Development, and reliability and validity testing of a knowledge needs questionnaire of respiratory rehabilitation training for in-service healthcare workers / 中国康复理论与实践

ObjectiveTo develop a questionnaire on the knowledge needs of respiratory rehabilitation training for in-service healthcare workers, and test its reliability and validity. MethodsA theoretical framework was constructed based on the contents of the respiratory rehabilitation course modules of American Association of Cardiopulmonary Rehabilitation and American Association for Respiratory Care. The first draft of the questionnaire was prepared through literature searches and analyses, semi-structured interviews, and expert group discussions. The reliability and validity of the questionnaire was tested by interviewing 17 respiratory rehabilitation professionals and 16 respiratory rehabilitation experts by correspondence, and investigating 380 cases of in-service healthcare workers engaged in respiratory rehabilitation. ResultsThe knowledge needs questionnaire of respiratory rehabilitation training for in-service healthcare workers included progress in respiratory rehabilitation, physiological basis and diagnosis of chronic lung diseases, individualized assessment and management principles of chronic lung diseases, treatment of chronic lung diseases and guideline-recommended medications, oxygen therapy, exercise assessment and exercise prescription, tobacco addiction and cessation, nutritional assessment and weight management, psychological screening and intervention, self-management and health behavior promotion, and effectiveness assessment of respiratory rehabilitation, totaling eleven dimensions and 52 items. The total Cronbach's α was 0.921, the total folded half reliability was 0.904, the total retest reliability was 0.922, and the Cronbach's α of each dimension ranged from 0.909 to 0.953; the folded half reliabilities ranged from 0.882 to 0.924, and the retest reliabilities ranged from 0.908 to 0.950. The validity of the questionnaire's content was 0.902. In exploratory factor analysis, eleven metric factors were extracted, and their cumulative variance contribution rate was 75.324%. ConclusionThe questionnaire on the knowledge needs of respiratory rehabilitation training for in-service healthcare workers is reliable and valid, and can be used to assess the knowledge needs of healthcare workers participating in in-service training in respiratory rehabilitation.

Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation / 中南大学学报(医学版)

OBJECTIVES@#Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections.@*METHODS@#In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed.@*RESULTS@#Enterococcus faecium was the dominant pathogenic bacteria (33/51, 64.7%), followed by Enterococcus faecalis (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (P>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (P=0.005), intraoperative red blood cell infusion ≥12 U (P=0.013) and exposure to more than 2 intravenous antibiotics post-LT (P=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (OR=2.378, 95% CI 1.124 to 5.032, P=0.024) and intraoperative red blood cell transfusion ≥ 12 U (OR=2.757, 95% CI 1.227 to 6.195, P=0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (OR=0.269, 95% CI 0.121 to 0.598, P=0.001).@*CONCLUSIONS@#Gram-positive cocci infections occurring early after liver transplantation were dominated by Enterococcus faecalis infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.

Characteristic of medication compliance behavior in renal transplantation patients / 中南大学学报(医学版)

OBJECTIVES@#After renal transplantation, patients need to take various immunosuppressant, but the drug compliance is poor. The theory of planned behavior suggests that the past medication behavior and subjective norms of individuals are closely related to medication compliance. This study aims to explore the change of medication compliance behavior and its influenting factors for renal transplantation patients at different stages.@*METHODS@#This study was a prospective longitudinal study. The Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS), Medication Belief Scale, Social Support Scale and Quality of Life Scale were used to dynamically follow up renal transplantation patients at pre-operation and 1-month, 6-month, and 12-month after transplantation.@*RESULTS@#A total of 300 patients completed the whole follow-up. The percentage of patients with good medication compliance was 97.60%, 87.30% and 84.30% at 1-month, 6-month and 12-month after transplantation respectively. The life quality of the patients was decreased at 6 months after the operation, and the patients with better self-reported life quality had poor medication compliance. After adjusting for demographic data, the risk of medication incompliance in patients with poor medication compliance before operation was 37.646 times than those with good compliance. Patients who did not use medication reminders had high risk (odds ratio=2.467) of drug non-adherence. The risk of drug non-adherence in patients with more postoperative misgivings was 1.265 times compared with that in patients with less postoperative misgivings.@*CONCLUSIONS@#The medication compliance decreases with the time of transplantation, but the medication compliance of patients with good self-reported life quality is poor. Medication concerns reduce the compliance behavior. Preoperative medication behavior has a significant predictive effect on postoperative behavior. Medication reminder is a protective factor for promoting compliance. Medical staff should pay more attention to preoperative medication belief, behaviors and reminder of using drug so as to provide precise intervention in the renal transplantation patients.

