Objective To investigate the effect of valsartan and amlodipine on urinary microalbumin in elderly hypertensive patients. Methods 100 elderly patients with hypertension treated in our hospital from May 2015 to October 2016 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The patients in the control group received oral valsartan, and the patients in the experimental group were treated with valsartan and amlodipine. The treatment time of the experimental group and the control group was 12 weeks. The clinical indexes of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, the experimental group and the control group did not have obvious adverse reactions. There were 2 cases of headache in the experimental group, 1 cases of vertigo, and 2 cases of vertigo in the control group. However, there was no significant difference in the incidence of adverse reactions between the experimental group and the control group, and there was no statistical significance. The antihypertensive effect of the experimental group was significantly higher than that of the control group, with statistical significance (P<0.05). After treatment, the urinary microalbumin in the experimental group and the control group was significantly lower than that in the treatment group, and the level of microalbuminuria in the experimental group was lower than that in the control group, with statistical significance (P<0.05). Conclusion The clinical effect of treatment of elderly patients with hypertension better combined with valsartan and amlodipine, antihypertensive effect is stronger, can significantly improve the patient's urinary albumin, with further clinical promotion and application significance.

Objective To discuss the significance of the application of neutrophil to lymphocyte ratio (NLR)combined with prostate specific antigen (PSA)in early diagnosis of prostate carcinoma.Methods 120 cases with surgery treatment of prostate carcinoma were selected as study group,and 120 healthy people were selected as control groups.The NLR and PSA were tested to diagnose the prostate carcinoma.The critical value of NLR in diagnosing prostate carcinoma was evaluated by ROC curves,and the advantages of combination of NLR and PSA were judged. Results By using ROC curves to evaluate the NLR in diagnosis,the critical value was 2.75.The susceptibility, specificity,Youden index,correct index were 0.79,0.85,0.65,0.72.The susceptibility,specificity,positive predictive value,negative predictive value,correct index of NLR combined with PSA in diagnosing the prostate carcinoma were 0.85,0.83,5.00,0.18,0.68.Conclusion The application of NLR has higher susceptibility and specificity to diagnose prostate carcinoma.NLR combined with PSA can improve the susceptibility and specificity of early diagnosis of prostate carcinoma.

Contrast induced nephropathy (CIN)is one of the main complications caused by intravenous iodinated contrast media injection,which can increase hospitalization rate and mortality of patients,and it has become the third main cause of acquired acute renal failure in hospital currently, but its fundamental pathogenesis is still not clear,which is considered to be related to inflammation and oxidative stress response etc.The present article made a review on pathogenesis of CIN and preventive effects of statins on CIN.

Objective: To observe curative effect of radiofrequency catheter ablation (RFCA) and changes of cardiac function and left atrial diameter after operation in patients with atrial fibrillation (AF). Methods: A total of 28 AF patients with obvious clinical symptoms and without effective for drug therapy received RFCA in our hospital, their data were retrospectively analyzed. They received RFCA under guidance of three dimensional electro-anatomic mapping (EAM) system. Changes of cardiac function and left atrial diameter were evaluated by echocardiography and curative effect was evaluated by ambulary blood pressure monitoring before, three and six months after operation. Results: Pulmonary vein isolation rate was 100% in all patients. No severe complication occurred during or after operation. After six-month follow-up, 27 cases（96.4%）did not recur AF among the 28 patients; Compared with before operation, there were significant decrease in left atrial diameter [(37.3±4.8) mm vs. (33.6±4.5) mm] and significant increase in left ventricular ejection fraction [(59.8±8.7) % vs. (64.2±6.8) %] by echocardiography, P<0.05 both. Conclusion: Radiofrequency catheter ablation is safe and effective in treatment of atrial fibrillation, and there are significant improvements in cardiac function and left atrial diameter.

