Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure.

AIMS: To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF). METHODS: From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status. RESULTS: The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777). CONCLUSION: Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

Effect of Nrf2 loss on senescence and cognition of tau-based P301S mice.

Cellular senescence may contribute to chronic inflammation involved in the progression of age-related diseases such as Alzheimer's disease (AD), and its removal prevents cognitive impairment in a model of tauopathy. Nrf2, the major transcription factor for damage response pathways and regulators of inflammation, declines with age. Our previous work showed that silencing Nrf2 gives rise to premature senescence in cells and mice. Others have shown that Nrf2 ablation can exacerbate cognitive phenotypes of some AD models. In this study, we aimed to understand the relationship between Nrf2 elimination, senescence, and cognitive impairment in AD, by generating a mouse model expressing a mutant human tau transgene in an Nrf2 knockout (Nrf2KO) background. We assessed senescent cell burden and cognitive decline of P301S mice in the presence and absence of Nrf2. Lastly, we administered 4.5-month-long treatments with two senotherapeutic drugs to analyze their potential to prevent senescent cell burden and cognitive decline: the senolytic drugs dasatinib and quercetin (DQ) and the senomorphic drug rapamycin. Nrf2 loss accelerated the onset of hind-limb paralysis in P301S mice. At 8.5 months of age, P301S mice did not exhibit memory deficits, while P301S mice without Nrf2 were significantly impaired. However, markers of senescence were not elevated by Nrf2 ablation in any of tissues that we examined. Neither drug treatment improved cognitive performance, nor did it reduce expression of senescence markers in brains of P301S mice. Contrarily, rapamycin treatment at the doses used delayed spatial learning and led to a modest decrease in spatial memory. Taken together, our data suggests that the emergence of senescence may be causally associated with onset of cognitive decline in the P301S model, indicate that Nrf2 protects brain function in a model of AD through mechanisms that may include, but do not require the inhibition of senescence, and suggest possible limitations for DQ and rapamycin as therapies for AD.

The Prognostic Value of Microvascular Density in Early Postoperative Recurrence and Metastasis of T1 Esophageal Squamous Cell Carcinoma.

OBJECTIVE: To identify the relation of microvascular density (MVD) to the early postoperative recurrence and metastasis of T1 esophageal squamous cell carcinoma, and to determine whether MVD could be a prognostic predictor of esophageal squamous cell carcinoma. METHODS: Patients with T1 esophageal squamous cell carcinoma were enrolled. Immunohistochemistry with primary antibody against CD-34 was performed to count MVD. ROC curve was plotted and appropriate cutoff value was determined to evaluate the potential power of MVD in predicting early recurrence and metastasis of T1 esophageal squamous cell carcinoma. Survival curves were drawn by the Kaplan-Meier method and significance were tested by the Mantel-Cox test. RESULTS: A total of 37 patients with T1 esophageal squamous cell carcinoma were enrolled. The MVD of T1 esophageal squamous cell carcinoma patients with early metastasis was significantly higher than that of T1 esophageal squamous cell carcinoma patients without early metastasis (65.83±4.39 vs. 42.26±2.34, p<0.001). MVD was available in distinguishing whether patients with early esophageal are prone to postoperative recurrence or metastasis (AUC=0.861; 95% CI 0.738-0.984, p<0.001), with 88.89% sensitivity and 68.42% specificity of MVD being obtained when the cut-off is 44.5. Kaplan-Meier survival curves showed that patients with a higher MVD had a lower survival (37.35 months) compared with those with low MVD (40.79 months) (p<0.05). CONCLUSIONS: MVD could be a promising indicator for early postoperative recurrence and metastasis of T1 esophageal squamous cell carcinoma and the prognosis of these patients.

Characterization of the complete chloroplast genome of Jatropha curcas var. nigroviensrugosus.

As a new variety of Jatropha curcas L., Jatropha curcas var. nigroviensrugosus has high development and utilization values because of its high flowering and fruiting rates and yield. In this study, the complete chloroplast (cp) genome of J. nigroviensrugosus was assembled using Illumina sequencing data. Results revealed that its cp genome is 170,811 bp in length and has 106 unique genes, including 76 protein-coding genes, 26 tRNA genes and 4 rRNA genes. Phylogenetic analysis indicated that J. nigroviensrugosus was closely related to J. curcas.

