Prediction of acute myocardial infarction by multi-parameter coronary computed tomography angiography.

AIM: To investigate the performance of multi-parameter coronary computed tomography angiography (CCTA), including stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from CCTA (FFRct), to predict acute myocardial infarction (AMI) and build a combined model. MATERIALS AND METHODS: Thirty patients with AMI 90 days after CCTA and 120 matched patients without AMI were enrolled retrospectively. Multiple CCTA parameters were analysed and compared. Independent risk factors were obtained through univariate and multivariate regression analyses, after which a multi-parameter model was built. RESULTS: A total of 150 patients were analysed successfully. The multi-parameter CCTA model (area under the curve, 0.944; p<0.001) had a higher predictive value than each single parameter (p<0.001, all). Independent risk factors were intra-plaque dye penetration (IDP; odds ratio [OR], 8.373; p=0.002), lipid plaque volume (LPV; OR, 1.263; p<0.001), and FFRct ≤0.83 (OR, 8.092; p=0.001). CONCLUSION: This one-stop multi-parameter CCTA model, comprising IDP, LPV, and FFRct as independent risk factors, has good performance to predict AMI.

[Stress, anxiety, depression and insomnia in adults outside Hubei province during the COVID-19 pandemic].

Objective: To investigate the severity of stress, anxiety, depression and insomnia during the novel coronavirus disease (COVID-19) pandemic in adults outside Hubei Province, China. Methods: An online survey of psychological and sleep by using Questionnaire Star program from 5th to 19th February 2020 was conducted. The Impact of Event Scale-Revised was used to assess COVID-19 outbreak-related stress symptoms. Meanwhile, Questionnaires of Generalized Anxiety Disorder-7, Patient Health Questionnaire-9 and the Insomnia Severity Index were respectively used to assess the severity of anxiety, depression and insomnia symptoms prior to and during the COVID-19 pandemic. Results: A total of 3 134 subjects were included. Among the included subjects, 15.5% (487), 24.9% (779), 28.7% (899) and 30.9% (968) of the subjects had COVID-19-related stress symptoms, anxiety, depression and insomnia after the COVID-19 outbreak, respectively. The severity levels of anxiety, depression and insomnia were significantly increased during the COVID-19 pandemic compared to prior to the outbreak (all P<0.01). Furthermore, the subjects' stress response to the COVID-19 outbreak was an independent risk factor for increased anxiety, depression and insomnia after the outbreak. Conclusion: The COVID-19 outbreak resulted in related stress response and widespread increase in anxiety, depression, and insomnia outside Hubei Province, China in the general population. The aggravation of anxiety, depression and insomnia is associated with stress levels. Our data demonstrate that the widespread psychological and insomnia problems in the general population need to be addressed at the early phase of the pandemic.

[Investigation on the awareness of snoring hazard and prevalence of obstructive sleep apnea among civil servants].

Objective: To investigate the awareness of snoring hazard and prevalence of obstructive sleep apnea (OSA) among civil servants. Methods: A cross-sectional survey was conducted to investigate the awareness of snoring hazards among in-service civil servants who had annual medical examination in a Guangdong provincial institution from September to November 2017. The high-risk group for OSA was screened and diagnosed by sleep monitoring. Results: 1 036 of 1 241 civil servants were enrolled in the study for integral data. 60.1% (623/1 036) of the subjects realized that snoring was harmful to health. The most common source to develop OSA awareness was network (59.6%, 371/623), followed by television (48.0%), relatives and friends (46.6%), newspaper (44.5%) and radio (18.9%). The awareness rate of snoring consequences was as follows: decreased sleep quality (71.9%, 448/623), sudden death (52.2%), daytime sleepiness (44.3%), cardiovascular and cerebrovascular diseases (42.9%), hypertension (24.4%) and sexual dysfunction (16.7%). 22.0% (228 / 1 036) of the cases were classified into high-risk OSA. The prevalence of OSA among high-risk group was 46.05%(105/228)and only 0.9% (2/228) of them had been diagnosed with OSA. Conclusion: Civil servants had awareness of snoring hazard to a certain extent. Among civil servants classified into high-risk OSA, the OSA perveance was high but the rate of diagnosis and treatment was very low.

