Objective To assess clinical safety and effect of intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction(AMI).Methods Eighty four AMI patients who had received emergency thromblysis or primary PTCA were enrolled in this study.Elective PCI was undergone in these patients 10-14 days after infarction.During the procedure,50 patients received introcoronary transplantation of autologous bone marrow derived mononuclear cells and the other 34 patients received normal saline as control.All patients achieved TIMI Ⅲ flow after PCI.Dobutamin stress echocardiography,SPECT and F-18-Fluorodeoxyglucose-PET were performed 1 day before and 6 months after the transplantation.All patients finished a 2-year follow up and stress echo examination.Twenty nine patients from the transplantation group and 22 patients from the control group accepted 6-month SPECT reassessment.Results No major adverse events were recorded in all patients who received autologous bone marrow cells transplantation during follow up.Less nitroglycerin usage and increased excercise were observed in the transplantation group.Stress echocardiography showed improvement in LVEF(27.00%?0.89% pre-operation,36.80%?0.58% after 6 months and 40.94%?0.58% after 2 years,P

Objective To explore the clinical characteristics and causes of death in patients with acute heart failure at aged 75 and over.Methods The prospective study collected 175 patients with acute heart failure from January 2012 to December 2014.They were divided into ≥75 years old group and＜75 years old group and the general clinical data were recorded.Follow-up was performed mainly by telephone with supplemented hospitalization follow-up and outpatient follow-up.Survival rates were assessed by Kaplan-Meier method.The survival rate difference between the two groups was compared using the log-rank test.Multivariate Cox proportional hazards regression analysis was used to determine the independent risk factors for death.Results The proportions of ischemic heart disease,hypertension and old myocardial infarction were higher in the elderly group than in the young group with a higher proportion of male,diabetes and body mass index in ＜75 years old group.Elderly group had a higher level of left ventricular ejection fraction(LVEF)and a lower level of total cholesterol,triglycerides and low density lipoprotein cholesterol(LDL-C).Kaplan-Meier curves showed that allcause mortality(x2 =4.005,P =0.045) and non-cardiovascular mortality(x2 =4.418,P =0.041) were significantly higher in the elderly group than in the younger group,whereas cardiovascular mortality had no significant difference between the two groups (x2 =0.754,P =0.385).In patients with noncardiovascular mortality,12 cases (63.2％)died of pulmonary infection in elderly group,3 cases(25.0％) died of lung infection in younger group,and the difference was statistically significant between the 2 groups (x2 =4.288,P =0.038).Multivariate Cox proportional hazards regression analysis showed that age≥75 years was an independent predictor for both non-cardiovascular mortality [HR(95％CI):2.71(1.50-6.55),Wald x2 =2.266,P=0.038]and all-cause mortality[HR(95 ％CI):1.75(1.28-3.13),Wald x2 =2.914,P=0.026]in patients with acute heart failure.Conclusions Age ≥75 years is an independent risk factor for all dead patients with acute heart failure and noncardiovascular death,but it is not the independent risk factors for cardiovascular death,which is of great significance to establish a more rational treatment strategy for senile heart failure.

Objective To study the biomechanical strength of calcium phoshphate cement (CPC) in fixating distal radial fractures. Methods A total of 18 human distal radius fracture models were made and randomly divided into three groups: fixed with Kirschner wire (Kirschner group), CPC (CPC group) or CPC combined with Kirschner wire (combination group). Compression test was performed to measure compression rigidity and rotational angle of distal fragment at 100 N and anticompression strength and maximum compression strength at 2 mm displacement. Results Compression rigidity, distal fragment rotation angle in coronal or sagittal plate had no significant statistical difference at 100 N of compression in three groups. Compression strength at 2 mm displacement in CPC group (average 375 N) and combination group (average 386 N) exceeded that in Kirschner group (average 116 N), with significantly statistical difference (P

BACKGROUND: Primary studies suggest that coronary artery stenosis is highly exactly shown by 16-slice spiral CT coronary artery imaging.OBJECTIVE: To compare the accuracy and limitation between coronary angiography and multi-slice computed tomography (MSCT) coronary artery imaging to diagnose moderate and severe coronary artery stenosis. DESIGN, TIME AND SETTING: Clinical diagnostic study based on gold standard, which was carried out in the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. PARTICIPANTS: Twenty-eight patients with suspected coronary arteriosclerotic heart disease were examined by 64-slice spiral CT coronary artery imaging and coronary artery angiography during the 1-month hospitalization in the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. METHODS: 280 segments of 28 patients were quantitatively analyzed coronary artery stenosis by selective coronary artery angiography and multi-slice spiral CT imaging based on eye-measurement diameter method. MAIN OUTCOME MEASURES: True positive, true negative, false positive, false negative, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of coronary artery stenosis were measured by multi-slice spiral CT imaging.RESULTS: All 28 patients were included in the final analysis. Multi-slice spiral CT imaging showed that the sensitivity, specificity, positive predictive value, and negative predictive value were 46.5%, 97.6%, 86.8%, and 84.3%, respectively. If excluding the effect of 31 coronary segments with severe calcification, the sensitivity, specificity, positive predictive value and negative predictive value were 66.7%, 98.6%, 90.3% and 93.6%, respectively.CONCLUSION: Multi-slice spiral CT imaging is simple, reliable, noninvasive and safe; moreover, it has a good potential for diagnosing especially excluding coronary arteriosclerotic heart disease, but still some limits.

