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In patients with stable coronary artery disease, low DBP is associated with an increased risk of myocardial infarction and cardiovascular death, but its association with clinical outcomes in patients with acute myocardial infarction undergoing percutaneous coronary intervention (PCI) is unknown.Consecutive patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI from January 2010 to June 2016 were enrolled. The patients were divided into five groups according to the quintiles of DBP at admission. The primary outcome was in-hospital major adverse cardiovascular events (MACE) including all-cause death, stroke, target vessel revascularization, and recurrent myocardial infarction.A total of 2198 patients were enrolled, of whom 157 (7.1%) developed in-hospital MACE. Patients with DBP lower than 60 mmHg was associated with a higher rate of in-hospital MACE (14.8, 7.8, 5.6, 6.1, and 3.8%, P 0.001) and all-cause death (12.5, 6.4, 4.3, 3.9, and 1.9%, P 0.001) compared with those with DBP 60-69, 70-79, 80-89, and at least 90 mmHg. Multivariate logistic regression analysis demonstrated that DBP higher than 90 mmHg was a significant predictor of lower risk of in-hospital MACE (OR = 0.16, 95% CI = 0.04-0.61, P = 0.007). Cubic spline models for the association between DBP and MACE did not demonstrate a U-type relationship after adjusting for potential risk factors. During the follow-up, lower DBP was associated with a higher risk of all-cause death (P 0.0001).Lower DBP is independently associated with an elevated risk of in-hospital MACE and follow-up all-cause death.

To investigate the association between baseline hemoglobin A1c (HbA1c) levels and bleeding in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention (PCI).This observational cohort study enrolled 6283 consecutive NSTE-ACS patients undergoing PCI from January 1, 2010 to December 31, 2014. Based on baseline HbA1c levels, the patients were divided into the group with HbA1c7% (Of patients enrolled, 4705 (74.9%) were male, and 2143 (34.1%) had a history of diabetes mellitus, with a mean (SD) age of 64.13 (10.32) years. The median follow-up duration was 3.21 years. Compared with the patients with HbA1c7%, the risk of major bleeding events during follow-up was higher in patients with HbA1c ≥ 7% (adjusted hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.01-2.44;Compared with the lower baseline HbA1c levels, the higher baseline HbA1c levels were associated with an increase in long-term bleeding risk in NSTE-ACS patients undergoing PCI, though higher baseline HbA1c levels were not associated with the higher risk in all-cause death.

Preeclampsia is a common disease during pregnancy that leads to fetal and maternal adverse events. Few head-to-head clinical trials are currently comparing the effectiveness of prophylactic strategies for preeclampsia. In this network meta-analysis, we aimed to compare the efficacy of prophylactic strategies for preventing preeclampsia in pregnant women at risk.Articles published in or before September 2021 from PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov, references of key articles, and previous meta-analyses were manually searched.Randomized controlled trials comparing prophylactic strategies preventing preeclampsia with each other or with negative controls were included.Two reviewers independently extracted data, assessed the risk of bias, and assessed evidence certainty. The efficacy of prophylactic strategies was estimated by frequentist and Bayesian network meta-analysis models. The primary composite outcome was preeclampsia/ pregnancy-induced hypertension.In total, 130 trials with a total of 112,916 patients were included to assess 13 prophylactic strategies. Low-molecular-weight heparin (0.60; 95% confidence interval, 0.42-0.87), vitamin D supplementation (0.65; 95% confidence interval, 0.45-0.95), and exercise (0.68; 95% confidence interval, 0.50-0.92) were as efficacious as calcium supplementation (0.71; 95% confidence interval, 0.62-0.82) and aspirin (0.79; 95% confidence interval, 0.72-0.86) in preventing preeclampsia/pregnancy-induced hypertension, with a P score ranking of 85%, 79%, 76%, 74%, and 61%, respectively. In the head-to-head comparison, no differences were found between these effective prophylactic strategies for preventing preeclampsia and pregnancy-induced hypertension, except with regard to exercise, which tended to be superior to aspirin and calcium supplementation in preventing pregnancy-induced hypertension. Furthermore, the prophylactic effects of aspirin and calcium supplementation were robust across subgroups. However, the prophylactic effects of low-molecular-weight heparin, exercise, and vitamin D supplementation on preeclampsia and pregnancy-induced hypertension varied with different risk populations, dosages, areas, etc. The certainty of the evidence was moderate to very low.Low-molecular-weight heparin, vitamin D supplementation, exercise, calcium supplementation, and aspirin reduce the risk of preeclampsia/pregnancy-induced hypertension. No significant differences between effective prophylactic strategies were found in preventing preeclampsia. These findings raise the necessity to reevaluate the prophylactic effects of low-molecular-weight heparin, vitamin D supplementation, and exercise on preeclampsia.

The combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has been demonstrated to be at least equally effective to ATRA and chemotherapy (CHT) in non-high-risk acute promyelocytic leukemia (APL). However, the efficacy of ATRA-ATO compared to ATRA-ATO plus CHT in high-risk APL remains unknown. Here we performed a randomized multi-center non-inferiority phase III study to compare the efficacy of ATRA-ATO and ATRA-ATO plus CHT in newly diagnosed all-risk APL to address this question. Patients were assigned to receive ATRA-ATO for induction, consolidation and maintenance or ATRA-ATO plus CHT for induction followed by three cycles of consolidation therapy, and maintenance therapy with ATRA-ATO. In the non-CHT group, hydroxyurea was used to control leukocytosis. A total of 128 patients were treated. The complete remission rate was 97% in both groups. The 2-year disease-free, event-free survival rates in the non-CHT group and CHT group in all-risk patients were 98% v 97%, and 95% v 92%, respectively (P = 0.62 and P = 0.39, respectively). And they were 94% v 87%, and 85% v 78% in the high-risk patients (P = 0.52 and P = 0.44, respectively). This study demonstrated that ATRA-ATO had the same efficacy as the ATRA-ATO plus CHT in the treatment of patients with all-risk APL.

Background: Pulmonary infection is highly prevalent in patients with acute myocardial infarction undergoing percutaneous coronary intervention. However, the potential mechanism is unknown. Myocardial ischemia-reperfusion injury (MIRI) was shown to induce acute lung injury (ALI) related to pulmonary infection and inflammation. Whether MIRI induces pyroptosis in the lungs remains unclear. Method: Sprague-Dawley rats were randomly divided into four groups: control, MIRI, low ticagrelor (30 mg/kg), and high ticagrelor (100 mg/kg). Rats were treated with ticagrelor or saline via intragastric gavage before undergoing surgery. Serum parameters of CK-MB and LDH were measured using automatic biochemistry analyzers. HE staining to obtain HE scores was performed following the calculation of the wet-to-dry ratio. NLRP3, ASC, and cleaved caspase-1 in lung tissue were detected by western blot, and IL-1β was assessed by ELISA. Immunohistochemistry was used to determine the MPO+, NLRP3+, and cleaved caspase-1+ area. Results: The HE score, wet-to-dry ratio, and MPO+ area were increased in the MIRI group, and attenuated after ticagrelor treatment. Pyroptosis-associated proteins including NLRP3, ASC, and cleaved caspase-1 were elevated in MIRI, and eliminated by ticagrelor. Similar results were observed using immunohistochemistry assays. Conclusions: Pyroptosis was augmented in lung tissue after MIRI, and pre-treatment with ticagrelor attenuated these effects.

