How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China.

BACKGROUND: Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China. METHODS: This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes. RESULTS: Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach's α = .70 to .86; retest rs = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (rs = .465 to .574) and discriminant validity (rs = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: "reflection of transference dynamics in the doctor-patient relationship", "emotional and cognitive learning" and "case mirroring in the dynamic of the group". Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures. CONCLUSIONS: The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

Effectiveness of clinical scenario dramas to teach doctor-patient relationship and communication skills.

BACKGROUND: The doctor-patient relationship in China has deteriorated in recent years, and poor doctor-patient communication is one of the main reasons. How to effectively carry out doctor-patient communication training originated from the West among Chinese medical students still to be studied. In the past decade, Peking Union Medical College has adopted clinical scenario drama to teach doctor-patient relationship and clinical communication skills. The aim of this study was to introduce clinical scenario dramas and evaluate its effectiveness in promoting doctor-patient relationships and clinical communication skills through students' self-perceptions in Chinese medical students. METHODS: This study was a retrospective, self-controlled study and conducted from March 2009 to October 2018. Doctor-patient relationship and communication skills training were administered to all sixth-year medical students, which involved lectures and various clinical scenario dramas. The program totaled 24 h, of which each class session was 3 h, with 8 sessions in total. All students were requested to complete an anonymous 5 likert self-rating survey including self-confidence in using communication skills and self-perceived learning attitude and ability before and at the end of the course. In addition, they were requested to evaluate the curriculum after completion of the course. RESULTS: Clinical scenario dramas helped students improve their self-confidence in clinical communication skills except for psychosomatic history taking (p < 0.05). The interests for participation in clinical scenario dramas were higher compared to attending lectures (4.39 ± 0.610 Vs 4.07 ± 0.831, p<0.01). Study participants were highly satisfied in the course setting, teaching instructors and content (4.61 ± 0.546, 4.65 ± 0.535, 4.63 ± 0.534). The self-evaluation results demonstrated that clinical scenario dramas improved the learning ability of medical students (p < 0.05). CONCLUSION: The use of clinical scenario dramas was helpful in teaching doctor-patient communication skills.

Synchronous Nutrient Controlled-Release of Greenhouse Gases During Mineralization of Sediments from Different Lakes.

Lake sediments, as an important emission source of nutrients and greenhouse gases, play a crucial role during the biogeochemical cycle processes. However, the impact mechanisms of different nutrient levels on greenhouse gas emission from lakes are still insufficient. In this study, the sediments from eight shallow lakes in the middle and lower reaches of the Yangtze River were cultured to study the release characteristics of greenhouse gases more than one month. Results showed that the greenhouse gases during the mineralization processes of sediments were mainly released to the atmosphere instead of being dissolved in the overlying water. The released concentrations of CH4 and CO2 were as high as 1 × 103 µmol L-1 in the later stage of the experiment, while the concentration of N2O was relatively low with a maximal value of about 10 µmol L-1. In addition, all the lake sediments displayed a nutrient release to the overlying water, where the concentrations of TC, TOC, TN, NH4+-N and TP were up to 173.0, 102.7, 36.7, 30.8 and 6.34 mg L-1, respectively. The nutrient levels of different lake sediments are symmetrical to the released nutrients concentrations in the overlying water. The further statistical analysis illustrated a synchronous nutrient controlled-release of greenhouse gases, that is, the higher the levels of nutrients in the sediments, the higher the concentrations of greenhouse gases released. These findings provide a better understanding that the control of endogenous nutrient levels of sediments is extremely important for lacustrine management, which can play a positive role in mitigating the greenhouse gas emissions from lake sediments.

[Research Advances in Big Data-based Diagnosis and Therapy of Heart Failure].

Heart failure is a serious condition with high prevalence and mortality. The application of the novel big data analysis in heart failure can improve the management of this condition,especially in terms of diagnosis,classification,and prognostic prediction. This articles reviews relevant literature and validates the role of big data analysis for heart failure patients.

Clinical characteristics of immunoglobulin G4-related disease: a prospective study of 118 Chinese patients.

