[PM2.5 Source Apportionment Based on a Variety of New Receptor Models].

In order to understand the applicability of various new receptor models, four receptor models, including the positive matrix factorization/multilinear engine 2-species ratio (PMF/ME2-SR), partial target transformation-positive matrix factorization (PTT-PMF), positive matrix factorization (PMF), and chemical mass balance (CMB), were used to analyze and verify the atmospheric fine particulate matter (PM2.5) data of a typical city in northern China. It was found that coal combustion (25%-26%), dust (19%-21%), secondary nitrate (17%-19%), secondary sulfate (16%), vehicle emissions (13%-15%), biomass burning (4%-7%), and steel (1%-2%) had a contribution to PM2.5. By comparing the source profiles and source contributions obtained by different models and calculating the coefficient of differences (CD) and average absolute error (AAE) of each source, we found that although the source apportionment results of the four models were in good agreement (the average CD value was between 0.6 and 0.7), there were still slight differences in the identification of some components in each source. Compared with the traditional model (PMF), the PMF/ME2-SR model can better identify sources with similar source profile characteristics, which is due to the component ratios of sources that are introduced. For example, the CD and AAE of dust sources were 15% and 54% lower than those of PMF, respectively. The PTT-PMF model takes the measured primary source profiles and virtual secondary source profiles as a constraint target, and the calculated CD and AAE of secondary sulfate were 0.25 and 17%, respectively, which were 55% and 23% lower than PMF. The PTT-PMF model can obtain more "pure" secondary sources and identify the pollution sources that are not identified by other models, which has more advantages in the refined identification of sources.

[Optimization of Operative Procedure in Total Laparoscopic Pancreaticoduodenectomy (with Video)].

OBJECTIVE: To optimize operative procedure on intraoperative exploration, resection and reconstruction in total laparoscopic pancreaticoduodenectomy (LPD). METHODS: The clinical data of patients who underwent total LPD in West China Hospital (and Shangjin Hospital) of Sichuan University from Dec. 2015 to Dec. 2017 were retrospectively analyzed. The diagnosis of the patients included ampullar cancer, distal common bile duct cancer, benign and maligant tumors of pancreatic head and chronic pancreatitis of pancreatic head. The patients were divided into experimental group and control group according to weather the optimization of operative procedure was used. The position and Trocar arrangement in both groups were same. Two Chief Surgeons Model was used in experimental group, the procedure was divided into three key steps: laparoscopic exploration, resection and reconstruction, each followed anticlockwise operative process, from left to right, from shallow to deep (see the Videos 1 to 3 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/202007606108). As to control group, the chief operation was finished by chief surgeon and no specific operative procedure was applied. All the patients were followed up to postoperative 90 d. RESULTS: A total of 146 patients were collected, including 76 patients undergoing LPD with optimization of operative procedure and 70 patients in the control group. There was no significant difference in preoperative data between the two groups regarding to ASA scoring, age, gender, body mass index and laboratory tests ( P>0.05). Compared with the control group, the operative time in the experimental group was significantly shorter (341 min vs. 397 min, P<0.05), estimated blood loss was significantly reduced (110 mL vs. 180 mL, P<0.05). The conversive rate, transfusion rate, length of postoperative hospital stay, number of harvested lymph nodes, post pancreatectomy hemorrhage, bile leakage, pancreatic fistula (Grade B+C), reoperation, the occurrence of severe postoperative morbidity (Clavien-Dindo Ⅲ-Ⅳ), and postoperative 90 d mortality were no statistically difference. CONCLUSION: With Two Chief Surgeons Model combined with anticlockwise operative process could optimize operative procedure in total LPD. It is safe and feasible, and could shorten the operation time and reduce intraoperative blood loss.

[Two Cases of Laparoscopic Pancreaticoduodenectomy in the Sophisticated and Complicated Situations (with Video)].

