To the Editor: Patients with coronary heart disease (CHD) complicated by coronavirus disease 2019 (COVID-19) are at an increased risk of coronary events. Many studies have reported an association between cardiovascular disease and COVID-19. It is also known that patients with COVID-19 have worse outcomes and an increased mortality risk if they have cardiovascular disease.[1] According to a report by the World Health Organization, the estimated COVID-19 mortality rate is about 3.4% overall; however, in patients with cardiovascular disease, this figure increases to 10.5%, which is higher than the death rate in those with underlying diabetes (7.3%) or chronic respiratory diseases (6.3%).[2] Several components in blood, including platelets and neutrophils, have an important role in ischemic heart disease, and particularly in acute myocardial infarction. White blood cells and their subtypes have been investigated as inflammatory biomarkers of adverse cardiovascular outcomes. COVID-19 infection has a considerable effect on the constituents of blood. In this retrospective observational study, we reviewed our patients with stable angina pectoris (AP) and COVID-19 treated between February 2020 and April 2020 with the aims of understanding better the relationship between these two conditions and providing guidance for clinical practice. This study was approved by the Research Ethics Committee of The Fourth Affiliated Hospital of China Medical University (No. EC-2022-KS-024). The Ethics Committee of The Fourth Affiliated Hospital of China Medical University approved a waiver of informed consent. Data were collected for 83 patients with stable AP and COVID-19 who were treated for COVID-19 at Wuhan Thunder God Mountain Hospital in February and March 2020 and for 49 patients with stable AP treated at Shenyang Fourth People's Hospital in March and April 2020. Information was collected including age, sex, clinical symptoms, complications, electrocardiographic findings, blood biochemistry, neutrophil count, lymphocyte count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), mean platelet volume-to-lymphocyte ratio (MPVLR), myocardial enzymes, and muscle calcium. COVID-19 was diagnosed in all 83 cases at Wuhan Thunder God Mountain Hospital by a positive result of the reverse transcription polymerase chain reaction assay, and a computed tomography scan of the chest. All patients were classified as common type (83 cases, 100%) according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Version 6).[3] Angina attack was identified by constricting discomfort in the chest or neck, shoulders, jaw or arms; precipitated by physical exertion; and relieved by rest or nitrates within about 5 to 10 min.[4] A total of 83 patients in the COVID-19 + stable AP group were divided into a COVID-AP event (attacks of angina) group (n = 50) and a COVID-no AP event group (n = 33). Symptoms of attacks of angina in the COVID-AP event group consisted of chest pain (n = 25, 50.0%), chest tightness (n = 12, 24.0%), shortness of breath (n = 9, 18.0%) and toothache (n = 4, 8.0%). Thirty-one (62.0%) patients in this group had electrocardiographic changes. A total of 49 patients with stable AP alone served as a control group. Blood components that were confirmed to be distributed in an approximately normal manner by the Kolmogorov–Smirnov test are expressed as the mean and standard deviation; those that were not are expressed as the median (Q1, Q3). Categorical variables, including sex, smoking status, comorbidities such as hypertension, diabetes mellitus, and ischemic stroke are shown as numbers and percentages. Differences in blood components and background characteristics were compared between groups using the Student's t-test, Fisher's exact test, chi-squared test, or Mann–Whithney U test as appropriate. Odds ratios (ORs) and 95% confidence intervals (CIs) for blood components and other risk factors for the attacks of angina in patients with stable AP complicated by COVID-19 were estimated using univariable and unconditional multivariable logistic regression analyses. All statistical analyses were performed using SPSS for Windows software (version 19.0; IBM Corp., Armonk, NY, USA). All tests were two-sided, and a P value of <0.05 was considered statistically significant. There was no significant difference in patient sex (51.1% vs. 51.8%, P = 0.931) or mean age (65.57 ± 7.48 years vs. 64.87 ± 7.13 years, P = 0.585) between the control group and the COVID-19 + stable AP group; moreover, there was no significant between-group difference in the rate of smoking, hypertension, diabetes, or ischemic stroke (all P >0.05, Table 1). Similarly, there was no statistically significant difference in sex or age distribution or in smoking history, hypertension, diabetes, or ischemic stroke between the COVID-AP event group and the COVID-no AP event group (all P >0.05, Table 1). Table 1 - Demographic and clinical data of patients with COVID-19 and stable angina (with or without attacks of angina) and a control group with stable angina alone. Characteristics Stable AP (control) group (n = 49) COVID-19 + stable AP group (n = 83) P-value COVID-19 + stable AP with attacks of angina (n = 50) COVID-19 + stable AP without attacks of angina (n = 33) P-value Age (years) 65.57 ± 7.48 64.87 ± 7.13 0.585 66.86 ± 6.66 61.67 ± 6.82 0.471 Sex 0.931 0.396 Female 24 (48.9) 40 (48.2) 26 (52.0) 14 (42.4) Male 25 (51.1) 43 (51.8) 24 (48.0) 19 (57.6) Smoking history 0.434 0.961 No 30 (61.2) 45 (54.2) 27 (54.0) 18 (54.5) Yes 19 (38.8) 38 (45.8) 23 (46.0) 15 (45.5) Hypertension 0.675 0.563 No 29 (59.2) 50 (60.2) 33 (66.0) 17 (51.5) Yes 20 (40.8) 33 (39.8) 17 (34.0) 16 (48.5) Diabetes mellitus 0.790 0.894 No 38 (77.5) 66 (79.5) 40 (80.0) 26 (78.8) Yes 11 (22.5) 17 (20.5) 10 (20.0) 7 (21.2) Ischemic stroke 0.733 0.862 No 44 (89.8) 76 (91.6) 46 (92.0) 30 (90.9) Yes 5 (10.2) 7 (8.4) 4 (8.0) 3 (9.1) Neutrophil count (×109/L) 3.91 ± 1.02 5.80 ± 1.58 0.041 6.47 ± 1.41 4.58 ± 1.52 0.002 Platelet count (×109/L) 196.34 ± 42.37 192.30 ± 31.96 0.412 201.16 ± 28.74 175.55 ± 31.47 0.006 MPV (fL) 8.12 ± 1.65 11.50 ± 2.12 0.034 11.88 ± 1.64 8.77 ± 0.79 0.003 Lymphocyte count (×109/L) 1.91 ± 0.46 1.14 ± 0.39 0.047 1.05 ± 0.40 1.23 ± 0.43 0.036 NLR 8.83 (5.79, 14.90) 10.14 (6.08, 14.51) 0.473 11.85 (7.50, 15.54) 7.42 (5.45, 10.33) 0.013 PLR 169.35 (104.25, 196.9) 182.03 (116.88, 266.77) 0.021 220.00 (147.01, 283.33) 127.42 (97.87, 187.73) 0.001 MPVLR 6.48 (4.63, 13.96) 9.84 (5.79, 14.09) 0.772 11.69 (7.42, 15.57) 6.59 (4.97, 10.11) 0.003 Continuous data are presented as mean and standard deviation or median (Q1, Q3) and categorical data as the number (percentage). AP: Angina pectoris; COVID-19: Coronavirus disease 2019; MPV: Mean platelet volume; MPVLR: Mean platelet volume-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio. Compared with the control group, the COVID-19 + stable AP group had a significantly higher neutrophil count (P= 0.041), MPV (P= 0.034), lymphocyte count (P = 0.047) and PLR (P= 0.021). However, there was no statistically significant between-group difference in the platelet count, NLR, or MPVLR (all P >0.05, Table 1). The platelet count, neutrophil count, MPV, NLR, PLR, and MPVLR were significantly higher in the COVID-AP event group than in the COVID-no AP event group (P = 0.006, 0.002, 0.003, 0.013, 0.001, and 0.003, respectively, Table 1). The lymphocyte count was significantly lower in the COVID-AP event group (P = 0.036). Univariable logistic regression analysis showed that the risk factors for attacks of angina in patients with COVID-19 and stable AP were neutrophil count (OR 3.248, 95% CI: 1.859–5.678, P <0.001), lymphocyte count (OR 0.241, 95% CI: 0.073–0.798, P = 0.020), platelet count (OR: 1.013, 95% CI: 1.000–1.026, P = 0.042), PLR (OR 1.014, 95% CI: 1.005–1.022, P = 0.026), MPVLR (OR 1.212, 95% CI: 1.078–1.362, P = 0.001), NLR (OR 1.196, 95% CI: 1.063–1.346, P = 0.003), and MPV (OR 2.547, 95% CI: 1.516–4.282, P = 0.033), but not smoking (OR 0.892, 95% CI: 0.370–2.150, P = 0.800), diabetes mellitus (OR 1.011, 95% CI: 0.342–2.987, P = 0.984), hypertension (OR 1.185, 95 CI: 0.492–2.856, P = 0.705), or lymphocyte count (OR 0.241, 95% CI: 0.073–0.798, P = 0.020). Multivariable logistic regression analysis identified risk factors for the attacks of angina in patients with COVID-19 and stable AP to be neutrophil count (OR 2.501, 95% CI: 1.322–4.733, P = 0.008), and MPV (OR 3.077, 95% CI: 1.094–8.658, P = 0.033), but not smoking (OR 0.222, 95% CI: 0.020–2.443, P = 0.219), hypertension (OR 3.886, 95% CI: 0.361–41.860, P = 0.263), diabetes mellitus (OR 1.138, 95% CI: 0.288–4.491, P = 0.854), or any other blood parameter (lymphocyte count, OR 0.262, 95% CI: 0.018–3.899, P = 0.331; platelet count, OR 0.991, 95% CI: 0.961–1.022, P = 0.564; NLR, OR 0.489, 95% CI: 0.158–1.511, P = 0.214; PLR, OR 1.004, 95% CI: 0.975–1.034, P = 0.792; MPVLR, OR 1.704, 95% CI: 0.722–4.017, P = 0.224). Our statistical analysis revealed significant differences in the neutrophil count and MPV between the control group and the COVID + stable AP group and between the COVID-AP event group and COVID-no AP event group. Therefore, for patients with COVID-19 and stable AP, components of blood should be investigated to identify risk factors for attacks of angina. Patients with COVID-19 and stable AP have a high mortality risk, and there may be a pathogenic relationship between COVID-19 and CHD, which could involve hematological abnormalities. COVID-19 infection alters inflammatory marker levels in the blood, which can cause an excessive immune inflammatory response, leading to many hematological abnormalities, including lymphopenia, neutrophilia, and an increased platelet count. These changes can be used to evaluate the severity of infectious diseases.[5] At present, an increasing number of studies found that components of blood, including neutrophils, MPV, and the NLR, are related to CHD.[6] In this study, the neutrophil count and MPV were higher in patients with COVID-19 than in those without COVID-19 and also higher in patients with COVID-19 who had attacks of angina than in their counterparts who did not have. Therefore, the immune response and inflammation caused by COVID-19 may be related to the occurrence of coronary ischemia. Logistic regression analysis showed that the relative risk of neutrophil count and MPV for attacks of angina was >1, which suggests that these two parameters were risk factors for acute ischemia in patients with COVID-19 and stable AP. An association of the neutrophil count and MPV with AP has been reported and may be due to the significant increase in neutrophil elastase and vascular endothelial injury caused by neutrophil extracellular traps, thrombosis, increased platelet adhesion, and a decreased coronary collateral circulation.[7,8] Moreover, the coronary collateral circulation is negatively correlated with MPV, indicating that the increase in MPV may contribute to coronary ischemia attack.[9] It has been reported in the literature that systemic inflammation or the cytokine storm caused by COVID-19 can induce coronary vasospasm and coronary microthrombosis, which are followed by AP.[1] It seems probable that COVID-19 and stable AP are linked via abnormalities in the components of blood. However, this is more than one possibility, and there are still many unknown reasons to be identified. The findings of this study suggest that a high neutrophil count and a high MPV increase the risk of attacks of angina in patients with stable AP who develop COVID-19. Acknowledgment We thank Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript. Funding This study was partially supported by a grant from the COVID-19 Foundation of China Medical University (No. 1210120011). Conflicts of interest None.

