Objective To investigate the incidence and relevant factors of upper gastrointestinal bleeding(UGB)in patients with coronary heart disease(CHD)undergoing dual antiplatelet therapy(DAT)with aspirin plus clopidogrel.Methods A total of 391 CHD patients treated with aspirin plus clopidogrel (DAT group)and 502 control CHD patients receiving single antiplatelet therapy(SAT)with aspirin or clopidogrel(SAT group)were enrolled.The incidence and relevant factors associated with UGB were retrospectively analyzed in both groups of patients.Data were analyzed with Chi-square test and logistic regression by using SAS software version 9.0.Results The incidence of UGB in DAT group was significantly higher compared with SAT group(7.1％ vs.3.4％,P ＜ 0.01).The factors,including DAT,age over 65 years,medication duration over 3 months and previous digestive diseases increased the risk of UGB in CHD patients(P ＜ 0.05),while the use of PPIs(proton-pump inhibitors)or gastric mucosal protectives lowered the risk of UGB(OR:0.415,95％ CI 0.226 ～ 0.762,P =0.0035).Conclusions DAT can significantly increase the risk of UGB.UGB can be increased in elderly CHD patients and those with long-term medication and previous digestive diseases.Utility of PPIs or gastric mucosal protectives can effectively lower the incidence of UGB.

To train high-qualified dental practitioner, the students in Chongqing Medical U-niversity were guided and regulated through rigorous training programs. Special attention was paid to the management of each aspect of clinical practice, the educational philosophy of early clinical expo-sure, early scientific research exposure and early contact with society have been fully implemented during the teaching practice in our stomatology college.

OBJECTIVETo observe therapeutic effect and prognosis of ear point taping and pressing therapy for primary dysmenorrhea.

METHODSOne hundred and fourteen cases were randomly divided into an ear taping and pressing group of 60 cases and a western medication group of 54 cases. The ear taping and pressing group were treated by ear point taping and pressing at Shenmen, Zigong (uterus), Neifenmi (endorine), Pizhixia (subcortex), Jiaogan (sympathesis) and Shen (kidney), which were taped and pressed by a adhesive plaster with Vaccaria seeds. The western medication group were treated with oral administration of Indomeixin enteric tablets. The therapeutic effects were assessed after treatment of 3 menstrual cycles.

RESULTSThe total effective rate was 91.7% in the ear taping and pressing group and 77.8% in the western medication group with a significant difference between the two group (P < 0.05); and the long-term therapeutic effect in the ear taping and pressing group was better than that in the western medication group.

CONCLUSIONEar point taping and pressing therapy has significant therapeutic effect on primary dysmenorrhea.

Acupuncture, Ear ; methods ; Adolescent ; Adult ; Dysmenorrhea ; therapy ; Female ; Humans ; Medicine, Chinese Traditional

BACKGROUNDHelical tomotherapy (HT) is a new image-guided intensity-modulated radiation therapy (IMRT) technique. It is reported that HT plan for non-small-cell lung cancer (NSCLC) can give better dose uniformity, dose gradients, and protection for the lung than IMRT plan. We compared the dosimetric characteristics of HT for NSCLC with those of conventional IMRT to observe the superiority of HT.

METHODSThere was a comparative case series comprising 10 patients with NSCLC. Computed tomographic (CT) images of delineated targets were transferred to the PrecisePlan planning system (IMRT) and Tomo planning system (HT). The prescription doses were 70 Gy/33F for the gross tumor volume (GTV) and the visible lymph nodes (GTVnd), and 60 Gy/33F for the clinical target volume (CTV) and the clinical target volume of the visible lymph nodes (CTVnd). The dose restrictions for organs at risk were as follows: the maximum dose to spinal cord ≤ 45 Gy, V20 to the total lungs < 30%, V50 to the heart < 50%, and V55 to the esophagus < 50%. Both plans were evaluated by means of the dose coverage of the targets, dose-volume histograms (DVHs), and other dosimetric indices.

RESULTSThe dose coverage, conformity, and homogeneity of the targets' volumes were found to be satisfactory in both plans, but the homogeneity of the HT plan was better than that of IMRT. The high-dose radiation volume (V20-V30) to the lung and the mean lung dose (MLD) decreased (P < 0.05), but the low-dose radiation volume (V5-V10) increased slightly in the HT plan (P > 0.05). The maximum doses to the spinal cord, heart, esophagus and trachea in the HT plan were lower than those in the IMRT plan, but the differences were not statistically significant.

