Objective:To determine the predictive role of combined assessment of vasoactive-inotropic score(VIS) and lactate for the prognosis of patients with postcardiotomy cardiogenic shock(PCS) requiring venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods:222 adults with PCS requiring VA-ECMO were retrospectively analyzed and divided into four groups according to the cut-off values of VIS and lactate(Lac) at 24 h after ECMO initiation: group 1(59 cases): VIS≤14.5, Lac≤2.45 mmol/L; group 2(17 cases): VIS>14.5, Lac≤2.45 mmol/L; group 3(90 cases): VIS≤14.5, Lac>2.45 mmol/L; group 4(56 cases): VIS>14.5, Lac>2.45 mmol/L. The incidence of in-hospital mortality and other clinical outcomes were analyzed. The associations of VIS and lactate and in-hospital mortality were analyzed using Cox proportional hazards analysis.Results:The in-hospital mortality was 18.6%, 58.8%, 63.3% and 71.4% in the four groups( P<0.001), while the rate of successful weaning off ECMO was 88.1%, 88.2%, 58.9% and 33.9% respectively( P<0.001). The group 1 significantly differed from other three groups with regards to in-hospital mortality and ECMO weaning rate( P<0.05). The groups 1 also showed significantly improved cumulative 60-day survival compared with other three groups( log- rank test, P<0.05). Cox proportional hazards analysis showed age( HR=1.03, 95% CI: 1.01-1.05, P=0.001), female( HR=1.87, 95% CI: 1.27-2.76, P=0.002), VIS at 24 h after ECMO initiation( HR=1.02, 95% CI: 1.00-1.05, P=0.020), and lactate at 24h after ECMO initiation( HR=1.12, 95% CI: 1.08-1.16, P<0.001) were independently predictive of in-hospital mortality. Conclusion:Patients with VIS≤14.5 and Lac≤2.45 within 24 h after ECMO initiation had better in-hospital and 60-day outcomes, suggesting that combined assessment of VIS and lactate may be instructive for determining the prognosis of PCS patients requiring VA-ECMO support.

Objective:To examine the long-term survival outcomes and identify mortality risk factors for coronary artery bypass grafting patients who received venoarterial extracorporeal membrane oxygenation(VA-ECMO) for postcardiotomy cardiogenic shock.Methods:Data from 121 consecutive venoarterial extracorporeal membrane oxygenation-treated coronary artery bypass grafting(CABG) patients at Beijing Anzhen Hospital between June 2012 and December 2016 were analyzed. There were 84 males and 24 females. The median age was 62(55, 67) years, and the median body mass index was 25(23, 27)kg/m 2. Thirty-seven patients(34%) had left main artery disease, and 56 patients(52%) underwent off-pump CABG. According to the 3 year survival outcome after ECMO, patients were divided into survival group(35 cases) and non-survival group(73 cases). The differences of clinical indicators between the two groups were compared and analyzed. Multivariable Cox regression modeling was used to identify factors independently associated with 36 month mortality. Results:Sixty-five patients(60%) could be weaned from VA-ECMO, 49 patients(45%) survived to hospital discharge, and 35 patients(32%) survived to 3 years. The median( IQR) time on VA-ECMO support was 4(3, 5) days. The median( IQR) length of ICU stay and hospital stay duration were 8(5, 12) and 20(13, 29) days, respectively. Older age( HR=1.06, 95% CI: 1.03-1.10, P<0.001), left main coronary artery disease( HR=1.62, 95% CI: 1.00-2.60, P=0.048), and vasoactive inotropic score( HR=1.09, 95% CI: 1.03-1.17, P=0.007)were independent risk factors associated with 3-year mortality. The area under the receiver operating characteristic curve for the model, which was constructed with age≥60years, left main coronary artery disease, and vasoactive inotropic score>60, was 0.88(95% CI: 0.80-0.95). Conclusion:Long-term survival of patients who survive to discharge appears favorable. Older age, left main coronary artery disease, and vasoactive inotropic score were associated with 3-year mortality in coronary artery bypass grafting patients who received VA-ECMO.

