Objective To investigate the association between syncope and transient suppression of sinoatrial node in patients with preexcitation syndrome and paroxysmal supraventricular tachycardia (PSVT).Methods Twelve patients (male 8,female 4;age range:19-49 years) were enrolled due to WPW(Wolff-Parkinson-White) syndrome and syncope when the tachycardia terminated.The function of sinoatrial node was evaluated with clinical electrophysiologic study,and then radiofrequency catheter ablation (RFCA) or antitachycardia pacemaker were optimized for the patients with a follow-up of 2 to 5 years.Results Electrocardiographic features of the 12 patients were: ventricular preexcitation (type A in 7 and type B in 5) and long pause when tachycardias ended up.Electrophysiologic study revealed the function of sinoatrial node was normal.Four patients received antitachycardia pacing therapy,5 underwent RFCA,and 3 received both.The 2 to 5 years follow-up found no relapse of PSVT associated syncope.Conclusion Transient suppression of sinoatrial node might explain the mechanism of syncope with preexcitation and PSVT.However,the reason why such a small group of patients differ from the majority of preexcited cases in clinical course remains to be unsettled.The first choice of prevention and treatment for these patients should be eliminating PSVT.Conventional pacemaker implantation for preventing syncope seems to be unnecessary.

Objective To explore the relationship of a polymorphism c.757T ＞ C in C-reactive protein gene (CRP) and carotid artery atherosclerosis in patients with ischemic cerebrovascular disease (ICVD).Methods A case-control study investigated 276 ICVD patients and 125 controls matched for age and sex.Genotypes of-757T/C in CRP were analyzed in patients with ICVD using polymerase chain reaction-restriction fragment length polymorphism.The level of serum C-reactive protein was detected by using immune scatter turbidimetry and the intima-media thickness of common carotid artery and internal carotid artery were measured by color Doppler ultrasonography.The relationship between the polymorphism -757T/C in CRP and carotid atherosclerosis was assessed.Results The genotypes of the polymorphism -757T/Cin CRP in the ICVD group (207/276(75.0％),65/276(23.6％),4/276(1.4％)) was significantly different from the control group (75/125 (60.0％),46/125 (36.8％),4/125 (3.2％) ; x2 =9.531,P =0.008),the frequence of T allele in patients with ICVD (479/552(86.8％)) was increased significantly compared to the control group (196/250 (78.4％)),the frequence of C allele in the ICVD group (73/552(13.2％)) was decreased significantly in contrast to the control group (54/250 (21.6％) ;x2 =9.056,P =0.004).Among the patients with ICVD,the level of serum C-reactive protein in patients with-757TC/CC genotype was elevated significantly than that with-757TC/CC ((4.2± 1.6) mg/L vs (2.7 ± 1.9) mg/L; t =5.900,P ＜ 0.01).Logistic regression analysis demonstrated that the-757C allele in CRP was related to the carotid artery atherosclerosis (OR =1.379,95％ CI 0.852-0.864,P =0.023).Conclusions The polymorphism-757T/C in CRP maybe related to the risk of developing ICVD.The frequency of the-757C allele can increase the level of serum C-reactive protein.And this polymorphism may be associated with carotid artery atheroselerosis in patients with ICVD.

Objective To explore the application of ABCD3 score on stratifying the antithrombotic treatment strategy in patients with capsular warning syndrome (CWS).Methods The clinical features of 15 patients with CWS were analyzed retrospectively,and the risk of stroke were evaluated by ABCD3 score and to guide the treatment of Stratifying antithrombotic therapy.The status of patients hospitalized,discharged and discharged after 90 d were evaluated.Results The frequency of patients with CWS accounted for 2.51％ (15/ 597) of all patients with transient ischemic attack(TIA),and the mean age in patients with CWS was (70.27 ±8.29) years old.The duration of the first onset was (10-30) min,the mean time was (17.33±1.53) min,and ABCD2 score was 5.0-9.0 points,mean score was 7.00±0.26 points,and the total episodes of CWS were 51 times during 24 hours,the mean duration was (18.13 ± 15.36) minutes ((3.0-60.0) min).All 15 cases presented with limb hemiparesis.Of them,9 cases had dysarthria,5 case with ipsilateral facial palsy.All 15 cases CWS patients showed no signs of cortical deficit.The mean NIHSS score at onset was 1.0-6.0 points,mean scores was 3.20±0.31 points.Fourtheen patients were treated with clopidogrel plus aspirin,and 2 cases with administration of the loading dose 300 mg of clopidogrel,1 case was treated with clopidogrel plus aspirin orally followed by intravenous rt-PA thrombolysis.The average hospital periods of all 15 patients was (7.67±0.29) days.The NIHSS score were 0 point at discharge.There was no symptomatic intracranial hemorrhage or death within 90 days follow-up periods.Conclusion CWS is prone to develop a completed stroke.Stratified antithrombotic therapy guiding by ABCD3 score may decrease the risk of ischemic stroke.

