At present,domestic medical drama has entered a period of rapid development,and has widespread attention.Medical drama is not only an industry play,but also a soul drama;not only fully demonstrates the medical staff's practice situation,but also more profound humanistic connotation.This paper analyzed the humanistic connotation of current domestic medical drama from four aspects of public understanding of medicine,metaphor of human nature and life motif,professionalism and realistic dilemma and humanistic care,and put forward the enlightenment to nurses.

[Objective]To explore an individualized treatment measure enjoying more practical,effective and safe characteristics through evaluating the efficacy and safety of combined medications of low-dose urokinase,low-molecular weight heparin nadroparin calcium and ozagrel sodium in treating patients with acute cerebral infarction.[Methods]One-hunderd patients with acute cerebral infarction patients were recruited in this trail,and grouped according to different treatment times:Group A (n=40,from January 2005 to February 2008,being selected into the group in accordance with standards of China Guideline for Cerebrovascular Disease Prevention and Treatment) and Group B (n=60,from March 2008 to June 2011,being selected into the group in accordance with indications for onset time within 24 h and allowing age more than 75 years).Standard thrombolytic therapy (high dose urokinase) was performed on Group A and combined medications of low-dose urokinase,low-molecular weight heparin nadroparin calcium and ozagrel sodium (triple antithrombotic therapy) were performed on group B.National Institute of Health Neurological Deficit Scale (NIHSS) and Evaluation Standard of Clinical Efficacy were used to evaluate the recovery of neurological function before treatment and 24 h,7 and 14 d after treatment.[Results] NIHSS scores after therapy rapidly decreased in both groups as compared with those before treatment (P＜0.05).The NIHSS scores of Group B at 24 h,and 7 and 14 d after treatment were significantly decreased as compared with those of Group A (P＜0.05).The efficacy rate of Group B was significantly higher than that of Group A (P＜0.05).Intraparenchymal hemorrhage rate was 10.0％ (4/40) in Group A and 3.3％ (2/60) in Group B.[Conclusion] Triple antithrombotic therapy is more effective and relatively safer than standard thrombolytic therapy in treatment of patients with acute cerebral infarction.

BACKGROUNDWhen performing superior vena cava isolation, the major concerns are inadvertent ablation on sinus node and right phrenic nerve. However, little is known about the spatial relationship of electrical connections between superior vena cava and right atrium with the sinus node and phrenic nerve locations among individual patients.

METHODSWe studied 87 patients (male/female 60/27, mean age of (51 +/- 9) years) with atrial fibrillation. Before superior vena cava isolation, the sinus node site was defined by right atrium activation mapping during sinus rhythm and the right phrenic nerve site was localized via pacing manoeuvre. Superior vena cava was isolated by ablation at the electrical connection under the guidance of circular mapping catheter. The sites of sinus node, phrenic nerve and electrical connections were noted. Continuous variables were compared using Student's t test. A P value < 0.05 was considered statistically significant.

RESULTSRight atrium activation mapping revealed that the sinus node located at the anterior lateral segment of superior vena cava-right atrium junction in all patients. In 82 patients with detectable diaphragmatic stimulations, the phrenic nerve sites were predominantly at the lateral segment (70/82) with anterior lateral and anterior segments for a few patients. A total of 165 electrical connections were located among all 87 patients, and this averaged 1.8 +/- 0.6 (1-3) per patient. The anterior septum (72 patients (43.6%)), the anterior wall (40 (24.2%)), and the posterior septum (35 (35.4%)) of superior vena cava-right atrium junction were the electrical connection regular sites. Superior vena cava was isolated in all patients. Two patients developed sinus bradycardia, with 3 mild superior vena cava stenosis and 2 phrenic nerve palsy.

CONCLUSIONSThe sinus node, phrenic nerve and electrical connection sites were distributed along the superior vena cava-right atrium junctions at expected locations for most patients. The electrical connections were separated from the sinus node and phrenic nerve sites. With the activation mapping of right atrium and pacing along superior vena cava-right atrium junctions, the sinus node and phrenic nerve were localized and superior vena cava isolated in most patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation ; pathology ; surgery ; Catheter Ablation ; methods ; Echocardiography ; Electrophysiology ; Female ; Heart Atria ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; pathology ; surgery ; Prospective Studies ; Sinoatrial Node ; pathology ; surgery ; Vena Cava, Superior ; pathology ; Young Adult

BACKGROUNDNoninvasive detection of vulnerable plaque has a significant implication for prevention and treatment of atherosclerotic diseases. The aim of this study is to investigate the difference between vulnerable plaques and stable plaques in magnetic resonance (MR) images.

