CLINICAL EVALUATION OF FOUR RECOMBINANT TREPONEMA PALLIDUM ANTIGEN-BASED RAPID TESTS IN THE DIAGNOSIS OF SYPHILIS

Objective To assess the sensitivity, specificity, and feasibility of 4 recombinant Treponema pallidum antigenbased rapid tests in the diagnosis of syphilis. Methods A total of 970 outpatients were selected from the Sexually Transmitted Diseases Centre of Peking Union Medical College Hospital. Venous blood was collected and serum was extracted. T. paUidum antibodies in whole blood, anticoagulant whole blood, and serum were detected using 4 recombinant T. pallidum antigen-based rapid tests. T. pallidum haemagglutination test （TPHA） was considered as the gold standard for the detection of T. pallidum specific antibodies in serum. The sensitivities and specificities of four methods were analyzed. Results The sensitivities and specificities of Abbott Determine Syphilis TP test, SD-BIOLINE Syphilis 3.0 test, VISITECT-SYPHILIS test, and Syphicheck-WB test for serum specimens were 100% and 98. 9%, 95.7% and 98.0%, 94.6% and 98.2%, 68.1% and 98.9% ; for whole blood were 74. 1% and 99. 5%, 87.9% and 99.4% , 73.2% and 99.7%, 64. 7% and 99.7%. The observed sensitivities of the 4 rapid diagnosis tests were not significantly different with TPHA （ P 〉 0.05 ）. Conclusions The 4 rapid tests show good performance and characteristics in the diagnosis of syphilis. Furthermore, they are more sensitive for serum specimens than whole blood.

Clinical Observation on Treatment of Ischemic Apoplexy by Electroacupuncture plus Acupoint-Injection

Objective: To observe the therapeutic effects of electroacupuncture plus acupoint-injection for ischemic apoplexy. Method: 78 cases of ischemic apoplexy were randomly divided into a treatment group of 39 cases treated by electroacupuncture plus acupoint-injection and a control group of 39 cases treated by electroacupuncture alone. Results: The neural functional defect score (NFDS) decreased while the functional independence mark (FIM) increased with obvious significant differences before and after treatment in both of the two groups. And there were very remarkable differences between the two groups in the changes of both NFDS and FIM after treatment (P<0.01), showing better results in the treatment group than that of the control group. Conclusion: Electroacupuncture plus acupoint-injection can promote the recovery of the neural function for the ischemic apoplexy patients and markedly enhance their daily living ability, with better effects than that in patients treated by electroacupuncture alone.

Effects of purified herbal extract of Salvia miltiorrhiza on lipid profile in hyperlipidemic patients

Background and Objective Hyperlipidemia is one of the most potent and best substantiated risk factors for coronary heart disease （CHD）. Purified Salvia miltiorrhiza extract （PSME） had been shown to have hypolipidemic effect in animal experiments. This study aimed to evaluate its lipids modulating effects in hyperlipidemic patients. Methods In this single-blind, placebo cantrolled study, lipid profiles of 80 hyperlipidemic patients were checked at same conditions. They were divided into two equal groups randomly （each composing of 40 patients）. They were given PSME tablet （800 mg） three times per day, or placebo tablet. All patients were put on NCEP type II diet and six weeks later, lipid profiles were checked. Results In PSME group, total cholesterol decreased by 27.32 mg/dl （12.3% reduction）, LDL-cholesterol decreased by 23.13 mg/dl （16.8% reduction） and HDL-cholesterol increased by 9.06 mg/dl （11.1%）, all were statistically significant. Although triglyceride dropped by 12.12 mg/dl （5.1%） but this was not significant statistically （P=0.34）. There were no significant changes oflipids levels in the placebo group. Conclusions PSME has significant favorable effect on total cholesterol, LDL-cholesterol, and HDL-cholesterol and may be a potential agent for the treatment ofatherogenic dyslipidemia.

