Background: and Purpose Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset. Methods: In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5–24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0–1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH). Results: Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46–2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0–2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group. Conclusion This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5–24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.

OBJECTIVETo study the association of polymorphisms of FokI rs2228570 in the vitamin D receptor (VDR) gene and TMPRSS6 rs855791 with cow's milk protein allergy (CMPA) in children.

METHODSQuantitative real-time PCR was used to analyze the single nucleotide polymorphisms of FokI rs2228570 in the VDR gene and TMPRSS6 rs855791 in 100 children with CMPA and 100 healthy children (control group). The multivariate logistic regression model was used to identify the risk factors for CMPA.

RESULTSThere were significant differences in the frequencies of CC, CT, and TT genotypes of TMPRSS6 rs855791 between the CMPA and control groups (P=0.008), and the CMPA group had a significantly higher frequency of TT genotype. The multivariate logistic regression analysis showed that the children with TT genotype of rs855791 had an increased risk of CMPA (OR=3.473, P=0.011). However, there was no significant difference in the genotype distribution of FokI rs2228570 in the VDR gene between the two groups (P=0.686).

CONCLUSIONSTMPRSS6 rs855791 polymorphism is associated with CMPA in children, and TT genotype may be the susceptible genotype of CMPA. FokI rs2228570 polymorphism is not associated with CMPA.

BACKGROUNDIn patients with nonvalvular atrial fibrillation (NVAF), embolic stroke is thought to be associated with left atrial appendage (LAA) thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China.

METHODSThe clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1, 3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period.

RESULTSThis study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years (ranging from 50 to 88 years), and the mean CHA2DS2-VASc score of all patients was 3.6 ± 1.6 (ranging from 2 to 9). Among those 106 NVAF patients, 100 (94.3%) patients were implanted with the device successfully. The procedural success rate was 94.3% (100/106), and the occlusion rate was 100.0% (100/100). There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a thrombus layer on the device that resolved with additional anticoagulation: one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% (95/100). In this study, the expected annual rate of ischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year.

CONCLUSIONSLAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate (2.0% per year) in our study was lower than the predicted annual stroke risk (4.0%) using the CHA2DS2-VASc score.

Aged ; Aged, 80 and over ; Atrial Appendage ; surgery ; Atrial Fibrillation ; complications ; Cardiac Surgical Procedures ; methods ; China ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prosthesis Implantation ; adverse effects ; methods ; Stroke ; prevention & control

Objective To investigate the impact of the regional cooperative chest pain center (CPC) on therapeutic time and short term outcome after primary percutaneous coronary intervention (PCI) of patients with ST segment elevated myocardial infarction.Methods 372 patients with ST segment elevated myocardial infarction were enrolled in the study who had received were operated primary PCI 18 months before and after the regional cooperative CPC was set up.There were 156 patients in the green channel group before the setup of CPC and 216 patients in the CPC group.Total ischemia time,first medical contact (FMC) time,FML-to-balloon (FMC2B) time,door-to-balloon (D2B) time,hospital mortality rates,cardiac failure rates on the next day after PCI,length of CCU stays and hospital stays were compared between the two groups.Results Compared to the green channel group,total ischemia time[(281.0±102.7)min vs.(365.2±115.6)min,P＜0.05],FMC time [(174.3±97.5) min vs.(225.4±104.6) min,P＜0.05],FMC2B time [(106.7±61.2) min vs.(139.8±75.7) min,P＜0.05] and D2B time [(75.2±45.4) min vs.(102.4±53.7) min,P＜0.05] of the CPC group were significant shorter.The rates of reaching the standard of FMC2B time (70.83％ vs.34.62％,P＜0.001) and D2B time (75.93％ vs.40.38％,P＜0.001)were significantly higher in the CPC group.Cardiac failure rates on the next day after PCI was lower in the CPC group (14.35％ vs.23.72％,P=0.021),and CCU stays was shorter [(64.3±13.72)h vs.(92.6±15.65)h,P=0.043].Conclusions Establishment of a standardized regional cooperative CPC requires combination and consideration of the characteristics of local resources FMC2B time and D2B time of STEMI patients can be shorten by a standardized CPC lending to further shortening of total ischemia time and improvement in cardiac function.

