Objective: To explore the advantage of RR-Lorenz plot (RR-LP) in analyzing the patients of sinus rhythm with long RR interval.
Methods: A total of 308 RR-LP patients with long RR interval were retrospectively studied. The patients were divided into 7 groups according to the type of long RR intervals. ① Sinus bradycardia with arrhythmia group, n=63,②Repeated transient sinus arrest group, n=16, ③Ⅱ° sino-atrial block group, n=14, ④Ⅱ° atrial ventricular block (Ⅱ° AVB) group, n=47, ⑤ Un-passed atrial premature beats (APB) group, n=28, ⑥ Atrial premature beats group, n=72 and ⑦ Premature ventricular beats group, n=68. We analyzed the patients of RR interval greater than 1500 ms with ambulatory electrocardiogram record.
Results: ①RR-LP of sinus bradycardia with arrhythmia group showed a single distributing area with 1500 ms for the origin of transverse and longitudinal axis with B line slope at 1, tilt angle of 45°.②RR-LP of repeated transient sinus arrest,Ⅱ° sino-atrial block,Ⅱ° AVB and APB groups showed special four distributing areas with B line slope at (0.51 ± 0.01), tilt angle of (23.04 ± 0.50) °, B line slope at 0.6, tilt angle of (27°), B line slope at (0.57 ± 0.21), tilt angle of (25.69 ± 9.59)° and B line slope at (0.50 ± 0.01), tilt angle of (22.59 ± 0.54) ° respectively.③RR-LP of premature beats groups showed special four regional distributing areas, B line slope for atrial premature beats was at (0.38 ± 0.12), tilt angle of (17.06 ± 5.22) ° and B line slope for ventricular premature beats was at (0.07 ± 0.05), tilt angle of (3.02 ± 2.39) °.
Conclusion: RR-LP in patients of sinus rhythm with long RR interval had speciifc morphology and distribution features, the local abnormality could be found in a plane via all RR intervals which provided a differential diagnosis for repeated occurrence of short RR interval.

Objective To explore the correlation between wide QRS of transesophageal atrial pacing (TEAP) and implicit ventricular pre-excitation.Methods 77 patients tested by TEAP were divided into two groups according to the ECG results .45 patients in group Ⅰhad normal electrocardiogram .32 patients in group Ⅱhad ven-tricular pre-excitation.In group Ⅰ,TEAP results showed that electric pulse wave (S wave) was followed by intermit-tent or continuous wide QRS complex .At the same time , the results of group Ⅰ were compared with the results of groupⅡ.Results (1)The patients of group Ⅰwere excluded the presence of concealed accessory pathway by intra-cavitary electrocardiographic test,among them 20 patients (group ⅠA) were ventricular pacing,the test results dis-played that S wave was followed by wide QRS complex exhibiting a pattern of right bundle branch block ( RBBB) ,SR interval was 0 s;SR intervals of 25 patients (groupⅠB) were not fixed,SR interval was (0.07 ±0.01)s,S wave had no concern with QRS wave ,the wide QRS complex was premature ventricular contraction ,QRS wave shapes were dif-ferent according to the different sites of pacing origin .(2)In groupⅡ,the test results displayed that S wave was close-ly followed by the atrial depolarization wave P ,and there was a wide QRS complex with pre-excitation wave at the be-ginning after a atrioventricular conduction time shorter than normal ,SR interval was fixed ,SR interval was (0.08 ±0. 03)s,at the same time,different parts of accessory pathway QRS complex had different morphological characteristics . (3) SR interval of ⅠA group compared with groupⅠB and groupⅡ,the differences were statistically significant ( t=2.97,3.02,all P<0.05);SR interval had no statistically significant difference between group ⅠB and groupⅡ(t=2.66,P>0.05).Conclusion When TEAP displaying pacing wide QRS complex ,in order to avoid bringing misdiag-nosis,TEAP results should be analyzed comprehensively rather than blindly believing that the reason was concealed accessory pathway .

