Objective To assess the clinical short-term outcomes of implanting D-shant atrial shunt device(aSD)in a single center for patients with heart failure with reduced ejection fraction(HFrEF).Methods From January 2022 to January 2023,a retrospective analysis was conducted on 12 patients with HFrEF who underwent percutaneous implantation of a D-shant aSD.We assessed cardiac chamber size and ventricular function using echocardiography,right heart catheterization measurements and patient clinical indicators were collected,follow up data of 12 months postoperative and pre-implantation D-shant were compared.The primary endpoint of the study was the cumulative occurrence of adverse cardiac,neurologic,or renal events during the follow-up period.Secondary endpoints were improvements in functional status included cardiac function,quality of life,and exercise capacity.Results All 12 patients underwent successful percutaneous inter-atrial shunting procedures using the D-shant.Postoperative immediately fluoroscopy and echocardiography confirmed accurate localization and patency of the atrial shunt devices in all cases.Postoperative hemodynamic assessment revealed a significant decrease in pulmonary capillary wedge pressure[(29.8±3.4)mmHg vs.(17.8±0.8)mmHg,P＜0.001].During 12 months follow-up,the cumulative adverse event rate was 8.3％(one patient received a heart transplant),a significant reduction in left atrial diameter from(65.8±6.5)mm to(48.0±4.5)mm(P＜0.001)was observed.Furthermore,there was notable improvement in clinical cardiac function indices quality of life,and exercise capacity of the patients.Conclusions This single-center retrospective study found that the use of a D-shant aSD to perform percutaneous interatrial shunting in patients with HFrEF is safe and effective.Short-term follow-up demonstrated sustained patency of the shunt and that the intervention was associated with improved functional status.

With the progress of globalization, the public health emergencies represented by major infectious diseases have become a major challenge for the public health management in China. The article briefly describes the emergency response capability assessment tools in China, and introduces two emergency response assessment tools with complete content structure and wide application in the world. Then the advantages and disadvantages of the tools are compared and discussed in order to provide reference for improvement of the assessment tools for public health emergency response capability in China.
China ; Disaster Planning ; Humans ; Public Health ; Public Health Administration

OBJECTIVE: To investigate the effect of silencing CD46 and desmoglein 2 (DSG2) in host A549 cells on the entry of human adenovirus type 3 (HAdV-3) and type 7 (HAdV-7) and host cell secretion of inflammatory cytokines. METHODS: RNA interference technique was use to silence the expression of CD46 or DSG2 in human epithelial alveolar A549 cells as the host cells of HAdV-3 or HAdV-7. The binding of the viruses with CD46 and DSG2 were observed with immunofluorescence staining at 0.5 and 1 h after viral infection. The viral load in the host cells was determined with qRT-PCR, and IL-8 secretion level was measured using ELISA. RESULTS: In infected A549 cells, immunofluorescent staining revealed colocalization of HAdV-3 and HAdV-37 with their receptors CD46 and DSG2 at 0.5 h and 2 h after infection, and the copy number of the viruses increased progressively after the infection in a time-dependent manner. In A549 cells with CD46 silencing, the virus titers were significantly lower at 2, 6, 12 and 24 h postinfection in comparison with the cells without gene silencing; the virus titers were also significantly decreased in the cells with DSG2 silencing. The secretion level of IL-8 increased significantly in A549 cells without siRNA transfection following infection with HAdV-3 and HAdV-7 (P < 0.0001), but decreased significantly in cells with CD46 and DSG2 silencing (P < 0.0001). CONCLUSION HAdV-3 and HAdV-7 enter host cells by binding to their receptors CD46 and DSG2, and virus titer and cytokines release increase with infection time. Silencing CD46 and DSG2 can inhibit virus entry and cytokine IL-8 production in host cells.
A549 Cells ; Adenoviruses, Human/metabolism* ; Desmoglein 2/metabolism* ; Humans ; Interleukin-8 ; Membrane Cofactor Protein/genetics* ; RNA, Small Interfering

