[Analysis of clinical characteristics and risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia].

Objective: To analyze and explore the clinical characteristics and risk factors related to nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia. Methods: 252 hospitalized patients with liver cirrhosis combined with atrial arrhythmia from January 2014 to December 2021 were enrolled, and their clinical characteristics were analyzed. The above-mentioned patients were divided into groups according to their nosocomial mortality rate. Among them, 45 nosocomial mortality cases were classified as the mortality group, and 207 survival cases were classified as the survival group. The differences in clinical data and laboratory data between the two groups were compared. The risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia were analyzed. The t-test, or rank-sum test, was used to compare measurement data. The chi-square test, or Fisher's exact probability method, was used to compare enumeration data. Multivariate analysis was performed by the logistic regression method. Results: Among the 252 cases, the male-to-female ratio was the same (male/female ratio: 126/126). The age range was 26 to 89 (66.77±10.46) years. Han ethnicity accounted for 79.5%. The main type of atrial arrhythmia was atrial fibrillation (P < 0.001). The main cause of liver cirrhosis was post-hepatitis B cirrhosis (56.3%). There were 57/72/123 cases of CTP grade A/B/C. The CTP and Model for End-Stage Liver Disease (MELD) scores were 10.30±1.77 and 18.0(11.0, 29.0), respectively. The nosocomial mortality rate was 17.9% (45/252). The overall incidence rate of complications in all patients was 89.28%, with complications occurring in the following order: 71.4% ascites, 71.0% hypersplenism, 64.7% spontaneous peritonitis, 64.3% esophageal gastric varices, 32.5% hepatorenal syndrome, 32.1% hepatic encephalopathy, and 26.2% esophageal gastric variceal bleeding. The incidence rate of new-onset atrial fibrillation in the nosocomial mortality group was 73.3%, which was much higher than the 44.0% rate in the survival group (P < 0.05). Multivariate logistic regression analysis showed that new-onset atrial fibrillation (OR=2.707, 95%CI 1.119 ~ 6.549), esophageal-gastric varices (OR=3.287, 95%CI 1.189 ~ 9.085), serum potassium (OR=3.820, 95%CI 1.532 ~ 9.526), and MELD score (OR=1.108, 95%CI 1.061~1.157) were independent risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia. Conclusion: Patients with cirrhosis combined with atrial arrhythmias have more severe liver function damage and are more likely to develop complications such as ascites, hypersplenism, and hepatorenal syndrome. New-onset atrial fibrillation, esophageal-gastric varices, hyperkalemia, and a high MELD score are risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia, so more attention should be paid to corresponding patients for timely symptomatic treatment.

[Advances in anticoagulant therapy for cirrhosis combined with atrial fibrillation].

Relevant research in recent years has demonstrated that the atrial fibrillation occurrence rate is significantly higher in patients with cirrhosis. The most common indication for long-term anticoagulant therapy is chronic atrial fibrillation. The use of anticoagulant therapy greatly reduces the incidence rate of ischemic stroke. Patients with cirrhosis combined with atrial fibrillation have an elevated risk of bleeding and embolism during anticoagulant therapy due to cirrhotic coagulopathy. At the same time, the liver of such patients will go through varying levels of metabolism and elimination while consuming currently approved anticoagulant drugs, thereby increasing the complexity of anticoagulant therapy. This article summarizes the clinical studies on the risks and benefits of anticoagulant therapy in order to provide a reference for patients with cirrhosis combined with atrial fibrillation.

[Analysis of the effect of spread through air spaces on postoperative recurrence-free survival in patients with stage pT1N0M0 lung adenocarcinoma of different tumor size].

