Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a metaanalysis

OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020,and meta-analysis was performed by STATA software(version 15.1).Using standardized data-collection forms,the authors screened the studies and independently extracted data,and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies.Cohort studies that examined the following results were included in the current study:in-hospital mortality,all-cause bleeding rate,gastrointestinal bleeding rate,intracranial hemorrhage rate,the incidence of shock,and hospital length of stay.RESULTS A total of eight articles,with 13,242 participants,involving 3962 participants in the CDT group and 9280 participants in the ST group were included.CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate[odds ratio(OR)=0.41,95%CI:0.30–0.56,P<0.05],all-cause bleeding rate(OR=1.20,95%CI:1.04–1.39,P=0.012),gastrointestinal bleeding rate(OR=1.43,95%CI:1.13–1.81,P=0.003),the incidence of shock(OR=0.46,95%CI:0.37–0.57,P<0.05),and hospital length of stay[standard mean difference(SMD)=0.16,95%CI:0.07–0.25,P<0.05].However,there was no significant effect on intracranial hemorrhage rate in patients with PE(OR=0.70,95%CI:0.47–1.03,P=0.070).CONCLUSIONS CDT is a viable alternative to ST in the treatment of PE,as it can significantly reduce in-hospital mortality rate,all-cause bleeding rate,gastrointestinal bleeding rate,and incidence of shock.However,CDT may prolong hospital length of stay to a certain extent.Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

Seroepidemiology of Helicobacter pylori infection in elderly people in the Beijing region, China

AIM:To investigate seroepidemiology of cagA+and vacA+strains of Helicobacter pylori(H.pylori)in an elderly population in Beijing and to determine risk factors for seropositivity.METHODS:A total of 2006 elderly persons(>60years)were selected using a random cluster sampling method in different parts of the Beijing area(urban,suburban and mountainous districts).Structured questionnaires were completed during home visits,including history of H.pylori infection,history of gastrointestinal diseases,diet types,hygiene habits,occupation and economic status.Blood samples(2 mL)were collected from each participant,and serum IgG antibodies to cagA,vacA and H.pylori urease antigens were measured by immunodetection.RESULTS:The prevalence of H.pylori infection in elderly subjects was 83.4%and the typeⅠH.pylori strain infection rate was 56%.The seroprevalence for typeⅠH.pylori strain infection in urban and suburbandistricts was higher than that in the mountainous areas(P<0.001).Elderly subjects who had previously performed manual labor or were in the young-old age group(age<75 years)had a higher seroprevalence of H.pylori infection than those who had previously performed mental labor or were in the oldest-old age group(age≥75 year)(P<0.05).The typeⅠH.pylori strain infection rate in the elderly with vegetarian diets was higher than in those eating high-protein foods(P<0.001).There was no significant difference in the prevalence of H.pylori strains between male and female elderly participants(P>0.05).CONCLUSION:TypeⅠH.pylori seroprevalence is higher in elderly people.The distribution of strains of H.pylori is significantly affected by age,area and dietary habits.

Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital

在 10 年的经期上在一所中国综合医院在尸体调查肺的栓塞( PE )的流行和特征，并且评估预防的临死前的成就，诊断，并且从中国人民解放军队( PLA )医院将军的西方布朗奇的死亡的 PE.MethodsAll 医药记录的治疗回顾地被考察，为到2015年12月31日的2006年1月1日的经期。尸体在被执行了的案例被识别并且进一步分析了。数字和有足的病人的详细特征被注意。与 PE 的诊断和治疗一起，，预防措施被记录 performed.ResultsDuring 10 年的时期， 1057 个病人在学习医院里死了， 278 验尸被执行(尸体率：26.3%) 。九个病人被发现有 PE (3.2%) ，并且在七个这些病人(2.5%) ， PE 被认为致命。栓塞在所有七个致命的 PE 案例在箱子和肺的动脉树的双边的主要树枝中被发现。正确 intracardiac 血栓在九个 PE 病人(55.6%) 中的五个被检测。有 PE 的所有病人在医药部门被就医了，并且仅仅在住院期间经历了外科。临死前的预防在九个 PE 盒子(22.2%) 中的二个中被执行。任何一个都没在 death.ConclusionsThe 发生前 9 个病人收到 PE 的临床的诊断，与 PE 联系的死亡率可以在不同赛跑和区域之中变化。在某些代表性的医药机构的借助于验尸的 PE 的连续监视是必要的。

