Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction

Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.

Analysis of Blood Lipids, Blood Glucose, Blood Uric Acid, and Blood Routine Test Results in Retired Employees of a Unit in the Civil Aviation System

Objective:To investigate and analyze the annual physical examination results of retired employees from a unit in the civil aviation system,focusing on blood lipids,blood glucose,blood uric acid,and blood routine results.The study aims to provide relevant references for formulating reasonable disease management measures for preventing and controlling hyperlipidemia,hyperuricemia,and other conditions in retired employees.Methods:The examination results of 231 participants were collected and analyzed.The participants were divided into four groups based on age:middle-aged group,young-old group,middle-old group,and old-old group.The blood test results were compared across these groups,and an assessment of atherosclerotic cardiovascular disease(ASCVD)risk levels was completed in conjunction with medical history.Blood test results were also compared by gender.Results:There were no significant statistical differences in blood test results when grouped by age.However,the prevalence of hyperuricemia was higher in males than in females,while the prevalence of hypercholesterolemia was higher in females than in males.The LDL-C target achievement rate was lower in the moderate-and-high-risk group as well as the very high-risk group as defined by ASCVD risk levels.Conclusion:Management of hyperuricemia and hyperlipidemia in retired employees(elderly patients)should be strengthened to reduce the risk of ASCVD events and alleviate the potential medical burden associated with disease progression.

Effects of Antimicrobial Peptides on Production,Slaughter Performance and Blood Routine of Tan Sheep

[Objectives]This study was conducted to analyze effects of antimicrobial peptides added to the diet of Tan sheep on their production, slaughter performance and blood composition. [Methods] Ninety two four-month-old Tan sheep were randomly divided into two treatment groups according to their body weight, 46 in each group. The control check group(CK) was feed with conventional diet, and the experimental group was fed with the addition of antimicrobial peptide on the basis of the conventional diet, with the added amount of 2.5 g/sheep per day. The experimental period was 60 d. [Results] The incidence rate was 75.06% lower in the experimental group than in the CK. The average daily weight gain per sheep was 11.27% higher in the experimental group than in the CK(P<0.05). The feed conversion ratio was 8.45% lower in the experimental group than in the CK(P<0.05). The average daily gross profit per sheep was 12.12% higher in the experimental group than in the CK. For slaughter performance, the data difference of each item was not significant. The PH at 45 min and 24 h after slaughter was within the normal range of fresh mutton. The cooked meat percentage and water loss rate showed no significant differences(P>0.05). The marbling ranged from 2.45 to 2.50, indicating that the fat content was moderate, and the difference between groups was not significant(P>0.05). The flesh color ranged from 3.00 to 3.15, between light red and bright red, belonging to the normal color of mutton, and the difference between groups was not significant(P>0.05). The shear force was between 2.50 and 2.65, without a significant difference between groups(P>0.05). The white blood cells, lymphocytes and platelets in the experimental group were lower than those in the CK(P<0.01). The erythrocytes and hemoglobin in the erythrocyte group were higher than those in the CK(P<0.05). The neutrophils and monocytes in the experimental group were lower than those in the CK(P<0.05). [Conclusions] This study provides a technical basis for the rational use of antimicrobial peptides and their application in ruminants.

Microscopic Characteristics and Routine Detection of Hedyotis hedyotidea(DC.)Merr.

[Objectives]To study the microscopic characteristics and routine detection of Hedyotis hedyotidea(DC.)Merr.[Methods]The microscopic characteristics of the root,stem cross section and the whole plant powder of H.hedyotidea were studied by the methods of slide-shaft section,biological staining and microscopic imaging;the routine detection items such as moisture,ash,acid-insoluble ash and extract were detected and analyzed in accordance with the requirements of Chinese Pharmacopoeia.[Results]The microscopic characteristics of the root,the stem and the whole plant powder of H.hedyotidea were obtained.The moisture content of 10 batches of H.hedyotidea samples was in the range of 4.25%-7.90%,the water-soluble extract is in the range of 15.08%-22.52%,the total ash was in the scope of 8.27%-10.45%,and the acid-insoluble ash was in 0.13%-0.95%.The proposed water content of H.hedyotidea should not exceed 10.00%,the water-soluble extract should not be less than 12.00%,the total ash content should not exceed 13.00%,and the acid-insoluble ash content should not exceed 1.20%.[Conclusions]The results of this experiment can provide a reference for the quality control and quality standard of H.hedyotidea.

