The chemoresistance of diffuse large B-cell lymphoma (DLBCL) is mainly due to drug resistance. Studies have shown that DLBCL resistance is related to the resistance gene and its resistancerelated protein, cytokines, adhesion molecules, which led to drug resistance through signal transduction in the hematopoietic microenvironment.

OBJECTIVE:To investigate the status of the use of angiotensin Ⅱ receptor blocker(ARB)in the outpatient of our hospital,and provide reference for the clinical rational drug use. METHODS:Totally 2 460 prescriptions of hypertension treated by ARB drugs in the outpatient of our hospital in 2013 were statistically collected,and the use of such drugs were comprehensively an-alyzed. RESULTS:The ratio of ARB in the treatment of hypertension in the outpatient of our hospital in 2013 was 36.22%,and the common ARB drugs were Irbesartan tablets,Irbesartan and hydrochlorothiazide tablets,Valsartan capsules and Telmisartan tab-lets. The prescriptions of hypertension in our hospital were mostly two-drug combination,the common combination of ARB drugs were ARB+calcium channel blocker(CCB)and ARB+potassium-sparing diuretics;the three-drug combination of ARB drugs were ARB+β-receptor blockers (β-RB)+CCB and ARB+CCB+potassium-sparing diuretics. Among 2 460 prescriptions of hypertension treated by ARB drugs,1 103 prescriptions were irrational,accounting for 44.84%;77 prescriptions were ARB combined with po-tassium-sparing diuretics with no clear indication,accounting for 6.98%;39 prescriptions were ARB combined with ACEI with no clear indication,accounting for 3.54%;330 prescriptions were ARB combined with β-RB with no clear indication,accounting for 29.92%;617 prescriptions had inappropriate frequency of ARB use,accounting for 55.94%;and 40 prescriptions were other irra-tional use,accounting for 3.63%. CONCLUSIONS:ARB drugs are commonly used for hypertension patients in outpatient of our hospital. However,there are still many problems of irrational use in clinical treatment. Therefore,hospital should take appropriate interventions to promote the rational drug use through the joint efforts of physicians,pharmacists and hospitals.

Objective To determine the antagonism of dizocilpine maleate(MK-801) and taurine to glutamate metabolism disturbance induced by methylmercury(MeHg) in cerebrum.Methods Forty Wistar rats were randomly divided into five groups.The first group was the control group,the second one was low dose MeHg-exposed group and the third was high dose MeHg-exposed group,these three groups were given physiological saline respectively.The fourth group was subcutaneously injected with 0.3 ?mol/kg of MK-801 and the five group was subcutaneously injected with 1 mmol/kg of taurine.Two hours later,the control group was intraperitoneally given physiological saline,the second group was intraperitoneally given 4 ?mol/kg of methylmercury chloride,the third,fourth and five groups were given 12 ?mol/kg of methylmercury chloride.The administration above was given five times a week for 4 weeks.The contents of mercury and Glu and Gln and the activities of GS and PAG in pallium were determined.Results Compared with the control group,the activities of PAG and the contents of mercury and Glu in MeHg-exposed groups increased significantly,the activities of GS and the contents of Gln decreased significantly.Compared with high dose MeHg group,in MK-801 and taurine treated groups,no significant differences were seen in the contents of mercury,and the contents of Glu,the activities of PAG were decreased significantly,the contents of Gln and the activities of GS were increased significantly.Conclusion Methylmercury can disorder glutamate metabolism in cerebrum of rats,and MK-801 and taurine can effectively counteract the adverse effects of methylmercury.

