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Abstract:Objective To investigate the relationships of 14-3-3zeta protein expression with the therapeutic efficacy and prognosis of the patients with mantle cell lymphoma (MCL). Methods Clinical data of 12 MCL patients who were confirmed pathologically and treated in the Department of Hematology of Xijing Hospital between March 2007 and March 2012 were collected and analyzed. The protein expression of 14-3-3zeta in the patients was detected immunohistochemically, and its correlation with the prognosis of the patients was analyzed. Results Compared with reactive lymphoid hyperplasia, 8 cases showed positive expression of 14-3-3zeta in the cytoplasm, accounting for 66.7%. The overall response rate (ORR), and 2-year overall survival (OS) and 2-year progression-free survival (PFS) were 62.5%,50.0% and 37.5% respectively in the patients with positive expression of 14-3-3zeta, significantly lower than those in the negative expression patients (75.0%, 100.0 and 75.0%). Our results need in-depth study with larger samples. Conclusion MCL patients have abnormally high expression of 14-3-3zeta protein, and its expression level may be correlated with the patients’prognosis.

Abstract:Objective To evaluate the clinical values of 99mTc-methoxyisobutylisonitrile (MIBI) gated myocardial perfusion imaging (MPI) in rest and stress states for coronary artery disease (CAD) patients before and after percutaneous coronary intervention (PCI). Methods Thirty CAD patients admitted in our affiliated hospital of Inner Mongolia Medical University from September 2014 to December 2015 were enrolled in the study. They all underwent PCI and 99mTc-MIBI stress/rest gated MPI in 2 weeks before and 3 months after PCI. The abnormal segments and stress/rest scores of MPI before and after PCI or stent implantation, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV) and segments of wall motion abnormalities before and after PCI were evaluated by ECTOOLBOX. Results There were 320 segments corresponding to 44 vessels with stenosis >75%. Significant differences were observed in the number of abnormal segments in the myocardial reversible defect (RD) patients before and in 3 months after operation (χ2=231.867, P<0.001), but not in the number among the myocardial fixed defect (FD) patients before and after the treatment (χ2=3.398, P>0.05). There were obvious differences in the summed stress score (SSS) and summed rest score (SRS) in the RD patients before and in 3 months after treatment (t=2.457, 2.115, P<0.05), so were in the SSS in the FD patients (t=2.042, P<0.05), but not in the SRS (t=0.258, P>0.05). The values of LVEF, EDV and ESV were all elevated after surgery, though without statistical differences (t=0.075, 0.032, 0.022, P>0.05). The number of segments of wall motion abnormalities had no significant difference before and after PCI (χ2=3.570, P>0.05). Conclusion 99mTc-MIBI stress/rest gated MPI is of guiding significance in therapeutic regimen, case selection, risk stratification before PCI and in the evaluation of the efficiency after PCI.

Abstract:Objective To identify the clinical features of cancer patients with venous thromboembolism (VTE), including types, stages and differentiation of the primary cancers, in order to identify high-risk patients, improve awareness of prevention and control, and reduce the occurrence of the disease. Methods A total of 280 cancer patients who were diagnosed with VTE in our hospital from January 2003 to January 2013 were recruited in this study. Their demographic and clinical data, including age, gender, differentiation, pathological types, TNM stages, chemotherapeutic regimens and prognosis were collected and retrospectively analyzed. Results A total of 280 cancer patients with VTE were enrolled, including 157 males and 123 females at an age of (66.60±12.60) years. There were 41 cases of isolated pulmonary thromboembolism (PTE), 189 of deep vein thrombosis (DVT) and 50 of PTE combined with DVT. Among them, 82 patients were lung cancers, 78 gastrointestinal cancer, 32 urinary tract tumor, 27 gynecological tumor, 27 haematological tumor, 12 breast cancer, and 22 other cancers. Compared with the cancer patients without VTE, VTE was more common in the patients with lung, gynecological and other cancers (P<0.05). Among all the patients, 151(53.9%) were diagnosed with adenocarcinoma, and 206 patients (73.6%) presented advanced cancer when developing VTE. For the 247 patients with explicit TNM stage, 187(66.8%) of them were at stage Ⅲ-Ⅳ. Among the 144 patients with definite cancer differentiation, 120(85.4%) were at moderate and poor differentiation. Till the end of follow-up, 130 patients died with a median survival time of (24.0±7.8) months. The cumulative mortality rates within 3, 6, 9 and 12 months were 46.9%, 69.2%, 80.0% and 82.3% respectively. The top 3 causes of death were cancer, PTE and infection. Conclusion Cancer is closely associated with VTE. Adenocarcinoma, advanced cancer, low differentiation of tumor and chemotherapeutic regimens containing platinum are more prone to developing VTE. Clinicians should pay attention to these patients, perform VTE risk evaluation, and take the necessary precautionary measures to reduce the incidence of VTE.

