[The thromboembolism risk of low-risk atrial fibrillation patients with different clinical characteristics]

Objective: This study explored the thromboembolism risk of low-risk atrial fibrillation (AF) patients (CHA₂DS₂-VASc score of 0 or 1 for male and 1 or 2 for female) with different clinical characteristics to provide the basis for anticoagulation decision-making in these patients. Methods: We prospectively enrolled consecutive 2 862 nonvalvular low-risk AF patients between August 2011 to December 2018 in China-AF (China Atrial Fibrillation Registry) Study, their CHA₂DS₂-VASc score was 0 or 1 for male and 1 or 2 for female. According to their age, sex, presence or absence of hypertension, diabetes mellitus, congestive heart failure, and vascular disease at the time of enrolling, patients were divided into CHA₂DS₂-VASc score 0 score group, 1 score group, and 2 score group. Patients were followed up every 6 months by outpatient clinic visit or telephone interview. The outcome was a thromboembolic event, including ischemic stroke and systemic embolism. Univariate Cox regression analysis was used to compare the thromboembolism risk between the patients with different risk factors and CHA₂DS₂-VASc score 0 group. Results: A total of 2 862 low-risk atrial fibrillation patients were enrolled in this study. 915 patients (32.0%) were female, and age was (55.0±10.7) years old. There were 933 patients (32.6%) in CHA₂DS₂-VASc score 0 group, 1 401 patients (49.0%) in score 1 group and 528 patients (18.5%) in score 2 group. During follow-up (median 1.5 years, 5 811.82 person-years), 33 cases of thromboembolic events were recorded, the annual rate of thromboembolism was 0.57% (95%CI 0.40%~0.80%). The number of thromboembolic events in patients with CHA₂DS₂-VASc score 0, 1 and 2 were 8, 11 and 14, respectively, and the annual thromboembolism event rates were 0.40% (95%CI 0.20%-0.81%), 0.39% (95%CI 0.22%-0.71%) and 1.34% (95%CI 0.80%-2.27%), respectively. The risk of thromboembolism of CHA₂DS₂-VASc score 2 group (HR=3.53, 95%CI 1.48-8.44; P=0.005), especially female patients aged 65-74 years in CHA₂DS₂-VASc score 2 group (HR=2.67, 95%CI 1.63-4.38; P<0.000) was significantly higher than that in patients of CHA₂DS₂-VASc score 0 group. Conclusion: Low-Risk Atrial Fibrillation patients with CHA₂DS₂-VASc score 2, especially female patients aged 65-74 years old with CHA₂DS₂-VASc score 2 are at higher risk of thromboembolism in low-risk AF patients. For such patients, intensified oral anticoagulant therapy might be helpful to reduce the risk of thrombolism.

Prediction of breakthrough pain during labour neuraxial analgesia: comparison of machine learning and multivariable regression approaches

INTRODUCTION

Risk-prediction models for breakthrough pain facilitate interventions to forestall inadequate labour analgesia, but limited work has used machine learning to identify predictive factors. We compared the performance of machine learning and regression techniques in identifying parturients at increased risk of breakthrough pain during labour epidural analgesia.

METHODS

A single-centre retrospective study involved parturients receiving patient-controlled epidural analgesia. The primary outcome was breakthrough pain. We randomly selected 80% of the cohort (training cohort) to develop three prediction models using random forest, XGBoost, and logistic regression, followed by validation against the remaining 20% of the cohort (validation cohort). Area-under-the-receiver operating characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were used to assess model performance.

RESULTS

Data from 20 716 parturients were analysed. The incidence of breakthrough pain was 14.2%. Of 31 candidate variables, random forest, XGBoost and logistic regression models included 30, 23, and 15 variables, respectively. Unintended venous puncture, post-neuraxial analgesia highest pain score, number of dinoprostone suppositories, neuraxial technique, number of neuraxial attempts, depth to epidural space, body mass index, pre-neuraxial analgesia oxytocin infusion rate, maternal age, pre-neuraxial analgesia cervical dilation, anaesthesiologist rank, and multiparity, were identified in all three models. All three models performed similarly, with AUC 0.763-0.772, sensitivity 67.0-69.4%, specificity 70.9-76.2%, PPV 28.3-31.8%, and NPV 93.3-93.5%.

