Alterations of the transmural gradient of repolarization may contribute to the increase of transmural dispersion of repolarization and ventricular arrhythmias. The transmural gradient of repolarization may play an important role in sudden death associated with left ventricular epicardial pacing. To investigate the changes of transmural gradient dispersion of ventricular repolarization with different pacing sites in heart failure (HF) canines, 8 mongrel dogs were randomized into healthy group and HF group (n = 4). We mapped the monophasic action potential duration (MAPD) in the subendocardial, subepicardial and mid-myocardial layers of the left ventricle (LV) in canines of healthy and HF groups during right atrium (RA) pacing, right ventricular apical endocardial (RV) pacing, left ventricular lateral epicardial (LV) pacing and biventricular (Biv) pacing respectively. The results showed that in the healthy group, the MAPDs were significantly different among the three layers during RA pacing (all P < 0.05). The MAPD was longer in the mid-myocardial layer compared with those in the subepicardial and subendocardial layers during RV, LV or Biv pacing (P < 0.05). However, there was no significant difference in MAPD between the subendocardial and subepicardial layers during RV, LV or Biv pacing (P > 0.05). In the HF group, the MAPDs in all three layers were prolonged compared with those in the same locations in the healthy group (all P < 0.05). However, there were no differences in MAPD among the three layers during RA, RV, LV or Biv pacing (all P > 0.05). By MAP recording with our new mapping electrode, we found a transmural MAPD gradient among the three layers of the LV during RA pacing and the gradient between the subendocardial and subepicardial layers vanished during RV, LV or Biv pacing in healthy dogs. In contrast, there was no transmural MAPD gradient during RA, RV, LV or Biv pacing in HF dogs. These results are helpful to understand the mechanism of ventricular arrhythmias in patients with HF.
Animals ; Arrhythmias, Cardiac ; Dogs ; Heart ; Heart Failure ; Heart Ventricles ; Humans ; Myocardium

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

PURPOSE: The aim of this study was to evaluate the applicability of machine learning methods that combine data on age and prostate-specific antigen (PSA) levels for predicting prostate cancer. MATERIALS AND METHODS: We analyzed 943 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy at Chungnam National University Hospital between 2014 and 2018 because of elevated PSA levels and/or abnormal digital rectal examination and/or TRUS findings. We retrospectively reviewed the patients’ medical records, analyzed the prediction rate of prostate cancer, and identified 20 feature importances that could be compared with biopsy results using 5 different algorithms, viz., logistic regression (LR), support vector machine, random forest (RF), extreme gradient boosting, and light gradient boosting machine. RESULTS: Overall, the cancer detection rate was 41.8%. In patients younger than 75 years and with a PSA level less than 20 ng/mL, the best prediction model for prostate cancer detection was RF among the machine learning methods based on LR analysis. The PSA density was the highest scored feature importances in the same patient group. CONCLUSIONS: These results suggest that the prediction rate of prostate cancer using machine learning methods not inferior to that using LR and that these methods may increase the detection rate for prostate cancer and reduce unnecessary prostate biopsy, as they take into consideration feature importances affecting the prediction rate for prostate cancer.
Biopsy ; Chungcheongnam-do ; Digital Rectal Examination ; Forests ; Humans ; Logistic Models ; Machine Learning ; Medical Records ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Support Vector Machine ; Ultrasonography

Objective To investigate the outcomes of patients with diabetic retinopathy (DR) in Shanghai communities and the influencing factors.Methods From October 2015 to April 2016,533 type 2 diabetic patients with DR were selected by target sampling and cluster random sampling method from six community health service centers in Shanghai.Patients were followed up for 1 year.The demographic information,physical examination,laboratory tests and eye fundus exam results were documented and the DR was graded.The factors associated with the regression of DR were analyzed.Results Total 478 patients,including 280 females (58.6％) and 198 males (41.4％),were followed up for 1 year.The mean age of patients was (64±7) years and the mean disease duration was (8.85±4.20) years.The original DR lesion was remitted in 35 patients with an improvement rate of 7.3％;while the original DR lesion was aggravated in 29 patients with a progression rate of 6.1％.Ordinal logistic regression analysis revealed that age (OR=0.197,95％CI:0.056-0.699),body mass index (BMI) (OR=0.383,95％CI:0.171-0.856),glycosylated hemoglobin (HbAlc) (OR=0.287,95％CI:0.102-0.803),triglycerides (TG) (OR=0.541,95％CI:0.295-0.991),urinary albumin to creatinine ratio (ACR)(OR=0.218,95％CI:0.066-0.720) were associated with DR in type 2 diabetic patients.Conclusion The regression of DR is closely related to age,BMI,glucose,serum lipids and renal function,so it is suggested that lowering BMI,controlling glucose and serum lipids and maintaining normal kidney function are necessary for preventing the progression and promoting the improvement of DR in diabetic patients.

