Objective:To analyze the clinical characteristics of elderly acute pulmonary thromboembolism(APE)patients complicated with preexisting atrial fibrillation(AF)and the impact of preexisting AF on in-hospital adverse outcomes in elderly patients with APE.Methods:A retrospective analysis was performed on elderly APE patients with preexisting AF hospitalized in Beijing Anzhen Hospital, Capital Medical University between January 1, 2008 and December 31, 2021.We compared the comorbidities, symptoms, signs, laboratory test results and echocardiographic features, simplified pulmonary embolism severity index(sPESI)scores and adverse in-hospital outcomes between the preexisting AF group and the non-AF group.Logistic regression was used to analyze the risk factors of in-hospital adverse outcomes in elderly patients with APE.Results:A total of 240 patients diagnosed with APE were enrolled.There were 120 patients in the AF group and 120 patients in the non-AF group.For patients in the AF group and the non-AF group, the proportions with chronic heart failure were 38.3%(46/120)and 15.8%(19/120), the proportions with lower extremity deep vein thrombosis(DVT)were 36.7%(44/120)and 65.8%(79/120), the left ventricular ejection fractions(LVEF)were(59±10)% and(62±7)%, and hospital stays were(15±7)and(11±4)days, respectively, and the differences were statistically significant( χ2=15.381, 20.429, t=2.527, -4.710, all P<0.05). The incidences of in-hospital adverse outcomes in the AF group and the non-AF group were 4.2%(5/120)and 3.3%(4/120), respectively, with no significant difference( χ2=0.000, P=1.000). The overall incidence of in-hospital adverse outcomes was 3.8%(9/240). Multivariate Logistic regression analysis showed that elevated lactic acid was an independent risk factor for in-hospital adverse outcomes( OR=2.753, 95% CI: 1.367-5.542, P=0.005). However, AF( OR=2.880, 95% CI: 0.587-14.141, P=0.192)and sPESI score( OR=2.056, 95% CI: 0.904-4.673, P=0.086)were not associated with in-hospital adverse outcomes. Conclusions:Elderly APE patients with preexisting AF have a relatively low incidence of DVT, but a higher proportion have concurrent chronic heart failure and need a longer hospital stay.Elevated lactic acid is an independent risk factor for in-hospital adverse outcomes of elderly APE patients with preexisting AF.However, preexisting AF has no predictive value for in-hospital adverse outcomes in elderly patients with APE.

Objective:To describe the characteristics and change trends of incidence, mortality and disease burden of acute myocardial infarction (AMI) in Qingdao from 2014 to 2020.Methods:We analyzed the incidence data of AMI retrieved from Qingdao Chronic Diseases Surveillance System. The average annual percent change (AAPC) of morbidity and mortality of AMI were evaluated by using Joinpoint log-linear regression model. Disability adjusted life year (DALY) was used to estimate disease burden of AMI in Qingdao.Results:A total of 70 491 AMI cases and 50 832 deaths of AMI occurred in Qingdao from 2014 to 2020. The age-standardized morbidity and mortality were 54.71/100 000 and 36.55/100 000, respectively. During 2014-2020, the AAPC of age-standardized morbidity was 2.86% (95% CI: 0.42%-5.35%), and 4.30% (95% CI: 1.24%-7.45%) in men and 0.78% (95% CI: -0.89%-2.47%) in women, respectively. The log-linear regression model showed that age-standardized morbidity in age groups 30-39, 40-49 years increased rapidly, with the AAPCs of 8.92% (95% CI: 2.23%-16.06%) and 6.32% (95% CI: 3.30%-9.44%), respectively. The trend was also observed in age groups 30-39, 40-49 and 50-59 years in men, with the AAPCs of 11.25% (95% CI: 3.54%-19.54%), 6.73% (95% CI: 2.63%-10.99%) and 6.72% (95% CI: 2.98%-10.60%), respectively. There was no significant change in age-standardized mortality. The DALY rate increased from 7.49/1 000 in 2014 to 8.61/1 000 in 2020, with the AAPC of 1.97% (95% CI: 0.36%-3.60%). Conclusions:The age-standardized morbidity of AMI in men increased in Qingdao, especially in those aged 30-49 years, while age-standardized mortality rate of AMI was relatively stable from 2014 to 2020. The burden of disease of AMI increased in both men and women.

