Objectives:To explore the feasibility and efficacy of electrophysiology guidance for transcatheter closure of perimembranous ventricular septal defect(PmVSD)in adults.Methods:Adult patients with PmVSD who underwent tr...Objectives:To explore the feasibility and efficacy of electrophysiology guidance for transcatheter closure of perimembranous ventricular septal defect(PmVSD)in adults.Methods:Adult patients with PmVSD who underwent transcatheter in Guangdong Provincial People’s Hospital,Guangdong Cardiovascular Institute from February 2016 to January 2018 were selected.The distribution of the His-Purkinje system(HPS)close to the margins of PmVSD in the left ventricle was identified using three-dimensional(3D)electro-anatomic mapping and near-field HPS was further confirmed by different pacing protocols.The follow-up protocol included electrocardiogram(ECG)and transthoracic echocardiography at 6,24,72 h,1,3,6 months and 1,2,3,5 years after the procedure.Results:Of the 21 patients in the study,with an average age of 28.1 years,61.9%were female and 38.1%were male.Eighteen patients(85.7%)successfully underwent transcatheter intervention.The minimum distance between the margins of the PmVSD and near-field HPS ranged from 2.5±0.7(1.3~3.9)mm.An average follow-up period was 4.1±1.3(0.25~5)years,median of which was 5 years.1,3,5-year follow-up rate was 95.2%,90.4%and 52.4%,respectively.At the end of the follow-up,ECG abnormalities were observed in 5 cases(23.8%),including left anterior hemiblock(LAH)in 3 cases(14.3%),incomplete right bundle branch block and LAH in 1 case(4.8%),premature atrial contraction in 1 case(4.8%).Mild tricuspid regurgitation(TR)and mild TR with mild mitral regurgitation with mild aortic regurgitation was observed in 1 case(4.8%),as well as left ventricular diastolic dysfunction.Conclusions:The study indicates that the results have guiding significance for transcatheter closure of PmVSD guided by 3D electro-anatomic mapping technique.However,this method requires a larger amount of clinical research data to support.展开更多
AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017...AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.展开更多
The aim of this study is to evaluate the efficacy of total saponins of Dioscorea（TSD）, an extract of the Chinese herbal Bi Xie, on hyperuricemia and to elucidate the underlying mechanisms. The rat hyperuricemia mode...The aim of this study is to evaluate the efficacy of total saponins of Dioscorea（TSD）, an extract of the Chinese herbal Bi Xie, on hyperuricemia and to elucidate the underlying mechanisms. The rat hyperuricemia model was established by administration of adenine. Thirty-two rats were randomly allocated into 4 groups： model group, low/high-dose TSD-treated groups, and allopurinol-treated group. Meanwhile, 8 rats were used as normal controls. Serum uric acid（UA）, blood urea nitrogen（BUN）, serum creatinine（Scr）, and organic anion transporting polypeptide 1A1（OATP1A1） levels were measured. Comparison between the model group and treatment（allopurinol and TSD） groups showed the serum UA levels were significantly decreased in treatment groups. TSD had similar effects to allopurinol. It was found that the OATP1A1 protein expression levels in treatment groups were higher than in model group and normal controls. And different from the allopurinol-treated groups, TSD-treated group had elevated OATP1A1 expression levels in the stomach, liver, small intestine and large intestine tissues. It was suggested that TSD may facilitate the excretion of UA and lower UA levels by up-regulating OATP1A1 expression.展开更多
Background Valvular heart disease(VHD)is expected to become more prevail as the population ages and disproportionately affects older adults.However,direct comparison of clinical characteristics,sonographic diagnosis,a...Background Valvular heart disease(VHD)is expected to become more prevail as the population ages and disproportionately affects older adults.However,direct comparison of clinical characteristics,sonographic diagnosis,and outcomes in VHD patients aged over 65 years is scarce.The objective of this study was to evaluate the differences in clinical characteristics and prognosis in two age-groups of geriatric patients with VHD.Methods We retrospectively enrolled consecutive individuals aged>65 years from Guangdong Provincial Peopled Hospital and screened for VHD using transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE).Finally,260(48.9%)patients were in the 65-74 years group,and 272(51.1%)were in the>75-year group.Factors that affected long-term survival was explored.A multivariable Cox hazards regression was performed to identify the predictors of major adverse cardiac events(MACEs)in each group.Results In our population,the older group were more likely to have chronic obstructive pulmonary disease(COPD),degenerative VHD,but with less rheumatic VHD,aortic stenosis(AS)and mitral stenosis(MS).Compared with those aged 65-74 years,the older group had a higher incidence of all-cause death(10.0%vs.16.5%,P=0.027),ischemic stroke(13.5%vs.20.2%,P=0.038)and MACEs(37.3%vs.48.2%,P=0.011)at long-term follow-up.In multivariable Cox regression analysis,mitral regurgitation,a history of COPD,chronic kidney disease,diabetes,hypertension,atrial fibrillation and New York Heart Association(NYHA)functional class were identified as independent predictors of MACEs in the older group.Conclusion Advanced age profoundly affect prognosis and different predictors were associated with MACEs in geriatric patients with VHD.展开更多
AIM To identify functional proteins involved in pancreaticduodenal homeobox-1(PDX1)-mediated effects on gastric carcinogenesis.METHODS A PDX1-overexpressed model was established by transfecting gastric cancer cell lin...AIM To identify functional proteins involved in pancreaticduodenal homeobox-1(PDX1)-mediated effects on gastric carcinogenesis.METHODS A PDX1-overexpressed model was established by transfecting gastric cancer cell line SGC7901 with pcDNA3.1(+)-PDX1 vector(SGC-PDX1). Transfection with empty pcDNA3.1 vector(SGC-pcDNA) served as control. Comparative protein profiles of the two groups were analyzed by two-dimensional electrophoresis basedproteomics(2 DE gel-based proteomics). The differential proteins identified by 2 DE were further validated by qRTPCR and immunoblotting. Finally, co-immunoprecipitation was used to determine any direct interactions between PDX1 and the differential proteins.RESULTS2 DE gel proteomics identified seven differential proteins in SGC-PDX1 when compared with those in SGC-pcDNA. These included four heat shock proteins(HSPs; HSP70 p1 B, HSP70 p8, HSP60, HSP27) and three other proteins(ER60, laminin receptor 1, similar to epsilon isoform of 14-3-3 protein). Immunoblotting validated the expression of the HSPs(HSP70, HSP60, HSP27). Furthermore, their expressions were lowered to 80%, 20% and 24%, respectively, in SGC-PDX1, while PDX1 exhibited a 9-fold increase, compared to SGC-pcDNA. However, qRT-PCR analysis revealed that mRNA levels of the HSP s were increased in SGC-PDX1, suggesting that the expression of the HSP s was post-translationally regulated by the PDX1 protein. Finally, co-immunoprecipitation failed to identify any direct interaction between PDX1 and HSP70 proteins.CONCLUSION This study demonstrates the potential involvement of HSPs in PDX1-mediated effects on the genesis of gastric cancer.展开更多
