Objective To evaluate the short-term effect of early treatment with clopidogrel before elective coronary stenting in patients with NSTE-ACS,compared with treatment with clopidogrel at the time of the procedure. Methods Patients with NSTE-ACS undergoing elective coronary stenting were randomly divided into two groups: early treatment group (n=272) and control group (n=265). Patients in the early treatment group were given clopidogrel immediately since hospitalization (300 mg loading dose, then 75 mg once daily); while in the control group, patients were given clopidogrel (300 mg) after coronary angiography followed by 75 mg per day after PCI. The composite endpoints were death, recurrent angina pectoris, instent thrombosis, myocardial infarction and urgent target vessel revascularization within 30 days after coronary stenting. Results Differences in baseline characteristics among patients between the two groups were negligible. There were no significant difference in the target vessel lesions requiring stenting between the 2 groups. Compared with the control group, early administration of clopidogrel showed a lower rate of death, myocardial infarction, refractory ischaemia, instent thrombosis and revascularization within 30 days of PCI. Conclusion Compared with administration of clopidogrel at the time of coronary stenting, pre-treatment with clopidogrel in patients with NSTE-ACS could significantly reduce the odds of adverse cardiovascular event and improve clinical outcomes within 30 days of PCI.

Objective To evaluate the efficacy and safety of facilitated PCI(low-dose rt-PA combined with percutaneous coronary intervention)in acute myocardial infarction(AMI).Methods One hundred and sixteen patients with AMI were divided into low-dose facilitated PCI group(n=69)and direct PCI group(n=47).69 patients in low-dose facilitated PCI group were treated with an intravenous drip of 50 mg rt-PA and PCI,while 47 patients in direct PCI group were treated with PCI.The rates of recanalization before and after PCI,and the left ventricular ejection fraction(LVEF)and major hemorrhage and major adverse cardiac events(MACE)in hospital were compared in two groups.Results There was no significant difference in the interval from hospitalization to the PCI between low-dose facilitated PCI group and direct PCI group.Compared with direct PCI group,the rates of recanalization and TIMI grade 3 before PCI were significantly higher in low-dose facilitated PCI group(44.7% vs 21.7%,P

Objective To establish a double-antigen sandwich ELISA(S-ELISA) for detection of total antibodies against hepatitis C virus(HCV).Methods Recombinant HCV proteins fusion-expressed with His-tag and GST-tag were separately used as coating and HRP-labeling antigen of the S-ELISA.Serum samples were tested with both the S-ELISA and another commercial indirect ELISA(I-ELISA) kit(Beijing Wantai Biological Pharmacy Enterprise Co.Ltd.).HCV RNA in some of the samples were tested by RT-nested PCR.Results Among 1 968 tested samples,190(9.7%) were total anti-HCV-positive while 1 761(89.5%) were negative by both of the S-ELISA and I-ELISA,with a resultant concordance rate of 99.1% of the two ELISA assays.However,the results of 17(0.9%) were not consistent in the two assays,in which 14 were S-ELISA negative but I-ELISA positive and 3 were S-ELISA positive but I-ELISA negative.One of the 14 samples(0.7%) with S-ELISA negative was detected as HCV RNA-positive,while 2 of the 3(66.7%) samples with S-ELISA positive were detected as HCV RNA-positive.In addition,HCV RNA was detectable in 23 of 31(74.19%) samples which were total anti-HCV positive in both S-ELISA and I-ELISA.Taking the PCR data together into account,the sensitivity of the S-ELISA and I-ELISA were 99.48% and 98.96% and specificity were 99.94% and 99.27%,respectively.Conclusions The established S-ELISA in this study may provide a novel means for detection of HCV antibody with high sensitivity and specificity.

Objective: To evaluate the impact of anemia on prognosis of elder patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).
Methods: A total of 908 consecutive ACS patients elder than 60 years of age with PCI in our hospital from 2010-06 to 2012-06 were studied. According to WHO deifnition of anemia (HB<12.0 g/dL in female and HB<13.0 g/dL in male), the patients were classiifed as Anemia group, n=283 and Non-anemia group, n=625. The patients were followed-up for 1 year. The basic clinical characteristics, incidences of mortality and major adverse cardiovascular and cerebravascular events (MACCE) were compared between 2 groups by cardiac death, myocardial re-infarction, worsening of cardiac function, target vessel revascularization, cerebral hemorrhage and cerebral infarction.
Results: There were 31%of patients suffering from anemia. Anemia group had more patients with the elder age, female gender, diabetes, hypertension, chronic kidney disease, decreased LVEF, more patients with 3 vessel-disease, and higher mortality at 1 year after PCI, higher rate of MACCE than those in Non-anemia group, all P<0.05. Multiple regression analysis indicated that anemia is the independent predictor for mortality in elder ACS patients at 1 year after PCI, P<0.05.
Conclusion: Anemia may increase the incidences of mortality and MACCE in elder ACS patients after PCI for a long-term.

