Objective To retrospectively analyze the influence of perioperatively transfusing different ratios of fresh frozen plasma (FFP) to red blood cell (RBC) on prognosis of patients receiving massive transfusion.Methods From January 2010 to September 2012,139 surgical patients with transfusion of ≥ 10 RBC units within 24 hours were included in the study.Patients were categorised into three groups based on the FFP ∶ RBC scale:high scale group (FFP ∶ RBC ＞ 1 ∶ 1,n =19),middle scale group (FFP ∶ RBC =1 ∶ 2-1 ∶ 1,n =43) and low scale group (FFP ∶ RBC ＜ 1 ∶ 2,n =77).Comparison among the groups was made in aspects of transfusion of different blood products in hospital,blood routine index before and after massive transfusion,blood coagulation index,electrolyte index,hospital stay,ICU stay,cure rate and mortality.Results FFP transfusion was the most in high scale group (2 600 ± 1 582) ml,followed by (1 390 ± 1 043) ml in middle scale group and (318 ± 342) ml in low scale group (P ＜0.05).Platelet (PLT) transfusion was more in high scale group (0-1.4 units) and middle scale group (0-1.0 units) compared with that in low scale group (0-0.0 units,P ＜ 0.05).Volume of RBC and cryoprecipitate transfused revealed no significant differences among the groups (P ＞ 0.05).Before blood transfusion prothrombin time (PT) [(20.2 ± 10.7) s] and activated partial thromboplastin time (APTT) [(57.2±45.8) s] in middle scale group were significantly prolonged than those in high scale group [(14.3 ±4.4) s and (35.3 ± 10.0) s] and low scale group[(12.5 ± 1.7) s and (31.5 ± 5.9) s] (P ＜ 0.05),but the differences were insignificant in indices of hemoglobin (Hb),PLT,international normalized ratio (INR),K +,and Ca2 + (P ＞ 0.05).After blood transfusion Hb [(106.8 ± 31.7) g/L] and Ca2+[(1.99 ± 0.24)mmol/L] in low scale group were higher than these in middle scale group [(82.5 ± 32.2) g/L and (1.76 ± 0.38) mmol/L] and in high scale group [(91.3 ± 19.1) g/L and (1.96 ±0.25) mmol/L] (P ＜0.05),but there were no significant differences in PLT,PT,INR,APTT and K+(P ＞ 0.05).Moreover,hospital stay,ICU stay,cure rate and mortality were not differed significantly among the groups (P ＞ 0.05).Conclusion For massive transfusion patients,transfusion of FFP and RBC at a 1 ∶ 2 to 1 ∶ 1 ratio is beneficial to preventing coagulation dysfunction and reducing plasma total infusion volume,and exerts no effect on the prognosis.

Objective To explore the relationships of post- traumatic growth with self- care efficacy and psychological resilience in patients with breast cancer. Methods Totally 303 patients with breast cancer were investigated with Post- traumatic Growth Inventory (PTGI), Chinese version of Strategies Used by People to Promote Health (C- SUPPH) and Connor- Davidson Resilience Scale (CD- RISC). Results The total score of PTGI was 63.74±13.00 and the status of post- traumatic growth in breast cancer patients was in middle level, with a highest interpersonal score of 24.49±5.05, a lowest mental change score of 3.84± 1.91. Correlation analysis showed that post- traumatic growth was positively correlated with the level of self- care efficacy and psychological resilience (P<0.01 or 0.05). Regression analysis showed that self- care efficacy and psychological resilience in breast cancer patients could effectively predict the post- traumatic growth with an explanation rate of 36.1%. Conclusions Self- care efficacy and psychological resilience in patients with breast cancer are closely correlated with post- traumatic growth. It is suggested to take appropriate measures to promote post-traumatic growth of the breast cancer patients.

