Objective:To evaluate the value of N terminal pro brain natriuretic peptide(NT proBNP) in assessment of left ventricular remodeling and left ventricular function in patients with acute myocardial infarction. Methods:Echocardiography was performed in 61 patients with acute myocardial infarction(AMI) and in 20 control participants Plasma samples for NT proBNP were obtained at 48 96 hours after AMI.NT proBNP was determined by ELISA method. Results:Compared with controls NT proBNP in AMI patients were significantly higher ( p 55.The sensitivity,specificity and accuracy were 84 6%,65 5% and 77 7%,respectively.In Multivariate analysis NT proBNP was correlated with Killip classification and wall motion index. Conclusion:Plasma NT proBNP was significantly increased in AMI patients Plasma NT proBNP was correlated with cardiac functional class and extension of myocardial infraction.

Objective To investigate the possible mechanisms of enhancing angiogenesis and arteriogenesis through the oberservation of the effect of gene transfer of angiopoietin-1 (Ang1) on its receptor Tie2 in rat models of acute myocardial infarction. Methods Myocardial infarction was induced in rats by left anterior descending artery ligation. Naked plasmid DNA encoding human angiopoietin-1 (phAng1) was delivered into the ischemic area (group A) by intramyocardial injection. On day 3, 7, 14 and 28 after the injection, the mRNA expression of Tie2 and its changes with time were determined by RT-PCR. The number of vessels and arterioles was examined by immunohistochemistry. The collagen was evaluated by Masson staining. Results RT-PCR showed that mRNA expression levels of Tie2 in group A were significantly higher than those in the control group, reached the highest level on day 7 post-injection, and gradually declined to normal level 28 days later. On day 7, 14 and 28, the vessel count showed the number of blood vessels (angiogenesis and arteriogenesis) in group A was greater than that of the control group at the same timepoint and the infracted myocardium in group A was significantly less than that of the control group. Conclusion Gene transfer of phAng1 enhances angiogenesis and arteriogenesis in acute myocardial infarction and reduces the infraction area probably by upregulating the expressions of Tie2 receptor.

Objective To evaluate whether High-Dose folic acid supplementation may improve endothelial function in patients with coronary artery disease undergone interventional therapy. Methods Forty six patients with coronary artery disease and undergone interventional therapy were divided into two groups: 23 with folic acid supplement (20 mg/d) and 23 Patients without folic acid as the controls for 6 months. Plasma homocystine (Hcy) was measured by fluorescence polarization immunoassay and Flow-mediated endothelium-dependent dilation (FMD) of the brachial artery was assessed by high resolution ultrasound before and after 6 months. Results Compared with the control, folic acid supplementation resulted in lower plasma Hcy levels (8.82?3.32 ?mol/L vs 13.16?5.06 ?mol/L, P

Objective: To assess the predictive value of coronary lfow reserve (CFR) for diagnosing coronary stenosis by transthoracic Doppler echocardiography (TTDE) in patients with hypertension.
Methods: A total of 132 patients scheduled for elective coronary angiography (CAG) due to chest pain were enrolled. The patients were divided into 2 groups: Hypertension group,n=95 and Non-hypertension group,n=37. The CRF of left anterior descending coronary artery (LAD) was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was deifned by LAD luminal diameter stenosis ≥ 70% in relevant patients.
Results: The condition of LAD stenosis was similar between 2 groups (42.1% vs. 35.1%),P>0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group (2.39 ± 0.86) vs. (2.87 ± 1.12),P<0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 (95% CI 0.83-0.94,P<0.0001), in Hypertension group at 0.874 (95% CI 0.81-0.94,P<0.0001) and in Non-hypertension group at 0.915 (95% CI 0.82-0.98,P<0.0001). With the cut-off point of CFR ≤ 2.2, it had the diagnostic sensitivity, speciifcity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively.
Conclusion: The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the signiifcant LAD stenosis in such patients.

Objective To investigate the relationship of B-type natriuretic peptide(BNP),Creactive protein(CRP)and left ventricular diastolic function with cardio-and cerebrovascular disease (CVD)in the elderly patients with hemodialysis.Methods 96 elderly patients with hemodialysis were divided into CVD group(n =35)and non CVD control group(n =61).The patients were followed up once a month for 24 to 30 months.The baseline anthropometric and laboratory parameters were measured.The ratio of mitral peak flow velocity(E)and peak velocities at mitral annuluses (Em)during early diastole of left ventricular was recorded by doppler echocardiography.The time and cause of hospitalization and mortality by CVD were documented.Results The levels of CRP and BNP were significantly higher in CVD group than in control group[(3.1 ± 6.7)mg/L vs.(1.8 ± 1.2)mg/L,(1345.2±1427.8)pmol/L vs.(719.8±1073.8)pmol/L](t=2.14 and-2.82,P＜0.05 or P＜0.01).The ratio of E/ Em was increased in CVD group as compared with control group(t=5.23,P＜0.01).Kaplan-Meier survival curves showed that the morbidity of CVD events was enhanced(P＜0.05 or P＜0.01)at BNP≥500 pmol/L,CRP≥1.5 mg/L and E/Em≥17 which were the independent risk factors of CVD events for the elderly patients with hemodialysis by COX regression model.There was positive correlation between LogBNP and E /Em(r =0.23,P ＜ 0.05).Conclusions Higher levels of BNP,CRP and E/Em may predict the increasing risks of CVD in the elderly patients with hemodialysis.