Nursing care of a patient with multiple renal transplantation with high sensitization and severe obstructive sleep apnea hypopnea syndrome / 中国实用护理杂志

Objective:To summarize the nursing experience of a patient with multiple renal transplants with high sensitization and severe obstructive sleep apnea hypopnea syndrome.Methods:A phased care intervention was implemented through multidisciplinary joint treatment.Results:The transplanted renal function of the patient recovered well, the concentration of immunopreparations was stable, and the patient was cured and discharged after 30 days of hospitalizationConclusion:Preoperative accurate antibody screening and effective desensitization therapy are the prerequisites for successful operation. Postoperative sleep apnea, rejection and observation and nursing of immunosuppressive drugs are implemented. Personalized rehabilitation guidance and psychological care are implemented throughout the whole process. Strengthening missions and attaching importance to continuous care have effectively protected patients' safety.

Clinical characteristics and prognostic factors of neonatal gastric perforation / 中华围产医学杂志

Objective:To investigate the clinical characteristics and experience in the diagnosis and treatment of neonatal gastric perforation, and the factors influencing prognosis.Methods:This was a retrospective analysis involving 49 neonatal gastric perforation cases who underwent surgical treatment in the Neonatal Surgery Department of Shanxi Children's Hospital from January 2008 to December 2017. Their clinical data, including manifestations, auxiliary examinations, operations, and prognosis, were analyzed. According to the prognosis, these patients were divided into two groups, survival group, and fatality group. Independent sample t-test or continuity correction Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) Of the 49 cases, 29 (59.2%) were boys, and 20 (40.8%) were girls. There were 30 (61.2%) premature and 19 (38.8%) full-term babies. Their birth weight ranged between 1 010 and 5 000 g with an average of (2 450±700) g. Low birth weight infants accounted for 59.2% (29/49). There were 11 cases (22.4%) having perinatal adverse events, 17 (34.7%) complicated by septic shock before the operation, and six (12.2%) with digestive tract malformation. Two cases (4.1%) underwent resuscitation due to postnatal asphyxia; two (4.1%) received mechanical ventilation due to respiratory distress syndrome; 12 (24.5%) received indwelling were indwelled gastric tube or gastric lavage. (2) The average onset time of neonatal gastric perforation in the 49 cases was (3.8±2.0) d after birth, and 47(95.9%) of them presented initial symptoms within one week, including 36 within four days. Twenty-five cases (51.0%) were operated within 12 h after the onset. (3) The common first symptoms include abdominal distention [69.4% (34/49)] and abdominal distension complicated with vomiting (24.5%, 12/49). Thirty-nine cases (79.6%) showed a large amount of free gas under the diaphragm, compressed and down-moving liver, and decreased or disappeared stomach bubble in the preoperative abdominal radiograph. (4) All cases received emergency laparotomy and primary gastric wall repair after admission. During the operation, 27 (55.1%) of all the cases had perforation at the greater curvature, five (10.2%) at the lesser curvature, 14 (28.6%) at the anterior wall, and three (6.1%) at the posterior wall. Perforation larger than 3 cm in diameter was found in 33 cases (67.3%). Three cases (6.1%) had postoperative wound infection; two (4.1%) developed anastomotic leakage; one was complicated by pneumohydrothorax 48 h after the operation due to esophageal duplication and perforation, which was confirmed by a second operation. (5) Of the 49 cases, 35 (71.4%) were due to congenital gastric wall muscular defect, four (8.2%) were caused by iatrogenic injury, and 10 (20.4%) were spontaneous perforation. (6) Among all cases, 36 (73.5%) survived, while eight (16.3%) died, and five (10.2%) withdraw treatment after the operation. After excluding the five cases giving up treatment after the operation, the proportion of patients who underwent operation within 12 h after onset or had the perforation <3 cm in diameter was higher in the survival group than in the fatality group [61.1% (22/36) vs. 1/8, χ2=4.404, P<0.05; 41.7% (15/36) vs. 0/8, P<0.05], and the incidence of septic shock before the operation was lower [22.2% (8/36) vs. 6/8, χ2=6.147, P<0.05]. Conclusions:Neonatal gastric perforation shows a high mortality rate, and its underlying pathologic etiology is congenital gastric wall muscle defect. Abrupt abdominal distension is the main clinical manifestation. Early operation is critical to improving neonatal prognosis.

