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    Research on the mechanism and countermeasure of clinical resource integration under the background of “double first-class” construction
    ZHANG Xiao-bo1, 2*, LI Chun-hong3*, JIANG Meng4, MA Fei5, TAO Ye-xuan3, KANG Li1
    2018, 38 (9):  1001. 
    doi: 10.3969/j.issn.1674-8115.2018.09.001

    Abstract ( 639 )   PDF (7147KB) ( 546 )  
    In recent years, with the development of Chinas reform of medical and health services, the level of clinical medicine in China has been greatly improved, but there is still a big gap between China and developed countries in Europe and America. China has a large population and rich and diverse clinical resources. However, innovative research and results in key guidelines, diagnosis and treatment programs, and major innovative drugs in the diagnosis and treatment of diseases are insufficient. The key reason is the lack of effective integration of clinical resources. Taking Shanghai Jiao Tong University School of Medicine as an example, under the background of “double first-class” construction, this paper summarized the status quo of clinical resource integration, analyzed the key issues in integration, and tried to put forward the strategies of medical, scientific research, and talent integration in clinical resource integration, to provide path for promoting clinical resource integration and clinical discipline construction.
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    Original article (Basic research)
    Effect of microenvironment on β-site amyloid precursor protein cleaving enzyme 1 in PC12 Cells
    YANG Huan-qing1*, HE Xiang2*, DU Xiao-guang2, XIAO Shi-fu1, WANG Tao1
    2018, 38 (9):  1005. 
    doi: 10.3969/j.issn.1674-8115.2018.09.002

    Abstract ( 548 )   PDF (10443KB) ( 470 )  
    Objective · To investigate the effect of microenvironment on the of β-site amyloid precursor protein cleaving enzyme 1 (BACE1) in PC12 cells. Methods · The PC12 cells were respectively treated with thapsigargin (Tg), lipopolysaccharide (LPS), H2O2, hypoxia incubator and hypoglycemic medium to produce mild endoplasmic reticulum stress (ERS), inflammatory environment, mild oxidative stress, hypoxia and low glucose conditions. Western blotting and fluorescence quantitative PCR were used to detect the of BACE1 protein and BACE1 mRNA. Results · After PC12 cells were treated with Tg (0.13 μmol/L) for 12 h or LPS (0.01 mg/mL) for 36 h, BACE1 protein and mRNA levels were significantly up-regulated (P<0.05). No significant changes were observed in the of BACE1 protein and mRNA of the PC12 cells treated with H2O2 (0.13 mmol/L or 0.25 mmol/L) for 12 h, under hypoxic or hypoglycemic environment (P>0.05). Conclusion · Mild ERS and inflammatory condition can up-regulate BACE1 mRNA and protein in PC12 cells.
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    Rho-associated coiled coil protein kinase 1 involved in amyloid &beta;-protein-induced damage in primary neurons of rats
    HU Yong-Bo1,2, REN Ru-Jing1, WANG Gang1
    2018, 38 (9):  1013. 
    doi: 10.3969/j.issn.1674-8115.2018.09.003

    Abstract ( 609 )   PDF (7461KB) ( 452 )  
    Objective &middot; To investigate the role of Rho-associated coiled coil protein kinase 1 (ROCK1) in amyloid &beta;-protein (A&beta;) induced damage of rat hippocampal neurons. Methods &middot; The rat primary neurons were treated with A&beta;40 oligopeptides to establish a neurotoxicity model. Western blotting was used to detect the protein of ROCK1. Its activity was detectedthe kit. Confocal laser scanning was used to observe the calcium signal in neurons, and apoptosis of neurons was detectedTUNEL assay. Y-27632, an inhibitor of ROCK1, was added into the culture medium into observe its effect on A&beta;40. Results &middot; A&beta;40 (10 &mu;mol/L) could significantly induce calcium overload, increase ROCK1 and activity, and promote apoptosis in primary neurons. Furthermore, ROCK1 inhibitor could decrease all the effect inducedA&beta;40. Conclusion &middot; ROCK1 is involved in both A&beta;induced neuronal calcium overload and neurotoxicity, and ROCK1 inhibitor can antagonize the toxic effects of A&beta;.
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    Bacterial signatures for diagnosis of colorectal cancerfecal metagenomics analysis
    ZHANG Xin-yu1*, ZHANG Jing2*, ZHU Xiao-qiang1, CAO Ying-ying1, CHEN Hao-yan1
    2018, 38 (9):  1019. 
    doi: 10.3969/j.issn.1674-8115.2018.09.004