The aim of this study was to identify some biomarkers for predicting lymph node metastasis and prognosis of human epidermal growth factor receptor 2 (Her-2)-positive breast cancer (BC). We analyzed correlations between microRNAs (miRNAs) and the prognosis of patients with BC based on data collected from The Cancer Genome Atlas (TCGA) database. The expression levels of miR-455, miR-143, and miR-99a were measured in clinical samples of Her-2-positive BC patients with different degrees of lymph node metastasis. We investigated the impacts of overexpressed miR-455 on the proliferation and invasiveness of MDA-MB-453 cells and measured its effects on the expression of long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) by quantitative real-time polymerase chain reaction (qRT-PCR). The expression of miR-455 was significantly and positively correlated to the prognosis and overall survival (OS) of the BC (P=0.028), according to TCGA information. The expression level of miR-455 was positively correlated with OS and relapse-free survival (RFS) of patients with Her-2-positive BC, and was negatively correlated with the number of metastatic lymph nodes (P<0.05). Transwell assay suggested that MDA-MB-453 cells became much less invasive (P<0.01) after being transfected with miR-455 mimics. During the qRT-PCR, the expression level of MALAT1 declined significantly after transfection (P<0.01). Overexpressed miR-455 significantly inhibited the proliferation and migration of MDA-MB-453 cells and the expression of MALAT1. We conclude that miR-455 may be a useful potential biomarker for forecasting lymph node metastasis and the prognosis of Her-2-positive BC patients. miR-455 may play an important role in lymph node metastasis of BC by interacting with MALAT1.

Objective:To investigate the relationship between positive rate and titer of hepatitis B surface antibody (anti-HBs) and CD4 + T lymphocyte count level in human immunodeficiency virus (HIV) infected patients after hepatitis B virus (HBV) exposure. Methods:A total of 4 893 HIV-infected patients were admitted to Zhongnan Hospital of Wuhan University from January 2010 to December 2018. The demographic data, HIV-related diagnosis, treatment information, CD4 + T lymphocyte count and serum markers of HBV infection of HIV infected patients were retrospectively analyzed. The patients were grouped according to the CD4 + T lymphocyte count and serum markers of HBV infection, and the differences of anti-HBs positive rate and HBV exposure rate in patients with different CD4 + T lymphocyte counts were compared.The differences of CD4 + T lymphocyte count in patients with different titer of anti-HBs were compared. Statistical analysis was performed using chi-square test, analysis of variance or t test. Results:Patients with HIV infection were divided into CD4 + T lymphocyte count<200/μL group (3 293 cases), 200-500/μL group (1 200 cases) and CD4 + T lymphocyte count>500/μL group (400 cases). The HBV exposure rates in the three groups were 78.0%(2 569/3 293), 77.0%(924/1 200) and 76.2%(305/400), respectively. The anti-HBs positive rates were 38.2%(1 258/3 293), 53.8%(645/1 200) and 62.5%(250/400), respectively. The anti-HBs titers were (120.00±36.45) IU/L, (148.00±26.40) IU/L and (212.00±92.08) IU/L, respectively. The exposure rates of HBV in the three groups were similar ( χ2=0.992, P=0.609), but the positive rates and titers of anti-HBs were significantly different ( χ2=146.779 and F=45.362, respectively, both P<0.01). When the patients were grouped by anti-HBs titer, 2 740 cases were divided into anti-HBs negative group (<10 IU/L), 1 220 cases in low anti-HBs group (10-99 IU/L), 693 cases in medium anti-HBs group (100-499 IU/L) and 240 cases in high anti-HBs group (≥500 IU/L). The CD4 + T lymphocyte count levels of the four groups were (150.00±8.42)/μL, (185.00±7.08)/μL, (243.00±12.07)/μL and (308.00±22.60)/μL, respectively. The overall CD4 + T lymphocyte count levels among the four groups were significantly different ( F=68.479, P<0.01). Among the 90 HIV infected patients who received anti-retroviral therapy (ART), the anti-HBs titer increased from (91.96±21.87) IU/L to (200.76±56.43) IU/L after treatment, and the anti-HBs level before and after treatment was significantly different ( t=-2.542, P=0.035). Among 208 patients with negative HBV markers, no patients had hepatitis B surface antigen switched to positive when monitored for an interval time of (26.2±5.3) months. Conclusions:The risk of HBV exposure in patients with HIV infection is not significantly related to the disease stage, but the positive rate and titer of anti-HBs are significantly positively correlated with CD4 + T lymphocyte count level. The monitoring of anti-HBs and the serum markers of HBV infection in the same individual is conducive to the in-depth understanding of the protective effect of anti-HBs and the scientific evaluation of the risk of infection after HBV exposure.