Objective Vitamin D(VD)deficiency was reported to contribute to the progression of Crohn’s disease(CD)and affect the prognosis of CD patients.This study investigated the role of serum VD,body mass index(BMI),and tumo...Objective Vitamin D(VD)deficiency was reported to contribute to the progression of Crohn’s disease(CD)and affect the prognosis of CD patients.This study investigated the role of serum VD,body mass index(BMI),and tumor necrosis factor alpha(TNF-α)in the diagnosis of Crohn’s disease.Methods CD patients(n=76)and healthy subjects(n=76)were enrolled between May 2019 and December 2020.The serum 25-hydroxyvitamin D[25(OH)D]levels,BMI,and TNF-αlevels,together with other biochemical parameters,were assessed before treatment.The diagnostic efficacy of the single and joint detection of serum 25(OH)D,BMI,and TNF-αwas determined using receiver operating characteristic(ROC)curves.Results The levels of 25(OH)D,BMI,and nutritional indicators,including hemoglobin,total protein,albumin,and high-density lipoprotein cholesterol,were much lower,and the TNF-αlevels were much higher in the CD patients than in the healthy subjects(P<0.05 for all).The areas under the ROC curve for the single detection of 25(OH)D,BMI,and TNF-αwere 0.887,0.896,and 0.838,respectively,with the optimal cutoff values being 20.64 ng/mL,19.77 kg/m^(2),and 6.85 fmol/mL,respectively.The diagnostic efficacy of the joint detection of 25(OH)D,BMI,and TNF-αwas the highest,with an area under the ROC curve of 0.988(95%CI:0.968–1.000).Conclusion The joint detection of 25(OH)D,TNF-α,and BMI showed high sensitivity,specificity,and accuracy in CD diagnosis;thus,it would be effective for the diagnosis of CD in clinical practice.展开更多
Background The prognosis of elderly patients with ST-segment elevation myocardial infarction(STEMI)is poor,and information on specific risk factors remains scarce.We aimed to investigate the prevalence and the prognos...Background The prognosis of elderly patients with ST-segment elevation myocardial infarction(STEMI)is poor,and information on specific risk factors remains scarce.We aimed to investigate the prevalence and the prognostic impact of postoperative carbon dioxide combining power(CO_(2)CP)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The association between postoperative CO_(2)CP and in-hospital and 1-year mortality was evaluated.Results A total of 775 elderly patients with STEMI were included and divided into two groups according to the lower normal limits of CO_(2)CP:<22 mmol/L(n=180),and≥22 mmol/L(n=595).The incidence of in-hospital death(12.2%vs.4.2%,P<0.001),acute kidney injury(25.0%vs.13.3%,P<0.001)and major adverse clinical events(30.0%vs.8.7%,P<0.001)were significantly higher in patients with a low CO_(2)CP.Multivariate logistic regression analysis showed an independent relationship between CO_(2)CP and in-hospital death[odd ratio(OR):0.88,95%confidential interval(CI):0.80-0.97,P=0.010].This relationship disappeared in one-year mortality[hazard ratio(HR):0.95,95%CI:0.89-1.01,P=0.116].Conclusions Postoperative CO_(2)CP is a feasible predictor during hospitalization for elderly patients with STEMI receiving PCI.展开更多
Background Although neutrophil-to-lymphocyte ratio(NLR) has been extensively studied in several diseases, its predictive role in infective endocarditis(IE) complicated with sepsis remains unclear. The aim of this stud...Background Although neutrophil-to-lymphocyte ratio(NLR) has been extensively studied in several diseases, its predictive role in infective endocarditis(IE) complicated with sepsis remains unclear. The aim of this study was to explore the prognostic value of NLR in IE patients complicated with sepsis. Methods Patients with the diagnosis of IE complicated with sepsis was retrospectively enrolled between January 2009 to February 2020 in the Guangdong Provincial People's Hospital. Multivariate analysis was used to investigate the relationship between NLR and short-term mortality. Results A total of 496 IE patients complicated with sepsis were included and divided into three groups according to the tertiles of NLR: <4.3(n=161), 4.3-8.7(n=170), and >8.7(n=165). Restricted cubic splines showed an approximately positive linear correlation between the level of NLR and risk of in-hospital death. Multivariate logistic regression analysis showed an independent correlation between elevated NLR and in-hospital death [odds ratio(OR): 1.04, 95% confidential interval(CI): 1.01-1.07, P=0.015]. The receiver operating characteristic curve analysis demonstrated a relatively high predictive value of NLR for identifying in-hospital death(area under curve: 0.643, 95% CI: 0.570-0.717, P<0.001, sensitivity: 45.1%, specificity: 81.6%, optimal cut-off value: 11). Multivariate Cox survival analysis revealed that NPR >11(HR: 1.57, 95% CI: 1.02-2.41, P=0.039) was independent predictor for 6-month mortality. Conclusions NLR is a feasible predictor of short-term mortality for IE patients complicated with sepsis.展开更多
OBJECTIVE:To observe the curative effect of an acupoint application with a Dingqi analgesic patch on moderate to severe pain caused by liver cancer.METHODS:Forty patients with moderate to severe pain caused by liver c...OBJECTIVE:To observe the curative effect of an acupoint application with a Dingqi analgesic patch on moderate to severe pain caused by liver cancer.METHODS:Forty patients with moderate to severe pain caused by liver cancer were randomly divided intoatreatmentgroup(TG)andacontrolgroup(CG).Patients with moderate pain were given 100 mg qd of a sustainably released tablet of tramadol hydrochloride;patientswithseverepainweregiven4.2mg q3d of the fentanyl transdermal system.The ashi points Ganshu(BL 18),Danshu(BL 19) and Qimen(LR 14) were chosen for the acupoint application intervention.CG patients were given a sham patch and TG patients were given a Dingqi analgesic patch.A visual analogue scale(VAS) was used before treatment and after 1,3,6,9 and 12 days of treatment.The Karnofsky score was measured before treatment and after 12 days of treatment.Any main adverse reactions(e.g.nausea,constipation,dizziness and headache) were recorded after 6 and 12 days of treatment.Any skin side effects(i.e.skin irritation and allergic reactions) were recorded.RESULTS:The VAS in TG was significantly lower than that in CG after 3,6,9 and 12 days of treatment(P<0.05).There was no significant difference in the Karnofsky score before treatment and after 12 days of treatment between CG and TG.There were also no significant differences in the main adverse reactions or skin side effects after 6 and 12 days of treatment between CG andTG(P>0.05).CONCLUSION:The Dingqi analgesic patch can enhance the analgesic effect of tramadol and fentanyl.展开更多
