Objective To evaluate endothelium-dependent dilation (flow-mediated dilation, FMD) and endothelium-independent dilation(nitroglycerin-mediated dilation, NMD) of the brachial and superficial arteries in elderly patients with atherosclerotic disease(LEASD) of the lower extremity, and to evaluate the correlation between brachial and superficial femoral FMD and NMD and their characteristics. Methods Both FMD and NMD of the brachial artery and the superficial femoral artery were determined in 33 old LEASD patients with the high-resolution ultrasound, and the results were compared with that of 40 healthy elderly controls and 30 non-LEASD elderly patients with cardiovascular risk factors, respectively. Results Both FMD and NMD of the brachial artery and the superficial femoral artery were significantly lower in 33 elderly LEASD patients compared with those of 40 healthy elderly controls and 30 non-LEASD elderly patients but with cardiovascular risk factors (P

Objective To investigate the effects between the modified and classic coracoid approach in infraclavicular brachial plexus nerve block.Methods Sixty patients scheduled for elective surgical procedures under infraclavicular brachial plexus block were divided into observation group and control group by table of random digit method with 30 cases each.The puncture point of control group was approach via the point 2 cm medial and caudal to the coracoid process.The puncture point of observation group was modified by surface projection of the brachial plexus.Peripheral nerve stimulator was used to confirm the proper localization of the plexus.The performance time,number of puncture,anesthesia success rate,incidence of complications and 24 h patient satisfaction were recorded.Results The performance time in observation group was less than that in control group [(3.2 ± 1.1) min vs.(4.3 ± 1.4) min](P＜ 0.05).The chance of locating the brachial plexus in a single puncture without adjusting the block needle in observation group was significantly higher than that in control group [73.3％ (22/30) vs.50.0％ (15/30)] (P ＜ 0.05).There were no statistical differences in anesthesia success rate,incidence of complications and 24 h patient satisfaction between two groups (P ＞ 0.05).Conclusions The modified coracoid approach can significantly improve the probability of locating the nerve in one puncture that reduces the performance time.It can improve the accuracy of puncture point position on the body surface.

Atherosclerosis is a chronic inflammatory disease,with both the innate and adaptive immune systems responding to many endogenous and exogenous antigens.Subsequent investigations have revealed that an immunomodulatory strategy via active immunization against atherosclerotic plaque antigen(s) could potentially alleviate atherosclerosis.Substantial data from clinical investigations support the key role of immune system in atherosclerosis.So,it may be promising to develop immunotherapy against atherosclerosis.The paper reviews current status of immunization studies and possible associated immunemediated inflammatory mechanisms in atherosclerosis.

Objective: To observe the value of CT-guided accurate localization of small pulmonary nodule with memory alloy coils before video-assisted thoracoscopic surgery (VATS). Methods: Totally 92 patients (102 small pulmonary nodules) underwent localization of small pulmonary nodules with memory alloy coils before VATS were enrolled. VATS was performed within 24 h after localization. The localization effect and complications were observed. Results: The success rate of localization of 102 small pulmonary nodules was 98.04% (100/102), and the operation time of localization for each lesion ranged 8 min to 45 min, with the average time of (17.26±5.92)min. The memory alloy coils of 2 patients took off from lung tissue and remained in the chest wall in VATS. After localization, the incidence of small amount of pneumothorax was 10.78% (11/102), of small amount alveolar hemorrhage was 12.75% (13/102), whereas the patients had no symptom and untreated. VATS was successfully performed for 102 small pulmonary nodules without conversion to thoracotomy. Conclusion: CT-guided accurate localization of small pulmonary nodule with memory alloy coils before VATS is effective and safe.

Objective To investigate analgesic effects of the selective blocking of descending facilitation targeting μ opioid receptor positive neurons in the rostral ventromedial medulla ( RVM) in a rat model of bone cancer pain. Methods Forty-eight adult female Wistar rats weighing 180-200 g were randomly divided into 6 groups: group Ⅰ control ( n = 3) ;group Ⅱ bone cancer pain induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells ( n = 9) ;group Ⅲ-Ⅵ received a single intra-RVM micro-injection of PBS (group Ⅲ), dermorphin (group Ⅳ) , saporin (group Ⅴ) and dermorphin-saporin ( group Ⅵ) respectively at 28 days before intra-tibia inoculation ( n = 9 each) . Starting from 3 to 20 days after intra-tibia inoculation, mechanical allodynia was assessed and recorded. The animals were sacrificed on 7, 14 and 20 days after intra-tibia inoculation, after repetitive non-noxious tactile stimulation of the hindpaw. The total number of Fos-positive neurons in the spinal dorsal horn was measured as a marker indicative of central sensitization. Results The animals developed nociceptive hypersensitivity after intra-tibia cancer cell inoculation in group Ⅱ -Ⅵ . Nociceptive hypersensitivity was significantly decreased during 4-7 days after the onset of nociception in group Ⅵ (dermorphin-saporin). The number of Fos positive neurons in bilateral spinal dorsal horn was significantly increased by intra-tibia inoculation of cancer cells in group Ⅱ-Ⅵ as compared with control group and was significantly lower at day 14 and 20 after inoculation in group Ⅵ (dermorphin-saporin) than in group Ⅱ - Ⅴ.Conclusion Selective blocking of descending facilitation targeting μ opioid receptor positive neurons in RVM can effectively reduce nociceptive hypersensitivity induced by intra-tibia inoculation of Walker56 mammary gland carcinoma cells.

