Atrial fibrillation (AF)is a strong risk factor for ischemic cerebral stroke.Some inherent defects of War-farin limit its clinic application,which accelerates research and development of new oral anticoagulants,such as Dabigatran,Apixaban,Rivaroxaban and Edoxaban etc..This article made an overview for these.

Researches have demonstrated that gradually increased morbidity and mortality of cardiovascular disease may be related to vitamin D deficiency.But there are few randomized controlled studies about preventing cardiovas-cular events via vitamin D supplementation.This article summarizes investigate progress for related matter recently.

Patients receiving long-term anticoagulation therapy of vitamin K antagonist (VKA)may face risk of bleeding when receive surgery or invasive operation,and perioperative interruption of VKA may increase risk of thromboembolism.Bridging anticoagulation therapy with therapeutic dose of heparin group drugs may avoid throm-boembolic events induced by temporary interruption of VKA therapy during perioperative period.This article made a relative discussion.

Objective To study the antithrombotic effect of polysaccharide extracted from Thallus Laminariae(PTP) on rats with endothelial injury.Methods Two kinds of endothelial injured rat models were established by injecting adrenaline and endotoxin.The wet weight of thrombus was evaluated by artery-vein loop method,the starting time of thrombus formation and the speed of blood flow were observed by mesentery microcirculation.Results In adrenaline-induced injury rats,the wet weight of thrombus was obviously decreased in high-dose PTP group and aspirin group compared with the model group.In endotoxin-induced injury rats,the starting time of thrombus formation was longer and the one-hour blood flow speed was faster in all TP groups and aspirin group than those in the model group.Conclusion PTP exerts the antithrombotic effect on rats with endothelial injury.

Objective To retrospectively study the variation of glucose in patients with insulinomas. Methods The medical records of patients who underwent operations in the last 20 years at Peking Union Medical College Hospital were reviewed retrospectively. Patients who received repeated operations, or just exploratory laparotomy or liver biopsy were excluded. The clinical data were collected and analyzed. Results There were 245 patients, including 103 males and 142 females. The mean age was (42.2+ 14.6) years old. The mean value of preoperative fasting glucose was (1.47+0. 57) mmol/L, and the ratio of insulin to glucose was greater than 0.3 in 87.4% patients. The glucose level rose gradually after removal of the tumor(s). The blood sugar rising more than 1 time over the baseline value at one hour after resection was observed in 79.6% patients. For all the other patients, the glucose level rose to this level in the morning of the first postoperative Day 1. Rebound hyperglycemia was common after operations, and the glucose gradually returned to normal, with a mean level of 5.56 mmol/L at the time when the patients were discharged home. Conclusions Patients with insulinomas had a serum fluctuation in glucose (low→high→normal) during the perioperative period.Intraoperative glucose test combined with ultrasound and frozen section helped to localize and to remove all the lesions. Rebound hyperglycemia after surgery should be treated with insulin pump actively to minimize the incidence of complications.

[ ABSTRACT] AIM:To investigate the effect of storage temperature in renal biopsy tissue frozen section on immu-nofluorescence results.METHODS:One hundred renal biopsy samples of Zhejiang Province People’ s Hospital from Janu-ary to June, 2015 were enrolled.Two sets of cutting slices were stored in -70 ℃ low temperature refrigerator as experi-mental group and in -12 ℃ freezing cryostat as control group.The immunoglobulins ( IgG, IgA and IgM) and comple-ments (C3, C4 and C1q) as well as fibrinogen were detected with direct immunofluorescence in the next day.The typeⅣcollagen a3 and a5 chains were also detected by indirect immunofluorescence, and the qualitative and semi-quantitative re-sults were observed under the fluorescence microscope.RESULTS:There were 16 cases of 3+~4+IgG in the experi-mental group, while the corresponding IgG was all 1+~2+in control group, significantly weaker than that in experimen-tal group.There were 99 cases of 3+~4+a3 and 3+~4+a5 in experimental group, white there were 92 cases of 1+~2+a3/a5 and 8 cases negative in control group.The positive intensity was decreased in control group with statistical difference between the 2 groups ( P<0.05) .There were 15 cases of 4+IgA, 19 cases of 3+IgA, 15 cases of 3+IgM, 11 cases of 2+IgM, 13 cases of 4+C3, and 12 cases of 3+C3 in experimental group.The control group were similar to the results of experimental group, and no difference between the 2 groups was observed.CONCLUSION:The immunoflu-orescence results of renal biopsy frozen sections are highly affected by the section storage temperature, which has greater in-fluence on the immunofluorescence positive intensity of IgG and typeⅣcollagen.The renal biopsy frozen section should be stored in -70 ℃low temperature refrigerator.

0.05). Positive expression of 2 or all 3 markers of neuroendocrine cell was detected in all 16 samples; negative expression of all 5 peptide hormones was observed in only 25% of samples. At a mean follow-up of 44.2 months (range 4 months-7 years ), the mean time from resection to relapse or metastasis was 29.8 months; 7 cases survived more than 5 years, of which 2 have survived for 7 years. Two cases, who subjected non-operative treatment, survired 39,61 months, respectively.Conclusions Clinical manifestations of NPNEC are non-specific. Only a few tumors in NPNEC patients do not yield peptide hormones. Treatment of NPNEC (including patients with liver metastasis) with aggressive surgical resection followed by interventional methods can result in excellent overall long-term survival.