CONCLUSIONS

Machine learning did not improve the prediction of breakthrough pain compared with multivariable regression. Larger population-wide studies are needed to improve predictive ability.

Advanced glycation end products enhance macrophage polarization to the M1 phenotype via the HIF-1α/PDK4 pathway

Atherosclerotic plaque rupture followed by luminal thrombosis is recognized as the main cause of acute cardiovascular events, especially in patients with diabetes. Although previous studies identified stimulation of macrophages polarization with advanced glycation end products (AGEs) results in the rapid progression of atherosclerosis, the underlying mechanisms are not understood fully. The purpose of this study was to investigate the effect of hypoxia-inducible factor-1α (HIF-1α) and pyruvate dehydrogenase kinase 4 (PDK4), critical proteins for regulating glucose metabolism, on macrophages polarization in diabetic atherosclerosis, and relevant mechanisms involved. We found that there is an increased number of M1 macrophages in carotid atherosclerotic tissues of diabetic mice and in AGE-bovine serum albumin (BSA)-treated RAW264.7 cells. Furthermore, we observed that HIF-1α was upregulated in AGE-BSA-induced M1 polarization and that the HIF-1α knockdown reduced macrophage polarization to M1 phenotype caused by AGE-BSA via regulation of PDK4. Thus, our study identified the critical role of HIF-1α/PDK4 axis in AGE-BSA-induced M1 polarization, which reflected the potential association between energy metabolism and inflammation in macrophages.

Mechanisms of picosecond laser-induced damage in common multilayer dielectric gratings

The modifications of multilayer dielectric (MLD) gratings arising from laser-induced damage using 0.6-ps and 10-ps laser pulses at 1053 nm are investigated to better understand the damage-initiation mechanisms. Upon damage initiation, sections of the affected grating pillars are removed, thereby erasing the signature of the underlying mechanisms of laser damage. To address this issue, we performed paired studies using macroscopic grating-like features that are 5 mm in width to reveal the laser-damage morphology of the different grating sections: pillar side wall, sole, and pillar top. The results suggest that, similarly to MLD coatings, there are two damage-initiation mechanisms corresponding to the different pulse durations.

[Progress of cohort studies in countries from Asia and Europe]

Objective: To share related knowledge and experiences with countries along the line, literature regarding current cohort studies was summarized. Distribution, establishment and development of cohort studies among large prospective general population were analyzed in 17 countries of Western Asia and the 16 countries of Central and Eastern Europe. Methods: Literature review was conducted to collect basic information on cohort studies, with descriptive study used to analyze the characteristics of these cohort studies. Results: There were 562 cohort studies with sample size as more than 1 000 stated in Western Asia and Central and Eastern Europe, including 468 (83.27%) carried out in the nation itself and 94 (16.73%) with international multicentered collaboration. According to the nature of cohort studies, 347 (61.74%) were etiologically based. As for the contents involved, 310 (55.16%) of them targeted on chronic/non-communicable diseases, 125 (22.24%) concentrated on maternal and child health. Among those on chronic/non-communicable diseases, 51 (16.45%) were on cancers and 83 (26.77%) on cardiovascular disease studies. There appeared 10 large prospective cohort studies targeting on general population, mainly ongoing in Iran and European countries, with a duration of 8-29 years, including 4 of them with sample size as more than 50 000. In terms of the contents, epidemiological investigation, physical examination and biological samples collection took the major parts. Few papers were published in 9 out of the 10 cohort studies at the early stage of those projects but the number of papers increased annually and stabilized to certain extent. Conclusions: The regional distribution of cohort studies carried out in countries from the Western Asia and Central and Eastern European areas appeared unbalanced. Contents of these designs would mainly involve etiological studies, with focus on non-communicable diseases as cancer, cardiovascular disease, diabetes, respiratory diseases, mental and psychological diseases, and maternal and infant health etc.. However, only few large prospective cohort studies would base on general population.

