OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
Collateral Circulation ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

Objective To explore the clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU).Methods Two hundred fifty-five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital from January 1 to August 31 in 2018.The patients were divided into two groups:traditional enteral nutrition group (control group,n=170),who were treated with enteral nutrition management at the early stage,and early combined application of parenteral and enteral nutrition group (experimental group,n=85),who were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later.The differences of Glasgow outcome scale (GOS),incidence of individual adverse reactions,daily average enteral nutrition,human albumin supplement,daily average fluid supplement,pulmonary infection rate,infection time and albumin level during hospitalization between the two groups were compared.The relationship among the course of enteral nutrition,nutrient content,pulmonary infection and serum albumin level in the experimental group were also discussed.The GOS was predicted by decision tree,random forests,nearest neighbor algorithm,adaboost and bagging.Results There was no significant difference between baseline scores after 1∶2 propensity score matching.The dominance ratio of GOS between the two groups was 1.853 (95％CI:1.018-3.385) (P=0.043).The change of albumin level was not related to the choice of nutritional regimen,but was related to the level of consciousness after admission and the level of basic albumin before admission.The level of consciousness in the experimental group was higher than that of the control group,and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased,the types of adverse reactions occurred more and earlier (P＜0.05).The misjudgment rate of GOS prediction models ranged from 0.482 to 0.606.Conclusions Compared with traditional early enteral nutrition therapy,early combined parenteral nutrition and enteral nutition can improve the prognosis of patients with severe neurological diseases.

Objective To discuss the correlation between gastrointestinal symptoms concomitant with chronic migraine and sleep disorders,anxiety and depression.Methods Self-rating Anxiety Scale (SAS),Self-rating Depression Scale (SDS),Pittsburgh Sleep Quality Index (PSQI) and Gastrointestinal Symptom Rating Scale (GSRS) were adopted to conduct comparative analysis on gastrointestinal symptoms,anxiety,depression,sleep disorders,and related risk factors in 151 chronic migraine patients who conformed to International Headache Society International Classification of Headache Diseases-Ⅱ diagnostic code and 151 healthy controls in the Third Affiliated Hospital of Qiqihar Medical University from January 2015 to December 2017.Results PSQI scores (8.46±2.54 vs 4.53±1.95,t=2.913,P＜0.05),SAS scores (53.24± 11.66 vs 39.58±8.63,t=3.112,P＜0.05),SDS scores (51.09±8.80 vs 36.11±5.74,t=3.520,P＜0.05),and GSRS scores (4.53 (3.74,5.32) vs 1.29 (0.73,1.31),Z=30.804,P＜0.05) were all higher in migraine patients than that in healthy controls,and the differences were all statistically significant.In chronic migraine patients,139 (92.05％) had one gastrointestinal symptom at least,and the overall incidence of each gastrointestinal symptom was abdominal distension (60 cases,39.74％),exhaust increase (51 cases,33.77％),and endless defecation (43 cases,28.48％),etc.,in turn.Multiple regression analysis showed that headache degree,frequency,PSQI scores,SAS scores,and SDS scores were the main risk factors of gastrointestinal symptoms concomitant with chronic migraine.GSRS scores of chronic migraine patients presented positive correlation with PSQI scores (r=0.65,P=0.000),SAS scores (r=0.42,P=0.000),and SDS scores (r=0.48,P=0.000),respectively.Conclusion Chronic migraine patients are easy to be accompanied with gastrointestinal symptoms,and headache degree and frequency,sleep disorders,depression and anxiety are the main risk factors of concomitant gastrointestinal symptoms.

