Objective To explore the affect of citalopram on Hamilton Depression Scale (HAMD) ,self rating Depression Scale (SDS) score ,high sensitive C reactive protein (hs‐CRP) ,heart rate variability (HRV) ,andrenin angiotensin systerm(RAS) levels of patients with coronary heart disease complicated with anxiety‐depression .Methods 160 cases of patients with coronary heart disease and anxiety depression in January 2012 to August 2014 were selected ,they were randomly divided into observation group and control group according to the list of number table methods ,the control group of 80 patients used routine treatment methods ,while 80 patients in observation group were added with citalopram on the basis of conventional therapy ,after 6 weeks of treatment ,the clinical efficacy and changes of the HAMD ,SDS score ,score ,and hs‐CRP ,heart rate variability ,and renin angiotensin levels of two groups were compared .Results (1)The total clinical effective rate of the observation group was 93 .75% ,significantly higher than 70 .0% of the control group ,the difference was statistically significant (χ2 =10 .21 ,P<0 .05);(2)HAMD score ,SDS score ,hs‐CRP of the observation group was significantly lower than that of the control group ,the difference was statistically signifi‐cant(t=12 .98 ,9 .43 ,11 .86 ,P<0 .05);(3)HRV of the study group was significantly higher than that in the control group ,there was a statistically significant difference (P<0 .05);(4)Angiotensin II of the observer group were (93 ± 26)ng/L ,Angiotensin Ⅱ of the control group were (37 ± 14)ng/L ,the difference was statistically significant (P<0 .05) .Conclusion Citalopram has a signifi‐cant efficacy in treatment of patients with coronary heart disease combined with anxiety‐depression ,which is safe and reliable that is worth clinical popularizing and applying .

Objective To investigate the risk factors and their prevention and treatment approaches for occurring radial artery spasm (RAS) during the brain digital subtraction angiography (DSA) with transradial catheterization in patients with ischemic cerebrovascular disease.Methods The patients who underwent DSA of transradial approach because of ischemic cerebrovascular disease were enrolled.Their clinical data,surgical complications,and radial artery spasm were collected.The data of occurring RAS or not during DSA of transradial approach in patients were compared.Multivariate logistic regression analysis was used to analyze the risk factors for occurring RAS during DSA of transradial approach.Results A total of 100 patients with ischemic cerebrovascular disease who underwent DSA of transradial approach (74 ischemic stroke,26 transient ischemic attack) were enrolled,of which 21 (21％) had RAS.Of the 21 patients with RAS,4 suspended their operations and completed their DSA after spasm relief; another 17 were treated with intrathecal cocktail (heparin 2500 U,nitroglycerin 0.5 mg,verapamil 1.25 mg) and completed their DSA after spasm relief.There were significant differences in the proportions of radial artery diameter (1.89 ±0.28 mm vs.2.12 ± 0.17 mm; t =1.582,P =0.041),duration of operation (12.3 ± 3.1 min vs.9.8 ±2.7 min; t =1.264,P =0.038),and radial artery diameter ＞2 mm (9.52％ vs.65.82％ ;x2 =9.624,P =0.002),radial artery anatomy variation (23.81％ vs.0.27％; x2 =14.185,P＜ 0.001),and the first successful puncture (42.86％ vs.78.48 ％ ;x2 =5.335,P =0.021) in patients between RAS group and the non-RAS group.Multivariate logistic regression analysis showed that the radial artery anatomy variation (odds ratio [OR] 1.940,95 ％ confidence interval [CI] 1.372-2.241; P=0.023) was an independent risk factor for the occurrence of RAS.Radial artery diameter ＞2 mm (OR 0.752,95％ CI 0.352-0.847;P=0.043) and the first successful puncture (OR 0.843,95％ CI 0.367-0.941; P=0.045) were the independent protective factors for RAS.Conclusions RAS is a common complication of DSA of transradial approach.Repeated puncture,radial artery diameter,and radial artery anatomy variation are its most important influencing factors.

