Physical activity levels and predictors in patients following percutaneous coronary intervention: a cross-sectional study

Objective: To examine physical activity(PA) of post-percutaneous coronary intervention(PCI) patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: A total of 246 post-PCI patients from the Peking University Third Hospital in Beijing, China, were included in this crosssectional study through convenience sampling. Data were collected from a self-repor ted questionnaire. PA was categorized into low, moderate, or high levels. The ordinal multinomial logistic regression model was used to estimate the relationship among demographic, medical, and psychosocial characteristics. Results: The overall prevalence of low, moderate, and high PA was 20%, 70%, and 10%, respectively. For the domain-specific PA patterns, most par ticipants took par t in leisure-time PA(84.5%);walking was the most common PA. Increased motivation and selfefficacy, lower monthly income, and unemployment were predictors of high PA. Conclusions: PA levels in post-PCI patients was not optimal, and leisure-time PA had the highest par ticipation rate. Analyses of influencing factors can provide medical staff and health workers information to focus on high-risk groups and introduce more tailored interventions. Future studies can explore more regions, and ecological models can be introduced to study more influencing factors.

Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China

Since December 2019,COVID-19 has occurred unexpectedly and emerged as a health problem worldw ide.Despite the rapidly increasing number of cases in subsequent weeks,the clinical characteristics of pediatric cases are rarely described.A cross-sectional multicenter study was carried out in 10 hospitals across Hubei province.A total of 25 confirmed pediatric cases of COVID-19 were collected.The demographic data,epidemiological history,underlying discascs,clinical mani festations,laboratory and radiological data,treatments,and outcomes were analyzcd.Of 25 hospitalized patients with COVID-19,the boy to girl ratio was 1.27:1.The median age was 3 years.COVID-19 cases in children aged<3 years,3-6 years,and≥6-years patients were 10(40%),6(24%),and 9(36%),respectively.The most common symptoms at onset of ilness were fever(13[52%]),and dry cough(11[44%]).Chest CT images showed essential normal in 8 cases(33.3%),unilateral involvement of lungs in 5 cases(20.8%),and bilateral involvement in 11 cases(45.8%).Clinical diagnoses included upper respiratory tract infection(n=8),mild pneumonia(n=15),and critical cases(n=2).Two critical cases(8%)were given invasive mechanical ventilation,corticosteroids,and immunoglobulin.The symptoms in 24(96%)of 25 patients were alleviated and one patient had been discharged.It was concluded that children were susceptible to COVID-19 like adults,while the clinical presentations and outcomes were more favorable in children.However,children less than 3 years old accounted for majority cases and critical cases lied in this age group,which demanded extra attentions during home caring and hospitalization treatment.

Could saline irrigation clear all residual common bile duct stones after lithotripsy?A self-controlled prospective cohort study

BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.

Clinicopathologic Characteristics and Prognosis Analysis of Marjolin's Ulcer in 40 Cases

Marjolin's ulcer (MU)is a rare but aggressive epidermoid carcinoma observed in scars or wounds.This article provides comprehensive characteristics and prognostic details of MU. Clinical data of 40patients with MU between January 2010 and December 2017 were analyzed retrospectively.Squamous cell carcinoma was the most common pathological type (35/40,87.5%). Extended resection was performed to treat all cases with skin grafting or flap grafting.Follow-up duration ranged from 6 to 96 months (median,52 months)and recurrence was noted in 9 cases.The 1-,3-and 5-year recurrence-free survival (RFS)rates were 87.2%,87.2%,83.2%respectively and the recurrence rate was 22.5%.Univariate analysis revealed that cause of scars (P=0.044),lesion appearance (P=0.036),ultraviolet radiation exposure (P=0.000),depth (P=0.001)and histological grade (P=0.027)had a statistically significant correlation with prognosis of MU.Multivariate analysis revealed that depth (P=0.034,RR=2,681,95%CI:1.077-6.674)and histological grade (P=0.008,RR=2.820,95%CI:1.3156.050)were independent prognostic factors for RFS.In conclusion,superficial infiltration and high-grade differentiation predict more favorable prognosis. Careful follow-up of high-risk groups is strongly recommended to prevent recurrence and improve prognosis.

Interferon-λ-related genes and therapeutic response in Chinese hepatitis C patients

AIM: To determine the association between rapid viral response and IL28 B, IL28 RA, IL10 RB and Mx A polymorphisms in the Chinese Han population.METHODS: The study cohort consisted of 238 chronic hepatitis C patients treated with interferon(IFN)-α-2b and ribavirin. Six single nucleotide polymorphisms were genotyped using the ABI Taq Man allelic discrimination assay. Biochemical indices were measured at baseline. Serum hepatitis C virus(HCV) RNA was detected at weeks 0, 4, 12 and 24 of therapy.RESULTS: Only IL28 B rs12980275 was associated with treatment response in the Chinese Han population. Patients carrying AG/GG genotypes had a reduced rapid viral response compared with patients carrying the AA genotype(additive model: adjusted OR = 0.43, 95%CI: 0.24-0.75). It took less time for patients with the AA genotype to achieve a viral load < 500 copies/m L(logrank test, P = 0.004). In addition, the protective effect of genotype AA was independent of baseline viral load. HCV genotype, and baseline white blood cell count, α-fetoprotein and viral load might also help predict treatment response. The area under the receiveroperating characteristic curve was 0.726. CONCLUSION: IL28 B rs12980275 AA genotype is a strong predictor of positive response to IFN therapy in Chinese Han patients with hepatitis C.

