LIMP-2 enhances cancer stem-like cell properties by promoting autophagy-induced GSK3β degradation in head and neck squamous cell carcinoma / 国际口腔科学杂志·英文版

Cancer stem cell-like cells (CSCs) play an integral role in the heterogeneity, metastasis, and treatment resistance of head and neck squamous cell carcinoma (HNSCC) due to their high tumor initiation capacity and plasticity. Here, we identified a candidate gene named LIMP-2 as a novel therapeutic target regulating HNSCC progression and CSC properties. The high expression of LIMP-2 in HNSCC patients suggested a poor prognosis and potential immunotherapy resistance. Functionally, LIMP-2 can facilitate autolysosome formation to promote autophagic flux. LIMP-2 knockdown inhibits autophagic flux and reduces the tumorigenic ability of HNSCC. Further mechanistic studies suggest that enhanced autophagy helps HNSCC maintain stemness and promotes degradation of GSK3β, which in turn facilitates nuclear translocation of β-catenin and transcription of downstream target genes. In conclusion, this study reveals LIMP-2 as a novel prospective therapeutic target for HNSCC and provides evidence for a link between autophagy, CSC, and immunotherapy resistance.

Finite element analysis method and optimization of flexible ginger moxibustion based on Abaqus and Taguchi method / 生物医学工程学杂志

Ginger moxibustion has the effect of regulating zang-fu organs and activating qi and blood circulation. When used, ginger paste is required to be close to human skin. Currently, the ginger box used clinically in the hospital can't meet the requirement of large area fitting human skin, and the efficacy of ginger moxibustion is significantly reduced. In this study, a flexible ginger paste box was proposed, which was composed of flexible components polydimethylsiloxane (PDMS), spring and wire netting. The large flexibility of the structure made it fit well with human skin. Finite element method was used to study the fitting degree between ginger paste box and waist soft tissue. Finite element models of flexible ginger paste box and waist soft tissue were established based on Hypermesh and Abaqus software. The equivalent contact area between the flexible ginger paste box and waist was obtained by numerical simulation under different PDMS unilateral thickness, spring wire diameter, wire netting diameter and ginger paste layer thickness. The four parameters were taken as the influencing factors, and the equivalent contact area was taken as the optimization objective. The typical value analysis and variance analysis of S/N were performed by Taguchi method, and the results showed that among the four influencing factors, the wire netting diameter had the largest influence on equivalent contact area and its contribution rate reached 41.98%. The contribution rates of PDMS unilateral thickness, spring wire diameter and ginger paste layer thickness reached 36.48%, 13.97% and 6.50%, respectively. The optimized PDMS unilateral thickness, spring wire diameter, wire netting diameter and ginger paste layer thickness were 1.5, 0.4, 0.15, 35 mm, respectively, and the equivalent contact area was 95.60 cm 2. The optimized flexible ginger paste box with great fitting performance can improve the effect of ginger moxibustion.

The relationship between serum sodium ion level and hospital death in patients with chronic heart failure / 中国医师进修杂志