[A cross-sectional survey of treatment acceptance and influence factors in patients with obstructive sleep apnea].

Objective: To investigate the treatment acceptance in patients with obstructive sleep apnea (OSA) and its influence factors. Methods: This cross-sectional survey recruited OSA patients diagnosed at sleep center in Guangdong General Hospital from January 2014 to December 2015. By phone follow-up, a pre-designed questionnaire was performed for all adults, which composed of the following sections: treatment or none, treatment method, reason for non-treatment, revisit or none. Results: From 524 OSA patients with completed contact information, 480 (91.6%) valid questionnaires were collected. The apnea hypopnea index was (36.1±21.4) /h. The mild, moderate, severe OSA patients accounted for 12.5%(60 cases), 33.1%(159 cases), 54.4%(261 cases) respectively. For all 480 included subjects, 200 (41.7%) received treatment and among them 184 (92.0%) were treated by continuous positive airway pressure. The treatment rate was lower in mild OSA, non-obesity, female, and patients without daytime sleepiness. Receiving treatment was negative correlated to difficult falling asleep. The first reason of non-treatment was self-determined behavioral intervention and the second was self-concept of no requirement for treatment. The specialist revisit rate was 3.8%, which was slightly higher in treated patients and those with sudden awakening when feeling asphyxia. Conclusion: A majority of OSA patients do not receive treatment, primarily as a result of their self-determined behavior intervention and self-concept of no requirement for treatment.

[Efficacy and outcome of transcatheter closure of patent foramen ovale in patients with cryptogenic stroke].

Objective: To investigate the efficacy and outcome of transcatheter patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS). Methods: Sixty consecutive patients with cryptogenic stroke who undertook transcatheter PFO closure between May 2015 and September 2017 in Beijing Tiantan Hospital were enrolled in this prospective study.Transcranial Doppler (TCD) bubble test was performed and right-left shunt(RLS) was confirmed in all patients.Closure success rate,effective closure rate, complications, recurrence of ischemic stroke and new onset atrial fibrillation were evaluated. Results: A total of 60 patients (42 male,age range 24-68 (47±11)years) were included in the study.PFO size (motionless state) was (1.6±0.6)mm.RLS before closure was graded and 11 patients had moderate RLS and 48 patients had large RLS (include 41 patients who experienced shower or curtain effect).Closure success rate was 100% (60/60).No severe complications were observed.At 6 months,45 patients completed TCD bubble test.Of these, 4 patients suffered from moderate to large residual and thus effective closure rate was 91%(41/45).The mean follow-up period was 2-29 (median 12) months. During the follow-up, only 1 patient experienced recurrent cerebral infarction.New onset atrial fibrillation was not detected. Conclusion: Transcatheter PFO closure is effective,safe and related with a good outcome in reduction of recurrent CS for patients with PFO.

[Effects of myocardial performance index on assessing left ventricular function in patients with primary hypertension].

