Objective To study effects of bivalirudin and heparin plus tirofiban on plasma P-selectin in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) and compare the clinical effects on bleeding and thrombosis.Methods 260 hospitalized patients with acute STEMI who accepted emergency PCI were enrolled in the study.They were randomly divided into the bivalirudin group (129 cases) and the heparin plus tirofiban group (131 cases).Blood samples were taken before operation,during operation (about 20 minutes after medicacion injection) and after operation (three hours after the end of operation).Serum P-selectin levels were measured.All patients were followed-up for 30 days.The main events included hemorrhage within 30 days,acquired thrombocytopenia and stent thrombosis.Results The level of P-selectin increased significantly in the heparin group during operation compared to the preoperative level and remained statistically higher at three hours after the end of operation than preoperative level (P ＜ 0.05).Compared with preoperative level,the P-selectin level of the bivalirudin group was significantly lower than that of heparin group (P ＜ 0.05).After 30 days of follow-up,bivalirudin had lower rates bleeding events compared to the heparin group(5.4％ vs.15.3％,P =0.009).The need of medical intervention for bleeding events (BRAC2-5 hemorrhage) was less in the bivalirudin group(0.8％ vs.5.3％,P =0.029).There was no significant difference in the major bleeding events between the 2 groups (BRAC3-5 hemorrhage) (0 vs.0.8％,P =0.32).No significant difference found between the two groups in acquired thrombocytopenia (P ＞ 0.05).Conclusion Bivalirudin may reduce P-selectin levels in STEMI patients undergone emergency PCI during perioperative period.Heparin increases perioperative P-selectin.Bivalirudin may reduce the bleeding events.

Objective:To study the expression levels of peripheral blood helper T cell 17 (Th17) cells and interleukin (IL)-17A in newly diagnosed acute myeloid leukemia (AML) patients and its significance.Methods:A total of 32 newly diagnosed AML patients in Binzhou People's Hospital of Shandong Province from September 2017 to January 2019 were treated as the study group, and 28 iron deficiency anemia patients were used as the control group. Flow cytometry (FCM) was used to detect the proportion of Th17 (CD3 + CD4 + IL-17 +) in CD4 + T cells (Th17 ratio) and the concentration of IL-17A in peripheral bloods for both groups. And then the correlation and significance of Th17 ratio and the concentration of IL-17A with proportion of bone marrow blast cells, chromosome karyotype in AML patients was also analyzed. Results:The proportion of Th17 cells in peripheral bloods of newly diagnosed AML patients was higher than that in the control group [(2.74±0.85)% vs. (1.02±0.12)%, t = 10.397, P < 0.01]; the concentration of IL-17A in the serums of AML patients was higher than that of the control group [(3.16±1.54) pg/ml vs. (2.22±0.21) pg/ml, t = 3.206, P = 0.002]. Th17 ratio and the concentration of IL-17A in patients with bone marrow blast cells percentage≥0.50 were higher than those in patients with bone marrow blast cells percentage <0.50. Th17 ratio and the concentration of IL-17A in the peripheral bloods for AML patients in the high-risk group was higher than that in the low-risk group, and the difference was statistically significant (both P < 0.05). There was no statistical difference between low-risk group and intermediate-group (both P > 0.05). Conclusions:The levels of Th17 cells and IL-17A in the peripheral bloods are associated with the proportion of bone marrow blast cells and cytogenetics/molecular genetics risk degree in AML patients. The regular detection of Th17 and IL-17A may help to monitor immune status, evaluate prognosis and provide the basis for immunotherapy of AML patients.