Prediction of mortality in patients with acute exacerbation of chronic obstructive pulmonary disease / 中国医师杂志

Objective:To evaluate the risk factors of mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 97 patients with AECOPD in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to January 2019 were prospectively selected and followed up for 2.5 years. According to the prognosis, they were divided into survival group (82 cases) and death group (15 cases). Logistic regression analysis was used to screen the independent risk factors for death. The area under receiver operating characteristic curve (AUC) was used to analyze the prediction accuracy. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to analyze the predictive value of the prediction model for 2.5-year mortality in AECOPD patients.Results:Drinking history ( OR=4.975, P=0.046), past long-term β receptor blockers ( OR=5.486, P=0.029) and creatine kinase isoenzyme (CK-MB) level ( OR=2.008, P=0.049) were independent risk factors for death in patients with AECOPD. The AUC was 0.729, 0.715 and 0.710 respectively. The weight values of the three in the prediction model were 5, 5 and 1 respectively and the AUC was 0.834. Kaplan Meier survival analysis showed that 8 points of the prediction model could predict the 2.5-year survival rate in AECOPD patients (Log Rank P<0.001). The risk of death in AECOPD patients with score >8 was significantly higher than that of patients with score ≤8 ( HR=12.471, 95% CI: 3.735-41.643, P<0.001). Conclusions:Drinking history, past long-term β receptor blockers and CK-MB levels are independent risk factors for 2.5-year mortality in patients with AECOPD. The combination of these three factors has high predictive value for the prognosis of patients.

Predictive value of endogenous digitalis-like factor on myocardial injury and mortality in sepsis / 中国医师杂志

Objective:To evaluate the value of endogenous digitalis-like factor (EDLF) dynamic changes in predicting myocardial injury and prognosis in patients with sepsis.Methods:A total of 160 sepsis patients admitted to the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to January 2019 were selected and divided into the myocardial injury(MI) group ( n=75) and the non-myocardial injury (NMI) group ( n=85) according to whether there was myocardial injury. The plasma EDLF concentration was tested on the 1 st, 3 rd and 7 th day after admission. The predictive factors of MI and 90-days outcome were evaluated by logistics regression analysis. Cox proportional hazards regression model was used to estimate the prognostic value of EDLF concentration on the 90 days after admission for sepsis. Results:Septic patients with MI had increased levels of myocardial enzymes, decreased left ventricular fractional shortening index (FS) and interventricular septum (IVS) amplitude and abnormal wall motion, when compared to NMI patients (all P<0.05). EDLF concentration on the 7 th day in the MI group was significantly lower than in the NMI group ( P=0.019). Logistic regression showed that EDLF 7 th was an independent protective factor for MI and 90-day mortality in sepsis respectively ( OR=0.964, 95% CI: 0.934-0.994, P=0.021; OR=0.931, 95% CI: 0.871-0.995, P=0.036). Cox proportional hazards regression analysis suggested that EDLF 7 th concentration <26.7 pmol/L was an independent predictor of 90-day mortality in patients with sepsis ( HR=4.601, 95% CI: 1.030-20.563, P=0.046). Conclusions:EDLF 7 th may serve as a protective factor for sepsis-induced MI and adverse outcome. The exogenous supplement of cardiotonic drugs at one week after MI may be a potential treatment to improve the survival rate of septic patients.

Early identification and complication management of acute biliary tract infection / 中国医师杂志

Acute biliary tract infection is a common digestive system emergency, which is prone to complications and high risk of death. Therefore, paying attention to the early identification of the severity of the disease in patients with acute biliary tract infection and taking appropriate intervention measures for complications will help to improve the survival rate of patients and shorten the length of hospital stay. Six articles in this column introduced the early severity identification and diagnosis methods of acute cholangitis and the clinical characteristics of common complications such as liver abscess and sepsis myocardial injury, and elaborated the treatment effect from the perspective of Western medicine and traditional Chinese medicine.