Regulatory roles of non-coding RNAs and m6A modification in trophoblast functions and the occurrence of its related adverse pregnancy outcomes.

Adverse pregnancy outcomes, such as preeclampsia, gestational diabetes mellitus, fetal growth restriction, and recurrent miscarriage, occur frequently in pregnant women and might further induce morbidity and mortality for both mother and fetus. Increasing studies have shown that dysfunctions of human trophoblast are related to these adverse pregnancy outcomes. Recent studies also showed that environmental toxicants could induce trophoblast dysfunctions. Moreover, non-coding RNAs (ncRNAs) have been reported to play important regulatory roles in various cellular processes. However, the roles of ncRNAs in the regulation of trophoblast dysfunctions and the occurrence of adverse pregnancy outcomes still need to be further investigated, especially with exposure to environmental toxicants. In this review, we analyzed the regulatory mechanisms of ncRNAs and m6A methylation modification in the dysfunctions of trophoblast cells and the occurrence of adverse pregnancy outcomes and also summarized the harmful effects of environmental toxicants. In addition to DNA replication, mRNA transcription, and protein translation, ncRNAs and m6A modification might be considered as the fourth and fifth elements that regulate the genetic central dogma, respectively. Environmental toxicants might also affect these processes. In this review, we expect to provide a deeper scientific understanding of the occurrence of adverse pregnancy outcomes and to discover potential biomarkers for the diagnosis and treatment of these outcomes.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study.

INTRODUCTION: Postoperative analgesia in elderly patients is still a thorny problem. Ultrasound-guided oblique subcostal transverse abdominis plane block (TAPB) has been demonstrated to provide postoperative analgesia after abdominal surgeries. However, recent studies have suggested that an alternative method, erector spinae plane block (ESPB), might also be effective. In this study, we compared the postoperative analgesic effects of ESPB and TAPB in elderly patients who had undergone laparoscopic colorectal surgery. METHODS: Sixty-two elderly patients (≥ 65 years old) scheduled for elective laparoscopic colorectal surgery with general anesthesia were randomly allocated to two equally sized groups: ESPB group and TAPB group. The ESPB group had a bilateral erector spinae plane block, and the TAPB group had a bilateral oblique subcostal transverse abdominis plane block. The primary outcome was visual analogue scale (VAS) pain score during the first 24 postoperative hours at resting and active states. The secondary outcomes were postoperative consumption of sufentanil, satisfaction score, the number of patients who required antiemetics, incidence of block-related complications, and other side events. RESULTS: There were no demographic differences between two groups. Compared to the TAPB group, the ESPB group had lower VAS pain scores and sufentanil consumption during the first 24 postoperative hours. Additionally, ESPB reduced the occurrence of postoperative nausea and vomiting. Furthermore, the satisfaction score was higher in the ESPB group. No other complications were reported between the two groups. CONCLUSIONS: Compared with oblique subcostal TAPB, ESPB more effectively reduced postoperative pain and opioid consumption. Thus, ESPB is suitable for postoperative analgesia in elderly patients who have undergone laparoscopic colorectal surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2000033236.

Distinct bacterial community of a solid-state fermented Chinese traditional food huase sufu revealed by high-throughput sequencing.

Sufu is a common solid-state traditional fermented food made from soybean. Huase sufu is a typical type found in several provinces of China, especially in Hubei. However, little is known about the bacterial community. High-throughput sequencing technology revealed that the dominant taxa at phylum level were: Firmicutes, Proteobacteria and Bacteroides, and at the genus level were: Pseudomonas, Lactococcus, Acinetobacter, etc. Additionally, LEfSe revealed that compared with the bacterial community of red sufu and white sufu, the biomarker genera for both huase sufu were Enterococcus, and Myroides. Moreover, there were twenty-eight hubs for the huase sufu samples, and four of them were dominant genera: Citrobacter, Myroides, Vagococcus, and Enterococcus. These results provide a new insight into our understanding of the bacterial diversity of huase sufu, and will facilitate the isolation, screening, and development potential bacterial strains for production of huase sufu. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10068-021-00963-3.

The case report of surgical and medical co-management in a triple organs resection surgery.

