Objective To evaluate the diagnosis and the optimal management of idiopathic thrombocytopenic purpura(ITP) with pregnancy and the related high risk factors with neonatal passive immune thrombocytopenia(PIT) occurring in infants born to mothers with ITP. Methods Medical records of 40 pregnant women with ITP and their neonatal outcomes were reviewed retrospectively from 1992.2 to 2001.8 in our hospital. Results The incidence of pregnancy with ITP was 3.4‰. The maternal complications included pregnancy-induced hypertension syndrome (17.5%), postpartum hemorrhage (15%), preterm labor (12.5%), gestational diabetes(7.5%) and FGR (7.5% ). One mother died at 36 weeks of gestational age. There were 13 cases delivered by vagina and 27 cases delivered by cesarean section. Nine neonates(28.1%)had neonatal PIT, Among them three neonates (9.3%) had severe PIT, One neonate(2.5%) had an intracranial hemorrhage(ICH) and two perinatal death (5%)occured in 40 neonates. No significant correlation was found between neonatal platelet counts and maternal platelet counts, maternal PAIgG values and maternal treatments respectively. Conclusion The prognosis of mothers and neonates in pregnancy with ITP are better. The incidence of severe fetal or neonatal PIT is low and not related to maternal platelet counts, maternal treatments and PAIgG values.

Objective:To study influence of insulin on myocardial microcirculation of patients with coronary heart disease (CHD)complicated type 2 diabetes mellitus (T2DM)after percutaneous coronary intervention (PCI).Meth-ods:A total of 65 patients,who was confirmed as CHD by coronary angiography and fractional flow reserve (FFR)<0.75 measured by pressure guidewire,were enrolled.After drug-eluting stent implantation,index of microcircula-tion resistance (IMR)was measured.According to insulin usage or not,they were divided into insulin therapy group (insulin group,n=30)and pure oral hypoglycemic agent therapy group (pure hypoglycemic agent group,n=35). After six-month follow up,IMR was reviewed,and IMR was compared between two groups.Results:There was no significant difference in incidence rate of major adverse cardiovascular events (MACEs)between two groups,P =0.07. On six months after PCI,IMR in insulin group was significantly lower than that of pure hypoglycemic agent group [(24.5±3.1)U vs.(30.2±4.3)U,P <0.05].Conclusion:Insulin therapy can improve myocardial micro-circulation in patients with coronary heart disease complicated type 2 diabetes mellitus after PCI.

Objective To observe the clinical efficacy and safety ofZhilou Lotion combined with modified Sihuang Ointment in treatment of anal cryptitis.MethodsOne hundred patients with anal cryptitis were randomly divided into observation group and control group, with 50 cases in each group. The control group was given propylene dispersible tablets oral and topicalHuazhi embolism. The observation group received steaming and hip bath with Zhilou Lotion combined with modifiedSihuang Ointment topical external application treatment, 7 days as a course of treatment and 2 courses successive. The TCM syndrome scores of two groups were compared before and after treatment to evaluate the clinical efficacy. The remission time of symptoms, hospitalization time, recurrence rate in 6 months and adverse reactions were observed.Results After treatment, the TCM syndrome scores of two groups were improved (P<0.01), and the scores in the observation group was lower than those in the control group (P<0.01). The total effective rate was 96.0% (48/50) in the observation group, and 80.0% (40/50) in the control group, with statistical significance (P<0.01). The remission time of anal edema, anal dampness, anal pain and anal fall-swell in observation group was obviously shorter than that in the control group, with statistical significance (P<0.01). The average hospitalization time was (15.25±2.78) days in the observation group and (18.46±3.41) days in the control group, the difference was significant (P<0.01). In the observation group, the recurrence rate was 0, 0 and 2.0% in 2, 4, 6 months follow-up, while that was 4.0%, 12.0% and 16.0% in the control group, respectively. The recurrence rates of the control group in 4 months and 6 months were higher than those of the observation group (P<0.05). No significant adverse reactions occurred in the two groups.Conclusion Zhilou Lotion combined with modifiedSihuang Ointment has good clinical efficacy in treatment of anal cryptitis, with low recurrence rate and high safety.