Ameliorated stress related proteins are associated with improved cardiac function by sarcoplasmic reticulum calcium ATPase gene transfer in heart failure

BackgroundPrevious 研究证明在许多心失败(HF ) 模型的 sarco-endoplasmic 蜂窝胃钙 ATPase (SERCA2a ) 的 overexpression 与极大地提高的心脏的性能被联系。然而，它仍然未定义全身的煽动性的反应和 neuro 神经质的 factors.MethodsA 上的 SERCA2a overexpression 的效果试验性的 HF 的快速的恰好室的踱步模型在猎兔犬被使用。然后，动物经历了 recombinant 联系 adeno 的病毒(rAAV1 ) 1 调停了由直接 intra 心肌层的基因 transfection 注射。HF 动物被使随机化收到 SERCA2a 基因，提高的绿色荧光灯缓冲的蛋白质(控制) 基因，或相等的磷酸盐盐。在基因交货以后的三十天，心脏的功能被测试的 echocardiographic 评估。SERCA2a 的蛋白质水平被西方的弄污测量。左的 proteomic 分析室(LV ) 样品被决定用二维(2-D ) 胶化电气泳动和 MALDI-TOF-MS。全身的煽动性、 neuro 神经质的因素的浆液层次是用心脏的功能由于显著地增加的 SERCA2a 蛋白质水平在 SERCA- 2a 基因转移以后改进了的放射性免疫测定 kits.ResultsThe 的 assayed。与 SERCA2a 对待的猎兔犬显著地减少了煽动性的标记的浆液层次(interleukin-6 和肿瘤坏死 factor-&#x003b1；) 并且 neuro 神经质的因素(大脑 natriuretic 肽， endothelin-1 和血管收缩素 II ) 与 HF 动物相比。心肌的 proteomic 分析显示出那 haptoglobin 重链，热吃惊蛋白质( alpha-crystallin-related ， B6 )是下面调整的，并且 galectin-1 与 HF 组，相比在 SERCA2a 组是起来调整的由起来调整的可收缩的蛋白质的 companied 和 NADH dehydrogenase.ConclusionsThese 调查结果证明 rAAV1-SERCA2a 向量的地区性的 intramyocardial 注射可以改进全球 LV 功能，与全身的煽动性的、过多的 neuroendocrin

Effectiveness of enhanced recovery after surgery in the perioperative management of patients with bone surgery in China

BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and research has contributed to progress of ERAS in China.In 2019,to promote the application of ERAS in bone tumor surgery,we formed the“Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.AIM To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.METHODS One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group(53 cases)and a control group(54 cases).The study group adopted the ERAS protocol and the control group adopted conventional care.Main outcome measures included postoperative length of stay(LOS),postoperative complications,mortality,and 30-d readmission rates.Secondary outcomes included postoperative visual analog scale(VAS)score of pain,number of blood transfusions,drainage volume in 24 h after operation,patient satisfaction 30 d after discharge,VAS score at 30 d after discharge,and daily standing walking time.RESULTS There were no significant differences in the baseline data,clinical features and surgical site between the two groups.The LOS in the study group with the ERAS protocol was 7.72±3.34 d compared with 10.28±4.27 d in the control group who followed conventional care.The incidence of postoperative nausea and vomiting(PONV)in the study group was 19%and 37%in the control group.The VAS scores of pain on postoperative day 1(POD1)and POD3 in the study group were 4.79±2.34 and 2.79±1.53 compared with 5.28±3.27 and 3.98±2.27 in the control group.The drainage volume in 24 h after the operation was 124.36±23.43 mL in the study group and 167.43±30.87 mL in the control group.The number of blood transfusions in the study group was also lower.The patient satisfaction rate was higher in the study group than in the control group.CONCLUSION The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS,PONV,and postoperative pain,blood transfusion and 24-h drainage,improve patient satisfaction and accelerate recovery.