Analysis of Serum Cys-C,TBA,and Routine Blood Parameters of Patients with Hepatitis B-Related Decompensated Cirrhosis

Objective:To study the levels of serum cystatin C(Cys-C),total bile acid(TBA),and other routine blood parameters on patients with decompensated hepatitis B cirrhosis.Methods:Study group 1 consisted of 30 patients with hepatitis B-related decompensated cirrhosis,and study group 2 consisted of 30 patients with hepatitis B;while the control group consisted of 30 healthy people who underwent physical examination.The blood parameters were used to evaluate the clinical treatment effect of patients.Results:The TBA,Cys-C,alanine transaminase(ALT),total bilirubin(TBIL),aspartate aminotransferase(AST),and international normalized ratio(INR)in study group 1 were significantly higher than those of study group 2 and the control group;while the platelet count(PLT),hemoglobin(Hb),albumin(ALB),and estimated glomerular filtration rate(eGFR)were significantly lower in the study group 1 compared to the control group and study group 2(P<0.05).The Cys-C,PLT,TBA,AST,TBIL,and INR of patients in study group 1 who were successfully treated were significantly lower than the patients who were not successfully treated(P<0.05).Conclusion:Serum Cys-C,TBA,and routine blood parameters are useful in predicting the condition and the prognosis of patients of hepatitis B-related decompensated cirrhosis.

Considerations for routine coagulation monitoring with rivaroxaban:A case report and review of the literature

BACKGROUND Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that does not require coagulation monitoring based on current recommendations. Our goal is to explore whether routine coagulation monitoring should not be required for all patients receiving oral rivaroxaban, what relationship between routine coagulation abnormalities and bleeding, and how to deal with the above clinical situations through our case and review of the literature.CASE SUMMARY We report a 67-year-old woman with a history of atrial fibrillation who presented to the hospital with worsening dyspnea and cough. Based on electrocardiogram,venous compression ultrasonography, and computed tomography pulmonary angiography, the diagnosis of atrial fibrillation, deep venous thrombosis, and acute pulmonary embolism was confirmed. Her coagulation assays and renal function were normal on admission; she was not underweight, did not have a history of hemorrhagic disease, and her CHA2 DS2-VAS, HAS-BLED, and simplified Pulmonary Embolism Severity Index scores were 3, 0, and 0,respectively. Oral rivaroxaban(15 mg twice daily) was administered. The following day, she presented gastrointestinal and gum bleeding, combined with coagulation abnormalities. Following cessation of rivaroxaban, her bleeding stopped and tests improved over the next 2 d. Rivaroxaban was begun again 3 d after recovery. However, she again presented with gastrointestinal and gum bleeding and the abnormal tests, and the therapy was discontinued. At 30-d follow-up after discharge, she presented normal coagulation tests without bleeding.CONCLUSION Although current guidelines recommend that using non-vitamin K antagonist oral anticoagulants including rivaroxaban do not require coagulation monitoring,a small number of patients may develop routine coagulation test changes and bleeding during rivaroxaban therapy, especially in the elderly. Clinicians should pay attention to these patients and further obtain evidence in practice.