Combination of pegylated interferon-alpha and nucleos(t)ide analogue treatment enhances the activity of natural killer cells in nucleos(t)ide analogue experienced chronic hepatitis B patients

A combination of pegylated interferon-alpha (peg-IFN-α) and nucleos(t)ides analogue (NA) therapy can effectively reduce hepatitis B surface antigen (HBsAg), especially in NA-experienced chronic hepatitis B (CHB) patients. However, the immune mechanism of this therapy is unclear. Forty NA-experienced CHB patients were enrolled into this study. The frequencies of peripheral blood natural killer (NK) cells, dendritic cells (DCs), CD4⁺ T cells, CD8⁺ T cells, T helper (Th) cells, regulatory T cells (T_reg ), B cells and follicular T helper (Tfh) cells were evaluated by flow cytometry. Seven of the 40 patients converted to peg-IFN-α combined with NA treatment, while the other 33 continued to NA therapy. The decrease in HBsAg was more pronounced in the combination treatment group, and only patients receiving combination treatment achieved HBsAg loss. The frequency and absolute number of CD56^bright NK cells in the combination treatment group increased significantly compared with the NA treatment group, whereas the CD56^dim NK cells were decreased. In the NA treatment group, the proportions of CD4⁺ T_N , CD8⁺ T_N , CD19⁺ B and cytotoxic T lymphocyte antigen-4 (CTLA-4)⁺ CD4⁺ T cells were increased, while the proportions of CD4⁺ T_EM , CD8⁺ T_EM , CD25⁺ CD4⁺ T_reg , CD25^high CD4⁺ T_reg , CD127^low CD25⁺ T_reg , programmed cell death 1 (PD-1)⁺ CD4⁺ T, PD-1⁺ CD8⁺ T, CTLA-4⁺ CD8⁺ T, CCR4⁺ CD25⁺ T_reg and CCR4⁺ CD25^high T_reg cells were decreased after therapy. For NA-experienced CHB patients who achieved low HBsAg levels, combination treatment is more likely to result in HBsAg decline and HBsAg clearance by increasing the activity of CD56^bright NK cells.

Desflurane pretreatment can reduce sepsis-evoked lung injury in rats via inhibiting STAT3 pathway

The purpose of this study was to investigate the effect of desflurane (Des) pretreatment on sepsisevoked lung injury in rats and its mechanism. The rat model of sepsis-evoked lung injury was prepared using lipopolysaccharide (LPS), while rat lung mesenchymal cell (MSC) model was cultured in vitro, followed by Des pretreatment or inhibitor S31-201 culture. The degree of lung tissue injury was analyzed by Hematoxylin-eosin (HE) staining. The expression levels of interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α in the serum of rats were detected by enzyme-linked immunosorbent assay (ELISA). One-step terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was utilized to determine the apoptosis levels of lung tissues and MSCs cultured in vitro. The expressions of the signal transducer and activator of transcription 3 (STAT3) pathway in rat lung tissues and MSCs were detected by Western blotting. After modeling, LPS induced the lung injury in rats, the expression levels of IL-6, IL-1β and TNF-α were up-regulated (P<0.05), the apoptosis rate was increased (P<0.05), and phosphorylated-Janus kinase 2 (p-JAK2) and phosphorylated-STAT3 (p-STAT3) protein expressions were up-regulated (P<0.05). Des pretreatment can alleviate LPS-induced lung injury, down-regulate IL-6, IL-1β and TNF-α expression levels (P<0.05), reduce apoptosis (P<0.05), and downregulate p-JAK2 and p-STAT3 protein levels (P<0.05). LPS induced an increase in apoptosis rate of MSCs (P<0.05) and the up-regulation of p-STAT3 protein expression (P<0.05). Both Des pretreatment and S31-201 inhibitor culture could reduce the apoptosis rate (P<0.05) and down-regulate p-STAT3 protein level (P<0.05). Des pretreatment can reduce sepsis-evoked lung injury in rats, which may be related to the inhibition of protein expressions of STAT3 pathway.

Changes in the prevalence of chronic disability in China: evidence from the China Health and Retirement Longitudinal Study

OBJECTIVES

Chinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations.

STUDY DESIGN

We used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities.

METHODS

Participants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures.