Objective:To observe the relationship between different serum sodium ion levels and hospital death in patients with chronic heart failure.Methods:The clinical data of patients hospitalized with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were continuously collected, and a retrospective cohort study database was established. The study collected clinical data of 10 488 patients. Use SPSS 26.0 software to establish a database and perform statistical analysis. The patients were divided into 6 groups by different blood sodium levels, the heart failure indicators and hospital deaths among the groups were compared, the lowest death rate group (141 - 145 mmol/L) was as a reference, and univariate Logistic analysis of different blood sodium levels were performed to clarify the risk of in-hospital death from heart failure with different blood sodium levels. GraphPad Prism 5 software was used to draw Kaplan-Meier curve and analyzed the cumulative survival rate during hospitalization.Results:In 10 488 patients, there were 417 cases occurred in-hospital deaths. The range of serum sodium at admission was 108.0 - 168.0 mmol/L, and the normal reference range was 135 - 145 mmol/L. The patients were divided into 6 groups according to the blood sodium level at the time of admission: group A (<130 mmol/L), group B(130 - 135 mmol/L), group C (136 - 140 mmol/L), group D (141 - 145 mmol/L), group E (146 - 150 mmol/L), group F(≥151 mmol/L), the hospital mortality of different blood sodium groups were 14.5%, 8.6%, 3.6%, 2.4%, 5.1% and 33.3% respectively. Took the lowest in-hospital mortality group D group as a reference, 6 groups with different serum sodium were included in a single factor binary Logistic regression analysis, the results showed that increased or decreased serum sodium may increase the risk of death in the hospital for patients with heart failure. Kaplan-Meier survival analysis showed that the accumulate survival rate among the 6 groups was statistically significant ( P<0.05). Conclusions:Patients with abnormal blood sodium at admission have a higher risk of death in the hospital during the hospital stay. The in-hospital mortality rate of patients with serum sodium ions ranging from 141 to 145 mmol/L is the lowest. With the increase or decrease in serum sodium, the in-hospital mortality rate increases with the increase or decrease in serum sodium. The blood sodium level and the mortality of patients with heart failure show a "U" shape. Curve relationship. Abnormal blood sodium on admission is an independent predictor of in-hospital mortality in inpatients with heart failure.

Engineering prodrug nanomicelles as pyroptosis inducer for codelivery of PI3K/mTOR and CDK inhibitors to enhance antitumor immunity

Aberrant activation of oncogenic signaling pathways in tumors can promote resistance to the antitumor immune response. However, single blockade of these pathways is usually ineffective because of the complex crosstalk and feedback among oncogenic signaling pathways. The enhanced toxicity of free small molecule inhibitor combinations is considered an insurmountable barrier to their clinical applications. To circumvent this issue, we rationally designed an effective tumor microenvironment-activatable prodrug nanomicelle (PNM) for cancer therapy. PNM was engineered by integrating the PI3K/mTOR inhibitor PF-04691502 (PF) and the broad spectrum CDK inhibitor flavopiridol (Flav) into a single nanoplatform, which showed tumor-specific accumulation, activation and deep penetration in response to the high glutathione (GSH) tumoral microenvironment. The codelivery of PF and Flav could trigger gasdermin E (GSDME)-based immunogenic pyroptosis of tumor cells to elicit a robust antitumor immune response. Furthermore, the combination of PNM-induced immunogenic pyroptosis with anti-programmed cell death-1 (αPD-1) immunotherapy further boosted the antitumor effect and prolonged the survival time of mice. Collectively, these results indicated that the pyroptosis-induced nanoplatform codelivery of PI3K/mTOR and CDK inhibitors can reprogram the immunosuppressive tumor microenvironment and efficiently improve checkpoint blockade cancer immunotherapy.

The prognostic value of myocardial infarct size measured by cardiovascular magnetic resonance in patients with acute ST-segment elevation myocardial infarction / 中华内科杂志