Objective To investigate the current practice of ventilation during cardiopulmonary resuscitation (CPR) in Chinese emergency physicians. Methods Self-designed questionnaires were used to survey mainly the present situation of CPR ventilation practice performed by 800 physicians who participated in the Peking Union International Summit for Emergency Medicine from April 17th to 19th, 2015. Results A total of 800 questionnaires were distributed and 638 (79.75%) valid questionnaires were taken back; the responders joining the survey came from 29 provinces and regions, including Beijing, Hebei, Shandong, Guangdong, Liaoning, etc. There were 331 males and 307 females; 91.54% (584 responders) were emergency physicians and 77.90% (497 responders) came from tertiary hospitals, 17.55% (112 responders) came from the secondary hospitals. Regarding ventilation during CPR, 86.4% (551 responders) declared the patients was routinely given endo-tracheal intubation; after intubation, 25.8% (142 responders) adopted bag-mask ventilation, and 74.2% (409 responders) applied mechanical ventilation. When a ventilator was used, 301 (73.6%) responders used the volume controlled ventilation mode, 334 (81.7%) responders set the respiratory rate (RR) lower than 15 bpm, while 89.2% (365 responders) used the tidal volume set at a range of 400-500 mL. When adopted the flow triggering sensitivity, 79.7% (326 responders) set the sensitivity at 1-6 L/min, while 16.4% (67 responders) selected the default parameter, not adjusting the flow triggering parameter; when adopted the pressure triggering sensitivity, 75.1% (307 responders) set the sensitivity between -1 to -6 cmH2O (1 cmH2O = 0.098 kPa) and 20.3% (83 responders) selected the default value, not adjusting the pressure triggering parameter. When the mechanical ventilation (MV) was adopted, 84.8% (347 responders) declared often experiencing problems with MV, such as airway high peak pressure alarms [39.6% (162/409)], lower ventilation volume per minute alarms [24.9% (102/409)], higher respiratory frequency alarms [21.3% (87/409)], but only 67.2% (275 responders) would again adjust the ventilation mode related parameters and only 59.2% (242 responders) would observe the actual respiratory frequency. Conclusions With regards to artificial ventilation during CPR, the majority of emergency physicians tend to adopt endotracheal intubation and commonly use the volume controlled mode of mechanical ventilation; among the ventilator parameter setting, the RR is not strictly in accordance with the CPR guidelines, and most of the inspiration triggering sensitivity setting was too low, very easily to induce hyperventilation; simultaneously, the emergency physicians often neglect the practical RR; although there are many problems with ventilation such as frequent alarms, only 67.2% of the emergency physicians would again adjust the ventilation parameters.

Objective To assess the effectiveness of the Mulliken's method in bilateral complete cleft lip patients with 3dMD system and anthropometric landmarks.Methods Thirty-one infants with bilateral complete cleft lip received treatment in Hospital of Stomatology,Wuhan University between January 2014 and December 2016.Patients underwent primary cheiloplasty and nasoplasty by the same senior surgeon.Periodic review was taken to measure and record the 7 items in the nasolabial area with three-dimensional (3D) images.Results The labial and nasal deformities were restored after primary surgery.The upper lip and nose were corrected and obtained the symmetric shape.The columella was elongated to acquire favorable nasal tip.The arc of nasal fornix was upward.The ridge of the white lipwas continuous and integrated with full vermilion tubercle.Total length of upper lip (Sn-Sto),thickness of the vermilion tubercle (Ls-Sto),protrusion of the nasal tip (Nh) and columellar height (Ch) were markedly improved and there were no significant difference between the observation group and the control group.The significant differences between two groups occurred in values of the nostril width (Nw),which was greater than control group and white lip height (Sn-Ls) and lower than that of control group.Conclusions Mulliken's method during the primary cheiloplasty of the bilateral complete cleft lip shows better results in correction the nasal deformity and the ideal effects are achieved during follow-up.

