AIM:To investigate the effect of CYP2C19 gene polymorphism combined with plate-let function test guiding antiplatelet drug selection on gastrointestinal bleeding in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS:A total of 216 elderly patients with ACS who were admitted to our hospital from April 2021 to December 2022 and successfully completed PCI were selected and divided into study group and control group accord-ing to the random number table method,with 108 cases in each group.All patients received 4 days the same dose aspirin combined with clopidogrel antiplatelet therapy before surgery.After surgery,CYP2C19 genotype detection was performed on the study group to obtain genotype grouping to dis-tinguish different metabolites.Thromboelastogram(TEG)detection was performed on the patients with intermediate metabolites.According to the re-sults,patients with platelet inhibition rate less than 50％(clopidogrel resistance type)were selected and their medication was changed from aspirin and clopidogrel to aspirin and ticagrelor.The control group was treated with aspirin and clopidogrel.Se-rum levels of cardiac troponin(cTnl),creatine ki-nase isoenzyme(CK-MB)and hypersensitive C-reac-tive protein(hs-CRP)were observed 5 weeks after PCI,and major adverse cardiovascular events(MACE)were observed 1 and 6 months after PCI.The expression of CD62P and fibrinogen receptor 1(PAC-1)in platelets of the two groups were com-pared before and after 7 and 14 days of treatment.The platelet aggregation rate of the two groups was compared.Gastrointestinal bleeding events and cardiac emergencies were recorded after treat-ment.RESULTS:Genetic tests showed that there were 21 cases(19.44％)of ultrafast metabolites and 25 cases(23.15％)of fast metabolites,42 cases of abnormal metabolites including intermediate metabolites(genotypes accounting for 10.19％,13.89％,9.26％and 5.56％,respectively)and 20 cas-es of slow metabolites(genotypes accounting for 11,respectively).8.33％,7.41％and 2.78％).5 weeks after surgery,the serum levels of cTnl,hs-CRP and CK-MB in the study group were lower than those in the control group(P＜0.05,P＜0.01).One month after operation,the total incidence of MACE between the observation group and the control group was similar(P＞0.05).Six months after opera-tion,the total incidence of MACE in the observa-tion group was significantly lower than that in the control group(P＜0.05).The expression levels of CD62P and PAC-1 in the study group were lower than those in the control group on day 7 and day 14 after treatment(P＜0.01).The maximum platelet aggregation rate in the study group was lower than that in the control group(P＜0.01).The occurrence of cardiac emergencies between the two groups was similar(P＞0.05).The number of postoperative gastrointestinal bleeding in the study group was lower than that in the control group(x2=9.479,P＜0.01).CONCLUSION:Aspirin combined with ticagre-lor antiplatelet therapy can reduce platelet activity,aggregation rate and gastrointestinal bleeding events in patients with low response to chlorpyrro-lore who are co-screened by CYP2C19 genotype and platelet function test.

Liver cancer is the most lethal form of cancer and carries a high risk of death around the world. Goniothalamin (GTN) is a styryl-lactone that possesses antiproliferative and apoptotic activity. The molecular action of GTN is not yet fully evaluated. Thus, our research has been intended to assess the chemopreventive and apoptotic activities of diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Rats were separated into 4 groups: control, DEN only, DEN + GTN (30 mg/kg bw), and GTN (30 mg/kg bw) alone. We evaluated body weight, liver weight, tumor incidence, hepatic toxic markers, antioxidants, inflammatory cytokines, histopathology, immunohistochemistry, and Western blot studies. DEN lessened body weight, antioxidants, and apoptosis, whereas it elevated tumor incidence, toxic markers, cytokines, and Bcl-2 expression. GTN treatment maintains body weight, liver weight, and antioxidant levels, and it also prevents tumor incidence, oxidative stress, toxic markers, pro-inflammatory cytokines, and histological changes. It triggers apoptosis by constraining Bcl-2 and elevating caspase-3 levels. GTN also attenuated the P13K/ AKT signaling which enhanced apoptosis. These findings revealed that GTN subdues the P13K/AKT pathway and has auspicious chemopreventive and apoptotic actions in DEN-induced HCC. Therefore, GTN would be suggested as a new medicine in natural remedies for liver cancer.

