Benralizumab efficacy and safety in severe asthma: A randomized trial in Asia.

BACKGROUND: Benralizumab is indicated as add-on therapy in patients with uncontrolled, severe eosinophilic asthma; it has not yet been evaluated in a large Asian population with asthma in a clinical trial. OBJECTIVE: To evaluate the efficacy and safety of benralizumab in patients with severe asthma in Asia. METHODS: MIRACLE (NCT03186209) was a randomized, Phase 3 study in China, South Korea, and the Philippines. Patients aged 12-75 years with severe asthma receiving medium-to-high-dose inhaled corticosteroid/long-acting ß2-agonists, stratified (2:1) by baseline blood eosinophil count (bEOS) (≥300/µL; <300/µL), were randomized (1:1) to benralizumab 30 mg or placebo. Endpoints included annual asthma exacerbation rate (AAER; primary endpoint), change from baseline at Week 48 in pre-bronchodilator (BD) forced expiratory volume in 1 second (pre-BD FEV1) and total asthma symptom score (TASS). Safety was evaluated ≤ Week 56. RESULTS: Of 695 patients randomized, 473 had baseline bEOS ≥300/µL (benralizumab n = 236; placebo n = 237). In this population, benralizumab significantly reduced AAER by 74% (rate ratio 0.26 [95% CI 0.19, 0.36], p < 0.0001) and significantly improved pre-BD FEV1 (least squares difference [LSD] 0.25 L [95% CI 0.17, 0.34], p < 0.0001) and TASS (LSD -0.25 [-0.45, -0.05], p = 0.0126) versus placebo. In patients with baseline bEOS <300/µL, there were numerical improvements in AAER, pre-BD FEV1, and TASS with benralizumab versus placebo. The frequency of adverse events was similar for benralizumab (76%) and placebo (80%) in the overall population. CONCLUSIONS: MIRACLE data reinforces the efficacy and safety of benralizumab for severe eosinophilic asthma in an Asian population, consistent with the global Phase 3 results.

Special considerations for influenza in the elderly / 中华老年医学杂志

Influenza is a common disease that affects the population in many ways.When the elderly contract influenza, they are prone to complications, leading to severe illness and even death.Influenza has serious consequences to the health of older people.Identification and prevention of influenza in the elderly are of critical importance.This paper summarizes certain distinctive features of influenza in the elderly.

The long-term mortality and related factors of community-acquired pneumonia in the elderly / 中华老年医学杂志

Objective:To investigate the prognostic factors of community-acquired pneumonia(CAP)in the elderly.Methods:Clinical and laboratory data of elderly patients(≥65 years old)hospitalized for CAP in the Department of Respiratory and Critical Care Medicine of Beijing Hospital from January to December 2019 were retrospectively analyzed.The patients were followed up after discharge.The patients were divided into a death group and a survival group according to their prognosis, and long-term mortality risk factors were analyzed by Cox regression.Results:A total of 118 elderly patients hospitalized for CAP with a male-to-female ratio of 1∶1 were included.The follow-up period was 20.7-39.0 months, with a median follow-up time of 29.8 months.The all-cause cumulative mortality rates at 1-2, 3, 6, 12, 24, and 36 months after discharge were 3.4%(4/118), 4.2%(5/118), 5.1%(6/118), 9.3%(11/118), 16.1%(19/118), and 21.6%(24/118), respectively.Pneumonia was the leading cause of death.Multifactorial Cox regression indicated that the Charlson comorbidity index score( HR=1.42, 95% CI: 1.11-1.83, P=0.006), the score of activities of daily living at discharge( HR=0.44, 95% CI: 0.23-0.84, P=0.013), body mass index( HR=0.83, 95% CI: 0.72-0.97, P=0.012), and the level of serum albumin( HR=0.84, 95% CI: 0.73-0.98, P=0.031)were independently associated with long-term mortality. Conclusions:The leading cause of long-term death for elderly CAP patients after discharge is pneumonia.High Charlson comorbidity index scores, lower BMI, low serum albumin levels and low scores of activities of daily living at discharge are independent risk factors for long-term mortality in these patients.Therefore, in order to reduce the occurrence of adverse prognosis and improve the quality of life, a multidimensional, comprehensive assessment and timely intervention should be performed during the acute phase of the disease.

