Pulse Oximetry and Perfusion Index Screening for Congenital Heart Defects: A Systematic Review and Meta-analysis

Congenital heart defects (CHDs) are the most common neonatal malformations and are a leading cause of infant death in developed countries. Finding safe and effective diagnostic methods to screen for CHDs is important. The aim of this study was to evaluate the effectiveness of pulse oximetry (PO) and perfusion index (PI) in screening CHD. We conducted a systematic review of studies in PubMed, Embase, and the Cochrane Library published on or before October 1, 2021. Studies based on PICOS were included in this systematic review. The flow chart is made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. Five studies containing 46,965 neonates were included in this study. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.82 (95% confidence interval [CI], 0.53-0.95) and 0.97 (95% CI, 0.57-1.00), respectively. The area under the curve was 0.92 (95% CI, 0.89-0.94). The combination PO and PI was significant in CHD screening. Once diagnosed by the combined method, it means that the neonate is most likely to have a CHD. KEY POINTS: · Pulse oximetry and PI screening.. · Congenital heart defects.. · A systematic review and meta-analysis..

[Comparative analysis of intestinal microbiota distribution characteristics based on metagenomics in patients with hepatitis B cirrhosis with or without ascites]

Objective: To use metagenomic sequencing to compare the differences in intestinal microbiota species and metabolic pathways in patients with hepatitis B cirrhosis with or without ascites and further explore the correlation between the differential microbiota and clinical indicators and metabolic pathways. Methods: 20 hepatitis B cirrhosis cases [10 without ascites (HBLC-WOA), 10 with ascites (HBLC-WA), and 5 healthy controls (HC)] were selected from the previously studied 16S rRNA samples. Metagenome sequencing was performed on the intestinal microbiota samples. The Kruskal-Wallis rank sum test and Spearman test were used to identify and analyse differential intestinal microbiota populations, metabolic pathways, and their correlations. Results: (1) The overall structure of the intestinal microbiota differed significantly among the three groups (R = 0.19, P = 0.018). The HC group had the largest abundance of Firmicutes and the lowest abundance of Proteobacteria at the genus level. Firmicutes abundance was significantly decreased (P(fdr) < 0.01), while Proteobacteria abundance was significantly increased (P(fdr) < 0.01) in patients with cirrhosis accompanied by ascites; (2) LEfSe analysis revealed that 29 intestinal microbiota (18 in the HBLC-WA group and 11 in the HBLC-WOA group) played a significant role in the disease group. The unclassified Enterobacteriaceae and Klebsiella species in the HBLC-WA group and Enterobacteriaceae in the HBLC-WOA group were positively correlated with the Child-Turcotte-Pugh (CTP) score, prothrombin time, and international normalized ratio score and negatively correlated with albumin and hemoglobin levels (P < 0.05). Escherichia and Shigella in the HBLC-WA group were positively correlated with CTP scores (P < 0.05); (3) The correlation analysis results between the KEGG pathway and 29 specific intestinal microbiota revealed that Enterobacteriaceae and arachidonic acid, α-linolenic acid, glycerolipid metabolism, and fatty acid degradation were positively correlated in the lipid metabolism pathway, while most Enterobacteriaceae were positively correlated with branched-chain amino acid degradation and negatively correlated with aromatic amino acid biosynthesis in the amino acid metabolic pathway. Conclusion: A significant increment of Enterobacteriaceae in the intestines of HBLC-WA patients influenced hepatic reserve function and was associated with amino acid and lipid metabolic pathways. Therefore, attention should be paid to controlling the intestinal microbiota to prevent complications and improve the prognosis in patients with hepatitis B cirrhosis, especially in those with ascites.

Comparison of aroma properties of infant formulas: Differences in key aroma compounds and their possible origins in processing

Aroma is an important attribute of infant formula (IF). In this study, 218 volatiles and 62 odor-active compounds were detected from IF by dynamic headspace sampling combined with comprehensive 2-dimensional gas chromatography-olfactometry-mass spectrometry. Aldehydes and ketones were determined as the most abundant odor-active compounds. Among them, the contents of pentanal and hexanal were the most abundant, while 1-octen-3-one had the highest flavor dilution factor and odor activity value in most of the IF. Sensory evaluation and electronic nose analysis showed that the skimming process, the fatty acid composition, and powdered or liquid milk base used for the production of IF may be important factors resulting in their differences in aroma profiles and compounds. These differences were assumed to be mainly ascribed to the Maillard reaction and lipid oxidation, which were largely influenced by the temperature and water activity.

