A novel avian influenza A (H7N9) virus recently emerged in the Yangtze River delta and caused diseases, often severe, in over 130 people. This H7N9 virus appeared to infect humans with greater ease than previous avian inlfuenza virus subtypes such as H5N1 and H9N2. While there are other potential explanations for this large number of human infections with an avian influenza virus, we investigated whether a lack of conserved T-cell epitopes between endemic H1N1 and H3N2 inlfuenza viruses and the novel H7N9 virus contributes to this observation. Here we demonstrate that a number of T cell epitopes are conserved between endemic H1N1 and H3N2 viruses and H7N9 virus. Most of these conserved epitopes are from viral internal proteins. The extent of conservation between endemic human seasonal inlfuenza and avian inlfuenza H7N9 was comparable to that with the highly pathogenic avian inlfuenza H5N1. Thus, the ease of inter-species transmission of H7N9 viruses (compared with avian H5N1 viruses) cannot be attributed to the lack of conservation of such T cell epitopes. On the contrary, our ifndings predict signiifcant T-cell based cross-reactions in the human population to the novel H7N9 virus. Our findings also have implications for H7N9 virus vaccine design.

The results of previous studies on the menstrual-related sleep changes were inconsistent. The menstrual-related circadian sleep-wake and rest-activity rhythms changes are still uncertain. Using actigraphic monitoring of wrist activity, we investigated the sleep-wake and rest-activity patterns of 12 normally cyclic healthy women during reproductive life. Multivariate analyses were performed during the four phases of the menstrual cycle: menstrual phase (lst to 5th day of menstrual cycle), late follicular/peri-ovulation phase (11th to 15th day), early to mid luteal phase (18th to 23rd day) and late luteal phase (25th to 28th day), respectively. The variables of circadian sleep-wake pattern were similar in the four phases, except an increased tendency of the sleep latency in peri-ovulation phase compared with the early to mid-luteal phase (19+/-18 vs 9+/-6), but unfortunately no statistical significance were found (P<0.10). Concerning the circadian patterning of rest and activity, the interdaily stability (IS) in menstrual phase was significantly higher than the early to mid luteal phase (P<0.05). In early to mid luteal phase, the M10 onset time was significantly earlier compared with that of the late follicular/peri-ovulation phase (P<0.05), and the cosinor peak time was significantly earlier compared with that of the late luteal phase (P<0.05). The circadian periodogram calculated the period length of the rhythm of average woman. The average length was (24.01+/-0.29) h, and there was no significant difference among the four menstrual phases. The results suggest that the phase of circadian rest-activity rhythm may be modulated by the menstrual cycle, but the quantity and quality of the rest-activity rhythm have no essential different, and that menstrual cycle may have no effects on the circadian sleep-wake rhythm in normally cyclic healthy women.
Activity Cycles ; physiology ; Circadian Rhythm ; Female ; Humans ; Luteal Phase ; physiology ; Menstrual Cycle ; physiology ; Sleep ; physiology ; Wakefulness ; physiology