Influential factors for insomnia in medical staff in the national medical aid team for Hubei Province during the outbreak of coronavirus disease 2019 / 中南大学学报(医学版)

OBJECTIVES@#To investigate the insomnia status and relevant factors for the medical staff in the medical aid team for Hubei Province during the outbreak of coronavirus disease 2019.@*METHODS@#A convenient sampling survey was conducted among 1 056 medical staff in the national medical team of Hubei Province by using the Insomnia Severity Index (ISI) and the Regulatory Emotional Self-Efficacy (RES).@*RESULTS@#The incidence from moderate to severe insomnia was 35.14%, and the total self-efficacy of emotion regulation was 3.60±0.91. Univariate analysis showed that the incidence of insomnia in female medical workers in Hubei Province was higher than that of male medical workers, which was increased with the elongation of work time and frequency. In addition, insomnia was associated with age, perceived ambient exposure and infection, and RES scores. Stepwise regression analysis showed that the occurrence of insomnia was mainly related to gender, perceived peripheral exposure, infection, and RES scores.@*CONCLUSIONS@#Insomnia is very common among medical workers in Hubei Province during the COVID-19 epidemic. Insomnia is related to the medical work status, the gender and their own emotional management and regulation in the epidemic area.

Research progress on fatigue in recipients of renal transplantation / 器官移植

Renal transplantation is one of the most effective treatment methods for end-stage renal diseases. However, some recipients present with fatigue symptoms after renal transplantation. Fatigue not only affects the quality of life, but also reduces the compliance of recipients with immunosuppressive agents. To strengthen the attention of medical staff to the fatigue, make early diagnosis and deliver effective interventions for renal transplant recipients, the current situation, risk factors and intervention methods of fatigue in renal transplant recipients were reviewed in this article.

Laparoscopic Malone antegrade continence enema / 中华普通外科杂志

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE).Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients).Results The operation time [(38.3 ±2.5) min vs.(60.5 ±3.6) min,t =13.7,P =0.00] was shorter in the laparoscopy group.All patients were followed up for 6 months to 3 years.No intestinal obstruction,fecal leakage in stoma and anal fecal incontinence or soiling happened.In laparoscopy group,the stomal stricture developed in 1 patient.The mucosa prolapse developed in 2 patients.In the laparotomy group,the stomal stricture developed in 2 patients.The mucosa prolapse in 1 patient.The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1 ± 1.4 vs.33.7 ± 1.5,t =28.4,P =0.00),laparotomy group (12.5 ± 1.6 vs.33.3 ± 1.7,t =25.36,P =0.00).While the irrigation volume [(607±151) mlvs.(594±161) ml,t=0.17,P=0.87],MACE scoring (22.1 ±1.4vs.22.0±1.7,t =0.18,P =0.86) and symptom severity scoring for constipation and fecal incontinence (12.1 ± 1.4 vs.12.5 ± 1.6,t =0.46,P =0.65) were not statistically different.Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic.

Application of early goal-directed sedation with bispectral index in sedation management of severe patients in ICU / 中国医师杂志