目的 探讨hsa_circ_0004771对顺铂(DDP)耐药胃癌细胞增殖、凋亡和迁移的影响.方法 体外培养胃癌细胞HGC-27和顺铂耐药胃癌细胞HGC-27/DPP,用实时定量聚合酶链反应(RT-qPCR)法检测hsa_circ_0004771和miR-149的表达水平.用双荧光素酶报告基因实验验证HGC-27/DPP细胞中hsa_circ_0004771和miR-149的调控关系.将HGC-27/DPP细胞分为hsa_circ_0004771小干扰RNA(si-hsa_circ_0004771)组(转染si-hsa_circ_0004771)、小干扰RNA阴性对照(si-NC)组(转染si-NC)、miR-149组(转染miR-149模拟物)、模拟对照序列(miR-NC)组(转染miR-NC)、si-hsa_circ_0004771+miR-149抑制剂(anti-miR-149)组(共转染si-hsa_circ_0004771和anti-miR-149)、si-hsa_circ_0004771+抑制剂阴性对照序列(anti-miR-NC)组(共转染si-hsa_circ_0004771和anti-miR-NC),用细胞计数试剂盒-8(CCK-8)法和克隆形成实验检测细胞的增殖情况,用流式细胞术检测细胞的凋亡情况,用划痕实验检测细胞的迁移情况.结果 HGC-27和HGC-27/DPP细胞中hsa_circ_0004771相对表达水平分别为1.00±0.00和3.60±0.20,miR-149相对表达水平分别为1.00±0.00和0.12±0.01,差异均有统计学意义(均P<0.05).hsa_circ_0004771在HGC-27/DPP细胞中靶向调控miR-149.si-hsa_circ_0004771组、si-NC组、miR-149组、miR-NC组、si-hsa_circ_0004771+anti-miR-149组和si-hsa_circ_0004771+anti-miR-NC组的细胞抑制率分别为(54.03±2.38)％,0,(47.27±3.18)％,0,(17.65±1.25)％ 和(54.52±2.20)％,集落形成数分别为(44.67±1.25),(104.00±2.94),(54.33±2.49),(104.00±3.56),(91.33±3.86)和(45.00±1.63)个,凋亡率分别为(22.35±1.56)％,(8.31±0.46)％,(19.52±1.03)％,(8.10±0.44)％,(22.35±1.50)％和(13.48±0.80)％,划痕愈合率分别为(27.14±1.21)％,(64.82±2.41)％,(34.08±1.18)％,(65.02±2.43)％,(50.67±2.92)％和(27.15±1.35)％.si-hsa_circ_0004771组的上述指标与si-NC组比较、miR-149组的上述指标与miR-NC组比较、si-hsa_circ_0004771+anti-miR-149组的上述指标与si-hsa_circ_0004771+anti-miR-NC组比较,差异均有统计学意义(均P<0.05).结论 hsa_circ_0004771在顺铂耐药胃癌细胞中表达升高,干扰其表达可能通过上调miR-149的表达,进而抑制顺铂耐药胃癌细胞的增殖和迁移,并诱导细胞凋亡.

