Objective To obtain the incidence of “clopidogrel low response”( CLR ) of acute coronary syndrome ( ACS ) patients after percutaneous coronary intervention ( PCI ) by Thrombelastography ( TEG) and Light transmission aggregometry( LTA) ,and explore the correlation of CLR with clinical related factors and major adverse cardiac events.Methods This study is a cohort study.214 ACS patients in the Department of Cardiology of Peking University People′s Hospital,who were ready to treat with PCI between May 2014 and November 2014 were enrolled.Among them, 168 cases(78.5%) were male with an average age of (61.32 ±10.79) years;46 cases(21.5%) were female with an average age of (68.72 ±8.38) years.The clinical data were recorded, such as history of present illness, the past medical history, clinical medication, and the results of coronary angiography.After taken clopidogrel 75 mg per day at least for 4 days,all patients were detected the contribution from ADP-stimulated platelets to maximal clot strength by TEG( TEG-ADP-Inhib), and detected ADP induced maximal platelet aggregation ratio by LTA ( LTA-ADPMAX ) .The occurrence rate of CLR was calculated, and the correlation between results of the two assays were anylysed.Patients were divided into two groups according to CLR.Univariate analysis was used to compare the difference of clinical data between CLR group and non-CLR group, then Logistic regression analysis was conducted to find out the related risk factors that may influence the occurrence rate of CLR.Compare the correlation between CLR and MACE according to 6-month followed-up.Results There was negative correlations between LAT and TEG in the adenosine diphosphate induced platelet reactivity ( r=-0.282,P=0.000).CLR was found in 115 (53.7%) patients by LTA and in 74(34.6%) patients by TEG and the difference between the two CLR ratio was significant (χ2 =10.486, P =0.001 ) .There were significant differences in age,smoking history and prior PCI/CABG history between CLR group and non-CLR group according to LTA grouping(t=2.829,P=0.005;χ2 =11.058,P=0.001;χ2 =4.252,P=0.039), and there was significant differences in history of cerebrovascular accident between CLR group and non-CLR group according to TEG grouping (χ2 =4.584, P=0.032 ).Logistic regression analysis showed smoking history was the protective factor for CLR ( OR=0.390,P=0.001) , while history of cerebrovascular accident was the independent risk factor (OR=2.499,P=0.037) for CLR.According to 6-month followed-up, the incidence of clinical ischemic events and bleeding events in CLRLTA group was 5.2%and 0 respectively, in N-CLRLTA group was 10.1% and 3% respectively;the occurrence rate of clinical ischemic events and bleeding events was no significant difference between two groups(χ2 =1.834,P=0.176;χ2 =1.682,P=0.195).The incidence of clinical ischemic events and bleeding events in CLRTEG group was 8.1% and 0 respectively, in N-CLRTEG group was 7.1%and 2.1%respectively;the occurrence rate of clinical ischemic events and bleeding events was no significant difference between two groups(χ2 =0.065,P=0.798;χ2 =0.432,P=0.511 ).Conclusions The correlation between the testing results of TEG and LTA in ACS patients treated with clopidogrel was poor, CLR ratios detected by two assays were significantly different.Smoking history was the protective factor for CLR , while history of cerebrovascular accident was the independent risk factor for CLR.CLR was not the risk factor for MACE in ACS patients.

Objective To explore the clinical effect of laparoscopic uterine artery occlusion combined with uterine myomectomy for uterine myomas.Methods 120 patients with uterine fibroids were selected and randomly divided into research group and control group according to the digital table,60 cases in each group.Patients of the control group directly received conventional laparoscopic myomectomy,and patients of the research group received uterine artery occlusion before laparoscopic myomectomy.The intraoperative blood loss,operative time,postoperative anal exhaust time,hospitalization time of the two groups were observed and recorded.The patients were followed up with menstrual with improvement and luteinizing hormone,estradiol,follicle stimulating hormone.Results The intraoperative blood loss,operative time,postoperative anal exhaust time,menstrual improvement,fibroids relapse and other indicators of the research group were better than those of the control group,the differences were statistically significant [(82.85 ± 19.32) mL vs.(153.26 ± 21.18) mL,(60.56 ± 12.21) min vs.(153.38 ± 21.34) min,(15.62 ± 1.66) h vs.(25.03 ± 1.98) h,96.7 ％ vs.78.3 ％,3.3 ％ vs.16.7 ％,t =28.06,27.67,28.21,x2 =9.21,5.92,all P ＜ 0.05].Two months after operation,the E2 and FSH levels of the research group were significantly different with those before operation (t =3.90,3.51,all P ＜ 0.05),but after 12 months,there were no statistically significant differences in E2,FSH and LH compared with before operation (t =0.42,0.50,P =0.68,0.62).There were no statistically significant differences in E2,FSH and LH compared with before operation at two or twelve months after operation(t =0.19,0.39,0.69,P =0.85,0.70,0.49;t =0.58,0.20,0.37,P =0.56,0.83,0.71).Conclusion Uterine artery occlusion before laparoscopic myomectomy can significantly reduce blood loss,shorten the operation time,speed up the recovery and reduce the recurrence rate,and its influence on ovarian function is temporary and reversible,it is worthy of clinical popularization and application.