OBJECTIVE: To explore the individualized surgical strategies and surgical methods which can greatly improve the efficacy and safety of laparoscopic pancreaticoduodenectomy in difficult and complicated situations, such as pancreatic head malignant tumors invade the major vascular and chronic pancreatitis with severe abdominal adhesions. METHODS: Case 1：A 65-year-old man with jaundice was diagnosed preoperatively with a pancreatic acinus process with superior mesenteric vein (SMV) invasion. In order to ensure R0 resection, the patient underwent laparoscopic pancreaticoduodenectomy combined with SMV resection and reconstruction, taking the way of the superior mesenteric artery (SMA)-first approach. The length of SMV removed was 2 cm (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760501). The portal vein (PV)-SMV occlusion time was 26 min, the reconstruction time was 17 min. The duration of the surgery was 340 min, with 200 mL of blood loss and no transfusion. Case 2: A 47-year-old man with abdominal pain was admitted with preoperative diagnosis of pancreatic head mass with obstructive jaundice. His past medical history included small bowel resection and bowel anastomosis for abdominal trauma, open Roux-en-Y choledochojejunostomy for acute pancreatitis and obstructive jaundice. In the operation, we used ultracision harmonic scalpel, hook electrode, laparoscopic scissors, and other means to separate the adhesion of different parts of the abdominal, adjusted traditional modular surgical procedure for laparoscopic pancreaticoduodenectomy with Easy First strategy to perform surgical resection (see the Video 2 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760501). Emergencies such as mass bleeding，used Two Chief Surgeons Model to control bleeding and suture the bleeding site. The duration of the surgery was 400 min, with 500 mL of blood loss and no transfusion. RESULTS: Case 1: The patient's postoperative course was uneventful, with a hospital stay of 9 d. Histology confirmed the diagnosis of a 3.6 cm×2.4 cm×1.8 cm pancreatic ductal adenocarcinoma tumor (R0 and lymph nodes 1/26, AJCC 8th T 2N 1M 0, stage ⅡA). The removed SMV layer was invased and the cut edges were negative. The patient underwent 6 cycles of GS (gemcitabine+tegio) chemotherapy. The patient was asymptomatic 1 year later, with no tumor recurrence and no pancreatic insufficiency. Case 2: The patient's postoperative course was uneventful, with a hospital stay of 11 d. Histology confirmed the diagnosis of a 6 cm pancreatic inflammatory mass. The patient was asymptomatic 20 months later, with no recurrence of acute pancreatitis again. CONCLUSION: With different surgical methods and individualized surgical strategies, laparoscopic pancreaticoduodenectomy in difficult and complicated situations is safe and feasible in the experienced pancreas minimally invasive center.

[Application of Early Splenic Artery Occlusion in Laparoscopic Spleen-preserving Distal Pancreatectomy using Kimura Technique].