Objective:To investigate the risk factors associated with death among patients with coronavirus disease 2019 (COVID-19).Methods:A total of 217 COVID-19 patients admitted to Zhongnan Hospital, Wuhan University from December 29, 2019 to January 31, 2020 were enrolled. The general conditions, clinical symptoms, comorbidities, laboratory test indicators and clinical outcomes of the COVID-19 patients were analyzed. According to prognosis, the COVID-19 patients were divided into the death group and the survival group, and the clinical manifestations and laboratory examination results of the two groups were compared by t test and chi-square test. The binary logistics regression model was used to analyze the risk factors related to death. Results:Among the 217 COVID-19 cases, 124 were males and 93 were females, as of March 4, 2020, 25 died and 192 survived, with the mortality of 11.5%. Eighty-nine patients (41.0%) had confirmed history of exposure to the Huanan seafood market or had close contact with another patient with confirmed COVID-19. Among the patients who died, 21(84.0%) were male, 21(84.0%) had comorbidities, 15(60.0%) had more than three types of clinical symptoms, 14(56.0%) had alaine aminotransferase or aspartate aminotransferase>1.5 upper limit of normal (ULN), 13(52.0%) had creatinine (Cr) >104 μmol/L, and 18(72.0%) had procalcitonin (PCT) >0.05 μg/L, whereas the above indicators among the survival patients were 103(53.6%), 95(49.5%), 92(47.9%), 23(12.0%), 14(7.3%) and 47(24.5%), respectively. The differences of the above indicators between the two groups were all statistically significant ( χ2=11.506, 7.889, 14.897, 30.307, 40.585 and 23.807, respectively, all P<0.01). The multivariate analysis results showed that age≥65 years old (odds ratio ( OR)=5.968, 95% confidence interval ( CI)1.991-17.888, P=0.001), male ( OR=6.009, 95% CI 2.504-14.422, P<0.01), comorbidities ( OR=7.152, 95% CI 2.058-24.851, P=0.002), having more than three types of clinical symptoms ( OR=7.944, 95% CI 2.280-27.676, P=0.001), alanine aminotransferase or aspartate aminotransferase>1.5×ULN ( OR=9.552, 95% CI 3.760-24.269, P<0.01), Cr>104 μmol/L ( OR=11.458, 95% CI 4.289-30.613, P<0.01), lactic acid dehydrogenase (LDH)>243 U/L ( OR=7.591, 95% CI 1.683-34.249, P=0.008) and PCT>0.05 μg/L( OR=12.410, 95% CI 4.433-34.744, P<0.01) were risk factors for death among COVID-19 infection patients. Conclusion:For elderly male COVID-19 patients with comorbidities, impaired liver and kidney functions, elevated LDH and PCT are early warning signs for disease deterioration.

OBJECTIVETo investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH).

METHODSA retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups.

RESULTSCompared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer.

CONCLUSIONCompared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.

Aged ; Carotid Arteries ; diagnostic imaging ; Carotid Stenosis ; diagnostic imaging ; physiopathology ; Fibrosis ; Hemorrhage ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Odds Ratio ; Plaque, Atherosclerotic ; diagnostic imaging ; Retrospective Studies

OBJECTIVETo explore the correlation between pathological characteristics of target organs and excess evil syndrome in IgA nephropathy.