Liver cancer is the most lethal form of cancer and carries a high risk of death around the world. Goniothalamin (GTN) is a styryl-lactone that possesses antiproliferative and apoptotic activity. The molecular action of GTN is not yet fully evaluated. Thus, our research has been intended to assess the chemopreventive and apoptotic activities of diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Rats were separated into 4 groups: control, DEN only, DEN + GTN (30 mg/kg bw), and GTN (30 mg/kg bw) alone. We evaluated body weight, liver weight, tumor incidence, hepatic toxic markers, antioxidants, inflammatory cytokines, histopathology, immunohistochemistry, and Western blot studies. DEN lessened body weight, antioxidants, and apoptosis, whereas it elevated tumor incidence, toxic markers, cytokines, and Bcl-2 expression. GTN treatment maintains body weight, liver weight, and antioxidant levels, and it also prevents tumor incidence, oxidative stress, toxic markers, pro-inflammatory cytokines, and histological changes. It triggers apoptosis by constraining Bcl-2 and elevating caspase-3 levels. GTN also attenuated the P13K/ AKT signaling which enhanced apoptosis. These findings revealed that GTN subdues the P13K/AKT pathway and has auspicious chemopreventive and apoptotic actions in DEN-induced HCC. Therefore, GTN would be suggested as a new medicine in natural remedies for liver cancer.

Liver cancer is the most lethal form of cancer and carries a high risk of death around the world. Goniothalamin (GTN) is a styryl-lactone that possesses antiproliferative and apoptotic activity. The molecular action of GTN is not yet fully evaluated. Thus, our research has been intended to assess the chemopreventive and apoptotic activities of diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Rats were separated into 4 groups: control, DEN only, DEN + GTN (30 mg/kg bw), and GTN (30 mg/kg bw) alone. We evaluated body weight, liver weight, tumor incidence, hepatic toxic markers, antioxidants, inflammatory cytokines, histopathology, immunohistochemistry, and Western blot studies. DEN lessened body weight, antioxidants, and apoptosis, whereas it elevated tumor incidence, toxic markers, cytokines, and Bcl-2 expression. GTN treatment maintains body weight, liver weight, and antioxidant levels, and it also prevents tumor incidence, oxidative stress, toxic markers, pro-inflammatory cytokines, and histological changes. It triggers apoptosis by constraining Bcl-2 and elevating caspase-3 levels. GTN also attenuated the P13K/ AKT signaling which enhanced apoptosis. These findings revealed that GTN subdues the P13K/AKT pathway and has auspicious chemopreventive and apoptotic actions in DEN-induced HCC. Therefore, GTN would be suggested as a new medicine in natural remedies for liver cancer.

Liver cancer is the most lethal form of cancer and carries a high risk of death around the world. Goniothalamin (GTN) is a styryl-lactone that possesses antiproliferative and apoptotic activity. The molecular action of GTN is not yet fully evaluated. Thus, our research has been intended to assess the chemopreventive and apoptotic activities of diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Rats were separated into 4 groups: control, DEN only, DEN + GTN (30 mg/kg bw), and GTN (30 mg/kg bw) alone. We evaluated body weight, liver weight, tumor incidence, hepatic toxic markers, antioxidants, inflammatory cytokines, histopathology, immunohistochemistry, and Western blot studies. DEN lessened body weight, antioxidants, and apoptosis, whereas it elevated tumor incidence, toxic markers, cytokines, and Bcl-2 expression. GTN treatment maintains body weight, liver weight, and antioxidant levels, and it also prevents tumor incidence, oxidative stress, toxic markers, pro-inflammatory cytokines, and histological changes. It triggers apoptosis by constraining Bcl-2 and elevating caspase-3 levels. GTN also attenuated the P13K/ AKT signaling which enhanced apoptosis. These findings revealed that GTN subdues the P13K/AKT pathway and has auspicious chemopreventive and apoptotic actions in DEN-induced HCC. Therefore, GTN would be suggested as a new medicine in natural remedies for liver cancer.

Liver cancer is the most lethal form of cancer and carries a high risk of death around the world. Goniothalamin (GTN) is a styryl-lactone that possesses antiproliferative and apoptotic activity. The molecular action of GTN is not yet fully evaluated. Thus, our research has been intended to assess the chemopreventive and apoptotic activities of diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC) in rats. Rats were separated into 4 groups: control, DEN only, DEN + GTN (30 mg/kg bw), and GTN (30 mg/kg bw) alone. We evaluated body weight, liver weight, tumor incidence, hepatic toxic markers, antioxidants, inflammatory cytokines, histopathology, immunohistochemistry, and Western blot studies. DEN lessened body weight, antioxidants, and apoptosis, whereas it elevated tumor incidence, toxic markers, cytokines, and Bcl-2 expression. GTN treatment maintains body weight, liver weight, and antioxidant levels, and it also prevents tumor incidence, oxidative stress, toxic markers, pro-inflammatory cytokines, and histological changes. It triggers apoptosis by constraining Bcl-2 and elevating caspase-3 levels. GTN also attenuated the P13K/ AKT signaling which enhanced apoptosis. These findings revealed that GTN subdues the P13K/AKT pathway and has auspicious chemopreventive and apoptotic actions in DEN-induced HCC. Therefore, GTN would be suggested as a new medicine in natural remedies for liver cancer.

