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Objective:To construct a predictive model for the risk of major adverse cardiovascular events(MACE) after surgery in patients with symptomatic arteriosclerosis obliterans(ASO) .Methods:From Jan 2018 to Dec 2021, 957 patients with symptomatic ASO admitted to Nanjing Drum Tower Hospital were selected and divided into MACE and non-MACE groups according to whether they had a post-op MACE. A risk prediction model was constructed based on a stepwise regression method with multi-factor COX regression analysis. The model was evaluated using the receiver operating characteristic curve (ROC), the calibration curve to assess the model fit, and the Bootstrap method for internal validation.Results:MACE occurred in 143 patients (14.94%). After COX regression analysis, BMI, creatinine clearance, fibrinogen, rivaroxaban and previous history of surgery were enrolled into model constructing. The ROC curve assessed the model with a C-statistic of 0.690 (95% CI: 0.644-0.736), sensitivity and specificity of 49.2% and 80.7% respectively, a Jorden index of 0.299 and an optimal cut-off value of 0.086. Calibration curves showing agreement between predicted and actual observed values. Internally validated C-statistic of 0.689 (95% CI: 0.672-0.700). The population was divided into high and low risk groups based on the best cut-off value and analysed for survival. The difference between the two groups was statistically different. Conclusion:The risk prediction model for the occurrence of MACE based on clinical parameters is simple and convenient, with good predictability and good discriminatory ability, and can provide reference for the assessment and treatment of MACE in ASO patients.
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Restless legs syndrome (RLS) is a common sensorimotor disorder. Although it does not pose a threat to life, it seriously affects the quality of life of patients. RLS pathogenesis is still unclear, and its incidence is associated with a variety of risk factors, including genetic factors and non-genetic factors. Genetic factors involve more than 20 risk genes, such as meis homeobox 1 ( MEIS1), BTB domain containing 9 ( BTBD9), mitogen-activated protein kinase kinase 5 ( MAP2K5), and protein tyrosine phosphatase receptor type Db ( PTPRD). Non-genetic factors include regional age, gender, obesity, medical related diseases, neuropsychiatric diseases and drugs. This paper reviews the recent advance in risk factors and related pathogenesis of RLS to provide references for early prevention and treatment of the disease.
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Objective:To investigate the possible role and mechanism of purinergic ligand-gated ion channel 7(P2X7)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome pathway in cognitive impairment induced by sleep deprivation (SD)mice.Methods:SPF grade male C57BL / 6J mice aged 6-8 weeks were randomly divided into 3 groups according to the random number table method with 6 mice in each group.They were normal control group (CC group), SD group and SD+ P2X7 receptor antagonist brilliant blue G(BBG) group (SD+ BBG group). Modified multiple platform method was used to establish a 5-day SD model in mice.During the SD intervention period, the mice in SD+ BBG group were injected with BBG(50 mg/kg) intraperitoneally once a day, while the mice in CC group and SD group were injected with the same volume of 0.9% sodium chloride solution.Morris water maze was conducted to evaluate the cognitive function of mice.The protein expression levels of P2X7, NLRP3, caspase-1, apoptosis-associated proteins(ASC) and interleukin-1β(IL-1β) in hippocampus were detected by Western blot.RT-qPCR was used to detect the mRNA expression levels of tumor necrosis factor-α(TNF-α), IL-1β, interleukin-18(IL-18) and microglial polarization surface markers CD206 and CD86 in hippocampus.Graph pad Prism 8.0 software and SPSS 25.0 software were used for statistical analysis and mapping.Results:(1) The interaction effect between time and groups of escape latency in three groups of mice was significant ( F=15.76, P<0.001). From the 2nd to 5th day, the escape latencies of mice in SD group were higher than those of CC group, while the escape latencies of mice in SD+ BBG group were lower than those of SD group (all P<0.05). (2)The results of the space exploration experiment showed that there were statistically significant differences in target quadrant residence time and the times of crossing the platform( F=6.65, P=0.009; F=12.39, P<0.001). The target quadrant residence time ((23.42±0.55) s) and times of crossing the platform ((17.67±0.71) times) of the SD group were both lower than those of the CC group ((29.48±1.78) s, (23.33±0.95) times) (both P<0.05), while the target quadrant residence time ((28.62±1.19) s) and the times of crossing the platforms ((21.33±0.76) times) of the SD+ BBG group were both higher than those of the SD group (both P<0.05). (3)There were statistically significant differences in the protein levels of inflammatory related proteins such as P2X7, NLRP3, caspase-1, ASC and IL-1β in the hippocampus of mice among the 3 groups( F=8.23, 8.97, 8.45, 54.42, 8.12, all P<0.05). Compared with CC group, the protein levels of P2X7 ((0.93±0.02), (0.71±0.04)), NLRP3 ((0.97±0.04), (0.62±0.09)), caspase-1 ((1.00±0.03), (0.76±0.07)), ASC ((0.96±0.02), (0.77±0.04)) and IL-1β ((0.85±0.07), (0.54±0.04)) in SD group were all higher (all P<0.05). Compared with SD group, the protein levels of P2X7 (0.74±0.05), NLRP3 (0.78±0.02), caspase-1 (0.74±0.04), ASC (0.67±0.02), IL-1β (0.53±0.07) in SD+ BBG group were all lower (all P<0.05). (4)There were statistically significant differences in the mRNA levels of IL-18, IL-1β, TNF-α, CD86 and CD206 in hippocampus among the three groups ( F=12.80, 12.28, 105.80, 7.06, 30.19, all P<0.05). The mRNA levels of IL-18, IL-1β, TNF-α, CD86 in SD group were all higher than those in CC group(all P<0.05), while the mRNA level of CD206 in SD group was lower than that in CC group( P<0.05). Compared with SD group, the mRNA levels of IL-18, IL-1β, TNF-α, CD86 were lower in SD+ BBG group (all P<0.05), while the CD206 mRNA level of SD+ BBG group was higher than that in SD group( P<0.05). Conclusion:SD intervention can lead to cognitive impairment and increased expression of P2X7 in hippocampus of mice, which may be related to the activation of P2X7/ NLRP3 inflammasome signaling pathway, promoting the polarization of microglia into pro-inflammatory type and up-regulating the expression of pro-inflammatory cytokines.Inhibition of P2X7 can improve the cognitive function of mice.
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Objective:To evaluate the efficacy and safety of of rivaroxaban for different doses in the treatment of isolated distal deep vein thrombosis.Methods:The clinical data of 853 patients of isolated distal deep vein thrombosis attending Nanjing Drum Tower Hospital from Jan 2018 to Dec 2020 was retrospectively analyzed.Results:Thrombotic recurrence rate increased with increasing follow-up in the standard and low dose groups, and it was significantly lower in the standard dose group than in the low dose group (HR=0.44, 95% CI: 0.25-0.78, P=0.005) with most thrombosis occurring within the first year of follow-up. There was no statistical difference between the two groups in terms of major bleeding events (HR=1.70,95%CI 0.56-5.14, P=0.530) and the incidence of clinically relevant non-major bleeding events was significantly higher in the standard dose group than in the low dose group (HR=2.36, 95%CI 1.26-4.44, P=0.020). Subgroup analysis on anticoagulation duration found when anticoagulation duration was longer than 1.5 months, the risk of thrombosis was lower in the standard dose group than the low dose group (1.5-3 months:HR=0.11, 95%CI 0.01-0.87, >3 months: HR=0.19, 95%CI 0.04-0.95), there was an interaction between anticoagulation duration and dose ( P=0.007). Conclusions:Based on the risk of thrombosis recurrence and bleeding events, the standard dose of rivaroxaban (20 mg qd) is recommended for patients with isolated distal deep vein thrombosis, and the anticoagulant duration should be maintained for 1.5 months or more.
