[Clinical analysis of 80 patients with oblique vaginal septum syndrome]

Objective: To investigate the clinical features, diagnosis and treatment of oblique vaginal septum syndrome (OVSS). Methods: The clinical data of 80 patients with OVSS admitted to The Second Hospital of Hebei Medical University from July 2005 to July 2023 were retrospectively analyzed. According to the classification system of OVSS proposed by Female Genital Anomalies Study Group, Chinese Obstetricians and Gynecologists Association in 2021, the patients were divided into four groups. The clinical manifestations, accompanied urinary system abnormalities, diagnosis and treatment methods and treatment outcomes were observed. Results: According to the above classification system, among the 80 patients with OVSS, 35 patients (44%, 35/80) were categorized as type Ⅰ, 33 patients (41%, 33/80) were categorized as type Ⅱ, 2 patients (3%, 2/80) were categorized as type Ⅲ and 10 patients (13%, 10/80) were categorized as type Ⅳ. The main onset symptom of patients was periodic abdominal pain (70%, 56/80), vaginal bleeding (20%, 16/80), dysuria or fecal impaction (15%, 12/80), vaginal mucopurulent discharge (10%, 8/80). The morbidity of combined urinary system abnormalities was 88% (70/80), and the most common urinary system abnormality was ipsilateral renal agenesis (81%, 65/80). Bilateral kidneys were normal in 13% (10/80) patients, and 6% (5/80) were combined with other urinary system abnormalities. A total of 74 patients underwent vaginal oblique septectomy or septum excision. Five of the 10 patients with type Ⅳ underwent hysterectomy on the cervical atresia side, 4 patients received hysteroscopy combined with cervicoplasty+oblique septotomy or septum excision, and one patient selected delayed menstruation. Two patients underwent laparoscopic resection of the dysplasia kidney and ectopic ureter which opening to the vagina. Eleven patients with endometriosis cyst, hydrosalpinx or empyema underwent laparoscopic surgery. Conclusions: The main symptom of type Ⅰ and Ⅳ patients is abdominal pain, while the main symptom of type Ⅱ and Ⅲ patients is bleeding. Magnetic resonance imaging (MRI) has advantages in the evaluation of complex OVSS, and MRI is recommended before operation to exclude other axial reproductive tract dysplasia and complex urinary system dysplasia. If there is leakage of urine, vaginal discharge or complex deformity, it is necessary to multidisciplinary discussion and formulate a reasonable surgical plan. The first treatment is related to the prognosis of patients especially children, and should be highly valued.

[Therapeutic efficacy of hematopoietic stem cell transplantation for Wiskott-Aldrich syndrome in 60 children]

Objective: To evaluate the therapeutic efficacy of hematopoietic stem cell transplantation (HSCT) for Wiskott-Aldrich syndrome (WAS), and to analyze the factors related to the outcomes. Methods: The clinical data of 60 children with WAS received HSCT in Shanghai Children's Medical Center from January 2006 to December 2020 were retrospectively analyzed. All cases were treated with a myeloablative conditioning regimen with busulfan and cyclophosphamide, and a graft-versus-host disease (GVHD) prevention regimen based on cyclosporine and methotrexate. Implantation, GVHD, transplant-related complications, immune reconstitution and survival rate were observed. Survival analysis was performed by Kaplan-Meier method, and Log-Rank method was used for univariate comparison. Results: The 60 male patients had main clinical features as infection and bleeding. The age at diagnosis was 0.4 (0.3, 0.8) years, and the age at transplantation was 1.1 (0.6, 2.1) years. There were 20 cases of human leukocyte antigen matched transplantation and 40 mismatched transplantation; 35 patients received peripheral blood HSCT, and 25 cord blood HSCT. All cases were fully implanted. The incidence of acute GVHD (aGVHD) was 48% (29/60) and only 2 (7%) developed aGVHD of grade Ⅲ; the incidence of chronic GVHD (cGVHD) was 23% (13/56), and all cases were limited. The incidence of CMV and EBV infection was 35% (21/60) and 33% (20/60) respectively; and 7 patients developed CMV retinitis. The incidence of sinus obstruction syndrome was 8% (5/60), of whom 2 patients died. There were 7 cases (12%) of autoimmune hemocytopenia after transplantation. Natural killer cells were the earliest to recover after transplantation, and B cells and CD4⁺T cells returned to normal at about 180 days post HSCT. The 5-year overall survival rate (OS) of this group was 93% (95%CI 86%-99%), and the event free survial rate (EFS) was 87% (95%CI 78%-95%). EFS of non-CMV reactivation group is higher than that of CMV reactivation group (95% (37/39) vs.71% (15/21), χ²=5.22, P=0.022). Conclusions: The therapeutic efficacy of HSCT for WAS is satisfying, and the early application of HSCT in typical cases can achieve better outcome. CMV infection is the main factor affecting disease-free survival rate, which can be improved by strengthening the management of complications.