Objective: To analyze the status of early use of oral β-blocker and its relationship with in-hospital outcomes in eligible patients with acute coronary syndrome (ACS). Methods: The study was based on the Improving Care for Cardiovascular Disease in China (CCC)-ACS project. The data of ACS patients that collected during 2014 to 2019 from 230 collaborating hospitals across China were analyzed. Propensity score matching method and Cox multivariate regression analysis were used to analyze the association between early use of oral β-blocker and in-hospital outcomes within 15 days. Results: A total of 38 663 eligible ACS patients were included in this study. The mean age was (57.0±9.0), and 78.8% of the ACS patients (30 470/38 663) were male. The proportion of early use of oral β-blockers was 64.9% (25 112/38 663), but varied substantially, in the 230 hospitals with a range from 0 to 100%. Compared with the patients no early use of oral β-blocker, the patients receiving early oral β-blocker had significantly lower incidence of major cardiovascular adverse events (MACEs) (3.4% (395/11 536) vs. 2.9%(339/11 536), P=0.036)and less occurrences of heart failure (2.7% (316/11 536) vs. 2.1% (248/11 536), P=0.004). Multivariate Cox regression analyses showed the patients receiving early oral β-blocker had 15.5%, 23.1%, and 35.3% lower risks of MACEs, heart failure and cardiogenic shock respectively than the patients no early oral β-blocker. Conclusions: Compared with the patients no early oral β-blocker, the patients receiving early oral β-blocker had lower risks of MACEs events, heart failure and cardiogenic shock. However, the early use of oral β-blocker in ACS patients was generally insufficient with huge differences among different hospitals in China.
Acute Coronary Syndrome/drug therapy* ; Adrenergic beta-Antagonists/therapeutic use* ; Heart Failure ; Hospitals ; Humans ; Male ; Shock, Cardiogenic

Objective: To analyze the current status, trend and predictors of thromboembolism risk assessment in patients hospitalized with non-valvular atrial fibrillation (NVAF) in tertiary hospitals in China. Methods: The study was based on data from the Improving Care for Cardiovascular disease in China (CCC)-Atrial Fibrillation (AF) project. About 10% of the tertiary hospitals in each geographic-economic stratum were recruited. Participating hospitals reported the first 10 to 20 patients with a discharge diagnosis of atrial fibrillation monthly. From February 2015 to December 2019, a total of 49 104 NVAF patients from 151 tertiary hospitals in 30 provinces, municipalities and autonomous regions were enrolled. Clinical data of the patients was collected. The proportion of NVAF patients receiving thromboembolism risk assessment, variations in the proportion between different hospitals, the time trend of the application of thromboembolism risk assessment, and the predictors of the application of thromboembolism risk assessment were analyzed. Results: The age of the NVAF patients was (68.7±12.1) years, 27 709 patients (56.4%) were male. Only 17 251 patients (35.1%) received thromboembolism risk assessment. The proportion varied substantially between hospitals with the lowest value of 0 and the highest value of 100%. Among the hospitals, which enrolled more than 30 patients, no patients received thromboembolism risk assessment in 18.4% (26/141) of the hospitals, more than 50% of the patients received thromboembolism risk assessment in 21.3% (30/141) of the hospitals, and all the patients received thromboembolism risk assessment in only 1 hospital. The proportion of NVAF patients receiving thromboembolism risk assessment was 16.2% (220/1 362) in the first quarter of 2015, and significantly increased to 67.1% (1 054/1 572) in the last quarter of 2019 (P<0.001). Patients' characteristics were associated with the application of thromboembolism risk assessment. The odds of receiving thromboembolism risk assessment was lower in male patients compared to female patients(OR=0.94,95%CI 0.89-0.99), lower in patients with acute coronary syndrome or other cardiovascular diseases compared to those with AF as the primary admission reason (OR=0.59, 95%CI 0.55-0.63, OR=0.52, 95%CI 0.45-0.61, respectively), and lower in patients with paroxysmal, persistent and long-standing/permanent AF compared to those with first detected AF (OR=0.62, 95%CI 0.57-0.67, OR=0.72, 95%CI 0.66-0.79, OR=0.57, 95%CI 0.52-0.64, respectively). The odds was higher in patients with a history of hypertension, heart failure, stroke/TIA, and previous anticoagulant therapy compared to those without the above conditions (OR=1.17, 95%CI 1.11-1.23, OR=1.18, 95%CI 1.07-1.30, OR=1.17, 95%CI 1.08-1.27, OR=1.28, 95%CI 1.19-1.37, respectively) (P all<0.05). Conclusion: Thromboembolism risk assessment was underused in patients hospitalized with NVAF in tertiary hospitals in China, and there were substantial variations between hospitals in the application of thromboembolism risk assessment. The application of thromboembolism risk assessment in tertiary hospitals has been improved in recent years, but there is still plenty of room for future improvement. Patients' characteristics could affect the application of thromboembolism risk assessment in China.
Aged ; Aged, 80 and over ; Anticoagulants ; Atrial Fibrillation/epidemiology* ; China/epidemiology* ; Female ; Humans ; Male ; Middle Aged ; Risk Assessment ; Risk Factors ; Stroke ; Tertiary Care Centers ; Thromboembolism/epidemiology*

