The Effectiveness of Online-Only Blended Cardiopulmonary Resuscitation Training: Static-Group Comparison Study

BACKGROUND

Basic life support (BLS) education is essential for improving bystander cardiopulmonary resuscitation (CPR) rates, but the imparting of such education faces obstacles during the outbreak of emerging infectious diseases, such as COVID-19. When face-to-face teaching is limited, distance learning-blended learning (BL) or an online-only model-is encouraged. However, evidence regarding the effect of online-only CPR training is scarce, and comparative studies on classroom-based BL (CBL) are lacking. While other strategies have recommended self-directed learning and deliberate practice to enhance CPR education, no previous studies have incorporated all of these instructional methods into a BLS course.

OBJECTIVE

This study aimed to demonstrate a novel BLS training model-remote practice BL (RBL)-and compare its educational outcomes with those of the conventional CBL model.

METHODS

A static-group comparison study was conducted. It included RBL and CBL courses that shared the same paradigm, comprising online lectures, a deliberate practice session with Little Anne quality CPR (QCPR) manikin feedback, and a final assessment session. In the main intervention, the RBL group was required to perform distant self-directed deliberate practice and complete the final assessment via an online video conference. Manikin-rated CPR scores were measured as the primary outcome; the number of retakes of the final examination was the secondary outcome.

RESULTS

A total of 52 and 104 participants from the RBL and CBL groups, respectively, were eligible for data analysis. A comparison of the 2 groups revealed that there were more women in the RBL group than the CBL group (36/52, 69.2% vs 51/104, 49%, respectively; P=.02). After adjustment, there were no significant differences in scores for QCPR release (96.9 vs 96.4, respectively; P=.61), QCPR depth (99.2 vs 99.5, respectively; P=.27), or QCPR rate (94.9 vs 95.5, respectively; P=.83). The RBL group spent more days practicing before the final assessment (12.4 vs 8.9 days, respectively; P<.001) and also had a higher number of retakes (1.4 vs 1.1 times, respectively; P<.001).

CONCLUSIONS

We developed a remote practice BL-based method for online-only distant BLS CPR training. In terms of CPR performance, using remote self-directed deliberate practice was not inferior to the conventional classroom-based instructor-led method, although it tended to take more time to achieve the same effect.

TRIAL REGISTRATION

Not applicable.

[Impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease]

Objective: This study sought to investigate the impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease. Methods: We retrospectively analyzed clinical data of male patients diagnosed with suspected coronary microvascular dysfunction (CMD) in the First Hospital of Shanxi Medical University between December 2015 and August 2021. All patients underwent the one-day rest and stress ¹³N-ammonia positron emission tomography myocardial perfusion imaging. Overall obesity was defined by body mass index (BMI) ≥28 kg/m² and abdominal obesity was defined by waist circumference ≥90 cm. Hyperemic myocardial blood flow (MBF)<2.3 ml·min^-1·g^-1 or coronary flow reserve (CFR)<2.5 were referred as CMD. All patients were grouped based on their BMI and waist circumference. MBF, CFR, the incidence of CMD, hemodynamic parameters, and cardiac function were compared among the groups. Results: A total of 136 patients were included. According to BMI and waist circumference, patients were categorized into 3 groups: control group (n=45), simple abdominal obesity group (n=53) and compound obesity group (n=38). Resting MBF did not differ between groups (F=0.02,P=0.994). Compared with the control group, hyperemic MBF was significantly lower in the simple abdominal obesity and compound obesity groups ((2.82±0.64) ml·min^-1·g^-1, (2.44±0.85) ml·min^-1·g^-1 and (2.49±0.71) ml·min^-1·g^-1, both P<0.05, respectively). Hyperemic MBF was comparable among the groups of patients with obesity (P=0.772). CFR was significantly lower in the simle abdominal obesity group compared with the control group (2.87±0.99 vs. 3.32±0.62,P=0.012). Compared with the control group, CFR tended to be lower in the compound obesity group (3.02±0.91 vs. 3.32±0.62,P=0.117). The incidence of CMD was significantly higher in both the simple abdominal obesity and compound obesity groups than in the control group (62.3%, 52.6% vs. 22.2%, both P<0.01, respectively). Waist circumference was an independent risk factor for male CMD (OR=1.057, 95%CI: 1.013-1.103, P=0.011). Conclusions: In male patients with non-obstructive coronary artery disease, abdominal obesity is associated with decreased coronary microvascular function. Male patients with simple abdominal obesity face the highest risk of CMD.

[Multiple pulmonary nodules with interstitial changes]

A 53-year-old female patient with pulmonary nodules for more than 3 years was admitted to Beijing Chao-Yang Hospital because of cough and sputum with shortness of breath after exercise for 4 months. In the first two and a half years, her pulmonary nodules remained stable, after that the nodules increased obviously with interstitial changes. After admission, a venous thromboembolic (VTE) event was quickly detected with a marked increase in D-dimer. Then, based on the clues of VTE examination, bronchoscopy, gastroscope, positron emission tomography-CT, head magnetic resonance and other examinations were performed. The final pathological diagnosis was lung adenocarcinoma, mainly solid with mucus secretion, with mediastinal hilar lymph node metastasis, intrapulmonary metastasis and gastric metastasis. Gene detection of lung and stomach histopathological tissues showed positive EML4-ALK fusion gene. The patient received therapies with crizotinib, alectinib in sequence and anticoagulation. After 20-month treatment, a telephone follow-up showed that there was no significant limitation in her daily activities.

