[A prospective cohort study on the impact of placement timing of LNG-IUS for adenomyosis].

OBJECTIVE: To investigate the impact of placement in the procedures of gynecological laparoscopies or routine placement on the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. METHODS: From December, 2006 to December, 2014, patients with adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital received the treatment of LNG-IUS.Before and after placement of LNG-IUS all the parameters were recorded including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects.Impact of placement timing (in the procedures of laparoscopies vesus routine placement) on the treatment effects, menstruation patterns and adverse effects of LNG-IUS were analyzed. RESULTS: 1 100 patients meet the inclusion criteria, with median age 36 years (20-44 years), median follow-up 35 months (1-108 months), of which 385 cases (35.0%) received LNG-IUS in the procedures of gynecological laparoscopies. Most common indications and pathology outcomes were endometriosis, major of which had deep infiltrating endometriosis. The accumulative carrying ratio of LNG-IUS were 73% and 63% on 60 months for operative patients and non-operative patients respectively (P<0.001), and accumulative take-out ratio were 7.8% and 10.3% (P=0.044). Placement timing of LNG-IUS was the only significant factor related with loss to follow-up (P<0.001) and take-out ratio (P<0.001). Operations and pathological outcome had no significant impact on patients' treatment effects, changes of menstruation patterns, adverse effects in total or in subclass. CONCLUSION: Placement of LNG-IUS in the procedures of gynecological laparoscopies for symptomatic adenomyosis increased carrying ratio and reduce take-out ratio at patients'request, but didn't influence treatment effects or adverse effects.

[Effect and related factors of extracorporeal cardiopulmonary resuscitation combined with emergent percutaneous coronary intervention on cardiac arrest patients due to acute myocardial infarction].

OBJECTIVE: To evaluate the effect of extracorporeal membrane oxygenation (ECMO) combined with primary percutaneous coronary intervention (PPCI) on cardiac arrest in patients with acute myocardial infarction (AMI). METHODS: We retrospectively analyzed the clinical data from twenty cardiac arrest patients due to AMI from January 2010 to January 2015, who received both ECMO and PPCI after failed conventional cardiopulmonary resuscitation (CCPR) procedure in our center. The mean age was (58.8±13.9) years old and seventeen cases were male. The patients were divided into weaned (8 cases) and non-weaned group (12 cases) according to the outcome of ECMO removal, or survivor (6 cases) and non-survivor group (14 cases) according to the in-hospital outcome. The risk factors that affected weaning from ECMO and survival to discharge were analyzed via Spearman rank correlation test. RESULTS: (1) The mean duration of CCPR and ECMO support was (46.7±22.2)min and (102.3±66.6)h, respectively. The rate of return of simultaneous beating was 100%(20/20). (2) CCPR duration was significantly shorter ((35.1±11.8)min vs. (54.4± 24.5) min, P<0.05) and cardiac care unit(CCU) stay time was significantly longer ((20.5±12.3)d vs. (4.3±4.0)d, P<0.05) in weaned group than in non-weaned group. Moreover, a significant difference was identified in culprit vessel distribution between the two groups (P<0.05). Culprit vessel distribution (left anterior descending artery r=-0.612, P<0.01; right coronary artery r=0.612, P<0.01) and length of cardiac care unit stay (r=0.784, P<0.01) were associated with weaned patients. (3) CCPR duration was significantly shorter ((29.2±4.9)min vs. (51.0±24.5)min, P<0.01). CCU stay time was significantly longer(16.0(9.5, 37.8)d vs. 3.0(2.0, 11.0) d, P<0.01). Weaning rate (6/6 vs. 2/14, P<0.01) and mean blood pressure ((87.9±19.4)mmHg(1 mmHg=0.133 kPa) vs. (63.7±18.6)mmHg, P<0.05) were significantly higher, while lactic acid level in arterial blood((1.74±0.85)mmol/L vs. (6.41±5.65) mmol/L, P<0.05) 48 hours after ECMO support was significantly lower in survivor group compared with non-survivor group. Culprit vessel of right coronary artery (r=0.491, P<0.05), length of CCU stay (r=0.609, P<0.01), successful weaning rate (r=0.802, P<0.01), and mean blood pressure at 48 hours after ECMO establishment (r=0.558, P<0.05) were positively associated with survival. CONCLUSION: ECMO combined with PPCI is an effective therapeutic option to rescue AMI patients complicating with cardiac arrest.

Circ_CHFR expedites cell growth, migration and inflammation in ox-LDL-treated human vascular smooth muscle cells via the miR-214-3p/Wnt3/ß-catenin pathway.

OBJECTIVE: Atherosclerosis (AS) is a representative inflammatory vascular disease. This study explored the molecular pathogenesis of AS based on circular RNA (circRNA), the checkpoint with forkhead-associated and ring-finger domains (circ_CHFR). PATIENTS AND METHODS: The cell model of AS in vitro was established by stimulating human vascular smooth muscle cells (VSMCs) with oxidized low-density lipoprotein (ox-LDL). The RNA expression was measured by quantitative Real-time polymerase chain reaction (qRT-PCR). Cell viability and colony formation ability were separately evaluated using 3-(4, 5-dimethylthiazol-2-y1)-2, 5-diphenyl tetrazolium bromide (MTT) and colony formation assay. Cell migration was assessed via the transwell assay. The inflammation injury was analyzed by enzyme-linked immunosorbent assay (ELISA). Associated proteins were determined through Western blot. The combination of hypothetic targets was ascertained using Dual-Luciferase reporter assay. RESULTS: Circ_CHFR was up-regulated in AS serums and ox-LDL-stimulated VSMCs. Circ_CHFR depletion weakened the ox-LDL-induced promotion of cell growth, migration and inflammation in VSMCs. Circ_CHFR positively regulated Wnt3 expression and the downregulation of Wnt3 abrogated the ox-LDL-triggered injuries in VSMCs. Circ_CHFR functioned as the sponge of microRNA-214-3p (miR-214-3p) and miR-214-3p targeted Wnt3. Circ_CHFR regulated cell growth, migration and inflammation via regulating the expression of Wnt3 as a competitive endogenous RNA (ceRNA) of miR-214 in ox-LDL-treated VSMCs. Circ_CHFR/miR-214-3p axis mediated the Wnt3/ß-catenin signal pathway. CONCLUSIONS: Circ_CHFR contributed to the progression of AS through the miR-214-3p/Wnt3/ß-catenin signals, which illuminated the molecular mechanism of AS and suggested circ_CHFR might be an index for AS treatment.