Objective To explore the clinical characteristics and causes of death in patients with acute heart failure at aged 75 and over.Methods The prospective study collected 175 patients with acute heart failure from January 2012 to December 2014.They were divided into ≥75 years old group and＜75 years old group and the general clinical data were recorded.Follow-up was performed mainly by telephone with supplemented hospitalization follow-up and outpatient follow-up.Survival rates were assessed by Kaplan-Meier method.The survival rate difference between the two groups was compared using the log-rank test.Multivariate Cox proportional hazards regression analysis was used to determine the independent risk factors for death.Results The proportions of ischemic heart disease,hypertension and old myocardial infarction were higher in the elderly group than in the young group with a higher proportion of male,diabetes and body mass index in ＜75 years old group.Elderly group had a higher level of left ventricular ejection fraction(LVEF)and a lower level of total cholesterol,triglycerides and low density lipoprotein cholesterol(LDL-C).Kaplan-Meier curves showed that allcause mortality(x2 =4.005,P =0.045) and non-cardiovascular mortality(x2 =4.418,P =0.041) were significantly higher in the elderly group than in the younger group,whereas cardiovascular mortality had no significant difference between the two groups (x2 =0.754,P =0.385).In patients with noncardiovascular mortality,12 cases (63.2％)died of pulmonary infection in elderly group,3 cases(25.0％) died of lung infection in younger group,and the difference was statistically significant between the 2 groups (x2 =4.288,P =0.038).Multivariate Cox proportional hazards regression analysis showed that age≥75 years was an independent predictor for both non-cardiovascular mortality [HR(95％CI):2.71(1.50-6.55),Wald x2 =2.266,P=0.038]and all-cause mortality[HR(95 ％CI):1.75(1.28-3.13),Wald x2 =2.914,P=0.026]in patients with acute heart failure.Conclusions Age ≥75 years is an independent risk factor for all dead patients with acute heart failure and noncardiovascular death,but it is not the independent risk factors for cardiovascular death,which is of great significance to establish a more rational treatment strategy for senile heart failure.

Objective To investigate the clinical efficacy of dog days' acupoint application in treating allergic rhinitis and assess its safety.Methods Two hundred and forty-nine patients were randomly allocated to a dog days' acupoint application group of 166 cases and a placebo group of 83 cases. The two groups were received treatment at the first day of the first, second and last periods of the hot season The dog days' acupoint application group received acupoint application of Chinese herbal medicine and the placebo group, acupoint application of non-medicinal placebo. In the two groups, the symptoms and signs were scored and the VAS score was recorded before and after treatment and during the follow-up period, and adverse reactions and relapses were observed and the clinical therapeutic effect of acupoint application and its safety were assessed after treatment and during the follow-up period.Results The total efficacy rate was 69.8% in the dog days' acupoint application group and 44.4% in the placebo group. The therapeutic effect was significantly better in the dog days' acupoint application group than in the placebo group (P<0.01). The totalefficacy rate was 89.4% at the 6-month follow-up and 90.7% at the 12-month follow-up in the dog days' acupoint application group and 4.9% and 1.2% in the placebo group. The long-term therapeutic effect was significantly better in the dog days' acupoint application group than in the placebo group (P<0.01). In the dog days' acupoint application group, the symptom score, the sign score and the VAS score were significantly lower after treatment and during the follow-up period than before treatment (bothP<0.01). In the placebo group, those scores only had significant pre-/post-treatment differences (P<0.01). There were statistically significant differences in the symptom score, the sign score and the VAS score between the two groups at different times. The adverse reaction rate was 4.3% in the dog days' acupoint application group and 2.5% in the placebo group; there was no statistically significant difference between the two groups (P>0.05). The relapse rate was 46,6% at the 6-month follow-up and 62.1% at the 12-month follow-up in the dog days' acupoint application group and 85.2% and 95.1% in the placebo group; there were statistically significant differences between the two groups (P<0.01).Conclusions Dog days' acupoint application has better short-term and long-term therapeutic effect on allergic rhinitis with a low relapse rate and high safety.

ObjectiveTo study the distribution,location and hemodynamics of perforating branches of the ulnar artery with color Doppler flow imaging (CDFI).MethodsPerforating branches of ulnar arteries were examined in 80 healthy volunteers in both forearms using CDFI.Following parameters were detected:number,diameter,jumping-off point,course,location and peak blood velocity.All the parameters data were analyzed statistically.ResultsThree hundred and forty-five perforating branches were detected in total 160ulnar arteries.These branches were classified into three types:type Ⅰ,myocutaneous perforator (10.3 ％);type Ⅱ,septocutaneous perforator(87 ％ ) ; type Ⅲ,direct cutaneous perforator (2.7 ％ ).The most dominant branches were located in the mesial of the upper third,middle third and lower third of the forearm.There was no significant difference among all age groups and no difference in peak blood velocity between left side and right side( P ＞0.05).The peak blood velocity was higher in male than that in female.( P ＜0.05).In relaxing period,the blood flow rate was almost disappeared and the frequency spectrum showed the characteristics of single direction,lower blood velocity and higher blood resistance.ConclusionsCDFI with high resolution showed better results of distribution and location of perforating branches of the ulnar artery and a better quality evaluation of the these branches.CDFI was helpful to design the skin flap containing cutaneous perforators of ulnar artery.