INTRODUCTION: and Importance: There have been few studies in the literature that report patient have triple combined procedures done via minimally invasive approaches. We report a co-management SMC intervention helped an 88-years-old patient with multiple surgery risk factors have combined procedures done via robotic-assisted approaches at one sitting with excellent surgical outcomes. CASE PRESENTATION: We describe the surgical and medical co-management (SMC) intervention of a 88-year-old male patient who was found to have colonic carcinoma, right renal carcinoma, gall bladder stones, hypertension, plumonary interstital fibrosis, atrioventricular block. The patient underwent simultaneous triple robotic-assisted laparoscopic surgery procedure consisting of right partial nephrectomy, right hemicolecomy and cholecystectomy using robot. Perioperative optimization approach was recommended and planned after consultation with group comprises internists and surgeons. The internists rounds on the patient daily and helps to manage all chronic medical comorbidities. He was discharged without any severe complications. CONCLUSIONS: This case shows the feasibility and safety of the synchronously triple robotic surgical treatments, with clinic outcomes that is better with that of the separately. SMC approach may maximize therapy efficiency and patient recovery in elder patients with chronic disease who has significantly higher postoperative complications.

Characterization of the complete chloroplast genome of Gymnocladus chinensis Baill.

Gymnocladus chinensis Baill (Fam.: Leguminosae; Trib.: Caesalpinieae) are widely distributed in China. In this study, we assembled the complete chloroplast (cp) genome of G. chinensis. The total cp genome size was 165,315 bp in length, containing a large single-copy region of 92,356 bp, a small single-copy region of 20,449bp, and a pair of inverted repeat regions of 26,255 bp. The all GC content of G. chinensis cp was 34.95%. It encodes a total of 105 unique genes, including 75 protein-coding genes, 26 tRNA genes, and four rRNA genes. Seventeen genes contain a single intron, and two genes (ycf3 and clpP) have two introns. Phylogenetic analysis results strongly supported that G. chinensis was closely related to Angylocalyx braunii.

The Predictive Efficacy of Tumor Mutation Burden (TMB) on Nonsmall Cell Lung Cancer Treated by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.

BACKGROUND: Nonsmall cell lung cancer (NSCLC) is the most common type of lung cancer, and the majority of NSCLC patients are diagnosed at the advanced stage. Chemotherapy is still the main treatment at present, and the overall prognosis is poor. In recent years, immunotherapy has developed rapidly. Immune checkpoint inhibitors (ICIs) as the representative have been extensively applied for treating various types of cancers. Tumor mutation burden (TMB) as a potential biomarker is used to screen appropriate patients for treatment of ICIs. To verify the predictive efficacy of TMB, a systematic review and meta-analysis were conducted to explore the association between TMB and ICIs. METHOD: PubMed, EMBASE, Cochrane Library, and son on were systematically searched from inception to April 2020. Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were estimated. RESULTS: A total of 11 studies consisting of 1525 nonsmall cell lung cancer (NSCLC) patients were included. Comparison of high and low TMB: pooled HRs for OS, 0.57 (95% CI 0.32 to 0.99; P = 0.046); PFS, 0.48 (95% CI 0.33 to 0.69; P < 0.001); ORR, 3.15 (95% CI 2.29 to 4.33; P < 0.001). Subgroup analysis values: pooled HRs for OS, 0.75 (95% CI 0.29 to 1.92, P = 0.548) for blood TMB (bTMB), 0.44 (95% CI 0.26 to 0.75, P = 0.003) for tissue TMB (tTMB); for PFS, 0.54 (95% CI 0.29 to 0.98, P = 0.044) and 0.43 (95% CI 0.26 to 0.71, P = 0.001), respectively. CONCLUSIONS: These findings imply that NSCLC patients with high TMB possess significant clinical benefits from ICIs compared to those with low TMB. As opposed to bTMB, tTMB was thought more appropriate for stratifying NSCLC patients for ICI treatment.

[Cloning and expression analysis of CpPMM gene in Codonopsis pilosula].