Objective: To investigate the effect of spread through air spaces (STAS) on the postoperative prognosis of patients with stage pT1N0M0 lung adenocarcinoma according to different tumor sizes. Methods: The clinicopathological and follow-up data of 511 patients with pT1N0M0 lung adenocarcinoma treated surgically in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2018 were retrospectively analyzed. There were 285 males and 226 females, aged 60 (53, 66) years. Those patients were divided into two groups according to STAS status, including STAS (-) group (342 cases) and STAS (+) group (169 cases). And the stratified analysis was performed according to the American Cancer Consortium (AJCC) 8th edition postoperative pathological tumor size T-stage (pT) of lung cancer, which was divided into pT1a (pT≤1 cm, 93 cases), pT1b (1 cm0.05]. Before and after IPTW adjustment, statistically significant differences were found in RFS between STAS (+) group and STAS (-) group [(72.50±2.23) vs (85.12±0.72) months, (77.74±1.12) vs (84.59±0.64) months, all P<0.001]. In addition, the risks of both local and distant recurrence were higher in STAS (+) group compared to STAS (-) group (6.7% vs 1.2% and 8.2% vs 3.6%, respectively; both P<0.05). Conclusion: For lung adenocarcinoma patients with pT1bN0M0 and pT1cN0M0, those patients with STAS (+) had a higher incidence of both local and distant recurrence and with poor RFS.

DWI in Brains of Fetuses with Congenital Heart Disease: A Case-Control MR Imaging Study.

BACKGROUND AND PURPOSE: Abnormal ADC values are seen in ischemic brain lesions such as acute or chronic hypoxia. We aimed to assess whether ADC values in the developing brain measured by in utero DWI were different in fetuses with congenital heart disease compared with healthy controls. MATERIALS AND METHODS: In utero DWI was performed in 50 fetuses with congenital heart disease and 100 healthy controls at a similar gestational age. Pair-wise ADC values of the ROIs were manually delineated on each side of the frontal and periatrial WM and in the basal ganglia, thalamus, and cerebellar hemisphere, as well as a single measurement in the pons. RESULTS: Fetuses with congenital heart disease had significantly lower ADC values in frontal and periatrial WM and the pons than controls (all P < .05) in the early stages of pregnancy. However, ADC values in the thalamus were higher for fetuses with congenital heart disease than for controls (gestational age, ≥26 weeks). For ADC values in the cerebellar hemisphere, there was no obvious significance between cases and controls (P = .07) in the late stages of pregnancy. Basal ganglia ADC values were consistently not significantly different between the 2 groups during the early and late stages of pregnancy (P = .47; .21). CONCLUSIONS: Abnormal brain diffusivity can be detected using in utero DWI in fetuses with congenital heart disease. Abnormal ADC values found at a mean gestational age of 26 weeks suggest structural changes, which may provide an early indicator of the impact of congenital heart disease on the developing brain.

[Long-term clinical effect of full-mouth implant fixation in middle-aged and elderly patients with static computer-assisted implant surgery].

Objective: To evaluate long-term clinical outcome of implant-supported fixed prosthesis with the guidance of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical template in old patients. Methods: Fifteen 50-67(58.6±5.3) year-old patients (11 males and 4 females) who received the digital implant surgery with the guidance of CAD/CAM surgical template and implant-supported fixed prosthesis in Department of Oral Implantology, Yantai Stomatological Hospital Affiliated to Binzhou Medical College from August, 2013 to Janurary, 2016 were included. There are 15 edentulous maxillas, 8 edentulous mandibles on which 145 implants were placed in total. After the placement of implant, the accuracy of CAD/CAM surgical template was assessed by comparing the post-operative 3-dimensional location of implant with the pre-operative design. The 5-year survival rate of implant and prosthesis was recorded, and marginal bone loss around implants and the development of complication were evaluated by radiological and clinical examination respectively. Results: The result on accuracy of CAD/CAM surgical template showed that deviations in neck and apex of implants were (0.78±0.59) and (1.38±0.63) mm respectively, depth deviation was (0.65±0.35) mm and angle deviation was 4.12°±2.77°. The 5-year cumulative survival rate of implants was 98.6%(143/145). In all 145 implants, the prevalence of implant-related biological complication was 4.1%(6/145). The prosthesis-related mechanical complication rate was 57%(13/23). After 5-year function, mean peri-implant bone loss was (0.69±0.35) mm. Conclusions: This 5-year follow-up retrospective study showed that implant-supported fixed prosthesis with the guidance of CAD/CAM surgical template in middle aged and elderly patients could achieve good long-term clinical outcome and patient satisfaction.