Characteristics, prognostic factors, and chronological trends of out-of-hospital cardiac arrests with shockable rhythms in Taiwan - A 7-year observational study

BACKGROUND

The study aimed to explore the characteristics, predictors, and chronological trends of outcomes for adult out-of-hospital cardiac arrests (OHCAs) with shockable rhythms.

METHODS

A 7-year, community-wide observational study using an Utstein-style registry was conducted. Patients who were not transported, those who experienced trauma and those who lacked electronic electrocardiography data were excluded; those with initial shockable rhythms of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) were included. Outcomes were survival of discharge (SOD) and favorable neurological status (CPC 1-2). The outcome predictors, chronological trends, and their relationship with system interventions were analyzed.

RESULTS

Of the 1544 shockable OHCAs (incidence 12.6%) included, 97.6% had VF and 2.4% had pVT. VF showed better outcomes than pVT. Predictors for both outcomes (SOD; CPC 1-2) were chronological change (adjusted odds ratio [aOR]: 1.133; 1.176), younger age (aOR: 0.973; 0.967), shorter response time (aOR: 0.998; 0.999), shorter scene time (aOR: 0.999; 0.999), witnessed collapse (aOR: 1.668; 1.670), and bystander cardiopulmonary resuscitation (BCPR) (aOR: 1.448; 1.576). Predictors for only SOD were public location (aOR: 1.450) and successful prehospital defibrillation (aOR: 3.374). The use of the supraglottic airway was associated with adverse outcomes. Chronologically with system interventions, BCPR rate, the proportion of shockable OHCA, and improved neurological outcomes increased over time.

CONCLUSIONS

The incidence of shockable OHCA remained low in Asian community. VF showed better outcomes than pVT. Over time, the incidence of shockable rhythm, BCPR rate and patient outcomes did improve with health system interventions. The number of prehospital defibrillations did not predict outcomes.

Three first records of stick insects attacking plants (Inseect: Phasmida) in Tibet

Except for a few stick insects that are economically valuable, most species be considered to be forest pests, so it is extremely important to obtain plant host-use information of more stick insects. In this paper, the plant hosts of three species of stick insects were recorded for the first time. We also discovered these stick insects can feed upon the flowers or leaves of plants. Lopaphus unidentatus (Chen & He, 1995) (Phasmida: Lonchodidae) attacked Hypericum choisianum Wall. ex N. Robson, 1973 (Hypericaceae), Leurophasma dolichocercum Bi, 1995 (Phasmida: Aschiphasmatidae) attacked Antenoron filiforme (Thunb.) Roberty & Vautier, 1964 (Polygonaceae) and Megalophasma granulatum Bi, 1995 (Phasmida: Lonchodidae) attacked Debregeasia orientalis C. J. Chen, 1991 (Urticaceae). Finally, we were lucky enough to also obtain photographs of them mating and feeding.

[Review on tree-based scan statistic in drug and vaccine safety monitoring]

To summarize the development and application of tree-based scan statistic (TreeScan), explain the methodology and provide a reference for future use of this method by reviewing the original pharmacoepidemiological and vaccine studies using the TreeScan. Medline, Embase and Web of Science databases were used for the retrieval of eligible studies using keywords related to TreeScan. A total of 15 eligible studies were included, in which 9 studies explored the adverse events of drugs and 6 studies focused on the safety of vaccines. Three types of models (Poisson probability model, Bernoulli probability model and tree-temporal scan statistic model) of TreeScan were used. The major differences among the three models were 1) whether predefined control was used according to research question, 2) whether the time from exposure to onset of adverse events was considered. Several studies explored its ability by comparing with other methods for adverse event detection or by using known adverse events. This review shows that TreeScan is an effective method for the safety signal detection of drugs or vaccines, which develops rapidly and globally. It is very necessary to promote its use in drug safety monitoring and other related fields in China.

Attitude and behavior toward bystander cardiopulmonary resuscitation during COVID-19 outbreak

Background

Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown.

Methods

A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals’ attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed.

Results

Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP.

Conclusions

Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions.

