[Predictive value of left ventricular ejection fraction for the occurrence of postoperative myocardial infarction after coronary endarterectomy in patients with diffuse coronary artery disease].

Objective: To investigate the predictive value of ejection fraction for the postoperative myocardial infarction after coronary endarterectomy (CE) in patients with diffuse coronary artery disease (DCAD). Methods: Patients who underwent cardiac artery bypass graft (CABG) surgery and CE in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2020 were enrolled in this prospective observational study. Baseline features including age, sex and echocardiography parameters were obtained. Left ventricular ejection fraction(EF) was measured by echocardiography. The patients were divided into postoperative myocardial infarction (PMI) group and non-PMI group according to PMI occurrence. Linear regression analysis, logistic regression model, and receiver operating characteristic(ROC) curve were used to analyze the correlation between left ventricular ejection fraction and PMI and the influencing factors. Results: A total of 120 patients were enrolled in the study. There were 32 patients (27%) in the PMI group (male 27(84%), age (62±8)), inferior myocardial infarction occurred in 24 (75%) patients. There were 88 patients (73%) in the non-PMI group (male 70(80%), age (62±8)). EF (55% (49%, 64%) vs. 62% (55%, 67%), P=0.01) was significantly lower in the PMI group than in the non-PMI group. Perioperative TNI, IABP use and length of hospitalization were significantly higher in the PMI group than in the non-PMI group. Multivariate logistic regression showed that lower EF was an independent risk factor of PMI (OR=0.93, 95%CI: 0.89-0.98, P=0.01) after adjusting age, sex and body mass index. ROC curve analysis showed that EF<60% could sufficiently predict the occurrence of PMI (AUC= 0.67, sensitivity 64%, specificity 69%, P=0.01). Linear regression analysis showed that left ventricular end-diastolic diameter (OR=-0.52, 95%CI:-1.13-0.60, P<0.001), graft flow in left anterior descending (OR=-0.20, 95%CI:-0.15-0.01, P=0.02) and history of diabetes (OR=-0.28, 95%CI:-8.25-1.85, P=0.002) were negatively correlated with preoperative EF value. Conclusion: Lower preoperative EF is an independent risk factor for PMI after CABG and CE in DCAD patients, closely related to the left ventricular end-diastolic diameter, graft flow in left anterior descending artery and diabetes mellitus.

Situational risk factors for fall-related vertebral fractures in older men and women.

Situational factors might help explain why most vertebral fractures occur in older people without a previous osteoporosis diagnosis. After adjusting for predisposing risk factors, the activity before the fall, type of fall, and falling direction remained as strong determinants of fall-related vertebral fractures in older men and women. INTRODUCTION: A matched case-control study was conducted to investigate the effects of situational factors, in addition to predisposing factors, on clinical vertebral fractures in older men and women in Taiwan. METHODS: Cases were community-dwelling individuals aged ≥ 65 years who visited emergency departments (EDs) of two university-affiliated hospitals due to a fall and had a primary diagnosis of a vertebral fracture during a 1-year period in 2017. Five control patients per case, matched by the time of falling, gender, and age, who sought care in the same ED due to a fall resulting in a soft tissue injury were selected. A total of 64 men (age range: 65 ~ 99 years) and 194 women (age range: 65 ~ 100 years), diagnosed with a vertebral fracture, participated in the study. RESULTS: Multivariable logistic models were conducted separately for men and women. Results suggested that the following factors were significantly associated with an increased risk of vertebral fractures in men: a low educational level (adjusted odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.02 ~ 3.71), asthma (OR = 2.96; 95% CI, 1.35 ~ 6.92), depression (OR = 4.31; 95% CI, 1.03 ~ 17.5), toileting (OR = 2.30; 95% CI, 1.04 ~ 4.94), slipping (OR = 5.27; 95% CI, 1.80 ~ 15.4), stepping down (OR = 3.99; 95% CI, 1.40 ~ 11.4), sudden leg weakness (OR = 3.73; 95% CI, 1.13 ~ 12.4), and falling backwards (OR = 3.78; 95% CI, 1.83 ~ 7.80); and in women: a fracture history (OR = 2.00; 95% CI, 1.07 ~ 3.76), osteoporosis (OR = 1.94; 95% CI, 1.15 ~ 3.49), getting in/out of the bed/chair (OR = 1.90; 95% CI, 1.07 ~ 3.39), stepping down (OR = 2.10; 95% CI, 1.17 ~ 3.77), and falling backwards (OR = 4.00; 95% CI, 2.39 ~ 6.68) and sideways (OR = 2.61; 95% CI, 1.38 ~ 4.96). CONCLUSIONS: The combination of predisposing and situational risk factors may display a more comprehensive risk profile for the occurrence of VFs, and thus, interventions that add both types of risk factors may result in greater risk reduction of VFs, although those specifically targeted at situational risk factors during falls are limited and their effectiveness and efficiency remained to be explored.