GDP-mannose is an important precursor for the synthesis of Codonopsis pilosula polysaccharides and involved in the synthesis of sugar chains. Phosphomannomutase(PMM)catalyzes the conversion of mannose-6-phosphate(Man-6-P)to mannose-1-phosphate(Man-1-P)to synthesize GDP-mannose. In this study, specific primers were designed based on the PMM gene sequence information in transcriptome data, and the full length of the C. pilosula PMM gene was cloned and named CpPMM. The correlation between the CpPMM gene expression and C. pilosula polysaccharide synthesis was analyzed by a series of bioinformatics analysis, prokaryotic expression and qRT-PCR. The results show that the CpPMM gene contains a 741 bp open reading frame(ORF), encoding 246 amino acids, which is highly similar to the PMM of other species and highly homologous to the Helianthus annuus from the Asteraceae family. It was predicted to be a hydrophilic non-transmembrane protein without signal peptide, which was predicted to be located in the cytoplasm with multiple phosphorylation sites. Combined with predictive analysis of conserved domains, this protein belongs to the HAD(haloacid dehalogenase)superfamily; prokaryotic expression studies show that the size of the CpPMM fusion protein is about 29 kDa, which is consistent with the relative molecular mass predicted. The target protein is an inclusion body and is partially soluble. The qRT-PCR results showed that the CpPMM gene exerted spatiotemporal expression patterns, and the expression level in fruiting period was significantly higher than that in the other three periods such as the flowering period. Along with the growth period of C. pilosula, the polysaccharide content of C. pilosula showed a gradual increase trend, reaching the highest during the harvest time. And there are significant differences in the polysaccharide content of C. pilosula in each period. In this study, the CpPMM gene was cloned from the root of C. pilosula, at the same time, the prokaryotic expression system was constructed. In addition, its gene expression level is highly correlated with the polysaccharide content of C. pilosula. It lays the foundation for further studying the function of CpPMM gene and the analysis of biosynthetic pathways of polysaccharides in medicinal plants.

Transcriptomic differences between male and female Trachycarpus fortunei.

Trachycarpus fortunei (Hook.) is a typical dioecious plant, which has important economic value. There is currently no sex identification method for the early stages of T. fortunei growth. The aim of this study was to obtain expression and site differences between male and female T. fortunei transcriptomes. Using the Illumina sequencing platform, the transcriptomes of T. fortunei male and female plants were sequenced. By analyzing transcriptomic differences, the chromosomal helical binding protein (CHD1), serine/threonine protein kinase (STPK), cytochrome P450 716B1, and UPF0136 were found to be specifically expressed in T. fortunei males. After single nucleotide polymorphism (SNP) detection, a total of 12 male specific sites were found and the THUMP domain protein homologs were found to be male-biased expressed. Cytokinin dehydrogenase 6 (CKX6) was upregulated in male flowers and the lower concentrations of cytokinin (CTK) may be more conducive to male flower development. During new leaf growth, flavonoid and flavonol biosynthesis were initiated. Additionally, the flavonoids, 3',5'-hydroxylase (F3'5'H), flavonoids 3'-hydroxylase, were upregulated, which may cause the pale yellow phenotype. Based on these data, it can be concluded that inter-sex differentially expressed genes (DEGs) and specific SNP loci may be associated with sex determination in T. fortunei.

Symptom Cluster of ICU Nurses Treating COVID-19 Pneumonia Patients in Wuhan, China.

BACKGROUND: In treating highly infectious coronavirus disease-19 (COVID-19) pneumonia, intensive care unit (ICU) nurses face a high risk of developing somatic symptom disorder (SSD).The symptom clusters in one population may show overlaps and involvements, a phenomenon that should be deliberately resolved to improve the management efficiency. OBJECTIVES: The present study aims to investigate the symptoms and causes of SSD of ICU nurses treating COVID-19 pneumonia. The research results are expected to provide evidence for the establishment of a better management strategy. METHODS: This study enrolled a total of 140 ICU nurses who were selected by Jiangsu Province Hospital to work in Wuhan (the epicenter of the COVID-19 epidemic in China) on February 3, 2020. A questionnaire, Somatic symptom disorders for ICU nurses in Wuhan No. 1 Hospital, was designed based on the International Classification of Functioning, Disability and Health. Exploratory factor analysis was performed to cluster the symptoms and logistic regression analysis to find the risk factors of the symptoms. RESULTS: Five major symptoms were chest discomfort and palpitation (31.4%), dyspnea (30.7%), nausea (21.4%), headache (19.3%), and dizziness (17.9%). In exploratory factor analysis, the symptoms were classified into three clusters: Cluster A of breathing and sleep disturbances (dizziness, sleepiness, and dyspnea); Cluster B of gastrointestinal complaints and pain (nausea and headache), and Cluster C of general symptoms (xerostomia, fatigue, as well as chest discomfort and palpitation). In Cluster A, urine/feces splash, sex, and sputum splash were independent predictive factors. In Cluster B, fall of protective glasses and urine/feces splash were independent predictive factors. In Cluster C, urine/feces splash and urine/feces clearance were independent predictive factors. CONCLUSION: The ICU nurses in Wuhan showed varying and overlapping SSDs. These SSDs could be classified into three symptom clusters. Based on the characteristics of their SSDs, specific interventions could be implemented to safeguard the health of ICU nurses.

