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25 February 2019, Volume 18 Issue 1 Previous Issue    Next Issue

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A prospective study on incidence of chronic thromboembolic pulmonary hypertension after pulmonary thromboembolism WEI Xiaomin, ZHANG Yuanyuan, DONG Liang, XIA Jingwen, GONG Yi, YU Yongping, LI Shengqing 2019, 18 (1):  37-43.  DOI: 10.16150/j.1671-2870.2019.01.008 Abstract ( 245 )   HTML ( 0 )   PDF (690KB) ( 86 )   Objective: To explore the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) in a series of patients with symptomatic pulmonary embolism(PE) diagnosed for the first time and receiving adequate anticoagulant treatment no less than 3 months, and to assess the risk factors of CTEPH in these patients. Methods: A prospective, long-term, 3 years follow-up study was conducted to assess the incidence and risk factors of CTEPH in 292 patients with PE diagnosed for the first time. Results: The cumulative incidence of CTEPH in 292 patients with PE diagnosed for the first time was 9.20% at three months, 10.40% at six months, 11.30% at one year, 11.90% at two years, and 12.90% at three years. The following factors increased the risk of CTEPH: time from symptoms to treatment of PE≥1 month (odds ratio OR=9.065), the intermediate risk PE (OR, 37.691) to high risk PE (OR=33.957); segmental and sub-segmental branch location of embolism (OR=6.216), the PE related primary risk factors (OR=3.659). Conclusions: The cumulative incidence of CTEPH in patients with PE is 12.90% at three years.CTEPH is a common complication in PE patients diagnosed for the first time. Figures and Tables | References | Related Articles | Metrics

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Epidemiological study on association of uric acid to creatinine ratio with metabolic syndrome in middle-aged and elderly populationin Shanghai HOU Yanan, XUAN Liping, ZHAO Zhiyun, LI Mian, CHEN Yuhong, DAI Meng, XU Min, BI Yufang, WANG Weiqing, GAO Jinli 2019, 18 (1):  44-50.  DOI: 10.16150/j.1671-2870.2019.01.009 Abstract ( 311 )   HTML ( 0 )   PDF (712KB) ( 118 )   Objective: To undertake an epidemiological study onassociation between serum uric acid to creatinine ratio (UA/Cr) and metabolic syndrome (MS) in middle-aged and elderly populationin Shanghai. Methods: A cross-sectional study was conducted in 6 570 residents aged 40 years or older in Jiading District of Shanghai in 2014. All participants received standard questionnaire, anthropometric measurements, biochemical evaluation. MS was defined according to the international Diabetes Federation (IDF) criteria. Participants were divided into 4 groups according to the quartiles of UA/Cr, and the associations of UA/Cr with MA were investigated by multivariate logistic regression analysis. Results: A total of 6 414 participants were included in this study, of which 33 135 (52.7%) participants were diagnosed with MS. The blood Cr level was 77（70-87） mmol/L, bloodUA level was 314（267-372） mmol/L, UA/Cr level was 4.01（3.46-4.65）. The UA/Cr of 1st quartile group was <1.0, the 2ndquartile group was 1.0≤ to<1.5, the 3rd quartile group was 1.5≤ to<2.0, the 4th quartile group was ≥2.0. From 1st UA/Cr quartile to 4th UA/Cr quartile, the body mass index (BMI), waist circumference, blood pressure, serum triglyceride, total cholesterol, low-density lipoproteincholesterol, HOMA-IR level, and serum C-reactive protein level increased with the increase of UA/Cr level（P<0.01）; the prevalence of MS and its components also showed a trend of increase (P<0.01). The multivariate logistic regression analysis revealed that serum UA/Cr was positively associated with MS, hypertension, dyslipidemia, hyperglycemia, central obesity, and insulin resistance. Compared with 1st quartile group, the risk of MS in 2nd quartile group, 3rd quartile group and 4th quartile group 4 were 1.15(0.96-1.38),1.36(1.14-1.64）,1.96(1.62-2.37）; the risk of hypertension were 1.04(0.86-1.25), 1.22(1.01-1.48), 1.33(1.09-1.62); the risk of central obesity were 1.06(0.86-1.31),1.26(1.02-1.56), 1.33(1.09-1.62); the risk of high TG were 1.29(1.08-1.54), 1.74(1.46-2.07), 2.81(2.35-3.36); the risk of low HDL were 0.93(0.77-1.13),1.35(1.12-1.61), 1.50(1.25-1.80); the risk of insulin resistance were 0.96(0.77-1.19),1.14(0.92-1.40), 1.81(1.48-2.22) (all P<0.01). Conclusions: Serum UA/Cr is significantly associated with MS in middle-aged and elderly populationin Shanghai. Serum UA/Cr could serve as a biomarker of MS, which contributes to early detection and thereby the intervention of metabolic syndrome and its associated diseases. Figures and Tables | References | Related Articles | Metrics

