Objective To evaluate the correlation between RPA or the polymorphism of CYP 2C19 and the incidence of ischemic events and the influence on the clinical prognosis .Methods A case-control study was used.A total of 202 patients [male 66%,(63 ±11) years] with ACS on aspirin and clopidogrel treatment were recruited , whose RPA were measured by whole blood aggregometry ( WBA ) , and their CYP2C19 polymorphism were also tested .Their clinical ischemic events were recorded in the mean follow-up period of 16 months.The RPA cut-off values for antiplatelet low-responsiveness were defined by the receiver operator characteristic curve ( ROC); the relationships of clinical outcomes with RPA and CYP 2C19 were assessed by the Kaplan-Meier survival analysis.Results CYP2C19*2 (681G>A) present in 52.5% of recruited patients and*3 (636G>A) present in12.9%.RPA induced by adenosine diphosphate ( ADP) showed significant difference among CYP 2C19*2 or *3 heterozygotes, CYP2C19*2 or *3 homozygotes and noncarriers (χ2 =9.318, P=0.009);whereas, RPA induced by arachidonic acid (AA) (χ2 =2.441, P=0.295) and the incidence of ischemic events (χ2 =0.513, P=0.774) were not.During follow-up, 18 (9%) patients experienced clinical ischemic episodes , and their RPA were higher than patients without ischemic episodes [(8.6 ±4.8) Ωvs (5.2 ±3.7) Ω, P =0.013; (8.6 ±6.8) Ωvs (1.6 ±3.7) Ω, P <0.001].Moreover, employing 6.5 Ω(induced by ADP) and 2.5 Ω(induced by AA) as cutoff values,RPA showed optimal negative predictive values (97%, 96%) and poor positive predictive values (16%,29%).Survival analysis showed, statistically, patients with clopidogrel low-responsiveness had higher riskof ischemic episodes than patients with clopidogrel responsiveness (HR =2.86, χ2 =11.27,P =0.0008);however, patients with aspirin low responsiveness (HR =1.77, χ2 =1.74, P =0.19) or patients withCYP2C19*2 or *3 (HR =0.89, χ2 =0.12, P =0.73) did not.Conclusion Clopidogrel lowresponsiveness is associated with the occurrence of clinical ischemic events ; however, patients withCYP2C19 function reduced genetypes do not show higher risk of ischemic episodes though it presented slighlyhigher RPA.

Objective To investigate on the gender and age distribution characteristics of serum lipid levels among apparently healthy adult population in Beijing and analyse its related risk factors .Methods This is a prospective study.1 712 healthy individuals between 18 and 79 years old were recruited from medical examination center of Peking University Third Hospital .By strict exclusion criteria , 951 healthy individuals (429 males and 522 females) were included in our study.A calibrated automatic biochemical analyzer was used to measure TC, TG, HDL-C, LDL-C, ApoA1, ApoB concentrations in serum.Test results were stratified by gender , age, related risk factors, and statistically analysed.Two groups of normally disthibuted data were compared using t test;multiple groups of data were compared using variance analysis . Results Results for TC (t=4.013, P<0.050), HDL-C(t=9.162, P<0.05) and ApoA1( t=8.225, P<0.05) appear generally higher in women than in men .On the contrary, males had greater levels of TG (Z=3.119, P<0.05) compared to females.There was an obvious increasing trend in TC ( F=47.984, P<0.05), TG(Chi square =146.616, P<0.05), LDL-C(F=46.024, P <0.05), non-HDL-C(F =45.027, P<0.05) and ApoB levels(F=52.020, P<0.05), as well as peaked in the 60-69 age group, decreased in 70-70 years old.The population of beneath the bachelor-degree had greater levels of ApoB ( t=5.989, P<0.05), LDL-C(t=4.445, P<0.05), TC(t=2.885, P<0.05), non-HDL-C(t=4.332, P<0.05) and TG(Z=3.346, P<0.05) compared to the group of bachelor degree or above .Meanwhile, The levels of TC(t=8.273, P<0.05), HDL-C(t=3.346, P<0.05), LDL-C(t=5.768, P<0.05), non-HDL-C(t=7.213, P<0.05), ApoA1(t=3.683, P<0.05), ApoB(t=6.267, P<0.05), TG(Z=5.626, P<0.05) of the population lived in urban area were higher than rural areas .Interestingly, the concentration of ApoA1(t=3.238, P<0.05), HDL-C( t=6.011, P<0.05) and TC(t=2.712, P<0.05) were much higher in the population of mental worker than the manual worker .BMI and waistline positively correlated with serum TG(rs=0.379, 0.443, P<0.01), TC(rs =0.160, 0.176, P<0.01), LDL-C(rs =0.238, 0.263, P <0.01), ApoB (rs =0.326, 0.371, P <0.01) and non-HDL-C(rs =0.304, 0.336, P<0.01) respectively, but negatively correlated with HDL-C(rs =-0.358, -0.386, P<0.01) and ApoA1 ( rs =-0.203, -0.209, P <0.01 ) .Conclusions The study obtained the distribution of lipid levels among apparently healthy a dult population in Beijing .It may offer objective basis for clinical risk assessment of ASCVD , and guid the clinician to choose the optimal individualized treatment .

