Objective To investigate the effect of CD40/CD40 ligand on the genesis and development of coronary artery disease (CAD),and the inhibitory effect of cyclosporine A (CsA) on CD40/CD40 ligand. Methods A total of 71 patients were divided into four groups:acute myocardial infarction group (AMI, n=19), unstable angina pectoris group (UAP, n=18), stable angina pectoris group (SAP, n=17) and normal control group (N, n=17). Flow cytometry was used to detect the expres?sion of CD40 and CD40L in peripheral blood mononuclear cells (PBMCs) of four groups. The group in which CD40 and CD40L were produced at the highest level was chosen, and a series concentrations of CsA(H1:0 mg/L, H2:0.01 mg/L, H3:0.1 mg/L, H4:1 mg/L)were used to treat the cells. Then the expressions of CD40 and CD40L were measured by flow cytome?try. Results Compared with N group,the expression of CD40 was significant higher in other groups (P<0.05). The expres?sion of CD40 was significant higher in UAP group and AMI group than that of SAP group. There was no significant difference in the expression of CD40 between UAP group and AMI group (P>0.05). The expression of CD40L was elevated and fol?lowed by different severity of CAD. There was significant difference in the expression of CD40L between groups (P<0.05) . AMI group showed the highest expression of CD40 and CD40L. After being treated with CsA, the expression of CD40 was higher in H1 group than that of H3 group and H4 group (P<0.05). The expression of CD40L was significantly higher in H1 group than that of other three groups (P < 0.05). Conclusion CD40 and CD40L may be involved in the development of CAD. Moreover, it might be restrained by CsA via regulation of CD40/CD40L.

Objective To determine the diagnostic accuracy of dual- source computed tomography coronary angiography (DSCT-CA) for detecting various degrees of coronary artery stenosis. Methods A total of 278 patients with coronary atherosclerotic heart disease (CHD) were selected for DSCT-CA examination. The coronary angiography (CAG) examination was carried out within 30 days in these patients. The result of CAG was used as the gold standard. The coronary artery stenosis of 50% and 75% was used as the sector. Based on the data of patients, DSCT-CA was calculated for quantitative assessment of the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of coronary stenosis for the coronary blood vessels and coronary artery segments. Kappa consistence test was used to analyze the results of two methods. Results The 50%and 75%of coronary artery stenosis was used for the sector, based on the patients, the sensitivities of DSCT-CA were 99.6% and 99.1%, specificities were 84.2%, 89.6%, diagnostic accuracies were 98.6%and 97.5%, and the Kappa values were 0.88 and 0.91. Based on coronary vessels, the sensitivities were 92.0%and 96.9%, specificities were 89.9%and 94.8%, diagnostic accuracies were 91.0%and 95.8%, and the Kappa values were 0.88 and 0.92. Based on coronary artery segments, the sensitivities were 97.3%, 96.5%, specificities were 93.3%, 98.1%, diagnostic accuracies were 94.2%and 97.9%, and the Kappa values were 0.84 and 0.91. Conclusion Based on patient’s coronary artery analysis, DSCT-CA can accurately assess the different degrees of coronary stenosis, but based on the analysis of the coronary artery segment, the false-positive results may occur in the diagnosis of DACT-CA, which
suggests that DSCT-CA can partly replace the CAG, still cannot completely replace the CAG.

Objective To investigate the relationship between vascular lesion and serological changes in patients with coronary heart disease (CHD) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods According to the standard, a total of 168 patients of OSAHS complicated with CHD were selected in this study. Those patients were divided into 3 groups according to the apnea hypopnea index (AHI) level:light group (AHI, 5-14/h), moderate group (AHI, 15-30/h) and severe group (AHI,>30/h). Syntax scores were performed on three groups according to coronary angiography results. The data of hemoglobin (Hb), platelet count (PLT), fibrinogen (FIB), D-Dimer (DD), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate transaminase (AST), uric acid (UA), creatinine (Cr) and echocardiographic examination index were collected and analyzed in three groups. Results The Syntax score was significantly higher in severe group than that in mild and moderate groups (P<0.05). There was no significant difference in the Syntax score between mild and moderate groups. The levels of Hb, FIB, LDL, pulmonary arterial pressure (PAP), and right ventricle transverse diameter (RVD) were significantly lower in the mild and moderate groups than those in the severe group (P<0.01). The left ventricular ejection fraction (LVEF) was significantly lower in the severe group than that in the mild and moderate groups (P < 0.01). There were no significant differences in levels of Hb, FIB, LDL, PAP, RVD and LVEF between mild group and moderate group (P > 0.05). Conclusion The serology and cardiac structure can change gradually in severe OSAHS patients, and the coronary artery lesion will be more complex. Therefore, the clinical treatment should pay attention to screening for OSAHS in patients with coronary heart disease.