METHODSData were collected in multicenter cooperation. Totally 266 IgA nephropathy patients were typed into exogenous wind-heat affection syndrome (49 cases), lower energizer damp-heat syndrome (100 cases), damp-phlegm syndrome (43 cases), and blood stasis syndrome (74 cases). Meanwhile, percutaneous renal biopsy was performed in all patients for Hass classification, Oxford classification, Katafuchi integral, and Jiang's classification methods. The correlation between excess evil syndrome and pathological index was analyzed.

RESULTSFour syndrome types were correlated with their Hass levels (r = 0. 341, P <0. 01). Affection of exogenous wind-heat syndrome was correlated with segmental proliferation of endothelial cells and damaged active lesions of segmental capillary loops. Lower-energizer damp-heat syndrome was associated with Hass III level, destroying active lesions of capillary loops, segmental proliferation of endothelial cells, glomerular segmental lesions, focal interstitial infiltration of inflammatory cells, focal interstitial fibrosis and tubular atrophy. Blood stasis syndrome was associated with Hass IV level, glomerular sclerosis, segmental glomerulosclerosis (S)/adhesion, mesangial hypercellularity (M), angiohyalinosis, multi-foci interstitial infiltration of inflammatory cells, multi-foci interstitial fibrosis and tubular atrophy. Phlegm-damp syndrome had higher proportions of Hass I and III levels, but with no association with other pathological parameters.

CONCLUSIONSExcess evil syndrome was associated with partial pathological characteristics of IgA nephropathy. It could reflect pathological damage degree of target organs, activities, chronic lesions, and prognosis of IgA nephropathy to certain extent. Correlated pathological characteristics and its evolution could indicate excess evil syndrome types and their evolution rules.

Capillaries ; Fibrosis ; Glomerulonephritis, IGA ; pathology ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Glomerulus ; Medicine, Chinese Traditional ; Prognosis ; Syndrome

Objective To evaluate the application of “OmniView”, a new three-dimensional ultrasound technology, in displaying the fetal palate. Methods The three-dimensional volume data was acquired from 100 normal fetuses, analysed by OmniView technology with the facial midsagittal plane as the starting plane. The imaging of fetal palate was obtained in axial plane (through maxilla, oral cleft), coronal plane, oblique coronal plane (through piriform aperture, oral cleft, submental triangle), and the palate′s curved plane tiled imaging by drawing the anatomical lines on referenced sagittal plane (facial midsagittal plane). The volumes of ifve fetuses with cleft lip and palate were obtained and analysed by the same technology. Results The volume dataset of 91 (91.0%, 91/100) normal fetuses were acquired successfully, and analyzed by OmniView technology, the results of 91 normal fetal palate in different plane were: (1) In axial plane through maxilla, the visualization of alveolar process bow was 91 (100%, 91/91). It was shown as“C”shaped arcuate structure, the anechoic structure of alveolar socket could be seen on the bow, and the ifrst 6 alveolar sockets were displayed clearly. The visualization number of hard palate was 91 (100%, 91/91), it was shown as hyperechoic lfake between two sides of alveolar bones. In axial plane through oral cleft, the visualization number of soft palate was 81 (89.0%, 81/91), it was shown as a strip of soft tissue echo band. (2) In coronal plane, the visualization number of hard palate was 91 (100%, 91/91), it was shown as a strip of hyperechoic band and separated the oral and nasal cavity. (3) In oblique coronal plane through piriform aperture, the visualization number of hard palate was 91 (100%, 91/91), it was shown as a short strip of hyperechoic band. In oblique coronal plane through oral cleft, the visualization number of hard palate was 91 (100%, 91/91). In oblique coronal plane through submental triangle, the visualization number of hard palate was 91 (100%, 91/91). In the above two planes, the hard palate was shown as a strip of hyperechoic band, due to acoustic shadow behind the hard palate, the nasal cavity and nasal septum above the hard palate couldn’t be displayed. (4) In oblique coronal plane through piriform aperture, the visualization number of soft palate was 81 (89.0%, 81/91). The visualization number of uvula was 25 (27.5%, 25/91). The soft palate was shown as a lfake of soft tissue echo behind the hard palate, and the uvula was shown as papillary protrusions on the edge of the soft palate in the midline. In oblique coronal plane through oral cleft, the visualization number of soft palate was 81 (89.0%, 81/91). In oblique coronal plane through submental triangle, the visualization number of soft palate was 81 (89.0%, 81/91). In the above two planes, the soft palate was shown as a strip of soft tissue echo band, the soft tissue echo of fetal tongue was in the lower front of soft palate, and the anechoic region of nasopharynx was superior behind the soft palate. (5) In the curved plane tiled imaging of palate, the visualization number of alveolar process bow (primary palate) was 91 (100%, 91/91). The visualization number of hard palate was 91 (100%, 91/91). The visualization number of soft palate was 81 (89.0%, 81/91). the visualization number of uvula was 25 (27.5%, 25/91), the planar panorama of alveolar process bow, hard palate and soft palate could be visualized intuitively, the alveolar arch and hard palate were shown as bone-like hyperecho, and the soft palate was shown as soft tissue hypoecho. In iffteen cases′volume involved cleft lip and palate, all five cases of malformations were detected through three-dimensional data analysis, the position and range of the cleft palate could also be conifrm. Abnormal fetuses were all veriifed after induction of labor. Conclusions By three-dimensional ultrasound technology-“OmniView”, the axial and coronal plane of fetal palate could be obtained easily which was dififcult by two-dimensional ultrasound, and the special oblique coronal plane of secondary palate could be displayed easily. The panorama of the palate could be visualized intuitively though curved plane tiled imaging by drawing a line tracking the structure of the palate. This technology could simplify the ultrasound examination procedure of the fetal palate, reduce the operators′skill-dependence, and quickly evaluated the integrity of the fetal primary palate and secondary palate. For the cleft lip fetus, this technology can determine whether the cleft palate exist or not, together with their position and range.