[A retrospective controlled study of TACE-HAIC-targeted-immune quadruple therapy for intermediate and advanced-stage hepatocellular carcinoma]

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC)-targeted-immune quadruple therapy in patients with intermediate and advanced-stage hepatocellular carcinoma (HCC). Methods: 101 patients with intermediate and advanced stage HCC were enrolled according to the inclusion and exclusion criteria, and then they were divided into a combination group and a control group. Patients in the combination group was treated with TACE-HAIC-targeted-immune quadruple therapy, while the control group was only treated with TACE therapy. The overall survival (OS), progression-free survival (PFS), and treatment-related adverse reactions were statistically analyzed in the two groups of patients. Statistical analysis was carried out by t-test, χ² test, rank sum test, Kaplan-Meier curve, log-rank test, Cox regression (or proportional hazards model) analysis according to different data. Results: The tumor objective response rate and disease control rate as evaluated by mRECIST 1.1 criteria in the combination group were 80% and 94%, respectively, which were significantly higher than those in the control group, 41.2% (P<0.001) and 74.5% (P=0.007). The OS and PFS of the combination group were 15.6 months [95%CI 11.3-NA ] and 8.8 months [95%CI 6.9-12.0], respectively, which were significantly better than the control group at 6.1 months [95%CI 5.3-6.6] (P<0.001) and 3.2 months [95%CI 3.0-3.6] (P<0.001). Gastric ulcer incidence was significantly higher in the combination group (9/50, 18%) than that in the control group (2/51, 3.9%) (P=0.023). Conclusion TACE-HAIC-targeted-immune quadruple therapy is a more effective treatment mode for intermediate and advanced-stage HCC than TACE alone, and attention should be paid to the monitoring of target immune-related adverse reactions.

[Percutaneous biliary stent combined with brachytherapy for malignant obstructive jaundice: a multicenter retrospective controlled study]

Objective: To investigate the efficacy, safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy (radiotherapy) in the treatment of malignant obstructive jaundice. Methods: Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed. Among them, 58 cases received biliary stent combined with iodne-125 seed chain brachytherapy (study group), and 49 cases received biliary stent implantation (control group). The changes of bilirubin, stent patency time, complications, overall survival (OS) and prognostic factors were analyzed in both groups. Results: The incidence of complications in the study group and the control group were 17.2% and 18.3% respectively, and the difference was not statistically significant (P=0.974). Serum total bilirubin levels were decreased significantly in both groups at one month after surgery (P<0.001). Postoperative stent patency time was significantly better in the study group (10.0±1.6 months) (95% CI: 8.2～12.5) than that in the control group (5.2±0.4 months) (95% CI: 4.1～6.0, P<0.001). The median OS was longer in the study group (11.2±1.8 months) (95% CI: 9.2～12.8) than that in the control group (8.0±1.1 months) (95% CI: 8.0～12.8, P<0.001). Multivariate analysis result showed that stent combined with brachytherapy (HR=0.08, 95% CI:0.04～0.15, P<0.001) and receiving further anti-tumor therapy after surgery (HR=0.27, 95% CI:0.15~0.49, P<0.001) were independent risk factors affecting the patency of biliary stents. Preoperative percutaneous transhepatic biliary drainage (HR=0.46, 95%CI:0.28～0.74, P=0.002), stent combined with brachytherapy (HR=0.23, 95%CI:0.14～0.39, P<0.001) and receiving further anti-tumor therapy after surgery (HR=0.37, 95%CI:0.22～0.61, P<0.001) were independent risk factors affecting OS. Conclusion: Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice, which can significantly prolong the patency time of biliary stent and the survival time of patients.

