Table of Content

21 February 2015, Volume 36 Issue 1

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The Second Grade National Prize for Science and Technology Progress—The establishment and application of new prevention and treatment technology of primary open angle glaucoma

Yang Diya, Wang Ningli

2015, 36(1):  1-7.  doi:10.3969/j.issn.1006-7795.2015.01.001

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In the recent 10 years, the prevalence of primary open angle glaucoma(POAG) in China has been increased from 0.29% to 2.6%, and POAG becomes the most important irreversible blindness disease. As it is still in vague of the mechanism of intraocular pressure elevation and impairment of optic nerve, and lacks of screening and prevention technology, the blindness rate of POAG is higher than 8% which is the average level of developed country. Leading by Professor Ningli Wang, this program established the new POAG prevention and treatment system by resolving the mechanism of POAG and the key technology and instrument. The new technology and instrument has been applied in over 26 provinces and over 300 districts, which covered 120 million peoples. There are 3.2 million patients have been benefited from this program. The blindness rate of POAG has reduced from 15% to 5%, and the disable rate reduced from 30% to 15%.

Watch out for Chikungunya

Sheng Ziyang, Gao Na, An Jing

2015, 36(1):  8-11.  doi:10.3969/j.issn.1006-7795.2015.01.002

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Numerous Chikungunya outbreaks have occurred throughout Central and South America in 2014. Around a million of local residents suffered. Chikungunya virus is a member of Genus Alphavirus, Family Togaviridae. The genome is a positive-sense single-stranded RNA. Genus Aedes mosquitoes are main vectors, especially Aedes albopictus and Aedes aegypti. The disease caused by the virus shows some similarities with Dengue fever in clinical manifestations. We need to pay attention to diagnosis of those two diseases. A small-scale epidemic of Chikungunya occurred struck in Guangdong Province in 2010 with the degree of health threat. It's in great need of controlling the spread of Chikungunya virus, for its economic burden is no less than that of Dengue virus.

Focus on diseases of vena cava

Wang Zhonggao

2015, 36(1):  12-17.  doi:10.3969/j.issn.1006-7795.2015.01.003

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Vena cava, including superior and inferior vena cava, is the largest vessels of human beings. This article summarizes history of vena cava diseases, their clinical manifestation and treatment progress. The disorder of the superior vena cava is represented by superior vena cava syndrome, while the disorders of the inferior vena cava include Budd-Chiari syndrome and inferior vena cava syndrome.

Hypoxia contributes to directed differentiation of mice bone marrow derived mesenchymal stem cells

Huang Ying, Zhang Jian, Chen Bing, Guo Lianrui, Li Jianxin, Zhang Shuwen

2015, 36(1):  18-22.  doi:10.3969/j.issn.1006-7795.2015.01.004

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Objective To monitor the intravital oxygen tension in mice femoral marrow, and assess effect of different oxygen tension on bone marrow derived mesenchymal stem cells (BM-MSCs). Methods Oxygen tension of mice femoral bone marrow was monitored by micro electrode to determine hypoxic level for ex-vivo cell culture. Mice BM-MSCs were obtained by density gradient centrifugation and cultured under 3% oxygen (hypoxia) and 20% (normoxia) oxygen in endothelial growth media-2(EGM-2). Dil-Ac-LDL and FITC-UEA absorbance assays were applied on 8 days culture of Passage 2. MTT proliferation and adhesion assays were performed on those endothelial-like cells under different oxygen condition. Results The oxygen tension in normal femoral bone marrow was (21.55±3.4)mmHg (1 mmHg=0.133 kPa), which equaled to (2.8±0.45)% (approximately 3%) oxygen in volume fraction. Mice BM-MSCs differentiated to endothelial-like cells in both 3% (hypoxia) and 20% (normoxia) oxygen. OA values for MTT proliferation assay was 0.31±0.05 and 0.16±0.01 in hypoxia and normoxia, respectively (P<0.01, n=5) and adhesion rate of endothelial-like cells was (8.72±2.95)% and (3.91±0.72)%, respectively (P<0.05, n=5). Conclusion Physiologic oxygen concentration in marrow is approximately 3%. At this level, directed differentiated endothelial-like cells present more proliferative and adhesive abilities.

Clinical characteristics and perioperative management of abdominal aortic aneurysm complicated with coronary heart disease

Yang Yaoguo, Chen Zhong, Tang Xiaobin, Kou Lei, Wu Zhangmin, Liu Hui, Wang Sheng, Zhang Zheng, Jia Yunfeng, He Nan

2015, 36(1):  23-27.  doi:10.3969/j.issn.1006-7795.2015.01.005

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Objective To investigate clinical features and perioperative treatment experience of abdominal aortic aneurysm (AAA) complicated with coronary heart disease. Methods A retrospective analysis was performed on 225 patients with perioperative AAA complicated with coronary artery disease (CAD)seen from January 1991 to August 2014 as study group, and another 225 cases with AAA without CAD treated with open surgery or endovascular aneurysm repair as control group. Treatment and complications were analyzed. Results Compared with the control group, preoperative inspection of diabetes and hyperlipidemia showed a high incidence (P<0.01) in the study group. The proportions of cases with low density lipoprotein-cholesterol (LDL-C) and LDL-C/high density lipoprotein-cholesterol(HDL-C) increased (P<0.01), HDL-C (P<0.01) decreased were significantly higher in the study group. Perioperative complication rate of circulatory and respiratory system was higher in the study group 19.1% (43/225), 7.6%(17/225), the difference was statistically significant (P<0.01, P<0.05). There was no significant difference in perioperative blood loss and intensive care unit (ICU) stay. Total complications in the study group increased significantly (P<0.01). Conclusion For patients with AAA complicated with coronary heart disease, attention should also be paid to the control of diabetes, hyperlipidemia, and take reasonable surgical program according to the disease status. If the anatomical conditions are suitable, endovascular aneurysm rapair (EVAR) is the treatment of choice. We should provide a careful and meticulous perioperative management to AAA patients to reduce postoperative complications.