目的:探讨舍曲林对肠易激综合征(IBS)大鼠环磷酸腺苷(cAMP)/环磷酸腺苷依赖性蛋白激酶A(PKA)通路及肠道炎症反应的影响.方法:采用母婴分离加醋酸灌肠联合结直肠扩张刺激法制备IBS大鼠模型,并将造模成功大鼠随机分为模型组、舍曲林低(10 mg/kg)、中(20 mg/kg)、高(30 mg/kg)剂量组和阳性对照组(匹维溴铵,2 mg/kg),每组15只,另取15只正常大鼠作为对照组,大鼠发育至9周龄时开始灌胃给药,对照组和模型组给予等体积生理盐水,其他各组给予相应药物,2次/d,连续10 d,10 ml/kg.末次给药结束后,观察记录各组大鼠一般情况、粪便含水量和排便时间;腹部撤回反射(AWF)评分法检测大鼠内脏敏感性;HE染色观察各组大鼠结肠组织病理学变化;ELISA检测各组大鼠结肠组织中TNF-α、IL-1β、IL-6和cAMP含量;Western blot检测各组大鼠结肠组织cAMP和PKA蛋白表达及cAMP反应元件结合蛋白(CREB)磷酸化水平.结果:对照组大鼠精神状态良好,发育正常,皮毛光亮,结肠组织肠黏膜屏障结构完整,无炎症因子浸润.与对照组相比,模型组大鼠状态较差,情绪烦躁易怒,活动较少,结肠组织出现明显水肿,肠黏膜完整性受损,出现大量炎症细胞浸润,排便时间、cAMP含量、cAMP、PKA蛋白表达及CREB磷酸化水平显著降低(P<0.05),粪便含水量、内脏敏感性、TNF-α、IL-1β和IL-6含量显著升高(P<0.05);与模型组相比,舍曲林低、中、高剂量组大鼠不良症状逐渐缓解,排便时间、cAMP含量、cAMP、PKA蛋白表达及CREB磷酸化水平依次升高(P<0.05),粪便含水量、内脏敏感性、TNF-α、IL-1β和IL-6含量依次降低(P<0.05);舍曲林高剂量组与阳性对照组各项指标差异无统计学意义(P>0.05).结论:舍曲林可剂量依赖性改善IBS大鼠肠道炎症反应,可能与上调cAMP/PKA通路有关.

