Objective To study the effect of clopidogrel on different CYP2C19 genotypes and platelet reactivity in acute cerebral infarction patients with antiplatelet aggregation.Methods Four hundred and seventy-four cases of cerebral infarction patients in Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2015 to April 2016 were collected.CYP2C19 genotype was determined,and the genotype was divided into the wild type group,the heterozygous type group and the mutant homozygous group.Platelet aggregation inhibition rate(ADP%) and platelet reactivity index induced by ADP were detected.Patients were divided into clopidogrel resistance group(group CR) and non resistant group according to whether ADP% was less than 30.SPSS 16.0 statistical software was used for statistical analysis,the comparison between groups using independent samples t test,chi square test and multivariate analysis using Logistic regression analysis,when P<0.05 difference was statistically significant.Results Among the 474 patients,204 cases(43.04%) were divided into wild-type group,and 204(43.04%) and 66(13.92%) were divided into the mutant heterozygous group and mutant homozygous group.In Chi square test analysis,clopidogrel resistance group and non resistance group CYP2C19 genotype distribution was significantly different(χ2=6.658,P=0.036).CR group angle(α) values((68.87±5.47)°) and MA((66.77±6.25) mm) were higher than that of CS group ((66.55±6.05)° and (63.30±5.66) mm,t=2.199,3.387,P=0.029,0.001).The multivariate logistic regression analysis showed that OR of angle level was 1.028,95%CI was 0.929-1.137 (P=0.595);OR of Ma level was 1.561,95%CI was 0.785-0.970 (P=0.012).Conclusion The effect of clopidogrel on platelet aggregation in patients with acute cerebral infarction is decreased by CYP2C19 gene mutation.CYP2C19 mutant allele is a risk factor for clopidogrel resistance.Angle (α) value and MA value are the risk factors for the diagnosis of CR in the patients with acute cerebral infarction,and the risk of clopidogrel resistance increased when the patients′ Angle (α) value and the value of MA increased.MA value as a predictor of CR and the screening tool has a certain value.

Objective To analyze the prevalence of human papilloma virus(HPV) and the relationship between HPV and vaginal environment in puerperium women.Methods One thousand and twenty-nine cases puerperium women were detected for HPV subtype by using nucleic acid flow-through hybridization.Patients with HPV positive had been considered as observe group and the rest as control.The prenatal infection of HPV of HPV-DNA positive and negative postpartum puerperium women, and the vaginal cleanliness of prenatal and postpartum were analyzed.Results In 1 029 cases puerperium women, the total HPV-DNA positive rate was 10.30％(106/1029) ,and high risk infection rate was 95.65％ (110/115).The rate of HPV positive before pregnant in HPV positive group (46.51％, 40/86) was higher than that in HPV negative group (9.09％, 10/110).There was significant difference of vaginal environment in the two groups (x2 =36.567, P＜0.05).In HPV-DNA positive and negative women during the puerperium vaginal cleaning degree of Ⅰ , Ⅱ ratio prenatal respectively were 56.98％ (49/86) and 76.36％ (84/110), and the difference was significant (x2 =8.317, P ＜0.05).Postpartum to 45.35％ (39/86) and 60.00 (66/110), and the difference was significant (x2 =3.941, P＜0.05).Conclusion The HPV infection of pregnant women are easy to getagain.There is relevance between HPV infection and vaginal environment.

