Objective To investigate and compare the plasma concentrations of adenosine in patients taking ticagrelor versus clopidogrel after percutaneous coronary intervention (PCI) and its influence on occurrence of adverse clinical events.Methods The study enrolled 180 patients who had received PCI in the Tianjin First Center Hospital between June 2014 to July 2016.The patients were divided into 2 groups as the ticagrelor group (n=90, patients given ticagrelor 90 mg twice daily) and the clopidogrel group (n=90, patients given clopidogrel 75 mg daily).The plasma concentration of adenosine was taken at 30 days and 90 days after PCI.The adenosine levels and clinical events were compared between the 2 groups.Results The adenosine concentration were higher in the ticagrelor group both at 30 days [(1.65±0.16) μmol/L vs.(0.71±0.08) μmol/L, P<0.01] and 90 days [(1.65±0.14) μmol/L vs.(0.72±0.06) μmol/L, P<0.01] than in the clopidogrel group.The rates of major adverse cardiocerebral events were lower in the ticagrelor group both at 30 days (3.3% vs.13.3%, P<0.05) and at 90 days (6.7% vs.15.6%, P<0.05) than in the clopidogrel group.No significant difference in bleeding complication between the 2 groups.Conclusions Ticagrelor increases the concentration of adenosine in patients after PCI which may have beneficial effect on reduction of clinical adverse events.

Objective To investigate the relationship between acute biliary pancreatitis (ABP) and anomalous pancreaticobiliary duetal union (APBDU). Methods 131 patients with ABP were enrolled to test the serum total bilirubin (TB), alanine amintransferase (ALT), aspartate amintransferase (AST), alkaline phosphates (ALP), γ-glutamyl transferase (γ-GT). All the patients received medical treatment, and then these tests were performed again. Thereafter, all the patients underwent selective surgery and intra-operative cholangiography was performed to observe the pancreaticobiliary duetal union. Results 27 patients (20.6%) with APBDU were found in 131 patients. Among them, 8 cases (29.6%) was B-P subtype (TypeⅠ), 16 cases (59.3%) was P-B subtype (TypeⅡ) , and the remaining 3 cases was mixed subtype (TypeⅢ). A significant decrease of ALT, AST, ALP, γ-GT after non-surgical treatment in both group of APBDU and NAPBDU was noted (P＜0.05). The serum levels of ALT, AST,γ-GT in APBDU patients were (71.81± 23.19) U/L, (47.85±27.87) U/L, (52.86±31.49) U/L, respectively; and in NAPBDU patients were (51.96±15.40) U/L, (40.77±16.58) U/L, (34.86±26.47) U/L. The difference was statistically significant (P＜0.05). Condusions APBDU is an important etiology of ABP.

Objectives To assess the clinical value of ultrasonography (US) and bioelectrical impedance analysis (BIA) in analyzing abdominal fat contents of obese children and adolescents through comparison with MRI. A correlation with other obese related metabolic parameters was conducted. Methods Ninety 7-17-y-old obese children and adolescents (60 boys and 30 girls with mean age of 9.6 ± 2.9 y and mean BMI of 24.5 ± 4.5 kg/m2) were recruited. Metabolic parameters were measured, and insulin resistance was estimated according to homeostasis model assess-ment (HOMA-IR). On the same day abdomen subcutaneous fat thickness (SFTUS) was measured by US. Body fat mass (FMBIA) and abdominal visceral fat area (VFABIA) were analyzed by bioelectrical impedance analysis (BIA). After obtaining informed consent, abdominal MRI was performed in 20 subjects. Each section of umbilicus level was analyzed by image threshold value segmentation using SigmaScan Pro 5 and abdominal subcutaneous fat area (SFAMRI) and visceral fat area (VFAMRI) were calculated. Results (1) A strong positive association was found between SFTUS and SFAMRI (P< 0.05), VFABIA and VFAMRI (P < 0.01) respectively. (2) FMBIA and SFAMRI, VFAMRI, SFTUS also showed significant correlations (P < 0.05). (3) VFAMRI showed extremely significant positive correlations with TG, Insulin,C-peptide and HOMA-IR (P < 0.01 ) ; SFAMRI was also correlated positively with them (P < 0.05). (4) SFTUS was correlated positively with UA (uric acid), Insulin, 2HIns (insulin measured at 2 hours after meal), C-peptide,2HC-peptide (C-peptide measured at 2 hours after meal) and HOMA-IR (P < 0.01). (5) VFABIA was correlated significant positively with UA, insulin, TG, 2HIns and HOMA-IR. FMBIA showed positive correlation with UA, Insulin,2HIns, C-peptide, 2HC-peptide and HOMA-IR. Conclusions abdominal subcutaneous and visceral fat of obese children and adolescents evaluated by US and BIA are correlated well with those assessed by MRI, and also correlated well with TG, insulin, C-peptide and other metabolic biochemical parameters. Our data support the value of using cost effective, simple and convenient methods such as BIA and US to evaluate the obese and related metabolic risk of children and adolescents in clinical practice.

