Objective To investigate the alternation of left ventricular systolic function in patients underwent transcatheter aortic valve implantation operation(TAVI) by three-dimensional speckle tracking technology (3D-STI).Methods Totally 20 patients with severe aortic stenosis were enrolled.All the subjects underwent successful TAVI operation.The real-time 3D full volume datasets on apical four-chamber view were acquired on before,7 days and 1 month after TAVI.Left ventricular global longitudinal strain(GLS),regional peak systolic longitudinal strain(LS),regional peak systolic circumferential strain(CS) and regional peak systolic radial strain(RS),were analysed using off-line TomTec software,the differences among the three groups were compared.Results Compared with the preoperation,aortic valve blood flow velocity (AV),mean aortic valve pressure gradient(mPAG) of 7 days after operation decreased significantly.Threedimensional left ventricular ejecation fraction(3D-LVEF) among the patients whose 3D-LVEF under 50％had a remarkable increase and whose 3D-LVEF exceed 50％ before operation had no significant change,while 1 month after operation the 3D-LVEF had a significant improvement compared with the preoperational data regardless of 3D-LVEF under 50％ or not.The GLS and LS of all segments of 7 days after TAVI were higher than pre-operation(all P ＜0.05),and it had a further improvement 1 month after TAVI.Conclusions LV systolic function had improvement early after TAVI.3D-STI is a new,convenient way to detect the global and regional left ventricular systolic function of TAVI patients.

Objective To construct small hairpin RNA(shRNA) lentiviral vectors targeting human a proliferation-inducing ligand(APRIL) gene and detect the titer of virus and suitable multiplicity of infection (MOI) after 293T cells were infected by the lentival vectors. Methods Three RNA interference targeting sequences of APRIL gene were screened including shAPRIL1210, shAPRIL1754 and shAPRIL1604. Both sense and antisense Oligo DNA of the targeting sequences were synthesized and cloned into the pGCL-GFP vector, respectively. The resulting lentiviral vectors containing shAPRIL were named LV-shAPRIL1210, LV-shAPRIL1754, LV-shAPRILI604. Then they were confirmed by PCR and DNA sequencing. 293T cells were co-transfected with LV-shAPRIL, pHelper 1.0 and pHelper 2. 0 to product lentivirus, respectively. The titer of virus and suitable MOI were tested according to the expression level of GFP in the 293T cells. Results PCR analysis and DNA sequencing confirmed that three shAPRIL DNA were successfully inserted into the lentiviral vectors. The titers of concentrated virus were 5 × 107, 6 × 107 and 4 × 107(transduction units )TU/ml, respectively, and the suitable MOI was 5. Conclusions Three shRNA lentiviral vectors targeting human APRIL gene have been successfully constructed, which lays a foundation for future studying APRIL's gene silencing in related target cells.

Objective To investigate the inhibitive effect of shRNA (short hairpin RNA) targeting APRIL gene on the pancreatic cancer cells in vitro and in vivo, in order to explore the feasibility of gene therapy for pancreatic cancer. Methods The LV-shAPRIL targeting APRIL gene had been constructed before, and was used to infect the CFPAC-1 cells. Cell proliferation and apoptosis were examined by MTT and flow cytometry. Then CFPAC-1 cells were used to construct the model of transplantation tumor into the nude mice, the tumor growth was assessed after LV-shAPRIL treatment. Results 96 hours after the LV-shAPRIL infection into CFPAC-1 cells, the cell proliferation was significantly inhibited when compared with control group and lentivirus infection group (P＜0.05 ). Flow cytometry showed the apoptosis ratio of the CFPAC-1 cells was (17.35±0.96)% in LV-shAPRIL group, which was higher than that in control group and lentivirus infection group (P＜0.05 ). After LV-shAPRIL injection into the model of nude mice, the tumor growth was slower than that in the two control groups. The tumor's volume of the LV-shAPRIL group was(821.8±123.3) mm3 and the mass was (2.16±0.18)g at 27 day, and were obviously depressed, when compared with two control groups (P±0.05). Conclusions LV-shAPRIL targeting APRIL gene can inhibit the growth of the CFPAC-1 cells in vitro and vivo. This may provide a new gene therapy approach for pancreatic cancer.