CONCLUSIONSThe HT plan provids better dose uniformity, dose gradients, and protection for the organs at risk. It can reduce the high-dose radiation volume for lung and the MLD, but may deliver a larger lung volume of low-dose radiation.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; radiotherapy ; Humans ; Male ; Middle Aged ; Radiography ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Treatment Outcome

OBJECTIVETo study absorption kinetics of scopoletin in rat stomachs and intestines.

METHODRats was cannulated for in situ recirculation. UV and HPLC methods were used to determine the concentrations of phenolsulfonphthalein and scopoletin, respectively.

RESULTThe absorption rates in rat stomachs at 2 h after administration was 76.31%; The absorption rates at colon, duodenum, ileum and jejunum were 46.25%, 40.54%, 38.21%, 32.77%, respectively. The absorption rate constant (Ka) at concentrations of 10.0144, 20.0288-40.0576 mg x L(-1) in intestine were 0.6434, 0.6137, 0.5970 h(-1), respectively. The Ka of scopoletin at pH of 6.0, 6.8 and 7.4 in intestine were 0.6217, 0.6033, 0.6137 h(-1), respectively.

CONCLUSIONThe concentrations and pH values of scopoletin solution had no distinctive effect on the absorption kinetics. The absorption of scopoletin was a first-order process with passive diffusion mechanism. Scopoletin was well absorbed at stomachs and intestines in rats. Colon was the best absorption site of scopoletin, which suggest that a sustained-release preparation should be suitable for this compound.

Absorption ; Animals ; Chromatography, High Pressure Liquid ; Female ; Hydrogen-Ion Concentration ; Intestinal Absorption ; Intestines ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Scopoletin ; pharmacokinetics ; Spectrophotometry, Ultraviolet ; Stomach ; metabolism

OBJECTIVETo introduce the procedure of the 1st ray stabilization combined with resection of the lesser metatarsal heads for patient with severe forefoot deformity caused by rheumatoid arthritis (RA) and evaluate the short to mid-term clinical results.

METHODSFrom Oct. 2006 to Aug. 2010,97 patients (129 feet) aged from 36 to 67 years (average 54), with forefoot deformity caused by rheumatoid arthritis were reviwed. There were 88 males and 9 females,65 single lateral involved and 32 bilateral involved, the average duration of disease was 17 years (6 to 32 years). The 1st ray instability and lesser metatarsophalangeal (MTP) joint stiff dislocation were found in all cases. The first ray stabilization combined with resection of the lesser metatarsal head procedure were performed for all cases. The radiographic Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measurde and the JSSF (Japanese Society for Surgery of the Foot) score were evaluated before operation and every follow up.

RESULTSThe average followed-up was 37 months (6 to 52 months) for all patients except 5 (7 feet) and 1 died for acute cardiac infarction 1 year after operation. The average JSSF score improved from (33.2 +/- 8.2) points preoperative to (67.3 +/- 3.1) points at final followed-up (P < 0.01); the average HVA was corrected from (50.0 +/- 11.8) degrees preoperative to (21.2 +/- 3.2) degrees at final follow up (P < 0.01); the average IMA was corrected from (15.5 +/- 3.6) degrees preoperative to (9.7 +/- 6.6) degrees at final follow up (P < 0.01). MTP joint nonunion was found in 4 feet. A radiographic high density mass was found in the 1st cuneiform bone during 8 to 11 months followed-up in 3 feet; delayed wound healing was happened in 9 feet; MTP joint infection was happened in 2 feet; tarsometatarsal joint infection was happened in 1 foot; lesser MTP joints deformity recurrence were found in 16 feet.

CONCLUSIONThe characters of forefoot with RA in later stage are the 1st ray deformity and instability compound with the lesser toes deformity. The 1st ray stability procedure which include the 1st MTP arthrodesis and the Lapidus procedure can correct the 1st ray deformities and rebuilt its stability. The lesser toes metatarsal head resection is effective in correct their deformity. This combined procedure is reliable. It is suitable for patients with severe Hallux valgus, increased IMA, tarsometatarsal joint instability and the lesser MTP joint stiff dislocation.