OBJECTIVE: To investigate the value of myocardial performance index (MPI) in assessing LV function in patients with primary hypertension (HP). METHODS: We studied 130 patients with HP (mean age 54.9±13.3 years)and 155 healthy control subjects (mean age 52.4±11.6 years). MPI was determined by tissue doppler imaging using the following formula: MPI=(isovolumic contraction time + isovolumic relaxation time)/ ejection time. The HP group was divided into hypertrophy subgroup( LVMI≥115 g/m(2) in males, or ≥95 g/m(2) in females) and normal mass subgroup(LVMI <115 g/m(2) in males, or<95 g/m(2) in females). RESULTS: MPI was significantly different in control group, normal mass subgroup and hypertrophy subgroup(0.72±0.23 vs. 0.54± 0.17 vs. 0.45±0.11, P<0.001). Hypertrophy subgroup had significant higher MPI than normal mass subgroup(P =0.046), and both the groups had significant higher MPI than control group(all P<0.001). MPI was positively associated with age(r=0.369,P<0.001), Left ventricular end diastolic diameter(r=0.169, P<0.05), Sm(r=-0.211, P<0.001) and Em(r=-0.383, P<0.001) in control group. In multiple linear regression analysis, MPI was independently related to age (ß=0.492, t=7.222,P<0.001) in control group. Among the HP patients, MPI was positively associated with left atrial area (r=0.293, P<0.001),intra ventricular septum(IVS) diameter (r=0.453, P<0.001), LVMI (r=0.453, P<0.001), relative wall thickness(r=0.458, P<0.001), and negatively associated with Sm(r=-0.414, P<0.001), Em(r=-0.508, P<0.001), left ventricular ejection fraction (r=-0.305, P<0.001) in bivariate analysis. In the multiple linear regression analysis, MPI was independently related to Em (ß=0.401, t=4.256,P<0.001) and IVS diameter (ß=-0.365, t=-3.878,P<0.001) in the HP patients. CONCLUSION: The HP patients had elevated MPI, especially in the ones with LV hypertrophy. Tissue doppler imaging (TDI) derived MPI could be a useful index to evaluate the overall cardiac function in HP patients.

[Hyperkalemia-induced failure of pacemaker capture and sensing: a case report].

Hyperkalemia may induce serious cardiac arrhythmia, with possible life-threatening effects. It may cause cardiac pacemaker (PMK) malfunctioning due to a reduction of the electronegativity of the resting myocardial potential. We report the case of a 71-year-old woman who had a previous history of chronic heart failure, chronic renal failure and DDI pacemaker. She was admitted for disturbance of consciousness. During hospitalization, she was observed for extreme hypotension, acute hyperkalemia, ventricular escape rhythm, associated with failure of pacemaker capture and sensing. She was treated with calcium chloride injection, followed by insulin/glucose and sodium bicarbonate infusions; the electrocardiogram recordings showed an correction of the PMK malfunctioning and serial improvement of the intraventricular conduction. This case supports that hyperkalemia should be closely monitored in the chronic heart failure patients combined with chronic renal failure.

Polymorphisms of the angiotensin II type 1 receptor gene affect antihypertensive response to angiotensin receptor blockers in hypertensive Chinese.

The renin-angiotensin-aldosterone system plays a key role in regulating blood pressure by maintaining vascular tone and the water/sodium balance. Many antihypertensive drugs target the renin-angiotensin-aldosterone system, but the effect differs considerably among hypertensive patients. We investigated whether genetic variants of the angiotensin II type 1 receptor are associated with blood pressure response to angiotensin II receptor blockers in hypertensive Chinese patients. After a 2-week single-blind placebo run-in period, 148 patients with mild-to-moderate primary hypertension received monotherapy with 80 mg/day telmisartan and then were followed up for 8 weeks. The 1166A/C, 573T/C, -810A/T, and -521C/T polymorphisms of the AT1R gene were determined through PCR and RFLP analysis. The relationship between these polymorphisms and changes in blood pressure was observed and evaluated after 8 weeks of treatment. Patients with the AT1R -521CC genotype had a significant reduction in diastolic blood pressure compared to those carrying the T allele. No significant reduction in blood pressure was found in individuals with the 1166A/C, 573T/C, or -810A/T polymorphisms of the AT1R gene. We conclude that only the AT1R -521CC genotype is associated with a significant decrease in blood pressure in response to telmisartan treatment in Chinese hypertensive patients.

Characterization of polyclonal and monoclonal anti-taxol antibodies and measurement of taxol in serum.