Clinical effects of anterior cervical discectomy and fusion combined with zero-profile anchored spacer application on cervical spondylosis / 中国基层医药

Objective:To investigate the clinical effects of anterior cervical discectomy and fusion combined with zero-profile anchored spacer (ROI-C) application on cervical spondylosis.Methods:Eighty-nine patients, consisting of 58 males and 31 females, who received anterior cervical discectomy and fusion combined with zero-profile anchored spacer (ROI-C) application in First People's Hospital of Guiyang from May 2015 to May 2018 were retrospectively analyzed. A total of 138 segments were fused. Operative time, intraoperative blood loss, postoperative complications and their incidence were recorded. The Japanese Orthopaedic Association score, Visual Analogue Scale score, and Neck Disability Index score were used to evaluate clinical effects of anterior cervical discectomy and fusion combined with ROI-C application. Imaging examination was performed to determine cervical curvature, intervertebral space height of fused segments, interbody fusion rate and changes in adjacent segments. The stability and long-term effects of postoperative cervical spine were evaluated.Results:All 89 patients were followed up for (25.6 ± 6.8) months (range 12-36 months). In 53 patients who underwent single-segment fusion, operative time was (85.54 ± 12.53) minutes and the amount of blood loss was (58.45 ± 10.24) mL. In 25 patients who underwent two-segment fusion, operative time was (115.57 ± 16.42) minutes and the amount of blood loss was (92.62 ± 12.44) mL. In 9 patients who underwent three-segment fusion, operative time was (148.63 ± 19.42) minutes and the amount of blood loss was (118.54 ± 11.25) mL. In 2 patients who underwent four-segment fusion, operative time and the amount of blood loss were 188 minutes and 175 mL, respectively in one patient and they were 214 minutes and 225 mL in another patient, respectively. With time went during 1 week to 12 months after surgery, Japanese Orthopaedic Association score was greatly increased, Neck Disability Index score was remarkably decreased, and Visual Analogue Scale score was also significantly decreased ( F = 11.25, 26.35, 20.26, all P < 0.05). Swallowing discomfort occurred in only 2 (2.2%) patients. No patients had incision hematoma, infection, hoarseness or choking cough. At 1 week to 12 months after surgery, cervical curvature and the height of intervertebral space of fused segments were superior to those before surgery (both P < 0.05). At 12 months after surgery, X-ray examination revealed bony fusion with no loosening and displacement of fusion cage and no obvious degeneration of adjacent segments. Conclusion:Anterior cervical discectomy and fusion combined with ROI-C application for the treatment of cervical spondylosis exhibits great therapeutic effects because it can greatly alleviate patient symptoms and improve cervical function.

Pay attention to the early recognition of severe digestive system infection and the treatment of integrated traditional Chinese and western medicine / 中国医师杂志

Digestive tract is one of the biggest contact surfaces between human body and environmental factors.It has a large number of microorganisms from the environment.Once bacteria transfer and release into the blood,it will cause sepsis and endanger life.Therefore,we should pay more attention to the infectious diseases of digestive system.This paper reviews six articles published in this journal,and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system,namely,acute diarrhea,acute cholangitis and acute pancreatitis,and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine.Therefore,we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Preparation of progressive gradient-aperture osteochondral scaffold and its cytocompatibility evaluation / 中华老年医学杂志