OBJECTIVETo investigate the effect of the fibronectin extra domain A on the aggressiveness of salivary adenoid cystic carcinoma (SACC) cells, via the clustered regularly interspaced short palindromic repeats (CRISPR)/ associated proteins (Cas) system.

METHODSOne sgRNA was designed to target the upstream of the genome sequences of extra domain A(EDA) exon and the downstream. Then the sgRNA was linked into plasmid PX-330 and transfected into SACC-83 cells. PCR and DNA sequence were used to testify the knockout cells, and the monoclones of EDA absent SACC cells were selected (A+C-2, A+C-6, B+C-10). CCK-8 cell proliferation and invasion was then tested in control group and the experimental group.

RESULTSThe sgRNA was successfully linked into PX-330 plasmid. Part of adenoid cystic carcinoma cells' SACC-83 genomic EDA exon was knocked out, and the knockdown efficiency was above 70%, but the total amount of fibronectin did not change significantly. Three monoclones of EDA absent SACC- 83 cells were successfully selected with diminished migration and proliferation.

CONCLUSIONSThe CRISPR/Cas9 system was a simplified system with relatively high knockout efficiency and EDA knockout could inhibiting SACC cell's mobility and invasiveness.

Base Sequence ; Carcinoma, Adenoid Cystic ; genetics ; pathology ; Cell Movement ; genetics ; Clustered Regularly Interspaced Short Palindromic Repeats ; genetics ; Exons ; Fibronectins ; chemistry ; genetics ; Gene Knockout Techniques ; Humans ; Neoplasm Invasiveness ; Plasmids ; genetics ; RNA ; Transfection

Objective:To investigate the correlation between triglyceride-glucose (TyG) index on admission and unfavorable outcomes of patients with moderate-to-severe traumatic brain injury (msTBI) at 6 months postinjury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 277 patients with msTBI admitted to Affiliated Jiangyin Hospital of Nantong University from January 2019 to December 2022, including 208 males and 69 females, aged 18-88 years [(57.0±15.1)years]. Glasgow Coma Scale (GCS) scores on admission were 3-8 points in 168 patients and 9-12 points in 109. According to the Glasgow Outcome Scale-Extended (GOSE) assessment at 6 months after injury, there were 121 patients with unfavorable outcomes (GOSE≤4 points) and 156 with favorable outcomes (GOSE≥5 points). The following indicators of the patients were recorded, including gender, age, history of diabetes, cause of injury, admission GCS, GCS motor score (GCSM), pupillary light reflex, worst Marshall CT classification within the first 24 hours after admission, admission TyG index, Mean Amplitude of Glycemic Excursions (MAGE) within 24 hours after admission, GCSM decline≥2 points within 72 hours after admission, craniotomy or not after admission, and prognosis, etc. TyG index served as the exposure variable focused in this study, which was calculated with fasting triglycerides and fasting blood glucose within 24 hours after admission. The 6-month prognosis of the patients was designated as the outcome variable of the study. After the patients were divided into different groups according to the three quantiles of the TyG index and unfavorable or favorable outcomes, the univariate analysis was conducted on watch variables, and variables with statistically significant differences were included in directed acyclic graphs (DAGs) for further identification of confounding variables. Factors which were found with no statistical significance in the univariate analysis but might affect insulin resistance after injury according to the authors′ previous researches were also included in the DAGs analysis. Three Logistic regression models were designed (Model 1 without correction, Model 2 with core variables of International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) corrected, and Model 3 with confounding variables screened by DAGs corrected) to analyze whether the TyG index was an independent risk factor for the prognosis of msTBI patients. The optimal Logistic regression model was selected and then restricted cubic spline (RCS) was employed to investigate the relationship between the TyG index and the unfavorable outcomes.Results:The univariate analysis suggested that there were significant differences in gender, history of diabetes, MAGE, GCSM decline, and prognosis among the three quantiles of the TyG index ( P<0.05 or 0.01). Significant differences in age, history of diabetes, GCSM, pupillary light reflex, Marshall CT classification, TyG index, MAGE and GCSM decline were observed between unfavorable and favorable outcome groups ( P<0.05 or 0.01). The results of Logistic regression analysis that identified the confounding variables that influenced the correlation between the TyG index and unfavorable prognosis with DAGs suggested that a high TyG index level was significantly correlated with unfavorable outcomes in msTBI patients. Moreover, Model 3 that was corrected with confounding variables screened by DAGs had an optimal goodness-of-fit and adaptability. Model 3-based further RCS analysis indicated that the risk of unfavorable outcomes following msTBI may increase approximately linearly with the increase in TyG index within a certain range (TyG index<9.79). Conclusions:A high TyG index level on admission is the identified as an independent risk factor for unfavorable outcomes of patients with msTBI at 6 months postinjury. As the TyG index level increases, the risk of unfavorable outcomes also rises and may show a linear increasing trend within a certain range (TyG index<9.79).