Anti-taxol antibodies were generated in the rabbit using a taxol-bovine serum albumin conjugate prepared from 2'-succinyltaxol using a mixed anhydride procedure. Immunization with 2'-succinyltaxol-bovine serum albumin gave rise to polyclonal anti-taxol antibodies. By a radioimmunoassay using [3H]taxol, a standard curve gave a 50% inhibitory concentration of 1.0 nM. Taxol levels in human serum could be measured, with the lower limit of detection and measurement being 0.1 nM or 0.085 ng/ml. Two mouse monoclonal anti-taxol antibodies were isolated by immunizing BALB/c mice with the same antigen. One was an immunoglobulin G1 (69E4A8E) and the other was immunoglobulin M (29B7B3C). The specificity of these antibodies was determined by a competitive enzyme-linked immunosorbent assay with taxol and 10 different related derivatives and analogues. 29B7B3C had higher binding affinities for biologically active derivatives and markedly lower affinities for inactive derivatives; i.e., the specificity was consistent with the results of tubulin disassembly and cytotoxicity studies using the same taxol derivatives, making it suitable for screening for taxol or taxol-like compounds in extracts of natural products. 69E4A8E recognized the benzamidocarbamyl group at the C-3' position of taxol and had a lower affinity for other active compounds with different substitutions. Taxol levels in human serum could be detected and measured by 69E4A8E using a competitive enzyme-linked immunosorbent assay. The lower limit of measurement was about 50 nM or approximately 42 ng/ml. Similar measurements could be made by radioimmunoassay.

The association between high-sensitivity C-reactive protein concentration and diabetic nephropathy: a meta-analysis.

OBJECTIVE: To explore the association between high-sensitivity C-reactive protein (hs-CRP) concentration and diabetic nephropathy (DN). MATERIALS AND METHODS: We systematically searched Pubmed, Medline and Embase databases up to September, 2014 for the relevant studies. Heterogeneity across studies was evaluated by Cochran's Q test and I2 statistic. The standard mean difference (SMD) and the corresponding 95% confidence interval (CI) were combined to evaluate the effect size. Sensitivity analysis was also performed by omitting each study to evaluate the stability of the results. In addition, publication bias was tested by Egger's test. RESULTS: A total of 11 studies containing 1 331 cases and 1 779 controls were included in this study. Significant heterogeneities were observed in our results. The result of meta-analysis showed that the hs-CRP concentrations in DN patients were significantly higher than that in controls of healthy people and diabetes mellitus (DM) patients without nephropathy. In addition, the hs-CRP concentration in macroalbuminuria (D3) group was significantly higher than that in microalbuminuria (D2) group and non-albuminuria group (D1). Sensitivity analysis revealed that the results were stable. As well, no publication bias was observed in our results. CONCLUSIONS: We suggest that hs-CRP concentration can be an indicator of DN in DM patients.

A strategy for immunohistochemical signal enhancement by end-product amplification.

We report a novel strategy, called end-product (EP) amplification, capable of enhancing the sensitivity of immunohistochemical procedures by about an order of magnitude or more. The strategy employs an antibody (anti-EP) to the product generated by the action of horseradish peroxidase on 3,3'-diaminobenzidine (DAB), and can be extended to the products of other enzymes as well, e.g., alkaline phosphatase. Amplification is the consequence of the ability of anti-EP to detect the multiplicity of product moelcules resulting from the turnover of substrate by a single enzyme molecule. The subsequent detection of anti-EP was by biotinylated goat anti-rabbit antibody, followed by avidin-peroxidase and DAB or by avidin-alkaline phosphatase and Vector Red. Further amplification can be accomplished by repeated cycles of the protocol. Anti-EP was produced by immunization with a bovine serum albumin (BSA) conjugate of a soluble polymer of DAB, prepared by a carefully controlled reaction of DAB with horseradish peroxidase and hydrogen peroxide. Coupling to BSA (and to RSA) was accomplished with glutaraldehyde. The titer of anti-EP was established by ELISA. Formalin-fixed, paraffin-embedded sections of five cases of Hodgkin's disease and five tonsils with follicular hyperplasia were immunolabeled for the following lymphoid markers: CD3, CD20, CD30, CD45RA, and CD68. EP amplification with anti-EP was also applied to cases of CMV pneumonia and cerebral toxoplasmosis to determine whether this procedure could improve detection of the infectious agents. Immunolabeling of the primary antibody was performed by the avidin-biotin-peroxidase technique with DAB as the reaction substrate. The specificity of EP amplification was tested by demonstrating binding of anti-EP with Vector Red with the generation of a fluorescence end-point. There was complete congruence in the distribution of the DAB signal and the red immunofluorescence representing EP amplification. The intensity of the DAB signal was increased as much as 16-fold by EP amplification, making possible a reduction in the amount of the primary antibody by as much as 85-90%. Sensitivity also increased with respect to weakly expressed antigens and low concentrations of infectious agents.

