OBJECTIVETo evaluate the potential usefulness of a multivariable model in predicting the response to immunosuppressive therapy (IST) in patients with aplastic anemia (AA), and its application to the clinical practice.

METHODSPB T cells subpopulation and BM T cells intracellular IFN-gamma and IL-4 were serially analyzed by flow cytometry (FCM) before and during treatment. HLA-DRB1 * 1501 phenotype was analyzed by PCR-SSP. The predictive potentials of different parameter combinations for clinical responsiveness were statistically assessed.

RESULTSIn all evaluated parameters, CD8+ cell intracellular IFN-gamma had the relatively best diagnostic value with sensitivity and specificity of 94.3% and 62.5%, and positive and negative predictive value of 84.6% and 83.3% respectively. Positive CD8+ cell intracellular IFN-gamma plus Tc1/Tc2 < 50 could increase the positive predictive value to 92.3%. A multivariable model consisting of absolute neutrophil count (ANC), BM T cell intracellular IFN-gamma, Tc1/Tc2 ratio and HLA-DRB * 1501 phenotype of the patients was finally established.

CONCLUSIONThe multivariable model is superior to each of the single parameters in terms of predictive power of IST therapeutic outcome, and its higher accuracy and the clinical application make it potentially useful in practice.

Adolescent ; Adult ; Aged ; Anemia, Aplastic ; drug therapy ; immunology ; Child ; Feasibility Studies ; Female ; HLA-DR Antigens ; immunology ; Humans ; Immunosuppression ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Models, Statistical ; T-Lymphocyte Subsets ; immunology ; T-Lymphocytes ; immunology ; Treatment Outcome

OBJECTIVETo analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).

METHODSBetween January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71 ± 26.3) months] with TGA. The patients were divided in intact ventricular septum group (n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113): TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality.

RESULTSThe overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤ 3 kg (OR: 4.571, P = 0.0409), complicating ventricular septal defect (OR: 4.444, P = 0.0406), complex TGA (OR: 4.321, P = 0.0140), coronary anomalies (OR: 4.867, P = 0.0104) and non-type A coronary arteries (OR: 3.045, P = 0.0243) were independent predictors for poor early postoperative survival.

CONCLUSIONBody weight ≤ 3 kg, complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.

Arteries ; surgery ; Body Weight ; Cardiac Surgical Procedures ; mortality ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; complications ; mortality ; surgery ; Hospital Mortality ; Humans ; Infant ; Logistic Models ; Male ; Risk Factors ; Transposition of Great Vessels ; mortality ; surgery

Objective To study the correlation analysis of mecobalamin in treatment of diabetic peripheral neuropathy and its plasma homocysteine level. Methods 100 patients were selected from January 2013 to August 2016 treatment of diabetic peripheral neuropathy, according to admission ID, were randomly divided into control group and observation group, each group of 50 people. At the same time, 50 healthy persons were collected as normal control group and two groups were given routine treatment of Western medicine. The observation group was given mecobalamin. The plasma levels of plasma homocysteine were detected in the three groups, and the improvement degree of neuropathy was assessed by clinical and electrophysiological methods. Results The observation group and the control group of patients before treatment, plasma homocysteine levels were significantly higher than normal control group; the observation group with Mecobalamin after treatment of plasma homocysteine level in patients were significantly better than the control group (P<0.05); through clinical and electrophysiological evaluation method of observation group of patients in the neuropathic symptoms and nerve conduction velocity is the control group improved significantly (P<0.05). Conclusion The levels of plasma homocysteine and diabetic peripheral neuropathy have a strong correlation, and the use of mecobalamin in treating diabetic peripheral neuropathy can decrease homocysteine levels in patients with, and is effective for the treatment of diabetic peripheral neuropathy, and can be widely applied in clinical treatment.

Objective:To evaluate the safety and efficacy of balloon-assisted tracking (BAT) technique in guiding the catheter through the spastic radial artery via percutaneous coronary intervention.Methods:The data of patients who received coronary intervention through the transradial approach in Department of Cardiology of Zhongshan Hospital Affiliated to Fudan University from June 2014 to September 2016 were retrospectively analyzed.69 cases of radial artery and / or brachial artery spasm were selected, of which 24 cases were treated with BAT technique (group BAT), and 45 cases were treated by the conventional method (conventional group).The success rate of the catheter through the spastic segment and the incidence of related complications were compared between the two methods.Results:In the BAT group, the guide catheter was successfully negotiated across the spastic segment or dissecting vessels in all 24 cases (100%), while in only 14 cases (31.1%) in the conventional group (P=0.000).Guide catheter traversing the spastic segment within 5min, between 5min and 15min, and more than 15min was seen in 20 (83.3%), 3 (12.5%) and 1 (4.2%) patients in the BAT group, while in 2 (14.3%), 6(42.9%) and 6 (42.9%) patients in the conventional group, respectively (P=0.000).Incidence of forearm hematoma was 8.3% and 20% in the BAT group and the conventional group, and the difference was not statistically significant.Conclusions:The BAT technique is a safe and effective way to guide the catheter through the spasm of radial and/or brachial artery via percutaneous coronary intervention.BAT is superior to the conventional technique.