Objective To analyze the incidence and risk factors of hypocalcemia after total parathyroidectomy without autotransplantation. Methods A total of 783 maintenance hemodialysis patients who underwent TPTX in the Second Affiliated Hospital of Nanjing Medical University from September 2008 to September 2017 were included in the study. The preoperative blood biochemical examination, preoperative iPTH, total mass of parathyroid gland (M) and postoperative iPTH and electrolyte results were collected. The incidence of severe hypocalcemia after TPTX were analyzed retrospectively. Binary logistic regression model was used to analyze the risk factors of severe hypocalcemia after TPTX. Results The age of 783 patients with TPTX was (46.90±10.78) years old, and the average dialysis age was (91.36±41.75) months. Postoperative severe hypocalcemia occurred in 235 cases (30.01％). Binary logistic regression analysis showed that higher preoperative blood iPTH (OR=7.56, 95％CI: 1.55-36.79, P=0.01), higher blood alkaline phosphatase (OR=36.71, 95％CI:14.75-91.36, P<0.01), blood phosphorus (OR=1.74, 95％CI: 1.11-2.71, P=0.02) and greater mass of resected glands (OR=1.18, 95％ CI: 1.06-1.31, P<0.01) were the risk factors for post-hypocalcemia. The higher preoperative serum calcium can reduce the risk of postoperative hypocalcemia (OR=0.02,95％CI: 0.01-0.07, P<0.01). Conclusions The incidence of hypocalcemia after TPTX treatment for SHPT is very high. Blood iPTH, alkaline phosphatase, phosphorus, and total mass of intraoperative parathyroid gland excision are the independent risk factors for severe hypocalcemia after surgery.

The aim of this work was to test the effect of p16 on the proliferation of leukemic cells and its potential in gene therapy for leukemia. The full-length p16 cDNA was transfered by recombinant retrovirus vector into leukemia cell line K562, which is homozygous p16 deletion and retains functional retinoblastoma (RB) protein. The cell proliferation was tested in liquid and in soft agar culture after transduction of p16 retrovirus. The results showed a strong inhibition of cell proliferation. Phosphorylation of RB protein was also inhibited. The findings demonstrated that p16 (MTS/CDKN2) inactivation is a significant factor in the genesis and progression of leukemia and p16 could be a candidate gene for gene therapy in leukemia.

Objective:To investigate the clinical effect of programmed death receptor-1 (PD-1)/programmed death receptor ligand-1 (PD-L1) immunotherapy combined with concurrent radiotherapy and chemotherapy in the treatment of locally advanced cervical cancer (LACC).Methods:From November 2018 to October 2019, 51 LACC patients in Qinhuangdao First Hospital who received anti-PD-1/PD-L1 immunotherapy (pembrolizumab) combined with concurrent radiotherapy and chemotherapy [intensity modulated radiotherapy (IMRT)+ TP (taxol+ carboplatin) chemotherapy] were selected as the observation group. 51 LACC patients who received concurrent chemotherapy and radiotherapy were selected as the control group. The objective remission rate, disease control rate, tumor markers [squamous cell carcinoma antigen (SCCAg), soluble cytokeratin 19 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125)], proliferation and apoptosis indicators [survivin (Survivin), B-cell lymphoma-2 (Bcl-2), Caspase-3 (Caspase-3), apoptosis-promoting substance (Bax)], PD-1/PD-L1 [soluble PD-L1 (sPD-L1), CD4 + T cell surface PD-1 expression (PD-1 CD4 + T cells), CD8 + T cell surface PD-1 expression (PD-1 CD8 + T cell) and CD14 + monocyte surface PD-L1 expression (PD-L1 CD14 + monocyte)], safety and survival rate within 1 year were compared between the two groups. Results:(1) Disease control and safety: the objective response rate and disease control rate of the observation group were 80.39%(41/51) and 92.16%(47/51), respectively, which were higher than those of the control group by 39.22%(20/51) and 70.59%(36/51) (all P<0.05), but there was no significant difference in the incidence of side effects between the groups (all P>0.05). (2) Tumor markers and proliferation and apoptosis indexes: compared with those before treatment, the levels of serum SCCAg, CYFRA21-1, CEA, CA125, survivin and Bcl-2 in the two groups after treatment were significantly lower, and the levels of Caspase-3 and Bax were significantly higher; the above indexes in the observation group were better than those in the control group after treatment (all P<0.05). (3) PD-1/PD-L1: after treatment, sPD-L1, PD-1 CD4 + T cells, PD-1 CD8 + T cells and PD-L1 CD14 + monocytes in the observation group were significantly lower than those before treatment (all P<0.05). After treatment, the sPD-L1, PD-1 CD4 + T cells, PD-1 CD8 + T cells, PD-L1 CD14 + monocytes in the observation group were lower than those in the control group (all P<0.05). (4) Survival: the survival rate of the observation group was higher than that of the control group within 1 year ( P<0.05). Conclusions:The clinical effect of anti-PD-1/PD-L1 immunotherapy combined with concurrent radiotherapy and chemotherapy in the treatment of LACC is significant. It can effectively inhibit the progression of the disease by regulating tumor markers, proliferation and apoptosis indicators and PD-1/PD-L1 expression without increasing the risk of treatment, and has a positive effect on improving the survival rate of patients.