Characterization of a monoclonal antibody to thymidine glycol monophosphate.

A monoclonal antibody specific for thymine glycol (TG) in irradiated or OsO4-treated DNA was obtained by immunizing with thymidine glycol monophosphate (TMP-glycol) conjugated to bovine serum albumin by a carbodiimide procedure. Screening by dot-immunobinding and enzyme-linked immunosorbant assay (ELISA) procedures gave eight clones that bound OsO4- treated DNA. One of them, 2.6F.6B.6C, an IgG2a kappa, was characterized further. Hapten inhibition studies with OsO4-treated DNA showed that the antibody was specific for TMP-glycol. Among the various inhibitors tested, inhibition was in the order TMP-glycol greater than 5,6-dihydrothymidine phosphate greater than TMP greater than thymidine glycol greater than TG. Inhibition by 5,6-dihydrothymidine, thymidine, thymine, AMP, and CMP was negligible. In OsO4-treated DNA, as few as 0.5 TG per 10,000 bp were detectable by direct ELISA. Inhibition assays could detect as few as 1.5 TG per 10,000 bp. The antibody was equally reactive with native or denatured DNA containing TG. Among the X-irradiated homopolymers dC, dA, dG, and dT, only dT reacted with the antibody. Using an ELISA, the antibody could detect damage in irradiated DNA at the level of 20 Gy. Thus the antibody is of potential use in assays for DNA damage caused by X rays or other agents that damage DNA by free radical interactions.

Immunoassay of taxol and taxol-like compounds in plant extracts.

A mouse monoclonal anti-taxol antibody (69E4A8E) and a rabbit polyclonal anti-taxol antiserum were used to measure taxol levels in plant extracts in a double-blind experiment in conjunction with assays by HPLC. 69E4A8E was previously shown by ELISA to be specific for taxol with only a slight cross reaction with another bioactive compound, cephalomannine; the antiserum, on the other hand, was, by radioimmunoassay (RIA), essentially equally reactive with taxol and cephalomannine. Immunoassays of the plant extracts gave results in agreement with that found by HPLC, suggesting that the antibodies can be used in simple routine procedures for the quantification of taxol or taxol-like compounds in extracts of plants or other potential natural sources.

Properties of a monoclonal antibody for the detection of abasic sites, a common DNA lesion.