Objective:To prepare a progressive gradient-aperture scaffold composed of silk fibroin(SF)-chitosan(CS)-nano-hydroxyapatite(nHAp)for osteochondral repair.Method:The SF solution, CS solution and nHA suspension were mixed in vitro at equal proportions.The progressive gradient osteochondral(OC)scaffold-1(2%), scaffold-2(3%)and scaffold-3(4%)was respectively prepared by using centrifugation, vacuum freeze-drying, chemical cross-linking and three shaping steps.General conditions, porosity, hot water dissolution rate, water swelling rate, compression water swelling rate, water swelling rate after dissolution, mechanical properties, internal structure observation and pore size were measured.Rat bone marrow mesenchymal stem cells(BMSCs)were cultured and the scaffold extract was prepared.The effect of scaffold extract on the proliferation of BMSCs was detected by the cell counting kit-8(CCK-8)method.BMSCs were co-cultured with the scaffold, and the distribution and morphology of the cells around the scaffold were observed.Results:The structure of scaffold was regular in each group and the porosity was more than 80%.Along with the increase of the material concentration, the water swelling rate of the scaffold was decreased gradually( P<0.05). Compared with before compression, the water swelling rate of scaffold-1 was decreased after compression( P<0.05). There was no significant difference in the hot water dissolution rate among all groups( all P>0.05), and the complete dissolution of the scaffold-1, scaffold-2 and scaffold-3 in vitro required 65.9, 60.9, and 73.9weeks, respectively.The elastic modulus of scaffolds in above three groups were 0.0955, 0.1762 and 0.3468 MPa, respectively.The examination results of scanning electron microscope(SEM)showed that the internal structure of scaffold was honeycomb in each group, the pore shape was regular, which showed an inter-connected pore network.The pore distribution was gradually dense and the pore diameter gradually decreased from the cartilage side to the osteogenic side( P<0.05), and the nHAp content increased gradually.The scaffold extract had no obvious toxicity to the growth and proliferation of BMSCs in each group.After BMSCs were seeded on scaffolds and co-cultured for 5 days, the cells grew well without obvious cell death or morphological abnormalities. Conclusions:In this study, a progressive gradient pore size OC scaffold is successfully prepared with good physical properties and biocompatibility, which is expected to be a new bio-mimetic composite scaffold material for repairing OC defects.

Pay attention to the early recognition of severe digestive system infection and the treatment of integrated traditional Chinese and western medicine / 中国医师杂志

Digestive tract is one of the biggest contact surfaces between human body and environmental factors. It has a large number of microorganisms from the environment. Once bacteria transfer and release into the blood, it will cause sepsis and endanger life. Therefore, we should pay more attention to the infectious diseases of digestive system. This paper reviews six articles published in this journal, and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system, namely, acute diarrhea, acute cholangitis and acute pancreatitis, and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine. Therefore, we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Clinical characteristics and risk factors of myocardial injury in patients with sepsis / 中华急诊医学杂志

Objective To analyze the clinical characteristics and risk factors of myocardial injury (MI) in patients with sepsis.Methods Totally 160 patients with sepsis in April 2016 to December 2017,divided into the MI group and non-MI group.The clinical data laboratory findings and ultrasonic cardiographic findings were recorded and compared between the two groups.Binary logistic regression analysis was performed to find the independent risk factors of/MI in patients with sepsis.Results Total of 160 patients with sepsis 75 (46.9％) patients developed MI.The MI group had older age and more patients with history of hypertension than the non-MI group (P＜0.05).In patients with sepsis,diastolic dysfunction accounted for 84.1％,systolic dysfunction accounted for 4.3％,and ventricular wall dyskinesia accounted for 17.3％.Compared with the non-MI group,the MI group had more abnormal wall motion (9.6％ vs 25.8％,P=0.012),lower interventricular septal amplitude (0.87±0.16 vs 0.80±0.21,P=0.03) and left ventricular posterior wall amplitude (1.03±0.21 vs 0.96±0.18,P=0.034),and decreased fractional shortening (P=0.033).Binary logistic regression analysis showed that age (RR=1.033,P=0.018) and decreased fractional shortening (RR=0.000,P=0.024) were independent risk factors of MI in patients with sepsis.Conclusions Age and decreased fractional shortening were independent risk factors of myocardial injury in patients with sepsis.