RESULTS

There were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed.

CONCLUSIONS

Chinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations.

[Clinical characteristics and prognosis of renal cell carcinoma patients with bone metastases]

Objective: To determine the status of bone metastasis (BM) and prognosis factors of patients with renal cell carcinoma (RCC) in our center. Methods: The clinical and medical records of RCC patients with BM, who were admitted to the Department of Urology, Bone Oncology and Spine Surgery, Beijing Jishuitan Hospital from August 2009 to August 2017 were collected. The gender, age, time of BM, location of BM, numbers of BM, presence or absence of visceral metastasis, pathological types of BM were investigated. The patients were followed up regularly, and the survival curves were analyzed by Kaplan-Meier method. Cox proportional hazard regression model was used to estimate the prognostic factors. Results: A total of 51 RCC patients with bone metastasis were collected. The age of patients ranged from 38 to 76 (58.6±8.2) years old, including 39 males (76.5%) and 12 females (23.5%). The ratio of male to female was 3.25∶1. The patients were followed up for 8 to 109 months, with a median follow-up time of 30 months. The follow-up rate was 90.2%. Thirty-one (60.8%) patients died at the last follow-up, with a median overall survival (OS) time of 25 months. The median OS was 38 months and 20 months in the solitary BM group (26 cases, 51.0%) and BM ≥ 2 group (25 cases, 49.0%), respectively. The difference between the two groups was statistically significant (P=0.021). The median OS was 30 months, 69 months and 17 months in the axis BM group (22 cases, 43.1%), appendicular BM group (19 cases, 37.3%) and both the axis and appendicular BM group (10 cases, 19.6%), respectively. The difference between the groups was statistically significant (P=0.012). The median OS was 22 months and 38 months in the patients with (15 cases, 29.4%) and without (36 cases, 70.6%) visceral metastases groups, respectively. The difference between the two groups was statistically significant (P=0.007). Univariate and multivariate Cox regression analysis showed that the numbers of BM (HR=3.130, 95%CI: 1.502-6.520, P=0.035) and visceral metastasis (HR=4.699, 95%CI: 1.810-9.545, P=0.001) were independent prognostic factors for RCC with BM. Conclusions: Solitary BM, no visceral metastasis are good prognostic factors for RCC with BM. For these patients, radical resection of BM is feasible to improve survival rate.

Methods for the generation of heritable germline mutations in the disease vector Culex quinquefasciatus using clustered regularly interspaced short palindrome repeats-associated protein 9

Culex quinquefasciatus is a vector of many diseases that adversely impact human and animal health; however, compared to other mosquito vectors limited genome engineering technologies have been characterized for this vector. Clustered regularly interspaced short palindrome repeats-associated protein 9 (CRISPR-Cas9) based technologies are a powerful tool for genome engineering and functional genetics and consequently have transformed genetic studies in many organisms. Our objective was to improve upon the limited technologies available for genome editing in C. quinquefasciatus to create a reproducible and straightforward method for CRISPR-Cas9-targeted mutagenesis in this vector. Here we describe methods to achieve high embryo survival and mutagenesis rates and we provide details on the injection supplies and procedures, embryo handling and guide RNA (gRNA) target designs. Through these efforts, we achieved embryo survival rates and germline mutagenesis rates that greatly exceed previously reported rates in this vector. This work is also the first to characterize the white gene marker in this species, which is a valuable phenotypic marker for future transgenesis or mutagenesis of this vector. Overall, these tools provide the framework for future functional genetic studies in this important disease vector and may support the development of future gene drive and genetic technologies that can be used to control this vector.

Identification and validation of novel microenvironment-based immune molecular subgroups of head and neck squamous cell carcinoma: implications for immunotherapy

Background

Targeting the immune checkpoint pathway has demonstrated antitumor cytotoxicity in treatment-refractory head and neck squamous cell carcinoma (HNSC). To understand the molecular mechanisms underpinning its antitumor response, we characterized the immune landscape of HNSC by their tumor and stromal compartments to identify novel immune molecular subgroups.

