Objective To investigate the correlation of diastolic blood pressure (DBP) ＜70mm Hg and isolated systolic hypertension (ISH) with coronary atherosclerosis (CAS) and coronary heart disease (CHD) in elderly patients and to analyze the independent risk factors for low DBP.Methods A total of 246 elderly patients with untreated ISH who underwent coronary angiography were divided into the low DBP group (n=102) and the non-low DBP group (n=144) according to DBP level.All clinical and angiographic data were collected and the retrospective analysis was performed to assess the risk of CAS and CHD in patients with low DBP and to analyze the risk factors for low DBP.Results There were no significant differences in systolic pressure level between the low DBP group and the non low DBP group [(156.2±15.6) mmHgvs.(154.4±14.2) mmHg,t=0.93,P＞0.05],while pulse pressure level was significantly higher in the low DBP group than in the non-lowDBPgroup [(91.3±±17.7) mmHgvs.(72.9±15.1) mm Hg,t=8.54,P＜0.01].Stepwise logistic analysis showed that age,diabetes and smoking were independent risk factors for low DBP.After adjustment for age,gender and other common risk factors,low DBP was independently associated with CAS and CHD (OR =1.72 and 1.44,95％ CI:1.082.72 and 1.04-1.99,respectively,both P＜ 0.05).Conclusions Low DBP is independently associated with CAS and CHD in elderly patients with untreated ISH.Age,diabetes and smoking are the independent risk factors for low DBP.

Objective To investigate the relationship between isolated systolic high-normal blood pressure and cor-onary heart disease (CHD) in the middle-aged and elderly population. Methods A total of 236 patients over 50 years old and undergone coronary angiography were enrolled and divided into isolated systolic high-normal blood pressure (ISHNBP) group (n=135) and non-ISHNBP (NISHNBP) group (n=101) according to their systolic and diastolic blood pressure levels. All clinical data and angiographic data were collected. Results There was no significant difference in systolic blood pres-sure between NISHNBP group and ISHNBP group (P>0.05). There were significantly lower levels of diastolic blood pres-sure and higher pulse pressure in ISHNBP group (P＜0.01). Results of multivariate logistic analysis showed that isolated sys-tolic high-normal blood pressure was the independent risk factor for CHD (OR=2.67,95%CI:1.50-4.75, P＜0.01). And the distribution of diseased coronary vessel numbers was more extensive in the ISHNBP group (P＜0.01). Conclusion The iso-lated systolic blood pressure in the middle-aged and elderly population with high risk of coronary heart disease should be paid attention to, and make appropriate interventions, which may help reduce the incidence of cardiovascular disease.

0.05);IGF-I after therapy was higher than before(P

Child ; Child, Preschool ; Female ; Humans ; Infant ; Lymphohistiocytosis, Hemophagocytic ; diagnosis ; drug therapy ; Male ; Practice Guidelines as Topic ; Prognosis

ObjectiveTo explore the best time for replacing the long-term indwelling catheter in patients with silicone catheter.MethodsDomestic literature were retrieved and analyzed using Cochrane systematic review,and the meta-analysis of randomized controlled trials was conducted in accordance with inclusion criteria and exclusion criteria so as to look into the most suitable time for replacing the indwelling catheter for patients with silicone catheter at clinical trials.The replacement frequency for the catheters of different size together with the relevant infections in urinary tract infection and relative risk(RR)were used as values for effectiveness of interventions.ResultsA total of 11 literature were retrieved. Meta-analysis results suggested that the RR values of urinary tract infections when the catheters were replaced once every two weeks vs. every four weeks,and once every three weeks vs. every four weeks were 0.51[95% CI(0.40,0.66),P <0.001],0.79[95% CI(0.58,1.08),P = 0.14],respectively.The urinary infection rate of replacing a silicone cathether every 2 weeks was higher than that of every 4 weeks,but there was no difference between that of every 3 weeks and 4 weeks.Conclusion According to the nature of silicone catheter material as well as the clinical indexes, it is most reliable to replace a silicone catheter every four weeks to reach a best clinical outcome.

Objective To assess the value of ~(18)F-FDG PET/CT in detecting primary tumors of patients with bone metastases, and to observe PET/CT characteristics of different types of bone metastases. Methods Whole-body ~(18)F-FDG PET/CT images of 34 patients with metastatic bone from unknown primary tumor (CUP) were retrospectively analyzed, and SUVmax was compared in osteolytic and osteoblastic subgroups based on CT characteristics. Results Diagnosis of these patients were confirmed by histopathological findings or ≥3 months follow-up. Primary tumors were detected with PET/CT in 22 patients (64.71%). SUV_(max) was 6.78±3.66 in 23 osteolytic metastases, and 4.13±1.69 in 11 osteoblastic metastases (P＜0.05). Conclusion ~(18)F-FDG PET/CT is helpful to find the localization of unknown primary tumors in patients with bone metastases, and to make treatment Planning. Osteolytic metastases show higher metabolic activity on ~(18)F-FDG PET/CT.

