[Advances in anticoagulant therapy for cirrhosis combined with atrial fibrillation]

Relevant research in recent years has demonstrated that the atrial fibrillation occurrence rate is significantly higher in patients with cirrhosis. The most common indication for long-term anticoagulant therapy is chronic atrial fibrillation. The use of anticoagulant therapy greatly reduces the incidence rate of ischemic stroke. Patients with cirrhosis combined with atrial fibrillation have an elevated risk of bleeding and embolism during anticoagulant therapy due to cirrhotic coagulopathy. At the same time, the liver of such patients will go through varying levels of metabolism and elimination while consuming currently approved anticoagulant drugs, thereby increasing the complexity of anticoagulant therapy. This article summarizes the clinical studies on the risks and benefits of anticoagulant therapy in order to provide a reference for patients with cirrhosis combined with atrial fibrillation.

[Analysis of the effect of spread through air spaces on postoperative recurrence-free survival in patients with stage pT1N0M0 lung adenocarcinoma of different tumor size]

Objective: To investigate the effect of spread through air spaces (STAS) on the postoperative prognosis of patients with stage pT1N0M0 lung adenocarcinoma according to different tumor sizes. Methods: The clinicopathological and follow-up data of 511 patients with pT1N0M0 lung adenocarcinoma treated surgically in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2018 were retrospectively analyzed. There were 285 males and 226 females, aged 60 (53, 66) years. Those patients were divided into two groups according to STAS status, including STAS (-) group (342 cases) and STAS (+) group (169 cases). And the stratified analysis was performed according to the American Cancer Consortium (AJCC) 8th edition postoperative pathological tumor size T-stage (pT) of lung cancer, which was divided into pT1a (pT≤1 cm, 93 cases), pT1b (1 cm<pT≤2 cm, 280 cases), pT1c group (2 cm<pT≤3 cm, 138 cases) and pT1b/c (1 cm<pT≤3 cm, 418 cases). Univariate and multivariate Cox regression analyses and inverse probability weighted (IPTW) adjusted Kaplan-Meier (K-M) curves were used to analyze the effect of STAS on recurrence-free survival (RFS) in patients included in this study. Results: The recurrence rate was significantly higher in the STAS (+) group compared to the STAS (-) group (22.5% vs 3.2%, P<0.001). Multifactorial Cox regression analysis based on pT stratification showed that the risks of recurrence were 4.56-fold (95%CI:1.56-13.33; P=0.006) and 3.16-fold (95%CI:1.07-9.33; P=0.038) higher in pT1b and pT1c staged patients with STAS (+) than in STAS (-) patients, respectively. There was no significant difference in RFS between the STAS (-) group of pT1b/c, pT1b and pT1c and all pT1a patients [(84.97±0.72) vs (84.05±1.11) months, (85.60±0.74) vs (84.05±1.11) months, (81.49±1.63) vs (84.05±1.11) months; all P>0.05]. Before and after IPTW adjustment, statistically significant differences were found in RFS between STAS (+) group and STAS (-) group [(72.50±2.23) vs (85.12±0.72) months, (77.74±1.12) vs (84.59±0.64) months, all P<0.001]. In addition, the risks of both local and distant recurrence were higher in STAS (+) group compared to STAS (-) group (6.7% vs 1.2% and 8.2% vs 3.6%, respectively; both P<0.05). Conclusion: For lung adenocarcinoma patients with pT1bN0M0 and pT1cN0M0, those patients with STAS (+) had a higher incidence of both local and distant recurrence and with poor RFS.