OBJECTIVE: To investigate the antiepileptic effects of Chaihushugan decoction(CHSGD) in rats with pentylenetetrazole(PTZ)-induced seizures and to discuss the impact of CHSGD on glutamate metabolism, a hypothesized und...OBJECTIVE: To investigate the antiepileptic effects of Chaihushugan decoction(CHSGD) in rats with pentylenetetrazole(PTZ)-induced seizures and to discuss the impact of CHSGD on glutamate metabolism, a hypothesized underlying mechanism of seizure reduction.METHODS: Fifty Wistar rats were divided randomly into either control(n = 10) or experimental(n = 40)groups. Rats in the control group were administered physiological saline intraperitoneally. A subconvulsive dose of PTZ(35 mg/kg) was administered intraperitoneally to rats in the experimental group to induce seizures. The fully PTZ-kindled rats were then randomly divided into five subgroups(n = 8 each) based on the following treatment categories: physiological saline, VPA(200 mg/kg), CHSGD(2.5 g/kg), CHSGD(5 g/kg), or CHSGD(10 g/kg),administered orally once per day, respectively. On day 28 following initiation of drug treatment, seizures were monitored. The rats were then sacrificed, and hippocampal dissections were performed for subsequent studies.RESULTS: CHSGD significantly prolonged the latency of myoclonic, clonic, and tonic seizures, while decreasing overall seizure rates in the kindled rats.The measured concentrations of 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-d-glucose(2-NBDG) and glutamate were significantly lower in the hippocampi of kindled rats in groups treated with CHSGD compared with those treated with PTZ alone. In addition, CHSGD was found to up-regulate both the expression of glutamate transporter-1(GLT-1) protein and the activity of glutamine synthetase(GS) in the hippocampi of kindled rats.CONCLUSION: These results suggest that CHSGD has antiepileptic effects on PTZ-induced seizures.The results further suggest an increase in glutamate metabolism at the synaptic cleft is a putative underlying mechanism of seizure reduction.展开更多
Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the rela...Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.Methods:A total of 441 patients were included.Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy.HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry.CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis.The data were compared by binary logistic regression to find the risk factors.The primary endpoint was major adverse clinical events (MACEs),and patients were followed for a median time of 29 months.Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.Results:The rate of HTPR was 17.2%.Logistic regression identified the following predictors of HTPR:age,therapy regimen,body mass index,diabetes history,CYP2C19^*2,or CYP2C19^*3 variant.The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval:0.738–0.848).Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs.9.9%;χ^2 = 7.572,P = 0.010).Conclusions:Our results suggest that advanced age,higher body mass index,treatment with regular dual antiplatelet therapy,diabetes,and CYP2C19^*2 or CYP2C19^*3 carriers are significantly associated with HTPR to clopidogrel.The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.展开更多
Background Mortality in patients with acute myocardial infarction(AMI)undergoing an intra-aortic balloon pump(IABP)implantation remains high.This study aims to analyze the risk factors and subsequent prognostic impact...Background Mortality in patients with acute myocardial infarction(AMI)undergoing an intra-aortic balloon pump(IABP)implantation remains high.This study aims to analyze the risk factors and subsequent prognostic impact of pulmonary infection in these populations.Methods Data of patients with AMI treated with the IABP between August 2017 and May 2018 was collected retrospectively.A total of 104 AMI patients who underwent the IABP and complicated with postoperative pulmonary infection were assigned to the observation group,meanwhile,73 patients without pulmonary infection were chosen as the control group.The clinical characteristics were compared between two groups of patients,the risk factors and outcomes for the postoperative pulmonary infections were analyzed.Results Pulmonary infection can prolong CCU duration(11.7±8.2 vs.6.5±4.1,P<0.001)and lead to higher in-hospital death(31.5%vs.12.5%,P=0.002).Killip>2 was an independent risk factor for pulmonary infection.In addition,multivariate logistic regression analysis indicated that Killip>2,diabetes,current smoking,and pulmonary infection were independently associated with in-hospital death.Conclusions Postoperative pulmonary infection was a risk factor for poor outcomes in patients with AMI undergoing IABP.It is necessary to take corresponding interventions to reduce the risk of postoperative pulmonary infection.展开更多
The abnormal activation of epidermal growth factor receptor(EGFR)drives the development of non-small cell lung cancer(NSCLC).The EGFR-targeting tyrosine kinase inhibitor osimertinib is frequently used to clinically tr...The abnormal activation of epidermal growth factor receptor(EGFR)drives the development of non-small cell lung cancer(NSCLC).The EGFR-targeting tyrosine kinase inhibitor osimertinib is frequently used to clinically treat NSCLC and exhibits marked efficacy in patients with NSCLC who have an EGFR mutation.However,free osimertinib administration exhibits an inadequate response in vivo,with only~3%patients demonstrating a complete clinical response.Consequently,we designed a biomimetic nanoparticle(CMNP^(@Osi))comprising a polymeric nanoparticle core and tumor cell-derived membrane-coated shell that combines membrane-mediated homologous and molecular targeting for targeted drug delivery,thereby supporting a dual-target strategy for enhancing osimertinib efficacy.After intravenous injection,CMNP^(@Osi)accumulates at tumor sites and displays enhanced uptake into cancer cells based on homologous targeting.Osimertinib is subsequently released into the cytoplasm,where it suppresses the phosphorylation of upstream EGFR and the downstream AKT signaling pathway and inhibits the proliferation of NSCLC cells.Thus,this dual-targeting strategy using a biomimetic nanocarrier can enhance molecular-targeted drug delivery and improve clinical efficacy.展开更多