Objective:To investigate the prognostic value of infarct size (IS) in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI).Methods:A total of 104 patients with acute STEMI who underwent primary PCI treatment in Shengjing Hospital of China Medical University from February 2017 to November 2018 were included in the present study. All patients underwent cardiovascular magnetic resonance (CMR) within one week after primary PCI treatment. The subjects were followed up for two years. Major adverse cardiac events (MACE) included new onset congestive heart failure and/or recurrent nonfatal myocardial infarction and/orcardiac death. The optimal IS cutoff value for MACE was determined by receiver operating character (ROC) curve. Based on the IS cutoff value, the patients were divided into the high IS group and the low IS group. Clinical characteristics between the two groups were compared. A cox regression model was used to analyze the prognostic value of IS in acute STEMI patients treated with primary PCI for the adverse events.Results:The IS cutoff value determined by ROC curve was 13.55%. 50 patients were in the high IS group (IS≥13.55%) and 54 patients were in the low IS group (IS<13.55%). More female patients [14 cases (28.0%) vs. 6 cases (11.1%)] were in the IS group, and a higher proportion of patients in the high IS group had anterior myocardial infarction [27 cases (54.0%) vs. 16 cases (29.6%)] or microvascular obstruction [32 cases (64.0%) vs. 16 cases (29.6%)]. White blood cell counts [11.25(8.90, 13.38) ×10 9/L vs. 9.25(7.58, 11.00) ×10 9/L], troponin I levels [50.63(16.56, 76.30)μg/L vs. 16.58(2.66, 38.42)μg/L] and brain natriuretic peptide levels [178.10(79.70, 281.95)μg/L vs. 79.60(42.83, 183.90)μg/L] in the high IS group were higher than those in the low IS group ( P<0.05), and left ventricular ejection fraction [(45.15±10.65)% vs. (51.95±12.91)%] in the high IS group was lower than that in the low IS group ( P<0.05). Multivariate Cox regression analyses showed that IS was independently associated with the risk of cardiac death in patients with acute STEMI two years after primary PCI( P=0.033, HR=1.075, 95% CI1.006-1.148). Every 1% increase in IS was associated with a 7.5% increase in cardiac death. Conclusions:Infarct size, measured by CMR within one week after primary PCI, is strongly associated with cardiac death in patients with acute STEMI two years after primary PCI. IS could be used as an index for the prognosis of patients with acute STEMI.

Enhanced recovery after surgery combined with laparoscopy for the treatment of colorectal cancer in the elderly: therapeutic efficacy and effects on proinflammatory factors and immune responses / 中华老年医学杂志

Objective:To investigate the efficacy of enhanced recovery after surgery(ERAS)combined with laparoscopy for the treatment of colorectal cancer in the elderly and its effects on proinflammatory factors and immune responses.Methods:A total of 158 elderly patients with colorectal cancer treated with surgery were retrospectively analyzed.According to different treatment methods, they were divided into the control group(76 cases)and the study group(82 cases). The control group received traditional open surgery and routine perioperative care.The study group received laparoscopic radical resection of colorectal cancer plus perioperative ERAS.Surgery parameters, complications, postoperative immune function and proinflammatory factor levels were compared between the two groups.Results:The operation duration of the study group was significantly longer than that of the control group[(128.5±33.7)min vs.(117.4±28.7)min, t=2.220, P=0.028], whereas the intraoperative blood loss[(100.8±20.5)ml vs.(250.7±62.3)ml, t=20.621, P<0.01]and the incision length[(4.5±1.2)cm vs.(17.5±3.0)cm, t=36.243, P<0.01]were significantly less than those in the control group.The time to first flatus[(2.0±0.9)d vs.(3.8±1.8)d, t=8.037, P<0.01], time to first defecation[(2.8±0.8)d vs.(4.5±1.1)d, t=11.167, P<0.01], time to first ambulation[(1.2±0.2)d vs.(3.8±1.3)d, t=17.888, P<0.01]and hospitalization length[(7.1±0.2)d vs.(11.4±2.2)d, t=17.625, P<0.01]were also significantly shorter than those in the control group.The incidences of surgical site infections(2.4% vs.10.5%, χ2=4.351, P=0.037), abdominal distension(7.3% vs.19.7%, χ2=5.279, P=0.023)and intestinal obstruction(9.8% vs.22.4%, χ2=4.711, P=0.030)in the study group were significantly lower than those in the control group.The levels of C-reactive protein, interleukin-6 and tumor necrosis factor-α in the study group were significantly lower than those in the control group at 1 d, 3 d and 7 d after surgery( t= 9.612, 7.300, 5.446, 8.762, 12.138, 15.370, 10.186, 10.432, 13.512, respectively, all P<0.05). The levels of CD3 + , CD4 + and CD4 + /CD8 + in the study group were significantly higher than those in the control group at 1 d, 3 d and 7 d after surgery( t= 2.128, 2.957, 2.313, 2.914, 2.937, 2.809, 5.089, 5.623, 5.409, respectively, P<0.05 for all), and the levels of CD8 + were significantly lower than those of the control group( t= 2.008, 2.580, 4.902, all P<0.05). Conclusions:Laparoscopy combined with ERAS for the treatment of colorectal cancer in the elderly can reduce surgical injury and complications and mitigate inflammatory responses with little impact on immune responses.

