BACKGROUND: Renal tubulointerstitial fibrosis is mainly featured as the accumulation of extracellular matrix (ECM) in renal interstitium. The tubular epithelial-myofibroblast transdifferentiation (TEMT) is important to the pathogenesy of renal tubulointerstitial fibrosis. OBJECTIVE: To examine the effects of sodium ferulate (SF) on TEMT, and ECM main components such as collagen Ⅰ, collagen Ⅲ and fibronectin, in rat renal tubular epithelial cellsinduced by transforming growth factor-beta 1 (TGF- β1)- DESIGN: Randomized and controlled experimental study based on cells. SETTING: Department of Kidney in West China Hospital of Sichuan University. MATERIALS: Rat renal tubular epithelial cells (NRK-52E) originated from American Type Culture Collection (ATCC), were offered by the laboratory of Department of Nephrology in Australian Monash Medical Center. Cell strain used in this study was cultured at the 36th passage. SF white crystal with water solubility and more than 98.0% purify, was from Chengdu Hengda Pharmaceutical Co., Ltd. Different concentrations of SF (125,250, 500μreel/L) were designed in this study. Rabbit anti-rat α-smooth muscle actin (α -SMA) was produced by Wuhan Boster Company. Enzyme-linked immunosorbent assay (ELISA) kit was the produced of Shanghai Senxiong Science and Technology Co.,Ltd. Human recombinant TGF- β1 was produced by R&D Company. DNA Engine OpticonTM real-time fluorescence quantitative polymerase chain reaction apparatus was the product of MJ Research Company. METHODS: Rat renal tubular epithelial cells (NRK-52E) cultured in vitro were divided into five groups. Control group was added with serum-contained DMEM; TGF-β1-induced group was added with TGF-β1 at final concentration of 5 ng/L; SF at different concentrations groups were added with 125, 250, 500 μ mol/L SF and TGF- β1 at final concentration of 5 ng/L,respectively. MAIN OUTCOME MEASURES: The contrast phase microscope, real-time fluorescence quantitative polymerase chain reaction and ELISA method were used to detect TEMT of NRK52E cells induced by TGF-β1 and levels of collagen Ⅰ, collagen Ⅲ and fibronectin in the supernatant. RESULTS: Morphology of NRK52E cells: Compared with control group, TGF-β1 could induce the transdifferentiation of NRK52E cells, showing fibroblast-like in morphology after 3 days, which were previously the typical road stone-like epithelial cells. In three different concentration SF groups, the morphologic transformation stimulated by TGF-β1 could be partly ameliorated in a dose-dependent manner. Expression of α-SMA mRNA: Compared with control group, 5 ng/L TGF- β1 enhanced expression of α-SMA at 6 hours, and reached a peak at 72 hours; SF depressed the expression in a dose-dependent manner at 72 hours (P < 0.05). Changes of ECM: After induced by 5 ng/L TGF- β1 for 72 hours, the levels of collagen Ⅰ, collagen Ⅲ and fibronectin in the supernatant increased significantly (P < 0.05), whereas SF decreased these levels in a dose-dependent manner (P < 0.05). CONCLUSION: TGF- β1 induces the TEMT, and promotes the secretion of collagen Ⅰ, collagen Ⅲ and fibronectin. SF can inhibit TGF- β1-induced TEMT In a dose-dependent manner.