    Abstract ( 602 )   PDF (10169KB) ( 461 )  
    Objective &middot; To construct bacterial signaturesanalyzing fecal metagenomics for the screening and diagnosis of colorectal cancer (CRC). Methods &middot; A total of 285 samples were included in the study. Diagnostic models for CRC according to six different machine learning algorithms were developed using the featured bacteria selectedrandom forest algorithm, and validated in validation sets. Results &middot; Nine bacteria that differentiated CRC and the control were identified, with which 6 models were established. The best model was random forest model, with an accuracy of 0.847 7 in the training set. Its accuracy in two test sets was 0.815 8 and 0.734 4, respectively. The area under curve (AUC) of receiver operating characteristic of the random forest model in the set including all samples was 0.894. Conclusion &middot; Bacterial signatures based on random forest algorithm for the diagnosis of CRC can differentiate patients with CRC and the control effectively, which suggests the potential clinical value of the bacterial signatures.
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    Construction of a knowledge database of gene fusion and mutation in acute lymphoblastic leukemia
    YAN Tian-qi1, CHEN Li-wei2, ZHU Yong-mei2, LI Jian-feng2, DAI Yu-ting2, 3, CUI Shu-Ya2, JIANG Lu2, CHEN Bing2, HUANG Jin-yan2
    2018, 38 (9):  1027. 
    doi: 10.3969/j.issn.1674-8115.2018.09.005

    Abstract ( 719 )   PDF (8380KB) ( 560 )  
    Objective &middot; To construct a database of fusion and mutation gene annotations for acute lymphoblastic leukemia (ALL) to assist genetic testing. Methods &middot; ALL related gene annotations were collectedmining medical literature. The web server of the database was constructed based on Express framework, a NodeJS web application framework, and MySQL as the server-side development environment. Results &middot; A total of 246 ALL-associated fusion and mutation gene entries were collected through programmed and manual text mining, including biological characteristics, clinical characteristics, clinical directions, target drugs and chemotherapeutic drugs. A web server of the ALL related gene knowledge database was established for convenient data management. Conclusion &middot; In addition to the basic information about ALL related or potentially related genes, the database also involves clinical information which can be a reference tool for precision medicine of ALL.
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    Comparative cultivation of single cell derived placental mesenchymal stromal cells in vitro
    SUN Bao-hangxing1, LU Yi1, WANG Yi-qing1, ZHOU Jia-le1, LIN Meng-lu1, SONG Wei2, JIANG Meng1, BU Jun1
    2018, 38 (9):  1033. 
    doi: 10.3969/j.issn.1674-8115.2018.09.006

    Abstract ( 473 )   PDF (8292KB) ( 453 )  
    Objective · To explore optimal placental derived mesenchymal stem cells (PMSCs) culture medium using different combination of human platelet lysate (HPL), basic fibroblast growth factor (bFGF) and traditional fetal bovine serum (FBS) for further basic and clinical study. Methods · Single cell derived PMSCs was harvested and incubated with 4 kinds of culture, i.e, FBS, FBS+bFGF, HPL and HPL+bFGF. The morphology, growth state, cell phenotype and multi-energy differentiation were observed. Cells of P1, P2, P3 and P4 generation were counted respectively. The number of units of colony formation was analyzedinoculating P4 cells. Results · It was identified that PMSCs had the biological properties of MSCs. Quantificationally, cell density reached (1.12×107) cells/cm2 in FBS+bFGF group and (1.24×107) cells /cm2 in HPL group (P>0.05) in P4, while those in FBS group and HPL+bFGF group were (5.58×106) cells /cm2 and (8.56×106) cells /cm2, respectively. For cell morphology, the P4 PMSCs of FBS+bFGF and HPL groups kept adherent growth, but the HPL cells could not be adherent in P5 generation. The number of colony was 51/well in FBS+bFGF group, and it was 52/well in HPL group (P>0.05) in P4. The FBS+bFGF group and the HPL group were able to maintain the characteristics of MSCs and the ability of pluripotent differentiation in the P4 generation. Conclusion · PMSCs in P4 cultured in HPL medium can keep the biological characteristics and meet the clinical transplantation requirements in quality and quantity, which are preferable for their low immunogenicity to clinical applications. In long term, PMSCs cultured in FBS+bFGF medium are preferable for the longer lasting characters of MSCs and larger quantity in basic studies. HPL+bFGF medium has no advantage on quality and quantity.
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    Rapamycin inhibiting the progression of acute myeloid leukemia with DNMT3Amutation
    YANG Ying, SHI Xiao-dong, DAI Yu-jun, WANG Yue-ying
    2018, 38 (9):  1039. 
    doi: 10.3969/j.issn.1674-8115.2018.09.007