Patients and methods

A training cohort of 522 HNSC samples from the Cancer Genome Atlas profiled by RNA sequencing was analyzed. We separated gene expression patterns from tumor, stromal, and immune cell gene using a non-negative matrix factorization algorithm. We correlated the expression patterns with a set of immune-related gene signatures, potential immune biomarkers, and clinicopathological features. Six independent datasets containing 838 HNSC samples were used for validation.

Results

Approximately 40% of HNSCs in the cohort (211/522) were identified to show enriched inflammatory response, enhanced cytolytic activity, and active interferon-γ signaling (all, P < 0.001). We named this new molecular class of tumors the Immune Class. Then we found it contained two distinct microenvironment-based subtypes, characterized by markers of active or exhausted immune response. The Exhausted Immune Class was characterized by enrichment of activated stroma and anti-inflammatory M2 macrophage signatures, WNT/transforming growth factor-β signaling pathway activation and poor survival (all, P < 0.05). An enriched proinflammatory M1 macrophage signature, enhanced cytolytic activity, abundant tumor-infiltrating lymphocytes, high human papillomavirus (HPV) infection, and favorable prognosis were associated with Active Immune Class (all, P < 0.05). The robustness of these immune molecular subgroups was verified in the validation cohorts, and Active Immune Class showed potential response to programmed cell death-1 blockade (P = 0.01).

Conclusions

This study revealed a novel Immune Class in HNSC; two subclasses characterized by active or exhausted immune responses were also identified. These findings provide new insights into tailoring immunotherapeutic strategies for different HNSC subgroups.

Raloxifene retards cartilage degradation and improves subchondral bone micro-architecture in ovariectomized rats with patella baja-induced - patellofemoral joint osteoarthritis

OBJECTIVE

Abnormal remodeling of subchondral bone (SB) induced by estrogen deficiency has been shown to be involved in osteoarthritis (OA). Raloxifene (RAL) is commonly used to treat postmenopausal osteoporosis (OP). However, little is known about its effects on OA combined with estrogen deficiency. This study was performed to evaluate the efficacy of RAL on patella baja-induced patellofemoral joint OA (PFJOA) in an ovariectomized rat model.

DESIGN

Patellar ligament shortening (PLS) and ovariectomy (OVX) were performed simultaneously in 3-month-old female Sprague-Dawley rats, which were treated with RAL (10 mg/kg/day) or vehicle at 72 h postoperatively for 10 weeks. PFJOA was assessed by immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), tartrate-resistant acid phosphatase (TRAP) staining, enzyme-linked immunosorbent assay (ELISA), micro-computed tomography (μCT), histomorphology and behavioral analyses.

RESULTS

X-ray examinations showed that patella baja was successfully established by PLS. Histomorphological analysis revealed that PFJOA was significantly exacerbated by OVX and markedly alleviated by RAL. Moreover, RAL improved cartilage metabolism by decreasing MMP-13, ADAMTS-4, and caspase-3 and increasing Col-II and aggrecan at both the protein and mRNA levels. Furthermore, RAL markedly improved bone mass and SB microarchitecture and reduced osteoclast numbers and the serum osteocalcin and CTX-I levels. Although RAL showed a trend toward reducing pain sensitivity based on mechanical allodynia testing, this result was not statistically significant.

CONCLUSION

These findings demonstrate that RAL treatment retards PFJOA progression in an ovariectomized rat model, suggesting that it may be a potential candidate for amelioration of the progression of PFJOA accompanied by postmenopausal OP.

[Prognosis analysis of 112 cases with Japanese encephalitis in adults]