[Surgical treatment of tricuspid valve disease due to permanent pacemaker lead]

Objective: To summarize the etiology and surgical treatment experience of tricuspid valve disease due to permanent pacemaker lead. Methods: The medical records of 22 patients who underwent tricuspid valve operation for tricuspid valve disease due to permanent cardiac pacemaker lead from January 2008 to December 2017 were retrospectively reviewed. There were 12 males and 10 females, with a mean age of (62.6±12.1) years old (45-82 years old). All patients underwent tricuspid valve surgery via open thoracotomy under general anesthesia, including 8 patients through median thoracotomy approach, 4 patients through right mini-thoracotomy approach, and 10 patients with endoscopy-assisted and totally endoscopic technique. Moreover, 8 patients underwent tricuspid valve replacement, and 14 patients received tricuspid valve repair. Results: During the operation, 10 cases of severe tricuspid regurgitation were detected due to valve and subvalvular structures dysfunction involved in the pacing electrode, 7 cases showed tricuspid annulus dilation, and pacing electrode-related infective endocarditis were involved in the tricuspid valve of 5 cases. Compared with conventional median thoracotomy surgery, the amount of postoperative drainage fluid and hospitalization time after minimally invasive surgery (including right mini-thoracotomy and endoscopic surgery) were significantly reduced [281(120, 489) ml vs 368(180, 560) ml, P=0.02; 9.2(4.8, 14.5) d vs 11.2(6.3, 16.9) d, P=0.03]. Postoperative echocardiographic data showed that the size of the right atrium and ventricle in these patients was significantly reduced compared with preoperative data, and their cardiac function were normal. There was no difference of pacing electrode parameters between pre-and postoperative period. All 22 patients were cured and discharged, with no valve-and pacemaker-related complications. Conclusions: Patients with tricuspid valve disease due to permanent cardiac pacemaker lead should actively undergo surgery including tricuspid replacement or repair according to different etiologies, which exhibit satisfactory outcomes. Minimally invasive endoscopic tricuspid surgery is a new technique for the treatment of isolated tricuspid valve disease, with less surgical trauma and faster recovery.

Regioisomeric and enantiomeric analysis of primary triglycerides in human milk by silver ion and chiral HPLC atmospheric pressure chemical ionization-MS

Triglycerides (TG) not only provide energy for infants but have important physiological functions. Understanding the composition and structure of TG in human milk is conducive to the development of infant formulas. In this study, TG species in human milk from 3 provincial capitals (Zhengzhou, Wuhan, and Harbin) in different regions of China were determined through C18 HPLC electrospray ionization tandem mass spectrometry (MS). The results showed that in human milk from these 3 regions, oleoyl-palmitoyl-linoleoylglycerol (OPL; 16.55, 19.20, and 18.67%, respectively) was more abundant than oleoyl-palmitoyl-oleoylglycerol (OPO; 10.08, 10.22, and 12.03%, respectively). Subsequently, regioisomeric and enantiomeric analysis of main TG in the human milk were performed on silver ion and chiral HPLC atmospheric pressure chemical ionization mass spectrometry (APCI)-MS, respectively. The results showed that rac-OPL (above 85%), rac-OPO (above 85%), rac-palmitoyl-oleoyl-oleoylglycerol (PPO; above 90%), and rac-OLaO (above 70%) were the main regioisomers of OPL, OPO, PPO, and lauroyl-oleoyl-oleoylglycerol (LaOO), respectively. The relative ratios of enantiomer pairs of rac-OPL (rac-OPL1 and rac-OPL2) were about 37 and 63%, respectively.

[The procedure choice for the reoperation of tricuspid valve lesion after left heart valve surgery]

Tricuspid insufficiency late after left-sided heart valve surgery is not uncommon. These patients usually suffer from severe right heart insufficiency and poor general condition due to untimely surgical intervention, and are often complicated with hepatic and renal insufficiency and hemopoietic dysfunction. The choice of strategy for reoperation and perioperative management are still the major challenges for contemporary cardiac surgeons. This article introduces the clinical characteristics and operation timing of patients with severe tricuspid insufficiency after previous left-sided heart valve surgery, and focuses on the selection of operation approach and operation methods.

[Uni-port totally thoracoscopic surgery in tricuspid insufficiency patients after previous left-sided valve surgery]

Objective: To examine minimally invasive tricuspid valve operations applied in tricuspid valve insufficiency patients with previous left-sided valve surgery. Methods: Between September 2017 and June 2019, thirty-six consecutive patients received minimally invasive totally thoracoscopic tricuspid surgery through right thoracotomy at Department of Cardiovascular Surgery, Fisrt Medical Center, People's Liberation Army General Hospital. There were 13 males and 23 females, aging (56±11) years (range: 43 to 79 years). All the patients had isolated significant tricuspid regurgitation after previous left-sided cardiac surgeries. A right anterolateral thoracotomy incision about 4 cm was made from the fourth intercostal space as main operating port. The arterial cannula was placed in femoral artery. The venous cannula was placed in femoral vein using Seldingger technique. Tricuspid valve operation was performed on beating heart by assist of vena vacuum. Results: Tricuspid valve repair was performed in 7 patients. Tricuspid valve replacement with bioprosthesis was performed in 29 patients. The operation time was (2.9±0.3) hours (range:2.5 to 3.6 hours). There was no conversion to sternotomy during operation. There was no severe complications during operation period. There were no complications related to this cannulation technique. The time of cardiopulmonary bypass establishment was (22±5) minutes (range: 12 to 24 minutes) and pump time was (82±16) minutes (range: 62 to 93 minutes). The length of hospital stay was (9±3) days after operation (range: 5 to 13 days). There was no early death in hospital. All patients were followed up for 3 to 22 months. No patient died. Conclusions: One single port-based minimally invasive approach seems to be safe, feasible, and reproducible in case of redo tricuspid valve operations. Only cannulation of inferior vena cava significantly simplified the complexity of isolated redo tricuspid surgery.

