Objective:To analyze the clinical characteristics of adult Chinese patients with syncope.Methods:This is a cross-sectional survey study. Patients with preliminary diagnosis of syncope in the Emergency Department, Geriatrics and Cardiology Outpatient Department, or Syncope Unit of 37 hospitals in 19 provinces, autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study. The clinical features of these patients with syncope were analyzed.Results:A total of 4 950 consecutive patients with syncope were included in this study. The age was (56.3±16.8)years, and 2 604 cases (52.6%) were male. The most common type of syncope was neurally mediated syncope (2 345 (47.4%)), followed by cardiac syncope (1 085 (21.9%)), orthostatic hypotensive syncope (311 (6.3%)), and unexplained syncope accounted for nearly one third (1 155 (23.3%)). Predisposing syncope was more common in patients under 65 years of age(2 066(72.4%) vs. 786(27.6%),χ 2=136.5, P<0.001). Presyncope was more common in patients with neurally mediated syncope (1 972(79.0%) vs.1 908(73.9%), χ 2=17.756, P<0.001). Premonitory symptoms were more common in women(1 837(80.0%) vs. 1 863(73.0%),χ 2=33.432, P<0.001). Presyncope syndrome was more common in patients under 65 years of age (2 482(77.8%) vs. 1 218(73.4%),χ 2=17.523, P=0.001). Cyanosis was more common in ≥65 years old patients (271(18.2%) vs. 369(12.7%), χ 2=23.235, P<0.001). Urinary incontinence was more common in old patients aged ≥65 years(252(15.2%) vs. 345(10.8%), χ 2=19.313, P<0.001). Family history was more common in patients with cardiogenic syncope compared with other types of syncope (264(24.3%) vs. 754(19.5%), χ 2=11.899, P=0.001). Hypertention(1 480(30.5%)), coronary heart disease(1 057(21.4%)), atrial flutter and atrial fibrillation(359(7.2%)), second degree atrioventricular block(236(4.8%)) were common complications of syncope. The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%) vs. 640(16.6%), χ 2=241.376, P<0.001). Other common complications included cerebrovascular diseases (551 (11.1%)) and diabetes mellitus (632(12.8%)). Conclusions:Neurally mediated syncope is the most common syncope in adult Chinese population. Patients with predisposing conditions and premonitory conditions are younger. Presyncope is more common in women. The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.

Objective:To analyze the risk factors of fatal outcome in patients with severe COVID-19.Methods:The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression.Results:Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators ( P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient’s clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion:COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.

To screen the pathogenic mutation location in a genetic family with the neurofibromatosis (NF1) by the next generation sequencing and analyze the clinical phenotype,Illumina Miseq sequencing was applied to capture and analyze the target regions of NF1 family's probands,and furtherly find out the suspicious mutations,as well as to verify the family members by Sanger sequencing.Two rare variants were identified in proband,including the heterozygous missense mutation c.C3649T (p.P1217S) in KIF1B gene and the missense mutation c.T6311C (p.L2104P) on exon 41 of NF1 gene (NM_000267.3).The amino acid at position 2104 was found to be changed from leucine to proline in NF1.The protein prediction SIFT and Polyphen-2 values were 0,0.997,which predicted a conformational change in the encoded protein and eventually affected its function.The mutation c.T6311C in NF1 gene was detected in all patients in this family,which showed genetic co-segregation.The clinical phenotype was neurofibroma in the spinal canal.There were no café au lait spots,iris Lisch nodules,scoliosis,tinnitus,heating loss,or elevated intracranial pressure.The missense mutation c.T6311C (p.L2104P) in NF1 gene might be the genetic cause of this hereditary disease of neurofibromatosis.