Adult ; Aged ; Arthritis, Rheumatoid ; complications ; surgery ; Female ; Foot Deformities, Acquired ; surgery ; Forefoot, Human ; abnormalities ; surgery ; Hallux Valgus ; surgery ; Humans ; Joint Instability ; surgery ; Male ; Metatarsal Bones ; surgery ; Metatarsophalangeal Joint ; surgery ; Middle Aged

OBJECTIVETo study the correlation between Apnea Graph (AG) analysis of airway obstruction and cephalometric assessment of the posterior airway space in the diagnosis of obstructive level in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), so as to improve the preoperative diagnostic accuracy and the therapeutic outcome.

METHODSThirty patients (28 males and two females) who were diagnosed with severe OSAHS (mean AHI 58.6) by overnight polysomnography in recent 3 months were enrolled. The ages of the patients ranged from 35 to 59 years old with the median age of 41.5 years old. The mean body mass index (BMI, x(-) ± s) was (28.8 ± 4.1) kg/m(2). Mean apnea-hypopnea index (AHI) was (58.6 ± 16.4)/h. The lowest oxygen saturation was averaged to 0.69 ± 0.09. All patients underwent AG study as well as cephalometric analysis preoperatively. A correlation analysis was performed between the percentage of lower level obstructions measured by AG and the posterior airway space (PAS) evaluated by cephalometric analysis.

RESULTSAll of the 30 patients had the obvious narrow PAS of 4.4 - 10.8 mm, with the average of (7.6 ± 2.1) mm. Their constituent ratios of lower level obstruction ranged from 2 to 87 percent with the median ratio of 15.5% [9.0%; 35.8%]. Among all the patients, only 2 cases had more than 50 percent obstruction of the airway at lower level, 8 cases had 30 to 40 percent obstruction, and 6 cases had the narrow PAS less than 6 mm. The constituent ratio of lower level obstructions had a negative rectilinear correlation with the data of PAS (r = -0.6511, P < 0.01), which meant the patient with a higher percentage of lower obstruction had the tendency to have a corresponding narrower PAS. Two cases whose constituent ratios of lower level obstructions were not compatible with the rectilinear tendency due to tonsillar hypertrophy were reported.

CONCLUSIONSAG analysis of airway obstruction and cephalometric assessment of the PAS could provide comparable and consistent results for the diagnosis of obstructive level in OSAHS. However, the tonsillar hypertrophy should be considered when using AG to identify the airway obstruction.

Adult ; Airway Obstruction ; diagnosis ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Sleep Apnea, Obstructive ; diagnosis ; diagnostic imaging ; physiopathology ; Tongue ; diagnostic imaging ; Transducers, Pressure

OBJECTIVETo analyze clinical characteristics in young and aged patients with coronary artery disease (CAD).

METHODSThe clinical and coronary angiographic data were compared between young (PCAD, male < 55 years old, n = 74, female < 65 years old, n = 71) and aged (CAD, male > 55 years old, n = 106, female > 65 years old, n = 111) patients. Seventy-one patients excluded with CAD by angiography served as controls (non-CAD). The traditional risk factors (including age, smoking, blood pressure, lipid profile, blood glucose, BMI, family history), coronary angiographic changes were analyzed and compared among various groups.

RESULTS(1) Compared with CAD group, PCAD patients had significantly higher rate of smoking (50.3% vs. 38.0%, P < 0.05), significantly higher positive CAD family history rate (29.7% vs. 19.9%, P < 0.05) and significantly higher TG level [(2.13 +/- 1.89) mmol/L vs. (1.78 +/- 1.14) mmol/L, P < 0.05], while had significantly fewer traditional risk factors (2.50 +/- 1.28 vs. 2.76 +/- 1.43, P < 0.05) and lower hypertension rate (59.3% vs. 73.3%, P < 0.05). There were significantly more PCAD patients with acute coronary syndrome (66.2% vs. 42.6%, P < 0.05), more PCAD patients had single vessel lesion (51.0% vs. 30.4%, P < 0.05), lower average lesion score (4.86 +/- 2.30 vs. 5.92 +/- 2.66, P < 0.05). (2) The logistic regression results showed that positive CAD family history (P = 0.029, OR = 1.766, 95% CI 1.060 - 2.940) and smoking (P = 0.066, OR = 1.561, 95% CI 0.971 - 2.510) are important independent risk factors for the development of PCAD.

