Objective: Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Peripheral artery disease (PAD) and liver fibrosis share many common metabolic dysfunctions. We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients. Methods: The study recruited 1,610 NAFLD patients aged ≥ 40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015. Fibrosis deterioration was defined as the NAFLD fibrosis score (NFS) status increased to a higher category at the follow-up visit. PAD was defined as an ankle-brachial index of < 0.90 or > 1.40. Results: During an average of 4.3 years' follow-up, 618 patients progressed to a higher NFS category. PAD was associated with 92% increased risk of fibrosis deterioration [multivariable-adjusted odds ratio ( ): 1.92, 95% confidence interval ( ): 1.24, 2.98]. When stratified by baseline NFS status, the for progression from low to intermediate or high NFS was 1.74 (95% : 1.02, 3.00), and progression from intermediate to high NFS was 2.24 (95% : 1.05, 4.80). There was a significant interaction between PAD and insulin resistance (IR) on fibrosis deterioration ( for interaction = 0.03). As compared with non-PAD and non-IR, the coexistence of PAD and IR was associated with a 3.85-fold (95% : 2.06, 7.18) increased risk of fibrosis deterioration. Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients, especially in those with IR. The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.
Adult ; Aged ; Aged, 80 and over ; Ankle Brachial Index ; China ; epidemiology ; Female ; Humans ; Liver Cirrhosis ; epidemiology ; etiology ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; epidemiology ; etiology ; Peripheral Arterial Disease ; complications ; Prevalence ; Prospective Studies ; Risk Factors

Objective: To elucidate the clinical behavior, causes of misdiagnosis, surgical management, and outcomes of facial nerve schwannomas (FNS). Methods: A retrospective review in Chinese People′s Liberation Army General Hospital from January 1, 2002 to December 31, 2015 was carried out and evaluated 110 patients with FNS, including 50 males and 60 females, aged 16-67 years old. The appropriate surgical strategy was selected based on each patient′s clinical manifestations, facial nerve function, and imaging characteristics. After surgery, patients received follow-up visits to assess their facial nerve functions, with the effect of treatment compared to the reality before surgery. The Kruskal-Wallis H test was used to distinguish between the pre- and post-operation facial nerve functions in patients who had different facial nerve functions before the operations. Results: 110 cases of FNS mainly presented with facial paralysis, hearing loss, tinnitus, otalgia, dizziness, and facial spasm. 20 of the cases were misdiagnosed as Bell′s Palsy, 6 were mistaken for chronic otitis media/cholesteatoma with radical mastoidectomy, 3 were mistaken for Meniere′s disease, 1 was misdiagnosed as petrous bone cholesteatoma, and 4 were mistaken for acoustic neuroma. 81.8 % (90/110) of the patients had multiple segments of the facial nerve, including the vertical segment of the facial nerve, accounting for 65.5% (72/110), followed by the labyrinthine/geniculate segment, for 61.8% (68/110), and the horizontal segment, for 55.5% (61/110). The appropriate surgical approaches were chosed based on the sizes and scopes of the tumors evaluated by imaging: transmastoid approach in 73 cases, translabyrinthe approach in 14 cases, middle cranial fossa approach in 13 cases, retrosigmoid approach in 3 cases, transmastoid-middle cranial fossa approach in 3 cases, and transmastoid-neck approach in 4 cases, with all the patients undergoing a total/subtotal resection of the tumor. Eighty-seven patients had their facial nerves reconstructed. Among them, 6 received facial nerve end-to-end anastomosis, 55 received great auricular nerve graft, and 26 were subjected to facial nerve-hypoglossal nerve anastomosis. Because of long histories, facial muscle atrophies, or other reasons, the remaining patients were not received facial nerve reconstruction. The House-Brackmann(H-B) grading scale was used to evaluate the facial nerve function pre- and post-operation. Patients with better facial nerve functions and shorter history of facial paralysis before operation would get relatively better facial nerve function. The before and after operation comparisons revealed that the recovery of the facial nerve functions in patients with H-B Ⅰ-Ⅲ was better than the improvement in patients with H-B Ⅳ-Ⅴ. The difference was statistically significant (Kruskal-Wallis H test, H=8.508, P<0.05). Conclusions The diagnosis of patients with unknown facial paralysis, hearing loss, and tinnitus should take into account the possibility of FNS. CT and other imaging examinations of the temporal bone can avoid misdiagnosis and determine the tumor size and extent of lesions, as well as provide the basis for the choice of the surgical approach. After tumors have been completely resected, facial nerve reconstruction can be performed simultaneously, according to the defect of the nerve.

