Objective To investigate the clinical application of Fibroscan to noninvasive detection of liver fibrosis in asymp‐tomatic carriers(ASCs)with chronic hepatitis B virus(HBV).Methods Clinical data of 195 chronic HBV ASCs were retrospec‐tively analyzed ,including liver function ,HBV DNA quantitation ,liver stiffness(LS) ,color Doppler ultrasound results of the liver and spleen and histopathological findings of the liver.LS was evaluated by transient elastography(Fibroscan).Liver biopsy was performed in 80 carriers for histological examination.Results The LS value was(6.22 ± 2.50)kPa in 195 cases.There was no significant difference in the LS value between HBV DNA <500 copies/mL and HBV DNA≥500 copies/mL groups.The LS value in patients with HBV carrying duration>15 years was significantly higher than that in patients with HBV carrying dura‐tion≤5 years(P<0.01).It was (6.72 ± 2.33) kPa in patients(n=49)with liver tissue inflammation and necrosis

Objective To investigate the effect of PBL combined with EBM applied in the teaching of fever of unknown origin. Methods PBL combined with EBM teaching was applied in fever of unknown origin course for 30 clinical medicine specialty(eight years) students of Tongji class of grade 2009(experiment group), while PBL teaching was applied in fever of unknown origin course for 30 clinical medicine specialty (eight years) students of Tongji class of grade 2008 (control group). After teaching, the theory examination for both basic knowledge and case analysis was organized for all students of both groups. At the same time the questionnaire survey was conducted to 30 students of grade 2009 to evaluate the teaching effect. The results were assessed by using SPSS 18.0 statistical software for the T-test of the experimental group and the control group.Inspection level was α=0.05. Results The theory test score of students in the experimental group was (93.5±3.2) point, signifi-cantly higher than that of the students in the control group(84.7±2.8). There was statistically signifi-cant difference between the scores of the two groups of students (P=0.00). Survey results showed 19 students ( 63 . 33%) thought that the development of PBL teaching combined with evidence-based medicine teaching had its necessity, and 16 students(53.33%) thought that the teaching method im-proved their clinical thinking ability of logical reasoning. Conclusion The concept of PBL combined with EBM has achieved significant resultsinthe teaching offever of unknown origin, and it is necessary to carry out this teaching mode in medical colleges with certain teaching strength.

The noninvasive measurement of liver stiffness (LS) was evaluated by transient elastography (FibroScan) and the possible influencing factors from the patients' clinical situations including age, gender, liver inflammation represented by alanine transaminase (ALT) and total billirubin (TBIL) level, HBV replication (HBV DNA loads), portal vein pressure (portal vessel diameter, PVD), splenic thickness (SPT) and body mass index (BMI) were analyzed in patients with chronic hepatitis B (CHB). A total of 466 patients including 31 patients with acute-on-chronic liver failure (ACLF), and 435 patients with chronic hepatitis B (CHB) among which 82 patients were diagnosed with liver cirrhosis (LC) by clinical manifestations and liver B-type ultrasonic inspection were enrolled at Tongji Hospital from April to December 2009. LS was measured by a FibroScan device (EchoSens, France). Simultaneously, ALT and TBIL levels, HBV DNA loads, PVD, SPT and BMI in all patients were also tested. Forty-one healthy volunteers served as controls. The values of LS were correlated positively with ages of CHB patients and significantly higher in males than in females. In patients with BMI>28 kg/m(2) (obesity) and abnormal levels of ALT and TBIL, LS values were significantly increased as compared with those having normal levels of ALT and TBIL. The patients with ACLF had the highest LS value. Furthermore, LS values in the patients with LC were significantly higher than those in patients without LC. It is concluded that noninvasive measurement of liver fibrosis by FibroScan provides an alternative method to evaluate liver fibrosis of patients with CHB. In order to properly illustrate the stiffness value taken by transient elastography, patients' gender should be taken into consideration and it is also suggested to avoid possible influencing factors including liver inflammation (high levels of ALT and TBIL) and obesity (high BMI).

Objective To assess the accuracy of mixed venous oxygen saturation ( S(-v)O2 ) in reflecting the change in CO during off-pump coronary artery bypass grafting (OPCABG) .Methods Twenty-five NYHA Ⅰ -Ⅲ patients of both sexes, aged 50-75 yr, weighing 55-85 kg, undergoing OPCABG, were studied. Anesthesia was induced with midazolam, fentanyl, etomidate and pipecuronium and maintained with propofol infusion and intermittent iv boluses of fentanyl and pipecuronium supplemented with isoflurane if necessary. The patients were mechanically ventilated (VT 8-10 ml/kg, RR 8-10 bpm, I:E 1:2). PETCO2 was maintained at 35-45 mm Hg.Radial artery was cannulated and pulmonary catheter was placed. CI, S(-v)O2 and Hb were monitored and recorded before skin incision, during anastomosis with left anterior descending artery (LAD), right coronary artery (RCA)and left circumflex coronary artery (LCX), when the chest was closed, when the patients' body position was changed and the heart was manipulated. S(-v)O2 and CI were scaled immediately after the pulmonary artery catheter was placed and before anastomosing LAD. Results The CO change in S(-v)O2 was real-time and accurate in reflecting the body positioning and elevation of hearts. There was no simultaneous significant change in CI.Conclusion The CO change in S(-v)O2 is real-time and accurate in reflecting the body positioning and elevation of hearts during OPCABG.