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Clinical and laboratory analysis of primary Sjögren′s syndrome complicated with neurological lesions WANG Yanqing, HUANG Wanxue, LIANG Yuanyuan, WU Zhenzhen, WANG Xuan, TANG Jianping 2019, 18 (1):  51-55.  DOI: 10.16150/j.1671-2870.2019.01.010 Abstract ( 215 )   HTML ( 0 )   PDF (562KB) ( 46 )   Objective: To investigate the clinical manifestations, electromyographic abnormalities and laboratory characteristics of primary Sjögren′s syndrome (pSS) complicated with peripheral neuropathy and to analyze the risk factor of pSS complicated with peripheral neuropathy. Methods: A retrospective analysis was performed on 132 pSS patients who met the 2002 American-European Consensus Group criteria for pSS at Tongji Hospital from January 2015 to September 2017. The patients were categorized into group with peripheral neuropathy (pSS-PNS) and group without peripheral neuropathy (pSS-nPNS). The clinical manifestations, corresponding examinations and laboratory characteristics of the two groups were compared. The data were analyzed by t test, χ2 test and logistic regression analysis. Results: A total of 132 patients with pSS were enrolled in this study, including 12 males and 120 females. The ratio of male to female was 1∶10. Among them, 21 patients suffered from peripheral nervous system involvement and the prevalence rate was 15.9%(21/132). There were no significant differences in gender composition, age, onset age and course between the two groups. Compared with the group without peripheral neuropathy, joint swelling and pain (71.4% and 44.1%, P=0.02) were more common in the group with peripheral neuropathy, and CD8 [(21.25±13.11)% and（26.65±9.44）%, P=0.02] decreased significantly, ratio of CD4/CD8(2.80±1.45 vs 1.91±1.12, P=0.04) increased significantly. ESSDAI (European League Against Rheumatism Sjögren′s Syndrome Disease Activity Index) score [(4.71±0.46) and (2.80±0.17) ] was significantly higher in pSS-PNS group. ESSDAI (OR=1.836, 95%CI 1.169-2.883, P=0.008) was an independent risk factor for pSS with peripheral neuropathy. Conclusions: The clinical manifestations of pSS complicated with peripheral neuropathy are diverse, and the disease activity is high. High disease activity is an independent risk factor for Sjögren′s syndrome complicated with peripheral neuropathy. Figures and Tables | References | Related Articles | Metrics

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Effect of α7 nicotinic acetylcholine receptor activation on transforming growth factor β1-induced phenotypic transformation of adventitia fibroblasts studied in vitro WEI Jian, GAO Pingjin, HAN Weiqing 2019, 18 (1):  56-60.  DOI: 10.16150/j.1671-2870.2019.01.011 Abstract ( 405 )   HTML ( 1 )   PDF (498KB) ( 76 )   Objective: To investigate the correlation between α7 nicotinic acetylcholine receptor (α7 nAchR) and phenotypic transformation of adventitial fibroblasts (AF). Methods: AF were isolated and cultured by using thoracic aorta of male Sprague-Dawley (SD) rats. For evaluating the effect of transforming growth factor-β1 (TGF-β1) on phenotypic transformation of AF, cultured AF were divided into three groups: blank control group A, group with 24 h TGF-β1 treatment, and group with 48 h TGF-β1 treatment. After treatment, real-time quantitative PCR and western blotting were used to detect the mRNA level and protein level of α7 nAchR, and the expression of a smooth muscle actin (α-SMA) and collagen Ⅰ. To further explore whether the activation of α7 nAchR can inhibit TGF-β1-induced phenotypic transformation and the underlying molecular mechanism, AF cultured in vitro were divided into three groups: blank control group B, group with 48 h TGF-β1 treatment, and group with 48 h TGF-β1 +PNU-282987 (an α7 nAchR activator) treatment. After 48 h treatment, the expression of α-SMA and collagen Ⅰ and the phosphorylation of extracellular regulated protein kinase 1/2 (Erk1/2) were detected by immunoblotting. Results: Compared with the blank control group A, TGF-β1 significantly decreased the mRNA level and protein level of α7 nAchR (P<0.05), whereas TGF-β1 induced significant increase of a-SMA and collagen Ⅰ (P<0.05). PNU-282987, an α7 nAchR agonist, inhibited TGF-β1-induced expression of α-SMA and collagen typeⅠ. Meanwhile, PNU-282987 also significantly inhibited TGF-β1-induced Erk1/2 phosphorylation. Conclusions: The inhibition of α7 nAchR is involved in TGF-β1-induced phenotypic transformation in AF, and the mechanism may be related to Erk1/2 phosphorylation. Figures and Tables | References | Related Articles | Metrics

