Objective:To investigate the value of CHA2DS2-VASc score for predicting percutaneous coronary intervention (PCI) prognosis in patients with coronary chronic total occlusion.Methods:The clinical data of 139 patients with coronary chronic total occlusion who underwent PCI at the Second Hospital of Anhui Medical University from January 2019 to December 2020 were retrospectively analyzed. These patients were divided into good prognosis and poor prognosis groups according to prognosis outcomes. Univariate and multivariate Cox regression analysis was performed to evaluate the influential factors of adverse events after PCI in patients with coronary chronic total occlusion. The receiver operating characteristic curves were plotted to evaluate the value of the CHA2DS2-VASc score for predicting the occurrence of adverse events in patients with coronary chronic total occlusion undergoing PCI.Results:Among the 139 patients with coronary chronic total occlusion, the average follow-up time was (19.88 ± 7.90) months, 19 (13.7%) patients had a poor prognosis, and 120 (86.3%) patients had a good prognosis. The age, uric acid, and CHA2DS2-VASc score in the poor prognosis group were 73 (65.0, 77.0) years, (383.26 ± 120.60) μmol/L, and 4 (3, 5) points, respectively, which were significantly higher than 66 (57.0, 71.8) years, (322.68 ± 91.88) μmol/L, and 3 (2, 4) points in the good prognosis group ( U = -2.74, t = 2.24, U = -3.09, all P < 0.05). However, the proportion of patients with the successful opening of the occluded coronary artery and albumin, hemoglobin, and triacylglycerol levels in the poor prognosis group were 11 (57.9%), 36.7 (34.4, 38.3) g/L, (120.26±19.74) g/L, and 1.03 (0.85, 1.49) mmol/L, respectively, which were significantly lower than 98 (81.7%)( χ2 = 4.16, P = 0.041), 39.3 (36.78, 42.1) g/L ( U = -2.85, P = 0.004), (133.62 ± 16.84) g/L ( t = 1.52, P = 0.002), and 1.52 (1.09, 2.25) mmol/L ( U =-2.13, P = 0.033) in the good prognosis group. Multivariate Cox regression analysis showed that CHA2DS2-VASc score was a risk factor for poor prognosis of patients with coronary chronic total occlusion undergoing PCI (95% CI: 1.137-2.274, P = 0.007). The receiver operating characteristic curve analysis results showed that the area under the receiver operating characteristic curve plotted for CHA2DS2-VASc score predicting poor prognosis in patients with coronary chronic total occlusion undergoing PCI was 0.716 (95% CI: 0.588-0.844, P = 0.003), with the cut-off point of 3.5, the sensitivity of 68.4%, and specificity of 66.7%, respectively. Conclusion:Compared with those with a good prognosis, patients with a poor prognosis have a higher CHA2DS2-VASc score. The CHA2DS2-VASc score has a certain application value for predicting mid- and long-term prognosis in patients with coronary chronic total occlusion who undergo PCI.

The global COVID-19 coronavirus pandemic has infected over 109 million people, leading to over 2 million deaths up to date and still lacking of effective drugs for patient treatment. Here, we screened about 1.8 million small molecules against the main protease (M^pro) and papain like protease (PL^pro), two major proteases in severe acute respiratory syndrome-coronavirus 2 genome, and identified 1851M^pro inhibitors and 205 PL^pro inhibitors with low nmol/l activity of the best hits. Among these inhibitors, eight small molecules showed dual inhibition effects on both M^pro and PL^pro, exhibiting potential as better candidates for COVID-19 treatment. The best inhibitors of each protease were tested in antiviral assay, with over 40% of M^pro inhibitors and over 20% of PL^pro inhibitors showing high potency in viral inhibition with low cytotoxicity. The X-ray crystal structure of SARS-CoV-2 M^pro in complex with its potent inhibitor 4a was determined at 1.8 Å resolution. Together with docking assays, our results provide a comprehensive resource for future research on anti-SARS-CoV-2 drug development.
Humans ; Antiviral Agents/chemistry* ; COVID-19 ; COVID-19 Drug Treatment ; High-Throughput Screening Assays ; Molecular Docking Simulation ; Protease Inhibitors/chemistry* ; SARS-CoV-2/enzymology* ; Viral Nonstructural Proteins

Point-of-care testing (POCT) has developed rapidly in various fields including medical health, customs quarantine, agriculture, graziery, forestry, fire-fighting, environment and food testing. It poses a huge challenge to the traditional inspection mode. Yet POCT still has many problems in terms of technical ability, quality control, regulation and industry-university-research cooperation and so on. Thus it is necessary for the health administrative departments, manufacturers and hospitals to establish consensus, and implement the total quality management system. The establishment of an independent evaluation system and the application of advanced quality control technologies of POCT is also essential given its particularity. This article focuses on the POCT application status and quality management in Shanghai based on the series of quality management measures for the POCT project carried out by the Shanghai Center for Clinical Laboratory, and raises some thoughts and suggestions for the existing problems.

