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Objective To observe the expression of PD-L1 in breast cancer tissue and to investigate its correlation with cellu-lar immunity.Methods One hundred and fourteen paraffin-embedded specimens of breast cancer were collected from the Qian′an Municipal People′s Hospital.The expression of PD-L1 in breast tumor tissue was detected by immunohitochemical technique,then the relationship between PD-L1 expression and tumor clinicopathological characteristics was analyzed;the levels of peripheral blood CD3+,CD3+CD4+,CD3+CD8+,CD3-CD19+,CD3-CD16+CD56+cells and CD4+/CD8+in the patients with PD-L1 negative and PD-L1 positive of the two groups were detected by the flow cytometry.Results Among 114 cases of breast cancer specimen,35 ca-ses(30.7%)were PD-L1 expression positive with the expression rate of 30.7%.The PD-L1 expression was correlated with the tumor size,histological grade and Ki-67 high expression(P<0.05);the cellular immunity status in the patients with PD-L1 negative expression was better than that in the patients with PD-L1 positive expression(P<0.05).Conclusion The PD-L1 expression is closely correlated with the poorer clinicopathological characteristics of breast cancer,its mechanism may be correlated with the dis-ruption of cellular immunity in the patients with PD-L1 positive expression.
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Objective To apply the optical coherence tomography(OCT) to detect the characteristics of coronary artery plaque and to investigate its correlation with levels of serum matrix metalloproteinase 7(MMP 7),MMP9 and MMP12.Methods The patients undergoing coronary arterial angiography for diagnosing coronary arterial lesions in the cardiology department of our hospital from October 2014 to March 2016 were collected and included into the research subjects.The subjects were divided into the stable plaque group and unstable plaque group based on the results of OCT scanning.The neovascularization characteristics such as the fibrous cap thickness of plaque,angle of lipid pool,macrophage infiltration and plaque cracks were detected by using OCT.ELISA was used to measure serum MMP7,MMP9 and MMP12 levels.Results (1) The fibrous cap thickness in the stable plaque group was more than that in the unstable plaque group(P＜0.01);the lipid pool angle,microphage infiltration,intima erosion and plaque cracks in the unstable plaque group were more than those in the stable plaque group(P＜0.05).(2) The MMP7 and MMP9 levels in the unstable plaque group were higher than those in the stable plaque group and control group(P＜0.05).(3) The fibrous cap thickness had significantly negative correlation with serum MMP9 level(r=-0.336,P=0.034);the MMP7 and MMP9 levels in the microphage infiltration group were higher than those in the non-microphage infiltration group(P＜0.05);the MMP9 level in the intima erosion group was higher than that in the non-intima erosion group(P＜0.01).Conclusion OCT can detect and find unstable plaque and the serum levels of MMP7 and MMP9 are significantly elevated in the patients with unstable plaque,which can be used as an important basis for predicting unstable plaque and guiding the treatment decisions.
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Objective This study aimed to assess the adherence to guideline-recommended therapies according to risk stratification in the management of acute coronary syndrome(ACS). Methods We analyzed 1,001 consecutive patients admitted with ACS. Patients were stratified using the GRACE risk score into low- and high-predicted risk of mortality at 6 months. We evaluated the use of hospital angiography,revascularization,and guideline-recommended medications between high and low-risk patients. Results High-risk compared to low-risk patients were less likely to underwent coronary angiography and/or revascularization during the hospitalization. The use of hospital-initiated pharmacotherapies was also lower in high-risk patients(P<0.05). Advanced age, increased creatinine level and higher GRACE score were independent predictors for failure to administer evidence-based therapies. Conclusion Patients with ACS at high risk of mortality were paradoxically less likely to undergo revascularization or receive medications according to guidelines. Better adherence to evidence-based therapies in high-risk patients may improve clinical outcome and quality of health care.