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Application of urinary neutrophil gelatinase-associated lipocalin/creatinine ratio in early diagnosis and severity assessment of renal injury in patients with type 2 diabetes mellitus DENG Lin, DING Yi, WANG Ping, BIAN Bingxian, SHEN Lisong 2019, 18 (1):  61-65.  DOI: 10.16150/j.1671-2870.2019.01.012 Abstract ( 297 )   HTML ( 0 )   PDF (504KB) ( 49 )   Objective: To investigate the application of urinary neutrophil gelatinase associated lipocalin (NGAL)/creatinineratio in the early diagnosis and assessment of severity of renal injury in patients with type 2 diabetes mellitus (T2DM). Methods: A group of 112 T2DM patients were recruited. Based on urinary albumin/creatinine ratio (UACR), diabetic patients were divided into three groups: 38 cases with normal albuminuria (NA group), 36 cases with minimal albuminuria (MA group) and 38 cases with clinical albuminuria (CA group). And, 32 healthy subjects were served as controls (NC group). Urinary NGAL/creatinine ratio was calculated and compared among the groups and their correlations with other clinical parameters were analyzed. Results: Urinary NGAL/creatinine ratio in T2DM groups [NA, 16.46(6.94-27.07) ng/mg;MA, 20.16(6.76-44.35) ng/mg;CA, 26.89(10.60-56.94) ng/mg] was markedly increased than that in the normal control group [9.13(3.92-17.36) ng/mg] (P<0.05). In the T2DM groups, urinary NGAL/creatinine ratio in CA group was significantly higher than that in NA group (P<0.05). Correlation analysis showed that urinary NGAL/creatinine ratio was positively correlated with UACR, duration of diabetes and glycated hemoglobin (HbA1c) (P<0.05). Conclusions: Urinary NGAL could be an earlier marker than minimal albuminuria for detecting renal injury in T2DM. Furthermore, urinary NGAL level can evaluate the severity of renal injury. Figures and Tables | References | Related Articles | Metrics

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Clinical and dosimetric factors associated with acute radiation-induced pneumonitis in esophageal carcinoma patients after intensity modulated radiation therapy (IMRT) ZHENG Lei, ZHAO Shengguang, XU Chen, JIANG Xu ming, CAO Lu, WU Hualing, CHEN Jiayi 2019, 18 (1):  66-71.  DOI: 10.16150/j.1671-2870.2019.01.013 Abstract ( 230 )   HTML ( 1 )   PDF (678KB) ( 153 )   Objective: To analyze the clinical and dosimetric factors associated with radiation-induced pneumonitis (RIP) in esophageal carcinoma patients treated with intensity modulated radiation therapy (IMRT) for developing a predictive model of RIP risk. Methods: Eighty-eight patients with histologically con?rmed esophageal carcinoma treated with IMRT from January 2013 to December 2016 were reviewed retrospectively. Clinical factors and dosimetric parameters were collected, and their correlations with risk of RIP were analyzed. Results: In total, twenty-five cases (28.4%) with grade 1 RIP, 13 (14.8%) with grade 2 RIP, and1 (1.1%) with grade 3 RIP (CTC 4.0) were observed. No grade 4 RIP was found.In univariate analysis, therapy modal of radiation, esophagectomy and dosimetric parameters V5, V10, V20 and mean lung dose (MLD) were significant factors for the development of RIP≥G1 (P<0.05). The V5, V10, V20, MLD were proved to be significant factors for the development of RIP≥G2 (P<0.05). By multivariate analysis, V5 was the only independent predictive factors for the development of RIP≥G1 (P<0.05); V10 was the only independent predictive factor for the development of RIP≥G2 (P<0.05). Conclusions: In comparison with MLD and V20, the widely used dosimetric parameters, our study showes that dosimetric parameters V5 and V10 could be the better predictor of RIP under the background of IMRT for esophageal carcinoma. Figures and Tables | References | Related Articles | Metrics

