[The impact of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year outcome in patients with premature coronary heart disease: results of a prospective, multicenter, observational cohort study].

Objective: To explore the relationship between low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio with the severity of coronary artery disease and 2-yeat outcome in patients with premature coronary heart disease. Methods: This prospective, multicenter, observational cohort study is originated from the PROMISE study. Eighteen thousand seven hundred and one patients with coronary heart disease (CHD) were screened from January 2015 to May 2019. Three thousand eight hundred and sixty-one patients with premature CHD were enrolled in the current study. According to the median LDL-C/HDL-C ratio (2.4), the patients were divided into two groups: low LDL-C/HDL-C group (LDL-C/HDL-C≤2.4, n=1 867) and high LDL-C/HDL-C group (LDL-C/HDL-C>2.4, n=1 994). Baseline data and 2-year major adverse cardiovascular and cerebrovascular events (MACCE) were collected and analyzed in order to find the differences between premature CHD patients at different LDL-C/HDL-C levels, and explore the correlation between LDL-C/HDL-C ratio with the severity of coronary artery disease and MACCE. Results: The average age of the low LDL-C/HDL-C ratio group was (48.5±6.5) years, 1 154 patients were males (61.8%); the average age of high LDL-C/HDL-C ratio group was (46.5±6.8) years, 1 523 were males (76.4%). The number of target lesions, the number of coronary artery lesions, the preoperative SNYTAX score and the proportion of three-vessel coronary artery disease in the high LDL-C/HDL-C group were significantly higher than those in the low LDL-C/HDL-C group (1.04±0.74 vs. 0.97±0.80, P=0.002; 2.04±0.84 vs. 1.85±0.84, P<0.001; 13.81±8.87 vs. 11.70±8.05, P<0.001; 36.2% vs. 27.4%, respectively, P<0.001). Correlation analysis showed that there was a significant positive correlation between LDL-C/HDL-C ratio and preoperative SYNTAX score, the number of coronary artery lesions, the number of target lesions and whether it was a three-vessel coronary artery disease (all P<0.05). The 2-year follow-up results showed that the incidence of MACCE was significantly higher in the high LDL-C/HDL-C group than that in the low LDL-C/HDL-C group (6.9% vs. 9.1%, P=0.011). There was no significant difference in the incidence of all-cause death, cardiac death, myocardial infarction, stroke, revascularization and bleeding between the two groups. Cox multivariate regression analysis showed that the LDL-C/HDL-C ratio has no correlation with 2-year MACCE, death, myocardial infarction, revascularization, stroke and bleeding events above BARC2 in patients with premature CHD. Conclusion: High LDL-C/HDL-C ratio is positively correlated with the severity of coronary artery disease in patients with premature CHD. The incidence of MACCE of patients with high LDL-C/HDL-C ratio is significantly higher during 2 years follow-up; LDL-C/HDL-C ratio may be an indicator for evaluating the severity of coronary artery disease and long-term prognosis in patients with premature CHD.

[Comparative study of hypersensitive quantitative fecal immunochemical test and qualitative fecal occult blood test for colorectal cancer and advanced adenoma].

Objective: To evaluate the screening performance of hypersensitive quantitative fecal immunochemical test (hs-qFIT) and qualitative fecal occult blood test (FOBT) for colorectal cancer and advanced adenoma. Methods: Consecutive participants scheduled to undergo colonoscopy from April 2020 to April 2021 in Qilu Hospital of Shandong University were included in the study. All the participants were 50-75 years old and at moderate to high risk for colorectal cancer. Participants completed hs-qFIT and two kinds of qualitative FOBTs (colloidal gold method and chemical-immunization method) before colonoscopy. The sensitivities and specificities of hs-qFIT and two qualitative FOBTs for colorectal cancer and advanced adenoma were compared. Results: A total of 910 participants were enrolled in the study, including 451 males and 459 females, aged (59.6±6.4) years. There were 22 cases (2.4%) of colorectal cancer, 61 cases (6.7%) of advanced adenoma, 276 cases (30.3%) of non-advanced adenoma, 194 cases (21.3%) of non-adenomatous polyp, 85 cases (9.3%) of other colorectal lesion and 272 cases (29.9%) of non-colorectal lesion. The sensitivities of hs-qFIT for detecting colorectal cancer increased from 72.7% (95%CI: 49.6%-88.4%) to 100% (95%CI: 81.5%-100%) with cut-off value decreasing from 200 ng/ml to 10 ng/ml, and the sensitivities of both colloidal gold method and chemical-immunization method were 63.6% (95%CI: 40.8%-82.0%) (P=0.008). The detection stability of hs-qFIT for colorectal cancer was higher than colloidal gold method (P=0.016) and chemical-immunization method (P=0.031). The sensitivity for detecting advanced adenoma of hs-qFIT at 10 ng/ml was 52.5% (95%CI: 39.4%-65.2%), which was significantly higher than that of colloidal gold method (13.1%, 95%CI: 6.2%-24.8%, P<0.001) and chemical-immunization method (6.6%, 95%CI: 2.1%-16.7%, P<0.001). Conclusions: The sensitivity and detection stability of hs-qFIT for detecting colorectal cancer was higher than qualitative FOBT. Moreover, the sensitivity for detecting advanced adenoma can be further improved using a lower cut-off value.