Objective To investigate caspase 3 in the apoptosis of EJ cells in bladder carcinoma induced by mitomycin C(MMC). Methods The apoptosis and changes in cell cycle were examined by means of TUNEL and flow cytometry. The ability of caspase 3 antibody to resist apoptosis induced by a low dose of mitomycin was also studied. Results The typical characteristics of apoptosis were observed in EJ cells treated with low dose of mitomycin and the apoptotic index (AI) was (62.9? 2.2 )%, being much higher than that in the group treated combinedly with caspase 3 antibody and MMC(4.9?0.3)% and in the controls (2.7?0.7)%, P

ObjectiveTo investigate rational surgical approaches for Siewert type Ⅰ adenocarcinoma of the esophagogastric junction (AEG),and analyze the prognostic factors.MethodsThe clinical data of 103 patients with Siewert type Ⅰ AEG who were admitted to the Renji Hospital from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into transthoracic approach group (61 patients) and thoracoabdominal approach group (42 patients).The incidences of numbers of lymph node dissected and postoperative complications of the 2 groups were compared using the chi-square test,Fisher exact probability or the t test.The survival curve was drawn by the Kaplan-Meier method and the survival was analyzed using the Log-rank test.Prognostic factors were analyzed using the one-way analysis of variance and Cox regression model.ResultsNo perioperative death was observed in the 2 groups.There were significant differences in the number of lymph node dissected and number of metastatic lymph node between the 2 groups (t =2.18,2.29,P ＜ 0.05 ).There was no significant difference in splenic injury between the 2 groups (P ＞ 0.05 ).There were no significant differences in postoperative bleeding,anastomotic fistula and stricture,esophagogastric reflux,pulmonary infection and esteomyelitis between the 2 groups (x2 =0.07,0.94,0.22,1.41,0.17,P＞0.05).Of the 103 patients,97(94.2％) were followed up.The mean postoperative survival time was 26 months.The median survival time was 26 months,and the 3-yearsurvival rate was 35.9％.The 3-year survival rates of transthoracic approach group and thoracoabdominal approach group were 32.8％ and 40.2％,with no significant difference between the 2 groups ( x2 =0.37,P ＞ 0.05).The results of univariate analysis showed that radical or palliative resection,TNM stage,lymph node metastasis stage,tumor diameter and metastasis rate,degree of radical resection were independent factors influencing the prognosis of patients with Siewert type Ⅰ AEG (x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).The results of multivariate analysis showed that degree of TNM stage,lymph node metastasis rate and radical resection were independent factors influencing the prognosis of patients ( Wald =12.01,8.75,10.03,P ＜ 0.05 ).Conclusions Thoracoabdominal approach is a reasonable selection for patients with Siewert type I AEG.Degree of TNM stage,lymph node metastasis rate and radical resection were independent risk factors influencing the prognosis of patients.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Basigin ; analysis ; Biomarkers, Tumor ; analysis ; genetics ; Carcinoma, Transitional Cell ; drug therapy ; genetics ; metabolism ; Gene Expression Profiling ; Humans ; In Situ Hybridization, Fluorescence ; Inhibitor of Apoptosis Proteins ; analysis ; Mutation ; Neoplasm Recurrence, Local ; metabolism ; Nuclear Proteins ; analysis ; Receptor, Fibroblast Growth Factor, Type 3 ; analysis ; genetics ; Tumor Suppressor Protein p53 ; analysis ; genetics ; Urinary Bladder Neoplasms ; drug therapy ; genetics ; metabolism

