[Correlation between fluid parameter and cardiovascular events in hemodialysis patients based on repeated body composition analyses].

Objective: To explore the correlation between fluid load index and cardiovascular events in hemodialysis patients based on repeated body composition analyses. Methods: A prospective cohort study was conducted to collect the clinical data of patients undergoing maintenance hemodialysis (MHD) in the Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine from July to September 2020. The pre-dialysis fluid overload (FO) index-overhydration (OH) was measured by bioelectrical impedance method, and the follow-up monitoring was conducted every 6 months. According to the baseline OH value, patients were divided into non-FO group (OH≤2.5 L) and FO group (OH>2.5 L). Moreover, according to the repeated measurements, the patients were divided into continuous non-FO group, continuous FO group and intermittent FO group. All patients were followed up until October 1, 2022, and the outcomes were recorded. The end point of follow-up was cardiovascular events. The cumulative incidence of cardiovascular events was calculated by the Kaplan-Meier method, and the risk factors of cardiovascular events were analyzed by Cox proportional hazards regression model. Results: A total of 289 patients were included, including 88 patients (30.4%) with FO and 201 patients (69.6%) with non-FO. There were 168 males (58.1%) and 121 (41.9%) females, with an average age of (58±13) years and an average follow-up time of (22.0±6.5) months. Kaplan-Meier analysis showed that the incidence of cardiovascular events in the baseline FO group was higher than that in the non-FO group (log-rank χ2=14.44, P<0.001). The incidence of cardiovascular events in both the continuous FO group and the intermittent FO group was higher than that in the continuous non-FO group (log-rank χ2=41.47, P<0.001; log-rank χ2=18.36, P<0.001). After adjustment for gender, age, comorbidities, and biochemical indicators, the incidence of cardiovascular events in the baseline FO group was 1.850 times of the non-FO group (95%CI: 1.046-3.271, P=0.034). The incidence of cardiovascular events in the continuous FO group was 4.679 times of the continuous non-FO group (95%CI: 2.189-10.002, P<0.001). The incidence of cardiovascular events in the intermittent FO group was 3.410 times of the continuous non-FO group (95%CI: 1.696-6.857, P=0.001). Conclusions: OH value measured by bioelectrical impedance can be used as an important reference index for clinical monitoring of cardiovascular events in MHD patients. Continuous chronic and intermittent exposures to FO are risk factors for cardiovascular events in hemodialysis patients.

[A randomized double-blinded placebo-controlled clinical trial of minodronate tablet in postmenopausal Chinese women with osteoporosis].

Objective: To verify the efficacy and safety of daily oral minodronate in postmenopausal women with established osteoporosis. Methods: In this randomized, double-blinded, placebo-controlled trial, 262 postmenopausal women were enrolled. Patients were randomized to receive daily oral minodronate 1 mg with supplements of 500 mg calcium and 200 U vitamin D3 (n=130) or placebo (n=132) with daily supplements of 500 mg calcium and 200 U vitamin D3, for 48 weeks. The primary endpoint was the average bone mineral density (BMD) change in the lumbar vertebrae 48 weeks post-treatment. Secondary outcome measures was the incidence of vertebral fractures. Safety assessments included the rate of adverse events. Results: At the end of 48 weeks treatment, the average BMD change rate from baseline were: full analysis set results: (3.52±4.82)% in the minodronate group and (2.00±5.74)% in the placebo group; per-protocol set results: (3.99±5.05)% in the minodronate group and (2.07±6.20)% in the placebo group; the differences were all significant (all P<0.05). Vertebral fracture occured in 3 patients (2.3%, 3/132) in the placebo group, and 1 case (0.8%, 1/130) in the minodronate group (P>0.05). The incidence of adverse events was 71.5% (93/130) in the minodronate group and 78.0% (103/132) in the placebo group (P>0.05). Conclusion: Minodronate is effective and safe in the treatment of postmenopausal osteoporosis without severe side effects.

[Medical historians and traditional Chinese physicians in early Chinese Society of Medical History].

In the early 20th century, the Chinese Society of Medical History was the only specialty society accepting members with traditional Chinese medicine background in the Chinese medical association. Therefore, it is of special significance to study the TCM members of the early Chinese Society of Medical History. By combing the medical journals of this period and referring to the researches today, this paper makes a comprehensive investigation on the life stories and academic works of the early 14 TCM doctors and scholars of the Chinese Society of Medical History, so as to understand their contributions to the development of Chinese medicine and the institute of medical history in this special historical period.