[Safety and efficacy of TIPS combined with iodine-125 seed strands in the treatment of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis]

Objective: To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 (¹²⁵Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods: 25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with ¹²⁵Ⅰseed strand. Tumor thrombus was controlled with ¹²⁵I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t-test, Chi-Squared test or Fisher's exact test. Results: TIPS combined with ¹²⁵Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ² = 4.771, P=0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ² =7.674, P=0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ² =13.246 , P=0.001). Conclusions: TIPS combined with ¹²⁵Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with ¹²⁵Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.

[Daratumumab for the treatment of primary systemic amyloidosis: a multicenter retrospective analysis]

Objective: To analyze the efficacy and safety of Daratumumab for the treatment of primary AL light chain systemic amyloidosis. Methods: Twenty one patients who were diagnosed as primary AL light chain systemic amyloidosis and treated with Daratumumab from 7 centers were retrospectively analyzed. Daratumumab was administrated as first line therapy in seven patients and 14 patients with relapsed settings. Hematological response, safety and survival were analyzed. Results: All 7 patients achieved very good partial response (VGPR) or better with first-line application of daratumumab. Three patients died, and the other four achieved organ remission. Among 14 relapsed patients, 2 patients had a difference of free light chain (dFLC) less than 20 mg/L before treatment, and 9 with a dFLC of more than 50 mg/L. All patients reached partial response (PR) or better, including 4 patients with complete response (CR), 3 with VGPR and 2 with PR. The response rate was 100% in 3 patients with dFLC 20-50 mg/L at baseline. The organ remission rate was 50% in patients with heart involvement and 58.3% in patients with kidney impairment. The overall median follow-up period was 5.3 months, and 11 months in surviving patients. One patient died of severe infection and disseminated intravascular coagulation (DIC) with stable amyloidosis. One patient switched to other regimens because dFLC elevated but did not fulfill progressive disease after 2 year application. As to safety, no grade 3/4 infusion reaction developed, and grade 1 infusion reaction occurred in 3 cases during the first infusion. Lymphocytopenia was seen in 75% patients including grade 3 or more in 30% patients. Conclusion: Daratumumab is effective to eliminate serum free light chain in both newly diagnosed and relapsed patients with systemic amyloidosis.

[Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study]

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

[To positively deal with the challenges brought by the diagnosis and treatment of systemic light chain amyloidosis]

To meet the challenges in the diagnosis and treatment of systemic light chain (AL) amyloidosis, the China Systemic Light Chain Amyloidosis Collaborative Group, together with multidisciplinary experts, developed the "Guideline for the Diagnosis and Treatment of Systemic Light Chain Amyloidosis" in 2016. In order to introduce progress in this field and better guide the clinical practice, the guideline has been updated recently. The in-depth understanding of AL amyloidosis has not only improved the level of diagnosis and treatment of the disease, but also promoted the integration of multiple disciplines, accelerated the development of clinical trials and the improvement of disease diagnosis and treatment modes.

[Effects of dynamic contrast enhancement on diffusion weighted imaging score of 3 in prostate imaging reporting and data system version 2 of peripheral zone]

Objective: To investigate the effects and value of dynamic contrast-enhanced (DCE) on diffusion-weighted imaging (DWI) score 3 in the prostate imaging data and reporting system version 2(PI-RADS V2)of peripheral zone. Methods: A retrospective study of consecutive 204 cases of prostate disease in peripheral zone was conducted from January 2015 to January 2018, including 169 cases of prostate cancer and 35 cases of non-prostate cancer. All cases were examined multi-parametric MR imaging on a 3-T MR scanner and confirmed by pathology. Images were analyzed according to PI-RADS V2.Inter-reader agreement of scores was evaluated by kappa coefficient. The constituent ratio of clinically significant prostate cancer (csPCa) in PI-RADS V2 overall scores 3, 3+1 and 4 were calculated and analyzed by non-parametric Chi-square test to determine whether the difference in composition ratio was significant. The positive rate of DCE in diffusion weighted imaging (DWI) score 3 and 4 were calculated. Results: There were 68.6%(140/204) cases in 204 patients with peripheral prostate disease who scored PI-RADS V2 overall score of 3,3+1 and 4. Kappa value was higher for the PI-RADS V2 overallscore of 4 than 3 or 3+1 in the PZ (k values of 0.802 vs 0.737 or 0.591, respectively; all P<0.01). The constituent ratio of csPCa in PI-RADS V2 overallscore of 3, 3+1 and 4 were 16.7%(3/18),43.2%(19/44),78.2%(61/78), the difference of which was significant (χ(2)=29.839, P<0.05).There was also a significant difference between the constituent ratio of csPCa in the score of 3+1 and 4 (χ(2)=15.286, P<0.01).The positive rate of DCE in cases of PI-RADS V2 overall score 3,3+1 and 4 was 76.4%(107/140).The positive rate of DCE incases of DWI score 3 and 4 were 71.0%(44/62), 80.8%(63/78),respectively. Conclusion: DCE has a certain value in PI-RADS V2 due to its high positive rate in the detection of prostate cancer in peripheral zone.DCE is helpful to DWI score 3 to improve the detection rate of csPCa.The PI-RADS V2 overall score 3+1 and 4 in the peripheral zone maybe need to be distinguished due to the different detection of csPCa.

