Objective To investigate the association of CYP2C19 gene polymorphism with the efficacy of clopidogrel in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI).Methods Thromboelastography was performed on 260 elderly ACS patients 3 days after PCI.Patients with the adenosine diphosphate(ADP)-induced platelet aggregation inhibition rate ＜30％ were assigned to the clopidogrel resistance group(CR group,n=78),and those with the ADP-induced platelet aggregation inhibition rate ＞ 30％ were assigned to the non-clopidogrel resistance group (non-CR group,n =152).Baseline data,clinical data,CYP2C19 genotype and phenotype were compared between the two groups.Results After drug treatment,the ADP-induced platelet aggregation inhibition rate was(16.0 ± 8.1) ％ for the CR group and (54.4 ± 17.3) ％ for the non-CR group.Of all 230 patients,36 (15.6 ％)had the slow metabolic genotype,66 (28.7 ％)had the intermediate metabolic genotype and 128 (55.7 ％) had the fast metabolic genotype.The difference was statistically significant between the intermediate or fast metabolic genotype group and the slow metabolic genotype group (All P＜ 0.05).In the non-CR group,the slow,intermediate and fast metabolic genotype cases were 12 (33.3 ％),46 (69.7 ％) and 94 (73.4 ％),respectively;There were no statistically significant differences between these groups(x2 =0.35,P＞0.05).In the CR group,the slow,intermediate and fast metabolic genotype cases were 24 (66.7 ％),20 (30.3 ％) and 34 (26.6％),respectively;There were statistically significant differences between these groups(x2=9.72,P＜ 0.01).Conclusions The incidence of CR in elderly patients with acute coronary syndrome after PCI is closely related to the CYP2C19 gene polymorphism.

Objective To observe the clinical efficacy of ezetimibe combined with atorvastatin calcium on hyperlipidemia,and to evaluate the role of ezetimibe on lipid management in elderly patients with coronary heart disease (CHD) after coronary intervention.Methods A total of 150 elderly CHD patients with hyperlipidemia to undergo coronary intervention in our hospital were selected.Patients were randomly divided into the control group and the experimental group (n=75,each).Patients in control group were treated with atorvastatin,and in the experimental group with ezetimibe plus atorvastatin.The change of blood lipids levels and the incidence of adverse reactions were compared between the two groups 1 month after the treatment.Results The numbers of patients with normal serum levels of total cholesterol (TC),triglycerides (TG),low density lipoprotein (LDLC) were much more in the experimental group than in the control group after treatment [68 cases (90.7％) vs.50 cases (66.7％),62 cases (82.7％) vs.44 cases (58.7％),56 cases (74.7％) vs.38 cases (50.7％),x2 =12.87,10.42,9.23,respectively,all P＜0.01].There was no significant difference in the incidence of adverse reactions between the two groups [5.3％ (4 case) vs.2.7％ (2 cases),x2 =0.17,P ＞ 0.05].Conclusions Compared with atorvastatin calcium treatment,ezetimibe combined with atorvastatin calcium treatment has a better clinical efficacy on hyperlipidemia with no increase of adverse reactions in elderly CHD patients.

Objective The main purpose is to investigate the status of brucellosis infection in high-risk areas of Urumqi and population characteristics,and to provide a basis for prevention of brucellosis.Methods In Urumqi City,Dabancheng District,Gaoxin District,Midong,Zone and Urumqi County were selected as survey sites;according to pastoral,agro-pastoral and agricultural,all towns in each survey site were classified into three categories;150 to 200 residents in each township were selected as subjects.Basic demographic information was collected,and blood samples were collected for serological detection.rose bengal plate agglutination test (RBPT) was used for preliminary screening,RBPT positive persons were further confirmed by standard tube agglutination test (SAT).Different regions,gender,age,occupation,exposure difference and brucellosis infection rates were studied.x2 test was used to compare rates.Results The infection rate was 5.42％ (29/535).Furthermore,the infection rate ofthe Dabancheng District [10.34％ (12/116)] was higher than those of Gaoxin District [2.94％ (3/102)] and Urumqi County [2.58％ (4/155),x2 =4.643,7.199,all P ＜ 0.05],the differences were statistically significant (x2 =9.327,P ＜0.05).Besides,infection rate of the average exposure occupation [8.33％ (24/288)] was higher than those of low exposure occupation [0(0/61)] and high exposure occupation [2.72％ (5/184),x2 =5.459,6.140,all P ＜ 0.05].The differences were statistically significant (x2 =10.846,P ＜ 0.05).The differences of infection rates in ages and nations showed no statistical significance (x2 =2.396,4.639,all P ＞ 0.05).Conclusions High risk areas of brucellosis are still exist in Urumqi.Health education should be strengthened in the future,in order to enhance residents' seff-protection awareness in exposed population.