[Clinical effect of high pressure oxygen and Butylphthalide in the recovery of cerebral metabolism after carbon monoxide poisoning].

Objective: To study the clinical effect of high pressure oxygen and Butylphthalide in the recovery of cerebral metabolism after carbon monoxide poisoning. Methods: 84 patients treated from May 2014 to May 2016 in our hospital were selected. The subjects were randomly and equally divided into two groups. The control group adopted the conventional therapy and high pressure oxygen; on the basis, the observation group also took Butylphthalide. The clinical effect, duration of coma, recovery of consciousness, incidence rate of delayed encephalopathy was observed. After 1m of treatment, the HDS point was evaluated. Results: The total effective rate of control group (76.19%, 32/42) was lower than that of observation group (95.24%, 40/42) (P<0.05) . The duration of coma for observation group was shorter than that of control group. The percentage for patients with recovery of consciousness and incidence rate of delayed encephalopathy for observation group was better than that of control group (P<0.05) . The HDS point for observation group was even higher than that of control group (P<0.05) . Conclusion: The high pressure oxygen and butylphthalide can improve the clinical effective rate, shorten the duration of coma and promote the patient's recovery of consciousness. It is worthy of clinical promotion.

[Preliminary analysis of the effects of tailor-made notched music therapy on chronic idiopathic tinnitus].

Objective: Tailor-made notched music was applied to alleviate the symptoms of chronic idiopathic tinnitus and compared its effectiveness with other existing sound treatment of tinnitus. Methods: Subjects (n=43; ears=75 )were recruited during June 2015 to October 2016 from the out-patients of our hospital. These patients had chronic (longer than 6months) and idiopathic tinnitus, with or without significant sensorineural hearing loss. In the prospective design, the patients were randomly divided into group A (treated with tailor-made notched music) and group B (treated with analogous sound masking), and received the treatment for 3 months. The tinnitus scale, tinnitus questionnaire and audiological findings were evaluated before treatment, and at one month and three months after treatment started. Results: After onemonth of treatment, the effective rate between the two groups was 40.9% and 42.9%, there was no significant difference between the two groups (χ(2)= 0.017, P=0.897). The average VAS for patients in group A showed more decrease in group A than in group B(VAS: 1.8 vs. 0.8, the percentage : 29.5% vs. 13.6%), but there was no significant difference between the two groups (t=-1.450, P=0.155). After 3 months of treatment, the effective rates were 68.2% and 23.8%, respectively. There was significant difference between the two groups (χ(2)= 8.503, P=0.004). The difference of the VAS scores between the two groups was statistically significant (t=-3.263, P=0.002), and the VAS score of group A was less.After 3 months of treatment, there was significant decreaseinthe average tinnitus loudness for patients in group A(t=5.569, P<0.01), and there was no significant changein group B(t=-0.953, P=0.374). There was also significant decreasein the scores of tinnitus handicap inventory (THI) (F=7.334, P<0.05), loudness visual analog scale (VAS) (F=20.48, P<0.001), and the proportion of patients with moderate to severe tinnitus(χ(2)=11.289, P<0.05) in the group A, and there was no significant change in group B(F=2.198, F=0.989, χ(2)=1.651; P=0.120, P=0.378, P=0.438>0.05). Conclusions: Our resultssuggest that long-term normalized listening to tailor-made notched music, can significantly reduce the perceived tinnitus loudness in varying degrees and improve the quality of life of patients. The effects and possible mechanism of this method were discussedin this paper.

Energetic basis for reduced contractile reserve in isolated rat hearts.