Identifying systems delays in assessment, diagnosis, and operative management for testicular torsion in a single-payer health-care system.

INTRODUCTION: Testicular torsion (TT) is a common pediatric urologic emergency. Management of TT is time sensitive and often confirmed on scrotal Doppler ultrasound (DUS). Acquiring DUS, however, can result in delays in the management of TT, affecting testicular salvage rates. OBJECTIVE: The objective of this study is to identify delays in the assessment and diagnosis for patients presenting with TT to a Canadian academic hospital using patient flow analysis. STUDY DESIGN: A retrospective review was performed for patients presenting to the emergency department (ED) who received a scrotal DUS to rule out possible TT between 2012 and 2017. The primary outcome measured cycle-time measurements (median time) between points along the clinical flow pathway for a patient with suspected TT. The secondary outcome assessed diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of standard scrotal DUS components (Doppler flow, arterial waveform, heterogeneous echotexture). RESULTS: A total of 609 patients presented with an acute scrotum warranting a scrotal DUS to rule out TT; of which, 46 underwent scrotal exploration. Testicular salvage rate was 82.6% in the series (38 testes salvaged, 8 required orchiectomy). Median time from symptom onset to ED presentation for patients with possible TT was 4 h. After triage, a median of 79.8 min was required for ED physician assessment and an additional 48 min for scrotal DUS to be performed. Absence of Doppler flow on scrotal DUS had a 97.4% PPV for diagnosing TT confirmed during scrotal exploration. DISCUSSION: Almost 4 h of in-ED time is required from triage to surgical intervention for potential TT at the institution. One area of delay is the time needed to conduct a scrotal DUS (48-128 min; Fig. 1). This represents an area of opportunity for patient flow optimization through the use of standardized clinical pathways and diagnostic adjuncts, such as point-of-care ultrasound. This study is limited in its retrospective nature and does not include patients with overt signs of TT who underwent surgical detorsion without need for scrotal DUS. CONCLUSION: Patient flow delays to surgical intervention for patients with TT represent a preventable cause of orchiectomy in young men. This study identifies intervention points in patient-care flow pathways where delays to surgical intervention can be potentially reduced by up to 2 h. The findings support the need for further studies into the optimization of patient flow and management protocols to reduce delays in the diagnosis and management of TT.

[Analysis on epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome in Shandong province, 2010-2016].

Objective: To analyze the epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome (HFRS) in Shandong province during 2010-2016 and provide references for developing prevention and control measures. Methods: Based on the data of Infectious Disease Reporting Information System in China, the incidence and temporal-spatial distribution of HFRS in Shandong from 2010 to 2016 were analyzed by spatial autocorrelation and space-time scan statistics. Results: A total of 9 114 HFRS cases were reported in Shandong during this period. The cases were mainly distributed in age group 30-70 years, and the male to female ratio of the cases was 2.63 ∶ 1. Most cases were farmers. The higher incidence rate was reported in southeastern Shandong, while the lower incidence rate was reported in northwestern Shandong. Among the epidemic periods, the highest incidence rate was 1.87/100 000 in 2013. The results of spatial autocorrelation and space-time scanning indicated that the high-high clusters of HFRS were concentrated in southeastern Shandong and then spread to central Shandong. The cluster mainly occurred from the end of 2011 to the first half of 2015. Both the incidence rate and the cluster decreased in 2016. Conclusions: The epidemic and cluster of HFRS still existed in Shandong from 2010 to 2016. The key areas for the prevention and control of HFRS were in southeastern and central Shandong.