Objective:To study the clinical outcome of lamellar keratoplasty combined with autogenous corneal stromal padding for treatment of corneal perforation.Methods:An observational case series study was conducted.A total of 14 patients (14 eyes) with corneal perforation underwent lamellar keratoplasty in Henan Provincial People's Hospital from January 2017 to August 2018 were collected.During the operation, the corneal stromal autograft was taken to pad the corneal perforation.Visual acuity, intraocular pressure, corneal epithelial healing time, infection recurrence, and the status of corneal graft and anterior chamber were recorded on the 1st, 7th, 14th day, 1st, 3rd, 6th, 9th and 12th month after operation.OCT examination of anterior segment was performed at 1 month, 6 and 12 months postoperatively to observe the interlamellar structure of corneal implantation bed and stromal graft, anterior chamber and iris.The safety and effectiveness of the operation were evaluated according to the 1-year follow-up.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[18]). Written informed consent was obtained from each patient prior to entering the study cohort.Results:The healing time of corneal epithelium was 2-4 days after operation, (3.01±0.59) days on average.At one day after surgery, all patients had normal anterior chamber depth without aqueous leak and no double chamber was observed.The corneal grafts attached to the implantation bed well and showed mild to moderate edema.There was no recurrence of corneal infection ulcer two weeks after operation, and the corneal ulcer was healed and anterior chamber was well formed in 14 patients.The corneal graft was transparent, and the anterior segment OCT image showed corneal implant bed and graft were well attached, and the anterior chamber depth was normal three months after operation.The best corrected visual acuity of 9 eyes was more than 0.3 one year after operation, and the vision acuity of the 14 patients improved obviously, and no refractory glaucoma occurred after operation.Conclusions:Lamellar keratoplasty combined with autogenous corneal stromal padding is a safe and effective surgical procedure for treating corneal perforation.

Objective:AFM1-BSA and AFM1-OVA were synthesized and then identified in this experiment.Methods: Using oximation method ,AFM1 was transformed to oxime compounds while the reaction process was monitored via TLC method aiming to identify the compounds.Coupled with carrier protein BSA and OVA respectively , we obtained AFM1-BSA and AFM1-OVA, then identified synthetic antigen via UV spectrophotometry and SDS-PAGE.Antigens were injected into experimental animals , finally obtaining the murine multi-antiserum.Eventually , the multi-antiserums were detected via indirect inhibition ELISA method to judge whether the antigens were effectively or not.Results:After oximation reaction ,the migration distance of oxime compounds in the thin layer plate was shorter.The maximum absorption peak of AFM1-BSA occurred in 274 nm,and was inconsistent with both UV absorption peaks of BSA and AFM 1.The electrophoretic velocity of AFM 1-BSA was less than that of BSA.All the titers of three immunized mice were 1×10-4 approximately;the multi-antiserum from No.3 sample had the best sensitivity ,its IC50 was 359.9 ng/ml.Conclusion:In this study,we obtained AFM1 artificial antigen and murine multi-antiserum of high sensitivity.

Apoptosis has been considered as the only form of regulated cell death for a long time. However, a novel form of programmed cell death called necroptosis was recently reported. The process of necroptosis is regulated and plays a critical role in the occurrence and development of multiple human diseases. Thus, the study on the molecular mechanism of necroptosis and its effective inhibitors has been an attractive field for researchers. Herein, we introduce the molecular mechanism of necroptosis and focus on the literature about necroptosis drug screening in recent years. In addition, the identification of the critical drug targets of the necroptosis is also discussed.