P3350Design of a multicenter, open-label, randomized controlled trial: effects of intensive systolic blood pressure lowering treatment in reducing risk of vascular events (ESPRIT)

Background

Patients with cardiovascular diseases (CVD) are at high risk for recurrent major cardiovascular events. Effective public health strategies to lower blood pressure (BP) are necessary to reduce risk of cardiovascular disease. However, substantial uncertainty remains about the optimal target level to lower BP in patients with cardiovascular disease.

Purpose

To assess the effects on the incidence of major cardiovascular events in patients with CVD during the scheduled treatment period of greater reduction in blood pressure with a systolic BP (SBP) target <120 mmHg versus <140 mmHg.

Methods

This study is a multicenter, open-label, randomized controlled trial comparing two strategies for lowering SBP: lowering SBP to the standard target of <140 mmHg; and lowering BP to a more intensive target of <120 mmHg. This study will enroll 12,000 Chinese participants from 100–200 hospitals, follow-up for about 3 years. We will include participants aged ≥50 years old with SBP ≥130 mmHg, having a history of vascular disease (including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, carotid endarterectomy or carotid stenting, peripheral artery disease with revascularization, abdominal aortic aneurysm ≥5 cm with repair) or stroke. The primary outcome is the first occurrence of major cardiovascular events defined as a composite of myocardial infarction, stroke, coronary or non-coronary revascularization events, and cardiovascular death. Secondary outcomes include the components of the primary composite outcome, hospitalized heart failure and all cause of death and non-cardiovascular outcomes (kidney disease and cognitive outcomes).

Results

Regarding the results, we hypothesize that comparing with SBP target of <140 mmHg, more intensive SBP target of <120 mmHg can further reduce the occurrence of cardiovascular events in CVD patients with elevated blood pressure.

Conclusion

This study can provide reliable evaluation on whether more intensive SBP target of <120 mmHg is more desirable than SBP target of <140 mmHg in CVD patients with elevated blood pressure.

[Female reproductive system dysplasia: a clinical study of 924 cases]

Objective: To explore the relationship between different types of female reproductive system dysplasia and age of visit, clinical manifestations, common types of combined malformations and endometriosis. Methods: The patient's medical records in the Second Hospital of Hebei Medical University from December 2002 to June 2016 were collected and retrospectively analyzed. Results: Among 924 cases of genital tract dysplasia, uterine dysplasia (65.3%, 824/1 261) was the most common, followed by vaginal dysplasia (28.3%, 357/1 261), hymen atresia and urogenital fistula (3.7%, 47/1 261), and cervical dysplasia (2.6%, 33/1 261). (1) The youngest age was in patients with hymen atresia and urogenital fistula, with a median of 14.5 years old, while the older age were in patients with uterine, vaginal and cervical dysplasia, with median age of 25.0, 24.0 and 23.0 years old, respectively. (2) The clinical manifestations were lack of specificity, mainly abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history. (3) About other systemic malformations, urological malformations were the most common (4.8%, 44/924), followed by spinal malformations (0.5%, 5/924), inguinal hernia (0.4%, 4/924), heart malformations (0.2%, 2/924), cleft lip and palate (0.2%, 2/924). Oblique vaginal septal syndrome and MRKH syndrome were the most likely to be associated with other system malformations. (4) About combination with endometriosis, there was no significant difference between obstructive genital tract malformations (2.3%, 9/385) and non obstructive genital tract malformations (1.7%, 9/539; P=0.469). Conclusions: Female reproductive system dysplasia is the most common in uterine dysplasia, followed by vaginal dysplasia, hymen atresia and urogenital fistula, and cervical dysplasia. The age of visit is generally older, often found by abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history;and could be combined with a variety of other system malformations, most seen by urinary system malformations,there is also the risk of endometriosis.