Objective To observe the adverse effect of methylmercury on the cortex and cerebellum respectively as well as to approach the antagonisms of dextromethorphan(DM) and riluzole to the mercury-induced neurotoxicity.Methods Twenty-eight Wistar rats were randomly divided into 4 groups by weight,7 in each.The first group was the control group and the second group was methylmercuric chloride(MMC) group.The third and fourth groups were DM and riluzole group respectively.Both of the former groups were subcutaneously injected with saline.The third and fourth groups were subcutaneously injected with 13.5 ?mol/kg DM and 21.35 ?mol/kg respectively every other day.Two hours later,the animals in the control group were intraperitoneally given the injection of saline.From the second to fourth groups were injected with 12.0 ?mol/kg MMC.The administration of MMC above was given five times a week(from Monday to Friday),for 4 weeks as well as the administration of DM and riluzole every other day before injected with MMC(on Monday,Wednesday and Friday).Twenty-four hours after the last injection,7 rats in each group were sacrificed.The contents of Hg,Ca2+-ATPase in the cerebellum were determined.Results In MMC group,the contents of Hg,Glu and the content of Gln were decreased,the activities of SDH,Na+-K+-ATPase and Ca2+-ATPase were decreased compared with the control group.Compared with MMC group,in DM and riluzole groups,the contents of Hg,Glu decreased,the content of Gln increased,moreover,the activities of SDH,Na+-K+-ATPase and glutamate(Glu),glutamine(Gln) in the rat cortex and the activities of SDH,Na+-K+-AT Pase and Ca2+-AT Pase increased significantly.Conclusion "Glu-Gln Cycle" can be destroyed by MMC,DM and liluzole present some antagonistic effects on MMC-indused neurotoxicity in rats.

Objective To investigate the changes of peripheral blood T cell subsets and serum soluble interleukin-2 receptor (sIL-2R),vascular endothelial growth factor (VEGF) and LDH in patients with diffuse large B cell lymphoma,and to investigate their relationship of the cellular immune function,clinical stage and disease progression.Methods 35 cases of DLBCL patients were selected as observe group,20 cases of healthy individuals as normal control group.Peripheral blood T cell subsets were detected by flow cytometry.Serum soluble interleukin-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF) were detected by ELISA assay.Serum levels of LDH were detected by the rate method for measuring.Results The expression levels of CD4,NK cells and CD4/CD8 ratios in all patients with DLBCL were lower than healthy individuals [(68.62±12.82) ％ vs(73.00±6.12) ％,(14.28±7.93) ％ vs (39.49±12.01) ％,(1.03±0.84) vs (1.45±0.28),all P ＜ 0.05].Serum sIL-2R in patients with DLBCL was significantly higher than healthy individuals [(501.50±157.70).μg/L vs (128.30±82.40) μg/L,P＜ 0.001].Serum levels of sIL-2R with Ⅲ-Ⅳ stage in patients with DLBCL was higher than that in ones with Ⅰ-Ⅱ stage [(618.38±192.22) μg/L vs (432.45±75.48)μg/L,P ＜ 0.05].Serum expression levels of sIL-2R in patients with DLBCL with B symptoms was higher than that in ones with A symptoms [(616.50±183.03) μg/L vs (441.52±103.48) μg/L,P ＜ 0.01].The expression levels of VEGF,LDH in patients with DLBCL were higher than healthy individuals [(304.03±163.05) pg/ml vs (156.25±47.83) pg/ml,(300.74±300.91) U/L vs (177.00±32.14) U/L,both P ＜ 0.05].The high expression level of serum sIL-2R was correlated with low CD4/CD8 ratio (r =0.4635,P ＜ 0.05).The high expression levels of serum sIL-2R was correlated with the high expression levels of serum VEGF,LDH (r =0.447,P ＜ 0.05; r =0.448,P ＜ 0.05).Conclusion High expression levels of serum sIL-2R in DLBCL are closely associated to low cellular immune function,tumor burden in vivo,disease progression and invasion.

Research-oriented study is a comprehensive learning method focusing on the experimental process deriving from a main issue.Given our clinical teaching experience in years,we incorporated the research-oriented studies into the undergraduate Clinical Medicine course for grade 2009,integrating the trait of the clinical skills education and our local professional training objectives.In the studies,students selected their own topic,designed and did their experiments,searched for the information,processed and analyzed the experiment result and finally completed the thesis.Practice showed that after the strict implementation of research learning plan,students' learning interest,innovative thinking,practical skills,research ability and cooperation spirit all significantly enhanced.

