The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

The global incidence rates of in-hospital cardiac arrest(IHCA)range from1.2 to 9.0 per1,000 hospitalized patients,as per the National Cardiac Arrest Database.[1] While IHCAs tend to exhibit superior 30-day survival rates relative to out-of-hospital cardiac arrests (OHCA) due to situational advantages,such as immediate access to medical personnel and treatments.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Lower synaptic density and its association with cognitive dysfunction in patients with obsessive-compulsive disorder

Background Understanding synaptic alteration in obsessive-compulsive disorder(OCD)is crucial for elucidating its pathological mechanisms,but in vivo research on this topic remains limited.Aims This study aimed to identify the synaptic density indicators in OCD and explore the relationship between cognitive dysfunction and synaptic density changes in OCD.Methods This study enrolled 28 drug-naive adults with OCD aged 18-40 years and 16 healthy controls(HCs).Three-dimensional T1-weighted structural magnetic resonance imaging and 18F-SynVesT-1 positron emission tomography were conducted.Cognitive function was assessed using the Wisconsin Cart Sorting Test(WCST)in patients with OCD and HCs.Correlative analysis was performed to examine the association between synaptic density reduction and cognitive dysfunction.Results Compared with HCs,patients with OCD showed reduced synaptic density in regions of the cortico-striatothalamo-cortical circuit such as the bilateral putamen,left caudate,left parahippocampal gyrus,left insula,left parahippocampal gyrus and left middle occipital lobe(voxel p<0.001,uncorrected,with cluster level above 50 contiguous voxels).The per cent conceptual-level responses of WCST were positively associated with the synaptic density reduction in the left middle occipital gyrus(R^(2)=0.1690,p=0.030),left parahippocampal gyrus(R^(2)=0.1464,p=0.045)and left putamen(R^(2)=0.1967,p=0.018)in patients with OCD.Conclusions Adults with OCD demonstrated lower 18Flabelled difluoro analogue of 18F-SynVesT-1 compared with HCs,indicating potentially lower synaptic density.This is the first study to explore the synaptic density in patients with OCD and provides insights into potential biological targets for cognitive dysfunctions in OCD.

Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

Evaluating the Nutritional Status of Oncology Patients and Its Association with Quality of Life

Objective The primary aim of the study was to compare two nutritional status evaluation tools： the Patient-Generated Subjective Global Assessment（PG-SGA） and Nutritional Risk Screening（NRS-2002）. Using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30（EORTC QLQ-C30）, the second aim was to provide constructive advice regarding the quality of life of patients with malignancy. Methods This study enrolled 312 oncology patients and assessed their nutritional status and quality of life using the PG-SGA, NRS-2002, and EORTC QLQ-C30. Results The data indicate that 6% of the cancer patients were well nourished. The SGA-A had a higher sensitivity（93.73%） but a poorer specificity（2.30%） than the NRS-2002（69.30% and 25.00%, respectively） after comparison with albumin. There was a low negative correlation and a high similarity between the PG-SGA and NRS-2002 for evaluating nutritional status, and there was a significant difference in the median PG-SGA scores for each of the SGA classifications（P 〈 0.001）. The SGA-C group showed the highest PG-SGA scores and lowest body mass index. The majority of the target population received 2 points for each item in our 11-item questionnaire from the EORTC QLQ-C30. Conclusion The data indicate that the PG-SGA is more useful and suitable for evaluating nutritional status than the NRS-2002. Additionally, early nutrition monitoring can prevent malnutrition and improve the quality of life of cancer patients.

Abnormal subchondral bone remodeling and its association with articular cartilage degradation in knees of type 2 diabetes patients