Objective: To analyze the improvement of clinical symptoms and recovery of neurological function in adult Japanese encephalitis, and study the prognostic factors. Methods: Follow-up was conducted for 112 hospitalized patients with Japanese encephalitis (JE) in adults at the Department of Neurology of three hospitals in Gansu province from July to October 2016, from July to October 2017, 6 months and 1 year after onset, respectively. The neurological functional recovery was evaluated by modified Ranking Scale (mRS).The influencing factors were analyzed by logistic regression model. Results: Among the 112 adult patients with JE after 1year follow-up, 57% (64/112) were completely recovered (mRS score=0), and 14%(16/112) had mild neurological dysfunction (mRS score=1 or 2 points), 20% (22/112) had moderate to severe neurological dysfunction (mRS score 3 to 5), and 9% (10/112) died. In 102 survivors, decreased consciousness were fully recovered (100%), 75% of the mental and behavior disorders, 64% of cognitive/memory impairment, 71% of language function disorder, 61% of paralysis, 73% of extrapyramidal symptoms were fully recovered, and 92% of the seizures were controlled. Comparison of clinical data of initial on-set between good prognosis group (mRS score≤2, 80 cases) and poor prognosis group (mRS score>2, 32 cases) showed that initial clinical manifestation with seizures, consciousness (GCS score), cerebrospinal fluid pressure, and lesion of MRI involved in midbrain had statistically significant differences (all P<0.05) . Multivariate analysis demonstrated that cerebrospinal fluid (CSF) pressure>250 mmH(2)O and lesion of midbrain in MRI were independent risk factors of poor prognosis in adult patients with JE. Conclusion: JE is an acute and infectious viral encephalitis of the central nervous system with high disability and mortality. Most patients were completely recovered, and some had neurological sequelae. CSF pressure>250 mmH(2)O and lesion of midbrain in MRI are independent risk factors for poor prognosis.

[Pulmonary rehabilitation guidelines in the principle of 4S for patients infected with 2019 novel coronavirus (2019-nCoV)]

A recent epidemic of pneumonia cases in Wuhan China was caused by a novel coronavirus with strong infectivity, the 2019 novel coronavirus (2019-nCoV). The article provides the pulmonary rehabilitation (PR) methods in the principle of 4S (simple, safe, satisfy, save) for patients with pneumonia caused by the novel coronavirus, shows how to establish a ventilative and convectional PR environment to prevent the spread of virus through droplets, how to guide the patients to carry out PR, how to carry out respiratory muscle training, effective cough, expectoration, sneeze, general exercise, digestive function rehabilitation and psychological rehabilitation, and how to clean and disinfect the PR environment.

[Analysis of mortality relative factors in patients with ventricular septal rupture complicating myocardial infarction]

Objective: To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients. Methods: A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, were retrospectively analyzed. There were 34 males and 17 females, with an age of (63±8) years (range: 44 to 82 years). The time between ventricular septal rupture and surgical procedure was (44±39) days (range: 3 to 187 days). The t test and χ(2) test were used for univariate analysis, Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors. Results: There were 8 patients dead in hospital, 43 patients survived, the overall mortality rate was 15.7% in hospital. The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week, but it's markedly decreased to 6.5% if the time over 4 weeks. Univariate analysis showed that renal failure before operation, creatinine before operation, left ventricular ejection fraction, cardiac function (New York Heart Association) grade Ⅳ, severe tricuspid regurgitation, dialysis post-operation, creatinine of the first day of post-operation, the time between and operation more than 4 weeks were in-hospital mortality relative factors. Multivariate analysis reflected that advanced age (OR=1.32, 95%CI: 1.05 to 1.75, P=0.033), cardiac function grade Ⅳ (OR=2.25, 95%CI: 1.62 to 2.82, P=0.003), severe tricuspid regurgitation (OR= 1.82, 95%CI: 1.31 to 2.43, P=0.001), renal failure before operation (OR=1.78, 95%CI: 1.26 to 2.32, P=0.015), the time between ventricular septal rupture and operation less than 1 week (OR=2.50, 95%CI: 1.52 to 2.98, P=0.012), were independent in-hospital mortality relative factors. Conclusions: The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction. The independent relative factors of in-hospital mortality are advanced age, cardiac function grade Ⅳ, renal failure before operation, severe tricuspid regurgitation, the time between ventricular septal rupture and operation less than 1 week.