Objective: To compare the efficacy and safety between indobufen and aspirin in the prevention of restenosis of bridge vessels at 1 year after off-pump coronary artery bypass grafting. Methods: This study was a prospective cohort study. We selected 152 patients who received coronary artery bypass grafting in Beijing Anzhen Hospital from December 2016 to December 2018. Patients were divided into the indobufen group and the aspirin group. Patients in the aspirin group were treated with aspirin and clopidogrel, and patients in the indobufen group were treated with indobufen and clopidogrel. During the 1-year follow-up, the rate of restenosis of saphenous vein bridge and internal mammary artery bridge, the rate of adverse cardiac events and adverse reactions were compared between the two groups. The levels of fibrinogen (FIB), D-dimer (D-D), thrombomodulin (TM) and thrombin-activatable fibrinolysis inhibitor (TAFI) were compared before and after antiplatelet therapy. Results: There were 76 cases in the indobufen group, including 57 males (75.0%), aged (60.3±6.6) years. There were 76 cases in the aspirin group, including 62 males (81.6%), aged (59.7±7.2) years. Baseline data were comparable between the two groups (P>0.05). During the follow-up, 3 cases were lost to follow up. Follow-up was completed in 74 patients in the indobufen group and 75 in the aspirin group. A total of 268 bridging vessels were grafted in the indobufen group and 272 in the aspirin group. One year after surgery, the patency rates of great saphenous vein bridge and internal mammary artery bridge were 94.5% (189/200) and 97.1% (66/68) in the indobuphen group, and 91.3% (189/207) and 96.9% (63/65) in the aspirin group, respectively. There was no significant difference in patency rate of great saphenous vein bridge and internal mammary artery bridge between the two groups (χ²=0.282, 0.345, P>0.05). The total incidence of adverse cardiac events was 5.4% (4/74) in the indobufen group and 6.7% (5/75) in the aspirin group (χ²=0.126, P>0.05). The overall incidence of gastrointestinal adverse reactions was significantly lower in the indobufen group than in the aspirin group (4.1% (3/74) vs. 13.3% (10/75), χ²=4.547, P<0.05). The levels of FIB, D-D, TM and TAFI in the two groups were lower than those before surgery (P<0.05), and there was no statistical significance between the two groups at baseline and post-operation (P>0.05). Conclusion: The efficacy of indobufen combined with clopidogrel in the prevention of 1-year restenosis after coronary artery bypass graft is similar to that of aspirin combined with clopidogrel, but the incidence of adverse reactions is lower, and the safety is higher in patients treated with indobufen combined with clopidogrel compared to aspirin combined with clopidogrel strategy.
Aspirin/therapeutic use* ; Clopidogrel/therapeutic use* ; Coronary Artery Bypass/adverse effects* ; Drug Therapy, Combination ; Humans ; Isoindoles ; Male ; Phenylbutyrates ; Platelet Aggregation Inhibitors/therapeutic use* ; Prospective Studies ; Treatment Outcome