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[Abstract ] Objective Cardiac shock wave therapy (CSWT) can promote arteriogenesis in ischemic myocardia , but the mo-lecular mechanism remains unclear .The study aimed to explore the effect of CSWT on arteriogenesis in human cardiac microvascular endothelial cells ( HCMEC ) and the role of focal adhesion kinase (FAK) and Calcium-activated potassium channels (KCa) in the sig-nal conduction pathway of CSWT arteriogenesis . Methods HC-MEC cells cultured in vitro were randomly divided into control group , CSWT group , CSWT +T ( FAK inhibitor PF-573228 ) group and CSWT+F( SCa inhibitor iberiotoxin ) group.Each group received one CSWT(0.09 mJ/mm2, 200Times) 48 h after added stimulant.24 hours'conventional culture later , tests were made on the levels of endothelial nitric oxide synthase ( eNOS ) and vascular endothelial growth factor ( VEGF) mRNA as well as the changes of related protein expression . Results ①QPCR test showed that eNOS , VEGF mRNA expressions increased in CSWT group compared with control group (4.61 ±0.19 vs 3.99 ±0.17, P<0.05), while compared with CSWT group, eNOS, VEGF mRNA expressions in CSWT +T group were decreased (0.62 ±0.10 vs 0.40 ±0.02, P<0.05), eNOS, VEGF mRNA expressions in CSWT +F group were also decreased (0.53 ±0.02 vs 0.64 ±0.02, P<0.05), all the differ-ences were of statistical significance .②Western blot showed that eNOS , VEGF protein expressions increased in CSWT group compared with control group(0.63 ±0.02 vs 0.43 ±0.02, P<0.05), while compared with CSWT group , eNOS, VEGF protein expressions in CSWT+T group were decreased (0.36 ±0.01 vs 0.29 ±0.02, P<0.05), eNOS, VEGF protein expressions in CSWT +F group were also decreased (0.37 ±0.02 vs 0.30 ±0.02, P<0.05), all the differences were of statistical significance . Conclusion CSWT can improve eNOS , VEGF mRNA and protein expressions in HCMEC cells and FAK and KCa may participate in the signal conduction pathway of CSWT arteriogenesis .
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Total 1 500 subjects aged over 60 years were selected from 10 community health service centers with cluster sampling method.A questionnaire survey and physical examination were performed in all subjects.Sixty five patients with chronic heart failure were detected.The questionnaire showed that 77.6％ (38/49)patients were diagnosed in tertiary hospitals,and 12.2％ (6/49) were diagnosed in community hospitals.When heart failure occurred,most patients (37.7％,20/53) chose to take a taxi to the tertiary hospital directly,and less patients (17.0％,9/53)contacted community doctors.When a heart attack happened,68.8％ (33/48)of the patients could reach the hospital within 30 min,and 55.3％ (26/47) within 60 min.45.7％ (21/46) elderly patients were hospitalized for heart failure once a year;31.1％ (14/45) were in hospital for less than 10 d each time.46.0％ (23/50) heart failure patients had received health education and 40.0％ (16/40) had taken drugs under supervision;the majority health educators were community doctors and majority supervisors were family members.The results suggest that the confirmed diagnosis and treatment of heart failure patients still rely on tertiary hospitals,community health institutions play an important role in health education and management of heart failure patients outside hospitals.But the utilization of community health services is still not enough in community health service centers.
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Objective To observe and evaluate the effects of metformin and pioglitazone on blood glucose,insulin,glucagon,β-cell function and insulin resistance among patients with diabetes and metabolic syndrome,so as to discuss the role of pancreatic α cells in pathogenesis of type 2 diabetes mainly caused by insulin resistance and the change of α-cell function after treatment.Methods A total of 60 patients diagnosed with diabetes and metabolic syndrome were selected in Beijing Chaoyang District Diabetes Center from April 2012 to April 2013 and divided with random number table into metformin group (treated with metformin 0.5 g orally thrice a day for 1 year,n =30) and pioglitazone group (treated with pioglitazone 15 mg orally once a day for 1 year,n =30).30 normal healthy people who had physical examination at the Center during the same period were enrolled into the control group,matched in age and gender with the intervention groups.The general condition of the 3 groups,and blood levels of glucose,insulin,and glucagon,insulin sensitivity index (ISI)-Matsuda,homeostasis model assessment of insulin resistance (HOMA-IR),β-cell function index (HOMA-β),1-phase index,2-phase index,and insulin secretion sensitivity index (ISSI) at baseline in the 3 groups and after treatment in the metformin group and the pioglitazone group were measured and calculated.Results Compared with the control group before treatment,the intervention groups as a whole had significantly higher fasting glucagon level [(146.22 ±25.41) pmol/L vs.