Objective To investigate the relationship between carotid artery plaque formation and blood pressure(BP),pulse pressure(PP),mean blood pressure(MBP) in elderly men.Methods A total of 1461elderly men were divided into carotid artery plaque group(n =1012)and non-carotid artery plaque group(n =449) according to vascular ultrasound examination.Systolic blood pressure(SBP) and diastolic blood pressure(DBP) were recorded by 24-hour ambulatory blood pressure monitoring(ABPM),at the same time pulse pressure (PP)and mean arterial blood pressure(MBP)were calculated.The relationship between carotid artery plaque formation and SBP,DBP,PP,MBP were analyzed.Results The age in carotid artery plaque group was significantly higher than that in non-carotid artery plaque group[(80.5±5.4) years old vs(77.3±5.9) years old,t =-4.233,P ＜ 0.01];The levels of SBP,PP and M BP in artery plaque group were significantly higher than those in non-carotid artery plaque group[SBP:(132.2±17.0) mm Hg vs(127.5±16.0) mm Hg,t =-4.893,P ＜ 0.001; PP:(60.8±13.4) mm Hg vs(55.9±12.5) mm Hg,t =-5.021,P ＜0.001) ;MBP:(92.6±10.3)mm Hg vs(91.0±9.9)mm Hg,t =-3.897,P ＜ 0.01].The incidence of carotid artery plaque was closely related to age(OR =1.061,P =0.0001),myocardial infarction(OR =1.896,P =0.0135),hypertension grades(OR =1.177,P =0.0019),high cholesterol(OR =1.353,P =0.0335),reduced systolic function(OR =2.466,P =0.0001),lower extremity arterial plaque(OR =5.453,P =0.0001).Conclusion In elderly men,formation of the carotid artery plaque is closely related to increased SBP,PP and MBP,but independent to DBP.

Objective To explore the relationship between autism spectrum disorder (ASD) and gastrointestinal problems. Methods 172 ASD children were investigated with self-made questionnaire from July, 2014 to Augest, 2015. The frequencies of motor behaviors, vocal behaviors and behavioral problems, and the intensity of the behavioral problems in the period with or without gastrointestinal symptoms were compared. Results The frequencies of motor behaviors (F=67.4, P<0.001), vocal behaviors (F=43.6, P<0.001) and behavioral prob-lems (F=79.4, P<0.001), and the intensity of the behavioral problems (F=65.7, P<0.001) were all more in the period with gastrointestinal symptoms than without gastrointestinal symptoms. Conclusion There are more behavioral problems in the ASD children with the presence of gastrointestinal symptoms;while the behavioral symptoms may be a indicator of gastrointestinal problems in children with ASD.

Objective , To investigate the influence of blood pressure variability on cerebral infarction in older men. Methods Ambulatory blood pressure was measured in 1527 elderly men ( older than 65 yrs) with atherosclerosis. All cases were divided into 2 groups: Six hundred and seven patients with cerebral infarction ( group A)and 920 patients without cerebral infarction ( group B). Smooth curve method was used to analyze each patient's ambulatory blood pressure data and the trend of each patient's blood pressure curve was portrayed. The differences between the actual blood pressure and the blood pressure on the curve was defined as blood pressure variability,and the blood pressure variability between the 2 groups was compared. Results The systolic blood pressure variability in 24 hours in group A was significantly higher than that in group B( [8.4'±2. 2]mm Hg vs [ 8.0 ± 2. 0 ] mm Hg, P ＜ 0. 01 ), especially for the systolic blood pressure variability in daytime( [ 8. 2 ± 2. 2 ] mm Hg vs [ 7. 8 ± 2. 1 ] mm Hg, P ＜ 0. 01 ). However, the systolic blood pressure variability at night was not significantly different between the 2 groups( [ 8.9 ± 3. 9 ] mm Hg vs [ 8. 7 ± 3.7 ] mm Hg,P ＞ 0. 05 ). There were no significant difference between the diastolic blood pressure of 24 hours( [5. 5 ± 3.8 ] mm Hg vs [5.5 ± 1.5 ]mm Hg,P ＞0. 05),during daytime([5.4 ± 1.5]mm Hg vs [5.3 ± 1.4] mm Hg,P ＞0.05)and nighttime ( [ 6. 1 ± 2.7 ] mm Hg vs [ 6. 1 ± 2. 6 ] mm Hg, P ＞ 0. 05 ). Conclusion In elderly men with atherosclerosis,cerebral infarction was closely related to systolic blood pressure variability,but independent of nighttime systolic blood pressure and diastolic blood pressure variability.