OBJECTIVE: To characterize the clinical features of IgG4-related disease (IgG4-RD) in China. METHODS: A prospective cohort study of IgG4-RD was carried out in Peking Union Medical College Hospital between 2011 and 2013. Patients with newly diagnosed IgG4-RD were enrolled. RESULTS: A total of 118 patients with IgG4-RD were enrolled, including 82 males and 36 females, aged 53.1 (s.d. 13.6) years. The most common symptom at onset was lacrimal gland swelling (38/32.2%). A range of organs were involved: 77 patients (65.3%) had lymphadenopathy, 76 (64.4%) had sialadenitis, 60 (50.8%) had dacryoadenitis, 45 (38.1%) had autoimmune pancreatitis, 32 (27.1%) had pulmonary involvement, 31 (26.3%) had periaortitis/retroperitoneal fibrosis, 29 (35.4% of male patients) had prostatitis and 29 (24.6%) had renal involvement. In addition, there were 21 (17.8%) cases of sclerosing cholangitis, 15 (12.7%) of sinusitis and 10 (8.5%) of inflammatory pseudotumour. Uncommon manifestations included mediastinal fibrosis, skin involvement, sclerosing thyroiditis, hypophysitis, orchitis and colitis. Multiple organ involvement was observed in 93 patients, whereas only 4.2% had only a single organ involved. A history of allergy was reported in 73 (61.9%) patients. The serum IgG4 level was elevated in 97.5% and was correlated with the number of organs involved. Most patients were treated with glucocorticoids alone or in combination with immunosuppressive drugs, and the majority usually improved within 3 months. CONCLUSION: IgG4-RD is a systemic inflammatory and sclerosing disease. Parotid and lacrimal involvement (formerly called Mikulicz's disease), lymphadenopathy and pancreatitis are the most common manifestations. Patients with IgG4-RD showed favourable responses to treatment with glucocorticoids and immunosuppressive agents.

[Long-term outcome of patients discharged with fever of unknown origin in the Department of General Internal Medicine of Peking Union Medical College Hospital].

OBJECTIVE: To investigate the clinical characteristics and outcome of patients with undiagnosed fever of unknown origin (FUO). METHODS: To retrospectively review the clinic data of patients discharged with FUO from the Department of General Internal Medicine, Peking Union Medical College Hospital during 2004 to 2008. Medical records and phone call follow-up data were collected until 2014. RESULTS: Among 758 in-patients diagnosed with FUO, 70 patients still discharged with FUO were enrolled in this study, including 23 males and 47 females. There were 14 missing patients. Finally, definite diagnoses were made in 20 patients by clinical reassessments, empirical therapy or repeated biopsies, in whom 3 patients dying from underlying diseases. A total of 36 patients did not get final diagnoses, while fever was relieved in 23 patients, including 10 treated with corticosteroids or non-steroid anti-inflammatory drugs (NSAIDs) from 1 month to 12 months due to suspected connective tissue diseases. Another 3 patients still had episodic fever. Seven patients died shortly after discharge. There were 3 dying in the long-term follow-up. The overall FUO-related mortality was 18.6%. Mortality was correlated with the number of dysfunctional organs, especially cytopenia, coagulation dysfunction, bleeding events, respiratory damage and acute renal failure with OR 2.1, 9.9, 3.3 and 6.6 (P < 0.05) respectively. CONCLUSIONS: Close follow-up, intermittent clinical reassessments, repeated biopsies will contribute to the diagnosis of patients discharged with FUO. Empirical therapy with corticosteroids, NSAIDs or anti-tubercular drugs in selected patients may be safe and effective. Mortality rates increased with impaired organs, especially the hematological, respiratory and renal systems.

[Association between chronic periodontitis and metabolic syndrome related mitochondria single nucleotide polymorphism].

