Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional ; Neoplasms ; complications ; therapy

To investigate the changes in activation and proliferation of Tregs after targeted RNA inter-ference of Kvl. 3 channel genes and in vitro administration of eplerenone (EPL). Methods After lenti-virus vector was transfected to regulatory T cells (Tregs) of rats, qPCR and whole-cell patch-clamp methods were used to detect gene knockout efficiency, and EOSA method was used to detect cytokine secretion IL-10 and TGF-p levels of Tregs group,Tregs + EPL group,RNAi-Tregs group,and RNAi-Tregs + EPL group. Results Lentivirus vector was successfully transfected into Tregs cells, and the mRNA level and current density of Kvl. 3 channel was 78% and 71.3% respectively; compared with Tregs group, extracellular and intracellular TGF-p levels in RNAi-Tregs group were significantly reduced (P < 0. 01), and extracellular and intracellular TGF-(3 levels in Tregs + EPL group were also reduced (P < 0. 05 ) ; compared with RNAi-Tregs group, extracellular and in-tracellular TGF-fJ levels in RNAi-Tregs + EPL group showed no change. However, IL-10 levels in Tregs group,Tregs + EPL group, RNAi-Tregs group, RNAi-Tregs + EPL group showed no significant change. Conclusions Kvl.3 channel mediates the activation and proliferation of Tregs cells, while EPL can reduce the activation and proliferation of Tregs cells by directly inhibiting Kvl.3 channel and reducing the secretion of TGF-fi levels, further indicating that EPL is a specific blocker of Kvl. 3 channel.

Objective To explore the short-term influences of conventional internal medical treatment combined with escitalopram on cognitive function and cardiac function in elderly patients with chronic heart failure (CHF) complicated with depression disorder.Methods A total of 97 patients with CHF complicated with depression disorder in Chongqing Ninth People's Hospital,from October 2014 to October 2015,were selected and randomly divided into the antidepressant group and control group.Both groups were undergoing conventional internal medical treatment.Additionally,patients in the antidepressant group were administrated with escitalopram,while patients in the control group were treated with placebo.The degree of depression and anxiety and cognitive function were assessed by using 24-item Hamilton depression scale (HAMD-24),14-item Hamilton anxiety scale (HAMA-14) and Montreal cognitive assessment(MoCA) scale,and the plasma level of NT-proBNP,left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were measured before and after 6-week treatment.Results After 6-week treatment,the HAMD-24 and HAMA-14 scores and plasma level of NT-proBNP in antidepressant group were lower than those in the control group,while the attention score and LVEF were greater than those in the control group,there were statistically significant differences(P＜0.05).After 6-week treatment,no statistically significant difference was found in other observed indicators between the two groups(P＞0.05).Conclnsion For elderly patients with chronic heart failure complicated with depression disorder,it is indicated that escitalopram could not only relieve their anxiety and depression,but also improve their cardiac function and attention.

ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

Objective To analyze the characteristics and prognosis of intra-aortic balloown pump (IABP) supported percutaneous coronary intervention (PCI) in patients with Acute Coronary Syndrome (ACS) complicated with cardiogenic shock (CS).Methods 197 ACS patients complicated with CS patients received IABP supported PCI in Beijing Anzhen hospital from January 2014 to December 2015 were involved.According to the clinical results, all patients were divided into survival group and non-survival group.The clinical and laboratory parameters were compared between groups.Results Among the 197 patients enrolled, there were 162 patients in the survival group and 35 patients in the non-survival group.The mean age was (57.3±14.7) year-old, mean arterial blood pressure (MAP) on admission was (53.3±14.6) mmHg (1 mmHg=0.133 kPa).Percentage of diabetes comorbidity, cTnI level, oxygen index and MAP were significantly different between the survival and the non-survival groups (P<0.05).The symptom onset to balloon time and door-to-balloon time intervals were found delayed with significant difference in the non-survival group compared to the survival group (P<0.05).IABP improved hemodynamic parameters including blood pressure, cardiac function and oxygen index (P<0.05) in both groups.Duration of vasopressor usage, IABP implantation, percentage of invasive mechanical ventilation, length of stay in intensive care unit, acute kidney injury (AKI) and re-infarction were also significantly different between the two groups (P<0.05).Conclusions Adverse events risk is higher in ACS patients complicated with cordiogenic shock requiring IABP support for PCI.Patients with mortal outcomes are older, comorbid with diabetes mellitus and history of myocardial infarction and higher event rates of re-infarction and acute kidney injury during hospitalization.Intensive care should be implemented to reduce the incidence of adverse events.

