Relevant research in recent years has demonstrated that the atrial fibrillation occurrence rate is significantly higher in patients with cirrhosis. The most common indication for long-term anticoagulant therapy is chronic atrial fibrillation. The use of anticoagulant therapy greatly reduces the incidence rate of ischemic stroke. Patients with cirrhosis combined with atrial fibrillation have an elevated risk of bleeding and embolism during anticoagulant therapy due to cirrhotic coagulopathy. At the same time, the liver of such patients will go through varying levels of metabolism and elimination while consuming currently approved anticoagulant drugs, thereby increasing the complexity of anticoagulant therapy. This article summarizes the clinical studies on the risks and benefits of anticoagulant therapy in order to provide a reference for patients with cirrhosis combined with atrial fibrillation.
Humans ; Atrial Fibrillation/epidemiology* ; Stroke/epidemiology* ; Anticoagulants/therapeutic use* ; Hemorrhage ; Liver Cirrhosis/drug therapy* ; Risk Factors

Alleles ; Asthma/genetics* ; Child ; Genetic Predisposition to Disease ; Genotype ; Glucocorticoids ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2)/genetics* ; Polymorphism, Genetic

Objective: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) in the treatment of refractory and relapsed acute leukemia (AL) patients. Methods: The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease (GVHD) with cyclosporine A (CSA)/short course of mycophenolate mofetil (MMF). Results: ①Of 22 patients, 9 cases were male and 13 female. The median age was 23 (15-44) years and median weight of 52.5 (43-82) kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 (1.71-5.30)×10⁷/kg (by weight), the median CD34⁺ cells was 1.60 (0.63-3.04)×10⁵/kg (by weight). ②The myeloid cumulative implantation rate was 95.5% (95%CI 45.2-99.7%) after transplantation of 42 d, with the median implantation time of 19 (13-27) d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% (95%CI 54.2-93.6%), the median implantation time of 42 (20-164) d. ③The incidence of Ⅱ-Ⅳ, Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. ④ The transplant related mortality (TRM) after transplantation of 180d was 22.7%, 2 year cumulative rate of relapse was 18.7% (95%CI 3.6-42.5%), 2 year disease-free survival rate (DFS) and overall survival rate (OS) were 53.7% and 58.1%, respectively. Conclusion: The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.
Acute Disease ; Adolescent ; Adult ; Cord Blood Stem Cell Transplantation ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia/therapy* ; Male ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Transplantation Conditioning ; Young Adult

Objective To evaluate the clinical efficacy of aerosolized inhalation of salbutamol suspension in the treatment of children with asthma and the influence of lung function,blood eosinophil (EOS) and immunoglobulin E(IgE).Methods A total of 160 children with asthma were randomly divided into treatment group (n =80 cases) and control group (n =80 cases).The control group was treated with inhaled budesonide 1.0 mg,5 min a time,twice a day,while the children in treatment group were treated combined with salbutamol 5 minutes a time,twice a day on the basis of control group.All patients were treated for 2 weeks.The clinical efficacy in two groups were observed.The changes of blood EOS and IgE at 3 months after treatment were observed.Results The total effective rate in treatment group was 98.68％ (75/76 cases),had significant difference with that in control group,which was 84.13％ (53/63 cases,P ＜ 0.05).And 3 months after treatment,the forced vital capacity (FVC),forced expiratory volume in first second(FEV1),peak expiratory flow (PEF),vital capacity(VC) in treatment group were (79.34 ± 6.52) L,(80.12 ± 3.32) L,(82.08 ±9.62) L· min-1,(83.42 ±4.10) L,had significant difference with those in control group,which were (70.20±3.34)L,(68.25 ±2.90)L,(71.21 ±4.52) L · min-1,(73.17 ±2.34) L (all P＜0.05).The absolute value of EOS and IgE in treatment group were (0.52 ± 0.13) × 109/L,(105.32 ± 62.35) ng · mL-1,had significant difference with those in control group,which were (0.96 ± 0.23) × 109/L,(222.58 ± 84.71) ng · mL-1(all P ＜ 0.05).The control group occurred 1 cases (1.59％) of nausea,while treatment group occurred 2 cases(2.63％) of hoarseness,with no significant difference (P ＞ 0.05).No drug allergy,nosocomial infections,rash and other adverse reactions occurred in two groups.Conclusion The application of glucocorticoid combined with salbutamol inhalation has significant effect on children with asthma,and can significantly reduce the levels of EOS and IgE in blood,and improve lung function.