Objective To investigate the clinical features and disease-causing mutations of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis.Methods In February 2016,a 24 year old female patient with left kidney stone and nephrocalcinosis in bilateral kidneys was admitted to our hospital.One month prior to this admission,she had been treated by PCNL to remove the most part of left kidney stone in otherhospital.Mter admission,She was found hypomagnesaemia (serum magnesium 0.65 mmol/ L) and hypercalciuria (24h urine calcium 364.0 mg) but with normal renal function (serum creatinine 101.5μmol/L).And the remained part of left kidney stone was removed by flexible ureteroscope.As she was considered probably with an autosomal recessive FHHNC,an analysis of CLDN16 and CLDN19 gene mutations was performed using her and her parents'peripheral white blood cells.Results Mutation analysis revealed this patient had two heterozygous mutations in the CLDN16.One is an one-base deletion mutation in the 123th codon in exon 2:368delA.The other is a missense mutation in the 139th codon in exon 2:416C →T which resulted in an amino acid change Ala139Val.Her parents respectively had one of each heterozygous mutation.In the six months follow-up,an oral administration with hvdrochlorothiazide,potassium citrate,and calcium magesium supplements significantly reduced her hypomagnesaemia (serum magnesiun 1.0 mmol/L) and hypercalciuria (24-h urine calcium 156.0 mg),and no stone recurrence and aggravation of nephrocalcinosis and renal dysfunction occurred.Conclusions We diagnosed a patient with FHHNC who had a novel compound heterozygous mutation of CLDN16.This rare disease should be suspected if there are three constant clinical features of hypomagnesaemia,hypercalciuria and nephrocalcinosis,and verified with CLDN16 and CLDN19 gene test.Currently the option for treatment of FHHNC is symptomatic treatment until severe deterioration of renal function.The hydrochlorothiazide,potassium citrate,and calcium magesium supplements may have considerable effects on hypomagnesaemia and hypercalciuria.

Objective To investigate the effect of voice training therapy on the voice improvement in patients with vocal nodules .Methods Twenty one patients with vocal nodules were recruited and were evaluated by the GRBAS perpetual evaluation ,voice handicap index (VHI)-30 subjective assessment ,vocal laryngostroboscopy , maximum phonation time (MPT) and acoustic analysis pre- and post-therapy .These patients completed 5 cour‐ses of voice training .Results The VHI value(29 .48 ± 21 .21) of post-therapy was less than the value (52 .95 ± 24 . 30)of pre -therapy (P< 0 .01) .There were significantly differences in voice perpetual evaluation between pre -training and post-training ,especially for G (grade) (P<0 .01) and R (roughness) (P<0 .01) .The post-training laryngostrobescopy vocal vibration improved comparing with pre-therapy in the closure of vocal cords ,symmetry of vibration ,the mucosal wave and vibration regularity of the vocal cords .After therapy ,three patient nodules dis‐appeared ,thirteen patient nodules became smaller ,and five patient nodules remained the same .The maximum pho‐nation time (MPT) (12 .54 ± 3 .68)of post-therapy was longer than MPT(8 .87 ± 3 .75) of pre-therapy MPT(P<0 .01) .The jitter value (0 .18% ± 0 .08% ) of post -therapy was less than that of pre-therapy(0 .43% ± 0 .31% ) (P<0 .01) .The shimmer of post -therapy (2 .10% ± 0 .98% ) was less than that of pre -therapy (4 .55% ± 1 .80% )(P<0 .01) ,The ratio of noise to harmonic(NHR)(0 .0034 ± 0 .0022 dB) of post-therapy was significantly less than NHR(0 .0184 ± 0 .028 dB)(P<0 .05) of pre-therapy .Conclusion The voice therapy could significantlyimprove voice of patients with vocal nodules .

Objective To evaluate the bone healing effect of vascularized tissue-engineered bone induced by endothelial progenitor cells(EPCs)in repair of large segmental radius defects in rabbits.Methods A total of 68 healthy New Zealand white rabbits were enrolled in the study and randomized into three groups,ie,experimental group(EPCs group):EPCs plus bone marrow mesenchymal stem cells (BMSCs)plus decalcified bone matrix(DBM);control group:BMSCs plus DBM;sham control group:pure DBM.Materials mentioned above were implanted into middle radius defects for 15 mm.At 12 and 16 weeks post-operatively,X-ray test,bone mineral density test,histological light microscopic test,osteocalcin immunohistochemical staining test and biomechanical test were carried out.Results Growth and plasticity of callus,speed of medullary cavity recanalization,bone healing speed and biomechanical intensity in the experimental group were all significantly better than those of control group.Conclusions Vascularized tissue-engineered bone induced by EPCs has strong osteegenic ability,can accelerate bone healing and hence is an effective method for repair of large segmental bone defects.

Objective To assess the levels of nucleosomes released from peripheral blood mononu-clear cells(PBMC)of patients with systemic lupus erythematosus(SLE),and their relationship with auto-antibodies as well as disease activity.Methods Levels of both nucleosomes released from PBMC and vari-ous auto-antibodies were detected by ELISA in sera from SLE patients.The disease severity was evaluated using SLEDAI(systemic lupus erythematosus disease activity index)system.Results Levels of nucleosomes released from PBMC were significantly higher in patients with active SLE than those of patients with inactive disease and normal controls(39.39?25.70,13.44?8.82,and11.73?7.87IU/mL,respectively).There was a significant positive correlation between nucleosome levels and SLEDAI scores,serum ds-DNA auto-an-tibody levels,and low C3levels.Conclusion Nucleosomes released from apoptotic PBMC of patients with SLE is closely correlated to disease activity,which implies that nucleosomes may play an important role in the pathogenesis of SLE.

