Objective To study the mode and clinical implications of onset of spontaneous tosade de pointes in the congenital long QT syndrome. Methods We reviewed electrocardiograms (ECGs) of 55 patients with congenital QT syndrome for syncope. Documentation of the onset of tosade de pointes was available for 16 patients. All these patients had "definitive long QT syndrome" by accepted clinical and ECG criteria. Results One hundren and forty-nine runs of tosade de pointes were documented in 16 patients,of whom,there were 130 runs of pause-dependent tosade de pointes. Conclusion Our results show that the pause-dependent tosade de pointes,which has been recognized as a hallmark of tosade de pointes in the acquired long QT syndrome,plays a major role in the genesis of tosade de pointes in the congenital long QT syndrome.

BACKGROUND: Smoking is an important cause of cardiovascular disease, its definite mechanism in inducing cardiovascular disease is still unclear, and whether there is linear correlation between the amount of cigarette smoking and cardiovascular risk still needs to be investigated.OBJECTIVE: To analyze the association between cigarette smoking and the severity of coronary atherosclerosis.DESIGN: A retrospective investigation and comparative study.SETTING: The First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 500 consecutive patients, who underwent coronary angiography for suspected or known coronary atherosclerosis, were selected from the First Affiliated Hospital of Nanjing Medical University from April 2004 to April 2005. The inclusive criteria included patients with history of chest pain and/or ischemic changes of electrocardiography (ECG), and those with suspected or known coronary artery disease by coronary angiography. Patients with spastic angina pectoris (acetylcholine-positive) were excluded. Patients with infectious processes within 2 weeks before catheterization, heart failure (Killip Class≥ 2 after acute myocardial infarction), hepatic dysfunction, vascular disease (aortitis should be treated with prednisolone), familial hypercholesterolemia, thyroid dysfunction, or adrenal dysfunction were also excluded. There were 370 males aged 42-76years with an average of (61±11) years and 130 females aged 45-75 years with an average of (61±12) years. There were no significant differences in the sex, age and general information among all the patients. This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and informed consent was obtained from each patient.METHODS: ① According to the smoking habit, 500 patients with suspected or known coronary artery disease were divided into smoking group (n=254) and non-smoking group (n=246). ② All the patients received anthropometric measurements including body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were drawn from every patient at admission to the detect the leukocyte counts in peripheral blood, including total leukocyte count, neutrophil count, eosinophil count, lymphocyte count, monocyte count and basophil count. ③ The severity of coronary atherosclerosis was defined by the Gensini score system, based on the hypothesis that the severity of coronary artery disease should be considered as a consequence of the functional significance of the vascular narrowing and the extent of the area perfused by the involved vessel or vessels. In this scoring system, a greater reduction of the lumen diameter was assigned a higher score than a distal lesion. ④The association of smoking amount with Gensini score, anthropometric measurements and leukocyte count were studies with the Spearman correlation analysis.MAIN OUTCOME MEASURES: ① Results of BMI, SBP, DBP, leukocyte count and Gensini score; ② Results of the Spearman correlation analysis on the association of smoking amount with Gensini score, anthropometric measurements and leukocyte count.RESULTS: ① The total leukocyte count, neutrophil count, monocyte count in peripheral blood and Gensini score were significantly higher in the smoking group than in the non-smoking group.② The Spearman correlation analysis indicated that the amount of cigarette smoking was significantly associated with the total cigarettes smoked, total leukocyte count,neutrophil count, monocyte count and Gensini score (r=0.109, 0.100,0.135, 0.139, P ＜ 0.05-0.01).CONCLUSION: Smoking is significantly associated with the severity of coronary atherosclerosis, and the inflammatory response may be part of the mechanisms underlying the association between coronary artery disease and cigarette smoking.

OBJECTIVETo evaluate the safety and efficacy of the Amplatzer septal occluder for transcatheter closure in patients with secundum atrial septal defect (ASD II).

METHODSPatients with clinically confirmed ASD II were recommended for transcatheter closure of ASD II.

RESULTS30 ASD II patients (20 females) underwent transcatheter closure at a median age of 18.4 years (5-55 years). Both the stretched diameters of ASDs and the sizes of the devices were from 18 to 34 mm (25 +/- 7 mm). The successful placement rate was 100%. The rest shunt documented by color Doppler, was immediately after implantation in 40% of patients, in 9.9% after 24 hours, and in 3.3% trace at 3 months. No serious complications were observed. There was improvement in symptoms and in cardiac size. Septal motion abnormalities normalized in all patients after 3 months follow-up.