Most of the maintenance hemodialysis patients (MHD) have a risk of protein energy waste (PEW). PEW is not only an independent risk factor for death，but also closely related to poor prognosis and quality of life in patients with MHD. At present, the mechanism of PEW is still unknown, so there are many ways to screen and assess it. This paper reviews the commonly used evaluation tools and their respective advantages and disadvantages through single and multiple factors.

OBJECTIVE To explore the effect and mechanism of Bushen Zhuyun formula(BSZYF)on gonadotropins and gonadotropin-releasing hormone receptor(GnRHR)signaling transduction in mifepristone-induced LPD rats,and to find the scientific evidence of"heart,kidney and uterus axis"theory of TCM.METHODS SD female rats were administered mifepris-tone suspension via oral gavage,followed by pharmaceutical intervention.Then,the serum follicle-stimulating hormone (FSH)and luteinizing hormone(LH)levels were detected by ELISA assay,the FSHβand LHβexpression levels in the pitui-tary were determined by qPCR,and the GnRHR expression levels were assessed by qPCR and Western blot analysis.Simulta-neously,transcription factors,such as c-Jun,Elk-1,Egr-1,Nur77 and CREB,and transduction molecules in PKC-MAPK, Ca2+-CAM,and cAMP-PKA signaling pathways,such as PKC,p38MAPK,ERK1/2,CAM,and PKA were assessed by qPCR and Western blot analysis.RESULTS After pharmaceutical intervention,BSZYF increased the serum FSH levels sup-pressed by mifepristone(P<0.05).Moreover,the expression of c-Jun,Elk-1,Egr-1,CREB,PKA,p38MAPK,JNK,ERK and PKA were was significantly upregulated in the BSZYF group compared with that in the mifepristone group(P<0.05). However,there was no statistical difference in Nur77 and CAM expression among the blank,mifepristone and BSZYF groups (P>0.05).CONCLUSION BSZYF can regulate abnormal pituitary gonadotropin secretion and GnRHR signaling transduc-tion systems induced by mifepristone,which confirms that the prescription can regulate the whole function of the reproductive axis,and explains the consistency of"Heart,kidney and uterus axis"theory in TCM and the concept of the hypothalamus-pitu-itary-ovary axis in modern medicine

OBJECTIVETo explore the changes in plasma angiotensin II (Ang II) and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome (SAS) before and after continuous positive airway pressure (CPAP) or surgical treatment.

METHODSA total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang II concentration, ambulatory blood pressure (ABP), and polysomnography (PSG) monitoring were performed before and 3 months after CPAP or surgical treatment.

RESULTSPatients were classified into three groups by their apnea-hypopnea index (AHI): essential hypertension group (EH group, n = 72; AHI< 5), essential hypertension with mild SAS group (EH+mild SAS group, n = 60, 5 ≤ AHI < 20), and essential hypertension with moderate and severe SAS group (EH + moderate-severe SAS group, n = 48, AHI ≥ 20). The concentrations of plasma Ang2 in the above three groups were 13.42 ± 3.27, 16.17 ± 3.82, and 18.73 ± 4.05 ng/mL respectively before treatment, and Ang2 concentration in EH patients combined with SAS was significantly higher than that in EH group (all P < 0.05). After treatment the values in the latter two groups significantly decreased to 14.67 ± 2.56 and 15.03 ± 3.41 ng/mL respectively (P < 0.05). The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone (P < 0.05). After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively (P < 0.05).

CONCLUSIONSAng II might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in patients with obstructive SAS.

