Objective:To investigate the influence of frailty on post-treatment outcomes in elderly heart failure patients with reduced ejection fraction treated with Sacubitril/Valsartan.Methods:The 231 heart failure patients aged 60 years or over with reduced ejection fraction were enrolled from October 2017 to October 2018 in Department of Geriatric Medicine, Henan Provincial People's Hospital.Patients were divided into the frailty group(n=116)and the control group(n=115). Frailty diagnosis was made by five indexes suggested by LP Fried.Both groups were treated with sacubitril/valsartan(49/51 mg)for 1 year.The left ventricular ejection(LVEF), estimated glomerular filtration rate(eGFR), N-terminal pro B-type natriuretic peptide(NT-proBNP)and other clinical and laboratory indexes were detected before and after treatment and compared between the frailty group and the control group.Results:16 subjects in the frailty group and 11 subjects in the control group dropped out of the study.The frailty group versus the control group showed a higher mortality rate of cardiovascular causes(13.0% or 13/100 vs.6.7% or 7/104, χ2=6.437, P=0.027), a higher first re-hospitalization rate(18.0% or 18/100 vs.11.5% or 12/104, χ2=4.458, P=0.043)and a higher all-cause mortality(16.0% or 16/100 vs.8.6% or 9/104, χ2=3.875, P=0.039). In the frailty group, levels of serum NT-proBNP and creatinine were higher and eGFR was lower after treatment than before treatment[(2 253±144) ng/L vs.(2 094±136) ng/L, (137±24) μmol/L vs.(125±23) μmol/L, (49.2±5.9) ml·min -1·1.73 m -2vs.(56.7±6.3) ml·min -1·1.73 m -2, t=3.674, 2.893 and 2.068, P=0.017, 0.026 and 0.029]. In the control group, serum NT-proBNP levels were lower after treatment than before treatment[(1 828±123) ng/L vs.(1 945±128) ng/L, t=1.896, P=0.043], while serum creatinine levels[(120±22) μmol/L vs.(117±19) μmol/L, t=2.099, P=0.650]and eGFR[(59.8±6.5) ml·min -1·1.73 m -2vs.(61.6±6.8) ml·min -1·1.73 m -2, t=2.444, P=0.173]had no significant difference between post-treatment and pre-treatment. Conclusions:Frailty has adverse affects on the mortality, re-hospitalization rate and renal function in elderly heart failure patients with reduced ejection fraction treated with Sacubitril/Valsartan.

Objective To evaluate the effects of age factors on sedation induced by dexmedetomidine.Methods One hundred and thirty-nine patients,aged 18-103 yr,with body mass index ≤ 30 kg/m2,scheduled for elective surgeries on lower abdomen or lower extremities,were divided into4 groups according to the age:group Ⅰ (18 yr≤age≤44 yr,n=40);group Ⅱ (45 yr≤age≤59 yr,n=38);group Ⅲ (60 yr≤age≤89 yr,n=39);group Ⅳ (≥90 yr,n=22).A catheter was placed in the subarachnoid space at L3,4 interspace,and ropivacaine 10-20 mg was injected via the catheter.At 20 min after ropivacaine injection,dexmedetomidine 1 μg/kg was infused via a pump over 10 min.The onset time and duration of sedation were recorded,and the occurrence of adverse effects such as hypoxemia,bradycardia and hypotension was observed.Results There was no significant difference in the onset time of sedation and incidence of bradycardia among the 4 groups (P＞0.05).Compared with group Ⅰ,the duration of sedation was significantly prolonged in Ⅱ-Ⅳ groups (P＜0.05).Compared with Ⅱ and Ⅲ groups,the duration of sedation was significantly prolonged in group Ⅳ (P ＜ 0.05).The incidence of hypoxemia and hypotension was significantly higher in group Ⅳ than in Ⅰ-Ⅲ groups (P＜0.05).Conclusion Dexmedetomidine-induced sedation is influenced by age factors,the duration of sedation induced by dexmedetomidine is prolonged,and the occurrence of adverse effects is increased,especially if the patients ≥ 90 yr of age.