OBJECTIVE: To investigate the relationship between Mitochondrial DNA(mtDNA) SNP and the severity of periodontitis. METHODS: In the study, 227 subjects in a community of Beijing received questionnaire interview, periodontal examination and biochemical laboratory examination in 2005. The designed primer was used to amplify the specific mtDNA fragments with PCR, and sequence the PCR products. Finally, the relationship between severity of chronic periodontitis and mtDNA SNP at site 10398 was analyzed. RESULTS: The number of the subjects included at mtDNA site 10398 was 227. The G allele frequency in the metabolic syndrome(MS) subjects was significantly higher than that in the non MS subjects [80(70.2%) vs. 34(29.8%),P=0.039 ]. The result of Logistic regression showed that the subjects with G allele had higher risk of MS than the subjects with A allele(OR=1.77,95%CI=1.02-3.06, P=0.042). But there was no significant relationship between the 10398 A→G SNP and severity of periodontitis. CONCLUSION: In this population, mtDNA SNP 10398 A→G may be associated with MS. However, there was no relationship between the 10398 A→G SNP and severity of chronic periodontitis.

[Periodontal status of patients with post-acute myocardial infarction].

OBJECTIVE: To evaluate the periodontal status of post-acute myocardial infarction patients, to identify whether periodontitis is associated with post-acute myocardial infarction in Chinese community population. METHODS: Case and control subjects were enrolled from a community population, the diagnose of post-acute myocardial infarction and systemic health were based on blood, electrocardiogram and ultrasound examinations by physicians. Full mouth periodontal examinations were performed in 103 post-acute myocardial infarction patients and 52 healthy subjects. Mesial-buccal and distal-lingual sites per tooth were examined. The periodontal parameters including plaque index (PLI), bleeding index (BI), probing depth (PD), attachment level (AL) and missing teeth number were recorded. Information of demographic data, behavior habits and general conditions were obtained by a questionnaire. Periodontal status were compared between case and control groups, the association between AL, PD, PLI, missing teeth and post-acute myocardial infarction was analyzed by Logistic regression. RESULTS: In post-acute myocardial infarction group, there were 83 males, 20 females, mean age was 68(41 to 84)years old, in healthy subjects there were 30 males and 22 females,mean age was 62(42 to 78) years old. There were no statistically differences between two groups in age structure, smoking condition, education status and working condition, but body mass index, total cholesterol, triglycerides and glucose in post-acute myocardial infarction group were significantly higher than that in healthy group,while high-density lipoprotein significant lower . The number of missing teeth(6.89±7.39 vs. 4.21±5.62, P=0.01), mean AL [(3.48±2.34) mm vs. (2.61±1.85) mm, P=0.02] and prevalence of severe periodontitis (44.7% vs. 32.7%, P<0.01) were significantly higher in post-acute myocardial infarction patients than that in healthy subjects. Plaque index (1.69±0.49 vs. 1.57±0.50, P=0.22), PD (2.88±1.02 vs. 2.64±0.68, P=0.09) were higher in post-acute myocardial infarction patients than that in healthy subjects, but not statistically significant. In the multivariate analysis, after adjusting sex, age, smoking, body mass index, diabetes, hypertension and serum lipid, AL≥4.00 mm was a significant risk indicator for post-acute myocardial infarction(odd ratio 4.89, 95%confidence interval 1.26 to 18.94, P=0.02). CONCLUSION: Periodontal status was worse in post-acute myocardial infarction patients than that in healthy subjects, AL≥4.00 mm was an independent risk indicator for post-acute myocardial infarction.

[Effects of dental health awareness and behaviours on the glycemic metabolic characteristics and periodontal disease of patients with type 2 diabetic].

OBJECTIVE: To analyze the effects of dental health awareness and behaviours on the relationship between glycemic metabolic characteristics and periodontal disease of type 2 diabetic patients. METHODS: In the study, 83 subjects with type 2 diabetes mellitus were recruited. The clinical periodontal indexes, such as pocket probing depth (PPD), attachment loss (AL), modified bleeding index (mBI), plaque index (PLI) were obtained with a Williams type periodontal probe; Laboratory examinations including glycosylated haemoglobin A1(HbA1C) were made, glucose assay tested, and the structured questionnaire interview conducted evaluationg the knowledge, attitude and practice (KAP) about periodontal health. RESULTS: The prevalence of moderate and severe periodontitis was 67.5%, compared with mild periodontitis, whose severities were affected by the higher level of HbA1C (≥8.0%) (OR 54.1-143.1), followed by using glycemic drug (OR=12.9-44.6), stress (OR=16.9-29.6), and the dissatisfaction with diabetic therapy (OR=16.9-18.0) et al. Meanwhile the attachment loss conditions were also correlated with the poor periodontal knowledge level(OR=3.4),older age(OR=1.1),and misjudgement of gingival inflammation (OR=13.3) et al. On the other hand, individuals with moderate and severe periodontitis, having bad teeth brushing effects and knowing about dental plaque inadequately, had a significantly higher risk for the poorly controlled glycemic results (HbA1C≥8.0%), and the OR was 8.61, 8.07, and 7.49 respectively. CONCLUSION: In patients with type 2 diabetes the severity of periodontal disease and the glycemic metabolic level (HbA1C) have a definite bidirectional adverse interrelationship, which is affected by the dental health awareness and behaviours.

