Objective To evaluate the value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP),C-reactive protein(CRP) and D-dimer(D-D) in prognosis of elderly patients confined to bed.Methods The clinical data of 150 elderly patients confined to bed were reviewed retrospectively,and 35 patients were in dead group and 115 patients were in survival group.The level o f plasma NT-proBNP,CRP and D-D were measured before treatment,during treatment and after treatment.Their characteristics and dynamic change were analyzed,and the value of NT-proBNP,CRP and D-D was evaluated in prognosis of elderly patients confined to bed.Results The level of NT-proBNP,D-D and CRP in dead group before treatment,during treatment and after treatment were significantly higher than those in survival group (P ＜ 0.05 or ＜ 0.01).The peak level of NT-proBNP,D-D and CRP in dead group emerged after treatment.By the way,the peak level of NT-proBNP,D-D and CRP in survival group emerged before treatment.Incidence of two or three markers positive in dead group [37.1％ (13/35),54.3％ (19/35)] was significantly greater than that in survival group [20.9％ (24/115),8.7％ (10/115)] (P =0.032,0.008).Multivariate Logistic regression analysis showed that the level of NT-proBNP,D-D and CRP were independent predictors of 28-day mortality (P ＜0.05).Conclusions The level of NT-proBNP,CRP and D-D are increased in severe elderly hospitalized patients.The level of above indexes have a dynamic change and reach peak before death.They are the independent prognostic markers of hospital mortality.Combined detection of NT-proBNP,D-D and CRP can improve the predictive value of hospital mortality in elderly patients confined to bed.

ObjectiveTo investigate the clinical significance of pyrosequencing assay for determining K-ras mutations in exon 2 codons 12 and 13 in clinical colorectal cancer tissues.Methods Genomic DNA,extracted from K-ras mutant cell lines SW480 (homozygous,c.35G ＞ T), DLD-1 (heterozygous,c.38G ＞ A) and wild-type HT-29,was first used as the sequencing template respectively to test the accuracy of pyrosequencing methodology.The SW480 and DLD-1 DNA was separately mixed with wild-type HT-29 DNA in proportions of 2％,3％,5％,10％,20％,30％ and 50％,the sensitivity for mutation detection was measured separately by pyrosequencing assay and directed Sanger DNA sequencing in the serial DNA mixture samples.The pyrosequencing assay results were compared with the corresponding Sanger sequencing and the datas were analysized by Fisher exact test.Pyrosequencing analysis was then performed for screening K-ras exon 2 mutations at codons 12 and 13 on DNA isolated from a panel of 30 colorectal cancer samples derived fromclinicalformalin-fixed andparaffinembedded(FFPE)tissues.ResultsCancer cell lines with known K-ras mutations ( SW480 and DLD-1 ) were readily detectable by pyrosequencing-based analysis.When the proportions of mutant colorectal cancer cell line DNA were 5％ and 10％ content,the mutation rates of K-ras gene detected by conventional Sanger DNA sequencing were 33.3％ (4/12) and 58.3％ (7/12) respectively,whereas the mutation rates detected by pyrosequencingbased assay were 91.7％ (11/12) and 100％(12/12) respectively,there were significant differences between those two sequencing methodology ( P ＜0.05).Furthermore,we found 10 patients with K-ras exon 2 point mutations at codons 12 and 13 by pyrosequencing-based assay from 30 colorectal cancer FFPE tissues,the point mutation rate was 33.3％ (10/30) and all of the mutations determined were heterozygous.The codon 12 was most frequently affected [30％ (9/30)].Mutations with the highest frequency were G ＞ A transitions [ 50％ ( 5/10 ) ],followed by G ＞ T transversions [ 30％ ( 3/10 ) ].Conclusion The pyrosequencing assay provides an accurate and sensitive method for mutation screening of K-ras exon 2 codons 12 and 13 in routine diagnostic specimens,thereby allowing the selection of the cancer treatment in clinical individualized practice.

Objective: To observe the inhibitory effect of gefitinib combined with DNA vaccine targeting EGFR against implanted Lewis tumors in mice.Methods: Chicken EGFR L2 domain and rabbit IgG Fc domain fusion pVAX1/cEGFR-rFc DNA vaccine was injected into mice and the titer of anti-EGFR in serum was determined by ELISA.The growth of Lewis cells was measured by MTT.Lewis lung cancer mouse models were established and were randomly divided into vaccine,gefitinib,gefitinib+vaccine,and control groups.The tumor volume and weight and survival of mice were examined in different groups.Results: The titer of anti-EGFR in mice vaccinated with pVAX1/cEGFR-rFc plasmid was 1∶1 000.The proliferation of Lewis cells in anti-EGFR combined with gefitinib was significantly inhibited compared with those in anti-EGFR and gefitinib groups(P

