Objective Chronic atrial fibrillation (AF) results in dedifferentiation of atrial cardiomyocytes that plays an important role in the perpetuation of AF.In this study,we aimed to investigate the changes of titin and α-smooth muscle actin (α-SMA) after long time of AF reversal.Methods Twenty-four goats were randomized into four groups:(1) sinus rhythm (SR),(2) 3 months AF (3-mo AF),(3) 3 months SR after 3 months AF (3-mo post AF),(4) 6 months SR after 3-mo AF (6-mo post AF),with 6 in each group.By pacing on the anterior bottom of left atria appendage (LAA),we established a goat model of chronic AF.Atria effective refractory period (AERP) was measured with electrophysiological methods.Ultra-structure was studied with echocardiography,light and electron microscopy.Titin and α-SMA protein expressions were determined by Western blot.Results The animals underwent high rate pacing on LAA for a mean of 42.23±21.70 days before presenting AF.Electrophysiological analysis revealed that AERP completely resumed in 3-mo post AF goats.Echocardiography displayed that the size of left atrium resumed almost in 6-mo post AF goats (P＜ 0.01).Pathological and electron microscopic examination revealed the disorder of myofibrils,augmentation of intercellular space,myolysis,accumulation of glycogen,and numerous bigger mitochondria among atrial cardiomyocytes in 3-mo AF goats.They recovered mostly in 6-mo post AF goats.Western blot showed that the band density of titin significantly reduced in 3-mo AF goats compared to SR ones [1826±319 vs 5012±854,P＜0.01].In 3-and 6-mo post AF goats,titin increased gradually and it reversed completely in 6-mo post AF goats (3841±601 and 4523±833 respectively,P ＜ 0.01).Conversely,the band density of α-SMA was significantly higher in 3-mo AF goats (5324±948) than in SR ones (1619± 271,P＜0.01).In 3-and 6-mo post-AF goats,α-SMA decreased gradually,and it recovered mostly in 6mo post AF goats (4437± 792 and 2205±540 respectively,P＜0.01,).Conclusions These data indicate that the reversal of dedifferentiation of atrial cardiomyocyts is a very slow process,and it is definitely essential for normal cardiac function.

Heart Atria ; Humans ; Speech ; Tachycardia

Objective To determine the clinicopathological risk factors and reliable biochemical predictors of the development of hypoparathyroidism after total thyroidectomy plus central compartment node dissection in papillary thyroid carcinoma (PTC).Methods A study was performed on 93 patients who underwent a total thyroidectomy with central compartment node dissection due to PTC.The rate of hypoparathyroidism was calculated.We evaluated the correlations between hypoparathyroidism and clinicopathological factors by chi-square test and logistic regression model for multivariate analysis.The prediction value of PTH and serum calcium level was assessed by a 2×2 contingency table and ROC curve analysis.Results Postoperative hypoparathyroidism was found in 46 patients (49.5％) and 2 with permanent hypoparathyroidism.Univariate analysis showed that tumor size (P=0.034),perithyroidal extension (P=0.003),bilateral cancer(P=0.045)and bilateral central neck dissection (P=0.028)were risk factors for postoperative hypoparathyroidism in patients with PTC.Multivariate analysis showed that perithyroidal extension (P=0.003) and bilateral central neck dissection(P=0.044)were independent risk factors for postoperative hypoparathyroidism in patients with PTC.ROC curve analysis showed that PTH level in the first after operation played significant roles in predicting hypoparathyroidism(AUC 0.875).Conclusions Hypoparathyroidism is the most common complication after total/near-total thyroidectomy.Perithyroidal extension and bilateral central neck dissection are the important risk factors of hypoparathyroidism.The level of PTH is a reliable and early predictive indicator of postoperative hypoparathyroidism.

OBJECTIVETo evaluate the diagnostic value of salivary and plasma miR-21 in patients with esophageal cancer (EC).

METHODSTotal RNA was extracted from saliva and plasma samples from 50 stage I and 50 stage II patients with EC and 50 healthy controls for measurement of miR-21 levels using qPCR. The diagnostic values of salivary and plasma miR-21 levels were assessed for stage I, stage II, and stage I+II EC.