OBJECTIVE: To present our institutional experience in laparoscopic spleen-preserving distal pancreatectomy (Lap-SPDP) using Kimura technique with or without early occlusion of the root of the splenic artery. In addition, to explore the safety and feasibility of this occlusion technique, especially its advantages in intraoperative hemorrhage control and spleen preservation. METHODS: From February 2011 to May 2019, 54 consecutive patients who were diagnosed as benign or low-grade malignant space-occupying lesions at the body and the tail of pancreas underwent Lap-SPDP using Kimura technique in our institution. Twenty-five patients before 2015 were allocated into non-occlusion group and 29 patients after 2015 were allocated into occlusion group. The non-occlusion group underwent direct dissection of the distal pancreas with blood supply from the splenic artery as well as traditional traction of the splenic artery without occlusion. Whereas the occlusion group underwent temporary occlusion of the root of the splenic artery by Bulldog clip after transecting the neck of the pancreas and distal pancreas was excised under a relatively bloodless situation. Surgical techniques were described in detail. Data between groups were retrospectively collected and stratification analysis was performed based on the diameter of tumor (>3 cm or ≤3 cm). RESULTS: Before stratification, there was a statistical difference in age between the two groups ( P=0.033), but no difference in body mass index (BMI) ( P=0.069). The median lesion diameter of the two groups was 2.5 cm and 4 cm, respectively, with no statistical difference ( P=0.065). The success rates of spleen preservation in the two groups were 93.1% and 92% respectively, showing no significant difference ( P=1.000). The length of hospital stay was slightly longer in the non-occlusion group than that in the occlusion group ( P=0.020). Comparing with the non-occlusion group, the occlusion group had significantly shorter operation time (median, 165 min vs. 235 min) and less estimated blood loss (median, 100 mL vs. 200 mL) ( P<0.05). After stratification by the tumor diameter, there were 2 cases of failed spleen preservation both in occlusion and non-occlusion group with tumor diameter >3 cm (occlusion group: 2/8, 25% and non-occlusion group: 2/14,14.3%). However there was no statistical difference between the two groups ( P=0.602). When the tumor diameter ≤3 cm, the spleen preservation rate of both groups reached 100%. When the tumor diameter was >3 cm, the operation time of the occlusion group was shorter than that of the non-occlusion group ( P=0.005). In terms of intraoperative blood loss, regardless of tumor size, the occlusion group had less estimated blood loss than that of the non-occlusion group ( P<0.05). In the occlusion group, no conversion or blood transfusion was needed intraoperatively and/or postoperatively. After stratification, there was no difference in the length of hospital stay between two groups ( P>0.05). During the follow-up period (median (Min-Max), 13.5 (3-96) months), no perioperative death, disease recurrence, portal vein or splenic vein thrombosis, gastric varices or upper gastrointestinal bleeding was noted. CONCLUSION: Lap-SPDP using Kimura technique with early occlusion of the root of splenic artery was safe and feasible and could be generally applied. By using this technique, we could reduce the operation time and blood loss, as well as sustain a high probability of spleen preservation.

[Predictive Value of POSSUM and P-POSSUM Scoring System for Risk Assessment in Laparoscopic Pancreatoduodenectomy].

OBJECTIVE: To evaluate the clinical predictive ability of POSSUM and P-POSSUM scoring system in laparoscopic pancreatoduodenectomy (LPD). METHODS: There were 132 consecutive LPD performed in West China Hospital of Sichuan University from February 2014 to July 2017. The clinical data were retrospective collected, including 12 preoperative physiological variables, 6 operative severity variables, and complications and mortality The postoperative expected mortality and morbidity were calculated by POSSUM and P-POSSUM score, and compared with measured morbidity and mortality. The clinical predictive ability of POSSUM and P-POSSUM system was evaluated by the receiver operating characteristic (ROC) curve and hierarchical analysis. RESULTS: The area under ROC curve ( AUC) was 0.83. The preoperative physiological score (PS) and POSSUM score of the patients with complications were higher, and the difference was statistically significant ( P<0.01). For the prediction of complications after LPD, the expected value was the most accurate to the measured value when POSSUM score was >0.4-0.6. POSSUM scoring system had no significant difference in predicting the incidence of complications for benign and malignant lesions ( P>0.05), with a higher predictive value for malignant tumors. It was valuable in predicting the incidence of complications in male and female, and there was no significant difference in expected value between the sexes. Expected morbidity rate by POSSUM scoring system was 36.6% and measured morbidity rate was 33.3%. The expected and measured morbidities had no significantly differences. The expected mortality was 7.0% and measured mortality rate was 1.5%. The expected and measured mortality had no significantly differences. Expected mortality by P-POSSUM system was 1.6%, the expected and measured mortality had no significantly differences. CONCLUSION: POSSUM and P-POSSUM scoring system had high value for predicting LPD postoperative morbidity and mortality of LPD patients.

Longitudinal behavioral and fMRI-based assessment of inhibitory control in heroin addicts on methadone maintenance treatment.