Study on the factors of short-term prognosis of very elderly patients with acute coronary syndrome after interventional therapy / 中国医师进修杂志

Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant ( P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant ( P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge ( OR = 0.046, 95% CI 0.006 to 0.383, P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant ( P<0.01). Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.

Value of serum urea nitrogen on in-hospital death in patients with heart failure / 中国医师进修杂志

Objective:To investigate the value of serum urea nitrogen on in-hospital death in patients with heart failure.Methods:The clinical data of 9 459 patients with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were retrospectively analyzed. Among them, 296 cases died in hospital (death group) and 9 163 cases survived (survival group). The clinical data of patients were collected, including general condition, disease history, physical examination, laboratory indicators and relevant physical examination, etc. Correlation was finished with Pearson correlation analysis. Multivariate Logistic regression analysis was used to determine independent risk factors for in-hospital death in patients with heart failure. Receiver operating characteristic (ROC) curve was used to determine the optimal predictive threshold of urea nitrogen for in-hospital death.Results:The in-hospital mortality in patients with heart failure was 3.1% (296/9 459). There were statistical differences in age, hypertension rate, diabetes rate, a history of atrial fibrillation rate, smoking history rate, hemoglobin, albumin, glycosylated hemoglobin, urea nitrogen, creatinine, uric acid, serum potassium, serum sodium, troponin I, N terminal brain natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) between death group and survival group ( P<0.01 or <0.05), and there were no statistical difference in gender composition, coronary heart disease rate, platelet, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) between 2 groups ( P>0.05). Pearson correlation analysis result showed that the urea nitrogen was positively correlated with age, coronary heart disease, hypertension, diabetes, glycosylated hemoglobin, creatinine, uric acid, serum potassium, troponin I, NT-proBNP, LVEDV and LVESV ( r = 0.130, 0.024, 0.053, 0.128, 0.033, 0.739, 0.468, 0.377, 0.065, 0.432, 0.084 and 0.101; P<0.01 or <0.05); and the urea nitrogen was negatively correlated with gender, history of atrial fibrillation, hemoglobin, platelet, albumin, total cholesterol, LDL-C, serum sodium and LVEF ( r = -0.033, -0.063, -0.272, -0.077, -0.188, -0.070, -0.071, -0.199 and -0.113, P<0.01); and there were no correlation between urea nitrogen and smoking history or triglyceride ( P>0.05). Multivariate Logistic regression analysis result showed that age, hypertension, albumin, urea nitrogen, troponin I and NT-proBNP were independent risk factors for in-hospital death in patients with heart failure ( OR = 1.018, 0.613, 0.924, 1.082, 1.340 and 1.005; 95% CI 1.002 to 1.033, 0.427 to 0.881, 0.889 to 0.961, 1.040 to 1.126, 1.111 to 1.617 and 1.003 to 1.007; P<0.05 or <0.01). ROC curve analysis result showed that the area under the curve (AUC) of urea nitrogen for prediction of in-hospital death in patients with heart failure was 0.737 (95% CI 0.728 to 0.748), and the optimal threshold value was 11.41 mmol/L, with a sensitivity of 60.16% and a specificity of 77.01%; the AUC of NT-proBNP for prediction of in-hospital death in patients with heart failure was 0.726 (95% CI 0.712 to 0.740), and there was no statistical difference in the AUC between urea nitrogen and NT-proBNP ( Z=1.055, P=0.291). Conclusions:Elevated urea nitrogen level is independently associated with an increase in in-hospital mortality in patients with heart failure, and the optimal threshold for predicting in-hospital death is 11.41 mmol/L.