Objective To investigate the correlation between expression levels of serum cytokines IL-2,IL-6, IL-8, IL-10, TNF-α and IFN-γ in patients with diffuse large B-cell lymphoma(DLBCL) and chemotherapy resistance. Methods 30 cases of DLBCL patients with chemotherapy resistant, 30 cases of DLBCL patients with chemotherapy sensitive and 20 cases of healthy individuals as normal control group were enrolled. The levels of serum cytokines IL-2, IL-6, IL-8, IL-10, TNF-α and IFN-γbefore, during and after treatment in both DLBCL groups and normal control group were detected by ELISA assay. Results The expression level of serum IL-6 and IL-10 before treatment in DLBCL patients with chemotherapy resistance was significantly higher than that in DLBCL patients with chemotherapy sensitive and normal control group (P ＜ 0.05), however,that after treatment in DLBCL patients with chemotherapy resistance was significantly lower than that before treatment (P = 0.02, P = 0.015). The level of serum IL-6 and IL-10 in patients with DLBCL recurrence into drug resistance was higher than that during of remission (P = 0.004, P ＜0.001). Before treatment, the expression level of serum IL-6 in patients with Ⅲ-Ⅳ stage in chemotherapy resistant group was significantly higher than that in ones with Ⅰ - Ⅱ stage(P ＜0.05). Levels of IL-2, IL-8, TNF-α and IFN-γin chemotherapy resistant group, chemotherapy sensitive group and the normal control group were no differences (P ＞0.05).Conclusion The expression levels of the serum IL-6 and IL-10 were closely correlated with the chemotherapy efficacy of DLBCL, they may be involved in drug resistance of DLBCL.

Objective To observe The clinical effect of Xingqihuoxue granule combined with low molecular weight heparin to prevent deep vein thrombosis after operation of lower limb fracture surgery.Methods60 patients from February 2014 to February 2015, were randomly divided into observation group 30 cases and the control group 30 cases.The control group received low molecular weight heparin, the observation group received Xingqihuoxue granule.Two groups of patients were followed up and recorded the changes related indicators.ResultsThe level of capillary plasma viscosity, hematocrit, red blood cell and aggregation index values of observation group patients after treatment were (1.52±0.11,41.78±2.30%, 2.19±0.16 points), than the control group (1.42±0.14,39.02±2.07%, 2.01±0.23 points), and the difference was significant (P<0.05).The level of platelets of observation group patients was (189.4±37.0)×10.9 / L, than the control group (259.3±40.1) × 10.9/L, and the difference was statistically significant (P<0.05).The level of PT and APTT of the observation group after treatment were (16.0±2.79,36.78±4.59) s, than the control group (13.96±2.94,33.14±4.47) s, and the difference was statistically significant (P<0.05).The adverse reaction ratio of observation group after treatment was 6.67%, lower than the control group 30.00%, and the difference was statistically significant (P<0.05).ConclusionsThe clinical treatment of Xingqihuoxue granule combined with low molecular weight heparin was better than low molecular weight heparin alone, and the side effects was lower.It is worthy of further research and application.