To observe the clinical efficacy of allogeneic peripheral blood stem cell transplantation（allo-HSCT） on the treatment of adult acute leukemia patients, moreover, to establish and evaluate a Logistic model to predict the risk of relapse in adult acute leukemia patients after allo-HSCT.The clinical data of 145 adult acute leukemia patients treated by peripheral blood stem cell transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2019 was enrolled and analyzed retrospectively. Complications and survival of patients were observed. The relationship between patients' age, diagnosis, leukocyte count at onset, risk stratification, time of diagnosis to transplantation, HCT-CI, minimal residual disease pre-transplantation, donor-recipient sex relationship, HLA match degree, prophylaxis of graft versus host disease(GVHD), donor age, number of transfused mononuclear cells, CD34 positive cells, engraftment time, acute and chronic GVHD, CMV, EBV infection, and hemorrhagic cystitis and recurrence after transplantation were analyzed by logistic regression. Relapse prediction model was established and evaluated according to the results.Among 145 acute leukemia patients, 81 with acute myeloid leukemia, 64 with acute lymphocytic leukemia, 18 with EBV infection, 2 with post-transplant lymphoproliferative disorder(PTLD), 85 with CMV, 26 with hemorrhagic cystitis, 65 patients developed acute GVHD, 51 patients developed chronic GVHD and 45 patients relapsed. The overall survival （OS） rates in one and three years were 86.4% and 61.8%, and the progress-free survival （PFS） rates in one and three years were 67.5% and 62.4%, respectively. There were significant differences in OS and PFS between relapsed and non-relapsed patients, as well as AML and ALL patients. Univariate analysis revealed that patient's age, risk stratification, time to transplantation, HCT-CI index, ATG based GVHD prophylaxis, minimal residual disease pre-transplantation, GVHD prophylaxis, and acute and chronic GVHD were associated with the relapse of disease, multivariate logistic regression analysis showed that pre-transplantation minimal residual disease showed positively correlation with relapse of the disease, while chronic GVHD showed negatively correlation.The relapse rate of adult acute leukemia patients treated with allo-HSCT in our hospital is 31.0%, and OS of AML patients is better than ALL patients'. OS of relapsed patients is significantly lower than non-relapsed patients'. Pre-transplantation minimal residual disease is a risk factor of relapse. The risk of relapse is reduced in patients with chronic GVHD.异基因外周血造血干细胞移植治疗成人急性白血病疗效及移植后复发风险预测模型的建立.观察成人急性白血病异基因外周血造血干细胞移植的临床疗效，并建立预测急性白血病移植后复发风险的Logistics模型.选取西安交通大学第一附属医院2010年1月至2019年12月收治的行异基因外周血造血干细胞移植的成人急性白血病患者145例及其供者的临床资料，观察移植后并发症及生存情况；通过多因素Logistics回归分析患者年龄、诊断、起病时白细胞数、危险度分层、移植前微小残留病灶、诊断到移植的时间、HCT-CI、供受者性别关系、HLA配型相合程度、移植物抗宿主病（GVHD）预防方案、供者年龄、输注单个核细胞及CD34+细胞数、造血重建时间、有无急慢性GVHD、CMV及EBV感染、出血性膀胱炎与移植后复发的关系；依据多因素分析的结果建立预测成人急性白血病移植后复发风险的模型，并进行评价.145例急性白血病患者中，急性髓系白血病（AML）81例,急性淋巴细胞白血病（ALL）64例，18例合并有EBV感染，其中2例合并移植后淋巴细胞增殖性疾病，85例合并CMV血症，26例合并出血性膀胱炎症，65例并发急性GVHD，51例并发慢性GVHD，共计45例复发。移植后1、3年OS率分别为86.4%和61.8%，移植后1、3年PFS率分别为67.5%和62.4%。急性髓系白血病与急性淋巴细胞白血病患者移植后OS及PFS存在统计学差异。未复发患者与复发患者OS及PFS存在统计学差异。单因素分析结果显示，患者年龄、危险度分层、诊断到移植的时间、HCT-CI指数、移植前微小残留病灶、GVHD预防方案中是否含有抗人胸腺细胞免疫球蛋白、移植后急慢性GVHD与移植后复发相关，纳入多因素Logistics回归分析，结果显示，移植前残留病灶与复发呈正相关，移植后慢性GVHD与复发呈负相关.成人急性白血病异基因外周血造血干细胞移植后复发率为31.0%，AML患者移植后长期生存率优于ALL患者,移植后复发患者长期生存率显著低于未复发患者。移植前微小残留病灶阳性是移植后复发的高危因素，移植后合并慢性GVHD的患者复发风险降低.

To analyze the risk factors affecting hemorrhagic cystitis(HC) after allogeneic hematopoietic stem cell transplantation(allo-HSCT).The clinical data of 153 patients underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2018 were selected and retrospectively analyzed. The incidence, median time and treatment outcome of HC should be observed. Multivariate analysis was used to observe the risk factors of HC in patients, including sex, age, diagnosis, disease status before transplantation, transplantation type, ATG and CTX in the pretreatment scheme, stem cell source, neutrophil and platelet implantation time; CMV, EBV and BKV infection, and acute graft-versus-host disease(aGVHD).Among 153 patients underwent allogeneic hematopoietic stem cell transplantation, 25 (16.34%) patients had HC, the median occurance time was 31 days, all patients achieved complete remission after treatment, no bladder irritation and bladder contracture were left. The results of univariate and multivariate Logistic regression analysis showed that the type of transplantation, ATG, CMV viremia before treatment, aGVHD (r=1.036, 3.234, 3.298 and 2.817, respectively) were the independent risk factors of HC.The urinary BKV detections in the patients with HC are positive, mainly occured during the period from day +13 to days +56. HLA haplotype, pretreatment including ATG, and CMV viremia, and aGVHD are the independent risk factors for HC after allo-HSCT.异基因造血干细胞移植后并发出血性膀胱炎的危险因素分析.分析异基因造血干细胞移植（allo-HSCT）后并发出血性膀胱炎（HC）的危险因素.回顾性分析2010年1月-2018年12月于西安交通大学第一附属医院行allo-HSCT的153例患者的临床资料。观察HC的发生率、发生中位时间及治疗转归。利用多因素分析观察患者性别、年龄、诊断、移植前疾病状态、移植类型、预处理方案中是否含有ATG、预处理方案中是否含有CTX、干细胞来源、中性粒细胞植入时间、血小板植入时间、CMV感染、EBV感染、BKV感染、急性移植物抗宿主病（aGVHD）是否为发生HC的高危因素.153例allo-HSCT患者中，25例发生HC，发生率为16.34%，发生的中位时间为31 d，治疗后全部好转，无1例遗留膀胱刺激症状及膀胱挛缩 。经单因素和多因素Logistic回归分析，结果显示，移植类型、预处理中含ATG、CMV血症以及aGVHD 4项因素（R值分别为1.036、3.234、3.298、2.817）是HC的独立危险因素.HC患者尿BKV检测均为阳性,主要发生在移植后13-56 d。 HLA配型半相合、含ATG的预处理方案、CMV血症及aGVHD是allo-HSCT后发生HC的独立危险因素.

