OBJECTIVE: Ruptured intracranial aneurysms usually present as a subarachnoid hemorrhage (SAH), but are sometimes associated with intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), or subdural hematoma (SDH). However, the presentation of a ruptured aneurysm without a SAH is quite unusual. We describe nine such cases and highlight some easily overlooked, but important clinical features. METHODS: Among 341 patients diagnosed with ruptured cerebral aneurysms during the past 4 years, 9 patients exhibited non-SAH bleeding on admission, as revealed by brain computed tomograms (CT). On these 9 patients, the characteristic features were reviewed using medical charts, emergency room notes, and radiographic findings. RESULTS: The incidence of aneurysmal rupture without SAH was 2.6%. Eight patients exhibited ICH, and among them, an IVH occurred in one patient and a SDH in two patients. The initial clinical grade was grave in 8 patients, and a favorable outcome occurred in 4 patients. All of these aneurysms arose from the anterior circulation (the circle of Willis in two patients, and distal aneurysms in seven patients). The causes of the aneurysms were spontaneous in four patients, trauma in two patients, infective endocarditis in two patients, and moyamoya syndrome with a history of craniotomy and clipping in one patient. In three patients, additional intervention was required because the initial radiographic images did not reveal a ruptured aneurysm. CONCLUSION: Ruptured aneurysms should be suspected in cases of unexplained intracranial bleeding, even if SAH is not present on the initial CT scan, because most patients exhibit a poor neurologic grade. Therefore, careful interpretation of the clinical and radiologic culprits and timely management should be provided to achieve total occlusion.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Brain ; Cerebral Hemorrhage ; Circle of Willis ; Craniotomy ; Emergencies ; Endocarditis ; Hematoma, Subdural ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Moyamoya Disease ; Rupture ; Subarachnoid Hemorrhage

BACKGROUNDStudies suggested that anesthetics administered upon the early reperfusion or "anesthetic postconditioning" could protect post-ischemic hearts against myocardial ischemia reperfusion injury (MIRI). However, the mechanism responsible for such protection was not well-elucidated. We investigated the cardioprotection induced by sevoflurane postconditioning (SpostC) in rat hearts in vitro, and the respective role of phosphatidylinositol-3-kinase (PI3K), extracellular signal-regulated kinase 1 and 2 (ERK 1/2), mitochondrial K(ATP) channels (mitoK(ATP)) and mitochondrial permeability transition pore (mPTP), by selectively inhibiting PI3K, ERK 1/2, mitoK(ATP), with LY294002 (LY), PD98059 (PD), 5-hydroxydecanoate (5-HD) and by directly opening of mPTP with atractyloside (ATR), respectively.

METHODSIsolated rat hearts were randomly assigned to one of the 12 groups (n = 15): Time control (continuous perfusion), ISCH (30 minutes of ischemia followed by 60 minutes of reperfusion alone), SpostC (3% sevoflurane postconditioning was administered during the first 15 minutes of reperfusion after 30 minutes of ischemia), ISCH + LY, ISCH + PD, ISCH + ATR, ISCH + 5-HD and ISCH + dimethyl sulfoxide (DMSO) groups (LY, PD, ATR, 5-HD and DMSO (the vehicle) was administered respectively during the first 15 minutes of reperfusion following test ischemia), SpostC + LY, SpostC + PD, SpostC + ATR and SpostC + 5-HD groups (LY, PD, ATR and 5-HD was coadministered with 3% sevoflurane, respectively). Hemodynamics was compared within and between groups. Infarction size was determined at the end of experiments using triphenyltetrazolium chloride (TTC) staining. Lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) released from necrotic myocardium, were compared among TC, ISCH and SpostC groups. To investigate the relationships between RISK and mPTP implicated in SpostC, NAD(+) content in myocardium, a marker of mPTP opening, was compared among some experimental groups (TC, ISCH, ISCH + LY, ISCH + PD, ISCH + DMSO, SpostC, SpostC + LY, SpostC + PD). To further investigate whether the anti-apoptotic mechanism is implicated in SpostC-induced cardioprotection and its association with mitochondria, TUNEL staining was performed in some experimental groups (TC, ISCH, ISCH + 5-HD, ISCH + ATR, ISCH + DMSO, SpostC, SpostC + 5-HD, SpostC + ATR).