(21.31 ±7.85) pmol/L,P =0.002] and area under curve (AUC) of glucagon [(469.84 ±13.12) pmol/(L · h) vs.(100.94 ± 7.73) pmol/(L · h),P =0.006].Compared with the results before treatment,the metformin group exhibited significantly reduced fasting glucose [(6.46 ± 1.38) mmol/L vs.(7.54 ± 0.43) mmol/L,P=0.031],fasting insulin [(119.22 ± 69.01) pmol/L vs.(139.38 ±71.13) pmol/L,P =0.042],fasting glucagon [(91.69 ±22.11) pmol/L vs.(142.81 ±24.56) pmol/L,P=0.029],AUC of glucose [(25.19 ± 1.31) mmol/ (L · h) vs.(32.68 ± 1.12) mmol/ (L · h),P =0.043],AUC of insulin [(468.65 ±20.10) pmol/ (L· h) vs.(786.32±21.37) pmol/ (L· h),P=0.017],and AUC of glucagon [(280.60±8.26) pmol/ (L · h) vs.(487.14±14.31) pmol/ (L · h),P=0.032];while the pioglitazone group after treatment also showed significantly decreased fasting glucose [(6.58 ±2.21) mmol/L vs.(7.68±0.59) mmol/L,P=0.028],fastinginsulin [(107.92±17.81) pmol/L vs.(144.66±74.43) pmol/L,P =0.033],fasting glucagon [(76.07 ±20.57) pmol/L vs.(148.34 ±28.94) pmol/L,P=0.025],AUC of glucose [(25.58 ±1.22) mmol/(L·h) vs.(35.07 ±1.38) mmol/(L· h),P=0.038],AUC of insulin [(435.54±19.30) pmol/ (L· h) vs.(854.75 ±20.61) pmol/(L·h),P=0.013],andAUCofglucagon [(223.43 ±5.83) pmol/ (L·h) vs.(458.55 ±12.96) pmol/ (L·h),P =0.026].The before-after-treatment differences were significantly smaller in the metformin group than in the pioglitazone group in terms of fasting insulin [(20.16 ± 2.98) mmol/L vs.(36.74 ± 2.88) mmol/L,P =0.011],fasting glucagon [(51.12 ± 3.67) pmol/L vs.(72.27 ± 4.58) pmol/L,P =0.016],AUC of insulin [(317.67 ±13.45) pmol/(L · h) vs.(419.21 ±15.44) pmol/(L · h),P=0.031] and AUC of glucagon [(206.54±9.66) pmol/(L· h) vs.(235.12±10.29) pmol/(L· h),P=0.046].Conclusions Glucagon in patients with diabetes and metabolic syndrome is higher than that in normal individuals.Metformin and pioglitazone can decrease the level of glucagon in patients with metabolic syndrome and diabetes as well as improve the glucose control,β-cell function and insulin resistance,suggesting improving effect of these two drugs on α-cell function.Pioglitazone manifests a stronger effect than metformin does.
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<p><b>INTRODUCTION</b>The paediatric hearing impairment caregiver experience (PHICE) questionnaire is a 68-item instrument that assesses the stress experienced by caregivers of children with hearing impairment (HI). While the questionnaire has been validated in the United States, it may need to be modified for use in the Singapore context due to the differing healthcare system, costing and culture related to caregiving for children with HI. This study aims to modify and validate the PHICE questionnaire to increase its relevance and ease of use in Singapore.</p><p><b>MATERIALS AND METHODS</b>The original PHICE questionnaire was filled out by 127 caregivers of HI children managed at the otolaryngology clinic of the National University Hospital (NUH). An expert panel was convened to assess the questionnaire for its suitability for use in Singapore. Exploratory factor analysis was conducted to evaluate the underlying factor structure of the original PHICE questionnaire. Items with high cross-loadings were removed and a new factor structure was adopted which was further analysed using confirmatory factor analysis (CFA). Cronbach's alpha (α) was computed to determine the internal consistency of the new subscales.</p><p><b>RESULTS</b>Items that are less relevant in Singapore and those with high cross-loadings were removed. A 5-factor structure with only 42 items remaining and corresponding to the factors: " Policy", "Healthcare", "Education", "Support" and "Adaptation" was adopted. CFA suggests a good model fit for the modified questionnaire, improved from the 8-factor structure of the original PHICE. Cronbach's α were high (>0.7) for each new subscale.</p><p><b>CONCLUSION</b>The original PHICE questionnaire has been shortened and reorganised in terms of the subscales composition. The resulting instrument is structurally valid and internally consistent. It is a simple and useful tool for identifying factors related to caregiving that can negatively impact rehabilitation outcomes for children with HI in Singapore. Removal of some sign language items makes this modified version less useful for caregivers, places or countries where sign language is the main focus of rehabilitation for children with HI.</p>
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Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cuidadores , Perda Auditiva , Terapêutica , Singapura , Inquéritos e QuestionáriosRESUMO