Background and aims Although ticagrelor exerts an antibacterial activity, its effect on infections in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is unclear. We aimed to assess whether ticagrelor and clopidogrel affect infections in these patients during hospitalization. Methods A total of 2116 consecutive patients with STEMI undergoing PCI were divided into the ticagrelor (n = 388) and clopidogrel (n = 1728) groups. The primary outcome was infection onset. Secondary outcomes were in-hospital all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). Propensity score analyses were conducted to test the robustness of the results. Results Infections developed in 327 (15.4%) patients. There was no significant difference in infection between both groups (ticagrelor vs. clopidogrel: 13.1% vs. 16.0%, p = 0.164). Patients in the ticagrelor group had lower rates of in-hospital all-cause death and MACCE than patients in the clopidogrel group. Multivariate logistic regression analysis determined that ticagrelor and clopidogrel had a similar preventive effect on infections during hospitalization (adjusted odds ratio [OR] = 1.20; 95% confidence interval [CI] = 0.80–1.78, p = 0.380). Compared to the patients treated with clopidogrel, patients treated with ticagrelor had a slightly lower risk of other outcomes, but no statistical difference. Propensity score analyses demonstrated similar results for infections and other outcomes. Conclusions Compared with clopidogrel treatment, ticagrelor treatment did not significantly alter the risk of infections during hospitalization among STEMI patients undergoing PCI, but was associated with a slightly lower risk of in-hospital all-cause death and MACCE.

Background Several studies have shown that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly correlated with the complexity of coronary artery disease and the prognosis of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS), However, it remains unclear about the prognostic value of NT-proBNP in patients with NSTE-ACS and multivessel coronary artery disease (MCAD) undergoing percutaneous coronary intervention (PCI). Therefore, this study aimed to reveal the relationship between NT-proBNP levels and the prognosis for NSTE-ACS patients with MCAD undergoing successful PCI. Methods This study enrolled 1022 consecutive NSTE-ACS patients with MCAD from January 2010 to December 2014. The information of NT-proBNP levels was available from these patients. The primary outcome was in-hospital all-cause death. In addition, the 3-year follow-up all-cause death was also ascertained. Results A total of 12 (1.2%) deaths were reported during hospitalization. The 4th quartile group of NT-proBNP (> 1287 pg/ml) showed the highest in-hospital all-cause death rate (4.3%) (P P = 0.022). NT-proBNP was able to predict the in-hospital all-cause death (area under the curve (AUC) = 0.888, 95% CI = 0.834–0.941, P P Conclusions The increasing NT-proBNP level is significantly associated with the increased risks of in-hospital and long-term all-cause deaths among NSTE-ACS patients with MCAD undergoing PCI. Typically, NT-proBN P > 1568 pg/ml is related to the all-cause and in-hospital deaths.

Background Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting. Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion. Trial design DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided vs angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary end point is the rate of 12-month target vessel failure, including cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. The secondary end points consist of the individual component of primary end point, all-cause death, myocardial infarction, and in-stent restenosis. The safety end point is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure. Conclusions DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.

Background Inspiratory muscle strength is associated with pneumonia in patients after surgery or those with subacute stroke. However, inspiratory muscle strength in patients with acute myocardial infarction (AMI) has not been studied. Objective To evaluate the predictive value of inspiratory muscle strength for pneumonia in patients with AMI. Methods Patients with AMI were consecutively enrolled from March 2019 to September 2019. Measurements of maximal inspiratory pressure (MIP) were used to estimate inspiratory muscle strength and mostly were taken within 24 hr after culprit-vessel revascularization. Patients were divided into 3 groups by MIP tertile (T1: 84.9 cm H2O, n = 89). The primary endpoint was in-hospital pneumonia. Results Among 265 enrolled patients, pneumonia developed in 26 (10%). The rates of pneumonia were decreased from MIP T1 to T3 (T1: 17%, T2: 10%, T3: 2%, P = 0.004). In-hospital all-cause mortality and major adverse cardiovascular events (MACEs) did not differ between groups. Multivariate logistic regression confirmed increased MIP associated with reduced risk of pneumonia (odds ratio 0.78, 95% confidence interval 0.65–0.94, P = 0.008). Receiver operating characteristic curve analysis indicated that MIP had good performance for predicting in-hospital pneumonia, with an area under the curve of 0.72 (95% confidence interval 0.64–0.81, P Conclusions The risk of pneumonia but not in-hospital mortality and MACEs was increased in AMI patients with inspiratory muscle weakness. Future study focused on training inspiratory muscle may be helpful.

To explore the renal pathology and cytogenetic features in the multiple myeloma (MM) patients with renal impairment.The clinical data of newly diagnosed MM patients with renal impairment in our hospital from January 2009 to January 2019 were analyzed retrospectively, and the relationship between FISH results and results of renal pathological exanimation was analyzed statistically by using SPSS 20.0.A total of 20 patients underwent renal biopsy, included 12 males and 8 females. FISH result showed that out of 20 patients, 7 cases presented interstitial nephritis, among which 3 cases were negative for FISH, and in the remaining cases the rate of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 42.86%, 28.57%, 28.57%, 28.57% and 14.29% respectively, the detection positive rate was statistically significantly lower as compared with total probe positive rate (P＜0.01). There were 6 cases of cast nephropathy, among which IgH rearrangement, the rate of 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 66.67%, 50%, 66.67%, 50% and 0% respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were 4 cases of acute tubular necrosis, among which the detection rates of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion was 100%, 50%, 50%, 25% and 25%, respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were one case of amyloidosis, and one case of tubular nephropathy with amyloidosis, the detection with 5 probes were all positive. One case of light chain deposition disease was positive for RB1 gene deletion + D13S319 gene deletion.FISH in the MM patients with different renal pathological changes is characterized by heterogeneity, which can be used to predict the risk of renal damage and speculate possible renal pathological types to guide prognosis.多发性骨髓瘤伴肾损害患者肾脏病理及细胞 遗传学检查的回顾性分析.探讨多发性骨髓瘤伴肾损害患者肾脏病理及细胞遗传学特点.回顾性分析本院2009年1月-2019年1月初诊多发性骨髓瘤伴肾损害并行肾穿刺患者的临床资料，并且分析骨髓荧光原位杂交检查（Fluorescence in situ hybridization, FISH）结果与肾脏病理检查结果之间的关系，采用SPSS 20.0进行统计分析.行肾穿刺活检患者20例，其中男性12例，女性8例。20例患者中间质性肾炎7例，其中3例FISH检查阴性， 其余IgH重排、1q21扩增、RB1缺失、D13S319缺失和P53缺失检出率分别为42.86%、28.57%、28.57%、28.57% 和14.29%，与总体探针阳性检出率相比显著降低（P＜0.01）；管型肾病6例，其中IgH重排、1q21扩增、RB1缺失、D13S319缺失、P53缺失检出率分别为66.67%、50%、66.67%、50%和0，与总体探针阳性率相比无统计学意义（P＞0.05）；急性肾小管损伤4例，IgH重排、1q21扩增、RB1缺失、D13S319缺失、P53缺失检出率分别为100%、50%、50%、25%和25%，与总体探针阳性率相比无统计学意义（P＞0.05）；淀粉样变及管型肾病合并淀粉样变各1例，均为5种探针检测为阳性；轻链沉积病1例为RB1基因缺失+D13S319基因缺失阳性.不同肾脏病理损伤的患者FISH表现出异质化特点，可用其预测肾损害风险及推测可能的肾脏病理类型以指导预后.