The abasic site is one of the most frequent changes occurring in DNA and has been shown to be lethal and mutagenic. An abasic site in DNA can be tagged by reaction with O-4-nitrobenzylhydroxylamine (NBHA), resulting in the formation of an oxime linkage between the abasic site and the NBHA moiety. In order to measure NBHA-tagged abasic sites, a monoclonal antibody was elicited against a 5'-phosphodeoxyribosyl O-4-nitrobenzyl hydroxylamine-BSA conjugate. The antibody was specific for the NBHA residue as demonstrated by hapten inhibition, with IC50 values for 5'-phosphodeoxyribosyl-NBHA, deoxyribosyl-NBHA, ribosyl-NBHA and NBHA of 0.3 microM, 5 microM, 5 microM and 7 microM, respectively. Other haptens examined, including benzylhydroxylamine, 5'-phosphodeoxyribosyl-, deoxyribosyl-, and ribosyl-benzylhydroxylamine, showed no inhibition even at 1 mM. The antibody showed high specificity for NBHA-modified AP sites in DNA and exhibited no cross reactivity with normal DNA bases, otherwise-modified DNA bases or unmodified AP sites. Using a direct ELISA assay, the antibody detected 1 AP site (after NBHA-modification) per 10,000 base-pairs or approximately 10 femtomoles of AP sites in DNA. DNA lesions were detectable in 60Co gamma-irradiated DNA at a dose as low as 10 rad (0.1 Gy) and the production of antibody detectable sites was proportional to the gamma-ray dose. Since NBHA reacts with lesions containing an aldehyde group, the simplicity and sensitivity of the antibody assay should provide a useful method for the quantitation of AP sites or other DNA lesions containing an aldehyde group.

Serum progesterone and 17 beta-estradiol concentrations during pregnancy of Bactrian camel (Camelus bactrianus).

Serum progesterone and 17 beta-estradiol during pregnancy in the Bactrian camel were measured by radioimmunoassay. Serum progesterone concentrations increased by 15 d after artificial insemination (AI) and remained elevated throughout most of gestation, the mean concentrations (3.06 +/- 0.49 to 8.51 +/- 4.80 ng/mL) were similar to those reported for many species during the same stage of pregnancy. Serum 17 beta-estradiol increased significantly from 11 m.o. of pregnancy with peak mean concentrations of 617.47 +/- 32.56 pg/mL at the 11.5 m.o.

Treatment of hallux valgus in China.

This is a review of the treatment of hallux valgus based on the paper material submitted to the First and Second Sino-American Conferences on Foot Disorders held in Beijing in 1987 and 1990. The data consisted of 676 cases (979 feet) from 10 major hospitals in China. There were 122 men and 554 women, giving a male to female ratio of 1:45. Sixty-nine (10%) cases had a family history of hallux valgus and 120 cases (18%) were associated with hammer toe deformity. The age ranged from 16-85 years with an average of 42. Among the 412 female cases (78.5%) at the age of 20-35, 339 (82.3%) had the history of wearing high heeled and narrow tipped shoes. Osteoarthritis changes of the first M-P joint were seen in 31 cases, all above the age of 60. 615 cases (90.9%) were treated surgically for pain relief and only 25 cases (3.7%) at the age of 20-30 had the deformity corrected for cosmetic purpose. The surgical procedures employed were bunionectomy (Silver's operation, 39 feet), Keller's operation (344 feet), McBride's operation (239 feet) and a variety of osteotomies of the first metatarsal (295 feet). Joplin and Lapidus operations were used by one author in 5 and 2 cases respectively. Overall excellent and good results were obtained in 609 cases (90%) during the follow-up of 1-14 years.

Immunological studies of osteoarthritis in bipedal rats.

Osteoarthritis (OA) models in bipedal rats were used to study the immune response, including the changes of IgG, antibody dependent cytotoxicity tests toward articular chondrocytes and the matrix. The results revealed significant difference between the bipedal and the quadruped rats. Immunological studies have proved that the OA model of bipedal rats is appropriate for the study of OA.

An improved technique for bloodless hepatic resection on in situ cold perfused liver.

An improved technique for bloodless hepatic resection using in situ isolation and asanguinous hypothermic perfusion was described to deal with huge liver tumors involved in the liver hilum, the main hepatic veins and retrohepatic inferior vena cava. The original Fortner's technique was modified, including the choice of incision; semi-isolated perfusion of the liver portion preserved through the single portal vein; suprahepatic outlet of the perfusate and the shortening of the period of hepatic ischemia by reperfusion of hepatic artery prior to the repair or reconstruction of the portal vein. The initial successful experience of the technique applied to 2 pediatric cases with giant liver tumors was reported, and the indications, intraoperative and early postoperative courses were discussed.