Animals ; Disease Models, Animal ; Sleep Deprivation ; physiopathology ; psychology

Objective To analyze the correlation factors between CT imaging features of pulmonary embolism(PE)and clinical severity stratification,to explore the value of CT pulmonary angiography (CTPA)in acute PE severity stratification.Methods According to the clinical severity,48 patients with acute PE proved by CTPA were classified into two groups,including 21 critical and 27 non-critical patients. Embolism index,ratio of central pulmonary involvement,ratio of right ventricle maximum minor axis (RVMMA)to left ventricle maximum minor axis(LVMMA),namely RV:LV,dilation of main pulmonary and/or right pulmonary trunk,and dilation of bronchial arteries in both groups were analyzed comparatively. The correlation factors between CT imaging features and PE clinical severity stratification were explored.The correlation between RV:LV and embolism index of 48 patients was analyzed.Results Pulmonary embolism index(22.0%—85.0%,median 38.0%),ratio of central pulmonary involvement(42.5%),RV:LV (0.90—1.90,median 1.30),dilation of pulmonary artery(14 cases),and dilation of bronchial artery (8 cases)in critical group(21 cases)were higher than those corresponding factors(5%—48%,median 21.5%,31.25%,0.80—1.40,median 1.00,5 eases,and 3 eases)in non-critical group(27 cases) (Z=4.27,X~2=5.40,Z=2.58,X~2=11.45,X~2=4.87,P

OBJECTIVETo observe the clinical value of protoparaxotril saporlirs (PTS) combined with aspirin in the secondary prevention of cerebral infarction.

METHODSThe 140 patients with cerebral infarction were collected, among them the 120 patients during recovery stage were equally assigned to three groups by randomized, single blinded and open controlled principle, and they were treated respectively by PTS (A), aspirin (B), and PTS plus aspirin (C) for 6 months. The other 20, who couldn't or were unwilling to use aspirin, were arranged in group D for control. The platelet aggregation rate, incidence of stroke recurrence, gastrointestinal adverse reaction and the NIHSS scores of patients were observed during the six-month period of treatment.

RESULTSAs compared with group D, the lowering amplitude of platelet aggregation rate after treatment in the three treatment groups were significantly higher (P < 0.01). Comparison of platelet aggregation rate between group A and B showed significant difference after 3-month treatment (P < 0.05), but the difference became insignificant after 6-month treatment (P > 0.05). The incidence of stroke recurrence in the group A, B and C was 18.9%, 13.2% and 10.8% respectively, which showed no significant difference among them, but all were significantly lower than that in the group D (44.4%, P < 0.05). NIHSS scores in group A and C were significantly lower than in group B (P < 0.01); and the occurrence of gastrointestinal reaction was significantly lower in group A (P < 0.01).

CONCLUSIONLong-term application of PTS has the effects for preventing stroke recurrence, lowering gastrointestinal adverse reaction and improving patients' neural function in patients with stroke. As used in combination with aspirin, it shows potential practical importance in the clinical secondary prevention of stroke.

Aged ; Aged, 80 and over ; Aspirin ; administration & dosage ; adverse effects ; Cerebral Infarction ; drug therapy ; physiopathology ; prevention & control ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; drug effects ; Sapogenins ; administration & dosage ; adverse effects ; Secondary Prevention

Until recently,the common treatment for phenylketonuria (PKU) was a phenylalanine (Phe)-restricted diet.Increasing evidence of suboptimal outcomes was observed in diet-treated individuals.The observation of clinically significant reductions in blood Phe levels in a subset of patients with PKU following oral administration of tetrahydrobiopterin(BH4),a cofactor of phenylalanine hydroxylase.Clinical studies suggest that treatment with BH4 provides better Phe control and increases dietary Phe tolerance,allowing significant relaxation or even discontinuation of dietary Phe restriction.The current knowledge on this novel pharmacologic approach to the treatment of PKU will be discussed.

BACKGROUNDIn recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services.

METHODSThis study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination.

RESULTSWe found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups.

