Objective: To investigate the impact of clopidogrel or aspirin resistance on major adverse cardiovascular events (MACE) in elderly patients with acute coronary syndrome (ACS) and to explore the application value of thromboelastogram (TEG) in antiplatelet therapy. Methods: A total of 177 ACS patients admitted in our hospital from 2012-09 to 2014-12 were enrolled. The patients were at the mean age of (70.4±10.7) years, all of them received TEG and coagulation function test. Based on the reaction of antiplatelet therapy, they were divided into 2 groups: Non-resistance group,n=98 and Resistance group,n=70, which was further divided into 2 subgroups as Maintenance dose subgroup,n=39 and Increased dose subgroup,n=40. The patients were followed-up for 3 months to observe MACE occurrence including cardiovascular death, angina recurrence, ischemic stroke, myocardial infarction, acute thrombosis and hemorrhage. Results: In Resistance group, there were 50/79 (63.3%) patients with aspirin resistance and 29 (36.7%) with clopidogrel resistance. Compared with Non-resistance group, Resistance group showed decreased coagulation time, clot formation time, TEG reducing rate after 30 minutes maximum amplitude (LY30), activated partial thrombin time (APTT), thrombin time (TT) and international normalized ratio (INR), allP<0.05; while increased levels angle, maximum amplitude of TEG, coagulationindex, ifbrinogen and D-dimer, allP<0.05. Compared with Non-resistance group, Resistance group had the higher MACE rate 21.5% vs 7.1%,P<0.05; in addition, Increased dose subgroup had the lower MACE rate than Maintenance dose subgroup 17.5 vs 25.6%,P<0.05. Conclusion: Clopidogrel or aspirin resistance had the higher incidence of MACE in elder ACS patients; TEG was helpful for guiding antiplatelet therapy and reducing MACE incidence.

Objective To study scientific use and management of orthopedics implants.Methods The management of the orthopedics implants admittance was carried out.According to the purchasing lists from Procurement Public Health Bureau,special person was arranged to get the implants received,checked,disinfected,inspected etc.The application form,checking list and using list were used to reinforce the management of the implants from preoperation to postoperation.Results The management was carried out two years ago.The lose rate of the orthopedics fixed material was 0,and there was no important malpractice.Conclusion The scientific and systematic management of the orthopedics implants not only guarantees the safety of surgical operation and reduces the medical treatment disputes,but also safeguards the operation legal rights between doctors and sufferers at the same time.

Objective To investigate the long term clinical effect of unilateral and bilateral percutaneous vertebroplasty(PVP) on the treatment of single segment osteoporotic vertebral compression fractures (OVCFs).Methods A total of 95 patients with OVCFs were retrospectively investigated.Each patient completed Visual Assessment Score(VAS) and Short Form-36 (SF-36) questionnaires preoperatively and follow-up to the endpoints postoperatively to assess the long term effect of unilateral and bilateral PVP.Patients underwent unilateral PVP (44 cases),whereas others underwent bilateral PVP (51 cases).Results VAS of immediate postoperative score (2.69 ± 0.55),(2.50 ± 0.39) and the last follow-up score (2.63 ± 0.46),(2.48 ± 0.32) in both techniques of PVP were significantly lower than the preoperative score (7.56 ± 0.73),(7.45 ± 0.54) (t =1.895,1.801,all P ＜ 0.01).However,VAS score at each time point in the unilateral PVP and bilateral PVP showed no significant difference (P ＞ 0.05).The last follow-up SF-36 scores (84.92±2.88),(86.71 t 2.73) in unilateral PVP and bilateral PVP were significantly higher than the preoperative score (58.35 ± 2.69),(57.93 ± 2.45) (P ＜ 0.01).But each time point of the SF-36 scores in both groups showed no significant difference (P ＞ 0.05).Unilateral percutaneous vertebroplasty showed some advantages on operation time,radiation exposure and usage of bone cement.Meanwhile,the bone cement leakage and recurrence of OVCFs on the adjacent segment in the two groups presented no significance.Conclusion Both unilateraland bilateral PVP could benefit the long term outcome of OVCFs,with regard to the significant advantage of unilateral PVP on operation time,radiation exposure and usage of bone cement.

Objective To investigate the role of FTY720, an agonist of the sphingosine 1-phos-phate (S1P) receptor, in acute graft-versus-host disease (aGVHD) caused by allogeneic hematopoietic stem cell transplantation and to further elucidate its possible mechanism .Methods BALB/c ( H2 d ) recipient mice were given whole body lethal irradiation (750 cGy) for 4 hours.A mouse model of aGVHD was estab-lished by intravenously injecting recipient mice with 1×107 C57BL/6 (H2b) mice derived bone marrow cells (BMCs) and 5×106 whole splenic cells.FTY720 (3 mg/kg) was intraperitoneally injected into recipient mice from the day before allogeneic bone marrow transplantation ( allo-BMT) to day 4 thereafter to monitor the survival rate .The mice in control group were perfused with equal volume of control reagent .Fluores-cence-activated cell sorting ( FACS) was used to analyze the phenotypes of immune cells in spleen , liver, lung as well as intestines of mice on the fourth day of allo-BMT with or without FTY720 treatment. Results FTY720 significantly prolonged overall survival in mice with allo-BMT induced aGVHD .FACS analysis showed that FTY720 significantly inhibited the distribution of matured dendritic cells ( DCs) in lung and small intestines .Conclusion FTY720 could significantly alleviate the symptom of aGVHD in mice re-ceived allogeneic hematopoietic stem cell transplantation .The possible mechanism might be associated with the inhibited distribution of matured DCs in lung and intestines .

