Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

哮喘患者血清嗜酸性粒细胞趋化蛋白测定及其临床诊断价值

目的探讨嗜酸性粒细胞趋化蛋白(Eotaxin)在哮喘发病中的作用及其临床诊断价值。方法应用ELISA方法测定38例过敏哮喘患者、28例非哮喘过敏体质患者及30例正常对照者血清Eotaxin水平。结果哮喘患者血清Eotaxin水平较非哮喘过敏体质患者及正常对照者显著增高(P<0.01)。哮喘急性发作患者Eotaxin水平较哮喘稳定组患者明显升高(P<0.001);哮喘急性期血清Eotaxin水平与外周血嗜酸粒细胞总数正相关(r=0.4196熏P<0.001)。与1秒钟用力呼气容积(FEV1)负相关(r=-0.3746熏P<0.001)。结论Eotaxin可能通过对过敏性炎性细胞的激活和从血中向支气管粘膜浸润过程的调控,与哮喘的病理生理过程有关,尤其与哮喘急性发作和疾病严重程度密切相关。Eotaxin有可能成为哮喘治疗的新靶点。

2019 Chinese guideline for the management of hypertension in the elderly

Table of contents Preamble 1 Introduction 1.1 Class of recommendations and level of evidences 1.2 Definition and categories of hypertension in the elderly 1.3 Current status of epidemiology of hypertension in the elderly 1.4 The characteristics of hypertension in the elderly.

Efficacy and safety of single-bolus tenecteplase compared with front-loaded alteplase in Chinese patients with acute myocardial infarction

Background and Objective Previous study showed tenecteplase and alteplaxe were equovalent for 30-day mortality in the treatment of acute myocardial infarction.The purpose of this open-label,randomized,multi-center,angiographic trial was to assess the efficacy and safety of tenecteplase compared with alteplase in Chinese patients with acute myocardial infarction.Methods We recruited patients with acute ST-elevation myocardial infarction presenting within 6 hours of symptom onset from October,2002 to March,2004,in 5 hospitals in Beijing.After giving informed consent,patients were randomly assigned a single-bolus injection of tenecteplase(30-50 mg according to body weight)or front loaded alteplase(100 mg),and underwent coronary angiography at 90 min after starting the study drug.All patients received aspirin and heparin(target activated partial thromboplastin time 50-70 s).The primary efficacy end point was the rate of TIMI grade 3 flow at 90 minutes.Other efficacy end points included TIMI grade 2/3 flow at 90 minutes.Safety end points included all stroke,intracranial hemorrhage(ICH),moderate/severe hemorrhage(except for ICH),all-cause mortality at 30-days,and major non-fatal cardiac events at 30 days.Results Overall 110 patients were eligible for statistical analysis,with 58 patients assigned to receive tenecteplase and 52 patients to alteplase.Tenecteplase produced a rate of TIMI grade 3 flow at 90 minutes after the start of thrombolysis(68.4%)similar to that of alteplase(66.7%,P=1.0);the rates of TIMI grade 2 or 3 were similar for patients treated with tenecteplase versus alteplase(89.5%versus 80.4%,respectively,P=0.278).At 30 days,rates for all strokes were similar for the two groups(5.17%for tenecteplase and 1.92%for alteplase,P=0.62);rates of ICH were 3.45%and 1.92%(tenecteplase and rt-PA,P=1.00)respectively.The rate of moderate/severe hemorrhage was 8.62%with tenecteplase and 5.77%with alteplase(P=0.72);total mortality was almost identical in the two groups(13.8%versus 9.6%,respectively,P=0.565)while the rates of non-fatal cardiac complications were 10.35%and 11.54%(tenecteplase and alteplase,P=1.0).Conclusions The efficacy of a single-bolus,weight-adjusted tenecteplase fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow,and TIMI 2 or 3 flow,but the 30-day mortality and ICH in both groups was so high that the use of tenecteplase is not permitted in China.These negative safety results might be due to the high rate of percutaneous coronary intervention(PCI)and high dose of bolus heparin and suboptimal concomitant medical therapy during hospitalization,so further studies are needed to confirm the safety for tenecteplase in Chinese patients.