Design of a new biodegradable vena cava filter

Zhao Hui, Zhang Fuxian, Li Hailei, Zhang huan

2015, 36(1):  28-33.  doi:10.3969/j.issn.1006-7795.2015.01.006

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Objective To design a new biodegradable vena cava filter which could degrade and be absorbed slowly when the risk of pulmonary embolism (PE) has passed. Methods The filters were handmade, and consisted of two parts: the cone was constructed of six polyglycolic acid polymer strands anchored to a handmade absorbable stent. Central inferior vena cava fixation were accomplished by the absorbable stent which was made of polycaprolactone. The filters were inserted to the inferior vena cava of ten dogs under ultrasound guidance. The filters were operatively retrieved at 6 weeks after implantation .The inferior vena cava were subsequently analyzed using light microscopy. The lungs were also removed to observe any pulmonary embolism caused by the degradation products of the biodegradable filter. Results Biodegradable vena cava filters were successfully made and implanted in 10 adult dogs. None of the 10 dogs had abnormal vital signs except one dog had lower extremity swelling. ① Migration:All the filters migrated cephalad. One filter migrated into the right atrioventricular orifice, the other 9 filters migrated cephalad approximately < 2 cm and remained below the renal vein ostia. ② Naked-eye observation:In 8 of the 9 remaining filters, the absorbable strands had completely dissolved. One specimen had evidence of incorporated residual strands within the caval wall on gross examination, resulting in 70% stenosis of inferior vena cava. All of the biodegradable stents were embedded into the caval wall. The caval wall became thick at the level of filter placement without significant lumen narrowing. ③ Hematoxylin and eosin (HE) staining:Intense inflammatory response with significant thickened intima and media was seen on HE staining. There was no evidence of pulmonary embolism or inflammatory response caused by degradation products of the absorbable strands. Conclusion We had designed a biodegradable inferior vena cava filter successfully, the biodegradability and biocompability had been proven through in vivo studies.

Radiation suppresses neointimal hyperplasia after revascularization

Yuan Liqin, Shu Chang, Zhou Xiao, Zhang Wenbo, Fang Kun, Li Xin, Li Quanming

2015, 36(1):  34-39.  doi:10.3969/j.issn.1006-7795.2015.01.007

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Objective To study the effect of postoperative fractionated X-ray radiotherapy, at a total dose of 28 Gy, on neointimal formation and strive to further elucidate the mechanisms of neointimal hyperplasia in the abdominal expanded polytetrafluoroethylene (ePTFE) prosthetic vascular graft. Methods The subrenal abdominal aortas of 12 mongrel dogs were replaced with an ePTFE graft. The dogs were randomly divided into either a radiotherapy group or a non-radiotherapy control group. Grafts were harvested at five weeks after surgery for comparing the thickness of neointimal formation and the expression of PCNA, S phase kinase associated protein 2 (Skp2) and p27^kip1 in the two groups.Results We observed that the graft neointimal and anastomotic vessel wall of the radiotherapy group were significantly thinner than those of the control group (P<0.01). The mRNA and the protein expression of p27^kip1 was elevated in the neointimal area after irradiation (P<0.01). The mRNA and the protein expression of PCNA and Skp2 were significantly down-regulated in the radiotherapy group (P<0.01). Conclusion Postoperative fractionated radiotherapy(28 Gy)after an ePTFE graft replacement of the abdominal aorta suppressed the development of neointimal hyperplasia and the proliferation of vascular smooth muscle cell (VSMC) in the graft in the short term.

Percutaneous transluminal angioplasty for treatment of below-the-knee arterial lesion

Tan Zengli, Liao Peng, Tian Ran, Song Xitao, Li Shuguo, Liu Changwei, Yu Zhengya

2015, 36(1):  40-44.  doi:10.3969/j.issn.1006-7795.2015.01.008

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Objective To report our experience in treating patients with below-the-knee (BTK) arterial lesions, Rutherford class Ⅱ-Ⅵ, with percutaneous transluminal angioplasty (PTA).Methods A retrospective analysis of BTK arterial angioplasty procedures was performed. Patients were classified according to different Rutherford stages. SVS runoff scores were determined after the completion of the intervention and tansluminal angioplasty (PTA) of infrapopliteal artery for the treatment of patients with lower extremity ischemia at Rutherford Ⅱ-Ⅵ stages. Data of 207 cases who underwent peripheral angioplasties for BTK arterial diseases in 189 patients seen from 2010 to 2014 were collected, stratified by Rutherford class, in two vascular surgery medical centers. Data included primary patency, limb salvage, and target vessels patency assessed by Kaplan-Meier life-table analysis.Results There were 189 patients (mean age 71.33±6.90 years) who received PTA surgeries, including 148 patients with diabetes, 60 smoking, 90 with hyperlipidemia, 124 with hypertension, 58 with coronary artery disease, 21 with renal insufficiency and 30 with cerebral infarction. Rutherford stage Ⅱ- Ⅲ diseases were seen in 45 limbs, stage IV in 21 limbs, and stage V-VI in 91 limbs. At the mid-term follow-up (21.8±5.2 months), the overall death rate was 7.94%. The limb salvage rates of Rutherford class Ⅱ-Ⅲ patients in 1 and 2 years postoperatively were 97.56% and 93.81%, respectively, in class IV patients 92.55% and 87.86%, respectively, and in class V-Ⅵ patients 86.50% and 77.58%, respectively. Primary patency rates the 1st year postoperatively were 86.85%, 67.12%, 38.78% and 65.14%, 54.67%, 37.68% at the 2nd years. Conclusion Our results showed that the patency rate as an intermediate clinical outcome of infrapopliteal PTA was low. But it had higher limb salvage rate and higher symptoms relief rate. These data suggested that PTA should be considered as initial therapy for treatment of below-the-knee lesion.