[Incidence and etiological analysis of abnormal cardiac uptake in patients underwent oncologic PET/CT imaging]

Objective: To investigate the incidence, location and etiology of abnormal cardiac uptake in patients underwent oncologic ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography(PET/CT) imaging. Methods: The ¹⁸F-FDG PET/CT images of 2000 consecutive patients with suspected or diagnosed malignancy in Beijing Chaoyang Hospital from January 2014 to September 2016 were retrospectively analyzed. Fasting time was more than 12 hours before imaging, and fasting blood glucose level before ¹⁸F-FDG injection was less than 6.7 mmol/L. Focal uptake in the non-basal and non-papillary regions of the left ventricle, uptake in the right ventricle exceeding uptake in the left ventricle, and uptake in the atrium higher than that of the blood pool (when uptake of left ventricle was zero or low) were defined as abnormal, and all abnormal uptake was visually determined by experienced nuclear medicine physicians. General clinical data and the results of cardiac examination were collected to explore the incidence, location and etiology of cardiac diseases. Results: There were 138 patients with history of diabetes (6.90%), 228 patients with history of cardiovascular disease (11.40%) out of the 2 000 patients ((60.5±13.2) years, 1 117 male (55.85%)). The number and proportion of patients with malignancy, benign lesions, diseases of unknown etiology were 939 (46.95%), 484 (24.20%), 557 (28.85%), respectively. Abnormal cardiac uptake was detected in 145 patients (7.3%). The proportion of abnormal uptake in left ventricle, right ventricle and atrium was 52.4% (76 cases), 12.4% (18 cases), 35.2% (51 cases), respectively. Of the 76 individuals who had abnormal uptake in left ventricle, 25 cases (32.9%) were caused by coronary artery disease, and other causes included hypertrophic cardiomyopathy and myocardial damage caused by chemotherapy drugs, etc. Of the 18 cases who had abnormal uptake in right ventricle, 14 cases (14/18) were caused by pulmonary hypertension. In addition, 20 out of the 51 cases (39.3%) with abnormal uptake in atrium suffered from atrial fibrillation. Seventy-one patients with abnormal cardiac uptake (49.0%) had no clear manifestation and evidence of heart disease before imaging. Conclusions: The abnormal ¹⁸F-FDG uptake on oncologic PET/CT is not rare. The most common site of abnormal uptake is left ventricle, coronary artery disease, pulmonary hypertension and atrial fibrillation are common causes of abnormal ¹⁸F-FDG uptake.

Comparison of Chest Compression Quality between Transfer Sheet and Stretcher Use for Transporting out-of-Hospital Cardiac Arrest Patients in a High-Rise Building - A Randomized and Open-Label Cross-over Design

OBJECTIVES

Stretchers are commonly used for transporting cardiac arrest patients, but their use may be limited in confined spaces, like elevators. Use of transfer sheet as an alternative has not been explored. We aimed to compare manual chest compression quality between these two methods. Methods: In this prospective, open-label, randomized cross-over manikin study, the subjects included emergency medical technicians who were assigned to 12 three-person crews. Scenarios included transport of a cardiac arrest in a high-rise building and elevator using transfer sheet (TS) and stretchers adjusted to 45° (S45) and 90° (S90). Chest compression quality was measured using a recording manikin and that before (on-scene phase) and after (transport phase) the manikin moved via transfer sheet or stretcher were compared. Results: The final analysis included 72 simulation runs. Chest compression quality did not differ among the groups in the on-scene phase. In the transport phase, the transfer sheet group provided greater mean compression depth (54.4 ± 4.2 vs 39.6 ± 7.2 mm, p < 0.01 and 54.4 ± 4.2 vs 40.6 ± 8.3 mm, p < 0.01, respectively) than stretchers of S45 and S90, and higher percentage of deep-enough compression (TS: 51.0 [23.8-74.8]% vs S45: 19.5 [5.8-29.5]%, p < 0.01) than the S45 group. Transfer sheet use showed a trend of lower percentages of full recoil (TS: 40.0 [12.8-64.5]% vs S45: 70.5 [47.0-79.8]% vs S90: 52.5 [25.3-76.0]%, p = 0.09). Chest compression fraction, compressions with correct hand position, and mean compression rates did not differ between groups in the transport phase. The TS group showed shorter time intervals of simulation start-to-first-compression (TS: 13.9 [12.4-15.1] sec vs S90: 15.9 [13.3-16.4] sec, p = 0.04) and total run time (TS: 145.7 [135.1-151.4] sec vs S90: 160.0 [151.9-175.4] sec, p < 0.01) than the S90 group. Conclusion: In this simulation, using transfer sheet outperform using stretcher for transporting cardiac arrest patients from high-rise buildings. Rescuers need to be aware of full chest recoil.

[Value of absolute quantification of myocardial perfusion by PET in detecting coronary microvascular disease in patients with non-obstructive coronaries]