Objective To analyze the detection results and clinical significance of human papillomavirus (HPV) DNA genotypes in the patients with condyloma acuminate (CA)and high risk (HR)population of CA and normal population of physical examination (PE).Methods 527 cases of CA patients (CA group),208 cases of HR (HR group)and 197 cases of normal PE (PE group)in the outpatient were selected.The human HPV DNA genotypes in 932 samples of different population were examined with HybriMax;the positive detection rates,the preponderance types of HPV and the multiple genotype infection in three groups were analyzed.Results The HPV positive rate in CA group was 98.29% and the preponderance types were HPV 6,11,33,and 52 genotypes.The HPV positive rate in HR group was 26.44% and the preponderance types were HPV 6,11,33,and 66 genotypes.The HPV positive rate in PE group was 5.58% and the preponderance types were HPV 6 and 11 genotypes.The difference in the positive detection rates of HPV between HR and PE groups had statistical significance (P < 0.05 ). The positive rates of multiple genotype infection in CA group and HR group were 36.43% and 5.77%,respectively,and there was significant difference (P < 0.01 ); the positive rate of double infection was the highest (18.41%), followed by the positive rate of triple heavy infection (11.20%) and the positive rate of septuple heavy infection (0.38%).Conclusion The HPV 6 and HPV 11 of low-risk HPV genotypes are the most common genotypes in different population. The HR group and PE group are all asymptomatic but the positive detection rate of HPV in HR group is higher than that in PE group. The positive rate of HPV multiple genotypes infection in CA group is higher than that in HR group,and the double infection or triple heavy infection are the most common infection.

ObjectiveThe purpose of this study is to describe the clinicopathologic characteristics and the survival of pulmonary carcinosarcoma.Methods Clinical data of 26 patients with pulmonary carcinosarcoma who underwent surgical treatment was analyzed retrospectively using Statistical Package for the Social Sciences ( Release 17.0,SPSS,Inc).Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test.ResultsThe overall 5-year survival rate of the patients was 31.7％.The 5-year survival rate of patients with stage Ⅰ,stage Ⅱ and stage Ⅲ/Ⅳ disease was 69.7％,38.6％ and 9.8％ respectively ( P =0.03 ) Conclusionp-TNM was correlated with survival.Early diagnosis and radical operation is important to the survival of the patients with pulmonary carcinosarcoma.

Objective To investigate the immune cell population change during the anesthesia process in patients undergoing craniotomy surgery. Methods A total of 18 patients undergoing craniotomy who had an inhalational general anesthetic were selected as our subjects. Blood samples were collected before anesthesia (T0)and 30 min(T1),45 min(T2),60 min(craniotomy operated,T3),120 min(tumor resected,T4)and 240 min(T5)after anesthesia. Blood cell counts including neutrophils,monocytes and lymphocytes were determined along with lymphocyte subpopulations( T cells,inducer and helper T cells,suppressor and cytotoxic T cells,NK cells,B cells ). Data were analyzed by SPSS 13. 0 software. Results In terms of the immune cell during neuroanesthesia,induction neutrophils,monocytes and lymphocytes decreased significantly from( 4. 50 ± 2. 00 ) × 109/L(,0. 51 ± 0. 22)× 109/L,(1. 90 ± 0. 70)× 109/L to(3. 10 ± 1. 50)× 109/L,(0. 32 ± 0. 17)× 109/L, (1. 10 ± 0. 50)× 109/L at the 30 min after anesthesia,and the differences were significant( P﹤0. 05). It also showed that Ts and NK cells decreased significantly from( 0. 55 ± 0. 29 )× 109/L,( 0. 32 ± 0. 14 )× 109/L to (0. 33 ± 0. 22 )× 109/L,( 0. 10 ± 0. 08 )× 109/L at the 30 min after anesthesia,and the differences were significant( P﹤0. 05 ). Conclusion Special and non special immune system are inhibited during craniotomy, especially at the early anesthesia. Among the inhibited immune cells,neutrophils recover early and followed Ts and NK cells.

Objective To compare real time PCR with PCR-reverse dot blot hybridization (PCR-RDB)for detecting human pap-illomavirus (HPV)infection in women.Methods A total of 109 genital specimens from women were collected in the study.All specimens were tested HPV by using real time PCR and PCR-RDB,discrepant samples were tested again by PCR-xMAP.Results The concordant rate was 83.5%(91/109)between real time PCR and PCR-RDB (kappa=0.671),the other 18 discrepant samples were retested by PCR-xMAP,7 of those were identical with real time PCR and 11 with PCR-RDB.No differences of PCR-RDB pos-itive rates were found between the high and low viral load groups (χ2 =1.476,P =0.224).Conclusion It demonstrated moderate consistency between real time PCR and PCR-RDB.The HPV positive rates of PCR-RDB were stable when the viral loads were 103-108 .