Objective To investigate whether maternal antibody to hepatitis B surface antigen (anti-HBs)in infants may interfere with the antibody response to hepatitis B vaccine. Methods Infants from singleton pregnant mothers,who delivered at full term at the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2006 to January 2007,were divided into two groups based on their mothers'status of anti-HBs(43 positive and 29 negative).All infants were vaccinated with hepatitis B vaccine at birth and one month thereafter.Serum anti-HBs were quantitatively determined for the mothers before delivery and for infants in cord blood at delivery and in serum at the age of 1 and 3.5 months. Results Anti-HBs of all 43 newborns in the positive group were positive in cord blood with the coefficiency of 0.98 to the maternal serum anti-HBs level(t=39.05,P<0.01).Forty-two out of the 43 infants remained anti-HBs positive at the age of 1 month.Anti-HBs was negative both at birth and 1 month old in infants of the negative group.However,all infants in both groups were anti-HBs positive at 3.5 months of age,while the average concentration of anti-HBs in infants of the negative group was significantly higher than that of the positive group [(466.9±86.7)mIU/ml vs(151.2±23.1)mIU/ml,t=2.72,P=0.011].Among the 5 infants whose maternal anti-HBs level>1000 mIU/ml,3 did not produce active antibodies against two doses of hepatitis B vaccination. Conclusions Passively acquired maternal anti-HBs in infants can inhibit the active antibody response to hepatitis B vaccine,and the extent of this effect is associated with maternal anti-HBs level.

Objective To establish an anti-hepatitis E virus (HEV) enzyme-linked immunosorbent assay (ELISA) one-step assay based on seven glutathione S-transferase (GST)-fusion recombinant proteins derived from different HEV genotypes and subtypes. Methods Concentration of the coating antigen was optimized by block titration. The cut-off values were determined for anti-HEV IgG and IgM, respectively. Assay sensitivity, specificity and reproducibility were investigated using samples with confirmed anti-HEV positive. Results An optimal concentration of mixture of recombinant proteins (Mix166) was 1.5 mg/L for antigen coating. Coefficient of variations (CV) of anti-HEV within-run and between-run were 8.67% and 10.85%, respectively. CV of anti-HEV IgM within-run and between-run were 4.56% and 5.99%, respectively. Positive rates of anti-HEV IgG and IgM were both 94% for 50 HEV-polymerase chain reaction (PCR) positive sera tested with the one step assay. Using one-step assay to detect 674 serum samples from healthy people, 52 samples were found anti-HEV IgG positive and 3 samples were anti-HEV lgM positive. A series of serum specimens collected at different time points until 76 weeks from a chimpanzee challenged with HEV Mexican strain were anti-HEV IgM positive during week 1--6 and anti-HEV IgG positive during week 2--76 determined by the one step ELISA. However, import ELISA kits were lack of both the IgM and lgG reactivity to all of the serial chimpanzee sera. Conclusions The sensitivity and specificity of anti-HEV ELISA one-step assay based on the Mix166 antigen are high and could be used for the diagnosis of HEV infection.

Objective To observe the difference among the patients with chronic fatigue syndrome (CFS), mild-to-moderate depression or anxiety disorders in symptoms of fatigue, depression and anxiety. Methods Fatigue Scale-14 (FS-14), Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA) were used to evaluate 182 cases with CFS, mild-to-moderate depression or anxiety disorders. Results There was no significant difference in physical fatigue, mental fatigue and comprehensive fatigue among 3 groups (P>0.05). There were 39 (62.9%) CFS patients perhaps with depression symptoms and 23 (37.1%) patients with mild-to-moderate depression symptoms. There were 46 (74.2%) CFS patients perhaps with anxiety symptoms and 16 (25.8%) patients with mild-to-moderate anxiety symptoms. The score of HAMD was significant lower in the CFS group than in the mild-to-moderate depression disorder group (P<0.001). There were significant differences in the anxiety/somatization and hysteresis (P<0.01), as well as in cognitive disturbance, diurnal variation and hopelessness (P<0.05) between the CFS group and mild-to-moderate depression disorder group. The scores of HAMA was significant lower in the CFS group than in the mild-to- moderate anxiety disorder group (P<0.001). There was significant difference in mental-anxiety (P<0.01), as well as in body-anxiety (P<0.05) between the CFS group and the mild-to-moderate anxiety disorder group. Conclusion The symptoms of emotion disorders and fatigue symptoms were both presented in patients with CFS, mild-to-moderate depression and anxiety disorders. They share common clinical features.