Association between Time Spent on Smart Devices and Change in Refractive Error: A 1-Year Prospective Observational Study among Hong Kong Children and Adolescents.

This study examined the association between smart device usage and the 1-year change in refractive error among a representative sample of Hong Kong children and adolescents aged 8-14 years. A total of 1597 participants (49.9% male, mean age 10.9, SD 2.0) who completed both baseline (2017-2018) and 1-year follow-up (2018-2019) eye examinations were included in the present study. The non-cycloplegic auto-refractive error was measured and the average spherical equivalent refraction (SER) was analyzed. The participants also self-reported their smart device usage at baseline. Multivariate regression adjusted for age, sex, baseline SER, parents' short-sightedness, BMI, time spent on moderate-to-vigorous physical activity (MVPA), and caregiver-reported socio-economic status showed that, compared with the reference group (<2 h per day on both smartphone and tablet usages), those who spent ≥2 h per day using a smartphone and <2 h per day using a tablet had a significantly negative shift in refractive error (1-year change in SER -0.25 vs. -0.09 D, p = 0.01) for the right eye, while the level of significance was marginal (1-year change -0.28 vs. -0.15 D, p = 0.055) for the left eye. To conclude, our data suggested spending at most 2 h per day on both smartphones and tablets.

[Exposure to famine in fetus and infant period and risk for hypertension in adulthood].

Objective: To investigate the relationship between exposure to famine in fetus and infant period and the risks for hypertension in adulthood. Methods: A total of 5 960 participants born between 1956 and 1965 were included in the study and were divided into unexposed group (1963-1965), fetal exposed group (1959-1961), early- childhood exposed group (1956-1958) and transitional group (1962). Logistic regression model was used to explore the association between famine exposure in early life and the risk for hypertension in adulthood. Results: Both the fetal exposure and the early-childhood exposure were the risk factors for hypertension in adulthood (OR=1.249, 95%CI: 1.049-1.486 and OR=1.360, 95%CI: 1.102-1.679). Meanwhile, in rural area, compared with unexposed group, the fetal exposure (OR=1.401, 95%CI: 1.091-1.798) and the early-childhood exposure (OR=1.460, 95%CI: 1.145-1.862) were also associated with a greater risk of hypertension in adulthood. In addition, fetal exposure and early-childhood exposure to famine in women were associated with 36.0% and 31.9% increased risks for hypertension (95%CI: 7.8%-71.7% and 95%CI: 4.8%-66.0%) according to the stratified analysis. Conclusion: Fetal exposure to famine might increase the risk for hypertension in adulthood.

Upregulation of long noncoding RNA LEF1-AS1 predicts a poor prognosis in patients with esophageal squamous cell carcinoma.

