Objective To detect the effect of Danhong injection on cerebral vascular hemodynamic parameters, Cys-c and Hcy in patients with transient cerebral ischemia(TIA), and analyze its clinical effect. Methods 80 TIA patients were selected. The patients were divided into a control group and a Danhong injection observation group with 40 cases each group. The control group was given conventional treatment, and the observation group was given conventional treatment and Danhong injection. The treatment course was 14 d. The hemodynamic parameters, Cys-c and Hcy expresssion were observed. Clinical effect was analyzed. Results After treatment, average blood flow speed (20.07 ± 4.28 cm/s vs. 16.17 ± 2.46 cm/s, t=5.230), average blood flow (11.14 ± 2.24 ml/s vs. 9.54 ± 1.65 ml/s, t=3.637), and cerebral vascular resistance (1 602.4 ± 98.3 kPa/s·m-1 vs. 1 738.5 ± 104.3 kPa/s·m-1, t=6.024) was significantly improved in the observation group than those in the control group (P<0.05). Cys-c (0.48 ± 0.11 mg/L vs. 0.71 ± 0.14 mg/L, t=8.170) and Hcy (17.45 ± 3.26 μmol/L vs. 23.62 ± 4.12 μmol/L, t=7.428) were significantly decreased in the observation group than those in the control group (P<0.05). The recurrence rate of TIA and cerebral infarction were 7.5% and 5% in observation group, which were significantly lower than that of 22.5% and 15% in control group (χ2=2.451, P<0.05;χ2=2.630, P<0.05).Conclusion Danhong injection can reduce the expression of Cys-c and Hcy and recurrence rate of TIA and cerebral infarction.

Objective To explore the predictive value of serum CEA and cytokeratin-19 fragments (CYFRA21-1)prior treatment for the epidermal growth factor receptor (EGFR) mutation and efficacy of tyrosine kinase inhibitors ( TKI ) in patients with non-small cell lung cancer.Methods The study was a clinical research.Totally 101 matched tissue and plasma samples were collected from Peking University People′s Hospital from 2012 to 2013.All clinical specimens were analyzed for EGFR mutations in exons of 18, 19, 20 and 21 by ADx-ARMS and direct sequencing, and the serum levels of CEA and CYFRA21-1 were analyzed by ECLI.The correlation between EGFR mutant status and efficacy of EGFR-TKI and clinicopathological parameters were analyzed by χ2 test, Log-rank text and Cox proportional hazards regression model.Results The mutation rate was 60.4%(61/101) by ADx-ARMS and 33.7%(34/101) by direct sequencing.Mutations were more frequently observed in the higher serum CEA level patients(≥5μg/L,78.8%).However, the rates of EGFR mutations of different CEA levels were similar.Among the patients receiving TKI therapy, the efficacy of EGFR-TKI was closely related to serum CYFRA21-1 level prior treatment and EGFR mutation (χ2 =8.903, P =0.003; χ2 =28.590, P <0.001 ).And serum CYFRA21-1 level prior treatment and EGFR mutation were independent factors for EGFR-TKI treatment affecting PFS (RR=0.298, P<0.001;RR=0.086, P<0.001).Conclusion The mutation rate of EGFR was significantly related with the expression level of CEA prior treatment, and serum CEA and CYFRA21-1 levels prior treatment could be potential predictors of EGFR-TKI efficacy.

Objective To investigate the clinical characteristics of the human Adenovirus (HAdv) infections in allogeneic hematopoietic stem cell transplantation ( allo-HSCT) patients and explore the clinical significance of HAdv monitoring .Methods A total of 845 cases underwent allo-HSCT were included retrospectively in Perking University People′s Hospital from October 2012 to August 2014.Peripheral blood HAdv load were monitored twice weekly within 100 days after allo-HSCT, or whenever necessary quantitatively by real-time PCR. Meanwhile, other clinical samples such as stool , urine, and bronchoalveolar lavage fluid ( BLAF ) were also detected qualitatively whenever necessary .The follow-up period was at least six months after allo-HSCT.All clinical data were collected and analyzed .Results The total positive rate of HAdv was 3.4% ( 29/845 ) .The incidence of HAdv infection was higher in children [3.8%(6/155), <18y] than that of adults [3.3%(23/690),≥18y].HAdv infection diagnosed within 100 days after allo-HSCT accounted for 72.4%(21/29) of the total number of positive cases .There were 19 cases detected positive in peripheral blood , 16 cases in stool , 9 cases in urine , and 1 cases in BLAF , respectively.One patient was positive in peripheral blood , stool and urine.The overall median time of HAdv was 69 (13-189) d.The median time was 56 (53 -144) d in stool ,which was earlier than that of in peripheral blood , urine and stool.Among 29 cases of HAdv positive patients , 17 patients were coinfected with Cytomegalovirus(CMV) and 11 casess with Epstein-Barr virus(EBV).Twenty-five cases of HAdv were diagnosed with acute graft-versus-host disease(aGVHD) before HAdv infection, and 4 cases were diagnosed with chronic graft-versus-host disease ( cGVHD ) . The most common clinical manifestation was HAdv enteritis (14 cases), followed by hemorrhagic cystitis (7 cases).Two cases complicated with multiple organ injury ( >2 ) clinically, 1 cases with pneumonia.There were 8 cases of death at the end of follow-up.Conclusions HAdv is an important pathogen causing infection in patients after allo-HSCT. The infenction is characterized with multiple organ involvement .CMV and EBV coinfection is common .HAdv monitoring was of great significance in allo-HSCT patients.