Improved Cuff Technique for Establishing a Mouse-Rat Heterotopic Cardiac Xenotransplantation Model.

BACKGROUND: The small animal model of cardiac transplantation is the most common model in organ transplantation studies. The cervical heterotopic transplantation is widely performed because this allows for direct observation of the graft heartbeat and contributes to early prediction of graft rejection. OBJECTIVE: A mouse-rat cervical heterotopic cardiac xenotransplantation model was modified with respect to the anesthesia method, cardiac graft harvesting method, and perioperative treatment. These improvements ensure the stability and reliability of xenotransplantation models for in vivo studies of immune-mediated graft rejection. METHODS: After establishing isoflurane inhalation anesthesia, the donors' hearts were harvested. The experimental method involved separate ligation of the left and right superior venae cavae; the other blood vessels were ligated in a cluster. Both the donor and recipient animals were placed on a heating pad intraoperatively to maintain a body temperature of 37-40 °C. The model establishment was divided into 3 stages: practice, stabilization, and stereotyping. The surgical success rate and operation time were recorded. Specimens were harvested at different time points for histopathological examination. RESULTS: The anesthetic effect of isoflurane was well maintained, and no animals died of adverse anesthetic events. Body temperature was maintained at 37-40 °C which effectively shortened the time to restoration. The modification of the cardiac graft harvesting method is conducive to rebeating of the donor heart. The success rates in the stabilization and stereotyping stages were significantly higher than that in the practice stage (P < .05). The operation time in the stabilization and stereotyping stages were significantly shorter than those in the practice stage (P < .05). Histopathological examination revealed thrombosis formation, interstitial hemorrhage, and inflammatory cell infiltration in the donor hearts. CONCLUSION: Our findings suggest that the mouse-rat cervical heterotopic cardiac xenotransplantation model is the ideal animal model for studying xenograft rejection.

Elevated vascular endothelial growth factor levels induce hyperpermeability of endothelial cells in hantavirus infection.

OBJECTIVE: To investigate the role of vascular endothelial growth factor (VEGF) in haemorrhagic fever with renal syndrome (HFRS). METHODS: VEGF, soluble VEGF receptor (sVEGFR)-2, angiopoietin (Ang)-1, tumour necrosis factor (TNF)-α and interferon (IFN)-γ levels were measured in serum samples from 68 patients with HFRS. Cultured human umbilical vein endothelial cells (HUEVCs) were infected by Hantaan virus (HTNV) and/or stimulated with recombinant VEGF; dextran permeability of the cells was determined. Claudin-1 and vascular endothelial (VE)-cadherin levels were determined by real-time reverse transcription-polymerase chain reaction and Western blot analyses. RESULTS: Serum VEGF, TNF-α and IFN-γ levels were significantly elevated, whereas sVEGFR2 and Ang-1 levels were reduced, during the acute phase of HFRS. In vitro cell permeability was unaffected by HTNV infection or VEGF stimulation alone, but the combination of HTNV infection and VEGF treatment significantly increased the permeability of endothelial cell monolayers in a time-dependent manner. Claudin-1 and VE-cadherin were downregulated at both the mRNA and protein level by combined HTNV infection and VEGF stimulation. CONCLUSIONS: Elevated VEGF induced by HTNV infection may play an important role in the vascular hyperpermeability that is characteristic of HFRS.

Elevated serum concentrations of inflammatory cytokines and chemokines in patients with haemorrhagic fever with renal syndrome.

OBJECTIVE: Prospective case-control study, undertaken to investigate serum cytokine and chemokine concentrations during all clinical phases and in different clinical types of haemorrhagic fever with renal syndrome (HFRS). METHODS: Serum was collected at various disease phases from patients with HFRS (n = 35) and healthy control subjects (n = 10). Tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-4, interferon (IFN)-γ, IL-8, interferon inducible protein-10 (IP-10) and chemokine (C-C motif) ligand 5 (also known as 'regulated upon activation, normal T-cell expressed and secreted' [RANTES]) were quantified using commercial enzyme-linked immunosorbent assay kits. RESULTS: Serum concentrations of TNF-α, IL-6, IFN-γ, IL-8, IP-10 and RANTES (but not IL-4) were significantly higher in patients compared with controls. Highest concentrations were generally found during the febrile, hypotensive and oliguric disease phases, as well as in clinically severe and critical cases. CONCLUSION: Serum concentrations of proinflammatory cytokines and chemokines increased in line with disease severity in HFRS patients.