MiR-19a suppress apoptosis of myocardial cells in rats with myocardial ischemia/reperfusion through PTEN/Akt/P-Akt signaling pathway.

OBJECTIVE: To detect differentially expressed micro ribonucleic acids (miRNAs) in rats with myocardial ischemia/reperfusion (MIR), and to explore the influence of miR-19a on MIR rats and its mechanism. MATERIALS AND METHODS: Firstly, the Sprague-Dawley (SD) rats were used to prepare MIR models, RNAs were extracted, and miRNA sequencing analysis was carried out to determine differentially expressed miRNAs related to MIR. Secondly, the predicted target genes of miR-19a were collected, and WebGestalt was applied to analyze gene ontology (GO) and pathway enrichment. Thirdly, the expression of the related proteins and the apoptosis of myocardial cells in MIR rats were detected via Western blotting. Fourthly, the interaction between miR-19a and the target gene phosphatase and tensin homolog (PTEN) was examined through Luciferase reporter assay. RESULTS: Compared with that in the Sham operation (Sham) group, the miR-19a expression in rat myocardial tissues in the MIR group was significantly increased (p<0.05). Compared with those in the miR-negative control (miR-NC) group, the messenger RNA (mRNA) and protein expressions of PTEN in the miR-19a group were notably decreased (p<0.05). In comparison with the miR-NC group, miR-19a group had elevated expression of phosphorylated protein kinase B (p-Akt) (p<0.05). The Luciferase reporter gene assay manifested the direct binding of miR-19a to PTEN mRNA. CONCLUSIONS: MiR-19a inhibits the PTEN expression by directly binding to the 3'-UTR of PTEN mRNA, thus activating the Akt/p-Akt signaling pathway to suppress the apoptosis of myocardial cells in MIR injury.

Postconditioning Protection Against Myocardiocyte Anoxia/Reoxygenation Injury From Penehyclidine Hydrochloride.

BACKGROUND/AIMS: To investigate the postconditioning protective effect of penehyclidine hydrochloride (PHC) against anoxia/reoxygenation (A/R) injury in H9c2 cells along with the involved mechanism and timing effect. METHODS: We divided H9c2 cells into 7 groups: control group, A/R group and PHC+A/R groups at 0 min, 5 mins, 10 mins, 20 mins, 30 mins, respectively (treated with 0.1 µm/L PHC at 0 min, 5 mins, 10 mins, 20 mins, 30 mins after the reoxygenation procedure began). Cell apoptosis, oxidative stress, intracellular Ca2+ concentration, mitochondrial membrane potential and mitochondrial permeability transition pore (MPTP) opening were explored. Bcl-2, Bax, Cyt C, caspase-3 and caspase-9 levels were measured. RESULTS: A/R significantly increased both cell injury and cell apoptosis. PHC showed postconditioning protective effect by attenuating superoxide production, decreasing Ca2+ overload, restraining MPTP activities, restoring mitochondrial membrane potential, regulating cell apoptosis proteins and modulation of mitochondrial pathway. Earlier administration of PHC offered greater postconditioning protective effect. CONCLUSION: H9c2 cells were protected by PHC from A/R injury regardless of timing of PHC administration (0 min, 5 mins, 10 mins, 20 mins, 30 mins). However, earlier administration of PHC resulted in better PHC postconditioning protection.

[Research progress in the pathogenic mechanisms of Porphyromonas gingivalis fimbriae].

