Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction (STEMI) with left ventricular aneurysms (LVA) by measurement of serum cystatin C (Cy-C) concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A (STEMI without LVA,n =183) and group B (STEMI with LVA,n =172) confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention (PCI) after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate (eGFR) and creatinine (Cr)-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ (P ＜ 0.01).With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ (min · 1.73 m2) or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality (OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01).Compared with the acute myocardium infarction (AMI) patients with chronic kidney disease (CKD) stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group (P ＜ 0.05),and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant (P ＜ 0.01).Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.

Objective To study the role of glucagon-like peptide-1 (GLP-1) analogue liraglutide played in the proliferation of CD4+CD25 T cells in normal people and newly-onset type 1 diabetic patients,and to evaluate the possible immune regulatory role of liraglutide in the therapy of type 1 diabetes.Methods CD4+ CD25-T cells of 10 normal people and 10 newly-onset type 1 diabetic patients were separated from peripheral blood by MACS immunomagnetic beads and stimulated by Human T-Activator CD3/CD28 Dynabeads to proliferate.CFSE labeling technique was used to evaluate the proliferation of CD4+ CD25-T cells by flow cytometry.Liraglutide of different concentrations(0,25,50,and 100 nmol/ml) was added to the proliferation system,then the proliferation of CD4+CD25-T cell was measured.Results (1) Liraglutide suppressed the proliferation of CD4+ CD25-T cells from either normal people or type 1 diahetic patients with dose-dependent manner (P ＜ 0.05).(2) Under the different concentrationsofliraglutide,the proliferation ofCD4+CD25 T cells from diabetic patients was mueh more robust than that of normal people (P＜0.01).(3) The inhibitory effects of liraglutide on CD4+ CD25-T cells proliferation in normal people and diabetic patients were similar (P＞0.05).Conclusion The proliferation of CD4+ CD25 T cells in type 1 diabetic patients was more robust than normal people,which indicated cellular immune dysfunction in type 1diabetes.Liraglutide inhibits the proliferation of CD4+ CD25-T cells of type 1 diabetic patients in vitro.The immunosuppression effect of liraglutide may have potential value in the treatment of type 1 diabetes.

Objective To compare clinical effect of gonadotropin releasing hormone agonist(GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD)in treatment of endometriosis.Methods Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups.35 patients in GnRH-a group were treated by goserelin (3.6 mg)for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg)combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily.Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index(KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E_2) and bone gla-protein (BGP) .The first menstruation and VAS were also followed up after treatment.Results Every 3 cases in two groups lost follow-up.(1)Reproductive hormone: the level of E_2 in add-back group [(94 ± 71) pmol/L]was significantly higher than (54±52) pmol/L in GnRH-a group(P <0.01).The level of FSH in add-back group [(3.0 ± 1.9) U/L]was significantly lower than (5.7 ± 2.9) U/L in GnRH-a group (P < 0.05).(2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment(P < 0.05), and remained until menstruated.(3) KMI: KMI in add back-group (10 ± 8) was significantly lower than (14 ± 6) in GnRH-a group (P < 0.05).(4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P < 0.05), no remarkable difference of BMD was observed before and after treatment in add-back group.Before treatment, serum BGP in both groups did not show statistical difference.After treatment, the level of BGP in GnRH-a group [(7932±5206) ng/L]was significantly higher than (5419±2917) ng/L in add-back group (P <0.05).Conclusions GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss.Therefore,it is a safe and effective treatment.

