Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction(AMI)complicated by pleural effusion and its effect on long-term prognosis.Methods It was a prospective single-center study.Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging(CMR)during hospitalization were consecutively enrolled and assigned to the with-pleural effusion group and the without-pleural effusion group according to the echocardiography result.Baseline data,cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups.The occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)was recorded through outpatient follow-up and telephone follow-up,including all-cause death,re-infarction,revascularization,rehospitalization for congestive heart failure and stroke.Cox regression analysis was performed to analyze influencing factors of all-cause death.Results Among 211 patients,31(14.7%)patients had pleural effusion and 180(85.3%)had no pleural effusion.Compared with the group without pleural effusion,the left ventricular end-diastolic diameter was larger,and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion(P＜0.05).There were no significant differences in infarct size,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR(all P＞0.05).At a median follow-up of 31 months,MACCE occurred in 43(20.4%)patients,and there was no significant difference between the two groups(χ2=3.160,P=0.075).Six cases(2.8%)had all-cause death.The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion(9.7%vs.1.7%,P<0.05).There was no significant difference in the incidence of other adverse events between the two groups(P＞0.05).Multivariate Cox regression analysis showed that advanced age and presence of pleural effusion were independent risk factors of all-cause death during follow-up.Conclusion Patients with AMI combined with pleural effusion have more severe myocardial injury and higher all-cause mortality.

Objective To investigate the hematopoietic effects and mechanisms of Asini Corii Colla with different processing methods on blood-deficient mice.Specifically,we aim to evaluate the blood-nourishing properties of Asini Corii Colla extracted using high-pressure steam extraction compared to the traditional atmospheric pressure extraction method.Methods Seventy female C57BL/6 mice were randomly divided into the following groups:normal control group(Normal),model group(Model),Asini Corii Colla processed by atmospheric pressure method low dosage group(aL),Asini Corii Colla processed by atmospheric pressure method high dosage group(aH),Asini Corii Colla processed by high-pressure steam low dosage group(AL),Asini Corii Colla processed by high-pressure steam high dosage group(AH),and positive control group treated with vitamin B12(VB12).Except for the normal group,all other groups were induced to develop blood deficiency syndrome in mice by combining acetylphenylhydrazine(APH)with cyclophosphamide(CTX).After the treatment,whole blood,kidney,and femur tissue samples were collected from the mice.The peripheral blood parameters of the mice were determined using a hematology analyzer.The levels of hematopoietic cytokines in the mouse serum were measured by ELISA.The protein levels related to hematopoietic function in the mouse serum and kidney tissue were determined by Western blot.Hematoxylin and eosin(HE)staining was performed to observe the pathological changes in the bone marrow tissue.Immunohistochemistry was used to evaluate the protein expression levels of granulocyte colony-stimulating factor(G-CSF)and granulocyte-macrophage colony-stimulating factor(GM-CSF)in the bone marrow tissue.Results Asini Corii Colla processed by different techniques significantly increased the levels of peripheral blood leukocytes,erythrocytes,hemoglobin,and lymphocytes in mice with blood deficiency.It also decreased the mean corpuscular volume and mean corpuscular hemoglobin concentration in peripheral blood,effectively improving the symptoms of reduced hematopoietic cells and increased adipose tissue in mice with blood deficiency.It increased the number of nucleated cells in the bone marrow,enhanced the protein levels of G-CSF and GM-CSF in the bone marrow,and increased the levels of erythropoietin(EPO),interleukin-3(IL-3),and GM-CSF in the serum.It also increased the expression of EPO in the kidneys and decreased the levels of interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)in the serum.Compared with Asini Corii Colla processed by traditional atmospheric pressure extraction,the Asini Corii Colla produced by high-pressure steam extraction exhibited more significant effects in increasing blood cell counts in peripheral blood,increasing the number of nucleated cells in the bone marrow,enhancing the protein levels of G-CSF and GM-CSF in the bone marrow,increasing the levels of erythropoietin(EPO)and G-CSF in the serum,and decreasing IL-6 levels.Conclusion Asini Corii Colla processed by different techniques demonstrated significant blood-supplementing effects in mice with blood deficiency,with the high-pressure steam extraction technique showing stronger effects than the traditional atmospheric pressure extraction technique.The mechanism involved the upregulation of EPO,IL-3,GM-CSF,and G-CSF as positive regulators of hematopoiesis,increased expression of EPO in the kidneys,enhanced protein expression of GM-CSF and G-CSF in the bone marrow,as well as the downregulation of TNF-α and IL-6 as negative regulators of hematopoiesis.