METHODSAtherosclerosis was induced in twenty male New Zealand white rabbits by high cholesterol diet and balloon injury of the abdominal aorta. After baseline (pre-triggering) MR imaging (MRI) scan, the rabbits underwent pharmaceutical triggering with Russell's viper venom and histamine to induce atherothrombosis, followed by another MRI scan 48 hours later (post-triggering). Rabbits were euthanized to obtain pathological and histological data. The results of MRI were compared with those of pathology and histology.

RESULTSMRI showed that abdominal aorta of the rabbits had pathological change of atherosclerosis in different degrees. Seventy-five plaques were analysed, among which 14 had vulnerable thrombi and 61 stable. Thrombosis was identified in 7 of 11 rabbits by post-triggering MRI, the sensitivity and K value of MR in detection of vulnerable plaque was 71% and 0.803 (P < 0.05). MRI data significantly correlated with the histopathological data in fibrous cap thickness (r = 0.749) plaque area (r = 0.853), lipid core area (r = 0.900). Compared with stable plaques, vulnerable plaques had a significantly thinner fibrous cap ((0.58 ± 0.27) mm vs. (0.95 ± 0.22) mm), larger lipid core area ((7.56 ± 2.78) mm(2) vs. (3.29 ± 1.75) mm(2)), and a higher ratio of lipid core area/plaque area ((55 ± 16)% vs. (27 ± 17)%), but plaque area was comparable in two groups on MRI. The ratio of lipid core area/plaque area was a strong predictor of vulnerable plaques.

CONCLUSIONMRI could distinguish vulnerable plaques from stable plaques in a rabbit model of atherothrombosis and may thus be useful as a noninvasive modality for detection of vulnerable plaques in humans.

Animals ; Aorta, Abdominal ; pathology ; Disease Models, Animal ; Magnetic Resonance Imaging ; methods ; Male ; Plaque, Atherosclerotic ; pathology ; Rabbits ; Thrombosis ; diagnosis

BACKGROUNDPrevious studies have investigated the technique of linear ablation at the mitral isthmus (MI) in patients with idopathic atrial fibrillation (AF), but MI ablation in patients with prosthetic natural mitral valves (MVs) was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs

METHODSPatients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium (LA) mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan.

RESULTSDuring the study period, a consecutive of 19 patients (male/female = 12/7, mean age of (48 ± 6) years) with prosthetic MVs (16 with metal valves, 3 with biologic valves) entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages ((2.0 ± 1.0) vs. (3.1 ± 1.3) mV, P = 0.002), more fragmented potentials (19/19 vs. 20/15, P < 0.001), and higher impedance ((132 ± 34) vs. (110 ± 20) Ω, P = 0.004). After initial ablation, more residual gaps along the MI lesions were found in study group (2.4 ± 0.4 vs. 1.7 ± 0.3, P < 0.001). The mean length of MI ((6.2 ± 3.3) vs. (7.1 ± 2.3) cm, P = 0.25) was comparable between 2 groups, but the MI in study group was much thicker ((3.1 ± 1.8) vs. (2.1 ± 1.07) cm, P = 0.01) and all were found as pouch type (19/19 vs. 2/35, P < 0.001). The follow-up results were comparable (65.1% vs. 72.3%, P = 0.30).

CONCLUSIONFor patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.

Adult ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Female ; Heart Atria ; surgery ; Heart Valve Prosthesis ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery

Objective?To compare the clinical effects of domestic video intubationscope (VIS) versus fiberoptic bronchoscope (FOB) for difficult nasotracheal intubation.?Methods?60 ASA Ⅰ or Ⅱ elective patients with difficult airway, Mallampati class Ⅲ or Ⅳ, aged 22 ～ 68 years, weight 53 ～ 82 kg, were randomly divided into domestic video intubationscope group (group V) and fiber bronchoscope group (group F), 30 cases in each group. The nasotracheal intubation was respectively guided by VIS in group V and FOB in group F. Tracheal intubation time, success rate of tracheal intubation and complications of tracheal intubation were recorded. MAP, HR and SpO2 were recorded at before anesthesia induction (T0), after anesthesia induction (T1), at glottic exposure (T2), at intubation (T3).?Results?Compared with T0, MAP and HR were significantly decreased in both groups at T1(P < 0.05). MAP and HR were significantly increased in both groups at T3 than those at T1(P < 0.05), and there were no significant differences between the two groups (P > 0.05). SpO2 during tracheal intubation was no significantly reduced in both groups. The tracheal intubation time were respectively (76.0 ± 18.0) s and (80.0 ± 20.0) s in group V and group F, and the one-time success rate of intubation in group V and group F were respectively 96.7% and 93.3%, but there were no significant differences between the two groups (P > 0.05). There was no significant difference in the incidence of tracheal intubation complications between the two groups (P > 0.05).?Conclusions?Compared with FOB, difficult nasotracheal intubation guided by domestic VIS also is a safe and reliable, fast and effective method with high intubation success rate and less complications of tracheal intubation.