Objective The bispectral index (BIS) was introduced into the sedation strategy of critical patients in intensive care unit (ICU) and replaced the Richmond agitation sedation scale (RASS).The ventilation time,ICU length of stay,and 90-day mortality were compared between the two groups of patients who performed early goal-directed sedation (EGDS) or standard traditional directed sedation (STDS) strategies.Methods A prospective controlled study of severe patients with mechanical ventilation ≥48 h in ICU (20 cases from April 2016 to May 2017,46 cases from June 2017 to April 2018) were randomly divided into EGDS or STDS group.There were no significant differences in age,gender,and acute physiology and chronic health evaluation score Ⅱ (APACHE Ⅱ) score between the two groups in the two periods.The correlation between RASS and BIS was analyzed in the first period.The BIS of the patients in a RASS range of (-2-1) was 73.65 ± 7.87 in the EGDS group,and that of RASS range of (-3--1) was 64.14 ± 7.25 in the STDS group.The above BIS was applied to the two sedation strategies in the second period respectively.The ventilation time,ICU length of stay,and 90-day mortality were recorded.Results There was no significant difference in the ventilation time between the two groups [(164.12 ± 137.96) h and (155.33 ±64.86)h,P =0.08].ICU length of stay of the EGDS group was longer than that of the STDS group.The 90-day mortality of the EGDS group was higher than that of the STDS group.Conclusions Correlations between RASS and BIS were found in this study,and BIS can be used for sedation assessment in ICU patients.Large sample study is still needed to compare EGDS and STDS with BIS.

Chromosomal microarray analysis of 339 fetuses with increased nuchal translucency and normal karyotype / 中华围产医学杂志

Objective To explore the value of chromosome microarray analysis (CMA) in determining the genetic etiology of fetuses with increased nuchal translucency (NT) but normal karyotype. Methods Amniocentesis, karyotype analysis and CMA were performed to singleton pregnant women with increased fetal NT ( ≥ 3.0 mm) in early pregnancy (11+1-13+6 gestational weeks) at Shenzhen Maternity and Child Healthcare Hospital from March 2015 to December 2017. A total of 339 fetuses with normal G banding karyotype analysis were recruited retrospectively. Peripheral blood samples were collected for CMA in parents whose fetuses were detected with pathogenic copy number variations (CNVs) or variants of uncertain significance (VUS). Descriptive analysis was used for CMA results. Moreover, Pregnancy outcomes and postnatal conditions of fetuses with abnormal CNVs were followed up. Results Pathogenic CNVs, ranging from 68 kb to 12.636 Mb, were detected in 15 out of the 339 fetuses (4.4%) including four microduplications and 11 microdeletions. Among them, there were eight known microdeletion or microduplication syndromes (nine cases) including Williams-Beuren syndrome, 18p deletion syndrome,Wolf-Hirschhorn syndrome, 22q11 duplication syndrome, 16p11.2 deletion syndrome, 17p13.3 duplication syndrome, 16p11.2 duplication syndrome (one case respectively) and DiGeorge syndrome/velocardiofacial syndrome (two cases). Of the 11 fetuses with VUS, five cases originated from parents with normal phenotype and the identified VUS were benign and the rest six were de novo mutations[1.8%(6/339)]. Of the 15 fetuses with pathogenic CNVs, one was lost to follow-up, four were live born and two of which was found to be growth retardation at the age of two. Among the 11 fetuses with VUS, nine were live born and no abnormality was reported in any cases at one year old. Conclusions For fetus with increased NT and normal karyotype, CMA is able to identify chromosomal microdeletion/microduplication that are not recognized by conventional karyotyping analysis, and may play an important role in prenatal diagnosis and genetic counseling.

Expression of CD90 and its clinical significance in different molecular subtypes of breast invasive ductal carcinoma / 临床与实验病理学杂志

Purpose To detect the expression of CD90 in invasive ductal breast carcinoma with different molecular subtypes and to explore its clinical significance.Methods The expression of CD90,ER,PR,Ki-67 and HER-2 were detected in 80 cases of invasive ductal breast carcinoma tissue and 20 cases of breast benign lesion with immunohistochemical method.The relationship between CD90 and clinicopathological parameters were analyzed.Results The positive expression rate of CD90 in invasive ductal breast carcinoma and breast benign lesion tissues were 62.5％ and 20.0％,respectively (P ＜0.001).The expression of CD90 in invasive ductal breast carcinoma was correlated with lymph node metastasis (P ＜ 0.05),but not with age,tumor size,TNM staging and histological grade (P ＞ 0.05).Among different molecular subtypes,CD90 expression level in Luminal A type was the lowest (40.0％),and the level in triple negative type was the highest (82.4％) (P ＜0.05).CD90 expression level was negatively correlated with ER (r=-0.342,P＜0.05) orPR (r=-0.374,P＜0.05) expression level,but not with Ki-67 (r =0.084,P ＞ 0.05).Condusion The over-expression of CD90 is related with molecular subtypes of breast carcinoma,and its high expression suggests a poor prognosis.