Effect of antidepressant therapy on cellular immunity and quality of life of patients with depression after thoracoscopic radical resection of esophageal cancer / 中华胸心血管外科杂志

Objective:To investigate the effect of antidepressant therapy on cellular immunity and quality of life of patients with depression after thoracoscopic radical resection of esophageal cancer.Methods:Between June 2015 to March 2019, our hospital during the period of line thoracoscope comorbid depressive patients, 186 cases of esophageal cancer radical, according to the indicator method were randomly divided into treatment group and the control group (n=93), the treatment group after surgery for antidepressant treatment, the control group did not give any postoperatively in patients with depressive drugs treatment, routine for psychological counseling. Self-rating Depression Scale SDS and Generic Quality of Life Inventory-74 (GQoli-74) were used to evaluate the changes of depression status and Quality of Life in 2 groups before and after treatment. Flow cytometry was used to detect the levels of CD 4+ and CD 8+ subsets in peripheral blood to evaluate the changes of immune system function in 2 groups before and after treatment. Results:After treatment, the SDS score of the treatment group was significantly lower than that before treatment, the difference was statistically significant( P<0.05), while the SDS score of the control group was not significantly changed before and after treatment, the difference was not statistically significant( P>0.05). After antidepressant treatment, CD 4+ and CD 4+ /CD 8+ levels in the immune system in the treatment group were significantly increased, and CD 8+ levels were significantly decreased, with statistical significance ( P<0.05), while CD 4+ , CD 8+ and CD 4+ /CD 8+ levels in the control group were not significantly changed before and after treatment. There was no significant difference ( P>0.05). After treatment, the body function, psychological function, social function, material state and total score of quality of life of patients in the treatment group were significantly improved compared with before treatment, the difference was statistically significant ( P<0.05), while the score of quality of life of patients in the control group was not significantly changed before and after treatment, the difference was not statistically significant ( P>0.05). Conclusion:Antidepressant therapy can significantly improve the depression status of postoperative esophageal cancer patients, and improve the immune system function and quality of life.

The correlation between cyclin Y and the lesion degree and preoperative, postoperative liver injury in patients with liver cancer / 中国医师进修杂志

Objective:To study the effect of cyclin Y (CCNY) on the lesion degree of patients with liver cancer and its correlation with preoperative and postoperative liver injury.Methods:The clinical data of 60 patients with liver cancer (liver cancer group) and 69 patients with liver cirrhosis (liver cirrhosis group) in Hangzhou Hospital of Zhejiang Medical and Health Group from January 2015 to October 2017 were retrospectively analyzed. In liver cirrhosis group, Child-Pugh liver function grade A was in 33 cases (liver cirrhosis grade A group), grade B was in 21 cases (liver cirrhosis grade B group), grade C was in 15 cases (liver cirrhosis grade C group). The serum total bilirubin (TBIL), alanine aminotransferase (ALT), albumin, cholinesterase, γ-glutamyl transpeptidase (GGT) and total bile acid were detected by automatic biochemical analyzer. The serum CCNY was detected by WB method, and compared with 40 healthy subjects (healthy control group).Results:Compared with those in healthy control group, the albumin and cholinesterase in liver cirrhosis grade A, B and C groups were significantly decreased, the ALT, TBIL, GGT, total bile acid and CCNY were significantly increased, , and the changes were more obvious with the severity of liver disease, and there were statistical differences ( P<0.05). Pearson correlation analysis result showed that the CCNY was positive correlation with TBIL, ALT, total bile acid and GGT in patients with liver cancer ( r = 0.544, 0.612, 0.553 and 0.539; P<0.05), and CCNY was negative correlation with albumin and cholinesterase ( r = - 0.478 and - 0.620, P<0.05). In patients with liver cancer, before operation and 1, 2 and 7 d after operation, the CCNY was 3.01 ± 1.10, 7.24 ± 2.57, 6.29 ± 1.78 and 4.01 ± 1.52, ALT was (98.74 ± 16.79), (430.55 ± 197.62), (255.73 ± 26.77) and (121.89 ± 20.42) U/L, respectively; the CCNY and ALT 1 and 2 d after operation were significantly higher than those before operation, those 2 d after operation were significantly lower than those 1 d after operation, those 7 d after operation were significantly lower than those 2 d after operation, and there were statistical differences ( P<0.05); there were no statistical difference between 7 d after operation and before operation ( P>0.05). The expression of CCNY before operation and 1 d, 2 d, 7 d after operation was positive correlation with ALT in patients with liver cancer ( r = 0.669, 0.821, 0.663 and 0.642; P<0.01). Conclusions:The more severe the degree of liver lesions in patients with liver cancer, the higher the serum CCNY, and the higher the expression of CCNY, the more severe the degree of liver injury in patients with liver cancer due to surgery, which is positively correlated with liver injury indexes.