FimA has been characterized as an important virulence factor for Porphyromonas gingivalis (Pg). These structures play a major role in the mechanisms of adhesion and invasion of Pg to host cells, and can induce cellular activation and cytokines release. FimA can also promote biofilm formation and induce immuno-inflammatory response of host cells. Many studies have characterized FimA to be associated with periodontitis and cardiovascular disease. Pg strains are classified into six types based on divergent nucleotide sequences of the fimA gene (types Ⅰ、Ⅰb、Ⅱ、Ⅲ、Ⅳ andⅤ). The expression of fimbriae is regulated by the fimA gene, which may be the key factor that leads to virulence diversities of Pg, At present, the research on the pathogenesis of FimA mainly focuses on periodontitis and atherosclerosis, which is of great significance for the prevention and treatment of diseases. This paper reviewed the pathogenic effect of FimA in the development of above mentioned two diseases and its application in the prevention.

Accuracy of three-dimensional facial soft tissue simulation in post-traumatic zygoma reconstruction.

The aim of this study was to evaluate the accuracy of novel software-CMF-preCADS-for the prediction of soft tissue changes following repositioning surgery for zygomatic fractures. Twenty patients who had sustained an isolated zygomatic fracture accompanied by facial deformity and who were treated with repositioning surgery participated in this study. Cone beam computed tomography (CBCT) scans and three-dimensional (3D) stereophotographs were acquired preoperatively and postoperatively. The 3D skeletal model from the preoperative CBCT data was matched with the postoperative one, and the fractured zygomatic fragments were segmented and aligned to the postoperative position for prediction. Then, the predicted model was matched with the postoperative 3D stereophotograph for quantification of the simulation error. The mean absolute error in the zygomatic soft tissue region between the predicted model and the real one was 1.42±1.56mm for all cases. The accuracy of the prediction (mean absolute error ≤2mm) was 87%. In the subjective assessment it was found that the majority of evaluators considered the predicted model and the postoperative model to be 'very similar'. CMF-preCADS software can provide a realistic, accurate prediction of the facial soft tissue appearance after repositioning surgery for zygomatic fractures. The reliability of this software for other types of repositioning surgery for maxillofacial fractures should be validated in the future.

[Targeted effect of microRNA on nerve growth factor pathway and its functional network in patients with unstable angina].

OBJECTIVE: To study microRNA profile alteration in unstable angina (UA) patients and its functional network via nerve growth factor (NGF) signaling pathway. METHODS: Whole blood microRNAs were isolated from individuals with angiographically negative report (n=6) and UA patients (n=6), Taqman low-density microRNA array was performed to detect the microRNA profile, and SAM tool was conducted to calculate the differential expressed microRNA. Bioinformatic prediction tools (Targetsan, Miranda, Diana-microT) were used to obtain microRNA target genes. Targets'enriched pathways were analyzed by DAVID and biological function clusters were figured out by Panther database. The functional network of microRNAs by Cytoscape was costructed. RESULTS: In the study, 20 microRNAs were significantly upregulated in the UA group were observed. Their main target signaling pathways were NGF, their target genes' functional clusters were in signal transduction, cell proliferation and differentiation, cell cycles, immunity and inflammation, neurogenesis, neuronal activity and apoptosis. CONCLUSION: To upregulate microRNAs in UA patients is a major way to inhibit NGF signaling pathways, whose function is to suppress cell proliferation and differentiation, immunity and inflammation, neuronal growth, etc., and to stabilize the vulnerable atherosclerotic plaque.

[microRNA-126 delivered by microparticles mediates intercellular signal transmission].

OBJECTIVE: To investigate the role of microRNAs (miRNAs) in mediating intercellular signaling. METHODS: Microparticles (MP) from HUVEC and 293T were isolated by sequential centrifugation. THP-1 was co-cultured with microparticles. And then the migration of THP-1 was measured by transwell. real-time PCR and Western blotting were used to study the related mechanisms. RESULTS: Compared with the microparticles from 293T, MP from HUVEC could promote the migration of monocytes (P<0.05) and upregulate the expression of CXCR4 mRNA and protein (P<0.05). MiRNA-126 deficient MP could downregulate the migration of monocytes (P<0.05) and the expression of CXCR4 mRNA and protein (P<0.05) compared with miRNA-126 abundant MP. CONCLUSION: Microparticles from HUVEC could promote the migration of monocytes. As carriers, microparticles could mediate intercellular signaling.