Biodegradation of polyvinyl alcohol by different dominant degrading bacterial strains in a baffled anaerobic bioreactor

Polyvinyl alcohol (PVA) is the main pollutant in printing and dyeing wastewaters. This pollutant exhibits great demand, poor biodegradability and refractory degradation. In this study, PVA wastewater treatment experiments were conducted in a stably operating baffled anaerobic bioreactor (ABR) by using simulated PVA wastewater. The PVA degradation pathway and mechanism of the mixed dominant PVA-degrading bacterial strains were identified through the analysis of their degradation products. From the results, we inferred that PVA was degraded in a stepwise process under the synergistic action of different extracellular and intracellular enzymes produced by the mixed dominant PVA-degrading bacterial strains. In this process, PVA was first degraded into ketones, fatty acids and alcohols. It was then regenerated into acetic acid, hydrogen and carbon dioxide. Finally, these substances could be further utilized by methanogens. PVA was thus degraded completely. This study may serve as a reference for future works on the degradation of PVA in the ecological environment. It may also guide the sustainable development of PVA.

[Clinical study of different adsorbents with dual plasma molecular adsorption system in the treatment of hepatic failure]

Objective: To investigate the effects of two different sorbents(Carbon perfusion apparatus and Resin perfusion apparatus)in Double plasma molecular absorb syetem for liver failure treatment. Methods: A total of 152 cases with liver failure who were admitted to The Sixth People's Hospital of Zhengzhou, from June 2016 to May 2018 were selected and divided into DPMARS Carbon group (77 cases) and Resin group (75 cases). The two groups were observed in terms of liver function, prothrombin activity(PTA),Plasma albumin ,tumor necrosis factor alpha and interleukin-6 were detected and compared between the two groups before and after treatment. Results: ①The clinical symptoms improved in different degree in two groups, the recovery rate of Carbon cans Carbon perfusion apparatus group and Resin group separately were89.6% (69/77)、90.7% (68/75)(χ(2) = 0.048, P = 0.975), there were no statistical differences. There were no statistical differences between the two groups in untoward reactions(χ(2) = 0.235, P = 0.995), ②Compared with before treatment, TBil(t = 3.735, 3.728; P = 0.000, 0.000)、ALT(t = 5.117, 5.203; P = 0.000, 0.000)、TNF-α (t = 3.158, 3.094; P = 0.000, 0.002)、IL-6(t = 3.647, 3.559; P = 0.002, 0.003)decreased and ALB (t = 2.300, 3.065; P = 0.024, 0.003) increased significantly after treatment in both groups, and there were statistical differences. There were no signifiant differences in the changes in ALB(t = 0.316, 0.209; P = 0.657, 0.720) and PTA(t = 0.810, 0.843; P = 0.429, 0.516). ③After treatment, there were no signifiant differences in the changes in TBil、ALT、ALB、PTA、TNF-α、IL-6(t = 0.377、0.904、-1.133、-1.552、0.841、0.401; P = 0.952、0.283、0.826、0.094、0.154、0.457). Conclusion: Double plasma molecular absorb syetem is effective in treating liver failure. Carbon perfusion apparatus or Resin perfusion apparatus can be combined with Specific bilirubin adsorption column for DPMARS in clinical treatment,and their effects are similar.

[Clinical application of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery]

Objective: To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. Methods: From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (n=10) and dual chamber pacemaker (n=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery. Results: All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up. Conclusions: For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.

[The multicenter study on the registration and follow-up of low anticoagulation therapy for the heart valve operation in China]

OBJECTIVE

To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations.

METHODS

In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015.

RESULTS

As for in-hospital patients, mean age of study population was (48.6±11.2) years old; main etiology of valve pathology was rheumatic (87.5%) origin among study cohort; 94.8% of study population received mechanical valve implantation; international normalized ratio (INR) monitoring (in all the study centers) and low-intensity anticoagulation strategy (31 hospitals chose target INR range of 1.5-2.5, and actual values of INR among 89.2% of 100 069 in-hospital monitoring samples were 1.5-2.5), with mean actual INR values of 1.84±0.53, and warfarin dosage of (2.82±0.93) mg/d were widely adopted among the study centers; strategies of in-hospital warfarin administration were similar in all the study centers; complication rates of low-intensity anticoagulation strategy were low in severe hemorrhage (0.02%), thrombosis (0.05%), and thromboembolism (0.05%) events, without anticoagulation-related death.As for 18 974 outpatient clinic patients, the follow-up rate was 92.47%, with a total of 30 012 patient-years (Pty). Anticoagulation-related morbidity and mortality rates were 0.67% and 0.15% Pty; major hemorrhage morbidity and mortality rates were 0.25% and 0.13% Pty; thromboembolism morbidity and mortality rates were 0.45% and 0.03% Pty.The mean dosage of warfarin daily dosage was (2.85±1.23) mg/d and INR value was 1.82±0.57.No significant regional difference in the intensity of anticoagulation therapy was noted during the study.