Multidisciplinary discussion for diagnosis of lung diseases: A retrospective analysis of 217 cases undergoing non-tumor lung biopsy / 中华老年医学杂志

Objective To study on the diagnostic value of non-tumor lung biopsy by the multidisciplinary discussion including clinician,radiologist and pathologist.Methods Clinical data,imaging data and data of hematoxylin-eosin,immunohistochemical and special staining of pathological lung tissues in 217 cases undergoing non-tumor lung biopsy in Beijing Hospital during July 2015 to July 2018 were retrospectively analyzed.The diagnosis results were summarized and analyzed.Results The age range in 217 cases was 45-89 years,and the median age was 67 years,with 92 females and 125 males.The descriptive diagnoses were found in forty-two cases(19.4％,42/217).And 175 cases could be confirmatively diagnosed by the multidisciplinary discussion of clinician,radiologist and pathologist.And the diagnostic rate of lung puncture biopsy was 80.6％ (175/217 cases).Inflammatory lesions were divided into infection and non infection.A total of 68 infection cases (31.3％,68/217) included tuberculosis (43/68,63.2％),bacterial pneumonia (14/68,20.6％) and fungal infection(11/68,16.2％).A total of 107 cases(49.3％,107/217)of non-infective cases included the following:organized pneumonia(53/107,49.5 ％),interstitial pneumonia with autoimmune features (iPAF) (16/107,15.0 ％),nonspecific interstitial pneumonia(NSIP) (13/107,12.1％),hypersensitivity pneumonitis(8/107,7.5％),granulomatosis with polyangiitis (GPA) (4/107,3.7％),eosinophilic pneumonia (2/107,1.9％),sarcoidosis (2/107,1.9％),acute fibrinous and organizing pneumonia (AFOP) (2/107,1.9 ％) and coal pneumoconiosis (2/107,1.9 ％,for each),and IgG4 related diseases (1/107,0.9％),pleuraparenchymal fibroelastomatosis (PPFE) (1/107,0.9％),asbestos lung(1/107,0.9％),lipid pneumonia(1/107,0.9％) and inhaled pneumonia(1/107,0.9％).Conclusions The diagnoses of the puzzled non-tumor lung diseases were more accurate by pathological examination of lung tissue by using special stain,immunohistochemical stain and other pathological means,and by close multidisciplinary consultation of clinician,radiologist and pathologist,so as to facilitate the diagnosis and treatment of diseases.

Multidisciplinary discussion for diagnosis of lung diseases: A retrospective analysis of 217 cases undergoing non-tumor lung biopsy / 中华老年医学杂志