Objective: To compare the consistency and accuracy of using 2 criteria for decision making of aspirin use for the primary prevention of ischemic cardiovascular disease (ISCVD) and explore the current status and related factors of aspirin use for the primary prevention of ISCVD in Chinese outpatients. Methods: This cross-sectional study enrolled 3 018 outpatients with hypertension, diabetes, or hypercholesterolemia, who visited the General Practice (GP) clinics of Anzhen hospital in Beijing from September to December 2015 were enrolled in. The information of risk factors for ISCVD and use of aspirin was collected. Both quantitative and qualitative criteria were used to make the decision of aspirin use for primary prevention of ISCVD in this patient cohort. Quantitative criteria were derived from the 2011 Chinese guideline of cardiovascular disease prevention: aspirin use for primary cardiovascular disease prevention in population with risk of ISCVD in the next 10 years≥10%. Qualitative criteria were derived from the Chinese expert consensus on the aspirin use issued in 2013: aspirin should be given for the purpose of primary ISCVD in population with≥3 risk factors:(1) men aged ≥50 years or postmenopausal women; (2) hypertensive subjects with blood pressure ≤150/90 mmHg(1 mmHg=0.133 kPa);(3) diabetes; (4) hypocholesteremia; (5) obesity with body mass index (BMI)≥28 kg/m²; (6) Smokers;(7) with familiar premature ISCVD history (male<55 years, female<65 years). Demographic data of participants were obtained by questionnaire, on-site measurements or screening previous medical records. Results: 67.1% participants (n=2 024) should be recommended to take aspirin as primary prevention medication using 10-year risk of ISCVD≥10% as the criteria, and 77.9% participants (n=2 350) should be recommended to take aspirin as primary prevention medication using number of risk factors≥3 as the criteria. With 10-year risk of ISCVD≥10% as the gold standard and risk factors≥3 as the evaluation criteria, the sensitivity was 97%, specificity was 61%, the consistency rate was 85%, Kappa value was 0.628 (U=35.824, P<0.001) , indicating that the consistency of the 2 criteria was good. The percentage of real-world aspirin use for primary prevention of ISCVD in this cohort was significantly higher for participants evaluated with the 10-year risk of ISCVD≥10% than that evaluated with 3 risk factors (53.1% vs. 49.2%, χ²=6.523, P=0.011). 12.7% participants with 10-year risk of ISCVD<10% and 6.6% participants with<3 risk factors took aspirin for the primary prevention of ISCVD in this cohort. Age, smoking, hypertension, diabetes and hypercholesterolemia were significantly related to the aspirin use in this cohort, relative ORs were 1.047 (95%CI 1.035-1.060) , 1.969 (95%CI 1.403-2.762) , 2.065 (95%CI 1.623-3.629) , 3.493 (95%CI 2.726-4.475, and 1.344 (95%CI 1.109-1.628) , respectively. Obesity and familial history of premature ISCVD were not related to the aspirin use, relative ORs were 1.137 (95%CI 0.828-1.562) and 0.986 (95%CI 0.767-1.266) . Conclusions The consistency of the 2 criteria for decision making of aspirin use for the primary prevention of ISCVD is good and about 50% participants who should be recommended to the use of aspirin for the primary prevention of ISCVD took the aspirin in the real-world scenario. The use of aspirin as primary prevention strategy for ISCVD in the real-world scenario is related to age, smoking, hypertension, diabetes and hypercholesterolemia.

Objective:To evaluate the effects of pulmonary embolism response team (PERT) on the quality of care and clinical outcomes in patients with acute pulmonary embolism.Methods:This was a single-center retrospective cohort study. Patients with acute pulmonary embolism treated in Beijing Anzhen Hospital Affiliated to Capital Medical University from July 5, 2016 to July 4, 2018 were enrolled. Patients with acute pulmonary embolism who had traditional care from July 5, 2016 to July 4, 2017 (before the implementation of PERT) were classified as PERT pre-intervention group. Patients with acute pulmonary embolism who started PERT care from July 5, 2017 to July 4, 2018 were divided into the PERT intervention group. The diagnosis and treatment information of patients was collected through the electronic medical record system, and the quality of care (time from visit to hospitalization, time from hospitalization to anticoagulation initiation, time from visit to definitive diagnosis, total hospital stay, time in intensive care unit (ICU), hospitalization cost) and clinical outcomes (in-hospital mortality and incidence of bleeding) were compared between the two groups.Results:A total of 210 patients with acute pulmonary embolism, aged (63.3±13.7) years old, with 102 (48.6%) female patients were included. There were 108 cases in PERT pre-intervention group and 102 cases in PERT intervention group. (1) Quality of diagnosis and treatment: there was a statistical significance between the two groups in the distribution of time from diagnosis to definitive diagnosis ( P=0.002). Among them, the rate of completion of diagnosis within 24 hours after PERT intervention was higher than that before PERT intervention (80.4% (45/56) vs. 50.0% (34/68), P<0.001). The time from treatment to hospitalization was shorter than that before PERT intervention (180.0 (60.0, 645.0) min vs. 900.0 (298.0, 1 806.5) min, P<0.001). The total length of hospital stay was less than that before PERT intervention (12 (10, 14) d vs. 14 (11, 16) d, P=0.001). There was no statistical significance in the time from hospitalization to anticoagulant therapy, the length of ICU stay and hospitalization cost between the two groups (all P>0.05). (2) Clinical outcomes during hospitalization: There was no statistical significance in the incidence of hemorrhage and mortality between the two groups during hospitalization (both P>0.05). Conclusion:PERT has improved the efficiency of diagnosis and treatment of patients with acute pulmonary embolism and significantly shortened the total hospital stay, but its impact on clinical outcomes still needs further study.