Outcome and influencing factors of bypass and endovascular treatment for Takayasu arteritis

Xiao Yaowen, Chen Zhong, Yang Yaoguo, Kou Lei, Tang Xiaobin, Wu Zhangmin, Liu Hui, Wu Qinghua

2015, 36(1):  45-52.  doi:10.3969/j.issn.1006-7795.2015.01.009

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Objective This study aimed to compare endovascular treatment and bypass surgery for Takayasu ateritis(TA), to analyze influencing factors and to provide reference data for the treatment options of Takayasu arteritis and prevention of postoperative complications. Methods This is a retrospective review of patients with TA referred to us between 2002 and 2014. We used the American Rheumatism Association standards published in 1990 as diagnostic criteria.Results Total number of patients who received surgery was 49, including 44 female cases, accounting for 89.8%, the average age was (27.20±10.35) years, the bypass surgery was performed for 27 cases, endovascular treatment was given to 22 cases (7 cases received stent placement, 15 cases received percutaneous transluminal angioplasty, PTA), 61 culprit vessels were treated. The average follow-up period was (50.43±42.708) months (3-148 months), no deaths occurred. The primary patency rates for 3-month, 6-month, 1-year, 3-year, 5-year, 10-year were 97.8%, 95.6%, 88.3%, 79.6%, 76.1% and 57.1%, respectively. The PTA and stent placement, 1-year patency rates were 91.7% and 68.6% (P= 0.045). Only 2 cases had early complications of hemorrhage. Late complications occurred in a total of 13 cases, including 5 cases after endovascular treatment and 8 cases after bypass (P=0.002); Cerebral infarction in 1 case, thromboembolism in 6 cases, and restenosis in 5 cases (stent restenosis in 2 cases, 3 cases had restenosis after PTA), artificial vascular rejection occurred in 1 case. The overall 1-, 3-, 5-, 10-year no complication rates were 88.1%, 79.0%, 75.4% and 51.9%, respectively. The Logistic regression analysis showed that the immune abnormalities in follow-up period were independent risk factors for postoperative complications (OR: 7.596, CI: 1.091-52.884, P= 0.041). Conclusion Endovascular treatment was significantly superior to bypass surgery in terms of late complications; no significant difference was found between bypass surgery and endovascular treatment in long-term patency rate. Abnormalities in immune parameters during the period of follow-up may be independent risk factors of postoperative complications, postoperative immunomodulatory therapy may be particularly important. PTA had a better primary patency than stenting.

A prospective clinical study on the efficacy and safety of catheter-directed thrombolysis compared with systemic thrombolysis in Deep Venous Thrombosis subjects with stent

Tian Xuan, Wang Sheng, Liu Jianlong, Chen Zhong

2015, 36(1):  53-57.  doi:10.3969/j.issn.1006-7795.2015.01.010

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Objective To assess the effectiveness of improving the filter retrieval rate by catheter-directed thrombolysis compared with systemic thrombolysis in patients presented with stent thrombosis after inferior vena cava filters implantation. Methods This was a prospective, randomized, parallel group, single-center clinical study conducted in Beijing Jishuitan Hospital. Sixty subjects implanted with OptEase retrievable filters due to deep venous thrombosis (DVT) secondary to traumatic lower limb fracture seen from February 2013 to August 2014 were enrolled in this study. All subjects were diagnosed with stent thrombosis at least 1.0 cm in diameter by infeior vena cava angiography or color Doppler ultrasound. Subjects were randomized to receive catheter-directed thrombolysis or peripheral intravenous thrombolysis for six days. The primary study endpoint was the filter retrieval rate. Results The filter retrieval rate was 80% (24/30) in catheter-directed thrombolysis group compared with 36.7% (11/30) in the control group, the difference was statistically significant (P<0.05). The efficacy of thrombolysis was superior in the catheter-direct thrombolysis group based on the change of the size of thrombus after treatment compared to the baseline (P<0.05). No subjects experienced pulmonary embolism in follow-up period. Conclusion Compared with systemic thrombolysis, catheter-directed thrombolysis provided better efficacy in terms of increasing the rate of filter retrieval after stent obstruction.

Analysis of the effect of possible influential factors on renal function among patients 1 year after coronary interventions