Objective To discuss the treatment of periprosthetic femoral fractures (PFF) with unstable prosthesis by replacement of long-stem femoral prosthesis and internal fixation.Methods From December 2005 to December 2014,15 PFF patients with unstable prosthesis (15 hips) following were treated at our department.They were 10 men and 5 women,aged from 64 to 89 years (mean,76.2 years).Their primary surgeries included total hip arthroplasty in 13 cases and biological bi-polar replacement of femoral head in 2.Two prostheses were cement and 13 biological.By Vancouver classification,9 cases were type B2,and 6 type B3.The unstable prostheses in the 15 cases were replaced by long-stem femoral ones,followed by internal fixation.At the last follow-ups,clinical outcome were evaluated by Harris scoring and images of PFF by Beals & Tower criteria.Complications were documented.Results One died 4 months after operation.The other 14 patients were followed up for an average of 4.5 years (from 6 months to 9 years).Fracture union was achieved in 12 cases after an average of 3.9 months (from 3 to 9 months).Nonunion occurred in 2 cases.Imaging evaluation revealed 9 excellent cases,3 good ones and 2 poor ones.The Harris scores at the last follow-up averaged was 82.3 points (from 50 to 100 points).Deep vein thrombosis occurred preoperatively in one case and posterior tibial vein thrombosis occurred in 2 cases respectively on day 3 and day 10 postoperatively.No such complications occurred as malunion,fixation failure,dislocation or prosthesis loosening.Conclusion Satisfactory outcomes can be achieved by replacement of long-stem femoral prosthesis combined with appropriate fixation for treatment of PFF with unstabrosthesis.

Objective To explore the reliability of Chinese simplified diagnostic method for acute drug‐induced liver injury (DILI) in diagnosis of acute DILI .Methods From 2008 to 2013 ,a total of 320 patients diagnosed with acute DILI were enrolled .The clinical data of them were collected .International recognized Roussel Uclaf causality assessment method (RUCAM ) was taken as control and then simplified diagnostic method for DILI in China was evaluated . Variance analysis was performed for statistical analysis .Gamma value of two diagnostic methods was calculated and the correlation was analyzed .Results Among the 320 patients with acute DILI ,according to RUCAM ,there were 39 cases (12 .19% ) with quite high probability ,193 with high probability (60 .31% ) ,74 with possibility (23 .12% ) ,11 with less possibility (3 .44% ) and three with no probability (0 .94% ) .According to simplified diagnostic method for acute DILI ,194 cases were diagnosed (60 .62% ) ,103 were suspicious (32 .19% ) and 23 were excluded (7 .19% ) .The RUCAM score of diagnosed group (7 .5 ± 1 .2) was higher than that of suspicious group (5 .3 ± 1 .3) and excluded group (2 .1 ± 1 .1) ,and the difference was statistically significant (F =239 .545 ,P< 0 .01) .The correlation analysis between these two diagnostic methods indicated that Gamma value was 0 .955 (P < 0 .01) .Conclusions The simplified diagnostic method for acute DILI in China is simple ,practical and consistent with RUCAM .It can be used as one of the clinical methods for screening acute DILI .

Objective To investigate the changes of hippocampal neurogenesis and cognitive dysfunction induced by cranial radiation therapy.Methods C57BL/6J mice aged 10 d were subjected to 10 Gy whole brain irradiation with 6 MV X-rays to develop irradiation-induced brain injury model.Morris water maze was designed to estimate spatial learning and memory.At different time post irradiation,brain tissue was removed to stain with hematoxylin-eosin for the pathological results.DCX and PCNA immunohistochemical staining was used to mark the level of neurogenesis in the hippocampus,and ED1immunohistochemical staining to mark the activation of microglia.The TUNEL assay was used to assess the apoptotic neuron death in situ in the hippocampus.Real-time PCR was supplied to inspect the expression of TNF-α and IL-1 β mRNA.Enzyme Linked Immunosorbent Assay (ELISA) was tested for the concentration of TNF-αt in the plasma.Results Pathological studies demonstrated that radiation could induce interstitial edema,inflammatory cell infiltration,cell degeneration,necrosis,apoptosis in the acute phase,edema subsiding,reduction of inflammatory cells,and cytothesis in the dentate gyrus of the hippocampus.IHC studies revealed that,at different time post irradiation,the number of DCX-positive cells and PCNA-positive cells decreased (F =4.9-12.5,5.2-15.7,P ＜ 0.05) but ED1-positive cells increased significantly (F =20.8,P ＜ 0.05).TUNEL-positive cells began to appear in the dentate gyrus of hippocampus 6 h post-irradiation,and its number reached to the highest level at 48 h post-irradiation (F =15.1,P ＜ 0.05).The formation of γ-H2AX foci got at the top 0.5 h post-irradiation (F =18.4,P ＜0.05) and then decreased.After irradiation,the expressions of TNF-α and IL-1β mRNA in the the irradiated group was higher than those of the control group (t =16.3,12.7,P ＜ 0.05).The concentration of TNF-α in the plasma of the irradiated group was higer than that in the control group 3 h post-irradiation,and maximized at 1 week post-irradiation (F =10.5,P ＜ 0.05).Morris water maze tests showed that the latency had no significant differences between the irradiated group and the control group at 1,2,3 d postirradiation,but the latency in the irradiated group was longer than that in the control group with a significant differences at 4,5,6 d post-irradiation (F =7.01,8.17,4.22,P ＜ 0.05).Conclusions Irradiation-induced cognitive dysfunction may be caused by microglial activation and suppression in hippocampal neurogenesis following cranial radiation therapy.