[Granulocyte elastase levels in saliva and gingival crevicular fluid of subjects with various periodontal conditions].

OBJECTIVE: To compare the granulocyte elastase (EA) levels in saliva and/or gingival crevicular fluid (GCF) of subjects with various periodontal conditions and analyze the relation between EA levels in GCF and in saliva. METHODS: GCF and salivary samples were collected from 17 subjects with healthy periodontium, 14 with gingivitis, 24 with chronic periodontitis (CP) and 24 with aggressive periodontitis (AgP). The EA levels in GCF and saliva were analyzed. RESULTS: The GCF-EA level in AgP were significantly higher than that in CP (0.485 3 ± 0.225 0 vs. 0.288 4 ± 0.193 1, P<0.01); the levels of EA in saliva of periodontitis patients (AgP and CP) were higher than those of healthy and gingivitis subjects (0.844 5 ± 0.660 6, 0.637 3 ± 0.648 9 vs. 0.031 6 ± 0.020 6, 0.012 2 ± 0.005 8, P<0.001). A positive correlation was found between EA levels in saliva and those in GCF (r=0.660). CONCLUSION: GCF-EA level may serve as a marker for clinical assessment of periodontal conditions. The measurement of EA levels in saliva may facilitate to overall screen periodontitis patients in epidemiological study or to monitor periodontal conditions in clinical practice.

[Relationship between the preterm low birth weight infant and the periodontal pathogen bacteria in maternal saliva].

OBJECTIVE: To investigate the possible relationship between the preterm and/or low birth weight (PLBW) and three anaerobic microorganisms in saliva of their mothers, including Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema Denticola (Td). METHODS: 110 retrospective cases were collected from 4 hospitals in Beijing urban and suburban areas. PLBW group included 72 subjects and NBW group included 38 subjects. They were made up of 2:1 matched data. Nonstimulated saliva samples were collected from all the individuals. The periodontal examinations included plaque index (PLI), probing depth (PD), bleeding index (BI), and clinical attachment loss (CAL) were performed in 1-1.5 years after preterm. According to the PCR results in their saliva, they were divided into positive group and negative group of Pg, Tf, Td. RESULTS: CAL in PLBW and NBW groups were 0.18 (0.00, 4.97) mm and 0.08 (0.00, 1.81) mm respectively which was significantly different (P<0.05). The detection rates of Pg in PLBW and NBW groups were 94.4% and 78.9% respectively (P<0.05). The detection rates of Tf were 84.7% and 94.7% respectively (P>0.05). The detection rates of Td were 86.1% and 89.5% respectively (P>0.05). The clinical parameters of CAL [2.25(0.54, 4.00) mm, 1.44(0.63, 3.80) mm], PD[(2.47 ± 0.43) mm, (1.94 ± 0.39) mm], PLI (1.80 ± 0.44, 1.36 ± 0.34) in Pg positive group was significantly higher than those in Pg negative group. The birth weight of Pg positive group [(2 482.95 ± 813.17) g] was significantly lower than Pg negative group [(3 425.00 ± 1 024.36) g]. CAL [0.14(0.00,4.9) mm, 0.03(0.00,0.44) mm], PD[(2.44 ± 0.46) mm, (2.17 ± 0.38) mm] were significantly different between Tf positive and negative group. PD [(2.44 ± 0.46) mm, (2.14 ± 0.43) mm] and BI (2.31 ± 0.86, 1.83 ± 0.68) were significantly different between Td positive and negative group. CONCLUSION: There is higher level of Pg, Tf and Td in the saliva of both PLBW and NBW groups. The detection of Pg may be related to PLBW.