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support

Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting （CABG） support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events （MACE）, defined as cardiac death, myocardial infarction and target-vessel revascularization （TVR）. Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients （86.8%）. Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths （（42.32±22.08） mm vs （27.61±22.85） mm, P=0.023）, a higher rate of perforation （25.0% vs 0, P=0.014）, and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure （10.0%, 30.0% and 35.0%） and the success （3.0%, 12.1% and 14.4%） groups （P=0.037, 0.034 and 0.040, respectively）. These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group （P=0.031 and 0.023, respectively）. Stump was the only predictor of recanalization success （HR 0.158, 95% Cl 0.041-0.612, P=0.008）, whereas procedural failure （OR 13.023, 95% CI 6.67-13.69, P=0.002）, incomplete revascularization （OR 9.71, 95% CI 2.93-5.59, P=0.005）, and total stent length （OR 6.02, 95% Cl 1.55-11.93, P=0.027） were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.

Relationship among bacterial colonization,airway inflam-mation, and bronchodilator response in patients with stable chronic obstructive pulmonary disease

Bronchodilator reversibility, a response of airway to bronchodilator, occurred in 64% of stable patients with chronic obstructive pulmonary disease （COPD）. In patients with COPD who have a significant response to bronchodilators, a clinical and functional response to inhaled corticosteroids is similar to that in asthmatics.

Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. This study aimed to observe the clinical feasibility of arterial pressure-based cardiac output （APCO） for cardiac output （CO） monitoring and to evaluate the correlation between APCO and pulmonary artery catheter （PAC） for CO measurement for patients undergoing OPCABG intraoperatively. Methods Fifty patients of American Society of Anaesthesiologists （ASA） classification Ⅱ-Ⅲ, undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study. All patients were assigned to CO monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe valvular heart disease, left ventricular ejection fraction （EF） 〈40%, cardiac arrhythmias, peripheral vascular disease, application of intra-aortic balloon pump （IABP） and emergent diversion to cardiac pulmonary bypass were excluded. The radial artery waveform was analyzed to estimate the stroke volume （SV） and heart rate （HR） continuously. CO was calculated as SV × HR; other derived parameters were cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR）, and systemic vascular resistance index （SVRI）. PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms. Continuous cardiac output （CCO）, CI and other hemodynamic parameters were monitored at following 5 time points： immediate after anesthesia induction （baseline value）, anastomosis of left internal mammary artery to left anterior descending artery （LAD）, anastomosis of left circumflex （LCX）, anastomosis of posterior descending artery （PDA） and immediate after sternal closure. Results In the 50 patients, preoperative echocardiography measured left ventricular EF was （52.8±11.5）%, and 35 patients （70%） showed regional wall motion abnormalities. The correlation coefficient of CO monitored by APCO and PAC were 0.70, 0.59, 0.78, 0.74 and 0.85 at each time point. The bias range of CI monitored from both APCO and PAC were （0.39±0.06） L.minl.m2, （0.48±0.12） L.min^-1.m2, （0.26±0.06） L.min1.m-2, （0.27±0.06） L.min-l.m2, （0.30＋0.05） L.min-l.m2 at each time point. The results of SVR by two hemodynamic monitoring techniques had good correlation during OPCABG. The variation trends of SVR were opposite comparing with the results of CO. SVR collected from PAC obtained the highest value of （1220.0±254.0） dyn.s.cm5 at PDA anastomosis, but the highest value obtained from APCO was （1206.0±226.5） dyn.s.cm-5 in LCX anastomosis. Conclusions APCO is feasible in hemodynamic monitoring for patients undergoing OPCABG The results of hemodynamic monitoring derived from APCO and PAC are closely correlated. Its characterizations of timely, accurate and continuous display of hemodynamic parameters are also obviously demonstrated in the present study.

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.

Autophagy induced by human adenovirus B7 structural protein VI inhibits viral replication

Human adenovirus B7(HAdV-B7)causes severe acute lower respiratory tract infections in children.However,neither the child-specific antivirals or vaccines are available,nor the pathogenesis is clear.Autophagy,as part of innate immunity,plays an important role in resistance to viral infection by degrading the virus and promoting the development of innate and adaptive immunity.This study provided evidence that HAdV-B7 infection induced complete autophagic flux,and the pharmacological induction of autophagy decreased HAdV-B7 replication.In this process,the host protein Bcl2-associated athanogene 3(BAG3)mediated autophagy to inhibit the replication of HAdV-B7 by binding to the PPSY structural domain of viral protein pVI through its WW structural domain.These findings further our understanding of the host immune response during viral infection and will help to develop broad anti-HAdV therapies.