Correlation and prognosis analysis of hypoalbuminemia in patients with heart failure with preserved ejection fraction / 中国医师进修杂志

Objective@#To investigate the correlation between hypoalbuminemia and heart failure with preserved ejection fraction (HFpEF) and to analyze the prognosis of patients with HFpEF and hypoalbuminemia.@*Methods@#Three hundred and fourteen patients with HFpEF who were hospitalized in Department of Cardiology, Shengjing Hospital of China Medical University from January 2012 to December 2013 were analyzed retrospectively. These patients were divided into two groups according to the serum albumin, hypoalbuminemia (< 35g/L) group and normal albumin group (≥ 35g/L). The prognostic correlation between hypoalbuminemia and HFpEF was analyzed by COX regression analysis.@*Results@#Patients with hypoalbuminemia had a higher mortality: 20.2%(20/99) vs. 9.8%(21/215). There was no significant difference in the average hospitalization time、hospital mortality and readmissions for heart failure between two groups. Univariate COX regression analysis showed that the relative risk ratio of readmissions between normal albumin group and hypoalbuminemia group was 0.554(0.374-0.820), and the relative risk ratio of cardiogenic death was 0.283(0.148-0.538), P < 0.05.@*Conclusions@#HFpEF patients with hypoalbuminemia have relative poor heart function; hypoalbuminemia may be a risk factor of cardiac death for patients with HFpEF.

Correlation and prognosis analysis of hypoalbuminemia in patients with heart failure with preserved ejection fraction / 中国医师进修杂志

Objective To investigate the correlation between hypoalbuminemia and heart failure with preserved ejection fraction (HFpEF) and to analyze the prognosis of patients with HFpEF and hypoalbuminemia. Methods Three hundred and fourteen patients with HFpEF who were hospitalized in Department of Cardiology, Shengjing Hospital of China Medical University from January 2012 to December 2013 were analyzed retrospectively. These patients were divided into two groups according to the serum albumin, hypoalbuminemia ( < 35g/L) group and normal albumin group ( ≥ 35g/L). The prognostic correlation between hypoalbuminemia and HFpEF was analyzed by COX regression analysis. Results Patients with hypoalbuminemia had a higher mortality: 20.2%(20/99) vs. 9.8%(21/215). There was no significant difference in the average hospitalization time、hospital mortality and readmissions for heart failure between two groups. Univariate COX regression analysis showed that the relative risk ratio of readmissions between normal albumin group and hypoalbuminemia group was 0.554(0.374-0.820), and the relative risk ratio of cardiogenic death was 0.283(0.148-0.538), P < 0.05. Conclusions HFpEF patients with hypoalbuminemia have relative poor heart function; hypoalbuminemia may be a risk factor of cardiac death for patients with HFpEF.

A novel cavernosum-free surgical technique for concealed penis of children / 中华整形外科杂志

Objective@#To explore the feasibility and applicability of a novel cavernosum-free surgical technique for concealed penis of children.@*Methods@#From June 2017 to August 2017, 38 boys with concealed penis were treated using our new cavernosum-free surgical technique. The median age was 8.5 years(4-13 years). The technique consisted of 3 steps: Step 1, making a horizon incision and expose the glans; Step 2, suturing skin of penis to the corresponding side of inguinal ligament medial crus at 2 and 10 o′clock without fixing of cavernosum.Step 3, pruning the foreskin and suturing together. No catheter was placed after surgery.@*Results@#All the patients were able to urinate 2 to 6 hours after operation. The numeric rating scales score of postoperative pain was 1-3. Wound dressing was removed 5 to 7 days post-operatively. All of the parents had good cosmetic appearance, penis stretched naturally without deflection. The length of penis increased more than 3.0 cm on average after operation.Edema was observed in 3 cases, but disappeared in 5-7 days.No serious complications such as bleeding or winding occurs.@*Conclusions@#The novel cavernosum-free surgical technique is easy to perform. It provides a safe and effective technique for concealed penis of children.