Background Researches determined that the pathogenesis of retinal vein occlusion (RVO) is associated with primary open angle glaucoma (POAG) in Caucasian population.However,the relationship between RVO and POAG in Asian population is unclear.Objective This study was to survey the percentage of POAG in RVO patients in China.Methods A prospective cross-sectional observational study based on hospital was performed.Three hundred and seventy five patients with newly diagnosed RVO by fluorescein fundus angiography (FFA) were consecutively enrolled in Peking University Third Hospital from October 2011 to May 2013,and gonioscopy was carried out in all the patients.Glaucoma was diagnosed according to the criteria of the International Society of Geographical and Epidemiological Ophthalmology (ISGEO).RVO was classified into central retinal vein occlusion (CRVO),hemicentral retinal vein occlusion (HRVO) and branch retinal vein occlusion (BRVO) based on fundus photograph and FFA,or classified into arteriovenous crossing RVO (AV-RVO),optic cup RVO (OC-RVO),optic nerve RVO without optical nerve head swelling (NONHS-RVO) and RVO with optical nerve head swelling (ONHS-RVO) based on the sites of venous occlusion.The percentages of POAG in different types of RVO were calculated.This study was approved by Ethic Committee of Peking University Third Hospital,and written informed consent was obtained from each patient before entering study cohort.Results Three hundred and seventeen RVO patients finished screening of glaucoma,with the response rate 84.5％.The percentage of POAG is 8.2％ in RVO patients,including 7.1％ in the CRVO patients,23.5％ in HRVO patients and 6.2％ in BRVO patients.The percentage of POAG was significantly higher in OC-RVO patients (27.9％) and NONHS-RVO patients (13.2％) than that in AV-RVO patients (4.7％) and ONHS-RVO patients (1.3％) (all at P＜0.05).Conclusions The overall percentage of POAG in RVO patients in China is 3-4 times higher than general population.Higher percentage of POAG is found in OC-RVO patients and NONHS-RVO patients,suggesting that pathogenesis of RVO is probably associated with the glaucomatous anatomic changes of optical nerve head.

Objective:To analyze the effects of protein intake of varied dietaries on the pregnancy of pregnant women.Methods:The pregnant women who had their medical records in our hospital were included in this study.Their dietary were collected based on the respective review of their food during 24 hours when they visited the Nutrition Clinics between 24 weeks and 28 weeks.The subjects were divided into six groups according to the dietary calories and protein intake:group A (normal calorie and normal protein),group B (normal calorie and low protein),group C (normal calorie and high protein),group D (high calorie and normal protein),group E (high calorie and high protein) and group F (low calorie and low protein).The gestational diabetes mellitus incidence rates,levels of fasting blood glucose (FBG),blood glucose (BG),hemoglobin Alc (HbAlc),and blood lipids,and bone mineral density were compared among six groups.Results:The gestational diabetes mellitus incidence rate,levels of postprandial blood glucose at 1 hour and 2 hour in groups of B,C,D,and E were significantly higher than those in group A (P ＜ 0.05).The levels of triglyceride,total cholesterol,and low density lipoprotein cholesterol were remarkably higher in groups of B,D,and E than those in group A (P ＜ 0.05).The bone mineral density was significantly lower in group A than that in groups of C,E,and F (P ＜ 0.05).Conclusion:The diet with normal calorie and normal protein is the scientific dietary structure.The pattern with high calorie and high protein intake is not recommended for pregnant women.

AIM: To observe the effect of Qingluo Tongbi Granule(QLTBG)——containing serum on the proliferation of osteoblasts(OB) and osteoclasts(OC),the activity of AKP of OB. METHODS: (1) OB were separated from the skull of SD rats aged 1 d and OC from the thighbone and shinbone of SD rats aged 5 d.(2) The proliferation of OB and OC was detected by MTT method,and the activity of AKP of OB was examined by diazol method. RESULTS: The proliferation capability of OB was strengthened markedly by the rat sera containing 7.2,14.4 g/kg QLTBG,which could reinforce the activity of AKP obviously as well,while the proliferation of OB was inhibited remarkably by the rat sera containing 3.6,7.2,14.4 g/kg QLT. CONCLUSION: The sera containing QLTBG could enhance the proliferation of OB and the activity of AKP,restrain the proliferation of OC simultaneously.

Objective To investigate the nature of Th17 cells in murine cytomegalovirus(MCMV)infection during the acute stage,we characterized the frequency of IL-17A-producing CD4 T cells and the level of Th17 cytokines,IL-17A,in MCMV-infected mice.Methods BALB/c mice were randomly divided into two groups.One was infected with MCMV Smith for establishing disseminative infection; the other was sham-inoculated control.On day 3,7,14 and 28 of the experiment,three mice of each group were randomly chosen to be killed separately.Real-time PCR was used to detect MCMV loads in organs of MCMV-infected mice,the pathology of spleen was observed by HE staining.The frequency of CD4+IL-17A+ T cells in total splenocytes of mice was detected by flow cytometry.The level of IL-17A in culture supernatants of splenocytes was measured by double antibody sandwich ELISA.Results MCMV loads in salivary gland reached the peak on day 14 after MCMV infection,the most severe spleen injury was also shown on day 14,the frequencies of CD4+IL-17A+ T cells in total splenocytes increased significantly( all P＜0.01 ) in MCMV-infected mice than those in controls,and reached the peak on day 14 ( 1.14％ ±0.09％ vs 0.19％ ±0.04％,t =17.551,P=0.000).The levels of MCMV-specific IL-17A in culture supernatants were increased dramatically in MCMV-infected mice than those in controls on day 14 [ (81.98± 12.37) pg/ml vs (44.96±8.44)pg/ml,t=4.281,P=0.006].In MCMV-infected mice,correlation was positive between the levels of MCMV-specific IL-17A in culture supernatants and MCMV loads in salivary gland tissues (r=0.54,P＜0.05 ),the levels of IL-17 A in culture supernatants were higher in more severe spleen injury.Conclusion Thl7 cells and IL-17A were involved in the immunity response during acute MCMV infection.They may correlate with the persistence of MCMV and the pathology of spleen in infected mice.

