Objective One hypothesis is that patients with uraemia showing hyporesponsiveness to rHuEPO may have enhanced levels of immune activation causing increased rdease of inflammatory cytokines. To study the effects of chronic inflammation on the hyporesponsiveness to rHuEPO and its possible mechanisms, T cell phenotypes using flow cytometry and the relationship between these changes were detected. Methods 40 patients with MHD and 20 age-matched healthy volunteers were enrolled in the study. The MHD patients were divided into two groups according to the responsiveness to rHuEPO:22 cases with good responders and 18 cases with poor responders. The percentages of T cell subsets including CD+4 ,CD+8,CD+4/CD+28,CD+8/CD+28 T cell using flow cytometry were detected. Results The percentages of CD+4 and CD+8 T cell were lower in MHD patients than that in control group. The percentages of CD4+/CD+28 and CD+8/CD+28 T cell were lower in group of poor responders than in good responders.Conclusion Chronic inflammation state is common in MIlD patients. The percentages of CD+4/CD+28 and CD+8/CD+28 T cell in poor responders were much lower than good responders. The changes of T cell phenotypes may play a role in pathogenesis of hyporespousiveness to rHuEPO.

Objective To study the efficacy of trimetazidine combined with perindopril in treating congestive heart failure (CHF). Methods One hundred and eighteen patients with CHF were randomly divided into experimental group and control group. All patients were given conventional medical treatment. Patients in the control group was treated with additionally with perindopril. The initial dose was 2 mg/d, and gradually increased to target dose of 4 mg/d. The experimental group was additionally treated with trimetazidine 20 mg orally 3 times a day for 12 weeks based on the regimen in the control group. The changes of left ventricular ejection fraction ( LVEF) , left ventricular end of diastolic volume ( LVEDV) , left ventricular end of systolic volume ( LVESV), stroke volume (SV),cardiac output (CO)and cardiac function (NYHA) were observed. Results In the experiment group, after treatment,LVEF,LVEDV,LVESV,CO and SV were(46. 89 ±8. 00)% ,(129. 20 ±25. 00)ml, (70.90 ±32. 00)ml, (4. 32 ±0. 65 ) L/min and (55. 06 ± 13. 27) ml, respectively, which were significantly improved compared to those before treatment (29.60 ± 11. 00)% ,(164. 40 ± 31. 00) ml, (95. 60 ± 33. 00) ml, (2.91 ±0.56) L/min and (37. 69 ± 13. 62) ml .respectively) ( P < 0.01 or P < 0. 05). After treatment, the LVEF, LVEDV, LVESV, CO and SV were (46.89 ± 8. 00)% , (34. 70 ± 9. 00)% ,( 129. 20 ± 25. 00) ml, ( 148. 20 ±29. 00) ml and (70.90 ± 32. 00)ml in the experiment group, respectively, which were significantly higher than those in the control group (81. 10 ±31.00)ml, (4. 32 ±0.65) L/min, (3. 14 ±0.60) L/min, (55. 06 ±13.27 )ml and (49. 56 ± 14. 29) ml, respectively) (P <0. 01 or P <0. 05). The overall effective rate in the experiment group was 93. 2% .which was significantly higher than that in the control group (66. 1% ) ( P < 0.01). No obvious adverse effect was observed. Conclusions The effect of trimetazidine combined with perindopril in treating congestive heart failure is satisfactory. It is safe and effective for CHF.

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Objective To examine whether the boundary patterns of the superior mesenteric artery (SMA) in the preoperative contrasted enhanced computer tomography (CE-CT) could predict poor postoperative prognosis.Methods From January 2010 to December 2015,104 patients of pancreatic head ductal adenocarcinoma received radical pancreaticoduodenectomy by a single group of surgeons.All patients underwent CE-CT before operation.The clinicopathological characteristics and the prognosis were comparatively analyzed among the patients with different SMA boundary patterns.Results The patients with obscure SMA boundary in CE-CT had a lower overall survival rate (P =0.012) and a higher liver metastasis rate (P ＜ 0.01) compared to the patients with clear SMA boundary.38.2％ of patients with obscure SMA boundary died within 6 months,69.1％ of them died within 12 months while the mortality rate was 6％ within 6 months and 29.2％ within 12 months in patients with clear SMA boundary.Only 2.2％ of patients with clear SMA boundary presented liver metastasis within 6 months,but that was 53％ in patients with obscure SMA boundary.18.4％ of patients developed liver metastasis within 12 months in patients with clear SMA boundary,whereas the rate was 82％ in patients with obscure SMA boundary.Furthermore,the tissues around the SMA presented a higher CT value in any phase in patients with obscure SMA boundary than in patients with clear SMA boundary (P ＜ 0.01).Conclusions The patterns of the SMA boundary in CE-CT is a potential prognostic factor in pancreatic head ductal adenocarcinoma after radical operation,and the obscure SMA boundary may be associated with early liver metastasis and high mortality.

Objective To investigate the clinical application value of fluorescence laparoscopy in radical resection of hepatocellular carcinoma (HCC).Methods Data of totally 113 patients with HCC in Henan Provincial People's Hospital between June 2016 to June 2018 were retrospectively analyzed.Among the 113 patients,46 patients underwent laparoscopic hepatectomy (LLR),and 67 patients underwent fluorescence guided laparoscopic hepatectomy (FLLR).Results No significant differences were observed between LLR group and FLLR group in terms of age,male proportion,liver function classification,surgical resection methods,and operation time (P＞0.05).The positive ratio of specimen surgical margin in LLR group was significantly higher than that in FLLR group,13.0％ vs.3.0％,and the difference was statistically significant (P＜0.05).In the FLLR group,22 patients received fluorescence guided anatomic hepatectomy with indocyanine green (ICG),10 with positive staining and 12 with negative staining,and fluorescence imaging was observed 2 minutes after ICG injection.There was no significant difference in operation time,hospitalization cost and length of stay between positive and negative staining (P＞ 0.05).Conclusion Fluorescence laparoscopy has certain advantages in hepatectomy,and can display the boundary of hepatocellular carcinoma in real time to ensure the safe margin of tumor resection.

Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.