Objective To summarize the experience in diagnosis and management for the space occupying lesion of spleen. Method The clinical data of 29 cases treated by surgery were retrospectively analyzed. Results There were 15 patients with benign masses including 7 hamartomas, 5 hemangiomas, 1 pseudocyst, 2 tuberculoses of the spleen, and 14 with malignant tumors including 9 lymphomas, 3 angiosarcomas, 2 metastatic tumors in the spleen. Splenectomy was performed in all patients. All patients with benign masses survived except 2 patients lost follow up and 1 coexisting with hepataocellular carcinoma died half a year after the operation. Twelve of 14 patients with malignant tumor were followed up.Of them, 5 patients survived more than 5 years and 2 were alive 1 and 3 years after the operation respectively; 5 patients died 6 months to 4 years after the operation. Conclusions Ultrasonography and CT or MRI are the main means of diagnosis for the space occupying lesion of spleen.It is difficalt to make diagnosis of the splenic tuberculosis before operation.Splenectomy is a primary procedure of surgery.

Objective To determine the pharmacokinetic parameters of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats by HPLC. Methods Gavage and intravenous injection were employed for administration. HPLC was used to determine the concentrations of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats in different time points. The pharmacokinetic parameters were computed by DAS3.0. Results The linear range of P-methoxybenzyl alcohol in plasma was 0.63-321.17 μg/mL, r 2=0.994 5. Intra-day accuracy, inter-day accuracy, absolute recovery and stability were in specified range. Conclusion The method is simple and accurate for the determination of the pharmacokinetic parameters of P-methoxybenzyl alcohol from Gastrodiae Rhizoma in plasma of rats.

Objective To investigate the clinicopathologic features and treatment of thyroid microcarcinoma (TMC). Methods From January 1997 to December 2006,311 patients who underwent surgery and defined as TMC(tumor size≤1 cm)were enrolled. Results TMC was identified incidentally by frozen pathologic examination on thyroidectomy specimens in tentative benign goiters in 181 patients; another 130 patients with clinically detectable primary tumors or suspected nodal metastases were grouped to as clinically overt TMC. The clinically overt TMC had a higher incidence of bilateral multifocal tumors (18.5%vs.9.4%,P=0.03),and cervical lymph node metastases(27.7%vs.10.5%,P=0.000)than that in clinically occult TMC group. Conclusion TMC may vary considerably in clinical and biologic behaviors between these two subtypes: clinically overt and occult. Lobectomy for single lesion, total or near total thyroidectomy for multifocal with central compartment nodal dissection should be performed, lateral nodal dissection was not carried out unless US or physical examination detected nodal metastases. Lobetomy, subtotal or more limited thyroidectomy for occult TMC, diagnosed incidentally following thyroid surgery for initially tentative benign thyroid disease, could all be treatment of choice depending on the preference of surgeons.

Objectives To investigate the efficacy of the shear wave velocity (SWV) based on acoustic radiation force impulse (ARFI) elastography in the differentiation of normal population with chronic kidney disease (CKD) and acute kidney injury (AKI) in middle aged and elderly patients.Methods Sixty-four middle aged and elderly patients referred to China-Japan Friendship Hospital and Zhejiang Provincial People's Hospital with AKI or CKD were enrolled in this study from February 2015 to December 2016 (kidney disease group).Among them,43 patients were CKD (CKD group),and 21 patients were AKI (AKI group,15 patients combined with prior CKD,6 patients without prior CKD).Twenty-nine middle aged and elderly healthy volunteers from China-Japan Friendship Hospital were enrolled at the same time (healthy control group).The SWV values of the renal middle pole cortex were acquired using the ARFI elastography.The differences of the kidney length,cortical thickness and SWV values among healthy control group,AKI and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The differences of cortical SWV values among healthy control group,AKI combined with prior CKD group,AKI without prior CKD group and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The receiver operating characteristic (ROC) curves of the cortical SWV values for diagnosing kidney disease was drawn.Results The mean cortical SWV values of healthy control group,AKI and CKD groups were (2.88±0.63),(2.42±0.83) and (2.06±0.72) m/s,respectively.The SWV values of AKI and CKD groups were significantly lower than that of healthy control group (t=2.158,P=0.033;t=5.234,P ＜ 0.001).The SWV values of CKD group were lower than that of AKI group,but there were no significant differences.The SWV values of AKI without previous CKD group and AKI combined with prior CKD group were (2.60±0.84) and (1.80±0.45) m/s,respectively.The SWV values of AKI combined with prior CKD group and CKD group were significant lower than that of healthy control group and AKI without prior CKD group (compared with healthy control group:t=2.916,P=0.004 and t=5.318,P ＜ 0.001;compared with AKI without prior CKD group:t=2.054,P=0.043 and t=-2.517,P=0.013).But there were no significant differences between AKI combined with prior CKD group and CKD group,so as to the AKI without prior CKD group and healthy control group.The cutoff value of cortical SWV for diagnosing kidney disease was 2.40 m/s,with an area under ROC curve was 0.767 (95％ CI 0.689-0.898,P=0.000).The sensitive and specificity were 57.1％ and 81.9％,respectively.Conclusions The SWV values of kidneys in middle aged and elderly CKD and AKI patients were significantly lower than those of apparently normal kidneys.The SWV values of AKI patients combined with prior CKD were lower than AKI patients without prior CKD.Determining cut-off SWV values based on ARFI elastography between normal and damaged renal parenchyma can help in the diagnosis of kidney disease in middle aged and elderly patients.

