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Analysis of heart rate variability in elderly patients with unstable angina pectoris and negative psychology

Yu ZHAO ; Lili YANG ; Xiaoxin KANG ; Chunfeng LI ; Lu YIN ; Yanhong WEI

Clinical Medicine of China.2010;26(10):1040-1043. doi:10.3760/cma.j.issn.1008-6315.2010.10.012

Objective To study the heart rate variability and arrhythmia characteristics in the elderly patients with unstable angina and negative psychology and to observe the changes before and after treatment. Methods Eighty patients aged ≥ 65 years with unstable angina were recruited in the study, and divided into two groups according to the determination of Hospital Anxiety and Depression Scale: 36 patients in the negative psychology group( NP group) and 44 in the non-negative psychology group ( non-NP group). All patients were monitored by Holter. Results The SDNN, SDANN, SDNNidex, rMSSD and PNN50 in the NP group were (86.8 ±14.1 ) ms, (78.1 ± 11.2 ) ms, (22.9 ± 4.5 ) ms, ( 6.3 ± 1.2 ) % and (40.3 ± 16.4) ms, respectively, which were significantly decreased compared to that in the non-NP group [ ( 138.9 ± 37.1 ) ms, ( 123.3 ± 32.5 ) ms, (25.7 ±12.3)ms,(9.2 ±5.3)% and (47.8 ± 10.7)ms,respectively] (t =4.20,2.52,2.32,2.28 and 2.20,Ps ＜0.05)The prevalence of ventricular arrhythmia, sinus tachycardia, ischemic ST-T changes and heart rate variability (HRV) (55.56%, 13.89%, 33. 33% and 52. 78%, respectively) significantly increased in the NP group,compared to those in the non-NP group(9.09% ,2.27% ,6.82%, 18.18% ,respectively) ( χ2 = 16.89,4.18,4.33 and 4.99, respectively, Ps ＜ 0.05 ). After treatment with Prozac ( fluoxetine hydrochloride scientific name), SDNN,SDANN,rMSSD,PNN50,SDNNindex significantly increased from (84.7 ± 34.0) ms, (79.2 ± 39.6) ms, (23.4 ±7.5)ms,(5.1 ±2.1)% and (38.1 ± 11.8)ms to (102. 1 ±29.6)ms,(94.2 ±26.7)ms,(35.6 ± 10.2)ms,(9.9 ± 7.5 ) % and (63.3 ± 13.8 ) ms ( t = 3.60,2.43,2.34,2.26 and 2.30, P ＜ 0.05 ). After treatment,ventricular arrhythmia,sinus tachycardia,ischemic ST-T changes and HRV significantly decreased compared to that before treatment in the NP group (χ2 = 5.58,4.33,4.24 and 4.06 ,P ＜ 0. 05 ). Conclusions In patients of coronary heart disease with unstable angina and negative psychologically , HRV decreased , and they are prone to ventricular arrhythmias,sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia arrhythmias, sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia.

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Clinical and electrophysiological study of diabetic lumbosacral radiculoplexus neuropathy

Hongfei TAI ; Hua PAN ; Zaiqiang ZHANG

Clinical Medicine of China.2010;26(10):1054-1056. doi:10.3760/cma.j.issn.1008-6315.2010.10.017

Objective To explore the clinical and electrophysiological characteristics of diabetic lumbosacral radiculoplexus neuropathy (DLRPN). Methods The clinical, electrophysiological and neuroimaging changes in 15 cases of DLRPN were investigated. Results The major clinical manifestations of 13 cases were unilateral or asymmetrical pain and progressive muscular weakness and atrophy of the proximal lower limb. The nerve conduction studies in affected nerves showed absent or reduced compound muscle action potential amplitudes and sensory responses with proportionate slowing of the conduction velocities. F waves and H reflexes were of long latencies or absent. Electromyography of affected muscles showed positive sharp waves and fibrillation potentials involving lumbar paraspinal muscles. Assessment of the motor unit action potentials (MUAPs) revealed high amplitude, long duration, and polyphasic MUAPs with reduced recruitment 50% cases have much lower R-R interval variation. Conclusions DLRPN presents disabling pain and muscular weakness and elctrophysiological examination has a paramount value in the diagnosis and evaluation of this disease

