Despite of great advances in drug management of heart failure in the past ten years,the condition remains a major public health issue,with high prevalence,poor clinical outcomes.Treatment of established systolic chronic heart failure includes agents that block the renin-angiotensin-aldosterone and sympathetic nervous systems to prevent adverse remodelling,to reduce symptoms and prolong survival.Diuretics,Vasodilator and Digoxin are often used to improve sign,with no influence on prognosis.Pharmacological agents aimed at new targets on clinically relevant endpoints are going under investigating.

Human health and public safety are being threatened while chemicals bring convenience and comfortable to our life. How to reduce and avoid the hazard of chemicals via toxicity warning is becoming more and more important. Today it is necessary to estimate new chemicals conveniently, quickly and precisely. The warning model of chemicals in toxicology has a favorable prospect of application. The toxic effect and kinds of models of chemicals and the study of quantitative structure activity relationships (QSAR) in toxicity research were reviewed in this paper.

Firstly the paper expounds the fact that letting patients pick their doctors goes with the tide of social development: ①the connotation of medical quality determines the necessity of patients involvement; ②evaluation of medical quality has extended from self appraisal to social assessment; and ③the mechanism of letting patients pick their doctors conforms to the medical quality requirements of the times. Then the paper discusses the positive impact of letting patients pick their doctors on medical quality, including the choice of doctors by outpatients and the impossibility of doing so in medico technical and emergency departments or by inpatients. The paper also gives an account of the measures taken for safeguarding medical quality when adopting the practice of letting patients pick their doctors. Lastly the paper explains the boosting role of the practice and the difference between letting patients pick their doctors and letting them name particular surgeons for their operations.

After an account of the background to the practice of letting patients pick their doctors in the Third Central Hospital of Tianjin, the paper points out the positive impact of the practice, comments on the specific measures, and narrates the results that have been achieved. These include: ①enhanced awareness of self management on the part of the staff; ②increased cohesion of the hospital; ③higher efficiency; ④greater initiative on the part of the scientific and technical personnel as a result of the reform; ⑤social recognition of the reform; and ⑥a higher level of professional ethics building. Lastly the paper discusses the hospitals experience in adopting the practice of letting patients pick their doctors.

Objective To study the operation methods and efficacy of joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone. Methods 28 patients with tumors at the end of bone had resection and limb salvage by joint prosthesis with artificial diaphysis. These cases consisted of 11 osteosarcomas, 10 bone giant cell tumors, 2 chondrosarcomas, 2 metastatic carcinomas, 1 malignant fibrous histiocytoma,1 aneurysmal bone cyst and 1 osteochondroma. Among them, there were 7 cases of proximal femoral tumors, 6 cases of distal femoral tumors, 10 cases of proximal tibial tumors, 5 cases of proximal humeral tumors. Results The follow-up periods were 16 months to 15 years. Eighteen patients died. Functional activity was satisfactory in 71% of the patients(2 years). Conclusions Joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone is feasible, and a better system for reattachment of the soft tissues is needed to avoid pain and a persistent limp.

Objective To assess the feasibility and the reliability of emergency temporary cardiac pacing under fluoroscopy and nofluoroscopy,and compare to the superiority and inferiority between two groups.Methods Fifty-seven patients were temporarily paced under fluoroscopy and nofluoroscopy by the way which the common bi-pole temporary endocardium pacing electrode was introduced into the right ventricle by the bi-subclavian vein and right internal jugular.Result Twenty-six patients were successfully paced under fluoroscopy,and 27 patients of 31 were successfully paced without fluoroscopy,the other 4 patients were not paced successfully.Besides,there was no any complication in all patients.Conclusion Emergency temporary cardiac pacing without fluoroscopy is utility,saving time and safety,Compared to other method,the effect is proximity and even superior than the way under fluoroscopy.The way of the emergency temporary cardiac pacing without fluoroscopy is applied widespreadly in the work of clinical first aid.

Objective To compare the clinical efficacy of laparoscope and open operation in treatment of adrenal pheochromocytoma.Methods 52 cases with adrenal pheochromocytoma were randomly divided into two groups,they were treated with laparoscope or open operation.Intraoperative blood loss,intraoperative blood pressure and heart rate fluctuations,operation time,drainage,hospitalization and postoperative complications were compared between two groups.Results Intraoperative comparison:In laparoscope group,operative blood loss was (65.7 ± 50.2) ml,blood pressure fluctuations in 1 case (3.8％),heart rate variability was (18.7 ± 6.1)/min and the operation time was (93.7 ± 21.7) min; in the open operation group,amount of bleeding during the operation was (240.4 ± 150.5) ml,blood pressure fluctuations in 7 cases(26.9％),heart rate variability was (25.6 ± 6.3)/min and the operation time was (137.7 ± 30.5) min,the differences between the two groups was significant (t =3.15,x2 =5.32,t =3.65,t =4.16,all P＜0.05).The maximum tumor diameter of open operation group was (7.3 ± 1.4) cm,which was bigger than that of the laparoscope group (6.6 ± 1.2) cm,but no significant difference between two groups (P ＞ 0.05).Postoperative comparison:in the laparoscope group,postoperative drainage was (174.3 ± 121.3)ml,drainage time was (4.3 ± 1.3) d and time of hospitalization was (8.4 ± 1.2) d,which were significantly less than those in open operation group(318.5 ± 132.6)ml,(8.7 ±2.3)d and (11.4 ±3.2)d(t =2.54 3.13,2.12,all P ＜0.05).No serious complications were observed in two groups,laparoscope group 1 case,open operation group 5 cases had postoperative pain,after the corresponding symptomatic treatment was improved.After 3 months of follow-up,clinical symptoms were significantly improved or disappeared,ultrasound or CT reexamination found no recurrence.Conclusion Laparoscope in treatment of adrenal pheochromocytoma not only has definite curative effect,but also has small trauma,shorter operation time and less complications,it is worth clinical application.