OBJECTIVETo investigate the incidence of hepatotoxicity in acquired immunodeficiency syndrome (AIDS) patients on combined anti-retroviral therapy (cART) containing nevirapine (NVP) and to assess the risk factors and its impact on cART.

METHODS330 AIDS patients from March 2003 to June 2008 at local county were enrolled and a retrospective study using Kaplan-meier survival and Multivariate logistic regression modeling was conducted.

RESULTS267 out of 330 patients received NVP based cART and 63 cases received EFV-based cART. The deference of prevalences of hepatotoxicity between the two groups is statistically significant (Chi2 = 6.691, P = 0.01). 133 out of 267 (49.8%) patients on NVP based cART had at least one episode of ALT elevation during a median 21 months (interquartile ranges, IQR 6, 37) follow-up time, amounts for 28.5 cases per 100 person-years. Baseline ALT elevation (OR = 14.368, P = 0.017)and HCV co-infection (OR = 3.009, P = 0.000) were risk factors for cART related hepatotoxicity, while greatly increased CD4+ T(CD4) cell count was protective against hepatotoxicity development (OR = 0.996, P = 0.000). Patients co-infected with HCV received NVP-based cART had the higher probability of hepatotoxicity than those without HCV co-infection (Log rank: Chi2 = 16.764, P = 0.000). 23 out of the 133 subjects (17.3%) with NVP related hepatotoxicity discontinued cART temporarily or shifted NVP to efavirenz.

CONCLUSIONNVP related hepatotoxicity was common among ARV naive HIV infected subjects in our cohort. Baseline ALT elevation and HCV co-infection were associated statistically with the development of hepatotoxicity. Hepatotoxicity led to discontinuing cART temporarily or switching to other regimens in some subjects. It suggested that NVP should be used with caution in patients co-infected with HCV among whom anti-HCV therapy before cART initiation may contribute to minimizing the probability of NVP associated hepatotoxicity.

Acquired Immunodeficiency Syndrome ; drug therapy ; metabolism ; Adolescent ; Adult ; Anti-Retroviral Agents ; adverse effects ; Asian Continental Ancestry Group ; Chemical and Drug Induced Liver Injury ; epidemiology ; virology ; Female ; Humans ; Incidence ; Liver ; drug effects ; metabolism ; Male ; Middle Aged ; Nevirapine ; adverse effects ; Retrospective Studies ; Risk Factors ; Young Adult