Differences in clinical characteristics between patients with diastolic heart failure and systolic heart failure / 天津医药

Objective To analyze the differences in clinical characteristics and risk factors in patients with diastolic heart failure and systolic heart failure. Methods A total of 2 088 patients with heart failure were divided into two groups, diastolic heart failure group (EF≥0.45,n=1 356) and systolic heart failure group (EF<0.45,n=732), according to ejection fraction (EF). The clinical features and related factors affecting the two types of heart failure were compared between two groups. Results There were higher age, higher proportion of women and higher proportion of hypertensive patients in dia?stolic heart failure group than those of systolic heart failure group, but lower rates of hypoalbuminemia, anemia, renal insuffi?ciency and hyperuricimia. There was higher incidence of functional class I and II in diastolic heart failure group. And com?pared with systolic heart failure group, there were higher levels of systolic blood pressure, albumin, prealbumin, cholesterol, sodium and serum chloride in diastolic heart failure group, but lower levels of heart rates, creatinine, blood uric acid, potassi?um and brain natriuretic peptide. Compared with systolic heart failure group, there were lower left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) in diastolic heart failure group. And there were lower RAS blocker andβ-blocker usage, higher statin usage in diastolic heart failure group. Logistic regression analysis showed that gender and hypertension were significantly correlated with diastolic heart failure, and hypoalbuminemia and hyper?uricimia were significantly correlated with systolic heart failure. Conclusion Our results show that there are differences in clinical features and risk factors in patients with diastolic heart failure and systolic heart failure. We should take the differ?ent treatment and prevention programs for the two kinds of heart failures.

Correlation of chronic heart failure with hyponatremia and its prognostic analysis / 天津医药

Abstrsct:Objective To analyze the correlation of hyponatremia with chronic heart failure (CHF) and the prognostic analysis of CHF. Methods Patients with CHF (n=507) and healthy adult (n=212) were included in this study. The general data of the two groups were analysed. The index which was statistically significant was indicated as independent variables. Multivariate logistic analysis was used to analysis the correlation between serum sodium and CHF. The relationship between serum sodium and the prognosis of CHF include mortality and rate of readmission were included in follow-up study. The prognostic correlation of serum sodium with BNP (brain natriuretic peptide), heart failure with preserved ejection fraction (HFpEF, LVEF≥0.45) and heart failure with reduced ejection fraction (HFrEF, LVEF0.05) while other indicators like age, hemoglobin, serum sodium presents statistical significance (P 0.05);While for patients with HFpEF, the mortality and the readmission rates were both significantly different (P<0.05). Conclusion Serum sodium is the protective factor in CHF, the patients with hypona?tremia have higher readmission rate and death rate in HFpEF background.

Application of combined detection of helper T lymphocyte 1 and 2 type cytokines in acute pancreatitis / 国际检验医学杂志

Objective To explore the value of the combined detection of helper T lymphocyte (Th)1 and 2 type cytokines ex‐pression in the evaluation of acute pancreatitis severity and treatment efficacy .Methods From May 2009 to June 2013 ,the enzyme‐linked immunosorbent assay (ELISA ) was adopted to detect the expression levels of Th1‐type cytokineinterferon‐γ (IFN‐γ) and Th2‐type cytokine interleukin (IL)‐4 in 32 cases of mild acute pancreatitis (MAP group) and 18 cases of severe acute pancreatitis (SAP group) on 1 ,4 ,7 d after admission as well as 15 cases of normal healthy people (control group) .Results The test results of IFN‐γ on 1 ,4 ,7 d after admission in the MAP group were (31 .47 ± 4 .35) ,(36 .92 ± 4 .12) ,(49 .09 ± 4 .97)ng/L ,which of IL‐4 were (54 .72 ± 5 .52) ,(45 .26 ± 4 .89) ,(39 .79 ± 3 .85)ng/L .The test results of IFN‐γ on 1 ,4 ,7 d after admission in the SAP group were (23 .97 ± 5 .39) ,(26 .29 ± 3 .47) ,(33 .64 ± 4 .47)ng/L ,and which of IL‐4 were (70 .45 ± 5 .05) ,(65 .99 ± 4 .58) ,(56 .23 ± 4 .23)ng/L .The test results of IFN‐γ and IL‐4 in the normal control group were (49 .26 ± 20 .67)ng/L and (35 .15 ± 16 .32)ng /L respectively .Compared with the normal control group ,the expressions of Th1‐type cytokine IFN‐γ in the MAP group (except which on 7 d) and peripheral blood Th1‐type cytokine IFN‐γ in the SAP group were decreased and the expression of Th2‐type cyto‐kine IL‐4 was increased ,the difference was statistically significant (P< 0 .05) ;The test results of each index in the same treatment time had statistically significant differences between the SAP group and the MAP group (P< 0 .05) .Conclusion The obvious po‐larization of Th1‐type cytokine and Th2‐type cytokine exists in acute pancreatitis ,and the polarization degree is related with the se‐verity of disease .The combined detection of Th1‐type cytokine and Th2‐type cytokine is beneficial to judge the extent of serious condition and treatment effect of acute pancreatitis .