Stellate ganglion blockade (SGB) protects patients from focal cerebral ischemic injury, and transection of the cervical sympathetic trunk (TCST) in a rat model can mimic SGB in humans. The purpose of this study was to investigate the mechanisms underlying the neuroprotective effects of TCST on neuronal damage in the hippocampus in a rat model of middle cerebral artery occlusion (MCAO) in an attempt to elucidate the neuroprotective effects of SGB. The modified method of Zea Longa was used to establish the permanent MCAO model. Male Wistar rats were randomly divided into three groups: sham-operated group, MCAO group, and TCST group. The animals in TCST group were sacrificed 48 h after TCST which was performed after the establishment of the MCAO model. Proteins were extracted from the ipsilateral hippocampus and analyzed by two-dimensional difference gel electrophoresis (2D-DIGE) and peptide mass fingerprinting (PMF). The levels of N-ethylmaleimide-sensitive factor (NSF) were measured as well. The results showed that 11 types of proteins were identified by 2D-DIGE. The expressions of eight proteins were changed both in the sham-operated and TCST groups, and the expressions of the other three proteins were changed in all three groups. Moreover, the expression of NSF was higher in the TCST group than in the MCAO group but lower in the MCAO group than in sham-operated group. The ratio of NSF expression between the MCAO group and shamoperated group was -1.37 (P<0.05), whereas that between the TCST group and MCAO group was 1.35 (P<0.05). Our results imply that TCST increases the expression of NSF in the hippocampus of adult rats with focal cerebral ischemia, which may contribute to the protection of the injured brain. Our study provides a theoretical basis for the therapeutic application of SGB to patients with permanent cerebral ischemia.
Animals ; Brain Injuries ; genetics ; metabolism ; pathology ; Brain Ischemia ; genetics ; metabolism ; pathology ; Gene Expression Regulation ; Hippocampus ; metabolism ; pathology ; Male ; N-Ethylmaleimide-Sensitive Proteins ; biosynthesis ; genetics ; Rats ; Rats, Wistar ; Stellate Ganglion ; metabolism ; pathology ; Transfection

AIM:To investigate the role of specific binding of precursor form of nerve growth factor(proNGF) to p75NTR(proNGF-p75NTR)in isoflurane-induced cognitive impairment in aging mice.METHODS: Aging C57BL/6J male mice were randomly divided into 3 groups:control group,isoflurane(Iso)group and p75NTR specific inhibitor 2-ami-no-3-methyl-pentanoic acid amide(LM11A-31,LM)+isoflurane(LM+Iso)group.Aging C57BL/6J mice in Iso group and LM+Iso group were exposed to isoflurane,and the mice in control group were exposed to air.The mice in LM+Iso group were treated with LM,which dissolved in normal saline water and was administered daily by oral gavage at 50 mg· kg-1· d-1for 1 month.The mice in control group and Iso group received an equivalent volume of normal saline by the same route.Arterial blood gas analysis was conducted to detect the physiological state of the mice after isoflurane exposure. Morris water maze was performed to evaluate the cognitive function.The protein levels of proNGF,p75NTR,phosphorylated p38 MAPK and cleaved caspase-3 were determined by Western blot.RESULTS: Compared with the control group, the protein expression of proNGF and p75NTR in the hippocampus of Iso group was significantly elevated(P<0.05).The phos-phorylation level of p38 MAPK was higher in Iso group than that in control group(P<0.05),which was reduced in LM +Iso group significantly(P<0.05).A significant increase in the protein level of cleaved caspase-3 was observed in Iso group as compared with control group(P<0.05), while LM11A-31 treatment reversed this elevation significantly(P<0.05).The escape latency prolonged and the number of crossing the original platform location reduced in Iso group com -pared with control group(P<0.05), which were reversed by LM11A-31 in LM+Iso group(P<0.05).CONCLU-SION:ProNGF-p75NTR probably plays an vital role in the apoptotic pathway activation and the cognitive dysfunction in ag -ing mice exposure to isoflurane,which provides a potential target for clinical intervention.

