Atrial fibrillation ( AF) is the most common sustained arrhythmia in clinical practice and it is associated with an in-creased thromboembolism risk , due mainly to embolism from the left atrial appendage ( LAA) .Percutaneous left atrial appendage clo-sure ( PLAAC) provides a valid alternative to oral anticoagulation ( OAC) mainly in patients who cannot tolerate this therapy due to a high bleeding risk .Recent studies showed PLAAC can substantially reduce stroke incidence .This article reviews the safety and efficacy of PLAAC preventing thromboembolism by retrospectively analyzing related studies of PLAAC .

Objective To investigate the distribution and changes of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in normal heart or heart after myocardial infarction (MI),and to explore beneficial effects of bFGF on heart after MI. Methods Eleven adult minipigs were randomly divided into 2 groups,control (n=5) and MI group (n=6). MI was induced by ligating the left anterior descending coronary artery. Sham-operation was carried out on the animals of control. bFGF-like-immunoreactivity (bFGF-ir) and FGFR-1-like-immunoreactivity (FGFR-1-ir) in heart tissues were detected by immuno-histochemistry and image analysts in 4 weeks after surgery. Results In controls,bFGF-ir and FGFR-1-ir in the atrium showed a considerable high level compared with 2 ventricles (P

Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.

AIM To develop a UPLC-MS/MS method for the simultaneous content determination of adenosine,salidroside,chlorogenic acid,calycosin-7-O-β-D-glycoside,specnuezhenide,calycosin,formononetin,quercetin,apigenin and astragaloside Ⅳ in Zhenqi Fuzheng Capsules (Ligustri lucidi Fructus and Astragali Radix).METHODS The analysis of methanol extract of this drug was performed on a 40 ℃ thermostatic Inertsutain C18 column (75 mm × 3.0 mm,2 μm),with the mobile phase comprising of methanol-acetonitrile-4 mmol/L ammonium acetate flowing at 0.5 mL/min in a gradient elution manner.RESULTS Ten constituents showed good linear relationships within their own ranges (r≥0.996 0),whose average recoveries were 95.1％-104.3％ with the RSDs of less than 4.20％.CONCLUSION This sensitive and specific method can be used for the rapid quality control of Zhenqi Fuzheng Capsules.

OBJECTIVE:To investigate the influence of CYP3A5*3 (rs776746) genetic polymorphism on blood concentration of tacmlimus (TAC) and renal function in renal transplant recipients during the stable period.METHODS:A total of 98 renal transplant recipients during the stable period receiving TAC-based triple anti-rejection scheme (TAC + sodium mycophenol +predrnisone acetate) after surgery and regular follow-up were selected from our hospital during Jan.1995-Dec.2014.The follow-up information during Jan.-Dec.2016 was also collected.Trough concentration of TAC in renal transplant recipients was determined by chemiluminescence microparticle immuno assay.Standard blood concentration (C/D) was calculated after corrected with body weight and daily dose.Scr level was detected with dry chemistry method.CYP3A5*3 genotype was detected by PCR-RFLP and direct sequencing.The relationship of CYP3A5*3 genetic polymorphism with TAC C/D value and Scr level was determined by Kruskal Wallis H or Mann-Whitney U assay.RESULTS:Among 98 renal transplant recipients,there were 9 cases of CYP3A5*3 *1/*1(AA) genotype,37 cases of *1/*3 (AG) genotype and 52 cases of *3/*3 (GG)genotype.The gene frequencies were 9.18％,37.76％,53.06％,which were all in line with Hardy-Weinberg equilibrium (P＞0.05).There was no statistical significance in trough concentration of TAC among different genotypes (P＞0.05).There was statistical significance in TAC dose and C/D value among different genotypes (P＞0.05).TAC dose of CYP3A5*3 *3/*3 genotype recipients was significantly lower than those of *1/*3 and *1/*1 genotype recipients;that of *1/*3 genotype recipients was significantly lower than that of *1/*1 genotype recipients.C/D value of *3/*3 genotype recipients was significantly higher than those of *1/*3 and *1/*1 genotype recipients;that of *1/*3 genotype recipients was significantly higher than that of *1/*1 genotype recipients,with statistical significance (P＜0.05).There was no statistical significance in Scr levels among different genotypes (P＞0.05).CONCLUSIONS:CYP3A5*3 genetic polymorphism significantly influences blood concentration of TAC in renal transplant recipients during the stable period,and *3 allele carriers have higher C/D values and need smaller TAC daily dose.CYP3AS*3 genetic polymorphism may be not associated with Scr level.