Selective removal of nicotine from the main stream smoke by using a surface-imprinted polymer monolith as adsorbent

Using molecularly imprinted polymer as a selective adsorbent for gaseous toxicants is a novel attempt. In present work, a nicotine surface-imprinted monolith (MIM) was used for the selective removal of nicotine from smoke. First, the retention capacity and selectivity for this MIM was tested by using it as the stationary phase in gas chromatography and chromatographic conditions optimized. Then, the gas phase adsorption isotherms of MIM were constructed and the adsorption thermodynamics explored. At last, the applicability for MIM in the removal of nicotine in smoke was explored. Results indicated a stronger retention capacity and a higher selectivity of MIM toward the template vapor, with a capacity factor (87.88) and a selectivity factor (10.15) under the optimized conditions. A higher standard adsorption enthalpy change for this MIM toward the template (ΔH_a⁰ = 65.53 kJ mol^-1) than that for the non-imprinted monolith (NIM) column (ΔH_a⁰ = 47.46 kJ mol^-1) was observed. The adsorption isotherm for MIM appears the BET type II shape, while that for the NIM was approximately linear. When this MIM was used as the adsorbent, it exhibited a high performance in the selective removal of nicotine from the main stream smoke, with an adsorption percentage of 99.43%.

MR imaging of hemorrhage associated with acute pancreatitis

PURPOSE

To study MRI findings of hemorrhage in acute pancreatitis (AP) and correlate the presence and extent of hemorrhage with the MR severity index (MRSI), Acute Physiology And Chronic Health Evaluation (APACHE) II scores, and clinical outcome.

MATERIALS AND METHODS

This retrospective study included 539 patients with AP. Hemorrhage was defined as areas of hyperintensity in or outside the pancreas on liver imaging with volume acceleration flexible (LAVA-Flex). The presence of hemorrhage was classified into three areas: within the pancreatic parenchyma, retroperitoneal space, and sub-or intraperitoneal space. Involvement of each area was awarded 1 point resulting in the hemorrhage severity index (HSI) score. The predicted severity of AP was graded by MRSI and APACHE II score. The association between HSI, MRSI, and APACHE II scores was analyzed. The length of hospital stay and organ dysfunction was used as clinical outcome parameters.

RESULTS

Among 539 AP patients, 62 (11.5%) had hemorrhage. The prevalence of hemorrhage was 1.1% (2/186), 13.9% (43/310), and 39.5% (17/43) in predicted mild, moderate, and severe AP, respectively, based on MRSI (χ² = 55.3, p = 0.00); and 7.7% (21/273) and 19.2% (18/94) in predicted mild and severe AP, respectively, based on APACHE II (χ² = 21.2, p = 0.00). HSI score significantly correlated with MRSI (r = 0.36, p < 0.001) and APACHE II scores (r = 0.21, p = 0.00). The prevalence of organ dysfunction was higher and length of hospital stay was longer in patients with hemorrhage than in those without hemorrhage (p < 0.01).

CONCLUSIONS

Hemorrhage in AP is common. The presence of hemorrhage, rather than its extent, correlates with poor clinical outcome.

[Analysis on clinical characteristics and prognosis of patients with mitral valve prolapse]

