.15) preoperatively to (85.77±2.50) postoperatively (P < 0.01). There were excelent in 20 knees, good in 11 knees, with an excelent and good rate of 89%. X-ray films showed that hindlimb alignment was apparently corrected, prosthetic position was good, no loosening occurred. These data indicate that total knee arthroplasty, using parapatelar medial approach, obtained good correction outcomes through the accurate amputation to correct hindlimb alignment and selective release of the soft tissue with Legacy posterior stabilized prosthesis in the treatment of valgus knee deformity.

Objective To evaluate the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction (ASTEMI) receiving primary percutaneous coronary intervention (PPCI). Methods The 217patients with ASTEMI receiving PPCI from Jan. 2005 to Dec. 2007 were enrolled in this study. And they were divided into two groups: DES group (n=92) and BMS group (n=125). The baseline characteristics including age, gender, angiographic characteristics, stents characteristics, Killip classification, cardiac troponin I(CTnI)levels, left ventricular ejection fraction(LVEF), hemoglobin levels, hypertension, diabetes, hyperlipidemia, obesity and smoking of the two groups were collected.Clinical follow-up end point were major adverse cardiac event(MACE)including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was(16.8±11.3) months (6-38 months). Results The average age (years), rate of Killip classification (class 2, 3, 4), average diameter (mm) of stent were significantly higher in BMS group than in DES group(64.6±11.9 vs. 61.2±11.8, t=2.09, P=0.037;25.9% vs. 12.2%, χ2=5.53, P=0.019;3.07±0.38 vs. 2.91±0. 40, t=2.78, P=0.006). And the average LVEF (%) was significantly lower in BMS group than in DES group (55.4±11.9 vs. 60.3±12.8, t= -2.57, P=0.011). The average length (mm) of stent, rate of stent post dilatation and diabetes were significantly higher in DES group than inBMSgroup (32.8±16.2 vs. 26.2±11.2, t=-3.54, P=0.001;45.7% vs. 21.6%, χ2=13.85, P=0. 000;28.2% vs. 16.0%, χ2=4.77, P=0.030). MACE occurred in 36 patients during clinical follow-up, 6 in DES group and 30 in BMS group. Incidence of MACE was significantly lower in DES group than in BMS group(6.5% vs. 24.0%, χ2=11.70, P＜0.01). Conclusions Using DES in ASTEMI patients is safe and may improve clinical outcomes by reducing incidence of MACE compared with BMS.

Compelling evidence has demonstrated the critical role of circular RNAs (circRNAs) during lung adenocarcinoma (LUAD) progression. Herein, we explored a novel circRNA, circ_0129047, and detailed its mechanism of action. The expression of circ 0129047, microRNA-665 (miR-665), and protein tyrosine phosphatase receptor type B (PTPRB) in LUAD tissues and cells was determined using reverse transcription quantitative polymerase chain reaction and Western blotting. Cell Counting Kit-8 and colony formation assays were conducted to detect LUAD cell proliferation, and western blotting was performed to quantify apoptosis-related proteins (Bcl-2 and Bax). Luciferase reporter and RNA immunoprecipitation assays were used to validate the predicted interaction between miR-665 and circ_0129047 or PTPRB.A xenograft assay was used for the in vivo experiments. Circ_0129047 and PTPRB were downregulated in LUAD tissues and cells, whereas miR-665 expression was upregulated. Overexpression of circ_0129047 suppresses LUAD growth in vivo and in vitro. Circ_0129047 is the target of miR-665, and the miR-665 mimic ablated the antiproliferative and pro-apoptotic phenotypes of LUAD cells by circ_0129047 augmentation. MiR-665 targets the 3ʹUTR of PTPRB and downregulates PTPRB expression. PTPRB overexpression offsets the pro-proliferative potential of miR-665 in LUAD cells. Circ_0129047 sequestered miR-665 and upregulated PTPRB expression, thereby reducing LUAD progression, suggesting a promising approach for preventing LUAD.

Objectives We sought to determine the factors that predicted in-hospital heart failure(HF)in patients undergoing successful primary percutaneous coronary intervention(PCI)for ST-segment elevation myocardial infarction(STEMI). Methods The clinical and angiographic data were retrospectively reviewed in patients undergoing successful primary PCI for their ifrst STEMI. According to the occurrence of in-hospital HF, patients were divided into HF group and non-HF group. The incidence and predictors of in-hospital HF and its impact on prognosis were determined. Results A total of 834 patients were included, among them 94 patients (11.3%) were in the HF group and 740 patients(88.7%) were in the non-HF group. The mean age was (62.9±12.9) years and 662 patients (79.4%) were male. All-cause mortality at 30 days was signiifcantly higher in the HF group than in the non-HF group (24.5%vs. 1.5%, P<0.001). In Cox regression analysis, left anterior descending artery (LAD) as the culprit vessel (HR 2.173, 95% CI 1.12~4.212, P=0.022), ln 24 h NT-proBNP (HR 1.904, 95%CI 1.479~2.452, P<0.001), 24 h hsCRP≥11.0 mg/L (median) (HR 2.901, 95%CI 1.309~6.430, P=0.009) and baseline serum glucose (HR 1.022, 95%CI 1.000 ~ 1.044, P=0.046) were independent predictors of in-hospital HF. Receiver operator characteristic analysis identiifed 24 h NT-proBNP ≥ 1171 pg/ml (c=0.883, P < 0.001) and 24 h hsCRP ≥ 13.5 mg/L (c=0.829, P < 0.001) were the best cut-off values in discriminating in-hospital HF with a sensitivity and speciifcity of 92.5%and 76.8%for 24 h NT-proBNP, 86.0%and 77.0%for 24 h hsCRP, respectively. Even among patients with LAD as the culprit vessel, the incidence of in-hospital HF was only 0.4%in patients whose 24 h NT-proBNP was<1171 pg/ml and 24 h hsCRP was<13.5 mg/L;while the incidence of in-hospital HF was up to 60.9%in patients whose 24 h NT-proBNP≥1171 pg/ml and 24 h hsCRP≥13.5 mg/L (P<0.001). Conclusions The incidence of in-hospital HF was still high in STEMI patients even after successful primary PCI. Patients with in-hospital HF had poor prognosis. LAD as the culprit vessel, hsCRP, NT-proBNP and baseline serum glucose were independent predictors of in-hospital HF. Assessment and combined use of different serum biomarkers were effective methods to estimate the risk of in-hospital HF in STEMI patients undergoing primary PCI.