OBJECTIVE: To investigate the effect of SARI overexpression on the proliferation and apoptosis of core binding factor leukemia (CBFL) cells and explore the potential molecular mechanisms. METHODS: C-KIT N822K mutation status in Kasumi-1 cell line was detected by exon 17 sequencing. Then the SARI lentiviral vector (pGC-FU-SARI) was constructed, meanwhile Kasumi-1 cells were transfected with the SARI lentiviral vector. Quantitative PCR and Western blot were employed to identify efficacy of SARI overexpression after the transfection of cells. Cells were divided into three groups, including the cells infected with pGC-FU-SARI (OE group), the cells infected with pGC-FU-GFP (NC group) and the untreated cells (blank control group). Cell proliferative activity was tested by MTT assay, cell apoptosis was measured by flow cytometry (FCM) and the expression of apoptosis-related proteins: BCL-2,BAX,Cyto C,Caspase 9,Caspase 3,cleaved-Caspase 3,PARP and cleaved-PARP as well as PI3K/Akt pathway proteins: PI3K（p85）,p-PI3K（p85）,Akt and p-Akt were detected by Western blot. RESULTS: The Kasumi-1 cells were detected to bear c-KIT N822K (T>A) mutation. The Kasumi-1 cells with SARI was overexpression were construeted successfully. Compared with NC group, the cell proliferation was decreased and cell apoptosis was increased; BCL-2 expression was reduced, BAX expression was enharued; cyto C expression appeared; the expression of Caspase 9 and Caspase 3 was down-regulated, the expression of cleaved Caspase 3 was up-regulated; the PARP expression was decreased, cleaved PARP expression was increased; the phosphorylation level of PI3K/Akt pathway proteins: p-PI3K/PI3K, p-Akt/Akt was down-regulated in OE group (P<0.05). CONCLUSION SARI gene may suppress the proliferation of CBFL cells, and induce their apoptosis through the mitochondrial pathway, which may be related with the inhibition of PI3K/Akt pathway.
Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Core Binding Factors ; Humans ; Leukemia ; Phosphatidylinositol 3-Kinases ; Proto-Oncogene Proteins c-akt

As a topical plaster developed by modern pharmaceutical technology based on traditional Tibetan medicine,Cheezheng Xiaotong Tiegao has functions of promoting blood circulation,relieving swelling and relieving pain. Since its introduction in 1993,it has been widely used in the treatment of various types of acute and chronic musculoskeletal pain and various types of spinal,joint and soft tissue diseases. In order to better standardize the clinical application and improve the clinical efficacy of Cheezheng Xiaotong Tiegao,the research and development work of the Experts consensus statement on Cheezheng Xiaotong Tiegao in clinical practice was officially launched on October 19,2017,upon approval from China Association of Chinese Medicine. In this paper,main R&D process and related technical links for the experts consensus on Cheezheng Xiaotong Tiegao would be summarized,which will help the various medical workers understand,master and apply more accurately,and also provide reference for the development of experts consensus on clinical application of other topical Chinese medicines.
Administration, Topical ; China ; Consensus ; Humans ; Medicine, Tibetan Traditional ; Pain ; Pain Management

Tumors are major chronic diseases and seriously threaten human health all over the world. How to effectively control and cure tumors is one of the most pivotal problems in the medical field. At present,surgery,radiotherapy and chemotherapy are still the main treatment methods. However,the side effects of radiotherapy and chemotherapy cannot be underestimated. Therefore,it is of great practical significance to find new anti-cancer drugs with low toxicity,high efficiency and targeting to cancer cells. With the increasing incidence of tumor,the anti-tumor effect of traditional Chinese medicine has increasingly become a research hotspot. Triptolide,which is a natural diterpenoid active ingredient derived from of Tripterygium wilfordii,as one of the highly active components,has anti-inflammatory,immunosuppressive,anti-tumor and other multiple effects. A large number of studies have confirmed that it has good anti-tumor activity against various tumors in vivo and in vitro. It can play an anti-tumor role by inhibiting the proliferation of cancer cells,inducing apoptosis of cancer cells,inducing autophagy of cancer cells,blocking the cell cycle,inhibiting the migration,invasion and metastasis of cancer cells,reversing multidrug resistance,mediating tumor immunity and inhibiting angiogenesis. On the basis of literatures,this paper reviews the anti-tumor effect and mechanism of triptolide,and analyzes the current situation of triptolide combined with other chemotherapy drugs,in order to promote deep research and better clinical application about triptolide.
Antineoplastic Agents, Phytogenic ; pharmacology ; Apoptosis ; Autophagy ; Cell Cycle Checkpoints ; Diterpenes ; pharmacology ; Epoxy Compounds ; pharmacology ; Humans ; Neoplasms ; drug therapy ; Phenanthrenes ; pharmacology ; Tripterygium ; chemistry

