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Objective To investigate the clinical value of coronary computed tomography angiography(CCTA)based CT derived fractional flow reserve(CT-FFR)and ΔCT-FFR in improving the diagnostic efficiency for coronary abnormal hemodynamics in patients with severe calcification.Methods We retrospectively analyzed the clinical data of coronary artery disease(CAD)patients who underwent CCTA,CT-FFR,invasive coronary angiography(ICA)and FFR during hospitalization from January 2018 to June 2019 in Chinese PLA General Hospital.Severe calcification was defined as coronary artery calcium score(CACS)≥100 on single vessel level.A total of 107 CAD patients with 149 coronary arteries were included in the present study.The enrolled coronary arteries were assigned to CACS≥100 group(n=56)and CACS<100 group(n=93).CT-FFR was performed on the deep FFR platform based on machine learning(ML)algorithms and ΔCT-FFR was defined as CT-FFR difference between proximal and distal to the coronary lesion.The correlation and consistency between CT-FFR and FFR values were analyzed by Pearson and Bland-Altman methods.We attempted to analyze the incremental value of ΔCT-FFR for coronary functional evaluation,especial for coronary arteries with severe calcification,regarding FFR≤0.8 as the diagnostic gold standard.Comparison of receiver operating characteristic curves(ROC)between different diagnostic methods was presented by Delong test.Results Pearson and Bland-Altman analyses showed appreciable correlation(CACS≥100 group,r=0.71,P<0.01;CACS<100 group,r=0.73,P<0.01)and consistency(CACS≥100 group,Mean=-0.01,P=0.25;CACS<100 group,Mean=0,P=0.96)between CT-FFR and FFR values in both groups.FFR(0.80±0.08 vs.0.84±0.09,P=0.004)and CT-FFR(0.81±0.06 vs.0.85±0.06,P<0.001)levels were significant lower in CACS≥100 group than those in CACS<100 group,while ΔCT-FFR(0.14±0.06 vs.0.09±0.06,P<0.001)levels were significant higher in CACS≥100 group.Moreover,the diagnostic efficiency of CT-FFR in CACS≥100 group was inferior to that in CACS<100 group[AUC=0.792(95%CI 0.663-0.889)vs.AUC=0.929(95%CI 0.856-0.972),P=0.04],while it achieved significant improvement after ΔCT-FFR adjustment[AUC=0.876(95%CI 0.760-0.949)vs.AUC=0.792(95%CI 0.663-0.889),P=0.02]and was similar to that in CACS<100 group(P=0.37).Conclusion For coronary arteries with severe calcification,CT-FFR demonstrated significant incremental value in improving the diagnostic efficiency of coronary abnormal hemodynamics after ΔCT-FFR adjustment.
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OBJECTIVE@#To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS).@*METHODS@#In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4.@*RESULTS@#Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group.@*CONCLUSIONS@#In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.
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The gut microbiota and its metabolites play a critical role on health maintenance, because they are involved in the absorption and metabolism of nutrients in the human bodies. This is also similar to traditional Chinese medicine (TCM) view that the ascending and descending of Qi movement affects Yin-Yang, Qi-blood, pneuma and body fluid, viscera and meridians of our bodies. More and more studies have demonstrated that gut microbiota is closely related to the development and progression of diabetes and its complications. Gut microbiota disorder could affect host metabolic signaling pathways, thereby promoting the formation and development of diabetes. The smooth ascending and descending of Qi movement is the basic form of maintaining host metabolic homeostasis, whose dysfunction however can lead to internal environment disturbance. Based on the theory of ascending and descending of Qi movement, this paper focuses on the pathogenesis of imbalanced intestinal flora in the process of the induction of diabetes mellitus from a dynamic perspective. It is assumed that the imbalance of Qi ascending and descending may act as a trigger for such symptoms as lung Qi impairment, spleen deficiency to dissipating essence, liver Qi stagnation and kidney Yang deficiency. Under this circumstance, gut microbiota will be out of balance, which will further lead to the nutrient substance metabolic disturbance in the body, and thus induce diabetes. Thus, it is significant to explore the regulatory mechanism of gut microbiota and its metabolites on diabetes based on the theory of ascending and descending of Qi movement, so as to reveal the scientific connotation of TCM in regulating substance metabolism homeostasis in the body.
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Objective To evaluate the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CTA) (FFRCT) for functional myocardial ischemia.Methods Thirty-nine patients undergone coronary CTA and FFR examination from Aug.2012 to Jul.2015 in PLA General Hospital were retrospectively included in present study.Measurements of invasive FFR value was used as reference standard,and FFRCT based on coronary CTA image was performed in either per-patient or per-vessel level to assess the accuracy,specificity,sensitivity,the positive predictive value and negative predictive value for functional myocardial ischemia.Results In per-patient level,the accuracy of FFRCT was 82.05％,sensitivity was 83.33％,specificity was 80.95％,positive predictive value was 78.95％ and negative predictive value was 85.00％.In per-vessel level,the accuracy of FFRCT was 76.79％,sensitivity was 69.57％,specificity was 81.82％,positive predictive value was 72.73％ and negative predictive value was 79.41％.The area under ROC was 0.826 in per-patient level,and 0.786 in per-vessel level.For per-vessel,FFRCT was positively correlated with FFR value significantly (r=0.644;95％CI:0.458-0.775).Conclusion With FFR as reference standard,domestic noninvasive FFRCT can be used for the diagnosis of functional myocardial ischemia with high diagnostic performance and clinical application prospect.