Objective To assess the long-term effects of pacing in patients with hypertrophic obstructive eardiomyopathy(HOCM),and explore the most specific echocardiographic indexes.MethodsA total of 37 consecutive HOCM patients implanted dual-chamber pacemakers were enrolled and followed up.Thirty-seven cases were followed up for 1 year,26 cases were followed up for 2 years,and 10 cases were followed up for 3 years.After 1,2 and 3 years pacemaker implantation,pacing frequency,pacing threshold,impedance,atrioventricular delay and cumulative percent atrial and ventricular pacing were respectively tested,and left atrial dimension (LAD),left ventricular end-diastolic dimension (LVEDd),left ventricular posterior wall thickness (LVPW),interventricular septum thickness (IVS),left ventricular outflow tract diameter(LVOTd),left ventricular outflow tract pressure gradient (LVOTPG),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure (PASP) were measured and mitral valve systolic anterior motion(SAM) was observed.Pacing parameters and echocardiography indexes were dynamically compared before and after pacemaker implantation.ResultsPacing frequency was adjusted 60～70 bpm,atrioventricular delay was adjusted 90～ 180 ms,in order to achieve more than 95％ ventricular pacing,pacing threshold,pacing impedance were normal.The difference of various pacing parameters were no statistically significant within 3 years ( P ＞ 0.05).Compared with before pacing,after 1,2 and 3 years pacemaker implantation,IVS and LVOTPG declined significantly (P ＜ 0.01 ),LVOTd widened significantly ( P ＜0.01),SAM phenomenon improved obviously ( P ＜0.01 ),but the difference of LAD,LVEDd,LVPW,LVEF,PASP were no statistically significant ( P ＞ 0.05 ).Conclusions The heart structure reconstruction of patients with HOCM can been chronically improved by dual-chamber pacing treatment.IVS,LVOTd and LVOTPG can be used as the sensitive and specific indexes to evaluate pacing treatment.

Objective To observe the effect of different doses of atorvastatin combined with probucol on contrast induced acute kidney injury (CIAKI) and serum uric acid in elderly patients.Methods Totally 121 cases admitted for coronary angioplasty were randomly divided into three groups.In standard combining treatment group (n＝35),atorvastatin 20 mg qn and probucol 0.25 g,tid were given with no loading dose intake before angioplasty.In intensively combined treatment group (n＝41),atorvastatin 40mg qn and probucol 0.25 g,tid were given with a loading dose of atorvastatin 40 mg and probucol 0.5 g at 2 hours before angioplasty.In intensive atorvastatin therapy group(n＝45),atorvastatin 40 mg qn were given,with a loading dose of atorvastatin 40 mg 2 hours before angioplasty.All patients were then evaluated 24 hours before and after angioplasty procedure,and their blood urea nitrogen (BUN),serum creatinine (Scr),serum uric acid (SUA),estimated glomerular filtration rate (eGFR) by modified diet in renal disease study (MDRD) method were tested.The serum and urine at 24 hours before and after operation were collected.Neutrophil gelatinase associated lipocalin (NGAL) were determinated by enzyme linked immunosorbnent assay (ELISA) method.Results After operation,eGFR was decreased in standard combining treatment group [(76.2±14.3) ml· min-1 · 1.73 m-2 vs.(71.9±17.9) ml· min-1 · 1.73 m-2,P＜0.05],while Scr,eGFR and uNGAL showed no changes in intensively combining treatment group and intensive atorvastatin therapy group (P＞0.05) ; BUN in the two groups was decreased [(5.6± 1.4)mmol/L vs.(4.7±0.9) mmol/L,(5.3±1.2) mmol/L vs.(4.8±1.2) mmol/L,P＜0.01,P＜0.05].SUA was reduced in intensively combining treatment group (P ＜ 0.05).uNGAL was increased in standard combining treatment group (P ＜ 0.05).Conclusions For elderly patients,intensive atorvastatin therapy and combining intensive treatment can both improve CIAKI.Only combination and intensive treatment benefit for decrease of uric acid.

