ADAM Proteins ; blood ; ADAMTS13 Protein ; Adult ; Case-Control Studies ; Female ; Fluorescence Resonance Energy Transfer ; Humans ; Male ; Middle Aged ; Purpura, Thrombotic Thrombocytopenic ; blood ; diagnosis ; Young Adult

Objective To investigate demographic factors implicated in the functional maturation of autologous arteriovenous fistula in a population of patients with end-stage renal disease. Methods The data of 335 consecutive patients with end-stage renal disease who were performed autologous arteriovenous fistula from January 2010 to December 2015 were analyzed retrospectively. The parameters affecting autologous arteriovenous fistula functional maturation were screened. Results Overall arteriovenous fistula functional maturation rate was 78.14%(218/279). The arteriovenous fistula functional maturation rate was 68.33%(82/120) in diabetes and 85.54%(136/159) in non-diabetes, and there was significant difference (χ2=11.844, P<0.01). The arteriovenous fistula functional maturation rate was 62.26%(33/53) in hypoproteinemia and 81.86%(185/226) in non-hypoproteinemia, and there was significant difference (χ2=9.648, P<0.01). Diabetes and hypoproteinemia were the risk factors to promote functional maturation (OR=6.003, 8.476). The arteriovenous fistula functional maturation rate was 87.10%(81/93) in calcium channel blockers using and 73.66%(137/186) in non-calcium channel blockers using, and there was significant difference (χ2=6.556, P<0.05). Calcium channel blockers was the protective factor for promoting functional maturation (OR=0.086). Conclusions Diabetes and hypoproteinemia are found to be associated with functional non-maturation, while calcium channel-blocker agents are associated with better functional maturation.

Objective To evaluate the value of ERCP in treating hepatocellular carcinoma complicated with tumor thrombi in bile duct.Methods To analyze retrospectively the results of 15 cases of hepatocellular carcinoma with tumor thrombi in the bile duct including ERBD 8 cases and ENBD 7cases,EMBE after ENBD 4 cases, EST with clearance of tumor thrombi and cytological brush 12 cases, ERCP conjugated with other compositive treatments 9 cases.Results The common feature of cholangiography is filling defect in the bile duct as the so called "tennis bat" sign and "flocculation" sign, 13 cases have got drainage successfully after ERCP with the effective rate 86 7%, Satisfactory results were obtained in patients received ERCP conjugated with other compositive treatments.Conclusion ERCP is very important treatment of hepatocellular carcinoma with tumor thrombi in the bile duct; the "tennis bat" sign and "flocculation" sign were the very important evidences of tumor thrombi in the bile duct. If combined with other compositive treatment such as surgery and TAE, ERCP is very effective treatment for the releasing symptoms, improving living quality and prolonging life span in these patients, even in some patients radical cure could be obtained.

Objective To estimate the clinic features of severe multiple trauma with secondary thrombocytosis as a factor influencing the prognosis.Methods A retrospective single-center study was carried out in 680 patients with severe multiple trauma survived longer than 72 hours in Chongqing Emergency Medical Center from March 2010 through March 2013.The variables including age,gender,ISS (injury severity score),APACHE Ⅱ score,splenectomy and the usages of vasopressors,blood products transfusion,hematopoietic medicines and anticoagulant were analyzed.The prognosis indices including total in-hospital mortality after 72 hours,length of hospital stay and morbidity of thrombo-embolism were explored.The clinic characteristics and prognosis of severe multiple trauma with secondary thrombocytosis (platelet count more than 450 × 109 L-1) were evaluated.T test or rank sum test was used for comparison between measurement data and Chi-square test or Fisher' s exact test was used for comparison between enumeration data.Results Thrombocytosis was identified in 99 (14.56％) patients and it occurred one week after injury with median time of 27 days (ranged from 8 days to 304 days),and maintained for (18.62±4.38) d.The median of platelet count was 584 × 109 L-1 (lowest 478 × 109 L-1,highest 1 072 × 109 L-1) in severe multiple trauma patients with thrombocytosis.The proportions of splenectomy,prolonged use of vasopressors and employment of hematopoietic medicines or anticoagulant were significantly higher in patients with thrombocytosis than those in patients without thrombocytosis (14.14％ vs.7.06％,P=0.03;62.63％ vs.39.07％,P＜0.01; 28.28％ vs.6.71％,P＜0.01; 90.91％ vs.19.45％,P＜ 0.01).The highest D-Dimer level presenting in patients with thrombocytosis during the time of platelet increasing was significantly more common than that in patients of non-thrombocytosis group 7 days after trauma [(11.68 ± 11.90) vs.(5.05 ± 5.11),P =0.004].However,the mortality,length of hospital stay and morbidity of thrombo-embolism were not significantly increased in patients with thrombocytosis compared with patients without thrombocytosis [8.08％ vs.8.78％,P=0.82; 34 d (28.5,54.5) d vs.45 d (23,67) d,P =0.41; 10.10％ vs.10.50％,P =0.91].Conclusion There was a higher rate of secondary thrombocytosis in severe multiple trauma patients.The factors such as splenectomy,vasopressors,hematopoietic medicines and so on might induce the reactive thrombocytosis in trauma patients.Thrombocytosis might increase the incidence of thromboembolism in severe multiple trauma patients without appropriate prophylactic anticoagulation.For the sake of prophylaxis,employment of anti-platelet agent might be the appropriately therapeutic strategy for patients suffering from severe multiple trauma with secondary thrombocytosis accompanying risk factors of arterial thrombo-embolism.