Characterization of the complete chloroplast genome of Trachycarpus fortunei.

Trachycarpus fortunei (Hook.) H. Wendl. (Fam.: Palmae; Gen.: Trachycarpus) is an evergreen tree that is widely distributed in China. In this study, T. fortunei complete chloroplast (cp) genome was assembled. The total cp genome size of T. fortunei was 158,613 bp in length, containing a large single-copy region of 86,422 bp, a small single-copy region of 17,847 bp, and a pair of inverted repeat regions of 27,172 bp. The overall GC-content of T. fortunei cp genome was 37.21%. It encodes a total of 109 unique genes, including 79 protein-coding genes, 26 tRNA genes, four rRNA genes. Twelve genes contain a single intron and 11 genes have two introns. Phylogenetic analysis results reveal that T. fortunei was closely related to Chamaerops humilis.

Characterization of the complete chloroplast genome of Pinus yunnanensis var. pygmaea.

Pinus Yunnanensis var. pygmaea (Fam: pinaceae; Gen: Pinus), is a mutant of Pinus yunnanensis. Franch. To contribute to its conservation, the complete chloroplast (cp) genome of P. yunnanensis var. Pygmaea was sequenced and assembled by high-throughput sequencing technology. The results show that P. yunnanensis var. pygmaea cp genome contained 101 genes, including 64 protein-coding genes, 33 tRNA genes, and four rRNA genes. The overall GC content of the cp genome is 38.50%. A phylogenetic tree reconstructed by 16 cp genomes reveals that P. yunnanensis var. pygmaea is most related with Pinus taiwanensis.

Evaluation of Whole Blood Trace Element Levels in Chinese Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which has increased markedly during the last decades. Essential trace elements play an important role in neurological function and their imbalances are common in children with ASD. The objective of the present study was to investigate whole blood levels of trace elements including zinc (Zn), copper (Cu), iron (Fe), and magnesium (Mg) in Chinese children with ASD. In total, 113 children diagnosed with ASD and 141 age-matched and gender-matched neurotypical children, divided into two gender and age groups of preschool age (2-5 years old) and school (6-10 years old) age, were examined. The quantitative analyses of whole blood trace element contents were performed by using flame atomic absorption spectroscopy. In the present study, the children with ASD generally had lower whole blood levels of Zn than the neurotypical controls. No significant differences in the whole blood Cu, Zn/Cu ratio, Fe, or Mg was detected between the ASD group and the control group. It is notable that whole blood Fe level in boys with ASD was significantly higher than in girls with ASD, and was nearly significant when compared with the control level of boys. After stratification for age, a significant 6% decrease in whole blood Zn levels was detected in preschool-aged children with ASD as compared to the control values. However, this significant ASD-related change was not detected in school-aged children. The whole blood Zn level and Zn/Cu ratio were significantly increased in school-aged children than in preschool-aged children in both ASD and control group. In addition, school-aged children with ASD had a significantly higher level of whole blood Fe than preschool-aged children with ASD. The results of the present study suggest an association between whole blood levels of Zn in Chinese children with ASD.

Role of TNFRSF1A and TNFRSF1B polymorphisms in susceptibility, severity, and therapeutic efficacy of etanercept in human leukocyte antigen-B27-positive Chinese Han patients with ankylosing spondylitis.