Objective: To compare the incidence of coronary microvascular disease (CMVD) between patients with non-obstructive and obstructive coronary arteries. Methods: We retrospectively analyzed 97 patients with angina pectoris, who underwent the absolute quantitative PET examination of myocardial perfusion and coronary anatomy examination within 90 days. All patients were divided into two groups: non-obstructive group (72 cases, no stenosis ≥50% in all three coronary arteries) and obstructive group (25 cases, at least one coronary stenosis ≥50%; and at least one coronary stenosis<50%). Quantitative parameters derived from PET including rest myocardial blood flow (RMBF), stress myocardial blood flow (SMBF), coronary flow reserve (CFR) and cardiovascular risk factors were compared between the two groups. CMVD was defined as CFR<2.90 and SMBF<2.17 ml·min(-1)·g(-1). Results: Incidence of CMVD was significant higher in the non-obstructive coronary arteries of the obstructive group than in the non-obstructive coronary arteries of non-obstructive group (47.1% (16/34) vs. 25.5% (55/216), χ(2)=6.738, P=0.009) while incidence of CMVD was similar between non-obstructive and obstructive patients ((44% (11/25) vs. 33.3% (24/72), χ(2)=0.915, P=0.339). RMBF ((0.83±0.14) ml·min(-1)·g(-1) vs. (0.82±0.17) ml·min(-1)·g(-1)), SMBF ((2.13±0.60) ml·min(-1)·g(-1) vs. (1.91±0.50) ml·min(-1)·g(-1)) and CFR (2.59±0.66 vs. 2.36±0.47) were similar between the two groups (all P>0.05). Conclusions: CMVD can occur in non-obstructive coronary arteries in both patients with non-occlusive coronary arteries and patients with obstructive coronary arteries. Prevalence of CMVD is significantly higher in patients with obstructive coronary arteries than in patients with non-obstructive coronary arteries. The CMVD severity is similar between the two groups.

[Alveolar echinococcosis metastatic to the brain: a case report]

This paper reports a case with alveolar echinococcosis metastatic to the brain. This case underwent 10-year antiechinococcosis treatment and operations of the liver, right kidney and brain. Following multiple operations and oral administration of albendazole, the case still had recurrence and distant metastasis of hepatic echinococcosis. It is suggested that early prevention, early diagnosis, early regular treatment and surgical radical treatment are critical to the treatment of alveolar echinococcosis.

[Primary cystic echinococcosis in the left femur: a case report]

This article reported a case with primary cystic echinococcosis in the left femur.

Cross-coupling drift between magnetic field and temperature in depolarized interferometric fiber optic gyroscope

We propose a theory of cross-coupling drift in depolarized interferometric fiber optic gyroscopes (D-IFOGs) under the joint influence of magnetic field and temperature. The magnetic field and temperature cross-coupling drift (MTCD) originates from the interaction of the nonreciprocal circular birefringence produced by the magnetic field, the thermal stress birefringence from the varying temperature, and the inherent residual birefringence in the fiber coil. The MTCD is much greater than the sum of the individual drifts induced by magnetic field and temperature. We established a relevant theoretical model and carried out numerical simulations, and verified the results experimentally. For a typical D-IFOG, the experimental results showed a cross-coupling degree exceeding 170% when the temperature varied from -20 °C to 60 °C, as predicted in the simulations.

[Pulmonary cavities with Takayasu arteritis: report of 3 cases and literature review]

Objective: To analyze the clinical features of 3 cases of Takayasu arteritis(TA) with pulmonary cavities on chest computed tomography(CT). Methods: The clinical data of 3 TA patients with cavities on the chest CT who were admitted into Beijing Chaoyang Hospital were retrospectively analyzed. A literature search was performed with "Takayasu arteritis" and "pulmonary" as the key words in China Knowledge Resource Intergrated Database (CNKI) and Pubmed Database for publications from Jan 1, 2000 to Dec. 31,2017. The relevant literatures were reviewed. Results: Among the 3 patients, 2 were males and 1 was female, aging 49, 28 and 28 years, respectively. They presented with cough, fever and chest pain, and chest CT showed cavities, single or multiple, either with thick or thin wall, or wedge-shaped consolidation, residual stripes after being absorbed, and one case had pulmonary biopsy results which showed hemorrhagic infarction. They were all misdiagnosed before as pneumonia, pulmonary tuberculosis, pulmonary thromboembolism. After being treated by combination therapy of glucocorticoids and immunosuppressive agents, the disease improved significantly. A total of 777 cases with TA involving pulmonary arteries were reported, from which 13 cases with involvement of pulmonary parenchyma were described. Therefore total 16 cases including the 3 cases in this article were included for analysis. Twelve cases showed patchy or wedge-shaped ground-glass opacity and consolidation, and peripheral lung stripes remained after being absorbed. Two cases showed pleural effusion, and 4 cases showed cavities, 3 cases were misdiagnosed as pulmonary tuberculosis, 7 as pulmonary infection, and 5 as pulmonary thromboembolism. Conclusions: TA with pulmonary arteries involved is susceptible to be misdiagnosed and missed, and therefore, in patients with cough, hemoptysis, chest pain and cavities in pulmonary parenchyma, TA should be suspected. Early diagnosis and appropriate treatment can lead to a better prognosis.

Effect of a knowledge-based and skills-based programme for physicians on risk of sexually transmitted reinfections among high-risk patients in China: a cluster randomised trial

BACKGROUND

China is experiencing growing epidemics of HIV and sexually transmitted infections (STIs). Programmes to train physicians in China on HIV and STI knowledge, diagnosis, treatment, and risk reduction counselling can potentially reduce HIV and STI risk among high-risk patients. We aimed to assess a knowledge-based and skills-based programme for physicians in China to reduce patients' STI risk.