    Abstract ( 539 )   PDF (8292KB) ( 487 )  
    Objective &middot; To investigate the effect of mammalian target of rapamycin (mTOR) inhibitor rapamycin on acute myeloid leukemia (AML) with DNA methyltransferase 3A (DNMT3A) R882 mutation in momodel. Methods &middot; AML cell line OCI-AML3 cells with DNMT3A R882 mutation were cultured with the treatment of rapamycin or DMSO, and then these cells were injected into the tail vein of sublethally irradiated NOD/SCID mice, respectively. The disease progression was monitoredblood routine examination and flow cytometry analysis of CD45+, OCI-AML3 cells, in peripheral blood. Survival time was recorded. Samples bone marrow, spleen and liver were harvested for flow cytometry analysis and pathological examination. Results &middot; The increasing trend of peripheral leukocytes in the rapamycin treated group was obviously slower than that in the DMSO treated group. The proportion of peripheral blood CD45+ cells in the rapamycin treated group was (4.44&plusmn;2.58)% (1 week after transplantation) and (34.42&plusmn;13.64)% (2 weeks after transplantation), which were lower than (16.71&plusmn;8.96)% and (51.55&plusmn;5.36)% in the DMSO treated group in the same period, respectively. The median survival time of the rapamycin treated group (27 d) was significantly longer than that of the DMSO group (23 d). The ratios of CD45+ cell infiltration in bone marrow, spleen and liver of the rapamycin treated group were all less than 5%, which were significantly lower than those [(51.32&plusmn;27.81)% in spleen and (50.03&plusmn;28.74)% in liver] of the DMSO treated group. Compared with the DMSO treated group, the spleen size of the mice was significantly smaller, and the spleen infiltration and structural damage were significantly alleviated in the rapamycin treated group. Conclusion &middot; Rapamycin shows effective inhibition on the progression of AML with DNMT3A R882 mutation in NOD/SCID momodel.
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    Original article (Clinical research)
    A meta-analysis of different internal fixation strategies of Pauwels Ⅲ femoral neck fractures
    WANG Qing, JIANG Da-jun, JIA Wei-tao
    2018, 38 (9):  1045. 
    doi: 10.3969/j.issn.1674-8115.2018.09.008

    Abstract ( 584 )   PDF (10737KB) ( 539 )  
    Objective &middot; To compare the clinical and functional outcomes of cannulated screw (CS) with sliding hip screw (SHS) in the fixation of Pauwels Ⅲ femoral neck fractures systematically. Methods &middot; In the meta-analysis, articles were searched Pubmed database, Embase database, Cochrane library, CNKI database, and Sinomed database. The selected articles were analyzedRevman 5.26 software. Results &middot; Six clinical studies met the inclusion criteria. A total of 350 patients including 213 with CS fixations and 137 with SHS fixations were pooled in the meta-analysis. The results showed that the non-rate in SHS group was significantly lower than that in CS group. However, the surgery time was significantly shorter in CS group. Conclusion &middot; SHS fixation has the advantage of reducing postoperative non-rate in Pauwels Ⅲ femoral neck fractures, but the operative process is relatively complicated, which seemingly causes more blood loss during surgery, and may lead to a less satisfactory functional recovery.
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    Preliminary application of 3D printed customized guide in bone tumor biopsy
    QU Yang1, 2, AI Song-tao2, WU Wen1, WANG Lei1, LI Xiao-min2, JIANG Wen-bo3, HAO Yong-qiang1, DAI Ke-rong1
    2018, 38 (9):  1053. 
    doi: 10.3969/j.issn.1674-8115.2018.09.009