OBJECTIVE: Recent studies have suggested that long noncoding RNAs (lncRNAs) are involved in various tumors. The present research was designed to examine the prognostic values of a newly identified lncRNA, lncRNA LEF1-AS1 (LEF1-AS1), in esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS: The relative levels of LEF1-AS1 in ESCC tissues and normal esophageal tissues were examined by applying quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relations between LEF1-AS1 expressions and clinical factors were analyzed by conducting the Chi-square test. The Kaplan-Meier assay was used for assays of the overall survival (OS) and disease-free survival (DFS) dates. Univariate and multivariate analyses were applied for the identification of the independent prognostic factors for ESCC. RESULTS: We showed that LEF1-AS1 was distinctly upregulated in ESCC tissues compared with the matched normal tissues (p < 0.01). Higher levels of LEF1-AS1 were associated with lymph nodes metastasis (p = 0.009) and clinical stage (p = 0.008). Clinical investigation revealed that ESCC patients with high LEF1-AS1 level showed a significant shorter 5-year OS (p = 0.0028) and DFS (p = 0.0025). Multivariate analyses confirmed LEF1-AS1 as an independent prognostic parameter indicating unfavorable clinical prognosis for ESCC patients. CONCLUSIONS: The present study suggested that LEF1-AS1 could be a novel ESCC-related lncRNA involved in the clinical progression of ESCC, which may be used as a potential predictor.

[Clinical characteristics of LC-BPPV patients with bilateral direction-fixed horizontal nystagmus in primary Roll test].

Objective:To investigate the clinical features of LC-BPPV with direction-fixed horizontal nystagmus in the primary Roll test. Method:Nine patients of LC-BPPV with bilateral direction-fixed horizontal nystagmus in the first Roll test were treated by repositioning maneuvers after judging the affected side and the prognosis was observed. Result:The affected side of eight patients was the side of the apogeotropic nystagmus. Barbecue or Gufoni maneuvers was effective for reposition. The other one had no conversion of nystagmus and could not judge the affected side. Conclusion:The nystagmus performance of patients with LC-BPPV is complicated. It is necessary to carefully analyze the nystagmus performance of each position. Combining with bow and lean test, lying down test and null plane, the position of the otolith is inferred. Comprehensive use of the Barbecue or Gufoni maneuvers, forced side lying on the affected side, mastoid sniper, shaking head method is effective to complete the reposition treatment.

The effects of recombinant human growth hormone (rHGH) on survival of slender narrow pedicle flap and expressions of vascular endothelial growth factor (VEGF) and classification determinant 34 (CD34).

OBJECTIVE: To explore the effects of recombinant human growth hormone (rHGH) on the survival of the mouse slender narrow pedicle flap and the expressions of vascular endothelial growth factor (VEGF) and classification determinant 34 (CD34). MATERIALS AND METHODS: A total of 20 BALB/c mice were randomly divided into the experimental group (n=10) and control group (n=10). The flaps were transplanted for mice in two groups respectively. 6 h after the operation, the mice in the experimental group were administrated with rHGH via local subcutaneous injection, while the mice in the control group were injected with the same amount of normal saline. The laser Doppler was used to measure the sub-flap blood flow rates before the operation, and 3 days, 7 days and 14 days after the operation, respectively; the flap necrosis and survival areas of mice in two groups were measured respectively, and the survival rate of the flap was calculated 14 days after the operation. Afterwards, the flaps of mice in two groups were exfoliated and the shape and structure of flap tissues were tested by the hematoxylin-eosin (HE) staining. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to test the levels of mRNA and protein of VEGF and CD34 in the flap tissues. RESULTS: The flaps of mice in the control group mainly exhibited the black or grayish-black and lost the elasticity with the hard texture, while those in the experimental group were ruddy in color with favorable elasticity. The survival rate of flaps of mice in the experimental group was significantly higher than that in the control group (83.61 ± 12.56% vs. 46.25 ± 9.70%) and the necrosis area of flaps of mice in the experimental group was significantly smaller than that in the control group (1.32 ± 0.16 vs. 4.13 ± 0.35, p < 0.05). There were no statistical differences in the blood flow rates of mouse flap both before the operation and three days after the operation between two groups (p > 0.05), while the blood flow rates of mouse flap both 7 days and 3 days after the operation in the experimental group were higher than those in the control group (p > 0.05). Compared with those in the control group, the levels of VEGF and CD34 were significantly increased, but the levels of the inflammatory factors of the interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly decreased (p < 0.05). CONCLUSIONS: rHGH plays an active role in the survival of the flap through promoting the angiogenesis and inhibiting inflammatory reaction.