Background Acute respiratory distress syndrome （ARDS） caused by H7N9 influenza in pregnant woman is a life-threatening event with an increased risk for maternal and baby＇ s death. The aim of this study was to evalu...Background Acute respiratory distress syndrome （ARDS） caused by H7N9 influenza in pregnant woman is a life-threatening event with an increased risk for maternal and baby＇ s death. The aim of this study was to evaluate the impact of point-of-care ultrasonography （POCUS） on the management and prognosis of these patients. Methods A case of 31-yr-old pregnant woman in our hospital, who was underwent POCUS for evaluating car- diopulmonary functions, volume state, fluid responsiveness and ultrasound-guided procedures was admitted to In- tensive Care Unit （ICU）. We performed ultrasonography daily for monitoring organ functions. Review of related literatures was also conducted. Results With the help of POCUS, we made quickly diagnosis of severe pneumo- nia and ARDS caused by H7N9 influenza. The therapies had also been changed after POCUS examinations, such as restrict fluid administration relying on the assessments of the inferior vena cava （IVC） to estimate preload and lung ultrasound monitoring to identify the early presence of extravascular lung water （EVLW） and avoid fluid over resuscitation, ultrasound-guided recruitment maneuver to improved respiratory distress syndrome, and so on. Conclusions POCUS has a significant impact on decision-making and therapeutic management and should become a clinical routine in the management of ARDS patients caused by H7N9 influenza in pregnancy.展开更多
Background Septic shock caused by bacteremia is a life-threatening infection whose prognosis is highly de- pendent on early recognition and appropriate treatment. Procalcitonin （PCT） has been shown to accurately and...Background Septic shock caused by bacteremia is a life-threatening infection whose prognosis is highly de- pendent on early recognition and appropriate treatment. Procalcitonin （PCT） has been shown to accurately and quickly distinguish bacteremia from noninfectious inflammatory states in critically severe patients. However, the extent of PCT magnitude elevation according to the Gram stain result in elderly patients with coronary heart disease （CHD） at the onset of septic shock caused by bacteremia varies, and has not been clearly elucidated. Methods The medical records of advanced age （non-neutropenic） patient with CHD and septic shock between Mar 2013 and Jun 2015 who had bacteremia caused by either Gram-positive （GP） bacteria or Gram-negative （GN） bacteria were reviewed, and the levels of PCT, C- reactive （CRP） protein and white blood cells count （WBC） in both groups were analyzed. Results 75 episodes of either GN bacteremia （n = 40） or GP bacteremia （n = 35） were enrolled. PCT levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia [（8.93± 17.58） vs. （64.42± 58.56） ng/L （P 〈 0.001）], whereas there was no significant differ- ence in CRP and WBC （P 〉 0.05）. Moreover, a high PCT level was found to be independently associated with GN bacteremia in this study population. A PCT level of 19.69 ng/mL yielded a 72.5% sensitivity, a 91.4% specificity, an 8.43 positive likelihood ratio and a 0.30 negative likelihood ratio for GN-related bacteremia in the study cohort [AUROCC = 0.870 （0.041）, 95% CI （0.790-0.949）]. Conclusion In an elderly patient （non-neutropenic） with CHD and septic shock, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia （PCT 〉 19.69 ng/mL）.展开更多
Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mo...Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.展开更多
Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare...Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.展开更多
Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not ...Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.展开更多
Background Acute kidney injury(AKI)was a risk factor for poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).Whether postoperative serum creatinine(SCr)level measured at early time(24 hour...Background Acute kidney injury(AKI)was a risk factor for poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).Whether postoperative serum creatinine(SCr)level measured at early time(24 hours)after percutaneous coronary intervention(PCI)had prognostic role in elderly patients with STEMI was unclear.Methods SCr was measured within 24 hours after PCI.A total of 883 elderly patients(≥60 years)with STEMI were finally included and divided into three group according to the tertiles of postoperative SCr level(umol/L):<81(n=283),81-107(n=302)and≥107(n=298).The relationship between postoperative Scr and in-hospital and 1-year adverse events was evaluated.Results In-hospital mortality was 5.4%(48/883),which was significantly higher in patients with a high postoperative SCr level(1.8%vs.3.0%vs.11.4%,P<0.001).Receiver operator characteristic curve analysis indicated that postoperative SCr>120 umol/L had a sensitivity of 66.7%and specificity of 79.2%for predicting in-hospital death[area under the curve(AUC)=0.768,95%CI:0.697-838,P<0.001].Multivariate analysis showed that postoperative Scr>120 umol/L was an independent risk factor for in-hospital mortality even after adjusting for the baseline renal dysfunction[estimated glomerular filtration rate(e GFR)<60 m L/(min·1.73 m2)].Kaplan-Meier analysis showed that patients with postoperative SCr>120 umol/L had a higher one-year mortality than those without(Log-rank test:57.8,P<0.001).Conclusions SCr level measured within 24 hours after PCI could serve as an early and powerful marker for predicting in-hospital and one-year mortality in elderly patients with STEMI.展开更多
Background A pulmonary-infected patient had severe hyponatremia that lasted two days during hospitalization.We could not find any history such as gluttony,liver and gall disease.The examination of liver function repor...Background A pulmonary-infected patient had severe hyponatremia that lasted two days during hospitalization.We could not find any history such as gluttony,liver and gall disease.The examination of liver function reported that the hepatic enzymology is normal.In ICU,we quickly found hemodiastase reached at extremely high level.The berry CT indicated that the head of pancreas swelling and the boundary was obscure and effusive.The patient was diagnosed as acute pancreatitis.This case raises a question to us：Does severe hyponatremia cause acute pancreatitis？ It has not been reported.Methods We established acute animal model of hyponatremia that did not include any other electrolyte chaos.After the animal model of hyponatraemia completed,serum amylase levels and pathological examination were analyzed.Results The hyponatremia models,out of 16 rats,only four rats＇ serum sodium were less than 120 mmol /L.In these four rats,besides serum sodium,the remaining electrolytes were normal and serum lipids were in normal range,only one rat＇s serum amylase increased significantly more than four times of the normal control group and its pathological findings hinted pancreatic edema.Conclusions The experimental model successfully duplicated the clinical and pathologic features of pancreatitis induced by hyponatraemia.Through this case report,we hope that attention can be paid to changes in serum amylase when hyponatremia appeared.展开更多