RESULTSWhen compared with unprotected hearts subjected to 30 minutes of ischemia, exposure to 3% sevoflurane for 15 minutes during early reperfusion significantly improved functional recovery, decreased myocardial infarct size, decreased LDH, CK-MB and cTnI release, and decreased cardiomyocyte apoptosis (P < 0.05). However, such cardioprotective effects of hemodynamic recovery and infarct size reduction by sevoflurane was completely abolished by any one of LY294002, PD98059, atractyloside and 5-hydroxydecanoate (P < 0.05). Additionally, either LY294002 or PD98059 could reverse the inhibitory effect of SpostC over mPTP opening upon reperfusion (P < 0.05). Both atractyloside and 5-hydroxydecanoate could abrogate the anti-apoptotic effects of SpostC (P < 0.05).

CONCLUSIONThese findings demonstrate that PI3K, ERK 1/2, mitoK(ATP) and mPTP are key players in sevoflurane postconditioning induced cardioprotective mechanisms in isolated rat hearts subjected to MIRI.

Anesthetics, Inhalation ; therapeutic use ; Animals ; Apoptosis ; drug effects ; Heart ; drug effects ; Male ; Methyl Ethers ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control

OBJECTIVE: To study the sequences of off-ladder alleles of PowerPlex 16 kit in Chinese Han population and their nomenclature. METHODS: 10071 Samples from unrelated individuals in Chinese Han population were screened by using PowerPlex 16 kit and ABI 377 or 3100. The samples showing off-ladder alleles were re-screened with PAGE and the off-ladder alleles were obtained and sequenced. RESULTS: 32 off-ladder alleles were found in 11 STR loci, whose frequencies ranged from 0.05 per thousand to 4.02 per thousand. These alleles were classified as four types: (1) having complete repeat but its length is out of the ladder; (2)having incomplete repeat; (3) having deletion or insertion of one or two base(s) in flanking sequence; (4) having deletion of some segment. CONCLUSION Off-ladder alleles have various types. It demonstrates varying repteating number of the core unit, and variation in the flanking sequence or core sequence as well. The nomenclature of International Society for Forensic Haemogenetics cannot define these alleles effectively.
Alleles ; Asian People/genetics* ; Base Sequence ; China/ethnology* ; DNA/analysis* ; Female ; Gene Frequency ; Genetics, Population ; Genotype ; Humans ; Male ; Sequence Analysis, DNA ; Tandem Repeat Sequences/genetics*

Background: Shared decision making using patient decision aids (PtDAs) was established over a decade ago, but few studies have evaluated its efficacy in Asian countries. We therefore evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents, neostigmine and sugammadex, and sequentially analyzed the regional differences and operating room turnover rates. Methods: This multicenter, outcome-assessor-blind, randomized controlled trial included 3,132 surgical patients from two medical centers admitted between March 2020 and August 2020. The patients were randomly divided into the classical and PtDA groups for pre-anesthesia consultations. Their clinicodemographic characteristics were analyzed to identify variables influencing the choice of reversal agent. On the day of the pre-anesthesia consultation, the patients completed the four SURE scale (sure of myself, understand information, risk-benefit ratio, encouragement) screening items. The operating turnover rates were also evaluated using anesthesia records. Results: Compared with the classical group, the PtDA group felt more confident about receiving sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt surer about their choice (P < 0.001). Moreover, the PtDA group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). Conclusions PtDA interventions in pre-anesthesia consultations provided surgical patients with clear knowledge and better support. PtDAs should be made available in other medical fields to enhance shared clinical decision-making.

In this article (J Korean Med Sci 2015; 30: 644-50), one author's name is misspelled. Correct Sung-Hun Im into Seong Hoon Lim.

OBJECTIVETo investigate the association between the polymorphism of HLA-DRB1 alleles and type 2 diabetes mellitus in Yi nationality of Yunnan.

METHODSPolymerase chain reaction-sequence specific primers (PCR-SSP) genotyping method was conducted in 79 patients with type 2 diabetes mellitus and 47 ethnically matched controls in Yi Nationality Autonomous Prefecture, Chuxiong.

RESULTSHLA-DR7 and DR11 allele frequencies in type 2 diabetic mellitus patients were significantly higher than those in non-diabetic control subjects respectively(P is 0.009, RR is 8.329;P is 0.029, RR is 7.734).

CONCLUSIONDR7 and DR11 alleles are probably susceptible genes of type 2 diabetes mellitus in Yunnan Yi nationality.

Adult ; Aged ; Aged, 80 and over ; Alleles ; Base Sequence ; China ; Diabetes Mellitus, Type 2 ; genetics ; Gene Frequency ; Genetic Predisposition to Disease ; genetics ; HLA-DR Antigens ; genetics ; HLA-DRB1 Chains ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Sequence Analysis, DNA

OBJECTIVETo investigate the association between the polymorphism of HLA-DQA1 alleles and type 2 diabetes in Yi nationality of Yunnan.

