Objective To study the value of echocardiogram in preoperative examination for the diagnosis of silent myocardial is-chemia in patients before surgery .Methods 172 patients with surgical preoperative suspected diagnosis of coronary heart disease , were divided into heart valve surgery group (72 cases) and non heart valve surgery group (100 cases) .All of the patients had echo-cardiography and coronary angiography before 2 weeks of operation .We drew a series of analysis to assess the sensitivity、specialty and accuracy of diagnosis of silent myocardial ischemia with regional wall motion abnormality (RWMA) and wall motion score in-dex (WMSI) .Results Coronary angiography as the gold standard of coronary heart disease diagnosis .The sensitivity of RWMA for the diagnosis of silent myocardial ischemia in patients undergoing heart valve surgery group and non heart valve surgery group was 85 .7% and 100 .0% ,while the specificity of RWMA was 100 .0% and 80 .0% ,respectively ,the differences between the two groups had no statistical significance (P>0 .05) .We also drew the ROC curve of WMSI for the diagnosis of silent myocardial ische-mia ,maximum area under the ROC curve of WMSI were 2 .20 and 2 .05 .In patients undergoing cardiac surgery and non-cardiac sur-gery ,the curves indicated that the sensitivity were 79 .7% and 75 .9% ,the specificity were 83 .0% and 67 .7% ,respectively .Area under the ROC curve was 0 .832 and 0 .702 ,but the difference was not statistically significant (P>0 .05) .Conclusion Using RW-MA and WMSI as reference indicators ,surgical preoperative echocardiography in the diagnosis of patients with silent myocardial is-chemia has good sensitivity ,specific ,and accurate ,there is no statistically significant difference between heart valve surgery and non heart valve surgery .

Objective:To evaluate the effects of periodontitis on the expression of apoptosis-related proteins in pancreas of rats with Type 2 Diabetes Mellitus.Methods:Spontaneously type 2 diabetic OLETF rats were randomly divided into 2 groups:diabetes with or without periodontitis(diabetes group and combination group).LETO rats with the same germline and the same age but having normal glucose tolerance were randomly divided into control group and periodontitis group.20 weeks after periodontitis were established,all the rats were sacrificed and the pancreas were pathologically examined by HE staining.The expression of Bax,Bcl-2 and Caspase-3 in the pancreas islet were detected by immunohistochemistry staining and semi-quantitative analysis.Results:The expression of Bax, Bcl-2 and Caspase-3 in the pancreas islet was no significant difference between control and periodontitis groups(P=0.324,P=0.091,P=0.852).Compared with diabetes group,the expression of Bax and Caspase-3 in combination group showed a significant increase(P=0.000,P=0.000),and the expression of Bcl-2 was significantly decreased(P=0.022).Conclusion:Under healthy conditions,periodontitis has no effect on the expression of apoptosis-related proteins in rat pancreas islet.However,in rats with diabe-tes,periodontitis may affect the expression of apoptosis-related proteins in pancreas islet.

Objective To analyze the influence of age on the diagnosis of acute heart failure (AHF) with amino terminal brain natriuretic peptide (NT‐proBNP) ,and to explore the best cut‐off value of NT‐proBNP in the diagnosis of AHF .Methods Totally 457 inpatients suspected with AHF obtained a blood NT‐proBNP measurement within 24 hours when in charged ,including 194 patients with AHF .Patients were divided into three groups according to their age :≤50 years ,>50-70 years and >70 years . The relationship between NT‐proBNPand AHF was analyzed .The diagnostic value of NT‐proBNP was evaluated for AHF in differ‐ent age groups .Results The median NT‐proBNP levels of AHF in all age groups were significantly higher than those without (P<0 .01) .AUC of NT‐proBNP for AHF in ≤50 years ,>50-70 years and >70 years groups were 0 .95 ,0 .91 ,0 .88 ,the best diagnos‐tic cut‐off points were 1 100 ,1 800 ,3 000 pg/mL ,respectively .The diagnostic specificity was 88% ,76% and 73% ,respectively .O‐verall ,the specificity of NT‐proBNP cut‐off values for age group was higher than non‐age groups .Conclusion NT‐proBNP has a good value in the diagnosis of AHF in patients with different ages .According to the age group ,the different NT‐proBNP cut‐off values can be used to improve the specificity of diagnosis .