objective To determine a proper fiducial photography distance setting for ideal amptitied endoscopic imaging of parathyroid gland by high definition endoscopy system.Methods 30 patients were operated with MIVAT mode (modified Miccoli's approach) for treatment of thyroid carcinoma from Apr.2013 to Mar.2014.High definition imaging was established by Image 1 Endoscopy System(Karl Storz Co.) to observe parathyroid gland and related fine anatomical structures during surgery.5 fiducial photography distances (1.0/1.5/2.0/2.5/3.0 cm) were separately tested during surgery.Maximally amplified parathyroid gland images of each setting were obtained by the approaching-amplifying photographic method,and then the size of the real parathyroid glands as well as their screen images were measured and recorded to calculate the magnification.A proper fiducial photography distance setting was determined postoperatively by comparison of the magnification times,as well as clarity,stability of the imaging and surgical maneuverability.Results ①90 parathyroid glands were successfully observed and measured.②At the longest fiducial photography distance (3.0 cm),the parathyroid gland could be stably magnified by 14.26±3.06(long trail)/12.62±2.88 (wide trail)times,but their contour and color not clear.③At the intermediate distance (2.5 cm),the parathyroid gland could be magnified by 16.74±3.15 (long trail)/14.81± 3.47(wide trail)times with the graphics stable,and the color and contour more clear,but the vascular pedicle and the tiny vessels under the capsule still blurred.④At the shortest distance (1.0 cm),the parathyroid gland could be magnified by 27.72±6.45 (long trail)/26.33±7.22(wide trail)times,not only the color and contour,but also the vascular pedicle and the tiny vessels under the capsule of the gland became further clearer,unfortunately the graphics was shimmy and unstable.Conclusions ①2.5 cm can be a proper fiducial photography distance for searching,identifying and preserving parathyroid gland in MIVAT,while 1.0 cm can be a special fiducial photography distance for further confirming parathyroid gland when necessary.② Current high definition endoscopy system can be applied to identify the parathyroid gland if fiducial photography distance was properly set and approachingamplifying photographic method was used.Along with the magnification of the imaging,the features of the parathyroid gland may become clearer,including its yellow-brown color and oval contour,as well as the detail structures such as the tiny vessels under the capsule and the vascular pedicle.

Objective To evaluate the association between serum 25-hydroxyvitamin D3 [25 (OH) D3],parathyroid hormone,and arterial stiffness in patients with type 2 diabetes.Methods Serum 25 (OH) D3 and parathyroid hormone(PTH) were determined in a cross-sectional sample of 258 patients aged 30 years and over.Arterial stiffness was assessed by pulse wave velocity(PWV) obtained with a VP-1000 pulse wave unit.Fasting plasma HbA1c,lipid profile,calcium,and high sensitive-C reactive protein were determined.Results (1)The prevalence of vitamin D3 deficiency was high(79.84％) in patients with type 2 diabetes.(2) Those with lowered serum vitamin D3 levels had raised PWV [(1610.76 ± 142.70 vs 1527.95 ± 58.02) cm/s,P＜0.05].(3) Multiple stepwise regression analysis showed that 25 (OH) D3 was an impact factor of PWV risk score,which was independent of age,duration of diabetes,and systolic blood pressure(β =-0.256,P＜0.01).(4) Serum PTH was positively correlated with PWV (r =0.210,P ＜ 0.05) and systolic blood pressure (r =0.229,P ＜ 0.05),but negatively correlated with 25 (OH) D3 (r =-0.153,P ＜ 0.05).Conclusions 25 (OH) D3 deficiency is common in patients with type 2diabetes,and a low serum 25 (OH) D3 level is significantly associated with increased arterial stiffness in these patients.The association of serum PTH with arterial stiffness may result via changes in vitamin D and blood pressure.

Objective To investigate the risk factors for carotid sinus reactions (CSR) during internal carotid artery stenting (CAS).Methods The clinical data of 36 patients treated with CAS were enrolled retrospectively.The patients were divided into either a CSR group or a non-CSR group according to whether they had CSR or not.The risk factors for CSR during procedure were analyzed using univariate and multivariate logistic regression analysis.Results Of the 36 patients,25 had CRS (7 simple hypotension,4 simple bradycardia,and 14 both co-existence).The constituent ratios of the patients of the age ≥ 75 years (64.00％ vs.27.27％ ;x2 =2.384,P =0.028),degree of CAS 70％ to 99％ (76.00％ vs.36.36％ ; x2 =4.430,P =0.035),symptomatic stenosis (72.00％ vs.36.36％ ; x2 =4.082,P =0.043),calcified plaque (76.00％ vs.36.36％ ;x2 =4.430,P =0.035),distance from stenosis to bifurcation ≤ 10 mm (72.00％ vs.27.27％ ;x2 =5.029,P =0.025) and balloon expansion (64.00％ vs.18.18％ ;x2 =44.483,P =0.000) in the CSR group were significantly higher than those in the non-CSR group.Multivariate logistic regression analysis showed that age ≥ 75 years (odds ratio [OR] 1.520,95％ confidence interval [CI] 1.376-4.369; P =0.034),distance from stenosis to bifurcation ≤ 10 wm (OR 2.432,95％ CI 2.423-3.421; P =0.041) and balloon expansion (OR 3.631,95％ CI 1.764-4.738; P=0.003) were the independent risk factors for occurring CSR during CAS.Conclusions CSR is a common perforrance during CAS.Advanced age,distance from stenosis to bifurcation ≤ 10 mm and balloon expansion are the independent risk factors for occurring CSR.

Hyperparathyroidism is an important complication of thyroid surgery.Identification is the premise of intraoperative pretection.At present,identification of the parathyroid gland relies on personal experience of surgeons.Amplifying display of endoscope or surgical magnifying glass,the use of dyeing agent such as methylene blue,nanocarbon,5-ALA or BB5-G1,the use of radionuclide imaging and contact endoscope,and biopsy like intraoperative frozen pathological examination and FNA are all important trials.This article is going to make a review of the methods.