Objective To investigate the correlation between plasma pentraxin 3 (PTX3)and cardiovascular disease(CVD) in maintenance hemodialysis(MHD) patients.Methods Plasma was obtained from 98 MHD patients before and after a session of HD and 50 age-matched healthy subjects.Plasma PTX3 was measured by enzyme-linked immunosorbant assay (ELISA).Spearman correlation and linear regression were used to examine the correlation between plasma PTX3 level and other laboratory parameters.Binary Logistic regression was used to assess the correlation between plasma PTX3 level and CVD.Receiver operator characteristic (ROC) curve was used to analyze the correlation among PTX3, high sensitive C-reactive protein(hsCRP) and CVD.Results Plasma PTX3 level was significantly higher in MHD patients compared to healthy controls [1.87 (1.34-2.50) μg/L vs 1.11(0.86-1.51) μg/L, P＜0.01], and increased after a single HD session[post-HD 2.18(1.80-3.14) μg/L vs pre-HD 1.87(1.34-2.50) μg/L, P＜0.01].Patients with CVD had higher concentrations of PTX3 than those without CVD[2.18 (1.48-2.74) μg/L vs 1.76 (1.25-2.26) μg/L, P＜0.05].High plasma PTX3 (＞1.87 μg/L) was positively and independently associated with CVD[OR=3.15, 95％CI(1.17-8.50), P＜0.05].ROC curve analysis showed the PTX3 was more closely correlated to CVD than hsCRP in MHD patients with hsCRP ＞3 mg/L, and the area under the curve of PTX3 and hsCRP was 0.655 ±0.083(P＜0.05) and 0.562±0.083(P＞0.05) respectively.Plasma PTX3 level was negatively correlated with body mass index (ρ=-0.248,P＜0.05), pre-albumin(ρ=-0.218, P＜0.05), total cholesterol(ρ=-0.265, P＜0.01), triglyceride (ρ=-0.246, P＜0.05), LDL-cholesterol (ρ=-0.254, P＜0.05), hemoglobin (ρ=-0.212, P＜0.05), and positively with erythropoietin dose per week(ρ=0.184, P＜0.01), cardiac troponin T (ρ=0.287,P＜0.01), carotid artery intima-media thickness (ρ=0.294, P＜0.05).Conclusions PTX3 level ismarkedly elevated in HD patients.HD procedure induces PTX3 elevation.Plasma PTX3 could be auseful marker of CVD risk factors in MHD patients.

Objective To investigate the effects of repeated low dose intravenous infusion of low molecular weight iron dextran and iron sucrose on oxidative stress in chronic renal failure (CRF) rats. Methods CRF model was established by 5/6 subtotal nephrectomy (5/6 Nx). Four weeks after removing the right kidney, successful rats were randomly divided into low molecular weight iron dextran group, sucrose iron group and CRF control group. The sham group was established simultaneously. The dose of iron administrated in each rat was similar in iron dextran group and sucrose iron group. There were 6 rats in each group. Animals were observed for 6weeks, then the blood, urine and renal tissue samples were collected, and indexes of renal function,anemia, iron status and oxidative stress were investigated. Results The hemoglobulin (Hb) level in iron groups was significantly higher as compared to control group (P＜0.05) but was not significantly different between two iron groups. The levels of serum iron, ferritin and saturation rate of transferring (TS) were obviously lower in control group as compared to sham group (P＜0.05).Levels of above 3 indexes were significantly higher in two iron groups as compared to control group (P＜0.05), but were not significantly different between two iron groups. Concentration of plasma advanced oxidation protein products (AOPP) was obviously higher in two iron groups than that in control group [(127.84±21.19) μmol/L, (134.21±29.38) μmol/L vs (81.83±19.93) μmol/L, P＜0.05]. Plasma malonaldehyde (MDA) was significantly higher in iron sucrose group than that in iron dextran group [(6.06±0.73) nmol/L vs (4.99i0.80) nmol/L, P＜0.05]. Serum levels of superoxide dismutase (SOD) and total anti-oxidant capacity (TAOC) had no significant differences among three CRF groups. Concentration of plasma glutathione peroxidase (GSH-Px) was significantly decreased in three CRF groups as compared to sham group (P＜0.05), while plasma GSH-Px was significantly lower in sucrose iron group than that in iron dextran group and control group [(2123.11±74.78)nmol ·ml-1 ·min-1 vs (2352.84±163.90) nmol· ml-1 ·min-1, (2310.23±125.99) nmol ·ml-1 ·min-1, P＜0.05]. Conclusions Injection of intravenous iron can partially improve the anemia and the iron status indexes in 5/6 Nx CRF rats. Repeated low dose intravenous infusion of iron dextran and iron sucrose can aggravate the oxidative stress state in CRF rats, and the iron sucrose is worst.