Objective@#To study on the diagnostic value of non-tumor lung biopsy by the multidisciplinary discussion including clinician, radiologist and pathologist.@*Methods@#Clinical data, imaging data and data of hematoxylin-eosin, immunohistochemical and special staining of pathological lung tissues in 217 cases undergoing non-tumor lung biopsy in Beijing Hospital during July 2015 to July 2018 were retrospectively analyzed.The diagnosis results were summarized and analyzed.@*Results@#The age range in 217 cases was 45-89 years, and the median age was 67 years, with 92 females and 125 males.The descriptive diagnoses were found in forty-two cases(19.4%, 42/217). And 175 cases could be confirmatively diagnosed by the multidisciplinary discussion of clinician, radiologist and pathologist.And the diagnostic rate of lung puncture biopsy was 80.6%(175/217 cases). Inflammatory lesions were divided into infection and non-infection.A total of 68 infection cases(31.3%, 68/217)included tuberculosis(43/68, 63.2%), bacterial pneumonia(14/68, 20.6%)and fungal infection(11/68, 16.2%). A total of 107 cases(49.3%, 107/217)of non-infective cases included the following: organized pneumonia(53/107, 49.5%), interstitial pneumonia with autoimmune features(iPAF)(16/107, 15.0%), nonspecific interstitial pneumonia(NSIP)(13/107, 12.1%), hypersensitivity pneumonitis(8/107, 7.5%), granulomatosis with polyangiitis(GPA)(4/107, 3.7%), eosinophilic pneumonia(2/107, 1.9%), sarcoidosis(2/107, 1.9%), acute fibrinous and organizing pneumonia(AFOP)(2/107, 1.9%)and coal pneumoconiosis(2/107, 1.9%, for each), and IgG4 related diseases(1/107, 0.9%), pleuraparenchymal fibroelastomatosis(PPFE)(1/107, 0.9%), asbestos lung(1/107, 0.9%), lipid pneumonia(1/107, 0.9%)and inhaled pneumonia(1/107, 0.9%).@*Conclusions@#The diagnoses of the puzzled non-tumor lung diseases were more accurate by pathological examination of lung tissue by using special stain, immunohistochemical stain and other pathological means, and by close multidisciplinary consultation of clinician, radiologist and pathologist, so as to facilitate the diagnosis and treatment of diseases.

Effectiveness and safety of carbapenem antimicrobial management / 中华医院管理杂志

Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.

RAAS antagonist therapy for prevention of atrial fibrillation in hypertension / 中华全科医师杂志

Hypertension is the most common and controlable risk factor of atrial fibrillation (AF).Resin-angiotensin-aldosterone system (RAAS) antagonist therapy may reduce atrial remodeling and hold promise as “upstream” therapy for AF,especially for the patients with left ventricular hypertrophy and left ventricular dysfunction.The RAAS antagonist therapy for prevention of AF in hypertensive patients needs to be further explored in large scale randomized studies.

Bloodstream infections with O16-ST131 and O25b-ST131: molecular epidemiology, phylogenetic analysis and antimicrobial resistance / 南方医科大学学报

OBJECTIVE@#To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features.@*METHODS@#Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system.@*RESULTS@#The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant.@*CONCLUSIONS@#The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.

Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Surveillance Program, 2017 / 中国感染与化疗杂志

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.

High flow humidification oxygen therapy for elderly patients with abnormal respiratory rhythms and difficult weaning:report of two cases and literature review / 中华老年医学杂志

Objective To evaluation the effect of high flow humidification oxygen (HFHO) therapy for two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction weaning from mechanical ventilation.Methods Clinical features and weaning processes of two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction were analyzed and the related literature was reviewed.Results Two elderly patients had multiple organ dysfunction,respiratory rhythm abnormalities and other difficult weaning factors.After a variety of unsuccessfully weaning patterns,HFHO was successfully used in helping patients wean from mechanical ventilation,with gradually increasing the time of HFHO and restoring respiratory muscle function.Conclusions For elderly patients with artificial airways,respiratory muscle dysfunction(long-term mechanical ventilation)and/or respiratory rhythm abnormalities,HFHO is a promising weaning method.

Comparative of Therapeutic Efficacy and Safety of 3 Chemotherapy Regimens in the Treatment of Small Cell Esophageal Cancer / 中国药房