Objective To investigate the red blood cell distribution width (RDWC)and serum leptin (Leotin)levels in pa-tients with early onset coronary heart disease (CHD)and their correlation.Methods From January 2013 to April 2016,320 cases of hospitalized patients with chest pain,chest tightness in the cardiovascular department of the Gaoming District People's Hospital of Foshan City,Guangdong Province,were examined by coronary artery.Of which 240 cases were male under 55 years old,female under 65 years old patients with coronary heart disease (coronary heart disease group),another 80 cases of normal coronary angiography and treadmill negative males under 5 5 years old,female under 6 5 years old patients,as the con-trol group.Gensini score in patients with premature coronary heart disease was calculated according to the coronary artery imaging results,Comparison between the two groups of red blood cell distribution width and serum leptin levels were differ-ent,analysis of red blood cell distribution width and serum leptin levels and the correlation between the degree of coronary artery lesions.Results The red blood cell distribution width and the serum leptin level in patients with early onset coronary heart disease were (13.87 ± 0.31)% and (12.24 ± 2.21)μg/L,significantly higher than the control group (14.31 ± 0.22)% and (9.21±1.78)μg/L (t=11.742,11.116,P<0.001).And Gensini score was positively correlated with coro-nary artery (r=0.413,0.124,P=0.000,0.041).Correlation of red cell distribution width and serum leptin levels were posi-tively (r=0.107,P=0.008).The research object curve the predictive value of red cell distribution width in patients with premature coronary heart disease (ROC)analysis showed that the area of ROC curve of red cell distribution width (AUC) under 0.725(95%CI:0.679~0.764),red cell distribution width value 12.85%,the sensitivity was 68.1%,specificity was 65.4%.Conclusion In patients with premature coronary heart disease,the red blood cell distribution width and serum leptin levels were significantly increased,and was positively correlated with the degree of coronary artery disease,can be used as an independent predictor of premature coronary heart disease.

ObjectiveTo define the high intraarterial signals on conventional MRI. Methods Review the conventional MRI data in all of the acute ischemic stroke patients in the First Affiliated Hospital,School of Medicine, Zhejiang University from January 2010 to December 2010. ResultsIn year 2010,according to the diagnostic criteria of China, there were 280 cases of acute cerebral infarction, all underwent conventional MRI. Twenty six patients (9. 29％ ) showed high intraarterial signals on conventional MRI.There were 14 cases with high signals in the anterior circulation, including 11 cases in the carotid artery, 2 cases in the anterior cerebral artery, and 1 case in the middle cerebral artery combined with the anterior cerebral artery. In the 11 patients with high signals in the carotid artery, MRA confirmed 14 internal carotid arteries stenosis, with 100％ specificity and 78.6％ sensitivity. There were 12 cases with high signals in the posterior circulation, including 5 cases in the vertebral artery, 3 cases in the basilar artery, and 4 cases in the basilar artery with vertebral artery. One patient did not undergo MRA. MRA confirmed 14 arteries with stenosis, with 100％ specificity and 78.5％ sensitivity. ConclusionsIntravascular high signals showed by conventional MR sequences have high clinical specificity, and its vascular lesions are consistent with the results of MRA.

Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with prednisone in the treatment of idiopathic membranous nephropathy (IMN) patients with positive serum phospholipase A2 receptor (PLA2R) antibody.Methods An open prospective study was performed on twenty-four biopsy-proven IMN patients with positive serum PLA2R antibody in Guangzhou First People''s Hospital from June 2012 to June 2016.The 24 patients were divided into two groups: MMF group in which MMF combined with prednisone was given for 12 months and CTX group in which intravenous cyclophosphamide (CTX) was monthly given combined with oral prednisone.Results After 6 months of immunosuppressive therapy,complete remission and partial remission rates were 25.0% vs.16.7% and 25.0% vs.25.0% in the MMF group and CTX group,respectively (P>0.05).In the MMF group and CTX group,serum PLA2R antibody in the same amount (8/12,66.7%) of patients turned negative.At the end of twelve-month treatment,all patients with negative PLA2R antibodies achieved complete or partial remission.Clinical remission (including complete and partial remission) rates in the MMF group and CTX group were both 66.7%.After immunosuppressive therapy,the levels of proteinuria and serum albumin in the two groups were significantly improved,but no significant difference were found between the two groups (proteinuria:F within-grouP=98.688,P<0.01;F between-grouP=0.133,P=0.719;F cross-grouP=1.223,P=0.304;serum albumin:F within-grouP=30.629,P<0.01;F between-grouP=0.137,P=0.715;F cros-grouP=0.455,P=0.565).At the end of six and twelve months of treatment,the proteinuria (after six months,MMF group: (2 893±2 515) mg/g vs.(6 236±2 117) mg/g,t=-3.522,P=0.002;CTX group: (2 690±2 254) mg/g vs.(5 386±2 447) mg/g,t=-2.808,P=0.010;after twelve months,MMF group:1 025(99-4 635) mg/g vs.(6 236±2 117) mg/g,Z=-3.291,P<0.0005;CTX group: (775(41-3 517) mg/g vs.(5 386±2 447) mg/g,Z=-3.118,P=0.001) and serum albumin levels (after six months,MMF group: (28.5±9.7) g/L vs.(19.8±4.4) g/L,t=2.841,P=0.012;CTX group: (29.0±7.6) g/L vs.(22.3±4.1) g/L,t=2.690,P=0.016;at the end of twelve months of treatment,,MMF group: (32.4±8.5) g/L vs.(19.8±4.4) g/L,t=4.570,P<0.0005;TX group: (32.2±7.9) g/L vs.(22.3±4.1) g/L,t=3.862,P=0.001) of the two groups were better than those prior to treatment.Conclusion For the IMN patients with positive serum PLA2R antibody,MMF combined with prednisone was as effective as conventional CTX combined with prednisone in the negative conversion of PLA2R antibody and the remission.The negative conversion of PLA2R antibody after 6 months of immunosuppressive treatment was an important indicator of predicting the remission.

Objective To explore the expression of ATP-binding cassette transporter C2(ABCG2) in adriamycin(ADM)-resistant human esophageal cancer cells.Methods The ADM-resistant human esophageal cancer cell(Eca109/ADM) was induced by gradually increasing the ADM concentration in the culture medium of human esophageal cancer cell line(Eca109) and long time screening culture.ABCG2 mRNA and protein of ADM-resistant cells was detected by RT-PCR,flow cytometry(FCM) and Western blot.Drug excretion of Eca109/ADM cells was examined by FCM.The drug resistance index to ADM was detected by MTT.Results The expression of ABCG2 in Eca109/ADM cells was higher than that in Eca109 cells.The drug excretion of Eca109/ADM cells was stronger than Eca109 cells.The Ecal09/ADM cells drug resistance index to ADM was 3.29.Conclusion The ADM-resistant cell line Eca109/ADM was established successfully as an ideal chemoresistant cell model.ABCG2 might be involved in the drug resistance of esophageal cancer cell.

