During the last fifty-year medical treatments have made great advances in the treatment of heart failure(HF).The current applicatin of treatment improves the life quality of patients with HF,and reduces their clinical envents and mortality.But the patients with refractory heart failure(RHF) have poor prognosis.This article reviews and analyzes the advances in the therapies for patients with RHF.

Objective To investigate the clinical values of dexmedetomidine in general anesthetic for laparo-scopic cholecystectomy.Methods One hundred patients admitted to our center with cholelithes were prospectively studied.According to the principle of completely random digital table,all patients were randomly signed to dexmedeto-midine group or control group.The primary outcomes were hemodynamic changes and postoperative complications. Results There was no significant differences at t0,t1,t2,t3,t4 and t5 in mean arterial pressure (P >0.05).There was no significant difference in heart rate at t0 (P =0.503),however,compared with the control group,patients in the dexmedetomidine group got a significant reduction in t1,t2,t3,t4 and t5 in heart rate(all P <0.05).Compared with the control group,the operation time of the dexmedetomidine group was significantly shorten[(1 18.52 ±15.42)min vs.(127.24 ±19.14)min,t = -5.673,P =0.021 ],the rate of movement of the center of the operation was significantly decreased (36% vs.64%,χ2 =7.840,P <0.001),the incidence rate decreased significantly (0% vs. 10%,χ2 =5.263,P =0.022).There was no difference between the two groups in intra -operative bleeding volume, hypertension,hypotension,tachycardia,postoperative drainage volume,postoperative bleeding,infection and vomiting (all P >0.05 ).Conclusion Dexmedetomidine contributed to maintaining the hemodynamic stable in general anesthetic for laparoscopic cholecystectomy,and reducing the rate of shivering.

Cardiac biomarkers of sensitive and specific are very important to the early diagnosis of cardiovascular diseases,such as cardiac troponin (high sensitivity),myoglobin,heart-fatty acid-binding protein,ischemia modified albumin,B-type natriuretic peptide and N-terminal-pro-B-type natriuretic peptide.They also play an important role in risk stratification and prognosis evaluation,but improvement is still needed.Biomarker of high sensitivity and specificity,convenient detection control is still required in clinical application.

Ostial lesions present many challenges for percutaneous coronary intervention (PCI). Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wire technique and focused-force angioplasty.

[Objective]To explore the clinical effects of selecting differents type of tendon transplants to reconstruct anterior cruciate ligament(ACL) using press fit technique.[Method]A total of 101 cases of ACL injury were included in this study,62 cases were athletic injuries,22 cases were traffic injuries,and 17 cases were daily-life injuries.According to patient's condition using different types of tendon transplant in which hamstring-tendon-knot 42 cases,bone-bolt-hamstring tendon knot 32 cases,patella bone-quadriceps tendon 27 cases,the tendon-knot was completely fit-into the bottle-necked femoral tunnel,and the tibial tunnel were pulled ont and seperated into two bundles, then tie a knot to fix the tendons tightly onto the bone bridge.[Result]In this group 98 patients were followed-up,According to the knee joint effective evaluate standard,88 were excellent,6 good and 4 fine.Excellent and good rate was 85.7%.[Conclusion]According to patient's condition,different type of tendon transplant to reconstruct ACL by press fit technique should be selected carefully.It is an method of easy to manipulate,reliable fixation,minimized trauma,biological fixation,economical and free expensive implant technique.

Objective To investigate the outcomes of arthroscopically lateral retinaculum patellae release and medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of habitual or recurrent dislocation of the patella. Methods 18 cases of recurrent dislocation of the patella were included in this group, among which there were 6 males and 12 females. The average age was 20 years old(range from 17 to 24 years). Arthroscopic investigation found tensed lateral retinaculum patellae and damaged cartilage at patellar medial margin and femoral lateral condyle. There were 6 cases of Ⅱdegree cartilage injuries, 5 cases of Ⅲ degrees injuries, and 7 cases of Ⅳ degree injuries caused by patellofemoral joint impact. For cases of Ⅳ degree injuries, the damaged cartilage was shaved and microfractured. For cases of Ⅱ or Ⅲ degree injuries, radiofrequency system was used for debridement. After the lateral retinaculum patellae was extensively released, semitendinosus tendon autograft was used to reconstruct the medial patellofemoral ligament. The knee joint was flexed and extended. Patella's dynamic motion, the tension of the tendon and relationship between the femoral trochlea and patellar bone were arthroscopically observed. Interface screw was used to fix the tendon ends within the bone tunnel on condylus medialis femoris. Results All patients were followed up for 9 to 19 months averaging 13 months. No patellar dislocation occurred postoperatively. Apprehensive test, patella tilt test were negative; and Apley test were negative in 16 patients and positive in 2 patients. One case of inferior pole of patella fractured. Axial view of X-ray and MR images of patella showed 15 cases regained normal anatomical relation of patellofemoral joint. 3 cases had mild semi-dislocation. Lysholm's score averaging (78.0?4.5) points preoperatively and (94.0?3.5) points postoperatively. Conclusion Lateral retinaculum patellae solution and medial part reconstruction under arthroscope can effectively cure recurrent subluxation of the patella and improve knee joint function.