Objective To compare the accuracy of jugular venous oxygen saturation (SjvO2),somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing clipping of intracranial aneurysm.Methods Forty-three ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with a body mass index of 20-25 kg/m2,undergoing clipping of intracranial aneurysm,were studied.Anesthesia was induced with sufentanil,rocuronium and propofol.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil and propofol.Blood samples were taken from the jugular bulb for detection of SjvO2 before aneurysm clipping or temporary occlusion of parent artery and at 1,3,10,20 and 30 min after clipping aneurysm or temporary occlusion of parent artery.The amplitude and latency of SSEPs and MEPs were recorded simultaneously.The occurrence of cerebral ischemia estimated by SjvO2,SSEPs and MEPs was recorded.The condition of nerve defect was recorded within 3 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of nerve defect.Results Among 43 patients,14 cases were diagnosed as having brain ischemia.The sensitivity and specificity of SjvO2 in estimation of the occurrence of intraoperative brain ischemia were 71％ and 93％,respectively (P ＜ 0.01).The sensitivity and specificity of SSEPs in estimation of the occurrence of intraoperative brain ischemia were 71％ and 62％,respectively (P ＜ 0.05).When the diagnostic criterion of cerebral ischemia was defincd as a decrease in the amplitude of MEPs or prolongation of the latency MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 79 ％ and 52 ％,respectively (P ＞ 0.05).When the diagnostic criterion of cerebral ischemia was defined as a loss of the amplitude of MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 57％ and 93％,respectively (P ＜0.05).Conclusion The sensitivity of SjvO2 and SSEPs in estimation of the occurrence of intraoperative brain ischemia is higher,however,the specificity of SjvO2 and MEPs is higher,indicating that SjvO2 is a reliable criteria for estimation of the occurrence of intraoperative brain ischemia in patients undergoing clipping of intracranial aneurysm.

Objective To compare the clinical outcomes of gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) fixed protocol with GnRH agonist (GnRH-a) long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer (IVF-ET) cycle,and to explore the feasibility and advantage of GnRH antagonist protocol performed in normal responders.MethodsFrom January 2011 to June 2011,771 infertile women with normal ovarian reserve function underwent their first IVF or intracytoplasmic sperm injection (ICSI) cycles in Peking University Third Hospital,which were divided into 245 cycles in GnRH-ant fixed protocol group ( GnRH-ant group) and 526 cycles in GnRH-a long protocol group ( GnRH-a group).The data of general demographic,treatment and clinical outcome were compared between two groups.ResultsAge,infertile duration,body mass index (BMI),baseline serum follicle-stimulating hormone (FSH) and estradiol levels between two groups did not reached statistical difference (P ＞ 0.05 ).The level of estradiol was (12 289 ± 6856) pmol/L in GnRH-ant group and (14934±8007)pmol/L in GnRH-a group at day of hCG injection.The mean length of stimulation was ( 10.3 ± 1.2) days in GnRH-ant group and ( 12.8 ± 1.6) days in GnRH-a group.The dose of gonadotropin was (2013 ± 607 ) U in GnRH-ant group and (2646 ± 913 ) U in GnRH-a group.The number of ovum was 15 ± 7 in GnRH-ant group and 17 ± 8 in GnRh-a group.Those clinical parameter all reached statistical difference (P ＜0.05 ).The number of embryo was 7 ±4 in GnRH-ant group and 8 ± 5 in GnRH-a group,the rate of clinical pregnancy was 40.9％ (94/230) in GnRH-ant group and 45.6％ (216/474)in GnRH-a group,the rate of implantation was 26.1％ (128/490)in GnRH-ant group and 30.9％ (307/994) in GnRH-a group,the rate of continuing pregnancy was 38.7％ ( 89/230 ) in GnRH-ant group and 42.6％ (202/474) in GnRH-a group,those parameter did not reach statistical difference (P ＞ 0.05).The rate of moderate or severe ovarian hyperstimulation syndrome was 2.4％ ( 6/245 ) in GnRH-ant group and 4.2％ (22/526) in GnRH-a group,which did not show significant difference ( P ＞ 0.05 ).ConclusionIn the first IVF or ICSI cycle of the patients with normal ovarian reserve function,the fixed GnRH-ant protocol could get the same satisfied clinical outcome,and it is more economic,convenient and safer compared with low dose depot GnRH-a long protocol.