OBJECTIVE: To explore infection rate of different adeno-associated virus (AAV) on knee joint cartilage in mice and to find a good gene editing tool for mice chondrocytes of knee joint. METHODS: Forty-five 4-week-old SPF C57BL/6 weighed(14.3±0.2) g were selected. According to different injections(6 μl) for right knee joint, mice were divided into 9 different groups, 5 mice in each group. The groups were such as following:control group (normal saline), Vigene 2 group (AAV2 from vigene biosciences, titer for 1×10¹³ vg/ml), Vigene 5 group (AAV5 from vigene biosciences, titer for 1×10¹³ vg/ml), Vigene 6 group (AAV6 from vigene biosciences, titer for 1×10¹³ vg/ml), Vigene 7 group (AAV7 from vigene biosciences, titer for 1×10¹³ vg/ml), Vigene 8 group (AAV8 from vigene biosciences, titer for 1×10¹³ vg/ml), Vigene 9 group (AAV9 from vigene biosciences, titer for 1×10¹³ vg/ml), Hanbio DJ group(AAV2-DJ from Hanbio, titer for 1×10¹² vg/ml), Hanbio 5 group (AAV5 from Hanbio, titer for 1×10¹² vg/ml). All AAVs were over-expressed green fluorescent protein(GFP). Knee joint specimens were taken and observed injury of cartilage under stereomicroscope at 30 days after injection, then 10 μm thick frozen sections were prepared. Distribution of green fluorescent protein of meniscus and cartilage of knee joint was observed under fluorescence microscope. RESULTS: Stereomicroscope observation indicated that no obvious lesion was observed in knee joint cartilage of mice after intra-articular injection of AAV. According to frozen sections of knee joints, strong green fluorescence was observed in knee joint cartilage in all AAV experimental groups. Compared with other groups, significantly stronger green fluorescence were observed both in AAV2 and AAV7 groups, whose average fluorescence density was 0.077±0.020 and 0.061±0.022. There were significant differences between two groups and other groups. CONCLUSIONS AAV could infect chondrocyte of knee joint in vivo by injecting into knee joint cavity. Higher infection efficiency of AAV2 and AAV7 on knee joint cartilage were observed. Local injection of AAV into knee joint cavity could be used as an effective tool for gene editing of knee joint chondrocyte.
Animals ; Cartilage ; Dependovirus ; Green Fluorescent Proteins ; Knee Joint ; Mice ; Mice, Inbred C57BL

The convective polymerase chain reaction (CCPCR) uses the principle of thermal convection to allow the reagent to flow in the test tube and achieve the purpose of amplification by the temperature difference between the upper and lower portions of the test tube. In order to detect the amplification effect in real time, we added a fluorophore to the reagent system to reflect the amplification in real time through the intensity of fluorescence. The experimental results show that the fluorescence curve conforms to the S-type trend of the amplification curve, but there is a certain jitter condition due to the instability of the thermal convection, which is not conducive to the calculation of the cycle threshold (CT value). In order to solve this problem, this paper uses the dynamic method, using the double S-type function model to fit the curve, so that the fluorescence curve is smooth and the initial concentration of the nucleic acid can be deduced better to achieve the quantitative purpose based on the curve. At the same time, the PSO+ algorithm is used to solve the double s-type function parameters, that is, particle swarm optimization (PSO) algorithm combined with Levenberg-Marquardt, Newton-CG and other algorithms for curve fitting. The proposed method effectively overcoms PSO randomness and the shortcoming of traditional algorithms such as Levenberg-Marquardt and Newton-CG which are easy to fall into the local optimal solution. The of the data fitting result can reach 0.999 8. This study is of guiding significance for the future quantitative detection of real-time fluorescent heat convection amplification.
Algorithms ; Fluorescence ; Fluorescent Dyes ; Polymerase Chain Reaction