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Clinical interventions of early swallowing syndrome on neonates

Junting ZHENG ; Wei GAO ; Hongmei LI

Clinical Medicine of China.2010;26(10):1104-1105. doi:10.3760/cma.j.issn.1008-6315.2010.10.039

Objective To assess the efficacy of clinical intervention of early swallowing syndrome on neonates. Methods Eighty-six cases of normal newborns were enrolled in the study, including 44 cases of natural delivery,32 cases of cesarean section,8 cases of premature infant. The cases started vomitting before feeding the milk, became more severe after feeding the milk. once the pathological factors were excluded, the cases were treated with breastfeeding, warm water enema, massaging the lower abdomen, 1% sodium bicarbonate solution to the gastric lavage. Results A variety of clinical interventions on the control of neonatal swallowing syndrome results are obvious. Conclusions Early detection early intervention can prevent complications occurring.

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Clinical significance of endothelin-1 and transforming growth factor-β in the newborns with respiratory distress.

Li XING ; Zhiwei HUANG ; Dongdong SUN

Clinical Medicine of China.2010;26(10):1099-1101. doi:10.3760/cma.j.issn.1008-6315.2010.10.036

Objective To measure the serum levels of endothelin-1 (ET-1) and transforming growth factor-β(TGF-β) in the newborns with respiratory distress and investigate its clinical significance. Methods Newborns with respiratory distress hospitalized into the Newborn Intensive Care Unit were included. The serum levels of ET-1 and TGF-β were all detected with ELISA in the first six hours,3,7,14 and 28 days after birth. Results The highest levels of ln ( 1 + ET-1 ) and ln ( 1 + TGF-β) were obtained from newborns with diagnosis as meconium aspiration syndrome ( 1.95 ± 1.02) ng/L and ( 1.51 ±0.99) ng/L,respectively) in the samples obtained in the first six hours after birth, and these were statistically different from those of the control group ( P ＜ 0. 05 ). Following were obtained for newborns with respiratory distress syndrome ( ( 1.52 ± 0.74 ) ng/L and ( 1.13 ± 0. 48 ) ng/L, t = 2.28,2. 13,respectively). After oxygen treatment, ET-1 levels obtained in the first six hours of life decreased gradually in the following days (P ＜0.05 ). Conclusions The measurements of ET-1 and TGF-β levels will help in differentiating diagnosis of the respiratory distress of newborns. The ET-1 levels will help to assess the therapy effectiveness and prognosis.

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Clinical characteristics of hospital infection and pathogens drug resistance in intensive care unit

Wei GAO ; Jin QIN ; Zhongjun FENG ; Junting ZHENG

Clinical Medicine of China.2010;26(10):1059-1062. doi:10.3760/cma.j.issn.1008-6315.2010.10.019

Objective To investigate the clinical characteristics of hospital infection and the pathogen type,distribution and drug resistance,in the intensive care unit of our hospital,to direct proper antibiotics use and supply the scientific basis for hospital infection control. Methods The clinical data of 392 inpatients in our intensive care unit from April 2008 to March 2010 were monitored prospectively and analyzed retrospectively. Results Of the 392 impatients,78 cases had hospital infection (19.89% 78/392),112 time-case infection (28.57% 112/392). The most common infection was the main respiratory tract infections accounted for 54.46% (61/112) ,followed by urinary tract infections accounted for 15. 19% ( 17/112 ), blood infection accounted for 11.61% (13/112). 152strains pathogens were identified in the study,in which G- bacilli accounted for 69.7%, G+ bacteria accounted for 17. 8% and fungi accounted for 12.5%. Main pathogens such as acinetobacter baumannii ,pseudomonas aeruginosa,klebsiella pneumoniae, staphylococcus aureus showed multiple drug resistance in different degrees. Conclusions Intensive care unit has a high nosocomial infection rate,lower respiratory tract infection is the most frequent type and the main pathogens have different degrees of multi-drug resistance. Standardized, rational use of antibiotics,prevention of the multi-drug resistant bacteria spread may help to reduce the occurrence of hospital infection in intensive care unit.

