Objective To compare the effects of ticagrelor and clopidogrel on patients undergoing percutane-ous coronary intervention(PCI)with acute ST elevated myocardial infarction (STEMI).Methods 120 patients with STEMI received PCI within 12h of symptom onset in our hospital were randomly divided into clopidogrel treated group (n=60)and ticagrelor treated group (n=60).Serum was collected before surgery and 36 hours after PCI for ALT, Cr,CK-MB,and MA.Cardiac ultrasound was examined,too.All patients were followed 6 months post-PCI for main adverse cardiovascular and cerebrovascular events (MACCE)and medicine side effect.Results No significantly difference was noted in baseline between the two groups.The level of CK-MB and MA in the ticagrelor treated group [CK-MB(56.5 ±8.3)U/L,MA (45.9 ±6.4)mm[and clopidogrel treated group[CK-MB(74.3 ±9.6)U/L,MA (35.6 ±7.3)mm]were significant difference (CK-MB,P=0.043;MA,P=0.038).The MACCE of patients in ticagrelor treated group were significantly lower than patients in clopidogrel treated group during post-PCI 6 months follow-up(The ratio of angina in ticagrelor group was 1.7%,while in clopidogrel group was 6.7%,P=0.042). Conclusion Ticagrelor is more effective in suppress the function of platelet,decrease MACCE in patients with STE-MI undergoing PCI.

Objective To observe the bone metabolism of psoriatic arthritis (PsA) and investigate the roles of some bone metabolism markers such as tartrate-resistant acid phosphatase 5b (TRACP5),C-terminal telopeptide of collagen-Ⅰ (CTX-Ⅰ) and BALP in PsA patients with bone destructions.Methods Sixty-five cases of psoriatic arthritis,30 cases of psoriasis and 30 cases of healthy people were enrolled.Bone mineral densities of lumbar spines and the left femoral necks were measured for all PsA patients using dual energy X-ray absorptiometry.The Serum levels of TRACP5b,CTX-Ⅰ,BALP of healthy controls,Ps and PsA patients were measured.The PsA group was further divided into bone destruction group and none bone destruction group by image datasets.The levels of TRACP5b,CTX-Ⅰ,BALP,PsAJAI,ESR and CRP from each group were detected.Mann-Whitney and x2 test were used for statistic analysis.Results TRACP5b levels of the healthy controls,Ps and PsA patients were (0.9±0.4),(0.7±0.5) and (2.0±1.4) U/L respectively,and were significantly higher in the PsA patients than those of the other two groups (Z=-3.698,-3.638; P＜0.05).The CTX-Ⅰ levels of these three groups were (0.9±0.8),(0.6±0.7) and (2.6±1.8) ng/ml respectively,and were also dramatically higher in the PsA patients than the other two groups (Z=-5.262,-5.734; P＜0.05).BALP levels of each group were (22±4),(22±4) and (25±7) U/L,and were also evidently higher in the PsA patients than patients in the other two groups (Z=-2.214,-2.000; P＜0.05).Meanwhile,the levels of TRACP5b [(2.6±1.4) U/L],CTX-Ⅰ [(3.1±1.8) ng/ml] and BALP [(26±7) U/L] were significantly higher in bone destruction group than those in the none bone destruction group [(1.2±1.0) U/L,(1.9±1.6) ng/ml,(23±6) U/L,Z=-3.544,-3.429,-2.083; P＜0.05].Conclusion The high levels of TRACP5b,CTX-Ⅰ and BALP in PsA indicate that there is bone metabolism imbalances in PsA.And the high levels of TRACP5b,CTX-Ⅰ and BALP in the bone destruction group suggest that the rises of TRACP5,CTX-Ⅰ and BALP levels may be related with bone erosions.

and adenovirns. The high rate of mixed viral infection brings clinical concern. ELISA combined with PCR improve the diagnostic sensitivity for norovirus, enteric adenovirns and astrovirus.

Objective To study the changes of neutrophil surface molecule CD64 and inflammatory factor levels in patients with burn infection. Methods 46 cases of patients with burn infection who were treated in the department of burn in our hospital between March 2010 and October 2015 were selected as the observation group. Meanwhile, 46 cases of healthy people who underwent physical examination in our hospital during the same period were included in the control group. The levels of neutrophil surface molecule CD64, C-reactive protein (CRP), white blood cell count (WBC) and inflammatory factor [interleukin IL-6 (IL-6), interleukin (IL-8), tumor necro-sis factor (TNF-α) in the two groups of subjects were determined by flow cytometry and were compared. Results In the observation group, the levels of CD64, CRP, WBC and inflammatory factors were significantly higher than those in the control group (P < 0.05). Conclusion The levels of CD64, CRP, WBC and inflammatory factors in patients with burn infection are significantly higher than those in healthy people , which indicates that neutrophil surface molecule CD64, inflammatory factors and burn infection are closely correlated.