Objective To explore antitumor effect of 131I-Trastuzumab on human epidermal growth factor receptor(HER) 2 overexpressing breast cancer cells and investigate its possible mechanism.Methods The expression levels of HER2 of three different breast cancer cell lines (BT474,MCF-7,HCC1937) were detected with immunofluorescence.Trastuzumab was labeled with 131I using the Iodogen method and 131I-Trastuzumab was isolated with ultrafiltration membrane,then the labeling efficiency,radiochemical purity and immunoreactivity were measured.The effects of 131I,Trastuzumab and 131I-Trastuzumab on viability of BT474 cells were evaluated with cell counting kit-8 (CCK-8) assay.The levels of total Akt and phosphorylated Akt (p-Akt) were detected with Western blot analysis.One-way analysis of variance (ANOVA),ANOVA for factorial design,Bonferroni correction and Pearson correlation analysis were used for data analysis.Results The expression level of HER2 in BT474 cells was much higher than those in HCC1937 and MCF-7 cells.The labeling efficiency,radiochemical purity and immunoreactivity of 131I-Trastuzumab were (89.71± 2.93)％,(91.80±1.43)％ and (58.84±3.35)％ respectively.131I (4.625 GBq/L),Trastuzumab(125.0 rmg/L) and 131I-Trastuzumab(4.625 GBq/L) exhibited a dose-dependent cytotoxicity against BT474 cells (r =-0.964,-0.912,-0.618;all P＜0.05).The cell viability of 131I-Trastuzumab treated gourp (34.73％ ±5.03％) was significantly lower than those of 131I and Trastuzumab treated groups (64.36％± 1.51％ and 58.09％±4.14％;t=10.373 and 8.180,both P＜0.05),and the cell viability of control group was (100.00±4.54)％.131I-Trastuzumab shown a positive multiplicative interaction between 131I and Trastuzumab (F=9.226,P＜0.05;CDI =0.929).Western blot results showed that there was no significant difference of total Akt expression among the control group,131I group,Trastuzumab group and 131I-Trastuzmab group (F=0.208,P＞0.05).P-Akt expression in both Trastuzumab group and 131I-Trastuzumab group were much lower than those of control group and 131I group (t=12.524,15.984,7.347,10.807;all P＜0.05),while there was no significant difference of p-Akt expression between Trastuzumab group and 131I-Trastuzumab group(t =3.460,P＞0.05).Conclusions 131I-Trastuzumab may kill HER2 overexpressing breast cancer cells more effectively than Trastuzumab alone.The underlying mechanism may be attributed to that 131I-Trastuzumab may enhance the radiosensitivity by the inhibitory effect on PI3K/Akt pathway and thus exert synergistic effects with 131I.

The purpose of this study was to detect the distribution of Treg and Th17 cells in bone marrow and to investigate the relationship of Treg/Th17 imbalance with the pathogenesis and progression of multiple myeloma (MM). The Bone marrow was collected from 37 MM patients and 12 healthy volunteers, the ratio of Treg and Th17 cells was detected by flow cytometry. The expression of Treg and Th17 cells simultaneously was examined in peripheral blood of 19 MM patients with same method. The results indicated that the frequency of Treg cells was higher in MM patients than that in control group (P < 0.05), there was a trend of increasing of Treg cell number in the ISS stage from I+II to III (P < 0.05). Furthermore, in the patients with MM, the Treg cell number in bone marrow was higher than that in peripheral blood (P < 0.05). Th17 cell rate was not statistically different between MM patients and control group (P > 0.05), and at different ISS stage (P > 0.05). Th17 cell number between bone marrow and peripheral blood was not significantly different (P > 0.05).The ratio of Treg/Th17 in patients with MM was higher than that in control group (P < 0.05), and increased gradually from ISS stage I+II to stage III (P < 0.05). It is concluded that the Treg/Th17 immune imbalance is presenced in bone marrow of patients with MM, this imbalance may promote the progression of MM.
Bone Marrow ; immunology ; Cell Count ; Disease Progression ; Flow Cytometry ; Humans ; Multiple Myeloma ; immunology ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology

OBJECTIVETo investigate the changes of thrombospondin 1(TSP1) level and von Willebrand factor cleaving protease(ADAMTS13) activity in the patients with hematologic malignancies before and after treatment and to evaluate their clinical significance.