Objective To investigate the incidence and risk factors of acute kidney injury (AKI)in hepatitis B virus (HBV)related acute-on-chronic liver failure (ACLF)patients,and to explore the impact of AKI on the prognosis of ACLF.Methods The medical records of 227 patients who were diagnosed with HBV-related ACLF at the Department of Infectious Diseases in the First Affiliated Hospital of Nanchang University from January 2015 to August 2016 were retrospectively reviewed.Patients were divided into AKI group and non-AKI group based on the AKI criteria published by International Club of Ascites in 2015 .Demographic and clinical data were compared between groups.The AKI incidence and its impact on patients’prognosis were analyzed.The comparison of continuous variables was done by t test or rank-sum test.The comparison of categorical variables was done byχ2 test or Fisher exact test.AKI risk factors were analyzed by using logistic regression.Results There were 66 (29.1 %)cases were diagnosed with AKI among 227 ACLF patients,among which,45 patients (68.2%)were stage Ⅰ,14 (21 .2%) were stage Ⅱ and 7 (10.6%)were stage Ⅲ.Age,cirrhosis,concentrations of total bilirubin and albumin,international normalized ratio (INR),percentage of neutrophils,MELD scores and spontaneous peritonitis rate (SBP)were all statistically different between AKI group and non-AKI group (all P <0.05).The binary logistic regression analysis revealed that only INR (OR=3.132,P =0.001 )and SBP (OR=4.204,P =0.001 )were the independent risk factors of AKI.The optimal cut-off value for INR was 2.025 with AUROC of 0.609 (P =0.01),sensitivity of 59.1 % and specificity of 62.1 %.The 30-day mortality of AKI group was significantly higher than non-AKI group (χ2= 18.324,P < 0.01). Conclusions AKI is relatively common in patients with ACLF.The risk factors of AKI are INR and SBP. AKI has significant impact on the short-term survival rate of ACLF.Therefore,physicians should pay attention to patients with INR of ACLF at admissions and SBP during the management so as to prevent the occurrence of AKI and to reduce the fatality of ACLF.

Objective To explore the relationship between Graves disease and hypokalemic periodic paralysis or thymus hyperplasia.Methods Sixty-two patients with Graves disease were enrolled in this study.Thirty-three patients without thymus hyperplasia were selected as group A and other 29 patients were group B.In addition,30 healthy volunteers served as control group.Results There were no significant difference between group A and group B in terms of sex,age,illness course,thyroid enlargement,exophthalmos,periodic paralysis and the levels of free triiodothyronine (FT3),free thyroxin (FT4),thyroid stimulating hormone (TSH) (P ＞ 0.05).The incidence rate of hypokalemic periodic paralysis in male Graves disease with thymus hyperplasia was 62％ (8/13),higher than that in female patients (6％ (1/16),x2 =10.24,P ＜ 0.05).The incidence rate of hypokalemic periodic paralysis in male Graves patients was 62％ (16/26),higher than in female Graves patients (6％ (2/36),x2 =22.96,P ＜ 0.05).There was no significant relationship between Graves disease patients combined with thymus hyperplasia and sex,age,illness course,thyroid enlargement,exophthalmos,periodic paralysis and the levels of FY3,FT4,TSH.Conclusion The incidence rate of hypokalemic periodic paralysis in male Graves disease patients combind with thymus hyperplasia is higher than in female,and therefore it should pay more attention of male Graves patients in case misdiagnosis.

In order to probe the biological function of O-GlcNAc and the pathogenesis of associated diseases, it is essential to prepare a potent and specific O-GlcNAcase (OGA) antibody. Based on protein sequence analysis, we found N terminal 1-350 amino acids of OGA (sOGA) has high antigenicity and hydrophilicity and then constructed it into plasmid pET28a vector. First, we optimized the expression of sOGA in Escherichia coli BL21(DE3) (0.05 mmol/L IPTG, 10 hours) and purified it with the Ni-NTA affinity chromatography and size exclusion chromatography respectively. SDS-PAGE verified the molecular weight (45 kDa) and the purity (>95%) of sOGA and the purified protein was subjected to immunize New Zealand rabbits. Finally, we obtained OGA polyclonal antibody by affinity purifying the antiserum with CNBr-activated Sepharose 4B beads. Western blotting and ELISA assay showed that this antibody could recognize three OGA isoforms with high specificity and the sensitivity was 0.11 ng/mL (the titer was 1:80 000). These results indicated the prepared polyclonal antibody of OGA can be used for the biological function study of OGA.
Animals ; Antibodies ; metabolism ; Antigen Presentation ; immunology ; Escherichia coli ; genetics ; metabolism ; Genetic Vectors ; genetics ; Humans ; Immunization ; Rabbits ; Recombinant Proteins ; biosynthesis ; genetics ; beta-N-Acetylhexosaminidases ; biosynthesis ; genetics ; immunology

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.