Objective: To analyze the electrocardiographic (ECG) characteristics for the ifrst diagonal branch of infarction related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI) in order to ifnd the rule for physician to make quick diagnosis. Methods: A total of 28 STEMI patients with coronary angiography (CAG) confirmed first diagonal branch of IRA were retrospectively analyzed. The patients were treated in our hospital from 2005-01 to 2014-06 and their ECG changes at admission were studied for ST-segment elevation/depression and q wave, Q wave changes during the period of evolution at different leads in all patients. Results: CAG presented that there were 19/28 (67.9%) patients with single vessel disease, 13 (46.4%) with isolated diagonal lesion. From onset of chest pain to AMI graph shown on ECG was about 240 (252 ± 71) min in all patients. All 28 (100%) patients were with ST-segment elevation in lead aVL, 27 (96.4%) in lead I, and 15 (55.6%) patients with ST-segment elevation by (0.5-1.0) mm. The incidence of ST-segment elevation in the chest lead was, in turn as 21 (75.0%) patients in lead V2, 16 (57.1%) in lead V3 and 12 (42.9%) in lead V1respectively; while ST-segment depression was as 28 (100%) patients in lead III, 27 (96.4%) in lead aVF and 22 (78.6%) in lead II respectively. During the period of evolution, the most q wave or Q wave formation were, in turn as 22 (88.0%) patients in lead aVL, 10 (40.0%) in lead V2, 9 (36.0%) in lead V3 and 7 (28.0%) in lead I respectively. Conclusion: The ECG changes in STEMI patients with diagonal branch of IRA have the high prevalence of ST-segment elevation in lead aVL and lead I, while there is an important feature that the ST-segment elevation < 1 mm in about half amount of relevant patients.

As the most abundant liver-specific microRNA, microRNA-122 (miR-122) is involved in various physiological processes in hepatic function as well as in liver pathology. There is now compelling evidence that miR-122, as a regulator of gene networks and pathways in hepatocytes, plays a central role in diverse aspects of hepatic function and in the progress of liver diseases. This liver-enriched transcription factors-regulated miRNA promotes differentiation of hepatocytes and regulates lipid metabolism. With regard to liver diseases, miR-122 was shown to stimulate hepatitis C virus (HCV) replication through a unique and unusual interaction with two binding sites in the 5'-UTR of HCV genome to mediate the stability of the viral RNA, whereas inhibit the expression and replication of hepatitis B virus (HBV) by a miR-122-cylin G1/p53-HBV enhancer regulatory pathway. In addition, miR-122 acts as a suppressor of cell proliferation and malignant transformation of hepatocytes with remarkable tumor inhibition activity. Notably, a clinical trial targeting miR-122 with the anti-miR-122 oligonucleotides miravirsen, the first miRNA targeted drug, has been initiated for treatment of HCV infection. With further understanding of the comprehensive roles of miR-122 in hepatic functions and the mechanisms involved in miR-122 down-regulation in chronic hepatitis or hepatocellular carcinoma, miR-122 appears to be a promising candidate for effective therapeutic approaches against tumor and infectious diseases.
Humans ; Lipid Metabolism ; genetics ; Liver ; growth & development ; metabolism ; physiopathology ; Liver Diseases ; genetics ; physiopathology ; MicroRNAs ; genetics ; metabolism ; Models, Biological