Objective To explore clinical advantages of N‐terminal pro‐B‐brain natriuretic peptide(NT‐proBNP) in early diagno‐sis and therapeutic effect monitoring of acute coronary syndrome(ACS) .Methods A total of 97 cases of patients with chest pain and obvious discomfort who treated with coronary angiography in this hospital from February to December 2014 were selected .A‐mong these patients ,34 cases with non‐ACS were enrolled in the control group ,while other 63 cases with ACS were divided into the ST‐segment elevation myocardial infarction(STEM ) group ,non‐ST‐segment elevation myocardial infarction(NSTEM ) group and unstable angina pectoris(UA) group .The glycemia ,lipemia ,blood pressure and other indicators were observed .Results The levels of fasting blood‐glucose were within the normal reference interval in all groups ,while levels of lipemia ,plasma NT‐proBNP and blood pressure were higher than the upper limits of normal reference intervals ,and plasma levels of NT‐proBNP were higher than standard of good prognosis(NT‐proBNP<200 pg/mL) .There was statistically significant difference in plasma levels of NT‐proB‐NP among these groups(P<0 .05) ,while no statistically significant differences were found in other indicators among these groups (P>0 .05) .The levels of lipemia and plasma NT‐proBNP and blood pressure were obviously decreased in patients with ACS at each treatment stage .Conclusion NT‐proBNP as a kind of myocardial marker has high accuracy in early diagnosis of ACS ,which could be applied in therapeutic effect monitoring and provide guidance for reasonable selection of treatment strategy .

OBJECTIVETo study the clinical and laboratory characteristics of chronic active Epstein-Barr virus (EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV.

METHODSThe clinical data of 13 children with CAEBV, as well as 15 cases of acute EBV infection (AEBV) as controls, were analyzed, including clinical manifestations, EBV antibodies, EBV DNA, and peripheral blood lymphocyte subsets.

RESULTSBoth groups of patients had infectious mononucleosis-like symptoms such as fever, hepatomegaly, splenomegaly, and lymphadenectasis, but CAEBV patients had a longer course of disease and continuous and recurrent symptoms. Compared with the AEBV group, the CAEBV group had a significantly higher EBV DNA load in peripheral blood (P<0.05), a significantly higher VCA-IgG titer (P<0.05), and significantly lower numbers of white blood cells, lymphocytes, B cells, total T cells, CD4+ T cells, and CD8+ T cells in peripheral blood (P<0.05). Among 13 CAEBV patients followed up, 8 cases died, 2 cases showed an improvement, 2 cases had a recurrence, and 1 case was lost to follow-up after being transferred to another hospital. All the AEBV patients were cured and had no recurrence during the one-year follow-up.

CONCLUSIONSThe clinical manifestations of CAEBV vary in children. It is difficult to distinguish CAEBV from AEBV early. More attention should be paid to CAEBV because of its severe complications, poor prognosis, and high mortality. Measurement of EBV DNA load, VCA-IgG titer, and lymphocyte subsets in peripheral blood may be helpful in the diagnosis and differential diagnosis of CAEBV.

Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Epstein-Barr Virus Infections ; diagnosis ; immunology ; virology ; Female ; Humans ; Infant ; Lymphocyte Subsets ; immunology ; Male

OBJECTIVETo illustrate the diagnostic value of Th1/Th2 cytokine pattern in childhood hemophagocytic lymphohistiocytosis (HLH) and its diagnostic accuracy.

METHODThe BD(TM) CBA Human Th1/Th2 Cytokine Kit II was used to measure the serum Th1 and Th2 cytokines, including Interferon-gamma (IFN-γ), tumor necrosis factor (TNF), interleukin (IL)-10, IL-6, IL-4 and IL-2 in 50 patients with de novo HLH admitted to our hospital from Oct. 2005 to Aug. 2009. The above cytokine levels were also determined in 250 healthy volunteers and 235 patients with sepsis as controls.

RESULTThe primary features of these patients were prolonged high-grade fever (50/50), hepatomegaly (44/50), splenomegaly (38/50), hemocytopenia (47/50), hyperferritinemia (49/50), coagulopathy (44/50), hemophagocytosis in bone marrow (42/50), liver dysfunction (42/50) and hypertriglyceridemia (42/50). The IFN-γ, TNF, IL-10, IL-6, IL-4 and IL-2 levels for healthy children were (4.6 ± 1.8) ng/L, (4.0 ± 1.2) ng/L, (6.5 ± 1.3) ng/L, (6.0 ± 1.5) ng/L, (2.9 ± 0.8) ng/L and (2.6 ± 0.7) ng/L, while the median levels of them in acute phase of HLH children were 1138.5 (49.2 - 5000.0) ng/L, 3.4 (1.0 - 25.1) ng/L, 740.5 (26.5 - 5000.0) ng/L, 66.1 (3.9 - 4472.6) ng/L, 3.9 (1.0-32.8) ng/L and 4.0 (1.0 - 51.1) ng/L, respectively. The cytokine levels decreased to 9.1 (1.9 - 180.1) ng/L, 2.9 (1.0 - 11.0) ng/L, 11.4 (2.9 - 184.2) ng/L, 6.5 (1.0 - 44.8) ng/L, 2.7 (1.0 - 6.5) ng/L and 4.1 (1.0 - 12.0) ng/L respectively after remission. The IFN-γ, IL-10 and IL-6 levels in acute phase were significantly higher than those after remission and those of the healthy control (P all < 0.001). IL-4, IL-2 and TNF slightly elevated or at normal range in acute phase of HLH. The patients with sepsis showed a different cytokine pattern, with an extremely high level of IL-6 (median: 251.3 ng/L, range: 8.4- > 5000.0 ng/L) and moderately elevated level of IL-10 (median: 46.5 ng/L, range: 3.1 - 5000.0 ng/L), whereas IFN-γ was only slightly elevated (median: 9.2 ng/L, range: 1.3 - 498.8 ng/L). When the criteria for HLH set as the following: IFN-γ > 100 ng/L, IL-10 > 60 ng/L and the concentration of IFN-γ higher than that of IL-6, the specificity reached as high as 98.7% and the sensitivity was 88.0% for the diagnosis of HLH among patients with HLH and sepsis. Meanwhile, the positive predictive value (PPV) and negative predictive value (NPV) could reach 93.6% and 97.5%, respectively.