Objective To understand the pathogen-carrying status of hand-foot-mouth disease (HFMD) among healthy people in Guangdong province.Methods Stool specimens were collected randomly on 7 age groups from 7 cities in Guangdong province.Real-time RT-PCR was used to detect enterovirus (EV),enterovirus 71 (EV71) and coxsackie virus A16 (CA16).Results Altogether,1285 stool specimens were collected.The positive rates of EV71,CA16 and other enterovirus were 0.39％ (5/1285),0.23％ (3/1285) and 7.00％ (90/1285),respectively.The highest EV71 positive rate (1.79％) was among the 4-6-year-old group,followed by the age group 0-3 with positive rate as 0.67％.EV71 was not found among the rest age groups.The highest CA16 positive rate (1.35％) was among the 4-6 year-olds group,but the CA16 was not found among the rest age groups.EV71 was only found among native population,with the positive-rate as 0.47％.CA16-positive rate was 0.19％ among the native population and 0.85％ among floating population,with no significant difference found (P＞0.05).The EV71 positive rate was 0.36％ among rural residents and 0.54％ among urban residents,but with no significant difference (P＞0.05).All CA16 was found among the urban residents.Conclusion Recessive infection of EV71 and CA16 were only found among 0-6 year-old group but not found among other groups,which suggested that the approaches on prevention and control should be targeted to all children especially on pre-school children.

OBJECTIVETo investigate the relationship of nasopharyngeal carcinoma (NPC) with the high frequency allele imbalance locus D6S1581, and the NPC associated gene FBXO30 which is located near D6S1581.

METHODSGenescan was used to genotype D6S1581 of 12 NPC pedigrees, 85 sporadic NPC patients and 181 normal volunteers. Then parametric/nonparametric linkage analysis and association analysis were performed.

RESULTSD6S1581 was linked with NPC, a Lod score of 2.611436 (P=0.00245) was obtained, and a significant difference in allele frequency was observed between familial NPC and control (P<0.005).

CONCLUSIONThese results suggest that D6S1581 is highly associated with NPC, and there may be one or more NPC associated genes near D6S1581, including FBXO30.

Adult ; Aged ; Aged, 80 and over ; Alleles ; China ; F-Box Proteins ; genetics ; Female ; Gene Frequency ; Genetic Linkage ; Genetic Predisposition to Disease ; genetics ; Humans ; Male ; Microsatellite Repeats ; genetics ; Middle Aged ; Nasopharyngeal Neoplasms ; genetics ; Pedigree

Objective:To estimate the burden of hip fractures and related factors among the Chinese middle-aged and elderly population.Methods:Based on the data of China Health and Retirement Longitudinal Study (CHARLS) in 2015, the burden of hip fractures among Chinese middle-aged and elderly population was evaluated as the years lived with disability (YLD) rate. The relationship between gender, age (45-49, 50-59, 60-69 and ≥70 years old), educational level (no education, elementary school, junior high school, high school and above), region (urban, rural), gross domestic production (GDP) per capita (low, medium and high) and geographic area (northern, eastern, south-central, northwest and southwest regions) and the YLD rate of hip fractures were analyzed, respectively.Results:Excluding items with missing basic information and hip fracture data, a total of 17,830 subjects (8,405 males and 9,425 females) were included in the study with average age 61.6±9.8 years (range 45 to 105 years). The average age in male was 61.9±9.6 years, and that in female was 61.2±10.1 years. The prevalence of hip fractures was 2.3% (410/17,830). The total YLD rate was [694/100,000 (95% Uncertainty Interval ( UI): 462/100,000, 989/100,000)]. The YLD rates were similar between male [693/100,000 (95% UI: 461/100,000, 988/100,000)] and female [696/100,000 (95% UI: 463/100,000, 992/100,000)] subgroups. The YLD rate of hip fractures was increasing with age, which reached at maximum of 1,155/100,000 (95% UI: 769/100,000, 1,646/100,000) for participants aged 70 years or above. The rate was gradually decreased with the upgrade of the educational level. The participants with high school education and above reached the lowest of 434/100,000 (95% UI: 289/100,000, 619/100,000). In addition, the YLD rate of hip fractures in rural areas [721/100,000 (95% UI: 480/100,000, 1,027/100,000)] was higher than that in urban areas [650/100,000 (95% UI: 433/100,000, 926/100,000)]. The YLD rate in areas with higher GDP per capita [545/100,000 (95% UI: 363/100,000, 777/100,000)] was lower than that in areas with lower GDP per capita [761/100,000 (95% UI: 506/100,000, 1,084/100,000)]. Moreover, the participants living in the Northwest region were with the highest YLD rate of hip fractures [1,056/100,000 (95% UI: 703/100,000, 1,506/100,000)], followed by the Southwest region [887/100,000 (95% UI: 590/ 100,000, 1,264/100,000)] and the Northeast region [317/100,000 (95% UI: 211/100,000, 452/100,000)]. Conclusion:Hip fractures exerted heavy burdens on the Chinese middle-aged and elderly population. The YLD rate of hip fractures varied according to geographical regions, greater age, rural areas, low educational levels and low GDP per capita. These related factors could affect the disease burden of hip fractures in China.