Adipose-derived stem cells improve neovascularization in ischemic flaps in diabetic mellitus through HIF-1α/VEGF pathway.

OBJECTIVE: To investigate the improvement effect of adipose-derived stem cells on neovascularization in an ischemic flap in diabetes mellitus (DM), and to explore the mechanism of hypoxia-inducible factor 1α (HIF-1α)/vascular endothelial growth factor (VEGF) pathway. MATERIALS AND METHODS: A total of 60 male Sprague-Dawley (SD) rats were divided into control group, model group, and adipose-derived stem cells (ADSCs) group. The survival rate of the flap and the number of new blood vessels were measured. The content of VEGF was determined by enzyme-linked immunosorbent assay (ELISA) kit. Then, the expressions of HIF-1α and VEGF in each group were measured by immunohistochemistry. Reverse transcriptase polymerase chain reaction (RT-PCR) method and Western blotting assay were used to detect the mRNA and protein expression of HIF-1α and VEGF in each group. RESULTS: Compared with control group, the flap survival rate of model group was decreased significantly, and the number of new blood vessels was also decreased significantly. Compared with model group, the flap survival rate of ADSCs group was increased significantly, and the number of new blood vessels was also increased significantly. The results of ELISA showed that compared with control group, the level of VEGF in model group was lower than that in model group, and the level of VEGF in the ADSC group was significantly higher than that in the model group. IHC results showed that both HIF-1α and VEGF proteins were decreased significantly in model group, whereas the expression of HIF-1α and VEGF in the ADSCs group was increased significantly. The results of RT-PCR and the Western blotting showed the mRNA and protein expressions in model group were all decreased, while those in ADSCs group were significantly increased (p < 0.05). CONCLUSIONS: ADSCs can improve the neovascularization of diabetic ischemic skin by regulating the HIF-1α/VEGF pathway.

Post-targeting strategy for ready-to-use targeted nanodelivery post cargo loading.

Based on boronate formation, this study reports a post-targeting methodology capable of readily installing versatile targeting modules onto a cargo-loaded nanoplatform in aqueous mediums. This permits the targeted nanodelivery of broad-spectrum therapeutics (drug/gene) in a ready-to-use manner while overcoming the PEGylation-dilemma that frequently occurs in conventional targeting approaches.

[Research progress of intervention strategies on voice disorders in children with vocal nodules].

Vocal nodules in children is one of the common diseases in children, characterized as the hoarse voice of the children, which is mainly due to improper use of sound long-term or excessive use of the voice. The hoarseness of children's voice undermine not only the physical and mental health of children, but also the quality of life of children and their families. In recent years, the incidence of vocal nodules in children has been increasing. There are considerable differences between the children's own characteristics and adults such as bronchial lumen and cognitive and cooperate aspects, which lead to a large number of difficulties for clinical diagnosis and intervention. Based on a large number of literatures, this paper reviews the risk factors, diagnosis, voice assessment and intervention strategies of vocal nodules in children, in order to provide more comprehensive reference for the medical workers.

[Curative effect analysis of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo].