Objective: To evaluate the clinical characteristics and prognosis of patients with mitral valve prolapse (MVP). Methods: We retrospectively analyzed the clinical characteristics and prognosis of 148 MVP patients who underwent mitral valve surgery in Fuwai hospital from January 2012 to December 2015.The patients were divided into mucoid degeneration group (52 cases) and without mucoid degeneration group(19 cases) according to pathological examination of leaflets and chordate. Results: The clinical symptoms of MVP patients included dyspnea (59.5%(88/148)), chest distress and pain (52.7%(78/148)), and palpitations (36.5% (54/148)). Mitral valve repair was performed in 144 cases (97.3%), and mitral valve replacement was performed in 4 cases (2.7%). Posterior leaflet prolapse was the most common form of MVP (68.9%, 102/148). Pathological examination revealed myxomatous degeneration in 73.2% patients (52/71), fibrosis in 8.5% patients (6/71), and fibrinoid necrosis in 8.5% patients (6/71). Patients with mucoid degeneration had less atrial fibrillation before surgery (5.8%(3/52) vs. 42.1%(8/19), P<0.01), smaller preoperative left atrium diameter ((43.2±6.5) mm vs. (48.2±8.9) mm, P<0.05), more posterior leaflet prolapse (94.2%(49/52) vs. 63.2%(12/19), P<0.01), redundant chordae (26.9%(14/52) vs. 0, P<0.05) and leaflet thickening (76.9%(40/52) vs. 52.6%(10/19), P<0.05) when compared with patients without mucoid degeneration.Echocardiography examination at the postoperative follow-up of 39.0(22.3, 57.0) months revealed smaller left atrium diameter((38.5±7.1) mm vs. (45.3±8.3) mm, P<0.01), left ventricular end-diastolic diameter ((48.9±6.2) mm vs. (57.5±7.6) mm, P<0.01), reduced left ventricular ejection fraction ((61.2±7.1)% vs. (65.1±6.2)%, P<0.01) and less moderate or severe mitral regurgitation (1.4%(2/148) vs. 100.0%(148/148), P<0.01) compared with the corresponding preoperative values. Conclusions: Dyspnea is the main symptom, and mucoid degeneration characterized by redundant chordae and leaflet thickening are the main pathological features of MVP patients.The surgical treatment of MVP patients is related with satisfactory outcome results.

[Prevalence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy: a case-control study]

Objective: To explore the clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study. Incidence rate and severity of PH were depicted. The study population was divided into two groups (PH group and control group), and the differences in clinical profile were elucidated. Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis. Results: The incidence of PH was 12.3% (37 cases), in which 48.6% patients (18 cases) were mild PH, 40.5% patients (15 cases) were moderate PH, and patients with severe PH accounts for 10.8% (4 cases). Multivariate logistic regression analysis indicated that female(OR=3.95, 95%CI 1.74-8.98, P=0.001), age ≥65 years(OR=3.87, 95%CI 1.16-12.97, P=0.030), history of atrial fibrillation(OR=2.76, 95%CI 1.01-7.57, P=0.049)and moderate or severe mitral regurgitation(OR=6.63, 95%CI 3.02-14.57, P=0.000)were independent risk factors of PH. Stratification according to sex showed that age ≥65 years(OR=7.79, 95%CI 1.35-47.26, P<0.05)and moderate or severe mitral regurgitation(OR=9.83, 95%CI 2.26-42.67, P<0.01)were independent risk factors of PH for male patients; while history of atrial fibrillation(OR=6.32, 95%CI 1.57-25.40, P=0.01)and moderate or severe mitral regurgitation(OR=5.23, 95%CI 1.92-14.26, P<0.01)were independent risk factors of PH for female patients. Risk factors were similar between the mild PH group and moderate to severe PH groups. Conclusion: Compared with patients without PH, HOCM patients complicated with PH were older and with higher percentage of female, and resting obstruction, history of atrial fibrillation and moderate or severe mitral regurgitation. Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female, advanced age, history of atrial fibrillation and moderate or severe mitral regurgitation.

[Surgical treatment and prognosis of pancreatic neuroendocrine carcinoma]

Objective: Pancreatic neuroendocrine carcinoma (pNEC) is a highly malignant tumor.This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma (pNEC). Methods: We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox-regression analysis wasused to evaluate the factors potentially influencing survival. Results: Twenty patients including 11 males and 9 females (median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum-based chemotherapy.The median follow-up time was 41 months (range, 1 to 127 months). The 1-, 3-, and 5-year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki-67 index were of prognostic significance. Conclusions: Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

[Prevalence and associated factors of female urinary incontinence in Hebei province]

Objective: To estimate the prevalence and associated factors of adult female urinary incontinence in Hebei province. Methods: Stratified and multistage sampling method was used, between January 2016 to May 2016, to investigate the target population in Hebei province. While, logistic regression was used to analyse datas. Results: A population-based survey was conducted in 2 450 women in Hebei province, there were 2 408 effective questionnaires after deleting 48 invalid questionnaires. According to the results, the average age of subjects was (56±15) years old, and the urinary incontinence prevalence of adult female in Hebei province was 27.70% (667/2 408). Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 23.13% (557/2 408), 1.58% (38/2 408) and 2.99% (72/2 408), respectively. There were only 2.85% (19/667) urinary incontinence patients seeking medical help. The results of logistic regression analysis showed that age, daily water intake, pulmonary diseases, urinary tract infection, hypertension, chronic low back pain, dysmenorrhea, vaginitis, abortion, mode of delivery, postpartum infection were statistically significant (all P≤0.05). Among these factors, cesarean section was the protective factor for urinary incontinence (OR=0.365, 95 % CI: 0.195-0.685, P<0.01). Conclusions: The prevalence of urinary incontinence in adult female in Hebei province is high, and there are few patients seeking medical help. It is a common disorder in women and is associated with many factors; among these factors, cesarean section is the protective factor for urinary incontinence.

