Objective To investigate and compare the plasma concentrations of adenosine in patients taking ticagrelor versus clopidogrel after percutaneous coronary intervention (PCI) and its influence on occurrence of adverse clinical events.Methods The study enrolled 180 patients who had received PCI in the Tianjin First Center Hospital between June 2014 to July 2016.The patients were divided into 2 groups as the ticagrelor group (n=90, patients given ticagrelor 90 mg twice daily) and the clopidogrel group (n=90, patients given clopidogrel 75 mg daily).The plasma concentration of adenosine was taken at 30 days and 90 days after PCI.The adenosine levels and clinical events were compared between the 2 groups.Results The adenosine concentration were higher in the ticagrelor group both at 30 days [(1.65±0.16) μmol/L vs.(0.71±0.08) μmol/L, P<0.01] and 90 days [(1.65±0.14) μmol/L vs.(0.72±0.06) μmol/L, P<0.01] than in the clopidogrel group.The rates of major adverse cardiocerebral events were lower in the ticagrelor group both at 30 days (3.3% vs.13.3%, P<0.05) and at 90 days (6.7% vs.15.6%, P<0.05) than in the clopidogrel group.No significant difference in bleeding complication between the 2 groups.Conclusions Ticagrelor increases the concentration of adenosine in patients after PCI which may have beneficial effect on reduction of clinical adverse events.

[Objective] In order to explore the optimal minor-factor culture system of CIK/NK cells by proliferating CIK/NK cells using single-factor,bi-factor,and tri-factor combinations of IL-2,IL-7,and IL-12.[Methods] Ficoll-Hypaque method was used to separate cord blood mononuclear cells and divide them into 6 groups.Add single-factor,bi-factor,and tri-factor combinations (IL-7;IL-12;IL-7 + IL-12;IL-2 + IL-7;IL-2 + IL-12;IL-2 + IL-7 + IL-12) of IL-2 (80 ng/mL),IL-7 (40 ng/mL),and IL-12 (40 ng/mL) and culture them in total 21 days then harvest the cells.To collect cell suspensions of each group in culture outset and day 21 and to count the proportion of CD3+ CD56+ CIK cells and CD3- CD56+ NK cells with flow cytometry.[Results] The proportion of CIK cells in single-factor culture system of IL-12 was the highest in all groups (30.23 ± 1.18%).The proportion of CIK cells in bi-factor culture system of IL-2 + IL-12 can raised to 18.58 ± 0.68%.The proportion of CIK cells of the two groups above can reach the level of that using traditional multi-factor culture methods.NK cell proportion in IL-12 was 30.23 ± 1.18%,NK cell proportion in IL-2 + IL-7 can also reach to 29.52 ± 0.89%.[Conclusions] It is adoptable to proliferate CIK/NK cells using minor-factor culture system of IL-12,IL-2 + IL-12,or IL-2 + IL-7.

ObjectiveTo investigate the influence on efficacy and quality of life of amisulpride in schizophrenia with predominantly negative symptoms.MethodsSeventy cases of schizophrenia with predominantly negative symptoms were randomly assigned to amisulpride group and clozapine group for 12weeks.The clinical efficacy and side effects were evaluated with SANS,BPRS and TESS before and 1,2,4,8,12 weeks after treatment respectively. GQOLI-74 were used to evaluate the patients' quality of life before and after drug administration.ResultsFor the last assessment,the score of BPRS decrease to 30.68 ±4.62 in amisulpride group,was significantly lower than the beginning(P＜0.01 ) ; the score of BPRS decrease to 31.31 ±4.78 in clozapine group,was significantly lower than the beginning (P ＜ 0.01 ).Two groups showed similar effects,with no significance.12weeks after treatment,the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in amisulpride group were 12.31 ± 4.43,9.66 ± 3.07,8.91 ± 2.56,10.29 ± 2.68,5.58 ± 1.43 ; and the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in clozapine group were 14.62 ± 4.27,9.32 ± 2.81,8.22 ± 2.60,9.54 ± 2.67,6.62 ± 1.59,and the efficacy of amisulpride in emotional dull and attention dysfunction were better than those of clozapine.And the scores of material life,physical function,psychological function,social function in amisulpride group were not higher than those in clozapine group(P＞ 0.05).And the scores of four domains in GQOLI-74 had been improved significantly in two groups(P＜0.01).The domains of physical function,psychological function,and social function in amisulpride was superior to clozapine(P＜0.01).The side effects were more in clozapine group than those in amisulpride group.ConclusionAmisulpride is as effective as clozapine for the treatment of schizophrenia with predominantly negative symptoms,but it has more advantage than clozapine to improve emotional dull,attention dysfunction and quality of life in schizophrenia with predominantly negative symptoms.