[Long-term clinical effect of full-mouth implant fixation in middle-aged and elderly patients with static computer-assisted implant surgery]

Objective: To evaluate long-term clinical outcome of implant-supported fixed prosthesis with the guidance of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical template in old patients. Methods: Fifteen 50-67(58.6±5.3) year-old patients (11 males and 4 females) who received the digital implant surgery with the guidance of CAD/CAM surgical template and implant-supported fixed prosthesis in Department of Oral Implantology, Yantai Stomatological Hospital Affiliated to Binzhou Medical College from August, 2013 to Janurary, 2016 were included. There are 15 edentulous maxillas, 8 edentulous mandibles on which 145 implants were placed in total. After the placement of implant, the accuracy of CAD/CAM surgical template was assessed by comparing the post-operative 3-dimensional location of implant with the pre-operative design. The 5-year survival rate of implant and prosthesis was recorded, and marginal bone loss around implants and the development of complication were evaluated by radiological and clinical examination respectively. Results: The result on accuracy of CAD/CAM surgical template showed that deviations in neck and apex of implants were (0.78±0.59) and (1.38±0.63) mm respectively, depth deviation was (0.65±0.35) mm and angle deviation was 4.12°±2.77°. The 5-year cumulative survival rate of implants was 98.6%(143/145). In all 145 implants, the prevalence of implant-related biological complication was 4.1%(6/145). The prosthesis-related mechanical complication rate was 57%(13/23). After 5-year function, mean peri-implant bone loss was (0.69±0.35) mm. Conclusions: This 5-year follow-up retrospective study showed that implant-supported fixed prosthesis with the guidance of CAD/CAM surgical template in middle aged and elderly patients could achieve good long-term clinical outcome and patient satisfaction.

Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction

OBJECTIVE

The purpose of this study was to evaluate the different components of left atrial (LA) dysfunction predictors in asymptomatic primary systemic hypertension patients with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (4D) longitudinal and circumferential strain values.

METHODS AND RESULTS

Patients with no left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) are all asymptomatic regarding primary blood hypertension. Thirty NLVH patients and 30 LVH patients according to LV mass index and 40 controls analyzed by 4D echocardiography were prospectively enrolled. LA volumes and longitudinal and circumferential strains were measured using 4D volume-strain echocardiography with a Vivid E95 Version 203 instrument. Correlation analysis indicated a significant relation between LV 4D mass index and LA 4D longitudinal/circumferential strain (r = -0.446 to 0.381, p = 0.000-0.042). LVH patients had a reduced LA emptying fraction compared with NLVH patients and control subjects (p < 0.01). NLVH patients had an impaired LA conduit function and increased contractile function compared with the control group (p < 0.01). LVH patients had increased LA volumes and significantly decreased reservoir, conduit and contractile functions compared with the controls (p < 0.01). LVH patients had increased LA volumes and decreased reservoir and contractile functions compared with NLVH patients (p < 0.01). The clinical utility of LA 4D volume-strain measurement was verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with NLVH, LVH and control group comparisons. Interclass correlation coefficients of interobserver and intraobserver assessments in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively.

CONCLUSIONS

LVH patients showed increased LA volumes and decreased LA emptying fractions. LA reservoir, conduit and contractile functions were significantly impaired in LVH patients. Decreased LA conduit function and increased contractile function were revealed in NLVH patients. LA volumetric and functional analyses with 4D volume-strain echocardiography may facilitate the recognition of subtle LA and LV dysfunctions in asymptomatic systemic hypertension patients.

Postconditioning Protection Against Myocardiocyte Anoxia/Reoxygenation Injury From Penehyclidine Hydrochloride

Background/Aims

To investigate the postconditioning protective effect of penehyclidine hydrochloride (PHC) against anoxia/reoxygenation (A/R) injury in H9c2 cells along with the involved mechanism and timing effect.

Methods

We divided H9c2 cells into 7 groups: control group, A/R group and PHC+A/R groups at 0 min, 5 mins, 10 mins, 20 mins, 30 mins, respectively (treated with 0.1 μm/L PHC at 0 min, 5 mins, 10 mins, 20 mins, 30 mins after the reoxygenation procedure began). Cell apoptosis, oxidative stress, intracellular Ca²⁺ concentration, mitochondrial membrane potential and mitochondrial permeability transition pore (MPTP) opening were explored. Bcl-2, Bax, Cyt C, caspase-3 and caspase-9 levels were measured.