OBJECTIVE:To compare therapeutic efficacy and safety of different chemotherapy regimens in the treatment of small cell esophageal cancer. METHODS:In retrospective analysis,58 patients with small cell esophageal cancer were divided into group A(18 cases),B(26 cases)and C(14 cases)according to chemotherapy regimens. Group A was given Cisplatin injection 75 mg/m2 intravenously,d1-3+Paclitaxel injection 175 mg/m2,d1-3. Group B was given Cisplatin injection 30 mg/m2 intravenously,d1-3+Et-oposide injection 100 mg/m2,d1-3. Group C was given Vinorelbine tartrate injection 25 mg/m2 intravenously,d1-3+Gemcitabine hydro-chloride for injection 1000 mg/m2,d1-3. A treatment course of 3 groups lasted for 21 d,and they all received 2 cycles of treatment. Clinical efficacies,1,2,3-year survival rate and the incidence of Ⅲ-Ⅳ degree toxic reaction(cough,fever,expectoration,short-ness of breath,fatigue,chest pain,bone marrow suppression,gastrointestinal reactions) were compared among 3 groups. RE-SULTS:Total response rate and 1,2,3-year survival rate were in descending order:group C>group B>group A;the incidence of Ⅲ-Ⅳ degree cough,fever,expectoration,shortness of breath,fatigue,chest pain were in ascending order:group C0.05). CONCLUSIONS:Therapeutic efficacy and 1,2,3-year survival rate of vinorelbine combined with gemcitabine are significantly higher than those of cisplatin combined with paclitaxel or etoposide with better safety.

Microstructure and modification of Nd and Zn trace elements in a Mg-Zn-Y-Nd vascular alloy stent / 中国组织工程研究

BACKGROUND: With the continuous development of materials science, magnesium alloy vascular stent materials have become a hot research. Because of the mechanical properties and biocompatibility of commercial magnesium alloy, it is difficult to meet the requirements of vascular stents. Therefore, effective measures to improve the sten's surface properties and comprehensive performance become the focus of research.OBJECTIVE: To study the histology and surface modification of vascular stents in rapidly solidified Mg-Zn-Y-Nd alloy.Methods: The low-zinc Mg-2Zn-0.2Y alloy with good mechanical properties and corrosion resistance was selected as the basic material, and Nd and Zn elements were added to refine the alloy stents. After the microstructure of the stent was extruded, the surface modification of the stent was completed and the comprehensive properties of the alloy were improved. The new magnesium alloy for the stent was obtained and the stent surface was modified. The metallographic microstructure, scanning electron microscopy and radiological analysis were used to study the microstructure and mechanical properties of the prepared stents. The mechanical properties of the stents were investigated by hardness and tensile tests.RESULTS AND CONCLUSION: (1) Metallographic microstructure results showed that: when Y elements were not added, the second phase of the magnesium alloy was rod-shaped, and there were a few granules embedded in the matrix. After addition of 0.5% Y elements, in the second phase of the magnesium alloy stent, the shafts were significantly reduced in number, and granules were increased in number and evenly distributed in the body. After the addition of 1% Y,the second phase number increased, a large number of dendrites were visible in the grains, and discontinuous rods existed in the second phase. After the addition of 1.5% Y, the second phase was rod-shaped, with mixture of large and local dendrites in the alloy. (2) X-ray diffraction test results: Mn-Zn-0.5Nd alloy and Mn-Zn-1.0Nd alloy contained the same phases (Mg4Zn7 and (Nd, Y) 2Zn17 phase). When the concentration of Nd increased to 1%, the new MgZn2 phase appeared in the alloy. (3) SEM & EDS test results of modified magnesium alloy showed that after magnesium alloy modification, the second phase contained Zn, Nd and Y elements, and their contents were very close. EDS analysis showed that after the addition of Zr elements, the level of Zn elements in the lamellar second phase decreased significantly, and the level of Nd and Y elements increased, indicating a more stable performance. (4) Micro-hardness test results showed that with the increasing of the content of magnesium alloy, the alloy microhardness increased. (5)Tensile test results showed that the tensile strength and yield strength of the Mg-Zn-Y-0.5Nd-Zr stent were significantly higher than those of Mg-Zn-Y-0.5Nd, Mg-Zn-Y-1.0Nd,Mg-Zn-Y-1.0Nd-Zr stents (P < 0.05); and the elongation at break of Mg-Zn-Y-0.5Nd-Zr and Mg-Zn-Y-1.0Nd-Zr stents was significantly higher than that of Mg-Zn-Y-1.0Nd and Mg-Zn-Y-0.5Nd stents (P < 0.05). To conclude, with Mg-2Zn-0.2Y as core materials, the material modification could be completed by the addition of Nd and Zn elements, and the surface modification could be implemented by extruding and refining the stent microstructure. The modified material has excellent properties.