Objective To construct of shRNA lentiviral expression vector targeting APRIL (aproliferation-inducing ligand) gene in CFPAC-1 cell of human pancreatic cancer. Methods We used gene engineering to screen RNA interference targeting sequence of APRIL gene. The complementary DNA containing both sense and antisense Oligo DNA of the targeting sequence was designed, synthesized and cloned into the pGCL-GFP vector. The resulting lentiviral vector containing shAPRIL were named LV-shAPRIL. Then it was conformed by PCR and DNA sequencing identification. 293T cells were eotransfected with LV-shAPRIL,pHelper 1.0 and pHelper 2.0 to product ientivirus. The titer of virus was tested according to the expression level of GFP in the 293T cells. After recombinant lentivirus infection into CFPAC-1 cells, we used real-time RT-PCR and Western blotting to examine APRIL mRNA and protein expression at different cell culture period.Results PCR analysis and DNA sequencing conformed that shAPRIL DNA was successfully inserted into the lentiviral vector. The titer of concentrated virus were 5 × 107 TU/ml. APRIL expression in CFPAC-1 cells were inhibited significantly at both mRNA and protein level. APRIL mRNA expression were decreased 73%, 70%and 71% , respectively, after the infection of 4 days, 4 weeks and 8 weeks by LV-shAPRIL. APRIL protein expression were decreased 66%, 63% and 62%, respectively , after the infection of 4 days , 4 weeks and 8weeks by LV-shAPRIL. Conclusions ShRNA lentiviral expression vector targeting APRIL gene has been successully constructed, and it can effectively inhibit the expression of APRIL gene in CFPAC-1 ceils. This study lays a foundatin for in vivo research APRIL gene scilence in pancreatic cancer cell using the model of nude mice.

Objective To investigate the incidence and trend of colorectal cancer in Wenling City of zhejiang Province from 2006 to 2011.Methods The date of colorectal cancer cases were collected from the tumor registersystem.The incidence rates,time trend and regional distributionof colorectal cancer were analyzed.Results The overall incidence of colorectal cancer in Wenling City was rising.The annual average incidence was 22.67/105.The incidence of colorectal cancer both in man and woman were increased with age,especially in ages between 55 and 75.The incidence of colorectal cancer was highest in city,followed in fringe area and lowest in rural.But the average annual growth rate was highest in rural.Conclusion The incidence trend of colorectal cancer is rising in Wenling City.Control measures of colorectal cancer according to the risk factors should be given,especially in rural area.

Around the world, the supply of health services faces challenges, especially in developing nations that suffer from inadequate infrastructure and aging equipment, frequent shortages of medicine and supplies, and low capacity and efficiency of primary health care. At present, more and more governments adopt public-private partner-ships to achieve public policy goals. Among those, Brazil, South Africa, and India have made greater achievements in changing the roles of local government, increasing the supply of primary health care and health care quality, pro-moting health care equality, meeting the needs of multi-level medical services, and promoting health capabilities by using public-private partnerships. This paper provides an overview of public-private partnership practices in the three countries, discusses their reform experiences, and concludes with implications which may be helpful for promoting and scaling up PPP in primary health care in China.

Owing to the increasing morbidity and pulmonary infection,management of pulmonary function has become an important problem for COPD patients who undergo surgery.Surgical patient with respiratory disease such as COPD has declined lung function before operation,then increased the risk of post-operative pulmonary complications.Ipratropium bromide can significantly improve pulmonary function.Therefore,we hypothesis the treatment with nebulized ipratropium bromide will benefit the perioperative patients with COPD.A randomized,double-blind,placebo-controlled,parallel-group,multi-center trial (Ipratropium bromide in Peri-Operative COPD study,IPO-COPD study)has been conducted to evaluate the efficacy and safety of nebulized ipratropium bromide in Chinese perioperative patients with COPD under general anaesthesia.A total of 192 COPD patients who satisfied the eligibility criteria were randomly assigned(1∶1) to one of the two treatment groups(ipratropium bromide 500 μg or normal saline 4 ml) for 11 days.Measurements will include the change of the forced expiratory volume in 1 second(FEV1),the forced vital capacity(FVC),blood gas analyses and main post-operative pulmonary complications.