METHODS

In this cluster randomised trial, we block randomised counties in two provinces in eastern China to intervention or control groups. In the intervention group, physicians from county general hospitals participated in a structured HIV and STI training programme and received opportunities to enhance their clinical and counselling skills, whereas in the control group, physicians from county hospitals received the training after the intervention group completed final assessments. We recruited STI patients from physicians in both groups, treated baseline gonorrhoea and chlamydia infections, and assessed 9-month gonorrhoea and chlamydia reinfection as the primary outcome. Statistical comparisons between intervention and delayed-control patients used multilevel analyses to account for cluster effects at county and physician levels. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, NCT00644150.

FINDINGS

Between April 1, 2007, and Sept 1, 2008, 51 counties were randomly assigned; 27 to receive immediate intervention and 24 to receive delayed intervention. 249 physicians from the 51 county-level hospitals were enrolled, 121 physicians in the intervention group and 128 in the control group. From these physicians, we enrolled 633 and 491 patients, respectively, of whom 508 (80%) and 402 (82%) were available for reassessment at 9 months. Intervention patients at follow-up had significantly lower odds of combined gonorrhoea or chlamydia reinfection than did control patients (58/508 [11%] vs 123/402 [31%]; adjusted odds ratio 0·62 [95% CI 0·46-0·84]).

INTERPRETATION

Integrating HIV and STI training into medical education in China could be an effective strategy to reduce the country's growing HIV risk and STI epidemics.

FUNDING

US National Institutes of Health.

TM4SF5-CTD-2354A18.1-miR-4697-3P may play a key role in the pathogenesis of gastric cancer

AIMS

Our aim is to identify important lncRNAs and mRNAs which may play a key role in contributing to pathogenesis of gastric cancer.

METHODS

Different LncRNAs and mRNAs are identified by microarray in gastric cancer tissue and corresponding normal tissues. The function and relationship of different LncRNAs and mRNAs is performed by GO analysis and Pathway analysis and made code-non-code network (CNC) by Pearson correlation coefficients (PCC). Then mRNA-miRNA relationship is predicted through mRNA-miRNA relationship software (http://www.targetscan.org). Lastly, mRNA-miRNA-LncRNA network is established for further research.

RESULTS

The expression profiles of 3732 lncRNAs showed different expression (fold change (FC)≥2.0, p<0.05) in gastric cancer tissue and normal tissue and expression profiles of 3994 mRNAs also showed different expression (FC≥2.0, p<0.05) in gastric cancer and corresponding normal tissue.

CONCLUSION

The expression of TM4SF5, CTD-2354A18.1 and miR-4697-3P is in balance at physiological conditions, however, the balance is disrupted by some situations, which may contribute to gastric cancer. GO analysis and Pathway analysis also showed TM4SF5 played an important role in proliferation, differentiation and apoptosis. Therefore, TM4SF5-miR-4697-3P- CTD-2354A18.1 may play a key role in the pathogenesis of gastric cancer (Tab. 2, Fig. 4, Ref. 30).

Research of inhibition of survivin in rat HSC-T6 cell by siRNA interference

OBJECTIVE

To explore the effects and mechanisms of siRNA targeting survivin of inducing apoptosis in rat HSC-T6 cells.

METHODS

The experiment was divided into blank group, pGPU6/GFP/Neo-shNC group and pGPU6/GFP/Neo-siRNA group. The siRNA was transfected into HSC-T6 cells mediated by LipofectamineTM2000 for 24 h, and then the efficiency of transfection was observed by fluorescence microscopy. After transfection for 48h, the expression of survivin mRNA and protein was assessed by reverse transcription-polymerase chain reaction (RT-PCR) method and Western-blot, and the form of cells was observed by microscopy. The apoptosis rate of HSC-T6 cells was measured by the flow cytometry with PI staining. The expression of caspase-3 protein was assessed by western-blot.

RESULTS

The prominent apoptosis of the pGPU6/GFP/Neo-siRNA group by PI staining was high, there was significant difference comparing with blank group and pGPU6/GFP/Neo- shNC group (p<0.05). The expression of caspase-3 by Western-blot in pGPU6/GFP/Neo-siRNA group was high, there was significant difference comparing with blank group and pGPU6/GFP/Neo-shNC group (p>0.05).

CONCLUSION

siRNA targeting survivin can inhibit the expression of survivin mRNA and protein in rat HSC-T6 cells. Expression of survivin is negative correlation with expression of caspase-3. siRNA targeting survivin may up-regulate expression of caspase-3 and increase apoptosis of rat HST-T6 (Fig. 6, Ref. 24).

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

PURPOSE

Previous research indicates elevated risk for psychological distress in sexual and gender minority populations, and some research suggests that stigma contributes to elevated psychological distress among members of these groups. This study examined the hypothesis that exposure to transgender-related stigma (TRS) is associated with both higher levels of depression and anxiety among transgender women.