Objective:To explore the curative effect and quality life of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Method:Residual dizziness after successful canalith repositioning maneuvers in patients with BPPV were enrolled in our study. They were randomized into three groups, the control group A were no disposition which include 32 patients, the intervention group B were guided to self rehabilitation training which include 33 patients, the control group C were guided to Brandt Daroff training which include 33 patients. Dizziness handicap inventory (DHI) and residual dizziness duration were used to evaluation the patients. Result:After one week vestibular rehabilitation training, the scores of DHI in group B and C decreased, and there was no significant difference (P>0.05), there were significant differences between group B and group C in group A, respectively (P<0.01). After four weeks of vestibular rehabilitation training, the scores of DHI in group B and group C were lower than those in group A, the decrease of group B was significantly higher than that of group C (P<0.01). The residual dizziness duration indicated that no statistical differences in the B, C groups (P>0.05) and scores of group B,C were significantly lower than group A (P<0.05). Conclusion:The appropriate vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with BPPV can help promote the central vestibular compensation, reduce the residual symptoms, improve the quality life of patients, and which can be used as the adjuvant treatment on BPPV patient who has residual dizziness symptoms.

[Review of 1 000 Hz probe tone tympanogram applying to evaluate middle ear of infants].

1 000 Hz probe tone acoustic admittance test as a efficient method used to evaluate function of middle ear in infants, has reached consensus from domestic and foreign scholars. But there still exsits controversy on proper use in infants of months old. Here is to make a brief introduction about physiological characteristics of middle ear in infants, 1 000 Hz tympanometry and applicable age range, hoping to providing reference for future research.

Clinical efficacy of one stage posterior debridement joint graft fixation for lumbar vertebral fractures in spinal tuberculosis patients with compression.

OBJECTIVE: Spinal tuberculosis, though destructive, can be cured in many patients by chemotherapy, though surgery is often necessary for decompression and deformity correction. Our aim of this study was to investigate the clinical efficacy of posterior debridement joint graft fixation therapy for lumbar vertebral fractures in patients with spinal tuberculosis with a compression fracture. PATIENTS AND METHODS: We prospectively included 48 patients diagnosed with spinal tuberculosis and lumbar compression fracture in our hospital from June 2010 to June 2013. The patients were randomly divided into observation group (n = 27) and control group (n = 21). The patients in the control group underwent an anterior debridement joint bone fixation therapy, whereas, the patients in the observation group underwent one stage posterior debridement joint bone fixation therapy. The patients in the both groups were followed-up for about 2 years and the postoperative complications were recorded and analyzed. RESULTS: Incision length, operative time and blood loss in patients of the observation group were significantly lower than the control group (p < 0.05). The kyphosis Cobb's angle was found to be reduced in a time-dependent manner in both groups, however, patients in the observation group achieved a significant reduction than the control (p < 0.05). The ASIA grade of few patients in the observation group significantly (p < 0.05) improved to class E from D at the time of the end of follow-up. The patients under the class 'excellent' and 'good' of Kirkaldy-Willis criteria were significantly (p < 05) higher in the observation group (92.6%) than the control group (85.7%). Also, the patients in the Bridwell grade I and II in the observation group (88.9%) were significantly (p < 0.05) higher in comparison with control group (81%). The prevalence of postoperative complications was significantly lower in the observation group (18.5%) when compared with the control group (28.6%). CONCLUSIONS: Our results indicate that one-stage posterior debridement joint bone fixation therapy is an effective and safe procedure for patients with spinal tuberculosis and lumbar compression; this method is worthy of clinical application.

Papular acantholytic dyskeratosis of the vulva associated with familial Hailey-Hailey disease.

Papular acantholytic dyskeratosis (PAD) of the vulva is a rare, chronic disorder first described in 1984. It presents in young women as white to skin-coloured smooth papules over the vulva, which are persistent but asymptomatic. Histologically, there is hyperkeratosis and focal parakeratosis with acantholytic and dyskeratotic cells forming corps ronds and grains, placing PAD within Ackerman's spectrum of focal acantholytic dyskeratoses with Hailey-Hailey disease (HHD) and Darier disease. There have been 17 previous reports of PAD of the vulva, to our knowledge. Only one demonstrated a familial pattern, and none of the cases was associated with a family history of HHD. This is the first report of PAD and HHD in a single family, suggesting that PAD and HHD lie on a spectrum of disease and are genetically linked.