Objective To explore the effect of web problem-based learning in electrocardiography (ECG) teaching.Methods 100 clinical medical students from Grade 2014 were randomly selected and divided into two groups,with 50 in each.The control group received traditional methods in ECG teaching,while the WPBL teaching method was conducted in experimental group.The effect of ECG teaching in two groups were evaluated and analyzed by test scores and questionnaire survey.Continuous variables were expressed as mean ± standard deviation and were compared by t-test.Categorical variables were expressed as counts and percentages.Counting data were test by Chi-square.Results Comparing with control group,students in the experimental group performed better on independent learning capability,interesting of learning ECG,ability to analyze and solve problems,team cooperation,self-presentation and presentation skills (P＜0.05).The average experimental score in experimental group was higher than that in control group [(32.91 ± 3.56) vs.(27.38 ± 4.63),P＜0.05].There were no significant differences of theoretical scores between the two groups [(54.16 ± 3.87) vs.(52.84 ± 4.56),P＞0.05].Conclusion WPBL teaching could improve medical students' interest in electrocardiogram learning and cultivates their ability of active learning and problem solving,which is worthy of promotion.

Objective To investigate the clinical effect of induction chemotherapy plus concurrent radiochemotherapy in the treatment of locally advanced non-small cell lung cancer (NSCLC) through a meta-analysis.Methods CBM, CNKI, Cochrane Library, PubMed, and EMbase were searched for the articles on comparison between induction chemotherapy plus concurrent radiochemotherapy and concurrent radiochemotherapy for patients with locally advanced NSCLC.According to the inclusion and exclusion criteria, the data on short-term outcome and survival were collected.A Meta-analysis was performed to evaluate the clinical effect of induction chemotherapy followed by concurrent radiochemotherapy.Results A total of 5 articles were included, which involved 845 patients.The results showed that the short-term outcome and the 2-and 3-year survival rates were similar between patients receiving induction chemotherapy plus concurrent radiochemotherapy and those receiving concurrent radiochemotherapy ( OR=0.875, 95% CI 0.507-1.510, P=0.631;HR=0.770, 95% CI 0.515-1.151, P=0.203;HR=0.809, 95% CI 0.559-1.172, P=0.262), but the patients receiving induction chemotherapy plus concurrent radiochemotherapy showed a significantly higher incidence rate of grade ≥ 3 leukopenia than those receiving concurrent radiochemotherapy alone ( OR=0.637, 95% CI 0.435-0.931, P=0.020).Conclusions Induction chemotherapy plus concurrent radiochemotherapy shows no significant advantages over concurrent radiochemotherapy alone in the short-term outcome and 2-and 3-year survival rates, but it significantly increases myelosuppression.Since there are few studies involving a limited number of cases included in this analysis, more multicenter randomized trials are needed to provide more detailed data and further clarify the clinical value of induction chemotherapy plus concurrent radiochemotherapy.

Objective To validate and compare the pyramidal tracts traced by functional magnetic resonance mo?tion activated area as the region of interest method (fMRI guided DTI-FT) and by the anatomy of primary motor cortex as region of interest method(traditional DTI-FT)using subcortical electrical stimulation (DsCS). Methods A prospective study was conducted in 12 cases of patients with central lesions involving the motor area. The pyramidal tracts were traced by fMRI guided DTI-FT method and traditional DTI-FT method. The lesions were resected with the assistance of neuronavigation. The distances between same stimulation positive point and pyramidal tracts traced by the fMRI DTI-FT or traditional DTI-FT were recorded. The coincidence rates between pyramidal tract imaging and DsCS were analyzed in order to verify the accuracy and reliability of these two methods. Results Two cases were excluded:one due to the failure of the fMRI activation caused by movement dysfunction and one case due to negative electrical stimulation.,The pyrami?dal tracts were successfully reconstructed in the rest 10 patients using these two methods which were further applied to assist surgery. The coincidence rates between DsCS and pyramidal tracts were 77%in fMRI DTI-FT and 70%in tradition?al DTI-FT. The shortest distances were 4.3mm±2.8mm and 5.5mm±3.4mm in fMRI DTI-FT and in traditional DTI-FT in 16 DsCS positive sites and the difference was statistically significant (P<0.05). Five cases had temporary postoperative pa?ralysis. Among them, four cases had upper limb paralysis and one case had hemiplegia. The motor function was improved in four cases and remained unchanged in two cases two weeks after the operation. The motor function in the rest six cases did not have any change before and after operation. Conclusion The fMRI guided DTI-FT can be helpful to deal with le?sions and effectively protect the brain function area in patients with the central area lesions involved motor area.