Objective:To evaluate the safety and efficacy of a combination of percutaneous mechanical thrombectomy (PMT) and drug coated balloon(DCB)for the treatment of in-stent restenosis(ISR) and arterial thrombosis of the lower extremity.Methods:The clinical data of 53 patients treated with PMT + DCB were analyzed retrospectively, including 38 cases of ISR and 15 cases of arterial thrombosis. 33 patients were males and the others were females , the mean age was (68.6±9.4) years . Patients were followed at 30 days, 6 months, and 12 months concerning clinical symptoms, calculation of ABIs and duplex ultrasonography.Results:Procedural success was achieved in all 53 patients. One patient died of cardiovascular event perioperatively. 6 operation-related complications occurred including 5 cases of distal embolism during the PMT managed by using 5 F angiography catheter suction and one case of artery perforation during PMT procedure, a balloon was used to cover it. 47 (88.6%) patients completed 12-month follow-up, the TLR was 10.6% (5/47). One patient had the amputation 4 months later; There were 7 cases with arterial restenosis.PMT+ DCB were performed again in 4 cases, 1 case received stent implantation and 2 cases treated by medication.Conclusion:The use of combination of PMT and DCB is a safe and effective method to treat ISR and arterial thrombosis of the lower extremity.

Objective To evaluate the effect of Xuefu-Zhuyu decoction combined with interactive acupuncture and ibuprofen sustained-release capsule in the treatment of acute lumbar sprain. Methods A total of 102 patients with acute lumbar sprain were randomly divided into two groups, 51 in each group.The control group received ibuprofen sustained-release capsules orally. The study group was treated with Xuefu-Zhuyu decoction combined with interactive acupuncture on the basis of the control group. Both groups were treated for 2 weeks. The degree of low back pain was assessed by VAS and the improvement of lumbar function was assessed by modified Japanese Orthopaedic Association Scores (M-JOA). The Oswestry dysfunction index (ODI) was used to evaluate the degree of lumbar dysfunction. The serum hs-CRP, IL-6, IL-10 and prostaglandin E2 (PGE2) level was detected by ELISA. The clinical efficacy was evaluated. Results The total effective rate was 80.4% (41/51) in the study group and 62.8% (32/51) in the control group. There was significant difference between the two groups (χ2=3.903, P=0.048). After treatment, the VAS (1.85 ± 0.40 vs. 4.06 ± 0.67, t=20.226), M-JOA (4.41 ± 1.35 vs. 11.18 ± 2.25, t=18.426), and ODI (9.66 ± 3.34 vs. 16.37 ± 3.64, t=9.700) in the study group were significantly lower than those in the control group (P<0.01). The serum level of hs-CRP, IL-6, IL-10 and PGE2 in the study group were significantly lower than those in the control group after treatment (t were 6.694, 8.416, 22.110 and 12.137, respectively, all P s<0.01). Conclusions The Xuefu-Zhuyu decoction combined with interactive acupuncture and ibuprofen sustained-release capsule can improve the degree of lumbago and lumbar dysfunction in patients with acute lumbar sprain, reduce the level of serum inflammatory cytokines, and improve the clinical efficacy.

In recent years , there are increasing articles concerning Epstein-Barr virus associated lymphoproliferative disorder (EBV+LPD), and the name of EBV +LPD is used widely.However,the meaning of EBV+LPD used is not the same , which triggered confusion of the understanding and obstacles of the communication.In order to solve this problem.Literature was reviewed with combination of our cases to clarify the concept of EBV +LPD and to expound our understanding about it .In general, it is currently accepted that EBV +LPD refers to a spectrum of lymphoid tissue diseases with EBV infection , including hyperplasia , borderline lesions , and neoplastic diseases .According to this concept , EBV+LPD should not include infectious mononucleosis ( IM ) and severe acute EBV infection ( EBV +hemophagocytic lymphohistiocytosis, fatal IM, fulminant IM, fulminant T-cell LPD), and should not include the explicitly named EBV+lymphomas ( such as extranodal NK/T cell lymphoma , aggressive NK cell leukemia , Burkitt lymphoma, and Hodgkin lymphoma , etc.) either.EBV +LPD should currently include: ( 1 ) EBV +B cell-LPD:lymphomatoid granulomatosis , EBV +immunodeficiency related LPD , chronic active EBV infection-B cell type, senile EBV +LPD, etc.(2) EBV +T/NK cell-LPD:CAEBV-T/NK cell type, hydroa vacciniforme, hypersensitivity of mosquito bite, etc.In addition, EBV+LPD is classified, based on the disease process , pathological and molecular data , as 3 grades:grade1, hyperplasia ( polymorphic lesions with polyclonal cells ); grade 2, borderline ( polymorphic lesions with clonality ); grade 3, neoplasm (monomorphic lesions with clonality).There are overlaps between EBV +LPD and typical hyperplasia, as well as EBV+LPD and typical lymphomas .However , the most important tasks are clinical vigilance , early identification of potential severe complications , and treating the patients in a timely manner to avoid serious complications , as well as the active treatment to save lives when the complications happened .

