Coronary artery disease (CAD) is a multifactorial disease in which inflammation plays a central role.This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio (NLR),the Global Registry of Acute Coronary Events (GRACE) score with in-hospital mortality of elderly patients with acute myocardial infarction (AMI) in an attempt to explore the prognostic value of these indices for elderly AMI patients.One thousand consecutive CAD patients were divided into two groups based on age 60.The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records.The NLR and GRACE score were calculated.In the elderly (≥60 years),patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) had significantly higher NLR than did those with unstable angina (UA) and stable angina pectoris (SAP) (P＜0.01).The NLR was considerably elevated in older AMI patients compared with their younger counterparts (＜60 years) (P＜0.05).In elderly AMI patients,the NLR was considerably higher in the high-risk group than in both the low-risk and medium-risk groups based on the GRACE score (P＜0.05 and P＜0.01,respectively),and the NLR was positively correlated with the GRACE score (r=0.322,P＜0.001).Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group (P＜0.05).By curve receiver operator characteristic curve (ROC) analysis,the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve (AUC) 0.771 and 0.787,respectively,P＜0.001].It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

DNA, Neoplasm ; analysis ; Flow Cytometry ; Hemangiopericytoma ; pathology ; Humans ; Immunohistochemistry ; Lipoma ; pathology ; Male ; Mediastinal Neoplasms ; pathology ; Middle Aged

The major clinical risk of atherosclerosis (AS) lesion is instability and vulnerability of plaque.Intraplaque vasa vasorum (VV) has structure defects with the characteristics of immature,irregular,fragile,and prone to extravasation and intraplaque hemorrhage due to the compromised structural integrity.It stimulates inflammatory reaction and provides channel for hemocyte and blood soluble composition entering into the plaque.Intraplaque VV can promote AS plaque formation and is closely related to the intraplaque hemorrhage,plaque rupture and occurrence of clinical cardiovascular events.In-depth study of VV function and key signaling pathways related to AS pathological process are promising to fundamentally prevent vulnerable plaque development,unstable plaque rupture and its complications.This article summarized the effect and mechanism of VV in pathological process of AS and related treatment,in order to provide theoretical basis for stabilization of AS vulnerable plaque.

This study was aimed to observe the effect of Si-Miao Yong-An (SMYA) decoction intervention in atherosclerosis (AS) vulnerable plaque,and to further explore the action mechanism from the entry point of vasa vasorum (VV) neovascularization.Male ApoE-/-mice were randomly divided into the model group,simvastatin group and SMYA group.High-fat diet added 1.1％ L-methionine was fed for 8 weeks to establish the AS vulnerable plaque model.The C57BL/6 mice were used as control.After 8 weeks' continuous medication,mice were sacrificed.HE staining were used to observe the pathological changes of mice aorta;immunohistochemical staining was used to observe the VV density in AS plaque and aortic adventitia;macrophage infiltration in plaque was also detected;the blood-lipid changes of TC,TG,LDL-C and HDL-C were detected;western blot was used to detect essential proteins of HIF-1α-Apelin/APJ signal pathway.The results showed that SMYA decoction decreased the plaque area and the ratio of plaque area and lumen area,increased the minimum thickness of fibrous cap,which significantly improved the pathological feature of aortic plaque in mice.The function of increasing the minimum thickness of fibrous cap was obviously superior to simvastatin.SMYA decoction effectively suppressed the VV neovascularization and decreased the macrophage content.SMYA decoction effectively decreased the serum level of TC,TG and LDL-C;however,it had no effect on HDL-C.SMYA decoction decreased the protein expression of HIF-1α.Its function was obviously superior to simvastatin.SMYA decoction can down-regulate the protein expressions of Apelin,APJ,Phospho-MEK1/2 (Ser217/221),Phospho-p44/42 MAPK (Erk1/2) (Thr202/Tyr204) and Phospho-p70 S6 Kinase (Thr421/Ser424).It was concluded that SMYA decoction regulated the HIF-1α-Apelin/APJ signal pathway,suppressed VV neovascularization and stabilized AS vulnerable plaque.