BACKGROUNDThe molecular and cellular origins of migraine headache are among the most complex problems in contemporary neurology. Up to now the pathogenesis of migraine still remains unclearly defined. The objective of this study was to explore new factors that may be related to the mechanism of migraine.

METHODSThe present study performed a comprehensive analysis of gene expression in the trigeminal nucleus caudalis induced by electrical stimulation of dura mater surrounding the superior sagittal sinus in conscious rats using microarray analysis followed by quantitative real-time reverse-transcribed polymerase chain reaction (qRT-PCR) verification. Student's two sample t-test was employed when two groups were compared. A P value <0.05 was considered to be statistically significant.

RESULTSComparing the placebo and the electrical stimulation groups, 40 genes were determined to be significantly differentially expressed. These significantly differentially expressed genes were involved in many pathways, including transporter activity, tryptophan metabolism, G protein signaling, kinase activity, actin binding, signal transducer activity, anion transport, protein folding, enzyme inhibitor activity, coenzyme metabolism, binding, ion transport, cell adhesion, metal ion transport, oxidoreductase activity, mitochondrion function, and others. Most of the genes were involved in more than 2 pathways. Of particular interest is the up-regulation of Phactr3 and Akap5 and the down-regulation of Kdr.

CONCLUSIONThese findings may provide important clues for a better understanding of the molecular mechanism of migraine.

Animals ; Dura Mater ; physiology ; Electric Stimulation ; Gene Expression ; physiology ; Male ; Microarray Analysis ; Migraine Disorders ; genetics ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Superior Sagittal Sinus ; physiology

OBJECTIVETo investigate the efficacy and safety of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) in the salvage therapy for the grade IV neutropenia induced by concurrent chemoradiotherapy, and to provide evidence for its clinical rational application.

METHODS114 malignant tumor patients suffered with grade IV neutropenia induced by concurrent chemoradiotherapy were treated in the following groups. In the P-50 group, 42 patients received a single subcutaneous injection of 50 µg/kg PEG-rhG-CSF. In the P-100 group, 30 patients received a single subcutaneous injection of 100 µg/kg PEG-rhG-CSF. In the P+R group, 22 patients received a single subcutaneous injection of 50 µg/kg PEG-rhG-CSF and multiple subcutaneous injections of 5 µg×kg(-1)×d(-1) rhG-CSF, until the absolute neutrophil count (ANC) ≥ 2.0×10(9)/L. In the R group, 20 patients received multiple subcutaneous injections of 5 µg×kg(-1)×d(-1) rhG-CSF, until ANC ≥ 2.0×10(9)/L. The P-50, P-100 and P+R groups were experimental groups, and the R group was defined as control group. In each group, the neutrophil proliferation rate and the neutrophil counts at different time points, the period of neutropenia symptom relief, and the rate of adverse reactions induced by above drugs were analyzed.

RESULTSBoth neutrophil proliferation rates and neutrophil counts in the patients of experimental groups at different time points were significantly higher than those in the control group. In the experimental groups the period of the clinical effect began in 12-24 hours, and the conditions of neutropenia were improved in 36 hours. In the experimental groups, the period of the symptom relief such as fever and skeletal muscle pain was (30.00 ± 7.48) hours and (30.00 ± 5.10) hours, respectively, significantly shorter than (72.00 ± 17.89) hours and (59.00 ± 11.46) hours in the control group (P < 0.05). The adverse drug reaction rate was 26.1% in the experimental groups and 25.0% in the control group (P > 0.05).

CONCLUSIONSFor the treatment of grade IV neutropenia induced by concurrent chemoradiotherapy, PEG-rhG-CSF is effective and safe. The recommend dose of this drug for the salvage therapy for those patients is a single hypodermal injection of 50 µg/kg. Usually it becomes effective in 12-24 hours.