Statins have been shown to reduce the risk of post-contrast acute kidney injury (PC-AKI) in patients undergoing percutaneous coronary intervention (PCI). However, the preventive effect of rosuvastatin versus atorvastatin on PC-AKI in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI remains unclear. Patients with STEMI undergoing PCI between January 2010 and May 2016 were consecutively enrolled. A total of 1300 included patients were divided into two groups according to the statin type (atorvastatin: n = 1040; rosuvastatin: n = 260). The primary endpoint was PC-AKI defined as an absolute increase of ≥ 0.5 mg/dL in the level of serum creatinine or an increase of ≥ 25 % over baseline within 48−72 h after contrast media exposure. In total, 245 (18.8 %) patients developed PC-AKI. The atorvastatin and rosuvastatin groups had similar rates of PC-AKI (19.1 % vs. 17.7 %, p = 0.595), in-hospital mortality (4.1 % vs. 3.8 %, p = 0.833), and major adverse clinical events (MACE). Multivariate logistic regression analysis revealed that rosuvastatin treatment had an effect similar to atorvastatin regarding PC-AKI (odds ratio [OR] = 0.97, 95 % confidence interval [CI], 0.66−1.43, p = 0.874). Propensity score analyses and subgroup analysis demonstrated similar results for PC-AKI. Kaplan-Meier survival curves and Cox proportional regression showed that the atorvastatin and rosuvastatin groups had no differences regarding follow-up mortality. Rosuvastatin exerted a similar preventive effect against PC-AKI and showed similar levels of in-hospital and follow-up all-cause mortality and in-hospital MACE compared with atorvastatin in patients with STEMI undergoing PCI.

AIM Diabetes is a risk factor in infective endocarditis. However, few studies have focused on the prognostic value of prediabetes in infective endocarditis. This analysis aimed to explore the relationship between prediabetes and outcomes for people with infective endocarditis. METHODS Diabetes and prediabetes definitions were based on the American Diabetes Association 2014 criteria. A total of 866 people who had been consecutively diagnosed with infective endocarditis between January 2009 and July 2015 were included in the analysis. They were divided into three groups: normoglycaemia (n = 469), prediabetes (n = 246) and diabetes (n = 151). Univariate and multivariate analyses were used to identify risk factors for adverse outcomes. RESULTS Overall in-hospital mortality was 8.5% (74 of 866), and differed significantly among the normoglycaemia, prediabetes and diabetes groups (3.4%, 12.6% and 17.9%, respectively; P < 0.001). Compared with the normoglycaemia group, the adjusted odds ratio for in-hospital death was 2.42 [95% confidence interval (CI) 1.11-5.31; P = 0.027) for prediabetes and 3.39 (95% CI 1.48-7.80; P = 0.004) for diabetes. The cumulative long-term death rate was significantly higher in the prediabetes or diabetes groups than in the normoglycaemia group (log-rank = 34.82; P < 0.001). CONCLUSION In addition to diabetes, prediabetes was also associated with a higher risk of in-hospital and long-term mortality among people with infective endocarditis. Therefore, attention should be paid to this population.

The monocyte to high-density lipoprotein cholesterol ratio (MHR) appears to be a newly emerging inflammatory marker. However, its prognostic value in patients with infective endocarditis (IE) and normal left ventricular ejection fraction (LVEF) has been unclear.Methods and Results:We enrolled consecutive patients with IE and normal LVEF and divided into 3 groups based on the tertiles of MHR. Of 698 included patients, 44 (6.3%) died while in hospital. The occurrence of in-hospital death (3.9%, 4.3%, and 10.8%, P=0.003) and of major adverse clinical events (MACEs) (15.6%, 20.9%, and 30.6%, P0.001) increased from the lowest to the highest MHR tertiles, respectively. Receiver-operating characteristic analysis demonstrated that MHR had good predictive value for in-hospital death (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.58-0.76, P0.001) and was similar to C-reactive protein (AUC 0.670 vs. 0.702, P=0.444). Furthermore, MHR21.3 had a sensitivity of 74.4% and specificity of 57.6% for predicting in-hospital death. Multiple analysis showed that MHR21.3 was an independent predictor of both in-hospital (odds ratio 3.98, 95% CI 1.91-8.30, P0.001) and long-term death (hazard ratio 2.29, 95% CI 1.44-3.64, P0.001) after adjusting for age, female, diabetes mellitus, estimated glomerular filtration rate90 mL/min/1.73 mElevated MHR was independently associated with in-hospital and long-term death in patients with IE and normal LVEF.

We evaluated the relationship between admission serum uric acid (SUA) and in-hospital and one-year mortality after valve replacement surgery (VRS) for patients with rheumatic heart disease (RHD).One-thousand five-hundred thirty-six consecutive patients with RHD undergoing VRS were divided into 4 groups based on the quartiles of SUA on admission. The association between SUA and adverse outcomes was analyzed.The in-hospital mortality (2.1% vs 2.6% vs 5.3% vs 7.7%, p0.001) and postoperative acute kidney injury (AKI) (52.0% vs 52.6% vs 61.6% vs 63.3%, p=0.001) increased from the lowest to the highest SUA quartiles. SUA levels were negatively correlated with eGFR value (r=-0.426, p0.001) and positively correlated with C-reactive protein value (r=0.103, p0.001). ROC analysis showed that SUA had good predictive value for in-hospital death (AUC=0.665, p0.001) and was similar to Euro score (Z=0.966, p=0.334). Multiple logistic regression analysis showed that SUA was independently associated with in-hospital (OR=1.21, 95% CI: 1.06, 1.37, p=0.004) and one-year mortality (HR=1.17, 95% CI: 1.05, 1.29, p=0.003). Kaplan-Meier analysis demonstrated that the cumulative rate of one-year mortality after surgery was higher in patients with SUA7.3mg/dl (Log-rank=21.1, p0.001).Admission SUA could be used as a preoperative risk assessment factor in RHD patients who underwent VRS.

Background: Infective endocarditis (IE) is associated with increased neutrophil and reduced platelet counts. We assessed the relationship between the neutrophil-to-platelet ratio (NPR) on admission and adverse outcomes in patients with IE. Methods: Patients diagnosed with IE between January 2009 and July 2015 (n=1293) were enrolled, and 1046 were finally entered into the study. Study subjects were categorized into four groups according to NPR quartiles: Q143.3 (n=262). Cox proportional hazards regression was performed to identify risk factors for long-term mortality; the optimal cut-off was evaluated by receiver operating characteristic curves. Results: Risk of in-hospital death increased progressively with NPR group number (1.9 vs. 5.0 vs. 9.8 vs. 14.1%, p Conclusions: Increased NPR was associated with in-hospital and long-term mortality in patients with IE. As a simple and inexpensive index, NPR may be a useful and rapid screening tool to identify IE patients at high risk of mortality.

// Xue-biao Wei 1, * , Yuan-hui Liu 1, * , Peng-cheng He 1 , Ying-ling Zhou 1 , Ning Tan 1 , Ji-yan Chen 1 and Dan-qing Yu 1 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China * These authors contributed equally to this work and co-first authors Correspondence to: Dan-qing Yu, email: gdydq100@126.com Ning Tan, email: gdtanning@126.com Keywords: infective endocarditis, c-reactive protein, red blood cell distribution width, outcome Received: July 14, 2016 Accepted: March 27, 2017 Published: April 06, 2017 ABSTRACT Objective: To evaluate the combined effect of C-reactive protein (CRP) and red blood cell distribution width (RDW) on the prediction of in-hospital and long-term poor outcomes in patients with blood culture-negative infective endocarditis (BCNE). Results: Patients with high CRP and high RDW has the highest incidence of in-hospital death (2.3% vs. 7.8% vs. 5.6% vs. 17.5%, P 17.8 mg/L (odds ratio [OR]=2.41, 95% confidence interval [CI], 1.06–5.51, P = 0.037), RDW >16.3 (OR = 2.29, 95% CI, 1.10–4.77, P = 0.027), and these two values in combination (OR = 3.15, 95% CI, 1.46–6.78, P=0.003) were independently associated with in-hospital death. Patients with RDW > 16.3 had higher long-term mortality ( P = 0.003), while no significant correlation was observed for CRP ( P = 0.151). Materials and Methods: In total, 572 participants with BCNE were consecutively enrolled. They were classified into four groups based on the optimal CRP and RDW cut-off values (which were determined using a receiver operating characteristic analysis): low CRP and low RDW ( n = 216), high CRP and low RDW ( n = 129), low CRP and high RDW ( n = 107), and high CRP and high RDW ( n = 120). Conclusions: Increased CRP and RDW, especially in combination, are independently associated with in-hospital death in BCNE. RDW, but not CRP, has long-term prognostic value.