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Objective To investigate the application of non-invasive positive pressure ventilation in emergency department in China.Methods A questionnaire survey was carried out in the emergency department in China,then the results were analyzed.Results Out of the 317 hospitals,non-invasive ventilators were available in the emergency department in 150 clinics (47.3％).Among them,144 clinics were the tertiary hospitals,and 6 clinics were the secondary hospitals.The leading five causes for NPPV were as follows:acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) (29.7％),acute cardiogenic pulmonary edema (23.2％),ventilator weaning (11.2％),acute respiratory distress syndrome (ARDS) (9.0％),and extubation failure (8.7％).The bi-level positive airway pressure (BiPAP) S/T was the most commonly used ventilation mode (51.8％),followed by the continuous positive airway pressure (CPAP)(30.3％) and BiPAP (S)(12.5％).The oronasal mask (73.7％) and the nasal mask (24.2％) were the most favorable interfaces for NPPV.The reasons for NPPV underusing mainly included insufficient training (36.8％),lacking of related knowledge (22.9％),medical teaching staff shortage (21.1％) and poor compliance of patients (11.0％).The main causes of the failure of NPPV were as follows:poor tolerance (31.5％),irrational parameters setting (25.6％),unfitness of interface (17.8％),airway secretions (14.7％),and disorders of consciousness (10.4％).Conclusions In China,the types of patients most commonly treated with NPPV in the emergency department are those with AECOPD and acute cardiogenic pulmonary edema.Barriers to popularize the use of NPPV in the emergency department include availability of equipment,physician with familiarity in operating the NPPV,and human resources required for NPPV.
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Objective To study the assisted diagnostic value and significance in precise surgery of MSCT angiography in torsion of ovar-ian tumors in children. Methods The dual-phase enhanced MSCT images data of 15 children patients with ovarian tumor torsion which were confirmed by surgery were retrospectively analyzed. Showed the vascular changes around the ovaries and judged the ovarian tumors arise and torsion side with the vascular reconstruction methods of multi-planar reconstruction (MPR),maximum intensity projection (MIP),volume rendering ( VR) ,then compared with the operation situation. Results Among the 15 cases aged from 2 months to 11 years old who were de-tected with MSCT scanning and angiography, there were 11 cases of benign tumor (9 cases of ovarian teratoma and 2 cases of serous cystade-noma) and 4 cases of malignant tumor (3 cases of yolk sac tumor and 1 case of malignant mixed germ cell tumor). MSCTA displayed that o-varian vessels changes were abnormal thickening and twisting of distal feeding artery and tumor vascular network formation;and there were thickening, tortuosity, increased density and a few visible‘whirl sign’ in draining veins. Preoperative MSCTA displayed ovarian tumor blood supply arteries were found 5 cases of downlink of ovarian artery and 10 cases of asscending branches of uterine artery. There were 4 cases of ovarian tumor originated from the left ovary combined with reverse and 11 cases originated from the right ovary combined with reverse, which were consistent with intraoperative findings. Intraoperative MSCTA provide information which helped accurate chose of the surgical incision, precise abruption of tumor blood vessels and resection of the tumor and ovarian lesions, thus saved the operation time and reduced the blood loss. Conclusion MSCT angiography can not only provide diagnosis information of torsion of ovarian tumors in children,but also more impor-tantly,it has an important assisted significance in precision surgery.