Chemoradiotherapy ; Granulocyte Colony-Stimulating Factor ; genetics ; metabolism ; Humans ; Injections, Subcutaneous ; Leukocyte Count ; Neutropenia ; chemically induced ; Neutrophils ; Recombinant Proteins ; Salvage Therapy ; methods

OBJECTIVETo assess the correlation of CHADS₂and CHA₂DS₂-VASc scores for left atrial thrombus in patients with nonvalvular atrial fibrillation and the differences in the results between the two scoring systems.

METHODSA total of 397 patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS₂and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared. The correlation of CHADS₂ and CHA₂DS₂-VASc scores with left atrial thrombus was analyzed.

RESULTSThe average score of CHA₂DS₂-VASc was significantly higher than that of CHADS₂in these patients (1.37 ± 1.19 vs 0.63 ± 0.78, P<0.001). The proportion of high-risk group was significantly higher (P<0.001) while that of low-risk group significantly lower as stratified by CHA₂DS₂-VASc scores than by CHADS₂scores (P<0.001). Transesophageal echocardiography detected left atrial thrombus in 44 of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS₂or CHA₂DS₂-VASc scores (P<0.05). Univariate analysis showed that female gender, age ≥ 65 years, left atrium diameter ≥ 38 mm, left ventricular ejection fraction ≤ 40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS₂≥ 2, and CHA₂DS₂-VASc ≥ 2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only CHA₂DS₂-VASc ≥ 2 as the independent risk factor for left atrial thrombus (OR=9.85, 95% CI: 2.178-44.542, P < 0.01).

CONCLUSIONThe average score of CHA₂DS₂-VASc is higher than that of CHADS₂and has better predictive ability for left atrial thrombus.

Atrial Fibrillation ; complications ; Echocardiography, Transesophageal ; Female ; Heart Atria ; pathology ; Humans ; Male ; Risk Factors ; Thrombosis ; complications ; diagnosis

Objective To explore the value of afterdischarges monitoring for intraoperative electrical stimulation for brain mapping. Methods 34 patients received cerebral cortex electrical stimulation for brain mapping during operation of brain function area , afterdischarges were monitored simultaneously to determine the upper limit of stimulus intensity. Results 34 cases underwent electrical stimulation successfully , and received surgery without neurologic decline except 2 cases of hypokinesia. Conclusion After discharges monitoring improve the accuracy, reduce the risk of intraoperative cerebral cortex electrical stimulation.

Objective To explore the effects of flunarizine hydrochloride on plasma calcitonin gene-related pep-tide and substance P levels after CSD in a rat migraine model of cortical spreading depression (CSD). Methods Thirty adult rats were randomly and evenly divided into three groups:control Group, CSD group and flunarizine group. The CSD waves were evoked by application of potassium chloride on brain surface with filter paper. Funarizine hydrochloride was intravenously administered to rats five minutes prior to application of potassium chloride. The plasma levels of CGRP and SP were measured by using radioimmunity assay. Statistical analyses were performed using two-sample t test and analy-sis of variance. Results CSD waves were absent in control group whereas CSD waves were induced in CSD and flunari-zine groups. The latency of the first CSD wave was longer in flunarizine group (167.90 ± 25.18 s) than in CSD group (130.90 ± 13.30 s) (P<0.01). The number of CSD waves was smaller in flunarizine group (4.50 ± 1.84) than in CSD group (8.50 ± 2.07) (P<0.01). The amplitude of CSD waves was lower in flunarizine group (11.40 ± 4.12 mv) than in CSD group (24.40±3.57 mv) (P<0.01). The levels of CGRP and SP in both CSD group (CGRP, 32.95±11.61 pg/mL;SP, 27.80±7.51 pg/mL) and flunarizine group (CGRP, 25.13 ± 5.67 pg/mL; SP, 19.45 ± 6.10 pg/mL) were higher than in control group (CGRP, 14.44 ± 6.39 pg/mL; SP, 12.36 ± 4.22 pg/mL) (P<0.01). The levels of CGRP and SP in flunarizine group (CGRP, 25.13±5.67 pg/mL;SP, 19.45±6.10 pg/mL) were lower than those in CSD group (CGRP, 32.95±11.61 pg/mL;SP, 27.80± 7.51 pg/mL) (P<0.05). Conclusions Flunarizine hydrochloride can inhibit CSD and reduce the plama levels of CGRP and SP in the rat model of CSD.