Objective:To investigate the correlations between subacromial impingement syndrome (SIS) and acromial morphology and subacromial intervals after surgery of proximal humerus fracture.Methods:A retrospective study was conducted of the 62 patients with proximal humerus fracture who had been treated by internal fixation with a locking titanium plate from December 2014 to December 2019 at Department of Orthopedics, People's Hospital of Gaoming District. They were 40 men and 22 women, with an average age of 53.5 years (from 35 to 71 years). By the Neer classification, there were 38 three-part and 24 four-part fractures. The incidence of SIS was determined by Nikolaus's diagnostic criteria. The patients were divided into a SIS group and a non-SIS group. The acromial morphology was observed and the subacromial intervals [acromio-greater tuberosity of humerus interval (AGI) and acromio-plate interval (API)] were measured on postoperative X-ray films. The correlations were analyzed between them and SIS.Results:All patients completed treatments and follow-ups from 3 to 15 months (average, 10 months). There was no incision infection or internal fixation failure. There were 18 cases in the SIS group and 44 ones in the non-SIS group. In the SIS group, 3 cases had type Ⅰ acromion while 15 ones type Ⅱ or type Ⅲ acromion; in the non-SIS group, 20 cases had type Ⅰ acromion while 24 ones type Ⅱ or type Ⅲ acromion. The proportion of patients with type Ⅱ or type Ⅲ acromion in the SIS group was significantly higher than that in the non-SIS group ( P<0.05). AGI and API in the SIS group were (11.6±2.1) mm and (14.2±2.4) mm, significantly shorter than those in the non-SIS group [(15.7±2.8) mm and (18.5±3.2) mm] ( P<0.05). Conclusions:SIS is a common complication after surgery of proximal humerus fracture. Abnormal acromial morphology (type Ⅱ or type Ⅲ acromion), poor fracture reduction (reduced AGI), and high placement of a titanium plate (reduced API) may be all important factors leading to SIS.

OBJECTIVE： To optimize the water extraction technology of Qiwei chanshen formula. METHODS： The content of polysaccharides from Gekko japonicus and Panax quinquefolium was determined by UV spectrophotometry， the contents of camptothecin from Camptotheca acuminata and ginsenoside Rb1 from P. quinquefolium were determined by HPLC. The extraction rate of above three components， dry extractum yield and HPLC fingerprint similarity were used as evaluation indicators； information entropy theory was used to determine the weight of each indicator so as to calculate comprehensive score. L9（34） orthogonal test was used to screen the optimal extraction technology of Qiwei chanshen formula with decoction time， water volume and decoction times as factors. Validation test was also performed. RESULTS： The optimal extraction technology included 10-fold water， decocting for 3 times， 1.0 h each time. The results of validation test showed that the average extraction rate of polysaccharide， camptothecin and ginsenoside Rb1 were 74.306％， 13.860％ and 52.958％， respectively. The average dry extractum yield was 16.150％， the average value of fingerprint similarity was 0.991 （all RSDs＜3.0％， n＝3）. CONCLUSIONS： The optimized extraction technology is reproducible， stable and feasible， providing reference for the subsequent development and industrial production of the formula.

Objective To compare the curative effect of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in lumbar disc herniation.Methods A literature search was performed in PubMed, Web of Science, Embase, Wanfang, CNKI. Two authors reviewed all articles individually. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool, and the quality of retrospective studies was evaluated by the modified Newcastle-Ottawa scale. The data was extracted by the Review Manager 5.30.Results A total of 19 articles were brought into this Meta-analysis. The outcomes were divided into primary outcomes and secondary outcomes. Excerpt for the short-term VAS score was lower in PELD group (P = 0.010), other index, including long-term VAS score (P = 0.120), ODI score (P = 0.260), complication (P = 0.100) and recurrence (P = 0.100), didn't had significant difference in two groups. The blood loss (P = 0.000), hospital stay (P = 0.000) and the length of incision (P = 0.000) were all superiority in PELD group. Whereas the operative time was shorter in MED group (P = 0.001).Conclusion PELD was a more minimally invasive and secure technique in lumbar disc herniation.

BACKGROUNDExposure of adult mice to more than 95% O2 produces a lethal injury by 72 hours. Nuclear factor kappa B (NF-κB) is a transcriptional factor that plays a key role in the modulation of cytokine networks during hyperoxia-induced acute lung injury (ALI). Osteopontin (OPN) is a phosphorylated glycoprotein produced principally by macrophages. Studies have reported that exogenous OPN can maintain the integrity of the cerebral microvascular basement membrane and reduce brain damage through inhibiting NF-κB activities in the brain after subarachnoid hemorrhage. However, it is not clear whether OPN can reduce lung injury during ALI by inhibiting transcriptional signal pathways of NF-κB and consequent inhibition of inflammatory cytokines. Thus we examined the effects and mechanisms of recombinant OPN (r-OPN) on ALI.

METHODSNinety-six mice were randomly divided into phosphate buffered saline (PBS) and r-OPN groups. Mice were put in an oxygen chamber (>95% O2) and assessed for lung injury at 24, 48, and 72 hours. Expressions of NF-κB, matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9), and tissue inhibitors of MMP-2 and MMP-9 (TIMP-1, TIMP-2) mRNA in lungs were examined with RT-PCR. Expression and distribution of NF-κB protein in lungs were measured with immunohistochemistry.