[Analysis of risk factors associated with weaning from mechanical ventilation in critical patients with major abdominal surgery].

OBJECTIVE: To analyze the risk factors involved in the weaning from mechanical ventilation in critical patients who underwent major abdominal surgery. METHODS: This retrospective study was conducted at Department of Critical Care Medicine in Peking University People's Hospital. The subjects included all critical ill patients who underwent major abdominal surgery from January 2011 to December 2013. Clinical and laboratory parameters in perioperative period were investigated for the risk factors involved in the weaning from mechanical ventilation. RESULTS: In this study, 381 patients were included, of whom, 274 were successfully weaned. We found old age, lower left ventricular ejection fraction (LVEF) before surgery, with the complication of myocardial injury after noncardiac surgery (MINS) and lower serum albumin level after surgery were the independent risk factors of weaning from mechanical ventilation. And the days of intensive care unit and 28-day mortality of patients who successfully weaned were better than patients who failed to wean. CONCLUSION: Old age, lower LVEF before surgery, with the complication of MINS and lower serum albumin level after surgery were independent risk factors of weaning in critical patients who underwent major abdominal surgery.

Free radical EPR spectroscopy analysis using blind source separation.

In this paper, we propose a novel approach for electron paramagnetic resonance (EPR) mixture spectra analysis based on blind source separation (BSS) technique. EPR spectrum of a free radical is often superimposed by overlapping spectra of other species. It is important and challenging to accurately identify and quantify the 'pure' spectra from such mixtures. In this study, an automated BSS method implementing independent component analysis is used to extract the components from mixed EPR spectra that contain overlapping components of different paramagnetic centers. To apply this method, there is no requirement to know the component spectra or the number of components in advance. The method is applied to analyze free radical EPR spectra which are collected from standard chemical system, cultured cell suspense, and ex vivo rat kidneys by spin trapping EPR technique. Results show that the BSS method proposed here is capable of identifying the component EPR spectra from mixtures with unknown compositions. The BSS technique can offer powerful aids in resolving spectral overlapping problems in general EPR spectroscopy analysis.

Reference data and predictive diagnostic models for calcaneus bone mineral density measured with single-energy X-ray absorptiometry in 7428 Chinese.

Calcaneus bone mineral density (BMD) of 7428 Chinese (4126 women, 3302 men; aged 22-94 years) was measured using single-energy X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Chinese men and women was established and the usefulness of this method for screening and diagnosis in osteoporosis was evaluated. The peak BMD occurred at 20-24 years old and peak BMD in women was significantly lower than in men. BMD loss in the calcaneus started at the age of 35 years for women, and at 63 years in men. BMD loss rate was 1.2%/year for women and 0.56%/year for men after 50 years. The young normal reference for calcaneus BMD was 442.1+/-69.6 mg/cm2 for men and 388.3+/-61.7 mg/cm2 for women calculated from the mean BMD value of subjects whose age ranged from 20 to 49 years. The accumulated BMD loss in the calcaneus is similar to that of Ward's triangle. Multiple linear regression showed that both age and weight were important factors. The incidence of osteoporosis in older men and women (> or = 60 years) is 6.6% and 32.1% respectively. We conclude that calcaneus BMD measurement is useful and sensitive for the screening and diagnosis of osteoporosis. A predictive diagnostic model for osteoporosis based on the calcaneus was constructed using multiple linear regression and the WHO criteria for diagnosing osteoporosis can be applied to calcaneus BMD.

[Comparative study on efficacy of qinggan granule and bushen granule in treating chronic hepatitis C].

