Objective To study clinical manifestations,laboratory variables,imaging features and therapies of refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods The retrospective analysis of clinical data was conducted in 45 children with RMPP and 74 children with Mycoplasma pneumoniae pneumonia (MPP)admitted to department of pediatrics.The general data,clinical manifestations,laboratory variables,imaging features and therapies were compared between two groups.Results As compared to MPP,the age(6.14 ±3.35)y,febrile days(9.49 ± 5.28)d,the hospitalized days(11.45 ±3.42)d were significantly higher than that of MPP group (P <0.001);RMPP had higher rations of unilateral pulmonary infiltration[41(91.11%)],large consolidation shadows[35(77.78%)], pulmonary[21(46.67%)]and extrapulmonary complications[24(51.33%)](P <0.05);CRP,ESR,LDH and IgM were increased,the difference was statistically significant (P <0.01);Thirty -seven cases(82%)of RMPP had to add ceftriaxone sodium,thirty -two cases(71.7%)of RMPP had to add glucocorticoid,,Bronchofiberoscope lavages were used in six cases of RMPP.Only one case of RMPP occured sequela.Conclusion The older children,the per-sistent high fever,large consolidation shadows of pulmonary,pulmonary and extrapulmonary complications,high level of serum CRP,ESR,LDH and IgM are the clinical related factors of RMPP.The combination of cephalosporins and (or)glucocorticoid might consider for the cases who have no effect with macrolides.The effect is sure for RMPP with Bronchofiberoscope lavages.

Objective T o determine the normal range of the 33 elements (Li, Be, B, mg, Al, Ca, Ti, V , Cr, mn, Fe, Co, Ni, Cu, Zn, Ga, As, Se, Rb, Sr, Zr, mo, Ag, Cd, Sb, Cs, Ba, Au, Hg, Tl, Pb, Th and U ) in human whole blood of general population in Hunan province. Methods Blood samples were ana-lyzed by inductively coupled plasma-mass spectrometry (ICP-mS ) to determine the normal range. T he influences of district, gender and age to the element content in blood samples were also observed. Re-sults T he normal range of 33 elements in blood samples fromgeneral population in Hunan province were obtained. Gender was shown to statistically influence the concentrations of B, mg, Ca, Ti, mn, Fe, Co, Cu, Zn, As, Se, Rb, Sr, Ag, Cd, Cs, Hg and Pb (P<0.05), while age was shown to influence the concentrations of Co, Ni, Cs and Hg in women (P<0.05) as well as Cu, Se and Hg in men(P<0.05). Conclusion Although there are variables in different districts, the normal ranges of trace element in blood of the four cities in Hunan province are established.

Objective To identify the possible existing suppressive oligodeoxynucleotides(ODNs)in the DNA sequence which encodes Schistosoma japonicum 22.6 kDa(Sj22.6)antigen.Methods Several ODNs within the DNA sequence encoding Sj22.6 antigen were synthesized.Splenocytes separated from mice were stimulated with optimal immunostimulatory CpG 1826 in the absence or presence of different synthetical ODNs.The suppressive efficacy of each ODN was examined by 3H-TdR incorporation.Results ODN F311 suppressed the proliferation of splenocytes caused by CpG 1826 stimulation.The significant suppression was observed when ODN F311∶CpG 1826 at a ratio of 1∶1 and 3∶1,the suppression reached 11% and 58% respectively.The maximal inhibition was observed when ODN F311 was pre-administered with CpG ODN for 2 h.Conclusions Certain suppressive ODN exists in the DNA sequence encoding Sj22.6 antigen,and this effect shows dose-and time-dependent manner.

Objective: To explore the efficacy of esmolol on cardiac ischemia in patients with serious coronary lesions who are not candidates for coronary revascularizations. Methods: Fifty seven aged patients (34 male) with serious coronary artery disease not candidates for coronary revascularizations were included. All patients had classical angina involved in cardiac ischemia, and definitely ischemic ST-segment depressions in surface electrocardiogram, however which were not relieved by routine treatment including intravenous nitrate or even morphine. All patients received loading dose injection and continuously intravenous infusion of Esmolol, and the baseline characteristics before treatment and the effects at 4 hours after infusion of Esmolol were carefully recorded. Results: After infusion of Esmolol, the ischemia-related symptoms of 41 patients completely relieved, and their ST depressions recovered to the baseline accompanied with significant reduction in blood pressure and heart rate (P＜0.0001 all) within (66±23) min. Moreover, nine patients were observed that their ischemia-related symptoms were relieved and ST alteration recovered partially (P＜0.0001 both) at four h after continuous infusion of esmolol. Conclusion: Esmolol is effective to relieve the serious cardiac ischemia-related symptoms and ST-T alteration of ECG in patients with serious coronary lesions.