Objective: To describe the incidence,clinical characteristics,therapy strategy and outcomes of spontaneous coronary artery dissection based on single-center experience in China.Methods:We performed retrospective case-identification study in 16 526 patients underwent coronary angiography in Zhongshan Hospital of Fudan University between March 2015 to December 2016,and identified 17 patients with spontaneous coronary artery dissection.Risk factors,clinical features,angiographic features,therapy strategy,and clinical outcomes were analyzed.Results:The incidence of SCAD was 17 of 16 526(1.03/1 000).The mean age was(49.06 ± 10.73)years old(range:26-67 years old).In these 17 cases,4 cases were males,and others were females.Females constituted 13 of 17(76.5%).All SCAD patients presented with acute coronary syndrome,including 10 patients with acute ST-elevated myocardial infarction,3 patients with acute non-ST-elevated myocardial infarction and 4 patients with unstable angina.Twenty dissection sites were identified in 17 SCAD patients. Dissection was predominantly located at the left descending artery(50%)and the right coronary artery(35%).All lesions fell into three types:type Ⅰ(n=5),type Ⅱ A(n= 7),type ⅡB(n= 6),and type Ⅲ(n= 2).The TIMI flow in the distal segment of the coronary dissection was classified as follows:class 0(n=4),class 1(n=2),class 3(n=14).Conservative medical treatment was adopted by 7 of 17(41.1%)patients,and percutaneous transluminal coronary angioplasty(PTCA)in 1 of 17(5.9%)patients.No recurrent angina and other cardiovascular events was observed during clinical follow up. Percutaneous coronary intervention(PCI)was performed in 9 of 17(52.9%)patients,and the mean number of deployed stent was(2.44 ± 1.13).Intramural hematoma was extended during PCI in 5 of 9(55.6%)patients,resulting in new-onset nonfatal myocardial infarction in one patient and cardiac death in another patient.Conclusions:SCAD should be considered in young and middle-aged female patients presented with acute coronary syndrome,especially in those with few coronary risk factors. Interventional cardiologist should be familiar with the angiographic characteristics of SCAD,and turn to intravascular ultrasound if necessary.Conservative treatment should be the first choice in most patients with SCAD,while PCI intervention could be considered in high risk patients.Be caution to prevent interventional complications such as dissection expansion in the patients with high-risk.

Chemical constituents were isolated from the fruiting bodies of Ganoderma australe by various column chromatographic techniques and HPLC method, and their chemical structures were identified through the combined analysis of physicochemical properties and spectral data. Meanwhile, their α-glucosidase inhibitory activity and anti-oxidative ability were evaluated. Seven compounds were isolated from G. australe and were identified as 6-methoxyl-cyclo-(Phe-Ile)(1), applanoxidic acid A methyl ester(2), ergosta-7,22 E-dien-3β-ol(3), cinnamic acid(4), 5α,8α-epidioxy-(20S,22E,24R)-ergosta-6,22-diene-3β-ol(5), 1-(3, 4-dihydroxyphenyl) ethanone(6), salicylic acid(7) and benzoic acid(8). Among the compounds, compound 1 was a new cyclic dipeptide. Compound 2 was a new lanosta natural product, and compounds 4, 6, 7 and 8 were obtained from G. australe for the first time. Moreover, compounds 4 and 8 exhibited α-glucosidase inhibitory activity with inhibition rates of 36.8% and 34.7%, and compounds 4, 7 and 8 had a certain activity in DPPH free radical scavenging activity with IC_(50) values of 0.168, 0.458 and 0.170 g·L~(-1), respectively. The DPPH radical scavenging rate of compound 1 was 41.1%.
Free Radical Scavengers ; isolation & purification ; Fruiting Bodies, Fungal ; chemistry ; Ganoderma ; chemistry ; Glycoside Hydrolase Inhibitors ; isolation & purification ; Molecular Structure

To investigate the clinical manifestations and laboratory characteristics of 6 cases of pemphigoid nodularis (PN). The clinical and laboratory data of 6 patients with PN admitted to the Department of Dermatology,Peking Union Medical College Hospital from January 2016 to August 2019 were retrospectively analyzed. PN mainly occurred in middle-aged and elderly people,with an average age of (58±16) years. Eosinophils were elevated in 4 patients. Immunoglobulin E (IgE) level was (530±672) kU/L in five patients. Direct immunofluorescence showed IgG and/or C3 deposition on basal membrane zone. Indirect immunofluorescence showed positive IgG anti-basement membrane zone,with a titer of 1:40-1:320. Enzyme-linked immunosorbent assay showed the anti-BP180 antibodies were positive [24-85 U/ml,average(43±26) U/ml] in 5 patients. None of the patients had neurological disorders. One patient was lost to follow-up. The disease recurred in 3 of 5 patients during the follow-up,and two patients still received maintenance corticosteroids. PN mainly occurs in middle-aged and elderly individuals. It is featured by elevated eosinophils and total IgE and relatively low anti-BP180 antibody titers. Recurrence is common but PN is less likely to be associated with neurological diseases.
Adult ; Aged ; Autoantibodies ; blood ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Humans ; Immunoglobulin E ; blood ; Middle Aged ; Pemphigoid, Bullous ; diagnosis ; pathology ; Retrospective Studies

OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.
Bronchopulmonary Dysplasia/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Respiratory Distress Syndrome, Newborn/epidemiology* ; Retrospective Studies ; Treatment Outcome