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Objective:Utilizing functional magnetic resonance imaging (fMRI) to investigate changes in brain structure and function in patients with alcohol dependence (AD) complicated by major depressive disorder (MDD), and assessing the clinical significance of fMRI in diagnosing alcohol dependence complicated by MDD.Methods:From August 2019 to October 2022, 90 patients with AD complicated by MDD and 90 healthy subjects who concurrently received physical examination in our hospital were included in the study. All participants underwent magnetic resonance imaging (MRI) and fMRI to observe the brain tissue structure of patients with AD complicated by MDD and to assess differences in N-acetylaspartic acid/creatine (NAA/Cr) and factional anisotropy (FA) values across different brain tissue regions.Results:The widths of the left and right ventricular temporal angles in the AD complicated by MDD group [(2.67 ± 0.24) mm, (2.63 ± 0.25) mm] were significantly higher than those observed in the healthy control group [(2.29 ± 0.21) mm, (2.31 ± 0.23) mm, t = 22.48, 20.64, both P < 0.001]. Additionally, the volumes of the left and right hippocampus and nucleus accumbens in the AD complicated by MDD group [(2 673.46 ± 155.74) mm 3, (2 692.29 ± 154.61) mm 3, (682.04 ± 65.37) mm 3, (729.65 ± 68.49) mm 3] were significantly lower compared with those in the healthy control group [(2 826.53 ± 158.95) mm 3, (2 849.17 ± 157.23) mm 3, (766.28 ± 69.51) mm 3, and (805.43 ± 71.36) mm 3, t = -9.53, -8.44, -15.62, -13.92, all P < 0.001]. Moreover, the NAA/Cr values in the left and right frontal lobes, temporal lobes, hippocampi, and nucleus accumbens in the AD complicated by MDD group were significantly lower than those in the healthy control group ( t = -11.36, -7.19, -9.96, -7.84, -14.59, -8.25, -7.64, -6.84, all P < 0.001). Similarly, the FA values of the left and right frontal lobes, temporal lobes, hippocampi, and right nucleus accumbens in the AD complicated by MDD group were significantly lower compared with those in the healthy control group ( t = -9.48, -11.74, -9.22, -10.36, -16.85, -14.67, -5.28, all P < 0.001). Conclusion:Patients with AD accompanied by MDD exhibit alterations in brain tissue structure, neuronal metabolic function, and the integrity of white matter nerve fibers. fMRI is effective in identifying changes in brain neuron metabolism and the integrity of white matter nerve fibers, making it invaluable for the diagnosis and assessment of AD accompanied by MDD.
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OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.
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Objective:To evaluate the clinical and echocardiographic characteristics of valvular involvement in SLE patients and its predictive value for valvular outcome.Methods:A retrospective study included 58 adult SLE patients with valvular involvement diagnosed for the first time by echocardiography in the First Affiliated Hospital of Wenzhou Medical University. According to gender and age, 1∶2 SLE patients without valvular involvement were selected as the control group. Clinical and echocardiographic data within 24 hours after initial admission were collected. The predictive factors were analyzed using cox parametric regression analysis.Results:①Among 58 patients,significant valve lesions were detected by echocardiography in 50 and presented as valve thickening with regurgitation. The mitral valve was the most commonly affected, followed by the aortic valves. ②Compared with the non-valvular involvement group, the percent of CRP, SLC-R, IgA、aCL-IgG were higher in the valvular involvement group [CRP:60.3% vs 30.4%, χ2=10.54, P=0.001; SLC-R: 63.8% vs 19.8%, χ2=33.08, P<0.001; IgA:27.6% vs 22.4%, χ2=16.04, P<0.001; aCL-IgG: 27.6% vs 2.6%, χ2=24.84, P<0.001]. ③Cox parametric regression analysis showed that CRP [ HR (95% CI)=2.641(1.499, 4.654), P=0.001,SLC-R HR(95% CI)=3.234(11.776, 5.888), P<0.001], and aCL-IgG[ HR(95% CI)=2.166 (1.148, 4.087) , P=0.017] were independent predictors of valvular involvement. Conclusion:SLE patients with increased levels of CRP、SLC-R、IgA and aCL-IgG have a high risk of valvular involvement. CRP、SLC-R and aCL-IgG are independent predictors of valvular involvement.