OBJECTIVE: To explore the composition characteristics of traditional Chinese medicine (TCM) syndromes in patients with acute ischemic stroke of yin or yang syndrome by investigating the characteristics of TCM syndromes at different periods after onset. METHODS: One thousand two hundred and forty-six patients with acute ischemic stroke were admitted in twenty hospitals. According to the "diagnostic criteria of syndrome differentiation of stroke", the characteristics of syndromes in the patients were investigated at the periods of 1-3 days, 4-10 days and 11-30 days after they had ischemic stroke. General distribution of six basic syndromes was compared between the patients with yin syndrome and the patients with yang syndrome at the three periods. The six basic syndromes were wind syndrome, pathogenic fire syndrome, phlegm syndrome, blood stasis syndrome, qi deficiency syndrome, and syndrome of yin deficiency and yang hyperactivity. RESULTS: The percentages of wind, pathogenic fire, and phlegm syndromes in the patients were decreased at the period of 11-30 days as compared with the period of 1-3 days (87.1% vs 79.3%, 52.1% vs 38.7% and 67.1% vs 57.4% respectively, P<0.01). However, the percentages of the syndromes of blood stasis, qi deficiency, and yin deficiency and yang hyperactivity were similar at the three periods (P>0.05). There were no differences in the distribution of yin and yang syndromes among the three periods (P>0.05). The percentages of syndromes of wind, pathogenic fire, phlegm, and yin deficiency and yang hyperactivity were higher (P<0.01), and the percentages of syndromes of blood stasis and qi deficiency were lower (P<0.05, P<0.01) in patients with yang syndrome than in patients with yin syndrome. The complex of three syndromes was the most frequent composition pattern in the patients at the three periods. The percentages of complex syndromes of four or five syndromes were higher, and the percentages of single-syndromes and complex syndromes of two syndromes were lower in patients with yang syndrome than in patients with yin syndrome (P<0.05, P<0.01). The most frequent complex syndromes in patients with yin syndrome were complex syndrome of wind, phlegm, blood stasis and qi deficiency, and complex syndrome of wind, phlegm and qi deficiency; while the most frequent complex syndromes in patients with yang syndrome were complex syndrome of wind, pathogenic fire, phlegm and qi deficiency, and complex syndrome of wind, pathogenic fire and phlegm. CONCLUSION: The main discrimination between the yin and yang syndromes is that the yang syndrome is characterized by pathogenic fire. The syndromes of phlegm, qi deficiency, and blood stasis are not associated with the diagnosis of yin or yang syndrome.

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.

Objective:To investigate the relationship between caspase recruitment domain protein 9 (CARD9) level and inflammatory response in cerebral tissue of ischemic brain injury mice.Methods:Totally 24 SPF BALB/c male mice were randomly(random number) divided into 4 groups: sham operated group, ischemia 3 h group, ischemia 6 h group, and ischemia 12 h group, 6 mice in each group. The permanant middle cerebral artery occlusion (pMCAO) model in the ischemia groups was established by using line embolism to block blood flow. Mice in each group were sacrificed at the predetermined time point after operation. CARD9 and p-p65NF-κB levels were detected by Western blot, and the inflammatory factors mRNA and protein including TNF-ɑ, IL-lβ and IL-6 were detected by RT-PCR and ELISA, respectively. The data were analyzed by SPSS 21.0 software, the comparison of measurement data between each two groups was analyzed by independent sample t test, and the correlations between CARD9 and inflammatory factors were analyzed by Pearson analysis. Results:Compared with the sham operated group, the CARD9 levels in the ischemia 3 h, 6 h and 12 h groups were increased significantly [(0.325±0.011) vs. (0.462±0.019), P=0.036; (0.735±0.036), P=0.003; (0.903±0.024), P=0.001], the p-p65NF-κB levels in the ischemia 3 h, 6 h and 12 h groups were increased significantly [(0.227±0.016) vs. (0.316±0.017), P=0.041; (0.445±0.021), P=0.016; (0.671±0.039), P=0.008], the TNF-ɑ levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(0.53±0.06) vs. (1.06±0.10), P=0.009; (1.47±0.15), P=0.004; (2.78±0.18), P=0.001], the IL-lβ levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(0.55±0.07) vs. (1.01±0.11), P=0.009; (2.13±0.16), P=0.003; (3.09±0.18), P=0.001], and the IL-6 levels in the ischemia 3 h, 6 h and 12 h groups were significantly increased [(1.99±0.18) vs. (4.10±0.41), P=0.006; (8.54±0.84), P=0.002; (11.56±0.96), P=0.001]. Pearson analysis showed that CARD9 was positively correlated with the p-p65NF-κB and TNF-ɑ, IL-lβ, IL-6 ( r=0.894, P=0.001; r=0.747, P=0.008; r=0.810, P=0.001; r=0.773, P=0.007). Conclusions:A positive correlation exists between CARD9 and inflammatory responses in the early stage of ischemic brain injury in mice