We used the Brucella data in Xinjiang between year 2009 to 2010 to explore and analyze the spatial clustering fea‐tures of brucellosis in Xinjiang ,and provided the basis for prevention and control on brucellosis in Xinjiang ,China .The time and population distribution of brucellosis in Xinjiang was analyzed for statistical analysis with descriptive epidemiology .Mean‐while ,we also used quartile classification methods to map the incidence of brucellosis in Xinjiang spatial distribution ,and calcu‐lated the Global Moran’s I index on the spatial clustering analysis .Results showed that brucellosis in Xinjiang had obvious sea‐sonal differences (peaked in May‐September) ,more cases for male than that for female (gender ratio‐‐2 .96∶1) ,and the total incidence of 74% were farmer and herdsman ,mainly concentrated at th e age of 40 to 60 years old .Compared with the onset range of brucellosis in 2009 ,there were clear tendency to spread in 2010 .The Global Moran’s I index was 0 .116 4 (P=0 .017) ,showing the spatial clustering on the incidence of brucellosis in Xinjiang .The incidence of hot spots concentrated in Tacheng and Altay ,and the incidence of cold spots concentrated in Kashi .The incidence level brucellosis has significant spatial aggregation in the area of Xinjiang ,which should be strengthened the prevention and control of high‐risk areas .

Objective:To evaluate the efficacy and safety of conventional diuretic therapy versus Tolvaptan in elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia, in order to provide clinical evidence for the treatment of heart failure in the elderly.Methods:This was a randomized control trial.A total of 88 elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia were randomly divided into the control group(n=46)and the experimental group(n=42). Once enrolled both groups stopped taking oral loop diuretics.In addition to routine treatment, the control group was treated with furosemide 40 mg once a day, while the experimental group was treated with Tolvaptan 15 mg once a day.The rate of effectiveness in relieving heart failure, the diuretic effects and improvement in heart and kidney function were monitored, and changes in serum potassium and sodium levels and the incidences of thirst and other adverse events were compared between the two groups.Results:The effectiveness rate on heart failure was higher in the experimental group than in the control group(85.7% or 36/42 vs.65.2% or 30/46, χ2=17.855, P<0.001). After treatment, greater changes in average 24-hour urine volume from baseline(787.4±219.6 ml vs.388.6±179.6 ml, t=322.588, P<0.001), more weight loss(-2.4±2.1 kg vs.-1.7±1.6 kg, t=6.942, P=0.009), smaller changes in N-terminal pro-B-type natriuretic peptide(NT-proBNP)from baseline(-897.6±432.1 ng/L vs.-578.4±476.9 ng/L, t=539.400, P<0.001), greater changes in left ventricular ejection fraction(LVEF)from baseline(6.5±5.6 % vs.1.5±5.7 %, t=3.966, P=0.048), smaller changes in serum creatinine from baseline(-8.6±12.4 μmol/L vs.9.6±11.3 μmol/L, t=87.161, P<0.001), and greater changes in estimated glomerular filtration rate(eGFR)from baseline(1.4±1.8 ml·min -1·1.73m -2vs.-4.1±5.6 ml·min -1·1.73m -2, t=63.856, P<0.001)and in serum sodium from baseline(6.2±2.1 mmol/L vs.1.4±1.9 mmol/L, t=234.065, P<0.001)were observed in the experimental group than in the control group.There was no significant difference in the incidences of thirst, dry mouth and other adverse events between the two groups(16.7% or 7/42 vs.10.9% or 5/46, χ2=0.626, P=0.429). Conclusions:Tolvaptan can effectively improve the clinical symptoms and cardiac function and correct hyponatremia in elderly chronic heart failure patients combined with mild to moderate renal insufficiency, with a good safety profile.

Objective To investigate the value of brain natriuretic peptide (BNP) detection in the diagnosis and treatment of heart failure patients with normal ejection fraction.Methods Totally 78 elderly patient were selected in our hospital,with left ventricular ejection fraction (LVEF) ≥45 ％,among which 52 cases of patients were consistent of heart failure criteria (heart failure group),27 cases with normal left ventricular diastolic function as control group.The echocardiographic indices of diastolic function and the change of the concentration of BNP were compared.Results As compared with heart failure group,BNP concentration (108.7 ± 32.2) ng/L vs.(190.3 ± 41.5) ng/L,left ventricular posterior wall thickness (11.3 ± 1.7) mm vs.(13.6 ± 1.4) mm,left ventricular mass index (119.3±10.2)g/m2 vs.(130.7±8.9)g/m2 were elevated in heart failure group (all P＜0.01).Conclusions BNP detection can be used for a diagnosis of heart failure as a simple and easy method.The BNP and ultrasound heart beat graph combination can improve heart failure diagnostic accuracywith normal ejection fraction in elderly patients.