Objective To investigate the clinic value of procalcitonin( PCT)and c-reactive protein ( CRP)in differential diagnosis for febrile diseases. Methods One hundred and forty patients with febrile diseases in May 2009 to February 2014 in the No. 309th Hospital of People Liberation Army were investigated and analyzed retrospectively. Based on discharge diagnosis,patients were divided into bacterial infection group( n=58),non-bacterial infection group(n=47)and rheumatic diseases group(n=35),another 40 healthy people were served as the control group. Serum PCT and CRP were detected and compared in four groups. One month after backing to normal temperature in all the patients,detected serum PCT and CRP again. Results Serum PCT and CRP level in bacterial infection group,non-bacterial infection group,rheumatic diseases group and control group were(5. 18 ± 1. 92)and(0. 45 ± 0. 22),(0. 34 ± 0. 13)and(0. 16 ± 0. 05)μg/L,(25. 31 ± 4. 24), (1. 94 ± 0. 37 ),( 62. 32 ± 15. 10 ) and( 1. 30 ± 0. 04 ) mg/L respectively. Serum PCT and CRP level in bacterial infection group were significantly higher than that in control group(P﹤0. 01). Even though serum PCT and CRP level in non-bacterial group slightly higher than that of healthy control group,there was no statistical difference(P﹥0. 05). Serum PCT and CRP level in bacterial infection group were significantly higher than that of non-bacterial infection group( P ﹤0. 01 ). Serum CRP level in rheumatic diseases group was significantly higher than that of healthy control group( P﹤0. 01),while PCT level only slightly higher compared with healthy control group(P﹥0. 05). One month after backing to normal temperature in all the patients,serum PCT and CRP level in bacterial infection group reduced significantly compared with that of febrile period( P ﹤0. 01). Serum PCT and CRP level in non-bacterial infection group were no significant change( P﹥0. 05 ),and serum CRP level in rheumatic diseases group reduced significantly( P﹤0. 01 ),while serum PCT were no significant change(P﹥0. 05). Conclusion Serum PCT combined with CRP might be of great importance in the differential diagnosis for febrile diseases.

Objective To assess the efficacy of early detection of breast cancer and the prognostic value of breast self-examination(BSE).Methods Randomized controlled trials(RCTs)involving BSE were included the present meta-analysis based on their qualities.The pooled analysis was performed with RevMany 4.2.8.Results Three RCTs were identified and then they were included the present metaanalysis.In women who conducted a BSE.the rate of biopsy fora lump in breast was 1.27%in the first 5 years,2.47%in more than 5 years but less than or equal to 10 years,and 2.50%in more than 10 years, respectively,all of which were significantly higher than in those who could not conduct a BSE(P<0.05) There was no significant difierence in the rate of final diagnosis and the mortality for breast cancer between the two populations in any follow-up time(P>0.05).Conclusion The rate of biopsy for a lump in breast in women could be increased by a BSE.which should not have been discarded from the early detection of breast cancer completely despite it is not helpful in increasing the rate of final diagnosis and decreasing the mortality for breast cancer.

OBJECTIVETo investigate EXT1 and EXT2 genes mutations in a family with hereditary multiple osteochondromas (HME).

METHODSA four-generation family with HME from Linyi city of Shandong Province was studied. There were 6 affected individuals among the 17 family members. Physical examination and radiographical evaluations were carried out for all family members. Genomic DNA was extracted from peripheral venous blood and the samples were subjected to mutation screening by PCR of the coding regions of EXT1 and EXT2 genes.

RESULTSThe family has featured an autosomal dominant inheritance pattern. Sequencing of the EXT1 and EXT2 genes suggested the causative gene in this family was in linkage with the second exon of EXT2. A c.244delG mutation was detected, which has resulted in a frameshift mutation p.Asp81IlefsX30. The mutation was found in all of the 6 affected individuals but not in normal family members. And the mutation has co-segregated with the phenotype.

CONCLUSIONThe mutation c.244delG in the EXT2 gene is the probably the cause of the disease in this family.