Study of hemodynamics during cardiac arrest and after restoration of spontaneous circulation in a porcine cardiac arrest model induced by acute pulmonary embolism / 中华急诊医学杂志

Objective To observe the hemodynamic change during cardiac arrest (CA) and after restoration of spontaneous circulation (ROSC) in a porcine acute pulmonary embolism model. Methods A total of 14 inbred Beijing Landraces were used to estalish the model of CA and ROSC induced by acute pulmonary embolism through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Five resuscitated pigs restored spontaneous circulation. Hemodynamic changes were determined at baseline, CA, ROSC, and 0.5, 1, 1.5, 2, 2.5, 4, and 6 h after ROSC. Results Compared with the baseline, mean arterial pressure was decreased significantly, mean pulmonary arterial pressure and right ventricular pressure were increased significantly, and the heart rate had no change during CA induced by acute pulmonary embolism. The mean arterial pressure restored normal level gradually after ROSC, but was decreased at 4 h after ROSC compared with the baseline (P<0.05). The heart rate was faster at ROSC and 0.5-2 h after ROSC than the baseline (P<0.05). The mean pulmonary arterial pressure restored the baseline level after ROSC; The right ventricular pressure were decreased at 2.5 h (26.5±11.4)mmHg and 4 h (24.8±9.3)mmHg after ROSC compared with the level during CA (46.2±13.01)mmHg (P<0.05). The systemic vascular resistance peaked at 4 h after ROSC. The pulmonary vascular resistance level at ROSC was higher than the baseline [(96.5±24.8)DS/cm5 vs. (26.5±13.4)DS/cm5, P<0.05], and was decreased at 1 h and 2 h after ROSC, but was increased at 4 h and 6 h after ROSC [(98.5±0.7)DS/cm5 and (98.0±1.4)DS/cm5]. The changes of heart function: compared with the baseline, the left ventricular function at ROSC and 1-6 h after ROSC were declined significantly (all P<0.05), and right cardiac output declined at ROSC and 4 h and 6 h after ROSC (all P<0.05), and the level of cardiac function index was dropped at 1 h and 2 h after ROSC (P<0.05). Conclusions The mean arterial pressure was declined, mean pulmonary arterial pressure, right ventricular pressure and pulmonary vascular resistance were increased, cardiac function was decreased during CA induced by acute pulmonary embolism; After ROSC, hemodynamic changes were described as compensated in the early stage (1-2 h after ROSC) and decompensated (4 h after ROSC) with time.

The molecular mechanism of angiotensin-converting enzyme 2 alleviating hepatocyte inflammation / 中华急诊医学杂志

Objective To observe the protective mechanism of angiotensin-converting enzyme (ACE) 2 on lipopolysaccharide (LPS)-induced hepatocyte inflammation by inhibiting P38 mitogen activated protein kinase (MAPK)/activator protein (AP)-1 pathway.Methods Rat liver BRL cells after immortalized culture were randomly divided into five kinds of groups:control group,LPS (10 μg/ mL) group,LPS + recombinant(r) ACE2 (5,10,20 ng/mL rACE2 for 30 min before cells stimulated with LPS) groups,LPS+ACE2 inhibitor MLN-4760 (10-7,10-6,105 mmol/L MLN-4760 for 30 min before cells stimulated with LPS) groups,LPS + rACE2 (20 ng/mL rACE2 for 30 min before cells stimulated with LPS) + P38MAPK inhibitor SB203580 (10-5 mmol/L SB203580 for 30 min before cells stimulated with LPS) groups.The changes in protein levels of ACE2,P38MAPK,p-P38MAPK and AP-1 were detected by western blot after LPS exposure for 6,12 and 24 hours,and the mRNA expressions of P38MAPK,AP-1 and tumor necrosis factor-α were quantified by real-time RT-PCR.Results Compared with control group,the protein levels of ACE2,P38MAPK and AP-1 were up-regulated in LPS-induced hepatic cells in a time-dependent manner,peaking at 12 h after LPS stimulation (all P＜0.05).Compared with LPS group,the mRNA expressions ofAP-l,P38MAPK,p-P38MAPK and tumor necrosis factor-oα decreased significantly in rACE2 group (all P＜0.05).The dose of 20 ng/mL rACE2 had the best inhibitory effects on the mRNA expression of AP-1 (0.12±0.002 vs.0.04±0.005,P＜0.01),P38MAPK (0.17±0.02 vs.0.02±0.002,P＜0.01) and p-P38MAPK(0.29±0.01 vs.0.02±0.01,P＜0.01)compared with LPS group.The mRNA expressions of AP-1,P38MAPK and p-P38MAPK increased in MLN-4760 group in a concentration dependent manner (all P＜0.05).Furthermore,the inhibitory effects of rACE2 on AP-1 and tumor necrosis factor-α levels were cancelled by SB203580.Conclusion The rACE2 can alleviate the LPS-induced hepatocyte injury by down regulating the P38MAPK/AP-1 signaling pathway.