Scavenger receptor class B type I mediates cell entry of hepatitis C virus.

This study assessed the functional role of human scavenger receptor class B type I (SR-BI) as a putative hepatitis C virus (HCV) receptor using Chinese hamster ovary (CHO) cells transfected with human SR-BI (CHO-huSR-BI). The expression of SR-BI by primary Tupaia hepatocytes (PTHs), human hepatocarcinoma cell line (HepG2) cells, untransfected CHO cells and CHO-huSR-BI cells was analysed by Western blotting. Receptor competition assays showed that anti-SR-BI antibodies that block the binding of soluble envelope glycoprotein E2 could prevent HCV infection. Pre-incubation of CHO-huSR-BI and HepG2 cells with anti-SR-BI antibodies resulted in marked inhibition of E2 binding. After incubation with HCV RNA-positive serum from a patient with chronic HCV infection, however, HCV infection could not be detected in CHO-huSR-BI cells, but was detected in PTHs. These results demonstrate that, whilst SR-BI represents an important cell surface molecule for HCV infection, the presence of SR-BI alone is insufficient for HCV entry.

In vitro hepatic differentiation of mesenchymal stem cells from human fetal bone marrow.

We examined whether human fetal mesenchymal stem cells (FMSCs) derived from fetal bone marrow were able to differentiate into functional hepatocyte-like cells in vitro. The surface phenotype of FMSCs was characterized by flow cytometry. To induce hepatic differentiation of FMSCs, we added hepatocyte growth factor, basic fibroblast growth factor and oncostatin M into the cell culture medium. After 21 days of hepatocyte induction, FMSCs expressed the hepatocyte-specific markers, alpha-fetoprotein and cytokeratin 18, as demonstrated by immunofluorescence staining. Differentiated FMSCs also demonstrated in vitro functions characteristic of liver cells, including albumin production, urea secretion and glycogen storage. In conclusion, fetal bone marrow-derived FMSCs are able to differentiate into functional hepatocytelike cells and may serve as a source of cells for liver disease therapy.

[The Value of CT Scanning in the Diagnosis of Temporomandibular Joint Dysfunction]

OBJECTIVE:To evaluate the role of CT in the diagnosis of temporomandibular joint dysfunction MATERIAL: 48 temporomandibular joints of 26 patients suspecting osseous changes were examined by CT, with 1mm of layer thickness. All patients had Sch llers position projection as comparison. RESULTS:CT is more sensitive to detect the osseous changes of TMJ than Sch llers position projection, but not well demonstrating sclerosis of TMJ. The Sch llers position projection can only shows the lesion of lateral 1/3 of condyle, but CT including total condyle. CONCLUSION: CT is an important and sensitive tool in detecting osseous changes of temporomandibular joint.

[Clinical Application of CT assisted Double Contrast Arthrography of Temporomandibular Joint]

OBJECTIVE:To introduce double-contrast arthrography of TMJ with reformatted sagittal and coronal CT imaging and to evaluate the value of its application in the diagnosis of temporomandibular joint dysfunction. METHODS: 14 patients in whom diagnosis can not be established with conventional arthrography were examined by double contrast arthrography with reformatted sagittal and coronal CT imaging. RESULTS: In double-contrast arthrography with CT imaging, 1 case was normal;1 case had anterior displacement with reduction;2 cases were anterior displacement without reduction, and 8 cases were with disk adhesion. CONCLUSION:The double contrast arthrography with reformatted sagittal and coronal CT imaging was a very important alternative to conventional arthrography, and has special value to demonstrate adhesion of TMJ.