    Abstract ( 552 )   PDF (8695KB) ( 488 )  
    Objective &middot; To explore the feasibility of applying customized guide, based on digital image processing and 3D printing technology, to bone biopsy. Methods &middot; Eleven patients (6 males and 5 females; 7-69 years old, average age of 36 years) diagnosed with bone tumor July 2017 to March 2018 in Shanghai Ninth Peoples Hospital were enrolled in this study. Routine CT and/or MRI data were taken as reference in designing the customized biopsy guide for 3D printingMedraw Print software. Needle insertion points were set under the supervision of surgeons to avoid damaging important anatomical structures such as nerves and blood vessels. 3D printed customized guide was designed to match local surface. The success of the puncture was confirmedX-ray or CT, and the accuracy of the puncture results was evaluatedthe pathological results of resection operation as a reference standard. The complications were analyzed. Results &middot; The 11 patients included 4 cases with neoplasms in femur, 3 cases in pelvis, 2 cases in tibia, 1 case in scapula and 1 case in metacarpal. The needling positions in operation were consistent with the preoperative virtual design, and the guide plates fitted perfectly to the body surface. The results of biopsy of 8 patients (88.9%) matched with the postoperative pathology, while another 2 patients did not receive bone tumor resection becaof the benign biopsy. No complications were observed during or after the procedure. Conclusion &middot; Customized guidedigital image processing and 3D printing may have a great value in improving the accuracy of preoperative tumor diagnosis and the effectiveness of its treatment.
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    Therapeutic effects of far-infrared ray in treating chronic lower extremity lymphedema with dermatolymphangioadenitis
    LI Ke, LIU Ning-fei, ZHANG Yi-xin
    2018, 38 (9):  1059. 
    doi: 10.3969/j.issn.1674-8115.2018.09.010

    Abstract ( 517 )   PDF (11163KB) ( 409 )  
    Objective · To explore therapeutic effects of far-infrared radiation (FIR) therapy on chronic lower extremity lymphedema accompanied with dermatolymphangioadenitis (DLA), occurring after gynecological tumor resection. Methods · The enrolled patients received regular sessions using the FIR therapy machine over the 20-day treatment course (five days in each week). Clinical and laboratory outcome measures were carried out before and after treatment. Clinical outcome measures included DLA seizure frequency, patients subjective feedback, quality of life, and side effects. Laboratory outcome measures included bacterial cultures and concentrations of inflammatory cytokines, detected in serum and local lymphedema tissue fluid samples. Results · A total of 64 cases completed FIR treatment and clinical curative effect evaluation, including 11 cases at the same time completing the laboratory tests. The frequency of DLA decreased during treatment (P0.000). The efficiency rate was more than 50% for 63 (98%) patients receiving treatment. Even 50 patients (78%) did not experience a single episode of DLA recurrence in the whole year after treatment. Patients reported a subjective decrease in lymphedema-related symptoms (all P<0.05), including tightness, heaviness, pain, hardness, soreness, discomfort, heat, fullness, weakness, and numbness. Patients quality of life was improved after treatment (P0.000). Laboratory analysis showed an elevation in serum concentration of IL-1β after FIR therapy (P<0.05) and reduction in local tissue fluid concentrations of IL-2, IL-10 and IL-18 (all P<0.05). Bacterial culture results were both negative before and after treatment. Conclusion · FIR therapy provides an effective treatment modality for patients with chronic lymphedema accompanied with DLA that develops secondarily the treatment of gynecological malignancies, whose therapeutic effects may be due to reduce immune dysfunction within local lymphedema tissues.
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    Analysis of risk factors of thyroid nodules in patients with type 2 diabetes in the community
    JIN Zhi-ping1, ZHANG Shan2, YU Xue-mei2, CHEN Hai-bing3, HU Cheng3
    2018, 38 (9):  1066. 
    doi: 10.3969/j.issn.1674-8115.2018.09.011