[Correlation between periodontitis and metabolic syndrome of the middle-aged and aged population in Shijingshan community of Beijing].

OBJECTIVE: To survey the metabolic status of the middle-aged and aged population with periodontitis in Shijingshan community of Beijing, and investigate the relationship between periodontitis and metabolic syndrome (MS). METHODS: The middle-aged and aged population in the community were investigated by questionnaires, periodontal clinical examinations and blood biochemical tests in 2005. A total of 903 subjects were enrolled, who were divided into two groups by severity of periodontitis. Their waist circumferences, values of high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, fasting glucose, MS and its individual components (central obesity, insulin resistance, hypertriglyceridemia, low HDL-C and hypertension) were compared between the two groups. The Logistic regression model was set to analyze the relationship between periodontitis and MS. RESULTS: There was a significantly higher mean of systolic blood pressure, fasting glucose in the subjects with moderate-severe periodontitis than that with no-mild periodontitis. With severity of periodontitis increasing, the prevalence of MS, high blood glucose and low HDL-C increased significantly. After adjustment for gender, age, and smoking, the subjects with moderate-severe periodontitis were 1.524, 1.527 and 2.349 times more likely to suffer from MS, high blood glucose and low HDL-C than those with no-mild periodontitis, respectively. CONCLUSION: With severity of periodontitis increasing, the prevalence of MS, high blood glucose and low HDL-C increased significantly in the middle-aged and aged population of the community in Beijing. Severity of periodontitis is associated with MS, high blood glucose and low HDL-C.

Volatility in metallic resources prices in COVID-19 and financial Crises-2008: Evidence from global market.

The prevalence of uncertainty is evident in natural resources and financial markets almost every period. However, the global financial crisis and the recent Covid-19 pandemic is considered the most distressful event that disturbs the global economic and financial performance. In such crises, natural resource (mineral) prices also fluctuate as a result of demand and supply shocks. Identifying volatility in metallic resource prices is now the time's need, which consequently leads to implementing appropriate policies for recovery of the global markets. In this sense, the current study analyzed these two period from August 21, 2007, to December 31, 2009 (global financial crisis) and from January 01, 2019, to September 17, 2021 (Covid-19 pandemic). The empirical results obtained via threshold generalized autoregressive conditional heteroscedasticity (TGARCH) and exponential autoregressive conditional heteroscedasticity (EGARCH) model asserted that volatility exists in metallic resource prices in both the crises periods. Concerning the global financial cristhe metallic resource prices were more volatile in 2008, while such priwere are highly volatile during the Covid-19 pandemic peak year (2020). Additionally, volatility in metallic resources is found higher in the Covid-19 pandemic, relative to global financial crisis. Based on the empirical results, this study suggests the appropriate policy measures that could help tackle the issue of metallic resource price volatility.

Corrigendum: Clinical Characteristics of Cryoglobulinemia With Cardiac Involvement in a Single Center.

[This corrects the article DOI: 10.3389/fcvm.2021.744648.].

[An analysis of disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital from 2004 to 2008, and the value of general internal medicine unit in comprehensive hospitals].

OBJECTIVE: To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. METHODS: A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. RESULTS: A total of 2593 patients were included in our study. It consisted of 1075 men and 1518 women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing, the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593) of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89.2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29.8%), certain infectious and parasitic diseases (26.3%), and neoplasm (14.5%)]. The final diagnostic rate of the 928 non-FUO cases was 86.8% (803/925), with the first three leading causes as musculoskeletal system and connective tissue (24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs (11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. CONCLUSIONS: During 2004 - 2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.

[Effect of community periodontal care intervention on periodontal health and glycemic control in type 2 diabetic patients with chronic periodontitis].