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, contrast-induced nephropathy (CIN) is a serious complication associated with poor outcomes. We assessed the predictive value of the Canada Acute Coronary Syndrome (C-ACS) score for CIN in these patients. A total of 394 consecutive patients with STEMI were enrolled and divided into 3 groups according to their C-ACS scores—group 1, score 0; group 2, score 1; and group 3, score ≥2. The clinical outcomes were CIN and major adverse clinical events (MACEs) during hospital and follow-up; 8.4% of patients developed CIN. Patients with high C-ACS scores were more likely to develop CIN, in-hospital death, and MACEs ( P < .001). The C-ACS score was an independent predictor of CIN (odds ratio = 2.87; 95% confidence interval = 1.78-4.63; P < .001) and risk factor for long-term MACEs. The C-ACS score had good predictive values for CIN, in-hospital morality, MACEs, and long-term mortality. Patients with high C-ACS risk scores exhibited a worse survival rate than those with low scores (death, P = .02; MACEs, P = .006). In conclusion, in patients with STEMI, the C-ACS could predict CIN and clinical outcomes.

Background Limited research studies with a large sample size were performed to evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for in-hospital or long-term poor outcomes in patients with infective endocarditis. Methods A total of 703 patients with infective endocarditis were enrolled and divided into four groups according to admission NT-pro-BNP (pg/mL) quartiles: Q1 (258), Q2 (258-1054), Q3 (1055-3522) and Q4 (3522). Multivariate regression was used to determine independent risk of NT-proBNP for in-hospital and one-year death. Results In-hospital death occurred in 9.0% of patients. The in-hospital mortality was increased from the lowest to the highest NT-proBNP quartiles (1.1%, 3.4%, 9.1% and 22.3%, P 0.001, respectively). During the one-year follow-up period, 29 patients died: 0 in Q1, 7 (4.6%) in Q2, 8 (5.7%) in Q3 and 14 (12.0%) in Q4 ( P 0.001). Log-transformed (lg) NT-proBNP had a linear correlation with lg C-reactive protein ( r = 0.308, P 0.001). Multivariate analysis showed lgNT-proBNP was an independent predictor for both in-hospital (odds ratio 4.59, 95% confidence interval (CI) 2.45-8.61, P 0.001) and one-year mortality (hazard ratio 3.11, 95% CI 1.65-5.87, P 0.001). In addition, NT-proBNP had a higher predictive power for in-hospital death than C-reactive protein (area under the curve 0.797 vs. 0.670, P = 0.005). NT-proBNP 2260 pg/mL had 76.2% sensitivity and 69.1% specificity for predicting in-hospital death. Kaplan-Meier analysis showed that patients with NT-proBNP 2260 pg/ml had a worse prognosis than those without (log-rank test 18.84, P 0.001). Conclusion Increased NT-proBNP was independently associated with in-hospital and one-year mortality in patients with infective endocarditis.

The present study aimed to propose the pulmonary hypertension for predicting left ventricular dysfunction in adults after patent ductus arteriosus closure. A total of 183 patients (age ≥18 years) after patent ductus arteriosus occlusion were retrospectively collected in this study. In brief, pre-, post-procedure and short-term follow-up transthoracic echocardiography were performed. Simpson’s method was used to measure the left ventricular ejection fraction (LVEF), and LVEF less than 50% after procedure was utilized as a criterion to identify left ventricular dysfunction. As a result, 36 (19.67%) patients developed newly identified left ventricular dysfunction. The rate of newly identified left ventricular dysfunction was significantly higher in moderate or severe pulmonary hypertension groups compared to the groups of mean pulmonary artery pressure (mPAP)

To investigate the influence of oridonin on the killing activity of NK-92 MI cells targeting THP1 and the related mechanism.The killing activity of NK-92 MI to THP1 before and after oridonin treatment was detected by LDH release assay; the expression of natural killer cell ligands activating receptor D (NKG2D, including MICA, MICB, ULBP1, ULBP2 and ULBP3) was detected by real-time quantitative polymerase chain reaction (qRT-PCR) and Western blot respectively; the expression of cytokine TNF-α, TNF-β and IFN-γ in the co-culture supernatant of NK-92 MI cells and THP1 cells were measured by ELISA.The killing efficiency after oridonin treatment at different effector-target ratio (1:1, 5:1, 10:1) was all significantly up-regulated in comparison with that before oridonin treatment (P＜0.05). QRT-PCR and Western blot showed that the expressions of mRNA and protein levels of MICB, ULBP1, ULBP2 increased to varying degree (P＜0.05), but the expression levels of MICA and ULBP3 were not statistically significant between experimental group and control group (P＞0.05). ELISA results indicated that IFN-γ and TNF-β release were significantly increased after oridonin treatment (P＜0.05), however, the TNF-α release was not statistically different in comparison with control group (P＞0.05).Oridonin can significantly improve killing efficiency of NK-92 MI on THP1, that might be related with up-regulation of MICB, ULBP1 and ULBP2 expression and promotion of IFN-γ and TNF-β release.冬凌草甲素对NK-92 MI杀伤THP1细胞的活性影响及机制.观察冬凌草甲素对效应细胞NK-92 MI杀伤靶细胞THP1活性的影响并探讨其作用机制.LDH释放法检测冬凌草甲素作用前后NK-92 MI对THP1的杀伤效率；应用qRT-PCR和Western blot分别检测THP1细胞表面自然杀伤细胞激活性受体D（NKG2D）相关配体表达情况；ELISA法检测效靶细胞共培养上清中细胞因子表达变化.冬凌草甲素处理后NK-92 MI在不同效靶比均可提高对THP1细胞的杀伤效率；冬凌草甲素可上调THP1细胞表面MICB、ULBP1和ULBP2表达，同时增加效靶细胞共培养上清中IFN-γ和TNF-β释放，而对MICA、ULBP3表达及TNF-α释放无明显影响.冬凌草甲素通过增加MICB、ULBP1和ULBP2表达以及促进IFN-γ和TNF-β释放提高THP1细胞对NK-92 MI的杀伤敏感性.