CONCLUSIONS

INR can be used as a normalized indicator for intensity of anticoagulation therapy in China.The optimal anticoagulation intensity with INR range from 1.5 to 2.5 is safe and effective for Chinese patients with heart valve replacement, and there is no significant regional difference in the intensity of anticoagulation therapy.

[Effects of statin intervention on mild coronary plaque progression assessed by serial coronary CT angiography]

OBJECTIVE

To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography.

METHODS

A total of 120 consecutive patients (74 men, ages(58.9±8.1)years) with mild (≤50%luminal narrowing and lesion length<20 mm) non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study.Subjects were divided into three groups: no statin (n=36), statin lowering LDL-C <50% (n=43), and statin lowering LDL-C ≥50%(n=41). Serial scans were performed after a median interval of 705 (interquartile range: 467, 803) days.Total plaque volume, percent plaque volume for both baseline and follow-up were measured.Baseline and follow-up data were compared.

RESULTS

Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up ((97.3±57.8) mm(3) vs. (82.2±57.7) mm(3,) P=0.075). However, no significant change was observed as for total plaque volume ((78.5±45.2) mm(3) vs.(77.6±50.5) mm(3), P=0.910) in the statin lowering LDL-C <50% group.Total plaque volume was significantly reduced by the end of follow-up ((61.5 ± 46.1) mm(3) vs.(77.7±48.1) mm(3), P=0.024) in the statin lowering LDL-C ≥50% group.Percent plaque volume in no statin group was significantly increased by the end of follow-up ((51.9±16.5)% vs.(45.9±12.8)%, P=0.036). However, no significant change was observed as for percent plaque volume ((49.1±13.7)% vs.(47.5±14.9)%, P=0.554) in the statin lowering LDL-C <50% group. Percent plaque volume was significantly reduced by the end of follow-up ((39.1±17.1)% vs.(48.2±15.0)%, P=0.003) in the statin lowering LDL-C ≥50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume(β=-0.50, P<0.001) and statin lowering LDL-C ≥50%(β=-0.32, P=0.001) were independent determinants of plaque regression.

CONCLUSION

This study suggests that LDL-C reduction ≥50% post statin treatment can retard plaque progression, and even induce regression of mild non-calcified coronary plaque, patients with greater baseline coronary plaque volume are more likely to benefit from statin therapy.

Curative effect of mechanical heart valve replacement and anticoagulant therapy after surgery

This study was carried out to determine the curative effect of low-intensity anticoagulant therapy by observing the oral administration of warfarin (anticoagulant therapy) on patients who had undergone mechanical heart valve replacement (MHVR) surgery with subsequent anticoagulation complications. Fifty patients who underwent MHVR in the Second Affiliated Hospital of Harbin Medical University and 52 patients in the Cardiovascular Surgery of Daqing Oilfield General Hospital between January 2013 and January 2016 were selected (63 males and 39 females, ages 26-77 years). They took warfarin after treatment and were followed-up by means of outpatient review and telephone after leaving the hospital. The effect of warfarin and the occurrence of anticoagulation complications were analyzed. The operations lasted 230±106 min, extracorporeal circulation for 110±50 min and aorta occlusion for 82±23 min. During post-operation 3 patients developed skin purpura and one patient died. During follow-up we found 3 cases of anemia caused by excessive menstruation, 4 cases of hematuresis, 3 cases of peated epistaxis, 1 case of gastrointestinal bleeding, 1 case of cerebral hemorrhage, 1 case of embolism in the lower limbs and 1 case of cerebral infarction, although they all improved or were totally cured. Therefore, the incidence of complications can be reduced significantly by the correct administration of warfarin as well as timely monitoring of interference factors after MHVR.

Influence of surgical resection of hepatocellular carcinoma(HCC) for hematogenous dissemination of HCC cells and its effect on recurrence and metastasis: 3 years prospective study

Aims was to study whether hepatal surgery leads to hematogenous dissemination of hepatocellular carcinoma (HCC) cells and determine period of its persistence by nested reverse transcription-polymerase chain reaction (RT-PCR). Peripheral vein blood (5ml) samples were obtained from 54 HCC patients of T1N0M0 and 6 HCC patients of T2N0M0 stage and 20 patients with liver cavernous hemangioma(LCH) before operation and 48h,72h and 1 week after surgical resection of hepatoma between Janurary 1st, 2007 and December 31th, 2010. We detected alpha-fetoprotein (AFP) messenger RNA(mRNA) by nested RT-PCR perioperatively.FPmRNA of all 60 cases of HCC patients and 20 cases of LCH were negative before hepatal surgery, 28 of 60 HCC cases became positve at 48h after surgery (46.7%), 16 of 60 HCC cases remained positive at 72h postoperatively(26.7%), none of 60 HCC patients AFPmRNA was detected at 1 week after hepatal surgery(0.0%). None of LCH patients were detected AFPmRNA after hepatal surgery(0.0%). For 28 HCC patients with AFPmRNA positive after hepatal surgery, 4 HCC patients developed intrahepatic tumor recurrences in 1st year (4/28, 14.3%),6 HCC patients relapsed in the second year(6/28,21.4%),10 HCC patients relapsed in the third year(10/28,35.7%). For 32 HCC patients with AFPmRNA negative group postoperation, 5 cases relapsed in 1st year (5/32, 15.6%),7 cases developed intrahepatic tumor recurrences in the second year (7/32, 21.9%),11 cases relasped in the third year (11/32, 34.4%,P>0.05),none of HCC patients occured distal metastasis after surgical resection of hepatoma. None of LCH patients relapsed postoperation within three years.Hepatal surgery may cause HCC cells spreading into peripheral blood shortly, but it may be not concerning with recurrence or metastasis of HCC.