Objectives To evaluate accurately hepatocyte injury degree of severe hepatitis patients by quantifying plasma DNA of severe hepatitis patients and study its clinical application in diagnosis of severe hepatitis comparing with ALT.Methods Six milliliters of peripheral blood samples were collected from 185 patients with hepatitis B which are divided into four groups, severe hepatitis with 30 cases, acute hepatitis with 20 cases, chronic B hepatitis with 90 cases, and liver cirrhosis with 45 cases. 100 healthy controls were enrolled. Circulating DNA was extracted from plasma by the BILATEST virus DNA/RNA extraction kit and quantified with a novel duplex real-time PCR assay, respectively.Results Plasma DNA levels of hepatitis B patients were significantly higher than those of healthy controls (104.2 ng/ml vs. 23.4 ng/ml (median),P=0.0000).A significant difference of plasma DNA concentration was found between severe hepatitis and acute hepatitis (P=0.0018), and chronic B hepatitis (P=0.0000), and liver cirrhosis (P=0.0000).The median value of serum ALT of hepatitis B patients was 107.5 U/L, much higher than that of the healthy controls (24.1 U/L,P=0.0000).The levels of serum ALT were significantly different between severe hepatitis and acute hepatitis (P=0.0024), while there was no remarkable difference between severe hepatitis and chronic B hepatitis (P=0.0600), liver cirrhosis (P=1.0000). Moreover, for distinguishing severe hepatitis from liver cirrhosis and chronic B hepatitis, the plasma DNA assay was notably superior to ALT by the analysis of receive operating characteristic (ROC) curves (AUC, 0.95 vs. 0.51,P=0.0000; 0.86 vs. 0.34,P=0.0000).Conclusion The results by measuring plasma DNA of hepatitis B patients with the novel duplex real-time quantitative PCR showed that plasma DNA may be considered as a robust predictive marker for accurately evaluating hepatocyte injury degree of severe hepatitis patients.

Autophagosomes derived from tumor cells have been proved to induce potent T cell response both in mouse and human. In human in vitro study, dendritic cells(DC)loaded with cytomegalovirus(CMV)pp65 antigen-containing DRibble were capable to efficiently re-stimulate pp65-specific T-cell recall responses from freshly isolated or frozen humanperipheral blood mononuclear cell(PBMC). This study developed more robust assays using in vitro expanded antigen-specific T cells that contained a much higher percentage of antigen-specific T cells. DC cross-presentation efficiency of OX40 and CD80 modified pp65-DRibble was detected by intracellular IFN-γ staining. Compared with Ctrl/pp65 DRibble, the percentage of IFN-γ+ in total CD8+ T cells andCD4+ T cells was improvedwith OX40/pp65 DRibbleand CD80/pp65 DRibble stimulation. In addition, vaccine induced IL-12indendritic cells, whichpolarizes Th cells toward the IFN-γ high Th1 phenotype, evaluated by ELISA inco-culture supernatantwas dramatically higher in OX40/pp65 DRibble and CD80/pp65 DRibblegroups than in Ctrl/pp65 DRibble group. These results have implications for the immuneactivity of OX40 and CD80 modified DRibble and choice for prospective clinical use ofDRibble-based cancer immunotherapy.

Objective To identify the risk factors of major bleeding in patients undergoing off-pump coronary artery by-pass grafting( OPCAB) .Methods Data on coronary artery disease patients who underwent off-pump CABG between December 2009 and December 2014 were reviewed.Baseline characteristics were compared between patients with clopidogrel discontinua-tion ≥5 days and <5 days.Univariate and multivariate logistic regression analyses were performed to investigate the risk fac-tors of perioperative major bleeding.Major bleeding was defined as the Universal Definition of Perioperative Bleeding(UDPB) class 3 -4.Results A total of 3988 patients who underwent OPCAB were included in this study.Major bleeding rate was 9.23%(n=368).Multivariable regression analysis showed that female sex(OR=1.99, 95%CI:1.57-2.52), age(OR=1. 02, 95%CI:1.00-1.03), lower BMI(BMI≤25 kg/m2)(OR=1.40,95%CI:1.12-1.75), decreased GRF(GFR<60 ml/min)(OR=1.43,95%CI:1.01-2.02), decreased preoperative Hct(Hct <0.40)(OR =1.57, 95%CI: 1.23-1.99) and clopidogrel discontinuation <5 days(OR=1.97, 95%CI:1.58-2.44) conferred a higher risk of perioperative major bleeding during OPCABG.Conclusion Female, advanced age, lower BMI, decreased GRF, decreased preoperative Hct and clopi-dogrel discontinuation<5 days are independent risk factors of perioperatice major bleeding in patients undergoing OPCAB .Pre-dicting risk of major bleeding can help sugeons to optimize perioperative management .