Adenocarcinoma ; pathology ; Carcinoma ; pathology ; Carcinoma, Squamous Cell ; pathology ; Humans ; Nasopharyngeal Neoplasms ; classification ; pathology ; World Health Organization

Objective To investigate the efficacy of combined high-dose intravenous immunoglobulin (IVIG) pulse therapy in patients with severe systemic lupus erythematosus (SLE). Methods Thirty-six patients were enrolled into this study, and randomly classified into WIG group (n=17) and methylprednisolone (MP) group (n=19). The treatment of patients in MG group began with a 3-day intravenous MP followed by intravenous WIG 400 mg per kilogram of body weight per day for 3-5 days, then was switched to oral prcdnisone and cyclophosphamide at routine dose. Intravenous MG was given repeatedly with an interval of 1 month for 2-5 sessions. Patients in MP group were treated with the same corticosteroids and immunosuppressants as used in WIG group but without IVIG. Patients were followed up for 3-12 months.The clinical efficacy, related serum parameters, and systemic lupus activity measurement (SLAM) were evaluated and compared between the two groups. Results Most patients in both groups showed a remission of symptoms and reduction in disease activity after treatment. The decrease in SLAM, positivity rates of antinuclear antibodies and anti-double-stranded DNA (anti-dsDNA) antibodies as well as the increase in platelets were faster in IVIG group than those in MP group (all P<0.05), but the long-term efficacy of the two groups was similar (P>0.05). Infections occurred in 11.8% of patients in WIG group and 36.8% of patients in MP group. Conclusions High-dose intravenous immunoglobulin may serve as an effective aid in the treatment of severe SLE, and is particularly beneficial to patients resistant to corticosteroids and immunosuppressants of routine dose and those accompanied by severe infections and intolerable to high dose of corticosteroids and immunosuppressants.

Objective To evaluate the safety and efficacy of bivalirudin in patients with acute myocardial infarction ( AMI) and diabetes undergoing primary percutaneous coronary intervention ( PCI) . Methods BRIGHT was a multicenter , randomized , controlled study which enrolled AMI patients underwent primary PCI in 83 Chinese centers between August 2012 and June 2013.All patients were randomly assigned to receive bivalirudin , heparin or heparin plus tirofiban. This study was a prespecified subgroup analysis of the BRIGHT study.A total of 465 diabetics in the BRIGHT study were included , consisted of 168 in the bivalirudin group , 137 in the heparin group and 160 in the heparin plus tirofiban group .Primary endpoint was net adverse clinical event ( NACE) at 30 days, which was defined as a composite of major adverse cardiac and cerebral events ( MACCE ) and any bleedings .Results The incidences of NACE at 30 days were significantly different among three arms ( Bivalirudin:10.1% vs.heparin:16.1% vs.Heparin plus tirofiban 20.6%, P=0.031 ) .Compared with heparin plus tirofiban , bivalirudin was associated with a significantly lower NACE rate (P<0.01).Bivalirudin treatment significantly reduced bleeding events at 30 days compared with heparin and heparin plus tirofiban ( 3.0% vs.7.3% vs.12.5%, P <0.01 ) .The 30-day incidences of MACCE and stent thrombosis were similar among the three groups ( P>0.05 ) . Conclusions The use of bivalirudin has dramatically reduced the rate of bleeding and did not increase the incidence of ischemic events compared with heparin and heparin plus tirofiban , indicating a better safety and efficacy profile of bivalirudin during primary PCI in patients with AMI and diabetes .

BACKGROUND:The intracel ular accumulation of reactive oxygen species leads to oxidative stress. Hypoxia is widespread in physiological and pathological condition. Variation of bone proliferation and differentiation when bone tissues cultured or bone cel s induced toxicity by reactive oxygen species under hypoxia have not yet been reported. OBJECTIVE:To observe the biological characteristics of MC3T3-E1 pretreated with different concentrations of hydrogen peroxide (H2O2) in hypoxia, thus understanding the cel mechanism underlying prolonged bone healing in the elderly with osteoporosis and diabetes. METHODS:The MC3T3-E1 cel s pretreated with different concentrations of H2O2 were cultured in different oxygen concentrations. The proliferation of MC3T3-E1 was detected by cel counting kit-8. The cel differentiation was detected through alkaline phosphatase staining and alizarin red staining. Total RNAs were extracted and used for analyzing the mRNA levels of col age type 1, alkaline phosphatase and Cbfa1. RESULTS AND CONCLUSION:When MC3T3-E1 pretreated with 200μmol/L H2O2 for 6 hours, the cel proliferation was increased with time, but lower than that in the control group. The alkaline phosphatase activity was weakened, and the number of mineralized nodes was decreased at the early stage of differentiation. When MC3T3-E1 pretreated with 400μmol/L H2O2 for 6 hours, the cel proliferation was decreased obviously. The alkaline phosphatase activity was stil weakened, and the number of mineralized nodes was decreased further, but not affected by hypoxia. When MC3T3-E1 pretreated with 400μmol/L H2O2 for 6 hours and then cultured in hypoxia, the mRNA expression of Cbfa1 was decreased, but the mRNA expressions of col age type 1 and alkaline phosphatase were significantly increased. These results suggest that MC3T3-E1 pretreated with low concentration of H2O2 show a significant decrease in proliferation, while MC3T3-E1 pretreated with a high concentration of H2O2 and cultured in hypoxia show a decrease in osteogenic differentiation, especial y at the early stage of alkaline phosphatase formation.