Objective To investigate the potential effect of depression on overweight and obesity in Tangshan city .Methods A total of 2 180 subjects were enrolled into this cross‐sectional survey conducted in Kailuan community .Anthropometric measurement and structured questionnaire survey were administered to each subject .Status of depression was assessed by Patient Health Ques‐tionaire‐9(PHQ‐9) .The potential effect of depression on overweight and obesity was analyzed with Logistic regression .Results The average score of PHQ‐9 as well as the prevalence of moderate or major status of depression in people with overweight and obe‐sity was significantly higher than those with normal weight .The multivariate logistic regression showed that the score of PHQ‐9 was a risk factor for prevalence of overweight and obesity (OR=1 .43 ,95% CI:1 .05-1 .95 ,P<0 .05;OR=1 .07 ,95% CI:1 .04-1 .10 ,P<0 .05) .In comparison to the none/mild depression ,moderate and major depression could significantly increase the risk for overweight (OR=2 .28 ,95% CI:1 .49-3 .49 ,P<0 .05 ;OR=3 .47 ,95% CI:2 .06-5 .84 ,P<0 .05) and obesity (OR=1 .22 ,95%CI:1 .03-1 .45 ,P<0 .05 ;OR=1 .81 ,95% CI:1 .44-2 .29 ,P<0 .05) .Conclusion The depression status could contribute to the development of overweight and obesity and the role of psychological elements should be taken into consideration in overweight and obesity management .

Objective To explore the clinical characteristics,management and pregnancy outcome in patients with ovarian tumor and ovarian tumor like condition complicated with pregnancy.Methods The clinical data of 248 patients with ovarian tumor and ovarian tumor like condition eomplicated with pregnancy who treated,operated and pathology conducted from January 2003 to December 2009 was analyzed retrospectively.Results Among of 248 patients,8 patients were found by pelrioscopy,184 patients were found by sonography.The rate of ovarian tumor and ovarian tumor like condition during pregnancy was 0.49％ (248/50 652),about 52.82％(131/248)were diagnosed as benign tumor,most of them were ovarian mature teratoma(22.18％,55/248).About 45.56％(113/248)were diagnosed as ovarian tumor like condition,most of them were ovarian chocolatecyst(23.79％,59/248).Four patients(1.61％,4/248)were ovarian malignant tumor.Two hundred and sixteen received operation,term birth was in 164 patients,premature birth was in 19 patients,miscarriage was in 33 patients.Conclusions Pelvioscopy and sonogaraphy are principally important in the diagnosis and detection of ovarian tumor during pregnancy.Pregnancy complicated with ovarian tumor or ovarian tumor like condition should be treated by tumor resection.Suitable surgery intervention during second trimester is safe.

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.