Application of pulse-indicated continuous cardiac output in patients with acute inferior wall myocardial infarction / 心血管康复医学杂志

Objective: To explore the guiding significance of transpulmonary thermodilution pulse-indicated continuous cardiac output (PiCCO) in treatment for patients with acute inferior wall myocardial infarction (AIMI). Methods: A total of 26 AIMI patients in intensive care unit of cardiology department in our hospital from Jul 2012 to Jan 2014 received PiCCO and ultrasonic cardiography (UCG) to monitor cardiac output (CO) and cardiac index (CI), and their correlation analysis. Results: When PiCCO placement and after placement 72h， PiCCO monitoring CI were （2.77±0.77）L•min-1•m-2, (3.17±0.39) L•min-1•m-2 respectively, there was significant difference（P＜0.01）, UCG measured CI were (2.49±0.64）L•min-1•m-2, (2.63±0.24) L•min-1•m-2, there was no significant difference（P＞0.05）; PiCCO monitoring CO were（4.78±1.06）L/min, (5.08±1.53) L/min respectively, there was significant difference（P＜0.05）, UCG measured CO were（4.51± 0.86）L/min, (4.57±0.91) L/min, there was no significant difference（P＞0.05）; and CI，CO measured by PiCCO were significantly higher than those of UCG group (P＜0.01 both) after PiCCO placement 72h. Conclusion: Pulse-indicated continuous cardiac output can offer more sensitive hemodynamic indexes compared with UCG, which possesses important treatment guiding significance in patients with acute inferior wall myocardial infarction and unstable hemodynamics.

Analysis of clinical characteristics and risk factors for chronic heart failure in the elderly / 中华老年医学杂志

Objective To investigate the clinical features and risk factors for chronic heart failure in elderly patients.Methods The 2,407 chronic heart failure patients were enrolled,including 1,513 elderly patients (62.9％) (aged≥≥65 years).Risk factors for chronic heart failure,clinical features,biochemical and physical examination were retrospectively analyzed.The effects of different factors on patients with different age were analyzed by Logistic regression analysis.Results Compared with the young and middle-aged patients,the higher prevalences of New York Heart Association functional classification (NAFC),diabetes,ischemic heart disease,hypertension,anemia,renal insufficiency and hyperuricemia were found,but the percentages of males,smoker,patients with dilated cardiomyopathy,valvular heart disease and hyperlipidemia were reduced in elderly patients.The levels of blood creatinine,high density lipoprotein (HDL),serum potassium,hemoglobin,albumin,pre-albumin,total cholesterol (TC),lower density lipoprotein (LDL),triglyceride (TG) and diastolic blood pressure were lower,but left ventricular ejection fraction (LVEF) and systolic blood pressure were higher,in the elderly patients than in young and middle-aged patients.Elderly patients had higher usage rates of stain and angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB),but lower usage rate of β-blocker as compared with young and middle-aged patients.In elderly patients,logistic regression analysis revealed that gender (OR=1.89,95％CI:1.566-2.285),a history of ischemic heart disease (OR=1.81,95％ CI:1.457-2.243),hypertension (OR=1.87,95％CI:1.462-2.389),anemia (OR=2.66,95％ CI:2.197-3.211),hyperuricemia (OR =1.41,95％ CI:1.186-1.678) were significantly related with chronic heart failure,whilein young and middle-aged patients,dilated cardiomyopathy (OR=0.49,95％ CI 0.351-0.689),hyperlipidemia (OR=0.53,95 ％ CI:0.433-0.641),smoking (OR=0.79,95 ％ C I:0.652 0.966) were significantly related with chronic heart failure.Conclusions Gender,ischemic heart? disease,hypertension,anemia,hyperuricemia are the independent risk factors for chronic heart failure in elderly patients.