[The diagnostic value of tremor analysis for defining the Parkinson's disease subtype]

Objective: To find more objective evidence and support for clinical classification of Parkinson's disease by means of tremor analysis in patients with early confirmed Parkinson's disease. Methods: A cross-sectional study was conducted to collect 65 patients with early Parkinson's disease treated in the Third Hospital of Peking University from January 2015 to December 2016. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr scale (H-Y scale), Mini-mental state examination (MMSE), Hamilton depression scale (HAMD) were recorded in all patients. According to the ratio of UPDRS rigidity score to tremor score, the patients were divided into tremor dominant (TD), postural instability/gait difficulty (PIGD) and mixed types. All patients were examined by tremor analysis and the results were analyzed and compared. Results: Among the 65 patients, the mean age of onset was (63±10) years, the course of disease was (14±8) months. Twenty-one patients were classified to TD group, 28 patients were classified to PIGD type, and 16 patients with mixed type. There was no significant difference in frequency and amplitude of tremor between the three groups (P>0.05), but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher (P<0.05). Twenty patients (71.4%) in TD group showed typical Parkinson's disease manifestations in tremor analysis. Only four patients (14.3%) in PIGD group showed the typical manifestations. More patients in PIGD group showed no clear main peak of tremor at rest. Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles. These two manifestations occured simultaneously in mixed type patients, including 10 cases (62.5%) with typical Parkinson's disease manifestations. Conclusion: As an objective electrophysiological method to evaluate tremor type, tremor analysis can be used as an important assistant method for clinical classification of Parkinson's disease. It can provide information of the pathway of pathological loss in different types and give important hints in prognosis and treatment.

[Analysis of sleep quality of a prison police]

Objective: To investigate the sleep quality of prison policemen and explore its influencing factors, so as to provide reference for improving the sleep quality of prison policemen. Methods: In August 2013, 177 policemen in a prison were selected by cluster sampling. The sleep quality of 177 prison policemen was investigated by Pittsburgh Sleep Quality Index Scale and General Situation Questionnaire, and the influencing factors were analyzed. Results: The PSQI scores of 177 prison policemen were (7.47+3.80). There were significant differences between the PSQI scores of prison policemen and the normal adult norm (P<0.05). According to the standard of poor sleep quality, 84 prison policemen (47.46%) had poor sleep quality, and the prison policemen scored higher on daytime dysfunction, subjective sleep quality, sleeping time and sleeping time components. Single factor t test and single factor variance analysis showed that there were significant differences in sleep quality among prison policemen in gender, age, educational level and job classification (P <0.05). The results of multiple stepwise regression analysis showed that gender, age and job classification entered the regression equation with PSQI total score as dependent variable (β=0.167, 0.270, 0.222) . Conclusion: The sleep quality of prison policemen is worse than that of normal adults, and is affected by gender, age, job classification and other factors, which should be paid attention to by prison administrators.

MiR-1298 expression correlates with prognosis and inhibits cell proliferation and invasion of gastric cancer

OBJECTIVE

To explore the association between miR-1298 expression and clinicopathological factors, prognosis of gastric cancer (GC) patients and biological functions underlying the GC progression.

PATIENTS AND METHODS

Expression of miR-1298 was examined by qRT-PCR in GC tissues and cells, the adjacent normal tissues and normal gastric cell line GES-1 cells were used as controls. Association of disease-free survival (DFS) and overall survival (OS) time with miR-1298 expression was analyzed by Kaplan-Meier analysis and log-rank test. Univariate and multivariate analysis were also performed to analyze relative prognostic risk factors of GC patients. Cell proliferation and invasion assays were used to examine cell proliferation and invasion capacities in vitro. The relative protein expression was analyzed by Western blot analysis.

RESULTS

MiR-1298 expression was lower in GC tissues and cells, compared to adjacent normal tissues and GES-1 cells, respectively. Lower miR-1298 expression levels were associated with lymph node metastasis and TNM stage. Kaplan-Meier analysis showed that lower miR-1298 expression predicted poor DFS and OS of GC patients. Furthermore, we demonstrated that lymph node metastasis, TNM stage, and lower miR-1298 expression were independent risk factors for DFS and OS in GC patients. In vitro, miR-1298 overexpression inhibited cell proliferation and invasion abilities. Additionally, our results revealed that miR-1298 overexpression suppressed PI3K/AKT signaling pathway in GC cells.

CONCLUSIONS

Our evidence indicated that miR-1298 may provide a specifically promising target for therapy of GC patients.