Objective:To explore the clinical characteristics of elderly patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CHD) and analyze the risk factors of CHD in patients with T2DM.Methods:Using the method of retrospective cohort study, 406 elderly male patients with T2DM (≥75 years old) admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2020 were selected and divided into T2DM without CHD group (165 cases) and T2DM with CHD group (241 cases). The clinical characteristics in elderly patients with T2DM complicated with CHD and risk factors for CHD were analyzed.Results:The age ((86.78±5.35 )years old), course of T2DM((12.32±0.46) years), fasting blood glucose(FPG)((7.64±2.81) mmol/L), hemoglobin a1c (HbA1c)((7.59±1.21)%), the proportion of hypertension(84.65%(204/241)), D-dimer((0.50±0.13) mg/L), the incidence of thromboembolic events(46.06%(111/241)), blood serum creatinine ((94.81±12.70) μmol/L), urea nitrogen((8.31±4.46) mmol/L), uric acid((376.44±116.01) μmol/L) in T2DM with CHD group were higher than those in T2DM without CHD((78.51±4.81)years old, (10.66±0.67)years, (6.84±2.19) mmol/L, (7.02±2.15)%, 63.03%(104/165), (0.21±0.04 ) mg/L, 13.33%(22/165), (83.01±14.40) μmol/L, (6.79±2.89) mmol/L, (333.56±95.15) μmol/L ), and the differences were statistically significant( t=15.908, t=2.042, t=3.055, t=3.088, χ 2=23.828, t=5.059, χ 2=42.098, t=2.401, t=4.188, t=4.075; all P<0.05). The total bilirubin(TBil)(8.80(6.60, 11.60) μmol/L), glomerular filtration rate(GFR)((76.49±29.80) mL/(min·1.75 m 2)) in T2DM with CHD group were lower than those in T2DM without CHD group (11.25(8.23, 15.28) μmol/L, (91.81±28.31) mL/(min·1.75 m 2)), the differences were statistically significant( Z=2.304, t=5.126; all P<0.001). The total cholesterol((3.84±0.85) mmol/L), low-density lipoprotein cholesterol(LDL-C)((2.12±0.68 ) mmol/L) in T2DM with CHD group were lower than those in T2DM without CHD group((4.10±1.00) mmol/L, (2.45±0.85) mmol/L), the differences were statistically significant( t=2.828, 4.156; all P<0.05). The rate of starting lipid-lowering and stable plaque treatment in T2DM with CHD group (82.57%(199/261))was higher than that in T2DM without CHD group(42.42%(70/165)), and the difference was statistically significant (χ 2=70.614, P<0.001). Influenced by lipid-lowering therapy, the total cholesterol and LDL-C in T2DM patients with CHD were significantly decreased.Logistic regression analysis showed that age elevated( OR 1.346, 95% CI 1.263-1.434, P<0.001), elevated hemoglobin a1c concentration( OR 1.427, 95% CI 1.140-1.785, P=0.002), complicated with hypertension( OR 3.534, 95% CI 1.684-7.418, P=0.001), elevated D-dimer concentration( OR 3.969, 95% CI 1.227-12.841, P=0.021)and elevated uric acid concentration( OR 1.005, 95% CI 1.001-1.008, P=0.006)were independent risk factors for CHD in elderly male patients with T2DM. Conclusion:Elderly patients with T2DM complicated with CHD are more likely to be in hypercoagulable state, more likely to have thromboembolic events, and more obvious renal function damage.Poor fasting blood glucose control and decreased total bilirubin concentration are the influencing factors of CHD in elderly male patients with T2DM.Age elevated, elevated hemoglobin a1c concentration, complicated with hypertension, elevated D-dimer concentration and elevated uric acid concentration are independent risk factors for CHD in elderly male patients with T2DM.