Li Boyu, Hua Qi, Li Jing, Shao Qiang, Chu Yanyan

2015, 36(1):  58-62.  doi:10.3969/j.issn.1006-7795.2015.01.011

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Objective To investigate the effect of possible influential factors on renal function among patients 1 year after coronary interventions. Methods Totally 287 patients with acute coronary syndrome (ACS) seen from Jan. 2013 to Sep.2013 were enrolled in this retrospective study. All of them were treated with percutaneous coronary intervention (PCI) and followed up for at least 1 year. Then the clinical data were collected and analyzed retrospectively. The patients were divided into two groups according to the estimated glomerular filtration rate (eGFR) decreased or maintained after 1 year follow-up and a Logistic regression analysis was used to analyze the effect of influential factors. Results Compared with eGFR maintained group (n=132), hypertension (HTN) (67.4% vs 55.5%) and non-ST segment elevation ACS (NSTEACS) (58.3% vs 42.6%) were much common in eGFR decreased group (n=155) (P=0.02). There was a statistical significant difference in hemoglobin (HGB) (140.4±17.6g/L vs 140.2±14.3g/L;F=5.384, P=0.02) but no significant difference in age, gender, diabetes mellitus (DM), ischemic stroke (IS) history, cholesterol, glucose, myocardial enzymes, left ventricular ejection fraction (LVEF), dosage of contrast media, number of vessels with stenosis and number of stents implanted in one patient (P > 0.05) between the two groups. The Logistic analysis indicated that HTN and NSTEACS were independent risk factors to influence the eGFR (P=0.01, OR=1.949, 95% CI:1.174-3.237 and P=0.004, OR=2.08, 95% CI:1.265-3.418).Conclusion For ACS patients who received PCI, those who had hypertension and NSTE-ACS were more likely to have decreased eGFR after 1 year follow-up.

Relationship between red cell distribution width and high-sensitivity C-reactive protein in acute coronary syndrome of elderly patients

Wei Zhanyun, Hua Qi

2015, 36(1):  63-66.  doi:10.3969/j.issn.1006-7795.2015.01.012

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Objective To investigate the relationship between the red blood cell distribution width (RDW), high sensitivity C-reactive protein (hs-CRP) and the severity of coronary artery disease in elderly patients with acute coronary syndrome (ACS). Methods A total of 178 elderly patients with ACS were enrolled. They were first hospitalized at the Xuanwu Hospital from January 2010 to April 2014, their coronary culprit lesion was improved by Gensini score, according to the results of coronary angiography. Based on the Gensini score, the patients were further divided into mild lesion group (<50 points) in 48 cases, moderate lesion group (50 to 100 points)in 69 cases, severe disease group (≥100 points) in 61 cases; There were 38 cases without coronary disease were enrolled as normal control group. All patients were tested for their RDW and hs-CRP after admission.Results ①RDW and hs-CRP were significantly higher in the elderly patients with ACS than in the control group, the difference is statistically significant (F=7.312, P=0.008;F=5.249, P=0.026); ②Using Gensini score as dependent variable, Logistic regression analysis showed that RDW and hs-CRP were independent predictors for the severity of coronary artery lesion(OR=2.014, 95%CI:1.736~3.794; OR=1.896, 95%CI:1.492~3.989); ③RDW and hs-CRP levels were positively correlated (r= 0.21, P<0.05) in elderly patients with ACS. Conclusion ①RDW and hs-CRP seem to be independent predictors for the severity of coronary artery lesion. ②The mechanism of elevated RDW may be related to chronic inflammation. RDW and hs-CRP can be used as markers for clinical evaluation of severity of coronary artery disease and may be used for risk stratification in elderly patients with ACS, which are simple, inexpensive, and practical.

Efficacy and safety of urapidil and nitroglycerin injection for treatment of hypertension and diabetes mellitus in elderly patients with acute heart failure

Yang Wei, He Jingyu, Wang Yanling, Tan Jing, Fan Zhenxing, Hua Qi

2015, 36(1):  67-72.  doi:10.3969/j.issn.1006-7795.2015.01.013

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Objective To evaluate whether the alpha-1 adrenoceptor blocker, urapidil, provides additional therapeutic benefits compared to nitroglycerin in treatment of non valvular heart failure complicated with hypertension and diabetes mellitus (DM) in elderly patients.Methods Eighty-two elderly patients with non valvular heart failure complicated with hypertension and diabetes mellitus were randomized into two groups who received either urapidil or nitroglycerin, respectively. All patients were monitored for blood pressure (BP), heart rate (HR), and received tests for metabolic activity and cardiovascular function prior to and after treatment. Results Patients receiving urapidil had significantly lower systolic blood pressure (SBP) than their counterparts in nitroglycerin group. Moreover, patients in urapidil group showed lower N-terminal B type natriuretic peptide (NT-proBNP) levels compared to patients in nitroglycerin group. While both urapidil and nitroglycerin decreased fasting plasma glucose (FPG) levels, there was no significant difference in FPG levels between these two groups.Conclusion Urapidil demonstrated better efficacy than nitroglycerin on lowering and stabilizing SBP, attenuating cardiac afterload, and improving cardiac function. Urapidil is a therapeutic option for the elderly patients complicated with hypertension and DM.

Efficacy and safety of ticagrelor combined with primary PCI in elderly patients with ST-elevated acute myocardial infarction

Xu Ji, Hua Qi, Hu Shaodong, Liu Zhi, Li Boyu, Sang Cheng, Xia Jinggang

2015, 36(1):  73-77.  doi:10.3969/j.issn.1006-7795.2015.01.014

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Objective To observe the efficacy and safety of ticagrelor combined with primary percutaneous coronary intervention (PCI) in elderly patients with ST-segment elevated myocardial infarction (STEMI). Methods Totally 113 elderly patients with STEMI were divided into two groups. Patients in ticagrelor group were given aspirin 300 mg/ticagrelor 180 mg; and those in clopidogrel group were given aspirin 300 mg/clopidogrel 600 mg before primary PCI. No-reflow events and thrombolysis in myocardial infarction (TIMI) blood flow in coronary artery after primary PCI, major adverse cardiovascular events(MACE) within one month, bleeding events, dyspnea and malignant ventricular arrhythmia were detected. Results The incidence of no-reflow and MACE of ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). There was no significant difference in bleeding events and malignant ventricular arrhythmia between the two groups. Conclusion Ticagrelor combined with primary PCI in treatment of the elderly patients with STEMI were effective and safe.