Results

A/R significantly increased both cell injury and cell apoptosis. PHC showed postconditioning protective effect by attenuating superoxide production, decreasing Ca²⁺ overload, restraining MPTP activities, restoring mitochondrial membrane potential, regulating cell apoptosis proteins and modulation of mitochondrial pathway. Earlier administration of PHC offered greater postconditioning protective effect.

Conclusion

H9c2 cells were protected by PHC from A/R injury regardless of timing of PHC administration (0 min, 5 mins, 10 mins, 20 mins, 30 mins). However, earlier administration of PHC resulted in better PHC postconditioning protection.

[ANAMMOX Reactor with Two Kinds of Inoculated Sludge: Start-up and Kinetics Characteristics]

Two different mixed sludges (aerobic nitrifying sludge and ANAMMOX-denitrification sludge:R1, and anaerobic digestion flocculent sludge and ANAMMOX-denitrification sludge:R2), were used as inocula in two UBF reactors to enrich Anammox bacteria. Both kinds of mixed sludge set up the Anammox process successfully. It took 36 days for R1, while R2 required 53 days. Nitrogen removal rates of R1 and R2 were high during the whole operation. During the stable operation stage, the removal rates of NH₄⁺-N, NO₂^--N, and TN were about 99.92%, 96.64%, and 81.87% for R1; and 97.54%, 94.91%, and 80.98% for R2. Illumina High-throughput Sequencing revealed Candidatus Kuenenia was in the top six taxa in the two reactors with 3.22% relative abundance in R1 and 2.35% in R2 after the successful start-up. Simulation results indicated that the Modified Stover-Kincannon model and the second-order model were appropriate models. It was deduced that the N-removal potential of R1 was a little greater than that of R2 after comparing the projected maximum substrate removal rate U_max of the two reactors.

[Research progress in the pathogenic mechanisms of Porphyromonas gingivalis fimbriae]

FimA has been characterized as an important virulence factor for Porphyromonas gingivalis (Pg). These structures play a major role in the mechanisms of adhesion and invasion of Pg to host cells, and can induce cellular activation and cytokines release. FimA can also promote biofilm formation and induce immuno-inflammatory response of host cells. Many studies have characterized FimA to be associated with periodontitis and cardiovascular disease. Pg strains are classified into six types based on divergent nucleotide sequences of the fimA gene (types Ⅰ、Ⅰb、Ⅱ、Ⅲ、Ⅳ andⅤ). The expression of fimbriae is regulated by the fimA gene, which may be the key factor that leads to virulence diversities of Pg, At present, the research on the pathogenesis of FimA mainly focuses on periodontitis and atherosclerosis, which is of great significance for the prevention and treatment of diseases. This paper reviewed the pathogenic effect of FimA in the development of above mentioned two diseases and its application in the prevention.

[Nitrogen Removal Characteristics and Diversity of Microbial Community in ANAMMOX Reactor]

The volume loading of upflow blanket filter increased from 0.52 kg·(m³·d)^-1to 2.75 kg·(m³·d)^-1 by improving the influent NH₄⁺-N and NO₂^--N concentrations. The removal efficiency of NH₄⁺-N, NO₂^--N and TN increased from 76.18%, 53.47%, 55.66% to 94.04%, 86.97%, 82.96% respectively. Meanwhile, the microbial community of UBF ANAMMOX reactor was analyzed by Illumina high-throughput sequencing during the initial and later operational process. The results indicated that the denitrifying bacteria coexisted in the reactor. The percentages of Planctomycetes, Proteobacteria and Nitrospirae in the sludge were 27.9%-39.9%, 1.1%-26.4% and 0.035%-0.188%, respectively. The proportions of Planctomycetes and Proteobacteria increased from 1.1%, 27.9% in the enrichment stage to 26.4%, 39.9% in the stable operation stage respectively. In addition, Planctomycetes increased significantly. The proportion of Brocadiacea reached 24.57%. Therefore, Brocadiacea became the dominant bacteria in the phylum Planctomycete, which contained Candidatus brocadia. The alpha diversity index and relative abundance of clustering figure indicated that the diversity of microbial community decreased gradually and the structure of microbial community changed obviously.

