ObjectiveTo investigate the serum soluble urokinase-type plasminogen activator (suPAR)in patients with multiple myeloma,its relationship with the 2-year survival rate and its clinical significance in predicting the disease prognosis.MethodsEnzyme-linked immunosorbent assay was applied to determine the levels of suPAR of 40 initial diagnosed patients with MM and 30 healthy persons as healthy control group.The patients were divided into three groups:effective (13 cases),remission (19 cases) and invalid (8 cases).ResultsUsually there was suPAR expression [(233.47±83.22) pg/ml] in serum of the healthy adults.There was no statistical difference of the suPAR expression in effective group or remission group before treated [(257.60±32.47) pg/ml,(331.00±99.80) pg/ml] compated with healthy group (t =2.04,t =1.83,P ＞ 0.05),and that in the invalid group,serum levels of suPAR [(562.20±291.0) pg/ml] was statistically significant with that of the effective group and that of the healthy control group (t =3.92,t =1.93,P ＜ 0.05).Through monitoring 17 patients,the suPAR of patients before treatment [(437.65±131.43) pg/ml] was statistically significant with that of healthy control group (P ＜0.01) and effective group after treatment [(298.76±108.59) pg/ml] (P ＜0.01).Serum suPAR of more than 2-year-survival patients [(333.02±85.37) pg/nl] during initial diagnosis was not statistically difference with that of the healthy control group (t =1.81,P ＞ 0.05).Serum suPAR of less than 2-year-survival patients [(646.01±103.97) pg/ml] was statistically different with that of healthy control group (t =3.84,P ＜0.01) and that of more than 2-year-survival patient group (t =3.50,P ＜0.01).ConclusionThe suPAR value was correlated to the stability of multiple myeloma,and can be used for disease prognosis and estimation of survival time.And the high expression of suPAR was related to the adverse prognosis.

Objective To determine the contents of four effective constituents in Euphorbiae Semen decoction;To provide evidence for Euphorbiae Semen decoction into clinical application. Methods Established quantitative analysis multi-components by single marker method was used to determine the contents of diterpenoids constituents, such as euphorbia storoid, euphorbia factor L2, and euphorbia factor L3. HPLC method was used to determine the contents of aesculetin. Results Contents of euphorbia storoid, euphorbia factor L2, and euphorbia factor L3 in smashed Euphorbiae Semen decoction were 0.015 9%, 0.005 9% and 0.024 1%, respectively. However, the contents of the above three constituents could not be detected in whole Euphorbiae Semen decoction. The content of aesculetin (0.693 6%) in smashed Euphorbiae Semen decoction was more than that in whole Euphorbiae Semen decoction (0.288 2%). Conclusion Decoction digestion effect of diterpenoids constituents in Euphorbiae Semen decoction is not good. Decocting with water is not suitable for the clinical application of Euphorbiae Semen for purgation and diuresis. Aesculetin in smashed Euphorbiae Semen decoction has good decoction digestion effect, in which clinical use for antisepsis and anti-inflammation is effective.

Objective To investigate the significance of CD44v6 expression in acute leukemia( AL) and it's relation with the prognosis of AL. Methods Sixty AL patients were treated by enzyme linked immunosorbent assay( ELISA)as initial treatment group. Fourty-seven cases were remission as remission group, and 20 cases with no-remission group. Meanwhile,45 healthy people were served as the control group. The level of CD44v6 was measured by ELISA. Results The serum CD44v6 in initial treatment patients,remission group, no-remission group and control group were( 179. 34 ± 39. 41 )μg/L,( 190. 61 ± 28. 05 )μg/L,( 106. 72 ± 26. 38)μg/L and(98. 31 ± 21. 78)μg/L respectively,and the difference was significant( F =56. 303,P﹤0. 01),and the CD44v6 of initial treatment group and remission group were higher than that of no-remission group and control group(P﹤0. 05). The leukocyte levels was positive related to CD44v6 levels in 60 patients(r=0. 826,P﹤0. 01),and it was also related to disease stage,extramedullary infiltration(( r=0. 485,0. 512;P﹤0. 01). Conclusion The level of CD44v6 is closely related with the occurrence and development of acute leukemia. The assay of CD44v6 in serum of AL patients is helpful in diagnosing and predicting the risk of metastasis and prognosis in AL.