    Abstract ( 540 )   PDF (8290KB) ( 422 )  
    Objective · To evaluate the prevalence, risk factors and the effects of macrovascular complications on the onset of thyroid nodules in patients with type 2 diabetes mellitus (T2DM) in the community. Methods · A total of 711 outpatients with T2DM March 2015 to December 2017 in Community Family Doctor Outpatient Department and Department of Endocrinology and Metabolism of Fengxian District Central Hospital were selected. Anthropometric data and clinical test data were collected. Patients were divided into two groups based on the results of thyroid ultrasound. The Logistic regression analysis was used to analyze the risk factors for thyroid nodules in T2DM patients, such as age, sex, body mass index, glycolipid metabolism index, pancreatic function index, and thyroid function index. Furthermore, the effect of macrovascular disease on the onset of thyroid nodules was analyzed. Results · Of the 711 patients with T2DM, 438 (61.60%) had thyroid nodules, including 231 males (55.13% of the male population) and 207 females (70.89% of the female population). Comparison of anthropometry data, glycolipid metabolism index, pancreatic function index, and thyroid function index in groups with and without thyroid nodules revealed that there was a statistically significant difference in gender, age, duration of T2DM, 2-hour post-meal plasma glucose, total cholesterol, triglyceride, low density lipoprotein-cholesterol, free triiodothyronine, and thyroid peroxidase antibody between the two groups (P<0.05). Multivariate Logistic regression analysis showed that gender, age, 2-hour post-meal plasma glucose, low density lipoprotein-cholesterol, and thyroglobulin antibodies levels were the risk factors of thyroid nodules in T2DM patients (P<0.05). After adjusting for these risk factors, it was found that there was no significant correlation between macrovascular complication and thyroid nodules in T2DM patients (P>0.05). Conclusion · This study found that females, seniors, reduction of 2-hour post-meal plasma glucose, low density lipoprotein-cholesterol, and thyroglobulin antibody levels were the risk factors of thyroid nodules in T2DM patients in the community. There is no certain correlation between macrovascular complications and the occurrence of thyroid nodules in T2DM.
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    Characteristic analysis of 590 older adults with geriatric syndromes in Shanghai based on cluster analysis
    JIANG Cai-xia1, ZOU Min2, JIANG Li-ping2
    2018, 38 (9):  1072. 
    doi: 10.3969/j.issn.1674-8115.2018.09.012

    Abstract ( 503 )   PDF (8608KB) ( 411 )  
    Objective &middot; To investigate the distribution of geriatric syndromes in older adults into provide reference for the care of different types of the elderly. Methods &middot; This study described distribution of 13 geriatric syndromes of 590 older adults 5 hospitals and 6 nursing homes in Shanghai based on k-means clustering. The data were collectedChinese version of continuity assessment record and evaluation (CARE) between May and November 2017. Results &middot; 97.8% of the 590 older adults suffered at least 1 geriatric syndrome. The top 5 geriatric syndromes were impairment in activities of daily living (80.7%), cognitive impairment (80.5%), polypharmacy (44.7%), visual impairment (45.3%), and hearing impairment (42.9%). The results of k-means clustering showed that the geriatric syndrome was divided into 4 clusters. Cluster 1 (named high incidence group of geriatric syndromes) exhibited high prevalence of impairment in activities of daily living, cognitive impairment, visual impairment, hearing impairment and delirium. On average, each older adult had 5.6&plusmn;1.1 geriatric syndromes. Cluster 2 (named extremely high group) exhibited the highest prevalence of geriatric syndromes, excluding pain, depression and pressure ulcer. On average, each older adult had 8.3&plusmn;1.1 geriatric syndromes. Cluster 3 was named low incidence group of geriatric syndromes, each older adult having 2.0&plusmn;1.2 geriatric syndromes. The incidence of polypharmacy and fall was relatively high. Cluster 4 (named medium group) exhibited high prevalence of impairment in activities of daily living, cognitive impairment, polypharmacy, urinary incontinence and fall. On average, each older adult had 4.0&plusmn;1.3 geriatric syndromes. Conclusion &middot; Classification of geriatric syndromes is helpful to identify the high-risk older adults who may suffer certain patterns of geriatric syndromes, and thus to carry out targeted interventions.
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    Impact of body weight and physical activity on quality of life among breast cancer patients receiving adjuvant chemotherapy
    FANG Qiong1, CHEN Yun-yun1, DONG Xiao-jing1, ZHAGN Nan1, SHEN Kun-Wei1, WU Bei-wen2
    2018, 38 (9):  1079. 
    doi: 10.3969/j.issn.1674-8115.2018.09.013