Adult ; Aged ; Angiotensin II ; blood ; Blood Pressure ; physiology ; Blood Pressure Monitoring, Ambulatory ; Circadian Rhythm ; physiology ; Continuous Positive Airway Pressure ; Female ; Humans ; Hypertension ; physiopathology ; Male ; Middle Aged ; Pharynx ; surgery ; Polysomnography ; Sleep Apnea Syndromes ; blood ; physiopathology ; surgery ; therapy

Objective To investigate the change of circadian blood pressure variability (BPV) and plasma neopterin before and after surgey (uvulopalatopharyngoplasty) for patients with obstrcuctive sleep apnea syndrome (OSAS). Methods A total of 382 OSAS patients underwent uvulopalatopharyngoplasty were divided into three groups based on polysomnography (PSG) results: mild OSAS ( n = 206 ), moderate OSAS (n = 108 ) and severe OSAS (n = 68 ). Plasma neopterin, 24-hour ambulatory blood pressure monitoring (ABPM), PSG were measured before and 3 months after surgery. Results Plasma neopterin increased in proportion to severity of OSAS before surgery (15.08 nmol/L,27. 68 nmol/L and 37.32 nmol/L in patients with mild to severe OSAS) which were significantly reduced post surgery (9. 92 ng/ml, 15.07 ng/ml and 18. 54 ng/ml, all P ＜0. 05 vs. pre-surgery). The incidence of non-dipper curve in three OSAS groups were 50. 2% ,72. 7% and 86. 5%, respectively before surgery and the values decreased to 34. 8%,48. 2% and 49. 2% after surgery (all P＜0. 05 vs. pre-surgery). Relevance analysis indicates that D-value of nocturnal and diurnal blood pressure was negatively correlated with plasma neopterin. Conclusion Our findings indicated that plasma neopterin and the incidence of non-dipper could reliably reflect OSAS severity and could thus be used to evaluate the surgery efficacy. Plasma neopterin might be an important player in the pathophysiology of OSAS via modulating blood pressure variability.

The study was aimed to investigate the pp65 antigen of human cytomegalovirus (CMV) and its clinical significance in patients revived allogeneic hematopoietic stem cell transplantation (HSCT). 104 patients received allogeneic HSCT were studied. Anticoagulant blood samples were obtained from the recipients before and after transplantation and in the convalescence. CMV pp65 antigen in leukocytes was detected by indirect immunofluorescence assay using CMV Brite Kit weekly. The results showed that among the 104 patients, 29 cases were CMV pp65 positive (27.88%). Out of 29 cases 16 were CMV antigenemia and 13 cases were CMV disease. There were 25 cases who positively responded to antiviral therapy (effective ratio 86.21%) and 4 cases died (case-fatality ratio 13.79%). The detection revealed a significant difference in the incidence of CMV infection between the patients received unrelated or haploidentical family donor HSCT (39.29%) and HLA-identical sibling donor HSCT (14.58%) (P < 0.05). The incidence rate of CMV infection in patients with 0-I grade aGVHD and patients with II-IV grade aGVHD were 19.44% and 46.88% respectively, which had significant difference (P < 0.05). There was significant difference in the occurrence of aGVHD between the patients with and without positive CMV pp65 (P < 0.05). It is concluded that infection of CMV can be detected by the CMV pp65 monoclonal fluorescence immunohistochemistry, The detection of CMV pp65 antigen in peripheral blood leukocytes as a indicator for CMV disease surveillance after HSCT, which may be used to early diagnose the CMV infection, to guide the antiviral treatment and evaluate its efficacy.
Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Child, Preschool ; China ; epidemiology ; Cytomegalovirus ; immunology ; Cytomegalovirus Infections ; diagnosis ; drug therapy ; epidemiology ; Female ; Graft vs Host Disease ; epidemiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Leukocytes ; virology ; Male ; Middle Aged ; Phosphoproteins ; blood ; Risk Factors ; Viral Matrix Proteins ; blood

Adult ; China ; epidemiology ; Dengue ; epidemiology ; Humans ; Male ; Travel