Objective To evaluate the accuracy of serum pro-adrenomedullin (pro-ADM) concentration in predicting sepsis at different degrees of severity.Methods A total of 145 patients of both sexes,aged 18-64 yr,who were admitted to intensive care unit (ICU) of the First Hospital of Hebei Medical University from March 2015 to April 2017,with length of ICU stay＞24 h,were enrolled.The patients were divided into 3 groups according to the Sequential Organ Failure Assessment (SOFA) score within 24 h after admission to ICU:2＜SOFA score ≤ 6 mild sepsis group (n =50),6＜SOFA score ≤ 12 moderate sepsis group (n =50) and SOFA score＞ 12 severe sepsis group (n =45).Peripheral venous blood samples were collected immediately after admission to hospital for determination of serum pro-ADM concentrations by enzyme-linked immunosorbent assay.The receiver operating characteristic (ROC) curve of pro-ADM in predicting sepsis at different degrees of severity was plotted,and the area under the curve and 95％ confidence interval,cut-off value,sensitivity and specificity were calculated.Results The serum pro-ADM concentrations were significantly increased with the severity of sepsis,and the length of ICU stay was prolonged with the severity of sepsis (P＜0.05).In mild sepsis group,the area under the ROC curve was 0.770,95％ confidence interval 0.591-0.949,sensitivity 0.725,specificity 0.700 and cut-off value 6.45 nmol/L.In moderate sepsis group,the area under the ROC curve was 0.776,95％ confidence interval 0.645-0.907,sensitivity 0.813,specificity 0.760,cut-off value 8.30 nmol/L.In severe sepsis group,the area under the ROC curve was 0.83,95％ confidence interval 0.715-0.963,sensitivity 0.73,specificity 0.800,cut-off value 5.70 nmol/L.Conclusion Serum pro-ADM concentration can be used as a reliable index in predicting sepsis at different degrees of severity.

Objective To analyze the controlled risk factors of osteoporotic vertebral fractures, and determine the clinical value for the management of risk factors. Methods 626 cases of postmenopausal women were selected, age, height, weight and bone mineral density(BMD) of patients were collected.The Tetrax balance test system was used to assess the fall risks.Vertebral changes of patients were evaluated through X ray of thoracolumbar lateral. The clinical data were analyzed and compared between vertebral fracture group and non-vertebral fracture group. Spearman test was used to analyze the correlation between vertebral fracture and age, height, weight, body mass index(BMI), the risk of fall, body fat and BMD. Results 328 patients presented with osteoporotic vertebral fractures, while the other 298 cases did not suffer from osteoporotic vertebral fractures. There were 426 vertebral bodies involved. Comparing to non-vertebral fracture group, the vertebral fracture group showed higher age [(68.67±9.29)years vs.(63.04± 9.30)years], lower height[(151.10 ± 4.39)cm vs.(154.90 ± 5.86)cm], lower bone mineral density[lumbar spine BMD (0.85 ± 0.16)g/cm2 vs.(0.93 ± 0.17)g/cm2, hip spine BMD (0.72 ± 0.18)g/cm2 vs.(0.81 ± 0.13)g/cm2],higher body fat [(41.30 ± 5.20)％vs.(36.30 ± 5.90)％] and higher fall risk (41.38 ± 25.79 vs. 36.20 ± 26.22) ( P<0.001). While there were no statistical differences in weight and BMI between the two groups, age, height, BMI, body fat, fall risk, lumbar spine and hip BMD were significantly correlated with vertebral fracture (r=0.358,-0.323, 0.169, 0.186, 0.135,-0.398,-0.364, respectively, all P<0.001). Conclusions Decreased bone mineral density, increased age, abdomen fat content and increased fall risk, are the risk factors of osteoporotic vertebral fractures.