Feasibility of single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST elevation myocardial infarction

Guo Jincheng, Wang Guozhong, Zhu Fuli, Chen Wenming, Liu Zijing, Xu Rong, Zhang Libin

2015, 36(1):  78-83.  doi:10.3969/j.issn.1006-7795.2015.01.015

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Objective To investigate the feasibility of using a single guiding catheter (MAC 3.5) for left and right coronary angiography and intervention in patients with ST segment elevation myocardial infarction (STEMI).Methods This was a single-center, prospective, randomized study conducted from August 2011 to April 2012; Totally 150 patients with STEMI indicated for transradial primary PCI performed by an experienced transradial operator were randomized into two groups: MAC group (75 cases) consisted of patients who underwent coronary angiography and primary PCI by using a single guiding catheter (MAC3.5). Control group (75 cases) included patients who first underwent coronary angiography with Tiger diagnostic catheter followed by guiding catheter selection at the operator's discretion for intervention. The primary outcomes were procedural time and fluoroscopic time. The secondary outcomes were complications of puncture site and composite of all-cause death, myocardial infarction or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days. Analysis was done by intention to treat mode.Results Baseline patient characteristics were similar between the MAC group and control group. Crossover from radial access to femoral access (4.0% vs 3.5%), guiding catheter exchange rate (10.7% vs 9.3%), procedure time of coronary angiography[(7.2±2.6) min vs (7.1±2.3) min] and door to balloon time [(86.1±39.4)min vs (88.8±36.3)min] in the two groups were not statistically significant (P>0.05), respectively. Compared with the Control group, PCI procedure time, total procedure time and the overall fluoroscopy time were significantly shorter in MAC group[(23.7±9.6)min vs (29.0±12.0)min, P=0.003; (30.9±10.4) min vs (36.4±12.3)min, P=0.004; (8.4±2.1)min vs (10.2±4.9)min, P=0.007, respectively]. Local hematoma occurred in 3 cases in each of the two groups that improved after physiotherapy. The composite endpoints at 30 days was 6.6%(5/75)in the MAC group compared with 5.3%(4/75)in the control group (χ²=0.118, P=0.731), respectively.Conclusion A single transradial MAC 3.5 guiding catheter for coronary angiography and intervention seems to be a better option for patients with STEMI for whom primary PCI is planned. It can shorten PCI procedure time and fluoroscopy time. Further study is required to determine whether this strategy can favorably affect clinical outcomes.

Analysis of clinical characteristics of hearing loss in diabetes mellitus patients

Gong Jing, Duan Jinping, Liu Bo, Yang Yi, Zhou Yun, Zhuang Xiaoming, Liu Gang, Jin Xin

2015, 36(1):  84-89.  doi:10.3969/j.issn.1006-7795.2015.01.016

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Objective To analyze the differences of hearing function between diabetic and healthy patients, and investigate the factors which affect hearing among diabetics.Methods Questionnaires and pure tone audiometry were performed in 110 patients with type 2 diabetes mellitus who visited Beijing Tongren Hospital, Capital Medical University from October 2011 to December 2013, and compared with 40 age- and sex-matched controls. The patients were categorized into groups according to gender, age, duration of diabetes and glycemic control level. Results In all of the 110 subjects with diabetes, 31 cases complained of hearing loss, pure tone audiometry also confirmed the presence of hearing loss; while 79 cases had normal hearing, 43 cases (54.4%) of them experienced varying degrees of hearing loss. Hearing threshold in each frequency of diabetic group was significantly higher than the normal group, the difference was statistically significant (P=0.000). And the average hearing levels were significantly lower than those of the control group (P=0.000). The proportion of hearing loss for male (46 /60, 76.7%) was significantly higher than that of female (28/50, 56%, P=0.021);the proportion of subjects with hearing loss for all ages, those aged > 40 years (60%, 60.5%, 88.1%) were significantly higher than that of diabetics aged ≤ 40 years (16.7%, 25%, P=0.001). The prevalence of hearing loss for duration with diabetes ≥ 10 years (45/56, 80.4%) was significantly higher than those < 5 years (16/29, 55.2%) and 5≤those < 10 years (13/25, 52.0%, P=0.006). The differences of hearing loss in varied glycemic control levels were not statistically significant (P=0.465). Conclusion There is a higher risk of damage to auditory function in diabetic patients. The patient's subjective feeling does not reflect their hearing accurately. The occurrence of hearing loss is related with duration of diabetes regardless the level of glycemic control.

Application of pure-tone audiometry in patients with impaired glucose regulation

Meng Yan, Liu Gang, Lu Bin, Liu Bo, Zhuang Xiaoming

2015, 36(1):  90-93.  doi:10.3969/j.issn.1006-7795.2015.01.017

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Objective To explore the value of the pure-tone audiometry in auditory function screening among the impaired glucose regulation(IGR) patients. Methods ①Thirty IGR patients without the symptoms of deafness and 30 controls were enrolled in the study. Pure tone audiometry and tympanometry were tested (evaluated). Results The prevalence rate of hearing loss was higher in the IGR group (33.67%) than that in the control group (10%, P<0.05). ②As compared with the control group, the hearing threshold at each frequency in the IGR group was higher, but there were statistically significant differences only at 4 000 and 8 000 Hz (P=0.008, P=0.003). ③Eleven cases in the IGR group had the symptoms of tinnitus, and among them 3 cases had hearing loss. There was no significant difference in the prevalence rate of hearing loss between the cases with hearing loss and those without hearing loss in IGR group (P=0.466). Conclusion The prevalence rate of hearing loss in patients with IGR was significantly increased, and high-frequency hearing loss was more profound. Hearing loss in IGR may occur before the symptom of deafness.

