Aged ; Aged, 80 and over ; Contraindications ; Humans ; Pacemaker, Artificial

Acupuncture Therapy ; Aged ; Female ; Humans ; Neurocirculatory Asthenia ; therapy

Objective To investigate the risk factors related to persistent unconsciousness in patients with severe traumatic brain injury (sTBI) by way of building a prognosis model.Methods The clinical data of 165 sTBI patients admitted from July 2011 to November 2013 were retrospectively analyzed.The eligible patients were randomly assigned to derivation cohort (n =115) and verification cohort (n =50) by treatment order.Inclusion criteria:(1) age ＞ 15 years; (2) definitive history of head injury; (3) traumatic brain injury confirmed by head computerized tomography or brain MRI; (4) initial Glasgow coma score (GCS) was less than 8; (5) patient's light come or consciousness impairment gradually deteriorating to profound coma on the day of admission.The exclusion criteria were as follows:(1) only a brief loss of consciousness or coma after trauma (coma time ＜ 6 hours) ; (2) post-injury hysteria or dementia causes appearance like coma ; (3) unconsciousness results of status epilepticus which was induced by emotion after injury.Univariate and muhivariable logistic regression were employed to determine the independent predictors of persistent unconsciousness in the derivation cohort,and then prognosis model was established.The Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve were used to assess the capacity of model for discrimination and calibration.Results Logistic regression analysis was used to identify GCS score,neurological complications,diffuse axonal injury (DAI),electrolytes disturbance as the most important predictors of persistent unconsciousness.The model was well calibrated in the derivation cohort (Hosmer-Lemeshow test,x2 =4.380,P =0.496).The model showed good discrimination (area under the receiver operating characteristic curve) in the derivation cohort (0.87; 95％ CI:0.798-0.942) and in the versification cohort (0.90; 95％ CI:0.803-0.997).Conclusions The prognosis model could accurately predict the persistent unconsciousness lasting in sTBI patients despite its certain limitations,and therefore,it has significantly clinical and societal value.

Objective To study the clinical significance of chromosome karyotyping in pregnant women with a history of abnormal pregnancy. Methods The fetal chromosome karyotypes of 1 193 pregnant women with a history of abnormal pregnancy in Peking University First Hospital from January 4, 2005 to December 31, 2013 were analyzed. According to the etiology of their previous abnormal pregnancy, these women were divided into four groups: 273 women had children with inherited metabolic disorders or single-gene genetic diseases (group A), 81 women had children or fetuses with chromosome abnormalities (group B), eight cases had an abnormal chromosomal karyotype in either husband or wife (group C), and 833 women had abnormal pregnancy of unknown causes(group D). Results Forty-eight [4.0%(48/1 193)] and fetuses were found to have abnormal chromosomal karyotypes, including 26 cases of chromosome polymorphism variations and 22 cases of numerical and structural abnormalities (four cases of trisomy 21, four cases of numerical sex chromosome abnormalities, three cases of trisomy 18, three cases of extra small chromosome mosaicism, three cases of reciprocal translocation, one case of Robertsonian translocation, one case of chromosome six inversion between the arms, one case of chromosome three inversion between the arms, one case of mosaicism of trisomy 14 and one case of structural abnormality of chromosome 14). In group A, four cases (1.5%) of chromosomal abnormalities of clinical significance and four cases of chromosome polymorphism variations were detected. Meanwhile, 61 fetuses with inherited metabolic disorders or single-gene genetic diseases and two cases of gene mutation carriers were detected in group A, but among whom, there were no abnormal chromosome karyotype cases. In group B, two cases (2.5%) of chromosomal abnormalities were found. In group C, two cases (2/8) of reciprocal translocation were found, whose karyotypes were the same as the parents. In group D, three cases of trisomy 21, three cases of trisomy 18, two cases of extra small chromosome mosaicism and two cases of numerical sex chromosome abnormalities were found. All the mothers in this group were of advanced age. Four cases of structural abnormalities and 22 cases of chromosome polymorphism variations were also found in this group, chromosomal analysis was subsequently performed in those couples, and found that the abnormal chromosomal karyotypes in the fetuses were the same as those in the parents. Conclusions Appropriate prenatal cell genetic diagnostic methods should be chosen according to the causes of abnormal pregnancy history.

Objective To compare the three different methods of enzyme linked immunosorbent assay(ELISA),to select the best method for clinical diagnosis and treatment.Methods Addcare ELISA800,TECAN freedom evolyzer and manual ELISA method were used to detect hepatitis B virus Pre S1 antigen(preS1Ag) hepatitis B virus Pre S2 antigen(preS2Ag) in confrontation control product samples and serum specimens from patients with HBV,and the results were analyzed by statistical methods.Results The batch precisions of the three methods to detect pre-S1Ag were 4.73%,5.38%,11.87%,the batch precisions of the three methods to detect pre-S2Ag were 4.91%,5.04%,11.75%.The inter batch precisions of the three methods to detect pre-S1Ag were 6.63%,7.90%,13.26%,the inter batch precisions of the three methods to detect pre-S2Ag were 6.74%,7.81%,12.59%.All the sensitivities were 100.00%.Conclusion All the three methods have good consistency,which could be used in the detection of Pre-S1Ag and Pre-S2Ag.The precision of Addcare ELISA800 is the best,which could further improve the quality of clinical testing.