Clinical Observation of Atorvastatin Combined with Levamlodipine Besylate in the Treatment of Elderly Patients with Hypertension Combined with Carotid Plaque / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of atorvastatin combined with levamlodipine besylate in the treatment of elderly patients with hypertension combined with carotid plaque. METHODS:160 elderly patients with hyperten-sion combined with carotid plaque were randomly divided into control group(80 cases)and observation group(80 cases). Control group orally received Atorvastatin tablet 3 mg,qd+compound reserpine tablets 2 tablets,tid;observation group was received Atorv-astatin tablet(the same dosage and usage with control group)+Levamlodipine besylate tablet 2.5 mg,qd. They were treated for 8 months. Antihypertensive efficacy,blood pressure,and carotid intima-media thickness (IMT) before and after treatment,and the incidence of adverse reactions in 2 groups were observed and recorded. RESULTS:The antihypertensive effective rate in observa-tion group was significantly higher than control group,with statistical significance(P0.05). After treatment,blood pressure and IMT levels in 2 groups were significantly lower than before,and observation group was lower than control group,with statistical significance(P0.05). CONCLUSIONS:Atorv-astatin combined with levamlodipine besylate shows good efficacy in the treatment of elderly patients with hypertension combined with carotid plaque,which can not only effectively control patients'blood pressure,but also improve atherosclerosis,reversing plaques and does not increase the incidence of adverse veactions.

Establishment of a modified myocardial ischemia reperfusion model in the SD rat / 医学研究生学报

Objective The establishment of the model of myocardial ischemia-reperfusion injury (MIRI) in SD rats involves lengthy time, severe damage, and death of the rats.We aimed at an efficient and rapid method for establishing an MIRI model in rats to ensure a high success rate of modeling and survival of the animals.Methods Using the trachea intubation-assisted breathing machine, we fully exposed the hearts of 80 adult SD rats (8-10 weeks old and weighing 250-300 mg) by mutilating the 2-3 intercostal muscles.Then, we rapidly positioned and ligated the left anterior descending (LAD) coronary artery for an hour, and established the model of MIRI at 48 hours after releasing the slipknot.We performed electrocardiography (ECG) before, during, and at 1 and 48 hours after operation, ligated the same part again at 48 hours postoperatively, and measured the size of the myocardial ischemia and infarction areas using Evans-TTC double staining.Results The survival rate of the 80 rats was 90% and the success rate of MIRI modeling was 86.25%.After ligation of the LAD coronary artery, ECG showed the ST segment and T wave elevation, followed by gradual decrease of the ST segment and R wave voltage, the myocardium and cardiac apex muscle grey or dark grey below the ligation slipknot.The heart rate myocardial motion amplitude were obviously reduced after ligation.Evans-TTC double staining revealed an evident myocardial infarction area at 48 hours after modeling and the ratio of the ischemia area + infarction area to the total myocardial area of the left ventricle was 0.43 to 0.55 (P>0.05) and that of the infarction area to the ischemia area + infarction area was 0.35 to 0.45 (P>0.05).Conclusion The modified rat model of MIRI can be fast and efficiently established, with a high success rate of modeling and a low mortality of the animals.

The correlation of age and the proximal humerus CR image of Chinese Han adults / 中国法医学杂志

Objective To study age-related structural changes of proximal humerusin Chinese Han adults,for the application inage estimation.Methods Shoulder joint computed radiographs(CR) of 210 Chinese Han adults were sampled,with 124 males aging from 18 to 83 years old and 86 females aging 18 to 60 years old.Four observation indexes (the height of humerus bone marrow cavity,the change of trabecular bone in proximal humeral epiphysis,the change of trabecular bone in humeral macronodular and the change of trabecular bone in subacromial-clavicular bone marrow cavity) related with age were observed and scored.The regression equations of age estimation and change scores were established and tested statistically.Results Every index wasclosely correlated with the age changes inadults.The changes of trabecular bone in proximal humeral epiphysis and the changes of trabecular bone in subacromialclavicular bone marrow cavity have much better effects than the height of humerus bone marrow cavity and the changes of trabecular bone in humeral macronodular.The regression equations could predict the age of Chinese Han adults with satisfactory accuracy.Conclusion CR changes of the height of humerus bone marrow cavity,the changes of trabecular bone in proximal humeral epiphysis,the changes of trabecular bone in humeral macronodular and the changes of trabecular bone in subacromial-clavieular bone marrow cavity can bepracticallyusefulin age estimation for Chinese Han adults.