Objective:To explore the clinical application value ofChinese evaluation method of 10-year morbid risk of ischemic cardiovascular diseasesself developed from China.Methods:Chinese evaluation method of 10-year motbid risk ofischemic cardiovascular diseasesdeveloped bv cardiovascular diseaseinstitute of Chinese academy of medical science,was used to evaluate motbid risk of cardiovascular diseases of 2465 community residents in Chaoyang district of Beijing.Relative analysis was done then.Results:(1)Compared with female group,mean values of systolic blood pressure[(122.84±16.42)mmHg vs.(126.83±16.36)mmHg],diastolic blood pressure[(80.67±9.51) mmHg vs.(84.54±9.89)mmHg]and total cholesterol[(4.86±1.06)mmol/L vs.(5.01±0.97)mmol/L]significantly increased in male group,P＜0.001 all;(2)For the ratio of subjects whose 10-year morbid risk of ischemic cardiovascular diseases≥10%(high risk subjects),was of 3.28% in men and significantly more than that of women(1.59%)P ＜0.05.It was consistent withthe data of absolute risk ofischemic cardiovascular diseasesfrom Chinese 9903 cases survey and follow up 15.1 years by the collaborative research group of the Chinese national 10th five years plan project.Conclusion:Chinese evaluation method of 10-year morbid risk of ischemic cardiovascular diseasescan accurately detect distribution condition of morbid risk among population andit makeforto simple screening of high risk population.
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Objective: To explore the clinical application value of “Chinese evaluation method of 10-year morbid risk of ischemic cardiovascular diseases”self developed from China. Methods: “Chinese evaluation method of 10-year morbid risk of ischemic cardiovascular diseases”developed by cardiovascular disease institute of Chinese academy of medical science, was used to evaluate morbid risk of cardiovascular diseases of 2465 community residents in Chaoyang district of Beijing. Relative analysis was done then. Results: (1) Compared with female group, mean values of systolic blood pressure [(122.84±16.42) mmHg vs. (126.83±16.36) mmHg], diastolic blood pressure [(80.67±9.51) mmHg vs. (84.54±9.89) mmHg] and total cholesterol [(4.86±1.06) mmol/L vs. (5.01±0.97) mmol/L] significantly increased in male group, P<0.001 all; (2) For the ratio of subjects whose 10-year morbid risk of ischemic cardiovascular diseases≥10% (high risk subjects), was of 3.28% in men and significantly more than that of women（1.59%） P<0.05. It was consistent with the data of absolute risk of ischemic cardiovascular diseases from Chinese 9903 cases survey and follow up 15.1 years by the collaborative research group of the Chinese national 10th five years plan project. Conclusion: “Chinese evaluation method of 10-year morbid risk of ischemic cardiovascular diseases”can accurately detect distribution condition of morbid risk among population and it make for to simple screening of high risk population.
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Objective To observe and assess the effect of different dosages of aspirin on inflammatory biomarkers, hemorheology (platelet aggregation rate) and clinical prognosis in patients with acute coronary syndrome ( ACS). Methods ACS patients were randomly assigned to receive different dosages of aspirin treatment orally. Patients in group A,B and C took 100 mg, 500 mg and 1000 mg of aspirin per day respectively. They were treated and followed-up for 1 year. High-sensitivity C-reactive protein ( hsCRP) , IL-6, tumor necrosis TNFot and platelet aggregation rate were examined and major adverse cardiac events( MACE) were recorded. Results A total of 312 patients with ACS were enrolled in the study. The baseline characteristics of the three groups were not different with respect to age, gender, cardiovascular risk profile, level of inflammatory biomarkers and concomitant treatment before and after randomization. The levels of baseline serum hsCRP, IL-6 and TNFa were higher in subjects of the study as compared with normal reference value (P<0. 05, <0. 05, <0. 01) and they decreased significantly after therapy with 3 different doses of aspirin (detected at 30 days, 6 months and 12 months, P <0. 001 ) , but there were no significant differences among the three groups( P >0. 05) . Rehospitalization , MACE and the change of platelet aggregation ratio were not significantly different among the three groups. The incidence of gastrointestinal complaints was significantly higher in groups B and C than in group A ( P < 0. 05 ). Conclusions The levels of serum inflammatory biomarker increase in patients with ACS. Aspirin therapy may decrease the level of inflammatory markers significantly, but increasing the dosage of aspirin from 100 mg to 1000 mg daily does not decrease the level of inflammatory markers and the clinical MACEs further. However, the incidence of gastrointestinal complaints increase significantly with the increase of aspirin dosage.