Objective: To explore the application value and safety of low-dose dobutamine stress echocardiogram (LDDSE) in patients of low-flow/low-gradient aortic stenosis combining left ventricular dysfunction with transcatheter aortic valve replacement (TAVR). Methods: A total of 5 eligible consecutive patients with contradiction of routine surgical valve replacement and going to receive TAVR in our hospital from 2013-10 to 2016-07 were enrolled. The mean aortic valvegradient, maximum flow velocity, each stroke volume and ejection fraction were recorded before and during LDDSE examination. The patients having confirmed diagnosis of true severe aortic stenosis with left ventricular contractile reserve received TAVR, for those without left ventricular contractile reserve received drug therapy or TAVR conditionally. The changes of cardiac function and NT-proBNP level were observed after TAVR. Results: All 5 patients showed positive finding in LDDSE; the mean aortic valve gradient ≥40mmHg and stroke volume≥20% implied that the patients had true severe aortic stenosis with left ventricular contractile reserve. No adverse reaction occurred during and after LDDSE. TAVR was performed in 4 patients and 1 was waiting for TAVR or balloon dilatation since temporary lacking of valve. The post-operative cardiac function was improved in all patients and NT-proBNP level was declined continuously. Conclusion: LDDSE examination could be considered in patients of aortic stenosis combining left ventricular dysfunction, low-flow and low-gradient to clarify ventricular contractile reserve and the severity of aortic stenosis. If the patients with ventricular contractile reserve, TAVR was recommended which was the effective treatment for relevant patients.

Objective To evaluate the safety and clinical efficacy of renal artery stent treatment for severe atherosclerotic renal artery stenosis (ARAS) in the elderly. Methods In a prospective nonrandomized study in our hospital from January 2003 to April 2008, 147 consecutive elderly patients with ARAS (diameter reduction ≥ 65％) underwent percutaneous transluminal renal angioplasty and stenting (PTRAS) for resistant hypertension or reserving renal function. They were followed up for 6- 66 months and the effects of the procedure on renal function, blood pressure and cardiovascular events were observed. Results The success rate of PTRAS was 100％. During 6-66 months of follow up, both systolic and diastolic blood pressure were significantly decreased, and less antihypertensive medication was taken (P<0.01). Serum creatinine was significantly decreased during 6-48 months of follow up (P<0. 05) and did not change significantly during 54-66 months of follow up (P>0. 05). Blood urea nitrogen was significantly decreased during 6-24 months of follow up (P<0.05) and did not change significantly during 30-66 months of follow up (P>0.05). Complications related with the procedure occurred in 7 cases (4.8％). 17 patients failed to follow up (11.6％) and in 18 cases cardiovascular events occurred (12.2％), including 4 cases of renal events (2. 7％), 4 cases of myocardial infarction (2.7％), 2 cases of stroke (1.4％) and 8 cases of cerebral and cardiovascular events (5.4％) during 6-66 months of follow up. The survival rates of free-of-events at year 1, 2, 3, 4 and5 were 91.0%(121/133), 90.2%(83/92), 78.5%(51/65), 73.8%(31/42) and 54.8%(17/ 31), respectively. The survival rates at year 1, 2, 3, 4 and 5 were 94.0% (125/133), 90. 2% (83/ 92), 84.6%(55/65), 73. 8%(31/42) and 61.3%(19/31), respectively. Conclusions Renal artery stent as treatment for ARAS in the elderly has a beneficial effect on blood pressure control and on renal function during middle and long term follow up. The treatment may be helpful in reduction of cardiovascular events and mortality, which should be investigated further.

AIM: To study the time-dependent effects of diabetes mellitus (DM) on the development of cardiac remodeling in untreated streptozotocin (STZ)-induced rats with acute myocardial infarction (MI). METHODS: The left anterior descending coronary arteries were ligated 10 weeks after DM induction without any therapy. Transmission electron microscopy, echocardiography, heart weight to tibial length ratios, histological examination, microarray analysis, and real time-PCR were utilized to monitor the changes up to 56 d. RESULTS: After MI, the diabetic rats experienced lower survival rate compared to non-diabetic animals. The pathophysiologic changes indicated that DM accelerated the cardiac remodeling post-infarction. In primary examination, 164 genes related to cardiac remodeling were found to be candidates for hierarchical analysis, such as leucine-rich PPR-motif containing (interleukin-6 signaling pathway), procollagen type I and III, fibronectin-1, RT1, and TIMP-1, etc. The gene expression profile at 14 d in diabetic rats were comparably similar to both 14 d and 28 d in non-diabetic rats, while such changes at 28 d and 56 d in diabetic rats was also similar to the ones at 56 d in non-diabetic rats. CONCLUSION: The accelerated cardiac remodeling of post-infarction in STZ-induced untreated diabetic rats seems be associated with the different profile of gene expressions.