RESULTSSalivary and plasma miR-21 were significantly higher in the EC patients than in the control group. The diagnostic sensitivities of plasma miR-21 for stage I, stage II, and stage I+II EC were 96%, 64% and 97%, with specificities of 44%, 84%, and 56%, respectively; the sensitivities of salivary miR-21 were 90%, 88%, and 89%, respectively, with the same specificities of 64%. Regardless of EC staging, the expression of plasma miR-21 showed a significant positive correlation with that of salivary miR-21, and their diagnostic values were comparable.

CONCLUSIONBoth salivary and plasmatic miR-21 can be sensitive biomarkers for EC, and salivary miR-21 detection has the potential to replace plasma detection for EC diagnosis.

Biomarkers, Tumor ; blood ; chemistry ; Esophageal Neoplasms ; blood ; diagnosis ; Humans ; MicroRNAs ; blood ; Plasma ; chemistry ; Real-Time Polymerase Chain Reaction ; Saliva ; chemistry ; Sensitivity and Specificity

Objective:To analyze the risk factors of major adverse kidney events within 30 days (MAKE30) in patients with acute pancreatitis (AP).Methods:A retrospective cohort study was conducted. A total of 162 patients who were first diagnosed with AP in the First Affiliated Hospital of Soochow University from June 2019 to June 2021 and the onset time was less than 72 hours were enrolled. Patients were divided into MAKE30 group and non-MAKE30 group according to the occurrence of MAKE30 after hospitalization. MAKE30 was defined as death from any cause, new renal replacement therapy (RRT), and persistent renal insufficiency (PRD). The clinical data of the two groups at admission were compared. The independent risk factors of MAKE30 were analyzed by multivariate Logistic regression method, and a regression equation was established as a quantitative prediction model of MAKE30. Receiver operator characteristic curve (ROC curve) was drawn to analyze the prediction of the quantitative prediction model value.Results:All 162 patients were included in the final analysis, including 32 in the MAKE30 group and 130 in the non-MAKE30 group. Univariate analysis showed that compared with the non-MAKE30 group, the body mass index (BMI), the proportion of severe AP, and the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, the sequential organ failure assessment (SOFA) score, blood urea nitrogen (BUN), serum creatinine (SCr), C-reactive protein (CRP), HCO 3-, Cl - levels and the proportion of hyperchloremia at admission in the MAKE30 group were significantly increased. Multivariate Logistic regression analysis showed that APACHE Ⅱ score at admission [odds ratio ( OR) = 1.659, 95% confidence interval (95% CI) was 1.426-1.956, P = 0.009], SOFA score ( OR = 1.501, 95% CI was 1.236-1.840, P = 0.014) and hyperchloremia ( OR = 1.858, 95% CI was 1.564-2.231, P = 0.004) were independent risk factors for MAKE30 in AP patients. The MAKE30 regression equation was established by the above risk factors [Logit( P) = 0.063+0.525×APACHEⅡ score+0.328×SOFA score+0.895×hyperchloremia], which was used as the MAKE30 quantitative prediction model. ROC curve analysis showed that the area under the ROC curve (AUC) of the model for predicting MAKE30 was 0.846 (95% CI was 0.774-0.923, P = 0.001). The patients were divided into two subgroups with hyperchloremia (Cl -≥110 mmol/L, n = 19) and non-hyperchloremia (Cl - < 110 mmol/L, n = 143) according to the blood Cl - level at admission. The incidence of MAKE30 and acute kidney injury (AKI) in the hyperchloremia group was significantly increased (MAKE30: 68.4% vs. 13.3%, AKI: 89.5% vs. 43.4%), and the levels of BUN and SCr at admission were significantly increased [BUN (mmol/L): 9.3±2.5 vs. 5.9±1.1, SCr (μmol/L): 162.3±26.4 vs. 78.6±9.2], the total length of hospital stay and length of intensive care unit (ICU) stay were significantly longer [total length of hospital stay (days): 10.2±1.6 vs. 5.6±1.2, length of ICU stay (days): 6.2±1.0 vs. 3.1±0.6], the cumulative intravenous infusion volume increased significantly at 48 hours and 72 hours (mL: 7 235.9±1 025.3 vs. 5 659.6±956.7 at 48 hours, 11 052.6±1 659.8 vs. 7 156.9±1 052.4 at 72 hours), differences were statistically significant (all P < 0.01). Conclusions:MAKE30 can be used as an important indicator to evaluate the short-term clinical prognosis of AP patients. APACHEⅡ score, SOFA score and hyperchloremia at admission are the main risk factors. The risk model of MAKE30 based on these three indicators has good predictive performance. AP patients with hyperchloremia are at high risk of developing MAKE30, which should be highly regarded in clinical practice.