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<p><b>OBJECTIVE</b>To study the value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (sPDA) in preterm infants.</p><p><b>METHODS</b>Preterm infants born at a gestational age (GA) of ≤ 32 weeks and diagnosed with patent ductus arteriosus (PDA) by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-proBNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into sPDA group and asymptomatic PDA (asPDA) group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-proBNP level and echocardiographic indices were analyzed. Serum NT-proBNP levels were compared between the two groups. The receiver operator characteristic (ROC) curve was applied to determine the sensitivity and specificity of serum NT-proBNP in the prediction of sPDA.</p><p><b>RESULTS</b>A total of 69 preterm infants were enrolled in this study, with 13 infants in the sPDA group and 56 infants in the asPDA group. Serum NT-proBNP level was positively correlated with the diameter of the arterial duct (r=0.856; P<0.05)and the ratio of left atrial diameter to aortic root diameter (LA/AO) (r=0.713; P<0.05). At 3 and 5 days after birth, the serum NT-proBNP levels in the sPDA group were significantly higher than those in the asPDA group (P<0.05). The area under the ROC curve (AUC) for the prediction of sPDA by NT-proBNP levels at 3 days after birth was 0.949 (95% CI: 0.892-1.000; P<0.001), with a cut-off value of 27 035 pg/mL (sensitivity: 92.3%; specificity: 94.6%); the AUC for the prediction of sPDA by NT-proBNP levels at 5 days after birth was 0.924 (95% CI: 0.848-1.000; P<0.001), with a cut-off value of 6 411 pg/mL (sensitivity: 92.3%; specificity: 92.9%).</p><p><b>CONCLUSIONS</b>NT-proBNP may be a quantitative index for shunt volume. The measurement of serum NT-proBNP levels on 3 and 5 days after birth may be useful to predict sPDA in preterm infants.</p>
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Female , Humans , Infant, Newborn , Male , Biomarkers , Ductus Arteriosus, Patent , Diagnosis , Infant, Premature , Natriuretic Peptide, Brain , Blood , Peptide Fragments , Blood , ROC CurveABSTRACT
<p><b>OBJECTIVE</b>To investigate the diagnostic value of histopathological changes in the liver of patients with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD).</p><p><b>METHODS</b>Liver specimens from 10 cases of NICCD were evaluated by hematoxylin-eosin stain, histochemistry and immunohistochemistry (EnVision method). SLC25A13 mutation analysis was performed to correlate with histopathology.</p><p><b>RESULTS</b>Most specimens showed varying degrees of fat deposition in hepatocytes, necrotic inflammation, cholestasis and fibrosis (so-called tetralogy). The combination of the above four histological changes was highly characteristic for NICCD. With the progression of the disease, hepatic fibrosis deteriorated and ultimately led to cirrhosis.</p><p><b>CONCLUSIONS</b>NICCD should be suspected in the presence of cholestasis during infancy. A liver biopsy must be performed to rule out other liver diseases. The tetralogy of the hepatic histopathological changes has a highly diagnostic value for NICCD, which is also practical for accurately assessing the degree of inflammation and fibrosis, and similarly the progression of hepatic cirrhosis.</p>
Subject(s)
Female , Humans , Infant , Male , Biopsy , Calcium-Binding Proteins , Genetics , Metabolism , Cholestasis, Intrahepatic , Genetics , Pathology , Disease Progression , Hepatocytes , Pathology , Liver , Pathology , Liver Cirrhosis , Pathology , Mitochondrial Membrane Transport Proteins , Genetics , Mutation , Organic Anion Transporters , Genetics , MetabolismABSTRACT
Objective To investigate expression and significance of decorin(DCN)in liver tissue and serum of liver transplant patients with chronic rejection(CR).Methods Immunohistochemistry(SP method)was used to detect expression of DCN in liver tissue of 16 normal controls, 20 patients with cirrhosis, 46 liver translantion patients without CR and 8 patients with CR.Enzyme-linked immunosorbent assay method(ELISA method)was used to determined the content of DCN in serum of all research subjects.Results The expression of DCN was negative in normal hepatic tissues and with/without CR, cirrhosis tissues showed strong expression of DCN.The positive expression rate and the average optical density value of DCN in liver transplant tissues with CR had significant difference comparing with Cirrhosis tissues(25% vs 55%, 0.1249 ±0.0039 vs 0.2357 ±0.0396, P <0.01,while no statistic siqnificance compared to normal liver tissues and those without CR.The level of DCN in serum was significantly higher in liver transplant patients with CR, with significant difference comparing with normal people, liver cirrhosis and transplant liver patients without CR(54.0833 ± 6.0325)μg/L vs(1.0232 ± 0.9105)μg/L,(12.6202 ± 1.5370)μg/L,(17.7102 ± 2.3562)μg/L, P < 0.01).The concentration of DCN in serum showed a positive correlation with the degree of CR.Conclusions DCN showed negative expression in liver tissue and increased significantly in serum of liver transplantation patients with CR.This suggests that DCN may be involved in occurrence and development of CR.At the same time the determination of DCN in serum maybe become an important indicator of the early diagnosis, development and prognosis of CR for liver transplant patients.
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<p><b>OBJECTIVE</b>To investigate the correlation between major histocompatibility complex (MHC) class I chain-related gene A (MICA) gene alleles matching rates and graft rejection in small intestine, liver and kidney transplantation.</p><p><b>METHODS</b>Genome DNA were extracted from blood samples or pathological sections collected from donors and recipients of living-related transplantation, included 4 cases of small bowel transplantation, 5 cases of liver transplantation and 6 cases of kidney transplantation. The correlation between MICA alleles matching rates and acute graft rejection was analyzed following 13 MICA alleles determination by polymerase chain reaction based on sequence-specific primers (PCR-SSP).</p><p><b>RESULTS</b>HLA zygosity of all donors and recipients was confirmed to be half-matching. The recipients displaying higher matching rates of MICA alleles with donors showed lighter clinical and pathological rejection and longer survival time. On the contrary, recipients with lower matching rates of MICA alleles with donors showed severer clinical and pathological rejection and shorter survival time relatively.</p><p><b>CONCLUSION</b>Matching rates of MICA alleles has negative relevance to acute rejection, and positive relevance to survival time of recipients in small bowel, liver, and kidney transplantation.</p>