CONCLUSIONThe Amplatzer septal occluder is a safe and effective device for transcatheter closure of ASD II. Long-term follow-up is still required before widespread clinical use can be recommended.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Septal Defects, Atrial ; surgery ; Humans ; Male ; Middle Aged ; Surgical Instruments

Objective:To evaluate the efficacy and safety of allopurinol in the treatment of chronic kidney disease.Methods:The databases of Embase, PubMed and the Cochrane library were searched for randomized controlled trials of allopurinol in patients with chronic kidney disease. According to the Cochrane system evaluation method, two evaluators independently screened the literature and extracted the data, and analyzed the results with Revman 5.3 software.Results:Finally, 10 articles were included, including 940 patients (472 in the experimental group and 468 in the control group). Meta analysis showed that allopurinol treatment could reduce blood uric acid ( MD=-2.40, 95% CI: -2.74--2.05, P<0.01), 24-hour urinary protein ( MD=-0.61, 95% CI: -1.17--0.06, P=0.03) and increase estimation of glomerular filtration rate(eGFR) ( MD=2.51, 95% CI: 1.86-3.17, P<0.01). There was no significant difference in adverse events between the experimental group and the control group ( OR=1.40, 95% CI: 0.61-3.19, P=0.42), but allopurinol treatment could reduce the risk of cardiovascular events ( OR=0.58, 95% CI: 0.38-0.89, P=0.01). Conclusions:Allopurinol treatment of chronic kidney disease can reduce urinary protein, improve eGFR, and reduce the risk of cardiovascular events.

Objective To systematically review the influencing factors of nutritional status in patients with head and neck cancer(HNC). Methods Researches on influencing factors of nutritional status in HNC patients were retrieved in databases,such as PubMed,EBSCO,Web of Science,CNKI,WanFang Data and Chinese Biological Medicine(CBM)by computer from January 2010 to July 2018. Quality assessment, content extract and analysis was carried out for literatures met inclusive criteria. Results Finally,a total of 19 researches were included.Qualitative analysis and simple correlation showed that those researches involved 47 factors,the influencing factors of nutritional status included the reduced ingestion,high levels of weight and body mass index(BMI)before treatment,low levels of hemoglobin and serum albumin,swallowing problem,thirst,sense problem,constipation and oral mucositis;23 factors of them were with varying degrees of influence,such as the ages,males,education levels and drinking. Multivariate analysis showed that those researches involved 35 factors;the influencing factors of nutritional status of HNC patients included the radiotherapy types/technology and swallowing problem;17 factors of them were with varying degrees of influence,such as the ages,habitation and smoking. In simple correlation and multivariate analysis,swallowing problem was the only factor with statistical differences in two kinds of analysis;the ages,tumor stage,tumor location/kinds of disease,grades of T and N,complications after radiotherapy and adverse reactions were only with statistical differences in simple correlation but without statistical differences in multivariate analysis. Conclusions Nutritional status of HNC patients is influenced by many factors and influence of most factors is uncertain with great individual differences. Influencing factors of nutritional status of HNC patients and mechanisms need to be explored and expounded respectively by further studies,especially pay attention to swallowing problem of HNC patients.

OBJECTIVE To optimize the system of patent linkage system and provide a reference for encouraging generic drugs to apply for listing. METHODS On the basis of literature research， combined with the author’s work experience， the situation of generic drug application and patent challenge were analyzed comparatively after the implementation of the patent linkage system in China. Based on the patent linkage system， the reasons for the insufficient incentive for the challenge of generic drug patents in China were analyzed； corresponding countermeasures and suggestions were proposed. RESULTS & CONCLUSIONS The patent linkage system in China was implemented in 2021， but due to the implementation of the system being still in its initial stage， the relevant documents for practical guidance are not yet complete， and the supporting incentive mechanism is not yet sound， resulting in a weak willingness of generic pharmaceutical enterprises to initiate patent challenges. It is suggested that China can further improve the patent linkage system by improving the patent information registration platform of generic drugs， developing professional drug patent agencies， and establishing the patent common challenges platform of the first generic drug， in order to incentivize Chinese generic drug enterprises to increase innovation motivation， challenge original research drug patents， and apply for listing， achieving the effect of suppressing drug prices and benefiting the people through full competition.

Objective To measure the peripheral dose distributions of the mobile head cone beam computed tomography (CBCT) and evaluate the impact of CBCT on the surrounding personnel and environment, and provide data support for clinical radiation protection management. Methods Combined with the structural characteristics of CBCT, AT1123 was used in the direction of 0° (counterclockwise), 45°, 90°, 135°, 180°, 225°, 270° and 315° in front of CBCT to measure the ambient dose equivalent rate of 30 cm, 80 cm and 130 cm away from the ground when the equipment was normally out of the beam, and the boundary of the temporary control area was drawn. At the same time, the dose level behind the lead screen 1 m away from the external surface of the equipment was measured and analyzed. Results The dose field around CBCT was symmetrically distributed with the dividing line of 0° and 180°, and the radiation dose level of 5.5 m in the direction of 0°, 3.5 m in the direction of 45°, 0.5 m in the direction of 90° and within 1.0 m in the direction of 180° (inside the "spoon" type) was higher than 2.5 μSv/h. The radiation dose levels of CT aperture 0° (straight forward), 45° and 315° behind the lead screen 1 m away from the equipment surface were 0.37 μSv/h, 0.22 μSv/h and 0.54 μSv/h, respectively. Conclusion The results show that the radiation dose around the mobile head cone beam CT is in a low dose level, the distribution of the dose field can provide necessary reference for the administrative and medical personnel to strengthen the radiation safety management. At the same time, it is suggested that lead screens should be set up in the clinical use of mobile CT to ensure the health and safety of the surrounding people and the environment.