The objective of the present study was to determine whether methadone maintenance treatment (MMT) in heroin-dependent patients affects inhibitory control, whether any MMT-induced changes correlate with methadone dose and MMT duration, and whether these changes depend on the psychological characteristics of patients, such as depression, anxiety and impulsivity. Response inhibition in the GO/NO-GO test was combined with functional magnetic resonance imaging (fMRI) scanning data to examine whether MMT affects inhibitory control in 21 heroin-addicted patients who had already undergone at least three months of MMT. Patients were evaluated one year prior to and after the MMT period. Participants exhibited no difference in their GO/NO-GO reaction time and accuracy rate, or in their false alarm rate under NO-GO conditions. However, increased activation was detected in numerous brain regions in their 12-month fMRI scans, although these were not in the frontal-striatal loop. Increased fMRI activation in the left precentral gyrus and superior temporal gyrus were negatively correlated with the daily methadone dose and total methadone dose during the one-year study period. In conclusion, these results suggested that MMT over one year does not significantly change the behavioral indicators of inhibitory control function in heroin-dependent patients. The increase in activation leads to the hypothesis that MMT over one year may increase cognitive inhibitory control, which may be the result of the combined negative effect of methadone and the positive effect of functional recovery after withdrawal of heroin.

Laparoscopic Roux-en-Y duodenojejunostomy for annular pancreas in adults: case report and literature review.

Annular pancreas is in adults is a rare congenital anomaly which incidence varied from 0.005% to 0.015%. Although 33% of the cases are symptomatic, the symptoms are most commonly associated with gastric outlet obstruction. Here we presented an adult diagnosed with annular pancreas treated by laparoscopic Roux-en-Y side to side duodenojejunostomy.

Comparison of Laparoscopic and Open Pancreaticoduodenectomy for the Treatment of Nonpancreatic Periampullary Adenocarcinomas.

BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD). MATERIALS AND METHODS: From October 2010 to September 2015, 58 LPDs were performed to treat NPPA and were compared with 58 OPDs, which can theoretically be carried out by laparoscopic approach. Patients were also matched based on their demographic data and pathologic diagnosis. Demographic information, intraoperative and postoperative data, pathologic data, and follow-up evaluation data were collected at our center. RESULTS: All patients had a median follow-up of 34 months (range, 8 to 60 mo). Overall median survival during the study between the groups was not different (P=0.760). No significant differences between the 2 groups were found in terms of patient demographics, short-term complications, pathologic outcomes, or tumor-node-metastasis stage. With regard to operative time, the LPD group was slightly longer than the OPD group (P<0.001). There were significant differences between groups in the time to the first passage of flatus and the time to oral intake (P<0.001). However, no differences were seen in blood loss, length of intensive care unit stay, node positive, or R0 resection between the laparoscopic and open groups. CONCLUSIONS: This study found that LPD is a feasible, safe, and effective method for the treatment of NPPA compared with OPD and may be a preferred method for surgeons to choose.

Magnetic resonance cholangiopancreatography study of pancreaticobiliary maljunction and pancreaticobiliary diseases.

AIM: To discuss the imaging anatomy about pancreaticobiliary ductal union, occurrence rate of pancreaticobiliary maljunction (PBM) and associated diseases in a Chinese population by using magnetic resonance cholangiopancreatography (MRCP). METHODS: Data were collected from 694 patients who underwent MRCP from January 2010 to December 2012. Three hundred and ninety-three patients were male and 301 patients were female. The age range was 16-92 years old and the average age was 51.8 years. The recruitment indication of all cases was patients who had clinical symptoms, such as abdominal pain, jaundice, nausea and vomiting, which thus were clinically suspected as relative pancreaticobiliary diseases. All cases were examined by MRCP using single-shot fast spin-echo sequences. In order to obtain MRCP images, the maximum intensity projection was used. RESULTS: According to the anatomy of pancreaticobiliary ductal union based on our analysis of MRCP images, all cases were classified into normal type and abnormal type according to the position of pancreaticobiliary ductal union. The abnormal type could be further divided into P-B type, B-P type and the duodenum type. By analyzing the incidence of biliary stone and inflammation, pancreatitis, biliary duct tumors and pancreatic tumors between normal and abnormal types, significant differences existed. The abnormal group was more likely to suffer from pancreaticobiliary diseases. Comparing three different types of PBM that were associated with pancreaticobiliary diseases by using Fisher's method, the result showed that there was no significant difference in the incidence of biliary stones, cholecystitis and pancreatic tumors. The incidence of pancreatitis in B-P type and P-B type was higher than that in duodenum type; the incidence of biliary duct tumor in B-P type was higher than that in P-B type; the incidence of biliary duct tumor in duodenum type was lower than that in P-B type. The incidence of congenital choledochus dilatation in normal type and abnormal type was similar, and there was no significant difference between the two types. CONCLUSION: Types of PBM are closely related to the occurrence of pancreaticobiliary diseases. MRCP has important clinical value in the early diagnosis and preventive treatment of pancreaticobiliary diseases.