Effect of fasudil hydrochloride on the post-thaw viability of cryopreserved porcine adipose-derived stem cells

BACKGROUND

Adipose-derived stem cells (ADSCs) are of interest for regenerative medicine as they are isolated easily and can differentiate into multiple cell lineages. Recently, it was reported that a Rho-associated kinase (ROCK) inhibitor Y-27632 could enhance the post-thaw viability and physiological function of cryopreserved BMSC.

OBJECTIVE

The present study is to investigate whether Fasudil hydrochloride (FH, a selective Rho-kinase inhibitor like Y-27632) can exert a similar beneficial effect on the post-thaw viability of cryopreserved ADSCs.

METHODS

ADSCs were allotted in three cryopreservation solutions [I:10 % (v/v) (DMSO), 30 % (v/v) FBS (as a negative control); II:10µM FH, 10 % (v/v) DMSO, 30 % (v/v) FBS; III:10 µM Y-27632, 10 % (v/v) DMSO, 30 % (v/v) fetal bovine serum, All groups were frozen using a rapid freezing method and stored at -196 degree C in liquid nitrogen for 30 days.After thawing and being cultured 24h,viability of ADSCs were detected by MTT assay.

RESULT

The MTT assay showed significant differences in the proportion of adherent viable cells over the concentration of Y-27632 and FH, Additionally, FH did not induce morphological changes in the frozen-thawed ADSCs like Y-27632 did.

CONCLUSIONS

FH might represent a promising cryopreservation solution in enhancing the post-thaw viability and physiological function of cryopreserved ADSCs and did not chang the cell appearance.

OX40 Ligand Levels and High-Sensitivity C-Reactive Protein Levels in Blood from Local Coronary Plaque and the Femoral Artery in Patients with Acute Coronary Syndrome or Stable Angina

OX40 ligand (OX40L) and high-sensitivity C-reactive protein (hs-CRP) play important roles in the pathogenesis of atherosclerosis. In this study, consecutive patients with acute coronary syndrome (ACS; n = 90) or stable angina (SA; n = 40) and healthy control subjects ( n = 50) were evaluated to assess plasma OX40L and serum hs-CRP levels in local coronary plaque and the femoral artery. OX40L and hs-CRP levels in the femoral artery were significantly higher in patients with ACS compared with controls. OX40L and hs-CRP levels in local coronary plaque (OX40Lc and hs-CRPc, respectively) were significantly higher in ACS than in SA patients. OX40L and hs-CRP levels were positively correlated with each other and were also correlated with fibrinogen levels. The number of complex lesions was correlated with OX40Lc and hs-CRPc levels. It is concluded that the OX40Lc level was highly sensitive for evaluating the inflammatory response in ACS and elevated levels of OX40Lc may be a valuable predictive marker for increased risk of atherosclerotic progression in ACS patients.

Correlation analysis of mineral element contents and quality traits in milled rice (Oryza stavia L.)

The relationships among potassium (K), calcium (Ca), sodium (Na), magnesium (Mg), iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn) contents in milled rice (Oryza stavia L.) of 274 genotypes and the relationships between these mineral element contents and other rice quality traits including 3 cooking quality traits, 17 amino acid contents, and protein content were investigated. The results showed that there were significant correlations among most of mineral element contents. Mg, Fe, and Mn contents were significantly correlated with most of the other mineral element contents, while Cu content had significantly negative associations with the K and Mg contents of rice. The relationships between mineral element contents and cooking quality traits showed that gel consistency (GC) was significantly correlated with K, Cu, and Mn contents of rice. Amylose content (AC) was significantly associated with K, Na, Mg, Cu, and Mn contents. The alkali spreading value (ASV) had closely positive relationships with Ca, Mg, and Mn contents. In addition, 8 mineral element contents had obvious correlations with different amino acid contents. Mg, Ca, and Zn contents were significantly correlated with most of the 17 amino acid contents, but Na content did not correlate with amino acid contents except aspartic acid of rice. Furthermore, significant associations were found between protein content and Na, Mg, Zn, Cu, or Mn content. Six principal components were extracted to explain 84.50% of the total variances and contained the information provided by the original 29 variables according to the principal component analysis.

Effects of window and threshold levels on the accuracy of three-dimensional rendering techniques in coronary artery electron-beam CT angiography

RATIONALE AND OBJECTIVES

The authors performed this study to evaluate the effect of window level and gray-scale threshold on the demonstration of coronary artery lumina at three-dimensional electron-beam computed tomographic (CT) angiography.

MATERIALS AND METHODS

Forty-four coronary artery branches in postmortem pigs were evaluated with electron-beam CT angiography, and the findings were compared with those from conventional angiography. Images from electron-beam CT angiography were reconstructed with maximal intensity projection (MIP), multiplanar reformation (MPR), and shaded-surface display (SSD). Four categories of window level and gray-scale threshold were evaluated.