Objective To evaluate the feasibility of precise hepatic segmentectomy or subsegmentectomy using intraoperative image-guided interventional intravascular segmental vessel balloon catheter occlusion of the segmental hepatic artery and portal vein.Methods 6 patients with liver resection carried out from 2011.3-2011.8 were retrospectively analyzed.Results The mean operating time was (270.83±21.31) min,the median of blood loss was 800 ml,the median of intraoperative transfusion volume was 450 ml.The tumors were mainly located in segments Ⅴ,Ⅵ,Ⅶ,Ⅷ.The mean diameter of tumor was (5.67±1.03) cm.Postoperative liver function in the first postoperative day showed the mean alanine aminotranferase (ALT) was (570.00±157.76) U/L,the mean aspirate aminotrarsferase (AST) was (410.00 ±189.94) U/L,and the mean total bilirubin (TBIL) was (10.83± 1.60) mmol/L.Liver function recovered to normal within 7 days.There was intestinal leakage and wound dehiscence in one patient,pleural and effusion in two patients.Conclusion Imageguided interventional intravascular segmental vessel balloon catheter occlusion was a safe and efficacious maneuver.This technique allowed hepatic segmentectomy or subsegmentectomy to be carried out,decreased intraoperative bleeding,and protected the function of the liver remnant.

Objective To investigate the effects of open reduction and internal fixation plus calcium sulfate artificial bone graft for the treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures.Methods Thc clinical data of patients with Sanders type Ⅲ and Ⅳ calcaneal fractures treated from January 2012 to December 2015 were retrospectively reviewed by case-control study.The patients were divided into two groups as bone graft group (open reduction and internal fixation combined with artificial bone graft) and control group (open reduction and internal fixation).The bone graft group was composed of 17 cases,among which there were 12 males and five females with age range of 19-62 years [(41.6 ± 12.9) years].In bone graft group,there were 12 cases of Sanders Ⅲ and five cases of Sanders Ⅳ.The control group was composed of 13 cases,among which there were eight males and five females with age range of 20-59 years [(39.4 ± 11.8) years].In control group,there were ten cases of Sanders Ⅲ and three cases of Sanders Ⅳ.The follow-up visits were done at 1,2,3,6,and 12 months after surgery with record of complication occurrence.The changes of Bohler's angle and Gissan's angle were observed preoperatively as well as at 2 days and 12 months after surgery.The function recovery was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up visit.Results Five cases of marginal necrosis of the incision and two cases of superficial soft tissue infection were seen in bone graft group,while there were two cases of marginal necrosis of the incision and one cases of superficial soft tissue infection in control group.In early postoperative comparison between two groups,the variation of Bohler's angle and Gissan's angle had no significant difference (P ＞ 0.05).At 12 months after surgery,Bohler's angle of bone graft and control groups were (23.2 ± 9.0) ° and (19.5 ± 11.1) °,respectively.The losses of Bohler's angle were (3.6 ± 2.7) ° and (6.9 ± 3.1) °,respectively.The difference in the losses of angle in two groups had statistical significance (P ＜ 0.05).Gissan's angle of bone graft and control groups were (123.4 ± 9.4)o and (122.2 ± 9.0)°,respectively.The losses of Gissan's angle were (2.8 ± 1.8) °and (3.8 ± 2.3) °,respectively (P ＞ 0.05).At the final follow-up,bone union was found in all cases,and there was no significant difference in AOFAS score between the two groups (P ＞ 0.05).Conclusions Open reduction and internal fixation can attain good treatment results for Sanders type Ⅲ and Ⅳ calcaneal fractures,no matter whether bone graft is carried out.However,artificial bone graft may have good effects to sustain the stability of fracture fragments and provide early mechanical support for the subtalar joint.