Neuroprotective effect of the Chinese medicine Tiantai No.1 and its molecular mechanism in the senescence-accelerated mouse prone 8

Tiantai No.1, a Chinese medicine predominantly composed of powdered Rhizoma Gastrodiae, Radix Ginseng, and Ginkgo leaf at a ratio of 2：1：2 and dissolved in pure water, is neuroprotective in animal models of various cognitive disorders, but its molecular mechanism remains unclear. We administered Tiantai No.1 intragastrically to senescence-accelerated mouse prone 8（SAMP8） mice（a model of Alzheimer＇s disease） at doses of 50, 100 or 150 mg/kg per day for 8 weeks and evaluated their behavior in the Morris water maze and expression of Alzheimer＇s disease-related proteins in the brain. Tiantai No.1 shortened the escape latency in the water maze training trials, and increased swimming time in the target quadrant during the spatial probe test, indicating that Tiantai No.1 improved learning and memory in SAMP8 mice. Immunohistochemistry revealed that Tiantai No.1 restored the proliferation potential of Ki67-positive cells in the hippocampus. In addition, mice that had received Tiantai No.1 had fewer astrocytes, and less accumulation of amyloid-beta and phosphorylated tau. These results suggest that Tiantai No.1 is neuroprotective in the SAMP8 mouse model of Alzheimer＇s disease and acts by restoring neuronal number and proliferation potential in the hippocampus, decreasing astrocyte infiltration, and reducing the accumulation of amyloid-beta and phosphorylated tau.

Settling behavior of spherical particles in eccentric annulus filled with viscous inelastic fluid

Hole cleaning is a complex process as there are many variables affecting cuttings removal(e.g.drilling fluid type,density,flow rate and rheological properties,cuttings size,drill pipe rotation speed).With the increasing number of drilling small diameter wells(e.g.coiled tubing drilling applications,ultra-deep wells drilled for exploitations of unconventional oil and gas resources),the wall resistance of the micro annulus also emerges as one of the most critical factors affecting the cuttings accumulation in wellbore.The eccentricity of drill pipes commonly observed during the drilling process of ultra-deep well and coiled tubing well makes the wall resistance effect on the cuttings transport even more prominent.Understanding the wall resistance effect on the particle settling behavior in eccentric annuli is,therefore,crucial for hydraulic design of efficient cuttings transport operations in these wells.In this study,a total of 196 sets of particle settling experiments were carried out to investigate the particle settling behavior in eccentric annuli filled with power-law fluids.The test matrix included the eccentricity ranges of 0-0.80,the dimensionless diameter ranges of 0.13-0.75 and the particle Reynolds number ranges of 0.09-32.34.A high-speed camera was used to record the particle settling process and determine the influences of the eccentricity,the dimensionless diameter,the fluid rheological properties,and the solid particle characteristics on the wall factor and the particle settling velocity.The functional relationship among the dimensionless diameter,the particle Reynolds number,and the wall factor was determined by using the method of controlling variables.An eccentric annulus wall factor model with average relative error of 5.16%was established.Moreover,by introducing Archimedes number,an explicit model of particle settling velocity in the eccentric annulus with average relative error of 10.17%was established.A sample calculation of particle settling velocity was provided to show the application of the explicit model.Results of this study can be used as a guideline by field engineers to improve hydraulic design of cuttings transport operations in concentric and eccentric annuli.

A New Immunosuppressive Therapy for Very Severe Aplastic Anemia in Children with Autoantibodies

Objective At present,a number of very severe aplastic anemia(VSAA)patients cannot receive hematopoietic stem cell transplantation(HSCT)or standard immunosuppressive therapy(IST)due to the high cost of therapy,shortage of sibling donors,and lack of resources to support the HSCT.In addition,some VSAA patients with autoantibodies have no life-threatening infections or bleeding at the time of initial diagnosis.Considering the disease condition,economics and other factors,the present study designed a new and relatively mild treatment strategy:cyclosporine A plus pulsed high-dose prednisone(CsA+HDP).Methods The present study retrospectively analyzed 11 VSAA patients,who were treated with CsA+HDP in our hospital from August 2017 to August 2019.Results The median follow-up time for these patients was 24.9 months.The overall response rate was 54.5%(6/11)at six months after the initiation of IST and 81.8%(9/11)at deadline.Five patients achieved complete remission and four patients met the criteria for partial response at the last follow-up.The median time to response for responders was 110 days.Three patients underwent HSCT due to the poor effect of CsA+HDP or to find a suitable transplant donor.Recurrence and clonal evolution were not found in any of these patients.The estimated 3-year overall survival rate and 3-year failure-free survival rate were 100.0%and 72.7%,respectively.In addition,the results revealed that the cyclosporine-prednisone-associated toxicity was mild and well-tolerated by most patients.Conclusion The novel CsA+HDP regimen has good therapeutic effect and safety for VSAA patients with autoantibodies,who have no serious life-threatening infections or bleeding at the time of initial diagnosis.