Objective To detect the sera anti-enteric neuronal antibodies ( AENA ) in irritable bowel syndrome with diarrhea ( IBS-D) patients and analyzed its correlation with IBS-D symptoms to explore the potential roles of AENA in the pathogenesis of IBS.Methods IBS-D patients diagnosed with RomeⅢdiagnostic criteria were en-rolled in this study.The sera of healthy subjects were used as controls.Indirect immunofluorescence ( IIF) was used to detect the sera AENA with the substrate of ileal submucosal plexus of guinea pig .The immune reactivity ( IR) stains were read in blinded method .The bowel symptoms of patients with positive AENA were compared to thatwithnegativeandweeklypositiveantibodies.Results 1)Atotalof127IBS-Dpatientswereenrolledinthis study.The positive rate of sera AENA was 85.8%in IBS-D patients, and 7.0%in healthy controls.Among 109 IBS-D patients with positive IIF reactivity , 23.6%present with strong positive , 43.3% with positive and 18.9%with weakly positive stain .The IR patterns included cytoplasm staining , nucleus staining , cytoplasms and nuclei staining , nuclear membrane staining , cytoplasm and nuclear membrane staining .Six positive sera of healthy control showed cytoplasm staining to substrate neurons .2 ) More patients of IBS-D with positive IR had higher intestinal symptoms scores (>10 scores, 58.8%vs 38.1%), frequent abdominal pain in non-defecation period (91.7%vs 60.0%) , and severe abdominal pain/discomfort before defecation ( 24.7% vs 9.5%) comparing to those with negative and weekly positive IR of AENA;IBS-D patients with positive IR of AENA are more commonly associated with urgency comparing to those with negative IR in IIF (57.1%vs 87.3 ) .Conclusions AENA may play a role in the pathogenesis of IBS , and is a potential biomarker of IBS-D.

Objective To discuss the value of leukocyte-targeted myocardial contrast echocardiography (MCE) as a tool in observing the degree of acute rejection after heart transplantation. Methods Abdominal heterotopic cardiac transplantation was performed on 32 rats successfully, among which 8 isografts served as group A, and groups B, C and D involved 8 allografts respectively. The rats in groups B and C were treated with cyclosporine A (CsA) at a high dose (10mg· kg-1 · day-1 ), a low dose (3 mg · kg-1 · day-1 ) from 3rd day before transplantation respectively.The rats in groups A and D were untreated with CsA. MCE was performed during continuous intravenous SonoVue injection postoperatively on the third day after operation. We performed 2 types of MCE: perfusion imaging and leukocyte-targeted imaging. The images were obtained at 20 s and 5 min after injection of contrast agent. The value of the contrast image grayscale (GS) was measured by image analyzer (GS20s, GS5 min). GStarget was calculated as the GS5min minus the GS20s in the same rat.Postmortem histology was performed after observation. The degree of myocardial rejection was determined by HE-stained graft myocardium. Immunohistochemistry was performed to quantify the CD3-positive cells, and correlation analysis was performed between CD3-positive cell count and GS20s,GS5min, GStarget. Results Perfusion imaging showed no significant difference in myocardial GS20s of each group. Leukocyte-Targeted imaging exhibited a clear gradient in these groups (P＜0. 05). There was significant difference in GStarget of each group (P＜0. 001). Postmortem histology showed 0- Ⅰ grade rejection in group A, Ⅰ -Ⅱ grade rejection in group B, Ⅱ-Ⅲ grade rejection in group C, Ⅲ-Ⅳ grade rejection in group D. Immunohistochemistry revealed the CD3-positive cell infiltration was increased in turn from the group A to the group D. There was a significantly positive correlation between the CD3-positive cell count and GStarget ( r = 0. 86, P ＜ 0. 001 ). Conclusion Leukocyte-targeted contrast echocardiography may thus offer a noninvasive and effective ultrasound imaging technique for detecting the degree of acute cardiac transplant rejection.