Objective:To explore the application effect of family-centered empowerment model (FCEM) in rehabilitation nursing of children with femoral shaft fractures treated by skin traction.Methods:A retrospective case-control study was conducted to analyze the clinical data of 107 children with femoral shaft fractures treated with skin traction in Anhui Children′s Hospital from April 2019 to October 2021, including 67 males and 40 females; aged 1.5-5.0 years [2.8(2.0, 3.5)years]. Fracture types included oblique fracture ( n=50), comminuted fracture ( n=26), transverse fracture ( n=14) and spiral fracture ( n=17). FCEM nursing was implemented in 55 patients (family empowerment group) and routine home rehabilitation nursing guidance was performed in 52 patients (routine nursing group). The face, legs, activity, cry, consolability (FLACC) behavioral score on admission and at days 1, 3 and 7 after skin traction, treatment compliance rate at 1 month after skin traction, complication rate at 1 month after skin traction, length of hospital stay and fracture healing time were compared between the two groups. Results:All patients were followed up for 12-18 weeks [13.4(12.7, 13.9)weeks]. There was no significant difference in FLACC behavioral score between the two groups on admission ( P>0.05). The FLACC behavioral score was (4.0±0.7)points,(3.4±0.6)points and (2.4±0.6)points in family empowerment group at days 1, 3 and 7 after skin traction, lower than (4.8±0.7)points, (3.9±0.8)points and (3.3±0.5)points in routine nursing groups (all Ρ<0.01). One month after skin traction, treatment compliance was excellent in 51 patients, good in 4, poor in 0, with treatment compliance rate of 92.7% (51/55) in family empowerment group, and was excellent in 40 patients, good in 9, poor in 3, with treatment compliance rate of 76.9% (40/52) in routine nursing group ( Ρ<0.05). The complication rate was 5.4% (3/55) in family empowerment group, lower than 21.2% (11/52) in routine nursing group ( Ρ<0.05). The length of hospital stay and fracture healing time were (15.6±0.3)days and (7.1±0.8)weeks in family empowerment group, shorter than (16.8±0.3)days and (8.2±0.4)weeks in routine nursing group (all Ρ<0.01). Conclusion:For children with femoral shaft fractures treated by skin traction, nursing using FCEM can alleviate pain, improve treatment compliance, reduce complication rate, reduce hospital stay and shorten fracture healing time.

Objective:To study on anti-osteoporosis effect of different extracts of Polygoni Multiflori Radix Praeparata on zebrafish.Methods:Three kinds extracts of Polygoni Multiflori Radix Praeparata, anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides were prepared. Prednisolone was used to construct the osteoporosis model of young zebrafish. Normal control group, model group, disodium etidronate group and low-, medium- and high-dosage groups of different extracts of Polygoni Multiflori Radix Praeparata were set up. Alizarin red staining was used to investigate the mineralized skull area and bone density of juvenile zebrafish in each group. Alkaline phosphatase (AKP) and tartrate-resistant acid phosphatase (TRACP) kits were used to detect the activity of osteoblast and osteoclast enzymes in zebra larvae. The qRT PCR method was used to detect the mRNA expressions of osteoporosis related genes Runx2b, col1a2, sparc, and vdrb in each group of zebrafish.Results:Compared with model group, the skull mineralized area and bone mineral density in different extracts of Polygoni Multiflori Radix Praeparata significantly increased ( P<0.01). Polygoni Multiflori Radix Praeparata, anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides (medium- and high-dosage) could significantly increase the AKP activity of zebrafish ( P<0.01), and lower the TRAP activity of zebrafish ( P<0.01); the mRNA expression levels of Runx2b, col1a2, sparc and vdrb in juvenile zebrafish osteoporosis model were significantly up-regulated by different extracts of Polygoni Multiflori Radix Praeparata. ( P<0.01). Conclusion:Polygoni Multiflori Radix Praeparata, Anthraquinone and stilbene glycosides and the removal of anthraquinone and stilbene glycosides show better anti-osteoporosis effects. The comparison of the efficacy of three extracts from Polygonum multiflorum shows that in addition to anthraquinone and stilbene glycosides, other chemical components of Polygonum multiflorum have anti-osteoporosis effects.

Objective To study the effects of concentration of glucose on the proliferation of bone marrow mesenchymal stem cells (BMMSCs).Methods BMMSCs passaged to the 4th to 6th were inoculated and cultured.The control group was treated with DMEM/F12 (1∶1) standard medium,and the basal glucose concentration was 5.5 mmol/L.The experimental group was treated with DMEM/F12 (1∶1) high-glucose medium with the concentration of 20.5,25.5,30.5 and 35.5 mmol/L respectively,and continuously cultured for 15 d.The absorbance (A) values of each group once per day were measured by thiazolyl blue (MTT) colorimetry.Results Compared with the control group,the absorbance was increased at the 2nd,3rd,and 5th days in the 20.5 and 30.5 mmol/L groups,and the differences were statistically significant (all P＜0.05).For the 25.5 mmol/L group,the absorbance was increased at the 2nd,3rd,5th and 8th days,and the differences were statistically significant (all P＜0.05).For the 35.5 mmol/L group,the absorbance was increased at the 2nd,3rd,5th and 8th days and decreased at the 8th day,and the differences were statistically significant (all P＜0.05).The results of 20.5,25.5,30.5 and 35.5 mmol/L groups were further compared one another.The results showed that the absorbance at the 4th and 12th days in the 35.5 mmol/L group were lower than that of the 20.5 mmol/L group,and the differences were statistically significant (all P＜0.05).The absorbance at the 11th and 14th days in the 30.5 and 35.5 mmol/L groups were lower than that of the 20.5 mmol/L group,and the differences were statistically significant (all P＜0.05).Conclusions High-glucose environment can promote the proliferation of BMMSCs in a short time.However,with the prolongation of culture time,this effect is gradually weakened because of the inhibiting effect of high-glucose environment to the cell proliferation.

