Objective To explore the incidence,clinical features,causes,treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery.Methods The retrospective case-control study was conducted.The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected.All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016.Observation indicators:(1) 30-day readmission situations after bariatric and metabolic surgery:cases with readmission,readmission time,clinical features,causes and treatment of readmission;(2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Thirty-day readmission situations after bariatric and metabolic surgery:among 631 patients receiving postoperative 1-months follow-up,21 had 30-day readmission,with an incidence of 3.33％ (21/631),including 13 males and 8 females;10 received LSG and 11 received LRYGB.The median readmission time of 21 patients was 12 days (range,4-30 days).Of 21 patients,nausea,vomiting and dehydration of the main manifestations were detected in 11 patients,gastrointestinal bleeding in 6 patients,high fever in 2 patients,bowel obstruction in 1 patient and abdominal pain in 1 patient.The causes of the readmission of 21 patients:8 had improper food intake including 5 with premature solid food intake,1 with premature semi-fluid food intake,1 with irritating food intake and 1 with swallowing whole tablets;3 had postoperative over-anxiety;1 had Petersen hiatal hernia;1 had anastomotic ulcer;1 had anastomotic edema;1 had abdominal abscess.Of 6 patients with uncertain causes,4 had gastrointestinal bleeding and didn't receive endoscopy;1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy,showing no trouble finding;1 had high fever,and no abnormality was detected by imaging examination.Of 21 patients,19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement,without readmission;1 with abdominal abscess was cured after emergency debridement and drainage;1 with Petersen hiatal hernia was cured by emergency surgery.The median duration of hospital stay in 21 patients with readmission was 7 days (range,3-40 days).(2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery:the results of univariate analysis showed that gender,preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (x2 =5.330,6.498,4.574,P＜0.05).The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489,2.912,95％ confidence interval:1.006-6.161,1.196-7.088,P＜0.05).Conclusions Nausea,vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery,and it might be associated with improper food intake.Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery.

Objective:To analyze influence factors in patients with acute myocardial infarction (AMI) undergoing e‐mergency percutaneous coronary intervention (PCI ) .Methods:Clinical data of 656 patients ,who received emer‐gency PCI because of AMI in our hospital from Jan 2005 to Jan 2015 ,were retrospectively analyzed .Short -term prognosis ,including incidence rates of heart failure (HF) ,cardiogenic shock (CS) ,arrhythmias and mortality , were compared and analyzed among these patients from onset related factors ,coronary disease and vascular reope‐ning time etc .Results:Mean onset age of men was significantly younger than that of women (P<0.05) .Incidence rate of AMI in winter and spring was significantly higher than those in summer and autumn (χ2 = 6.244 , P=0.012) .According to complicated with hypertension ,DM ,dyslipidemia and smoking or not ,patients were divided into corresponding disease group and normal group ;only incidence rates of CS (37.78% vs .29.62% ) and arrhyth‐mia (47.78% vs .38.24% ) in DM group were significantly higher than those of non -DM group ,mortality rate of dyslipidemia group was significantly lower than that of normal blood lipid group (0.73% vs .3.69% ) , P<0.05 or< 0.01 ,there were no significant difference in incidence rates of other events between normal group and disease group (P>0.05 all) .Incidence rate of arrhythmia in RCA group was significantly higher than those of LAD group , LCX group and multi -vessel group (56.36% vs .31.55% ,37.50% ,34.38% ) ,mortality of LM group was signifi‐cantly higher than those of LAD group ,RCA group and LCX group (25.00% vs .1.79% ,0.91% ,0% ) , P<0.05 or <0.01. Incidence rate of HF in 10~12h group was significantly higher than those of 0~3h ,4~6h and 7~9h group (79.46% vs .61.70% ,66.81% ,64.78% ) ,incidence rate of arrhythmia was significantly lower than those of 0~3h ,4~6h and 7~9h group (32.14% vs .55.32% ,43.81% ,44.65% ) ,and incidence rate of CS was significant‐ly higher than that of 0~3h group (35.27% vs .21.28% ) , P<0.05 or <0.01. Conclusion:Onset age ,season and DM ,coronary disease extent ,vascular reopening time are risk factors influencing short‐term prognosis of AMI .