N-terminal pro-brain natriuretic peptide but not high-sensitivity C-reactive protein is related to severity of coronary artery stenosis in patients with acute coronary syndrome

象N终端支持大脑的类型 natriuretic 肽( NT pro-BNP )和高敏感的 Creactive 蛋白质( hsCRP )那样的客观生物化学的指示物在急性冠的症候群(交流)预言死亡 .However ，很少在 331 使遭到包括 246 个不稳定的心绞痛病人的病人 with.Methods 对与冠的动脉狭窄的严厉的这些因素的关系被知道， 85 个心肌的梗塞病人被招募并且分类进二groups:single容器

Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China

Background:Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China.Visitation is not usually permitted or may be strictly limited,and NICU care for most neonates is provided by health-care professionals with little participation of the parents.An exception to this rule is the level 2 'Room-In' ward in Qilu Children's Hospital,Shandong University,where parents have 24-hour access to their infants and participate in providing care.Methods:This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group,n=428),admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group,n=1018),or admitted straight to the Room-In ward (RIn only group,n=629).Results:There were no significant differences in the rates of nosocomial infection,bronchopulmonary dysplasia,intraventricular hemorrhage,and retinopathy of prematurity between the NICU-NICU and NICURIn groups.The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04),while weight gain and duration of hospital stay were significantly higher (both P<0.001).Rates of adverse outcomes were lower in RIn-only infants due to their low severity of illness on admission.Conclusions:Allowing parents access to their infant in the NICU is feasible and safe in China,and may result in improvements in infant outcomes.Further studies are required to generate stronger evidence that can inform changes to neonatal care in China.

Effect of Metabolic Syndrome Score, Metabolic Syndrome, and Its Individual Components on the Prevalence and Severity of Angiographic Coronary Artery Disease

Background： The clinical significance of metabolic syndrome （MS） score, MS, and its individual components with respect to risk prediction of coronary artery disease （CAD） remains unclear. The objective of this study was to investigate whether and to what extent MS score, MS, and its individual components were related to the risk of CAD. Methods： Among 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia, 858 were included in this study according to the inclusion criteria from September 2010 to June 2013. MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria. The severity of coronary atherosclerosis was assessed by Gensini score. Results： The results showed that the age- and sex-adjusted odds ratios （ORs） tbr CAD were as follows： MS score, 1.327; MS, 2.013; elevated waist circumference, 1.447; reduced high-density lipoprotein cholesterol, 1.654： and elevated fasting glucose, 1.782： all P〈 0.05： whereas for elevated triglycerides, 1.324, and elevated blood pressure, 1.342, both P 〉 0.05. Alter multivariate adjustment, results showed that only MS and elevated fasting glucose were significantly associated with CAD （OR, 1.628, 95% confidence interval [CI], 1.151-2.305, P = 0.006 for elevated fasting glucose, and OR, 1.631, 95% CI, 1.208-2.203, P = 0.001 for MS）. The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score （standardized coefficient, 0.101, P = 0.031 for elevated fasting glucose and standardized coefficient, 0.103, P = 0.009 for MS score）. Conclusions： The present study demonstrated that MS score, MS, and its individual components might have different contributions to CAD prevalence and severity. MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.

2019 Chinese expert consensus statement on aspirin application in primary prevention of cardiovascular disease

Aspirin has been widely used in primary prevention of atherosclerotic cardiovascular disease(ASCVD)J141 Aspirin for primary prevention of ASCVD does not significantly reduce all-cause mortality or cardiovascular mortality,and the main benefit of aspirin for primary prevention of ASCVD is a significant reduction in non-fatal ischemic events including myocardial infarction,transient ischemic attack,ischemic stroke,and major cardiovascular events(cardiovascular death,non-fatal myocardial infarction,and non-fatal stroke),whereas the main risk is a significant increase in non-fatal major bleeding events including gastrointestinal bleeding and intracranial hemorrhage.1 Obviously,it makes sense to prescribe aspirin for primary prevention only if the benefits clearly outweigh the risks.In Europe and the United States,the benefit-risk ratio of aspirin for primary prevention has gradually decreased compared to the past due to the wide application of other primary prevention measures such as blood pressure reduction,smoking cessation,and the use of statins.Three recent large-scale clinical trials have shown that aspirin has no net clinical benefit when used in low-risk populations.19'1^Therefore,aspirin must be used with caution in the primary prevention of ASCVD.