Objective To provide the guidance for the control and treatment of blood stream infec-tion caused by Serratia marcescens strains through analyzing the homology and drug resistant genes of the iso-lates collected from the Intensive Care Unit ( ICU) of Shaoxing County Central Hospital.Methods Serratia marcescens strains were isolated from ICU patients with blood stream infection and also from the hands of health care providers in the ICU from June 1st to September 30th, 2013.The antibiotic susceptibilities of the Serratia marcescens isolates were tested.PCR was performed to amplify the common drug resistant genes. Pulse-field gel electrophoresis ( PFGE) was carried out for analyzing the homology of all isolates.The com-plete clinical data of the patients were collected and statistically analyzed with Spearman′s rank correlation coefficient.Results Seventeen strains were isolated in this study.All of the 17 strains were resistant to the first and second generation Cephalosporin, Gentamicin and Ciprofloxacin, and sensitive to Amikacin and Ceftazidime.The drug resistant rates to Carbapenems ranged from 11.76%to 35.29%.One of the isolates (5.88%) carried the TEM gene.The results of PFGE showed that the phenotypes of all isolates were identi-cal.Conclusion Serratia marcescens strains were critical hospital infectious pathogens.They were able to spread in the hospital and were resistant to multiple antibiotics.Clinical physicians should properly use anti-biotics for the patients based on the result of drug susceptibility test.A control regulation for Serratia marces-cens infection within hospital should be enforced to avoid the cross infection and the outbreak of resistant strains.

Objective To observe the role and related mechanism of chemerin and its receptor ChemR23 in glomerular endothelial cells (GEnCs) stimulated by high glucose.Methods Mouse GEnCs were cultured and divided into control group,20.0 mmol/L high glucose group,40.0 mmol/L high glucose group and mannitol control group.Then the expressions of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in cell culture supematant as well as the expressions of intracellular protein and mRNA of chemerin,ChemR23,IL-6 and TNF-α were detected.Lentiviral transfection targeting ChemR23 was applied before high glucose-or Chemerin-stimulated,and expressions of supernatant and intracellular mRNA of IL-6 and TNF-α were measured.Meanwhile whether p38 mitogen-activated protein kinase (p38 MAPK) pathway was activated by high glucose was detected.The specific inhibitor of p38 MAPK was added prior to high glucose-stimulated,then supernatant and intracellular mRNA expressions of IL-6 and TNF-α was detected.The supernatant expressions of IL-6 and TNF-α were measured by ELISA.The intracellular protein expression and p38 MAPK phosphorylation activity were detected by Western blotting.The mRNA expression was detected by real time PCR.Results Compared with those in the control group,in high glucose groups the expressions of IL-6,TNF-α and chemerin were significantly increased (all P ＜ 0.05),however,the expressions of ChemR23 did not change (all P ＞ 0.05);the supernatant and mRNA expressions of IL-6 and TNF-α were also elevated in the chemerin group (all P ＜ 0.05).Lentivirus baring shRNA could efficiently suppress ChemR23 expression,and the Chemerin-or high glucose-induced expressions of IL-6 and TNF-α were reduced (all P ＜ 0.05).Also it could significantly reduce the expression of phosphorylated-p38 MAPK (p-p38 MAPK) induced by high glucose (P ＜ 0.05),as high glucose group had higher p-p38 MAPK than control group (P ＜ 0.05).While the high glucose-elevated expressions of IL-6 and TNF-α were significantly attenuated by p38 MAPK inhibitor (all P ＜ 0.05).Conclusions High glucose stimulation can induce the expression of chemerin in GEnCs.By binding to ChemR23,chemerin activates p38 MAPK signaling pathway,and then promotes the expressions of IL-6 and TNF-α.These inflammatory cytokines aggravate inflammation of GEnCs.

Long-term medical education program requires that the medical students should ac-quire both professional knowledge and scientific research ability. These students,with heavy task and course,have difficulty in performing the scientific research systematically. It is very important to develop the early scientific research training. Department of pathology in Central South University,took early sci-entific research activities in various forms,such as literature searching,reviews writing,research design-ing,experiment performing,lecture communicating and clinical practicing after combining the discipline characteristic and arranging the overall process. Satisfactory effects were achieved with efforts.