RESULTS

Three-dimensional electron-beam CT angiography accurately depicted the luminal diameters of the coronary arteries compared with conventional angiography (r = 0.83-0.90, P < .0001). The length of lumina visualized at electron-beam CT angiography was significantly shorter than that visualized with conventional angiography (P < .001). The use of MPR enabled visualization of longer segments of coronary arteries than did the use of MIP or SSD (P < .05). The higher the window level and gray-scale threshold used, the smaller the coronary luminal diameters measured (P < .05). The most accurate window level and gray-scale threshold (82.6 HU +/- 29.8 and 89.5 HU +/- 29.7, respectively) were found to correspond to the attenuation of the lumina (275.8 HU +/- 58.8). Results of simple linear regression showed a strong correlation between luminal attenuation and window level (r = 0.89, P < .0001) or gray-scale threshold (r = 0.95, P < .0001).

CONCLUSION

Electron-beam CT angiography shows promise in the visualization of coronary artery lumina. For accurate display of lumina, a proper window level and gray-scale threshold for three-dimensional rendering techniques should be determined and used on the basis of the attenuation of the target vessel.

Coronary artery stenoses: a phantom study using contrast enhanced three-dimensional electron beam tomography

This paper evaluated the accuracy of electron beam tomographic angiography (EBA) with conventional coronary arteriography (CCA) using four graded artificial stenoses in a postmortem swine coronary phantom model. The sensitivity, specificity, and accuracy of EBA for diagnosing significant stenosis (> or =50% stenosis) were 94.3%, 96.7%, and 95.8%, respectively. The diagnostic accuracy of EBA had no significant difference with CCA (chi(2)=0.0162; P>.05). EBA three-dimensional (3D) procedures had high interobserver reproducibility (k=.92-.95, P>.05). Maximum intensity projection (MIP) was the most sensitive and curved planar reformation (CPR) was the most accurate 3D procedure for quantitatively identifying coronary stenosis. EBA yields promising results concerning the visualization of coronary artery stenosis with high accuracy for stenoses >50%.

[Study on the characteristics and applications of a new hydrophobic interaction chromatographic packing using chitosan as support]

Based on chitosan, by using valeraldehyd as ligand, a new hydrophobic interaction chromatographic (HIC) packing material was prepared by an improved method. The effects of salt concentration, temperature, pH on the adsorption of bovine serum albumin(BSA) were investigated. The results showed that the adsorption behavior of protein by packing material is in agree with the theory of hydrophobic interaction. The alpha-amylase could be separated by HIC with high recovery of enzymatic activity.

C-reactive protein and serum amyloid A mRNA stability following induction by cytokines

We determined the effects of cytokine withdrawal on C-reactive protein (CRP) and serum amyloid A (SAA) mRNA abundance in Hep3B cells following 24 h of preinduction with interleukin 6 plus interleukin 1 beta. After cytokine withdrawal, CRP transcription rate rapidly fell to undetectable levels and mRNA levels fell with a half-disappearance time of about 2.5 h. In view of the relatively small amount of CRP transcription occurring at this time, it is likely that this value closely reflects the actual half-life of CRP mRNA. In contrast, substantial SAA transcription continued for at least 8 h, while SAA mRNA fell with a half-disappearance time of about 8.5 h. It is not possible, under these conditions, to determine SAA mRNA half-life, but it clearly was no greater than 8.5 h. Both Actinomycin D (ActD) and cycloheximide enhanced the stability of SAA mRNA, strongly suggesting that SAA mRNA degradation requires synthesis of a short-lived protein. CRP mRNA stability was also enhanced by ActD, but cycloheximide did not have a protracted stabilizing effect, suggesting complex regulatory processes. These studies provide insight into the stability of CRP and SAA mRNA following induction with [IL-6 + IL-1 beta] and into the mechanisms regulating their degradation.

The effect of interleukin-1 on C-reactive protein expression in Hep3B cells is exerted at the transcriptional level

The combination of interleukin 6 (IL-6) and interleukin 1 (IL-1) synergistically induces the human acute-phase reactant, C-reactive protein (CRP) in Hep3B cells. While previous studies have indicated that IL-6 induces transcription of CRP, the mode of action of IL-1 has not been clearly defined. It has been suggested that the effect of IL-1 might be post-transcriptional, exerted through the 5'-untranslated region (5'-UTR). To evaluate the role of IL-1 in CRP gene expression, we studied the effects of interleukin-6 (IL-6) and interleukin-1 beta (IL-1 beta) on both the endogenous CRP gene and on transfected CRP-CAT constructs in Hep3B cells. In kinetic studies of the endogenous CRP gene, IL-1 beta alone had no effect on CRP mRNA levels, but when added to IL-6, synergistically enhanced both CRP mRNA levels and transcription, as determined by Northern-blot analyses and nuclear run-on studies. IL-6 alone and the combination of [IL-1 beta + IL-6] each induced increases in mRNA levels roughly comparable with observed increases in transcription. These findings indicate that the effect of IL-1 beta on CRP expression is exerted largely at the transcriptional level in this system. This conclusion was confirmed by studies in Hep3B cells transiently transfected with CRP-CAT constructs, each containing 157 bp of the CRP 5'-flanking region but differing in the length of the 5'-UTR from 104 bp to 3 bp. All constructs responded in the same way; IL-6, but not IL-1 beta, induced significant chloramphenicol acetyltransferase (CAT) expression which was synergistically enhanced 2- to 3-fold by IL-1 beta. These results indicate that IL-1 beta stimulates transcriptional events in the presence of IL-6 and that the upstream 157 bases of the CRP promoter contain elements capable of both IL-6 induction and the synergistic effect of IL-1 beta on transcription.