Large vessel vasculitis with rare presentation of acute rhabdomyolysis:A case report and review of literature

BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.

Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review

Purpose:To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit(ICU).Methods:The randomized controlled trials(RCTs)on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library,MEDLINE,Web of Knowledge,Embase,CNKI,CBM and VIP Data.Two reviewers independently assessed the quality of studies and extracted the data.Meta-analysis was conducted on the included studies.Results:Eight RCTs involving 757 patients were included.The daily sedation interruptions could shorten the duration of mechanical ventilation(Z=5.36,p<0.0001),length of stay(Z=2.93,p=0.003<0.05)and reduce the rate of tracheotomy(Z=3.97,p<0.00001)in these patients.Additionally,daily sedation interruption was not associated with increased rate of unplanned extubation by the patients(Z=0.53,p=0.6<0.05).Conclusion:The application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.

Enhancing thermoelectric performance in P-type Mg_(3)Sb_(2)-based Zintls through optimization of band gap structure and nanostructuring

P-type Mg_(3)Sb_(2)-based Zintls have attracted considerable interest in the thermoelectric(TE)field due to their environmental friendliness and low cost.However,compared to their n-type counterparts,they show relatively low TE performance,limiting their application in TE devices.In this work,we simultaneously introduce Bi alloying at Sb sites and Ag doping at Mg sites into the Mg_(3)Sb_(2)to coopera-tively optimize the electrical and thermal properties for the first time,acquiring the highest ZT value of∼0.85 at 723 K and a high average ZT of 0.39 in the temperature range of 323-723 K in sample Mg_(2.94)Ag_(0.06)Sb_(1.9)Bi_(0.1).The first-principle calculations show that the codoping of Ag and Bi can shift the Fermi level into the valence band and narrow the band gap,resulting in the increased carrier concentration from 3.50×10^(17)cm^(-3)in the reference Mg 3 Sb 0.9 Bi 0.1 to∼7.88×10^(19)cm^(-3)in sample Mg 2.94 Ag 0.06 Sb 0.9 Bi 0.1.As a result,a remarkable power factor of∼778.9μW m^(-1)K^(-2)at 723 K is achieved in sample Mg 2.94 Ag 0.06 Sb 0.9 Bi 0.1.Meanwhile,a low lattice thermal conductivity of∼0.48 W m^(-1)K^(-1)at 723 K is also obtained with the help of phonon scattering at the distorted lattice,point defects,and nano-precipitates in sample Mg 2.94 Ag 0.06 Sb 0.9 Bi 0.1.The synergistic effect of using the multi-element co-doping/-alloying to optimize electrical properties in Mg_(3)Sb_(2)holds promise for further improving the TE performance of Zintl phase materials or even others.

Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment

Background:Early neurologic deterioration(END)may occur in patients with anterior circulation ischemic stroke(ACIS)after receiving endovascular treatment(EVT).Hemodynamic insufficiency,re-occlusion,and post-re-canalization hyper-perfusion are likely to play a critical role in END.We hypothesized that hemodynamic changes can predict END in patients with ACIS postsuccessful EVT using trans-cranial Doppler(TCD).Methods:We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital,Capital Medical University.TCD parameters including peak systolic velocity(PSV),bilateral mean flow velocity(MFV),and pulse index(PI)were determined via the middle cerebral arteries within 72 h post-EVT.A logistic regression model was applied to detect independent predictors for END.Results:Totally,112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with<50%residual stenosis,while 17/80(21.3%)patients suffered END,for which vasogenic cerebral edema(11/17)was considered as a leading role and followed by symptomatic intra-cranial hemorrhage(4/17)and ischemia progression(2/17).For the 80 patients,the PSV(median:127 cm/s vs.116 cm/s,P=0.039),the ratio of ipsilateral-MFV/contra-lateral-MFV(iMFV/cMFV)(median:1.29 vs.1.02,P=0.036)and iMFV/mean blood pressure(MBP)(median:0.97 vs.0.79,P=0.008)in END patients were higher than those of non-END.Using the receiver-operating characteristic curve to obtain cut-off values for PSV,PI,iMFV/cMFV,and iMFV/MBP for END,we found that PI≥0.85(odds ratio:11.03,95%confidence interval:1.92–63.46,P=0.007)and iMFV/MBP≥0.84(odds ratio:9.20,95%confidence interval:2.07–40.84,P=0.004)were independent predictors of END in a multivariate logistic regression model,with a sensitivity of 82.4%and 76.5%and a specificity of 42.9%and 66.7%,respectively,and had the positive predictive values of 29.0%and 38.2%,and negative predictive values of 90.0%and 91.3%,with an area under the receiveroperating characteristic curve of 0.57 and 0.71,respectively.Conclusion:TCD examination of EVT patients may be used as a real-time tool to detect END predictors,such as the higher PI and iMFV/MBP,allowing for better post-thrombectomy management in ACIS patients.