Background and Objectives: Psoriasis is a chronic inflammatory skin disease, which the mechanisms behind its initiation and development are related to many factors. DMSCs (dermal mesenchymal stem cells) represent an important member of the skin microenvironment and play an important role in the surrounding environment and in neighbouring cells, but they are also affected by the microenvironment. We studied the glucose metabolism of DMSCs in psoriasis patients and a control group to reveal the relationship among glucose metabolism, cell proliferation activity，and VEC (vascular endothelial cell) differentiation in vitro, we demonstrated the biological activity and molecular mechanisms of DMSCs in psoriasis. Methods: and Results: We found that the OCR of DMSCs in psoriatic lesions was higher than that in the control group, and mRNA of GLUT1 and HK2 were up-regulated compared with the control group. The proliferative activity of DMSCs in psoriasis was reduced at an early stage, and mRNA involved in proliferation, JUNB and FOS were expressed at lower levels than those in the control group. The number of blood vessels in psoriatic lesions was significantly higher than that in the control group (p＜0.05), which the mRNA of VEC differentiation, CXCL12, CXCR7, HEYL and RGS5 tended to be increased in psoriatic lesions compared to the control group, in addition to Notch3. Conclusions We speculated that DMSCs affected local psoriatic blood vessels through glucose metabolism, and the differentiation of VECs, which resulted in the pathophysiological process of psoriasis.

Objective To investigate the effect of preoperative serum uric acid level on the incidence of acute kidney in-jury after off-pump coronary artery bypass grafting and to discuss whether serum uric acid level is an independent predictor of postoperative acute kidney injury.Methods A total of 631 patients undergoing off-pump coronary artery bypass grafting in Anzhen Hospital from January 2018 to June 2018 were reviewed.Patients were divided into high uric acid group(higher-than-median)and low uric acid group(lower-than-median) , based on the preoperative serum uric acid level of the patients.The de-mographic variables, comorbidities, the chelsea comorbidity index, preoperative medication, serum creatinine level and glo-merular filtration rate were compared between the two groups.Meanwhile, intraoperative operative time, infusion volume, post-operative acute kidney injury staging and the rate of frozen plasma usage , continuous renal replacement therapy and reoperation rate were observed.Results Among the 631 patients, 83(13.2％, 83/631)cases developed postoperative acute kidney inju-ry, 65(78.3％, 65/83) cases had a higher level of preoperative serum uric acid above the median(OR =3.143, 95％CI:1.850-8.798, P=0.001).After adjustment, multivariate analysis showed that elevated level of serum uric acid and BMI >30 kg/m2, the increase of preoperative serum creatinine level, the decrease of glomerular filtration rate( <60 ml/min) and higher CCI score were associated with postoperative acute kidney injury independently .Intraoperative fluid volume , diabetes and preoperative diuretic administration did not relate to the incidence of acute kidney injury after cardiac surgery .Conclusion Elevated serum uric acid level can be a strong predictor for the incidence of acute kidney injury after off-pump coronary artery bypass grafting.

Objective To investigate the effect of atorvastatin calcium with different doses on inflammatory cytokine and carotid atherosclerotic plaque of patients with cerebral infarction.Methods One hundred and seventy-eight patients with cerebral infarction admitted into our hospital from January 2014 to June 2015 were divided into low dose (LD) group and high dose (HD) group.Ninety patients in LD group were treated with atorvastatin calcium in a dose of 10 mg/d,and eighty-seven patients in HD group were treated with atorvastatin calcium in a dose of 20 mg/d.The serum levels of lipid including TC,TG,LDL-C,HDL-C,inflammatory cytokine including hs-CRP,IL-6,TNF-α,and carotid atherosclerotic plaque of both groups were analyzed and compared before and after treatment.Results After six months of treatment,the serum levels and inflammatory cytokine of patients in both groups showed remarkable improvement (P ＜ 0.05),and those in HD group were significantly better than those of LD group (P ＜ 0.05).Additionally,compared with those before treatment,changes in carotid atherosclerotic plaque of patients in LD group were not obvious,while those in HD group markedly decreased,and which were significantly lower than those of LD group (P ＜ 0.05).Conclusion Atorvastatin calcium with HD of 20 mg/d showed a better capability on improving serum levels of lipid,inflammatory cytokine,and carotid atherosclerotic plaque of patients with cerebral infarction than those with LD of 10 mg/d.