Kinetic modeling and mathematical analysis indicate that acute phase gene expression in Hep 3B cells is regulated by both transcriptional and posttranscriptional mechanisms

To evaluate the possible role of posttranscriptional mechanisms in the acute phase response, we determined the kinetics of transcription (by nuclear run-on assay) and mRNA accumulation of five human acute phase genes in Hep 3B cells incubated with conditioned medium from LPS-stimulated monocytes. Increase in mRNA accumulation was comparable to increase in transcription rate for fibrinogen-alpha and alpha-1 protease inhibitor, suggesting largely transcriptional regulation. In contrast, mRNA accumulation was about 10-20-fold greater than transcriptional increase for serum amyloid A, C3, and factor B, suggesting participation of posttranscriptional mechanisms. Since finding a disparity between the magnitudes of increase in mRNA and transcription does not definitively establish involvement of posttranscriptional mechanisms, we subjected our data to modeling studies and dynamic mathematical analysis to evaluate this possibility more rigorously. In modeling studies, accumulation curves resembling those observed for these three mRNAs could be generated from the nuclear run-on results only if posttranscriptional regulation was assumed. Dynamic mathematical analysis of relative transcription rates and relative mRNA abundance also strongly supported participation of posttranscriptional mechanisms. These observations suggest that posttranscriptional regulation plays a substantial role in induction of some, but not all acute phase proteins.

Induction of human serum amyloid A in Hep 3B cells by IL-6 and IL-1 beta involves both transcriptional and post-transcriptional mechanisms

Previous studies of murine serum amyloid A (SAA) regulation during inflammatory states or following exposure to macrophage-conditioned medium have raised the possibility that both post-transcriptional and transcriptional mechanisms participate in induction of this family of proteins. Since IL-6 and IL-1 have been shown to induce SAA in human hepatoma cell lines, we explored the possibility that these cytokines might induce human SAA through post-transcriptional as well as transcriptional mechanisms. In kinetic studies, we found that continuous exposure of Hep 3B cells to either IL-6 or IL-1 beta alone caused only minimal increases in SAA mRNA and marginal increases in transcription (as measured by nuclear runon). In contrast, the combination of these cytokines led to a 23-fold increase in transcription, maximal at 12 h, with continuing increase in mRNA, achieving levels more than 1,000-fold greater than baseline by 72 h. This massive disparity between increases in mRNA and in transcription rate strongly supports the participation of post-transcriptional mechanisms in SAA induction by (IL-6 + IL-1 beta), whereas the lag between peaks of transcription and mRNA abundance reflects a relatively slow degradation rate of SAA mRNA. As observed by other workers, mean size of SAA mRNA decreased progressively over the course of incubation. Simultaneous kinetic studies of complement factors B and C3, haptoglobin, and alpha-1 protease inhibitor revealed several different patterns of response to IL-6 and IL-1 beta.

Induction of human serum amyloid A in Hep 3B cells by IL-6 and IL-1 beta involves both transcriptional and post-transcriptional mechanisms

Previous studies of murine serum amyloid A (SAA) regulation during inflammatory states or following exposure to macrophage-conditioned medium have raised the possibility that both post-transcriptional and transcriptional mechanisms participate in induction of this family of proteins. Since IL-6 and IL-1 have been shown to induce SAA in human hepatoma cell lines, we explored the possibility that these cytokines might induce human SAA through post-transcriptional as well as transcriptional mechanisms. In kinetic studies, we found that continuous exposure of Hep 3B cells to either IL-6 or IL-1 beta alone caused only minimal increases in SAA mRNA and marginal increases in transcription (as measured by nuclear runon). In contrast, the combination of these cytokines led to a 23-fold increase in transcription, maximal at 12 h, with continuing increase in mRNA, achieving levels more than 1,000-fold greater than baseline by 72 h. This massive disparity between increases in mRNA and in transcription rate strongly supports the participation of post-transcriptional mechanisms in SAA induction by (IL-6 + IL-1 beta), whereas the lag between peaks of transcription and mRNA abundance reflects a relatively slow degradation rate of SAA mRNA. As observed by other workers, mean size of SAA mRNA decreased progressively over the course of incubation. Simultaneous kinetic studies of complement factors B and C3, haptoglobin, and alpha-1 protease inhibitor revealed several different patterns of response to IL-6 and IL-1 beta.

Applicability of Orem's conceptual framework: a cross-cultural point of view

Orem's conceptual framework for nursing is analysed and evaluated for its applicability in Chinese nursing practice. The appropriateness of Orem's nursing theory for application in Chinese nursing practice is determined through an examination of its completeness, compatibility, practicality and feasibility. Some insights and recommendations are offered for consideration.