A study on working memory of patients with impaired glucose tolerance by functional magnetic resonance imaging technique

Wu Xiaojuan, Zhuang Xiaoming, He Yueming, Sheng Shuli

2015, 36(1):  94-97.  doi:10.3969/j.issn.1006-7795.2015.01.018

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Objective To investigate the working memory in the patients with impaired glucose tolerance (IGT) by functional magnetic resonance imaging (fMRI). Methods Verbal and objective working memory tasks were performed in 13 patients with IGT and 19 persons with normal glucose tolerance (NGT) while performing fMRI. The cognitive function, memory function and the activation map were analyzed.Results ① There was no significant difference in cognition function between the NGT and IGT group (t=0.459, P=0.635). ②Compared with NGT group, there was less activation of right temporal and superior temporal gyrus (BA22) area in IGT group during word working memory; less activation of right putamen, lenticular body in IGT group during number working memory; less activation of right caudate body in IGT group during object working memory (P<0.01). Conclusion IGT group may have lesions in the classic activation areas during verbal working memory and object memory.

Impaired glucose regulation and hearing impairment

Lu Bin, Duan Jinping, Meng Yan, Wu Xiaojuan, Yan Qian, Zhuang Xiaoming, Liu Bo

2015, 36(1):  98-102.  doi:10.3969/j.issn.1006-7795.2015.01.019

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The incidence of hearing impairment has been increasing significantly in recent years. Epidemiologic studies have demonstrated an increased risk for sensorineural hearing loss in patients with diabetes. The common features of hearing impairment are bilateral sensorineural hearing loss on high-frequency. The pathogenesis is still unconfirmed. Many studies have shown that hearing dysfunction may have a relationship with the diabetic microangiopathy and neuropathy. Pure tone audiometry, distortion product otoacoustic emission and auditory brainstem response are often used to evaluate the function of hearing. Impaired glucose regulation (IGR) is a stage which we call pre-diabetes. People with pre-diabetes often have the microangiopathy and neuropathy. Diabetic microangiopathy and neuropathy.which can damage the inner ear nerve and the microvessel nourishing the nerve to some extent. Both of them may be the causes of hearing impairment.

Effect of Bmi-1 on apoptosis of human fetal striatum derived neural stem cells

Zhao Chunsong, Zou Haiqiang, Yan Xiaoming, Chen Ling, Wang Jiayin, Guan Yunqian, Zhang Y. Alex

2015, 36(1):  103-110.  doi:10.3969/j.issn.1006-7795.2015.01.020

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Objective To explore the effect of Bmi-1 on the apoptosis of human fetal striatum derived neural stem cell (NSC). Methods The NSC was isolated from the striatum of 16-18 week fetus suffered from accidental spontaneous abortion, cultured and passaged 3-5 times in vitro. Bmi-1RNA interference and rescue (over-expression of Bmi-1) experiments were performed by lentivirus. The effects of Bmi-1 on the apoptosis of NSC were then observed.Results The Bmi-1 transcription of human striatum derived NSCs was decreased significantly by RNAi and was reversed by rescue experiments(overexpression of Bmi-1). Correspondingly, both at the time points of 2h and 3d after passaging, the RNAi of Bmi-1 increased the apoptosis significantly. Conclusion Given human fetal striatum derived NSCs, Bmi-1 inhibited their apoptosis in vitro. In the cases studying the effect of Bmi-1 on the self-renewal, proliferation of NSC, the anti-apoptosis effect of Bmi-1 should be taken into consideration.

Change of G-protein expression in the myocardial damage induced by acute brain injury

Guo Caixia, Zeng Xiangjun, Du Fenghe, Chen Buxing

2015, 36(1):  111-115.  doi:10.3969/j.issn.1006-7795.2015.01.021

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Objective To test the effect of G_s-protein and G_q-protein on cardiac damage induced by acute brain injury, and the contribution of β1-ARB and 5-HT_2ARB to G-protein. Methods The Wistar rat model of acute brain injury was built. The mRNA level of G_sα and G_qα were evaluated with real time PCR, and the protein level of G_sα and G_qα were detected by Western blotting assay.Results Compared with NORM group, the mRNA level of G_sα was (92.6±24)% in SHAM group, (39.7±30)% in ABI group and (80.1±12)% in BETA group, respectively. The mRNA level of G_sα was significantly decreased in ABI group compared to SHAM group, but significantly increased in β1-ARB treated BETA group, and there is no difference of G_sα mRNA level between β1-ARB treated BETA and SHAM groups. Compared with NORM group, the protein level of G_qα was (105±30)% in SHAM group, (110±14)% in ABI group and (107±23)% in BETA group. There was no statistical difference among three groups. Conclusion The mRNA and protein of G_sα were significantly decreased after acute brain injury, which indicates the occurrence of myocardial damage induced by acute brain injury may be related to the inhibition in signal transduction pathway mediated G_s-protein. G_s-protein may be in the form of expression change involved in the occurrence of myocardial damage induced by acute brain injury.