Objective To investigate the value of cysteine-rich secretory protein LCCL domain-containing 2 (CRISPLD2) in diagnosis and prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit (ICU) of the First Hospital of Hebei Medical University from December 2014 to December 2016 were retrospectively analyzed. According to the severity of sepsis, the patients were divided into three groups: sepsis patients, severe sepsis patients and septic shock patients, and 100 healthy persons were enrolled as control group. Levels of serum CRISPLD2, procalcitonin (PCT) and C-reactive protein (CRP), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, and 28-day prognosis were recorded. Analysis of the correlation between CRISPLD2 and PCT, CRP, APACHEⅡscore, SOFA score was done. The receiver operating characteristic (ROC) curve was plotted for the CRISPLD2 value for the diagnosis and prognosis in patients with sepsis.Results A total of 115 patients with sepsis were enrolled in this study, including 52 sepsis, 48 severe sepsis, and 15 septic shock; 29 patients died after 28 days, 28-days mortality rate was 25.2%. There was no significant difference in CRISPLD2 between sepsis and healthy control group (mg/L: 204.1±74.5 vs. 211.3±12.0, P > 0.05); the level of CRISPLD2 in septic shock group was significantly lower than that in sepsis group and severe sepsis group (mg/L: 139.0±55.0 vs. 240.2±89.6, 233.0±8.9, bothP < 0.05). The level of PCT, CRP and APACHE Ⅱ score, SOFA score in sepsis patients were significantly higher than those in healthy control group, and increased with the severity of sepsis. There was no statistically significant difference in CRISPLD2 level between the dead and the survival of sepsis, and the levels of PCT and CRP in death group were significantly higher. The levels of CRISPLD2 were significantly negative correlated with the levels of PCT, CRP, APACHE Ⅱ score and SOFA score (r values were -0.089,-0.431, -0.115, -0.201, respectively, allP < 0.05). It was shown by ROC curve analysis that the area under ROC curve (AUC) and 95% confidence interval (95%CI) of CRISPLD2, PCT, CRP for diagnosis of sepsis were 0.907 (0.871-0.944), 0.922 (0.886-0.958), 0.916 (0.878-0.954) respectively, allP = 0.000; when the cut-off value of CRISPLD2 > 216.0 mg/L, the sensitivity was 96.7%, and the specificity was 92.6%, which power lied between PCT and CRP. The AUC of CRISPLD2 for prognosis was significantly lower than that of PCT [0.617 (0.507-0.727) vs. 0.786 (0.668-0.903),P <0.01]; when the cut-off value of CRISPLD2 was 103.5 mg/L, the sensitivity was 100%, and the specificity was 25.6%. Conclusion CRISPLD2 is a potential biomarker in sepsis, but cannot predict the prognosis of patients with sepsis.

Objective To investigate the correlation of moesin and E-cadherin with biological behavior of breast cancer and its mechanism by comparing expression of moesin and E-cadherin in breast invasive carcinoma of no specific type (BIC-NST),breast ductal carcinoma in situ (BDCIS) and normal breast tissues adjacent to carcinoma.Methods Breast cancer cases of the Huizhou Municipal Center People Hospital were collected between Jan 2008 and Dec 2010,expression of moesin and E-cadherin in 104 cases of BIC-NST,84 cases of BDCIS and 53 cases of normal breast tissues adjacent to carcinoma were detected by tissue-microarray and SP immunohistochemical staining.Western blot was used to detect moesin expression of 16 BIC-NST fresh tissues.Results Expression rate of moesin in BIC-NST and BDCIS were significantly higher than normal tissues(P ＜ 0.01),but the expression rate of E-cadherin in BIC-NST and BDCIS were significantly lower than those of normal tissues(P ＜ 0.01).Expression rate of moesin in BIC-NST grade Ⅲ group was significantly higher than that of the grade Ⅰ group.There was a significantly positive correlation between histological grade and moesin expression(P ＜ 0.05).However,E-cadherin expression rate in BICNST grade Ⅲ group was significantly lower than that in grade Ⅰ group,and there was a significantly negative correlation between histological grade and E-cadherin expression (P ＜ 0.05).Moreover,no significant correlation was observed between moesin and E-cadherin expression in BDCIS tissues.Expression of moesin in clinical stage Ⅱ + Ⅲ BIC-NST was significantly higher than that in stage Ⅰ (P ＜ 0.01).Expression of moesin was significantly associated with lymph node metastasis (P ＜ 0.01).But no significant correlation was observed between moesin expression and age,tumor size and vascular invasion.However,expression of E-cadherin in clinical stage Ⅱ + Ⅲ BIC-NST was significantly lower than that in stage Ⅰ (P ＜ 0.01).Expression of E-cadherin was significantly associated with lymph node metastasis and vascular invasion (P ＜ 0.01).But no significant correlation was observed between E-cadherin expression,age and tumor size.There was a negative correlation between expression of moesin and E-cadherin in BIC-NST(P =0.021)and BDCIS(P =O.032).Conclusion Higher moesin and lower E-cadherin signal transduction is closely related to the recurrence and development of breast carcinoma,therefore moesin and E-cadherin might provide new targets for gene therapy in breast carcinoma.