Objective To evaluate the post-operative glucose level and insulin dose of patients undergoing total pancreatectomy.Methods From September 1980 to September 2014, 21 patients underwent total pancrea-tectomy in Peking Union Medical College Hospital, who were enrolled in our study.We reviewed the changes in their insulin dosage and glucose levels after operation, also summarized type and dose of insulin as well as glucose level in stable period.Results The required insulin dose reached peak within 4 days after surgery ( maximum dose 300 U/d).The average dose was (143.5 ±62.8) U/d and decreased gradually.During the perioperative period (needing parenteral nutrition), the blood glucose level fluctuated markedly (1.52-29.06 mmol/L) and the average level was (11.18 ±0.95) mmol/L.During the stable period ( without parenteral nutrition) , patients on average had (5.3 ±2.0) U of preprandial rapid-acting insulin and (8.1 ±2.9) U of long-acting insulin be-fore sleeping;the average fasting blood glucose was (6.69 ±1.48) mmol/L, 2 h postprandial blood glucose was (9.08 ±2.84) mmol/L, bedtime blood glucose was (9.66 ±2.49) mmol/L, and blood glucose level at night was (8.15 ±2.78) mmol/L.67%of the patients had 13 hypoglycemic episodes monthly on average.For those five followed-up patients, the average hemoglobin A1c was (6.15 ±1.20)%.Conclusions Patients undergoing total pancreatectomy may experience marked fluctuation of blood glucose level and short-term increase of insulin need which gradually decreases afterwards.After entering the stable period, the glucose level could be well-con-trolled but with frequent hypoglycemia.There is no diabetic ketoacidosis.

Objective To determine the effecting factors for diagnosis of binign or malignant in cystic lesions of pancreas(CLP).Methods One hundred twenty-six patients undergoing operations for CLP or suspected CLP in this hospital from January 1984 to June 2008 were reviewed.Patients were divided into two groups according to lesion's histological features after operation.The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated.Results One hundred twenty-six patients underwent operations for suspected pancreatic cystic neoplasms.There were 89 benign and 37 malignant CLPs.The univariate analysis showed that gender, clinical symptoms(jaundice and weight loss), elevated serum CA199, and presence of one or more of three morphologic features such as solid component, nodule or septation were significantly different between benign and malignant cystic neoplasm of pancreas.The multivariate analysis indicated that imaging features and gender were independent predictors of malignancy.Conclusion In patients with suspected pancreatic cystic neoplasms, elevated serum CA199, clinical symptoms(jaundice and weight loss)and presence of suspicious morphologic features on imaging are predictors of malignant potential of CLP.Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.

Objective:To investigate the effect of hemoglobin (Hb) volatility on cardiovascular prognosis in peritoneal dialysis (PD) patients.Methods:Retrospective cohort study was designed. Patients undergoing stable PD for more than 3 months and followed up regularly for at least 1 year were enrolled from May 1, 2013 to October 31, 2014 in the General Hospital of Ningxia Medical University. According to the Hb variation based on the mean changes in Hb standard deviation at 1 month, 3 months, 6 months, 12 months over baseline Hb, all patients were divided into low volatility group (≤10 g/L), moderate volatility group (>10-20 g/L) and high volatility group (>20 g/L), and baseline information were compared among these groups. Kaplan-Meier survival analysis and Cox regression equation were used to analyze the relationship between Hb variation and cardiovascular mortality and all-cause mortality. Besides, the patients were divided into qualified group (Hb≥110 g/L) and substandard group (Hb<110 g/L) by the Hb level at the study endpoint (cardiovascular death and all-cause death) according to KDIGO guidelines and relevant literature. Cox regression analysis was used to analyze the relationship between Hb variation and cardiovascular death in qualified group or substandard group. Multivariate linear regression analysis was used to analyze the related factors of Hb fluctuation in PD patients.Results:A total of 267 patients were enrolled. There were 160 males (59.93%) in this study. The age was (52.66±13.72) years old, and the median dialysis age was 37(21, 61) months. The patients' baseline Hb (before dialysis) was (80.16±14.89) g/L and at the end of the study Hb was (105.34±22.08) g/L. Body mass index and baseline Hb levels in the high volatility group were lower than those in low volatility group and moderate volatility group (all P<0.05). Both moderate and high volatility groups had lower estimated glomerular filtration rate than that in low volatility group, and high volatility group had higher urea nitrogen level than that in low volatility group (all P<0.05). The amount of erythropoietin usage in the high volatility group was higher than that in moderate volatility group ( P<0.05). The Kaplan-Meier survival analysis results showed that there was no significant difference in survival rate for all-cause death (Log-rank χ2=0.735, P=0.693) and cardiovascular death (Log-rank χ2=2.961, P=0.228) in different Hb volatility groups. Cox regression analysis showed that after adjusting for age, sex, serum creatinine, and blood albumin, higher Hb volatility was associated with a lower risk of cardiovascular death ( HR=0.972, 95% CI 0.947-0.999, P=0.040). After adjusting for related confounding factors, higher Hb volatility was still a protective factor for cardiovascular death in the substandard group ( HR=0.946, 95% CI 0.903-0.992, P=0.022), but there was no significant correlation between Hb fluctuation and all-cause death. Multivariate linear regression analysis results showed that the fluctuation level of Hb was positively correlated with Kt/V ( B=4.682, 95% CI 2.480-6.884, P<0.001) and erythropoietin dosages ( B=0.001, 95% CI 0-0.001, P=0.003), and negatively correlated with baseline Hb ( B=-0.554, 95% CI -0.651--0.457, P<0.001). Conclusions:High Hb variability is a protective factor for cardiovascular death in PD patients with lower Hb level (substandard Hb). Adopting a reasonable program to correct anemia timely to reach the standard level has a greater impact on reducing risk of cardiovascular death in PD patients than Hb variation in anemia treatment.