METHODS

We analyzed data from a diverse sample of 191 adult transgender women living or working in the San Francisco Bay area who were recruited using purposive sampling methods to participate in a cross-sectional survey, which included measures of stigmatization, depression, and anxiety.

RESULTS

Higher levels of exposure to TRS were independently associated with higher levels of depression (β=0.31, P<.001) and anxiety (β=39, P<.001), adjusting for self-reported health and sociodemographic co-variates. Associations between stigmatization, depression, and anxiety were not moderated by participants' age or race/ethnicity.

CONCLUSION

Findings suggest a need for counseling interventions to address the role of stigmatization as a factor potentially contributing to psychological distress among transgender women. This research further highlights the need to develop a stronger evidence base on effective counseling approaches to improve the mental health of transgender women.

Opportunistic posttransplantation virus infections in renal transplant recipients

BACKGROUND

Opportunistic virus infection is one of the most common complications in renal transplant (RT) recipients. Cytomegalovirus (CMV) and BK virus (BKV) are important pathogens and each of these infections affects the other. In contrast, there is only limited information on JC virus (JCV) infection and its relation to CMV infection in RT recipients. This prospective study investigated the rates of JCV and CMV infections and their risk factors and correlations.

METHODS

We studied 52 RT recipients. JCV and CMV were detected using nested qualitative polymerase chain reaction assays of urine. The clinical characteristics of JCV and CMV infection were compared and risk factors analyzed with the use of binary logistic regression.

RESULTS

JCV and CMV were detected in 40.4% and 34.6% of the RT recipients, respectively. Cyclosporine (CsA) was a risk factor for both JCV and CMV infection (odds ratio [OR] 7.187; P=.002; OR 4.182; P=.021); CMV infection was a risk factor for JCV infection (OR 3.900; P=.039).

CONCLUSIONS

JCV and CMV infections are common in RT recipients. CsA is a risk factor for both JCV and CMV infection. JCV infection is related to CMV infection.

Monitoring of human cytomegalovirus infection in bone marrow and liver transplant recipients by antigenaemia assay and enzyme-linked immunosorbent assay

Human cytomegalovirus (HCMV) infection is a common complication in transplant recipients. Sensitive, specific and timely diagnostic tests for the detection of HCMV infection remain essential for successful therapy. The results of three tests to detect HCMV in bone marrow and liver transplant recipients were compared: a pp65 antigenaemia assay, an immediate-early (IE) antigenaemia assay and an anti-HCMV immunoglobulin M (IgM) antibody enzyme-linked immunosorbent assay (ELISA). Of 1344 samples, 911 (67.8%) and 917 (68.2%) samples were positive for pp65 and IE, respectively. The coincidence level was 85.1%. There was no statistical difference after transplantation to the first positive detection of HCMV (mean first checkout time) between the pp65 and IE antigenaemia assays. Moreover, the levels of HCMV detected by the pp65 and IE antigenaemia assays were significantly correlated. The HCMV-positivity rate as detected by the anti-HCMV IgM ELISA was 11.1%, which was significantly different from the IE and pp65 antigenaemia assays. We suggest that the IE antigenaemia assay could replace the pp65 antigenaemia assay for monitoring active HCMV infection and early detection of HCMV infection.

Genetic analysis of four porcine avian influenza viruses isolated from Shandong, China

A Bayesian phylogenetic analysis of eight separate gene segments indicated A/Swine/Shandong/2/2003 (H5N1), A/Swine/Shandong/na/2003 (H9N2), A/Swine/Shandong/nb/2003 (H9N2) and A/Swine/Shandong/nc/2005 (H9N2) probably represent two multiple reassortant lineages, that had not been described before, with genes coming from H5N1, H9N2 and other lineages from poultry in Asia. Amino acid motifs within the haemagglutinin sequence of A/Swine/Shandong/nb/2003 suggested it may be able to infect people, whereas the sequences of the other three isolates suggested they would not have had that capability. Our analysis emphasizes the need for a comprehensive study of the interactions between H5N1 and H9N2 viruses in Asia that includes sequencing and phylogenetic investigation.

Analysis of factors influencing the blood levels and activities of tissue-type plasminogen activator (t-PA)

This study aimed to correlate plasmatic tissue-type plasminogen activator (t-PA) levels and activity with parameters of artery blood flow and vessel walls, nail fold microcirculation, hemorheology, serum glucose, and lipids. Thirty healthy volunteers (female/male 12/18) aged 40-60 (average 46) were included in the study. In citrate venous blood, the following parameters were determined: carotid mean velocity, carotid intimal-medial-thickness (IMT), capillary circulation parameters, hemorheology index, serum glucose, and lipids. Analysis of data showed that t-PA concentration was positively and significantly correlated with total cholesterol, triglycerides, and serum glucose (P<0.05, P<0.05, and P<0.01), but t-PA activity showed no correlation with them; among the hemorheology factors investigated, t-PA concentration showed the strongest positive correlation with both whole blood viscosity and reduced blood viscosity at high and low shear rate separately (P<0.01), t-PA activity showed no correlation with any hemorheology factors; t-PA concentration showed no correlation with any investigated nail fold capillary parameters, whereas t-PA activity was significantly and negatively associated with capillary loop number (P<0.05); t-PA concentration and activity was not associated with values of carotid maximum intimal-medial-thickness (mIMT) and mean velocity or systolic, diastolic blood pressure (P>0.05). But subjects with mIMT 1.0 mm showed higher t-PA levels compared with those with mIMT < 1.0 mm (P<0.05) and decreased carotid mean velocity (P<0.01). These findings suggest that multiple vascular disease risk factors would influence the t-PA level; t-PA concentration does not parallelize with t-PA activity.