CONCLUSIONSWe argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

Aged ; Diabetes Mellitus, Type 2 ; economics ; Female ; Health Expenditures ; standards ; Humans ; Insurance, Health, Reimbursement ; Male ; Middle Aged ; Outpatients

OBJECTIVETo investigate effects of low-dose cyclophosphamide and prednisone (CP) metronomic chemotherapy on microvessel density of bone marrow, serum vascular endothelial growth factor (VEGF) and platelet derived growth factor BB (PDGF-BB)in multiple myeloma (MM) patients.

METHODS54 refractory or relapsed MM patients were treated with CP metronomic chemotherapy consisted of oral cyclophosphamide (CTX, 50 mg/d) and prednisone (Pred, 15 mg/d). Bone marrow and peripheral blood of each patient were collected before and 2, 4, 6 months after treatment. Among the 37 assessable patients, 30 cases were responsive with the response rate of 81.08%. Another 17 cases were follow-uped less than 6 months or failure to obtain serum samples or lost to follow-up. Microvessel density of bone marrow was measured by immunohistochemistry and serum VEGF/PDGF-BB expression was analyzed by ELISA in the 37 assessable patients.

RESULTS2, 4, 6 months following CP metronomic chemotherapy, microvessel densities of bone marrow in the responders were 33.1 ± 4.8/HP, 24.8 ± 3.7/HP, 19.7 ± 2.1/HP respectively; the expressions of VEGF were (394 ± 57) ng/L, (268 ± 32) ng/L and (217 ± 20) ng/L respectively; the expressions of PDGF-BB were (304 ± 31) ng/L, (274 ± 31) ng/L and (196 ± 22) ng/L respectively. After CP metronomic chemotherapy, there were significantly lower of microvessel density, VEGF and PDGF-BB levels than pretreatment \[MVD 48.5 ± 5.9/HP, VEGF (517 ± 60) ng/L, PDGF-BB (484 ± 60) ng/L\]in the responders (P < 0.01). While in the non-responders, after treated by CP metronomic chemotherapy for 2 months, microvessel density, the expression of VEGF and the expression of PDGF-BB were 32.5 ± 4.7/HP, 512 ± 39 ng/L and (452 ± 39) ng/L respectively. There were no significant changes of MVD, VEGF and PDGF-BB levels compared with pretreatment \[MVD 33.2 ± 5.6/HP,VEGF (498 ± 55) ng/L, PDGF-BB (488 ± 44) ng/L\] (P > 0.05).

CONCLUSIONSOur findings suggested that continuous low-dose CP metronomic chemotherapy could decrease microvessel density of bone marrow in MM patients. Furthermore, it down-regulated expression of serum VEGF and PDGF-BB to exert its anti-angiogenesis in MM.

Aged ; Aged, 80 and over ; Angiogenesis Inhibitors ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; administration & dosage ; Female ; Humans ; Male ; Microvessels ; drug effects ; Middle Aged ; Multiple Myeloma ; blood ; blood supply ; drug therapy ; Prednisone ; administration & dosage ; Proto-Oncogene Proteins c-sis ; blood ; Vascular Endothelial Growth Factor A ; blood

Animals ; Carnosine ; pharmacology ; therapeutic use ; Liver ; drug effects ; pathology ; Male ; Rats ; Rats, Wistar ; Reperfusion Injury ; prevention & control ; Shock, Hemorrhagic ; complications ; pathology

OBJECTIVETo observe therapeutic effect of acupuncture at acupoints selected according to rehabilitation medical theory on upper limb spasticity in the patient of poststroke.

METHODSSixty cases were randomly divided into an acupuncture group and an electro-stimulation group, 30 cases in each group. The acupuncture group were treated by acupuncture at the contralateral scalp motor region of the affected limb, Jiquan (HT 1), Chize (LU 5), Daling (PC 7) on the flexor side and Jianyu (LI 15), Tianjing (TE 10), Yangchi (TE 4) on the extensor muscle side of the affected limb; the electro-stimulation group were treated by electric stimulation. The two groups also were treated with necessary medical treatment and anti-spasm rehabilitation motor training. The course was 3 weeks. Modified Ashworth Scale for muscle spasm (MAS), modified Fugl-Meyer Assessment (FMA) for upper limb motor function, and Modified Barthel Index (MBI) for ability of daily living were used for assessment of the therapeutic effect.