Objective: To investigate the effects of Fufang Jiangzhi No. 3, a compound traditional Chinese herbal medicine, on cholesterol-bile acid metabolism in rabbits with hypercholesterolemia and to explore the mechanism. Methods: Twenty-four male New Zealand white rabbits were randomly assigned into normal control group, untreated group and Fufang Jiangzhi No. 3 group, with 8 rabbits in each group. Rabbits in the untreated group and Fufang Jiangzhi No. 3 group were fed high cholesterol diet to induce hypercholesterolemia. After 4-week treatment, serum total cholesterol and bile acid contents were assessed. Activity of cholesterol 7alpha-hydroxylase (CYP7A1) in liver tissues was measured by enzyme-linked immunosorbent assay. The expressions of CYP7A1, bile salt export pump (BSEP) and small heterodimer partner (SHP) mRNAs in liver tissues were observed by real-time fluorescent quantitative polymerase chain reaction. Results: Compared with the normal control group, serum total cholesterol and bile acid contents in the untreated group were increased (P<0.01). Activity of CYP7A1 and expression of CYP7A1 mRNA were decreased and expressions of BSEP and SHP mRNAs were increased in liver tissues in the untreated group as compared with the normal control group (P<0.01). Serum total cholesterol level, and expressions of BSEP and SHP mRNAs in the Fufang Jiangzhi No. 3 group were lower than those in the untreated group (P<0.01). The CYP7A1 activity and expression of CYP7A1 mRNA in the Fufang Jiangzhi No. 3 group were increased as compared with the untreated group (P<0.01), however, there was no significant difference in bile acid between the Fufang Jiangzhi No. 3 group and the untreated group. Conclusion: Fufang Jiangzhi No. 3 can up-regulate the expression of CYP7A1 mRNA, raise the activity of CYP7A1, and inhibit the expressions of BSEP and SHP mRNAs to regulate the metabolism of total cholesterol in rabbits.

Objective To develop a detection method based on the technology of gene chips which can quickly distinguish genes of Enterococcus faecalis, E.faecium and vancomycin resistance.Methods Based on the specific gene ( ddl) sequences of two types of Enterococcus from GenBank, oligonucleotide probes which could detect and distinguish special genes and drug resistance genes ( vanA,vanB) of Enterococcus were designed and compounded.Then,the probes were dotted to modified slide.The target DNA fragments of vancomycin-resistant Enterococcus ( VRE) were labeled with biotin by multiple PCR amplification, and then hybridized with oligonucleotide probes on slide.The results were analyzed by portable imager.The multiple PCR system, hybridization reaction and condition of the chemiluminescence method were optimized before the specificity, sensitivity and reproducibility of the chip were evaluated.Results One universal primer, four specific primers, one universal probe and four specific probes were selected.This gene chip was demonstrated of high specificity and repeatability.The detection sensitivity was 103 CFU/ml.The gene chip detection results of 10 clinical samples were basically consistent with the drug sensitivity test ( 8/10 ) .Conclusion A gene chip technique for the detection of VRE is established successfully.It is possible to distinguish the type of VRE and detect the genetic phenotypes of drug resistance by gene chip technique.

Objective:To evaluate the value of vasoactive-inotropic Score (VIS) at different time points in predicting the 28-day mortality of patients with septic shock, so as to reduce the risk of death and improve the prognosis of patients.Methods:This experiment was a single-center retrospective cohort study. The clinical data of 275 adult patients with septic shock who were treated with vasoactive drugs in the intensive care unit of the Affiliated Hospital of Xuzhou Medical University from February 2016 to February 2020 were collected. According to the 28-day survival condition, all recruited patients were divided into the death group and the survival group, and the maximum vasoactive-inotropic score of all patients at the first 24 h and the second 24 h were calculated, which were expressed as VIS max24 and VIS max48. Multivariate logistic regression analysis was used to find the independent risk factors that influencing the prognosis. The receiver operating characteristic curve was used to analyze the predictive value of VIS. Results:There was no significant difference between the death group and the survival group in the characteristics including age, sex, weight, infection sites, blood culture results, cardiac arrest, hormone use, and 24 h rehydration volume ( P>0.05). APACHE II score, basic lactic acid, and lactic acid after 24 h of treatment were increased significantly in the death group ( P<0.05). VIS max24 could accurately predict the 28-day mortality (AUC=0.953, 95% CI: 0.924-0.982), which were more efficent compared to VIS max48 (AUC=0.919, 95% CI: 0.881-0.957), basic lactic acid (AUC=0.937, 95% CI: 0.900-0.966) and APACHEⅡ score (AUC=0.865, 95% CI: 0.818-0.913). Conclusion:VIS max24 can more accurate predict the 28-day mortality in patients with septic shock.