Objective To investigate specific cellular immune response induced by dendritic cells(DCs) activated by human papilloma virus (HPV) 16 E7 peptide. Methods DCs separated from peripheral blood mononuclear cells were induced with granulocyte/macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4), the DCs were then activated by HPV 16 E7 peptide. After that the surface antigens on the DCs were detected by flow cytometer. Homogenic mixed lymphocyte reaction (HMLR) with DCs was performed. LDH release assay was also used to detect the activity of cytotoxic T lymphocytes(CTL)to Caski tumor cells, which was induced by DCs. Results The surface antigens on the activated DCs were highly expressed, such as CD1a(58.4 ? 6.7)%, CD80(70.6 ? 3.4)% and HLA-DR(74.8 ? 4.2)%. HMLR showed that the activated DCs stimulated T cell proliferation significantly. Antigen-specific CTL induced by the activated DCs specifically killed Caski tumer cells, but had no effect on SiHa and AN3CA cells. Conclusions DCs loaded with HPV 16 E7 peptide can induce highly effective and specific cellular immune response.

Objective To screen and identify the predicted epitopes of synthesized predicted HLA-A2-restricted cytotoxic T lymphocytes (CTLs) derived from HPV16 E7 antigen. Methods The predicted epitopes of HLA-A2-restricted CTLs derived from HPV16 E7 antigen were synthesized and purified with Standard Fmoc assays, and the standard 51Cr release assay was used to determine their activities to induce specific CTL. Results Two epitopes of HLA-A2-restricted CTLs, namely E711-19 (YMLDLQPET) and E749-57 (RAHYNIVTF) derived from HPV16 E7 antigen were identified. Conclusion E711-19 (YMLDLQPET) and E749-57 (RAHYNIVTF) have antigenicity, and may be the candidates for development of peptide vaccine in the treatment of HPV infections.

[ ABSTRACT] AIM:To study the effect of idazoxan ( IDA) on the permeability of blood-brain barrier ( BBB) and the expression of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in mouse ex-perimental autoimmune encephalomyelitis (EAE).METHODS: Female C57BL/6 mice (n=36) were randomly divided into control group, EAE group and IDA group, with 12 mice in each group.EAE was induced by myelin oligodendrocyte glycoprotein 35-55 ( MOG35-55 ) .IDA (2 mg/kg, ip, bid) was administered for 15 d after immunization.The neurological defects of the mice were observed daily and scored.The pathological changes were observed under microscope with HE stai-ning and LFB myelin staining.The BBB permeability was detected by Evans blue extravasation.The expression of MMP-9 and TIMP-1 in the brain of EAE mice was determined by Western blotting.RESULTS: Compared with EAE group, the score of neurological defects in IDA group was decreased, the inflammation was relieved, the BBB permeability was re-duced, and the expression MMP-9 and the ratio of MMP-9/TIMP-1 were decreased ( P<0.05 ) .CONCLUSION: The neuroprotective effect of IDA on mouse EAE might be related to the down-regulation of MMP-9 and the ratio of MMP-9/TIMP-1, thus reducing the degradation of BBB and the permeability of BBB, and ameliorating the pathologic process of EAE.

Objective To set the criteria of mild spinal tuberculosis and investigate the ettect of standard chemotherapy regimen for further establishing the clinical classification of spinal tuberculosis and standardizing management.Methods According to the criterion,a total of 89 patients with mild spinal tuberculosis were enrolled for outpatient conservative management and follow-up.Ambulant treatments were carried out in all patients,including nutrition support and standard chemotherapy regimen.The regimen was consisting of four first-line antituberculosis drugs (rifampicin,isoniazid,ethambutol and pyrazinamide).All patients were followed up one month later,then every 3 months for the following 12 months,and subsequently at intervals of half a year.The clinical manifestations,kyphosis progression,neurological status,erythrocyte sedimentation rate and liver function were analyzed.Results A mean of 30.62± 13.20 (range,18-46) months' follow-up was achieved in 85 patients,whose tuberculosis lesions were cured completely.Another 4 patients,who were diagnosed with drug-resistant tuberculosis later,had underwent surgery for progressive bone destruction and no response to chemotherapy.The mean visual analogue scale score and Cobb's angle was 5.6± 1.6 and 6.25°±3.11° before chemotherapy,and 2.1 ± 1.1 and 12.36° ±6.31 °at the last follow-up time,respectively.Signals of vertebral body and intervertebral disc returned to normal in 6 patients,while solid bony fusion of adjacent segment was achieved in 79 patients.Asymptomatic mild kyphosis was observed in 69 patients.2 patients with sinus before treatment all healed.No neurological deficit was found.Conculusion For patients early diagnosed with mild spinal tuberuclosis,standard chemotherapy regimen could work safely and effectively for healing the tuberculous lesion,avoiding surgery as well as preventing kyphosis,vertebral instability and neurological deficit.Mild spinal tuberculosis that was early diagnosed could be considered as a subtype of spinal tuberculosis.