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Association of PPAR gamma Pro12Ala polymorphisms with coronary heart disease

Li FAN ; Shiyao WU ; Yuqin YAN

Clinical Medicine of China.2010;26(10):1043-1046. doi:10.3760/cma.j.issn.1008-6315.2010.10.013

Objective To investigate the association of PPAR gamma Pro12Ala polymorphisms with conroy heart disease(CHD). Methods One hundred eighty impatients were recruited in the study. Venous blood samples were collected after 12 h of fasting from all patients. DNA was extracted and Pro2Ala polymorphism in the PPAR gamma 2 genes was genotyped through the PCR-RFLP. The frequency and distribution of Pro2Ala polymorphism in Chinese Han population with CHD were analyzed. Gensini Score based on coronarography were used to grade the coronary. Results There were a total of 135 CHD patients,of which 52 were affected with single coronary lesion,43 with multi-coronary lesion,and 45 were normal. The frequency of P12/P12, A12/P12 in the coronary lesion group were 92.6% (125/135) and 7.4% (10/135) which were similar to that of 93.3% (42/45) and 6.7% (3/45)(P =0. 548). In the single coronary lesion group, the frequencies of P12/P12 and A12/P12 were 94.0% (42/52)and 9.6% (5/52) ,and 90.0% (36/40) and 10.0% (4/40) in the bi-coronary lesion group,97.7% (42/43) and 2.3% (1/43) in the multi-coronary lesion group,with no significant difference among the three groups( P ＞0.05).There were no significant difference on the frequency of P12/P12 and A12/P12 between various subgroups defined according to Gensini score (P = 0. 246). Compared to the frequency in non-obese, the frequency of A12/P12 were significantly higher in the obese ( P = 0.028 ). In PPAR gamma 2 genes B the Exton BstuI enzyme restriction site genes, BMI,waist-hip ratio and total cholesterol in the carriers of P12A genotype were significantly higher than those in the P12P genotype carriers ( P ＜ 0. 05 ). Conclusions PPAR gamma Pro12Ala polymorphisms might not be associated with CHD in Chinese Han population. The frequency of A12/P12 in obese is significantly higher than that in non-obese. PPAR gamma Pro12Ala polymorphisms might be associated with adiposity and lipid metabolism.

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Clinical analysis of 1272 cases of pelvic endometriosis

Xiaoling ZHANG ; Yufen CHENG ; Shuang WANG ; Qingxian ZHU

Clinical Medicine of China.2010;26(10):1026-1029. doi:10.3760/cma.j.issn.1008-6315.2010.10.007