Objective To evaluate left ventricular myocardial function altemation by three-dimensional speckle tracking imaging (3D-STI) after surgical aortic valve replacement (AVR) in severe aortic stenosis (AS) patients with preserved left ventricular ejection fraction (LVEF),and discuss its clinical value.Methods Forty patients with severe aortic stenosis who were hospitalized or outpatient in Nanjing First Hospital Affiliated to Nanjing Medical University during the period of October 2014 to October 2016 (AS group),and forty healthy volunteers (normal control group) were enrolled in this study.Normal control group underwent conventional echocardiography and 3D-STI measurement,while the AS group underwent conventional echocardiography and 3D-STI measurement at preoperative,1 week postoperative and 3 months postoperative,then we obtained left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),interventricular septum thickness diameter (IVSd),left ventricular posterior wall thickness diameter (LVPWd),left ventricular ejection fraction (LVEF),global longitudinal strain (GLS),global circumferential strain (GCS),global radial strain (GRS),global area strain (GAS) strain and 3D-strain.The independent sample t test was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters between AS preoperative patients and healthy controls,AS patients at 3 months postoperative and healthy controls.The single factor analysis of variance was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters in severe patients at preoperative,1 week postoperative and 3 months postoperative.LSD-t test was used to compare in different AS groups.Results Compared with normal control group,IVSD,LVPWD and GCS of severe AS patients increased significantly (t=13.824,11.298 and-6.584,all P ＜ 0.001),GLS,GRS and 3D-Strain decreased significantly (t=10.221,-6.237 and-5.674,all P ＜ 0.001),LVEDD,LVESDand GAS had no significant difference.Compared with preoperative AS patients,LVEF,GLS,GAS and GCS decreased significantly (t=-2.205,-2.093,-2.034 and-3.152,all P ＜ 0.05 or 0.01) at 1 week postoperative,LVEDD,LVESD,IVSD,LVPWD,GRS and 3D-strain had no significant difference at 1 week postoperative;GLS,GRS and 3D-strain increased significantly (t=5.446,-4.923 and-4.388,all P ＜ 0.05 or 0.01) at 3 months postoperative,GCS,IVSD and LVPWD decreased significantly (t=-3.988,4.794 and 4.211,all P ＜ 0.05 or 0.01) at 3 months postoperative,LVEDD,LVESD,LVEF and GAS had no significant difference at 3 months postoperative.Compared with AS patients at 1 week postoperative,LVEF,GLS,GRS,GAS and 3D-strain increased significantly (t=-2.631,7.383,-4.719,2.923 and-4.154,all P ＜ 0.05 or 0.01) at 3 months postoperative,GCS,IVSD and LVPWD decreased significantly (t=-2.109,4.747 and 4.323,all P ＜ 0.05 or0.01) at 3 months postoperative.But in AS patients at 3 months postoperative,IVSD,LVPWD,GLS and GCS were still higher than those of normal control group (t=9.809,7.066,4.752 and-2.553,all P ＜ 0.001 or ＜ 0.05),LVEDD,LVESD,LVEF,GRS,GAS and 3D-strain had no significant difference.Conclusion The alternation of left ventricular myocardial function have a certain characteristic before and after aortic valve replacement in severe aortic stenosis patients with preserved LVEF,and 3D-STI can evaluate it more accurately.

AIM:To investigate the expression of aplasia rashomolog member I ( ARHI) gene in acute myeloid leukemia cells (AML) and to study the effects of ARHI on the growth of AML cell line U937.METHODS:The mRNA ex-pression of ARHI in AML cells, 293FT cells, AML primary cells and healthy volunteer blood cells were detected by RT-PCR.After transfection with the MSCV-IRES-GFP-ARHI plasmid to the U937 cells, the growth curve was analyzed by MTT assay.U937 cells were re-suspended by fresh medium and cultured for 24 h, then the cell cycle distribution and ap-optotic rate were determined.RESULTS:The mRNA of ARHI was positively detectable in 293FT cells and healthy volun-teer blood cells instead of AML cell line and AML primary cells.The growth curve showed that cell viability in U937 cells with high expression of ARHI (U937-ARHI) was lower than that in the control cells (U937-GFP) on 6th~8th day.The ratio of G2/M phase and apoptotic rate in the U937-ARHI cells were increased compare with control group ( P<0.05 ) . CONCLUSION:The mRNA level of ARHI is low in AML cells.High expression of ARHI gene in U937 cells inhibits cell growth, arrests the cells at G2/M phase and induces apoptosis.