Accuracy of three-dimensional facial soft tissue simulation in post-traumatic zygoma reconstruction

The aim of this study was to evaluate the accuracy of novel software-CMF-preCADS-for the prediction of soft tissue changes following repositioning surgery for zygomatic fractures. Twenty patients who had sustained an isolated zygomatic fracture accompanied by facial deformity and who were treated with repositioning surgery participated in this study. Cone beam computed tomography (CBCT) scans and three-dimensional (3D) stereophotographs were acquired preoperatively and postoperatively. The 3D skeletal model from the preoperative CBCT data was matched with the postoperative one, and the fractured zygomatic fragments were segmented and aligned to the postoperative position for prediction. Then, the predicted model was matched with the postoperative 3D stereophotograph for quantification of the simulation error. The mean absolute error in the zygomatic soft tissue region between the predicted model and the real one was 1.42±1.56mm for all cases. The accuracy of the prediction (mean absolute error ≤2mm) was 87%. In the subjective assessment it was found that the majority of evaluators considered the predicted model and the postoperative model to be 'very similar'. CMF-preCADS software can provide a realistic, accurate prediction of the facial soft tissue appearance after repositioning surgery for zygomatic fractures. The reliability of this software for other types of repositioning surgery for maxillofacial fractures should be validated in the future.

[Analysis of risk factors associated with weaning from mechanical ventilation in critical patients with major abdominal surgery]

OBJECTIVE

To analyze the risk factors involved in the weaning from mechanical ventilation in critical patients who underwent major abdominal surgery.

METHODS

This retrospective study was conducted at Department of Critical Care Medicine in Peking University People's Hospital. The subjects included all critical ill patients who underwent major abdominal surgery from January 2011 to December 2013. Clinical and laboratory parameters in perioperative period were investigated for the risk factors involved in the weaning from mechanical ventilation.

RESULTS

In this study, 381 patients were included, of whom, 274 were successfully weaned. We found old age, lower left ventricular ejection fraction (LVEF) before surgery, with the complication of myocardial injury after noncardiac surgery (MINS) and lower serum albumin level after surgery were the independent risk factors of weaning from mechanical ventilation. And the days of intensive care unit and 28-day mortality of patients who successfully weaned were better than patients who failed to wean.

CONCLUSION

Old age, lower LVEF before surgery, with the complication of MINS and lower serum albumin level after surgery were independent risk factors of weaning in critical patients who underwent major abdominal surgery.

[Targeted effect of microRNA on nerve growth factor pathway and its functional network in patients with unstable angina]

OBJECTIVE

To study microRNA profile alteration in unstable angina (UA) patients and its functional network via nerve growth factor (NGF) signaling pathway.

METHODS

Whole blood microRNAs were isolated from individuals with angiographically negative report (n=6) and UA patients (n=6), Taqman low-density microRNA array was performed to detect the microRNA profile, and SAM tool was conducted to calculate the differential expressed microRNA. Bioinformatic prediction tools (Targetsan, Miranda, Diana-microT) were used to obtain microRNA target genes. Targets'enriched pathways were analyzed by DAVID and biological function clusters were figured out by Panther database. The functional network of microRNAs by Cytoscape was costructed.

RESULTS

In the study, 20 microRNAs were significantly upregulated in the UA group were observed. Their main target signaling pathways were NGF, their target genes' functional clusters were in signal transduction, cell proliferation and differentiation, cell cycles, immunity and inflammation, neurogenesis, neuronal activity and apoptosis.