Objective To investigate the expression of CD200 in peripheral lymphocytes and hair follicles from patients with alopecia areata (AA).Methods Flow cytometry was used to detect the expression of CD200 in peripheral lymphocytes from 43 patients with AA and 43 healthy controls.Immunohistochemistry was carried out to quantify the expression of CD200 and cytokeratin 15(CK15,a marker for basal cells of the outer root sheath) in resected scalp specimens from 8 patients with AA and 8 healthy controls.Differences in the expression of CD200 and CK15 between the patients and controls were assessed by independent-samples t test and rank sum test.Data were processed by the software SPSS17.0.Results The percentage of CD200-expressing cells in peripheral blood lymphocytes and T lymphocytes was significantly lower in the patients with AA than in the healthy controls (5.73％ ± 3.46％ vs.12.01％ ± 4.90％,8.85％ ± 4.80％ vs.12.31％ ± 3.12％,t =6.865,3.964,respectively,both P ＜ 0.05).However,no significant difference was observed in the percentage of CD200-expressing cells in peripheral blood B lymphocytes between the patients and controls (74.68％ ± 8.12％ vs.75.75％ ± 9.45％,t =0.570,P ＞ 0.05).Further more,the patients showed a lower expression of CD200 (P ＜ 0.05),but a similar expression of CK15 (P ＞ 0.05) in hair follicles compared with the controls.Conclusion The decrease in CD200 expression in peripheral lymphocytes and hair follicles may be involved in the pathogenesis of AA.

Objective To study the pathogenic prevalence and genotypes of astrovirus among children under 5 years old hospitalized with diarrhea in Tianjin. Methods A total 837 stool specimens were collected from children with diarrhea hospitalized in Tianjin children's hospital from May 2008 to April 2009. Astrovirus antigens were detected using ELISA and the postive specimens were inoculated in CaCo-2cells. After the CPE caused by virus were observed, the total RNA of virus was extracted, then the genomc fragments of the strains were amplified by using RT-PCR and confirmed by sequencing of the RT-PCR products. Detection of rotavirus was employed by Colloidal Gold Device. Results Astrovirus antigen was found positive in 3.0% of the patients. The coinfection rate of astrovirus and rotavirus was 0. 7% (6/837).Ninety-six persent of children with astrovirus diarrhea were younger than 2 years of age, Forty-eight persent of children with astrovirus diarrhea were younger than 6 months. The astrovirus infections occurred mainly between August 2008 and April 2009. Of the 21 astrovirus positive specimens, 11 cases were successfully identified by RT-PCR and they were all serotype 1. Conclusion Astrovirus is a major cause of nonbacterical diarrhea between 2008 and 2009 in Tianjin, and the predominant serotype is type 1.

Objective HupA is one of the potential drugs which can be used to treat Alzheimer's disease(AD).The aim of this study was to explore the pharmacokinetics and biodistribution of HupA in vivo by using 11C-HupA.Methods A total of 25 SD rats were studied.They were divided into 5 groups (5 rats in each group).All had intravenous injection of 22 MBq(in0.2 ml)11C-HupA through tail vein.Dynamic im-aging Was acquired from 5 to 90 minutes after injection.Venous blood and organ activities were collected at 5,15,30,60.and 90 minutes after injection.Percentage activity of injected dose per gram of tissue(%ID/g)was calculated to characterize the biodistribution of tracer in different brain regions: frontal,apical, temporal,occipital,cerebellum,hippocampus,striatum,thalamencephalon, and brain stem, Variance analysis using SPSS 11.5 software was performed and compared among the study groups.Results 11C-HupA was character-istic for its quick clearance from blood,with half time T1/2 of (14.61±1.77) min,and clearance rate (CL)macokinetics of 11C-HupA in rats corresponded to a one-compartment model.with an activity curve(area 11C-HupA distribution in different brain regions,being greater in cerebral cortex,hippocampus,hypothala-mus and brain stem. Conclusions Pharmacokinetic study of 11C-HupA in brain was fast.convenient and showed high specificity and sensitivity.Its ability to quantitatively evaluate brain function and its character-istic distribution in mice provided some evidence for monitoring therapy in AD patients.

OBJECTIVETo systematically evaluate the effect and safety of Xuezhikang Capsule (XZKC) for adjuvant treatment for coronary heart disease (CHD) patients accompanied with or without dyslipidemia.

METHODSChina National Knowledge Infrastructure (CNKI) Database, Chongqing VIP Database (VIP), Wanfang Data base, Cochrane Library, and Medline (PubMed) were retrieved with the deadline of August 30, 2013. Randomized controlled trials (RCT) of XZKC in treating CHD patients with or without dyslipidemia were all included. Assessment of bias risk for included studies was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention (Version 5.0.2): Criteria for judging risk of bias in the "risk of bias" assessment tool. Review Management (5.1.0) was employed for data statistics. If there was no significant heterogeneity, results from the random-effect model were presented. If the heterogeneity was not substantial, a meta-analysis was not performed and a narrative and qualitative summary was performed instead.