Objective    To compare the ascending aortic diameter and postoperative outcomes of patients with simple ascending aortic dissection or simple ascending aortic dilatation and to study the reliability of the surgical indication in present guideline for Chinese patients with ascending aortic dilatation. Methods    The clinical data of patients with aortic aneurysm and aortic dissection who underwent surgery at Beijing Anzhen Hospital, Capital Medical University from 2010 to 2017 were retrospectively reviewed. After exclusion of patients with Marfan syndrome, heart valve and other diseases, 139 patients were divided into two groups: a simple ascending aorta dilatation group (56 patients) and a simple ascending aortic dissection group (83 patients). The ascending aortic diameter and postoperative outcomes of two groups were compared.  Results    The inner ascending aortic diameter (57.30±9.41 mm vs. 50.72±9.53 mm, P <0.001) and the inner ascending aortic diameter index (31.12±5.38 vs. 27.22±6.40, P<0.001) in the simple ascending aorta dilatation group were significantly greater than those in the simple ascending aortic dissection group. For male patients, the results were similar (60.28±10.80 mm vs. 47.40±6.53 mm; 30.00±6.33 vs. 23.60±3.72, both P<0.001). But for the female patients, there was no significant difference between the two groups (54.90±7.47 mm vs. 53.81±10.84 mm; 32.03±4.37 vs. 30.58±6.56, both P>0.05). The mortality, the incidence of tracheotomy and postoperative reopen rate in the simple ascending aortic dissection group were higher. Conclusion    In this study, the inner diameter of the ascending aorta in the group of ascending aorta is mostly < 5.5 cm. In our opinion, the present surgical indication for Chinese patients with ascending aortic dilatation is not enough. In the future clinical studies, we also need to find more reasonable surgical indications.

OBJECTIVETo evaluate the relationship between A46G and C79G polymorphisms in the β2-adrenergic receptor (ADRB2) gene and the incidence of essential hypertension (EH) among the Han Chinese population.

METHODSWe conducted a computer retrieval of PUBMED, EMBASE, CNKI, Wanfang and VIP databases prior to May 2010. Articles investigating the relationship of EH and ADRB2 gene polymorphism of Han group were found through literature search, including 15 articles on A46G and 10 articles on C79G. According to the including and excluding criteria, a Meta-analysis was conducted in EH and ADRB2 gene polymorphism of A46G and C79G. The association was examined by RevMan4.2 software through quantitative analysis.

RESULTSEight articles on A46G polymorphism (including 1078 EH cases and 788 control subjects) and six articles on C79G polymorphism (including 1367 EH cases and 1006 control subjects) were included in the current study. Meta-analysis showed that there was a significant association between A46G polymorphism and EH: genotype GG/(AA + AG) (fixed-effected model, OR = 1.35, 95%CI = 1.04 - 1.74, P = 0.02), genotype GG/AA (fixed-effected model, OR = 1.41, 95%CI = 1.06 - 1.89, P = 0.02). No significant association was found between C79G polymorphism and EH of Han group in China: G/C allele comparison (random-effected model, OR = 0.88, 95%CI = 0.55 - 1.39, P = 0.57).

CONCLUSIONSignificant association was found between A46G polymorphism of ADRB2 gene and EH, whereas no association could be found between C79G polymorphism and EH among Han Chinese population.

Alleles ; Asian Continental Ancestry Group ; genetics ; China ; epidemiology ; Gene Frequency ; Genotype ; Humans ; Hypertension ; epidemiology ; genetics ; Polymorphism, Single Nucleotide ; Receptors, Adrenergic, beta-2 ; genetics ; Risk Factors

OBJECTIVETo study the use of traditional Chinese medicine (TCM) or both TCM and guideline-recommended Western medicine (WM) in Chinese patients with coronary heart disease (CHD).

METHODSA cross-sectional nationwide survey of 2803 CHD outpatients was completed by collecting information, including general demographic data, disease history, and use of drugs (including TCM and WM).

RESULTSOf the 2712 CHD outpatients with complete drug treatment data, only 3.1% received TCM without any WM for CHD, 30.0% received both TCM and WM recommended by current CHD guidelines, and 66.9% received only WM. Patients with a longer history of CHD or with a history of stroke, were more likely to use TCM. However, 90.6% of CHD patients who used TCM also used certain WM. Furthermore, patients who used more types of TCM tended to use much less WM recommended by current guidelines.