Objective To assess the surgical effectiveness of pelvic endometriosis (EMS) by Laparoscopic. Methods Retrospective analysis was performed in 1272 pelvic EMS patients underwent laparoscopic surgical treatment. All patients were classified into four groups according to the R-AFS,63 patients of Ⅰ stage,44 patients of Ⅱ stage,475 patients of Ⅲ stage and 690 patients of Ⅳ stage. Symptoms of EMS,surgical effect and follow-up outcomes were compared. Results In all stages, there were no significant differences on moderate to severe dysmenorrhea,increase in CA125 and infertility (Ps ＞ 0. 05 ). In the EMS patients combined with AM or/and DIE, the rates of the moderate to severe dysmenorrhea, CA125 increase and infertility were 84.6% (11/13 ) ,92.3 %(12/13) and 53.8% (7/13)in stage Ⅰ ,81.8% (9/11) ,90. 9% ( 10/11 )and 54.5% (6/11) in stage Ⅱ ,84.8%(173/204) ,93. 1% (190/204) and 47.1% (96/204) in stage Ⅲ ,and 81.6% (213/261) ,91.2% (238/261) and 46.4% ( 121/261 ) in stage Ⅳ, respectively. The rates in non-consolidated AM or/and DIE patients were 46.0%(23/50),62.0% (31/50) and 22.0% ( 1 1/50) in stage Ⅰ ,45.5 % ( 15/33 ),54.5% ( 18/33 ) and 18.2% (6/33)in stage Ⅱ ,41.7% ( 113/271 ) ,62.7% ( 165/271 ) and 23.6% (64/271) in stage Ⅲ ,and 47.3% (203/429),60.1% (248/429) and 21.7% (93/429). The difference between the two groups with and without consolidated AM or/and DIE had statistical significance( P ＜ 0.05 or P ＜ 0.01 ). After the treatment, the scores of life's energy, ache,emotion,sleep,social activity and body movement of NHP were significantly superior than those before treatment in all patients ( P ＜ 0.01 ). The surgery time-consuming of Ⅲ and Ⅳ stage patients were (64.5 ± 18.4) min and (61.7 ± 17.1 ) min respectively, which were significantly higher than that of Ⅰ and Ⅱ stage ( ( 31.9 ± 12.3 ) min and (40.3 ± 10. 6) main ] ( t = 20.25, P ＜ 0.01 ). The massive hemorrhages and the internal damage organs occurred in Ⅲ and Ⅳ stage surgery [2.9% and 3.5% ,respectively] ,whereas much less in Ⅰ and Ⅱ stage (0.8% and 1.4% ) ,with no significant difference(P ＞0. 05). After treatment,the rate of symptoms recurrence of Ⅲ and Ⅳ stage patients respectively were 21.4% ,which were higher than that of Ⅰ and Ⅱ stage patients ( 2.3% ) (P ＜ 0.05 )The rate of pregnancy in Ⅲ and Ⅳ stage patients ( 15.4% ) were lower than that of Ⅰ and Ⅱ stage patients (69. 6% ) ( P ＜ 0. 01 ). Conclusions Pelvic EMS decreased the quality of life. EMS patients combined with adenomyosis or/and deep infiltrating EMS have more severe pelvic pain symptoms, less surgical effectiveness and more serious complications. Ⅲ and Ⅳ stage patients are more liable to symptoms recurrence and lower pregnancy rate.

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Expression of CK19 in sentinel lymph node for breast cancer and its clinical significance

Chunmei YE ; Fengling LUO ; Mingxing XUE ; Bo CHEN ; Ziming HUANG ; Song ZHAO ; Rong WANG

Clinical Medicine of China.2010;26(7):751-753. doi:10.3760/cma.j.issn.1008-6315.2010.07.029

Objective To detect the expression of CK19 in sentinel lymph node for breast cancer and to evaluate its clinical significance.Methods SLNs of 30 patients with breast cancer were successfully detected with methylene blue,both SLN and ALN were examined by hematoxylin and eosin staining ( HK staining). The expression level of CK19 in SLNs were assessed by RT-PCR and Western Blot for mRNA and Protein respectively. Results Detection positive rate of SLN melastases was 26. 67% (8/30) by HE staining,and 1 case of false negative. Through RT-PCR,12 cases,including all the positive cases detected by routine pathological examination,were detected to be positive in the expression of CK19mRNA, with a positive rate of 40. 0% ( 12/30) , and a positive rate of 36. 67% (11/30) for CK19 was observed by Western Blot There was a significant difference between RT-PCR or Western Blot methods and routine pathological examination ( P < 0.05 ) for the detection efficiency of SI.Ns melastases. Conclusions CK19rnRNA may be a potential tumor marker for detecting micrometastasis in SLNs of breast cancer. The combined utilization of locating SLNs and detecting CK19 mRNA expression by RT-PCR instead of histopathological examination can greatly enhance the detection efficiency of SLN micrometastasis of breast cancer.