Objective To investigate the value of non-contrast CT(NCCT)-based radiomics for identifying acute unilateral middle cerebral artery occlusion(MCAO)with negative hyperdense artery sign(HAS).Methods All 80 patients with acute unilateral MCAO confirmed by angiography(MR angiography[MRA]or CT angiography[CTA]or DSA)and presenting with negative NCCT presentation for HAS were enrolled from January 2015 to June 2023 in the Emergency Department of Stroke Center of Affiliated Hospital of Yangzhou university.On the NCCT images,the occluded segment of the middle cerebral artery on the affected side of each case and the corresponding segment of the vessel on the normal side were used as the regions of interest,and a total of 108 radiomic features were extracted.The least absolute shrinkage and selection operator(LASSO)was used to screen the key features,construct and calculate the radiomics score,and four imaging histology models,support vector machine(SVM),light gradient boosting machine(LightGBM),GradientBoosting and adaptive boosting(AdaBoost),were built respectively to predict MCAO.Predictive performance was evaluated by the area under the receiver operating characteristic curves,and comparisons between the modeled receiver operating characteristic curves were made using the Delong test.Finally,the value of the application of radiological modeling was assessed by clinical decision curve analysis(DCA).Results The NCCT images based on 160 vessels were finally screened for 6 key features,including skewness,energy,gray level size zone matrix(GLSZM)-gray uneven,GLSZM-low gray area emphasis,GLSZM-size area non-uniform standardization,GLSZM-area entropy.The area under the curve(AUC)of the SVM-test was 0.688(95％CI 0.497-0.878)with an accuracy of 0.688;the AUC of the LightGBM-test was 0.787(95％CI 0.620-0.955)with an accuracy of 0.781;the AUC of the GradientBoosting-test was 0.654(95％CI 0.457-0.852)with an accuracy of 0.688;the AUC of the AdaBoost-test was 0.707(95％CI 0.515-0.899)with an accuracy of 0.750.The Delong test showed a statistically significant difference between LightGBM-test and GradientBoosting-test(P=0.040),and no statistically significant difference in performance between the remaining models(all P＞0.05).DCA showed that the LightGBM-test performed better.Conclusion NCCT-based radiomics has good diagnostic efficacy for identifying acute unilateral MCAO with negative HAS,and this conclusion needs to be further verified by multi-center and large sample studies.

Objective:To systematically analyze and integrate the psychological experience of heart failure patients using mobile medical applications (App) for self-management.Methods:Qualitative research on the self-management experience of heart failure patients using mobile medical App was retrieved through computer on PubMed, Web of Science, Embase, Cochrane Library, CINAHL, PsycINFO, Australian Joanna Briggs Evidence-Based Health Care Center Database, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Literature Database. The search period was from the establishment of the database to December 30, 2022. The quality of literature was evaluated in accordance with the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center (2016) . The results were integrated using the aggregative integration method.Results:A total of 14 articles were included, 32 research results were extracted, and 7 new categories were summarized. Finally, three integrated results were obtained (positive experience of heart failure patients using mobile medical App, risks and challenges of heart failure patients using mobile medical App, and preferences and expectations of heart failure patients towards mobile medical App) .Conclusions:The mobile medical App provides new ideas for self-management of heart failure patients, and its effectiveness is recognized by most heart failure patients, who perceive significant benefits. Future research should enrich the functionality and participation forms of the App based on the personalized needs of patients and their families, explore remote health management intervention models at home, and promote the promotion and application of mobile medical App.