Laparoscopic splenectomy for treatment of splenic marginal zone lymphoma.

AIM: To investigate the short-term and long-term efficacy and safety of laparoscopic splenectomy (LS) for treatment of splenic marginal zone lymphoma (SMZL). METHODS: A total of 18 continuous patients who were diagnosed with SMZL and underwent LS in our department from 2008 to 2012 were reviewed. The perioperative variables and long-term follow-up were evaluated. To evaluate the efficacy and safety of this procedure better, we also included 34 patients with liver cirrhosis who underwent LS, 49 patients with immune thrombocytopenia (ITP) who underwent LS, and 20 patients with SMZL who underwent open splenectomy (OS). The results observed in the different groups were compared. RESULTS: No differences were found in the sex and Child-Pugh class of the patients in SMZL-LS, SMZL-OS, ITP, and liver cirrhosis groups. The splenic length of the patients in the SMZL-LS group was similar to that in the SMZL-OS and liver cirrhosis groups but significantly longer than in the ITP group. The SMZL-LS group had a significantly longer operating time compared with the SMZL-OS, ITP, and liver cirrhosis groups, and the SMZL-LS group exhibited significantly less blood loss compared with the SMZL-OS group. No difference was found in the length of the postoperative hospital stay between the SMZL-LS, SMZL-OS, ITP, and liver cirrhosis-LS groups. After surgery, 6 (33.3%) SMZL-LS patients suffered slight complications. During mean follow-up periods of 13.6 and 12.8 mo, one patient from the SMZL-LS group and two from the SMZL-OS group died as a result of metastasis after surgery. None of the ITP and liver cirrhosis patients died. CONCLUSION: LS should be considered a feasible and safe procedure for treatment of SMZL in an effort to improve the treatment options and survival of patients.

[Delayed gastric emptying after laparoscopic versus open pancreaticoduodenectomy: a comparative study].

OBJECTIVE: To investigate the effect on postoperative delayed gastric emptying (DGE) after laparoscopic versus open pancreaticoduodenectomy (PD). METHODS: Data from 67 consecutive PD procedures performed between October 2010 and October 2012 were retrospectively analyzed. Among them, 20 patients underwent laparoscopic PD (LPD group), and 47 patients underwent open PD (OPD group; 22 patients underwent pylorus-preserving PD, 25 patients underwent standard PD). RESULTS: The LPD group had significantly longer operative times ((494 ± 46) minutes vs. (391 ± 70) minutes, t = -4.40, P = 0.000), reduced blood loss ((294 ± 158) ml. vs. (399 ± 68) ml, t = 2.73, P = 0.008) and shorter postoperative hospital stay (13.0 days vs. 16.3 days, t = 3.01, P = 0.009) compared to the OPD group. However, there was no difference in terms of DGE occurrence and postoperative complication rates. There was one postoperative death in the OPD group and none in the LPD group. Multivariate analysis by Logistic regression showed that DGE was significantly more frequent among patients with longer operative times (OR = 1.01, 95%CI: 1.000 - 1.024, P = 0.048), increased intraoperative blood loss (OR = 1.01, 95%CI: 1.000 - 1.022, P = 0.040) and postoperative intraabdominal complications (OR = 6.22, 95%CI: 1.400 - 27.700, P = 0.017). Mean postoperative hospital stay was longer among patients who developed DGE (19.7 days vs. 13.6 days, t = -6.50, P = 0.000) than those without DGE. CONCLUSIONS: Longer operative time, increased intraoperative blood loss and postoperative intraabdominal complications appear to be risk factors for DGE development. Meanwhile, the laparoscopic approach PD is safe and feasible, and outcomes appears comparable with those undergoing an open approach.