Relationship between R219K polymorphism of adenosine triphosphate-binding cassette transporter 1 gene and cerebral infarction: A case-controlled analysis

BACKGROUND： Studies have shown that adenosine triphosphate-binding cassette transporter 1 （ABCA1） gene influences atherosclerosis. Studies have also demonstrated that cerebral infarction does not occur often in pre-menopausal women. It has been, therefore, assumed that sex plays a role in R219K polymorphism of ABCA1 gene and cerebral infarction. OBJECTIVE： To explore the relationship between lipid metabolism-correlated R219K polymorphism of ABCA1 gene, risk factors of cerebral infarction and lipid level, and to determine whether there were significant differences in gender between R219K polymorphism of ABCA1 gene and cerebral infarction. DESIGN, TIME AND SETTING： A multicentral and non-randomized, controlled study based on gene polymorphism was performed at the Chinese National Human Genome Center, and lipid concentrations were measured at Beijing Xuanwu Hospital. Patients with cerebral infarction and healthy subjects were enrolled from eight hospitals of six provinces of China between October 2002 and December 2004. PARTICIPANTS： There were 177 patients in the cerebral infarction group, including 119 males and 58 females, with a mean age of （60 -＋ 13） years, and 234 healthy subjects in the normal control group, including 79 males and 155 females, with a mean age of （58 ± 12） years. METHODS： R219K polymorphism of the ABCA1 gene was detected using polymerase chain reaction-restriction fragment length polymorphism, and blood lipid concentrations were simultaneously measured. MAIN OUTCOME MEASURES： Genotype and allele frequency of R219K polymorphic site, and blood lipid concentrations. RESULTS： RR genotype and R allele frequency of males in the cerebral infarction were significantly greater than males in the normal control group [RR genotype： x2 = 5.305, OR （95% CO, 2.326 （1.120 4.828）, P〈 0.05; R allele： x2= 4.219, OR （95% CO, 1.528 （1.019 2.292）, P〈 0.05]. In addition, RR genotype and R allele frequency of males were significantly greater than females in the cerebral infarction group [RR genotype： x2= 5.172, OR （95% C/）, 2.604 （1.120-6.057）, P〈 0.05; R allele： x2= 4.818, OR （95% CO, 1.652 （1.053 2.589）, P〈 0.05]. There were no significant differences between genotype and lipid concentrations between the two groups （P〉 0.05）. CONCLUSION： The RR genotype of ABCA1 R219K might be associated with onset of cerebral infarction in males, but blood lipid concentrations do not relate to R219K polymorphism.

Observation on the Therapeutic Effect of Shangjinbitong Powder(伤筋痹痛散)on Improving Acupoint Plaster

Objective:To study the therapeutic effect of Shangjinbitong Powder(伤筋痹痛散)on improving acupoint plaster,in order to provide some scientific basis for clinical use.Methods:This project was carried out from June 2020 to January 2021,30 patients with low back pain in the outpatient department of orthopedics and traumatology in our hospital and 30 patients with low back pain in the rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine were selected as the research objects.Patients with low back pain in our hospital were treated with Shangjinbitong Powder as the control group,and patients in rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine as the research group were treated with acupoint plaster improved by Shangjinbitong Powder.After one week of treatment,the effective rates of the two groups were compared.Results:The effective rate of treatment in the study group was significantly higher than that in the control group(P<0.05).There were no adverse reactions such as infection,scald and bleeding in the study group and the control group during the treatment.Conclusion:Shangjinbitong Powder improved acupoint plaster has good curative effect,convenient use,certain safety and clinical popularization value.

Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery.Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group.Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage, and contribute to the neurological function recovery. TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage, but also has a certain value in evaluating the prognosis of neurological function.

Efficacy and safety of PD-1 blockade plus long-course chemoradiotherapy in locally advanced rectal cancer(NECTAR):a multi-center phase 2 study