CONCLUSIONThe significant increase of IFN-γ and IL-10 with slightly increased level of IL-6 is a sensitive and specific cytokine pattern for childhood HLH, which is helpful for its diagnosis and differential diagnosis.

Adolescent ; Case-Control Studies ; Child ; Child, Preschool ; Cytokines ; blood ; Female ; Humans ; Infant ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Interleukin-6 ; blood ; Lymphohistiocytosis, Hemophagocytic ; blood ; diagnosis ; Male ; Sensitivity and Specificity ; Th1 Cells ; metabolism ; Th2 Cells ; metabolism ; Tumor Necrosis Factor-alpha ; blood

Shigella flexneri is an infectious pathogen that causes dysentery to human, which remains a serious threat to public health, particularly in developing countries. In this study, the global protein expression patterns of S. flexneri during transition from exponential growth to stationary phase in vitro were analyzed by using 2-D PAGE combined with MALDI-TOF MS. In a time-course experiment with five time points, the relative abundance of 49 protein spots varied significantly. Interestingly, a putative outer membrane protein YciD (OmpW) was almost not detected in the exponential growth phase but became one of the most abundant proteins in the whole stationary-phase proteome. Some proteins regulated by the global regulator FNR were also significantly induced (such as AnsB, AspA, FrdAB, and KatG) or repressed (such as AceEF, OmpX, SodA, and SucAB) during the growth phase transition. These proteins may be the key effectors of the bacterial cell cycle or play important roles in the cellular maintenance and stress responses. Our expression profile data provide valuable information for the study of bacterial physiology and form the basis for future proteomic analyses of this pathogen.
Bacterial Proteins ; analysis ; Computational Biology ; Electrophoresis, Gel, Two-Dimensional ; Gene Expression Profiling ; methods ; Kinetics ; Peptide Mapping ; Proteome ; analysis ; Proteomics ; methods ; Shigella flexneri ; growth & development ; metabolism ; pathogenicity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Temperature ; Trypsin ; pharmacology ; Virulence

OBJECTIVETo investigate the children with hearing loss from the age 0 to 6, and discuss the found age, found way and audiological characteristics.

METHODSGeneral information of found age and found way of 265 children, were investigated with self-made questionnaire and routine audiological evaluations, and then made statistical analysis.

RESULTSThe average (x +/- s) found age for the children with hearing loss was (23.21 +/- 10.02) months, and the first average coming age was (28.01 +/- 13.41) months. The found age of girls [(27.11 +/- 13.13) months] was 6.1 months later than the boys' [(21.03 +/- 12.32) months] and the countryside children [(28.27 +/- 11.09) months] later than the city's [(19.52 +/- 13.05) months] 8.65 months in the average found age. The found age of children who were found with speech disability was later than others. As the hearing loss degree of children went milder, the found age might later.

CONCLUSIONSThe popularization of knowledge in preventing from hearing loss must be strengthened. It is also necessary to popularize newborn hearing screening and early intervention while to enhance the parents' consciousness.

Child ; Child, Preschool ; Female ; Hearing Loss ; diagnosis ; prevention & control ; Hearing Tests ; Humans ; Infant ; Infant, Newborn ; Male ; Mass Screening ; Surveys and Questionnaires

OBJECTIVETo study the distribution of genomovars and microevolution of Yersinia pestis in the Qinghai-Tibet Plateau.

METHODSPrimer pairs targeting the twenty-two different regions(DFRs) were designed for detecting the presence or deletion of each DFR in 297 strains isolated from the Qinghai-Tibet Plateau.

RESULTS9 genomovars, i. e. Genomovar 1, 5, 6, 7, 8, 10, 11, new type and Ype-ancestor were identified in the Marmota himalayana plague focus of the Qinghai-Tibet Plateau. Among these genomovars, genomovar 5,8 and 10 were dominant types. The total rate of the three genomovars was 80.6% (204/253) and the genomovars in different regions were different. All of 44 strains of Y. pestis in the Microtus fuscus plague focus of the Qinghai-Tibet Plateau belonged to genomovar 14.

CONCLUSIONThe distribution of genomovars of Y. pestis in the Qinghai-Tibet plateau had remarkable characteristics geographically. Based on the distribution of genomovars of Y. pestis, the routes of transmission and microevolution of Y. pestis were proposed.

Biological Evolution ; China ; Geography ; Humans ; Plague ; transmission ; Yersinia pestis ; genetics