文摘Objectives:To explore the feasibility and efficacy of electrophysiology guidance for transcatheter closure of perimembranous ventricular septal defect(PmVSD)in adults.Methods:Adult patients with PmVSD who underwent transcatheter in Guangdong Provincial People’s Hospital,Guangdong Cardiovascular Institute from February 2016 to January 2018 were selected.The distribution of the His-Purkinje system(HPS)close to the margins of PmVSD in the left ventricle was identified using three-dimensional(3D)electro-anatomic mapping and near-field HPS was further confirmed by different pacing protocols.The follow-up protocol included electrocardiogram(ECG)and transthoracic echocardiography at 6,24,72 h,1,3,6 months and 1,2,3,5 years after the procedure.Results:Of the 21 patients in the study,with an average age of 28.1 years,61.9%were female and 38.1%were male.Eighteen patients(85.7%)successfully underwent transcatheter intervention.The minimum distance between the margins of the PmVSD and near-field HPS ranged from 2.5±0.7(1.3~3.9)mm.An average follow-up period was 4.1±1.3(0.25~5)years,median of which was 5 years.1,3,5-year follow-up rate was 95.2%,90.4%and 52.4%,respectively.At the end of the follow-up,ECG abnormalities were observed in 5 cases(23.8%),including left anterior hemiblock(LAH)in 3 cases(14.3%),incomplete right bundle branch block and LAH in 1 case(4.8%),premature atrial contraction in 1 case(4.8%).Mild tricuspid regurgitation(TR)and mild TR with mild mitral regurgitation with mild aortic regurgitation was observed in 1 case(4.8%),as well as left ventricular diastolic dysfunction.Conclusions:The study indicates that the results have guiding significance for transcatheter closure of PmVSD guided by 3D electro-anatomic mapping technique.However,this method requires a larger amount of clinical research data to support.
文摘AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.
基金supported by grants from the National Natural Science Foundation of China(No.81072806,and No.81373500)Natural Science Foundation of Guangdong Province(No.S2012010009277)Traditional Chinese Medicine Bureau of Guangdong Province(No.20141046)
文摘The aim of this study is to evaluate the efficacy of total saponins of Dioscorea（TSD）, an extract of the Chinese herbal Bi Xie, on hyperuricemia and to elucidate the underlying mechanisms. The rat hyperuricemia model was established by administration of adenine. Thirty-two rats were randomly allocated into 4 groups： model group, low/high-dose TSD-treated groups, and allopurinol-treated group. Meanwhile, 8 rats were used as normal controls. Serum uric acid（UA）, blood urea nitrogen（BUN）, serum creatinine（Scr）, and organic anion transporting polypeptide 1A1（OATP1A1） levels were measured. Comparison between the model group and treatment（allopurinol and TSD） groups showed the serum UA levels were significantly decreased in treatment groups. TSD had similar effects to allopurinol. It was found that the OATP1A1 protein expression levels in treatment groups were higher than in model group and normal controls. And different from the allopurinol-treated groups, TSD-treated group had elevated OATP1A1 expression levels in the stomach, liver, small intestine and large intestine tissues. It was suggested that TSD may facilitate the excretion of UA and lower UA levels by up-regulating OATP1A1 expression.
基金National Nature Science Foundation of China (No.81370295)Science and Technology Program of Guangdong Province, China (No.2017A020215054)Science and Technology Planning of Guangzhou City, China (No.2014B 070705005)
文摘Background Valvular heart disease(VHD)is expected to become more prevail as the population ages and disproportionately affects older adults.However,direct comparison of clinical characteristics,sonographic diagnosis,and outcomes in VHD patients aged over 65 years is scarce.The objective of this study was to evaluate the differences in clinical characteristics and prognosis in two age-groups of geriatric patients with VHD.Methods We retrospectively enrolled consecutive individuals aged>65 years from Guangdong Provincial Peopled Hospital and screened for VHD using transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE).Finally,260(48.9%)patients were in the 65-74 years group,and 272(51.1%)were in the>75-year group.Factors that affected long-term survival was explored.A multivariable Cox hazards regression was performed to identify the predictors of major adverse cardiac events(MACEs)in each group.Results In our population,the older group were more likely to have chronic obstructive pulmonary disease(COPD),degenerative VHD,but with less rheumatic VHD,aortic stenosis(AS)and mitral stenosis(MS).Compared with those aged 65-74 years,the older group had a higher incidence of all-cause death(10.0%vs.16.5%,P=0.027),ischemic stroke(13.5%vs.20.2%,P=0.038)and MACEs(37.3%vs.48.2%,P=0.011)at long-term follow-up.In multivariable Cox regression analysis,mitral regurgitation,a history of COPD,chronic kidney disease,diabetes,hypertension,atrial fibrillation and New York Heart Association(NYHA)functional class were identified as independent predictors of MACEs in the older group.Conclusion Advanced age profoundly affect prognosis and different predictors were associated with MACEs in geriatric patients with VHD.
基金Supported by Guangdong Natural Science Fund,No.2016A030313765Guangdong medical scientific research fund,No.A2017070 and No.A2017122
文摘AIM To identify functional proteins involved in pancreaticduodenal homeobox-1(PDX1)-mediated effects on gastric carcinogenesis.METHODS A PDX1-overexpressed model was established by transfecting gastric cancer cell line SGC7901 with pcDNA3.1(+)-PDX1 vector(SGC-PDX1). Transfection with empty pcDNA3.1 vector(SGC-pcDNA) served as control. Comparative protein profiles of the two groups were analyzed by two-dimensional electrophoresis basedproteomics(2 DE gel-based proteomics). The differential proteins identified by 2 DE were further validated by qRTPCR and immunoblotting. Finally, co-immunoprecipitation was used to determine any direct interactions between PDX1 and the differential proteins.RESULTS2 DE gel proteomics identified seven differential proteins in SGC-PDX1 when compared with those in SGC-pcDNA. These included four heat shock proteins(HSPs; HSP70 p1 B, HSP70 p8, HSP60, HSP27) and three other proteins(ER60, laminin receptor 1, similar to epsilon isoform of 14-3-3 protein). Immunoblotting validated the expression of the HSPs(HSP70, HSP60, HSP27). Furthermore, their expressions were lowered to 80%, 20% and 24%, respectively, in SGC-PDX1, while PDX1 exhibited a 9-fold increase, compared to SGC-pcDNA. However, qRT-PCR analysis revealed that mRNA levels of the HSP s were increased in SGC-PDX1, suggesting that the expression of the HSP s was post-translationally regulated by the PDX1 protein. Finally, co-immunoprecipitation failed to identify any direct interaction between PDX1 and HSP70 proteins.CONCLUSION This study demonstrates the potential involvement of HSPs in PDX1-mediated effects on the genesis of gastric cancer.