Objective:To investigate the clinical features and prognosis of patients with pancreatic metastasis from clear cell renal cell carcinoma(CCRCC).Methods:From Jan 2000 to May 2020, the clinical data of patients pathologically diagnosed as CCRCC with pancreatic metastasis and admitted in Cancer Institute and Hospital of Tianjin Medical University were analyzed retrospectively. The gender, age, metastasis time, relapse time, metastatic sites, numbers of metastatic lesions and whether metastatic pancreatic lesions should be surgerically removed were recorded and the influencing factors were analyzed.Results:Among the 20 patients, there were 12 males and 8 females. The median age of diagnosis was 50 years. There were 12 patients(60%) of left renal carcinoma and 8 patients(40%)of the other side. 12 cases(60%) had single pancreatic metastatic lesion and the other 8 cases(40%) had multiple metastatic lesions. Seven patients(35%) had other organs metastasis besides pancreatic metastasis. Two patients(10%) had simultaneous pancreatic metastasis and renal cancer, and the other eighteen patients(90%) had pancreatic metachronous metastasis after being diagnosed as renal cancer. The median time from the diagnosis of CCRCC to pancreatic metastasis was 102 months. Thirteen patients(65%)had recurrences within 10 years and the other seven patients(35%)had recurrences after 10 years. Pancreatectomy was performed in nine patients(45%) and targeted therapy was conducted in thirteen patients. The mean follow-up was 122.9 months (1-256 months). Three patients (15%) died and 17 patients (85%) survived. The median overall survival was 75.9 months, and the 5 year-survival rate was 66.7%. Simultaneous metastasis and extra-pancreatic metastasis were prognostic factors in patients with CCRCC with pancreatic metastasis.Conclusions:Pancreatic metastases from renal clear cell carcinoma were rare, but the prognosis was good, especially in patients with only pancreatic metastases several years after renal carcinoma was diagnosed.

Objective To study the effect of antiapoptosis factors PED/PEA-15 and XIAP on prostate cancer cells(PC-3)apoptosis.Methods The expressions of XIAP and PED/PEA-15 in prostate cancer cells(PC-3)were respectively assayed using the RT-PCR technique.XIAP and PED/ PEA-15 specific siRNA vectors were designed and constructed and then were transiently cotransfected into PC-3 cells under induction of liposome.The effects of siRNA vectors on PED/PEA-15 and XIAP transcription were assayed by RT-PCR technique,and the effect of XIAP and PED/PEA-15 on cancer cell apoptosis were determined by flow cytometry and microscope observation.Results PED/PEA- 15 and XIAP were both highly expressed in PC-3 cells.Enzyme digestion analysis and DNA sequencing confirmed that the PED/PEA-15 and XIAP-specific siRNA expression vectors were constructed successfully.The designed siRNA sequences of PED/PEA-15 and XIAP could specifically inhibit their transcription.The PC-3 cells which were cotransfected with PED/PEA-15 and XIAP- specific siRNA vectors were more sensitive to doxorubicin.The apoptosis rate of cotransfected cells was significantly increased.Conclusions PED/PEA-15 and XIAP might be involved in the development of prostate cancer.

Objective To explore the mechanisms of integrin β1 on connective tissue growth factor(CTGF)-induced proliferation,migration,change of cytoskeleton of pulmonary arterial smooth muscle cell(PASMC) in vitro,and to investigate the effects of CTGF-integrin β1 signal pathway on pulmonary vascular remodeling in pulmonary arterial hypertension (PAH).Methods Pulmonary artery smooth muscle cells of SD rats were cultured in vitro.WST-1 assay was used to detect the effects of anti-integrin β1 antibody on CTGF-induced proliferation of PASMC.Transwell chambers were used to observe the effects of anti-integrin β1 antibody on CTGF-induced migration of PASMC.The cytoskeletal rearrangement was observed with coomassie brilliant blue R250 staining and Confocal Lasar Scanning Microscopy (CLSM).Results Different concentration of anti-integrin β1 antibody could inhibit the proliferation of PASMC induced by CTGF,which presents concentration dependent pattern (P ＜ 0.05).The higher the concentration of anti-integrin β1 antibody,the more severity the proliferation of PASMC induced by CTGF was inhibited.and inhibition rate of PASMC proliferation was the highest at 72 hours.Anti-integrin β1 antibody(15 mg/L) decreased significantly the number of PASMC passing through Transwell induced by CTGF,compared with CTGF group (P ＜ 0.01).Meanwhile,antiintegrin β1 antibody could change cytoskeletal rearrangement of PASMC induced by CTGF.Conclusions Integrin β1mediates the proliferation,migration,cytoskeletal rearrangement of PASMC induced by CTGF.The CTGF-integrin β1signal pathway may play a key role in proliferation,migration,cytoskeletal rearrangement PASMC.