Effect of combinations of cytokines and hormones on synthesis of serum amyloid A and C-reactive protein in Hep 3B cells

We have previously shown that induction of synthesis of the two major human acute phase proteins, serum amyloid A (SAA) and C-reactive protein (CRP), can be accomplished in the human hepatoma cell line Hep 3B, in the presence of dexamethasone, either by conditioned medium from LPS-stimulated monocytes or by the combination of IL-6 and IL-1. Neither of these cytokines alone caused significant induction of either SAA or CRP. In the present study we extended our earlier observations by evaluating the role of dexamethasone, the effect of different concentrations of IL-6 and IL-1 alpha in combination, and the possible role of TNF-alpha in regulating synthesis of SAA and CRP. Dexamethasone alone had no effect on induction of SAA or CRP. Incubation of Hep 3B cells with conditioned medium from LPS-stimulated monocytes, in the absence of dexamethasone, led to modest induction of SAA or CRP, but addition of dexamethasone potentiated this response in a dose-dependent manner. Similar results were obtained for the effect of dexamethasone on the induction of SAA by IL-6 plus IL-1 alpha. Checkerboard titration of IL-6 and IL-1 alpha revealed that increases in concentration of either cytokine led to dose-related increases in synthesis of both SAA and CRP as long as a minimal amount of the other cytokine was present. TNF-alpha alone had no significant effect on synthesis of either SAA or CRP, but the combination of IL-6 plus TNF-alpha led to substantial induction of SAA. This combination was less effective than the combination of IL-6 plus IL-1 alpha. No detectable effect of IL-6 plus TNF-alpha was observed on CRP synthesis. Both combinations of cytokines, IL-6 plus IL-1 alpha, and IL-6 plus TNF-alpha, caused increased SAA mRNA accumulation that roughly paralleled increase in synthesis. These data indicate that IL-6, IL-1 alpha, TNF-alpha, and dexamethasone in various combinations are all capable of influencing synthesis of SAA in Hep 3B cells, whereas only IL-6, IL-1 alpha, and dexamethasone can influence CRP synthesis.

Effect of combinations of cytokines and hormones on synthesis of serum amyloid A and C-reactive protein in Hep 3B cells

We have previously shown that induction of synthesis of the two major human acute phase proteins, serum amyloid A (SAA) and C-reactive protein (CRP), can be accomplished in the human hepatoma cell line Hep 3B, in the presence of dexamethasone, either by conditioned medium from LPS-stimulated monocytes or by the combination of IL-6 and IL-1. Neither of these cytokines alone caused significant induction of either SAA or CRP. In the present study we extended our earlier observations by evaluating the role of dexamethasone, the effect of different concentrations of IL-6 and IL-1 alpha in combination, and the possible role of TNF-alpha in regulating synthesis of SAA and CRP. Dexamethasone alone had no effect on induction of SAA or CRP. Incubation of Hep 3B cells with conditioned medium from LPS-stimulated monocytes, in the absence of dexamethasone, led to modest induction of SAA or CRP, but addition of dexamethasone potentiated this response in a dose-dependent manner. Similar results were obtained for the effect of dexamethasone on the induction of SAA by IL-6 plus IL-1 alpha. Checkerboard titration of IL-6 and IL-1 alpha revealed that increases in concentration of either cytokine led to dose-related increases in synthesis of both SAA and CRP as long as a minimal amount of the other cytokine was present. TNF-alpha alone had no significant effect on synthesis of either SAA or CRP, but the combination of IL-6 plus TNF-alpha led to substantial induction of SAA. This combination was less effective than the combination of IL-6 plus IL-1 alpha. No detectable effect of IL-6 plus TNF-alpha was observed on CRP synthesis. Both combinations of cytokines, IL-6 plus IL-1 alpha, and IL-6 plus TNF-alpha, caused increased SAA mRNA accumulation that roughly paralleled increase in synthesis. These data indicate that IL-6, IL-1 alpha, TNF-alpha, and dexamethasone in various combinations are all capable of influencing synthesis of SAA in Hep 3B cells, whereas only IL-6, IL-1 alpha, and dexamethasone can influence CRP synthesis.

[Coronary arteriography in coronary heart diseases with angina pectoris (an analysis of 55 cases)]

A retrospective study of the coronary arteriographic findings in 55 cases with angina pectoris, 10 spontaneous angina and 45 effort angina (unstable angina 21, stable 24) was presented in the present article. Among the 10 cases with spontaneous angina, 8 showed normal coronary arteries, 2 with double vessel disease. In the 45 cases with effort angina, single and multiple vessel disease was found in 9/45 (20%) and 33/45 (73.3%) respectively, the remaining 3/45 (6.7%) were normal. There was no significant difference in severity and distribution of coronary atherosclerotic lesion (P greater than 0.05) in the two subgroups of unstable and stable angina. However in 3 out of 21 cases (14%) with unstable angina total occlusion of coronary arteries was found suggesting the presence of intracoronary thrombus. Triple vessel disease or/and left main coronary artery lesion was observed more frequently in cases with unstable angina (13/21, 61.9%) than in cases with stable angina (10/24, 41.7%).