Objectives To evaluate the count of endothelial progenitor cells (EPCs) in peripheral blood (PB) and bone marrow (BM) of acute leukemia (AL) patients and explore its clinical significance.Methods EPCs were detected by flow cytometry procedures in 43 AL patients and in 10 benign hematologic patients as control group.Results The absolute counts of EPCs in AL patients before the treatment [(119.46± 72.23)/μl in BM and (13.69±8.26)/pl in PB] were significantly higher than those in control group [(23.21 ± 12.59)/pl in BM and (1.86±1.18)/μl in PB] (P ＜ 0.01).The absolute counts of EPCs were significandy higher in BM than those in BP in AL patients before the treatment (P ＜ 0.001).After the treatment, the absolute counts of EPCs in no remission (NR) group [(110.02±67.28)/μl in BM and (10.04±9.51)/μ1 in PB] were significantly higher than those in control group (P ＜ 0.05), while the counts of EPCs in complete remission (CR) group were no significant difference compared with those in control group (P ＞ 0.05).After the treatment ,the absolute counts of EPCs both in BM and in BP of CR group [(26.32±17.44)/μl and (2.54±2.12)/μl, respectively] were significantly lower than those before treatment [(113.18±69.22)/μl and (14.45±10.76)/μl, respectively] (P ＜ 0.05), however those of NR group were no significant difference than before (P ＞ 0.05).The absolute counts of EPCs whether in PB or in BM were no significant difference between acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL) (P ＞ 0.05).The absolute counts of EPCs in PB of AL had a positive correlation with β2-MG and LDH (P ＜ 0.05).Conclusions EPC levels are significantly increased in BM and BP of AL patients and may correlate with disease status, response to treatment and prognosis.

Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases.Methods Tumor markers (CA19-9,CEA and CA242) examination and bacterial culture were performed in a total of 160 patients,who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for biliary diseases.Resuts There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9,CEA and CA242 (P ＜0.05) ; Cut-off value,according to ROC curve,was 239 ku/l in CA19-9,40 ng/ml in CEA and 60 ku/ml in CA242,respectively.There were significant differences between the bile marker and the serum marker in sensitivity,accuracy,negative predicative value of CEA (P ＜ 0.05).No significant differences was found in specificity between the serum group and the bile group.There were significant differences in bile CA19-9 level between cholangiocarcinoma,pancreatic cancer,duodenal papilla carcinoma with carcinoma metastasizing to bile duct,and hepatocellular carcinoma (P ＜ 0.05).Both in benign group and malignant group,there were significant differences in CA19-9 level between infectious bile and noninfectious bile (P ＜ 0.05).Conclusion The level of CA19-9,CEA and CA242 in bile can be applied to differentiate benign and malignant biliary diseases.The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis.Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.

Objective To explore the impact of basal sphincter of Oddi (SO) pressure on pancreatobiliary reflux (PBR).Methods A total of 120 consecutive patients who received therapeutic ERCP for biliary tract diseases with or without the history of EST were enrolled,and were assigned to normal basal SO pressure group (n =23),elevated basal pressure group (n =55) and EST group (n =24).Basal SO pressure,bile amylase (BA) and bacteria culture findings were compared between the three groups.Results There were no differences in positive rate of bacteria culture,SO pressure increase and BA between the normal basal SO pressure group and elevated basal pressure group.In the latter group,negative correlation was observed between SO pressure and BA.The BA value [median(quartile range)] in patients with common bile duct ≥ 15 mm [4270 (12 337)U/L] was significantly higher than that in patients with common bile duct ＜ 15 mm [279.5 (1370) U/L].Furthermore,significant difference in both the proportion of elevated BA patients (83.3％ vs.59.0％) (P ＜0.05) and the positive rate of bacteria culture (75.0％ vs.33.3％) was seen between the intact papilla patients in the former two groups and those in EST group (P ＜ 0.05).Conclusion There was no direct correlation between the elevated basal SO pressure and PBR,but marked increase in diameter of common bile duct can lead to a rise in BA.Moreover,although EST can bring about PBR and bile bacterial infection,it may facilitate the outflow of the refluent pancreatic juice by relieving cholestasis.