Effects of Ginkgo biloba extract on somatosensory evoked potential, nitric oxide levels in serum and brain tissue in rats with cerebral vasospasm after subarachnoid hemorrhage

This study aimed to investigate the protective effects of Ginkgo biloba extract on cerebral vasospasm and neural damage following subarachnoid hemorrhage (SAH) in rats. It was found that the regional cerebral blood flow decreased immediately and persistently after SAH in SAH rats. The latency of somatosensory evoked potential delayed progressively. The nitric oxide levels in serum and brain tissue decreased and increased, respectively, after SAH. Ginkgo biloba extract effectively antagonized the changes of above parameters. It was concluded that somatosensory evoked potential is useful for the judgement of cerebral ischemic damage during cerebral vasospasm after SAH. Decrease in serum nitric oxide and increase in brain tissue nitric oxide are important factors leading to cerebral vasospasm and neural damage, respectively, after SAH. Ginkgo biloba extract relieves cerebral vasospasm and cerebral ischemic damage by reversing the pathological alteration of nitric oxide.

Effects of blockade of cerebral lymphatic drainage on cerebral ischemia after middle cerebral artery occlusion in rats

This experiment aimed to investigate the effects of blockade of cerebral lymphatic drainage on cerebral ischemic damage. Seventy six Wistar rats were divided randomly into middle cerebral artery occlusion (MCAO) group and MCAO plus cerebral lymphatic blockade (MCAO+CLB) group for the experiment. The contents of water and electrolytes, the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in the ischemic brain tissue were detected at 24, 48 and 72 hours after the operation. The morphologic examination was also performed. In MCAO group, contents of water, sodium and calcium in the ischemic brain tissue increased significantly at any time after the operation. The SOD activity decreased while the MDA content increased markedly. The morphologic findings showed severe damage of ischemic brain tissue and neurons. In MCAO+CLB group, the above parameters were altered more obviously. The present observation suggests that blockade of cerebral lymphatic drainage may deteriorate ischemic brain damage after MCAO.

[Changes of nitric oxide and endothelin-1 levels in rat brain tissue during cerebral vasospasm following subarachnoid hemorrhage and protective effect of nimodipine]

AIM

To investigate the changes of nitric oxide and endothelin-1 levels in brain tissue in rat with cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH), and the protective effect of nimodipine.

METHODS

Wistar rats were divided randomly into SAH group, nimodipine-treated group and sham-operated group. Diameters of basilar artery before and after operation were measured, and dynamic changes of regional cerebral blood flow (rCBF), brain nitric oxide and endothelin-1 levels were determined within 24 h. Pathological examination of hippocampus was also performed.

RESULTS

SAH resulted in significant and persistent decrease of rCBF. Diameter of basilar artery was reduced markedly. Neurons in hippocampus CA1 subfield were damaged severely. Both nitric oxide and endothelin-1 levels in brain tissue were increased significantly from 1 h to 24 h after SAH. However, the pathological changes of above parameters were not so severe in nimodipine-treated rats.

CONCLUSION

Increase of nitric oxide and endothelin-1 levels in brain tissue is probably involved in the development of ischemic brain damage caused by CVS after SAH. Nimodipine exerts its protective effect on brain neurons by antagonizing CVS and the pathological changes of nitric oxide and endothelin-1 in brain tissue.

[Effects of ginkgo biloba extract on somatosensory evoked potential and nitric oxide after subarachnoid hemorrhage]

OBJECTIVE

To observe the changes of somatosensory evoked potential(SEP) and nitric oxide (NO) after subarachnoid hemorrhage(SAH), and the influence of Ginkgo biloba extract (EGb).

METHOD

Rats in sham-operated group, SAH model group and EGb-treated group underwent measurement of dynamic changes of regional cerebral blood flow(rCBF), SEP and NO levels both in serum and in brain tissue within 24 h after operation.

RESULT

In SAH group, rCBF decreased immediately after operation, with no tendency to recover within 24 h. The latency of SEP delayed progressively from 1 h to 24 h after SAH. NO levels in serum and in brain tissue decreased and increased respectively from 1 h to 24 h after SAH. EGb effectively antagonized the changes of above parameters.

CONCLUSION

SEP is helpful in the judgement on brain ischemic damage after SAH. Decrease of NO in serum and increase of that in brain tissue may lead to cerebral vasospasm and ischemic brain damage respectively after SAH. EGb relieves SAH-induced brain ischemic damage by reversing the pathological alterations of NO.