OBJECTIVE: To evaluate the effectiveness of community periodontal care intervention in type 2 diabetic patients with chronic periodontitis who participated in community non-communicable diseases management service. METHODS: The randomized controlled and blinded community trial with a duration of six months was designed to compare effects of "periodontal initial therapy" on group I(22 cases), of "professional mechanical tooth cleaning (PMTC), i.e. coronal scaling" on group II(19 cases)and of "non-clinical therapy" on the control group(25 cases). The clinical periodontal indexes, such as probing depth (PD), attachment loss (AL), modified bleeding index (mBI), plaque index (PLI) were obtained with a Williams type periodontal probe; Laboratory examinations including glycosylated haemoglobin A1(HbA1C), glucose assay, were conducted. RESULTS: The reductions of PD in groups I and II were 0.71 and 0.70 mm, respectively, which was more significant than in control group (0.20 mm); the reductions of AL in groups I, II, and control group were 0.86, 0.57, and 0.03 mm, respectively, which showed significance in all the three groups. The subjects of groups I and II had 0.56% and 1.01% reductions of HbA1C respectively, and the significance was observed in group II. In addition, the improvement of HbA1C values in group II was highly correlated with the decrease in gingivitis (r=0.51, P=0.03). CONCLUSION: The community periodontal care approaches implemented in the community health service centers have significantly improved periodontal health as well as reduced glycemic level, which could be regarded as basic health care strategies for the patients with diabetes.

Clinical Characteristics of Cryoglobulinemia With Cardiac Involvement in a Single Center.

Background: Cryoglobulinemia is a syndrome characterized by the presence of cryoglobulins (CGs) in serum, and cardiac involvement is a rare occurrence that can affect treatment and prognosis. This study aimed to explore the clinical characteristics of cryoglobulinemia with cardiac involvement. Methods: 108 patients diagnosed with cryoglobulinemia who were admitted and treated in Peking Union Medical College Hospital (PUMCH) between June 1985 and June 2019 were enrolled in the present study. Clinical characteristics, therapy, and prognosis of patients with cardiac involvement were retrospectively analyzed. Results: The cryoglobulinemia with cardiac involvement was found in 7 patients, thus reaching the incidence of 6.5%. Heart failure was the main cardiac manifestation found in these patients, all with the involvement of external cardiac organs. Laboratory examinations showed significant elevation of N-terminal brain natriuretic peptide precursor (NT-proBNP) and brain natriuretic peptide (BNP) with negative troponin (cTnI). Electrocardiogram (ECG) was generally normal or only showed low-flat and biphasic multi-lead T waves. Echocardiography was performed in 6 patients, all of whom showed enlargement of heart cavity. Five patients had reduced left ventricular myocardial contractible motion with decreased ejection fraction, 3 patients had pericardial effusion, and 1 patient had left ventricular hypertrophy or severe aortic insufficiency. Cardiac magnetic resonance imaging showed delayed myocardial enhancement in 2 patients. One patient underwent a myocardial biopsy, which showed perivasculitis. Condition in 6 patients who received active treatment targeting improved in the early stage. Three patients (3/7, 42.9%) died due to disease progression during follow-up period. Conclusions: Cryoglobulinemia with cardiac involvement is a rare but serious condition that has relatively high risk of death. When patients with cryoglobulinemia without underlying heart disease experience heart failure, chest pain, or elevation of asymptomatic NT-proBNP and BNP, there is a high possibility of cardiac involvement, even if the electrocardiogram and troponin are negative. Further examinations such as echocardiography, cardiac magnetic resonance imaging, and myocardial biopsy examination could contribute to the diagnosis. Cardiac manifestations could be timely reversed after active targeted treatment. NT-proBNP and echocardiography could be used for the monitoring of disease efficacy.

[Combination therapy of periodontal intrabony defects with demineralized freeze-dried bone powder and platelet-rich plasma].