To investigate the mechanism of rapamycin-induced apoptosis of chronic myelogenous leukemia cells.The chronic granulocytic leukemia K562 cells were divided into 3 groups: A, B and C group were treated with rapamycin of 10, 15 and 20 nmol/L, repectively for 24 h, while the K562 cells in control group were not treated with rapamycin. The effect of rapamycin on the proliferation of K562 cells was detected by MTT, and the effect of rapamycin on the apoptosis of K562 cells was detected by AnnexinV-FITC/PI double staining. The expression level of EZH2/Hedgehog signaling pathway genes in K562 cells was detected by RT-PCR, and Western blot was used to detect the levels of apoptotic protein and the related signaling pathway proteins in K562 cells.The MTT assay showed that the different concentration of rapamycin had obvious inhibitory effects on the cells, and the survival rate of cells in group C was 37.6%±3.4%, which was significantly lower than that of the other groups (P＜0.05). The apoptosis rate of cells in group C was 93.1%±8.1%, which was significantly higher than that of the other groups (P＜0.05). By Western blot, it was found that the relative expression levels of Caspase-3 and BAX protein in group C were 0.36 ± 0.04 and 0.39±0.06, respectively, which were significantly higher than those in other groups (P＜0.05), and the level of BCL-2 protein was 0.17±0.03, which was significantly lower than that of other groups (P＜0.05). By RT-PCR, it was found that the mRNA levels of EZH2 and Hedgehog genes in A, B and C groups were significantly lower than those in the control group (P＜0.05), but mRNA level of Ptch1 gene was significantly higher than that of the control (P＜0.05). By Western blot, it was found that the expression levels of EZH2 and Hedgehog protein in A, B and C groups were significantly lower than that in the control group (P＜0.05), but the level of Ptch1 protein was higher than that of the control (P＜0.05). The relative levels of EZH2 and Hedgehog protein in group C were 0.21 ±0.03 and 0.16±0.05 respectively, which were significantly lower than those in other groups (P＜0.05), and Ptch1 protein level were 0.46 ±0.06, significantly higher than that of other groups (P＜0.05).Rapamycin can inhibit the protein expression of EZH2 in leukemic cells, thus interfere with the activation of Hedgehog signaling pathway, promote the expression of apoptotic protein, reduce the level of anti apoptotic protein, and eventually induce apoptosis of leukemia cells.雷帕霉素通过EZH2/Hedgehog信号通路诱导慢性髓系白血病细胞凋亡.探讨雷帕霉素诱导慢性髓系白血病（CML）细胞凋亡的机制.对CML细胞K562用雷帕霉素10（A组）、15（B组）和20（C组） nmol/L分别处理24 h，对照组不加雷帕霉素。采用MTT法检测雷帕霉素对K562细胞增殖的影响, AnnexinV-FITC/PI 双染法检测雷帕霉素对K562细胞凋亡的影响, RT-PCR检测雷帕霉素对K562细胞EZH2/Hedgehog信号通路基因表达水平，Western blot检测雷帕霉素对K562细胞凋亡及相关信号通路蛋白表达水平.MTT法检测发现，不同浓度雷帕霉素对细胞增殖有明显抑制作用，其中C组的细胞存活率37.6%±3.4%，显著低于其它各组（P＜0.05）。通过AnnexinV-FITC/PI双染法检测发现，C组细胞的凋亡率为93.1%±8.1%，显著高于其它各组（P＜0.05）。Western blot检测发现，K562细胞在雷帕霉素作用后，C组的Caspase-3和BAX蛋白相对表达水平分别为0.36±0.04、0.39±0.06，显著高于其它各组（P＜0.05）；BCL-2 蛋白水平0.17±0.03，显著低于其它各组（P＜0.05）。RT-PCR检测发现，K562细胞在雷帕霉素作用后，EZH2与Hedgehog基因mRNA水平明显下降（P＜0.05），而Ptch1基因mRNA水平明显上升（P＜0.05）。Western blot检测发现，K562细胞在雷帕霉素作用后，其EZH2与Hedgehog蛋白表达水平下降，而Ptch1蛋白水平上升（P＜0.05）。C组的EZH2与Hedgehog蛋白相对水平分别为0.21±0.03、0.16±0.05，显著低于其它各组（P＜0.05）；Ptch1蛋白水平0.46±0.06，显著高于其它各组（P＜0.05）.雷帕霉素可抑制白血病细胞中EZH2蛋白表达，从而干扰Hedgehog信号通路的激活，并促进凋亡蛋白的表达，减少抗凋亡蛋白水平，最终诱导白血病细胞的凋亡.

To investigate the effect of decitabine on proliferation and apoptosis of multiple myeloma KMS-18 cells and its possible mechanism.CCK-8 was used to detect cell proliferation, flow cytometry was used to detect the changes of apoptosis, real-time quantitative PCR was used to detect the expression of P53 gene mRNA in myeloma KMS-18 cells, and MSP assay was used to detect the methylation status of P53 gene promoter.The proliferation inhibition and apoptosis of KMS-18 cells significantly increased after treatment by decitabine (P＜0.05). The expression of P53 mRNA increased in KMS-18 cells after treatment of decitabine (P＜0.05). The methylation status of the P53 gene promoter in KMS-18 cells could be partially reversed by decitabine.Decitabine can inhibit the proliferation of KMS-18 cells and induce their apoptosis, its mechanism ralates with partially reversing the methylation of P53 gene promoter in KMS-18 cells.地西他滨诱导多发性骨髓瘤KMS-18细胞凋亡及其机制研究.研究地西他滨对多发性骨髓瘤KMS-18细胞的抑制增殖及诱导凋亡的作用及其可能机制.采用CCK-8法检测不同浓度地西他滨干预后KMS-18细胞增殖抑制率；流式细胞术检测地西他滨干预的细胞凋亡变化；实时荧光定量PCR检测地西他滨干预前、后P53基因mRNA表达水平；MSP法检测地西他滨干预前后P53基因启动子甲基化的状态.地西他滨干预后KMS-18细胞增殖抑制率呈时间及浓度依赖性增加（r =0.9790，P＜0.05）；干预后细胞凋亡率显著增加，差异有统计学意义（P＜0.05）；地西他滨干预后KMS-18细胞P53基因mRNA表达增加（P＜0.05）；地西他滨可以部分逆转KMS-18细胞P53基因启动子甲基化状态.地西他滨可抑制细胞增殖，并诱导其凋亡，与其部分逆转KMS-18细胞P53基因启动子甲基化有关.

IMPORTANCE: The association of parenteral anticoagulation therapy with improved outcomes in patients with non–ST-segment elevation acute coronary syndrome was previously established. This benefit has not been evaluated in the era of dual antiplatelet therapy and percutaneous coronary intervention. OBJECTIVE: To evaluate the association between parenteral anticoagulation therapy and clinical outcomes in patients with non–ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 8197 adults who underwent percutaneous coronary intervention for non–ST-segment elevation acute coronary syndrome from January 1, 2010, to December 31, 2014, at 5 medical centers in China. Patients receiving parenteral anticoagulation therapy only after percutaneous coronary intervention were excluded. EXPOSURES: Parenteral anticoagulation therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital all-cause death and in-hospital major bleeding as defined by the Bleeding Academic Research Consortium definition (grades 3-5). RESULTS: Of 6804 patients who met the final criteria, 5104 (75.0%) were male, with a mean (SD) age of 64.2 (10.4) years. The incidence of in-hospital death was not significantly different between the patients who received and did not receive parenteral anticoagulation therapy (0.3% vs 0.1%; P = .13) (adjusted odds ratio, 1.27; 95% CI, 0.38-4.27; P = .70). A similar result was found for myocardial infarction (0.3% vs 0.3%; P = .82) (adjusted odds ratio, 0.77; 95% CI, 0.29-2.07; P = .61). In-hospital major bleeding was more frequent in the parenteral anticoagulation group (2.5% vs 1.0%; P

To evaluate the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in relation to Mehran risk score (MRS) for contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).We prospectively enrolled 283 consecutive patients treated with PPCI for STEMI. NT-proBNP was measured, and the MRS was calculated. The primary end point was CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL from baseline within 48-72 h after contrast medium exposure.The incidence of CIN was 9.2 %. Patients with CIN had higher NT-proBNP and MRS than those without CIN. The value of NT-proBNP was similar to MRS for CIN (C statistics 0.760 vs. 0.793, p = 0.689). After adjustment for MRS, elevated NT-proBNP (defined as the best cutoff point) was significantly associated with CIN. The addition of elevated NT-proBNP to MRS did not significantly improve the C statistics, over that with the original MRS model (0.833 vs. 0.793, p = 0.256). In addition, similar results were observed for in-hospital and long-term major adverse clinical events.Although NT-proBNP did not add any prognostic value to the MRS model for CIN, NT-proBNP, as a simple biomarker, was similar to MRS, and may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.