Objective:To investigate the relationship between serum matrix metalloproteinase-9 (MMP-9) level and the location and severity of bleeding in patients with cerebral microbleeds(CMBs).Methods:A total of 60 CMBs patients admitted to the Department of Neurology of the First Affiliated Hospital of the Xinxiang Medical University from January 2019 to August 2020 were selected as subjects as the CMBs group, and 60 healthy controls without nervous system diseases in outpatient physical examination during the same period were selected as the control group. The clinical data and biochemical indicators of the two groups were collected. Serum MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA). According to susceptibility weighted imaging (SWI), CMBs patients were divided into grade 1 group ( n=24), grade 2 group ( n=19) and grade 3 group ( n=17), and according to the micro analytical rating scale (MARS), the CMBs patients were divided into the lobar group ( n=19), the deep or infratentorial group ( n=17) and the mixed group ( n=24).The relationship between serum MMP-9 level and the location and severity of CMBs was analyzed. SPSS 19.0 software was used for data statistical analysis.One-way ANOVA, t-test and rank sum test were used for comparison. Logistic regression analysis was used to analyze the influencing factors. Pearson correlation analysis and Spearman correlation analysis were used for correlation analysis. Results:The level of MMP-9 in CMBs group was significantly higher than that in control group (208.13(142.25, 285.88) μg/L, 149.50(93.40, 186.51)μg/L), and the difference was statistically significant ( P<0.05). Serum MMP-9 level was a risk factor of CMBs ( β=1.322, OR=3.750, 95% CI=2.038-7.997, P=0.002). The difference of level of MMP-9 in different severity of CMBs was statistically significant (147.55(109.25, 266.47)μg/L, 242.12(147.55, 288.80)μg/L, 270.42(203.43, 364.27)μg/L, P=0.017). Serum MMP-9 level was positively correlated with the number of CMBs ( r=0.371, P=0.003). The difference of MMP-9 level of CMBs in different locations were statistically significant (249.77(158.43, 338.46)μg/L, 188.83(138.52, 243.15)μg/L, 210.65(144.25, 255.78)μg/L, P=0.013). The increased serum MMP-9 level was a risk factor for CMBs( β=0.401, OR=1.122, 95% CI=1.004-1.204, P=0.036). Conclusion:The increased level of serum MMP-9 may be a risk factor of CMBs, especially for CMBs in cerebral lobesand, and the level of MMP-9 is positively correlated with the severity of CMBs.

Objective To investigate the effectiveness and safety of esophageal covered stent for the treatment of esophagogastric cervical anastomotic fistula. Methods Retrospective analysis of clinical and imaging data of patients with esophageal and gastric anastomotic neck fistula treated by esophageal membrane stent implantation in the Affiliated Tumor Hospital of Zhengzhou University from July 2015 to June 2018. Twenty‐one cases, 15 males and 6 females were enrolled. All patients showed fistula after esophagogastrostomy for esophageal carcinoma. All the fistulas were located in the cervical segment of esophagus and were diagnosed as anastomotic fistula 2 to 13 days after surgery. The length of esophagus residue, the position and size of the fistula were measured by esophagography. We retrospectively analyzed the data of patients with cervical anastomotic fistula treated with esophageal covered stent. Patients were followed up for more than 6 months by review and telephone follow‐up. Results In the 21 patients, 19 (90.5%) were successfully implanted stents at one time, and 2 (9.5%) were placed at a lower position. The esophageal stent was implanted for 10 to 60 days (31±19) days, and the stent was successfully removed after the fistula healed, with a procedure time of 6 to 23 minutes. No recurrence of fistula was found during follow‐up. Four patients had anastomotic scar stenosis, and eating smoothly after balloon dilatation. Conclusion Esophageal covered stent implantation is a safe and effective technique for gastroesophageal cervical anastomotic fistula.