Objective To investigate the effects of simvastatin on membrane ionic currents in left ventricular myocytes after acutemyocardial infarction(AML.so as to explore the ionic mechanism of statin treatment for antiarrhythmia.Methods Fourty-five NewZeland rabbits were randomly divided into three groups:AMI group,simvastatin intervention group(statin group)and sham-operatedcontrol group (CON).Rabbits were infarcted by ligation of the left anterior descending coronary artery after administration of oralisolated enzymatically from the epicardial zone of the infractcd region.Whole cell patch clamp technique was used to record mmbranewas significantly decreased in AMI group(-23.26+5.1 8)compared with CON(-42.78±5.48,P＜0.05),while it was significantlyincreased in Stating roup(-39.23±5.45)compared with AMI group(P＜0.01);The peak Ica-L current density(at 0 mV) was significantlydecreased in AMI group(-3.23±0.91)compared with CON(-4.56±1.01,P＜0.05),while it was significantly increased in Statin group(-4.18±0.95)compared with AMI group(P＜0.05);The Ito current density(at+60 mV)was significantly decreased in AMI group(10.41±1.93)compared with CON(17.41±3.13,P＜0.01),while it was significantly increased in Statin group(16.21±2.42)compared withattenuate this change without lowering the serum cholesterol level,suggesting that simvastatin reverse this electrical remodeling thuscontributing to the ionic mechanism of statin treatment for antiarrhythmia.

Objective To assess the efficacy and safety of tacrolimus (TAC) combined with methotrexate (MTX) for the treatment of refractory rheumatoid arthritis (RA),and to compare it with cyclophosphamide (CTX) added to MTX for the treatment of refractory RA.Methods Thirty-six cases of refractory RA patients were divided into the observation group and the control group.TAC+MTX were used in the observation group,and CTX+MTX were used in the control group.We used repeated measures to analyze the variance and Fisher exact probability method to analyze the efficacy at 8 weeks and 24 weeks.Results The effective rate of the observation group in 8 weeks,24 weeks were 77.8％(14 cases) and 100％(18 cases) respectively,while those of the control group were 11.1％ (2 cases) and 44.4％(8 cases),it showed that both TAC+MTX and CTX+MTX in the treatment of refractory RA were effective,but the efficacy of TAC+MTX was better than CTX+MTX,the difference of C reactive protein (CRP) and disease activity score (DAS)28 was statistically significant (P＜0.05),and it could significantly improve the clinical symptoms and laboratory indexes.Conclusion TAC+MTX is effective and safe in treating refractory RA,and is worth of spreading.

Objective To investigate the protective effect of basic fibroblast growth factor(bFGF) gene modified mesenchymal stem cells(MSCs-bFGF)on cerebral isehemia in rats.Methods MSCs or MSCs-bFGF were transplanted into rat models of focal cerebral ischemia by intravenous injection.The neurological deficits and infarction volumes were evaluated,and the survival rate and differentiation of grafted MSCs were observed by double immunofiuoreseent labeling.Results In the rat cerebral ischemic model, both MSCs and MSCs-bFGF showed protective effect on the rats in comparison with control group.However, the protective effect was more significant in MSCs-bFGF group.Double immunofluorescent staining showed the number of BrdU-labeled and NeuN co-expression cells in MSCs-bFGF treated animals(127.40?7.43 and 11.20?3.09)were much more than in those of MSCs treated animals.While there was no significant difference between MSCs-bFGF and MSCs group in the number of GFAP co-expression cells.Conclusion MSCs transplantation has protective effect on cerebral ischemia in rats.Basic fibroblast growth factor gene modified MSCs is more effective than MSCs in neuroproteetion.

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) on the the detection of hepatic metastases in comparison with conventional ultrasonography (US) and contrastenhanced computed tomography (CECT).MethodsNinety-seven patients with hepatic metastases underwent US,CEUS and CECT images.Their detection of hepatic metastases were compared.Results Hepatic metastases showed five enhancement patterns with CEUS,including bolus hyper-enhancement,peripheralrimenhancement,inhomogeneousenhancementwithnecrosis,hypo-enhancement,isoenhancement with liver parenchyma,all hepatic metastases showed dark defects in portal and delayed phase.The mean number of metastases at CEUS was greater than that of US (2.6±1.9 vs 1.6 ±1.2,P＜0.05).The detection of hepatic metastases was 53.4％ and 87.1％ respectively(P＜0.05).CEUS and CECT have no statistically significant difference in the detection of hepatic metastases (P＞0.05).ConclusionsCEUS can improve detection of hepatic metastases.

Acupuncture Therapy ; Aged ; Atrial Fibrillation ; physiopathology ; therapy ; Humans ; Male