Abstract:Objective To analyze the efficacy of a new iron chelator, deferasirox, in treatment of iron overload secondary to myelodysplastic syndrome (MDS) and investigate its adverse reactions. Methods Clinical data of all the iron overload patients secondary to MDS who receiving deferasirox therapy in our hospital from January 2012 to April 2014 were collected and retrospectively analyzed. Their serum ferritin (SF) level, amount of red blood cell transfusion, and hemoglobin level were measured and recorded before and after treatment, and adverse reactions were observed. Results There were totally 8 cases of MDS secondary iron overload enrolled in this study. They were 7 males and 1 female, and at a median age of 52 (ranging from 38 to 71) years. After 3 months’ treatment, complete response (CR) was obtained in 3 cases, minor response (MiR) in 3 cases, and stable iron load (SIL) in 2 cases. The overall response rate was 75.0% (6/8), and the median amount of red blood cell transfusion was 2 (1-3) u/month. In 1 year after treatment, SF level was significantly decreased［(871.0±584.2) vs (2164.9±1233.6)ng/ml］, while that of hemoglobin was obviously increased［(101.5±34.59) vs (65.37±21.35)g/L］, with statistical differences (P<0.05). At this time point, 5 patients were out of red blood cell transfusion, and the amount of red blood cell transfusion was 0.5, 1.5 and 2.0 u/month respectively, for the other 3 patients. After 1 year treatment, only 1 patient died, 3 patients experienced nausea and vomiting, and 1 patient diarrhea. Conclusion Deferasirox therapy is safe and effective for MDS secondary iron overload patients.

Abstract:Objective To investigate the correlation of heart valve calcification with coronary atherosclerosis in the adults at the age of 50-70 years in order to provide early warning before the symptom appearance induced by atherosclerosis. Methods Totally 205 subjects who underwent coronary artery angiography or coronary computed tomographic angiography (CTA) in our hospital from January 2010 to June 2015 were recruited in this study. According to the results of echocardiography, they were divided into calcification group (n=107) and non-calcification group (n=98). The blood pressure, blood glucose level and lipid profiles were measured and compared between the 2 groups. The correlations of the incidence of coronary heart disease and severity of coronary artery lesions were analyzed with heart valve calcification. Results The patients in calcification group had significantly higher incidences of hypertension, diabetes and hyperlipemia than those of non-calcification group (P<0.05). Except for high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and fasting plasma glucose were obviously higher in calcification group than in non-calcification group (P<0.05). The incidence of coronary artery disease was 64.49% in calcification group, with 42.99% of single vessel, 13.08% of 2 vessels, and 8.41% of ≥ 3 vessels of coronary artery lesions. However, in non-calcification group, the incidence of coronary artery disease was only 17.35%, and most of them were single vessel lesion. Both the incidence of coronary artery disease and the involved vessels of coronary artery lesions were remarkably higher in calcification group than in non-calcification group (P<0.05). ConclusionHeart valve calcification and coronary artery lesions are correlated. Investigation of heart valve calcification is an easy, fast and effective method to screen the patients needing for CTA or coronary artery angiography.