目的 探讨不同剂量利福昔明联合益生菌治疗腹泻型肠易激综合征(IBS-D)合并小肠细菌过度生长(SIBO)的效果.方法 选择河北医科大学第一医院自2017年5月至2019年12月收治的114例IBS-D合并SIBO患者,按照随机数表法分为A组、B组和C 组,每组38例.所有患者均采用马来酸曲美布汀片及益生菌治疗,在此基础上A、B、C组分别应用低剂量(0.8 g/d)、中剂量(1.2 g/d)、高剂量(1.6 g/d)利福昔明治疗.比较3组的临床疗效、临床症状体征总积分、SIBO转阴率、血清炎性因子水平、呼出气一氧化氮(eNO)体积分数及不良反应发生率.结果 治疗4周后,C组的总有效率(94.74%比71.05%、78.95%)、SIBO转阴率(92.11%比65.79%、73.68%)均较A组、B组明显升高(P均＜0.05).治疗后3组的临床症状体征总积分、血清IL-1β和IL-18水平及eNO体积分数均较治疗前明显降低(P均＜0.05),且C组的上述指标均较A组、B组明显降低(P均＜0.05).治疗后3组的血清IL-10水平均较治疗前明显升高(P均＜0.05),且C组的血清IL-10水平较A组、B组明显升高(P均＜0.05).A组、B组、C 组的不良反应发生率(7.89%、15.79%、18.42%)差异无统计学意义(P＞0.05).结论 对IBS-D合并SIBO患者给予高剂量利福昔明联合益生菌治疗的效果优于低、中剂量利福昔明联合益生菌治疗,可明显改善临床症状,提高SIBO转阴率,有效缓解肠道炎性反应,并且用药的安全性较好.

Background: Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP. Methods: Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors. Results: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. Conclusion: This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.