Adding PD-1 blockade in the neoadjuvant regimens for locally advanced rectal cancer(LARC)patients with microsatellite stable(MsS)/mismatch repair-proficient(pMMR)tumors is an attractive,but debatable strategy.This phase 2,multicenter,prospective,single-arm study enrolled patients from 6 centers from June 2021 to November 2022.Locally advanced rectal cancer(LARC,cT_(3-4a)N_(0)M_(0) and cT_(1-4a)N_(1-2)M_(0))patients aged≥18 years with the distance from distal border of tumor to anal verge≤10 cm(identified by Magnetic Resonance Imaging)were qualifed for inclusion.The patients received long-course radiotherapy(50 Gy/25 fractions,2 Gy/fraction,5 days/week)and three 21-day cycles capecitabine(850-1000 mg/m2,bid,po,day1-14)and three 21-day cycles tislelizumab(200 mg,iv.gtt,day8)as neoadjuvant.Total mesorectal excision(TME)was 6-12 weeks after the end of radiotherapy to achieve radical resection.A total of 50 patients were enrolled in this study.The pathological complete response rate was 40.0%[20/50,95%confidence interval(CI):27.61-53.82%],while 15(30.0%,95%CI:19.1-43.75%),9(18.0%,95%CI:9.77-30.8%),2(4.0%,95%CI:1.10-13.46%)patients respectively achieved grade 1,2,and 3 tumor regression.Treatment-related adverse events(TRAEs)occurred in 28(56.0%)LARC patients,including 26(52.0%)with grade I-II and 2(4.0%)with grade II(1 with grade 3 immune-related colitis and 1 with grade 3 rash).PD-1 blockade plus long-course chemoradiotherapy(CRT)showed promising therapeutic effects according to pathological complete response rate and is well-tolerated in LARC patients.A larger randomized controlled study is desired to further validate the above findings.

Clinical heterogeneity in patients with early-stage Parkinson’s disease:a cluster analysis

The aim of this study was to investigate the clinical heterogeneity of Parkinson's disease(PD) among a cohort of Chinese patients in early stages.Clinical data on demographics,motor variables,motor phenotypes,disease progression,global cognitive function,depression,apathy,sleep quality,constipation,fatigue,and L-dopa complications were collected from 138 Chinese PD subjects in early stages(Hoehn and Yahr stages 1-3).The PD subject subtypes were classified using k-means cluster analysis according to the clinical data from five-to three-cluster consecutively.Kappa statistical analysis was performed to evaluate the consistency among different subtype solutions.The cluster analysis indicated four main subtypes:the non-tremor dominant subtype(NTD,n=28,20.3%),rapid disease progression subtype(RDP,n=7,5.1%),young-onset subtype(YO,n=50,36.2%),and tremor dominant subtype(TD,n=53,38.4%).Overall,78.3%(108/138) of subjects were always classified between the same three groups(52 always in TD,7 in RDP,and 49 in NTD),and 98.6%(136/138) between five-and four-cluster solutions.However,subjects classified as NTD in the four-cluster analysis were dispersed into different subtypes in the three-cluster analysis,with low concordance between four-and three-cluster solutions(kappa value= 0.139,P=0.001).This study defines clinical heterogeneity of PD patients in early stages using a data-driven approach.The subtypes generated by the four-cluster solution appear to exhibit ideal internal cohesion and external isolation.

Using Ultrasonography to Evaluate the Relationship between Capsular Invasion or Extracapsular Extension and Lymph Node Metastasis in Papillary Thyroid Carcinomas

Background： Previous studies have demonstrated that ultrasonography is the recommended imaging modality for preoperative staging of papillary thyroid carcinomas （PTCs）. However, only a few studies have kept watch on preoperative evaluation of capsular invasion （CI） or extracapsular extension （ECE） and cervical lymph node metastasis using preoperative ultrasonography. This study aimed to investigate the relationship between the CI or ECE and the cervical lymph node metastasis in PTCs using preoperative ultrasonography and postoperative pathology in Chinese patients. Methods： The data of preoperative ultrasonography and postoperative pathology of 166 patients who had a defnitive diagnosis of PTCs from October 2011 to July 2014 at Xuanwu Hospital, Beijing were collected and reviewed. Preoperative ultrasonic parameters of thyroid nodules were compared with those of postoperative pathological diagnoses. All the patients were divided into bilateral PTCs group （n - 42, 78 nodules） and unilateral PTCs group （n = 124, 124 nodules）, and the data of the nodnle sizes, CI or ECE, and cervical lymph node metastasis by preoperative ultrasonography were compared between two groups. Results： A total of 202 nodules of 166 patients which were confimled by preoperative ultrasonography and postoperative pathology were analyzed. Hypoechogenicity （n = 201, 99.5%） and inegular margins （tl = 167, 82.7%） were the main ultrasonic characteristics of PTCs. A significant moderate agreement between preoperative ultrasonic examination and postoperative pathology fbr CI or ECE （K - 0.622, P 〈 0.001 ） was observed. The diagnostic sensitivity was 92.0%~ and specificity was 7 I. 1%. In bilateral PTCs group, 81.0% had CI or ECE, and 61.9% had cervical lymph node metastasis. In unilateral PTCs group, 76.6% had CI or ECE, and 58.1% had cervical lymph node metastasis. There were no significant differences in the incidence of Cl or ECE and cervical lymph node metastasis between two groups （all P 〉 0.05）. Conclusions： Ultrasonography was proved to be a valuable method lbr preoperative diagnosis ofPTCs. Hypoechogenicity and irregular margins were strongly associated with PTCs. C1 or ECE in unilateral PTCs strongly implied the cervical lymph node metastasis. Therefore, the cervical lymph nodes should be carelhlly examined by ultrasonography in patients with PTCs.