CONCLUSION

To upregulate microRNAs in UA patients is a major way to inhibit NGF signaling pathways, whose function is to suppress cell proliferation and differentiation, immunity and inflammation, neuronal growth, etc., and to stabilize the vulnerable atherosclerotic plaque.

[microRNA-126 delivered by microparticles mediates intercellular signal transmission]

OBJECTIVE

To investigate the role of microRNAs (miRNAs) in mediating intercellular signaling.

METHODS

Microparticles (MP) from HUVEC and 293T were isolated by sequential centrifugation. THP-1 was co-cultured with microparticles. And then the migration of THP-1 was measured by transwell. real-time PCR and Western blotting were used to study the related mechanisms.

RESULTS

Compared with the microparticles from 293T, MP from HUVEC could promote the migration of monocytes (P<0.05) and upregulate the expression of CXCR4 mRNA and protein (P<0.05). MiRNA-126 deficient MP could downregulate the migration of monocytes (P<0.05) and the expression of CXCR4 mRNA and protein (P<0.05) compared with miRNA-126 abundant MP.

CONCLUSION

Microparticles from HUVEC could promote the migration of monocytes. As carriers, microparticles could mediate intercellular signaling.

Free radical EPR spectroscopy analysis using blind source separation

In this paper, we propose a novel approach for electron paramagnetic resonance (EPR) mixture spectra analysis based on blind source separation (BSS) technique. EPR spectrum of a free radical is often superimposed by overlapping spectra of other species. It is important and challenging to accurately identify and quantify the 'pure' spectra from such mixtures. In this study, an automated BSS method implementing independent component analysis is used to extract the components from mixed EPR spectra that contain overlapping components of different paramagnetic centers. To apply this method, there is no requirement to know the component spectra or the number of components in advance. The method is applied to analyze free radical EPR spectra which are collected from standard chemical system, cultured cell suspense, and ex vivo rat kidneys by spin trapping EPR technique. Results show that the BSS method proposed here is capable of identifying the component EPR spectra from mixtures with unknown compositions. The BSS technique can offer powerful aids in resolving spectral overlapping problems in general EPR spectroscopy analysis.

[Comparative study on efficacy of qinggan granule and bushen granule in treating chronic hepatitis C]

OBJECTIVE

To evaluate the efficacy of Qinggan Granule (QGG) and Bushen Granule (BSG) in treating chronic hepatitis C (CHC) from blood donors clinically, biochemically and pathologically as well as to explore the therapeutical principle and methods of TCM.

METHODS

Sixty-six patients with CHC were divided into three groups, the 36 patients in the QGG group treated with QGG, the 18 patients in the BSG group treated with BSG and the 12 patients in the control group untreated. The dose of QGG and BSG given was 30 g each time, three times per day for 6 consecutive months. Clinical and serum biochemical parameters as well as pathological change of liver biopsy before and after treatment were observed dynamically and compared.

RESULTS

After treatment, in the two treated group, clinical symptoms were improved significantly, alanine transaminase (ALT) and aspartate aminotransferase (AST) reduced markedly. Moreover, QGG showed the effects of increasing albumin and lowering alkaline phosphatase (ALP). On the contrary, ALT still remained as before but AST further increased in the control group. Pathological examination showed that the inflammatory grade (IG) decreased in 42.2% and fibrotic stage (FS) decreased 21.2% of the patients in the QGG group, but no significant changes of the two indexes occurred in the BSG group, while in the control group, IG unchanged and FS increased in 3 cases. Chevallier's semi-quantity system analysis showed significant decrease of both scores in the QGG group (P < 0.05), only decrease of IG in the BSG group, and slight raise of IG and significant increase of FS (P < 0.05) in the control group.

CONCLUSION

Condition of chronic hepatitis C patient would deteriorate progressively if not treated in time, especially the development of fibrosis. QGG and BSG could improve the clinical symptoms significantly, lower ALT and AST, eliminate inflammatory damage in the liver, slow down or reverse liver fibrosis process with stable long-term effect. Though most of the patients present a Syndrome of Liver-Kidney Yin-deficiency, the effect of QGG is superior to that of BSG, suggesting that the treatment of CHC should mainly be clearing principle, and method of clearing Liver and eliminating Dampness may be more suitable for them.