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Objective To investigate the value of echocardiography in assessing right ventricular function of primary light-chain amyloidosis(AL)-cardiac amyloidosis(CA)patients.Methods A total of 25 patients biopsy diagnosed as AL-CA,who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2021,were enrolled in this study as amyloidosis group.And 25 heathy volunteers were set as control group.The routine right ventricular morphology and functional parameters were acquired by standard echocardiography.Right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVfwLS)were obtained by two-dimensional speckle tracking imagine.Tricuspid annular plane systolic excursion(TAPSE)/pulmonary artery systolic pressure(PASP),RVGLS/PASP,RVfwLS/PASP ratio were calculated as the noninvasively parameters of right ventricular-pulmonary artery coupling.Results ①Compared with control group,patients in amyloidosis group showed significantly larger right heart size,and significantly thicker right ventricular free wall[(7.16±1.84)mm vs.(3.76±0.66)mm],the difference was statistically significant(P<0.001).②Compared with control group,RVGLS[(17.43±2.45)%vs.(23.22±3.73)%]and RVfwLS[(18.44±2.10)%vs.(22.62±3.64)%]were significantly impaired in amyloidosis group,the difference was statistically significant(P<0.001).The ratios of TAPSE/PASP,RVGLS/PASP,RVfwLS/PASP were found to be lower in amyloidosis group,the difference was statistically significant(P<0.001).③TAPSE/PASP showed mild correlations with N-terminal brain natriuretic peptide precursor(NT-proBNP),highly sensitive T cardiac troponin(hs-TNT)(r=0.45 and 0.40)there were statistically significant(P<0.05).Conclusion Echocardiography can effectively evaluate the right heart function impairment in AL-CA patients,providing valuable information for a deeper understanding of the pathological and physiological mechanisms of the disease.
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Objective To analyze the epidemiology of the emergency medical service in Urumqi City in 2011.Methods All patients from 120-Ambulance Center of Urumqi City admitted from January 1,2011 through December 30,2011 were enrolled for prospective study.Descriptive analysis the gender,age,race,underlying diseases,the peak of calling,the time taken by ambulance and so on.Results The 120-Ambulance Center answered overall 53786 callings,the callings of effective answer were 47260,while the ineffective answers were 6526 accounting for 13.8％,and the average number of answer per day was 147.The ratio of male to female was 1.61:1 ; the number of callings from Han nationality was predominant accounting for 68.87％ (37043 callings),and the number of callings from Weiwuer nationality was next to that from Han nationality.The five most common emergency problems were traffic injury,acute cardiovascular diseases,cerebro-vascular diseases,trauma and poisoning.There was no significant difference in monthly number of emergency cases during the 12 months of 2011,and the average monthly number of emergency cases was ranged in 2500-3500.The peak time of answering occurred in 10:00 am-13:00 pm、16:00 pm-18:00 pm、21:00 pm-24:00 pm; the ages of patients were dominant in the population of 20-29 years old、30-39 years old and 70-79 years old.Conclusions We should lay the emphasis on the most common diseases,the peak of answering,and the most vulnerable population,in order to come across with the theoretical and practical evidence to the relevant public health bureau for the improvement of transport mode carried out by 120-Ambulance Center in Urumqi City.
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Eighty two patients aged 60 or over with stable angina pectoris were randomized to control group ( n = 42, receiving conventional western medicine) and treatment group ( n = 40, receiving 1.5 g Songlingxuemaikang capsules three times a day in addition to western medicine) .The treatment was lasted for 12 weeks, angina classification of CCS, hs-CRP, blood pressure levels and SF-36 (36-item short form)of the patients were evaluated before and after the treatment.The degrees of angina pectoris in angina classification of CCS, hs-CRP and blood pressure levels decreased, and the quality of life was improved in both groups; but more markedly in treatment group than those in control group (P ＜ 0.05 ).Songlingxuemaikang capsule combined with conventional western medicine can effectively relieve the symptoms of ischemic chest pain in elderly patients with stable angina pectoris, which is associated with blood pressure reduction and life quality improvement.