OBJECTIVETo understand provider initiated HIV testing and counseling (PITC) in a region with high HIV/AIDS epidemic in China, and analyze its effect to early detection of HIV infections.

METHODSBetween January and December, 2013, 37 county level medical institutions were selected as the study sites, among which, 19 were public medical institutions and 18 were private institutions. According to the related regulation, procedures and contents of PITC, the study was implemented among outpatients and inpatients who seek for doctors in these medical institutions and PITC were provided for them. The 'Individual Investigation Form' was used to record the information and high-risky factors, and the respondents were taken venous blood and given HIV screening and confirmation. All available serum samples of newly found HIV/AIDS cases were tested using the BED HIV Incidence Capture Enzyme Immunoassay (BED-CEIA) to differentiate the long-term infections and new infections (early detected infections). Chi-square analysis was used to compare the differences of characteristics of newly infected patients.

RESULTSBetween January and December, 2013, a total of 37 medical institutions provided PITC. 55 164 person times were received HIV screening, among which 658 were HIV positive, and 598 were confirmed to be HIV positive. The 598 cases were all provided transferring service. The differences of age, marital status, education levels, transmission routes and testing institutions had statistical significance to early detection (χ(2) equals to 23.54, 10.50, 17.96, 21.22 and 4.80; P equals to < 0.001, 0.005, < 0.001, < 0.001 and 0.029, respectively). And the early detection proportions among patients aged from 20 to 29 and from 50 to 84 were 47.1% (114/242) and 42.1% (24/57), respectively; the proportions among single and married patients were 37.8% (56/148) and 38.9% (143/368), respectively; the proportion among patients with high school education levels were 42.6% (26/61); the proportion among patients transmitted by fixed heterosexual sexual partners was 46.0% (86/187); the proportion among private hospitals was 40.3% (58/144).

CONCLUSIONA certain proportion of HIV infections were early detected by PITC in this region. The HIV early detection proportions among specific age group and population with spouse/fixed sexual partners were relatively high.

Acquired Immunodeficiency Syndrome ; diagnosis ; epidemiology ; Adult ; Aged ; Aged, 80 and over ; China ; Counseling ; Early Diagnosis ; Epidemics ; HIV Infections ; diagnosis ; epidemiology ; Humans ; Marital Status ; Mass Screening ; Middle Aged ; Outpatients ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.

METHODSFrom December 20, 2010 to March 10, 2011, the system sampling method was used to get the cases. A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi, Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture, Yunnan province were interviewed, and the demographic characteristics, quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared. A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.

RESULTSOf the 462 cases, 239 cases were from standard MMT clinic, and 223 cases were from the extension MMT clinic. Among them, 117 cases were new research objects into the group during the investigation. Among the clients of extension MMT clinic, 96.7% (147/152) of them were males, 37.5% (57/152) were Dai nationality, and 61.2% (93/152) were married, 38.8% (59/152) with primary school education, 95.4% (145/152) lived with their family or relatives, 96.7% (147/152) could arrive at the clinic from their habitation within 15 minutes. The positive detection rates 72% (13/18), 71% (24/34), 58% (30/52), 29% (15/52), 14% (6/44), 14% (4/29), 15% (5/34), 17% (6/35), 6% (2/33), 16% (5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ(2) = 61.04, P < 0.05). The period of retention of the clients in extension MMT clinics was 175-days averagely, with an average retention 122 days of when withdrawing. The retention rates of the clients were 52% (37/71)and 61% (28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively. There was no difference in the retention rate between those of two types of clinics (χ(2) = 0.82, P = 0.37) .

CONCLUSIONMost of the clients in extension MMT clinics lived with their family or relatives, and spent less time on the way to the clinics. After 9 months methadone maintenance therapy, the quality of life of clients in extension clinics was improved while addiction among them decreased. The extension clinic was an effective strategy for retention in remote areas.