OBJECTIVETo investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI).

METHODSWe performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed.

RESULTS(1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05).

CONCLUSIONSIn this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.

Aged ; Anticoagulants ; therapeutic use ; Coronary Disease ; Female ; Hemorrhage ; epidemiology ; Heparin ; therapeutic use ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Whole Blood Coagulation Time

OBJECTIVETo investigate the impact of gender on early outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI) as their reperfusion strategy.

METHODSThe present study included consecutive patients with STEMI treated with primary PCI in our hospital from November 2003 to December 2012. Gender difference and predictors of 30 day all-cause death were examined among 957 patients, 197 of whom were women (20.6%). The impact of gender on 30 all-cause death was further evaluated by a propensity-matched analysis to adjust the differences in baseline characteristics between men and women.

RESULTSCompared with men, women were older ((69.4±10.2) years old vs. (60.6±12.6) years old, P<0.001), more likely to have hypertension (72.1% (142/197) vs. 54.6% (415/760), P<0.001) and diabetes (45.2% (89/197) vs. 32.4% (246/760), P = 0.001), but less likely to be treated with β-blockers (85.3% (168/197) vs. 92.0% (699/760), P = 0.006) and angiotensin converting-enzyme inhibitors/angiotensin-receptor blockers (82.2% (162/197) vs. 88.4% (672/760), P = 0.024). Symptom-to-balloon time was longer in women than in men (330 (240, 600) minutes vs. 270 (180, 450) minutes, P < 0.001). Multivariate linear regression analysis of log-transformed symptom-to-balloon time revealed that female gender was an independent predictor of longer symptom-to-balloon time (β = 0.141, 95% confidence interval (CI) 0.053-0.228, P = 0.002). Women with STEMI had higher unadjusted 30 day all-cause death (12.6% vs. 4.2%, P < 0.001) than men. Female gender independently predicted 30 day all-cause mortality both with (hazard ratio (HR) = 3.497, 95% CI 1.485-8.234, P = 0.004) and without (HR = 2.495, 95% CI 1.170-5.323, P = 0.018) the adjustment for baseline characteristics by propensity-matched analysis.

CONCLUSIONSEven with primary PCI as their reperfusion strategy, women with STEMI had higher 30 day all-cause death than men. Aggressive control of cardiovascular risk factors, adequate medical treatment and shortening of delay in reperfusion therapy might further improve the outcomes of female STEMI patients undergoing primary PCI.

Acute Disease ; Aged ; Aged, 80 and over ; Cause of Death ; Female ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Myocardial Infarction ; therapy ; Percutaneous Coronary Intervention ; Proportional Hazards Models ; Risk Factors ; Sex Factors ; Time Factors

Domestic and foreign literatures related to the persistence of SARS-CoV-2 and the re-positive cases infected with SARS-CoV-2 were reviewed, and the characteristics and infectivity of the re-positive cases were analyzed to provide scientific evidence for the improvement of case management and the development of measures to stop the spread of SARS-CoV-2. Existing studies have shown that re-positive rate of SARS-CoV-2 ranged from 2.4% to 19.8%, the median of interval between re-positive detection and discharge was 4-15 days. Following the second course of the disease, the anti-SARS-CoV-2 IgM, IgG and IgA positive rates of the cases were 11.11%-86.08%, 52.00%-100.00% and 61.54%-100.00% respectively, the total antibody and neutralizing antibody positive rates were 98.72% and 88.46%. The viral load of the re-positive cases was lower than that in the initial infection. At least 3 380 re-positive cases have been reported globally. SARS-CoV-2 strains were isolated from the samples of 3 re-positive cases (1 immunodeficiency case and 2 cases with abnormal pulmonary imaging). There were close contacts that were infected by an asymptomatic case taking immunosuppressive agents. In conclusion, the infectivity of re-positive cases infected with SARS-CoV-2 is generally very low. Rare re-positive cases infected with SARS-CoV-2 might cause further transmission. The management approach for the re-positive cases can be based on the assessment of the individual transmission risk according to the pathogen detection results.
Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 ; Humans ; Immunoglobulin M ; SARS-CoV-2