Objective: To analyze the impact of dual antiplatelet (DAPT) therapy combining with or without proton pump inhibitors (PPI) on the main outcomes after percutaneous coronary intervention (PCI). Methods: The PubMed, EMBASE and Cochrane Library were searched for relevant literature and the references obtained from these sources were retrieved manually from inception till September 2017. Inclusion and exclusion criteria were established follow the Cochrane review standard. A total of 977 literatures were included, 193 duplicates were excluded, 74 reviews, case reports, letters and systematic reviews were excluded, 667 literatures were excluded after reading the title and abstract, 34 literatures were excluded due to non-randomized control studies and unrelated outcome indicators, and 9 literatures were finally included with a total of 16 589 patients. RevMan 5.3 software was used to compare the incidence of major adverse cardiovascular events (MACE), cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis, stroke, gastrointestinal bleeding and gastrointestinal events in patients with DAPT combining with or without PPI after PCI. Results: MACE was observed in 8 out of the 9 included literatures, and the results showed that MACE occurred in 561 out of 6 282 patients receiving DAPT combining with PPI therapy and in 951 out of 9 632 patients using DAPT alone (OR=1.15, 95%CI 0.88-1.51, P>0.05). Cardiogenic death was observed in 7 out of the 9 included literatures, and the results showed that cardiogenic death occurred in 172 out of 6 453 patients receiving DAPT combining with PPI treatment and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Recurrent myocardial infarction was observed in 7 out of the 9 included literatures, the results showed 416 out of 6 282 cases in DAPT combining with PPI therapy group experienced recurrent myocardial infarction and 691 out of 9 632 cases in DAPT group experienced recurrent myocardial infarction (OR=1.01, 95%CI 0.89-1.16, P>0.05). Four out of 9 literatures observed revascularization. The results showed that revascularization was performed in 64 out of 2 173 patients receiving DAPT combining with PPI therapy and in 105 out of the 2 770 patients using DAPT alone (OR=1.33, 95%CI 0.55-3.24, P>0.05). All-cause death was observed in 7 out of the 9 included literatures, and the results showed that all-cause death occurred in 172 out of the 6 453 patients in DAPT combining with PPI therapy group and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Three out of the 9 included articles observed stent thrombosis, and the results showed that stent thrombosis occurred in 99 out of 2 997 patients receiving DAPT combining with PPI therapy and in 245 out of the 6 198 patients treated with DAPT (OR=1.07, 95%CI 0.83-1.37, P>0.05). Stroke was observed in 2 out of the 9 included literatures. The results showed that stroke occurred in 5 out of 2 019 patients receiving DAPT combining with PPI therapy, and in 4 out of the 2 033 patients treated with DAPT (OR=1.00, 95%CI 0.29-3.49, P>0.05). Gastrointestinal bleeding was observed in 6 out of the 9 included literatures. The results showed that gastrointestinal bleeding occurred in 26 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 93 out of the 3 506 patients treated with DAPT, gastrointestinal bleeding was significantly lower in the DAPT combining with PPI group than DAPT alone group (OR=0.27, 95%CI 0.17-0.41, P<0.01). Gastrointestinal events were reported in 6 out of the 9 included articles. Similarly, gastrointestinal events were observed in 51 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 190 out of the 3 506 patients treated with DAPT alone, the incidence of gastrointestinal events in the DAPT combined with PPI group was significantly lower than DAPT alone group (OR=0.24, 95%CI 0.14-0.42, P<0.01). Conclusions The incidence of MACE, cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis and stroke are not affected by DAPT combined with PPI therapy after PCI, while the incidence of gastrointestinal bleeding and gastrointestinal events could be reduced by adding PPI to DAPT in patients undergoing PCI.

A retrospective study was conducted on data of 23 patients with pancreatic duct diseases who were underwent peroral pancreatoscopy (POPS) at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from August 2020 to October 2022. The intraoperative observation, postoperative complications, and the diagnosis and treatment of POPS for pancreatic duct diseases were analyzed. All patients underwent POPS and achieved technical success. Among them, 7 patients were diagnosed as having intraductal papillary mucinous neoplasm of pancreas and 3 pancreatic malignant tumor. Eight patients with pancreatolithiasis accepted laser or eletrohydraulic lithotripsy under POPS. Abdominal pain improved in 2 patients with chronic pancreatitis after treatment. Melena disappeared in 2 patients with pancreatic duct hemorrhage or pancreatic enterostomy inflammation after conservative treatment. The symptom of 1 patient with pancreatic enterostomy stenosis improved after balloon dilation. There was no complication in the 23 patients, and the operation time was 35-90 min. The results indicate POPS is safe, effective with distinctive advantages in the diagnosis and treatment for pancreatic duct diseases.