Objective To observe the clinical efficacy of dendritic cell-cytokine-induced killer cell (DC-CIK) combined with interleukin (IL)-2 in treatment of renal cell carcinoma.Methods A total of 60 patients with renal cell carcinoma after radical nephrectomy were randomly divided into treatment group and control group.Thirty cases in treatment group were given DC-CIK cells combined with IL-2 treatment.Thirty cases in control group were treated with IL-2 treatment.The immune function,quality of life,survival rate and adverse reactions were analyzed in two groups.Results Compared with before treatment,the percentages of CD3+,CD4+,CD4+/CD8+ ratio and CD16+CD56+ increased and CD8+ decreased significantly in treatment group(P ＜ 0.05).In control group,there was no significant change before and after treatment in the percentages of CD3+,CD4+,CD4+/CD8+ ratio,CD16+ CD56+ and CD8+(P ＞ 0.05).Quality of life of 83.3％(25/30)patients in treatment group was improved,56.7％(17/30) patients in control group was improved,there was significant difference between two groups (P ＜ 0.05).The 1-year survival rate in treatment group and control group were 93.3％ (28/30),83.3％ (25/30),and the 1-year recurrence rate in two groups were 6.7％ (2/30)and 13.3％ (4/30),there were no significant difference between two groups (P ＞ 0.05).There were no significant statistically in the incidence of adverse reactions between two groups (P ＞ 0.05).Conclusion DC-CIK cells combined with IL-2 in treatment of renal cell carcinoma after radical nepbrectomy can improve patients' immune function and quality of life.

Objective To investigate the effect of low molecular weight heparin on lung Injury complicated by severe acute pancreatitis and explore its mechanism.Methods Ninety Wistar rats were randomly divided into 3 groups,namely sham operation (SO) group,acute necrotizing pancreatitis (ANP) group,low molecular weight heparin treatment (LH) group.4％ sodium taurocholate was injected into the pancreatic duct to induce ANP model.Subcutaneous low molecular weight heparin (10 U/100 g body weight) was injected in the LH group,the equivalent amount of normal saline was injected in the SO and ANP group.After 6,12,24 h,rats were sacrificed respectively,pancreas and lung tissues were harvested to observe the pathological changes and the pathological changes were scored;and the changes of TLR4 and VEGF protein expression in lung tissue was determined by immunohistochemical method.Serum and lung levels of IL-6,IL-l0,TNF-α were determined by ELASA method.Results The pancreas and lungs tissues were normal in SO group,diffuse hemorrhage,necrosis and a large number of inflammatory cells infiltration was observed in pancreas tissue in ANP group.Lung alveolar wall rupture,interstitial hyperemia,edema,a large number of infiltrating neutrophils could be seen in lung tissue in ANP group.The pancreas and lungs tissues injuries were significantly alleviated.The pancreas and lungs pathological scores of ANP group at 12 h were 6.34 ± 1.09,7.01 ± 1.16,and those were 5.48 ± 0.86,6.24 ± 0.86 in LH group,the values in LH group were significantly lower than those in ANP group (P ＜ 0.05),and there was a positive association between lung and pancreas scores (r =0.812,P ＜ 0.01).The expressions of TLR4,VEGF,IL-6,TNF-o,IL-10 in lung tissue of ANP group at 12 h were 0.68 ± 0.10,0.50 ± 0.11 and (2617.2 ± 485.3),(1603.1 ± 519.7),(608.3 ±137.5)pg/g,which were 0.61 ±0.09,0.41 ±0.06 and (2398.5 ±503.7),(1302.4±389.8),(753.2 ±100.0) pg/g in LH group,and the expressions of TLR4,VEGF,IL-6,TNF-α in LH group were significantly lower than those in ANP group,but the expression of IL-10 was significantly up-regulated,and the difference between the two groups was statistically significant (P ＜ 0.05).The serum levels of IL-6,TNF-α,IL-10 in ANP group at 12 h were (184.3 ± 45.7),(289.7 ± 60.4),(143.2 ± 30.4) μg/L,which were (143.8 ±31.8),(256.4 ±40.7),(189.3 ± 50.9)μg/L in LH group,and the levels of IL-6,TNF-α in LH group were significantly lower than those in ANP group,but the expression of IL 10 was significantly increased,and the difference was statistically significant (P ＜ 0.05).The expression of TLR4,VEGF in lung tissue was positively associated with the degree of lung injuries (r =0.524,0.503,P ＜ 0.05).Conclusions Low molecular weight heparin may improve lung injury complicated by ANP.The mechanism may involve inhibiting the expression of TLR4 and VEGF protein,IL-6,TNF-α,and up-regulation of the expression of IL-10.