OBJECTIVE: To evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) and DFDBA with platelet-rich plasma (PRP) in the treatment of periodontal infrabony defects. METHODS: Fifteen periodontal infrabony defects (30 sites) in 12 patients with periodontitis (9 patients with chronic periodontitis and 3 patients with aggressive periodontitis) were selected. Three months after initial therapy, they were assigned to either the DFDBA group (10 defects with 20 sites) or the DFDBA with PRP group (5 defects with 10 sites). The patients were evaluated for plaque index (PI), bleeding index (BI), probing depths (PD) and clinical attachment loss (CAL) before the treatment and at 6 months after periodontal bone graft surgery. RESULTS: The PI, BI, PD and CAL in the DFDBA group were 1.7, 2.7, 6.0 mm and 7.0 mm at baseline; 1.5, 1.8, 3.9 mm and 4.4 mm at the 6 months after periodontal surgery. The PD, CAL and BI in DFDBA with PRP group at baseline were 6.2 mm, 7.1 mm and 2.9; 3.2 mm, 3.6 mm and 1.7 at the 6 months after periodontal surgery. The PI did not change significantly after surgery in both groups. While both groups showed significant improvement (P<0.01) in BI, PD and CAL, the improvement in the DFDBA with PRP group was significant greater than in the DFDBA group (P<0.05). CONCLUSION: DFDBA is an effective therapy for periodontal intrabony defects. DFDBA with PRP can significantly improve the clinical effect of periodontal infrabony defects.

[Cardiac valve involvement in Behcet's disease: a clinical study of 10 patients].

OBJECTIVE: To assess the clinical features in patients with cardiac valve lesions associated with Behcet's disease (BD). METHODS: We retrospectively reviewed the clinical data of 10 BD patients with cardiac valve lesions who were admitted to Peking Union Medical College Hospital (PUMCH) during June 1999 to June 2009. RESULTS: Aortic regurgitation occurred in 6% of patients with BD in PUCMH. Patients included 8 male and 2 female with the mean age of 36.5. All the patients had occult onset cardiac symptoms with an average length of clinical course of 6 years. 5 patients fulfilled the ISG diagnostic criteria for BD and another 5 patients diagnosed by experts. The main echocardiography findings were severe aortic regurgitation, aneurysmal dilatations of ascendant aorta, echo-free space at the aortic root, aortic valve prolapse, mesh like mass incorporating aortic cusp, aortic valve perforation, et al. 3 patients underwent 7 operations. 5 simple aortic valve replacement (AVR) surgeries resulted in severe perivalvular leakage. 2 patients underwent Bentall and heart transplant surgeries respectively with perioperative immunosuppressive therapy had no complications. CONCLUSION: Cardiac valve involvement in BD is a rare but critical problem that requires a timely diagnosis and management. The current diagnostic criteria may have possibilities of delayed diagnosis of such problem. Echocardiography seems to be helpful for the timely diagnosis. The immunosuppressive therapy and Bentall type operations may be essential for improving the treatment outcome of BD with cardiac valve lesions.

Relationship of metabolic syndrome to chronic periodontitis.

BACKGROUND: Many studies have suggested that periodontal disease is related to metabolic disorders. Few studies have investigated metabolic syndrome (MS), as defined by the International Diabetes Federation in 2005, in the Chinese population. The aim of this study was to assess the association of periodontitis with MS. METHODS: In this case-control study, 152 patients with MS and 56 generally healthy adults received a comprehensive clinical dental examination. Attachment loss, probing depth, bleeding index, and plaque index were examined at two sites per tooth (mesio-buccal and disto-lingual). The number of missing teeth was noted in each subject. RESULTS: The male patients with MS were significantly younger and their periodontal parameters were significantly higher than those of the healthy group. The female patients with MS were significantly older, and all periodontal parameters were higher than those in the healthy group; only plaque index was statistically significantly different (P = 0.001). After adjustment for gender, age, and smoking, the corresponding adjusted odds ratios for MS were 6.9 (95% confidence interval [CI]: 1.07 to 44.77), 9.9 (95% CI: 1.50 to 65.24), and 15.6 (95% CI: 2.20 to 110.43) for subjects with attachment loss > or = 3 mm in >0% to 33% of sites, >33% to 67% of sites, and >67% of sites, respectively. Most periodontal parameters were highest in patients with four components of MS, but these differences were not statistically significant. CONCLUSION: Patients with MS had poor periodontal conditions, and periodontal disease was associated with MS, independent of other risk factors.