Type 2 diabetes （T2D） is associated with systemic abnormal bone remodeling and bone loss. Meanwhile, abnormal subchondral bone remodeling induces cartilage degradation, resulting in osteoarthritis （OA）. Accordingly, we investigated alterations in subchondral bone remodeling, microstructure and strength in knees from T2D patients and their association with cartilage degradation. Tibial plateaus were collected from knee OA patients undergoing total knee arthroplasty and divided into non-diabetic （n---70） and diabetes （n = 51） groups. Tibial plateaus were also collected from cadaver donors （n = 20） and used as controls. Subchondral bone microstructure was assessed using micro-computed tomography. Bone strength was evaluated by micro-finite-element analysis. Cartilage degradation was estimated using histology. The expression of tartrate-resistant acidic phosphatase （TRAP）, osterix, and osteocalcin were calculated using immunohistochemistry. Osteoarthritis Research Society International （OARSI） scores of lateral tibial plateau did not differ between non-diabetic and diabetes groups, while higher OARSI scores on medial side were detected in diabetes group. Lower bone volume fraction and trabecular number and higher structure model index were found on both sides in diabetes group. These microstructural alterations translated into lower elastic modulus in diabetes group. Moreover, diabetes group had a larger number of TRAP~ osteoclasts and lower number of Osterix~ osteoprogenitors and Osteocalcin~ osteoblasts. T2D knees are characterized by abnormal subchondral bone remodeling and microstructural and mechanical impairments, which were associated with exacerbated cartilage degradation. In regions with intact cartilage the underlying bone still had abnormal remodeling in diabetes group, suggesting that abnormal bone remodeling may contribute to the early pathogenesis of T2D-associated knee OA.

Genetic associations with adverse events from anti-tumor necrosis factor therapy in inflammatory bowel disease patients

AIM To study the type and frequency of adverse events associated with anti-tumor necrosis factor(TNF)therapy and evaluate for any serologic and genetic associations.METHODS This study was a retrospective review of patients attending the inflammatory bowel disease(IBD) centers at Cedars-Sinai IBD Center from 2005-2016. Adverse events were identified via chart review. IBD serologies were measured by ELISA. DNA samples were genotyped at Cedars-Sinai using Illumina Infinium Immunochipv1 array per manufacturer's protocol. SNPs underwent methodological review and were evaluated using several SNP statistic parameters to ensure optimal allele-calling. Standard and rigorous QC criteria were applied to the genetic data, which was generated using immunochip. Genetic association was assessed by logistic regression after correcting for population structure.RESULTS Altogether we identified 1258 IBD subjects exposed to anti-TNF agents in whom Immunochip data were available. 269/1258 patients(21%) were found to have adverse events to an anti-TNF-α agent that required the therapy to be discontinued. 25% of women compared to 17% of men experienced an adverse event. All adverse events resolved after discontinuing the antiTNF agent. In total: n = 66(5%) infusion reactions; n = 49(4%) allergic/serum sickness reactions; n = 19(1.5%) lupus-like reactions, n = 52(4%) rash, n = 18(1.4%) infections. In Crohn's disease, Ig A ASCA(P = 0.04) and Ig G-ASCA(P = 0.02) levels were also lower in patients with any adverse events, and anti-I2 level in ulcerative colitis was significantly associated with infusion reactions(P = 0.008). The logistic regression/human annotation and network analyses performed on the Immunochip data implicated the following five signaling pathways: JAK-STAT(Janus Kinase-signal transducer and activator of transcription), measles, IBD, cytokine-cytokine receptor interaction, and toxoplasmosis for any adverse event. CONCLUSION Our study shows 1 in 5 IBD patients experience an adverse event to anti-TNF therapy with novel serologic, genetic, and pathways associations.

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

The incidence of gram-negative multidrug-resistant(MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit(ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through Pub Med search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients:an optical coherence tomography study