    Abstract ( 567 )   PDF (8217KB) ( 466 )  
    Objective &middot; To investigate the impact of body weight and physical activity during different stages of adjuvant chemotherapy on the quality of life after chemotherapy among breast cancer patients. Methods &middot; In a convenient sample of breast cancer patients with no prior history of systemic therapy, physical activity and quality of life were measured with anthropometric measurements, international physical activity evaluation questionnaire and Chinese version of functional assessment of cancer therapy-breast (FACT-B) scale before, during and after chemotherapy. Data was processed using repetitive measurement variance analysis and correlation analysis. Results &middot; Among the 140 breast cancer patients, the average incidence of obesity during chemotherapy was 30.24%. An increase of body mass index (BMI) was observed throughout the treatment course. During adjuvant chemotherapy, the median physical activity was 844.50 (MET&middot;min)/week. Obesity before chemotherapy was significantly negatively correlated with quality of life among patients receiving adjuvant chemotherapy (r-0.21, P0.014), while physical activity energy consumption was positively correlated with quality of life (r0.20, P0.019). Conclusion &middot; Obesity and insufficient physical activity are rather common during adjuvant chemotherapy treatment in breast cancer patients, and they are strongly correlated with patients quality of life after chemotherapy.
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    Correlation of anxiety and depression with sleep quality and quality of life in elderly patients with percutaneous coronary intervention
    LIU Xia1,2, DING Biao3, ZHANG Ya-qing1
    2018, 38 (9):  1085. 
    doi: 10.3969/j.issn.1674-8115.2018.09.014

    Abstract ( 527 )   PDF (10123KB) ( 457 )  
    Objective &middot; To explore the correlation of anxiety and depression with sleep quality and quality of life in elderly patients with percutaneous coronary intervention (PCI). Methods &middot; A total of 297 elderly patients undergoing PCI were surveyed according to hospital anxiety and depression scale (HADS), Piusburgh sleep quality index (PSQI) and 12-item short form health survey version 2.0 (SF-12v2) on the day before they were discharged two hospitals (Xinhua Hospital, Shanghai Jiao Tong University School of Medicine and Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University). All data was based on their subjective feelings in the past month. Spearman correlation analysis was performed on the scores of anxiety and depression to sleep quality and life quality. The multiple linear regression was used to analyze the influencing factors of life quality. Results &middot; 21.5% of the patients were assessed as anxiety positive, and 22.2% were assessed as depression positive, both higher than those of the patients in general hospitals of China (both P0.000). The average score of patients sleep quality was 6.50&plusmn;3.46, which was higher than the domestic norm (P0.000). The average score of patients quality of life was 132.20&plusmn;30.83, the physiological score was 60.44&plusmn;17.58, and the psychological score was 71.76&plusmn;15.96. Correlation analysis showed that there was a significant positive correlation between total scores of anxiety and depression and total scores of sleep quality (P0.026, P0.027), and a significant negative correlation between total scores of anxiety and depression and total quality of life scores, the physiological scores and the psychological scores (all P0.000). The linear regression equation of anxiety and depression scores and quality of life scores in elderly patients with PCI was significant (P0.000, R20.246). Conclusion &middot; The incidence of anxiety and depression in elderly PCI patients was high in the last month before admission, and the sleep was poor. The more obvious the anxiety or depression, the worse the quality of sleep and quality of life. Attention should be paid to the relations of anxiety and depression to sleep quality and quality of life, and efforts should be made to improve the negative emotions of patients and enhance their sleep quality and quality of life.
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    Risk factors of recurrence of atrial fibrillation in aged patients with chronic diseases after cryoballoon ablation
    DONG Feng-wei, MA Jia-li, ZHANG Ying
    2018, 38 (9):  1092. 
    doi: 10.3969/j.issn.1674-8115.2018.09.015