Background: Hypobaric hypoxia (HH) exposure at high altitudes can result in a decline in cognitive function, which may have a serious impact on the daily life of people who migrate to high altitudes. However, the specific HH-induced changes in brain function remain unclear. This study explored changes in brain activity in rats exposed to a sustained HH environment using functional magnetic resonance imaging (fMRI). Methods: Healthy male rats (8 weeks old) were randomly divided into a model group and a control group. A rat model of cognitive impairment induced by sustained HH exposure was established. The control and model groups completed training and testing in the Morris water maze (MWM). A two-sample t-test for between-group difference comparisons was performed. Repeated measures analyses of variance for within-group comparisons were performed and post-hoc comparisons were made using the Tukey test. Between-group differences in spontaneous brain activity were assessed using a voxel-wise analysis of resting-state fMRI (rs-fMRI), combined with analyses of the fractional amplitude of low frequency fluctuations (fALFF) in statistical parametric mapping. Results: In the MWM test, the escape latencies of the model group were significantly longer compared with those of the control group (control group vs. model group, day 1: 21.6 ± 3.3 s vs. 40.5 ± 3.4 s, t = -11.282; day 2: 13.5 ± 2.2 s vs. 28.7 ± 5.3 s, t = -7.492; day 3: 10.5 ± 2.8 s vs. 22.6 ± 6.1 s, t = -5.099; day 4: 9.7 ± 2.5 s vs. 18.6 ± 5.2 s, t = -4.363; day 5: 8.8 ± 2.7 s vs. 16.7 ± 5.0 s, t = -3.932; all P < 0.001). Within both groups, the escape latency at day 5 was significantly shorter than those at other time points (control group: F = 57.317, P < 0.001; model group: F = 50.718, P < 0.001). There was no within-group difference in average swimming speed (control group, F = 1.162, P = 0.956; model group, F = 0.091, P = 0.880). Within the model group, the time spent within the original platform quadrant was significantly shorter (control group vs. model group: 36.1 ± 5.7 s vs. 17.8 ± 4.3 s, t = 7.249, P < 0.001) and the frequency of crossing the original platform quadrant was significantly reduced (control group vs. model group: 6.4 ± 1.9 s vs. 2.0 ± 0.8 s, t = 6.037, P < 0.001) compared with the control group. In the rs-fMRI study, compared with the control group, rats in the model group showed widespread reductions in fALFF values throughout the brain. Conclusions The abnormalities in spontaneous brain activity indicated by the fALFF measurements may reflect changes in brain function after HH exposure. This widespread abnormal brain activity may help to explain and to provide new insights into the mechanism underlying the impairment of brain function under sustained exposure to high altitudes.

Objective     To evaluate the clinical and follow-up results of the surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Methods     We retrospectively analyzed the clinical data of the patients with hypertrophic obstructive cardiomyopathy plus aortic stenosis in our hospital from February 2008 to October 2015. There were 4 males and 3 females aged 55.6 ± 7.5 years. All the patients were received concomitant aortic valvulopasty at the time of modified extended Morrow procedure. Echocardiographic data and major complications were recorded through the outpatient clinic and telephone. Results     The postoperative ventricular septal thickness, left ventricular outflow tract gradient and aortic gradient were significantly lower than those in preoperation with statistical differences (P<0.05). During the mean follow-up 25.6 ± 28.2 months period, 1 patient died of cerebral hemorrhage, 1 patient was implanted a permanent pacemaker, and 1 patient had a postoperative new-onset atrial fibrillation. All patients had a satisfied prosthetic valve function and the left ventricular outflow tract gradient. The patient's symptoms and heart function significantly improved postoperatively. Conclusion     For patients with hypertrophic obstructive cardiomyopathy associated with moderate to severe aortic stenosis, concomitant aortic valvulopasty at the time of modified extended Morrow procedure is an appropriate and effective treatment, which can significantly alleviate the clinical symptoms, and improve quality of life with a satisfied prognosis.