BACKGROUND Healed plaques are frequently found in patients with acute coronary syndrome,but the prognostic value is debatable.This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography(OCT)with the aim of predicting plaque progression of healed plaques.METHODS This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT ima-ging and follow-up angiography from January 2015 to December 2019.Plaque progression predictors were assessed by multivariate analysis.RESULTS Among 113 non-culprit lesions,27 healed plaques(23.9%)were identified.Patients with non-culprit healed plaques had prior antiplatelet therapy(65.0%vs.33.8%,P=0.019),hypertension(85.0%vs.50.7%,P=0.009),and dyslipidemia(70.0%vs.41.5%,P=0.04)which were more frequently than those without healed plaques.The thickness(r=0.674,P<0.001),arc(r=0.736,P<0.001),and volume(r=0.541,P=0.004)of healed plaque were correlated with minimum lumen diameter changes.At a mean follow-up of 11.5 months,the non-culprit healed plaques had a lower minimum lumen diameter(1.61±0.46 mm vs.1.91±0.73 mm,P=0.016),lower average lumen diameter(1.86 mm vs.2.10 mm,P=0.033),and a higher degree of diameter stenosis(41.4%±11.9%vs.35.5%±13.1%,P=0.031)when compared to baseline measurements.The plaque progression rate was higher in the healed plaque group(33.3%vs.8.1%,P=0.002),and multivariate analysis identified healed plaques[odds ratio(OR)=8.49,95%CI:1.71−42.13]and lumen thrombus(OR=10.69,95%CI:2.21−51.71)as predictors of subsequent lesion progression.CONCLUSIONS Healed plaques were a predictor for rapid plaque progression.The quantitative parameters of healed plaque showed a good agreement with plaque progression.Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol.Bifurcation lesions might be the predilection sites of healed plaques.

Cognitive impairment and its association with circulating biomarkers in patients with acute decompensated heart failure

BACKGROUND Cognitive impairment(CI)is common in patients with heart failure(HF),but the association between CI and biomarkers related to HF or cognitive decline in patients with HF remains unclear.METHODS This prospective observational study investigated the incidence of CI,subsequent cognitive changes,and the asso-ciation between CI and novel biomarkers in patients with left ventricular ejection fraction<40%who were hospitalized for acute decompensated HF.Patients were evaluated for CI,depressive symptoms,and quality of life with the Mini-Mental State Examin-ation(MMSE)and the Mini-Cog,Beck Depression Inventory(BDI)-II,and Kansas City Cardiomyopathy Questionnaire(KCCQ),respectively.The primary endpoint was a composite of all-cause mortality or hospitalization for HF at one year.RESULTS Among the 145 patients enrolled in this study,54 had CI(37.2%)at baseline.The mean MMSE increased signific-antly at the 3-month and 1-year follow-up,accompanied by decreased BDI-II and increased KCCQ scores.The improvement in the MMSE scores mainly occurred in patients with CI.Among the biomarkers assayed,only growth/differentiation factor(GDF)-15>1621.1 pg/mL was significantly associated with CI(area under the curve=0.64;P=0.003).An increase in GDF-15 per 1000 units was associated with an increased risk of the primary endpoint(hazard ratio=1.42;95%confidence interval:1.17-1.73;P<0.001).CONCLUSIONS In patients with HF with CI,cognitive function,depression,and quality of life measures improved at the 3-month and 1-year follow-up.GDF-15 predicted CI with moderate discrimination capacity and was associated with worse HF out-comes.

Association between apolipoprotein E promoter-219G/T polymorphism and total cholesterol level in patients with Alzheimer disease

BACKGROUND: Many researches have suggested that apolipoprotein E (APOE) and total cholesterol metabolism are closely related with dementia. In the supposed theory, 219 site of APOE promoter region is near gene coding region, so its polymorphism may result in the abnormality of APOE gene and protein expression, and finally lead to dementia. OBJECTIVE: To observe the association between APOE promoter-219G/T polymorphisms with serum total cholesterol in patients with Alzheimer disease, and compare it with non-dementia people. DESIGN: Case-control, comparative observation. SETTING: Department of Neurology, Fengtian Hospital of Shenyang Medical College. PARTICIPANTS: Fifty-five dementia patients including 27 males and 28 females aged (66±3) years and treated in the Department of Neurology, Fengtian Hospital were selected from January 2002 to December 2005 as the Alzheimer disease group. They all diagnosed according to the DSM-Ⅳdiagnostic criteria of Alzheimer disease instituted by American Psychiatry Association in 1994. Meanwhile, 44 none-dementia patients including 21 males and 23 females aged (66±3) years were selected from other clinical departments of Fengtian Hospital as control group. All the participants were informed the detection and agreed. METHODS: Genomic DNA was extracted from the peripheral blood of all subjects, then 'NEST'PCR, DNA sequence and enzyme digestion were adopted to detect the expression of APOE promoter-219 polymorphism, following by biomedical statistics analysis based on the clinical total cholesterol level. MAIN OUTCOME MEASURES: Polymorphism of APOE promoter-219 G/T and total cholesterol level. RESULTS: All 55 dementia patients and 44 non-dementia ones were involved in the result analysis. ①Allele and genotype frequency: The T allele frequency of the Alzheimer disease group was significantly higher than that in the control group [88.2% (97/110), 54.5% (48/88)], while G allele frequency was remarkably lower than that in the control group [11.8%(13/110), 45.5%(40/88), χ2=8.2, P < 0.01]. The TT allele frequency of the Alzheimer disease group was significantly higher than that in the control group [76% (42/55), 48% (21/44)], while GT+GG allele frequency was remarkably lower than that in the control group [24%(13/55), 52%(23/44), χ2=8.7, P < 0.01]. ②Total cholesterol level: The level of the TT genotype patients in the Alzheimer group was obviously higher than that in GT+GG genotype patients (t =2.46, P < 0.05); the cholesterol level in the two genotypes of the control group was similar (P > 0.05). CONCLUSION: TT genotype and allele T in the APOE promoter-219 polymorphisms are the sensitive gene, and genotype TT has a relationship with the increase of total cholesterol level.