Objective To explore the changes and clinical significance of plasma redox status in patients with acute myocardial infarction,angina pectoris and people with normal coronary artery.Methods According to the clinical manifestation,electrocardiograms and the myocardium markers,68 acute myocardial infarction patients (group A) were involved.68 angina pectoris patients (group B) and 68 normal coronary artery people (group C) were also chosen according to the coronary artery radiographs.Peripheral venous blood of 3 groups were collected.Plasma glutathione (reduced form GSH and oxidized form GSSG) and nicotinamide adenine dinucleotide phosphate (reduced form NADPH and oxidized form NADP+) were detected.The GSH/GSSG and NADPH/NADP+ redox potentials were calculated according to Nernst equation.Results Along with the pathological aggravation of coronary artery (from group C to group A),the levels of GSH [(8.39±1.03)μmol/L,(6.54±0.94) μmol/L,(4.49±0.86) μmol/L,respectively] and GSH/GSSG (14.22±2.14,9.76±1.67,5.76±1.18,respectively) were gradually reduced; the levels of GSSG [(0.59±0.03) μmol/L,(0.67±0.04) μmol/L,(0.78 ± 0.05) μmol/L,respectively] and GSH/GSSG redox potential [(-150.43±3.43) mV,(-141.22±3.12) mV,(-135.21±2.31) mV,respectively] were gradually increased (all P＜ 0.05); the changes of NADPH/NADP+ redox status were similar to GSH/GSSG but milder.Conclusions The imbalance of plasma redox status deviating to oxidation has a relationship with atheromatous plaque formation,plaque rupture and plaque thrombosis in the coronary artery.

Objective To investigate the predictive value of clinical and radiographic features in fungal pathogen identification in immunocompromised patients with pulmonary invasive fungal infection (IFI).Methods All consecutive immunocompromised adult patients with pulmonary IFI in respiratory intensive care unit (ICU)in the First Affiliated Hospital of Xinjiang Medical University were recruited during a 2 year period.All patients met the 2008 European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC /MSG) criteria were studied for proved or probable IFI responding to antifungal agents.The data of demographic,clinical and radiographic features,as well as serological test results of the patients were collected.Differences in the clinical and radiographic features of pulmonary IFIs caused by yeasts and molds were compared by χ2 test.A logistic regression model was used to perform discriminant analysis,and the effect of discrimination was assessed for accuracy.Results The study included 143 patients with a probable diagnosis of IFI who had the following risk factors:diabetes mellitus (43.4%),chronic lung disease (32.2%),broad-spectrum antibiotics administration (≥14 days;35.7%),malignancy (23.1%),corticosteroid therapy (≥14 days;23.1%),chronic renal failure and renal replacement therapy (16.1%),and immunological disease (10.5%).Frequent broad-spectrum antibiotics administration was associated with yeast infection (P <0.05 ),while mold infection was associated with chronic lung disease (P <0.05 ) .Yeast was more often isolated from patients with concurrent bacterial infection and on mechanical ventilation (P <0.05 ) . Thoracic high-resolution computed tomography (HRCT)showed the following images:bronchial pneumonia/pulmonary consolidation (53.1%),massive shadowing (29.4%),small nodules (24.5%),large nodules (18.9%),pleural effusion (18.9%),halo sign (14%),and cavity (9.8%).Imaging showed that mold was more common than yeast in patients with pleural and pericardial effusions (P <0.05).Logistic regression modeling showed that broad-spectrum antibiotics administration,prolonged mechanical ventilation,and pleural and pericardial effusions were statistically significant in fungal identification (P <0.05 ),with a predictive accuracy of 77.6%.Conclusions For immunocompromised patients with pulmonary IFI,most of the risk factors ,the main clinical and chest HRCT features did not help to predict the type of fungal pathogen,and yeast but not cryptococcus may be accompanied or colonized.

Objective: To analyze the association between recombinant solute carrier family 11, member 1 ( SLC11A1 ) rs17235409 polymorphism and treatment failure of pulmonary tuberculosis, so as to provide the basis for the prevention and treatment of pulmonary tuberculosis. Methods: The patients with pulmonary tuberculosis registered for treatment at the Urumqi Center for Disease Control and Prevention in 2019 was recruited and collected demographic, clinical and treatment information from National Infectious Diseases Reporting System. The polymorphism of SLC11A1 rs17235409 was detected by multiple ligase chain reaction and Hardy-Weinberg balance test was performed. The multivariate logistic regression analysis was conducted for the association between rs17235409 and the treatment outcome of tuberculosis. Results: A total of 731 cases of pulmonary tuberculosis patients were enrolled, and 37 cases failed, with a failure rate of 5.06%. The failure rate of the patients with G/A was 8.55%, with G/G was 4.23%. The results of multivariate logistic regression analysis showed that the patients with G/A were more likely to fail in the treatment than those with G/G ( OR=2.213, 95%CI: 1.041-4.702 ). The males with G/A were more likely to fail in the treatment than those with G/G ( OR=2.547, 95%CI: 1.021-6.356 ). Conclusion The rs17235409 polymorphism of SLC11A1 is associated with the failure of tuberculosis treatment, and the patients with G/A are more likely to fail.

Objective: To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students. Methods: The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. Results: A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students. Conclusions There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.