RESULTSA total of 28 RCTs (6,949 patients) were included after screening results. The methodological quality of included trial was generally lower. Results of Metaanalysis showed that XZKC was beneficial for CHD patients in decreasing cardiovascular events: when compared with the basic treatment group, the relative risk (RR) was 0.53 and 95% confidence interval (CI) was [0.35, 0.81]; when compared with the placebo + basic treatment group, RR was 0.52 and 95% CI was [0.42, 0.65]; when compared with the basic treatment group, RR for improving symptoms of angina was 1.20 and 95% CI was [1. 12, 1.30]; when compared with the basic treatment group, RR for improving abnormal ECG was 1.38 and 95% CI was [1.21, 1.57]. Thirteen studies showed that XZKC + basic treatment was obviously superior in lowering total cholesterol (TC) to that of the basic treatment group. Three studies showed that XZKC + basic treatment was obviously superior in lowering total cholesterol (TC) to that of the placebo + basic treatment group. Thirteen studies showed that XZKC + basic treatment was obviously superior in lowering low density lipoprotein cholesterol (LDL-C) to that of the basic treatment group. Three studies showed that XZKC + basic treatment was obviously superior in lowering LDL-C to that of the placebo + basic treatment group. A total of 18 studies describing adverse reactions (ADs) involved 61 ADs in the XZKC + basic treatment group. All suffered from mild symptoms or were improved after treatment. No severe ADs occurred.

CONCLUSIONTreatment of CHD by XZKC might lower the occurrence of cardiovascular events in CHD patients accompanied with or without dyslipidemia, relieve clinical symptoms, improve ECG, lower blood lipid levels, and with less adverse reactions.

Angina Pectoris ; Cardiovascular Diseases ; Combined Modality Therapy ; Confidence Intervals ; Coronary Disease ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Randomized Controlled Trials as Topic

Objective To study the clinical presentations of Kennedy disease (KD) and compare the neurophysiological features between KD and amyotrophic lateral sclerosis(ALS). Methods Nine patients with KD, 13 patients with ALS and 26 normal control subjects were recruited. The clinical presentations of KD were analyzed, and the results of nerve conduction studies and electromyography were compared among the 3 groups. Results The rates of tongue atrophy and facial fasciculation were 100% and 88.9%, respectively, in the early course and mid-course of KD, sensory damages might be perceived. 2)The sural nerve sensory nerve action potential (SNAP) was not elicited in 56.3% of the patients with KD, and sural nerve SNAP amplitudes were significantly lower in KD (7.9±3.4μV) than in ALS patients (20.0±5.2μV) and normal control subjects (26.1± 16.8 μV) (P<0.05). Conclusion The onset of clinical presentations mimicking motor neuron disease, appearance of tongue atrophy and facial fasciculation in the early and mid-course, and presence of sensory impairment with a decreased sural nerve SNAP amplitude may suggest the diagnosis of KD and should prompt a genetic test for KD.

Objective To study the clinical presentations of Kennedy disease (KD) and compare the neurophysiological features between KD and amyotrophic lateral sclerosis(ALS). Methods Nine patients with KD, 13 patients with ALS and 26 normal control subjects were recruited. The clinical presentations of KD were analyzed, and the results of nerve conduction studies and electromyography were compared among the 3 groups. Results The rates of tongue atrophy and facial fasciculation were 100% and 88.9%, respectively, in the early course and mid-course of KD, sensory damages might be perceived. 2)The sural nerve sensory nerve action potential (SNAP) was not elicited in 56.3% of the patients with KD, and sural nerve SNAP amplitudes were significantly lower in KD (7.9±3.4μV) than in ALS patients (20.0±5.2μV) and normal control subjects (26.1± 16.8 μV) (P<0.05). Conclusion The onset of clinical presentations mimicking motor neuron disease, appearance of tongue atrophy and facial fasciculation in the early and mid-course, and presence of sensory impairment with a decreased sural nerve SNAP amplitude may suggest the diagnosis of KD and should prompt a genetic test for KD.

OBJECTIVETo observe the effect of Zishen Huoxue Recipe (ZHR) on pathomorphology in coronary heart disease (CHD) rats with Shen deficiency blood stasis syndrome (SDBSS).