Objective To evaluate the clinical and pathological features of patients with prostate cancer who were diagnosed by single positive core biopsy and treated by radical prostatectomy (RP).Methods Between July 2012 and June 2016,164 patients with prostate cancer diagnosed by single positive core biopsy underwent RP.The mean age was 66.3 years old (ranged 41-82 years old),and the mean PSA level was 12.3 ng/ml (ranged 0.6-59.5 ng/ml).The biopsy Gleason score showed 6 scores in 113 cases,3 + 4 =7 scores in 21 cases,4 + 3 =7 scores in 18 cases,≥8 scores in 12 cases.Clinical stage was cT1 in 71 cases,cT2 in 92 cases,and cT3 in 1 case.The patients were divided into subgroups according to age,preoperative PSA level,biopsy Gleason score and clinical stage,and the pathological results were compared among these subgroups.Results Of the 164 patients,67 cases had Gleason score ≤ 6,52 cases Gleason score 3 + 4 =7,24 case Gleason score 4 + 3 =7,and 11 cases Gleason score ≥ 8.Ten patients had pT0 disease according to the RP specimen,3 had extraprostatic extensions,5 had seminal vesicle invasions,and 24 had positive surgical margins.Compared to the biopsy,the Gleason score of RP specimens was higher in 53 cases,concordant in 77 cases,and lower in 24 cases.There was no significant difference in the postoperative pathological features between the age group ＜ 70 years and the group ≥ 70 years.Compared with PSA ＜ 10 ng/ml,the likelihood of postoperative Gleason score ＞ 7 was significantly increased in PSA ≥10 ng/ml group [41.4％ (36/87) vs.66.2％ (51/77),P＜0.05].When the biopsy Gleason score was divided into four groups (6,3 + 4 =7,4 + 3 =7,≥ 8),there were significant differences in postoperative pathological stages among the four groups (P ＜ 0.05),and the patients with biopsy Gleason score 6 were more likely to have no residual cancer (stage T0) when compared with other Gleason scores [8.8％ (10/113) vs.0,P =0.09].The probability of no residual cancer in clinical T1 stage patients was significantly higher than that in T2 stage [11.3％ (8/71) vs.2.8％ (2/92),P =0.02],while the probability of Gleason score upgrading was significantly lower [23.9％ (17/71) vs.39.1％ (36/92),P ＜ 0.05].Conclusions Most single core prostate cancer have clinically significant disease.The treatment plan must be evaluated individually for patients with single core prostate cancer.

Objective:To evaluate the clinical efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in children with severe aplastic anemia（SAA）.Methods:Twenty-seven cases with SAA who had been treated with allo-HSCT from January 2020 to December 2022 were retrospectively analyzed and reviewed.Results:（1）A total of 27 SAA patients were enrolled，including 18 males and 9 females，with a median age of 8 (2-15) years.There were 20 cases of SAA-Ⅰ type,7 cases of SAA-Ⅱ type.Based upon donor sources，three cases of matched sibling donors hematopoietic stem cell transplantation,and 24 cases of haploidentical hematopoietic stem cell transplantation were adopted.（2）Hematopoietic reconstruction was achieved in all 27 cases.The median implantation time of neutrophils and platelets was 10（9-20）days and 12（7-26）days respectively.The cumulative incidence of acute graft-versus-host disease（GVHD）was 66.67%（18/27）.The incidence of grade Ⅰ-Ⅱ was 55.56%（15/27）and that of grade Ⅲ-Ⅳ was 11.11%（3/27）.The incidence of chronic GVHD was 7.41%（2/27）.Transplant-associated thrombotic microangiopathy (TA-TMA) occurred in 7.41%（2/27）patients,cytomegalovirus viremia in 62.96%（17/27）patients,epstein-barr virus infection in 33.33%（9/27）patients,and 14.81%（4/27）patients progressed to post-transplant lymphoproliferative disorder (PTLD).（3）The median follow-up time was 12 (2-28) months.The overall survival rate was 96.29%.Twenty-six patients survived,and one patient died due to multiple complications of severe acute GVHD,TA-TMA,cytomegalovirus infection,PTLD and secondary epilepsy.Conclusion:Allo-HSCT is an effective therapy for SAA in children.The effective rate of this research is 96.29%.Acute GVHD is still the key to therapy.The incidence rate of acute GVHD is 66.67% in this study.The blood incompatibility of donor and recipient may affect the incidence of GVHD.The intensity of GVHD prevention should be reduced after HLA-matched sibling donor-hematopoietic stem cell transplantation so as to avoid the complications of virus recurrence and PTLD.