10.3969/j.issn.2095-4344.2013.25.001

Objective To observe the effect of three dimensional conformal radiotherapy combined capecitabine in treatment of rectal cancer. Methods Sixty patients with advanced rectal carcinoma from January 2010 to January 2011 were selected, 32 cases with three dimensional conformal radiotherapy combined capecitabine establishment as the ob-servation group, 28 cases with simple radiotherapy establishment as the control group, the total effective rate, disease control rate, the rate of local recurrence, distant metastasis rate, adverse reaction rate were compared between two groups. Results After 4 cycles of therapy, the clinical total effective rate of observation group was 53.1%, the control group was 28.6%, there were significant differences (P<0.05). The disease control rate of observation group was 90.6%, the control group was 67.9%, there were significant differences(P<0.05). Compared with control group, the local recur-rence rate and the rate of distant metastasis of observation group had statistically significant difference (P<0.05). Con-clusion Concurrent three dimensional conformal radiotherapy combined with capecitabine in the treatment of rectal cancer has curative effect, good safety, can reduce the recurrence rate and distant metastasis rate and increase the sur-vival rate of patients.

OBJECTIVE To explore the protective effect and mechanism of Longshengzhi capsules on cerebral ischemia- reperfusion injury in rats. METHODS The model of middle cerebral artery occlusion （MCAO） was established by using the improved thread occlusion method. The experiment was divided into six groups： sham surgery group （only separating blood vessels without inserting thread plugs， given the same volume of normal saline）， model group （modeling， given the same volume of normal saline）， nimodipine group （positive control， modeling， dose of 20 mg/kg）， and low-dose， medium-dose， and high-dose groups of Longshengzhi capsules （modeling， doses of 0.72， 1.44 and 2.88 g/kg， respectively）， with 10 mice in each group. Each group was given corresponding medication solution/normal saline by gavage， once a day， for 7 consecutive days. One hour after the last administration， the Zea Longa scoring method was used to score the neurological deficits in each group of rats， and the ABC enzyme-linked immunosorbent assay was used to detect the serum levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in rats； TTC staining was used to observe the volume of cerebral infarction in rats and calculate the cerebral infarction volume ratio. Hematoxylin eosin staining was used to observe the pathological changes in the brain tissue of rats. Immunohistochemical staining was used to detect the positive expression of NLRP3 protein in the brain tissue of rats. Real-time fluorescence quantitative PCR was used to detect mRNA relative expressions of Toll-like receptor 4 （TLR4） and nuclear factor-κB （NF-κB） in the brain tissue of rats. Western blot assay was adopted to detect the relative expressions of TLR4， NLRP3 and phosphorylated NF-κB （p-NF-κB） protein in the brain tissue of rats and its intracellular NF-κB protein. RESULTS Compared with the sham surgery group， the neural dysfunction score， serum levels of TNF-α and IL-6， cerebral infarction volume ratio， relative expression levels of NF-κB and TLR4 mRNA， as well as protein relative expressions of TLR4， NLRP3 and p-NF-κB in the brain tissue， and relative protein expression of intracellular NF-κB were increased significantly in the model group （P＜0.01）； the enlarged gap and significant edema were observed in cortical nerve cells of brain tissue in rats， with a large amount of inflammatory cell infiltration； the positive expression of NLRP3 protein in brain tissue of rats obviously increased. Compared with the model group， the levels of the above indicators in the medium-dose and high-dose groups of Longshengzhi capsules， as well as the Nimodipine group， were reversed to varying degrees， and most differences were statistically significant （P＜0.05 or P＜0.01）； the pathological morphology observation showed a significant improvement， and the positive expression of NLRP3 protein in the brain tissue of rats was obviously reduced. CONCLUSIONS Longshengzhi capsules may inhibit TLR4/NF-κB/NLRP3 signaling pathway and neuroinflammatory response， thereby achieving a protective effect against cerebral ischemia-reperfusion injury in rats.

Objective To analyze the predictive value of serum interleukin-27 (IL-27) for acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) from unrelated donors. Methods Serum samples were collected from 72 patients after receiving allo-HSCT from unrelated donors during January to December 2012. Serum samples collected from 70 patients received allo-HSCT in 2013 were used for confirmation. All patients received myeloablative conditioning regimen prior to allo-HSCT. Cyclosporin A (CsA)+mycophenolate mofetil (MMF)+short-term methotrexate (MTX) were used for GVHD prophylaxis. Serum IL-27 levels in patients with aGVHD were measured by ELISA. The pre-dictive value of IL-27 index,defined as the ratio of serum IL-27 level at neutrophil engraftment to that before pre-conditioning regimen, for allogeneic HSCT was retrospectively analyzed. Results Serum IL-27 index was significantly decreased in patients with gradeⅡ-ⅣaGVHD(grade 0-Ⅰ : 1.89±0.68 vs gradeⅡ-Ⅳ :1.26±0.49;P<0.000 1). IL-27 index had good value for grade Ⅱ-Ⅳ aGVHD (AUC=0.782,95% CI:0.675-0.889,P<0.001). Patients with a lower serum IL-27 index (<1.33) were more likely to have a higher cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with a higher serum IL-27 index (P<0.001). Multivariate analysis confirmed that low IL-27 index was the most significant risk factor for gradeⅡ-Ⅳ aGVHD (HR=4.50,95% CI:2.1-9.8,P<0.01). These findings were consistent with the results found in the serum samples collected in 2013. Conclusion Low IL-27 index could be used to predict the incidence of grade Ⅱ-Ⅳ acute GVHD after allo-HSCT from unrelated donors.

Factor VII ; Factor VII Deficiency ; Genotype ; Humans ; Pedigree

Anemia, Iron-Deficiency ; Humans