METHODSPolymerase chain reaction with sequence-specific primers (PCR-SSP) genotyping method was conducted in 58 ethnic Yi patients with type 2 diabetes mellitus and 82 ethnically matched controls from Chuxiong of Yunnan. Then a study was made on the association between the polymorphism of HLA-DQA1 alleles and type 2 diabetes mellitus.

RESULTSThe frequency of HLA-DQA1*0301 allele in the patients with type 2 diabetes mellitus was significantly higher than that in the healthy controls (P=0.002, RR=3.097), and the frequency of HLA-DQA1*0601 in the patients was significantly lower (P=0.025, RR=0.429).

CONCLUSIONIn Yi nationality of Yunnan, HLA-DQA1*0301 allele may be a susceptible gene and the HLA-DQA1*0601 allele may protect individuals from the risk of diabetes mellitus.

Adult ; Aged ; Aged, 80 and over ; China ; Diabetes Mellitus, Type 2 ; genetics ; Female ; Genetic Predisposition to Disease ; genetics ; HLA-DQ Antigens ; genetics ; HLA-DQ alpha-Chains ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Genetic

OBJECTIVETo investigate the association between the polymorphism of HLA-DQA1 alleles and type 2 diabetes mellitus in Yunnan Hans.

METHODSPolymerase chain reaction-sequence specific primers(PCR-SSP) genotyping method was conducted in 108 Han patients with type 2 diabetes and 56 ethnically matched controls from the same area of Yunnan Province.

RESULTSHLA-DQA1*0301(RR=3.092, P<0.01) and DQA1*0501 (RR=3.257, P<0.05) allelic frequencies in type 2 diabetic patients were significantly higher than those in non-diabetic control subjects respectively. HLA-DQA1*0401 (RR=0.371, P<0.01) allelic frequencies in patients were significantly decreased, compared with controls; HLA-DQA1*0302 (RR=3.356, P<0.01) allelic frequencies in patients with type 2 diabetic nephropathy were significantly increased.

CONCLUSIONHLA-DQA1*0301 and DQA1*0501 are susceptible genes of type 2 diabetes in Yunnan Han nationality; in reverse, HLA-DQA1*0401 is a resistant gene. HLA-DQA1*0302 is a susceptible gene of type 2 diabetic nephropathy.

Adult ; Aged ; Aged, 80 and over ; Alleles ; China ; ethnology ; Diabetes Mellitus, Type 2 ; genetics ; Female ; HLA-DQ Antigens ; genetics ; HLA-DQ alpha-Chains ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic

To sequence and analyze the full-length gene sequence of rabies vaccine virus aG strain. The full-length gene sequence of aG strain was amplified by RT-PCR by 8 fragments,each PCR product was cloned into vector pGEM-T respectively, sequenced and assemblied; The 5' leader sequence was sequenced with method of 5' RACE. The homology between aG and other rabies vaccine virus was analyzed by using DNAstar and Mega4. 0 software. aG strain was 11 925nt(GenBank accession number: JN234411) in length and belonged to the genotype I . The Bioinformatics revealed that the homology showed disparation form different rabies vaccine virus. the full-length gene sequence of rabies vaccine virus aG strain provided a support for perfecting the standard for quality control of virus strains for production of rabies vaccine for human use in China.
Amino Acid Sequence ; Antigens, Viral ; genetics ; immunology ; Base Sequence ; China ; Genome, Viral ; genetics ; Genotype ; Humans ; Molecular Sequence Data ; Phylogeny ; Rabies ; immunology ; prevention & control ; virology ; Rabies Vaccines ; immunology ; Rabies virus ; genetics ; immunology ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Sequence Homology, Amino Acid ; Species Specificity

BACKGROUNDThe new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed to address the systematic underestimation of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with relatively well-preserved kidney function. Performance of the new equation in the Chinese population is unknown. The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease (CKD).

METHODSWe enrolled 450 Chinese patients (239 women and 211 men) with CKD in the present study. The renal dynamic imaging method was used to measure the referenced standard GFR (rGFR) for comparison with estimations using the two equations. Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics (ROC) analysis. Performance of the two equations in lower and higher estimated GFR (eGFR) subgroups was further investigated.

RESULTSBoth eGFRs correlated well with rGFR (r = 0.88, 0.81, P < 0.05). In overall performance, the CKD-EPI equation showed less bias, higher precision and improved accuracy, and was better for detecting CKD. In the higher-eGFR subgroup, the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.

CONCLUSIONSThe CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied. For the present, the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Kidney Failure, Chronic ; physiopathology ; Male ; Middle Aged ; Models, Theoretical