[Synthesis of a supermolecular nanoparticle γ-hy-PC/Ada-Dox and its antitumor activity].

OBJECTIVE: To synthesize a (2-Hydroxypropyl)-γ-cyclodextrin-polyethylenimine/adamantane-conjugated doxorubicin (γ-hy-PC/Ada-Dox) based supramolecular nanoparticle with host-guest interaction and to identify its physicochemical characterizations and antitumor effect. METHODS: A novel non-viral gene delivery vector γ-hy-PC/Ada-Dox was synthesized based on host-guest interaction. 1H-NMR, NOESY, UV-Vis, XRD and TGA were used to confirm the structure of the vector. The DNA condensing ability of complexes was investigated by particle size, zeta potential and gel retardation assay. Cytotoxicity of complexes was determined by MTT assay in BEL-7402 and SMMC-7721 cells. Cell wound healing assay was performed in HEK293 and BEL-7404 cells. The transfection efficiency was investigated in HEK293 cells. H/E staining and cell uptake assay was performed in BEL-7402 cells. RESULTS: The structure of γ-hy-PC/Ada-Dox was characterized by 1H-NMR, NOESY, UV-Vis, XRD, TGA. The drug loading was 0.5% and 5.5%. Gel retardation assay showed that γ-hy-PC was able to completely condense DNA at N/P ratio of 2; 0.5% and 5.5% γ-hy-PC/Ada-Dox was able to completely condense DNA at N/P ratio of 3 and 4,respectively. The cytotoxicity of polymers was lower than that of PEI25KDa. The transfection efficiency of γ-hy-PC was higher than that of γ-hy-PC/Ada-Dox at N/P ratio of 30 in HEK293 cells; and the transfection efficiency was decreasing when Ada-Dox loading was increasing. Cell uptake assay showed that γ-hy-PC/Ada-Dox was able to carry drug and FAM-siRNA into cells. CONCLUSION: The novel vector γ-hy-PC/Ada-Dox has been developed successfully, which has certain transfection efficiency and antitumor activity.

[Involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention].

OBJECTIVE: To explore the involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention (PCI). METHODS: A total of 396 patients undergoing PCI were investigated between January 2009 and December 2010. All of them completed the Hospital Anxiety and Depression Scale (HADS) before discharge and at 12 months post-PCI. We evaluated the involvement characteristics and used Logistic regression to analyze the influencing factors of mood changes. RESULTS: The relevant factors of post-PCI anxiety were gender (P = 0.003), age (P = 0.004) and acute myocardial infarction (P = 0.009) while depression was associated with acute myocardial infarction (P < 0.001). A 12-month follow-up study showed that anxiety remained stable in 76.3% of patients while depression in 79.5%. Multi-factor analysis showed that factors of presence of adverse cardiovascular events (OR: 1.323, 95%CI: 1.026 - 1.705, P = 0.031), Seattle angina score (OR: 0.870, 95%CI: 0.772 - 0.981, P = 0.023) and anxiety scores at pre-discharge (OR: 1.228, 95%CI: 1.053 - 1.432, P = 0.009) were correlated with the deterioration degree of depression. And the factor associated with the deterioration of depression was the scores before discharge (OR: 1.287, 95%CI: 1.072 ∼ 1.545, P = 0.007). CONCLUSION: The levels of anxiety and depression remain stable in the majority of PCI patients at Month 12 post-PCI. Perioperative communication and effective control of postoperative cardiovascular events may ease a patient's negative emotions and improve their living quality.