CircHIPK3 is upregulated and predicts a poor prognosis in epithelial ovarian cancer

OBJECTIVE

CircRNAs have been recently identified as important regulators in tumors biological functions. However, the clinical significance of circHIPK3 in epithelial ovarian cancer (EOC) remains unknown.

PATIENTS AND METHODS

The expression of circHIPK3 in EOC tumor tissues and adjacent noncancerous tissues was analyzed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). The association between circHIPK3 expression and clinicopathological factors was analyzed by using Chi-square test. Kaplan-Meier method and log-rank test were used to analyze the association of circHIPK3 expression with disease-free survival (DFS) and overall survival (OS) time of EOC patients. Univariate and multivariate Cox analysis was also performed.

RESULTS

We found that circHIPK3 was higher expressed in EOC tissues and cells compared to adjacent normal tissue and ovarian epithelium cell line, respectively. Higher circHIPK3 expression associated with lymph node invasion, FIGO stage, and worse DFS and OS of patients. Moreover, multivariate Cox analysis showed that higher circHIPK3 was an independent predictor of DFS and OS in EOC patients.

CONCLUSIONS

Thus, circHIPK3 may be a novel biomarker for predicting EOC prognosis.

Heterozygote carriers of mutations in the F11 gene, encoding Factor XI, have normal coagulation by thromboelastography during pregnancy

BACKGROUND

Evidence to guide clinical decision-making in pregnant women who are usually asymptomatic, but identified as heterozygote carriers of F11 mutations, is lacking. We hypothesized that women identified on prenatal screening as heterozygous for a mutation in the F11 allele would have minimal evidence of an in vitro coagulation abnormality.

METHODS

We prospectively enrolled women identified by prenatal screening as F11 mutation carriers and pregnant women who were presumed to be normal as controls. We collected blood during antepartum visits or at presentation for delivery and assessed Factor XI (FXI) coagulant activity level, as well as whole-blood coagulation, by thromboelastography.

RESULTS

F11 mutation carriers had lower serum FXI activity levels than controls (51.2 ± 8.5% vs 94.1 ± 19.4%; P <0.0001). Thromboelastography values of all control subjects and F11 mutation carriers were within the normal range. The R-time was slightly longer in F11 mutation carriers (5.3 ± 1.0 s vs 4.2 ± 0.8 s, P <0.002), but no other statistically significant differences in thromboelastogram parameters were identified between groups.

CONCLUSIONS

Despite lower FXI activity in the F11 mutation group, we found minimal differences in whole-blood measures of coagulation using thromboelastography. These findings support our hypothesis that a single copy of an F11 mutation does not produce significant evidence of an in vitro coagulation abnormality. Thromboelastography might be useful in determining the risk of neuraxial anesthesia in pregnant women, but additional work is required to establish the validity of this test.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

[Diagnostic value of digital breast tomosynthesis for mass lesions in dense breast]

Objective: To explore the diagnostic efficiency of digital breast tomosynthesis (DBT) for mass lesions in dense breast by comparing with digital mammography (DM). Methods: A retrospective analysis was made of 125 female patients with breast masses confirmed by pathology in the First Affiliated Hospital of Jinzhou Medical University from June 2018 to April 2019, all of whom were dense breast. Pathological results were taken to compare the diagnostic value of DM, DBT and the combination of the two for breast mass lesions. Results: The overall detection rates of DM, DBT and their combination were 77.6% (97/125), 88.8%(111/125) and 92.8%(116/125) in dense breast. The detection rates of burr sign and lobulation sign by DM and DBT in malignant tumors were 39.7%(31/78), 60.3%(47/78) and 48.7%(38/78), 67.9%(53/78), respectively, with statistically significant differences (all P<0.05). The sensitivity of DM, DBT and their combination in differentiating benign from malignant breast mass lesions of dense breast was 75.6% (59/78), 83.3%(65/78), 93.6%(73/78), the specificity was 63.8%(30/47), 80.9% (38/47), 76.6%(36/47),and the area under ROC curve(AUC) was 0.697, 0.821 and 0.852, respectively. Conclusion: DBT is more effective than DM in the diagnosis of dense breast mass lesions, and the combination of DBT and DM is more significant.