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Value of non-enhanced magnetic resonance angiography in assessing renal artery stricture LIU Fangtao, QI Xiaofeng, XU Xueqin, HUANG Juan, DONG Haipeng, NI Genxiong, ZHOU Wen, KONG Deyan 2019, 18 (1):  72-76.  DOI: 10.16150/j.1671-2870.2019.01.014 Abstract ( 375 )   HTML ( 0 )   PDF (563KB) ( 74 )   Objective: To study the value of non-enhanced MRA in assessment of renal artery stricture. Methods: A total of 73 patients with clinically suspected renal artery stricture undergone magnetic resonance angiography were enrolled. The 1.5T MR device combined with respiratory triggering technique was used to perform non-enhanced MRA and then enhanced MRA imaging was undertaken. The two imaging results were compared and analyzed for image quality, consistency of renal artery stricture evaluation and display of branches of renal artery. Results: There was no statistically significant difference in image quality between non-enhanced MRA and enhanced MRA of renal artery.In the evaluation of renal artery stricture, the two were in good agreement (Kappa value 0.98), The non-enhanced MRA showed better renal artery branches than enhanced MRA (P<0.001). Conclusions: Non-enhanced MRA can fully display the renal artery stricture, and it is superior to enhanced MRA in displaying renal artery branches. Therefore，non-enhanced MRA is of great importance in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Application of microsatellite polymorphism and repetitive sequence-based PCR in genotyping of Candida tropicalis WANG Guoqing, LI Zhen, PENG Yibing 2019, 18 (1):  77-81.  DOI: 10.16150/j.1671-2870.2019.01.015 Abstract ( 268 )   HTML ( 0 )   PDF (477KB) ( 44 )   Objective: To evaluate the application of microsatellite polymorphism in genotyping of Candida tropicalis. Methods: From August 2014 to November 2015, 50 clinical isolates of Candida tropicalis were collected form 4 hospitals, including Ruijin Hospital, Children’s Hospital, the First People’s Hospital and Zhongshan Hospital. Primers Ca21, Ca22, Com21 were used in pairs to find the best suitable pairs for the repetitive extragenic palindromic polymerase chain reaction (REP-PCR) genotyping. Three microsatellite markers Ctrm1, Ctrom10, Ctrm12 were used to analyze the microsatellite polymorphism. Finally, the discriminatory results of the two genotyping methods were compared. Result: The combination of Ca21-Com21 primers had the best effect in REP-PCR genotyping. Seven REP-PCR types A-G were found in 50 isolates of Candida tropicalis. The index of discriminatory power was 0.75. The 50 isolates were classified into 30 genotypes by the microsatellites polymorphism. The index of discriminatory power was 0.97. Conclusions: Microsatellite polymorphism is a simple and rapid method for molecular typing with higher discrimination power than REP-PCR. Therefore, microstellite polymorphism is the preferred choice in clinical laboratories. Figures and Tables | References | Related Articles | Metrics

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Correlation of glycosylated hemoglobin and fasting blood glucose level with severity of lesion in elderly patients with carotid artery atherosclerosis HUANG Xiaoyi, CAI Wei, SHU Shizhen, PANG Xiaofen 2019, 18 (1):  82-85.  DOI: 10.16150/j.1671-2870.2019.01.016 Abstract ( 283 )   HTML ( 0 )   PDF (483KB) ( 42 )   Objective: To investigate the correlation of glycosylated hemoglobin and fasting blood glucose level with severity of lesion in elderly patients with carotid artery atherosclerosis. Methods: A total of 144 patients with carotid artery atherosclerosis admitted to the Geriatrics Department of Shanghai Ruijin Hospital Luwan Branch from May 1, 2017 to May 31, 2018 were enrolled. According to the results of vascular ultrasonography, patients were categorized into mode-rate atherosclerosis group and severe atherosclerosis group. The general condition and related medical history were recor-ded, and the Crouse score of carotid artery plaque was calculated. On the second day of admission, fasting blood sample was taken to detect glycosylated hemoglobin and fasting blood glucose level. The correlation of glycosylated hemoglobin and fasting blood glucoselevel with severity of atherosclerotic lesion was analyzed. Results: Compared with moderate atherosclerosis group, the fasting blood glucose level [(6.86±1.98) mmol/L vs （5.72±1.33） mmol/L, P<0.05] and glycated hemoglobin [(6.47±2.53)% vs （5.43±1.24）%, P<0.05) of severe atherosclerosis group were significantly increased. Logistic regression analysis showed that glycated hemoglobin (r=0.578, P<0.05) and fasting blood glucose level (r=0.479, P<0.05) were positively correlated with the severity of carotid artery atherosclerosis. Conclusions: Glycated hemoglobin and fasting blood glucose level in elderly patients with carotid artery atherosclerosis are correlated significantly with the severity of carotid artery atherosclerosis. Key woeds: Atherosclerosis; Glycated hemoglobin; Blood glucose; Crouse integral Figures and Tables | References | Related Articles | Metrics