Effects of exogenous hydrogen sulfide on autophagy of HepG2 cells

Chen Ning, Wang Shanshan, Chen Yuhan, Yin Jiming, Chen Dexi, Ding Huiguo

2015, 36(1):  116-120.  doi:10.3969/j.issn.1006-7795.2015.01.022

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Objective To investigate the effects of exogenous hydrogen sulfide (H₂S) on the autophagy of HepG2 cells and its underlying mechanism.Methods HepG2 cells were administrated by sodium hydrosulfide (NaHS), a donor of H₂S, for 24h, the expression of autophagy-related protein LC3-Ⅱ was detected via Western blotting; The mRNA level of autophagy related gene beclin1 and atg5 were detected via RT-PCR. The autophagy particles and apoptosis were observed using immunofluorescence. AnnexinV/PI flow cytometry were performed to assess the effect of NaHS on cell apoptosis. Results NaHS enhanced the autophagy-related protein (LC3-Ⅱ) expression and beclin1 mRNA, atg5 mRNA and autophagosome formation compared with control. 3-MA could inhibit NaHS-induced autophagy.Immunofluorescence showed the M30 positive cells were significantly increased compared with the controls.Additionally, both the nuclear heterochromatin and apoptotic bodies were significantly increased. Flowcytometry showed that NaHS increased the apoptosis rate of HepG2 cells. Conclusion The autophagy is induced by exogenous hydrogen sulfide through the autophagy related genes (beclin1 and atg5), and can promote apoptosis in HepG2 cells.

A high-sensitivity UPLC-MS/MS determination for triptolide in rat plasma and its pharmacokinetics

Qin Chunyu, Zhou Tao, Gong Wenwen, Bai Lu, Qin Yi, Xu Weizhe, Xu Pingxiang, Wang Xiaomin, Xue Ming

2015, 36(1):  121-126.  doi:10.3969/j.issn.1006-7795.2015.01.023

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Objective To develop a high-sensitivity liquid chromatographic(UPLC) assay for determing the triptolide in rats plasma and to study the pharmacokinetics of triptolide in rats. Methods Sprague Dawley rats were given triptolide at the doses of 40 μg/kg and 200 μg/kg via oral administration and i.v. administration.The samples of plasma were collected at different times after administration and a ultra performance liquid chromatography-mass spectrometer/mass spectrometer(UPLC-MS/MS) was developed to determine the concentration of triptolide in biological samples.The plasma samples were extracted by ethylacetate and separated by a C18 reversed-phase column with a cycle time of 4 min. Results The linear range of 0.1-200.0 ng/mL, and lower limits of detection of 0.05 ng/mL and quantification of 0.1 ng/mL were established. This method was successfully applied to determine triptolide in rat plasma.The mean recovery was more than 95%. The relative standard deviation(RSD) of intra-day and inter-day were all less than 15%. After oral administration of triptolide with two dosages(40 and 200 μg/kg) to rats, the corresponding distribution half-time were 1.45, 3.05 h, respectively and the half-time of iv administration was 12.47 min.Conclusion This method is convenient, accurate and reliable. It can be used for determining the triptolide in rats plasma and pharmacokinetic studies

Effect of chronicunpredictable stress on neurotransmitter and hypothalamic-pituitary-adrenal axis in rats

Yang Yilong, Yao Xiaoquan, Wang Yali, Wang Haizheng, Ouyang Junyao, Liu Sisi, Wang Lei, Zhang Qiuxia, Zhao Hui

2015, 36(1):  127-131.  doi:10.3969/j.issn.1006-7795.2015.01.024

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Objective To investigate the effect of chronic unpredictable stress (CUS) on neurotransmitter and hypothalamic-pituitary-adrenal axis(HPA)in rats. Methods Totally 16 male SD rats were randomly divided into normal group and model group. The model group was established by chronic unpredictable stress. The weights of rats were examined every day.The behavior changes of rats were observed by the sucrose preference test. The contents of dopamine(DA), 5-hydroxeytryptamine(5-HT)inhippocampus were measured by High performance liquid-electrochemical method. And the secretion of glutamic acid(Glu), γ-aminobutyric acid(γ-GABA) in hippocampus were determined by the method of high-effective liquid chromatography fluorescence.The concentrations of corticotropin-releasing hormone(CRH), adrenocorticotropic hormone (ACTH), corticosterone (CORT) in plasma and hypothalamus were tested by Radioimmunoassay(RIA)method. Results Compared with the normal group, the model group's weight was significantly reduced. The consumption of sucrose was decreased in model group. The contents of DA, γ-GABA in hippocampus was significantly reduced in model group, and the 5-HT, Glu had the trend of increase.The adrenocorticotropic hormone(ACTH) in hypothalamus was significantly decreased and the plasma's corticosterone(CORT) was significantly increased in model group.Conclusion The chronic unpredictable stress (CUS) could induce the changes of animal behavior and abnormalities of neurotransmitter and hypothalamic pituitary adrenal (HPA)axis.

Protective effect of postconditioning on myocardial ischemic reperfusion injury in aged rats

Wang Mengran, Zhang Jian, Liang Yanhong, Chen Yanrong, Li Min, Xiao Yao, Xiu Hui

2015, 36(1):  132-136.  doi:10.3969/j.issn.1006-7795.2015.01.025

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Objective To study the effect of ischemic postconditioning(IPC) on cardiomyocyte apoptosis of aged rats with myocardial ischemia reperfusion. Methods The aged(22-24 months) male Wister rats were randomly divided into 3 groups(30 animals in each group): aged sham group, aged ischemic reperfusion group and aged ischemic postconditioning group. Rats in the ischemic reperfusion groups were subjected to 40 minutes of myocardial ischemia by ligating the left anterior descending coronary artery(LAD), followed by a release of the ligature and 6 h of reperfusion. Ischemic postconditionging groups were treated for 40 minutes ischemia, followed by three 10 s cycles of reperfusion and re-occlusion applied at the onset of 6 h of reperfusion. A silk suture around the LAD was not ligated in the sham-operation groups. Myocardial apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) staining. The levels of superoxide dismutase(SOD) and malonaldehyde(MDA) in serum were detected by colorimetry. Results The aged rat hearts had markedly decreased cardiomyocyte apoptosis in the IPC compared with the IRG[AI(%):45.51±8.81 vs 53.99±10.54, P<0.01]. The serum levels of SOD were higher in the IPC than that in the IRG(277.70±29.55 vs 303.72±25.25, P<0.05), while lower levels of MDA were found in the IPC(25.02±2.35 vs 22.54±2.64, P<0.05). Conclusion The IPC can inhibit cardiomyocyte apoptosis induced by the ischemic reperfusion injury, probably results from the increased antioxidant efficiency while decreased oxidative damage. The IP has protective effects on the acute aged ischemic reperfusion myocardium.