BACKGROUND: Stem cells are the potentially immortal cells capable of self-renewal, which are essential to the mystery of human development and aging, and are also the core of research for regenerative medicine. OBJECTIVE: To summarize the biological characteristics of embryonic stem cells, adult stem cells and induced pluripotent stem cells, to review the clinical and commercial applications in stem cell therapy and drug screening, and to analyze the problems and prospects in stem cell industry. METHODS: We searched relevant articles about stem cell models in PubMed and CNKI databases during 1995 to 2017 on internet, and took"stem cells, embryonic stem cells, adult stem cells, induced pluripotent stem cells, stem cell therapy, drug screening" as the keywords in English and Chinese, respectively. RESULTS AND CONCLUSION: According to the origin, stem cell models are divided into three types: embryonic stem cells, adult stem cells and induced pluripotent stem cells. Different types of stem cells have their unique biological advantages. Embryonic stem cells can generate all somatic cell types, but the application is limited by ethical disputes. As for adult stem cells, there are the most extensive and in-depth, studies as the well as the most prevalent and mature applications. Induced pluripotent stem cells have similar characteristics as embryonic stem cells, and furthermore their use avoids source restriction, moral and ethical controversies, bringing new opportunities for stem cell application. Stem cell-based cell therapy has shown successful achievement. There have been a few commercial products about adult stem cells-based cell therapy; in the meanwhile both embryonic stem cells and induced pluripotent stem cells are making their way into clinical trials. In addition, pluripotent stem cells hold great promise for the specific drug screening because they enable scientists to establish a variety of cell and disease models in vitro.

Objective To compare the difference of perception on nursing work environment between male and female nurses in secondary and tertiary hospitals in Guangdong Province.Methods Practice Environment Scale of the Nursing Work Index was used to measure nurses' perception on nursing work environment.Propensity score matching was used to control confounders when comparing the gender difference of nurses' perception on nursing work environment.Results Totally 3 456 nurses in secondary and tertiary hospitals in Guangdong Province were surveyed,and 190 of them were male nurses who were distributed with a significant higher proportion in tertiary hospitals,ICUs and emergency departments.Compared with female nurses,male nurses were significantly younger in age,had shorter working years and higher proportion of being single,contract employed,having associate degree or above for initial educational degree.Controlling confounders with propensity score matching,male nurses' perception on nursing work environment was significantly worse than females for three subscales:collegial nurse-physician relations,nursing foundations for quality of care,nurse manager ability,leadership,and support of nurses.Conclusion The proportion of male nurses in Guangdong Province should be raised.Distributed more in tertiary hospitals,ICUs and emergency departments,male nurses were characterized as being less experienced,more contract employed and having higher initial educational degree compared to female nurses.Worse perception on nursing work environment from male nurses indicated that nursing managers should attach more importance to male nurses to improve their orientation and in-service training,professional development support and collegial nurse-physician relations for their better perception on nursing work environment and retention.

Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.

OBJECTIVETo establish the association between the geometric anatomical characteristics of the patients and the corresponding three-dimensional (3D) dose distribution of radiotherapy plan via feed-forward back-propagation neural network for clinical prediction of the plan dosimetric features.

METHODSA total of 25 fixed 13-field clinical prostate cancer intensity-modulated radiation therapy (IMRT)/stereotactic body radiation therapy (SBRT) plans were collected with a prescribed dose of 50 Gy. With the distance from each voxel to the planned target volume (PTV) boundary, the distance from each voxel to each organ-at-risk (OAR), and the volume of PTV as the geometric anatomical characteristics of the patients, the voxel deposition dose was used as the plan dosimetric feature. A neural network was used to construct the correlation model between the selected input features and output dose distribution, and the model was trained with 20 randomly selected cases and verified in 5 cases.