Reference data and predictive diagnostic models for calcaneus bone mineral density measured with single-energy X-ray absorptiometry in 7428 Chinese

Calcaneus bone mineral density (BMD) of 7428 Chinese (4126 women, 3302 men; aged 22-94 years) was measured using single-energy X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Chinese men and women was established and the usefulness of this method for screening and diagnosis in osteoporosis was evaluated. The peak BMD occurred at 20-24 years old and peak BMD in women was significantly lower than in men. BMD loss in the calcaneus started at the age of 35 years for women, and at 63 years in men. BMD loss rate was 1.2%/year for women and 0.56%/year for men after 50 years. The young normal reference for calcaneus BMD was 442.1+/-69.6 mg/cm2 for men and 388.3+/-61.7 mg/cm2 for women calculated from the mean BMD value of subjects whose age ranged from 20 to 49 years. The accumulated BMD loss in the calcaneus is similar to that of Ward's triangle. Multiple linear regression showed that both age and weight were important factors. The incidence of osteoporosis in older men and women (> or = 60 years) is 6.6% and 32.1% respectively. We conclude that calcaneus BMD measurement is useful and sensitive for the screening and diagnosis of osteoporosis. A predictive diagnostic model for osteoporosis based on the calcaneus was constructed using multiple linear regression and the WHO criteria for diagnosing osteoporosis can be applied to calcaneus BMD.

Effects of berberine of L- and T-type calcium channels in guinea pig ventricular myocytes

AIM

To study the effects of berberine (Ber) on L-(ICa,L) and T-type (ICa,T) channels in isolated guinea pig ventricular myocytes.

METHODS

Using whole cell patch-clamp recording technique.

RESULTS

Ber 10, 30 mumol.L-1 inhibited the ICa, L from 1400 +/- 247 pA to 978 +/- 204 pA (n = 5 cells of 5 guinea pigs, P < 0.05), and to 664 +/- 179 pA (n = 5, P < 0.01), respectively. The inhibitory effect was concentration-dependent and non-frequency-dependent. The peak value of ICa,L in the current-voltage relationship was decreased. Ber affected the inactivation kinetics of ICa,L. The half activation potential (V0.5) was shifted from -27.8 mV to -34.2 mV and the slope factor (kappa) was changed from 9.22 into 13.03. Ber did not affect the activation kinetics. Ber 10 and 30 mumol.L-1 also inhibited ICa,T (from 154 +/- 80 pA to 101 +/- 78 pA, and to 48 +/- 45 pA, n = 8 cells of 5 guinea pigs, P < 0.05).

CONCLUSION

Ber possessed blocking effects on both L- and T-type calcium channels.

The new model of age-dependent changes in bone mineral density

To theoretically and quantitively describe the phenomena that bone mineral density (BMD) was changed with, the three-exponential model was proposed. Our results showed that BMD in radius and ulna in a sample of 36,879 healthy people ranging in age from 2 to 100 years fit the three-exponential equation well. Bone mass loss in Chinese women was faster than that in Chinese men. The method to accurately calculate the peak BMD and the corresponding age was given. The peak BMD and age for Chinese men and women in radius were 0.7469 g/cm2 and 35 years old, and 0.7051 g/cm2 and 33 years old respectively. The peak BMD and age in ulna were 0.7515 g/cm2 and 35 years old for Chinese men, and 0.6904 g/cm2 and 31 years old for Chinese women. Peak BMD in Chinese women was lower than in men. Peak BMD occurred slightly earlier in Chinese women. We concluded that our model could successfully characterize the regularity of bone mass accumulation and loss during the whole lifetime. The quantitive relationship was very useful in the diagnosis of osteoporosis.