Detection and Analysis of Routine Blood Indexes in Guike Pig

[Objectives] In this study,routine blood indexes of Guike pig were detected to clarify quantity variation and morphology distribution of different functional cells（ red blood cells,white blood cells and platelets）,thus providing reference data for immunological evaluation and disease resistance research of Guike pig. [Methods] Blood samples were collected from forty-four 49-day-old healthy Guike pigs（ 22 males and 22 females） once a week for seven consecutive weeks to detect routine blood indexes,and the results were compared with routine blood indexes of Landrace pig and Enshi black pig. [Results]Among red blood cell indexes of Guike pig at different day ages,red blood cell count（ RBC） and hemoglobin count（ HGB） both reached the lowest levels（ 6. 85 × 10^12/L and 97. 1 g/L）at 70 days of age,which were significantly lower than the corresponding indexes at 49,56,63,84 and 91 days of age（ P 〈 0. 05,similarly hereinafter）; mean corpuscular hemoglobin（ MCH） and mean corpuscular hemoglobin concentration（ MCHC） demonstrated basically the same variation pattern,which both reached the lowest levels（ 15. 11 pg and 275. 70 g/L） at 70 days of age and reached the highest levels（ 16. 40 pg and 314. 30 g/L） at 91 days of age; hematocrit（ HCT）,mean corpuscular volume（ MCV） and red blood cell distribution width（ RDW） exhibited relatively stable changes with no significant differences among different day ages（ P 〉 0. 05,similarly hereinafter）. Among white blood cell indexes of Guike pig at different day ages,white blood cell count（ WBC） reached the lowest level（ 13. 71 × 10^9/L） at 63 days of age and reached the highest level（ 17. 52 × 10^9/L） at 84 days of age,with significant differences; neutrophil count（ NEUT）reached the lowest level（ 3. 61 × 10^9/L） at 70 days of age,which was significantly lower than that at 49,56 and 77 days of age; lymphocyte count（ LYMPH） exhibited relatively stable changes and was not significantly affected by the increase in day age. Among platelet indexes of Guike pig at different day ages,platelet count（ PLT）,thrombocytocrit（ PCT） and platelet volume distribution width（ PDW） exhibited relatively stable changes among different day ages,which were not significantly affected by the increase in day age. Compared to 35-day-old Landrace pig and 5-month-old Enshi black pig,most routine blood indexes of Guike pig were similar to or ranged between those of Landrace pig and Enshi black pig except HCT,mean platelet volume（ MPV）,PCT and PDW. [Conclusions]Guike pig has a certain uniqueness in routine blood indexes,which has developed a stable immune system at 49-91 days of age.

Can progesterone be a better alternative to dexamethasone for use in routine brain surgery?

Can progesterone be a better alternative to dexamethasone for use in routine brain surgery？ Surgical brain injury （SBI） is a form of brain trauma caused by various forms of neurosurgical interventions including brain tumor excision, evacuation of intracere- bral hemorrhage and brain lobectomv （e.g., in epililepsv surger）.

Preoperative ultrasound combined with routine blood tests in predicting the malignant risk of pancreatic cystic neoplasms

Objective:Accurate preoperative identification of benign or malignant pancreatic cystic neoplasms(PCN)may help clinicians make better intervention choices and will be essential for individualized treatment.Methods:Preoperative ultrasound and laboratory examination findings,and demographic characteristics were collected from patients.Multiple logistic regression was used to identify independent risk factors associated with malignant PCN,which were then included in the nomogram and validated with an external cohort.The Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were calculated to evaluate the improvement in the predictive power of the new model with respect to that of a combined imaging and tumor marker prediction model.Results:Malignant PCN were found in 83(40.7%)and 33(38.7%)of the model and validation cohorts,respectively.Multivariate analysis identified age,tumor location,imaging of tumor boundary,blood type,mean hemoglobin concentration,neutrophil-tolymphocyte ratio,carbohydrate antigen 19-9,and carcinoembryonic antigen as independent risk factors for malignant PCN.The calibration curve indicated that the predictions based on the nomogram were in excellent agreement with the actual observations.A nomogram score cutoff of 192.5 classified patients as having low vs.high risk of malignant PCN.The model achieved good C-statistics of 0.929(95%CI 0.890–0.968,P<0.05)and 0.951(95%CI 0.903–0.998,P<0.05)in predicting malignancy in the development and validation cohorts,respectively.NRI=0.268;IDI=0.271(P<0.001 for improvement).The DCA curve indicated that our model yielded greater clinical benefits than the comparator model.Conclusions:The nomogram showed excellent performance in predicting malignant PCN and may help surgeons select patients for detailed examination and surgery.The nomogram is freely available at https://wangjunjinnomogram.shinyapps.io/DynNomapp/.