Objective:To evaluate the radiation dose to the injured persons in a radiological accident, provide the guidance on the diagnosis and treatment of radiation injury, and provide the basis for determination of the level of radiological accident.Method:Firstly, the air-absorbed dose rates at 206 locations surrounding a X-ray device were measured by using LiF (Mg, Cu, P) thermoluminescence detectors and self-made radiation field measuring frames. Secondly, the spatial distribution of radiation level was obtained by fitting the inverse square law between absorbed dose rate and distance, which is used as the basis of dose estimation. Finally, based on the actual working conditions of injured operators, a parameter calculation method was proposed for estimating hand skin absorbed dose.Results:The air-absorbed dose rate surrounding X-ray beam outlet was higher than 1.0 mGy/h. The maximum air-absorbed dose rate value in the space of within 200 cm outside X-ray beam outlet was 262 μGy/h and the minimum value was 2.1 μGy/h, 2 orders of magnitude higher than environmental background level. During normal operation, the total absorbed doses to the hand skin of two injured female operators were 36.9 and 16.9 Gy, respectively. During extreme operation, the hand skin-received total absorbed doses to the two operators were 85.2 and 38.9 Gy, respectively. Under the occupational health standard GBZ 106-2020, the two persons had acute radiation skin injury of grade Ⅲ or Ⅳ on their hands.Conclusions:The results of hand skin exposure doses provide effective support for diagnosis and treatment of radiation injuries and for the determination of radiological accident level. The method used in radiation field reconstruction and dose estimation mentioned in this study can provide reference for the treatment in the similar radiological accident.

Objective To investigate the effect of gaseous effluent from the six generator sets on the radiation level of the surrounding terrestrial environment in Daya Bay Nuclear Power Base after the operation of Ling’ao Nuclear Power plant. Methods The radiation level in the peripheral environment of the Base was monitored using the thermoluminescence dosimeter （TLD）. Twenty-five monitoring sites were set around the Base to investigate the variation of radiation level over a long period of time by collecting the TLDs every three months. Results From 2011 to 2020, the annual γ dose rate of the 25 sites ranged from 76.7 to 207.1 nGy/h, with an average value of (123.3 ± 5.7) nGy/h and a relative deviation of 2%-12%. The TLD monitoring and instantaneous measuring results of γ dose rate were consistent with the survey of the State Environmental Protection Administration in the 20th century and the baseline level prior to the operation of the nuclear power plant. Conclusion There are great differences in natural environmental radiation level across the TLD monitoring sites. The overall environmental γ radiation level within 50 km of the nuclear power base remains unchanged. The emission of gaseous effluent from the operation of the nuclear power plant does not have a cumulative impact on the radiation level of surrounding environment.

Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.

OBJECTIVETo investigate how the intra-cardiac activation was translates into the characterized flutter wave in patients with cavatricuspid isthmus-dependent counter-clockwise atrial flutter (CTI-AFL).

METHODSA total of 15 hospitalized CTI-AFL patients (mean age: (60 ± 14) years old, 1 female) from October 2012 to February 2014 were enrolled in the study. The activation map was re-constructed during AFL rhythm for left atrium and right atrium using 3-dimensional mapping system. The flutter wave in surface electrocardiogram was analyzed in combination with the intra-cardiac activation.

RESULTSThe mean left ventricular ejection fraction was (60.8 ± 6.6)%, and the left atrial diameter was (39.0 ± 3.4) mm. The mean tachycardia cycle length was (220 ± 24) ms. The activation map was completed in all cases. In inferior leads, the flutter wave was divided into three parts: slowly downward part, sharp downward part and the terminal positive part. The three parts corresponded to the fixed activation part of the macro-reentry.

CONCLUSIONThe distinctive flutter wave of CTI-AFL was determined by the unique macro-reentry activation in the right atrium. The activation of left atrium contributes to the downward part of the wave.

Aged ; Atrial Appendage ; Atrial Fibrillation ; Atrial Flutter ; Electrocardiography ; Female ; Heart Atria ; physiopathology ; Humans ; Male ; Middle Aged ; Ventricular Function, Left