A preliminary study on the fabrication of silk fibroin/chitosan/nano-hydroxyapatite osteochondral scaffolds with a gradient pore size structure / 中华老年医学杂志

Objective To explore the feasibility and methods of preparing silk fibroin(SF)/ chitosan(CS)/nano hydroxyapatite(nHA)composite osteochondral scaffolds with a gradient pore size structure.Methods We prepared an SF solution,a CS solution and an nHA suspension,all with a 2％ concentration,and mixed them with equal proportions.The mixture was used to prepare SF/CS/nHA composite osteochondral scaffolds with a pore size gradient through a centrifugal freeze drying and chemical cross linking method.The porosity,hot water loss rate,water swelling rate and mechanical properties of the scaffold were measured,and the dissolution curve and stress strain curve were drawn.The internal structure and morphology of the scaffold were observed by scanning electron microscopy(SEM)and the sizes of pores in the scaffold were measured.Results The porosity of the scaffold was(91.30± 3.35)％;The five week hot water loss rate was(16.57± 3.18)％;And the water swelling rate was (3218.53 ± 84.37)％.Mechanical test results demonstrated a good compression performance of the scaffold.SEM showed that the internal pores of the scaffolds were honeycomb structured with communicating passages;The density of pores gradually increased with decreasing pore sizes from the top to the bottom(pore sizes at four different levels:(141.11± 11.85)μm,(119.94± 9.05)μm,(93.10 ± 14.98) μm,and (79.95 ± 8.65)μm,respectively,F =22.973,P =0.000).Scaffold cytotoxicity test results indicated no significant difference between A values of the extract group and of the negative control group at any time point(t24 h =0.520,P =0.610;t48 h =0.665,P =0.515;t72 h =0.439,P =0.666),and all RGR values were greater than 100％.Conclusions SF/CS/nHA composite osteochondral scaffolds with a gradient pore size structure can be prepared with a centrifugal-freeze drying and chemical cross-linking method.Scaffolds prepared this way have a three-dimensional structure,a gradient pore size structure,high porosity,strong water absorption,suitable degradation rates and good compressive resistance.Besides,the good cell compatibility and low cytotoxicity of the scaffolds satisfy the requirements for osteochondral tissue engineering materials.

Value of red blood cell distribution width (RDW) and mean platelet volume (MPV) on emergency department admission in patients with venous thrombosis / 中国医师杂志