AIM: To investigate the action of testosterone on atherosclerosis in a rabbit model. METHODS: 37 male cholesterol-fed rabbits were divided into five groups: castration group: castrated rabbits without exogenous testosterone administration; testosterone Ⅰ group: castrated rabbits with exogenous testosterone 0.25 mg?kg -1?d -1; testosterone Ⅱ group: castrated rabbits with exogenous testosterone 2.5 mg?kg -1?d -1; testosterone Ⅲ group: castrated rabbits with exogenous testosterone 12.5 mg?kg -1?d -1. The sham operation group was also set. Three months later, the levels of testosterone, blood lipids (including TG, HDL-C, LDL-C), PAI activity, nitric oxide (NO) content, endothelin (ET), angiotensin Ⅱ (AngⅡ) in blood were detected. RESULTS: It showed that testosterone in castration group was the lowest. There was no significant difference of TG or LDL-C between castration group and the other four groups. HDL-C in castration group was lower than that in other four groups. NO content of castration group was lower than that in others, but PAI activity, ET and AngⅡ concentration were higher than that in other groups. CONCLUSION: Testosterone is a protective factor against atherosclerosis in male rabbits.

Objective To explore the clinical.significance of serum anti-lysosomal associated membrane protein-2 (LAMP-2) antibody in the pathogenesis of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AASV) by investigating the relationship of its levels and AASV.Methods Sera from twenty patients with AASV and twenty healthy controls were collected.Serum anti-LAMP-2 antibody was detected using commercial enzyme linked immunosorbent assay (ELISA) kits.Anti-LAMP-2 antibody levels between the two groups were assessed using the t test,the correlation between anti-LAMP-2 antibody levels and erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) was assessed by Spearman's rank correlation test,the correlation between anti-LAMP-2 antibody levels and the Birmingham vasculitis activity score(BVAS),hemoglobin (Hb),albumin (Alb) was assessed by Pearson's rank correlation test.Results ① The serum level of anti-LAMP-2 antibody in patients with AASV [(3714±1446) pg/ml] was higher than that in the healthy controls [(174±43) pg/ml] (t=10.94,P＜0.05).The serum level of Hb [(99±30) g/L] and Alb [(27±5) g/L]in patients with AASV was lower than that in healthy controls [(138±14) g/L,(44±3) g/L] (t=5.27,t=13.04,P＞0.05).② The level of anti-LAMP-2 antibody in AASV was positively correlated with BVAS (r=0.669 9,P＜0.05),and was not found elevated compared with ESR,CRP,Hb and Alb (P＞0.05).Conclusion ① AntiLAMP-2 antibody is involved in the pathogenesis of AASV.② Anti-LAMP-2 antibody is correlated with the activity of AASV,it may be an indicator of AASV disease activity.

Outpatient care services are usually the patient's first contact between the patients and the most bas-ic health care. The provision of outpatient care contributes to immediate and large gains in health status. The pay-ment method is one of the most common incentive methods applied by purchasers to guide the performance of outpa-tient care providers. This systematic review applied cochrane review method, and searched, screened, assessed and synthesized the relevant original studies. 19 studies were finally included. It was found that existing payment methods combined with P4 P interventions could probably slightly improved the health professionals' use of some tests and treat-ments ( adjusted RR median = 1 . 095 , range 1 . 01 to 1 . 17 ) , but may have led to little or no difference in patients' utilisation of health services ( adjusted RR median = 1 . 01 , range 0 . 96 to 1 . 15 ) and may have led to little or no difference in the control of blood pressure or cholesterol ( adjusted RR = 1 . 01 , range 0 . 98 to 1 . 04 ) . Pay for per-formance involves a complex design, each detail design may contain different incentive effect, therefore policy makers intend to apply pay-for-performance to guide the behavior of health providers, the design on each components of pay for performance should be analyzed in order to find more potential intervention points.