Objective To investigate the values of recombinant tissue type plasminogen activator (rt-PA)) in the treatment of acute cerebral infarction complicated with atrial fibrillation.Methods Used the prospective research methods,74 patients of acerebral infarction complicated with atrial fibrillation in Xi'an XD Group Hospital from February 2015 to August 2016 were selected and were equally divided into the observation group and the control group accorded to the principle of random envelope drawing.The control group was treated with urokinase intravenous thrombolytic therapy,the observation group was treated with rt-PA intravenous thrombolytic therapy,and the prognosis of the two groups were observed.Results There were no significant differences in gender,age,time window,disease,systolic blood pressure and diastolic blood pressure compared between the two groups.The treatment efficiency in the observation group and control group were 94.6％ and 75.7％,the observation group was significantly higher than that of the control group (P ＜ 0.05).After treatment,the mRS scores in the observation group and the control group were (5.22± 1.83) points and (7.29± 1.45) points,were significantly lower than those before treatment of (10.24± 1.31) points and (10.19 ± 1.52) points (P ＜ 0.05),and the observation group was significantly lower than the control group (P ＜ 0.05).In the observation group,the symptomatic intracerebral hemorrhage and non symptomatic cerebral hemorrhage were 5.4％ and 2.7％ respectively,so that were 18.9％ and 16.2％ in the control group that the observation group were significantly lower than those of the control group (P ＜ 0.05).Conclusion Intravenous thrombolysis with recombinant tissue type plasminogen activator of patients with acute cerebral infarction combined with atrial fibrillation is safe and effective,it can promote the improvement of neurological function,and has good application value.

Objective To analyse the timing of cerebral infarction after cardiac surgery,summarize the intensive care treatment and prognosisof patients with cerebral infarction,and provide the basis for clinical prevention and treatment of postoperative cerebral infarction.Methods A retrospective review of patients undergoing cardiac surgery between January 2014 and December 2016 in our department.Patients had the clinical manifestations of central nervous system injury within 7 days after surgery and confirmed cerebral infarction by CT or MRI examination.The cerebral infarction patients were divided into the onpump and off-pump group,and the clinical data were compared between the two groups.Cerebral infarction was defined as any focal or global neurological deficits lasting for more than 24 hours.Cerebral infarction was classified as early cerebral infarction when it occurred less than 24 hours postoperatively,and delayed cerebral infarction when it occurred more than 24 hours postoperatively.Results In a total of 41 patients with cerebral infarction were included in the study.Early cerebral infarction occurred in 12 patients and delayed cerebral infarction occurred in 29 patients.The off-pump group patients had significantly lower risk of early cerebral infarction(P =0.01).All patients in this study were treated with comprehensive therapy.The time of on-pump and off-pump group staying in ICU was respectively(9.63 ± 6.42)days and(8.19 ± 4.63)days,the total length of hospital stay was (24.25 ± 13.51) days and (19.14 ± 12.81) days,the difference was statistically significant (P ＜ 0.05).When discharged BI was severe disability in 8 cases,deterioration of discharged automatically in 4 cases,death in 1 cases.Conclusion Compared with patients undergoing off-pump CABG,patients undergoing on-pump surgery more frequently had early cerebral infarction.Early and delayed cerebral infarction differed in their mechanisms.Different preventive strategies should be applied in future intervention.Perioperative cerebral infarction seriously affected the patient's prognosis and quality of life.