To study the relationship between myocardial energetics and contractile reserve, we acutely and selectively inhibited creatine kinase (CK) activity in isolated perfused rat hearts, using increasing doses of iodoacetamide. 31P nuclear magnetic resonance spectroscopy was used to measure intracellular pH and the concentrations of ATP, phosphocreatine, and inorganic phosphate. Contractile reserve was assessed as the increase of rate-pressure product (RPP) from baseline during high-calcium perfusion. Contractile reserve was reduced by 9, 35, and 72% in hearts with 26, 6, and 1% CK activity, respectively. An inverse linear relationship between RPP and the free energy release from ATP hydrolysis ([delta G approximately P[) was shown for all groups. Furthermore, the maximal RPPs of all hearts were achieved at the same level of [delta G approximately P[ (52-53 kJ/mol), which is equal to the free energy requirement of sarcoplasmic reticulum Ca2+ adenosine 5'-triphosphatase (ATPase). We suggest that inhibition of the CK reaction caused a decrease of [delta G approximately P[ which, in turn, limits the Ca(2+)-handling capacity of sarcoplasmic reticulum Ca2+ ATPase. In this way, the ability of the heart to increase its contractile performance is restricted.

Inhibition of the creatine kinase reaction decreases the contractile reserve of isolated rat hearts.

To define the relation between phosphoryl transfer via creatine kinase (CK) and the ability of the intact beating heart to do work, we chemically inhibited CK activity and then measured cardiac performance under physiological and acute stress conditions. Isolated perfused rat hearts were exposed to iodoacetamide (IA) and subjected to one of three cardiac stresses: hypercalcemic (Ca2+ = 3 mM) buffer perfusion (n = 7), norepinephrine (2 mumol/min) infusion (n = 6), or hypoxic buffer perfusion (n = 5). IA decreased CK activity to near zero, measured in intact hearts by 31P magnetization transfer, and to 2% of control CK activity, measured in myocardial homogenates. The CK isoenzyme profile was unchanged, suggesting nonselective IA inhibition of all isoenzymes. Mitochondria isolated from IA-treated hearts had normal ADP:O ratios, state 3 respiratory rates, and unchanged acceptor and respiratory control ratios. Neither actomyosin adenosinetriphosphatase nor adenylate kinase activities were changed. After IA exposure, end-diastolic pressure, left ventricular developed pressure, and heart rate were unchanged for at least 30 min at physiological perfusion pressures, but large changes were observed during stress conditions. The increase in left ventricular developed pressure induced by hypercalcemic perfusion and by norepinephrine infusion decreased by 39 and 54%, respectively. During hypoxia, the rate of phosphocreatine depletion was decreased by 57%, left ventricular developed pressure declined, and end-diastolic pressure increased faster than in controls. These results show that inhibition of CK to < 2% of control activity by IA reduced contractile reserve by approximately 50%. We conclude that CK activity is essential for the expression of the full dynamic range of myocardial performance.

Five new triterpene glycosides from Wisteria brachybotrys (Leguminosae).

From the vines of Wisteria brachybotrys (Leguminosae), five new oleanene glycosides, called wistariasaponins YC1,2, B3 and A2,3, together with four known ones were isolated. Their structures have been elucidated to be 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta-D- glucuronopyranosyl yunganogenin C 21-O-beta-D-glucopyranoside (1), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-galactopyranosyl-(1-->2)-beta -D- glucuronopyranosyl yunganogenin C 21-O-beta-D-glucopyranoside (2), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta- -D-glucuronopyranosyl wistariasapogenol B 30-O-beta-D-glucopyranoside (3), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-(1-->2)-beta-D- glucuronopyranosyl wistartiasapogenol A 30-O-beta-D-glucopyranoside (4) and 3-O-beta-D-galactopyranosyl-(1-->2)-beta-D-glucuronopyranosyl wistariasapogenol A 30-O-beta-D-glucopyranoside (5), respectively.

Two new steroidal saponins from dried fermented residues of leaf-juices of Agave sisalana forma Dong No. 1.

In a previous paper, we reported the isolation and structure determination of three new steroidal saponins, dongnosides C (3), D (2) and E (1) from the dried fermented residues of leaf-juices of Agave sisalana forma Dong No. 1. In a continuing study on this plant, two additional new major steroidal saponins, named dongnosides B (4) and A (5), were obtained. Their structures were characterized respectively as tigogenin 3-O-alpha-L-rhamonpyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)- [beta-D- glucopyranosyl-(1-->3)]-beta-D-glucopyranosyl-(1-->4)-beta-D-galactop yranoside and 3-O-alpha-L-rhamnopyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)-[beta- D- xylopyranosyl-(1-->3)-beta-D-glucopyranosyl-(1-->3)]-beta-D- glucopyranosyl-(1-->4)-beta-D-galactopyranoside on the basis of chemical and physicochemical evidence.