基金This research was funded by Guangzhou Science and Technology Plan Projects(No.202002020066)the Young Scientists to the NSFC Application of Guangdong Provincial People’s Hospital(No.8210120306)the Open Foundation of the State Key Laboratory of Bioactive Seaweed Substance(No.SKL-BMSG2022-03)。
文摘Objective Vitamin D(VD)deficiency was reported to contribute to the progression of Crohn’s disease(CD)and affect the prognosis of CD patients.This study investigated the role of serum VD,body mass index(BMI),and tumor necrosis factor alpha(TNF-α)in the diagnosis of Crohn’s disease.Methods CD patients(n=76)and healthy subjects(n=76)were enrolled between May 2019 and December 2020.The serum 25-hydroxyvitamin D[25(OH)D]levels,BMI,and TNF-αlevels,together with other biochemical parameters,were assessed before treatment.The diagnostic efficacy of the single and joint detection of serum 25(OH)D,BMI,and TNF-αwas determined using receiver operating characteristic(ROC)curves.Results The levels of 25(OH)D,BMI,and nutritional indicators,including hemoglobin,total protein,albumin,and high-density lipoprotein cholesterol,were much lower,and the TNF-αlevels were much higher in the CD patients than in the healthy subjects(P<0.05 for all).The areas under the ROC curve for the single detection of 25(OH)D,BMI,and TNF-αwere 0.887,0.896,and 0.838,respectively,with the optimal cutoff values being 20.64 ng/mL,19.77 kg/m^(2),and 6.85 fmol/mL,respectively.The diagnostic efficacy of the joint detection of 25(OH)D,BMI,and TNF-αwas the highest,with an area under the ROC curve of 0.988(95%CI:0.968–1.000).Conclusion The joint detection of 25(OH)D,TNF-α,and BMI showed high sensitivity,specificity,and accuracy in CD diagnosis;thus,it would be effective for the diagnosis of CD in clinical practice.
文摘Background The prognosis of elderly patients with ST-segment elevation myocardial infarction(STEMI)is poor,and information on specific risk factors remains scarce.We aimed to investigate the prevalence and the prognostic impact of postoperative carbon dioxide combining power(CO_(2)CP)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The association between postoperative CO_(2)CP and in-hospital and 1-year mortality was evaluated.Results A total of 775 elderly patients with STEMI were included and divided into two groups according to the lower normal limits of CO_(2)CP:<22 mmol/L(n=180),and≥22 mmol/L(n=595).The incidence of in-hospital death(12.2%vs.4.2%,P<0.001),acute kidney injury(25.0%vs.13.3%,P<0.001)and major adverse clinical events(30.0%vs.8.7%,P<0.001)were significantly higher in patients with a low CO_(2)CP.Multivariate logistic regression analysis showed an independent relationship between CO_(2)CP and in-hospital death[odd ratio(OR):0.88,95%confidential interval(CI):0.80-0.97,P=0.010].This relationship disappeared in one-year mortality[hazard ratio(HR):0.95,95%CI:0.89-1.01,P=0.116].Conclusions Postoperative CO_(2)CP is a feasible predictor during hospitalization for elderly patients with STEMI receiving PCI.
文摘Background Although neutrophil-to-lymphocyte ratio(NLR) has been extensively studied in several diseases, its predictive role in infective endocarditis(IE) complicated with sepsis remains unclear. The aim of this study was to explore the prognostic value of NLR in IE patients complicated with sepsis. Methods Patients with the diagnosis of IE complicated with sepsis was retrospectively enrolled between January 2009 to February 2020 in the Guangdong Provincial People's Hospital. Multivariate analysis was used to investigate the relationship between NLR and short-term mortality. Results A total of 496 IE patients complicated with sepsis were included and divided into three groups according to the tertiles of NLR: <4.3(n=161), 4.3-8.7(n=170), and >8.7(n=165). Restricted cubic splines showed an approximately positive linear correlation between the level of NLR and risk of in-hospital death. Multivariate logistic regression analysis showed an independent correlation between elevated NLR and in-hospital death [odds ratio(OR): 1.04, 95% confidential interval(CI): 1.01-1.07, P=0.015]. The receiver operating characteristic curve analysis demonstrated a relatively high predictive value of NLR for identifying in-hospital death(area under curve: 0.643, 95% CI: 0.570-0.717, P<0.001, sensitivity: 45.1%, specificity: 81.6%, optimal cut-off value: 11). Multivariate Cox survival analysis revealed that NPR >11(HR: 1.57, 95% CI: 1.02-2.41, P=0.039) was independent predictor for 6-month mortality. Conclusions NLR is a feasible predictor of short-term mortality for IE patients complicated with sepsis.
基金Supported by the Administration of Traditional Chinese Medicine of Guangdong Province,China (No. 2010431)
文摘OBJECTIVE:To observe the curative effect of an acupoint application with a Dingqi analgesic patch on moderate to severe pain caused by liver cancer.METHODS:Forty patients with moderate to severe pain caused by liver cancer were randomly divided intoatreatmentgroup(TG)andacontrolgroup(CG).Patients with moderate pain were given 100 mg qd of a sustainably released tablet of tramadol hydrochloride;patientswithseverepainweregiven4.2mg q3d of the fentanyl transdermal system.The ashi points Ganshu(BL 18),Danshu(BL 19) and Qimen(LR 14) were chosen for the acupoint application intervention.CG patients were given a sham patch and TG patients were given a Dingqi analgesic patch.A visual analogue scale(VAS) was used before treatment and after 1,3,6,9 and 12 days of treatment.The Karnofsky score was measured before treatment and after 12 days of treatment.Any main adverse reactions(e.g.nausea,constipation,dizziness and headache) were recorded after 6 and 12 days of treatment.Any skin side effects(i.e.skin irritation and allergic reactions) were recorded.RESULTS:The VAS in TG was significantly lower than that in CG after 3,6,9 and 12 days of treatment(P<0.05).There was no significant difference in the Karnofsky score before treatment and after 12 days of treatment between CG and TG.There were also no significant differences in the main adverse reactions or skin side effects after 6 and 12 days of treatment between CG andTG(P>0.05).CONCLUSION:The Dingqi analgesic patch can enhance the analgesic effect of tramadol and fentanyl.