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Objective:To investigate the correlation between single nucleic acid polymorphisms (SNPs) of MEIS1, BTBD9, MAP2K5, PTPRD and restless leg syndrome (RLS).Methods:By searching the literatures published before March 1, 2021 at home and abroad, case-control studies on risk genes associated with RLS were collected, and the Review Manager 5.3 and Stata 15.1 softwares were used for statistical analysis.Results:A total of 8 studies were included, with a total of 7 824 cases and 14 645 controls.Meta analysis results showed that the SNPs locus of the risk gene associated with RLS was MEIS1 rs2300478( OR=1.68, 95% CI: 1.59-1.78), BTBD9 rs9296249( OR=1.62, 95% CI: 1.47-1.77), BTBD9 rs9357271( OR=1.49, 95% CI: 1.44-1.55), MAP2K5 rs12593813( OR=1.44, 95% CI: 1.36-1.53), MAP2K5 rs11635424( OR=1.47, 95% CI: 1.34-1.60)and PTPRD rs1975197( OR=1.34, 95% CI: 1.21-1.49). Conclusion:MEIS1 rs2300478, BTBD9 rs9296249, BTBD9 rs9357271, MAP2K5 rs12593813, MAP2K5 rs11635424 and PTPRD rs1975197 are the risk loci of RLS.
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Objective:To investigate the characteristics of transcranial sonography (TCS) in patients with restless legs syndrome (RLS), and analyze the correlations of scores of RLS Self-rating Severity Scale by International Restless Leg Syndrome Study Group (IRLS) and TCS parameters with clinical data of these patients.Methods:Twenty-one patients with RLS admitted to the Sleep Disorder Clinic of our hospital from September 2020 to January 2021 were selected as RLS group, and 23 healthy controls at the same time period were recruited as control group. IRLS was used to evaluate the severity of patients in the RLS group, and the 14-item Hamilton anxiety rating scale (HAMA-14) and 24-item Hamilton depression rating scale (HAMD-24) were used to evaluate the anxiety and depression of subjects from the 2 groups. Pittsburgh Sleep Quality Scale (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) were used to evaluate the sleep quality of subjects from the 2 groups. TCS was used to examine the occurrence of hypoechoic substantia nigra and raphe nucleus rupture and the width of the third ventricle in the two groups. The clinical data and TCS parameters of patients in the 2 groups were compared, and the correlations of IRLS scores and TCS parameters with clinical features of patients in the RLS group were analyzed.Results:As compared with those in the control group, the HAMA-14, HAMD-24, ISI and PSQI scores in the RLS group were statistically higher ( P<0.05). As compared with the control group, RLS group had significantly higher proportion of patients with hypoechoic substantia nigra or raphe nucleus rupture ( P<0.05). In RLS patients, the IRLS scores were positively correlated with HAMA-14, HAMD-24, and ISI scores ( P<0.05); ESS scores were negatively correlated with hypoechoic substantia nigra and width of the third ventricle ( rs=-2.005, P=0.045; r=-0.477, P=0.029); width of the third ventricle was negatively correlated with gender (male) and years of education ( rs=-0.592, P=0.005; r=-0.627, P=0.002), and positively correlated with age and course of the disease ( r=0.756, P<0.001; r=0.167, P=0.047). Conclusions:Patients with RLS are prone to anxiety, depression and sleep disorders; their TCS shows hypoechoic substantia nigra and raphe nucleus rupture. RLS severity may affect HAMA-14, HAMD-24, and ISI scores. Gender, age, years of education, course of disease, and ESS scores of RLS patients may affect TCS related parameters.
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Restless legs syndrome (RLS) is a kind of common diseases of the nervous system, of which adult prevalence rate is from 1% to 15%. The etiology, pathogenesis and related gene therapy of RLS are not fully understood. Studies have shown that RLS may be associated with the polymorphism of some risk genes. Genome-wide association studies have revealed a total of seven risk sites to date, including MEIS1, BTBD9, MAP2K5/SKOR1, PTPRD, TOX3, NOS1 and 2p14 intergenic regions. This article reviewed the research progress of single nucleotide polymorphisms in RLS risk genes in recent years.