The successful therapeutic use of anti-TNF biological agents in patients with ankylosing spondylitis (AS) indicates that tumor necrosis factor-α (TNF-α) and tumor necrosis factor receptor (TNFR) genes are involved in the pathogenesis of AS. TNF-α exerts its biological activity by binding to its cell surface receptors (p55 TNF-α receptor [TNFRI, encoded by the Tumor Necrosis Factor Receptor Superfamily Member 1A (TNFRSF1A)] and p75 receptor [TNFRII, encoded by the Tumor Necrosis Factor Receptor Superfamily Member 1B (TNFRSF1B)]. TNFRSF1A and TNFRSF1B may be related to AS, but the relevant studies are still limited. Therefore, we aim to explore the association between TNFRSF1A and TNFRSF1B polymorphisms and susceptibility and short- and long-term response to anti-TNF treatment in human leukocyte antigen-B27 (HLA-B27)-positive Chinese Han patients with AS.A total of 215 HLA-B27-positive patients with AS and 216 HLA-B27-positive matched controls were enrolled and genotyped for rs767455, rs2234649, and rs1061622. A subset of 50 AS patients was also studied for the association of these polymorphisms with the short- and long-term response to etanercept assessed by Assessment in Ankylosing Spondylitis 20 (ASAS20) and Assessment in Ankylosing Spondylitis 40 (ASAS40).Our data showed that rs767455 was associated with the susceptibility of AS, G allele of rs767455 exhibited an association with the risk of developing AS (OR = 1.63 (1.04-2.55), P = .032). Rs1061622 polymorphism was associated with total back pain and chest expansion. Only rs1061622 was significantly associated with long-term efficacy of etanercept: the TG genotype of rs1061622 worsened ASAS20 and ASAS40 responses at 12 months (P = .021 and .041, respectively).The results suggest that TNFRSF1A and TNFRSF1B polymorphisms were associated with susceptibility, severity, and the long-term therapeutic efficacy of etanercept of patients with AS.

Diagnosis and Treatment of Lambl's Excrescence on the Aortic Valve.

OBJECTIVE: Our objective is to summarize our experience in the diagnosis and treatment of Lambl's excrescence (LE) on the aortic valve. Methods: The clinical data of 25 patients with LE admitted to our hospital from January 2010 to December 2014 were analyzed retrospectively. There were 17 males and 8 females, with the mean age of 55.7 ± 11.43 years (range: 30 to 70 years). Among the patients analyzed, eight also had cerebral embolism. All of the patients were diagnosed by transesophageal echocardiography (TEE). In seven cases, surgical treatment to remove the excrescence was successfully performed. Results: All 25 patients were cured and discharged. There were no complications or operative mortalities in the seven patients that underwent surgical treatment. Follow-ups were performed for all patients for an average of 2.9 ± 1.5 years. During this time, none had a new cerebrovascular accident (CVA). Conclusions: Most patients with LE are asymptomatic, though some patients showed repeated episodes of stroke. We recommend TEE as the main diagnostic means of the disease. Patients with LE that have experienced two or more CVAs or combined other heart disease and need open heart surgery should be offered surgical excision of the excrescences. Other patients should be treated conservatively with anticoagulation, or monitored closely.

Evaluation of Diagnostic Scores for Acute Appendicitis.

OBJECTIVE: To assess the sensitivity of the Alvarado score (AS), modified Alvarado score (MAS), Fenyo-Lindberg score (FS), Lintula score (LS), Eskelinen score (ES), Teicher score (TS), and Christian score (CS) [seven scorings] in patients with acute appendicitis (AA). STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The First Affiliated Hospital of Chongqing Medical University, China, from January 2012 to June 2015. METHODOLOGY: Patients with diagnosis of AA were evaluated retrospectively to compare the scoring systems. The diagnostic sensitivity (the correct number of diagnoses divided by the total number) was compared. Data were analyzed using SPSS software. RESULTS: One hundred and seventy-nine patients were studied. The sensitivity of AS was 92.7%; It outperformed each of the other scores. The sensitivity of FS, LS, and TS in women was lower than that in men (p=0.016, p<0.001, and p<0.001, respectively). The sensitivity of the FS, ES, TS, and CS in patients with a duration of illness greater than 48 hours was lower than that in patients with a duration of illness less than 48 hours (p<0.001 for all). CONCLUSION: AS is the most useful and sensitive diagnostic tool for AA. FS, LS, and TS had a lower diagnostic sensitivity in women; and FS, ES, TS, and CS had a low sensitivity in patients with a duration of illness greater than 48 hours.