Evaluation of transesophageal echocardiography on the morphology and function of the left atrial appendage in nonvalvular atrial fibrillation / 中华超声影像学杂志

Objective To investigate the application value of the transesophageal echocardiography TEE in patients with nonvalvular atrial fibrillation about the size lobes morphology and function of left atrial appendage LAA Methods One hundred and forty-two patients underwent TEE were divided into nonvalvular atrial fibrillation group 98 cases and non atrial fibrillation group 44 cases The orifice diameter depth volume peak emptying velocity PEV of the LAA and the 1 eft atrial dimension LAD were measured The form and lobes of LAA thrombus and spontaneous echo contrast SEC in LAA were observed Results The LAA orifice diameter depth volume and LAD of patients with atrial fibrillation were significantly higher than those in the group without atrial fibrillation which showed statistical significance P < 0 05 Forty-one cases in atrial fibrillation group were found with the SEC and the number with thrombus in LAA was 22 The differences of PEV between chicken wings and non-chicken wings were statistically significant P <0 05 The SEC in LAA and the lobe number of LAA had no relevance Conclusions It was reliable to analyze the size morphologies lobes and hemodynamic parameters of LAA in patients with atrial fibrillation by TEE which provided reference for percutaneous LAA occlusion and anticoagulation therapy for the patients with atrial fibrillation.

Complication analysis of endorectal pull-through radical operation for Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases(81.5%) were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases(87.8%), transabdominal approach in 17 cases (5.9%), laparoscopy-assisted endorectal pull-through in 18 cases (6.3%). The operations were performed in 54 cases (18.9%) within 3 months of age, in 183 cases (64.1%) between 3 and 6 months, in 38 cases(13.3%) between 6 months and one year, in 10 cases (3.5%) older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases (male:250, female:36) were followed up for 2 to 5 years.</p><p><b>RESULTS</b>There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases(22.0%) and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases(3.8%), including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases(15.7%), among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocolitis and soiling were higher in infants undergoing operation within 3 months as compared to those more than 3 months [90.7%(49/63) vs. 6.0%(14/63), P=0.000; 9.3%(5/54) vs. 2.6%(6/232), P=0.022; 25.9%(14/54) vs. 13.4%(31/232), P=0.022]. Morbidity of perianal erosion enterocolitis was higher in infants undergoing subtotal or total colectomy as compared to those partial colon resection[51.9%(14/27) vs. 18.9%(49/259), P=0.000; 18.5%(5/27) vs. 2.3%(6/259), P=0.000].</p><p><b>CONCLUSIONS</b>Primary transanal endorental pull-through procedure can be performed in most children with Hirschsprung disease. Postoperative short-term complications are mainly perianal erosion and long-term ones are enterocolitis and soiling. Early diagnosis, colon irrigation, avoiding premature operation and anal dilation can decrease the morbidities of enterocolitis and soiling.</p>

Analysis of clinical and imaging features of cardiac amyloidosis: a multicenter study / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the features of clinical manifestations, laboratory tests and imaging findings of patients with cardiac amyloidosis (CA).</p><p><b>METHODS</b>A total of 60 CA patients (including 41 male and 19 female patients) from 4 centers admitted between May, 2012 and November, 2013 were included in the study. The demographic data, medical history, clinical manifestations, laboratory test data, ECG, cardiac ultrasound, and cardiac magnetic resonance (CMR) imaging of the patients were analyzed.</p><p><b>RESULTS</b>Two-thirds of the 60 CA patients, were middle-aged or elderly men, and 47% of the patients had AL-CA. The clinical manifestations included exertional dyspnea (73%), pedal edema (47%), hypotension (47%), and hypertrophy of the tongue (22%); abnormal laboratory test results included albuminuria (53%) and liver (15%) and kidney (28%) dysfunction; blood routine, urine and serum immunoglobulin quantification and immunofixation electrophoresis could help the screening of AL-CA. Kidney (53%) and liver (15%) involvement was common, and 86% of AL-CA patients had kidney involvement. Typical ECG characteristics included poor R wave progression (35%), low voltage in limb leads (33%), and a pseudo infarct Q wave (30%); the latter two were more frequent in AL-CA. The characteristics of ultrasound findings included left ventricle thickening (100%), left atrial enlargement (87%) and enhanced echo of the myocardial granules(92%), and diastolic dysfunction was obvious in all the CA patients regardless of the systolic function. The DT and E/e' of the mitral annulus could be used as an index to evaluate diastolic dysfunction in early stage of the disease. Left ventricular (LV) global subendocardial late gadolinium enhancement (LGE, 81%) accompanied by right ventricular (RV) and atrial LGE was the typical characteristic of CMR, and the range of LGE in the RV and the two atria was wider in AL-CA than in non-AL-CA. NT-proBNP (97%) and cardiac troponin (53%) in CA patients were both elevated, which helped in diagnosing and assessing the severity of cardiac involvement, according to which 50% of the patients were found to be at a high risk, 43% at an intermediate risk, and 7% at a low risk.</p><p><b>CONCLUSION</b>The combination of the features of clinical, laboratory tests and imaging findings of CA have important diagnostic and prognostic value for CA.</p>