Objective To survey the utilization of basic public health service among hypertensive and diabetic patients in communities.Methods A survey on the utilization of basic public health service was conducted between October 2014 and November 2014,1 511 patients with hypertension and 1 508 patients with type 2 diabetes aged ≥35 years were randomly selected for the survey from 18 communities in 2 cities and 4 townships of Shandong and Jiangsu provinces in China.Results The survey showed that 87.0％ (1 314/1 511) of hypertensive patients and 88.5％ (1 334/1 508) of diabetic patients visited community hcalth services within the year,and the blood pressure/blood glucose elevation were found in community health services in 68.5％ (1 035/1 511) of the hypertensive patients and 53.3％ (804/1 508) of the diabetic patients,respectively.The proportion of participants in community health education was higher in rural areas than that in urban areas [hypertension 73.2％ (556/760) vs.60.3％ (453/751),x2 =48.48,P ＜ 0.01;diabetes 77.8％ (591/760) vs.62.6％ (468/748),x2 =43.73,P ＜ 0.01].The proportion of outpatients who were followed up for more than 4 times was higher in rural areas than that in urban areas [hypertension 61.3％ (466/760) vs.48.4％ (363/751),x2 =79.31,P ＜ 0.01;diabetes 58.8％ (447/760) vs.50.5％ (378/748),x2 =17.78,P ＜0.01].The self-test rate of blood pressure and blood glucose in the urban was higher than that in rural areas [hypertension 41.8％ (314/751) vs.17.8％ (135/760),x2=104.59,P＜0.01;diabetes41.7％ (312/748) vs.11.3％ (86/760),x2=179.28,P ＜ 0.01].The proportion of patients with hypertension who did not take medication was higher in rural areas than in that in urban areas [36.7％ (279/760) vs.24.0％ (180/751),x2 =70.88,P ＜ 0.01],and the proportion of patients with diabetes who did not take medication was not statistically significant between rural and urban areas [20.8％ (156/760) vs.19.8％ (148/748),x2 =1.95,P ＞ 0.05].The control rates of hypertension and diabetes were 39.8％ (602/1 511) and 39.6％ (597/ 1 508),respectively.82.5％ (1 247/1 511) hypertensive patients and 75.6％ (1 140/1 508) diabetic patients selected community clinics for treatment and disease management,and satisfaction rate with primary health care in community clinics were 82.1％ (1 077/1 312) and 82.5％ (1 101/1 334) respectively.Conclusions High percentage of community clinic choice and visit was found,and most of the patients got the recommendation about health life style.But difference existed between the practice of self-monitoring of blood pressure and fasting blood glucose and control of blood pressure and blood glucose and plan of chronic disease prevention and control.

Objective:To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.Methods:Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.Results:A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions:There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.

Humans ; Cardiovascular Diseases ; Risk Factors ; Myocardial Infarction/complications* ; Coronary Disease/etiology* ; Heart Disease Risk Factors