Objective: To propose reasonable suggestions to promote the standardization of clinical studies by reviewing the systematic reviews and meta-analyses of acupuncture-moxibustion treatment of essential hypertension (EH). Methods: Computer retrieval was conducted through Excerpta Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), and Wanfang Academic Journal Full-text Database (Wanfang) to collect systematic reviews and meta-analyses relevant to treating EH with acupuncture-moxibustion therapy. The time range was from the database's inception till July, 2020. The studies were screened based on the inclusion and exclusion criteria and then data-extracted. The study's quality and evidence ratings were performed by referring to the preferred reporting items for systematic review and meta-analysis (PRISMA), a measurement tool to assess systematic reviews 2 (AMSTAR 2), and the grading of recommendations, assessment, development, and evaluation (GRADE). Results: A total of 14 studies, 10 in Chinese and 4 in English, published between 2012 and 2019, were included, involving 70 outcome measures. The methodological quality was rated as critically low, the reporting was relatively complete or had certain flaws, and the evidence strength was rated as low or very low. Conclusion: Regarding the acupuncture-moxibustion treatment of EH, the methodological quality and outcome measure evidence of existing systematic reviews and meta-analyses are relatively low, and the reporting quality also expects further improvements.

Digestive system malignant tumor is one of the common malignant tumors in humans,and its high morbidity and low survival rate at advanced stages bring heavy disease burden to patients,families and society.However,current tumor screening technologies are not suitable for screening in large-scale populations and long-term follow-up because of the invasiveness or complexity.Thus,liquid biopsy,which based on biomarkers such as circulating tumor DNA,circulating tumor cells,exosomes and other new biomarkers,has broad prospects for development in tumor screening.Exosome,secreted by living cells,is a type of extracellular vesicle with the lipid bilayer.Compared to other biomarkers,exosome has the advantages of high stability,wide distribution,and high quantity.The various proteins carried by exosome can reflect the characteristics of the origin cells,and exosome has important research value for the early diagnosis of tumors.This article reviews the studies of exosomal proteins as biomarkers for early diagnosis of digestive system malignant tumors in the past five years,and summarizes the characteristics and limitations of the above studies,so as to provide reference for promoting the clinical transformation of exosomal proteins.

[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.

Objective To analyze the clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma ( TESCC ) and to modify the target volume .Methods A total of 286 patients with node-positive middle TESCC underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences, from 2004 to 2009.In addition, 90 of these patients received postoperative intensity-modulated radiotherapy.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.The chi-square test was used for comparing the recurrence between patients receiving different treatment modalities.Results The 5-year overall survival ( OS) rates of the surgery alone ( S) group and surgery plus postoperative radiotherapy ( S+R) group were 22.9%and 37.8%, respectively, and the median OS times were 23.2 and 34.7 months, respectively ( P=0.003) .For patients with 1 or 2 lymph
node metastases (LNMs), the 5-year OS rates of the S group and S+R group were 27.3%and 44.8%, respectively ( P=0.017);for patients with more than 2 LNMs, the 5-year OS rates of the S group and S+R group were 16.7%and 25.0%, respectively (P=0.043).The peritoneal lymph node metastasis rates of N1 , N2 , and N3 patients in the S group were 2.9%, 10.9%, and 20.0%, respectively ( P=0.024) .The S+R group had a significantly lower mediastinal lymph node metastasis rate than the S group ( for patients with 1 or 2 LMNs:8.0%vs.35.3%, P=0.003;for patients with more than 2 LNMs, 10.0%vs.42.3%, P=0.001) , and had a prolonged recurrence time compared with the S group ( 25.1 vs.10.7 months, P=0.000) .However, for patients with more than 2 LNMs, the S+R group had a significantly higher hematogenous metastasis rate than the S group (46.7%vs.26.1%, P=0.039).Conclusions Patients with node-positive middle TESCC could benefit from postoperative radiotherapy.The target volume can be reduced for patients with 1 or 2 LNMs.Prospective studies are needed to examine whether it is more appropriate to reduce the radiotherapy dose than to reduce the target volume for patients with more than 2 LNMs.A high hematogenous metastasis rate warrants chemotherapy as an additional regimen.