Holistic education is an important philosophy of medical education.Medical graduate students can show their skills of medical specialties,improve their abilities of communication and cooperation,and promote their sense of social responsibility through social practice.Through conducting questionnaire among medical graduate students of Peking University Third Hospital who major in internal medicine,we have got to know the effect of social practice on holistic education philosophy.Meanwhile,social practice is a crucial approach to implementing holistic education.

Objective:To analyze the clinical and echocardiographic features of constrictive pericarditis. Methods: Thirty-six patients diagnosed as having constrictive pericarditis from Oct. 1989 to Jun. 2007 were enrolled in this retrospective study. Clinical manifestations and echocardiographic features were analyzed. Results: The main clinical manifestations were fatigue, effort dyspnea(100%), and sign of pressure elevation of vena cava(97%). Echocardiographic features included thickening of pericardium(67%), abnormal motion of septal and posterior wall of left ventricle in diastole(83%,75% respectively), left and right atrial enlargement(92%,39% respectively), early filling changes of mitral flow with respiration(93%), inferior vena cava dilation and without respiration variation(100%), mitral annulus paradoxical enhanced motion in early diastole. Conclusion: Clinical manifestations of pressure elevation of vena cava were indicators for diagnosis of constrictive pericarditis. Echocardiography could be a valuable method for confirming the diagnosis.

Objective To analyze the evolutionary trend of clinical features in infective endocarditis.Methods The study enrolled 68 patients who were diagnosed as having infective endocarditis from July 1987 to July 2007.The patients were divided into two groups:group Ⅰ included patients from 1987 to 1997,group Ⅱ included patients from 1997 to 2007.All clinic data were compared.Results In both groups,61 patients(89.7%) had basic heart diseases,67 patients(98.5%) had fever and 62 patients(91.2%)had cardiac murmur;41 patients(60.3%) had positive results in the blood culture.Vegetations were found in 57 cases(83.8%) by echocardiography.The rate of surgical treatment was 19.1%,the total cure rate was 66.7%.Comparing the data between the two groups,age of onset changed from (36.7?12.7)years to (44.4?18.6)years(P

AIM: To investigate the role of angiopoietin-1 (Ang1) and Tie2 receptor in angiogenesis after myocardial infarction through detecting their mRNA expression in normal and infracted myocardium. METHODS: The experiment was conducted in the laboratory of Biochemistry and Molecular Biology, Medical Department of Peking University from April 2006 to April 2007. Forty male SD rats were randomly divided into acute myocardial infarction model group and sham-operation group. The myocardial infarction model was established in the rats of model group through the ligation of left anterior descending artery, while the rats in sham operation group were braided of the left anterior descending artery without ligation. Five rats in both groups were executed at 3, 7, 14, and 28 days after model establishment. RNA was extracted from the same site of left anterior wall, and the polymerase chain reaction was used to semiquantitatively analyze the Ang1 and Tie2 receptor mRNA expression with GAPDH gene as internal control; meanwhile, the immunohistochemistry was used to detect vascular density in and around infarction area. All the treatments for animals were accorded with the animal ethical standards. RESULTS: All 40 rats were included in the final analysis. Both Ang1 and Tie2 receptor were expressed in normal myocardium. In the 28 days after myocardial infarction, Ang1 expression kept at almost the same level without changing, but Tie2 receptor expression was slightly elevated at 3 days, reached peak value at 7 days, and returned to the baseline value at 14 days. The vascular density increased both infarction and peri-infarction area at 7 days after acute myocardial infarction, and did not change with time. CONCLUSION: Tie2 receptor expression is elevated and coincided with angiogenesis after myocardial infarction. It may play a role in the development and stabilization of the blood vessel after myocardial infarction.

Objective To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n =40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E:(0. 88 ±0. 18)cm/s vs (0. 76 ±0. 19) cm/s;E/A ratio:0. 86 ±0. 28 vs 1.02 ±0. 38;Em: (9. 4 ±2. 8)cm/s vs (11. 9 ±3. 8)cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8: with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; (7.7 ±2. 6) cm/s vs (9. 9 ± 2. 8) cm/s, E/Em: 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [(0. 90 ± 0. 22) cm/s vs (0. 87 ± 0. 17) cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.