OBJECTIVETo describe the morphological features of congenital heart defects and their spatial orientations to the neighboring structures in special two-dimensional echocardiographic views.

METHODSConventional two-dimensional echocardiographic sections were obtained in 45 patients with atrial septal defect (ASD) and 15 with ventricular septal defect (VSD) before the en face imaging, a special echocardiographic view, was performed using a transthoracic probe for morphological characterization of the ASD and VSD. En face views of the secundum ASD and perimembranous and outflow tract or doubly committed subarterial VSD were imaged on the interatrial septal section and inflow and outflow interventricular septal section at parasternal or apical position, respectively.

RESULTSThe special echocardiographic section provided en face plane views of the congenital heart defects in 35/43 (81%) of secundum ASD and 10/15 (67%) of VSD patients, and allowed full assessment of their size, shape, circumference and spatial orientations to the neighboring structures, showing also the relationship between two or multiple defects.

CONCLUSIONThe special transthoracic two-dimensional echocardiography not only displays the morphological features of ASD and VSD, but also provides additional information for making clinical decisions.

Adolescent ; Adult ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Defects, Congenital ; diagnostic imaging ; Heart Septal Defects, Atrial ; diagnostic imaging ; Heart Septal Defects, Ventricular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate the effects of glutamine-enriched enteral nutrition on the nutritional status and prognosis of patients with severe head injury.

METHODSThirty-three patients with severe head injury were randomly divided into control group (C, 15 cases) and glutamine-enriched group (Gln, 18 cases). Patients in both groups were given routine treatment and enteral nutrition with the same amount of nitrogen and calorie. Patients in Gln group were given glutamine 0.5 g x kg(-1) x d(-1) additionally added into the nutrient fluid. Vital signs and the occurrence of side effects of all patients were observed before and after nutrition support. Venous blood and urine sample of all patients were collected before and 7, 14 days after treatment to determine the parameters of blood, urine routine and hepatorenal function. At the same time points, body mass, skin fold thickness at the region of triceps brachii (TSF), upper arm circumference (AC), upper arm muscle circumference (AMC) and fasting blood glucose of all patients were detected and determined, Glasgow coma scale (GCS) scoring was performed. The length of hospital stay of all patients was recorded.

RESULTSVital signs and parameters of blood, urine routine and hepatorenal function of patients in 2 groups after nutrition treatment were close to those before treatment. Side effects, such as nausea and diarrhea occurred with spontaneous remission in a few patients. There was no statistical significant difference between 2 groups, and within each group before and after treatment, in respect of body mass and TSF (P > 0.05). Values of AC and AMC of patients in Gln group were obviously higher than those of C group (P < 0.01) on post-treatment day 14. Fasting blood glucose and GCS score of all patients before treatment were close to those on post-treatment day 14 (P > 0.05). Fasting blood glucose and GCS score of patients was respectively lower and higher in Gln group than that in C group on post-treatment day 7 (P < 0.05). Length of hospital stay of patients in Gln group (25 +/- 9) d was obviously shorter than that of C group (33 +/- 12) d (P < 0.05).

CONCLUSIONSGlutamine-enriched enteral nutrition can control the blood glucose level, prevent the loss of lean tissue, improve nutrition status of patients,shorten hospital stay, and accelerate the recovery of patients to some extent.

Adolescent ; Adult ; Craniocerebral Trauma ; therapy ; Enteral Nutrition ; methods ; Female ; Glutamine ; therapeutic use ; Humans ; Male ; Middle Aged ; Nutritional Status ; Prognosis ; Young Adult

OBJECTIVETo determine the anatomical variation and classification of ventricular septal defect (VSD) using echocardiography for percutaneous catheter closure in eligible cases.

METHODThe isolated ventricular septal defect was diagnosed with echocardiography in 240 patients , and 167 patients screened by transthoracic echocardiography were suitable for percutaneous catheter closure, but only 62 with isolated perimembranous VSD voluntarily received the procedure.

RESULTSThe procedure was successful in 58 patients, with a success rate of 93.5% with Amplatzer device. The diameter of VSD ranged from 2.4 to 13.9 (mean 5.3-/+2.0) mm with echocardiography, and the size of Amplatzer device ranged from 4-18 (mean 8.3-/+2.9) mm. Perimembranous ventricular septal defect was complicated by aneurysm formation in 22 patients. Residual trivial or mild shunt was seen in seven (12%) patients at 24 h and one (1.7%) patient at 3 months. Seven (12.1%) patients developed heart block, 3 (5.2%) had intermittence and transient complete heart block, and one had transient second degree atrioventricular block disappearing in 3 to 10 days, and 3 (5.2%) patients had complete right bundle branch block lasting for one month. None of the patients developed significant aortic regurgitation (P>0.05), although 22 showed a superior margin of the defect less than 3 mm from the aortic valve. The mean distance from the aortic valve was 3.7-/+2.7 (1.0 to 10.5) mm. No significant mitral and tricuspid regurgitation occurred in these patients. Four patients had unsuccessful procedures.