[Mutation screening for the causative gene in a four-generation Chinese pedigree with progressive cardiac conduction defect]

OBJECTIVE

To define the potential causative gene mutation in a Chinese pedigree with progressive cardiac conduction defect (PCCD).

METHODS

Sanger sequencing was performed to define potential causative gene mutation in a four-generation family with 68 members including seven PCCD patients (5 male) from 2010 to 2015.No causative gene was detected by screening known candidate genes related to PCCD including SCN5A, NKX2.5 and LMNA.High-throughput sequencing technology on exon-enriched DNA was then used to search the causative genes in 2 patients and one normal family member.

RESULTS

Eight new non-synonymous single nucleotide variants including AQP7 gene (exon5: c.T343C: p.Y115H), CACNA1B gene (NM_001243812: exon19: c.A2986G: p.T996A), CATSPERB gene (exon27: c.C3254G: p.P1085R), CLCA2 gene (exon11: c.G1725T: p.W575C), CLCA3P gene (ncRNA_intronic), MYLK-AS1 gene (ncRNA_intronic), TTN gene (ncRNA_UTR3), LMNA gene (LMNA: NM_170708: exon5: c.C922T: p.Q308X) were identified by comparing and filtering the results with known public databases.Then, more detailed biological analysis on these 8 genes was conducted.Traditional Sanger sequencing validated the exome sequencing results, and found that the mutation c. 1725G﹥T in gene CLCA2 segregated with the phenotype of this PCCD pedigree.The mutation c. 1725G﹥T in gene CLCA2 was thus be considered as the causative PCCD gene in this pedigree from the perspective of genetics and genomics.

CONCLUSION

The heterozygote mutation c. 1725G﹥T in gene CLCA2 might be causative gene in this PCCD pedigree.This finding adds new gene mutation variant responsible for PCCD.

[Atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy: clinical characteristics and risk factors]

Objective: To evaluate the clinical characteristics and risk factors for atrial fibrillation(AF)in patients with obstructive hypertrophic cardiomyopathy(OHCM). Methods: Patients with OHCM hospitalized in Fuwai Hospital from March 2011 to January 2016 were enrolled in the present study. Each patient underwent examinations including transthoracic echocardiography, body surface electrocardiograph or dynamic electrocardiogram (Holter). Cardiac troponin I (cTNI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP)levels were tested and clinical profiles were collected.The subjects were divided into two groups (the AF group and non-AF group). Risk factors for AF in patients with OHCM were assessed by multivariate logistic regression analysis. Results: A total of 309 patients were evaluated in the study. Among them, 17.5%( 54/309) patients were with AF.Age[(51.2±10.1)years vs (43.1 ± 14.4)years], New York Heart Association class(NYHA class)(2.8±0.5 vs 2.6±0.6), disease duration[6.0(4.0, 10.0)years vs 3.0(1.0, 6.0)years], left atrial (LA) dimension[(45.1±7.0)mm vs(42.6 ± 7.4)mm]and NT-pro-BNP levels[2 007(1 565, 3 199)pmol/L vs 1 509(729, 2 921)pmol/L]in the AF group were significantly higher than those in the non-AF group (all P<0.05). Multivariate logistic regression analysis indicated that advanced age(OR=1.04, 95% CI 1.01-1.08, P<0.01), higher NYHA class(OR=2.00, 95% CI 1.08-3.70, P<0.05)and longer disease duration(OR=1.08, 95% CI 1.01-1.15, P<0.05)were independent risk factors for AF in patients with OHCM, in which advanced age(OR=1.05, 95% CI 1.02-1.09, P<0.01), higher NYHA class(OR=3.39, 95% CI 1.53-7.54, P<0.01), LA dimension(OR=1.06, 95% CI 1.01-1.12, P<0.05)and longer clinical course(OR=1.12, 95% CI 1.04-1.20, P<0.01)were associated with AF in male patients, and advanced age (OR=1.05, 95% CI 1.01-1.09, P<0.05)and longer disease duration(OR=1.14, 95% CI 1.01-1.28, P<0.01)were associated with AF in female patients when stratified by gender. Conclusion: Advanced age , higher NYHA class and longer clinical duration are independent risk factors for AF in OHCM patients.