In December 2019, the 2019 novel coronavirus pneumonia (NCP, officially named Coronavirus Disease 2019(COVID-19) by the World Health Organization) broke out in Wuhan, Hubei, and it quickly spread to the whole country and abroad. The situation was at stake. The sudden and serious COVID-19 epidemic has brought us a lot of urgent problems. How to effectively control the spread of COVID-19? When does the population infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to effectively treat with existing drugs? Can it successfully improve the survival rate of critically patients? In response to the above questions, we put forward corresponding suggestions and reflections from the perspective of the infectious clinician.

OBJECTIVE: To determine the effect of Tongxinluo on the endothelial function and hypersensitive C-reactive protein (hs-CRP) in acute coronary syndrome patients undergoing percutaneous coronary intervention(PCI). METHODS: Thirty-three patients with unstable angina pectoris and 6 patients with acute myocardial infarction who underwent PCI for stenotic lesions of the coronary artery were enrolled. The patients were randomly assigned to a conventional group (n = 19) which took routine treatment or a tongxinluo group (n = 20) which took Tongxinluo(4 capsules once, 3 times per day) at the base of routine treatment after PCI. Nitric oxide synthase (NOS), nitric oxide (NO), endothelium-dependent vasodilation which was evaluated in the brachial artery flow mediated diameter(FMD) and hs-CRP were measured before the PCI and 24 hours and 3 months after the PCI. The correlation between NO and hs-CRP was analyzed. RESULTS: NOS, NO, and FMD in the 2 groups 24 hours after the PCI were significantly lower than those before the PCI(P < 0.05), but hs- CRP obviously increased (P < 0.05). NOS, NO, and FMD 3 months after the PCI in the 2 groups were significantly higher than those before the PCI (P < 0.05 or P < 0.01), but hs-CRP obviously decreased (P < 0.01).All indexes mentioned above in the Tongxinluo group showed greater changes than those of the conventional group(P < 0.05). NO was negatively correlated with hs-CRP (r = -0.3219, P<0.01). CONCLUSION Tongxinluo capsules have obvious beneficial effect on endothelial function and anti-inflammation in acute coronary syndrome patients undergoing PCI, by directly acting on the endothelium and indirectly inhibiting inflammation.
Acute Coronary Syndrome ; blood ; physiopathology ; therapy ; Aged ; Angioplasty, Balloon, Coronary ; methods ; C-Reactive Protein ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Endothelium, Vascular ; drug effects ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy

Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P<0.001). There was no signiifcant difference in the amount of pericardiac drainage between the two groups (365±222 ml vs. 506±300 ml, P=0.137). Two patients in group 1 patient (11.1%) and 1 in group 2 (11.1%) needed emergency surgical repair (P>0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.

BACKGROUNDShensong Yangxin (SSYX) is one of the compound recipe of Chinese materia medica. This study was conducted to investigate the effects of SSYX on sodium current (I(Na)), L-type calcium current (I(Ca, L)), transient outward potassium current (I(to)), delayed rectifier current (I(K)), and inward rectifier potassium currents (I(K1)) in isolated ventricular myocytes.

METHODSWhole cell patch-clamp technique was used to study ion channel currents in enzymatically isolated guinea pig or rat ventricular myocytes.

RESULTSSSYX decreased peak I(Na) by (44.84 +/- 7.65)% from 27.21 +/- 5.35 to 14.88 +/- 2.75 pA/pF (n = 5, P < 0.05). The medicine significantly inhibited the I(Ca, L). At concentrations of 0.25, 0.50, and 1.00 g/100 ml, the peak I(Ca, L) was reduced by (19.22 +/- 1.10)%, (44.82 +/- 6.50)% and (50.69 +/- 5.64)%, respectively (n = 5, all P < 0.05). SSYX lifted the I - V curve of both I(Na) and I(Ca, L) without changing the threshold, peak and reversal potentials. At the concentration of 0.5%, the drug blocked the transient component of I(to) by 50.60% at membrane voltage of 60 mV and negatively shifted the inactive curve and delayed the recovery from channel inactivation. The tail current density of I(K) was decreased by (30.77 +/- 1.11)% (n = 5, P < 0.05) at membrane voltage of 50 mV after exposure to the medicine and the time-dependent activity of I(K) was also inhibited. Similar to the effect on I(K), the SSYX inhibited I(K1) by 33.10% at the test potential of -100 mV with little effect on reversal potential and the rectification property.

CONCLUSIONSThe experiments revealed that SSYX could block multiple ion channels such as I(Na) I(Ca, L), I(k), I(to) and I(K1), which may change the action potential duration and contribute to some of its antiarrhythmic effects.

Animals ; Anti-Arrhythmia Agents ; pharmacology ; Calcium Channels ; drug effects ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; pharmacology ; Guinea Pigs ; Heart Ventricles ; Ion Channels ; drug effects ; Male ; Myocytes, Cardiac ; drug effects ; Potassium Channels ; drug effects ; Rats ; Sodium Channels ; drug effects