Objective:To investigate the relationship between CD8 +FoxP3 +CD25 + T cell subsets and the therapeutic effect of programmed death receptor 1 (PD-1) inhibitor pembrolizumab in treatment of uterine cervical cancer. Methods:The data of 105 patients with uterine cervical cancer who received pemblizumab therapy based on chemotherapy in the First Hospital of Qinhuangdao from January 2018 to January 2020 were retrospectively analyzed. Flow cytometry was used to detect the ratio of CD8 +FoxP3 +CD25 + T cell in peripheral blood of patients. The efficacy and safety were analyzed. According to the efficacy, all patients were divided into remission group (complete remission + partial remission) and non-remission group (stable disease + progressive disease). The clinical characteristics and CD8 +FoxP3 +CD25 + T cell ratio of the two groups were compared. Multivariate logistic regression model was used to analyze the influencing factors for the efficacy. The efficacy of CD8 +FoxP3 +CD25 + T cell ratio predicting the therapeutic effect of patients was analyzed by using receiver operating characteristic (ROC) curve. Results:The objective remission rate of all patients was 17.14% (18/105), and the incidence of adverse reaction was 39.05% (41/105). The proportion of patients with a family history of cervical cancer in the remission group was lower than that than in the non-remission group [5.56% (1/18) vs. 34.48% (30/87)], and the difference was statistically significant ( χ2=6.00, P=0.014). The proportion of CD8 +FoxP3 +CD25 + T cell of 105 patients before and after treatment was (0.83±0.21)% and (0.77±0.10)%, respectively; the proportion of CD8 +FoxP3 +CD25 + T cell before and after treatment in the remission group was (0.55±0.26)%, (0.31±0.12)%, respectively; the proportion of CD8 +FoxP3 +CD25 + T cell before and after treatment in the non-remission group was (0.89±0.30)%, (0.87±0.28)%, respectively. The proportion of CD8 +FoxP3 +CD25 + T cell after treatment in the remission group was lower than that before treatment ( P < 0.05); there was no statistically significant difference in the proportion of CD8 +FoxP3 +CD25 + T cell before and after treatment in the non-remission group ( P>0.05). The proportion of CD8 +FoxP3 +CD25 + T cell before and after treatment in the non-remission group was higher than that in the remission group (all P<0.001). The proportion of CD8 +FoxP3 +CD25 + T cell higher than the mean value of both groups before treatment and the proportion of CD8 +FoxP3 +CD25 + T cell higher than the mean value of both groups after treatment were independent risk factor of disease remission ( OR=2.542, 95% CI 1.649-3.918, P<0.001; OR=2.936, 95% CI 2.154-4.002, P<0.001). ROC curve analysis showed that the area under the curve of CD8 +FoxP3 +CD25 + T cell ratio predicting the disease remission before treatment was 0.720, and its best cut-off value was 0.77%, the senfitivity was 77.78%, the specificity was 70.11%. Conclusions:Early detection of CD8 +FoxP3 +CD25 + T cell ratio helps to predict the effect of PD-1 inhibitor pembrolizumab therapy for uterine cervical cancer.

Objective Although aspirin resistance has been recognized to occur in patients with diabetes mellitus, the prevalence and related risk factors for aspirin resistance in elderly patients with diabetes mellitus have not been reported yet. The purpose of the present study was to evaluate the prevalence and potential risk factors for aspirin resistance in elderly patients with type 2 diabetes.Methods The 140 elderly patients [aged from 60 to 92 years, mean age (73.8±8. 0) years] with type 2 diabetes receiving daily aspirin therapy (≥ 75 mg) over one month were recruited. Platelet aggregation was measured by light transmittance aggregometry (LTA) and thrombelastograph (TEG)platelet mapping assay. Results By LTA, 6 patients (4.3%) of the diabetic patients were found to be resistant to aspirin therapy, 44 patients (31.4 %) were semi-responders. By TEG, 31 patients (22. 1%) were aspirin resistant. Among the 31 patients who were aspirin resistant by TEG, 3 were aspirin resistant by LTA. In the multivariate logistic regression analysis, female gender (OR= 5. 54,95%CI: 1.17-27.47, P=0.036) and homocysteine level (OR=1.15, 95%CI: 1.00-1.35, P=0. 043) were statistically significant risk factors for aspirin resistance by TEG. Conclusions The prevalence of aspirin resistance in elderly patients with type 2 diabetes is considerably higher in elderly female patients and in elderly patients with higher serum homocysteine level.