Geraniin, an active compound isolated from Geranium sibiricum, has been reported to have antioxidant and anti-inflammatory activities. The aim of this study was to investigate the protective effects of geraniin against cisplatin (CP)-induced kidney injury in mice. Geraniin was administrated for three consecutive days following CP (20 mg/kg) injection. The results showed that geraniin inhibited CP-induced kidney histopathologic changes, MDA, inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) production in kidney tissues. Geraniin also inhibited CP-induced blood urea nitrogen (BUN) and creatinine production. Meanwhile, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) decreased by CP were reversed by the treatment of geraniin. In addition, geraniin significantly inhibited CP-induced NF-κB activation in kidney tissues. Treatment of geraniin dosedependently upregulated the expression of Nrf2 and HO-1. The anticancer effects of CP were not affected by the treatment of geraniin. In conclusion, these results indicated that geraniin protected against CP-induced nephrotoxicity by inhibiting oxidative stress and inflammatory response.

The expression of SET nuclear proto‑oncogene (SET) is commonly associated with cell proliferation and tumorigenesis. In the present study, a eukaryotic SET expression plasmid (pEGFP‑N1‑SET) was constructed and transiently transfected into 293T human embryonic kidney cells. Transfection led to expression of the SET oncoprotein at high levels, as indicated by polymerase chain reaction and western blot analysis. In addition, the relative mRNA and protein expression of protein phosphatase 2A in pEGFP‑N1‑SET‑transfected 293T cells was downregulated compared with that in empty vector‑transfected cells. Furthermore, overexpression of SET increased the percentage of 293T cells in S and G2/M phases compared with the control transfectants. An increase in B‑cell lymphoma 2 (Bcl‑2) and a decrease in Bcl‑2‑associated X (Bax) protein expression was observed in the pEGFP‑N1‑SET‑transfected cells compared with that in the controls, and their susceptibility to As4S4‑induced apoptosis was decreased. The protein SET is involved in a number of cellular processes, including DNA replication, chromatin remodeling, gene transcription, differentiation, migration and cell cycle regulation. SET is overexpressed in several neoplasms, particularly in acute myeloid leukemia. The findings of the present study suggested that the SET gene may contribute to tumorigenesis and may be a potential novel effective therapeutic target for leukemia and other cancer types.

To expolore the effect of programmed death receptor ligand 1 (PD-L1) expression level on killing effect of different cell lines of acute myeloid leukemia (AML) and its possible mechanism.Peripheral blood from healthy individuals was collected routinely; NK cells were isolated using immunomagnetic beads; PD-L1 expression level was detected by flow cytometry; the killing effect of NK cells on acute myelogenous leukemia cell lines was evaluated with LDH release method and monoclonal antibody blocking experiment; the expression levels of IFN-γ and IL-2 in the supernatants from the co-cultured effector/targer cells were measured by ELISA.The ratio of CD3The killing effect of NK cells on acute myelogenous leukemia cell line is inversely proportional to PD-L1 expression; blocking PD1/PD-L1 binding can significantly enhance the killing efficiency of effector-target cells, which way be related with promoting the release of IFN-γ and IL-2.

Background: No randomized trial has been conducted to directly compare enoxaparin with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In an era where early invasive strategies are recommended in high risk patients, the effect of enoxaparin and UFH needs to be re-evaluated. The authors performed a meta-analysis to determine whether enoxaparin is superior to UFH in patients with NSTE-ACS undergoing PCI. Methods: The composite efficacy end point included all-cause mortality and myocardial infarction (MI) in the hospital or within 60 days. Major bleeding, as defined in the individual clinical trials evaluated, was the main safety endpoint within the same time period. Pooled estimates of the difference in outcome between enoxaparin and UFH were calculated using fixed or random effects models. Results: A total of 8,861 patients from 4 trials were included. In the pooled analysis, rates of death or MI were similar in patients treated with enoxaparin and UFH [risk ratio (RR), 0.89, 95% confidence interval (CI): 0.77–1.02, P=0.09; I 2 =50%]. Major bleeding was also similar between enoxaparin and UFH (RR, 1.21, 95% CI: 0.94–1.56, P=0.15, I 2 =39%). A subgroup analysis, including randomized trials only or trials with a large sample size, and a leave-one-out sensitivity analysis, demonstrated similar results with above, respectively. Conclusions: In patients undergoing PCI for NSTE-ACS, rates for both death/MI and major bleeding were similar between patients treated with enoxaparin and UFH.

To explore the characteristics and diagnostic values of bone marrow cell morphology and immunophenotyping in lymphoma cell leukemia patients.Data of the bone marrow cell morphology and immunophenotyping of 35 patients with lymphoma cell leukemia admitted from January 2012 to January 2017 were analyzed retrospectively, and the value of bone marrow cell morphology and immunophenotype in the diagnosis of lymphoma cell leukemia was evaluated.Bone marrow cell morphological examination showed the typical lymphoma cells in all the patients. The expression of differentiation antigens in lymphoma cell leukemia was consistent with that of original pathological diagnosis. In T-cell lymphoma cell leukemia, the expression of CD7, CD3, CD2, CD5, CD11b, CD34, and HLA-DR were present predominantly, among them the CD7 was the most sensitive antigen and its positive expression rate was 69.2%. In B-cell lymphoma cell leukemia, the expression of CD19, CD20, CD22, CD79a, Skappa, and early antigen HLA-DR were observed predominantly, among them the positive expression rate of CD19 was the highest (89.5%). Out of 35 cases, 28 cases showed that the percentage of lymphoma cells on bone marrow smears was consistent with that of bone marrow immunophenotyping, and 7 cases showed that the percentage of lymphoma cells between bone marrow smears and immunophenotyping differed by more than 1.5-fold.Bone marrow slides combined with immunophenotyping may be helpful for judging lymphoma cell marrow invasion and making early diagnosis of lymphoma cell leukemia.

It is common for patients with rheumatic heart disease to have an enlarged heart. We investigated the prognostic value of cardiothoracic ratio (CTR) in patients with rheumatic heart disease undergoing valve replacement surgery.A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR:0.56 (n = 349), 0.56-0.61 (n = 488), 0.61-0.66 (n = 449) and ≥0.66 (n = 486). The CTR was measured from postero-anterior chest radiographs. We then investigated the association between the CTR and adverse outcomes.In-hospital mortality was 4.0% (71/1772). Analyses of receiver operating characteristic curves showed that, at a cut-off of 0.6, the CTR exhibited 66.2% sensitivity and 64.0% specificity for detecting in-hospital death (area under curve 0.671, P 0.001). The prevalence of in-hospital death was 7.1% in males with a CTR0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR0.6 was an independent predictor of in-hospital (odds ratio 2.36, P = 0.005) and 1-year mortality (hazard ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR0.6 (log-rank 16.36, P 0.001).CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with rheumatic heart disease undergoing valve replacement surgery.