Abstract:Objective To evaluate the predictive value of the STOP-Bang questionnaire in screening obstructive sleep apnea hypopnea syndrome (OSAHS) in the patients with hypertension. Methods A total of 220 patients admitted in the Department of Cardiology of the First People’s Hospital of Yangzhou from June 2014 to December 2015 due to hypertension but with suspected OSAHS were enrolled in this study. All the subjects were surveyed with STOP-Bang questionnaire, and given polysomnography (PSG). According to the results of PSG, they were divided into non-OSAHS, and mild, moderate and severe OSAHS groups. The results of STOP-Bang score and PSG were compared and analyzed for the sensitivity, specificity, positive predictive values, negative predictive values and the area under the receiver operating characteristics (ROC) curve of the questionnaire. Results The STOP-Bang questionnaire scores were elevated with the increased severity of OSHAS (2.58±0.85, 3.28±1.09, 4.09±1.13 and 4.83±1.09). Significant difference were found in the STOP-Bang scores between the non-OSAHS group and the other 3 OSAHS groups respectively (P<0.001). The sensitivities of STOP-Bang scoring model for apnea hypopnea index (AHI)≥5, >15, >30 were 88.58%, 95.52% and 98.96% respectively, and the negative predictive values were 47.5%, 85.0% and 97.5% respectively. The coincidence rate of STOP-Bang scoring model was 82.73% when compared with gold standard to diagnose OSAHS. The area under the ROC curve at AHI≥5 was 0.844. Conclusion The STOP-Bang questionnaire is suitable to screen OSAHS among hypertensive patients, with sound feasibility and accuracy.

Abstract:Objective To investigate the correlation of plasma homocysteine (Hcy) level with carotid intima-media thickness (IMT) and carotid atherosclerosis in Uygur and Han patients with hypertension living in Xinjiang Region. Methods A total of 420 essential hypertension patients admitted to Department of Geriatrics in our hospital from 2011 to 2015 were enrolled in this study. There were 214 subjects of Han nationality, at an age of (63.36±14.82) years, and 206 subjects of Uygur nationality, at an age of (64.16±15.79) years. Another 405 healthy individuals who taking physical examination in that period served as normal controls, and they were 203 of Han nationality (60.45±14.11 years old) and 202 of Uygur nationality (61.23±12.71 years old). Enzyme-linked immunosorbent assay was applied to determine the plasma level of Hcy, and color Doppler ultrasonography was applied to measure the carotid IMT. Results Compared with the normal controls, the hypertension group had higher body mass index (BMI), systolic blood pressure (SDP), diastolic blood pressure (DBP), and plasma Hcy level, but lower folic acid (FA), thicker carotid IMT and higher incidence of carotid plaques (P<0.05). There were no obvious differences between the Han and Uygur hypertensive patients in age, sex, uric acid (UA), triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), FA, carotid IMT and incidence of atherosclerotic plaques (P>0.05). Plasma Hcy level was positively correlated with age, TC, LDL-C and SBP, but negatively with FA. Carotid IMT was positively correlated with age, TC, LDL-C, SBP and Hcy level, but negatively with FA. Conclusion Age, TC, LDL-C and hyperhomocysteine are risk factors of carotid atherosclerosis for Uygur and Han hypertensive patients living in Xinjiang.

Abstract:Objective To investigate the relationship between plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and myocardial remodeling in hypertensive patients over 80 years old. Methods A total of 113 patients (>80 years old) admitted in our hospital from Feb. 2012 to Apr. 2016 were enrolled in this study. They were divided into hypertension group (n=71) and normal blood pressure (control) group (n=42), and the former group was further assigned into 3 subgroups according to their systolic blood pvessure (SBP) and diastolic blood pressure (DBP), that is, level 1 subgroup (SBP 140-159 mmHg, DBP 90-99 mmHg, n=5), level 2 subgroup (SBP 160-179 mmHg, DBP 10-109 mmHg, n=17) and level 3 subgroup (SBP ≥180 mmHg, DBP ≥110 mmHg, n=49). The plasma NT-proBNP level was determined and compared among the groups and subgroups, and its correlation with myocardial remodeling indicators was analyzed. Results With the increase of blood pressure levels, the plasma NT-proBNP level was gradually elevated. Except the level 1 subgroup and control group, significant differences were found in the plasma level among other groups (P<0.05). The NT-proBNP level was positively correlated to hypertension duration (r=0.508), 24-hour DBP (r=0.312), left ventricular mass index (r=0.301), interventricular septum thickness (r=0.285), and negatively to E/A ratio (r=-0.376, all P<0.01). Conclusion A good correlation is observed between NT-proBNP level and myocardial remodeling in hypertensive patients aged over 80 years.