Objective: To explore the features of ascending aortic distensibility (AAD) and risk factors in pre-hypertension (PHT) patients. Methods: A total of 206 participants who received retrospective ECG-triggered coronary CTA by physical check-up or by clinically suspected coronary artery disease (CTA) were enrolled. The participants were divided into 2 groups: Control group, the subjects with normal blood pressure,n=85 and Pre-hypertension group,n=121. A 128 slice dual-source CT scanner was used and the image was automatically reconstructed at every 5% absolute phases in entire R-R interval. The beginning of left coronary artery plane was deifned as the reference and 25 mm above the reference plane was deifned as interested region. ADD value was calculated. Results: Compared with Control group, Pre-hypertension group had decreased AAD,P<0.01 and similar normalized cross-sectional area (Ss),P>0.05; ADD value was similar among different gender and blood lipid levels. Correlation analysis presented that AAD was negatively related to age (r=-0.69,P=0.001), systolic blood pressure (r=-0.37,P=0.001), pulse pressure(r=-0.43,P=0.001) and glycosylated hemoglobin (r=-0.43,P<0.05). Age and systolic blood pressure were the independent risk factors for AAD decline (standardized β=-0.66,P=0.001) and (standardized β=-0.44,P=0.001). Conclusion: Without additional contrast media consumption and radiation dosage, retrospective ECG-triggered coronary CTA may detect AAD changes with risk factors at the early stage in pre-hypertension patients which is helpful to distinguish the high risk individuals.

Clostridium difficile is a gram-positive,obligate anaerobic bacillus,which is one of the most common pathogenic bacteria of antibiotic associated diarrhea,and can cause Clostridium difficile-associated diarrhea.In recent years,the incidence of Clostridium difficile infection has increased significantly in the world with the excessive use of broad-spectrum antibiotics,the increase of strains resistance,and the emergence of hypervirulent strains.This paper presents a brief review on research progress of Clostridium difficile-associated diarrhea.

Objective To study CT features of thymoma,so that to improve the accuracy of CT diagnosis and differential diagnosis.Methods 31 cases of thymomas proved by surgery and pathology were examined with conventional CT scans.CT findings of thymoma were analyzed.Results The lesions in 27 cases(87.1%)were located in the anterior upper and middle mediastinum.There were benign lesion in 11,including mass-cardiovascular interface(MCI) with convex type(8 cases),flatness type(1 cases) and concave type(2 cases).20 cases were malignant lesion,including MCI with cast type(18 cases) and concave type(2 cases).Irregular invasion to adjacent organs was found in 11 cases,others included pericardiac effusion(n=6),pericardial and mediastinal invasion(n=2),pleural effusion(n=4),pneumonia(n=2),lung,bone,mediastinal lymphadens metastasis(n=2) and liver,pancreas metastasis(n=1).Conclusion CT scans is of significant value in diagnosis and differential diagnosis of thymoma.

Objective To investigate the relationship between the severity of diabetic retinopathy and serum bilirubin level. Methods From August 1 2008 to December 31 2009, hospitalized patients of 1062 cases with type 2 diabetes were divided into three groups according to fundus examination: no diabetic retinopathy (NDR) group (457 cases), non-proliferative diabetic retinopathy (NPDR) group (484 cases)and proliferative diabetic retinopathy (PDR) group ( 121 cases). The difference in serum bilirubin level was compared. Results Total bilirubin in PDR, NPDR and NDR group were (9.96 ± 3.84), ( 11.41 ± 3.82),( 13.38 ± 3.98) μ mol/L respectively. There was significant difference among three groups (P ＜ 0.01 ). Logistic multivariate regression analysis showed that a drop in serum total bilirubin level was an independent risk factor of diabetic retinopathy. Conclusions Bilirubin level and the severity of diabetic retinopathy have some relationship. The antioxidant bilirubin and anti-inflammatory effect should be paid attention to.

With the development of modem clinical medical engineering,especially some large medical equipment,medical engineering section needs more talents in management and maintenance profession.Aiming at problems in the section construction,some viewpoints and suggestions are put forward.It is expected that the leadership could attach importance to medical engineering section,make good use of the talents and lay solid foundation for the development of hospitals.