Objective To evaluate the surgical strategy for giant pituitary adenomas apoplexy complicated with obstructive hydrocephalus.Methods Twenty-three patients with giant apoplectic pituitary adenomas associated with obstructive hydrocephalus,admitted to our hospital from January 2010 to March 2015,were chosen;their clinical and surgery data were retrospectively summarized.Results Transsphenoidal microsurgery was conducted in 22 patients and craniotomy in one.All tumors showed cystic degeneration and soft texture.Seven patients had faint yellow or hyaline cyst fluid and 16 had soybean sauce or dark red cyst fluid.Near-total tumor resection was achieved in 2 patients (8.7％),subtotal resection in 16 (69.6％),and partial resection in 5 (21.7％).Twenty-three patients were followed up for 4-38 months,one patient accepted repeated operation for residual rumors,5 had postoperative adjuvant radiation therapy,and no other patients showed re-growth or recurrence.Postoperatively,there was no long-term cerebrospinal fluid leakage and diabetes insipidus,with hydrocephalus disappeared in 100％,visual improved in 60.9％,and headache relieved in 81.8％.Conclusions Pituitary adenoma presented with apoplexy and concurrent obstructive hydrocephalus is often soft.Transsphenoidal microsurgery is the preferred safe and effective method which can relieve hydrocephalus and achieve improved clinical symptoms.

Objective To observe the effect of Xiaoxianxiong Decoction combined with metformin on glucose and lipid metabolism of phlegm-heat type 2 diabetic patients (T2DM). Methods Totally 104 phlegm-heat T2DM patients were randomly divided into two groups (each contains 52 cases), and given the diabetes lifestyle intervention. Control group additionally took 0.5 g metformin twice daily. And treatment group, besides taking 0.5 g metformin, was given Xiaoxianxiong Decoction, one dose and three times per day warmly. After 12 weeks, FBG, HbA1C, TC, TG, HDL-C, LDL-C, 2 hPG of the two groups were determined, and the therapeutic effect was evaluated. Results The total effective rate in the treatment group was 92.31%, and 76.92%in control group (P<0.01). The difference in symptom score, FBG, 2 hPG, TC, TG, HDL-C and LDL-C between the two group were significant, so as that between before and after treatment of both groups (P<0.05). Conclusion Xiaoxianxiong Decoction combined with metformin can effectively lower the levels of blood glucose and blood lipid in phlegm-heat T2DM patients, enhance the therapeutic effect and improve the metabolism of glucose and lipid.

Objective To explore the effects of lactoferrin on T cells ( the levels of CD4 + T and CD8 +T lymphocytes) and the development of intestinal mucous membrane (villus heights, crypt depths, villus circumferences, and villus areas) in neonatal SD rats. Methods Totally 96 neonatal (one week old) SD rats were equally and randomly divided into twelve groups, in which animals were fed with lactoferrin at a dose of 1.0 g/( kg · d) (dose Ⅰ group), 3.0 g/(kg · d) (dose Ⅱ group), or 5.0 g/(kg · d) (dose Ⅲ group) for 2, 3, or4 weeks,with corresponding blank control groups. Rats in the dosage groups were killed at the set time points and the levels of venous blood CD4 + and CD8 + T lymphocytes were detected using immunofluorescence method. Jejunum ( 1 cm)and ileum (1 cm) specimens were obtained for pathological sectioning, and the villus height, crypt depth, villus circumferences, and villus areas were measured through image analysis system. Results The CD4 + T lymphocyte levels at two weeks were significantly different among dose I group, dose Ⅱ group, and control groups ( all P ＜0. 05).The CD8 + T lymphocyte levels at two weeks were significantly different among dose Ⅱ group, dose Ⅲ group,and control groups ( all P ＜ 0. 05 ). The villus heights, crypt depths, villus circumferences, and villus areas of jejunum at two weeks between feeding groups and control groups were not significantly different ( all P ＞ 0. 05 ), while the condition in ileum was on the contrary. The CD4 + T lymphocyte levels at three weeks were significantly different between feeding groups and control groups ( P ＜ 0. 05 ). The CD8 + T lymphocyte levels at three weeks between dose Ⅲ group and control groups were significantly different ( P ＜ 0. 05 ). The villus heights, crypt depths, villus circumferences, and villus areas of jejunum and ileum at three weeks were significantly different between feeding groups and control groups ( all P ＜ 0. 05 ). The CD4 + T lymphocyte levels at four weeks between feeding groups and control groups were significantly different (P ＜0. 05). The CD8 + T lymphocyte levels at four weeks were significantly different among dose Ⅱ group, dose Ⅲ group, and control groups ( all P ＜ 0. 05 ). Except villus areas of ileum, the villus heights, crypt depths, villus circumferences of jejunum and ileum, and villus areas of jejunum at four weeks were significantly different between feeding groups and control groups ( all P ＜ 0.05 ). Conclusions Lactoferrin can promote the levels of CD4 + and CD8 + T lymphocytes in venous blood and facilitate the development of the mucous membranes of jejunum and ileum. However, such effects are affected by the dose and timing of lactoferrin feeding.