Changes of cardiac function and left atrial diameter after radiofre-quency catheter ablation in patients with atrial fibrillation / 心血管康复医学杂志

Objective: To observe curative effect of radiofrequency catheter ablation (RFCA) and changes of cardiac function and left atrial diameter after operation in patients with atrial fibrillation (AF). Methods: A total of 28 AF patients with obvious clinical symptoms and without effective for drug therapy received RFCA in our hospital, their data were retrospectively analyzed. They received RFCA under guidance of three dimensional electro-anatomic mapping (EAM) system. Changes of cardiac function and left atrial diameter were evaluated by echocardiography and curative effect was evaluated by ambulary blood pressure monitoring before, three and six months after operation. Results: Pulmonary vein isolation rate was 100% in all patients. No severe complication occurred during or after operation. After six-month follow-up, 27 cases（96.4%）did not recur AF among the 28 patients; Compared with before operation, there were significant decrease in left atrial diameter [(37.3±4.8) mm vs. (33.6±4.5) mm] and significant increase in left ventricular ejection fraction [(59.8±8.7) % vs. (64.2±6.8) %] by echocardiography, P<0.05 both. Conclusion: Radiofrequency catheter ablation is safe and effective in treatment of atrial fibrillation, and there are significant improvements in cardiac function and left atrial diameter.

Modulation of low molecular weight heparin and heparin-binding epidermal growth factor on biological functions of human first trimester trophoblast / 中华妇产科杂志

Objective To evaluate the effects of low molecular weight heparin(LMWH)and heparin-binding epidermal growth factor(HB-EGF)on the biological function of human trophoblast in first trimester.Methods From Feb.2011 to Nov.2011,the trophoblast isolated from human first trimester chorionic villi was cultured in vitro.Based on variation of LMWH concentration,the trophoblast was classified into 0.025 U/ml group,0.25 U/ml group,2.5 U/ml group,25 U/ml group and 250 U/ml group.In the mean time,based on treatment of heparin,the trophoblast was classified into LMWH group (0.25 U/ml),HB-EGF group(10 μg/L),combination group(LMWH at 0.25 U/ml + HB-EGF at 10 μg/L)and add with DMEM as control group.Cell prolferation was assessed by the methyl thiazolyl tetrazolium(MTY)test,which was showed with the mean absorbance as A value.Cell invasion was measured by transwell,which counted the number of cells migrated to the superficies inferia of filter membrane.Cell differentiation was assessed by the concentration of hCG secretion.Results Compared with control group,the trophoblast proliferation and invasion treated by LMWH at 0.025 U/ml did not show significant difference (P ＞ 0.05).When treated by LWMH at 0.25 U/ml and 2.5 U/ml,trophoblast proliferation and invasion was increased significantly(P ＜ 0.05).When LMWH at 25 U/ml and 250 U/ml,it could inhibit trophoblast proliferation and invasion(P ＜ 0.05).When compared with A value of 0.44 ± 0.04 in control group,the increased A value were 0.51 ± 0.05 in LMWH group,0.56 ± 0.04 in HB-EGF group and 0.69 ± 0.06 in combination group(P ＜ 0.05).In the transwell test,the cell number were 511 ± 78 in LMWH group,669 ± 67 in HB-EGF group and 872±64 in combination group,which were significantly higher than 405 ± 67 in control group(P ＜ 0.05),respectively.And the hCG concentration were(7143 ± 649)U/L in LMWH group,(11 762 ± 1059)U/L in HB-EGF group and(11 015 ± 1084)U/L in combination group,which showed statistical difference with(8182 ± 666)U/L in control group(P ＜ 0.05).Conclusion LMWH could modulate trophoblast proliferation,invasion,and differentiation.HB-EGF is one of important factors involved in effects of LMWH on trophoblast function.