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Analysis and management of difficult cross-matching blood in Jiaozuo region from 2014 to 2017 GUAN Yin, XU Fei, TIAN Zongbin 2019, 18 (1):  86-88.  DOI: 10.16150/j.1671-2870.2019.01.017 Abstract ( 332 )   HTML ( 1 )   PDF (325KB) ( 67 )   Objective: To investigate the causes of difficult blood cross-matching and methods of proper blood transfusion and to propose effective managing measures. Methods: From January 2014 to December 2017, 81 patients with difficult blood cross-matching in hospitals in Jiaozuo district were recruited.All the patients were examined before transfusion and analyzed retrospectively and corresponding appropriate management measures were taken. Results: Of the 78 cases of difficult cross-matching blood samples, false coagulation caused by protein turmoil occurred in 4 cases, accoun-ting for 5.1% of the difficult cross-matching specimens, and was managed by adding appropriate amount of normal saline in the procedure cross-matching; 5 cases were with cold autoantibodies, accounting for 6.4% of difficult specimens, and managements was cross-matching under 370 C and transfusing blood under warming condition; 13 cases were with warm autoantibodies, accounting for 16.6% of difficult specimens, management was performing cross-matching after adsorption of the auto-antibody; 56 cases had irregular allotype antibodies detected, accounting for 71.9% of difficult specimens, mana-gement was screening appropriate compatible matching blood for transfusion. Conclusions: The most frequent causes of difficult blood cross-matching are the presence ofirregular alloantibodies and autoantibodies. For avoiding effectively this situation, it is necessary to formulate appropriate transfusion regimen suitable for the patients to ensure the safety and effectiveness of transfusion. Figures and Tables | References | Related Articles | Metrics

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Analysis of clinicopathological characteristics of breast encapsulated papillarycarcinoma WANG Shunli, DENG Shuangshuang, GAO Hui, XIAO Tianyu, GAO Jinli 2019, 18 (1):  89-92.  DOI: 10.16150/j.1671-2870.2019.01.018 Abstract ( 838 )   HTML ( 0 )   PDF (894KB) ( 99 )   Objective: To analyze the clinical-pathological features, treatment and prognosis of encapsulated papillary carcinoma (EPC) of breast. Methods: Thirty-one cases with EPC were enrolled. Clinical symptoms and pathological characteristics were retrospectively analyzed. The immunohistochemical staining included P63, CK5/6, Calponin, ER, PR, HER2, Ki67. Results: All of the cases were woman with a mean age of 63 years old, ranging from 34 to 83 years old. Palpable mass and nipple discharge were the most common symptoms. The mass ranged in size from 0.8-6.5 cm (mean 3 cm). Microscopic examination showed that majority of the EPCs were single lesion. A thick fibrous capsule is evident under low-power examination. The nodule surrounded by capsule was composed of delicate fibrovascular stalks, covered with a monomorphic population of neoplastic epithelial cells with low-or intermediate-grade nuclei. The epithelial cells were typically arranged in either solid or cribriform pattern. The tumor cells were positive for ER and PR, but were HER2 negative; P63, CK5/6 and Calponin were negative. The positive percentage for Ki67 was under 10%. Conclusions: EPC is a breast tumor with good prognosis generally found in elderly women. The tumor cells are typically arranged in either solid or cribriform pattern and diffusely positive for ER and PR, but HER2 was negative. Myoepithelial cell markers including P63, CK5/6 and Calponin were negative. The positive percentage for Ki67 is under 10%. The EPC is diagnosed according to these characteristics, which are helpful for the designing of reasonable treatment. Figures and Tables | References | Related Articles | Metrics