CONCLUSIONA substantial proportion of Chinese CHD outpatients use both TCM and WM for secondary prevention of CHD. It is important to assess the effect of combined TCM and WM on major clinical outcomes in Chinese CHD patients.

Aged ; Asian Continental Ancestry Group ; statistics & numerical data ; China ; Coronary Disease ; prevention & control ; Cross-Sectional Studies ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; utilization ; Middle Aged ; Secondary Prevention ; statistics & numerical data

OBJECTIVETo study the significance of intra-tumoral cavitation in the patients with advanced NSCLC treated by rh-endostatin plus NP chemotherapy.

METHODSFifty-seven patients with advanced NSCLC were randomly assigned to receive chemotherapy with rh-endostatin plus NP or NP alone. The numbers of activated circulating endothelial cells (aCECs) were measured by flow cytometry. Chest computed tomography was performed to evaluate the efficacy after 2 cycles of chemotherapy.

RESULTSCavitation occurred in 5 of 29 patients in the rh-endostatin plus NP group, but not in any case of the NP group. Of the 5 patients, there were 2 males and 3 females, with pathological types of 3 adenocarcinomas, 1 adenosquamous cell carcinoma and 1 sarcomatoid carcinoma. All of these 5 cases had a peripherally located tumor in the CT scan. There was only one cavity in each case and most of these were roundish. Four cavities were situated in the center of the tumor and another one was eccentric. There were 3 cavities with thin wall and 2 with thick wall. Their average diameter was 2.7 cm. No hemoptysis occurred in these 5 patients. The blood-supply of the tumors showed by perfusion CT images was inhibited in 3 cases after treatment. The average number of aCECs decreased from 323.2/10(5) to 33.0/10(5) after treatment.

CONCLUSIONIntratumoral cavitation is a peculiar imaging characteristics after anti-angiogenic therapy, which may be caused by inhibition of blood-supply to the tumor. CT perfusion imaging and measurement of activated circulating endothelial cells may be helpful to predict the efficacy of anti-angiogenic therapy combined with chemotherapy.

Angiogenesis Inhibitors ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; drug therapy ; pathology ; Cisplatin ; administration & dosage ; Endostatins ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Recombinant Proteins ; therapeutic use ; Tomography, X-Ray Computed ; Vinblastine ; administration & dosage ; analogs & derivatives

BACKGROUNDChronic heart failure (CHF) is a severe clinical syndrome associated with high morbidity and mortality, and with high health care expenditures. No nationwide data are currently available regarding the quality of clinical management of CHF patients in China. The aim of this study was to assess the quality of care of CHF inpatients in China.

METHODSThe American College of Cardiology/American Heart Association Clinical Performance Measures for Adults with Chronic Heart Failure (Inpatient Measurement Set) with slight modifications was used to measure the performance status in 612 CHF patients with acute coronary syndrome (ACS) from 65 hospitals across all regions of China.

RESULTSThe implementation rates of guideline recommended strategies for CHF management were low. Only 57.5% of the CHF patients received complete discharge instructions, 53.6% of the patients received evaluation of left ventricular systolic function, 62.8% received an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at discharge, and 52.7% received a β-blocker at discharge, 56.3% of the smokers received smoking cessation counseling. The rate of warfarin utilization was only 9.7% in CHF patients with atrial fibrillation. Most patients (81.4%) did not receive all the first four treatments. There were marked differences in the quality of CHF management among patients with different characteristics.

CONCLUSIONSPerformance measures provide a standardized method of assessing quality of care, and can thus highlight problems in disease management in clinical practice. The quality of care for CHF patients with ACS in China needs to be improved.

Acute Coronary Syndrome ; therapy ; Aged ; China ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Quality of Health Care ; Secondary Prevention ; Sex Characteristics