BACKGROUND:Hepatocyte transplantation has attracted more and more attention as a therapeutic measure for liver failure and genetic metabolic liver diseases.OBJECTIVE:TO evaluate the efficacy and safety of human hepatocyte transplantation in treating hepatitis B related liver failure in one case by a 2-year follow-up.DESIGN:A case-report of 2-year follow-up.SETTING:No.9 Department of Infectious Diseases,Bioengineering Research Room,the 302 Hospital of Chinese PLA.PARTICI PANT:One inpatient with hepatitis B related liver failure was selected from the 302 Hospital of Chinese PLA.and she was diagnosed according the laboratory tests.The transplanted hepatocytes were originated frOm the healthy liver of a 24-year-old man,who had signed the protocol for liver donation before death.METHODS:The hepatocyte transplantation was completed in the Department of Radiology,the 302 Hospital of Chinese PLA in December 2004.Liver was isolated to obtain human primary hepatocytes, and then cryopreserved.The hepatocytes were transplanted into recipient spleen via femoral vein after resuscitation.The clinical symptoms,changes of blood biochemical indexes,and changes of spleen MRI signals were observed before and after operation.The patient was reexamined every half a year after operation, including liver function, blood coagulation function,B-mode ultrasonography,gastroscopy and MRI,and she was followed up for 2 years. MAIN OUTCOME MEASURES:Liver function,blood coagulation function, imaging indexes, immunological indexes,complication and rejection.RESULTS:①Totally(1-2)×1010 hepatocytes were harvested,and the viability of rewarmed hepatocytes was 60%,and finally 2×109 hepatocytes were transplanted.②Two months later,the clinical symptoms of the recipient were obviously ameliorated,and serum bilirubin and aspartate aminotransferase(AST)were obviously decreased,while prothrombin activity was markedly increased.20 months later,the MRI results showed that there was hepatocyte image in spleen.Two years after operation.the total bilirubin level was 20 μmol/L,direct bilirubin level was 7 μmol/L, alanine aminotransferase was 416.75 nkat/L,AST was 533.44 nkat/L,albumin was 37 g/L,prothrombin activity was 90%,which were all obviously ameliorated as compared with those before operation(474.5 μmol/L,340.3 μmol/L,400.08 nkat/L,1 200.24 nkat/L,38 g/L,25%).The patient left the hospital 2 months later and could do light-burdened job.No complications of hydroperitonia and liver function failure, etc.were observed,and no rejection occurred.Several reexaminations by B-mode ultrasonography all indicated the further aggravations of liver cirrhosis and esophageal varices.She was admitted to hospital for twice because of esophageal varices bleeding,and cured by endoscopic variceal sclerosis therapy.CONCLUSION:Hepatocyte transplantation can ameliorate liver function without rejection,but it cannot relieve portal hypertension.

Objective To systematically evaluate the effect of early mobilization on the physical function of patients in intensive care unit (ICU). Methods The randomized controlled trials (RCT) about early intervention in ICU patients were retrieved from the Cochrane Library, PubMed, Wed of Science, Medline, CBM, CNKI, VIP, and Wanfang database, all of which were published literatures from the establishment to October 2018. Early activities were carried out in the intervention group, while only routine nursing was carried out in the control group. Outcome measures included the medical research council score (MRC-Score), physical function ICU test (PFIT), independent walking ability, score of quality of life health survey short form (SF-36), incidence of ICU-acquired weakness (ICU-AW) and hospital mortality. Two researchers independently screened the literature, evaluated the quality of the literature and extracted the data. After literature selection, literature quality evaluation and date extraction was performed, and RevMan 5.3 software was used for Meta-analysis. The publication bias was analyzed by funnel plot. Results A total of 13 literatures were included, 10 in English and 3 in Chinese; of the 1 347 patients, 695 in intervention group and 652 in control group. Compared with the control group, the MRC-Score was increased in intervention group [mean difference (MD) = 4.74, 95% confidence interval (95%CI) = 2.30-7.19, P = 0.000 1], independent walking ability was improved [odds ratio (OR) = 2.04, 95%CI =1.39-2.99, P = 0.000 3], the incidence of ICU-AW was decreased (OR = 0.22, 95%CI = 0.14-0.35, P < 0.000 01), and there was no significant difference in PFIT (MD = -0.19, 95%CI = -0.69-0.31, P = 0.46), physical health (PCS) after 6 months (MD = -1.39, 95%CI = -4.18-1.39, P = 0.33) and inpatient mortality (OR = 0.77, 95%CI = 0.53-1.12, P = 0.17) between two groups. It was shown by funnel plot that the publication bias of each literature was relatively small in terms of MRC-Score, PFIT, independent walking ability and SF-36. Conclusion Early mobilization are beneficial for the physical function recovery of ICU patients, which can improve the muscle strength, improve the ability of patients to walk independently, reduce the occurrence of ICU-AW, and do not increase the mortality rate in hospital.

Glioblastoma (GBM), characterized by rapid progression, easy recurrence and treatment resistance, is the most aggressive and lethal tumor of the central nervous system. Adenovirus E1A binding protein p300 (p300) serves rich functions as transcriptional coactivator and lysine acetyltransferase. Studies have shown that p300 plays an important role in the occurrence, proliferation, invasion and resistance to chemoradiotherapy of GBM. This paper reviews the structure and function of p300, and systematically expounds its various ways participating in GBM development and its translational perspectives, so as to provide references for GBM study.