RESULTSAfter treatment, the spasm was significantly alleviated, the motor function of the upper limb and daily living ability were significantly increased (P<0.01) in the two groups; after treatment, BMI scores in the acupuncture group was very significantly superior to that in the electro-stimulation group. The total effective rate was 93.3% in the acupuncture group and 86.7% in the electro-stimulation group, with no significant difference between the two groups.

CONCLUSIONProper acupuncture is an effective method for upper limb spasm in the patient of poststroke, and the therapeutic effect is better for mild-moderate spasm of the upper limb.

Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Muscle Spasticity ; therapy ; Stroke Rehabilitation

Objective To study the application value of dynamic monitoring of blood pressure in the prevention and treatment of elderly hypertension. Methods 519 hypertensive patients from December 2017 to December 2018 were monitored with ambulatory blood pressure monitoring, and were divided into the elderly group (≥60 years old, 264 cases) and the control group (<60 years old, 255 cases). The results of ambulatory blood pressure monitoring in two groups were analyzed, which inclued the circadian rhythm of blood pressure, blood pressure, pulse pressure, coefficient of variation of blood pressure, blood pressure load value, average heart rate and morning blood pressure surge. Results The incidence of abnormal circadian rhythm of ambulatory blood pressure in the elderly group was 76.5%. Compared with the control group, there were differences in the indexes of diastolic blood pressure (DBP), diastolic blood pressure load value (DBPLV), pulse pressure (PP), 24 h average heart rate (24 hAHR), systolic blood pressure coefficient of variation (SBPCV), 24 h diastolic blood pressure coefficient of variation (24 h DBPCV) and morning diastolic blood pressure surge (MDBPS) between the two groups(all P<0.05). There were differences in 24 h systolic blood pressure (24hSBP), night systolic blood pressure (nSBP), night diastolic blood pressure (nDBP), night pulse pressure (nPP), day systolic blood pressure load value (dSBPLV), ninght systolic blood pressure load value (nSBPLV), 24 h SBPCV, 24 h dDBPCV and other indicators among different blood pressure types in the elderly group (all P<0.05). Conclusion Ambulatory blood pressure monitoring indicators have important guiding value for the prevention and treatment of elderly hypertension.

OBJECTIVETo observe serum uric acid (UA) level distribution and explore risk factors of hyperuricemia (HUA) in a large cohort of active and retired employees underwent physical examination.

METHODSPhysical examination was arranged for 21 700 active and retired employees from May 2010 to September 2011, 16 416 employees were examined and complete examination data were obtained in 14 044 subjects. The distribution characteristics of UA level and correlations of UA level and HUA prevalence rate with gender, age, body mass index (BMI), systolic pressure (SBP), diastolic pressure (DBP), fasting blood-glucose (FPG), serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) were analyzed.

RESULTSHUA prevalence rate was 11.2% in this cohort, which was significantly higher in males (15.8%) than in females (4.1%, P < 0.05). The UA level and the HUA prevalence rate presented a "J" curve relationship with aging and positively correlated with BMI, SBP, DBP, TG, LDL-C, TC and FPG while negatively correlated with HDL-C. Multiple linear regression analysis showed that SBP, BMI, FPG, TG, and LDL-C were independent risk factors while HDL-C and female gender were the protective factors of HUA(all P < 0.01). Aging and high DBP were independent risk factors of HUA for females (all P < 0.05) and LDL-C was risk factor of HUA for males (P < 0.05).

CONCLUSIONSSerum UA level presents a "J" wave relationship with aging. The risk factors of HUA are increased SBP, BMI, FPG, TG, LDL-C while the protective factors of HUA are female gender and high HDL-C.

Adult ; Aged ; Female ; Humans ; Hyperuricemia ; epidemiology ; Male ; Middle Aged ; Physical Examination ; Prevalence ; Risk Factors ; Uric Acid ; blood