目的 分析不同疾病程度溃疡性结肠炎(UC)患者的肠道屏障功能及小肠细菌过度生长(SIBO)情况.方法 选取2016年5月至2018年10月就诊于该院的确诊UC患者126例,按照Southerland疾病活动指数分为症状缓解期组(n=20)、轻度活动组(n=42)、中度活动组(n=46)及重度活动组(n=18),采用乳果糖氢呼气试验(LHBT)检测患者SIBO情况,测定患者红细胞沉降率、C反应蛋白(CRP)、粪便钙卫蛋白(FC)、大便白细胞计数及肠道屏障功能指标水平[血清D-乳酸、二胺氧化酶(DAO)、细菌内毒素(LPS)].结果 除轻度活动组与中度活动组患者CRP水平无明显差异(P>0.05),红细胞沉降率、FC水平、大便白细胞计数、CPR水平在其余各组间两两比较,差异均有统计学意义(P<0.05).症状缓解期组、轻度活动组、中度活动组、重度活动组患者LHBT阳性率分别为10.0％、4.8％、23.9％、88.9％,差异有统计学意义(χ2=51.326,P<0.05).重度活动组患者DAO水平明显高于其他组(P<0.05),4组患者血清D-乳酸及LPS水平无明显差异(P>0.05).肠道屏障中DAO与患者LHBT阳性率呈正相关(R=0.87,P<0.05),D-乳酸及LPS水平与LHBT阳性率无明显相关性(P>0.05).结论 UC患者肠道屏障受损,主要表现为DAO升高,并与患者SIBO相关,可以通过氢呼气试验检测患者的小肠过度生长情况,为患者病情评估及治疗提供依据.

目的 观察复合乳酸菌胶囊联合艾司西酞普兰口服治疗合并小肠细菌过度生长(SIBO)的抑郁症患者的临床效果.方法 82例合并SIBO的抑郁症患者按照随机数字表法分为治疗组和对照组,对照组给予艾司西酞普兰治疗(1次10 mg,每天1次),治疗组在对照组的基础上给予复合乳酸菌胶囊(1次0.66 g,每天3次)治疗,两组均治疗7 d.比较两组治疗总有效率、汉密顿焦虑量表评分(HAMA)、汉密顿抑郁量表(HAMD)评分及小肠细菌阴性率,炎性因子水平[肿瘤坏死因子(TNF-α)、白细胞介素-2(IL-2)],外周血T淋巴细胞比例[成熟T细胞(CD3+T)、抑制性T淋巴细胞(CD8+T)、辅助性T淋巴细胞(CD4+T)比例、CD4+T/CD8+T],不良反应发生率.结果 治疗组总有效率、小肠细菌阴性率分别为90.24％、87.80％,明显高于对照组68.29％、65.85％(P均<0.05);两组HAMA评分、HAMD评分较治疗前均降低(P均<0.05),以治疗组为著(P均<0.05);两组IL-2、TNF-α、CD8+T细胞比例较治疗前均降低(P均<0.05),以治疗组为著(P均<0.05);两组CD3+T比例、CD4+T比例及CD4+T/CD8+T较治疗前均升高(P<0.05),以治疗组为著(P均<0.05);治疗组不良反应发生率低于对照组(7.32％比26.83％,P均<0.05).结论 复合乳酸菌胶囊联合艾司西酞普兰口服治疗合并SIBO的抑郁症疗效显著,可降低患者抑郁、焦虑程度,有效杀灭小肠细菌,减轻炎性反应,调节外周血T淋巴细胞亚群平衡,减少不良反应发生率.

目的 探讨塞来昔布对幽门螺杆菌(Helicobacter pylori,H.pylori)感染的胃癌细胞凋亡及炎症反应的影响及机制.方法 以终浓度为50、75、100μmol/L的塞来昔布作用于H.pylori感染的人胃癌SGC-7901细胞,MTT法检测作用24、48和72 h的细胞增殖;作用48 h,流式细胞术检测细胞凋亡率,Western blotting检测PCNA、Bcl-2、Bax和p-AKT3蛋白表达,qRT-PCR检测IL-6、IL-8和miR-145表达.双荧光素酶报告基因实验检测miR-145和AKT3的靶向关系.结果 不同浓度塞来昔布均可明显抑制SGC-7901细胞增殖,且呈剂量、时间依赖性(P<0.05).不同浓度塞来昔布均可明显促进细胞凋亡,下调PCNA、Bcl-2、p-AKT3、IL-6和IL-8表达,上调Bax和miR-145表达,呈剂量依赖性(P<0.05).双荧光素酶报告基因实验结果显示,miR-145和AKT3存在靶向关系.结论 塞来昔布可抑制H.pylori感染的胃癌细胞增殖,促进细胞凋亡,降低炎症因子IL-6和IL-8表达,机制可能与塞来昔布引起miR-145表达改变进而调控其靶基因AKT3表达有关.