Acetylcysteine ; urine ; Humans ; Hydrocarbons, Brominated ; metabolism ; urine

OBJECTIVETo establish a method for simultaneously determining the urinary concentrations of 8 carbamate pesticides.

METHODSAfter being purified by acetonitrile precipitation, urine samples were transferred to a liquid chromatography-tandem mass spectrometry system, and the concentrations of 8 carbamate pesticides were determined by external standard method. A C18 column was used for ultra-high-performance liquid chromatography; methanol/ammonium acetate solution was used as the mobile phase for gradient elution; the mass spectrometer was operated in a multi-reaction monitoring mode.

RESULTSThe calibration curves were linear when the urinary concentrations of these carbamate pesticides were 20~800 µg/L, and the recovery rates were 61.0%~121% at spiked levels of 20, 200 and 800 µg/L, with a relative standard deviation of 1.7%~5.5%.

CONCLUSIONThis determination method meets the Guide for establishing occupational health standards-part 5: Determination methods of chemicals in biological materials, and can be used for simultaneous determination of 8 carbamate pesticides in the urine of poisoning patients.

A method based on HPLC-ICP-MS was established to separate the reaction products of ( ethylenediamine) palladium(Ⅱ) chloride([Pd ( en ) Cl2])and 5’-deoxyguanylic acid ( 5’-dGMP). Two reaction products were detected at pH 8. 0 with 25 mmol/L phosphate buffer solution as chromatography eluent. One was the main product with HPLC retention time of 2. 8 min, the other product’s retention time was 3.2 min. According to ESI-MS(MS/MS) study, m/z=510, 511, 512, 514, 516[M+1]+ parent ions ( abundances same to palladium isotopes) were detected. Further analysis showed that the main product was[Pd( en) ( N1-5’-dGMP) ]. However the other product was hardly to be detected by ESI-MS. By using HPLC-DAD and HPLC-ICP-MS, we found that the two reaction products had the same UV absorption spectra and palladium percentage content. Combined with other groups’research, the other reaction product was deduced as dimmer, trimer or tetramer form of[Pd( en) ( N1-5’-dGMP) ]. Further study revealed that[Pd( en) ( N1-5’-dGMP) ] was easily formed in acid solution while its polymer form was generated in alkaline solution. At pH 6. 0, [Pd(en)(N1-5’-dGMP)] was formed within 12 hours with good stability. Research also revealed that the total amount of two reaction products declined as reaction pH climbed.

Objective To investigate effects of Danhong on the serum levels of CD137, high-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) in patients with non-ST elevation acute myocardial infarction complicating metabolic syndrome. Methods A total of 126 patients with non-ST elevation acute myocardial infarction complicating metabolic syndrome were enrolled and randomly divided into a conventional treatment group and a Danhong treatment group using a random-digit table, with 63 patients in each group. All patients underwent angiography or percutaneous coronary intervention. The patients in the Danhong treatment group treated with intravenous Danhong 20 ml on the basis of conventional treatment for 1 week. The serum levels of CD137, hs-CRP and Hcy were measured at hospital admission and 10 days after treatment. The severity of coronary artery disease was assessed by the Gensini-score. Results The levels of CD137, hs-CRP and Hcy in both groups after treatment were significantly lower than before treatment (conventional treatment group: t 12.393, 17.408 and 9.458; Danhong treatment group: t 16.110, 17.573 and 13.481; all P<0.01), and the Danhong treatment group were significantly decreased than the conventional treatment group (t 2.815, 3.224 and 3.157, all P<0.01). The serum levels of CD137 and hs-CRP before treatment were significantly correlated with Gensini scores in 126 patients (r 0.720 and 0.562,all P<0.01). Conclusions The serum levels of CD137 and hs-CRP are significantly correlated with the severity of coronary artery disease, intravenous Danhong may has protective effect for coronary artery disease via decreasing CD137 and hs-CRP.