Efficacy of Gastrosis No.1 Compound on Functional Dyspepsia of Spleen and Stomach Deficiency-Cold Syndrome:A Multi-Center,Double-Blind,Placebo-Controlled Clinical Trial

To assess the efficacy and safety of Gastrosis No.1 compound in the treatment of functional dyspepsia with Spleen （Pi） and Stomach （Wei） deficiency-cold syndrome. Methods： A randomized, double-blind, placebo-controlled trial was performed in 5 centers. Patients with functional dyspepsia （FD） of Spleen-deficiency and qi-stagnation syndrome （162 cases） were randomly assigned to groups given Chinese herbal medicine （CHM） Gastrosis No.1 compound or placebo in a 2：1 ratio. This trial included a 4-week treatment period and a 4-week follow-up period. The outcomes were the dyspepsia symptom scores （measured by total dyspepsia symptom scale and single dyspepsia symptom scale） and syndromes of traditional Chinese medicine score （measured by traditional Chinese medicine syndrome scale）. The outcomes were noted at weeks 0, 4 and 8. Results： Compared with patients in the placebo group, patients in the CHM group showed significant improvement in the dyspepsia symptom scores as rated by patients and investigators （P〈0.01）, and also showed improvement in syndromes of traditional Chinese medicine score （P〈0.01）. No serious adverse event was reported. Safety tests obtained after 4 weeks of treatment showed no abnormal values. Conclusion： CHM Gastrosis No.1 compound was effective and safe in the treatment of functional dyspepsia with Spleen and Stomach deficiency-cold syndrome.

The Relevance between Symptoms and Magnetic Resonance Imaging Analysis of the Hippocampus of Depressed Patients Given Electro-acupuncture Combined with Fluoxetine Intervention - A Randomized,Controlled Trial

Objective： To probe the relevance between depressive symptoms and hippocampal volume and its metabolites detected by magnetic resonance imaging （MRI） in depressed patients who were given electro- acupuncture （EA） combined with Fluoxetine before and after treatment. Methods： A randomized, controlled trial was conducted. A total of 75 cases of mild or moderate depression were randomly assigned to two groups： the EA group which received EA combined with Fluoxetine; the Fluoxetine group which received Fluoxetine only as the control. The 17-item Hamilton Scale for Depression （HAMD） was used to assess the depression level. The relevance between the changes of the hippocampal volume and its metabolites, including N-acetyl aspartate （NAA）/creatine （Cr） and choline containing compounds （Cho）/Cr, and the reduction rate of the HAMD score before and after treatment of the two groups were analyzed. Results： At the end of the treatment, the therapeutic response rates were not statistically different between the two groups （73.53% for the Fluoxetine group and 83.33% for the EA group, respectively）. Compared to that of the Fluoxetine group, a significant difference was shown in the EA group in the reduction rate of the HAMD scores （P〈0.05）. There was a negative correlation between the therapeutic effect and the HAMD scores before treatment in both groups of patients. There was no significant difference in the hippocampal volume before and after treatment. The NAA/Cr ratio of both groups increased after treatment, with the EA group increasing more. There was a negative correlation between the rate of change of the NAA/Cr after treatment and the HAMD scores before treatment in the two groups. In the Fluoxetine group, the Cho/Cr ratio showed no significant difference before and after treatment, which had no relevance with the HAMD scores before treatment either. Meanwhile, in the EA group, the Cho/Cr ratio showed a significant difference before and after treatment, which also had a positive relevance with the HAMD scores before treatment. Conclusions： There was a significant improvement in the hippocampal metabolites in depressed patients who treated by EA combined with Fluoxetine. Those differences showed relevance with the HAMD scores before treatment.