Objective:To investigate the molecular pathogenesis of two coagulation factor Ⅺ (FⅪ) deficiency patients.Methods:Coagulant assays: activated partial thromboplastin time(APTT), normal pooled-plasma corrected APTT test, PT, PT-INR and one-stage assay of coagulation factors activities were validated to diagnose coagulation factor Ⅺ deficiency. The patients’ DNA samples were extracted and all exons and flanking sequences of F11 gene were amplified using PCR. After purified, the products of PCR were sequenced directly, the mutations were detected by comparing with wild sequences and analyzed using some bio-informatics softwares. Results:The two patients were diagnosed with coagulation factor Ⅺ deficiency due to prolonged APTT, corrected APTT and low activities of coagulation factor FⅪ. The results of APTT, FⅪ∶C were 88.1s, 1.1% and 107.1s, 3.8% , and the prolonged APTT could be corrected to normal range 32.9s and 31.5s, respectively. Through genetic analysis, we discovered compound heterozygous mutations g. 1305-1G>A and g. 1325delT in patient 1 and the sequencing results of TA plasmid clones showed that the two mutations were located on different strands of chromosomes. Compound heterozygous mutations g. 1124A>G and g. 1550C>G were detected in patient 2 resulting in Lys357Arg and Cys482Trp. Software analysis indicated the mutations probably brought amino acid sequence changed, protein features affected and splice site changed.Conclusion:Compound heterozygous mutations g. 1305-1G>A, g. 1325delT and g. 1124A>G, g. 1550C>G had been identified in two coagulation factor Ⅺ deficiency patients which might be responsible for their prolonged APTT and low FⅪ∶C. To the best of our knowledge, g. 1325delT and g. 1550C>G have been reported, while g. 1124A>G and g. 1305-1G>A are reported for the first time in the literature.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

Objective To evaluate the effect on nexible ureteroscope one-step treat and step-by-step treat for impacted upper ureteral calculi. Methods The clinical data of 98 cases of impacted upper ureteral calculi were retrospectivelv analvzed between January 2016 and January 2018. The one-step nexible ureteroscopic lithotripsy was used in 48 cases (observation group), and the step-by-step nexible ureteroscopic lithotripsy was used in 50 cases (control group). During the one-step nexible ureteroscopic lithotripsy, only flexible ureteroscope was used to crush the stone, no matter whether the stone located in the ureter or returned to the renal pelvis. During step-by-step nexible ureteroscopic lithotripsy, the rigid ureteroscopy was firstly used for crushing the stone in the ureter. When the stone returned to the renal pelvis, the rigid ureteroscopy was changed into nexible uretemscope for continuous crushing the stone. Operating time, 2 weeks stone clearance rate and the cases of fever after operation were compared between two groups. Results Compared with that of the control group, the operation time of the observation group was significantly shortened [(38.3 ± 10.5) min vs. (55.1 ± 12.7) min, t=-6.415], and the proportion of postoperative body temperature ≥ 38.5 ℃ was also reduced [(4.2％ (2/48) vs. 22.0％(11/50), χ2=5.276]. The differences between the two groups were statistically significant (P<0.05). Two weeks stone clearance rate was 89.6％(43/48) in observation group and 82.0％(41/50)in control group, and there was no significant difference between two groups (χ2=0.493, P > 0.05). Conclusions Flexible ureteroscope one-step method is a safe and effective alternation for incarcerated upper ureteral calculi.

Objective To observe the metabolic changes of subcortical structures in children with intractable epilepsy using 18 F-FDG PET/CT,and to investigate the mechanism of subcortical structure involvement in epileptic seizures and its clinical significance.Methods Features of 18F-FDG PET/CT imaging in 611 intractable epilepsy children were analyzed.The metabolic changes of cortex and subcortical structures (basal ganglia,thalamus and cerebellum) were observed.The children were divided into three groups (young,middle and older groups) according to age,also mild group and severe group according to the number of involved lobar,respectively.The incidence of metabolic abnormalities in subcortical structures of different groups were analyzed.Results Among 611 children,unilateral cortical metabolic abnormality was found in 525,and bilateral cortical metabolic abnormalities were found in 86 children.The involvement of subcortical structures was detected in 190 children,including basal ganglia (n=64),thalamus (n=113) and cerebellum (n=105).The incidence of metabolic abnormality in subcortical structures under different age groups was not statistically different (all P＞ 0.05),while the incidence of metabolic abnormality in subcortical structures of severe group was significantly higher than that of mild group (all P＜0.001).Conclusion 18 F-FDG PET/CT might be able to detect the metabolic abnormalities of subcortical structures,therefore indicating the involvement of cerebral cortex.