RESULTSThe constructed model showed a small model training error, small dose differences among the verification samples, and produced accurate prediction results. In the model training, the point-to-point mean dose difference (hereinafter dose difference) of the 3D dose distribution was no greater than 0.0919∓3.6726 Gy, and the average of the relative volume values corresponding to the fixed dose sequence in the DVH (hereinafter DVH difference) did not exceed 1.7%. The dose differences among the 5 samples for validation was 0.1634∓10.5246 Gy with percent dose differences within 2.5% and DVH differences within 3%. The 3D dose distribution showed that the dose difference was small with reasonable predicted dose distribution. This model showed better performances for dose distribution prediction for bladder and rectum than for the femoral heads.

CONCLUSIONWe established the relationships between the geometric anatomical characteristics of the patients and the corresponding planning 3D dose distribution via feed-forward back-propagation neural network in patients receiving IMRT/SBRT for the same tumor site. The proposed model provides individualized quality standards for automatic plan quality control.

BACKGROUNDEndogenous nitric oxide and adenosine increase simultaneously to keep the balance of energy demand and supply when the oxygen supply is insufficient, which suggests that nitric oxide and adenosine might exert a synergistic myoprotection during tissue hypoxia. In this study, we tested this hypothesis utilizing a canine model of prolonged global myocardial ischaemic reperfusion injury.

METHODSIn this double blind, controlled study, the hearts of 24 anaesthetized mongrel dogs were arrested for 2 hours with aortic cross clamping and blood cardioplegia. The treatment groups were those supplemented with 2 mmol/L L-arginine (ARG), supplemented with 1 mmol/L adenosine (ADO), ARG + ADO supplemented with both, and no supplementation (control) (n = 6 in each group). Haemodynamics, biochemical indices, adenosine triphosphate (ATP) content and myeloperoxidase activities of myocardium were determined to evaluate myocardial injury. Statistical comparison was performed by two way ANOVA.

RESULTSAlthough the requirements for inotropic supports were higher, the cardiac outputs were lower in control group than in ARG, ADO and the combination groups. Plasma cardiac troponin I levels were higher and the areas of hydropic changes were larger in control group than in ARG and ADO groups. Combination of arginine and adenosine provided further myoprotection with respect to better cardiac performance, lower release of cardiac troponin I, and smaller areas of hydropic changes compared with ARG and ADO groups. ATP content was higher, but myeloperoxidase activities of myocardium were significantly lower in the combination group than in control, ARG and ADO groups (P < 0.05).

CONCLUSIONSCombination of L-arginine and adenosine provides synergistic myoprotection in a canine model of global myocardial ischaemia. Thus, the combination is recommended when the heart is exposed to a prolonged ischaemia during cardiac surgery.

Adenosine ; therapeutic use ; Adenosine Triphosphate ; analysis ; Animals ; Arginine ; therapeutic use ; Cardiotonic Agents ; therapeutic use ; Disease Models, Animal ; Dogs ; Drug Synergism ; Energy Metabolism ; Female ; Heart Arrest, Induced ; Male ; Myocardial Reperfusion Injury ; prevention & control ; Myocardium ; metabolism ; pathology ; Peroxidase ; metabolism

OBJECTIVETo observe the performance of liver metastases with contrast-enhanced ultrasound (CEUS) and assess its clinical application.

METHODSTwenty-one patients with 21 untreated liver metastases underwent CEUS with low mechanical index imaging. The characteristic appearances of CEUS in different vascular phases were observed.

RESULTSOf 21 metastases, 19 (90.5%) were identified as fast-in and fast-out enhancement pattern. In the arterial phase, all the 21 lesions showed enhancement but with varied appearances: 12 (57.1%) showed early diffuse enhancement, 8 (38.1%) showed ring-like enhancement, and the remaining one lesion of large size showed slowly enhomogenous minor enhancement. In the late phase, sharp defects were found in 20 lesions (95.2%), and more lesions were detected in 3 patients (14.3%).

CONCLUSIONCEUS can show the characteristic appearance of liver metastases, and can be used for the screening and diagnosis of liver cancers.

Contrast Media ; Humans ; Liver Neoplasms ; diagnostic imaging ; secondary ; Ultrasonography