Digital guide plates for correction of unilateral delayed orbitozygomatic complex fractures / 中华创伤杂志

Objective To investigate the clinical outcome of correction of unilateral delayed orbitozygomatic complex fractures with digital guide plates.Methods The study involved 14 cases of unilateral delayed orbitozygomatic complex fractures treated between September 2007 and March 2012.Craniofacial structures were measured by thin-section CT before operation,followed by data input to the image processing software.Before and after the processing of images,three dimensional skull models were produced using rapid prototyping technique and applied to have surgical simulation.Digital guild plates were produced for guiding the reduction of fractures and orbital walls were reconstructed as well.Results All cases were followed up for a period of 6-11 months,which showed basic restoration of facial structure and significant correction of diplopia and enophthalmos,with no infection or dislocation of implants buried in orbit floor.Mild ectropion of the lower eyelid occurred in one case and temporary decrease of frontal wrinkle in two cases,but all recovered in 3-6 months postoperatively.Conclusion Digital guide plate is easy in operation and reliable for treatment of unilateral delayed orbitozygomatic complex fractures.

Clinical effect of myofunctional trainers on malocclusion in primary and mixed dention / 中华医学美学美容杂志

Objective To clarify the effect of myofunctional treatment on primary and mixed dentition malocclusion.Methods Twenty-seven children were selected,3 were in primary dentition among which 2 showed deep overbite.24 were in mixed dentition and presented crowding in anterior area among which 4 children combined with anterior crossbite,2 showed deep overbite and deep overjet.All the patients were treated with myofunctional trainer such as INFANT,T4K or I2N appliances according to their age and malocclusion type.The patients were instructed to wear the trainers for at least one hour a day keeping their lips together or overnight while sleeping.Muscle exercises were done when wearing the trainer during daytime.Results After 6-10 months,24 patients who were in good compliance had their teeth aligned,deep overjet and deep overbite corrected,and facial profile improved.Conclusions Myofunctional treatment is effective on primary and mixed dentition malocclusion.It is important to have patients' good compliance.

Pharmacokinetics of three alkaloids in Huanglianjiedu decoction in rat serum by LC-MS-MS / 中国中药杂志

<p><b>OBJECTIVE</b>To develop a sensitive and reliable high-performance liquid chromatography-tandem mass spectrometry (LC-MS-MS) method for simultaneous determination of jatrorrhizine, palmatine and berberine in rat serum, and study the pharmacokinetics of the three alkaloids in rat serum after an intragastrical (ig) administration of Huanglianjiedu decoction to rat.</p><p><b>METHOD</b>The optimal ionization and fragmentation conditions, as well as HPLC ones, to detect jatrorrhozine, palmatine and berberine were developed and validated. After the Huanglianjiedu decoction were administered to rats through ig route, LC-MS-MS method has been applied to the pharmacokinetic study of the three alkaloids in rat serum. DAS procedure was used to process concentration-time data.</p><p><b>RESULT</b>The detection was performed by MRM mode via electrospray ionization (ESI) source operating in the positive ionization mode. The precursor-to-product ion transitions were at m/z 338-322 for jatrorrhozine, m/z 351.9-308 for palmatine, m/z 336-319.8 for berberine and m/z 356.1-192.1 for tetrahydropalmatine (IS) respectively. The method was linear over the concentration range of 0.2-25 microg x L(-1) for jatrorrhozine, 0.4-50 microg x L(-1) for palmatine and berberine. The method was validated according to the requirements. The pharmacokinetic process of the three alkaloids after oral administration of Huanglianjiedu decoction was fitted to be a one-compartment model.</p><p><b>CONCLUSION</b>The fully validated LC-MS-MS method has been successfully applied to the pharmacokinetic study of the three alkaloids in rat serum after oral administration of Huanglianjiedu decoction.</p>