Derris eriocarpa, a traditional Chinese medicine belonging to the family of Leguminosae, is widely distributed mainly over Yunnan, Guangxi and Guizhou of China. Modern pharmacological researches on this herb showed that it had extensive bioactivities, such as promoting urination, removing dampness and cough and reducing inspissated mucus and other biological activities. The extensive studies on the chemical constituents of this plant have resulted in the isolation of triterpenoids, steroids, fatty acid and others, but the flavone compounds haven't reported before. In our further research on the ethyl acetate of this plant, nine flavone compounds were obtained by column chromatography on silica gel, Sephadex LH-20, semi-prep HPLC, polyamide column chromatography and recrystallization for separation and purification. The structures were determined on the basis of extensive spectroscopic analysis, including MS, NMR experiments and comparison with spectroscopic data in the literature, respectively, as diosmetin (1), 3, 3'-di-O-methylquercetin (2), afromosin (3), 6, 3'-dihydroxy-7, 4'-dimethoxyisoflavone (4), odoratin (5), 7, 3'-dihydroxy-8, 4'-dimethoxyisoflavone (6), 6, 4'-dihydroxy-7, 3'-dimethoxyisoflavone (7), 5, 7, 4'-trihydroxy-3, 3', 5'-trimethoxyflavone (8), and alpinumisoflavone (9). All these compounds were isolated from Derris eriocarpa How for the first time. And the in vitro assays showed that compound 2 possessed moderate inhibitory activity against human cancer cells K562 and HEL.
Derris ; chemistry ; Flavonoids ; chemistry ; isolation & purification ; pharmacology ; Humans ; K562 Cells

OBJECTIVETo review the recent progress of multilayer stents in treating arterial aneurysms and to draw an initial conclusion about its paradigm.

DATA SOURCESPubMed database and ELSEVIER database were searched with the keywords "cardiatis" or "multilayer stent" for relevant articles from January 2008 to September 2012. Relevant websites (provided by Cardiatis) were also involved in the review process.

STUDY SELECTIONWell-controlled, relatively large-scale, retrospective studies as well as meaningful individual cases were all selected as materials.

RESULTSA total of 23 articles were involved in this review. The newly introduced Cardiatis multilayer stent aims at creating an active flow-modulating barrier between normal blood flow and aneurismal sac, which can induce thrombosis within aneurismal sac and preserve collateral circulation at the same time. Currently, it has been applied for complicated aneurysms located in different segments of the arterial system.

CONCLUSIONThis new concept of multilayer uncovered stent offers a promising alterative in the treatment of arterial aneurysms. However, a further large-scale clinical and hemodynamic study is required to evaluate the long-term effects.

Aneurysm ; physiopathology ; therapy ; Databases, Factual ; Hemodynamics ; physiology ; Humans ; Retrospective Studies ; Stents

OBJECTIVETo assess the acceptability of pre-exposure prophylaxis (Pr-EP) among the female sex workers in Xinjiang.

METHODSA volunteer-based, anonymous and one-to-one questionnaire survey was conducted in 762 female sex workers (FSW) in Urumqi and Kelamayi of Xinjiang Uyghur Autonomous Region.

RESULTAmong 762 FSW surveyed, 673 (88.32%) was not aware of pre-exposure prophylaxis with an awareness rate of 11.55%. The awareness rate of FSWs working in high-end entertainment venues was higher than that of FSWs working in medium-low end entertainment venues(P<0.001). Five hundred and twenty eight FSWs (69.29%) were willing to take Pr-EP, 145 (19.03%) were unwilling to take the medicine and 89 (11.68%) were possible to use the Pr-EP. There was no significant difference in willingness of using Pr-EP among FSWs working in high and medium-low end entertainment venuew (P=0.285). The subjects who were willing to take Pr-EP mainly concerned of the drug security, effectiveness and cost. The main reasons for not willing to take Pr-EP were: not having risk of infecting HIV, suspecting effectiveness of Pr-EP and worrying about side effects.

CONCLUSIONThe acceptability to use Pr-EP in female sex workers of Xinjiang is relatively high and the drug security, effectiveness and cost will influence the promotion and application of Pr-EP in the future.