A Special Electroencephalography Pattern Might Help in the Diagnosis of Antibody-positive Encephalitis

Background： Patterns observed with electroencephalography （EEG） for patients who have encephalitis are usually known as generalized nonspecific cerebral abnormalities. The aim of this study was to investigate the presence of a special EEG pattern for patients with encephalitis and to explore features related to this special and uncommon pattern. Methods： EEG monitoring was performed for every patient aged 〉15 years with encephalitis who was hospitalized between December 2011 and March 2014. Clinical characteristics and EEG recordings were collected and evaluated. Results： Filly-two patients with encephalitis were enrolled in our study with a 2-h median EEG recording time, and extreme beta brushes （EBBs） occurred in 17 patients （32.7%）. Its presence was not significant regarding gender, age, psychiatric medication use, EEG rhythmic disorganization （P 〉 0.05）. Nevertheless, among the patients with EBBs, nine patients （52.9%） had epileptic seizures that had a significant detection rate （P 〈 0.05）： moreover, the cerebrospinal fluid （CSF） or serum of 15 patients （88.2%） with EBBs was positive for antibodies （P 〈 0.05）. Four patients （23.5%） who had EBB had corresponding regional distributions on neurnimaging scans. The EBBs completely correlated with the regional distributions of spike discharges for four patients. Conclusion： EBB is a special EEG pattern for patients with encephalitis, especially those with epileptic seizures or who have antibody-positive CSF/serum, and should be considered in clinical practice.

Modified biological training model for percutaneous renal surgery with ultrasound and fluroscopy guidance

Background The 12th rib is an important anatomic marker in the process of percutaneous renal surgery; while the previous models without ribs can not provide close simulation conditions to human upper abdomen. To facilitate the learning and training of percutaneous renal access and intrarenal procedures under ultrasound and fluoroscopy guidance we reported a biological bench model for percutaneous renal surgery. Methods The model was developed using an ex vivo porcine kidney with a longer than 3 cm ureter, a flap of full thickness of thoracic wall with skin, subcutaneous fascia, muscle and two ribs, as well as the standard equipment for percutaneous nephrolithotomy. The porcine kidney with a catheterized ureter was placed within the porcine flap and fixed to a wooden board with two long steel nails. Afterward, contrast medium or physiological saline （0.9% sodium chloride solution） was injected through the ureter, and the urinary system was examined with a fluoroscopy unit or an ultrasound. Artificial stone material was implanted in the renal pelvis. After practicing, the model could be dissected for kidney examination and a technical analysis. Results The advantage of this model was simple to set up and inexpensive, by using widely available material. The biological bench model can be employed for percutanous renal access, tract dilation, nephroscopy, and stone disintegration in the training and learning of clinical practice. Imaging is feasible under fluoroscopic and ultrasound guidance. The kidney models were utilized in hands on courses with over 100 people, and 90.5% attendants rated the porcine kidney model for simulation of percutaneous renal surgery as ＂very helpful＂ or ＂helpful＂. Conclusion This biological training model simulates realistically the clinical procedure of percutaneous nephrolithotomy under fluoroscopic and ultrasound guidance.

Comparison of Composition and Diversity of Bacterial Microbiome in Human Upper and Lower Respiratory Tract

INTRODUCTIONMicrobiome residing in the airways and parenchymal tissues, as a biological barrier of respiratory tract, plays an important role in maintaining the normal functions of individual＇s respiratory system and preventing the invasion and colonization of exogenous pathogens.H1 Changes of microbial community may result in the occurrence and progression of infectious pneumonia and acute exacerbation of chronic diseases, through disordering commensal microorganisms and increasing invasive ability of pathogens.F21 Traditional methods for detecting bacteria normally rely on culture technique, which have a number of critical problems, including time-consuming and relatively low positive rate of detection. In the last 1 0 years, 16S rRNA gene sequencing technique has been thought to be more comprehensive and reliable than those of culture-dependent methods for monitoring bacterial microbiome in skin, organs, and tracts quantitatively and qualitatively.E31 In this case, choosing credible samples are critical to evaluate the community composition of microbiome in the host tracts, including respiratory tract. In the present study, we aimed to compare the composition and diversity of bacterial community structure in different samples collected from the individuals＇ airways using 16S rRNA gene sequencing technique.