Abstract:Objective To investigate the clinical characteristics and outcome of the aged patients with disseminated pulmonary tuberculosis (DPT). Methods A total of 96 patients with identified DPT admitted in our department from January 2006 to April 2014 were subjected in this study. According to their age, they were divided into the aged group (n=42) and the non-aged group (n=54). The clinical features and outcomes of 2 groups of patients were retrospectively analyzed. Results The aged group had a significantly higher incidence of complications than the non-aged group (66.7% vs 24.1%, P=0.000). The positive rate of tuberculin purified protein derivative (PPD) test, and the levels of hemoglobin and albumin were obviously lower in the former than in the latter group (P<0.05). Compared with the non-aged group, the patients of the aged group had significantly higher misdiagnosis rate (45.2% vs 24.1%, P=0.029), lower recovery rate (52.4% vs 77.8%, P=0.009) and higher mortality (11.9% vs 1.9%, P=0.044). Conclusion The aged DPT patients have lower recovery rate, higher mortality and misdiagnosis rate. Special attention should be paid to them in clinical practice.

Abstract:Objective To analyze the clinical features and prognosis of primary bone lymphoma (PBL). Methods Clinical data of 42 PBL patients admitted in our hospital from 2006 to 2014 were collected and analyzed retrospectively. They were 24 males and 18 females, at an age ranging from 11 to 78 (median 45.6) years. Their clinical data, including sex, age, systemic symptoms, location of disease, clinical stage, pathological type, treatment regimen, and efficacy evaluation, were collected. They were followed up till March 2015 through phone call follow-up or outpatient revisit. Results Pain in the lesion and numbness in the surrounding area were the first presentation in all the patients. Their pathological types were all identified as non-Hodgkin lymphoma (NHL), mainly diffuse large B-cell lymphoma (DLBCL, 21/42, 50%). Among them, 17 subjects received medical treatment, including 5 with radiotherapy and chemotherapy, and 12 with simple chemotherapy. There was no significant difference in short-term efficacy between two groups (P>0.05). After 4 courses of treatment, short-term effect evaluation showed age, sex, stage, lactate dehydrogenase (LDH) level, systemic symptoms, pathological type, Eastern Cooperative Oncology Group (ECOG) score, international prognostic index (IPI), retuximab injection, and combination with radiotherapy had no obvious effects on complete remission (CR) in the subjects (P>0.05). During the median follow-up of 13(2-48) months, 3 patients of the 4 patients with >3 years progression-free survival received retuximab injection. Conclusion Among the 42 subjects, DLBCL is the main pathological type. Chemotherapy is the main treatment, and combination of radiotherapy has no obvious effect. Retuximab injection may improve prognosis, but further research with a larger sample size is still needed.

Abstract:Objective To investigate the incidences of depression and anxiety in the elderly patients with chronic congestive heart failure (CHF). Methods A total of 180 CHF patients admitted in our department from January 2014 to December 2015 were enrolled in this study. The other 60 sex- and age-matched healthy subjects served as control group. Self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to evaluate the anxiety and depression status in the 2 groups, and color Doppler ultrasonography was employed to measure the left ventricular ejection fraction (LVEF). Results The SDS and SAS scores were significantly higher, while the LVEF values were obviously lower in the CHF patients than in the controls (P<0.05). With the increase of the cardiac function grade, there were more and more patients with high SDS and SAS scores and high incidences of anxiety and depression, but gradually reduced LVEF values (P<0.05). Conclusion CHF elderly patients have high complications of anxiety and depression. Clinicians should pay attention to the intervention of anxiety and depression in the process of diagnosis and treatment of such patients.