Objective To observe the correlation between conventional coagulation tests and Dabigatran concentration in order to find proper test method to predict the bleeding risk of patients receiving Dabigatran.Methods The clinical data of forty-nine non-valvular atrial fibrillation (NVAF) patients who took Dabigatran in Peking University Third Hospital from 2015 to 2017 were analyzed and the bleeding rates were calculated.The plasma samples from twenty healthy volunteers were collected and mixed up into normal pooled plasma (NPP).Different doses of active Dabigatran were mixed with NPP,making Dabigatran concentrations from 0 to 1 000 ng/mL.Prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (Fib) and diluted Russell viper venom time (dRVVT) were determined.Fresh whole blood samples from three normal volunteers were collected and mixed with Dabigatran in the same way to perform thromboelastogram (TEG).Results The total bleeding rate of NVAF patients receiving Dabigatran was 28.6％,among which gastrointestinal bleeding accounts for the most.APTT,dRVVT,R time (R) and clot index (CI) showed a good linear correlation with Dabigatran concentration.The sensitivity of dRVVT was the best,followed by APTT.R and CI showed low sensitivity compared with APTT and dRVVT.Conclusion APTT and dRVVT should be good parameters for monitoring the bleeding risk of Dabigatran and helpful for physicians to choose proper point-in-time for withdrawal of Dabigatran and reduce bleeding events.

Alleles ; Amelogenin/genetics* ; Chromosomes, Human, Y ; Humans ; Male ; Sex Determination Analysis

Objective: To describe online learning and eye strain situation of college students during the COVID-19 outbreak, to provide a scientific basis for guiding students eye health. Methods: A self-filled electronic questionnaire survey through questionnaire star was administered to college students across China. Information about online learning and eye strain of 1 046 college students during the epidemic was collected in Hefei, Anhui Province from March 16 to 20, 2020. The univariate and multivariate Logistic regression analysis were performed to analyze the association between online learning and eye strain of college students. Results: The rate of eye strain during online learning was 72.1%, totally of 68.4% in 421 male students and 74.6% in 625 female students. Boys with online learning time <6 h/d, slow internet access，difficulty in understanding online class reported higher rate of eye strain than girls( χ 2=17.36,8.72,7.02, P ＜0.05). Freshmen reported the highest rate of slow internet access occasionally and active online class( χ 2=15.26,16.11, P ＜0.05), junior students reported highest rate of online learning time <6 h/d, and easy understandable online class( χ 2=15.33,32.59, P ＜0.05), medical college students reported higher rate of slow internet access, inactive online class than non-medical college students( χ 2=11.79,11.03, P ＜0.05). Multivariate Logistic regression analysis showed that odds ratio( OR ) of eye strain in females was 1.40 (1.06-1.87), compared with males; the OR of eye strain were 1.43 (1.01-2.03) and 1.54 (1.10-2.15) in the groups with online learning time 6-<8 h/d and ≥8 h/d, respectively, compared with the group with online learning time <6 h/d, the OR of eye strain in the groups with slow internet access was 2.28 (1.25-4.14), compared with students without slow internet access, the OR of eye strain in the capable to understand and difficult to understand group were 2.54 (1.73-3.74) and 5.40 (2.70-10.80) respectively, compared with the easy to understand group. Conclusion Female students, online learing time ≥ 8 h/d, slow internet access, difficult to understand class content were positively related with college students eye strain. Attention should be paid to the eye health of college students to reduce the adverse effects of online learning on vision.during the COVID-19 epidemic.