OBJECTIVE: To evaluate the effects of jejunal-ileal bypass(JIB) in addition to sleeve gastrectomy(SG) on glycemic regulation and body weight in Zucker Diabetic Fatty(ZDF) rats and underlying mechnisms. METHODS: Twelve ZDF(fa/fa) rats were randomly divided into two groups based upon the procedure performed including sleeve gastrectomy plus jejunal-ileal bypass surgery group(SG+JIB,n=6) and sleeve gastrectomy plus sham procedure group(SG+Sham,n=6). In addition,five healthy ZDF(fa/+) rats were employed as normal controls. Body weight,fasting blood glucose,food intake,oral glucose tolerance test and plasma GLP-1 levels were measured before surgery and at 2 and 4 weeks after surgery. RESULTS: Preoperatively,all baseline parametes had no statistical difference between SG+JIB and SG+Sham groups. In comparison with SG+Sham group,fasting plasma glucose levels at postoperative week 2(17.3 mmol/L vs. 8.7 mmol/L) and 4(21.4 mmol/L vs. 11.9 mmol/L)were significantly lower in SG + JIB group(P<0.0001). Oral glucose tolerace was significantly improved,represented by glucose excursion area under curve for 180 minutes period(4221 vs.2964,P<0.0001 at postoperative week 2;and 4104 vs. 3388,P<0.01 at postoperative week 4). Simutaneously,plasma GLP-1 levels were significantly higher in SG + JIB group than SG + Sham group(64.58 pmol/L v.s.30.52 pmol/L,P<0.001). However,SG + JIB had less food intake and body weight only decreased at postoperative week 2,but not at week 4. CONCLUSION: By adding JIB onto SG,the metabolic regulation capability is able to be furtherly enhanced. However,it seems that there is not additional benefit in weight loss.Therefore,based upon these results,we suggest that SG + JIB should be recommended to the patients who needs additional metabolic effects,but not to the patients for the purpose of additional weight loss above SG alone.

In order to study the pathways of biosynthesis of flavonoids in Sophora japonica, 113 797 unigenes were obtained by Trinity software, with an average length of 803 bp, of which 72 752 unigenes were obtained from the database by high-throughput sequencing, and a total of 38 891 SSR loci were searched. Through the metabolic pathway analysis, we found that there were 135 unigenes involved in the biosynthesis of flavonoids and 959 unigene involved in other secondary metabolic pathways. Further analysis of genes involved in rutin biosynthesis revealed that 24 were associated with CHS, 52 were associated with FLS, and 11 were associated with UFGT. The obtained data of S. japonica transcriptome lays the foundation for studying the pathways of biosynthesis of flavonoids in S. japonica and provides theoretical basis for the formation of the quality of S. japonica.

Objectives:To analyze the impact of extended myectomy on reducing mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods:We retrospectively analyzed 480 consecutive HOCM patients who underwent surgical treatment by the same surgeon in our institution from October 2002 to July 2017. The efficacy of extended myectomy for reducing mitral regurgitation and left ventricular outflow tract (LVOT) obstruction were evaluated by echocardiography after surgery. Results:Among the 480 patients, 22 (4.6%) received concomitant mitral repair or replacement because of their intrinsic mitral diseases. In the remaining 458 (95.4%) patients without concomitant mitral valve surgery, 1 (0.2%) died at the 5th day after surgery because of infective shock, and another 4 (0.9%) lost to follow-up, a total of 453 (98.9%) patients underwent echocardiographic follow-up (median follow-up time:6 months [3, 12]). During follow-up, left ventricular out flow tract gradient was significantly decreased from (89.1±30.6) to (12.8±11.6) mmHg (P＜0.001); the number of patients with systolic anterior motion (SAM) of mitral leaflets decreased from 451(98.5%) to 42 (9.3%) (P＜0.001); 297 (64.8%) patients presented with moderate or severe mitral regurgitation before surgery, which decreased to 14 (3.1%) at follow-up (P＜0.001); the multivariate regression analysis showed that patients with residual SAM were significantly associated with a higher incidence of moderate to severe mitral regurgitation during follow-up (odds ratio 30.334, 95% confidence interval:5.619-163.739, P＜0.001). Conclusions:Extended myectomy, combined with dividing the anomalous links between mitral apparatus and septum, and trimming papillary muscles, yields satisfactory outcomes of relieving LVOT obstruction and reducing mitral regurgitation in most of patients with HOCM. Concomitant mitral valve surgery is rarely required unless the patient have intrinsic mitral valve disease.

Objective To assess the effect of community management of type 2 diabetes mellitus (T2DM)patients with signing on family doctor service in Shanghai.Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017.T2DM patients,who visited the community health service centers more than three times in the last one year, were enrolled in the study.The questionnaire survey was conducted and lab tests were documented.Results A total of 5 078 T2DM patients were enrolled in this study,among whom 2 033 had signed contract service with family doctors(signing group)with a signing rate of 40.8%.Compared to non-signing group,the patients in the signing group were better followed the recommendations of blood glucose control[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)], diet[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)]and physical activity[63.4%(1 295/2 053)vs.34.8%(1 033/2 978)](χ2=356.507, 400.649 and 393.996, P<0.01).The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group[80.2%(1 615/2 053)vs.77.6%(2 272/2 978), χ2=3.894,P<0.05;81.8%(1 679/2 053)vs.74.5%(2 215/2 978),χ2=38.084, P<0.05]. The control rates of GLU,2 h PPG,HbA1c,and blood pressure in signing group were higher than those in non-signing group[40.0%(823/2 053)vs.35.9%(1 069/2 978),47.3%(971/2 053)vs.45.4%(1 352/2 978),35.2%(722/2 053)vs.32.5%(968/2 978), χ2=18.495,5.218, 5.006, all P<0.05].Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low.