The cross-sectional and longitudinal association of the BODE index with quality of life in patients with chronic obstructive pulmonary disease

Background The body mass index, airflow obstruction, dyspnea, and exercise capacity （BODE） index was shown at predicting the risk of death, exacerbation and disease severity among patients with COPD, but few studies verified relationship between BODE index and health related quality of life （HRQoL） among Chinese COPD patients. The objective of this study was to evaluate the relationship between BODE index and HRQoL in cross-sectional and longitudinal association analyses. Methods A multi-center prospective cohort study was initially conducted in 491 stable COPD patients in Beijing, China. Health status （HRQoL） was assessed by St. George＇s Respiratory Questionnaire （SGRQ）; the BODE index was calculated for each patient; dyspnea was assessed using the 5-grade Medical Research Council dyspnea scale. Other measurements included socio-demographic, body mass index （BMI）, lung function test and 6-minute-walk test （6MWT）. Patients were then followed monthly for 12 months. Results Only 450 patients completed the 1-year follow up and were enrolled in our present analyses. Mean age was （65.2 ±10.6）years,＇ men 309 （68.7%）. The BODE index was categorized into 4 subgroups： 0-2, 3-4, 5-6 and 7-10. At baseline BODE index was gradually increased with baseline total SGRQ and SGRQ subscales （P trend 〈0.001）. For individual components of BODE index, with the decrease of airflow limitation, and 6MWD, and with the increase of Medical Research Council （MRC） dyspnea grade, total SGRQ and SGRQ subscales were increased correspondingly, P trend 〈0.05, respectively. Similar association patterns were found between baseline BODE index and its individual components and mean SGRQ scores at the end of 1-year follow up. By multiple linear regression analyses, baseline BODE index was not only significantly associated with SGRQ score at baseline but also with SGRQ score at the end of 1-year follow up after adjustment for age, male, current smoking, 13s being 0.434 and 0.378, respectively. Conclusions BODE index is associated with SGRQ score cross-sectionally and longitudinally among stable COPD patients. BODE index might have potential to be used as a sensitive tool to assess the status of quality of life and to monitor disease progression among stable COPD patients.

Effect of lycopene on androgen receptor and prostate-specific antigen velocity

Background There is increasing interest in the role of dietary factors in both the development and behaviour of prostate cancer.This study was carried out to evaluate the impact of the dietary factor lycopene on DNA synthesis,activity and expression of the androgen receptor gene element in prostate LnCaP cells and to report our pilot phase Ⅱ study investigating its effect on prostate-specific antigen velocity over one year.Methods LnCaP cells were grown with or without different concentrations of lycopene or tetrahydrofuran （THF solvent）added to the culture medium for 48 hours.DNA synthesis was measured by the incorporation of bromodeoxyuridine （Brdu） into DNA during a 4-hour pulse, followed by immunostaining and visualization of stained cells using fluorescence microscopy.A transient transfection of a plasmid DNA recombinant containing an androgen receptor element-luciferase （ARE-Luc） report gene into LnCaP cells was developed and the impact of different concentrations of lycopene on the androgen receptor element was reflected by quantitative analysis of the luciferase enzyme function.Expression of the androgen gene was also studied by Western blotting.The phase Ⅱ pilot study patients （n=41） previously diagnosed with prostate cancer were enrolled and given lycopene supplement, 10 mg per day, and response was measured by observing changes in the plasma prostate-specific antigen （PSA） levels.Results The addition of 0.5 μmol/L, 5 μmol/L, 10 μmol/L and 15 μmol/L of lycopene was shown to inhibit cell growth by 2.66%, 4.29%, 3.73% and 13.66%, respectively, compared with the THF solvent control samples （P=0.015）.As compared with the RPMI1640 medium group, cell proliferation in the presence of 5 μmol/L, 10 μmol/L, and 15 μmol/L lycopene was inhibited by 8.12%, 6.33% and 12.00%, respectively （P=0.024）.We showed for the first time that lycopene inhibited the activity of the androgen receptor gene element in a dose-related manner.Inhibition was seen in the transcription of the luciferase construct and confirmed by androgen receptor element expression assayed by Western blotting.Regression slopes of （log） PSA vs.time decreased in 26/37 （70%, 95% CI 53%-84%） of the patients after supplementation and in eight cases （21%） the post-treatment slope was negative.For these eight patients, the average fall in PSA was equivalent to 2% over 28 days （i.e.an average slope/d of -0.000 713）.The Wilcoxon rank-sum test showed an overall statistically significant decrease in slope （P=0.0007）.Analysis of the PSA doubling time （pretreatment vs.posttreatment） showed a median increase after supplementation for 174 days; however, this was not statistically significant （P=0.18）.Conclusions Lycopene as an antioxidant dietary factor could significantly inhibit DNA synthesis in a dose-dependent pattern; the result revealed lycopene might inhibit androgen receptor gene element activity and expression.Dietary lycopene may play an important role in prostate cancer cell proliferation and further supports a large randomized study into the role of lycopene supplementation in malignant prostate disease.