METHODSEighty-two patients with hematologic malignancies were enrolled in this study, among them 20 patients were with acute leukemia, 48 patients were with lymphoma and 14 patients were with multiple myeloma. The plasma samples of 82 patients with hematologic malignancies and 45 healthy controls were collected. The activities of ADAMTS13 were evaluated by residue collagen binding assay(R-CBA), the levels of TSP1 and vWF antigen were measured by enzyme-linked immunosorbent assay(ELISA).

RESULTSThe activity of plasma ADAMTS13 in patients with hematologic malignancies was lower than that of normal controls(P<0.05). The levels of vWF antigen and TSP1 in the patients with hematologic malignancies were higher than those in normal controls(P<0.05). After standard induction chemotherapy, the ADAMTS13 activity of the patients with hematologic malignancies at the complete remission was higher than that before therapy(P<0.05); the vWF antigen level was significantly lower than that in the patients with hematologic malignancies before therapy(P<0.05), but still higher than that in controls(P<0.05). There were 25 infection patients in 82 cases of hematologic malignancies, and the ADAMTS13 activity in the patients with newly diagnosed hematologic malignancies complicated with infection before therapy was obviously lower than that in the patients with hematologic malignancies without infection(P<0.05), the levels of vWF antigen and TSP1 were significantly lower than that in patients without infection (P<0.05). In the process of treatment, 8 patients have been speculated to suffer from thrombus, and the ADAMTS13 activity in the patients with thrombus was obviously lower than that in the patients without thrombus(P<0.05).

CONCLUSIONLow ADAMTS13 activity and high TSP1 level may participate in the progress of hematologic malignancies, the infection and thrombotic events may lead to further reduction of the ADAMTS13 activity. Assaying the level of ADAMTS13 activity in the patients with malignant tumor may be helpful to prevent the infection and thrombosis in the patients with hematologic malignancies.

OBJECTIVETo detect the plasma activity of von Willebrand factor-cleaving protease (ADAMTS13) in the patients with prothrombotic status, and explore the effect and significance of ADAMTS13 in the prothrombotic status. The correlation of ADAMTS13 with von Willebrand factor (vWF), thrombospondin 1 (TSP1), C-reactive protein etc, and blood pressure was simultaneously analyzed．

METHODSThe activity of ADAMTS13 in patient groups (atherosclerosis, diabetes, acute promyelocytic leukemia, cancer and sepsis, a total of 260 cases) and in control group 50 cases were evaluated by residue collagen binding assay（R-CBA）, the protein levels of TSP1 and vWF were measured by ELISA kits； the correlation of ADAMTS13 activity with CRP, creatinine, and blood pressure was analyzed with statistical soft ware.

RESULTSThe activity of plasma ADAMTS13 in patient group was significantly lower than that in normal control group(P<0.05). And the protein levels of TSP1 and vWF in the patients with prothrombotic status were higher than those in the normal controls(P<0.05). Analysis of the correlation showed that the ADAMTS13 activity correlated negatively with the levels of TSP1 protein, blood sugar, blood pressure, D-dimer, creatinine,and CRP levels (P<0.05), however, the ADAMTS13 activity did not significantly correlate with the levels of serum lipids, blood type, platelet number and hemoglobin level(P>0.05).

CONCLUSIONThe plasma ADAMTS13 activity is decreased in the patients with prothrombotic status, suggesting that the decreased ADAMTS13 activity may participate in the occurrence of prothrombotic status, and the dectection of plasma ADAMTS13 activity may help the diagnosis of pro-thrombotic disease.