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【Objective】 To identify one blood sample with ambiguous antibody screening result, explore the identification strategy of complex antibodies and provide blood transfusion plan. 【Methods】 Blood typing and antibody screening were performed by serological test. The genotyping of Diego blood group was carried out by gene detection. Absorption and elution test were designed to identify the complex antibodies. 【Results】 Serological test showed that the patient′s blood type was B, ccDEE, Jk(a-b+ ), Le(a-b+ ), Fy(a+ b-), Di(a+ b-). The results of genotyping showed that the Diego genotype of the patient was Di (a+ b-). Based on the above results, absorption and elution tests were designed and IgG anti-Dib, IgG anti-Ce, and IgG anti-Jka antibodies were detected in serum of the patient. Combined with the use of immunoglobulin and targeted blood transfusion measures, successful treatment was provided for the patient. 【Conclusion】 For the identification of antibodies against high frequency antigen combined with multiple antibodies, a variety of experimental techniques and methods should be combined, and the experimental scheme should be designed flexibly.
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【Objective】 To investigate the clinical staffs′ knowledge about blood transfusion and their demands, so as to provide evidence for arranging the content for continuing education of blood transfusion medicine. 【Methods】 A self-designed questionnaire was used to investigate the blood transfusion related knowledge of 652 clinical staffs from other cities or counties/districts in Shaanxi Province, who came to our hospital to attend meetings, further training and study from July to August 2019. 【Results】 Clinical stsffs investigated lacked a deep understanding of blood transfusion and blood donation related knowledge, and even were ignorant of certain knowledge. The awareness rate of relevant knowledge was the highest among doctors, followed by laboratory technicians and the lowest among nurses. 【Conclusion】 The awareness rate of blood transfusion related knowledge among medical staffs is relatively low, suggesting the training of blood transfusion related knowledge should be enhanced.
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Objective:To investigate the efficacy and safety of different doses of rivaroxaban in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis.Methods:Clinical data of 92 patients with lower extremity deep venous thrombosis received catheter directed thrombolysis at Nanjing Drum Tower Hospital from Jun 2017 to Dec 2018 were collected and analyzed. Patients were divided into Rivaroxaban group (10 mg qd), Rivaroxaban group (20 mg qd) and Warfarin group according to the anticoagulant therapy, and followed up for 6 months. The change of limb swelling rate, lower limb venous patency rate, venous clinical severity score(VCSS), score of chronic venous insufficiency questionnaire(CIVIQ) and adverse reactions were analyzed to evaluate the curative effect and safety during 6 months of follow-up.Results:There was no significant difference in the change of limb swelling rate, lower limb venous patency rate, VCSS score, and CIVIQ score between the three groups(all P>0.05). The total hemorrhage events in warfarin group were significantly higher than the other two groups. Conclusions:The efficacy and safety of low-dose rivaroxaban (10 mg qd) in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis were comparable to that of Rivaroxaban (20 mg qd).
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OBJECTIVE：To eva luate the anticoagulant effect of clinical pharmacist management in clinic. METHODS ：Retro- spective analysis was performed on medical records of 481 patients in anticoagulant clinic of Nanjing Drum Tower Hospital （herein- after referred as “our hospital ”）from Aug. 2019 to Jan. 2020. The general information （gender，age，patient grading ）of patients ， anticoagulant drug ，anticoagulant causes ，anticoagulant examination [prothrombin time ，international standardized ratio results （INR）]，warfarin dose ，NOACs usage and ADR were recorded. RESULTS ：Totally 481 patients visited anticoagulant clinic of our hospital for 1 587 times in total. The case number of primary ，secondary and tertiary patients were 401，547 and 639，respectively. 470 patients received warfarin ，and 11 patients received NOACs （including 6 cases of riva roxaban，5 cases of dabigatran etexi - . The valve replacement was the main cause of anticoagu - lation（65.28％），followed by atrial fibrillation （14.97％）， valve ring repairment （12.47％）. The main detection method NDYG2017012） of prothrombin time was POCT （83.44％）. Their average dose of warfarin was （3.03±1.28）mg. The average INR of outpa - tients receiving warfarin was 1.99±0.56，and time within treat - E-mail：xiaochongzi78@sina.com ment range （TTR）was 72.79％. The average INR of the first grade was 2.12±0.84 and the TTR was 44.33％；the average INR of the second grade was 1.95±0.52 and the TTR was 72.34％； the average INR of the third grade was 1.94±0.33 and the TTR was 90.42％. There were 102 cases（6.43％）of small bleeding ， and 2 cases（0.13％）of clinical related non major bleeding ；no major bleeding and thromboembolism was observed. CONCLU - SIONS：Clinical pharmacists of anticoagulant clinic in our hospital formulate scientific management and provide individualized con - sultation for patients through implementing hierarchical management of patients. Patients show mild symptoms and low incidence of adverse reactions ；the patients taking warfarin have higher TTR ；clinical pharmacist management has significant anticoagulant effect.