Adult ; Base Sequence ; Child, Preschool ; DNA Mutational Analysis ; Exons ; Exostoses, Multiple Hereditary ; genetics ; Female ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; N-Acetylglucosaminyltransferases ; genetics ; Pedigree ; Point Mutation ; Young Adult

Objective To observe the relationship between CYP2C19 gene polymorphisms and major adverse cardiovascular events in the patients of acute coronary syndrome (ACS) who accepted percutaneous coronary intervention (PCI) in Han population from Dalian. Methods A total 809 cases with ACS who had undergone PCI in the cardiology department of Dalian Municipal Central Hospital from Janurary 2012 to Janurary 2014 were selected,Among 809 cases of ACS,there were 178 cases of acute ST segment elevation myocardial infarction (STEMI),105 cases of acute non ST segment elevation myocardial infarction (NSTEMI) and 526 cases of unstable angina. The patients were divided into three groups according to their CYP2C19 genotype.CYP2C19 genotype (*1/*1) were classified as extensive metabolizers (EM group), CYP2C19 genotype (*1/*2、*1/*3) were classified as intermediate metabolizers (IM group) and CYP2C19 genotype (*2/*2、*3/*3、*2/*3) were classified as poor metabolizers (PM group). The occurrence of major adverse cardiovascular events at least 24 months was observed. Results Seven hundred and ninety patients finished the follow-up at least 24 months, 19 patients lost in follow-up, 350 cases (43.2%) were CYP2C19 (*1/*1),318 cases (39.3%) were CYP2C19(*1/*2), 42 cases(5.2%) were CYP2C19 (*1/*3),77 cases (9.5%) were CYP2C19 (*2/*2), 21 case(2.2%)were CYP2C19 (*2/*3), and 1 case (0.1%) was CYP2C19(*3/*3), 350 cases (43.2%) were classified as EM group, 360 cases (44.5%) were classified as IM group, and 99 cases(12.2%)were classified as PM group. No significant difference in age, gender, hypertention, diabetes mellitus, smoking was shown among three groups (P > 0.05). The rate of MACE were 3.3% , 8 cases had target lesion revascularization(EM group 3 cases, IM group 3 cases, PM group 2 cases), 2 cases had non-fatal myocardial infarction (IM group 1 case, PM group 1 case), 15 cases were died(EM group 6 cases, IM group 7 cases, PM group 2 cases), 1 case had subacute stent thrombosis in IM group. The rates of MACE were higher in PM group (5.1%) than those in EM group(2.65%) and IM group (3.41%) , but there was no significant difference in three groups (P>0.05). There was no significant difference in the rate of target lesion revascularization , thrombus in stent, non- fatal myocardial infarction and death among three groups(P > 0.05). Conclusions There is no significant correlation between CYP2C19 gene polymorphism and long-term prognosis in patients with ACS who accepte PCI treatment in Han population from Dalian.

Objective: To study the effect of nutrition intervention on the body composition and blood glucose in newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity. Methods: A total of 84 newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity were selected from the department of endocrinology in China-Japan Friendship Hospital from April 2015 to December 2016. Basic information and body composition of these patients were collected and measured. Also the food frequency questionnaire (FFQ) was used to investigate the dietary status in the past month, and calculate the intake of energy, three major nutrients and dietary fiber. All patients received nutrition intervention by nutritionist for three months as requested by Diabetes guidelines. After 3-month intervention, blood glucose, body composition and dietary status were examined again. Relevant indicators of patients were compared before and after the intervention. All patients were divided into three groups according to the degree of body mass index (BMI)′s change: <5%, 5%-10% and >10%. The differences of body weight, muscle, body fat rate, visceral fat index and blood glucose level among three groups were quantified. Results: There were 53 male patients with age (41.5±8.9) years and HbA1c (7.5±0.4)%, and 31 female patients with age (40.1±8.5) years with HbA1c (7.6±0.5)%. The intake of energy, carbohydrate and fat of patients were significantly decreased (P<0.05) and dietary fiber was significantly increased (P<0.05) after nutrition intervention. The body weight, muscle mass, fat mass and visceral fat index were also significantly decreased (P<0.05). The average decrease of fat was about 2.8 kg accounting for 73.7% (2.8 kg/3.8 kg) of the total weight loss. The body fat rate decreased from (31.2±3.1)% to (28.8±3.2)% (P<0.05). The fasting blood glucose and postprandial blood glucose were both decreased significantly after intervention (P<0.05). Among three BMI decreased groups, there was no significant difference in body weight and muscle mass (P>0.05), but a significant difference in body fat rate and visceral fat index (P<0.05). The body fat rate, visceral fat index, fasting blood glucose and postprandial blood glucose had more decreases with the greater amount of weight loss (P<0.05). Conclusion The three-month nutrition intervention could change the dietary habit and components of patients with type 2 diabetes mellitus by reducing the blood glucose, body fat rate and visceral fat index significantly. The degree of reduced BMI is positively related to the decrease of fasting blood glucose and postprandial blood glucose.