Differences in functional magnetic resonance imaging following cutaneous and routine acupuncture at different acupoints

Few studies have examined the effects of different stimuli at a single acupoint using functional magnetic resonance imaging.The present study applied acupuncture at the Neiguan（PC 6）,Waiguan（SJ 5）,Zhigou（SJ 6） and Yanglingquan（GB 34） acupoints in healthy volunteers.fMRI was used to examine the activation of brain areas in response to different types of acupuncture（cutaneous or routine acupuncture） at each acupoint.There were no significant differences in the distribution of activation in the regions of interest between cutaneous and routine acupuncture at the Neiguan,Waiguan,and Zhigou acupoints,but some differences were observed between the two methods of acupuncture at the Yanglingquan acupoint.There were no significant differences in the intensity of induced activation between cutaneous and routine acupuncture at the Neiguan,Zhigou and Yanglingquan acupoints,but the activation intensity in the right cerebellum induced by routine acupuncture at the Waiguan acupoint was greater than that induced by cutaneous acupuncture.Results confirmed that cutaneous and routine acupuncture at the Neiguan,Waiguan,Zhigou and Yanglingquan acupoints activated different functional brain areas,and caused activation of different intensities in some areas.

Is routine measurement of international normalized ratio necessary as part of the investigation of patients with cardiac-type chest pain?

Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Emergency and Trauma Centre in Halifax, Nova Scotia, Canada, 4,800 (6.6%) of the approximately 73,000 patients per year register with a complaint of “chest pain”, and 20% of patients are referred to cardiology. Coagulation studies, specifi cally international normalized ratio (INR) frequently part of the “routine” panel of blood tests, are ordered for patients in the ED being investigated or treated for chest pain suspected to be cardiac in nature. Recent calls to examine how much of our practice is likely to benefit patients in any way have led us to question the clinical utility of routine use of these tests.

An Analysis on the Experience and Routines of Experimental Site of New-countryside Construction of Xianhong in Hubei

The paper tends to make an empirical analysis on the experimental site of new countryside construction of Xianhong in Hubei, pointing out that the inner and outer dependence on routines of experimental construction. The paper also puts forward the beneficial policies, focusing on the agricultural production and fostering professional farmers, to reduce much dependence on routines.

Innovation Management Processes and Routines for Business Success and Value Creation

Innovation is managed through the development of processes and routines, considered as critical for business success and value creation. The identification of relevant routines as well as the understanding of which factors affect business innovation is the main objective of this research, based on a survey applied in Portuguese companies and their experience shared in best practices guides. Conclusions highlighted 10 key innovation routines, reinforcing the idea that innovation must be supported through a systematic and sustained management process. Results also indicate that SMEs face greater difficulties in benefiting from the potential of innovation practices and collaboration may present opportunities to overcome their limited resources. Therefore, regardless of size, business activity, science and technology intensity or other factors influencing firms dynamic capabilities, innovation should be considered as a management imperative as it can influence not only the present but also the future of business success.

Improving Routine Immunization Coverage Through Optimally Designed Predictive Models

Routine immunization(RI)of children is the most effective and timely public health intervention for decreasing child mortality rates around the globe.Pakistan being a low-and-middle-income-country(LMIC)has one of the highest child mortality rates in the world occurring mainly due to vaccine-preventable diseases(VPDs).For improving RI coverage,a critical need is to establish potential RI defaulters at an early stage,so that appropriate interventions can be targeted towards such populationwho are identified to be at risk of missing on their scheduled vaccine uptakes.In this paper,a machine learning(ML)based predictivemodel has been proposed to predict defaulting and non-defaulting children on upcoming immunization visits and examine the effect of its underlying contributing factors.The predictivemodel uses data obtained from Paigham-e-Sehat study having immunization records of 3,113 children.The design of predictive model is based on obtaining optimal results across accuracy,specificity,and sensitivity,to ensure model outcomes remain practically relevant to the problem addressed.Further optimization of predictive model is obtained through selection of significant features and removing data bias.Nine machine learning algorithms were applied for prediction of defaulting children for the next immunization visit.The results showed that the random forest model achieves the optimal accuracy of 81.9%with 83.6%sensitivity and 80.3%specificity.The main determinants of vaccination coverage were found to be vaccine coverage at birth,parental education,and socioeconomic conditions of the defaulting group.This information can assist relevant policy makers to take proactive and effective measures for developing evidence based targeted and timely interventions for defaulting children.

Role of routine check-up in the prognosis of patients with pancreatic cancer:A puzzling phenomenon

Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.