Objective Observing changes in thehaemostatic system to determinetheseverity and prognosis of HELLP syndrome. Methods 127 cases of HELLP syndrome diagnosed in Peking University Third Hospital were enrolled from August 2010 to August 2018. Maternal and fetaldemographic characters, postpartum complications,length of hospital stay,prothrombin time(PT),activated partial thromboplastin time (APTT), Fibrinogen(Fg) and D-Dimer(D-D) were collected. Results There was no statistical difference inparturient PT, APTT, D-D levels between maternals of HELLP syndrome with and without postpartum hemorrhage,which were [9.6 (9.0, 11.5)s vs 9.4 (8.9, 9.7)s, P=0.243], [30.2 (29.1, 38.3)s vs 29.8 (27.7, 31.8)s, P=0.151], and [0.80 (0.52, 4.52)μg/ml vs 0.91 (0.55, 2.48)μg/ml, P=0.923] respectively. There was a statistically significant difference obvious difference in parturient Fglevels between two groups [(2.94±1.48) g/L vs (3.61±1.00)g/L, P=0.022). The receiver operating characteristic curve(ROC) analysis showed that the AUC of fibrinogen level when estimating postpartum hemorrhage was 0.688(95％CI:0.600-0.767), cut-off value was 3.04 g/L, negative predictive value was 74.3％. There was a negative correlation between parturient Fg and days of hospital stay of HELLP syndrome maternal(r=-0.182, P=0.040). There was no statistical difference in parturient PT, APTT, Fg and D-D levels between the fetal survival group(n=93) and non-survival group (n=34), and between the distressed group (n=23) and he undistressed group(n=70) (P>0.05). Conclusions The low parturient Fg level may be a risk factor of maternal adverse clinical outcomes in HELLP syndrome. Maintaining the Fg at a stable level may reduce the incidence of HELLP syndrome adverse outcomes.

BACKGROUNDThe effects of triterpenic acid from Prunella vulgaris L. (TAP) on diabetes and its mechanism are uncertain. The aim of this study was to investigate the effects of TAP on antihyperglycemic, antioxidant, and pancreas-protective in streptozotozin (STZ)-diabetic rats.

METHODSThe diabetic model was produced by injection of 60 mg/kg STZ. Blood was drawn from the tail vein of rats after 72 hours. Rats with blood glucose ≥ 16.7 mmol/L were considered diabetic. Diabetic rats were randomly divided into four groups: (1) Diabetes rat (STZ), (2) Diabetic rats treated with 50 mg/kg of triterpenic acid from Prunella vulgaris L (STZ + TAP50), (3) Diabetic rats treated with 100 mg/kg TAP (STZ + TAP100), and (4) Diabetic rats treated with 200 mg/kg TAP (STZ + TAP200). Normal rats (n = 10) acted as the control group (NC). TAP was administered by the intragastric route once each day for six weeks. Body weight and the concentration of blood glucose (BG) were measured after three and six weeks. Fructosamine (FMN), malondialdehyde (MDA), and nitric oxide (NO), and the activities of nitric oxide synthase (NOS) and superoxide dismutase (SOD) in serum were determined after six weeks using commercially available kits following the manufacturer's instructions. Pathologic changes in pancreatic β-cells were also investigated by microscopic examination after hematoxylin-eosin (HE) staining. The level of SOD mRNA in pancreatic β-cells was measured by polymerase chain reaction (PCR).

RESULTSThe levels of BG, FMN, NO, and MDA and the activities of NOS in serum in the four diabetes groups were significantly increased compared with the control group (P < 0.01). The activity of SOD in serum and the body weight was significantly decreased compared with the control group (P < 0.01). After administration of TAP to diabetic rats for six weeks, the body weight and the levels of BG, FMN, MDA, NO and the activity of NOS in serum decreased significantly compared with the STZ group in a dose-dependent manner. The activity of SOD in serum and body weight increased significantly compared with the STZ group in a dose-dependent manner. In addition, diabetic rats showed a significant decrease in SOD mRNA expression in pancreatic β cells. However, these changes were reversed by TAP. Histopathological examination also showed the protective effect of TAP on pancreatic β cells.

CONCLUSIONSTriterpenic acid from Prunella vulgaris L. has an anti-diabetic effect, by controlling blood glucose and antioxidants, and has a protective effect on the pancreas.

Animals ; Blood Glucose ; analysis ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Insulin-Secreting Cells ; drug effects ; pathology ; Male ; Prunella ; chemistry ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Superoxide Dismutase ; genetics ; Triterpenes ; therapeutic use

Adult ; Female ; Humans ; Intracranial Thrombosis ; etiology ; surgery ; Ovarian Hyperstimulation Syndrome ; complications ; diagnosis