ADAMTS13 Protein ; Factor Analysis, Statistical ; Fibrin Fibrinogen Degradation Products ; Humans ; Sepsis ; Thrombosis ; von Willebrand Factor

OBJECTIVETo investigate the clinical efficacy and immune mechanism of immunotherapy of dendritic cells (DC) and cytokine-induced killer cell (CIK) combined with chemotherapy in patients with newly diagnosed multiple myeloma (MM).

METHODStwenty-two newly diagnosed MM patients were chosen and divided into two groups, out of them,12 patients in single chemotherapy group were treated by chemotherapy only, 10 patients in combined group were treated by adoptive immunotherapy (DC-CIK) combined with chemotherapy. Using flow cytometry, the CD4 Treg cells in the peripheral blood of 22 MM patients were detected before and after treatment. And the clinical outcomes between two groups were also compared.

RESULTSAfter treatment the overall response rate(ORR) of patients in the single chemotherapy group was 50% (6/12), among them 2 cases were in complete remission (CR) (16.67%), 2 cases very good partial remission (VGPR) (16.67%), 2 cases were in partial remission (PR) (16.67%). However, the ORR of patients in immunotherapy combined with chemotherapy group was 70.% (7/10), including in 3 cases of CR (30%), 2 cases of VGPR (20%), 2 cases of PR (20%). Compared to healthy volunteers, the proportion of Treg cells in peripheral blood of two groups before treatment was significantly higher (P<0.05). In contrast, the proportion of Treg cells in the peripheral blood of above-mentioned 2 groups after treatment was reduced significantly (P<0.05). In addition, compared to chemotherapy group, the proportion of Treg cells in the combined group decreased significantly (P<0.05). The further analysis found that the proportion of Treg cells in the peripheral blood of the 2 groups was not significant changed (P>0.05) in the patients with ineffictive clinical treatment, but the proportion of Treg cells significantly decreased (P<0.05) in the patients with effective clinical treatment.

CONCLUSIONDC-CIK immunotherapy can synergize or enhance the effect of chemotherapeutics, alleviate the immune dysfunction in MM; and DC-CIK immunotherapy combined with chemotherapy can elevate the clinical efficacy in patients with newly diagnosed multiple myeloma.

Antineoplastic Agents ; Cytokine-Induced Killer Cells ; Dendritic Cells ; Flow Cytometry ; Humans ; Immunotherapy ; Multiple Myeloma ; Remission Induction ; T-Lymphocytes, Regulatory ; Treatment Outcome

Objective: To examine the efficacy and safety of pemetrexed plus apatinib for the treatment of advanced non-squamous non-small cell lung cancer (NSCLC) in elderly patients. Methods: Between January 2016 and June 2017, 38 elderly patients with ad-vanced non-squamous NSCLC from Qingdao Municipal Hospital were examined. All patients received first-or second-line therapy. The inclusion criteria were an age of≥65 years, physical status score of 0-2, and expected survival time of>3 months. Eighteen patients were assigned to the test group, and the remaining 20 patients were assigned to the control group. The patients in the test group were treated with pemetrexed plus apatinib, pemetrexed 500 mg/m2 on day 1 and apatinib 250 mg/d on days 1-21. The control group re-ceived pemetrexed in a 21-day cycle until the disease progressed or intolerable adverse reactions developed. The study was reviewed and approved by the medical ethics committee of Qingdao Municipal Hospital. Results: The disease control rates in the test and con-trol groups were 72.2% and 35%, respectively, with a statistically significant difference (χ2=5.265, P=0.022). The median progression-free survival time (PFS) in the test and control groups were 5.7 months [95% confidence interval (CI): 2.8-8.6] and 3.1 months (95% CI:2.7-3.5), with a statistically significant difference (χ2=4.01, P=0.045). The difference in the incidence of hand-foot syndrome and hyper-tension between the two groups was statistically significant (P=0.007 and P=0.016, respectively), with side effects of 1 or 2 degree in most cases, which was acceptable. Conclusions: Pemetrexed plus apatinib has a definite curative effect on advanced NSCLC, with con-trollable adverse reactions.