Objective Mean platelet volume (MPV) and Red Blood Cell Distribution Width (RDW) have been demonstrated to be associated with deep vein thrombosis (DVT).However,their role in the prediction of pulmonary embolism (PE),which is a major complication of DVT,are still unclear.Therefore,we investigated the association of MPV and RDW values with acute PE in patients with DVT.Methods A case-control study was conducted in patients hospitalized in emergency department of Beijing Friendship Hospital from November 2006 to June 2016.The study included three groups:patients with DVT and PE (PE group,n =96),patients with DVT without PE (non PE group,n =95),and control group (No DVT,No PE,n =96).Results (1) MPV was significantly higher in all DVT patients than that in control group (9.8 ±0.5 vs7.8 ±0.6,P ＜0.05;8.6±0.6 vs7.8 ± 0.6,P＜0.05) and MPV was significantly higher in DVT patients with PE than that in DVT patients without PE [(9.8 ± 0.5) fL,(8.6 ± 0.6) fL] (P ＜ 0.05).(2) The percentage of patients with RDW ＞ 14.5％ was significantly higher in PE group and non PE group than that in control group (52.1％ vs 20.8％),and (45.3 ％ vs 20.8％) (P ＜ 0.05).(3) In logistic analysis,MPV is an independent risk factor for PE patients (OR:22.18,95％ CI:9.36-53.16,P ＜0.01),the area under receiver operating characteristic (ROC) curve is 0.91,and the best critical value is 9.15 fL.The incidence of PE in patients with MPV ＞ 9.15 fL and MVP ＜ 9.15 fL was 75.6％ vs 15％ respectively,with statistically significance (P ＜ 0.05).Conclusions Combining use of RDW and MPV may be used as an early assessment of venous thromboembolism.MPV ＞ 9.15 fL suggests that patients may have PE.

Myocardial apoptosis and anti-apoptotic mechanism of captopril on cardiac arrest after resuscitation of pulmonary embolism / 中华急诊医学杂志

Objective To observe the myocardial apoptosis and the molecular mechanism of captopril inhibiting myocardial apoptosis on cardiac arrest (CA) after resuscitation in a porcine acute pulmonary embolism (APE) model. Methods In this study, 29 inbred Beijing Landrace wererandomly (random number)divided into four groups (n=5, each group): control, APE-CA, restoration of spontaneous circulation (ROSC)-captopril, and ROSC-saline. The model of CA and ROSC was induced by APE through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Ten of 19 pigs with CA recovered to spontaneous circulation were divided randomly into the ROSC-captopril and ROSC-saline groups. Pigs in the ROSC-captopril group were treated with captopril (22.22 mg/kg) via porcine femoral vein at 30 min after ROSC. Pigs in the ROSC-saline group were treated with equal normal saline at 30 min after ROSC. The myocardial tissues were evaluated at 6 h after ROSC. Western blot was used to evaluate the protein levels of Bax, Bcl-2, Caspase-3, phosphorylated (p)-Src and phosphorylated extracellular regulated protein kinase (p-ERK1/2). Immunohistochemistry was used to evaluate the protein expression of p-Src and p-ERK1/2. Enzyme-linked immunosorbent assay was used to detect myocardial Na+-K+-ATPase levels. Statistical analysis was performed using one-way analysis of variance and pearson correlation test. Results Compared with the control group, the protein expression of Bax (0.25±0.01, 0.53±0.01, 0.37±0.05, F=14.16, P<0.05) and Caspase-3 (0.24±0.01, 0.33±0.01, 0.34±0.06, F=7.32, P<0.05) in the APE-CA and ROSC- saline group were increased significantly, and the Bcl-2 expression was significantly decreased (0.56±0.02, 0.19±0.01, 0.37±0.10, F=6.68, P<0.05). Captopril reduced the protein levels of Caspase-3 and Bax, while stimulated the Bcl-2 expression (all P<0.05). Compared with the control group, the protein expression of p-Src and p-ERK1/2 were higher and the Na+-K+-ATPase level was decreased on CA and ROSC induced by APE (all P<0.05). Compared with the APE-CA group, the p-Src expression in the ROSC-captopril group (0.46±0.01 vs. 0.35±0.06, P<0.05) was decreased significantly. Captopril inhibited the activation of p-ERK1/2 than saline group (0.41±0.10 vs. 0.26±0.07, P<0.05), but has no effect on the Na+-K+-ATPase level. The protein expression of p-Src and p-ERK1/2 were positively correlated with the Bax, and negatively correlated with the Bcl-2 respectively. The myocardial Na+-K+-ATPase level negatively correlated with Caspase-3 protein expression. Conclusions The molecular mechanism of cardiomyocyte apoptosis on CA and ROSC induced by APE might be related to decreased Na+-K+-ATPase level and activation of p-Src and p-ERK1/2. The cardiomyocyte apoptosis were inhibited by captopril through reducing the expression of p-Src and p-ERK1/2 in myocardium.