Objective To explore the effect of iliac bone flap combined with cancellous bone graft in the treatment of traumatic avascular necrosis of the femoral head (TFHIN). Methods The patients were treated with iliac bone flap and cancellous bone graft. The operation time, intraoperative blood loss, fracture healing time, follow-up time and the postoperative complications were recorded.The degree of hip movement (flexion, external rotation, internal rotation, abduction and adduction) was recorded;the hip functions of patients with different stages were analyzed;the long-term curative effect of postoperative was analyzed. Results The operation time was (68.36 ± 6.81) min, intraoperative blood loss was(93.65 ± 10.42)ml, fracture healing time was(4.31 ± 1.25)months, follow-up time was 35-62 (48.92 ± 2.61)months, and the postoperative complication was 1.42%(3/212).The scores of hip function were significantly improved in each postoperative stage, joint flexion, external rotation, internal rotation, abduction and adduction range was significantly expanded: (94.86 ± 12.37)° vs. (118.24 ± 15.25)°, (32.07 ± 10.34)° vs. (43.64 ± 10.82)°, (28.33 ± 9.61)° vs. (33.41 ± 11.85)°, (19.44 ± 8.37)° vs. (24.36 ± 7.65)°, and the differences were statistically significant (P<0.05). At the last follow-up, the total excellent and good rate of hip function recovery was 88.74%(205/231).The stability rate of imaging was 80.09%(185/231). Conclusions In patients with TFHIN, treatment with the iliac bone flap pedicled with cancellous bone could the blood pressure of the femoral head, restore the blood supply to the damaged site, participate in the bone induction, and improve the hip movement and function,which has a good effect.

Objective:To assess the clinical characteristics and grafts status by coronary angiography(CAG) in symptomatic patients with prior coronary artery bypass graft(CABG).Methods:A retrospective descriptive study of symptomatic patients with prior CABG who underwent CAG was performed, 1 136 patients were included and analyzed. The mean age was(62.5±8.7) years, 76.4% were male. There was a high prevalence of risk factors like hypertension(75.0%), dyslipidemia(48.2%), diabetes(46.1%) and smoking history(62.8%).Results:The mean duration after CABG was (4.65±3.39) years. 94.5% of patients had chest pain. 12.9% of patients had all diseased grafts and 28.7% had all patent grafts. The proportion of diseased SVG was higher than that of diseased arterial grafts. The proportion of diseased grafts anastomosed to RCA territory was higher than that of grafts anastomosed to LCX territory or LAD territory. 52.5% of patients received percutaneous coronary intervention(PCI) revascularization, and 88.3% of PCI was performed in native vessels.Conclusion:The most common symptom recurring to patients with prior CABG was chest pain. Graft status in symptomatic patients with prior CABG was worse than we expected. Patients received repeated revascularization mostly by PCI and PCI was mainly performed in native vessels.

Objective:To explore the perioperative effect of coronary artery bypass grafting(CABG) or CABG+ mitral valve repair(MVP) in patients with coronary heart disease(CAD) and moderate ischemic mitral regurgitation(IMR).Methods:The clinical data and perioperative complications of 210 patients with CAD and moderate IMR, who underwent CABG from January 2018 to December 2019, were included into this study, with 155 males and mean age of(62.3±8.5) years old. According to the operation mode, patients were divided into CABG group(138 cases) and CABG+ MVP group(72 cases).Results:There were no significant differences in age, gender, comorbidities(diabetes, hypertension, hyperlipidemia, peripheral vascular disease, cerebrovascular events, previous history of myocardial infarction and PCI), LVEF and of coronary artery lesions between the two groups(all P>0.05). Sequential anastomosis was the main method, and most patients underwent internal mammary artery graft in both groups, there was no significant difference between the two groups( P>0.05). CABG group was higher than CABG+ MVP group in all-cause death, heart failure, cerebrovascular events, secondary thoracotomy, CRRT and IABP support events, but there were no significant differences between the two groups( P>0.05). Echocardiographic reexamination showed that the indexes of cardiac function in CABG+ MVP group were higher than those in CABG group, but there was no significant difference between the two groups( P>0.05). The mean area of mitral regurgitation in CABG + MVP group was 1.3 cm 2, significantly lower than that in CABG group(2.5 cm 2), P<0.05. Conclusion:CABG+ MVP has low perioperative risk in patients with CAD and moderate IMR, and the area of mitral regurgitation is lower.