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Antimicrobial stewardship enhancing the submission rate of microbiological specimens before therapeutic use of antimicrobial agents WU Hao, FANG Hua, WANG Ruizhong, QU Jinghua, SHEN Xiaofeng, CHEN Huaping, GU Wenchao 2019, 18 (1):  93-97.  DOI: 10.16150/j.1671-2870.2019.01.019 Abstract ( 564 )   HTML ( 1 )   PDF (614KB) ( 61 )   Objective: To investigate the effect of antimicrobial stewardship（AMS） on enhancing submission rate of microbiological specimens before therapeutic use of antimicrobial agents. Methods：January 2017 to June 2017 was the pre-intervention group; July 2017 to September 2017 was the post-intervention group. Submission rate of microbiological specimens before therapeutic use of antimicrobial agents were compared between the two groups. Constituent ratio of different microbiological specimens was also compared between the two groups. Results: The submission rates of microbiolo-gical specimens for general, restricted and special therapeutic use of antimicrobial agents before and after AMS increased from 49.46%, 47.82%, 69.91% to 61.94%, 62.11%, 83.45%, respectively (P all <0.01). The submission rate of microbiological specimens for general and special therapeutic use of antimicrobial agents before and after AMS in key departments reached the assessment criteria.The constituent ratio of sputum culture specimen was decreased from 53.46% to 51.66%( P<0.01), and the constituent ratio of blood culture and aseptic humoral specimen increased from 11.96% and 3.60% to 15.32% and 4.10%(P<0.01, P<0.05). Conclusions: AMS can effectively improve the submission rate of microbiological specimens before therapeutic use of antimicrobial agents and the quality of specimens for inspection; it provides laboratory evidence for the rational use of antibiotics. Figures and Tables | References | Related Articles | Metrics

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Study on visual working memory deficit in patients with first-episode schizophrenia LI Xuanzi, SHE Shenglin, ZONG Kunlun, BI Taiyong, ZHENG Yingjun 2019, 18 (1):  98-103.  DOI: 10.16150/j.1671-2870.2019.01.020 Abstract ( 201 )   HTML ( 1 )   PDF (644KB) ( 36 )   Objective: Working memory deficit has been found in people with schizophrenia and is thought to be a core cognitive dysfunction. However, little is known that whether the working memory deficits are different in working memory tasks using different stimuli. Methods: In the current study, a typical match-to-sample task was adopted to exa-mine the visual working memory in first-episode schizophrenic patients(n=18) and healthy controls(n=18). Face and house were used as the stimuli and the memory load was manipulated. Results: As face processing has been shown to be impaired in schizophrenia, it was hypothesized that the deficit is more severe in face working memory task than that in house working memory task. However, the results showed an equivalent amount of deficits in face and house working memory task. In addition, the working memory deficit was also independent of the memory load and had no relationship with the duration of illness, the medication, or the schizophrenic symptoms. Conclusions: These results imply that the working memory deficit in schizophrenia is independent of the stimuli. Figures and Tables | References | Related Articles | Metrics

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Change and significance of clinical indices on treatment with tacrolimus combined with piperazine ferulate for primary nephrotic syndrome in elderly JIAO Jieru, LI Yanran, CHEN Xiaonong, LIN Qing 2019, 18 (1):  104-106.  DOI: 10.16150/j.1671-2870.2019.01.021 Abstract ( 366 )   HTML ( 1 )   PDF (358KB) ( 66 )   Objective: To observe the change of clinical indicesontreatment with tacrolimus combined with piperazine ferulate in elderly patients with primary nephrotic syndrome. Methods: Fifty elderly patients with primary nephrotic syndrome were randomly divided into combined therapy group (25 case) and the single therapy group (25 case) to be treated with tacrolimus combined with piperazine ferulate or single tacrolimus for 6 months, respectively. The changes of indices includedserum triglyceride, cholesterol, albumin, creatinine, urea nitrogen, urine protein andtherapeutic efficacy; the two groups were compared. Theadverse reactions were also compared. Results: The overall therapeutic efficacy of combined therapy group and single therapy group were 84% and 72%, respectively (P<0.05). The combined therapy group showed better improvement in serum albumin [(39.9±1.9) g/L vs (34.6±2.1) g/L] and urine protein [(2.5±0.9) g vs (3.6±1.0） g](P<0.05). Adverse reactions showed no significant difference between the combined therapy group and single therapy group（12% vs 8%, P>0.05）. Conclusions: Tacrolimus combined with piperazine ferulate is better than tacrolimus only for the treatment of primary nephrotic syndrome in elderly patients without increase inadverse reactions. Figures and Tables | References | Related Articles | Metrics