BACKGROUND:An association between left ventricular end-diastolic pressure (LVEDP) and outcomes of ischemic heart diseases has been reported. The present study aimed to investigate the LVEDP patterns and the effecting factors in patients with acute ST-segment elevation myocardial infarction (STEMI).METHODS:A total of 515 STEMI patients receiving immediate percutaneous coronary intervention (PCI) were divided into two groups according to their LVEDP before left ventricular angiography: LVEDP of 15 mmHg or less (group A, n=145) and LVEDP above 15 mmHg (group B, n=370). Blood samples were collected before and within 24 hours after PCI, and an ultrasonic cardiogram was conducted to measure left ventricular ejection fraction (EF%) and to evaluate ventricular structure changes. The narrowness of each artery was measured with coronary angiography.RESULTS:In comparison with group A, patients in group B had a more infarction-related artery (IRA) descending branch and regional wall motion abnormality, a larger left atrial end-diastolic diameter (LAEDd) and a left ventricular end-diastolic diameter (LVEDd), a smaller EF%, a higher level of myocardial necrosis markers, and a higher heart failure rate. Furthermore, LVEDP level was found to be positively correlated with Gensini score, LAEDd, LVEDd, N-terminal pro b-type natriuretic peptide, troponin T, uric acid, creatine kinase (CK), CK myocardial band, low-density lipoprotein cholesterol and fasting blood glucose, and negatively correlated with glomerular filtration rate and EF%.CONCLUSIONS:LVEDP elevation has a higher incidence of heart failure and a higher risk of death, which is associated with the criminal blood vessels.

目的 探讨血尿酸与老年急性ST段抬高型心肌梗死(STEMI)患者的冠状动脉病变严重程度及预后的关系.方法 回顾性分析2年内(2017年1月—2018年12月)于中国医科大学附属第四医院住院首次行冠状动脉造影的171例老年(年龄≥60岁)STEMI患者.根据血尿酸水平分为高尿酸血症组(25例)及正常组(146例),根据冠脉病变支数分为单支病变组(85例)、两支病变组(59例)及三支病变组(27例).比较入院临床资料;分析两组中冠脉病变程度;分析两组心脏彩超检查.结果 (1)高尿酸血症组SYNTAX评分[(19.98±2.01)分]显著高于正常组[(13.45±2.03)分],两组比较差异有统计学意义(P<0.05);在亚组冠脉病变支数两支及三支病变中,SYNTAX评分在高尿酸血症组均高于正常组,均有统计学意义(P<0.05);(2)两组比较,左室射血分数(LVEF)有明显差异(P<0.05).结论 在老年STEMI患者中,血尿酸水平与冠状动脉病变严重程度及其预后有重要意义.

Growing evidence shows that circRNA acts as an miRNA sponge to regulate a variety of tumor types. Gastric carcinoma is one of the most malignant cancers. However, the functions of circRNA and its associated regulatory mechanisms remain largely unknown. In this study, we used quantitative real-time PCR (qRT-PCR) to determine that the circKIF4A expression is abnormal in gastric carcinoma tissues and different tumor cell types. Next, we investigated the circKIF4A function in gastric carcinoma using apoptosis and migration assays. Western blot was used to explore the miR-135b sponging function of circKIF4A in gastric carcinoma. A qRT-PCR demonstrated that circKIF4A is up-regulated in gastric carcinoma. The knockdown of circKIF4A promotes apoptosis and the migration of SGC-7901. Moreover, miR-135b regulates the expression of mRNA (including PARP, Pax-4, FOXJ2, and Elf-1) in gastric carcinoma, and circKIF4A inhibits miR-135b’s regulatory function on mRNA (including PARP, Pax-4, FOXJ2, and Elf-1). Taken together, our findings show that circKIF4A acts as an miR-135b sponge, which affects the expression of mRNA (including PARP, Pax-4, FOXJ2, and Elf-1) and ultimately acts as a gastric carcinoma promoter.