[Association of differentially expressed genes in the macrophages of spleen in patients with idiopathic thrombocytopenic purpura by cDNA microarray].

OBJECTIVE: To study the differentially expressed genes of splenic macrophage in patients with immune thrombocytopenic purpura. METHODS: Macrophages were isolated from the spleen. Total RNA of the macrophages were extracted and reversely transcript into cDNA. cDNAs were labeled with Cy5, then hybridized with cDNA chips containing 30968 genes. The gene chips were scanned and analyzed for the differentially expressed genes. RESULTS: A total of 1545 differentially expressed genes were identified by cDNA chip. 718 genes were highly expressed and 827 genes were down-regulated. The differently expressed genes include those involved in immunologic response, cell adhesion, cell signal transduction, cytoskeleton, exercise metabolism, apoptosis, enzyme regulator activity and so on. The pathway association analysis were related with Toll-like receptor pathway, Fc gamma mediated phagocytosis, MAPK signaling pathway, endocytosis. CONCLUSION: cDNA mircroarray is an effective technique in screening for differentially expressed genes of the macrophages in patients with ITP. Further analysis of the obtained genes will help understanding the pathogenesis of ITP, and the therapeutic targets.

Predictive factors of recurrent angina after acute coronary syndrome: the global registry acute coronary events from China (Sino-GRACE).

BACKGROUND: Many patients with acute coronary syndrome (ACS) develop recurrent angina (RA) during hospitalization. The aim of this non-randomized, prospective study was to investigate the predictive factors of RA in unselected patients with ACS enrolled in the global registry acute coronary events (GRACE) during hospitalization in China. METHODS: Between March 2001 and October 2004, enrolled were 1433 patients with ACS, including ST segment elevation myocardial infarction (662, 46.2%), non-ST segment elevation myocardial infarction (239, 16.7%) and unstable angina (532, 37.1%). The demographic distribution, medical history and clinical data were collected to investigate the predictive factors of RA by Logistic regression. RESULTS: During hospitalization 275 (19.2%) patients were documented with RA including unstable angina (53.2%), non-ST segment elevation myocardial infarction (27.5%), ST segment elevation myocardial infarction (19.3%). A comorbidity of dyslipidemia, prior angina, percutaneous coronary intervention (PCI) within 6 months was more common in patients with RA, P < 0.05. In the patients with RA, a significantly higher proportion of patients with acute pulmonary edema was observed, 23 (8.4%) versus 43 (3.7%), P = 0.001. Acute renal failure was present in 8 (2.9%) of patients with RA versus 19 (1.6%) of patients without RA, P = 0.165. Hemorrhagic events were present in 6 (2.2%) of patients with RA versus 8 (0.7%) of patients without RA, ventricular tachycardia/ventricular fibrillation events in 12 patients (4.3%) versus 22 patients (1.9%), congestive heart failure in 69 patients (25.0%) versus 94 patients (8.1%), myocardial re-infarction in 28 patients (10.1%) versus 15 patients (1.3%), P < 0.05, respectively. A lower proportion of patients with RA underwent in-hospital PCI, 687 (59.3%) versus 114 (41.5%), P = 0.000. A higher proportion of patients with RA received heparin, 260 (94.5%) versus 1035 (89.4%), P = 0.006; and beta-blockers 176 (64.0%) versus 864 (74.5%), P = 0.000. Multivarible regression analysis showed that RA was associated with prior angina (OR 2.086, 95% CI 1.466 - 2.967), in-hospital PCI (OR 0.579, 95% CI 0.431 - 0.778), in-hospital congestive heart failure (OR 2.410, 95% CI 1.634 - 3.555), myocardial re-infarction (OR 7.695, 95% CI 3.701 - 15.999), beta-blocker (OR 0.626, 95% CI 0.458 - 0.855), and heparin (OR 3.411, 95% CI 1.604 - 7.382). CONCLUSIONS: In-hospital congestive heart failure, myocardial re-infarction, prior angina history and use of heparin are stronger independent predictors of RA; beta-blockers and PCI are also important predictive factors for RA.