Objective To evaluate whether the patients with Parkinson′s Disease (PD) having higher occurrence rate of frac-ture .Methods CMB ,CNKI ,PubMed ,Embase ,Web of Science ,Medline ,Embase and Cochrane Library were retrieved ,meanwhile which was assisted by the manual retrieval .The retrieval time was until February 2017 .The cohort studies on the occurrence rate of fracture in PD patients were collected .Then the included studies were analyzed after the data extraction and treatment evaluation . Results A total of 1160 articles were retrieved ,finally 11 cohort studies were included ,involving 988723 subjects .The analysis showed that the fracture occurrence risk in PD patients was significantly higher than that in the control group (RR=2 .09 ,95% CI:1 .91-2 .28) ,in which the occurrence rate of hip fracture was significantly higher than that in the control group (RR=2 .33 ,95%CI:1 .79-3 .02) ,while the occurrence rate of spinal fracture had no statistical difference (RR=1 .33 ,95% CI:0 .78-2 .27) ,and the fracture occurrence risk in male and female patients of PD group was significantly higher than that in the control group (RR=2 .40 , 1 .69 ,95% CI:2 .21-2 .60 ,1 .62-1 .76) .Conclusion The fracture occurrence risk in PD patients is significantly higher than that in the control group ,due to existence of certain geographic bias and publication bias risk ,it is needed more high quality clinical stud-ies to accurately evaluate whether the fracture risk in PD patients being much higher .

Objective To investigate germline mutation of breast cancer susceptibility genes BRCA1/2,TP53 and PTEN in Chinese breast cancer patients. Methods All of128 female breast cancer patients in Peking University People′s Hospital from January 2016 to August 2018 were selected as objects. Among them,44 cases were sporadic breast cancer and 84 werebreast cancer patients with genetic high risks. Germline mutations of BRCA1,BRCA2,TP53 and PTENwere detected by NGS.χ2 test was used to analyze the difference of pathogenic mutation rates between sporadic breast cancer group and breast cancer with high genetic risks.Groups were divided according to the clinical features of the patients(family history, triple-negative breast cancer,age and bilateral breast cancer).Among them,there were 42 cases with family history of breast cancer,34 cases of triple-negative breast cancer,33 cases of early-onset breast cancer and 7 cases of bilateral breast cancer. Fisher′s exact probability test compared the relationship between pathogenic mutations of BRCA1/2 gene and clinical characteristics of breast cancer patients with hereditary risk factors. Results In 128 cases of breast cancer,30 germline mutations of BRCA1/2 were detected, including 13 pathogenic mutations and 3 newly discovered mutations(BRCA1:c. 4760C>G,BRCA2:c. 44134414del and BRCA2:c. 64826485del). The new mutations may be unique mutations of Chinese population. There were 3 cases of TP53 mutations,including 1 pathogenic mutation. All of the 3 mutations were found in early-onset breast cancer. Germline mutation of T53 has important detection significance for early-onset hereditary breast cancer. There were 5 cases of PTEN mutations,including 3 pathogenic mutations. Among 84 breast cancer patients with genetic high risks,the carry mutation rate was 40.5％(34/84)and the pathogenic mutation rate was 15.4(13/84). Among 44 sporadic cases,the carry mutation rate was 9％(4/44). The pathogenic mutation rate was 6.8％(3/44). Breast cancer susceptibility genes were carried at a higher rate in breast cancer patients with genetic high risks(P<0.001). BRCA1/2 mutations did not show statistical differences among groups of breast cancer patients with hereditary high risk factors . Conclusion Germline mutation detection of breast cancer susceptibility genes by next-generation sequencing is of great significance in breast cancer risk prediction and prognosis evaluation.

Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture.Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016.There were 24 males and 17 females,aged 24-70 years [(46.3 ± 13.1)years].According to AO/OTA classification,fractures weres was AO/OTA type 42A1 in 29 cases,type 42A2 in nine cases,type 42A3 in two cases,and type 43A1 in one case.All patients were treated with plate and screw fixation.According to the method of plate fixation,the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients),the LCP bridge fixation group (12 patients) and the LCP + dynamic double thread locking screw (DDTL) bridge fixation group (15 patients).The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1,2,3,6 months and 1 year after operation.The operation time,time to radiological fracture union,time to full weight bearing,callus index and complications were analyzed.Results All the patients were followed up for 12-18 months [(14.5 ± 2.0)months].In the LCP absolute fixation,LCP and LCP + DDTL groups,the operation time was (74.3 ± 15.6) minutes,(78.6 ± 20.1) minutes and (82.5 ± 24.6) minutes,respectively;the time to radiological fracture union was (4.3 ± 1.5) months,(4.5 ± 1.3) months and (4.6 ± 1.4) months,respectively;the time to full weight bearing were (3.4 ± 0.7) months,(3.5 ± 0.6) months and (3.6 ±1.1) months,respectively (all P ＞ 0.05).There was no significant difference in complication incidence among the three groups (P ＞ 0.05).However,the callus index in the LCP + DDTL group (1.19 ±0.13) was significantly higher than that of the LCP absolute fixation group (1.08 ±0.06) and that of the LCP group (1.09 ± 0.09) (P ＜ 0.05).Conclusion For simple distal tibia fracture,both absolute and bridging fixation can attain good fracture union,and LCP combined with DDTL can better promote the formation of callus and facilitate the union.