Human arrest defective 1(hARD1) is an acetyltransferase catalyzing the N-terminal acetylation of proteins after translation. The high expression of hARD1 could be an indicator of the breast cancer. In current study, we produced an anti-hARD lp monoclonal antibody that could specifically recognize ARD1 in breast cancer tissues by using the immunohistochemical assay. The full-length His-tag hARD1 protein (1-235 aa) was over-expressed in Escherichia coli, and purified recombinant protein was injected into Balb/c mice to perform immunization procedure. Eight stable positive monoclonal cell lines were isolated. ELISA results demonstrated that all light chains of antibodies were kappa, and the heavy chains displayed three subtypes IgG1, IgG2a and IgG2b, respectively. A monoclonal antibody, which could specifically recognize hARD1 protein in breast cancer tissues, was identified by screening different cancer tissues using antibody-specificity method. Further, the specificity of the antibody was confirmed by Western blotting analysis. Our study would facilitate breast cancer diagnosis by using this ARD1 monoclonal antibody in clinic. Also, this antibody could be used as an important tool for further investigating the role of ARD1 in tumorigenesis.
Acetyltransferases ; genetics ; immunology ; Animals ; Antibodies, Monoclonal ; biosynthesis ; genetics ; immunology ; Biomarkers, Tumor ; biosynthesis ; immunology ; Breast Neoplasms ; immunology ; metabolism ; pathology ; Escherichia coli ; genetics ; metabolism ; Female ; Humans ; Immunization ; Mice ; Mice, Inbred BALB C ; N-Terminal Acetyltransferase A ; N-Terminal Acetyltransferase E ; Recombinant Proteins ; biosynthesis ; genetics ; immunology

Human arrest defective 1 (hARD1) is an acetyltransferase; its physiological significance remains unclear. To explore the relationship between ARD1 protein and tumors, we detected the hARD1 protein in tumor tissues in vivo. We cloned hARD1 gene from Hela cell and construct recombinant plasmid pET28b-hARD1. The recombinant plasmid was transformed into E. coli BL21 (DE3)plysS. hARD1 protein was expressed by inducing with IPTG(1 mmol/L) and purified up to 95% through Ni2+ chelation affinity chromatography. We used the purified hARD1 protein as antigen immunized the Balb/c mice and obtained the hARD1 specific polyclonal antiserum. Through immunohistochemical analysis of different tumor tissues in vivo, we found that hARD1 expressed at high frequency in breast cancer, prostate cancer and lung cancer, especially, hARD1 expression frequency in breast cancer was up to 70%, which is higher than in the other tumors. These results indicate that the high expression level of hARD1 could be an indicator of the breast cancer. This new finding would be a foundation to further explore the relationship between breast tumor and hARD1.
Acetyltransferases ; analysis ; genetics ; immunology ; Amino Acid Sequence ; Animals ; Antibodies ; blood ; immunology ; Base Sequence ; Biomarkers, Tumor ; Breast Neoplasms ; metabolism ; pathology ; Cell Line, Tumor ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Female ; Humans ; Immune Sera ; biosynthesis ; Immunization ; Immunohistochemistry ; Lung Neoplasms ; metabolism ; pathology ; Male ; Mice ; Mice, Inbred BALB C ; Molecular Sequence Data ; N-Terminal Acetyltransferase A ; N-Terminal Acetyltransferase E ; Prostatic Neoplasms ; metabolism ; pathology ; Recombinant Proteins ; biosynthesis ; genetics ; immunology