Objective To discuss the value of echocardiography for the assessment of structure and function of right heart in normal Chinese adults Methods The structure and function of right heart was assessed by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). The echocardiographic data of right heart of 130 normal Chinese adults were analyzed to acquire the normal reference values of echocardiographic parameters and evaluate the differences of these results among different age groups. Results There were significant differences among different age groups for some of the parameters. Right atrium (RA) transverse diameter was greater in the middle-aged group than that in the young-aged group [(36.90±5.10) mm vs (33.90±5.20) mm, t=-2.79, P=0.006]. RA longitudinal diameter (RAL) and RA area (RAA) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(40.10±5.10) mm vs (42.90±5.10) mm, (43.40±5.60) mm, t=-2.51 and-2.91, P=0.013 and 0.004;(11.90±3.20) mm2 vs (13.40±2.90) mm2, (13.90±3.60) mm2, t=-2.24 and-2.90, P=0.027 and 0.004]. Parasternal long-axis right ventricule outflow tract (PLAX RVOT), parasternal short-axis right ventricule outflow tract (PSAX RVOT) and pulmonary artery diameter (PAD) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(24.20±3.00) mm vs (26.20±2.30) mm, (25.90±2.90) mm, t=-2.80 and-2.32, P=0.006 and 0.022;(24.70±3.00) mm vs (27.20±2.50) mm, (26.90±2.60) mm, t=-4.40 and -3.84, P=0.000 and 0.000; (20.60±2.00) mm vs (22.10±2.70) mm, (21.90±2.10) mm, t=-3.12 and-2.67, P=0.002 and 0.008]. RV lateral wall thickness was smaller in the young-aged group than that in the middle-aged and old-aged groups [(5.10±0.60) mm vs (5.60±0.60) mm, (5.40±0.70) mm, t=-3.12 and-2.22, P=0.02 and 0.028];DTI e wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(14.90±3.70) cm/s vs (10.90±3.10) cm/s, (11.10±2.60) cm/s, t=5.82 and 5.49, P=0.000 and 0.000]. DTI a wave was smaller in the young-aged group than that in the middle-aged and old-aged groups [(12.50±3.90) cm/s vs (14.60±3.70) cm/s, (16.60±3.60) cm/s, t=-2.79 and -5.04, P=0.007 and 0.000] and DTI a wave was smaller in the middle-aged group than that in the old-aged group (t=-2.26, P=0.02). Tricuspid E wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(0.61±0.11) m/s vs (0.51±0.11) m/s, (0.48±0.08) m/s, t=4.58 and 5.44, P=0.000 and 0.000]. E/A was greater in the young-aged group than that in the middle-aged and old-aged groups (1.45±0.30 vs 1.12±0.33, 1.10±0.27, t=4.58 and 5.44, P=0.000 and 0.000). No significant differences were found among different age groups in RV systolic function parameters, whereas a trend of decrease in RV diastolic function was detected. Conclusion Echocardiography can be useful in assessing the structure and function of right heart quantitatively.

OBJECTIVE: To investigate the expression of hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4) and connexin43 (Cx43) in the sinoatrial node of electric shock death. METHODS: As experimental group, 34 cases of electric shock death who had definite current mark evidence were selected from pathology department of Xuzhou Medical College from 2010 to 2013. As the control group, 20 cases of fatal severe craniocerebral injury in traffic accidents were chosen. The expressions of HCN4 and Cx43 in the sinoatrial node were observed by immunohistochemical technology. RESULTS: HCN4 positive cells expressed in the cell membrane and cytoplasm of the sinoatrial node. Cx43 positive cells expressed in the cell membrane and cytoplasm of T cells and myocardial cells. The expression of HCN4 was significantly higher than that of the control group (P < 0.05) and the expression of Cx43 was significantly lower than that of the control group (P < 0.05). CONCLUSION The changes of HCN4 and Cx43 expressions in the sinoatrial node illustrate electric shock death might be related to the abnormalities of cardiac electrophysiology and conduction.
Connexin 43/metabolism* ; Cyclic Nucleotide-Gated Cation Channels ; Heart Rate ; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels/metabolism* ; Immunohistochemistry/methods* ; Myocardium/metabolism* ; Myocytes, Cardiac ; Sinoatrial Node/physiopathology*

Objective To summarize the clinical experience of harvesting and using the lungs of cardiac death donor.Methods The lungs from donation after cardiac death (DCD) were harvested and used for lung transplantation.The donors suffered from severe craniocerebral trauma or brain neoplasms and were identified after cardiac death post declaration of brain death.Written consent about DCD was obtained from the consanguinities.The donor lungs were harvested after clinical evaluation of donors with considerable function and after the determination of DCD.The preoperative lymphocytotoxic cross match test was negative,ABO blood type was compatible,and the donors were all suitable for the transplant procedure.Results Two bilateral lung transplantations and one single lung transplantation were performed,with the warm ischemic time being 23,27,and 32 min,respectively.The operative course was uneventful The ICU stay was 31,18,and 26 days respectively,with dramatic improvement of pulmonary function postoperatively.Acute rejection occurred in two cases,which was treated with bolus of corticoids.There were no infection in our 3 patients,and the life quality was satisfactory during the follow-up period.Conclusion The lung from DCD may be one of the available resources used for lung transplantation on the basis of efficient management of the potential donors and clear evaluation of the donors.