Objective To construct the recombinant yeast expressing PreS2 120-146-hepatitis B surface antigen (HBsAg),and to evaluate the immune effects of whole yeast cells.Methods PreS2 120-146 and HBsAg gene sequence were optimized according to the yeast cell codon preference,and were recombined and cloned into pPIC3.5K yeast expression vector to construct pPIC3.5K/PreS2 120-146 plasmid.After digested and linearized by Bgk Ⅱ restriction enzyme,pPIC3.5K/PreS2 120-146-HBsAg recombinant plasmid was electrotransformed into GS115 strain to screen PreS2 120-146-HBsAg-recombinant Pichiapastoris .The expression of PreS2 120-146-HBsAg was identified by sodium doclecyl sulfate polyacrylamide gel electrophogesis (SDS-PAGE),Western blot and enzyme linked immunosorbent assay (ELISA)analysis. BALB/c mice were vaccinated by inactivated whole recombinant yeast cells expressing target protein. Specific antibodies to HBsAg were detected by ELISA.Cytotoxic T lymphocyte (CTL)response induced by interferon (IFN)-γ was detected by reverse transcription-polymerase chain reaction (RT-PCR)when immune spleen cells of mice were stimulated by CTL epitope on HBsAg.Independent sample t test was used. Results Data of PCR detection,restriction enzyme digestion and sequencing analysis showed that recombinant pPIC3.5K/PreS2 120-146-HBsAg plasmid was successfully constructed.SDS-PAGE,Western blot and ELISA verified the expression of PreS2 120-146-HBsAg in the lysate of the recombinant Pichiapastoris induced by methanol.Levels of specific anti-HBsAg IgG antibodies produced by inactivated yeast cells vaccinated mice were comparable to purified HBsAg immunization (t =0.946,P =0.381 ). Analysis of HBsAg-specific CTL responses revealed that the level of IFN-γwas significantly higher when the immune spleen cells of mice were stimulated by CTL epitope peptides on HBsAg (t =2.305 ,P =0.044).Conclusions PreS2 120-146-HBsAg target protein is successfully expressed by construction of recombinant Pichiapastoris . The specific humoral and cellular immune responses are induced by recombinant whole yeast cells vaccinated mice.

Objective: To evaluatethe efficacy of renal artery stenting combining optimal drug therapy in patients with atherosclerotic renal artery stenosis.
Methods:This is a prospective cohort study for patients who received percutaneous renal artery stenting in our hospital from 2011-09 to 2013-03. All patients had conifrmed diagnosis of atherosclerotic renal artery stenosis combing hypertension and/or renal functional damage. Thepatients received optimal drug therapy for anti-platelet and blood pressure, lipids, glucose controlling, and they were followed-up for at least 12 months to observe the improvement of blood pressure and renal function.
Results:There were 149 patients at the mean age of (61.54 ± 9.63) years and 185 renal artery stenosis with stent implantation;the average stenosis rate was (83.11±7.30)%and the success rate of operation was 99.32%(148/149). During follow-up period, the patients had increased estimated glomerular ifltration rate (GFR) compared to base line from (76.49 ± 22.50) ml/(min·1.73 m2) to (84.09 ± 28.79) ml/(min·1.73 m2), P<0.05 and decreased 24 h urinary protein from 0.1(IQR 0.02, 0.5) g to 0.04 (IQR0.01, 0.11)g, P<0.001;less type of drug therapy for hypertension from 2.22 to 1.56, P<0.05, decreased clinical and 24h dynamic systemic/diastolic blood pressure from (153.4 ± 15.6)/(83.77 ± 12.60) mmHg to (134.6 ± 14.4)/(73.57 ± 9.12) mmHg and from (143.32 ± 19.87)/(80.51 ± 11.33) mmHg to (124.44 ± 14.90)/(69.09 ± 9.49) mmHg, all P<0.05.
Conclusion:Renal artery stenting combining optimal drug therapy may improve blood pressure controlling and renal function in strictly selected patients with atherosclerotic renal artery stenosis.

Objective: To study the aortic root imaging and clinical application in 15 patients with transcatheter aortic valve implantation (TAVI).
Methods: A total of 15 patients with severe aortic valve stenosis received TAVI in our hospital from 2011-03 to 2013-11 were studied. The CT scan and transthoracic echocardiography were conducted to measure the aortic root anatomy and the differences of annulus size between CT and echocardiography were calculated. The prosthetic valves were selected based on CT measurement. The pre-operative accuracy of measurement was evaluated by the follow-up study at 6 months after operation.
Results: The CT measured pre-operative aortic annulus short diameter was (21.5 ± 2.4) mm, long diameter was (27.3 ± 2.7) mm, the average inner diameter was (24.4 ± 2.4) mm, left ventricular out lfow (LVOF) tract long diameter was (28.3 ± 4.5) mm, the average inner diameter of LVOF was (24 ± 3.5), ascending aorta diameter was (35.3 ± 4.4) mm. The Venus Medtech A-Valve implanted in 8 patients with #26 and in 7 patients with #29. The average inner diameter of aortic annulus measured by CT was larger than transthoracic echocardiography, P<0.001. During 6 months follow-up period, no patients had aortic root rupture, coronary obstruction, moderate and severer aortic and peri-aortic regurgitation. There were 4 patients with atrio-ventricular block and received permanent pacemaker implantation.
Conclusion: There is a difference for aortic annulus size by CT and transthoracic echocardiography measurements. CT may presisely assess the aortic root morphology and provide strong support for TAVI.