基金Supported by Guangdong Natural Science Foundation(The effects of "Treatment from Gan"on Regulation of A-type Potassium Channels by KChIP/Kv4 in the pathomechanism of Refractory Epilepsy,No.2014A030310052)National Natural Science Foundation of China(Study on Regulation of A-type Potassium Channels by KChIP/Kv4 in the Pathomechanism of Refractory Epilepsy and the Effects of "Treatment from Gan",No.81503564)
文摘OBJECTIVE: To investigate the antiepileptic effects of Chaihushugan decoction(CHSGD) in rats with pentylenetetrazole(PTZ)-induced seizures and to discuss the impact of CHSGD on glutamate metabolism, a hypothesized underlying mechanism of seizure reduction.METHODS: Fifty Wistar rats were divided randomly into either control(n = 10) or experimental(n = 40)groups. Rats in the control group were administered physiological saline intraperitoneally. A subconvulsive dose of PTZ(35 mg/kg) was administered intraperitoneally to rats in the experimental group to induce seizures. The fully PTZ-kindled rats were then randomly divided into five subgroups(n = 8 each) based on the following treatment categories: physiological saline, VPA(200 mg/kg), CHSGD(2.5 g/kg), CHSGD(5 g/kg), or CHSGD(10 g/kg),administered orally once per day, respectively. On day 28 following initiation of drug treatment, seizures were monitored. The rats were then sacrificed, and hippocampal dissections were performed for subsequent studies.RESULTS: CHSGD significantly prolonged the latency of myoclonic, clonic, and tonic seizures, while decreasing overall seizure rates in the kindled rats.The measured concentrations of 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-d-glucose(2-NBDG) and glutamate were significantly lower in the hippocampi of kindled rats in groups treated with CHSGD compared with those treated with PTZ alone. In addition, CHSGD was found to up-regulate both the expression of glutamate transporter-1(GLT-1) protein and the activity of glutamine synthetase(GS) in the hippocampi of kindled rats.CONCLUSION: These results suggest that CHSGD has antiepileptic effects on PTZ-induced seizures.The results further suggest an increase in glutamate metabolism at the synaptic cleft is a putative underlying mechanism of seizure reduction.
文摘Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.Methods:A total of 441 patients were included.Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy.HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry.CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis.The data were compared by binary logistic regression to find the risk factors.The primary endpoint was major adverse clinical events (MACEs),and patients were followed for a median time of 29 months.Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.Results:The rate of HTPR was 17.2%.Logistic regression identified the following predictors of HTPR:age,therapy regimen,body mass index,diabetes history,CYP2C19^*2,or CYP2C19^*3 variant.The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval:0.738–0.848).Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs.9.9%;χ^2 = 7.572,P = 0.010).Conclusions:Our results suggest that advanced age,higher body mass index,treatment with regular dual antiplatelet therapy,diabetes,and CYP2C19^*2 or CYP2C19^*3 carriers are significantly associated with HTPR to clopidogrel.The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.
文摘Background Mortality in patients with acute myocardial infarction(AMI)undergoing an intra-aortic balloon pump(IABP)implantation remains high.This study aims to analyze the risk factors and subsequent prognostic impact of pulmonary infection in these populations.Methods Data of patients with AMI treated with the IABP between August 2017 and May 2018 was collected retrospectively.A total of 104 AMI patients who underwent the IABP and complicated with postoperative pulmonary infection were assigned to the observation group,meanwhile,73 patients without pulmonary infection were chosen as the control group.The clinical characteristics were compared between two groups of patients,the risk factors and outcomes for the postoperative pulmonary infections were analyzed.Results Pulmonary infection can prolong CCU duration(11.7±8.2 vs.6.5±4.1,P<0.001)and lead to higher in-hospital death(31.5%vs.12.5%,P=0.002).Killip>2 was an independent risk factor for pulmonary infection.In addition,multivariate logistic regression analysis indicated that Killip>2,diabetes,current smoking,and pulmonary infection were independently associated with in-hospital death.Conclusions Postoperative pulmonary infection was a risk factor for poor outcomes in patients with AMI undergoing IABP.It is necessary to take corresponding interventions to reduce the risk of postoperative pulmonary infection.
基金supported by the National Key R&D Program of China(No.2022YFD2401900)the National Natural Science Foundation of China(No.52203163)+4 种基金the High-level Hospital Construction Project(No.DFJH201905)the Natural Science Foundation of Guangdong(No.2021A1515010838)the International Science and Technology Cooperation Program of Guangdong(No.2022A0505050048)the Science and Technology Program of Guangzhou(No.201903010028)Guangdong Provincial People’s Hospital Intermural Program(No.KJ012019447).
文摘The abnormal activation of epidermal growth factor receptor(EGFR)drives the development of non-small cell lung cancer(NSCLC).The EGFR-targeting tyrosine kinase inhibitor osimertinib is frequently used to clinically treat NSCLC and exhibits marked efficacy in patients with NSCLC who have an EGFR mutation.However,free osimertinib administration exhibits an inadequate response in vivo,with only~3%patients demonstrating a complete clinical response.Consequently,we designed a biomimetic nanoparticle(CMNP^(@Osi))comprising a polymeric nanoparticle core and tumor cell-derived membrane-coated shell that combines membrane-mediated homologous and molecular targeting for targeted drug delivery,thereby supporting a dual-target strategy for enhancing osimertinib efficacy.After intravenous injection,CMNP^(@Osi)accumulates at tumor sites and displays enhanced uptake into cancer cells based on homologous targeting.Osimertinib is subsequently released into the cytoplasm,where it suppresses the phosphorylation of upstream EGFR and the downstream AKT signaling pathway and inhibits the proliferation of NSCLC cells.Thus,this dual-targeting strategy using a biomimetic nanocarrier can enhance molecular-targeted drug delivery and improve clinical efficacy.