Objective To assess the efficacy and safety of two kinds of arterial suture-mediated closure devices (Angioseal and Perclose) in patients after coronary arteriography(CAG) and percutaneous coronary intervention (PCI). Methods 1?020 patients (672 male, 348 female, mean age 57.8?2.4 yr) undergoing CAG or PCI were randomized into either the Angioseal group (CAG 380, PCI 120) or the Perclose group (CAG 392, PCI 128). The procedural success rate and occurance of local complications were compared between the two groups. Results Both kinds of devices had a high success rate (Angioseal 94% vs Perclose 96%) and there was no statistical difference between them. There were five cases of hematoma and no pseudoaneurysm in the Angioseal group. On the other hand, there were four cases of hematoma and three cases of pseudoaneurysm in preclose group. There was no statistal difference in terms of local complications between the 2 groups. Conclusion Both kinds of arterial suture-mediated closure devices (Angioseal and Perclose) are feasible and safe for patients undergoing CAG and PCI.

Objective To evaluate the short-term effect of early treatment with clopidogrel before elective coronary stenting in patients with NSTE-ACS,compared with treatment with clopidogrel at the time of the procedure. Methods Patients with NSTE-ACS undergoing elective coronary stenting were randomly divided into two groups: early treatment group (n=272) and control group (n=265). Patients in the early treatment group were given clopidogrel immediately since hospitalization (300 mg loading dose, then 75 mg once daily); while in the control group, patients were given clopidogrel (300 mg) after coronary angiography followed by 75 mg per day after PCI. The composite endpoints were death, recurrent angina pectoris, instent thrombosis, myocardial infarction and urgent target vessel revascularization within 30 days after coronary stenting. Results Differences in baseline characteristics among patients between the two groups were negligible. There were no significant difference in the target vessel lesions requiring stenting between the 2 groups. Compared with the control group, early administration of clopidogrel showed a lower rate of death, myocardial infarction, refractory ischaemia, instent thrombosis and revascularization within 30 days of PCI. Conclusion Compared with administration of clopidogrel at the time of coronary stenting, pre-treatment with clopidogrel in patients with NSTE-ACS could significantly reduce the odds of adverse cardiovascular event and improve clinical outcomes within 30 days of PCI.

Objective To investigate the character and differentiation diagnosis of coronary artery fistula in aged.Methods Clinical symptom, sign and laboratory examination were analyzed in 8 aged patients with coronary artery fistula. Results Myocardial ischemia is the main manifestation of agedness coronary artery fistula, and should be discriminated with coronary artery disease. Conclusion If myocardial ischemia symptom aggravates with age in patient with long-term angina, coronary angiogram is the most dependable method.

Objective To investigate the significance of three electrocardiographic indexes in predicting the myocardial infarct related artery (IRA) in inferior wall of acute myocardial infarction (IAMI) Methods One hundred and twenty patients with IAMI were studied Results (1) IRA was related to right coronary artery (RCA) in 98 (81 7%) case, left circumflex branch (LCX) in 22 (18 3%) cases (2) ST segment depression in lead Ⅰ identified RCA occlusion with a sensitivity of 77 6%, specificity of 90 9% in patient with IAMI, but isoelectric or elevated ST segment in lead Ⅰ identified LCX occlusion with a sensitivity of 90 9%, specificity of 77 6% (3) About QRS wave of lead aVL, S/R≥1/3 identified RCA occlusion with a higher sensitivity of 93 9% and a lower specificity of 63 6% (4) When IRA was RCA, ST segment elevated amplitude Ⅲ≥Ⅱ identified as a diagnostic index no matter the location of occlusion Conclusion Three electrocardiographic indexes have significant value in predicting the infarct related artery in inferior wall acute myocardial infarction