The clinical characteristics of adult patients with community acquired pneumonia caused by acute Mycoplasma ;pneumoniae infection：a multicentre cross-sectional study / 中华危重病急救医学

Objective To investigate the clinical characteristics of adult patients with community acquired pneumonia (CAP) caused by acute Mycoplasma pneumoniae (MP) infection, and provide evidence for early identification of MP infection. Methods A prospective, multicenter and cross-sectional study was conducted. 452 adult patients with CAP admitted to Beijing Friendship Hospital, Beijing Guangwai Hospital and Air Force General Hospital from August 2011 to October 2015 were enrolled. The diagnosis of adult MP infection was confirmed by the combined application of double serum antibody titer and MP-DNA nested polymerase chain reaction (PCR) through testing serum and throat swab samples from patients to identify acute infections, past infections, pathogen carrying, and non-MP infection. The clinical characteristics of patients with acute MP infection were summarized by analyzing the baseline data, clinical parameters and chest imaging findings in patients with non-MP infection and acute MP infection. Results Of 452 enrolling patients with CAP, 288 patients (63.7%) suffered from MP infection, and 164 patients (36.3%) with non-MP infection. There were 56 patients (12.4%) with acute infection, 10 patients (2.2%) with past infections, 222 patients (49.1%) with pathogen carriers in MP infective patients indicating susceptible to MP in adult patients. There were no significant differences in gender, age, fever extent, duration of fever, sputum production, shortness of breath, rales, underlying diseases, etc. between non-MP infection and acute MP infection patients, which suggested that the baseline data of the two groups were equilibrium. The acute infection rates of MP in summer and autumn (43.9% and 43.5% respectively) were more than those in spring and winter (13.3% and 12.3% respectively). It was shown by laboratory examination results that serum cardiac troponin T (cTnT) increased significantly in acute MP infectious patients more than that in non-MP infection patients (30.4% vs. 9.8%, P < 0.01), which indicated that patients with acute MP infection were more likely to have myocardial injury. While there were no significant differences in blood routine, blood electrolytes, blood glucose, as well as heart, liver and kidney function between the two groups. It was shown by chest imaging that the diffuse lesions (57.1% vs. 37.2%), mediastinal lymphadenopathy (60.7% vs. 37.8%) were less founded in the middle lobe of the right lung (12.5% vs. 32.9%), which were the main manifestations in patients with acute MP infection as compared with non-MP infection patients with statistical difference (all P < 0.01). There were no significant differences in the chest imaging performances of pulmonary ground glass shadow, lobar and segmental consolidation, patch shadow, a shadow, acinar nodules, grinding glass density nodules, the photic zone, hilar lymphadenopathy and pleural effusion occurrence between the two groups. Conclusion Adult CAP patients are easy to carry MP, myocardial damage is a common complication in acute MP infectious patients which are characteristic of image findings of diffuse lung disease, mediastinal lymphadenopathy and less founded in the middle lobe of the right lung.

Progress of pathophysiological mechanism of angiotensin-converting enzyme 2 in treating pulmonary arterial ;hypertension / 中华危重病急救医学

Pulmonary arterial hypertension (PAH) is an incurable fatal disease, with the mechanism of imbalance of vascular contraction and relaxation which start as a series of pathophysiological reactions. Angiotensin-converting enzyme 2-angiotensin (1-7)-G protein-coupled receptor axis [ACE2-Ang(1-7)-Mas], an expanded vascular axis which is considered as new axis of renin-angiotensin system (RAS) is a negative regulator of the classical angiotensin-converting enzyme-angiotensin Ⅱ-angiotensin Ⅱ type 1 receptor axis (ACE-AngⅡ-AT1R), a contraction vessel, proliferation axis. A retrospective study concerning the pathophysiological mechanism of ACE2 in the treatment of PAH was done and found that ACE2-Ang-(1-7)-Mas axis could reduce PAH induced by monocrotaline (MCT) through declining the inflammatory cascade, improving endothelial dysfunction and regulating autonomic nerve, reduce PAH induced by hypoxia through inhibiting the proliferation of pulmonary artery smooth muscle cells and reduce PAH induced by congenital heart disease. Therefore, ACE2 may become a future drug of preventing and treating PAH.