Overexpression of glycogen synthase kinase 3beta in the treatment of myocardial infarction with cardiac stem cell transplantation / 中国组织工程研究

BACKGROUND:The mechanism and effect of glycogen synthase kinase 3β(GSK-3β) in the differentiation of cardiac stem cel s into cardiomyocytes are stil unclear, although GSK-3βis closely related to the life activities of cel s. OBJECTIVE:To investigate the changes of GSK-3βexpression in the treatment of myocardial infarction in rats undergoing cardiac stem cel transplantation. METHODS:The isolation and culture of cardiac stem cel s were performed in 10 neonatal rats. Lentivirus overexpressing GSK-3βor LacZ (control) was constructed and transferred into cardiac stem cel s. Animal model of myocardial infarction was made in 30 Sprague-Dawley rats. Six weeks after model preparation, rat models were assigned into GSK-3β, LacZ or PBS group. GSK-3βor LacZ overexpressing cardiac stem cel solution or PBS in equal volume was injected into the rat myocardium, respectively. Four weeks after transplantation, the cardiac function and myocardial col agen production in rats were detected and compared. RESULTS AND CONCLUSION:Compared with the other two groups, the left ventricular ejection fraction was significantly higher, and the left ventricular end diastolic diameter was significantly lower in the GSK-3βgroup (P<0.05). Hydroxyproline content, type I col agen mRNA, and type III col agen mRNA expression were significantly lower in the GSK-3βgroup than the other two groups (P<0.05). Findings from Masson staining showed that the content of blue-stained col agen was significantly lower in the GSK-3βgroup than the LacZ group. Moreover, lowest myocardial infarction size was found in the GSK-3βgroup (P<0.05). Al these experimental findings show that GSK-3 overexpression plays a positive role in promoting the therapeutic effect of cardiac stem cel transplantation.

Clinical distribution and antimicrobial resistance of 427 Serratia marces-cens isolates / 中国感染控制杂志

Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.

PTEN-silenced bone marrow mesenchymal stem cell transplantation for acute myocardial infarction / 中国组织工程研究

BACKGROUND:Bone marrow mesenchymal stem cel transplantation for myocardial infarction becomes popularized in recent years, but transplanted cels cannot survive and proliferate under early inflammatory reaction or local ischemia/hypoxia microenvironment, eventualy hampering the therapeutic outcomes. OBJECTIVE:To investigate the therapeutic effect of PTEN-silenced bone marrow mesenchymal stem cels on acute myocardial infarction. METHODS:(1) Bone marrow mesenchymal stem cels from Sprague-Dawley rats were randomly assigned to receive no treatment, NCsiRNA transfection using Lipofectamin2000orPTEN siRNA transfection using Lipofectamin2000. Cel growth curves were described using MTT method to detect cel cycle using flow cytometry. (2) Thirty Sprague-Dawley rats were selected to prepare myocardial infarction models that were randomized into three groups (n=10 per group): blank control, negative control and RNAi group. Six hours after modeling, bone marrow mesenchymal stem cels transfected with nothing, NCsiRNA and PTEN siRNA were respectively injected into the infarcted center of the left ventricular anterior wal in these three rat groups. After 4 weeks, al rats were subjected to cardiac function detection using echocardiography, and the survival and proliferation of bone marrow mesenchymal stem cels in the rats were observed by fluorescence microscopy. RESULTS AND CONCLUSION:Compared with the other two groups, a significant increase in the absorbance values at different culture time, the proportion of cels in S+G2phase, and the number ofbone marrow mesenchymal stem cels in the myocardial tissue was found in the RNAi group (alP< 0.05). Additionaly, the left ventricular ejection fraction and left ventricular shortening fraction were significantly reduced in the RNAi group than the blank control and negative control groups at 4 weeks after cel transplantation (P< 0.05). Bothin vivoandin vitroexperimental findings showed that PTEN silencing could effectively improve cel survival and proliferation in the infarcted myocardium. Moreover, in thein vivoexperiment, an overt improvement in rat’s cardiac function was achieved.