OBJECTIVE:To investigate the relationship between small intestinal bacterial overgrowth (SIBO) and Endotoxin (ET) concentration in peripheral blood, and levels of toll-like receptors (TLR) 2 and TLR4 expression on surface of peripheral blood mononuclear cells (PBMCs) in patients with ulcerative colitis.STUDY DESIGN:An experimental study.PLACE AND DURATION OF STUDY:The First Hospital of Hebei Medical University, from July 2018 to October 2019.METHODOLOGY:The 130 patients with ulcerative colitis were included in case group. Another 72 healthy cases were selected as control group. SIBO, ET, TLR2, and TLR4, were determined, and compared.RESULTS:Positive rate of SIBO in case group was higher than that in control group (p <0.001). Lactulose hydrogen breath test (LHBT) intestine set value, peripheral blood ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs in case group were higher than those in control group (all p <0.001); the above indexes in SIBO-positive patients in case group were higher than those in SIBO-negative patients in case group (all p <0.001). Pearson's correlation analysis showed that LHBT intestine set value of SIBO-positive patients in case group was positively correlated with ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs (r= 0.910, p <0.001; r = 0.970, p <0.001; and r = 0.965, p <0.001 respectively). ET concentration of SIBO-positive patients in case group was positively correlated with expression levels of TLR2 and TLR4 on surface of PBMCs (r=0.962, p <0.001; and r = 0.829 p <0.001 respectively).CONCLUSION:Patients with ulcerative colitis are easy to occur SIBO, and SIBO increases blood endotoxin, TLR2 and TLR4 levels. Synergistic effects of endotoxin and endotoxin receptors TLR2 and TLR4 overexpression mediate body inflammation and may be involved in progression of ulcerative colitis. Patients with ulcerative colitis with excessive growth of small intestinal bacteria are more likely to have hypertoxemia.

目的 探讨微信支持的混合式教学模式在心血管内科教学中的应用及效果.方法 选取接受心血管内科课程学习的临床医学班学生116名,随机分为观察组与对照组.对照组采用传统的以课堂讲授为主的教学方法,观察组采用基于微信的混合式教学法.课程结束后,应用理论考试成绩、病例分析成绩及问卷调查评价教学效果.结果 观察组学生理论成绩[(58.00±8.47)vs.(52.92±10.93),P<0.01)和病例分析成绩[(15.27±1.39)vs.(13.85±1.63),P<0.01]均高于对照组,且观察组学生对该组教学法评价良好.结论 将微信支持的混合式教学法应用于心血管内科学课程中效果良好,能够提高成绩,激发学生学习意愿和参与程度,具有应用前景.

目的 探讨比索洛尔联合曲美他嗪对高龄冠心病心力衰竭患者心肌重塑的影响.方法 选择高龄冠心病心力衰竭患者60例,按照随机数字表法分为研究组和对照组,对照组采用曲美他嗪,研究组在常规治疗的基础上加用比索洛尔,比较两组治疗效果、不良反应及心功能〔左室射血分数(LVEF)〕、心肌重塑〔左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕情况.结果 研究组治疗总有效率(90.0％)明显高于对照组(66.7％,P<0.05).两组均未发生明显不良反应,顺利完成治疗.治疗前两组LVEF及LVEDD、LVESD比较差异无统计学意义(P>0.05);治疗后两组LVEF均明显升高,LVEDD、LVESD均明显缩小,但研究组LVEF明显高于对照组,LVEDD、LVESD明显小于对照组(均P<0.05).结论 比索洛尔辅助治疗高龄冠心病心力衰竭,能够改善心功能,降低心肌重塑风险,提高治疗效果.

Objective To investigate correlation between QT interval(QT),corrected QT interval(QTc) and metabolic syndrome(MS). Methods Residents who participated in our survey concerning atherosclerosis and related diseases conducted in Shenyang were included. They accomplished questionnaire,physical examination, laboratory tests and electrocardiography test. We divided them into MS group and non-metabolic syndrome (NMS)group according to International Diabetes Federation(IDF)diagnostic criteria for MS. QT interval was measured from the standard 12-lead electrocardiogram. QTc was calculated by using Bazett and Fridericia equations. We analyze correlation of QT ,QTc and MS. Results A total of 739 residents who were 35~64 years old were included. Individuals with MS had longer QTcB and QTcF than NMS group[(415.8 ± 31.9)ms vs.(410.1 ± 32.1)ms, (407.2± 29.1)ms vs.(402.6 ± 28.8)ms,P<0.05]. The more the number of abnormal MS parameters they had, the longer the QT,QTcB and QTcF they had. Regression analysis showed that QT was associated with serum potassium,smoking,blood glucose,and LDL,and QTcB and QTcF were associated with hypertension,waist circumference and blood potassium. Conclusions MS is associated with corrected QTc. Careful ECG monitoring among persons with MS for early detection of a long corrected QT interval may prevent severe and often fatal arrhythmias or sudden death.

经皮冠状动脉介入治疗(PCI)技术的发展,提高了冠心病患者的生存率,而治疗不仅是延缓疾病进展,更应注重生活质量的提高.性活动是生活质量的主要方面之一,性活动的满意度与冠心病事件的风险降低相关[1-3].文献表明,24％ ～89％的患者在冠脉事件后性活动存在异常[4-5].本文通过对PCI术后患者性活动状况的调查,为医生提供更好的干预策略,改善PCI术后患者的生活质量.