Effect of octreotide on dynamic excretion of bile in Chinese acromegalic patients assessed by [99mTc]EHIDA hepatobiliary scan

We used [99mTc]EHIDA hepatobiliary scintigraphy to determine whether both hepatic bile secretion and gallbladder contractility are suppressed in acromegalic patients receiving long-term treatment with the somatostatin analogue octreotide. We studied three groups of patients: group 1, untreated patients; group 2, average dose of octreotide 500 +/- 100 micrograms/day for 33 +/- 4 months; and group 3, 1000 +/- 200 micrograms/day for 33 +/- 4 months. Images were taken at specified time intervals during the 120-min period following injection of EHIDA. After a single injection of octreotide, group 1 patients demonstrated delayed visualization of the radioisotope in the liver, gallbladder, and duodenum. At the end of long-term treatment, group 2 patients showed a delay in appearance of maximal radioactivity in the gallbladder. Two weeks following discontinuation of octreotide, this parameter had decreased significantly (P < 0.001). In group 3, visualization of the liver, gallbladder, and duodenum were prolonged, with delayed visualization of the gallbladder persisting two weeks after withdrawal (P < 0.005). These results indicate that gallbladder contractility is decreased after a single injection of octreotide and that during chronic octreotide therapy the rate of bile secretion is reduced. Impaired gallbladder contractility normalizes more rapidly after discontinuation of octreotide in patients receiving low doses of the analog.

Effect of monensin on the neuronal ultrastructure and endocytic pathway of macromolecules in cultured brain neurons

1. The endocytic pathway of horseradish peroxidase (HRP) was investigated in the perikarya of cultured neurons by electron microscopy and enzyme cytochemistry. The tracer was observed in endocytic pits and vesicles, endosomes, multivesicular bodies, and lysosomes. It took approximate 15 min for the transfer of HRP from the exterior of the cell to the lysosomes. 2. Monensin induced distension of the Golgi apparatus and formation of intracellular vacuoles. When neurons were incubated with both monensin and HRP for 30 to 120 min, the number of HRP-labeled endosomes was greater than that in the monensin-free group, whereas the reverse was seen for HRP-positive lysosomes. The formation of HRP-positive lysosomes in monensin-treated cells was blocked by 47 to 79%. 3. These results indicate that the intracellular transport of the endocytosed macromolecule is pH dependent. It is also possible that the export of lysosomal enzymes is inhibited by monensin, resulting in an accumulation of the endosomes and a reduction of the lysosomes.

[Effect of cardiac sympathetic nerves on changes of TXB2 and 6-keto-PGF1 alpha in venous blood of ischemic myocardium]

Experiments were performed on 54 anesthetized, open-chest dogs to observe the effect of cardiac sympathetic nerves and alpha- and beta-adrenoceptor blockades on changes of platelet function during the early phase of myocardial ischemia. It was shown that contents of TXB2 and 6-keto-PGF1 alpha after coronary occlusion were markedly increased, and the platelet count was reduced in the coronary venous blood of ischemic myocardium. It was found that the changes in parameters of platelet function after coronary occlusion were significantly relieved by topical application of lignocaine-soaked gauze pads to the ischemic area of the heart or by bilateral stellectomy for blocking impulse of afferent and efferent of cardiac sympathetic nerves, compared with changes in parameters of control group, P less than 0.01. On the other hand, changes in parameters of the control group could be restored by intravenous infusion of noradrenaline to dogs which bilateral stellectomy was performed on, but not by infusion of normal saline. Different effects of alpha- and beta-adrenoceptor blockades on the changes in aforementioned parameters were found. The changing degrees in elevation of TXB2 and 6-keto-PGF1 alpha and in decrease of platelet count were significantly relieved by intravenous infusion of yohimbine (an alpha 2-blocker), phentolamine (a nonselective alpha-blocker), and propranolol (a beta-blocker), but not by infusion of prazosin (an alpha 1-blocker). Results were compared with the control group, P less than 0.01. These results suggest that cardiac sympathetic nerves play an important role for the changes of platelet function during the early phase of myocardial ischemia and that, yohimbine and phentolamine may exert an improving effect by blocking alpha 2-receptors on the platelet membrane, and propranolol may directly contribute to stabilization of the platelet membrane.

[Prostaglandin E (PGE) and gastric carcinoma]

Since 1984, an experimental and clinical study on the relation between PGE and gastric carcinoma has been performed by determining PGE content in the bioptic gastric mucosa and plasma. It is found the PGE content in the gastric mucosa and plasma is increased in all patients with gastric cancer, especially with signet ring cell carcinoma. It is higher in the regional lymph node metastasis than in the early cancer, extensive metastases and normal subjects. The PGE content in the plasma is reduced obviously 7-10 days after operation but is increased markedly in recurrent patients. There is no significant difference in extensive metastases, relapse free and normal subjects. The PGE content in the plasma is significantly higher in gastric carcinoma than in chronic atrophic gastritis, but no difference is present between chronic atrophic gastritis and normal subjects.