Clinical research of sentinel lymph node biopsy in patients with early breast cancers / 重庆医学

Objective To perform the sentinel lymph node biopsy (SLNB) in the patients with early breast cancer by the strict screening conditions and to analyze the accuracy of the sentinel lymph node for predicting the axillary lymph node status .Methods SLNB combined with methylene blue dye and isotope was performed in 266 cases of early breast cancer treated in this department with full treatment courses .Then the axillary lymph node dissection(ALND) was routinely conducted .With the pathological ex-amination as the standard ,the related factors affecting SLNB were analyzed .Results The detection rate of SLN ,accuracy rate ,sen-sitivity and the false negative rate were 100% ,98 .5% ,95 .56% and 4 .44% respectively ;the accuracy of SLN was significantly cor-related with the tumor size ,pathological type and axillary lymph node status(P<0 .01);the false negative rate of SLN was related with the tumor location(P<0 .05) .Conclusion The combination of methylene blue dye and isotope used in SLNB is feasible in the patients with early breast cancer ,SLN could accurately predict the axillary lymph node metastasis status .

Clinical significance of hemodynamic monitoring using PiCCO / 心血管康复医学杂志

Transpulmonary thermodilution pulse-indicated continuous cardiac output (PiCCO) monitoring only needs a central venous catheter and an artery catheter ,so is a minimally invasive ,simple ,accurate and continuous cardiac output monitor technique used at home and abroad now .It combines transpulmonary thermodilution and analysis technique of arterial pulse wave area under curve (AUC) .It helps to better evaluate ,guide and improve treatment in critically ill patients .

Diagnosis of obstructive coronary artery disease using CT coronary angiography combined with CT first-pass myocardial perfusion imaging at rest / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the feasibility and accuracy of CT coronary angiography (CTCA) combined with CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of obstructive coronary artery disease (CAD).</p><p><b>METHODS</b>Fifty-five patients, suspected or diagnosed as CAD, were performed with CTCA and CAG within 2 weeks. CT first-pass MPI detected myocardial ischemia through analyzing the raw date of CTCA.</p><p><b>RESULTS</b>Comparison with the results of CAG, the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting obstructive CAD were 84.6%, 68.8%, 86.8%, 64.7% and 80.0%, respectively; and 92.3%, 93.8%, 97.3%, 83.3%, 92.7% for CTCA combined with CT first-pass MPI, respectively.</p><p><b>CONCLUSION</b>CTCA combined with CT first-pass MPI at rest could detect obstructive CAD feasible and accurately.</p>

Meta-analysis of the teaching effectiveness of PBL method for medical students in surgery bed side teaching / 中华医学教育探索杂志

ObjectiveTo evaluate the effectiveness of PBL teaching model for medical students in surgery bed side teaching.MethodsThe method of meta-analysis.ResultsFinally,twenty-six documents met the requirement.The resuhs of Meta-analysis showed that,in the aspect of theory improvement for medical students,WMD=6.46,95 ％ CI 为 2.56 ～ 10.36,P＜0.01 ; in the aspect of skill ability improvement,WMD=5.32,95 ％ CI 为 2.47 ～ 8.16,P ＜0.01.ConclusionThe model of PBL teaching could significantly improve the effectiveness in theoretical knowledge and skill ability.