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

A 36-year-old woman suffered meningioma in her right cerebellopontine angle.Air embolisms often complicate sitting-position surgeries.Because TEE guides the localization of central venous catheters and promptly locates air embolisms promptly enough for effective treatment,TEE is an effective monitoring method for sitting-position surgeries.

Efficacy and safety of Liangxue Jiedu decoction for the treatment of progressive psoriasis vulgaris: a multicenter, randomized, controlled study

OBJECTIVE: To determine the clinical efficacy and safety of Liangxue Jiedu decoction(LJD) for the treatment of progressive psoriasis vulgaris and to provide the basis for the development of a standardized treatment protocol for psoriasis vulgaris.METHODS: In this multicenter, randomized, controlled study, patients with blood-heat type psoriasis were randomly assigned to receive either Chinese herbal medicine(LJD;treatment group) or Western Medicine(cetirizine hydrochloride, vitamin C, and vitamin B complex;control group). Psoriasis Area and Severity Index(PASI) scores were calculated in addition to the number of patients who achieved ≥ 50% or ≥ 75% improvement in PASI score from baseline. The change in symptoms of Chinese medicine(color of rash, burning sensation,itchiness, severity of irritation, and anger) was evaluated and safety was assessed as adverse events and laboratory analysis. t test, independent sample non-parametric test and χ2 test were used to analyze the results.RESULTS: A total of 238 participants were included in the study [treatment group, n = 122(PP analysis117);control group, n = 116(PP analysis 104)]. LJD treatment was associated with a significant improvement in skin lesions and symptoms com-pared with Western Medicine treatment. At the end of the 8-week treatment period, 23.77%(PP analysis 24.79%) of patients in the treatment group had achieved PASI75 and 57.38%(PP analysis 58.97%)had achieved PASI50;the corresponding figures in the control group were 9.48%(9.62%) and 25.00%(25.00%), respectively. The between-group differences were statistically significant(P < 0.05).CONCLUSION: Treatment of psoriasis vulgaris of the blood-heat type using LJD was associated with significantly better outcomes compared with those achieved using standard Western Medicine.

Chinese Internet Searches Provide Inaccurate and Misleading Information to Epilepsy Patients

Background： Most patients with epilepsy want to learn as much as possible about the disease, and many have turned to the internet for information. Patients are likely to use information obtained from the internet to control their epilepsy, but little is known about the accuracy of this information. In this survey, we have assessed the feasibility and usability ofinternet-based interventions for the treatment of epilepsy. Methods： Data were collected from an internet search. Different search terms were used to obtain general information on epilepsy together with information about medication, types of epilepsy, treatment, women＇s health, and other information. The accuracy of the information was evaluated by a group of experts. Results： A total of 1320 web pages were assessed. The majority were websites related to health. A large number （80.2%） of web pages contained content related to the search term. A significant number of web pages 450/1058 （42.5%） claimed to provide information from a credible source： however, only 206/1058 （19.5%） of the information was accurate and complete; 326/1058 （30.8%） was accurate but incomplete; 328/1058 （31.0%） was correct but nonstandard, and 198/1058 （18.8%） was inaccurate. The authenticity of the information was not significantly different between the two search engines （x^2 = 0.009, P - 0.924）. No significant difference was observed in the information obtained from a specialist or nonspecialist source （x^2 = 7.538, P- 0.057）. There was also no correlation between the quality of the information and the priority （x^2 = 6.880, P = 0,076）. Conclusions： Searching for information about epilepsy on the internet is convenient, but the information provided is not reliable. Too much information is inaccurate or for advertisement purposes, and it is difficult for patients to find the useful information. Turning to the internet for medical knowledge may be harmful. Physicians should be aware that their patients may search for information on the internet and guide them to safe, reputable websites.