[Evaluation of disease free survival after radical resection for primary duodenal adenocarcinoma]

Objective: To investigate the risk factors associated with the disease free survival (DFS) for primary duodenal adenocarcinoma patients undergoing radical resection. Methods: The clinicopathological data of 101 primary duodenal adenocarcinoma patients who underwent radical resection from January 2001 to October 2014 were retrospectively reviewed. Using SPSS 13.0 software, the survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by Log-rank test.COX regression model was used to identify independent risk factors. Results: Among 101 patients, the main clinical manifestation were upper abdomen discomfort, abdominal pain, jaundice, gastrointestinal obstruction, hemorrhage, emaciation and so on. A total of 87 patients had the tumor located at the descending part of the duodenum. All the 101 patients underwent radical resection, and 85 patients received pancreatoduodenectomy while 16 patients underwent segmental resection. The median disease free survival time was 26 months and the postoperative 1, 3, 5 year DFS rate were 79.7%, 60.3% and 53.6%, respectively. The univariate analyses identified elevated preoperative CEA and CA19-9 level, T stage, lymph node state, vascular invasion and perineural invasion predicting a worse DFS(P<0.05). On multivariate analysis, positive lymph node state was an independent risk factor for DFS (RR=5.394, 95% CI: 1.624-17.913). Conclusion: Radical resection is the best therapeutic method for primary duodenal adenocarcinoma; the positive lymph node state is the independent risk factor affecting the disease free survival of patients after radical resection.

[Effects of microRNA-379-5p on proliferation, migration and invasion of hepatocellular carcinoma cell line]

OBJECTIVE

To investigate the effects of microRNA-379-5p (miR-379-5p) on proliferation, migration and invasion of hepatocellular carcinoma (HCC) cells.

METHODS

Human HCC cell line HepG2 was infected with lentivirus carrying miR-379-5p (miR-379-5p group) or lentivirus carrying negative control sequences (negative control group). The untreated HepG2 cells represented blank control group. Cell proliferation was determined by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazoliumbromide (MTT) assays. Cell migration and invasion were assessed by Transwell assays. The mRNA and protein expressions of matrix metalloproteinase-2 (MMP-2) and MMP-9 were analyzed by real-time quantitative polymerase chain reaction and Western blot, respectively.

RESULTS

Compared with negative control group and blank control group, cell migration and invasion was significantly inhibited in miR-379-5p group (P<0.05). However, there was no significant difference in cell proliferation among the three groups (P>0.05). Furthermore, the mRNA and protein levels of MMP-2 and MMP-9 in miR-379-5p group were significantly lower than that in negative control group and blank control group (P<0.05).

CONCLUSION

miR-379-5p can suppress migration and invasion of HCC cell lines, which may be achieved by inhibiting MMP-2 and MMP-9 expressions.

[HSP70 gene polymorphism on genetic susceptibility to the coal worker's penumoconiosis of han nationality in Xinjiang, China.]

Objective: To explore the influence of heat shock protein 70 (HSP70) gene genetic susceptibility of coal worker's pneumoconiosis among the han nationality in xinjiang. Methods: 156 coal worker's pneumoconiosis patients and 96 mine workers were randomly selected from the han coal worker's pneumoconiosis patients and attend the health check retirement mine workers from March to December, 2014 in Xinjiang Uygur Autonomous Region of Occupational Disease Hospital. Using TaqMan genotyping methods to detect HSP70 genotype distribution in the two groups. Results: The HSP70-1+190 loci GC genotype occurrence frequencies of coal worker's pneumoconiosis was significantly higher than the control group (χ²=6.75, P<0.05) , the risk of coal worker's pneumoconiosis armed with HSP70-1+190 GC genotype individual was 2.21 times of CC genotype individual (95%CI: 1.03~4.75) , and HSP70-2+1267 and HSP70-hom+2437 loci polymorphism were no significant difference between the two groups (HSP70-2+1267: χ²=3.30, P=0.19; HSP70-hom+2437: χ²=0.12, P=0.94) . Conclusion: HSP70-1+190 GC genotypes may be a susceptible genotype, the genotype individual may be more likely to suffer from coal worker's pneumoconiosis.