Abstract:Objective To investigate the expression of Klotho in the myocardial tissue of the patients with chronic heart failure (CHF), and explore its relationship with myocardial fibrosis. Methods Myocardial tissue samples were collected from 60 CHF patients during cardiopulmonary bypass surgery in the Department of Cardiac Surgery, Kunming General Hospital of Chengdu Military Command from August 2013 to August 2014. According to the New York Heart Association (NYHA) Functional Classification, the patients were assigned into NYHA Ⅰ group, NYHA Ⅱ group and NYHA Ⅲ group (n=20 for each group). The mRNA level of Klotho in the obtained heart tissues was detected by real-time fluorescence quantitative reverse transcription PCR (RT-PCR). Enzyme linked immunosorbent assay (ELISA) was used to detect the serum level of carboxyterminal propeptide of typeⅠ procollagen (PⅠCP). The morphological differences were observed between the normal myocardium and heart failure myocardial tissue by HE staining. Results （1） HE staining showed hyperplasia of mayocardial collagen in CHF patients. （2）The mRNA level of Klotho was significantly decreased in both the NYHA Ⅱ group and NYHA Ⅲ group than in the NYHA Ⅰ group (both P<0.05), and was lower in the NYHA Ⅲ group than in the NYHA Ⅱ group (P<0.05). （3）The serum level of PⅠCP was highest in the NYHA Ⅲ group, followed by that in the NYHA Ⅱ group and then in the NYHA Ⅰgroup (all P<0.05). Conclusion Klotho expression is decreased in CHF patients, which may involved in its insufficient anti-aging effect and insufficient anti-myocardial fibrosis effect along with the deterioration of heart function.

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Abstract:We have successfully implemented endovascular stenting in a patient with severe innominate artery (IA) occlusion with aid of carotid filter under the guidance of digital subtraction angiography (DSA). The patient had amaurosis for 1 year and right upper extremity numbness for half a year. He had a history of hyperlipidemia for 1 year and smoking for 30 years. Combined with magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) examinations, he was diagnosed as severe IA occlusion. After pre-operative assessment, we decided to use the right femoral artery and right brachial artery as double entries. With the help of distal internal carotid artery (ICA) filter as cerebral protective umbrella, we successfully performed the endovascular stenting in the innominate artery. Through this case we can learn that the interventional therapy is the first choice for patients with IA occlusive disease due to its safety, effectiveness and high success rate. The proper selection and application of cerebral protective umbrellas (carotid filter) have great significance in the prevention of cerebral infarction.

Abstract:The index of microcirculatory resistance (IMR) can be measured readily and simultaneously with fractional flow reserve (FFR), and is a comprehensive integrated assessment for the epicardial and microvascular compartments of the coronary circulation. In contrast to other invasive and non-invasive tests, this method is known to be stable and reproducible under various hemodynamics and even in the presence of coronary artery stenosis. This review summarized the theoretical basis, operation skills, and the clinical practice of IMR.

Abstract:Platelet function is closely associated with cardiovascular diseases. With the increased awareness of the diseases, there are more and more methods for platelet function est developed. Since the invention of light transmission aggregometry(LTA), it has been thought to be the golden standard of platelet function testing. In recent years,various test methods have been developed with the increasing awareness of disease and treatment as well as technological advances. However, despite the gold standard or the latest methods, they have more or less flaws and some aspects of advantage. In this article, we introduced and summarized currently available methods of measuring platelet unction.

Abstract:Osteoporosis and vascular calcification are both degenerative diseases associated with aging, and affected by a variety of factors. The occurrence and development of the 2 diseases are closely related to calcium and phosphorus metabolism. Recently, there are many studies concerning their common pathogenesis. One of the hot spots is fibroblast growth factor-23 (FGF23)-Klotho axis. This article mainly elaborated its roles in the comorbidity of osteoporosis and vascular calcification.

Abstract:Ventilator-associated pneumonia (VAP) is commonly severe, and associated with high health care costs. After endotracheal intubation, endotracheal tube (ETT) provides an ideal surface for bacterial adhesion and proliferation, which then leads to parenchymal lung infection. The growth of biofilm on the inner lumen of the ETT is the main cause of VAP. This article introduced the factors affecting the formation and development of ETT biofilms and their roles in the treatment of VAP.