Objective To study the clinical value of heart‐type fatty acid binding protein(H‐FABP) ,high‐sensitive cTnI(hs‐cT‐nI),homocysteine(Hcy)andcystatinc(Cys‐C)intheearlydiagnosisofacutemyocardialinfarction(AMI).Methods 150casesof AMI patients with coronary arteriography (AMI group) were selected from the cardiovascular department admitted within the first 6hours of chest pain attack .An additional 30 case for control group .The level of four novel cardiac marker were measured in each group of serum .Results The level of serum H‐FABP ,hs‐cTnI ,Hcy and Cys‐C in AMI group were markedly higher than control group(P<0 .05) ,and rose with the increase of coronary artery lesions with statistical difference (P<0 .05) .Each cardiac markers showed high specificity in the diagnosis of AMI ,amongst which H‐FABP and hs‐cTnI ,stood out with sensitivity of 97 .34% and 89 .98% respectively .With Youden index ,positive likelihood ration ,negative likelihood ration ,positive predictive value and negative predictive value ,H‐FABP and hs‐cTnI appeared to have higher diagnostic value than Hcy and Cys‐C in AMI .Conclusion H‐FABP and hs‐cTnI displayed significant clinical value as a most sensitive indicator in the early diagnosis of AMI (within 6 hours of attack) . The level of H‐FABP ,hs‐cTnI ,Hcy and Cys‐C elevated as coronary artery lesions increase .

Purpose To investigate the pathological characteristics of loco-regional recurrent nasopharyngeal carcinoma ( rNPC ) . Methods Nasopharyngeal biopsy specimens of 46 rNPCs and 63 primary NPCs were collected. HE staining, immunohistochemistry and EBV small RNAs ( EBERs) in-situ hybridization were performed. Results The over-expression rates of both p63 and CK5/6 in rNPC were significantly higher than those of primary NPCs (P=0. 005, P=0. 026), while no statistical significance of Ki-67 over-ex-pression existed between the two groups ( P=0. 387 ) . More necrotic tissues, inflammatory exudates, giant bizarre carcinoma cells, desmoplastic stroma, giant bizarre tumor cells and higher degree of squamous differentiation were found in rNPCs. The carcinoma cells of 5 rNPCs were negative for both EBERs in-situ hybridization and LMP-1 immunohistochemical staining. Conclusion The loco-re-gional rNPC has two peaks of latency interval:2~5 and 9~11 years. The loco-regional rNPC cells have higher degree of squamous differentiation with higher expression of p63 and CK5/6, as well as more invasive ability. In addition, both EBERs in-situ hybridization and LMP-1 immunostaining are negative in 10. 87% (5/46) of loco-regional rNPC.

To evaluate the value of serum human epididymis protein 4(HE4),cancer embryonic antigen(CEA), carbohydrate antigen(CA125,CA19-9,CA153),alpha fetoprotein(AFP) and β-human chorionic gonadotrophin (β-HCG) in ovarian cancer early diagnosis.Methods:Abbott Architect i2000SR was used to detect the levels of preoperative serum tumor markers (n=7) in ovarian cancer group,benign ovarian tumor group and the normal control (each n=60).Results:The levels of serum HE4,CA125, CA199,CEA,CA153,AFP and β-HCG in ovarian cancer group were markedly higher than the benign ovarian tumor group and the control group.There was statistically significant difference ( P<0.05 ).The diagnosis of ovarian cancer tumor markers were high specificity,but sensitivity was not high except HE4 (76.67%) and CA125 (68.33%).With Youden Index,the area under curve of ROC,the HE4 was demonstrated higher specificity ,sensitivity and accuracy.There was also medium diagnostic value of CA 125 ,CA199 and CEA for ovarian cancer.The sensitivity of ovarian cancer diagnosis is raised by combined assay with serum tumor marker ,but the specificity would be reduced accordingly.HE4, CA125, CA199 and CEA combined detection is considered the best.Conclusion:CA153,AFP and β-HCG have lowered diagnosis for ovarian cancer.HE4, CA125, CA199 and CEA combined detection could significantly improve specificity ,sensitivity and accuracy in the early diagnosis of ovarian cancer.