Mitochondrial tRNA(Thr)T15943C mutation may be a new position that affects the phenotypic expression of deafness associated 12s rRNA A1555G mutation / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify secondary mutations associated with deafness in a Chinese family affected with deafness.</p><p><b>METHODS</b>The family has been subjected to clinical and molecular analyses, in addition with measurement of reactive oxygen species and doubling time after establishment of immortalized lymphocyte cell lines.</p><p><b>RESULTS</b>The results showed that the hearing loss level and audiometric configuration were discrepant among the family members with maternally transmitted hearing loss. The penetrance of hearing loss in this family was respectively 66.7% and 44.4% when aminoglycoside-induced hearing loss was included or excluded. Analysis of whole mitochondrial genome has found 33 variants as previously reported polymorphisms, except for a 12s rRNA A1555G mutation and a tRNA(Thr)T15943C mutation. Haplotype evolutionary tree has verified that this family belonged to East-Asian haplogroup F. 15943 position was located on the T-stem of the tRNA(Thr), which has destroyed the extremely conserved T-A base pair when T changed to C at this position. However, functional experiments indicated that the population doubling time in special galactose and glucose were longer, whilst the level of reactive oxygen species has increased. Compared with the control cell line groups and a family only carrying the 12s rRNA A1555G mutation, all of the three groups belonged to the same haplogroup.</p><p><b>CONCLUSION</b>Mitochondrial tRNA(Thr)T15943C mutation may act as a potential modifying factor and interact with 12s rRNA A1555G mutation, and thereby enhance the penetrance and expression of deafness.</p>

Treatment of Acne Vulgaris Based on TCM Syndrome Differentiation: An Observation of 64 Cases with Lung-heat and Spleen-deficiency / 广州中医药大学学报

[Objective] To observe the therapeutic effect of Qingfei Jianpi Decoction (QJD) for the treatment of acne vulgaris (AV) . [Methods] One hundred and five cases of AV were randomized into two groups: group A (n =64) was treated with QJD, a prescription medicine mainly composed of Herba Houttuyniae, Cortex Lycii, Cortex Moutan, Radix Scutellariae, Radix Fici Simplicissimae, Radix Flemingiae Philippinensis, Rhizoma Atractylodis Macrocephalae, Poria, etc. , and group B (n=41) with tetracycline for 4 weeks. After treatment, the therapeutic effect, changes of facial lesion and signs, and side effects were observed. A 3-month follow-up was made for the cured patients to investigate the recurrence rate. [Results] Facial lesion and seborrheic degree were relieved in group A, the difference being significant as compared with those before treatment (P0.05 ) . The therapeutic effect was better in group A than that in group B (P

Inhibitory Effect of Danggui Decoction on Passive Cutaneous Anaphylaxis in Mice / 广州中医药大学学报

【Objective】To explore the mechanism of Danggui Decoction (DD) in counteracting allergic reaction bymeans of passive cutaneous anaphylaxis (PGA) test.【Methods】Among fifty NEH mice, ten were used to prepareantiserum and the rest forty were randomized into 4 groups: normal control group (A), clarityne group (B), low-doseDD group (C) and high-dose DD group (D) . PGA was induced by intraperitoneal injection of antiserum in the fourgroups and the mice were treated with gastric infusion simultaneously. After the last feeding, antigen attack wasconducted. Inhibitory rate of PCA in four groups were measured by colorimetric analysis after treatment. 【Results】High-and low-dose DD and clarityne could inhibit PCA in mice (P0.05).【Conclusion】The anti-allergic effect of DD may be associated with the inhibition of type Ⅰ allergic reaction.