The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤ 10 (n = 588) and MELD-XI 10 (n = 270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p 0.001) and major adverse clinical events (33.3 vs. 18.4%, p 0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR] = 1.06, 95% CI, 1.02-1.10, p = 0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein 9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p 0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score 13 than those without (log-rank = 25.30, p 0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio = 1.08, 95% CI, 1.04-1.12, p 0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.

In this paper, the optimal projection recognition (OPR) developed in our lab has been used to find the regularities of forming core-shell Co-Al Hydroxides superstructures.The criteria for predicting core-shell Co-Al Hydroxides superstructures can be obtained by using OPR method among different kinds of pattern recognition diagrams. The new samples predicted to be core-shell Co-Al Hydroxides superstructures were designed by using the inverse projection based on the OPR method. The predicted results agreed well with our experiments. Therefore, the work presented is very useful in the shape-controlled synthesis of core-shell Co-Al Hydroxides superstructures.

We aimed to evaluate the value of the contrast volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut-off value to avoid CIN in patients with chronic total occlusions (CTOs) undergoing cardiac catheterization. We prospectively enrolled 728 consecutive patients with CTOs undergoing cardiac catheterization. Receiver-operator characteristic (ROC) curves were used to identify the optimal sensitivity for the observed range of V/CrCl. The predictive value of V/CrCl for CIN was assessed using multivariate logistic regression. Twenty-one patients (2.88%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk ( P 2.76 remained significantly associated with CIN (OR = 5.22; 95% CI = 1.65–16.53, P = 0.005) or worse long-term outcomes [death: hazard ratio (HR) = 2.72, 95% CI = 1.32–5.60, P = 0.007; major adverse clinical events: HR = 1.46, 95% CI = 1.03–2.06, P = 0.034]. A V/CrCl ratio >2.76 was a predictor of CIN and was independently associated with poor long-term outcomes from our data.

Previous studies have shown that the therapeutic action of tetra-arsenic tetra-sulfide (As4S4) is effective for acute promyelocytic leukemia. However, the molecular mechanism of the action of As4S4 in retinoic acid-resistant acute promyelocytic leukemia (APL) therapy remains unclear. In the present study, the signaling of the cytotoxic effects induced by As4S4 on retinoic acid-resistant APL NB4-R1 cells was investigated. A time-dependent increase in cell death and DNA cleavage was observed following As4S4 treatment. Changes in B-cell lymphoma 2 and Bax accompanied by the activation of caspase-3 and cleavage of poly ADP-ribose polymerase were observed as actions of As4S4. As4S4 induced an accumulation of NB4-R1 cells in the S and G2/M phases, as detected by flow cytometry. Therefore, the present results suggest that As4S4-mediated apoptosis in NB4-R1 cells involves a mitochondria-dependent pathway.

Background The clinical significance of immediate type Ia endoleaks after thoracic endovascular aortic repair (TEVAR) for aneurysms has been described in detail. However, this phenomenon is still controversial in TEVAR patients treated for acute type B aortic dissection. Methods A single-institution study was conducted in 81 prospectively evaluated patients treated between January 2012 and June 2012 for acute type B aortic dissection. Preoperative and postoperative computed tomography angiography (CTA) images were analyzed using 3-dimensional reconstruction to measure the areas and indices of the true lumen, false lumen, and total aorta in the proximal, middle, and distal descending thoracic aorta. Data were analyzed and compared between the 2 groups of patients, with and without immediate type Ia endoleaks. Results The average follow-up period was 12 months (range 10–13 months) after the procedure. TEVAR was successfully performed in all patients (mean age 53 years; 86% men). Thirty-six of the 81 patients were diagnosed with complicated type B dissection, including persistent pain (19/36, 52.7%), refractory hypertension (4/36, 11.1%), and end-organ ischemia (13/36, 36.1%). Of all the patients, 37 (45.7%) were diagnosed with immediate type Ia endoleaks. The differences between the 30-day and 1-year all-cause mortality rates between the 2 groups were nonsignificant (13.5% vs. 2.2%, P = 0.08; 16.2% vs. 4.5%, P = 0.13). No stroke or paraplegia occurred during the follow-up. Reintervention was performed in 2 patients for delayed type I endoleaks in the group without immediate type Ia endoleaks. Pre- and postoperative CTA images were available for analysis in 54 patients. Among them, 24 patients had type Ia endoleaks. Patients with immediate type Ia endoleaks had a significantly larger preoperative distal false lumen area (498 ± 274 vs. 284 ± 213 mm2, P = 0.02) and a larger distal aortic area (759 ± 275 vs. 624 ± 185 mm2, P = 0.03). The 1-year follow-up CTA demonstrated significantly smaller true lumen indices and larger false lumen areas and false lumen indices in the proximal, middle, and distal sections in patients with immediate type Ia endoleaks. Differences in the postoperative morphological changes of the whole descending thoracic aorta were significant between the 2 groups, with the maximum area and the proximal, middle, and distal regions involved. The occurrence of endoleaks and the rates of postoperative false lumen thrombosis throughout the length of stent grafts were not significant at 1-year follow-up. Conclusions The majority of immediate type Ia endoleaks following TEVAR in acute type B aortic dissections could seal spontaneously, without additional procedures needed. However, the appearance of such complications could be a risk factor of poorer aortic remodeling. Careful surveillance is recommended more frequently in patients with immediate type Ia endoleaks.

To study the expression of DNMT3b gene in myeloma RPMI8226 cells and its biological significance.The activity of DNA methyltransferase was detected by ELISA, and the expression of DNMT3b in RPMI8226 cells was analyzed by semi-quantitative RT-PCR and real-time fluorescent quantitative PCR. The proliferation and expression of DNMT3b gene in RPMI8226 cells intervened with capecitabine for 24 hours were detected.The activity of DNMT and expression of DNMT3b in RPMI 8226 cells increased. The proliferation of RPMI8226 cells was inhibited, and the apoptosis occurred in RPMI 8226 cells intervened with capecitabine for 24 hours. The expression level of DNMT3b gene was decreased after being intervened with capecitabine for 24 hours.The expression level of DNMT3b in myeloma RPMI 8226 cells increase, and capecitabine can inhibit the proliferation of RPMI 8226 and induce apoptosis by inhibiting the expression of DNMT3b gene. Therefore, DNMT3b is expected to be a new target for myeloma therapy.

Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE).The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients.Patients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes.Of the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; P = .006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; P .001). ApoA-I (area under the curve, 0.671; P .001) and HDL-C (area under the curve, 0.672; P .001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I0.90 g/L and HDL-C0.78 mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1 g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P = .023) and HDL-C (increments of 1 mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P = .015) were independently associated with long-term mortality.ApoA-I and HDL-C were inversely associated with adverse IE prognosis.

To investigate the risk factors and therapeutic outcome of acute graft versus host disease (aGVHD) in patients with acute leukemia after haploidentical peripheral hematopoietic stem cell transplantation.The clinical data of 19 cases of acute leukemia underwent haploidentical hematopoietic stem cell transplanttion during January 2010 and December 2010 were retrospectively analyzed. The effects of patients sex, donor-recipient sex difference, donor age, conditioning regimen, dosage of anti-thymocyte globulin(ATG), mononuclear cell and CD34Intestinal aGVHD occurred in 5 cases with 1 case at stage II 3 cases at stage III and 1 case at stage IV on the 7th, 22th, 27th, 70th and 154th day after transplantation, respectively. Single factor analysis showed that the patient's sex, donor-recipient sex difference, donor age, dosage of ATG, mononuclear cell and CD34Conditioning regimen of haploidentical peipheral hematopoieitc stem cell transplantaion has effects on the intestinal aGVHD, which needs to be confirmed by further research.