Association of anxiety- depressive disorders with irritable bowel syndrome among patients attending a rural family practice center: a comparative cross- sectional study

Background Comorbidity of irritable bowel syndrome(IBS)and psychiatric disorders is common,and the prevalence of at least one psychiatric disorder has been reported as high as 80%among patients with IBS.Aims To explore the association of anxiety-depressive disorders with IBS and its different subtypes,and to evaluate the associations of lifestyle habits,dietary habits and sleeping quality with IBS.Methods A comparative cross-sectional study was conducted at the AL-Mahsama Family Practice Center,Ismailia,Egypt.It was carried out between October 2019 and October 2020.Participants were categorised into 175 patients with IBS,diagnosed using the Rome IV criteria,and 175 patients without IBS.A semistructured questionnaire was used to collect data on sociodemographic characteristics,lifestyle habits,dietary habits and sleep quality from both groups.The Hamilton Anxiety Rating Scale was used to assess anxiety symptoms,whereas the Beck Depression Inventory Second Edition was used to assess depression symptoms.Results There was a high statistically significant difference between both groups with regard to age,education,occupation and socioeconomic status(SES),being a smoker,being physically inactive,having sleep disturbance and having irregular meals;being either obese or overweight was more reported in the IBS group.There was a high statistically significant difference in the rate of anxiety and depression between patients with and without IBS.Mild,moderate and severe anxiety were reported in 37.1%,42.9%and 20.0%of patients with IBS while most(80.0%)of the patients without IBS reported mild anxiety.Regarding depression,mild,moderate and severe depression were reported in 60.0%,14.3%and 25.7%of the patients with IBS while most(82.9%)of the non-IBS participants reported mild depression.Conclusions The study shows a significant association between anxiety-depressive disorders and IBS,but no significant associations between anxiety-depressive disorders and IBS subtypes.

Association of severity and sex with vasoactive substance and sexual hormone level in patients with vascular dementia in the type of kidney asthenia and blood stasis syndrome