RESULTSExposure to hyperoxia for 72 hours induced more severe lung injury in the PBS group compared with the r-OPN group. Expression of NF-κB mRNA in the PBS group exposed to hyperoxia for 48 and 72 hours was significantly higher than the r-OPN group (P < 0.05). With 72-hour exposure, expression of TIMP-1 mRNA in the r-OPN group was significantly higher than that of the PBS group (P < 0.05). Expression of TIMP-2 mRNA in the r-OPN group at 48 and 72 hours was significantly higher than those in the PBS group (P < 0.05). After 72-hour exposure, expression of NF-κB protein in airway epithelium in the PBS group was significantly higher than that in the r-OPN group (P < 0.05).

CONCLUSIONr-OPN can inhibit the release and activation of MMPs through inhibition of the expression of NF-κB and promotion of the expression of TIMPs, and alleviate hyperoxia-induced ALI.

Acute Lung Injury ; genetics ; metabolism ; Animals ; Hyperoxia ; metabolism ; physiopathology ; Matrix Metalloproteinase 2 ; genetics ; metabolism ; Matrix Metalloproteinase 9 ; genetics ; metabolism ; Mice ; NF-kappa B ; genetics ; metabolism ; Osteopontin ; genetics ; metabolism ; Tissue Inhibitor of Metalloproteinase-1 ; genetics ; metabolism ; Tissue Inhibitor of Metalloproteinase-2 ; genetics ; metabolism

Background Exposure of adult mice to more than 95％ O2 produces a lethal injury by 72 hours.Nuclear factor kappa B (NF-κB) is a transcriptional factor that plays a key role in the modulation of cytokine networks during hyperoxia-induced acute lung injury (ALl).Osteopontin (OPN) is a phosphorylated glycoprotein produced principally by macrophages.Studies have reported that exogenous OPN can maintain the integrity of the cerebral microvascular basement membrane and reduce brain damage through inhibiting NF-κB activities in the brain after subarachnoid hemorrhage.However,it is not clear whether OPN can reduce lung injury during ALl by inhibiting transcriptional signal pathways of NF-κB and consequent inhibition of infiammatory cytokines.Thus we examined the effects and mechanisms of recombinant OPN (r-OPN) on ALl.Methods Ninety-six mice were randomly divided into phosphate buffered saline (PBS) and r-OPN groups.Mice were put in an oxygen chamber (＞95％ O2) and assessed for lung injury at 24,48,and 72 hours.Expressions of NF-κB,matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9),and tissue inhibitors of MMP-2 and MMP-9 (TIMP-1,TIMP-2) mRNA in lungs were examined with RT-PCR.Expression and distribution of NF-κB protein in lungs were measured with immunohistochemistry.Results Exposure to hyperoxia for 72 hours induced more severe lung injury in the PBS group compared with the r-OPN group.Expression of NF-κB mRNA in the PBS group exposed to hyperoxia for 48 and 72 hours was significantly higher than the r-OPN group (P ＜0.05).With 72-hour exposure,expression of TIMP-1 mRNA in the r-OPN group was significantly higher than that of the PBS group (P ＜0.05).Expression of TIMP-2 mRNA in the r-OPN group at 48 and 72 hours was significantly higher than those in the PBS group (P ＜0.05).After 72-hour exposure,expression of NF-κB protein in airway epithelium in the PBS group was significantly higher than that in the r-OPN group (P ＜0.05).Conclusion r-OPN can inhibit the release and activation of MMPs through inhibition of the expression of NF-κB and promotion of the expression of TIMPs,and alleviate hyperoxia-induced ALl.

ObjectiveTo study the types of anatomical variations of hepatic arteries. Methods Hepatic arteries of 64-slice spiral CT scanning data were three-dimensional constructed by using self-designed software. The types of anatomical variations were analyzed and classified with Michels' classification criteria. Results The model presented with realistic profile of hepatic arteries which allowed vivid three-dimensional observation. Of these patients, 40 had normal hepatic arteries (60.61%), 26 had variations (39.39%), and 5 had infrequent aberrant hepatic arteries that was not included in Michels' classification (7.58%). Conclusion Three-dimensional model of hepatic arteries can volumetricly display the anatomical variations of hepatic arteries.

Heart Valve Diseases ; therapy ; Humans

Objective To verify the convergent validity,discriminant validity and concurrent validity of the Action Research Arm Test(ARAT)in patients with chronic stroke.Methods 30 cases with chronic stroke were assessed with ARAT,upper limb section at Fugl-Meyer Assessment and Motor Activity Log(MAL)on the same day.The validity was investigated using Spearman ρ and t test.Results The scores of the ARAT closely correlated with upper limb section at Fugl-Meyer Assessment(ρ=0.906,P<0.001).The upper limb section at Fugl-Meyer scores≥33 group achieved a significantly higher scores of the ARAT than the scores<33 group(t =6.614,P<0.001).The scores of the ARAT closely correlated with the amount of use(AOU)and quality of movement(QOM)of MAL(ρ=0.894 and 0.761,respectively,P<0.001).Conclusion The ARAT has been shown good convergent validity,discriminant validity and concurrent validity in people with stroke.