Adult ; Chemoprevention ; China ; Female ; HIV Infections ; prevention & control ; Health Knowledge, Attitudes, Practice ; Humans ; Patient Acceptance of Health Care ; Sex Work ; Surveys and Questionnaires ; Young Adult

Objective To investigate the mental health status of the midshipwomen involved in Mission Harmony-2010 and its influencing factors, and also to provide scientific basis for the maintenance of mental health and selection of female ship crew.Methods With midshipwomen, female medical personnel, male shipcrew as study subjects, and with cluster sampling and stratified random sampling as study methods, questionnaires were conducted 4 times by using symptom checklist (SCL-90) and routine interviews were also made during our study.Results During the prolonged seagoing deployment, the rate of detection for mental health problems among the midshipwomen was 21.8%. Scores of various factors during the mid stage of deployment were obviously higher than those of the normal people. However, in the later stage, scores of various factors were slightly lower than those of the normal people. Statistical significance was shown in the mental health status of the midshipwomen, when a comparison was made between pre-deployment,early stage of deployment and the mid and later stages of deployment(P<0.05). Scores of somatization, depression, phobia and other factors were significantly higher than those of the norms of Chinese military personnel (P<0.05). Scores of interpersonal sensitivity, anxiety and paranoia were lower than those of the norms of Chinese military personnel, but without statistical significance. During the mid and later stage of the prolonged seagoing deployment, the mental health status of midshipwomen was worse than that of the male ship crew and female medical personnel(P<0.05).Conclusions Prolonged seagoing deployment could significantly worsen the mental health status of midshipwomen. It was necessary to give in-time psychological intervention so as to ensure the mental health of midshipwomen.

Objective To survey the risk factors of metabolic syndrome (MS) of military flying personnel so as to provide the basis of prevention and control measures.Methods Body mass index (BMI),triglyceride (TG),fasting plasma glucose (FPG) and blood pressure (BP) were measured for 682 flying personnel.Such diagnostic criteria as BMI≥ 25 kg/m2 (obesity),TG≥ 1.7 mmol/L (hypertriglyceridemia),BP≥ 140/90 mm Hg (hypertension),and FPG≥ 6.1 mmol/L (impaired fasting blood glucose,IFG) were chosen based on the criteria issued by China Diabetes Association in 2004.MS was diagnosed in case of the personnel exceeded above 3 or more criteria.Their health history was reviewed upon above mentioned parameters for comparison and analysis.Results The crude prevalence of MS was 6.45％ (44 out of 682 cases).The prevalence of MS was 0.00％,4.73％,18.99％ and 25.00％ respectively corresponding to the flying personnel aged over 20,30,40 and 50 years old.The prevalence of obesity,hyper triglyceride,hypertension,raised fasting blood glucose was 39.44 ％,22.29 ％,8.21％,and 1.61％ respectively.Among which,321 personnel were diagnosed as metabolic disorders based on one or more abnormal parameters.The total prevalence of abnormal metabolic index was 47.07％.Conclusions The prevalence of MS is so high in military flying personnel.Overweight,hyper triglyceride and aging have become the high risk factors to MS.It is necessary to take early intervention for preventing MS.

Objective To investigate the mental health status of the midshipwomen involved in Mission Harmony-2010 and its influencing factors, and also to provide scientific basis for the maintenance of mental health and selection of female ship crew.Methods With midshipwomen, female medical personnel, male shipcrew as study subjects, and with cluster sampling and stratified random sampling as study methods, questionnaires were conducted 4 times by using symptom checklist (SCL-90) and routine interviews were also made during our study.Results During the prolonged seagoing deployment, the rate of detection for mental health problems among the midshipwomen was 21.8%. Scores of various factors during the mid stage of deployment were obviously higher than those of the normal people. However, in the later stage, scores of various factors were slightly lower than those of the normal people. Statistical significance was shown in the mental health status of the midshipwomen, when a comparison was made between pre-deployment,early stage of deployment and the mid and later stages of deployment(P<0.05). Scores of somatization, depression, phobia and other factors were significantly higher than those of the norms of Chinese military personnel (P<0.05). Scores of interpersonal sensitivity, anxiety and paranoia were lower than those of the norms of Chinese military personnel, but without statistical significance. During the mid and later stage of the prolonged seagoing deployment, the mental health status of midshipwomen was worse than that of the male ship crew and female medical personnel(P<0.05).Conclusions Prolonged seagoing deployment could significantly worsen the mental health status of midshipwomen. It was necessary to give in-time psychological intervention so as to ensure the mental health of midshipwomen.