BACKGROUND: Kidney asthenia is the basic cause of the development of vascular dementia (VD). Kidney asthenia lasting for a long time will result in blood stasis. Also, the cause of VD may have relationships with endothelin (ET), nitric oxide (NO), homocysteine (HCY), estrogen (E2), and testosterone (T). OBJECTIVE: To observed clinical curative effect of the kidney tonic, pancreas tonic, and blood tonic with promoting blood circulation components in treating kidney asthenia with blood stasis syndrome of VD. DESIGN: Case controlled study. SETTING: Geriatric Institute of Integrated Medicine, Fujian College of Traditional Chinese Medicine. PARTICIPANTS: A total of 70 patients, including 39 males and 31 females aged 60-80 years, were selected from Department of Neurology, Pingshan Hospital from May 2000 to September 2002. Diagnostic criteria were used for probable VD of the American Psychiatric Association. Diagnostic and Statistical of Manual of Mental Disorder, 4th ed (DSM-Ⅳ), 1994 revised, mini-mental state examination (MMSE), and criteria of kidney asthenia with blood stasis with mixed weak and sthenia syndrome of Guidelines of Clinical Research of New Chinese Medicine in Treating Dementia. According to score of kidney asthenia with blood stasis syndrome, they were classified to three groups: mild (n =22), moderate (n =33) and severe (n =15). All of them with complete chest X-Ray, ECG, blood chemistry and other related examinations, exclusive of cardiovascular, liver, kidney diseases, homeopathy and psychiatry diseases. And hereby we also select 30 normal people as the comparing group, having no substantial diseases in heart, brain, kidney, liver, lung and other main organic systems after medical examination. Of this group, 11 were males and 19 were females, ranging from 62 years old to 78 years old. There were no obvious differences between the above two groups in sex, age, and education level after statistical analysis. All patients observed in Pingxi Hospital, Fuzhou, from May 2000 to September 2002. METHODS: ① According to the diagnoses standard of blood stasis syndrome: 0-89: The increase in score indicated that blood stasis syndrome was getting serious. ② According to MMSE: All the test samples were evaluated, those with scores of 0-30, in which the non-educated ≤ 17, primary school ≤ 20, above middle school ≤ 24 were categorized. ③ Testing all sample's ET, E2 and T by using radioimmunoassay, the RIA kits were provided by Scientific and Technological Development Center of General Hospital of PLA. ④ Testing the level of NO by using colorimetic method. ⑤ Testing the level of HCY by using Enzyme-linked Immunoassay. ⑥ Meanwhile, analyzing the blood stasis score by comparing with every standard. The differences of data were compared by using t test and F test. MAIN OUTCOME MEASURES: ① Blood plasma ET, blood serum NO, HCY, E2 and T. ② The analyzing results obtained from comparing score of blood stasis with every indicators. RESULTS: The result analysis was including of both the 70 patients of VD with kidney asthenia and blood stasis and compared group consist of 30 healthy people. ① ET, NO, HCY and ET/NO: The levels of ET, HCY and ET/NO were increasing with pathography, while the levels of ET, NO, HCY and ET/NO were decreasing with the pathography, and the difference in statistics was significant (P < 0.01). ② The level of E2 and T: The levels of both E2, T and E2/T for male VD patients were (67.72±12.18) pg/L and (351.58±155.02) ng/L, 0.24±0.12 respectively, which were higher than the compared group [(53.96±16.13) pg/L, (471.83±143.99) ng/L, 0.12±0.00, P < 0.05]. The level of E2 in the female VD patients was lower than the compared group [(34.23±10.99), (44.81±14.65) pg/L, P < 0.05]. ③ The relationship between the score of blood stasis and each indicators: The levels of ET, ET/NO and HCY had significant positive relationship with blood stasis mark (r = 0.352, 0.754, 0.347, P < 0.05-0.01), obvious negative relationship with NO (r =-0.528, P < 0.01) and no clear relationship with female E2/T and male E2/T (r = -0.210, 0.04, P > 0.05). CONCLUSION: ① The levels of ET, HCY and ET/NO are increasing with pathography, while the level of NO is decreasing, which may be the evidence that the possibility of VD pathography may have relationship with the indicators above. ② The level of E2 increase in male's VD patients, and decrease in male's. And the decrease of the female may have relationship with the VD.

Association of baseline hemoglobin A1c levels with bleeding in patients with non-ST-segment elevation acute coronary syndrome underwent percutaneous coronary intervention:insights of a multicenter cohort study from China

OBJECTIVE To investigate the association between baseline hemoglobin A1c(HbA1c)levels and bleeding in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)who underwent percutaneous coronary intervention(PCI).METHODS This observational cohort study enrolled 6283 consecutive NSTE-ACS patients undergoing PCI from January 1,2010 to December 31,2014.Based on baseline HbA1c levels,the patients were divided into the group with HbA1c<7%(n=4740)and the group with HbA1c≥7%(n=1543).The primary outcomes are major bleeding(BARC grades 3-5)and all-cause death during follow-up.RESULTS Of patients enrolled,4705(74.9%)were male,and 2143(34.1%)had a history of diabetes mellitus,with a mean(SD)age of 64.13(10.32)years.The median follow-up duration was 3.21 years.Compared with the patients with HbA1c<7%,the risk of major bleeding events during follow-up was higher in patients with HbA1c≥7%(adjusted hazard ratio[HR]=1.57;95%con-fidence interval[CI]:1.01-2.44;P=0.044),while the risk of all-cause death during follow-up was not associated with the higher HbA1c levels(adjusted HR=0.88;95%CI:0.66-1.18;P=0.398).CONCLUSIONS Compared with the lower baseline HbA1c levels,the higher baseline HbA1c levels were associated with an increase in long-term bleeding risk in NSTE-ACS patients undergoing PCI,though higher baseline HbA1c levels were not associ-ated with the higher risk in all-cause death.