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Objective To investigate the displacement characteristics of intraoperative and postoperative positions of electrodes on CT imaging for bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in Parkinson's disease (PD).Methods A retrospective analysis on preoperative MR imaging,intraoperative and postoperative CT images of 35 patients with PD treated with STN-DBS in our hospital from January 2014 to June 2018 was performed.A three-dimensional coordinate system was established based on preoperative MR imaging.MR imaging/CT fusion technique was used to fuse intraoperative and postoperative CT images with preoperative MR imaging to locate intraoperative and postoperative electrode positions.The displacement characteristics of intraoperative and postoperative electrodes were analyzed.Results The spatial distance between intraoperative and postoperative positions of bilateral electrodes was about 1 mm,and the depth displacement was minimal.The postoperative position of the first side electrode on lateral axis was shifted outwardly from intraopemtive position,and the second side electrode was shifted internally with a small degree;on anterior-posterior axis,the first side electrode obviously shifted backward,and the second side electrode slightly shifted backward.For bilateral electrodes,corresponding coordinate deviation of three axis between intraoperative electrode-preoperative target and postoperative electrode-preoperative target,showed a significant positive linear correlation,therefore,leading out the coordinate deviation regression function model.Conclusions The displacement of electrodes between intraoperative and postoperative positions has obvious rules after STN-DBS in PD,which can guide the adjustment of intraoperative electrode position and predict the postoperative position of electrode.
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Objective:To investigate the effects of PHT on the differentiation of rat bone marrow mesenchymal stem cells(BMSCs) into vascular endothelial cells(VECs).Methods:rBMSCs were cultured in indirect coculture system with VECs and independent culture system in the presence of phenytoin at 0,20 and 40 μg/ml respectively.After 1 4 d culture the mRNA expression levels of the intercellular adhesion molecule-1 (ICAM-1 ),vascular cell adhesion molecules-1 (VCAM-1 ),vascular endothelial growth factor re-ceptor -2(KDR)and Runt-related transcription factor 2 (RUNX2)were detected by real-time PCR.Results:The expression levels of ICAM-1 ,KDR and RUNX2 were upregulated in rBMSCs by PHT treatment.The expression levels of ICAM-1 ,KDR and RUNX2 in the co-culture groups were higher than those in the independent culture groups of rBMSCs treated by PHT at the same concentra-tion.The expression level of VCAM-1 in co-culture groups was lower than that in the independent culture groups.Conclusion:PHT may promote rBMSCs differentiation into rVECs in the co-culture system.