Sorbitol induces flower bud formation via the MADS-box transcription factor EjCAL in loquat

Sorbitol is an important signaling molecule in fruit trees. Here, we observed that sorbitol increased during flower bud differentiation(FBD) in loquat(Eriobotrya japonica Lindl.). Transcriptomic analysis suggested that bud formation was associated with the expression of the MADS-box transcription factor(TF) family gene, EjCAL. RNA fluorescence in situ hybridization showed that EjCAL was enriched in flower primordia but hardly detected in the shoot apical meristem. Heterologous expression of EjCAL in Nicotiana benthamiana plants resulted in early FBD. Yeast-one-hybrid analysis identified the ERF12 TF as a binding partner of the EjCAL promoter. Chromatin immunoprecipitation-PCR confirmed that EjERF12 binds to the EjCAL promoter, and β-glucuronidase activity assays indicated that EjERF12 regulates EjCAL expression.Spraying loquat trees with sorbitol promoted flower bud formation and was associated with increased expression of EjERF12 and EjCAL. Furthermore, we identified EjUF3GaT1 as a target gene of EjCAL and its expression was activated by EjCAL. Function characterization via overexpression and RNAi reveals that EjUF3GaT1 is a biosynthetic gene of flavonoid hyperoside. The concentration of the flavonoid hyperoside mirrored that of sorbitol during FBD and exogenous hyperoside treatment also promoted loquat bud formation. We identified a mechanism whereby EjCAL might regulate hyperoside biosynthesis and confirmed the involvement of EjCAL in flower bud formation in planta. Together,these results provide insight into bud formation in loquat and may be used in efforts to increase yield.

In vivo real-time imaging of gemcitabine-leaded growth inhibition in the orthotopic transplantation model of human pancreatic tumor

Human xenograft mouse models,which have been used in cancer research for over a century,provided significant advances for our understanding of this multifaceted family of diseases.Orthotopic transplantation tumor models are emerging as the preference for cancer research due to the increasing clinical relevance over subcutaneous mouse models.In this study,a stable luciferaseexpressed Capan-2 cell line was constructed and the expression of luciferase was tested.The results showed that the luminorescence intensity of Capan-2^(Luc) cells was associated with the number of cells and the minimal detectable cell population was 600 cells/well.We established an orthotopic transplantation model of pancreatic cancer using Capan-2^(Luc) cell line in athymic mice and investigated the inhibitory effects of gemcitabine(Gem)in vitro and in vivo.Optical imaging system was applied to evaluate the tumor growth of orthotopic transplantation model in vivo.The results suggested that the orthotopic transplantation model of pancreatic cancer was well established and the luminorescence intensity of Gem-treated group was markedly lower than that of control group with an inhibitory rate of 56.8%(P<0.001).Our orthotopic transplantation model of pancreatic cancer and real-time imaging observation method established in this study could be an ideal model and a useful tool for therapeutic approaches for pancreatic cancers.

The effectiveness of zinc supplementation in men with isolated hypogonadotropic hypogonadism

A multicenter, open-label, randomized, controlled superiority trial with 18 months of follow-up was conducted to investigate whether oral zinc supplementation could further promote spermatogenesis in males with isolated hypogonadotropic hypogonadism （IHH） receiving sequential purified urinary follicular-stimulating hormone/human chorionic gonadotropin （uFSH/hCG） replacement. Sixty-seven Chinese male IHH patients were recruited from the Departments of Endocrinology in eight tertiary hospitals and randomly allocated into the sequential uFSH/hCG group （Group A, n = 34） or the sequential uFSH plus zinc supplementation group （Group B, n = 33）. In Group A, patients received sequential uFSH （75 U, three times a week every other 3 months） and hCG （2000 U, twice a week） treatments. In Group B, patients received oral zinc supplementation （40 mg day-1） in addition to the sequential uFSH/hCG treatment given to patients in Group A. The primary outcome was the proportion of patients with a sperm concentration 〉1.0 × 106 ml-1 during the 18 months. The comparison of efficacy between Groups A and B was analyzed. Nineteen of 34 （55.9%） patients receiving sequential uFSH/hCG and 20 of 33 （60.6%） patients receiving sequential uFSH/hCG plus zinc supplementation achieved sperm concentrations ≥1.0 × 106 ml-1 by intention to treat analyses. No differences between Group A and Group B were observed as far as the efficacy of inducing spermatogenesis （P = 0.69）. We concluded that the sequential uFSH/hCG plus zinc supplementation regimen had a similar efficacy to the sequential uFSH/hCG treatment alone. The additional improvement of 40 mg day-1 oral zinc supplementation on spermatogenesis and masculinization in male IHH patients is very subtle.