Objective:To summarize the ultrasound features of medullary thyroid cancer (MTC) and analyze its diagnosis value for MTC.Methods:91 patients with medullary thyroid carcinoma (103 nodules) in Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from Apr. 2013 to Nov. 2018 were retrospectively analyzed, including 36 males and 55 females. Preoperative ultrasound features and serum calcitonin levels were recorded. SPSS 22.0 was used and the measurement data of normal distribution was expressed as ± s, and the enumeration data was described by ratio or rate. The comparison between groups was performed by single factor ANOVA and rank sum test. Results:83.5% (86/103) of the MTC nodules were located in the middle and upper thyroid gland. Hypoechoic accounted for 78.6% (80/103) . 81.6% (84/103) of them had calcification and 74.8% (77/103) of these nodules had abundant blood flow signals (color Doppler flow imaging, CDFI Ⅱ-Ⅲ) . 91.3% (94/103) of them had aspect ratio less than 1, 87.4% (90/103) were solid and 35.0% (36/103) had comet tail sign. The positive rate of preoperative serum calcitonin was 86.8% (79/91) . There were significant differences in shape ( P=0.001) , margin ( P=0.012) , cystic ( P=0.004) , comet-tail ( P<0.001) , lymph node ( P<0.001) and color Doppler flow imaging ( P=0.001) through comparing MTC nodules in different TI-RADS grades. Conclusions:MTC can behave as single, solid, hypoechoic, large round nodule located in the middle or upper thyroid gland, with thick calcification and abundant blood flow signals in ultrasound. The surrounding area may be accompanied with comet tail sign, and the probability of lymph node metastasis is high. The suspicious nodules screened by ultrasound can be further diagnosed by serum calcitonin.

Objective : To understand the prevalence of overweight and obesity, and the influencing factors among students aged 7-22 years in Zhejiang Province. Methods : Stratified random cluster sampling was used to randomly select students aged 7-22 years in 11 prefectures of Zhejiang Province in 2019. Height and weight were measured. The general information, dietary habits and living habits of students were collected using the Student Health Status and Influencing Factors Questionnaire. The multivariate logistic regression model was used to analyze the influencing factors of overweight and obesity. Results : A total of 33 800 respondents were included, 7 685 (22.74%) were overweight/obese, 4 729 ( 13.99% ) were overweight, and 2 956 ( 8.75% ) were obese. The multivariate logistic regression analysis suggested that boys ( OR=2.059, 95%CI：1.949-2.175), not living on campus( OR=1.306, 95%CI: 1.214-1.405), history of alcohol consumption ( OR=1.158, 95%CI：1.083-1.238 ), average daily consumption of sugar-sweetened beverages in the past week ( less than once, OR=1.214, 95%CI: 1.103-1.336; once and more, OR=1.431, 95%CI: 1.259-1.626 ), average daily consumption of fries in the past week ( less than once, OR=1.171, 95%CI: 1.065-1.288; once and more, OR=1.266, 95%CI: 1.102-1.454 ), and average daily consumption of sweets in the past week (less than once, OR=0.727, 95%CI: 0.658-0.802; once and more, OR=0.504, 95%CI: 0.444-0.572) were associated with overweight and obesity in students. Conclusion The prevalence rates of overweight and obesity among students aged 7-22 years in Zhejiang Province are 13.99% and 8.75%, respectively, which are associated with boys, not living on campus, and consumption of sugar-sweetened beverages, fries, sweets and alcohol.