[A Comparative Study of MRI and CT Double-Contrast Arthrography in Diagnosis of Disc Adhesion of TMJ]

OBJECTIVE:To compare the results of CT-assisted double-contrast arthrography and MRI in the diagnosis of adhesion of TMJ. MATERIAL:18 patients with adhesion of TMJ were examined by CT-assisted double-contrast arthrography and MRI, and their results were analysed including position, degree and with or without osseous changes. RESULTS:18 cases of adhesion were demonstrated on CT-assisted double-contrast arthrography, and that only 6 cases of them were diagnosed on MRI.CONCLUSION: CT-assisted double-contrast arthrography is more sensitive and accurate than MRI in demonstrating the disk adhesion of TMJ.

[CT findings in the recurrent oral maxillofacial tumors eroding the central skull base]

OBJECTIVE:To domonstrate the CT manifestations of the recurrent oral maxillofacial tumors invading the middle skull base.METHODS:CT detections with axial (37 cases) and coronal (26 cases) scans were performed in thirty-seven patients who suffered from the recurrent oral maxillofacial tumors.All lesions were proven histopathologically.RESULTS:Four patterns of the central skull base erosion showing on CT images were encompassed:1.resorption of the outer cortical margin (5 cases);2.resorption of both outer and inner cortical laminae (24 cases);3.enlargement of the ovale foramen (3 cases);4.combined of sclerosis and resorption of the skull base (5 cases).The sphenoid greater wing involvement by the recurrent lesions was more frequently seen in our series (36 cases).Twenty four patients with the recurrent lesions were identified as following intracranial structures affected:the cavernous sinus (n=16),temporal lobe (n=15),and pituetary (n=1).CONCLUSION:It is believed that involvement of the intracranial structures is in close relationship with the aforementioned erosive patterns of the central skull base.The role of CT examination for evaluating the oral maxillofacial recurrent lesions invading the central skull base is very important.

[Evaluation of 28 cases of salivary malignancies with MR imaging]

Twenty-eight cases of MRI of the salivary malignancies confirmed histopathologically were shown in this paper.By observing separately and comparatively with SE (spin echo) T2 weighted imaging and PE(field echo) imaging,the authors consider that (1)the malignant tumors within the salivary glands displaying low and intermediate signal intensities on T2 weighted image may be thought as a characteristic sign in the diagnostic processes. (2) PE imaging as an effective method is able to differentiate the tumors from the calcification and fibrosis which were low and intermediate signal intensities on T2 weighted image. (3)the locations and sizes of the tumors have directly influenced on their marginal manifestations and adjacent normal tissue structures.

The min-max function differentiation and training of fuzzy neural networks.

This paper discusses the Delta-rule and training of min-max neural networks by developing a differentiation theory for min-max functions, the functions containing min (wedge) and/or max (V) operations. We first prove that under certain conditions all min-max functions are continuously differentiable almost everywhere in the real number field R and derive the explicit formulas for the differentiation. These results are the basis for developing the Delta-rule for the training of min-max neural networks. The convergence of the new Delta-rule is proved theoretically using the stochastic theory, and is demonstrated with a simulation example.

Radiographic findings in Langerhans' cell disease affecting the mandible.

The radiographic features of histopathologically diagnosed mandibular Langerhans' cell disease are described for 29 cases of the condition. We divided the patients into two groups: adults (age 27 to 60 years) and juveniles (age 1.5 to 15 years). A characteristic sign in juveniles was an osteolytic lesion with an uneven margin and either a continuous or discontinuous periosteal reaction. Because of the wide variability in radiographic presentation in adults, it was very difficult to differentiate this from other lesions in adults on the basis of radiologic criteria.

[Analysis of treatment in 84 cases of severe pancreatitis].

84 patients who suffered from severe pancreatitis were treated in our hospital. In order to compare the efficacy of different therapy in early, middle and recent stages, the patients were divided into 3 groups. In early stage group (Jan, 1983-Dec, 1985) the treatment mainly was surgical drainage of the pancreas, the mortality was 72.7%. In middle stage group (Jan, 1986-Jan, 1989) the main treatment consisted of incision and decompression of pancreatic capsule, debridement of pancreas and inhibiting pancreatic secretion, the mortality decreased to 34.8%. In recent stage group (Jan, 1990-Jan, 1994) the therapy was Integrated Chinese Traditional and Western Medicine which comprised the method used in middle stage with TCM including acupuncture depending upon the syndrome. The mortality further lowered to 25.6%.