OBJECTIVE: To evaluate the efficacy of Qinggan Granule (QGG) and Bushen Granule (BSG) in treating chronic hepatitis C (CHC) from blood donors clinically, biochemically and pathologically as well as to explore the therapeutical principle and methods of TCM. METHODS: Sixty-six patients with CHC were divided into three groups, the 36 patients in the QGG group treated with QGG, the 18 patients in the BSG group treated with BSG and the 12 patients in the control group untreated. The dose of QGG and BSG given was 30 g each time, three times per day for 6 consecutive months. Clinical and serum biochemical parameters as well as pathological change of liver biopsy before and after treatment were observed dynamically and compared. RESULTS: After treatment, in the two treated group, clinical symptoms were improved significantly, alanine transaminase (ALT) and aspartate aminotransferase (AST) reduced markedly. Moreover, QGG showed the effects of increasing albumin and lowering alkaline phosphatase (ALP). On the contrary, ALT still remained as before but AST further increased in the control group. Pathological examination showed that the inflammatory grade (IG) decreased in 42.2% and fibrotic stage (FS) decreased 21.2% of the patients in the QGG group, but no significant changes of the two indexes occurred in the BSG group, while in the control group, IG unchanged and FS increased in 3 cases. Chevallier's semi-quantity system analysis showed significant decrease of both scores in the QGG group (P < 0.05), only decrease of IG in the BSG group, and slight raise of IG and significant increase of FS (P < 0.05) in the control group. CONCLUSION: Condition of chronic hepatitis C patient would deteriorate progressively if not treated in time, especially the development of fibrosis. QGG and BSG could improve the clinical symptoms significantly, lower ALT and AST, eliminate inflammatory damage in the liver, slow down or reverse liver fibrosis process with stable long-term effect. Though most of the patients present a Syndrome of Liver-Kidney Yin-deficiency, the effect of QGG is superior to that of BSG, suggesting that the treatment of CHC should mainly be clearing principle, and method of clearing Liver and eliminating Dampness may be more suitable for them.

The new model of age-dependent changes in bone mineral density.

To theoretically and quantitively describe the phenomena that bone mineral density (BMD) was changed with, the three-exponential model was proposed. Our results showed that BMD in radius and ulna in a sample of 36,879 healthy people ranging in age from 2 to 100 years fit the three-exponential equation well. Bone mass loss in Chinese women was faster than that in Chinese men. The method to accurately calculate the peak BMD and the corresponding age was given. The peak BMD and age for Chinese men and women in radius were 0.7469 g/cm2 and 35 years old, and 0.7051 g/cm2 and 33 years old respectively. The peak BMD and age in ulna were 0.7515 g/cm2 and 35 years old for Chinese men, and 0.6904 g/cm2 and 31 years old for Chinese women. Peak BMD in Chinese women was lower than in men. Peak BMD occurred slightly earlier in Chinese women. We concluded that our model could successfully characterize the regularity of bone mass accumulation and loss during the whole lifetime. The quantitive relationship was very useful in the diagnosis of osteoporosis.

Effects of berberine of L- and T-type calcium channels in guinea pig ventricular myocytes.

AIM: To study the effects of berberine (Ber) on L-(ICa,L) and T-type (ICa,T) channels in isolated guinea pig ventricular myocytes. METHODS: Using whole cell patch-clamp recording technique. RESULTS: Ber 10, 30 mumol.L-1 inhibited the ICa, L from 1400 +/- 247 pA to 978 +/- 204 pA (n = 5 cells of 5 guinea pigs, P < 0.05), and to 664 +/- 179 pA (n = 5, P < 0.01), respectively. The inhibitory effect was concentration-dependent and non-frequency-dependent. The peak value of ICa,L in the current-voltage relationship was decreased. Ber affected the inactivation kinetics of ICa,L. The half activation potential (V0.5) was shifted from -27.8 mV to -34.2 mV and the slope factor (kappa) was changed from 9.22 into 13.03. Ber did not affect the activation kinetics. Ber 10 and 30 mumol.L-1 also inhibited ICa,T (from 154 +/- 80 pA to 101 +/- 78 pA, and to 48 +/- 45 pA, n = 8 cells of 5 guinea pigs, P < 0.05). CONCLUSION: Ber possessed blocking effects on both L- and T-type calcium channels.