CONCLUSIONSSmoking, positive family history and the increased TG might contribute to the pathogenesis of PCAD.

Adult ; Aged ; Coronary Artery Disease ; diagnosis ; epidemiology ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Smoking ; adverse effects ; Triglycerides ; blood

OBJECTIVETo study the relations between different feeding patterns and the body weight retention of the perinatal women living in rural areas of China.

METHODSA cluster sampling method was used to investigate 409 women, who are currently living in rural areas of Tianjin, at pregnant and perinatal status. While, their body weights and heights before pregnancy, antepartum and postpartum were measured, respectively. Body weight retention was the difference of the measured data after postpartum minus pre-pregnant weight. Variance analysis was used for statistic comparison.

RESULTSThe rate of exclusive breastfeeding was 70.9% (290/409) within four months. The net body weight retention of women (5.8 kg) using the exclusive breastfeeding was lower than that of the women (7.0 kg) using artificial feeding within 4 - 6 months, but there was no significantly statistic difference (F = 1.45, P = 0.236). However, there was the opposite result within 7 - 9 months, the data showed that the body weight retention in the women using the exclusive breastfeeding was 4.9 kg, which was significantly higher than that the women (2.9 kg) with artificial feeding (F = 3.17, P = 0.043). The food consumption of the women (901 g) using exclusive breastfeeding was the highest, followed by those (877 g) using mixed feeding and the women (750 g) using artificial feeding.

CONCLUSIONThe body weight retention after postpartum should be related to infant feeding patterns. After postpartum, the weight loss of women using the exclusive breastfeeding is relatively low. While, for the women using the exclusive breastfeeding, the net weight retention during pregnancy and after postpartum were lower than those with artificial feeding. Therefore, it is necessary to enhance health education and guidance on promoting exclusive breast-feeding as well as increasing awareness on pre-pregnant health.

Body Weight ; Breast Feeding ; Feeding Behavior ; Female ; Health Status ; Humans ; Infant ; Rural Population ; Sampling Studies

OBJECTIVETo investigate the molecular mechanism of haemophilia B caused by the novel mutation of Arg327Ile (R327I) in FIX gene.

METHODSThe R327I, R327Ala(A), R327Lys(K), R327Asn(N) and a replacement mutant (FIXβFVII), in which FIX β strand 324-329 was replaced by that of FVII 298-303, expression plasmids were constructed with site-directed mutagenesis method based on the wild-type (WT) FIX expression plasmid. The HEK293 cell was transiently transfected, then the activity of FIX (FIX:C) was assayed by one stage method in the conditioned medium, while the FIX:Ag in both the conditioned media and the cell lysates was measured by ELISA. The molecular weight and the semi-quantity of expressed FIX were analyzed by Western blot. Fluorescent protein expression plasmid was constructed to investigate the synthesis and secretion of the FIX R327I mutation in the viable cells.

RESULTSFIX:C of the R327I mutant protein was 4.49% of the level of the WT in the conditioned medium, and the FIX:Ag of the R327I mutant protein in the conditioned medium and the cell lysates was 31.02% and 129.29% compared to that of WT, respectively. The mutation was characterized as cross-reaction material reduced (CRMR). The viable cell fluorescent assays showed that the R327I protein was more in both the viable cells and in lysosome than that of WT. The FIX:C of the R327A, R327K, R327N and FIXβFVII mutants was reduced compared to that of WT, the reduction of FIX:C of FIXβFVII was the most significantly amount among all the mutants in medium. FIX:Ag of all the mutants in the medium, except that the R327K increased, was reduced. The result of Western blot showed that the molecular weight of R327I protein was the same as that of WT, but the amount of the protein was much less compared with WT in the conditioned medium.

CONCLUSIONThe abnormal synthesis and secretion as well as the abnormal function of the R327I mutant protein causes haemophilia B. The residue of R327 as well as the β strand domain of R327 located play important roles of the specific function of FIX.

Factor IX ; genetics ; HEK293 Cells ; Hemophilia B ; genetics ; pathology ; Humans ; Mutagenesis, Site-Directed ; Mutation ; Transfection