[Objective]To investigate the method and efficiency of operative femoral supracondylar varus osteotomy combined with new blade plate on treatment of valgus deformity of knees.[Method]Thirty-seven patients with 43 knees with valgus deformity were treated with femoral supercondylar varus osteotomy with Giebel blade plate(Link company/Germany)from Oct.2000 to Oct.2005.The study group consisted of seven men with 8 knees and thirty women with 35 knees,the average age of the patients was 31.2 years(range,fifteen to seventy years).Eleven patients with 13 knees had lateralcompartment osteoarthritis,Ahlback stage Ⅰ eight patients with 10 knees and stage Ⅱ three patients 3 knees.The full-length Ap view of the lower extremity and the weightbearing AP view of the knee were obtained before and after operation,as well as the femoral angle and femoral-tibial angle were evaluated.The Giebel blade plates were taken out average 1.5 year after operation and the patients were followed-up,bone union and the change of the correction angles and the pain of the knees were evaluated.[Result]All deformity of the knees were well corrected,the femoral angle were corrected from 71.7?(62?～75?) to 82.1?(78?～85?),the average correction angle was 10.4?(8?～21?).With average 1.5 year follow-up thirty four patients with 40 knees got good bone union,two knees had non-union and we changed the internal fixationwith bone autc-grafting and got good results,as well as lost follow-up for one knee.The pain relieved in 10 knees with lateral osteoarthritis and disappeared in 3 knees after operation.[Conclusion]Femoral supracondylar varus deformity of the knee,the technique is simple and damage is slight,fixation is safety and effective.

[Objective]To measure the change of anatomic configuration of proximal tibial after high tibial osteotomy and probe its clinical consequences.[Method]From 2001 to 2005,there were 59 knees of 35 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy.Anatomic configuration of proximal tibia were measured both pre and postoperatively on radiographs.They included posterior slope angle of proximal tibia,tibial angle,lateral shift of articular surface of proximal tibial and level of the joint line.The alteration of the above features was calculated and analyzed statistically with paired t test.[Result]The mean tibial posterior slope angle were(8.9??2.6?)preoperatively and(5.0??2.3?)postoperatively.The tibial posterior slope angle was averagely decreased about(3.9??1.7?).Tibial angle were(99.1??4.3?)and(91.1??3.8?)before and after high tibial osteotomy respectively.Lateral shift of articular surface of proximal tibial were(46.2?3.6)% and(53.1?3.9)% in pre and postopratively.Level of joint line was(41.2?3.6)mm and(38.0?3.2)mm in pre and postopratively.Statistical analysis indicated that there was significant difference of posterior slope angle or tibial angle or lateral shift of articular surface of proximal tibial or level of joint line between pre and post operative(P

[Objective]To investigate the method and effeciency of management massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty[Method]Twenty-one patients 21 hips with massive acetabular bone defect were treated with impaction bone grafting plus mesh during Dec 2001 to Jan 2006,including 6 men and 15 women,the average age were 51.9 years at the revision operation(range,38~77 years).The acetabular defects of the patients in this study group were type III(combined defect)according to the American Academy of Orthopaedic Surgeons(AAOS)classification scheme.At first the combined defect was transformed into cavitary defect with metal mesh,then the contained acetabulum was tightly packed with deep-frozen morselized cancellous allograft chips(size 7~10mm),the anatomy of the hip was reconstructed and the cup was inserted after pressurizing the cement directly onto the graft.The AP view of the hip at 3 days,3 months,1 year and yearly after the operation were obtained,cup migration according to the teardrop and radiolucent line were evaluated,at the same time the Harris hip score were also evaluated.[Result]The mean follow-up time was 2.8 years,the mean Harris hip score improved from 46.4 points preoperatively to 81.3 points at the final evaluation,no cup migration were found,except for one dislocation and one sciatic nerve injury,as well as lost follow-up for one hip.[Conclusion]Impaction bone grafting plus mesh is an effective approach to treat massive acetabular bone defect in revision total hip arthroplasty,it can restore bone stock and help the cup to be placed to the anatomic position,as well as provide execellent prothesis stability.