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ABSTRACT:Objective To investigate the effects of phenytoin (PHT)on the secretion of vascular endothelial growth factor (VEGF)and stem cell factor (SCF)based on the establishment of indirect co-culture system of rat bone marrow mesenchymal stem cells (BMSCs)and vascular endothelial cells (VECs).Methods Indirect co-culture model of rat BMSCs and VECs was established.Experimental groups:indirect co-culture groups (PHT concentrations were 0,20 and 40 μg/mL);the control group:BMSCs culture group and VECs culture group (PHT concentrations were 0,20 and 40μg/mL).The contents of VEGF and SCF in the culture supernatant were measured using double antibody sandwich ABC-ELISA method on cultivation days 2,4,6.Results ELISA assay of the rBMSCs and rVECs in indirect co-culture supernatants,collected on culture days 2,4 and 6 showed that:① VEGF:On culture day 2,VEGF level in the co-culture groups was significantly higher than those in BMSCs group (P SCF increased as the incubation time increased;but as the incubation time increased, PHT concentration of 40 μg/mL made SCF content decrease.Each group did not significantly differ (P > 0.05 ).Conclusion PHT promotes the secretion of VEGF and may reduce the secretion of SCF.
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?Objective: To study the stress distribution of one segment type mono dowel implant with various length and diameter in alveolar bone. Methods: The thickness of cortical bone is 1～2 mm, implant was in close contact with alveolar bone directly. Implants with root length of 10,12,13 and 14 mm, cast diameter of 3.6, 3.7, 3.8, 3.9 and 4.0 mm, corona tall 4 and 9 mm were put into a bone model with alveolar bone. 200 N force was loaded in vertical, 45? oblique and 45? oblique of non center. CT and 3D FEM were used to study the stress distribution and selected the morphology of alveolar bone from first molar of lower jaw and an incisor of maxillary. Results: There was an area of stress in the boundary of the cortical and cancellous bony tissue,horizontal hole. The main region of stress was at the cancellous. Thickness and shape of alveolar bone could affect the distribution of stress. The maximal Von Mises Stress was always in the boundary of cortical and bone that contacted with implant. Higher elastic modulus of bone around the implant had higher stress in cortical stress . Conclusion: The stress of cortical and cancellous bone can be depressed to rise elastic modulus of implant.
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砄bjecat:To study the correlatiom between stress and structure of one piece spiral implant.Methods: The morphology of alveolar bone was selected by CT around the first molar of mandible and around the incisor of maxilla of a healthy man in the position of normal occlusion. Cortical bone with the thickness of 1～2 mm was used to make the alveolar bone model. The one piece spiral implants with root, in the shape of cylinder, length of 10,12, 13 and 14 mm, corona height of 4 and 9 mm,diameter of 3.6,3.7, 3.8,3.9 and 4.0 mm were prepared respectively. The implants were put into the alveolar bone models and a load of 200 N was applied vertically, or 45 ℃ obliquely or 45℃ non center obliquely. The stress on the implants was measured and studied with 3D FEM. Results:The stress on the implants was inversely correlated to the length and diameter in the place of front teeth and molars except non centeraly obliquely loading to molar. The greatest stress was found around the neck of the implants. The distribution and intensity of the stress were related to the way of loading and the elastic modulus of bone. Conclusion:The length and diameter of one piece implant are the factors correlated to the stress on the implant and surrounding bone.
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In bone marrow transplantation (BMT), cytomegalovirus (CMV) interstitial pneumonitis (IP) is one of the most dangerous complications, which has been the first important cause to lead the failure of BMT. At present, there is no effective and specific therapy for CMV-IP, therefore how to prevent CMV infection effectively is a top task. From 1991 to 1996, we used comprehensive steps to prevent CMV-IP in BMT, and none of 14 patients developed CMV-IP. The preventing results that we achieved by using the steps were quite satisfied.
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Objective To study the expression of human telomerase reverse transcriptase (hTERT) and P16 protein and their relation with telomerase activity in the carcinogenesis of acute leukemia. Methods Telomerase activity and hTERTmRNA were detected in 40 patients with acute leukemia and 20 normal controls by TRAP and RT-PCR, respectively; P16 protein was examined by immunocytochemical method. Results The positive rates of telomerase activity and hTERTmRNA were 75% and 80% in 40 cases of acute leukemia, respectively, whereas neither hTERTmRNA nor telomerase activity was detected in normal controls. There was a significant correlation between the expression of hTERTmRNA and telomerase activity (r= 0.65, P