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Objective To establish a method for the detection of methylene tetrahydrofolate reductase (MTHFR) 677 C→T mutation by real-time fluorescence PCR.Methods MTHFR 677 C→T mutation was detected in 300 healthy people by the technique of polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) and real time fluorescence PCR. Sequencing was performed to confirm the accuracy of detection results. Results Three genotypes (CC, CT and TT) were found with two methods in all the 300 people. There were no significant differences in genotype frequency and allele frequency between the two groups (P>0.05).Conclusion Real-time fluorescence PCR is an accurate and rapid method for prompt grouping of MTHFR gene locus.
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BACKGROUND: Valsartan is an antagonist of angiotensin Ⅱ (Ang Ⅱ ) receptor. Many researches have proved that it can protect heart tissue. Val-PREST suggests that valsartan with a long-term administration can decrease restenosis rate in stent; however, effect of valsartan on restenosis rate of Chinese population is still unclear presently.OBJECTIVE: To evaluate the effect of oral valsartan for 6 months on patients with coronary heart disease (CHD) who undertook successful intervention therapy.DESIGN: Multicenter, double blind, randomized, and controlled evaluation and prospective design.SETTING: Beijing Friendship Hospital Affiliated to Capital Medical University; Beijing Anzhen Hospital Affiliated to Capital Medical University; Peking Union Hospital; People's Hospital of Peking University; Beijing Tongren Hospital Affiliated to Capital Medical University; Beijing Shijingshan Hospital; Beijing Fuxing Hospital Affiliated to Capital Medical University;Beijing Chuiyangliu Hospital.PARTICIPANTS: Eight three-grade A hospitals in Beijing participated in the study. Since December 2002 to October 2003, a total of 200 patients who underwent bare mental stent implantation were consented, but 196 patients were recruited in the end. All 196 patients were randomized into valsartan group (100 cases) and control group (96 cases).METHODS: Basic medicines in the two group included aspirin, clopidogrel, nitrides, statins, β-receptor antagonists, calcium channel antagonists, etc. Additionally, Patients in valsartan group were also given valsartan (Beijing Nuohua Pharmaceutical Co. Ltd., batch number: SD 34004) in a dosage of 80 mg a day. Both groups were followed-up once a month for total 6 months.MAIN OUTCOME MEASURES: ① Major adverse cardiac events within 6 months on clinics (death, non-fatal myocardial infarction, hospitalisation once more due to recurrent myocardial ischemia, and target vessel revascularization); ② Results of duplicated coronary angiography or exercise treadmill test (ETT) of partial patients within 6 months.RESULTS: ① Two patients (2%) in valsartan group were excluded in this study because of intolerance, so 194 patients were involved in the final analysis. ② No significant differences of baseline characteristics in terms of lesion type, the number of diseased vessels and the cardiac function were found between the two groups (P ＜ 0.05). ③ During the period of 6-month follow-up, one case died in control group. One acute myocardial infarction occurred in each group, whilst one case undertook target vessel revascularization in valsartan group. It was found that the proportion of recurrent cardiac events was lower in valsartan group than that in control group (11.2% vs. 15.6%). However, this difference did not reach the statistic significance. ④ During the period of 6-month duplicated contrast examination, one case had restenosis of in-stent in valsartan group. ⑤ The positive rate of exercise treadmill test (ETT) was lower in valsartan group (25.7%) than that in control group (36.4%), but there was no statistic difference.CONCLUSION: Six-month oral valsartan on patients with coronary heart disease who undertook successful intervention therapy can decrease the trend of recurrent cardiac events and positive rate of ETT.
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<p><b>OBJECTIVE</b>To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF).</p><p><b>METHODS</b>This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer.</p><p><b>RESULTS</b>cTnT concentration was 0.181 +/- 0.536 ng/mL in CHF patients and 0.003 +/- 0.001 ng/mL in controls (P < 0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF </= 35%, cTnT was 0.311 +/- 0.221 ng/mL. In the second group of 106 patients with LVEF > 35%, cTnT was 0.07 +/- 0.0 5 ng/mL (P < 0.01). In patients with NYHA class I, II, III and IV, cTnT values were 0.062 +/- 0.022 ng/mL, 0.113 +/- 0.121 mg/mL, 0.191 +/- 0.231 mg/ml and 0.384 +/- 0.211 mg/mL, respectively (class I vs class II P > 0.05, class II vs class III P < 0.01, class III vs class IV P < 0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r = -0.493, P < 0.001).</p><p><b>CONCLUSIONS</b>This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.</p>