Association between the related characters of hemispatial neglect and prognosis in stroke patients

OBJECTIVE： To recognize the significances of the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of hemispatial neglect （HSN） in the treatment and prognosis of stroke patients. DATA SOURCES： Articles related to HSN in stroke published in English from January 1985 to December 2002 were searched in Medline database by using the keywords of ＂stroke, hemispatial neglect （HSN）, rehabilitation＂. Chinese relevant professional works and articles were also referred to. STUDY SELECTION： The data were primarily checked. Inclusive criteria： ① articles about the HSN symptoms in stroke; ② articles about the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of HSN, as well as the treatment and prognosis of stroke. The repetitive studies or reviews were excluded. DATA EXTRACTION ： Totally 474 articles related to HSN in stroke were collected, 43 of them were involved and 431 repetitive studies or reviews were excluded. DATA SYNTHESES： HSN can be classified as sensory neglect and motor neglect. Because HSN is caused by the injury of network structure which mediated directed attention, it is generally believed that the inferior parietal Iobule of dominant hemisphere is the most closely correlated with neglect. The main theories related to the pathogenesis of HSN at present include ＂internal instruction＂, ＂directed bradykinesia＂, ＂sensory attention＂, etc. The main clinical manifestations are setover in drawing lines, picture drawing towards one side, imitation towards one side, picture description towards one side, etc., which can be evaluated by the line bisection test, target cancellation test, picture drawing test and pegboard test. The most important thing for the treatment is to make the patients continuously concentrate on the neglected side. CONCLUSION： HSN is an indicator for the bad outcome of cerebrovascular disease, the symptoms take longer time to rehabilitate with slow recovery, but quite a few HSN patients will get good prognosis if timely treatment and proper program are given.

Association of neuroelectrophysiology and analysis of cerebrospinal fluid immunoglobulin with pathogenetic conditions of patients with Guillain-Barre syndrome

BACKGROUND： Guillain-Barre syndrome （GBS） is an autoimmune disease which is characterized by demyelination of peripheral nerve and nerve root, and inflammatory reaction of lymphocyte and macrophage. Neuroelectrophysiological examination and cerebrospinal fluid （CSF） analysis are of significance for its diagnosis. OBJECTIVE： To study the association of neuroelectrophysiology and cerebrospinal fluid immunoglobulin （CSF-lg） with pathogenetic conditions of patients with GBS. DESIGN： Case control study SETTING： Department of Neurology, Shenzhen Municipal Shekou Group Hospital; Department of Neuroelectrophysiology, People＇s Hospital of Guangdong Province. PARTICIPANTS： A total of 32 GBS patients including 18 males and 14 females who aged from 17 to 72 years were selected as experimental group from the Department of Neurology, People＇s Hospital of Guang- dong Province from January 2004 to December 2005. All cases conformed with GBS diagnostic criteria established by Asbury in 1990 and they were divided into three types according to neurological criteria established by Chinese Neurology and Psychology Journal in 1993： mild, moderate and severe types. Another 30 patients with vascular headache were selected as control group from the same hospital including 14 males and 16 females who aged from 17 to 79 years. METHODS： ① Neuroelectrophysiological examination： Multiple-functional electromyography device provided by Nicolet Company, USA was used to measure nerve conduction velocity （NCV）, including motor nerve conduction velocity （MCV） and sensory nerve conduction velocity （SCV）; meanwhile, electromyologram （EMG）, somatosensory evoked potential （SEP） and electroencephalogram （EEG） were also measured. ② Detection of CSF-lg： Concentrations of IgG, IgA and IgM were measured with immunofixation electrophoresis. ③Follow-up： Among 32 GBS patients, 14 cases received follow-up after treatment and the longest fol- low-up time was 1 year after onset. Among them, 8 cases were reexaminined with neuroelectrophysiological and CSF examinations. MAIN OUTCOME MEASURES： Results of NCV, EMG, SEP and EEG; comparison of CSF-lg content; results of follow-up examinations. RESULTS： All 32 GBS cases and 30 patients with vascular headache were involved in the final analysis. ① Abnormal rate of neuroelectrophysiological test： 75% of NCV, 88% of F-wave, 53% of MCV, 25% of SEP, 47% of EMG and 31% of EEG. There were no significant differences among various types （P 〉 0.05）. ② Results of CSF-lg test： There were no significant differences among various types （P 〉 0.05）; however, abnormalities in experimental group was higher than those in control group （P 〈 0.01）. CONCLUSION ： Results of follow-up study suggest that improvement of clinical symptom is earlier than neuroelectrophysiological recovery; MCV and EMG recoveries are faster than that of NCV; the earlier the abnormality of EMG, the poorer the recovery. CSF4g recovers normally along improvement of clinical symptoms. It is of significance for neuroelectrophysiology and abnormality of CSF-Ig to determine degree of peripheral nerve demyelination and prognosis.