Objective: To analyze CYP2C9 and VKORC1 gene polymorphisms in Chinese Han population and their correlation with the maintenance dosage of warfarin. Methods: From October 2017 to April 2018, 458 Chinese Han patients (213 males and 245 females, aged from 26 to 94 years old) who underwent coagulation analysis in Peking University People′s Hospital were included in this retrospective study. PCR-Fluorescent probe method was applied to detect CYP2C9*3 and VKORC1-1639A>G gene polymorphisms in 458 patients, and among them, 130 patients who took warfarin for anticoagulant therapy and reached the international standard ratio of prothrombin time (INR) within the range of 2.0-3.0 were recorded. The basic information, dosage of warfarin and INR were also recorded. The statistical analysis data were compared with the reference table of recommended dosage of warfarin for different genotypes of patients recommended by FDA and the formula of predicted dosage of warfarin was simply verified by SPSS. Results: Among the 458 patients who took anticoagulant therapy, the genotype frequencies of CYP2C9*1/*1(AA), CYP2C9*1/*3(AC) and CYP2C9*3/*3(CC) were 90.8%, 8.5%, and 0.7%; the genotype frequencies of VKORC1-1639GG and VKORC1-1639AG were 0.9% and 14.2%; the genotype frequencies of VKORC1-1639AA was 84.9%. After INR was reached, the results showed that the variant CYP2C9*1/*3 and CYP2C9*3/*3 required lower daily maintain dosage [(2.92±1.29) mg] than wild-type CYP2C9*1/*1 patients did [(3.91±1.63) mg], with statistically significant difference (P=0.018). And variant VKORC1-AA required lower daily maintain dosage [(3.68±1.64) mg] than variant VKORC1-AG patients did [(4.54±1.29) mg], with statistically significant difference (P=0.001). The application dosage of warfarin in patients with different VKORC1+CYP2C9 genotypes was consistent with the recommended dosage of the FDA reference table. The prediction accuracy of miao 2007 formula was lower than that of IWPC formula, and 94.1% of patients′ dosages of warfarin were underestimated. Conclusion Patients with CYP2C9*3 or VKORC1-AA genotype required lower warfarin dosage. The CYP2C9 and VKORC1 gene polymorphisms had a certain correlation with maintenance dosage of warfarin.

Objective To determine the distribution of common deafness gene mutations by microarray-PCR in pregnant women of Beijing, then explore their prevalence and clinical significance. Methods Totally 1709 pregnant women were prospectively enrolled from the outpatients of Obstetrical Clinical from Peking University Peoples' Hospital in this study from June 2016 to April 2018. Peripheral blood samples were obtained and DNA templates were extracted from all subjects. The coding region of the GJB2 gene(35del G, 235delC, 176-191del16, 299-300delAT), SLC26A4 gene(IVS7-2 A>G, 2168A>G), 12sRNA gene(1494C>T,1555A>G) and GJB3 gene(538 C>T)were detected by microarray-PCR. Meanwhile,256 cases firstly recruited in this study were confirmed by Sanger sequencing. The analysis was performed to explore the distribution of deafness gene mutations and the subjects detected to be positive were further followed up until they had given birth to their babies.Results Among 1709 pregnant women, 89 cases were found to be carrying at least one mutation sites(5.21％).Among them,83 cases were heterozygous mutation(35 cases of GJB2235delC, 12 cases of GJB2299-300delAT mutation, one case of GJB2176-191del 16, 30 cases of SLC26A4 IVS 7-2 A>G, 3 cases of SLC26A42168 A>G and two cases of GJB3538 C>T). There were one case of 235delC homozygous mutation and 2 cases of double mutations(IVS7-2 A>G /GJB2299-300delAT, IVS7-2 A>G/GJB2235delC). The positive rate of 235delC, 299-300delAT and 176-191del16 was 2.17％, 0.76％and 0.06％, respectively. As to SLC26A4, 1.87％of the pregnant women were carrying IVS 7-2 A>G and 0.18％for 2168 A>G. Two cases were detected carrying GJB3 C>T mutation and three for 12s RNA1555 A>G mutation, respectively. The results of microarray-PCR were identical to those of Sanger sequencing, with the coincidence of 100％.26 spouses of the 56 cases were followed up. Two proved to be carrier of the same gene mutation. One of their babies was born with normal hearing until the end of this research, while another baby was born deafness and implant cochlear when three month old. Conclusions GJB2235delC and SLC26A4 IVS 7-2 A>G were the most prevalent mutations in pregnant women of Beijing, and it may provide guidance to eugenics and early clinical intervention.