Objective To explore the underlying anatomy of iliac vein compression syndrome (IVCS) using CT, and discuss the imageological index for subtype diagnosis and potential clinical significance. Methods We retrospectively analyzed the imageological data of 69 IVCS patients from July, 2009 to June, 2014. According to CT findings, patients were categorized to simple IVCS (sIVCS, the iliac vein is compressed by only the anterior iliac artery, n=22), lumbar degeneration?related IVCS ( dIVCS, besides the iliac artery, the lower lumbar degenerative changes including osteophyte, protruded disc, etc. pressed the iliac vein from the back, n=33) and other IVCS causes (oIVCS, including tuberculosis, inflammation and fracture hematoma of the lumbar spine, n=14); meanwhile, 69 age? and sex?matched subjects was set as a control group. Evaluated indexes were onset age, course of lower limb swelling and pain, size of the iliac vein tunnel ahead lumbar (IVTAL), lower lumbar spine forward curvature angle (LLSCA), iliac vein?pressed signs by lower lumbar degeneration, compression sites, scope of deep venous thrombosis and interventional therapeutic effect. The differences of those indexes of various groups were compared. Data as onset age, course of disease, sizes of IVTAL and LLSCA were evaluated using variance analysis of the general linear model, with Bofferroni test correction for multiple comparisons. Data as iliac vein?pressed site, scope of venous embolism and therapeutic effect were assessed by crossing table χ2 test. All statistical analyses were performed using SPSS17.0 software (SPSS company, Chicago, USA). Bilateral P≤0.05 were considered to be significant. Results The onset mean age was (61.5 ± 10.6) yr. in dIVCS, (42.3 ± 6.5)yr in sIVCS. and(53.1 ± 16.8)yr. in oIVCS with a significant difference ( F=11.030, P<0.01). Mean sagittal diameter of the IVTAL and LLSCA were(2.3±0.5)mm and(121.8±5.4)° in dIVCS and(2.5± 0.5)mm and(124.4 ± 3.9)° in sIVCS, respectively; which were smaller than those of control group [(6.4 ± 1.6)mm and(127.5 ± 7.3)° , respectively ] and oIVCS [(5.9 ± 2.3)mm and(129.5 ± 5.9)° , respectively ](F=125.275,P<0.01 for sigittal diameter and F=7.95,P<0.01 for LLSCA). The degenerative changes compressing the iliac vein of dIVCS had 41 sites of 33 patients which were respectively the discal forward protrusion or bulge (51%, 17/33), vertebral anterior osteophyte (50%, 16/33)and lower lumbar vertebrae slippage (19%,8/33). The compression sites of dIVCS located exactly anterior to the fifth lumbar(18/33, 56%), the intervertebral disk between the fourth and fifth lumbar(9/33, 26%), the right front (3/33, 9%) and left front (3/33, 9%) of the fifth lumbar, however, that of sIVCS sited the right front(14/22, 64%), exactly the front(4/22, 18%)of the fifth lumbar and exactly anterior(4/22, 18%)to the intervertebral disk between the fourth and fifth lumbar, with a significant difference of location distribution(χ2=19.305, P<0.01). In sIVCSs, deep vein thrombosis of all exceeded the iliac vein length and implicated the femoral vein by 27%(6/22)and the popliteal vein by 73%(16/22), while in dIVCSs 18%(6/33)patients had deep vein thrombosis in the iliac vein, 30%(10/33)in the femoral vein and 52%(17/33)in the popliteal vein, and in oIVCSs, 30%(4/14)patients had deep vein thrombosis in the iliac vein, 40%(6/14)in the femoral vein and 30%(4/14)in the popliteal vein, with a significant difference of thrombosis scope(χ2=9.28, P<0.01). 86%sIVCSs needed intravenous stent?implanted operation to obtain effective treatment, only 52%dIVCSs were performed stent?implanted operation for effective therapy, none of oIVCSs had stent?implanted operation before the iliac vein recanalization. Conclusion CT can precisely display the pathological anatomy features of different IVCS patients, which can potentially help clinicians plan accurate treatment strategy.