CONCLUSIONSPercutaneous closure with Amplatzer device can be carried out successfully in a majority of suitable defects screened using transthoracic echocardiography. Echocardiography can exactly demonstrate the anatomical variation and classification of ventricular septal defect in adults. Attention should be given to the misdiagnosis by echocardiography of a doubly committed defect as a perimembranous outflow defect. Heart block can be an important complication of the procedure.

Adolescent ; Adult ; Aged ; Balloon Occlusion ; instrumentation ; methods ; Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Septal Defects, Ventricular ; classification ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Prosthesis Implantation ; methods ; Septal Occluder Device ; Young Adult

Objective To construct recombinant adenovirus vector containing Rattus norvegicus microtubule-associated protein 4 gene,and transfect it into the rat cardiac myocytes cultured in vitro.Methods A pair of primers were designed,and full length MAP4 DNA was cloned from rat total mRNA by PCR.The PCR product was double-digested with restriction endonucleases NheⅠ and NocⅠ,and inserted orientationally into pShuttle2.The plasmid of pShuttle2-MAP4 was double-digested with restriction endonucleases NheⅠ and NocⅠ,and inserted BD Adeno-X~(TM) Virul DNA,named pAd2-MAP4.The non-recombinant adenovirus was screened out with PacⅠ, pAd2-MAP4 was linerized with SwaⅠ,and the recombinant virus genome was transfected into HEK293 cell line for packaging and amplification of Ad-MAP4 virus.The recombinant adenovirus was transfected into rat cardiac myocytes and MAP4 was identified by immunohistochemistry.Results The recombinant adenovirus-MAP4 was constructed successfully and the titer was about 2.3?10~(8) pfu/ml.The expression of MAP4 was enhanced at 48 h after the transfection.Conclusion We have successfully constructed a recombinant adenovirus Ad-MAP4 that has enforced the expression of MAP4 in vivo.

OBJECTIVE This study aimed to investigate the influence of IgD on T/B cell activationand construct hIgD-Fc-Ig fusion protein to competitive inhibition IgD binding with IgDR. METHODS T/B cells were sorted by magnetic cell sorting. The differences of mIgD and IgD-R level between different T/B cell subtypes were detected by FCM. Serum IgD level was detected by ELISA. Human IgD-Fc-IgG1- Fc sequence was amplified by cross- PCR and then subcloned into PET28a(+ ) empty vector. After prokaryotic expression through escherichia coli, we obtained the hIgD-Fc-Ig fusion protein by affinity chromatograph. Western blot was used to identify the hIgD- Fc- Ig fusion protein. Human peripheral blood monouclear cells (PBMC) and fibroblast like synoviocytes (FLS) proliferation were detected using a cell counting kit-8 (CCK-8). RESULTS The percentage of CD3+/CD4+, CD3+/IgD+, CD3+/CD4+/IgD+, CD3+/IgD-R+ and CD3+/CD4+/IgD-R+ cells increased significantly in RA patients comparing to healthy people. IgD can stimulate PBMC proliferation. IgD (1, 3, 10, 30 μg·mL-1) stimulate PBMC proliferation significantly after 24 h. We obtained stable and active hIgD-Fc-Ig fusion protein. The hIgD-Fc-Ig fusion protein showed no effect on PBMC proliferation. But it could downregulate human IgD protein promoting proliferation effects in human PBMC. CONCLUSION This result suggests that IgD and IgDR play an important role on T/B cell activation in RA patients and the hIgD-Fc-Ig fusion protein may competitively inhibit IgD's function and may play an therapeutic role in autoimmune diseases.

Objective:To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule (pGGN).Methods:The clinical, pathological and imaging data of 316 patients (320 pGGNs) confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. All pGGNs were divided into preinvasive group (148 pGGNs) and invasive group (172 pGGNs) according to histopathology. Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN, and the ROC curve analysis was performed on each risk factor.Results:Crescent sign was found in 24 cases (16.2%) in the preinvasive group and 49 (28.5%) in the invasive group, and the difference between the two groups was statistically significant (χ2=6.804 ,P=0.009).There were statistically significant differences in patient′s age, lesion size, shape, lobulation sign, and vascular stretch sign between the two groups ( P<0.05). The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value, the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%, the specificity was 61.5%, and the area under the curve was 0.666. Logistic regression analysis showed that maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN, and the OR value (95%CI) were 3.192 (1.981-5.144), 3.672 (1.545-8.725), 1.972 (1.104-3.521), and 2.026 (1.087-3.777), respectively. A logistic model was established based on the above four independent risk factors, and the area under curve was 0.711 (95%CI 0.655-0.768). Conclusion:Crescent sign can effectively reflect the invasiveness of pGGN. Maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.