目的 对比多环套扎黏膜切除术(MBM)和内镜下透明帽法黏膜切除术(EMR-Cap)对于早期食管癌及癌前病变的治疗价值.方法 选取行内镜治疗并获随访的早期食管癌及癌前病变患者82例,其中行MBM治疗50例(MBM组),EMR-Cap治疗32例(EMR-Cap组).分析内镜下切除早期食管癌及癌前病变的内镜完整切除率、治疗成功率、病灶大小和侵及周径、治疗时间、并发症、治疗费用和术后随访情况.结果 MBM组完整切除率及治疗成功率与EMR-Cap组比较,差异均无统计学意义(P>0.05);MBM组切除病变长度及累及周径显著大于 EMR -Cap 组(P <0.01);MBM 组平均治疗用时显著短于 EMR -Cap 组(P<0.05);MBM组合并出血及狭窄发生率与EMR-Cap组比较,差异无统计学意义(P>0.05);MBM组平均治疗费用显著低于EMR-Cap组(P<0.05);术后随访MBM组复发率与EMR-Cap组比较,差异无统计学意义(P>0.05).结论 MBM与EMR-Cap均为治疗早期食管癌及癌前病变的有效方法;MBM较 EMR -Cap具有切除范围大、治疗用时短、易于掌握、花费少等优点.

Background: The purpose of this study was to develop a coronary artery disease (CAD) prediction model that optimally estimates the pre-test probability of CAD for patients suspected of CAD.Methods and results: This retrospective, multi-centre study included 7360 consecutive patients (4678 men, 57.87 +/- 11.42 years old; 2682 women, 61.60 +/- 9.58 years old) who underwent coronary angiography for evaluation of CAD. A prediction model was fitted for diagnosis of CAD with the help of eight significant risk factors including sex, age, smoking status, diabetes, hypertension, dyslipidaemia, serum creatinine and angina. All potential predictors were significantly associated with the presence of CAD. The prevalence of CAD was significantly higher in men than in women. The clinical model gives a relatively accurate prediction of CAD with an area under the curve (AUC) of 0.74 (95% CI, 0.88-0.96; P < 0.001). Addition of angina to the prediction model improves the predictive precision of the model. The optimal cut-off for predicting CAD in this model was 0.79 with a sensitivity of 0.658 and a specificity of 0.709.Conclusion: A prediction model including age, sex, and cardiovascular risk factors allow for an accurate estimation of the pre-test probability of coronary artery disease in Chinese populations. This algorithm may be useful in making decisions relating to the diagnosis of CAD. (C) 2017 Published by Elsevier B.V. on behalf of Cardiological Society of India.

Objective To investigate the value of microRNA-92a combined with pepsinogen(PG) in the diagnosis of gastric carcinoma.Methods Sixty cases of gastric cancer,141 cases of chronic atrophic gastritis and 162 cases of chronic non-atrophic gastritis were adopted,using real-time PCR assay for detection of micro RNA-92a and using immune colloidal gold technique for measuring PG.The sensitivity and specificity of miRNA-92a,PG and miRNA-92a combined with PG in the diagnosis of gastric cancer were calculated respectively.Results The expression of miRNA-92a in chronic atrophic gastritis group and non atrophic gastritis group was lower than gastric cancer group.The expression level of plasma miRNA-92a in chronic non atrophic gastritis group was lower than chronic atrophic gastritis group(P<0.05).The expression level of PG Ⅰ and PG Ⅰ/PGⅡ in gastric cancer group were lower than chronic atrophic gastritis group and chronic non atrophic gastritis group.The value of PG Ⅰ/PGⅡ in chronic atrophic gastritis group was lower than non atrophic gastritis group(P<0.05).There was not significant between chronic atrophic gastritis and chronic atrophic gastritis group(P>0.05).microRNA-92a sensitivity in the diagnosis of gastric cancer and specificity were 85.70% and 70.8%.PG in sensitivity and specificity in the diagnosis of gastric cancer were 75.80% and 84.90%.The sensitivity of micro RNA-92a combined with PG diagnosis of gastric cancer and precancerous lesion and the specificity was 86.49%,the specificity was 89.32%.Conclusion micro RNA-92a combined with PG was better than single detection in diagnosis of gastric cancer.

Objective It is to investigate the effect of miR-92a on the biological characteristics of gastric cancer cell line and its possible molecular mechanism.Methods The miR-92a inhibitor were transiently transfected in SGC-7901, the proliferation circumstance of cell lines was detected by CKK-8 method, the apoptosis circumstance were detected by TUNEL method, the cell migration circumstance was observed by Transwell migration and invasion experiments, the expression of Bcl-2 and Survivin protein were detected by Western blot method.Results After transient transfection of miR-92a inhibitor, the proliferation of SGC-7901 was decreased significantly (P<0.05), apoptosis was increased significantly (P<0.05), the number of the migration and invasion was decreased significantly (P<0.05), and the results of Western blot showed that the expression of Bcl-2 and Survivin protein were decreased significantly (all P<0.05).Conclusion miR-92a can promote proliferation, migration and invasion of tumor cells, and inhibit apoptosis, it may promote the development of gastric cancer by controlling Bcl-2 and Surviving expression.