Objective: To investigate the effects of clopidogrel resistence and CYP2C19 genotype on the clinical prognosis of acute coronary syndrome(ACS) patients undergoing percutaneous coronary intervention(PCI). Methods: This study was a retrospective cohort study. ACS patients who underwent PCI in Beijing Anzhen Hospital from October 2015 to January 2017 were recruited. The inhibition rate of adenosine diphosphate(ADP) was monitored by thromboelastography. All of these patients were divided into clopidogrel resistance and non-resistance group according to the monitoring results. CYP2C19 genotype was detected by TaqMan probe-based real-time quantitative PCR. Patients were divided into slow, medium and fast metabolic group, according to the CYP2C19 genotype. After 12 months of follow-up, the end points included all-cause death, cardiac death, angina, myocardial infarction, stent thrombosis, ischemic stroke and hemorrhage were collected. Combined thrombotic events were defined as a composite of angina, myocardial infarction, stent thrombosis and ischemic stroke. The differences of the incidence of clinical events between groups were compared. Cox regression was used to analyze the effects of clopidogrel resistance and CYP2C19 genotype on the combined thrombotic events, cardiac death and hemorrhage. Results: A total of 1 696 patients were included, and the age was (59.4±9.6) years, with 1 280(75.5%) males. There were 471 cases(27.8%) in clopidogrel resistance group, and 1 225 cases(72.2%) in clopidogrel non-resistance group. There were 218 patients(12.9%) were in slow metabolic group, 668(39.4%) in medium metabolic group, and 810 (47.8%) in fast metabolic group. The median follow-up time was 13.3 months, and 131 cases were lost to follow-up, with a loss follow-up rate of 7.7%. Compared with the clopidogrel non-resistance group, the clopidogrel resistance group had a higher incidence of myocardial infarction(7.6%(36/471) vs. 5.1%(62/1 225), P=0.041), a lower incidence of hemorrhage (13.2%(62/471) vs. 17.9%(219/1 225), P=0.020) and minor hemorrhage(11.5%(54/471) vs. 15.8% (194/1 225), P=0.022). There were no statistically significant difference in all-cause death, cardiac death, angina, stent thrombosis, ischemic stroke and severe bleeding between clopidogrel resistance and non-resistance group(all P>0.05). There was no statistically significant difference in the incidence of endpoint events among different CYP2C19 genotypes (all P>0.05). Cox regression analysis showed that clopidogrel resistance was an independent factor of combined thrombotic events (OR=2.334, 95%CI 1.215-4.443, P=0.016) and bleeding events (OR=0.481, 95%CI 0.174-0.901, P=0.023). While CYP2C19 genotype was not independent factor for combined thrombotic events, cardiac death and hemorrhage (all P>0.05). Conclusion: For ACS patients after PCI, clopidogrel resistance can increase the risk of combined thrombotic events, but also reduce the risk of bleeding; while CYP2C19 genotype is not an independent factor for clinical prognosis.
Acute Coronary Syndrome/genetics* ; Clopidogrel/therapeutic use* ; Cytochrome P-450 CYP2C19/genetics* ; Genotype ; Humans ; Male ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/therapeutic use* ; Prognosis ; Retrospective Studies ; Treatment Outcome