Objective To understand the clinical distribution characteristics of Acinetobacter baumannii in our hospital and the change situation of drug resistance rates to provide a basis for the clinical rational drug use and the nosocomial infection manage-ment.Methods The Acinetobacter baumannii strains isolated in our hospital from January 2005 to December 2013 were performed the retrospective analysis on its department distribution,specimen distribution and change of drug resistance rates.Results 964 strains of Acinetobacter baumannii were isolated during these 9 years,in which 713 strains were multi-drug resistant.The isolated strains were less during 2005 -2008,which were 30,26,22,19 strains respectively.The isolated strains began to increase during 2009-2010,which were 65,50 strains respectively.The detection rate began to enormously increase from 2011,which were 157, 229,366 strains respectively from 2011 to 2013.The top three departments of the highest isolation rates during these 9 years were ICU,neurosurgery department and respiratory department.The specimen source was always dominated by the respiratory tract specimens,followed by the secretion samples,in recent years,the detection rates of blood,urine and drainage specimens were in-creased to some extent.The drug resistance rates in 13 kinds of drugs totally showed the increasing trend,the resistance rate of par-tial drugs was decreased to some extent.Conclusion Acinetobacter baumannii easily cause nosocomial infections,which is difficult to be eliminated and has high occurrence in the departments centralized with critical patients.The respiratory infection is the main pathogenic type.Its drug resistance is serious,multi-drug resistant and pan-resistant strains have the higher proportion.Clinic should rationally use the drugs based on the drug susceptibility test results,coordinates with the infection control departments for doing disinfection and isolation well and prevent ing the outbreak of nosocomial infections.

Objective To learn the species distribution characteristics and proportion occurrence of methicillin-resistant strains about Staphylococcus detected in the First People′s Hospital of Kunming.Methods The species distribution characteristics and proportion occurrence of methicillin-resistant strains were analyzed retrospectively from January 2005 to December 2013.Results A total of 3 561 Staphylococcus strains were detected in 9 years,included 21 species and subspecies,and another 12 strains were not i-dentified to species.2005-2013 species composition showed an increasing trend,there were five kinds of Staphylococcus in 2005, until 2013 reach to 13 kinds.Each year the main bacterial were Staphylococcus aureus,Staphylococcus epidermidis,Staphylococcus haemolyticus and staphylococcal hominis.Methicillin resistant Staphylococcus aureus incidence decreased significantly since 201 1, decrease from 76.3% in 2010 to 25.6% in 2013.Staphylococcus epidermidis,Staphylococcus haemolyticus,Staphylococcal hominis and coagulase-negative Staphylococci resistant to high incidence of methicillin-resistant strains of the average,remained stable at a-round 70.0%.Conclusion The distribution characteristic of Staphylococcus in this hospital was increasingly complex year by year, the opportunity of infection caused by Staphylococcus was also increased,the detection rate of methicillin-resistant strains was high, it should be noted to use clinical drug rationally.

Objective To explore the correlation between brainstem auditory evoked potential (BAEP) combined with mesencephalic morphology and the prognosis of coma patients with severe craniocerebral injury.Methods Forty-seven coma patients with severe craniocerebral injury were examined with BAEP and moaitored dynamically in early period of coma,and all these patients got head CT scans and the ratio of anteroposterior diameter and transverse diameter of mesencephalon were measured at the same time.Results There was a significantly negative relationship between the first BAEP classification and GOS score at the end of the follow-up (r =-0.755,P =0.000 ).Among all of the patients,there were 27 patients with the ratio of anteroposterior diameter and tansverse diameter of mesencephalon from 0.9 to 1.1,19 patients (70.4％,19/27) with good prognosis;20 patients with the ratio ＞1.1 or ＜ 0.9,6 patients (30.0％,6/20 ) with good prognosis.The rate of good prognosis between the two had significant difference ( x2 =7.521,P =0.006).The sensitivity and specificity were 73.7％(14/19),82.6％ (19/23) at the first BAEP combined with mesencephalic morphology,88.2％ (15/17),100.0％ (21/21) at the second BAEP combined with mesencephalic morphology.Conclusion BAEP combined with mesencephalic morphology can evaluate effectively the prognosis of coma patients with severe craniocerebral injury.

Objective To evaluate the abstinence rate and relapse rate of smoker with ACS after discharged from hospital, to evaluate the effect of simple smoking cessation interventions.Methods 150 smokers with ACS were collected and was divided into simple intervention group ( n = 87) and control group (n = 63) , respectively, followed up for 6 months.2 months, 6 months abstinence rate, relapse rate were compared between two groups, logistic regression model was used to analyzed the relevant factors for relapse.Results The smoking rate in patients with ACS was 31.14% , 6-month continuous abstinence rate and 6-month relapse rate was 64.6% , 36.4% , respectively.6-month continuous abstinence rate and relapse rate between simple quit-smoking intervention group and control group showed no difference.Nicotine dependence score more than 4 points can be used as predictor of relapse.Conclusions The smoking rate and the abstinence rate of smoker with ACS is higher than the general population, simple quit-smoking intervention do not increase the success rate of quit-smoking, indicated the need to strengthen the intervention in patients with ACS and smoking.