The perioperative variation of blood glucose and lactate in cardiac surgery patients with cardiopulmonary bypass

Li Yaqiong, Xu Dong, Shang Xuebin, Zhang Kefeng, Zhang Rui

2015, 36(1):  137-140.  doi:10.3969/j.issn.1006-7795.2015.01.026

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Objective Retrospective study was carried out for perioperative variation of blood glucose and lactate in cardiac surgery patients with cardiopulmonary bypass. Methods From January to December in 2013, 58 adult patients undergoing cardiac surgery with cardiopulmonary bypass were selected and these patients were divided into non - diabetic group and diabetic group according to whether patients have had diabetes mellitus preoperatively. According to the cardiopulmonary bypass time patients were divided into CPB time less than two hours group(group A)and more than two hours group(group B). The perioperative trends of blood glucose and lactate levels were observed, and the related clinical data were analyzed.Results Totally 58 patients CPB time were 59-315[average time:(126.07±50.74)]minutes and aorta cross-clamping time were 35-161[(average time:(67.61±22.95)]minutes, and the automatic heart beat recovery rate is 52%. Blood glucose and lactate levels were increased gradually after induction of anesthesia during operation. The Pearson test shows a positive correlation between blood glucose and lactate. Blood glucose levels rose to the highest level at the end of the surgery and then gradually decreased. Conclusion Effects of cardiopulmonary bypass on perioperative blood glucose in diabetic patients is more obvious, perioperative glycemic control can help lower blood lactate levels. Improving the management of CPB, can help to lower the perioperative blood glucose and lactate levels, thereby reducing complications and improving the prognosis.

Effect of the protein intake on the patients' handgrip strength and the incidence of hypertension in the middle aged and elderly people in Zhangfang Village,Fangshan District,Beijing

Hong Zhongxin, Wang Jia

2015, 36(1):  141-146.  doi:10.3969/j.issn.1006-7795.2015.01.027

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Objective To investigate the effect of the protein intake on the patients' handgrip strength and the incidence of hypertension in the middle aged and elderly people.Methods Totally 134 middle aged and elderly villagers in Zhangfang village, Fangshan district, Beijing were selected randomly. According to the intake of protein, the villagers were separated into two groups, relatively high protein(RHP) group and relatively low protein(RLP) group. The diet intake was investigated using 24-hour dietary review method. Then the nutrients and energy intake were calculated. We measured the handgrip, the blood pressure and blood glucose using grip dynamometer, electronic sphygmomanometer and glucometer, respectively. We measured the parameters of anthropometry. Then we surveyed the daily life habit, such as sleeping and exercise. Then we used Student's t test and χ² test to analyze the difference of indexes between two groups.Results The handgrip strength and arm muscle circumference were higher in RHP group than those in RLP group.The staple food, vegetable and fruit, fish and meat, egg, bean curd and oil were higher in RHP group than those in RLP group. The carbohydrate, fat, dietary fiber and energy were higher in RHP group than those in RLP group. The morbidity of hypertension was lower in RHP group than that in RLP group.Conclusion The dietary pattern in the villagers surveyed was imbalance. The low protein intake may be related to the low handgrip strength and the high morbidity of hypertension. To some extent, increasing the protein intake is likely to enhance the handgrip strength and reduce the morbidity of hypertension.

Recent advances in surgical timing of myelotomy after traumatic spinal cord injury

Yang Degang, Li Jianjun, Yang Mingliang, Hu Anming, Gu Rui, Du Liangjie

2015, 36(1):  147-150.  doi:10.3969/j.issn.1006-7795.2015.01.028

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The prevalence of traumatic spinal cord injury(TSCI) is increasing year by year, and there is no fundamental change in its prognosis, therefore it seriously influences the patients' health and quality of life. After trauma, spinal cord hemorrhage and swelling without damage of the dura matter increase subdural pressure and results in exacerbation of ischemia and hypoxia, which aggravate secondary damage. Myelotomy cuts open dura, pia matter and swelling spinal cord, and evacuates necrotic tissues, which could be a potential therapeutic method for SCI. However, there is no standardized operational process on myelotomy in the treatment of TSCI. Here issues related to the surgical timing of myelotomy after traumatic spinal cord injury are discussed.

Application of statistical model to study of the impact of PM_2.5 on population morbidity and mortality

Xu Qin, Liu Long, Wang Chao, Cao Kai, Gao Qi, Guo Xiuhua

2015, 36(1):  151-154.  doi:10.3969/j.issn.1006-7795.2015.01.029

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There are a lot of studies regarding the impact of PM_2.5 on population morbidity and mortality by using the statistical model at home and abroad. Based on the characteristics of time series model, the Logistic regression model, Cox proportional hazards regression model and poisson regression model, the application of these models were reviewed in the paper, and the limitation of different statistical models in the study of PM_2.5 were analyzed.