How to do when PFO closure failed under routine guidance:the first clinical experience for PFO closure

Patent foramen ovale(PFO)is the most common abnormality of fetal origin and is affecting approximately 25%of the worldwide adult population.[1]During the past two decades,instead of surgical closure,catheter-based procedures to close the PFO have become widely used among patients.Periprocedural guidance with fluoroscopy,transesophageal echocardiography(TEE)or intracardiac echocardiography have been the mainstream technique to ensure a safe and successful procedure.

Discrimination of TCM constitutions by biochemical and routine urine indexes

Objective:To investigate whether the specific traditional Chinese medicine(TCM)constitution of individuals can be defined by certain biological indexes instead of answering the questionnaire,and to explore the possibility of discriminating nine TCM constitutions from each other simultaneously using biological indexes.Methods:Blood and urine samples from 152 individuals with nine TCM constitutions were collected,and the related biological indexes were analyzed combining ANOVA,multiple comparison,discriminant analysis,and support vector machine.Results:We found that 4 out of 24 blood routine indexes,7 out of 10 urine routine indexes,and 12 out of 32 biochemical indexes showed differences among the constitutions.High-sensitivity C-reactive protein,apolipoprotein A1,and alkaline phosphatase were potential candidates for screening out individuals with unbalanced constitutions.Combining uric acid,high-density lipoprotein,apolipoprotein A1,creatine kinase,total protein,aspartate aminotransferase,total bile acid,dehydrogenase,sodium,and calcium levels had the potential to directly distinguish the nine TCM constitutions from each other.Among these indexes,the highest ratio of discriminant analysis between two constitutions was 95.5%,while the lowest was 66.1%.Conclusion:Our results suggest that some biochemical and urine indexes are related to various TCM constitutions,and thus they have the potential to be used for TCM constitution classification.

Thermal Equilibration in the Cavity Volume of a Farmer Ion Chamber for Routine Dosimetry

A Farmer ion chamber with an air cavity volume is the most widely used dosimeter for accurate dose determinations in radiotherapy. The quantity of ionization in the cavity volume occurred a given radiation dose has to be corrected to the cavity air temperature according to a dosimetry protocol because the mass of air in the cavity volume is subject to atmospheric variations. In the present study, we aim to measure the thermal equilibration time in the cavity volume of a Farmer ion chamber for the routine dosimetry. The Farmer ion chamber’s electrode was replaced by a thin thermocouple and coated by the PMMA for a waterproofing so that the measurement of the temperature in the cavity performed in water. As a result of the measurement, A Farmer ion chamber in thermal equilibrium with waterproofing equilibrates rapidly, followed by an exponential fall-off. In water, equilibration to less than 10% of the initial temperature difference required only a few minutes. Thermal equilibrium time is hardly affected by the room temperature change.

Effect of the Routine Varicella Immunization on Herpes Zoster in Japan in the First Half of the Year

In Japan, herpes zoster is not monitored officially or nationwide. Recently, the databases of all electronic medical claims nationwide (NDBEMC) have been available for research. We use NDBEMC from April 2011 to March 2015. To evaluate the effects of initiation of routine immunization for varicella in children, we regressed the number of herpes zoster patients on the dummy variable for the routine immunization for varicella in children with and without a linear time trend. The estimated coefficient for the routine immunization for varicella was 0.5157 and its p-value was 0.001. However, if the time trend was added as an explanatory variable, the estimated coefficient for the routine immunization for varicella changed to be -0.039 and its p-value was 0.384. It means that the routine immunization for varicella was 7.8% higher after introduction than before. However, it was presumed to reflect such an upward trend.

The Sampling Quality Control in the Routine Monitoring of Livestock and Poultry Products

The routine monitoring of livestock and poultry products is the monitoring work carried out by the Ministry of Agriculture in order to grasp the quality and safety of national livestock and poultry products,and the sampling work is the first part of routine monitoring. This paper analyzes various factors during the implementation of sampling work such as preparatory work,sampling tools,sampling process,pretreatment,packaging,transfer,storage conditions and sample delivery. Carrying out the effective quality control can help to ensure the impartiality of the test results so as to provide reliable scientific basis for the department to study regulatory measures.