Assessment of Knowledge and Attitude in a Sample of Patients with Rheumatoid Arthritis and Its Association with Disease Activity and Severity: A Cross-Sectional Study

Background: Rheumatoid arthritis (RA) is a chronic and disabling disease that has a major impact on the lives of patients. Objectives: To test the patients’ knowledge about their disease, its treatment, its complications, and if this affects severity of the disease as measured by the disease activity index (DAS 28). Patients and Methods: A sample of 100 patients with RA who met the Criteria of American College of Rheumatology for RA agreed to participate in this study over the period September 2011-March 2012. Patients’ data were obtained by personal interview. The questionnaire included demographic characteristics and the patients’ knowledge about their disease. The disease activity was measured using standard (DAS28). Results: Thirty three percent of the patients didn’t have an idea about their disease, 20% didn’t know the reason for the investigations, 49% didn’t know the treatment and 40% didn’t know the side effects of their medications. Most patients had a high disease activity index, and there was a poor correlation between patients’ educational level and the disease activity. Conclusions: Neither the educational level nor the frequency of hospital admissions had effects on the knowledge about this disease. As most patients had a high disease activity, a better knowledge may improve disease control and prevent complications.

Human leukocyte antigen associations and c-reactive protein levels in lebanese patients with aggressive periodontitis—HLA and CRP in aggressive periodontitis

Background: Periodontal disease, which affects tooth- supporting structures, results from disequilibrium between the oral micro flora and host defense mecha- nisms. It has been classified into chronic (CP) or ag- gressive (AP) periodontitis according to disease onset, localization and progression. Because of their invol- vement in generating immune responses, Human Leukocyte Antigen (HLA) alleles are considered can- didate genetic risk markers for periodontitis. Addi- tionally, periodontitis appears to contribute to the severity of some systemic conditions such as cardio- vascular disease and adverse pregnancy outcome as indicated by elevated levels of C-reactive protein (CRP). Aim: The aims of this study were to deter- mine if there is an HLA-AP association in Lebanese patients, and to determine CRP levels in patients and compare them to those in healthy controls. Materials and methods: The study groups included 26 patients with AP and 39 healthy controls. HLA profiles were determined by DNA typing and CRP levels by ELISA. Results: HLA-A*30 (P-value = 0.010), HLA- B*41 (P1 = 0.012 and P2 = 0.014), HLA-DRB1*13 (P1 = 0.031 and P2 = 0.063) alleles seemed to be associ- ated with protection against AP in Lebanese patients. No linkage disequilibrium existed between alleles as-sociated with AP. Ten of 26 AP patients (38.5%) and 10 of 39 (25.7%) controls had elevated CRP lev- els. Conclusion: In conclusion, protective, but no sus- ceptible HLA alleles were detected in AP. CRP levels were not elevated in the entire AP group, and were not significantly different from controls. No linkage disequilibrium existed between alleles.