    Abstract ( 571 )   PDF (9082KB) ( 419 )  
    Objective &middot; To evaluate the recurrence rate of atrial fibrillation (Af) and its related risk factors in aged patients with chronic diseases after cryoballoon ablation. Methods &middot; With the method of convenient sampling, a total of 159 patients with Af after cryoballoon ablation were enrolled in the Department of Cardiology, Ruijin Hospital Oct. 2016 to Jan. 2018. Self-rating depression scale (SDS) and CHA2DS2-VASc scores [congestive heart failure, hypertension, age &ge;75 y (doubled), diabetes mellitus, stroke(doubled)-vascular disease, age 65-74 and sex category(female)] were used to assess the patients. Follow-up checks consisted of chief complaint, postoperative electrocardiogram (ECG), and 24 h Holter monitoring. Logistic regression models were performed to explore the independent risk factors of Af recurrence after cryoballoon ablation. Results &middot; 152 patients (95.6%) completed the follow-up checks, with an average age of (61.9&plusmn;8.9) years. The average time of follow-up period was (8.35&plusmn;2.41) months. A total of 41 patients (27.0%) developed Af after cryoballoon ablation. Logistic regression analysis showed the number of chronic disease &ge;2(OR2.466, 95% CI: 1.375-4.452), CHA2DS2-VASc scores &ge; 2(OR2.088, 95% CI: 1.142-5.557), irregular of anti-arrhythmic drugs (OR1.581, 95% CI: 1.351-2.125), hypertension (OR1.317, 95% CI: 1.076-2.809), and body mass index (BMI) (OR1.147, 95% CI: 1.009-1.174) were the independent risk factors of Af recurrence. Conclusion &middot; There is still a certain percentage of recurrence in aged patients with chronic diseases after cryoballoon ablation. 2 and more chronic diseases, irregular of anti-arrhythmic drugs, hypertension, CHA2DS2-VASc scores &ge; 2, and overweight may be potential risk factors of Af recurrence after cryoballoon ablation.
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    Evaluation of the effect of using the new PRISM IV to assess the condition of children with mechanical ventilation
    ZHANG Ting-ting1, HUANG Run1, WU Yin1, XU Yi1, GE Xiao-hua2
    2018, 38 (9):  1099. 
    doi: 10.3969/j.issn.1674-8115.2018.09.016

    Abstract ( 573 )   PDF (6598KB) ( 561 )  
    Objective · To evaluate the application effect of the newly updated pediatric critical illness score PRISM Ⅳ on assessing the condition of children with mechanical ventilation after congenital heart disease (CHD). Methods · T test, area under ROC curve and Hosmer-Lemeshow goodness of fit test were used to assess the performance of PRISM Ⅳ . The performance of PRISM Ⅳ was also compared with PRISM Ⅲ and specific severity of illness scoring system for CHD. Results · 230 children with CHD were included. Reliability among evaluators was good. The discriminatory power (AUC>0.75) and calibration capability (P>0.05) of PRISM Ⅳ , PRISM Ⅲ and specific score for CHD were tolerable. The results of PRISM Ⅳ evaluation were similar to specific scores for CHDT0-4 and CHDT0-12 (P>0.05). Conclusion · PRISM Ⅳ has been updated to shorten the assessment time and has certain advantages over other tools. It is recommended that nursing staff take it in the prognosis prediction system for critically ill children based on clinical status and practical needs, to detect high-risk children early, and to intervene early to reduce the complications and mortality of children.
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    Review
    Advances of anti-inflammation therapy targeting ApoB-100 against atherosclerosis
    GUO Xiao-yu, XUE Yu-chen, HE Bin, XUE Xiao-mei, HONG Ting, YOU Sha-sha
    2018, 38 (9):  1104. 
    doi: 10.3969/j.issn.1674-8115.2018.09.017

    Abstract ( 604 )   PDF (8464KB) ( 513 )  
    Atherosclerosis is an inflammatory disease of arterial wall causedmany factors, which is the main pathological basis of many cardiovascular diseases. Currently, "inflammatory response" theory is widely accepted as pathogenesis of atherosclerosis. Abnormal increase of apolipoprotein ApoB-100, a composition of low density lipoprotein (LDL), which causes pathological inflammation, is a major factor leading to atherosclerosis. Therefore, inhibition of ApoB-100 induced pathological inflammatory responseimmunotherapy is expected to delay the development of atherosclerosis. This review focused on the recent advances of ApoB-100 vaccine and other ApoB-100 inhibitors against atherosclerosis.
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    Research advances in hypokalemic salt-losing tubulopathies
    GUO Qin, ZHANG Chong
    2018, 38 (9):  1109. 
    doi: 10.3969/j.issn.1674-8115.2018.09.018