China ; Cohort Studies ; Demography ; Heroin Dependence ; Humans ; Male ; Methadone ; Opiate Substitution Treatment ; Quality of Life ; Substance-Related Disorders ; Treatment Outcome

OBJECTIVETo conduct health economic evaluation of the prevention of mother-to-child HIV among pregnant women in Dehong prefecture, Yunnan province, China from 2004 to 2013.

METHODSData on cost were collected mainly from the annual prevention of mother-to-child transmission (PMTCT) reporting system of Dehong prefecture, and supplemented by HIV PMTCT-related resource allocation data from local health bureau. Effectiveness indexes were from local continuous HIV surveillance system and annual reported data. Cost-effectiveness and cost-utility analysis were used to conduct the health economic evaluation.

RESULTSFrom 2004 to 2013, 283980 pregnant women were screened for HIV, 2 059 were detected as positive, and the HIV positive rate was 0.73%. The total cost of the PMTCT program was 14 227 000 RMB after discounting, and the unit cost of positive case finding was 4 200 RMB. A total of 26 cases of adults and 325 infants were avoided HIV infection, and the cost-effectiveness ratio (CER) was 40 500 RMB/case. The total obtained quality adjusted life years (QALY) from the program was 8 911.5, each one of which cost 1 600 RMB/QALY. If the feeding pattern were breast feeding, CER would be 42 800 RMB/case and each one of QALY would cost 2 200 RMB.

CONCLUSIONBased on the cost-effectiveness and cost-utility analysis, the HIV PMTCT of Dehong prefecture had economic value, which indicates that continued investment is needed to strengthen local HIV PMTCT work.

Acquired Immunodeficiency Syndrome ; Adult ; Child ; China ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Female ; HIV Infections ; Health ; Humans ; Infant ; Infectious Disease Transmission, Vertical ; Mothers ; Pregnancy ; Quality-Adjusted Life Years

Objective:To compare the effects of staged percutaneous coronary intervention(PCI)after emergency PCI and emergency culprit-only PCI on clinical outcomes of elderly patients with ST-segment elevation myocardial infarction(STEMI)and multivessel disease.Methods:A retrospective analysis was performed on 389 elderly patients with STEMI and multivessel lesions, aged ≥70 years and within 12 h of onset, admitted to the Clinical College of Thoracic Medicine, Tianjin Medical University, between January 2014 and September 2019.According to different revascularization strategies, enrolled patients were divided into the culprit-only PCI group(79.18%, 308)and the staged PCI group(20.82%, 81). Kaplan-Meier analysis and the Cox proportional hazards regression model were used to compare the incidences of major adverse cardiac and cerebrovascular events(MACCE), all-cause death, cardiac death, recurrent myocardial infarction, stroke and ischemia-driven revascularization between the two groups and to evaluate the effects of different revascularization strategies on MACCE and all-cause death.Then subgroup analysis was performed.Results:During a 56-month follow-up, 131 patients developed MACCE and 96 patients died.Compared with the culprit-only PCI group, the staged PCI group had a lower risk of MACCE( HR: 0.404, 95% CI: 0.227-0.716, P=0.002), all-cause death( HR: 0.354, 95% CI: 0.171-0.730, P=0.005), cardiac death( HR: 0.363, 95% CI: 0.157-0.838, P=0.018), and recurrent myocardial infarction( HR: 0.229, 95% CI: 0.055-0.953, P=0.043). There was no significant difference in the incidence of stroke or ischemia-driven revascularization between the two groups( P>0.05). The reduced risk with staged PCI for MACCE and for all-cause mortality persisted in all subgroups.Multivariate Cox proportional hazards regression revealed that, after adjusting for confounding factors, staged PCI was an independent protective factor for MACCE( HR: 0.44, 95% CI: 0.239-0.815, P=0.009)and for all-cause death( HR: 0.390, 95% CI: 0.90, P=0.020). Conclusion:Compared with culprit-only PCI, staged PCI can significantly improve the long-term prognosis of elderly patients ≥70 years with STEMI and multivessel disease within 12 h of onset.