Trimetazidine in angina and poor muscle function: protocol for a randomized controlled study

Background: Low handgrip strength (HS) and declining gait speed (GS) are increasingly obvious with aging, requiring effective, and safe medication for treatment. Trimetazidine (TMZ) modified release tablets, a common anti-angina drug, has potential benefits for alleviating the condition, but this has not yet been fully studied and therefore is the aim of this study. Methods: This is a prospective randomized controlled study. Fifty-eight eligible patients will be randomly assigned to one of two study groups: TMZ group or control group. For the TMZ group, a dose of 35 mg of oral TMZ will be administered with a meal twice a day for 3 months, in addition to any conventional treatments for angina. Only conventional treatments for angina will be administrated in the control group. The primary outcome will be the 6-min walking distance and the secondary outcomes will be: muscle strength (HS and pinch strength), GS, muscle endurance (five times sit-to-stand test), balance maintenance (tandem standing test), and the frequency of angina per week. Additionally, body mass index, circumferences (biceps, waist, hip, and calf), albumin levels, and the score on a five-question scale for sarcopenia will be obtained during the study. Discussion: This study aims to evaluate the usefulness of TMZ in a population with poor muscle function. The results may provide an effective and safe medical treatment to people with low muscle strength or physical performance.

Variation in the Coat Protein Gene of Papaya ringspot Virus Isolates from Multiple Locations of China

The potyvirus Papaya ringspot virus （PRSV） is an important pathogen of papaya that causes severe losses in economic crops for papaya production globally. The coat protein （CP） genes of five PRSV isolates originating from different locations in China were cloned and sequenced. The CP-coding region varied in size from 864-873 nucleotides, encoding proteins of 288-291 amino acids. The five Chinese isolates of PRSV have been characterized as papaya-infecting （PRSV-P）. The CP sequences of the Chinese isolates were compared with those of previously published PRSV isolates originating from different countries at amino acid levels. A number of KE repeat boxes in the N terminus of the PRSV-CP were found in all Chinese isolates. The phylogenetic branching pattern revealed that there was certain extended grouping between geographic locations, and the Asian type probably represents the oldest population of PRSV. The information of CP genes will be useful in designing and developing durable virus resistant-PRSV transgenic papaya in China. Meanwhile broad-spectrum-virus resistant, strongly resistant-PRSV and good safe papaya lines are required.

Ablation of steroid receptor coactivator-3 in mice impairsadipogenesis and enhances energy expenditure

Obesity is a medical condition in which excess body fat has accumulated to an extent and may have an adverse effect on health,leading to reduced life expec-tancy,impaired energy homeostasis and increased health problems.The p160 steroid receptor coactivator(SRC)gene family members have been suggested to be involved in energy homeostasis,but the impact of SRC-3 ablation on white and brown adipose tissue needs to be elucidated.In the current study,we collected in vivo data and carried out morphological studies on the effect of SRC-3 deficiency on white adipose tissue(WAT)and brown adipose tissue(BAT).Primary cells were cultured to investigate the differentiation ability of both adipocytes.Western blot was applied to detect the expression of master genes governing adipogenesis and thermogenesis.We observed that SRC-3^(–/–)mice were lean,with reduced WAT and decreased serum leptin levels,mainly due to the smaller white adipocyte size caused by impaired adipo-genesis,presented by decreased peroxisome proliferator activated receptor g(PPARg)expression.In the BAT,the lipid droplets decreased significantly in SRC-3^(–/–)mice as demonstrated by histological analysis and electron micro-scopic observation,which could be explained by enhanced thermogenesis.The expression of thermogenic marker gene PPARg coactivator 1αand uncoupling protein-1 increased in BAT of SRC-3^(–/–)mice,which proved our observations.Collectively,these results demonstrate that SRC-3 plays a key role in adipogenesis and energy expenditure.