Objective:To explore the relationship between lipid accumulation product (LAP) and disease activity, nutritional status in patients with Crohn disease (CD).Methods:The clinical data of 74 patients with CD in the Affiliated Hospital of Yangzhou University from July 2020 to June 2021 were retrospectively analyzed. The patients were divided into active group (32 cases) and remission group (42 cases) according to simplified Crohn disease activity index (CDAI). The general clinical data, laboratory examination results and body fat indexes were recorded, body fat indexes including body mass index (BMI), waist circumference, waist-to-height ratio, LAP and nutritional risk screening 2002 (NRS2002) score. Spearman method was used for correlation analysis; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of LAP in predicting the disease activity and nutritional status in patients with CD.Results:The proportion of males, body weight, hemoglobin, albumin, total cholesterol, triglyceride and high-density lipoprotein cholesterol in active group were significantly lower than those in remission group: 46.9% (15/32) vs. 71.4% (30/42), (53.58 ± 8.13) kg vs. (61.05 ± 9.38) kg, (109.94 ± 23.70) g/L vs. (134.19 ± 18.03) g/L, (34.01 ± 5.71) g/L vs. (39.15 ± 4.27) g/L, (3.23 ± 0.68) mmol/L vs. (3.66 ± 0.74) mmol/L, (1.12 ± 0.36) mmol/L vs. (1.34 ± 0.55) mmol/L and (0.91 ± 0.23) mmol/L vs. (1.04 ± 0.33) mmol/L, the nutritional risk rate, platelet count, C-reactive protein and erythrocyte sedimentation rate were significantly higher than those in remission group: 68.8% (22/32) vs. 19.0% (8/42), (317.97 ± 130.19) ×10 9/L vs. (194.00 ± 51.91) × 10 9/L, 14.15 (6.15, 41.35) mg/L vs. 1.51 (0.22, 5.58) mg/L and 40.00 (20.50, 64.25) mm/1 h vs. 9.00 (3.00, 20.00) mm/1 h, and there were statistical differences ( P<0.01 or <0.05); there were no statistical difference in age, height, total protein and low-density lipoprotein cholesterol between the two groups ( P>0.05). The BMI, waist circumference, waist-to-height ratio and LAP in active group were significantly lower than those in remission group: 19.46 (17.70, 21.45) kg/m 2 vs. 21.08 (18.87, 23.12) kg/m 2, (72.51 ± 5.92) cm vs. (77.67 ± 7.27) cm, 0.44 ± 0.03 vs. 0.46 ± 0.04, 13.42 (5.07, 17.72) cm·mmol/L vs. 15.49 (9.37, 31.71) cm·mmol/L, the NRS2002 was significantly higher than that in remission group: 3.00 (1.00, 3.75) scores vs. 1.00 (0, 2.00) scores, and there were statistical differences ( P<0.01 or <0.05). Spearman correlation analysis result showed that LAP was positively correlated with BMI, waist circumference and waist-to-height ratio ( r = 0.701, 0.766 and 0.829; P<0.01); LAP was negatively correlated with NRS2002 score, platelet count and erythrocyte sedimentation rate ( r =- 0.609, - 0.249 and - 0.243; P<0.01 or<0.05). ROC curve analysis result showed that the areas under the curve of LAP predicting disease remission and nutritional status improvement in patients with CD were 0.645 and 0.832 (95% CI 0.520 to 0.770 and 0.739 to 0.925), the best cut-off values were 20.89 and 12.86 cm·mmol/L, the sensitivities were 45.2% and 81.8%, and the specificities were 87.5% and 73.3%. Conclusions:LAP has good predictive value for disease remission and nutritional status improvement in patients with CD.

BACKGROUNDSeveral small sample-size observational studies evaluated the association of plasma brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP) with atrial fibrillation (AF), but the results were contradictory. We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.

METHODSWe performed an extensive literature search on PubMed, Web of Science (WOS) and the Cochrane Library databases. Pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to assess the strength of association using random effects models. We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity. We also estimated publication biases. Statistical analyses were performed using the STATA 12.0 software.

RESULTSA total of 11 studies including 777 cases and 870 controls were finally analyzed. Overall, the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.

RESULTSshowed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units (95% CI 1.76 to 3.60); test for overall effect z-score = 5.7 (P < 0.001). There was significant heterogeneity between individual studies (I(2) = 97.8%; P < 0.001). Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.

CONCLUSIONSIncreased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation. This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.