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Study on the senescence of rat glomerular mesangial cells induced by Tert-Butyl hydroperoxide in vitro and the influnce of probucol on its senescence

Hongli ZHOU ; Yarong HAN ; Ruixia JIN ; Bo HUANG

Clinical Medicine of China.2010;26(7):733-736. doi:10.3760/cma.j.issn.1008-6315.2010.07.022

Objective To investigate the senescence of rat mesangial cells induced by Tert-Butyl hydroperoxide (tBHP) and the protective effect of probucol on senesecence. Methods Human glomerular mesangial cells(hGMC) were cultured in vitro and intervened by tBHP. The cell survival rate was observed by methyl thiazolyl tetrazolium( MTT). β-gal staining and cell cycle analysis were used to identify cell senescent status;transmission eletric microscopy was used to evaluate the ultra-microstructure of hGMC. Senescent-related indexes were detected after treatment with probucol. Results The cell survival rate with 30 μmol/L tBHP was (80. 12 ± 3. 25 ) % , the positive rate of β-gal staining was significantly higher in tBHP-induced cells (about 81% )than that of the control cells( P <0. 01). 86% of the cells was arrested at G0-G1 phase. Invagination of nucleus membrane and chromatin condensation at the nuclear margin in tBHP-induced cells was observed through transmission eletric microscopy. In the probucol intervented cells, the cell survival rate was higher than that of tBHP-induced cells (92. 68 ± 5.03) % vs. ( 80. 12 ± 3. 25) % (P < 0. 05 ). The positive rate of β-gal staining decreased to 45. 2%. The proportion of cell cycle stage was similar to the control cells.The change of morphous and ultrastructure was relieved. Conclusions tBHP can induce hGMC senescence in vitro and probucol may play a role in preventing hGMC senescence.

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Clinical observation of metallic intra-biliary stents for palliative management of 160 malignant obstructive jaundice patients

Chen YAO ; Zhi DU ; Yijun WANG ; Tong BAI ; Laiyuan LI

Clinical Medicine of China.2010;26(7):718-721. doi:10.3760/cma.j.issn.1008-6315.2010.07.016

Objective To study clinical value of percutaneous intrabiliary expandable metallic biliary stenting (EMBS) for treatment of malignant obstructive jaundice. Methods One hundred and sixty patients with malignant obstructive jaundice were treated with EMBS ( EMBS group) . Thirty patients underwent only external drainage by PTCD were recruited as control. The patency rate of stent,decline of bilirubin and the complication were analyzed retrospectively. Both groups were followed up for three months. The Kaplan-Meier method (log-rank test) was used to compare the survival period between the two groups. Results Anorexia,skin pruritus and color of urine alleviated at a certain degree in both groups.In the EMBS group,plasma total bilirubin was(218. 78 ±2. 29) μmol/L pre-stent,and decreased to (134. 90 ±2. 34), (83. 18 ±2.40) , (40. 74 ±2. 29) μmol/L at the 7,14,21 days after the stenting, respectively; direct bilirubin was (128.82 ±2.40) μmol/L pre-stent, and decreased to (81.28 ± 2. 34), (51. 29 ±2. 45) and (25. 70 ±2.40)μmol/L at the 7,14,21 days after the stenting ( P =0. 000). In the PTCD group,plasma total bilirubin was (223. 57 ± 2. 58) μmol/L pe-stent, and decreased to ( 145. 68 ± 2. 57 ) ,(87.57 ±2.58) ,(38.65 ±2. 20) μmol/L at the 7,14,21 days after the stenting,respectively;direct bilirubin was (127. 6 ±2. 59)μmol/L pre-stent,and decreased to (79. 78 ±2. 70) ,(58. 36 ±2. 46) and (29.46 ±2. 20)μmol/L at the 7,14,21 days after the stenting,respectively ( P <0.001 ). No significant difference was found between the two groups at any time point ( P > 0. 05). Complications occurred in 34 patients in the EMBS group and the incidence rate was 20. 62% . Two or more complications occurred in 9 patients. In the PTCD group, complications occurred in 60.00% of the patients. In the EMBS group, 14 patients were failed to follow up, and 136 died. The median length was 214 days. In the PTCD group,all patients were followed up and all died,with a median length of survival of 75. 5 days. The survival analysis showed that the EMBS group survived longer than the PTCD group (P =0. 000). Conclusions EMBS placement showed better effect than PTCD. Compared to PTCD, internal drainage of metallic stents lead few complications and faster recover, and can improve the life quality and prolong survival time of patient with malignant obstructive jaundice. The placement of metallic stents is recommended as a preference for palliative therapy of malignant biliary obstruction.

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