METHODSTotally 60 healthy Wistar rats were divided into the blank control group, the model group, high, middle, and low dose ZHR groups according to random digit table, 12 in each group. Myocardial ischemia SDBSS rat model was prepared by ligating the left anterior descending coronary artery and injecting hydrocortisone. ZHR physic liquor was administered to rats in high, middle, and low dose ZHR groups at the daily dose of 21.6, 10.8, 5.4 g/kg by gastrogavage for 7 successive days, equal volume of pure water was administered to rats in the blank control group and the model group by gastrogavage for 7 successive days. Rat heart was collected for pathomorphological observation under light microscope.

RESULTSIn the model group the heart muscle fiber was swollen and deformed with widened space, loose and dropsy tissues. Blood vessels in myocardial mesenchymal were dilated, infiltrated with more inflammatory cells. Myocardial cells were markedly swollen, degenerated, or necrotic, with caryolysis or disappearance of partial nuclear. A large amount of collagen fibrous tissue became hyperplasia. Endocardial blood vessels were swollen and degenerated with infiltration of few inflammatory cells. Epicardium tissue and structure were destroyed and got hyperplasia. Swollen, degenerated, or necrotic vessels could be seen, with infiltration of more inflammatory cells and collagen deposition. Pathomorphological injuries were alleviated in each ZHR group. The higher ZHR concentration, the milder the injury degree of myocardial tissue, the more limited range of damage.

CONCLUSIONZHR could attenuate pathomorphological injuries of myocardial ischemia rats with SDBSS and regulate myocardial function, thus improving myocardial ischemia in CHD rats with SDBSS.

Animals ; Coronary Artery Disease ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Medicine, Chinese Traditional ; Myocardial Ischemia ; Myocardium ; Rats ; Rats, Wistar

Objective To study the effect of dexmedetomidine hydrochloride (Dex) on lipopolysaccharide (LPS) induced inflammatory response in Kupffer cells. Methods Healthy male SD rats were selected for isolation and culture of liver Kupffer cells. The cells were randomly divided into 6 groups: normal group, model group, experimental-L group, experimental-H group, combined group and control group. The normal group was cultured routinely, model group was cultured with 1μg·m L-1 LPS solution 3 h, experimental-L, experimental-H group were cultured respectively with 0. 01 μmol·L-1 or 1 μmol·L-1 Dex 24 h + 1 μg·m L-1 LPS solution 3 h, combined group was cultured with 1μmol·L-1 Dex + 100 μmol·L-1 yohimbine hydrochloride (α2 adrenergicreceptor antagonist) 24 h + 1 μg·m L-1 LPS 3 h, control group was cultured with 100 μmol·L-1 yohimbine hydrochloride 24 h. The survival rate of Kupffer cells was determined by MTT. The contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the supernatant of Kupffer cells were determined by enzyme linked immunosorbent assay. Results After disposal, the survival rates of Kupffer cells in normal group, model group, experimental-L group, experimental-H group, combined group and control group were respectively (100. 00 ± 0. 00) ％, (56. 35 ± 4. 21) ％, (64. 78 ± 4. 37) ％, (83. 84 ± 5. 16) ％, (57. 03 ± 4. 09) ％ and (54. 58 ± 3. 95) ％. The TNF-αin the 6 groups were respectively (1. 19 ± 0. 16) , (57. 36 ± 7. 23) , (48. 27 ± 5. 58) , (7. 64 ± 0. 92) , (56. 98 ± 7. 05) and (58. 03 ± 7. 34) ng ·m L-1; the IL-6 in the 6 groups were respectively (47. 38 ± 6. 05) , (289. 49 ± 27. 83) , (231. 17 ± 22. 58) , (85. 35 ± 8. 23) , (287. 96 ± 26. 45) and (291. 43 ± 28. 04) pg·m L-1. Comparison between model group and normal group, the differences of the factors were significant (all P < 0. 05) ; comparison between two dose experimental groups and model group, the differences of the factors were significant (all P < 0. 05) ; comparison between combined group and control group with two dose experimental groups, the differences of the factors were significant (all P < 0. 05) . Conclusion Dex can reduce the activity of LPS induced Kupffer cells in a dose-dependent manner, inhibit oxidative stress injury and inflammatory response induced by Kupffer cells, which may be related to the agitation ofα2 adrenalic receptor. Yohimbine has antagonistic effect on its therapeutic effect.