Objective    To evaluate the diagnostic value of various severity assessment scoring systems for sepsis after cardiac surgery and the predictive value for long-term prognosis. Methods    The clinical data of patients who underwent cardiac sugeries including coronary artery bypass grafting (CABG) and (or) valve reconstruction/valve replacement were extracted from Medical Information Mark for Intensive Care-Ⅲ (MIMIC-Ⅲ). A total of 6 638 patients were enrolled in this study, including 4 558 males and 2 080 females, with an average age of 67.0±12.2 years. Discriminatory power was determined by comparing the area under the receiver operating characteristic (ROC) curve (AUC) for each scoring system individually using the method of DeLong. An X-tile analysis was used to determine the optimal cut-off point for each scoring system, and the patients were grouped by the cut-off point, and Kaplan-Meier curves and log-rank test were applied to analyze their long-term survival. Results    Compared with the sequential organ failure assessment (SOFA) score, acute physiology score-Ⅲ (APS-Ⅲ, P<0.001), the simplified acute physiology score-Ⅱ (SAPS-Ⅱ, P<0.001) and logistic organ dysfunction score (LODS, P<0.001) were more accurate in distinguishing sepsis. Compared with the non-septic group, the 10-year overall survival rate of the septic group was lower (P<0.001). Except for the systemic inflammation response score (SIRS) system, the 10-year overall survival rates of patients in the high risk layers of SOFA (HR=2.50, 95%CI 2.23-2.80, P<0.001), SAPS (HR=2.93, 95%CI 2.64-3.26, P<0.001), SAPS-Ⅱ (HR=2.77, 95%CI 2.51-3.04, P<0.001), APS-Ⅲ (HR=2.90, 95%CI 2.63-3.20, P<0.001), LODS (HR=2.17, 95%CI 1.97-2.38, P<0.001), modified logistic organ dysfunction score (MLODS, HR=2.04, 95%CI 1.86-2.25, P<0.001) and the Oxford acute severity of illness score (OASIS, HR=2.37, 95%CI 2.16-2.60, P<0.001) systems were lower than those in the low risk layers. Conclusion    Compared with SOFA score, APS-Ⅲ score may have higher value in the diagnosis of sepsis in patients who undergo isolated CABG, a valve procedure or a combination of both. Except for SIRS scoring system, SOFA, APS-Ⅲ, SAPS, SAPS-Ⅱ, LODS, MLODS and OASIS scoring systems can be applied to predict the long-term outcome of patients after cardiac surgery.

Objective    To explore the hemodynamic effects of inhaled nitric oxide (iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease (CHD) combined with decreased pulmonary blood flow. Methods    From 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure (SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5 (9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group (33 patients, conventional therapy only) and a combined therapy group (28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared. Results    There was no statistical difference between the two groups in demographic characteristics and surgical parameters (P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score (VIS, 21.6±6.6 vs. 17.3±7.2, P=0.020) along with the increase in blood pressure (SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001) , the decrease in central venous pressure (10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate (2.2±1.7 mmol/L vs. 1.2± 0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant (22.1±7.9 vs. 20.0±8.5, P=0.232). Besides, we discovered that the need for renal replacement therapy (RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery (RACHS-1) ≤3] subgroup (9.5% vs. 40.7%, P=0.016). Conclusion    In pediatric patients after corrective repair of cyanotic and pulmonary blood follow decreased CHD with increased pulmonary vascular resistance, iNO combined with conventional therapy can improve the hemodynamics effectively. Compared with the conventional therapy, the combined therapy with iNO can decrease the VIS and the need for RRT, which is beneficial to the postoperative recovery of patients.

Objective    To identify the risk factors of postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot (TOF) and to develop nomogram predicting the risk of postoperative blood loss. Methods    A retrospective case-control study was conducted in pediatric TOF patients who underwent corrective operation in our hospital from November 2018 to June 2019. And the clinical data from each enrolled patient were gathered and analyzed. Clinically significant postoperative blood loss was defined as drainage volume from chest tube ≥ 16 mL/kg during the first 24 h after surgery, which corresponded to the 75th percentile of the blood loss in our population. The primary outcome was to determine the independent predictors of postoperative blood loss by the least absolute shrinkage and selection operator (LASSO) regression, univariate and multivariate logistic regression analysis. On the basis of the independent predictors of postoperative bleeding, nomogram was developed and its discrimination and calibration were estimated. Results    A total of 105 children were selected (67 males and 38 females aged 3-72 months). The drainage volume from chest tube in the bleeding group was significantly higher than that in the non-bleeding group during the first 24 h (P<0.000 1). Multivariate logistic regression analysis showed that low body weight (OR=0.538, 95%CI 0.369-0.787, P=0.001), high preoperative hemoglobin concentration (OR=1.036, 95%CI 1.008-1.066, P=0.013) and prolonged intraoperative aortic cross clamp time (OR=1.022, 95%CI 1.000-1.044, P=0.048) were independent risk factors for postoperative blood loss. In the internal validation, the model displayed good discrimination with a C-index of 0.835 (95%CI 0.745-0.926) and high quality of calibration plots in nomogram models was noticed. Conclusion    The nomogram demonstrated good discrimination and calibration in estimating the risk of postoperative blood loss among pediatric patients following corrective operation of TOF.