Objective: To evaluate the anthracyclines-induced cardiotoxicity in patients with early-stage breast cancer. Methods: This retrospective study analyzed data of 64 patients (aged from 36 to 59 years old) with early-stage breast cancer after surgery. Patients were divided into ACT group (n=21), FAC group (n=19) and EC group (n=24). The NCI CTC 4.0 scores was used to evaluate the side effects at the time of 2 weeks, 4 weeks and 6 weeks after chemotherapy. Meanwhile, the level of cTnT, the incidence of abnormal electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) were used to evaluate the anthracyclines-induced cardiotoxicity, the follow-up observation points were as follows: at the acute cardiotoxicity (time A), subacute cardiotoxicity (time B), 24 months after chemotherapy (time C), 36 months after chemotherapy (time D), 48 months after chemotherapy (time E), 60 months after chemotherapy (time F). The 3-years and 5-years overall survival and progress free disease survival among three groups were compared. Results: The ages, clinical stage, the size of tumor, axillary lymph node positivity and Eastern Cooperative Oncology Group Scores were similar among three groups (P>0.05); the incidence of side effects level 4 was 0. The levels of cTnT in the three groups were significantly lower than those at the baseline and time points C, D, E and F (all P<0.05), and the levels of cTnT were significantly higher in EC group than in FAC and ACT group at the time points B, C, D, E and F (P<0.05); however, the incidence of abnormal ECG and LVEF was similar among the 3 groups (P>0.05). The 5-year overall survival was 95.2% (20/21) ,100% (19/19) and 95.8% (23/24) in ACT group, FAC group and EC group, respectively; 5-year progress free disease survival was 95.2% (20/21) ,94.7% (18/19) and 91.7% (22/24) in ACT group, FAC group and EC group, respectively (P>0.05) . Conclusions Patients with early-stage breast cancer after surgery could tolerate the anthracyclines-induced cardiotoxicity. Three chemotherapy schemes of ACT, FAC and EC, especially the EC protocol, could affect the myocardial damage. However, outcome is comparable among patients treated with above chemotherapy schemes in this patient cohort.

Objective: To investigate the clinical efficacy and outcome determinants in cardiac arrest patients secondary to acute myocardial infarction treated with extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI). Methods: The clinical data of 27 patients hospitalized from January 2014 to March 2017 in 3 hospitals were retrospectively analyzed. The clinical data of the surviving group (12 cases) and the death group (15 cases) were compared and the outcome determinants were explored. Results: Twenty seven patients were successfully treated with coronary angiography and emergency PCI under ECMO assistance, and the successful procedure rate was 100%. The survival rate was 44.4% (12/27). There was no significant difference in gender, age, body weight, myocardial infarct location, past disease history and smoking status between the two groups (all P>0.05). Traditional cardiopulmonary resuscitation time was significantly longer, the CCU hospitalization time was significantly shorter, the number of diseased vessels was significantly higher, and the prevalence of distribution of blood vessels in left main stem was significantly higher and mean artery pressure at 24 and 48 hours post ECMO was significantly lower in the death group than in survival group (all P<0.05). Multiple logistic regression analysis showed that left anterior descending artery lesion, higher number of lesion vessels, longer traditional cardiopulmonary resuscitation time, longer time interval between cardiac arrest and ECMO placement were related increased risk of death post ECMO and emergency PCI in this patient cohort(OR=1.316, 95%CI 1.217-5.792, P=0.002; OR=1.238, 95%CI 1.107-4.961, P=0.000; OR=1.712, 95%CI 1.136-3.973, P=0.001; OR=1.629, 95%CI 1.132-4.521, P=0.000, respectively), while higher mean artery pressure at 48 hours post ECMO was related with reduced risk of death post ECMO and emergency PCI in this patient cohort(OR=0.672, 95%CI 0.326-0.693, P=0.001). Conclusions ECMO combined with emergency PCI can improve the success rate of traditional cardiopulmonary resuscitation in patients with cardiac arrest secondary to acute myocardial infarction. Left anterior descending artery lesion, number of lesion vessels, traditional cardiopulmonary resuscitation time, time interval between cardiac arrest and ECMO placement and mean artery pressure at 48 hours post ECMO are outcome determinants post ECMO and emergency PCI in this patient cohort.

Contracture and spasticity of ankle joints were major sources of disability in neurological impairment including stroke and cerebral palsy, etc. The manual stretching used in physical therapy might be laborious and time-consuming to the therapists and the outcome was dependent on the experience and the subjectiveend feelingof the therapists. A device was developed that could safely stretch the an-kle joint to its extreme positions with quantitative control of the resistance torque and stretching velocity. Furthermore, it could satisfy a strong need for quantitative and objective measures of the impairment and rehabilitation outcome. This was just the meaning intelligent stretching referred to. This article described the origin of the concept of intelligent stretching and its definition, operational principle, and su-periority and weakness, as well as its application in ankle joint spasticity and contracture in patients with stroke and cerebral palsy.