    Abstract ( 573 )   PDF (10271KB) ( 520 )  
    Hereditary tubular disorders play an important role in the ion transport mechanism of kidney. Hypokalemic salt-losing tubulopathies (SLTs) are a set of rare hereditary diseases, which accompany with hypokalaemic metabolic alkalosis, normo or hypotension, and are associated with high plasma renin activity and hyperaldosteronemia. Bartter syndrome and Gitelman syndrome, characterizedthe disability of the thick ascending limb of Henles loop and/or the distal convoluted tubule, respectively, are two common types of SLTs. Some types of SLTs share similar clinical manifestations, making them difficult to diagnose. Besides, with the development of molecular genetics, new disease-causing genes have been discovered. Its inconvenient for clinicians to refer to the old classification of SLTs. The review mainly covered the newly discovered pathogenic genes of SLTs and the corresponding pathogenic mechanisms. In addition, a new system for classification of SLTs based on physiology and pharmacology was introduced.
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    Research progress of neurogenic bowel dysfunction in spinal cord injury
    GAO Tao, ZHU Xiao-zhong, BAO Bing-bo, LI Xing-wei, ZHENG Xian-you
    2018, 38 (9):  1116. 
    doi: 10.3969/j.issn.1674-8115.2018.09.019

    Abstract ( 680 )   PDF (9928KB) ( 530 )  
    Spinal cord injury has the characteristics of high incidence, high disability, high cost and younger age. It imposes a huge burden on patients and society. Neurogenic bowel dysfunction is one of the serious complications of spinal cord injury. It often manifests as constipation and fecal incontinence, which severely limit the social activities of patients and reduce the quality of life. It is a major problem for clinicians to solve. In recent years, the concern for neurogenic bowel dysfunction after spinal cord injury has been increasing. This article reviewed its epidemiology, classification, pathophysiological, diagnosis and treatment.
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    Advances in oriented differentiation of stem cells to retinal pigment epithelia in the treatment of age-related macular degeneration
    RUAN Shang, WANG Feng-Hua
    2018, 38 (9):  1122. 
    doi: 10.3969/j.issn.1674-8115.2018.09.020

    Abstract ( 556 )   PDF (9232KB) ( 571 )  
    Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss related with aging, including wet AMD and dry AMD. At present, there is still no effective treatment for dry AMD. Retinal pigment epithelium (RPE), located between the retina and the choroid, plays an important role in the survival of photoreceptor and maintenance of its physiological function. In AMD patients, the aging of RPE leads to degeneration and dysfunction of Bruch&rsquo;s membrane, choroidal and photoreceptor, thus causing the loss of the retina photoreceptor cells. Since 1991, researchers have been trying various replacement therapies of RPE cells. With the development of technique for induction and differentiation of pluripotent stem cells (PSC) in vitro, the transplantation of stem cells differentiating into RPE cells is going to be a feasible strategy for replacing impaired RPE cells in AMD. This article reviewed the advances in the study of the source of RPE cells, identification of cell differentiation, transplantation and the related clinical trials in cell replacement therapy of AMD.
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    Application of mechanical thrombectomy in the patients with wake-up stroke
    HU Yue, HE Xin-wei, LIU Yi-sheng, ZHAO Rong, LIU Jian-ren
    2018, 38 (9):  1128. 
    doi: 10.3969/j.issn.1674-8115.2018.09.021

    Abstract ( 568 )   PDF (7293KB) ( 455 )  
    Wake-up stroke (WUS), which is characterizedthe uncertain onset time and poor short-term outcome, accounts for 25% of stroke. Due to the above two points, how to choose the treatment methods remains to be researched. The mechanical thrombectomy is the first-line treatment of acute ischemic stroke (AIS). DAWN and DEFUSE-3 studies have recently demonstrated that the treatment window can be expanded to 24 hours, so the endovascular treatment may be effective and safe in some WUS patients according to the existence of &ldquo;the mismatch of clinical score and imaging infart core&rdquo;CT perfusion imaging and other modern imaging methods. This article summarized the application of mechanical thrombectomy in WUS treatment in recent years.
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    Frontier literatures in translational medicine
    New advances in translational medicine research in the field of tumor
    DING Wen-jing1, WU Hui1, FAN Rong1, XU Min2, QIU Xiao-chun1
    2018, 38 (9):  1133. 
    doi: 10.3969/j.issn.1674-8115.2018.09.022

    Abstract ( 768 )   PDF (10120KB) ( 548 )  
    In recent years, translational medicine has become more and more widely used in the field of tumor. This article summarized the research progress in the field of translational medical tumors in the last few months, focusing on the summary analysis of breakthrough research results on tumor heterogeneity, drug resistance, pathogenesis and metastasis, into provide novel and cutting-edge research trends in the field of tumor for oncology researchers and clinicians, and promote the transformation of basic research results into clinical diagnosis and treatment.
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