基金supported by Medical Scientific Research Foundation of Guangdong Province,China(No.C2015046)
文摘Background Acute respiratory distress syndrome （ARDS） caused by H7N9 influenza in pregnant woman is a life-threatening event with an increased risk for maternal and baby＇ s death. The aim of this study was to evaluate the impact of point-of-care ultrasonography （POCUS） on the management and prognosis of these patients. Methods A case of 31-yr-old pregnant woman in our hospital, who was underwent POCUS for evaluating car- diopulmonary functions, volume state, fluid responsiveness and ultrasound-guided procedures was admitted to In- tensive Care Unit （ICU）. We performed ultrasonography daily for monitoring organ functions. Review of related literatures was also conducted. Results With the help of POCUS, we made quickly diagnosis of severe pneumo- nia and ARDS caused by H7N9 influenza. The therapies had also been changed after POCUS examinations, such as restrict fluid administration relying on the assessments of the inferior vena cava （IVC） to estimate preload and lung ultrasound monitoring to identify the early presence of extravascular lung water （EVLW） and avoid fluid over resuscitation, ultrasound-guided recruitment maneuver to improved respiratory distress syndrome, and so on. Conclusions POCUS has a significant impact on decision-making and therapeutic management and should become a clinical routine in the management of ARDS patients caused by H7N9 influenza in pregnancy.
基金supported by Medical Scientific Research Foundation of Guangdong Province,China(No.C2015046,/B2015076/B2014001/C2014036)
文摘Background Septic shock caused by bacteremia is a life-threatening infection whose prognosis is highly de- pendent on early recognition and appropriate treatment. Procalcitonin （PCT） has been shown to accurately and quickly distinguish bacteremia from noninfectious inflammatory states in critically severe patients. However, the extent of PCT magnitude elevation according to the Gram stain result in elderly patients with coronary heart disease （CHD） at the onset of septic shock caused by bacteremia varies, and has not been clearly elucidated. Methods The medical records of advanced age （non-neutropenic） patient with CHD and septic shock between Mar 2013 and Jun 2015 who had bacteremia caused by either Gram-positive （GP） bacteria or Gram-negative （GN） bacteria were reviewed, and the levels of PCT, C- reactive （CRP） protein and white blood cells count （WBC） in both groups were analyzed. Results 75 episodes of either GN bacteremia （n = 40） or GP bacteremia （n = 35） were enrolled. PCT levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia [（8.93± 17.58） vs. （64.42± 58.56） ng/L （P 〈 0.001）], whereas there was no significant differ- ence in CRP and WBC （P 〉 0.05）. Moreover, a high PCT level was found to be independently associated with GN bacteremia in this study population. A PCT level of 19.69 ng/mL yielded a 72.5% sensitivity, a 91.4% specificity, an 8.43 positive likelihood ratio and a 0.30 negative likelihood ratio for GN-related bacteremia in the study cohort [AUROCC = 0.870 （0.041）, 95% CI （0.790-0.949）]. Conclusion In an elderly patient （non-neutropenic） with CHD and septic shock, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia （PCT 〉 19.69 ng/mL）.
基金supported by Medical Research Fund Project of Guangdong Province(No.C2017054)
文摘Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.
基金supported by grants from Science and Technology Projects of Guangzhou(No.201903010097)。
文摘Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.
文摘Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.
文摘Background Acute kidney injury(AKI)was a risk factor for poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).Whether postoperative serum creatinine(SCr)level measured at early time(24 hours)after percutaneous coronary intervention(PCI)had prognostic role in elderly patients with STEMI was unclear.Methods SCr was measured within 24 hours after PCI.A total of 883 elderly patients(≥60 years)with STEMI were finally included and divided into three group according to the tertiles of postoperative SCr level(umol/L):<81(n=283),81-107(n=302)and≥107(n=298).The relationship between postoperative Scr and in-hospital and 1-year adverse events was evaluated.Results In-hospital mortality was 5.4%(48/883),which was significantly higher in patients with a high postoperative SCr level(1.8%vs.3.0%vs.11.4%,P<0.001).Receiver operator characteristic curve analysis indicated that postoperative SCr>120 umol/L had a sensitivity of 66.7%and specificity of 79.2%for predicting in-hospital death[area under the curve(AUC)=0.768,95%CI:0.697-838,P<0.001].Multivariate analysis showed that postoperative Scr>120 umol/L was an independent risk factor for in-hospital mortality even after adjusting for the baseline renal dysfunction[estimated glomerular filtration rate(e GFR)<60 m L/(min·1.73 m2)].Kaplan-Meier analysis showed that patients with postoperative SCr>120 umol/L had a higher one-year mortality than those without(Log-rank test:57.8,P<0.001).Conclusions SCr level measured within 24 hours after PCI could serve as an early and powerful marker for predicting in-hospital and one-year mortality in elderly patients with STEMI.
文摘Background A pulmonary-infected patient had severe hyponatremia that lasted two days during hospitalization.We could not find any history such as gluttony,liver and gall disease.The examination of liver function reported that the hepatic enzymology is normal.In ICU,we quickly found hemodiastase reached at extremely high level.The berry CT indicated that the head of pancreas swelling and the boundary was obscure and effusive.The patient was diagnosed as acute pancreatitis.This case raises a question to us：Does severe hyponatremia cause acute pancreatitis？ It has not been reported.Methods We established acute animal model of hyponatremia that did not include any other electrolyte chaos.After the animal model of hyponatraemia completed,serum amylase levels and pathological examination were analyzed.Results The hyponatremia models,out of 16 rats,only four rats＇ serum sodium were less than 120 mmol /L.In these four rats,besides serum sodium,the remaining electrolytes were normal and serum lipids were in normal range,only one rat＇s serum amylase increased significantly more than four times of the normal control group and its pathological findings hinted pancreatic edema.Conclusions The experimental model successfully duplicated the clinical and pathologic features of pancreatitis induced by hyponatraemia.Through this case report,we hope that attention can be paid to changes in serum amylase when hyponatremia appeared.
