Objective:To investigate the expression of serum heat shock protein 70 (HSP70), soluble programmed death protein 1 (sPD-1), and 25-hydroxy vitamin D 3 in hepatitis B associated liver cirrhosis (HBLC) combined with type 2 diabetes mellitus (T2DM) and their value in prognostic prediction. Methods:The clinical data of 97 patients with HBLC combined with T2DM (HBLC combined with T2DM group), 105 patients with HBLC (HBLC group) and 118 patients with T2DM (T2DM group) from June 2018 to November 2019 in Zhejiang Putuo Hospital were prospectively analyzed. The serum levels of HSP70, sPD-1 and 25-hydroxy vitamin D 3 were compared among 3 groups, and the correlation between above serum indexes and liver function indexes, blood sugar indexes were analyzed. The liver function indexes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the blood sugar indexes included fasting blood glucose (FBG) and glycosylated hemoglobin (HbA 1c). According to the prognosis 6 months later, the patients with HBLC combined with T2DM were divided into poor prognosis (28 cases) and good prognosis (69 cases), and the HSP70, sPD-1, 25-hydroxy vitamin D 3 and liver function Child-Pugh classification were compared. The predictive value of serum HSP70, sPD-1 and 25-hydroxy vitamin D 3 on prognosis in patients with HBLC combined with T2DM was analyzed by receiver operating characteristic (ROC) curve. Results:The HSP70 and sPD-1 in HBLC combined with T2DM group were significantly higher than those in HBLC group and T2DM group: (4.28 ± 1.19) μg/L vs. (2.27 ± 0.76) and (2.40 ± 0.84) μg/L, (7.86 ± 2.45) ng/L vs. (4.23 ± 1.62) and (3.85 ± 1.27) ng/L, the 25-hydroxy vitamin D 3 was significantly lower than that in HBLC group and T2DM group: (13.62 ± 3.96) μg/L vs. (18.63 ± 6.11) and (17.45 ± 4.36) μg/L, and there were statistical differences ( P<0.05); there were no statistical differences between HBLC group and T2DM group ( P>0.05). The Pearson correlation analysis result showeds that HSP70 and sPD-1 were positively correlated with ALT, AST, FBG and HbA 1c ( P<0.01), the 25-hydroxy vitamin D 3 was negatively correlated with ALT, AST, FBG and HbA 1c ( P<0.01) in patients with HBLC combined with T2DM. In patients with HBLC combined with T2DM, the HSP70, sPD-1 and rate of Child-Pugh classification B in patients with poor prognosis were significantly higher than those in patients with good prognosis: (6.03 ± 1.63) μg/L vs. (3.57 ± 1.02) μg/L, (9.86 ± 1.59) ng/L vs. (7.05 ± 2.62) ng/L and 71.43% (20/28) vs. 30.43% (21/69), the 25-hydroxy vitamin D 3 was significantly lower than that in patients with good prognosis: (9.26 ± 3.02) μg/L vs. (15.39 ± 5.84) μg/L, and there were statistical differences ( P<0.01 or <0.05). The ROC curve analysis result showed that the area under curve of HSP70, sPD-1 combined with 25-hydroxy vitamin D 3 in predicting prognosis was the highest in patients with HBLC combined with T2DM, which was 0.890, with a sensitivity of 89.29% and a specificity of 79.71%. Conclusions:The levels of serum HSP70 and sPD-1 in patients with HBLC combined with T2DM increase, and the level of 25-hydroxy vitamin D 3 decreases. There is a good linear relationship with liver function and blood glucose. Early combined detection of the above serum levels can provide new ideas for clinical implementation of symptomatic treatment and prognosis prediction.

Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw (DHS) and anti-rotation screw.Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015.There were 59 males and 47 females,with an average age of 57.0 years (range,27-76 years).By Garden classification,there were 27 cases of type Ⅱ,51 cases of type Ⅲ and 28 cases of type Ⅳ.All cases were divided into femoral head necrosis group (18 cases) and none-necrosis group (88 cases) according to the radiographs of the fractured hip at the follow-up.Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis:sex,age,Garden classification,Pauwels classification,Singh index,injury-to-surgery time interval,reduction methods,reduction quality,complete weight-bearing time,implant removal and the time cost of implant removal surgery.Results All the 106 patients obtained a mean follow-up of 49 months (range,26-76 months).Femoral head necrosis occurred in 18 cases (17.0％).In univariate analyses,Garden classification,reduction quality,implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis (P ＜ 0.01).In multivariate logistic regression analysis,high level of Garden classification(95％ CI 0.008,0.998,P ＜ 0.05),implant removal and long time of the implant removal surgery (95％ CI 0.000,0.143,P ＜ 0.01) were found to have a significant effect on femoral head necrosis development.Conclusions Fracture displacement,removal of internal fixation and broadening the screw canal,which cand hinder the blood supply of femoral head,will enhance the rate of femoral head necrosis.As a result,it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures.When it is difficult to remove the anti-rotation screw,it is better to give up,rather than to force a removal.

To investigate changes in the angiotensin converting enzyme 2 (ACE2) and angiotensin (1-7) [Ang (1-7)] and to explore the role of ACE2-Ang (1-7)-Mas receptor axis in hypertension with heart failure with preserved ejection fraction (HFPEF).
 Methods: A total of 70 patients with primary hypertension and preserved left ventricular ejection fraction (LVEF>50%) were recruited and patients were divided into a hypertension group (HBP) and a heart failure with preserved ejection fraction group (HFpEF) according to the diagnostic criteria of HFpEF. Thirty-five healthy participants were selected randomly as a control group. Enzyme linked immunosorbent assays (ELISA) method was used to detect concentration of Ang (1-7), ACE2, angiotensin II (Ang II), brain natriuretic peptide (BNP) in plasma. Male Sprague- Dawley (SD) rats was randomly divided into 2 groups: An HFpEF group (n=16) and a sham group (n=8). Rats (n=8) in the AAC group were given Ang (1-7) [0.5 mg/(kg.d), intraperitoneally] for 6 weeks, and the rest were given equal dose normal saline. Then all the rats were killed, and the hearts were taken out for hematoxylineosin (HE) staining. The protein expressions of angiotensin converting enzyme (ACE), ACE2, and Mas receptor were detected by Western blot.
 Results: The BNP and Ang II were significantly increased in the HBP group and the HFpEF group compared with the control group (P<0.01). There were not significantly different in levels of ACE2 and Ang (1-7) between the HBP group and control group (P>0.05), whereas those levels were significantly increased in the HFpEF group compared with the HBP group and control group (P<0.01). HE staining showed obvious hypertrophy of myocardial cell in the AAC group compared with the sham group. Hypertrophy of myocardial cell in the AAC+Ang (1-7) group was significantly higher than that in the AAC group. Expressions of ACE, ACE2, and Mas receptor proteins were significantly higher in the AAC group than those in the sham group (P<0.05), while the expressions of ACE2 and Mas receptor proteins in the AAC+Ang (1-7) group were significantly higher than those in the AAC group (P<0.05). There was no significant difference in the ACE protein expression between groups (P>0.05).
 Conclusion: ACE2 and Ang (1-7) are important predictive factors for the severity of heart failure and myocardial remodeling of HFpEF with hypertension; ACE2-Ang (1-7)-Mas receptor axis may play a protective role in preventing myocardial remodeling in HFpEF with hypertension.
Angiotensin I ; physiology ; Angiotensin II ; Animals ; Atrial Remodeling ; physiology ; Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Heart Failure ; metabolism ; physiopathology ; Humans ; Hypertension ; metabolism ; physiopathology ; Male ; Peptide Fragments ; physiology ; Peptidyl-Dipeptidase A ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, G-Protein-Coupled ; physiology ; Stroke Volume ; Ventricular Function, Left ; physiology ; Ventricular Remodeling ; physiology