Objective To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of the myomatous hepatic angiomyolipoma (MHAML).Methods The retrospective cross-setional study was conducted.The clinicopathological data of 22 patients with MHAML who were admitted to the Southwest Hospital of the Third Military Medical University between January 2010 and June 2016 were collected.Patients underwent plain and enhanced scans of CT and MRI,and then received pathological examination after surgical resection or liver puncture and immunohistochemical staining.Observation indicators:(1) findings of CT and MRI,2 radiologists independently read films;(2) diagnostic consistency of 2 radiologists;(3) results of pathological examination.The Kappa test was used for evaluating the consistency,κ ≥0.75 as a good consistency,0.40＜κ＜0.75 as a normal consistency and κ ≤0.40 as a poor consistency.Results (1) Findings of CT and MRI:of 22 patients,16 received CT scans and 6 received CT and MRI scans.Tumors of 22 patients were single lesion,showing similar-circular type.Tumors located in the right liver lobe,left liver lobe and caudate lobe were respectively detected in 14,7 and 1 patients.① Plain and enhanced scans of CT:tumors of 22 patients showed low density.Twenty patients had clear boundary of tumor and 2 had an unclear boundary.Tumors of 22 patients demonstrated obvious enhancement in arterial phase by enhanced scans of CT,including fast-in and slow-out enhancement in 10 patients and fast-in and fast-out enhancement in 12 patients.The draining veins inside tumors were detected in 12 patients in early arterial phase by enhanced scans of CT.The dilated blood vessels inside tumors were found in 12 patients.The ring enhancement of tumor margin was detected in 16 patients,with formation of small blood vessels involving tumor blood supply.② MRI scan:tumors of 6 patients presented as low signal on T1WI and high signal on T2WI.Of 6 patients,5 had clear boundary of tumor and 1 had an unclear boundary.Tumors of 6 patients demonstrated obvious enhancement in arterial phase by enhanced scans of MRI,with a fast-in and fast-out enhancement.The draining veins inside tumors were detected in 3 patients in early arterial phase by enhanced scans of MRI.The dilated blood vessels inside tumors were found in 1 patient.The persistent ring enhancement of tumor margin was detected in 5 patients,with formation of small blood vessels.All the lesions of 6 patients using GD-EOB-DTPA MR contrast-enhanced scan demonstrated restricted diffusion with a high b value (b=800 s/mm2),an average apparent diffusion coefficient of 1.549× 10-3 mm2/s (1.209× 10-3-1.796× 10-3 mm2/s) and low a signal in liver phase.(2) Diagnostic consistency of 2 radiologists:there were good diagnostic consistencies of 2 radiologists in tumor location,density,T1WI,T2WI,bleeding,enhancement method and dilated blood vessels (κ=1.00,1.00,1.00,1.00,0.82,0.82,P＜0.05).There were normal diagnostic consistencies of 2 radiologists in tumor fat,calcification,component of cystolization,boundary,draining veins and enhancement of tumor margin (κ =0.46,0.45,0.64,0.54,P＜0.05).(3) Results of pathological examination:results of pathological examination of tumors from surgical resection of 17 patients and liver puncture of 5 patients showed that smooth muscle cells were the major components,and thick-walled vessels were found in the tumor of 12 patients.Results of immunohistochemical staining showed that anti melanoma specific monoclonal antibody (HMB-45) was positive.Conclusion The persistent enhancement of tumor margin,draining veins in early arterial phase by enhanced scans and dilated blood vessels might play roles in diagnosis of MHAML.