Objective To observe the TCM syndromes of acute exacerbation of chronic obstructive pulmonary disease (COPD) with malnutrition. Methods TCM Syndromes Questionnaire of Acute Exacerbation of COPD was formulated with TCM clinical epidemiology methods. Totally 220 cases of hospitalized patients met the inclusion criteria were divided into two groups, 120 cases of malnutrition and 100 cases of non-malnutrition. The clinical data were observed and syndrome elements of malnutrition group and non-malnutrition group were analyzed to discuss the rule of syndromes in acute exacerbation period. Results In addition to respiratory system, the frenquency of symptoms such as weight loss, shortness of breath, easy cold, aversion to wind and cold, poor appetite, abdominal distension, constipation, belching, dizziness and tinnitus, tooth loose and hair loss, soreness and weakness of waist and knees significantly increased in COPD with malnutrition, mainly involving in syndromes of spleen deficiency and incoordination between spleen and stomach. In patients with acute exacerbation of malnutrition COPD, the single syndromes were 36 cases (30%), the composite syndromes were 84 cases (70%). The simple excess syndromes were 38 cases (31.67%), the simple deficiency syndromes were 23 cases (19.17%), and the intermingled deficiency and excess syndromes were 59 cases (49.17%). Conclusion Patients with acute exacerbation of COPD with malnutrition are mainly composite syndromes and the intermingled deficiency and excess syndromes. Spleen deficiency and incoordination between spleen and stomach may be the important pathogenesis of COPD with malnutrition.

Recent studies have showed that RNAs regulate each other with microRNA ( miRNA ) response elements ( MREs ) , and this mechanism is known as “competing endogenous RNA (ceRNA)” hypothesis. Long noncoding RNAs(lncRNAs) are non-protein coding transcripts longer than 200 nucleotides. Ab-errant expression of lncRNAs has been found associated with gastric cancer, one of the most malignant tumors. Compelling evidence suggests that lncRNAs can interact with miRNAs and regulate the expression of miRNAs as ceRNAs. Several lncRNAs such as GAPLINC, BC032469, H19, HOTAIR, FER1L4 and MEG3 have been found to be associated with miRNAs in gastric cancer( GC) . It is tempting to speculate that a multitude of ln-cRNAs may interrupt definitive steps in GC suppressive and on-cogenic pathways. The uncovering of the underlying mechanisms of lncRNAs may benefit our understanding of gastric cancer′s pathogenesis.

AIM: To study the neuroprotective effect and possible mechanism of ganglioside GM 1 on neonatal hypoxic-ischemic-encephalopathy(HIE). METHODS: A rat model of neonatal HIE was established, then the pathological changes and expressions of nitric oxide synthase (NOS) in the brain tissues were investigated in different periods after hypoxia-ischemia (HI) and the subseqent changes of the above results after GM 1 administrated. RESULTS: The damage of the brain exposed to HI were alleviated significantly after GM 1 administrated. The levels of NOS expressions in the brain tissue increased after HI. GM 1 could inhibit NOS expressions induced by HI. CONCLUSION: GM 1 may have some protective effects on neonatal HIE, and the possible mechanism is related to the partial inhibition of NOS expression.

Objective To study clinicopathologic significance of microvessel density(MVD)and the expres- sion of CD34 in nasopharyngeal carcinoma.Methods Using Elivision Plus immunohistochemistry method.50 cases of nasopharyngeal carcinoma and 15 cases of inflammation nasopharyngeal tissues were stained with CD34.Results In comparison with inflammation nasopharyngeal tissues MVD(9.23?1.84),the MVD in nasopharyngeal carcino- ma(21.92?7.80)was significantly higher(P

Objective: To investigate the incidence of CMV infection(CMV-I) and CMV related diseases (CMV-D) after allogeneic hematopoietic stem cells transplantation in 70 consecutive allogeneic hematopoietic stem cells transplantation(allo-HSCT) patients and to search for the optimal prophylactic strategy.Methods: Blood samples were monitored using the CMV pp65 antigenemia assay.Of the 70 patients observed,30 patients with chronic myeloid leukemia［CML:CP(27),AP(2),BC(1)］,12 with acute myeloblastic leukemia(AML),10 with acute lymphoblastic leukemia(ALL)and other cases were NHL(3), AA(5), MDS(7), SCLC with pancytopenia (1),CLL(1), and MF (1). Sixty six patients received HLA - identical siblings transplantation and four received tranplants from their HLA- haploidentical donors. Seventy cases included allo-PBPCT (64 cases) , allo-BMT (4 cases) and allo-PB+BMT (2). Before transplantation, all patients and donors received CMV serological examination except 4 pairs of donors/recepients. All 66 patients (3 cases were CMV IgM positive) and 64/66 donors were CMV IgG positive. Results：After transplantation, 64/70 patients developed CMV viremia during monitoring period. Forty three of 70 patients developed CMV-D.Thirty five of them suffered from CMV-associated interstitial pneumonia(CMV-IP). The high peak levels of CMV antigenemia were associated with development of CMV disease　. Close correlation was found between acute graft vs host disease(GVHD) and CMV disease. The patients were followed up for 2 to 24 months. The patients who received preemptive therapy(group A)had significantly better outcome than CMV disease group(group B, P=0.0001). Conclusions: The results suggest that CMV antigenemia has high predictive value for subsequent CMV disease and CMV pp65 antigenemia -guided early therapy has particular advantage for avoiding morbidity and mortality caused by CMV disease.