Objective To explore relationship between clinical features and peripheral blood test indicators and curative effect in adult patients with acquired hemophagocytic syndrome (HPS). Methods A total of 61 adult patients with acquired HPS who were admitted to the First Affiliated Hospital with Nanjing Medical University and the Affiliated Jiangning Hospital of Nanjing Medical University from April 2014 to March 2017 were enrolled, including 38 males and 23 females, with a median age of 48 years (17-86 years). The retrospective analyses of their clinical data and laboratory examination results were made in this study. Results There was no significant difference in the therapeutic effective rate of 61 HPS patients caused by different inducements after treatment (P ＝0.184). The prothrombin time (PT) before treatment was higher than that after treatment [(12.90±1.97) s vs. (12.35±1.78) s, P＝ 0.046]; the level of lactate dehydrogenase (LDH) before treatment was higher than that after treatment (median: 476 U/L vs. 231 U/L, P ＝ 0.000); the level of D-dimer (D-D) before treatment was higher than that after treatment (median: 1.46 mg/L vs. 0.51 mg/L, P ＝ 0.007); the level of aspartate aminotransferase (AST) before treatment was higher than that after treatment (median: 54.9 U/L vs. 26.0 U/L, P＝ 0.000); the level of serum calcium before treatment was lower than that after treatment [(2.07±0.20) mmol/L vs. (2.18±0.23) mmol/L, P ＝ 0.043]. The peripheral blood platelet counts (Plt) in the effective group (32 cases) before treatment was higher than that in the ineffective group (29 cases) (median: 104.0×109/L vs. 63.5×109/L, P ＝0.007), the level of albumin (ALB) in the effective group was higher than that in the ineffective group [(35.50 ±6.17) mmol/L vs. (31.93 ±6.54) mmol/L, P ＝ 0.033], the level of serum calcium in the effective group was higher than those in the ineffective group [(2.18±0.18) mmol/L vs. (2.08±0.20) mmol/L, P ＝ 0.047], the level of prothrombin time (PT) in the effective group was lower than that in the ineffective group [(12.40±1.76) s vs. (13.43±2.06) s, P ＝ 0.041], and the level of LDH in the effective group was lower than that in the ineffective group (median: 415.0 U/L vs. 593.5 U/L, P＝ 0.032). Conclusion The lower expressions of Plt, ALB and serum calcium, and the higher expressions of PT and LDH may indicate the poor prognosis of adult acquired HPS, and there fore these patients need to be paid attention.

Objective To study the clinical effect of bilateral anterior internal capsulotomy on patients with refractory anxiety disorders.Methods Twenty-one patients with anxiety disorders,failed to pharmacological and cognitive behavior therapies for 5 years and admitted to our hospital from November 2009 to January 2012,were chosen; they received MRI-guided stereotactic bilateral anterior capsulotomy.The coordinates of the lesion target were determined under high resolution MRI directly and confirmed by intra-operative impedance test and high frequency stimulation.The lesions were received radiofrequency at 80 ℃ for 60 seconds.Pre-and post-operative mini-mental state examination (MMSE),self-rating anxiety scale (SAS),Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA) were performed by the same psychiatrists.Results In the 21 patients,8 had anxiety-free,10 had significant improvement,and 3 had no significant improvement.No serious surgery-related complications were noted.Nine patients had mild cognitive deficit and transient dysmnesia only at 1-2 weeks after operation.Personality changes,such as lack of motivation,apathy and indolence,appeared in 4 patients.Psychiatric evaluations demonstrated significant decrease of SAS,HAMD and HAMA scores after operation as compared with those before operation (P＜0.05).However,the difference of MMSE scores between pre-and post-operation was not statistically significant (P＞0.05).Conclusion MRI guided stereotactic bilateral capsulotomy is precise,safe and much an effective treatment for refractory anxiety disorders,whcih is promising to alleviate the symptoms of anxiety and depression,as well as improving the quality of life.