Objective To investigate if diastolic function could be improved by cardiac sympathetic nerve blockade in patients with dilated cardiomyopathy (DCM). Methods Sixty consecutive cases of DCM were randomed into therapeutic group and control group. Patients in therapeutic group were administered thoracic epidural blockade (TEB) (T 1-5 ) with 0.5 % lidocaine intermittent injection every two hours for four weeks, in addition to some routine medicine, while patients in control group were only administered routine treatment. Then the parameters of left ventricular diastolic function were evaluated with Doppler echocardiography before and after four weeks. Results ①All the patients in TEB group felt better within five minutes after injection of lidocaine within local epidural cavity.Their symptoms were relieved more rapidly than those of the drug therapy alone. Some patients with NYHA class Ⅳ could lie down supine in a short time. Exercise tolerance increased in patients with NYHA class Ⅱ to Ⅲ. But symptoms and signs of patients in control group were relieved very slowly, some patients even got worsen. ② Thirteen of thirty in therapeutic group got improvement on diastolic function after treatment. One of thirty in this group deteriorated. In detail, six of fifteen patients with demonstrated improvement of left ventricular diastolic filling changed from having a restrictive filling pattern to having a pseudonormal left ventricular filling pattern. Four of nine patients with a pseudonormal filling pattern changed to have a delayed filling pattern.Three of six patients, left ventricular filling pattern moved from a pseudonormal left ventricular filling pattern to a normal filling pattern. Only one patient acquired a restrictive filling pattern from a pseudonormal filling pattern. In contrast, in control group one of thirty got improvement on diastolic function after treatment. Nine of thirty in this group deteriorated. Individual changes of left ventricular filling pattern showed that only one patient improved from a delayed filling pattern to normal filling pattern, whereas seven patients had a restrictive left ventricular filling pattern developed from a pseudonormal filling pattern and another two patients achieved a pseudonormal filling pattern from delayed filling pattern. Conclusions Diastolic function in patients with DCM was improved significantly by cardiac sympathetic nerve blockade. The approach has beneficial effects on the patients of DCM.

Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects, and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group, who took simvastatin 20mg/d orally for 18 months; fifty-eight patients were in the control group, and received conventional therapy except for statins. All patients were followed up for 18months. The level of blood lipid, recurrence rate of paroxysmal atrial fibrillation, incidence rate of persistent or permanent atrial lipids did not change significantly in the control group (P＞0.05); concentrations of total cholesterol (TC) and low density lipoprotein five patients during 18 months follow-up in the simvastatin group (11.1%), whereas it occurred in 14 patients of the control group(24.1%, P＜0.05); the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%, which was lower than (6.6%), two rehospitalizations for deterioration of coronary heart diseases (4.4%), three cardiac deaths (6.6%), and one cerebral stroke (2.2%), which was lower evidently than in the control group (41.4%, P＜0.05). Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.

Objective To explore the mechanism of effects of cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF) and left cardiac cavity size of patients with dilated cardiomyopathy.Method 121 consecutive patients with dilated cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEA group) and control group(c group).In TEA group,5％ lidocaine was injected into thoracic epidural cavity for about 4 to 8 weeks in addition with routine therapy.In c group,only routine therapy was used.We observe the changes of LVEF and left cardiac cavity size before and after treatment in both groups. Result In TEA group,after anesthesia,LVEF was increased from(31.3± 12.8) to(47.3± 21.3),P<0.001;left ventricular end－ diastolic diameter was reduced from(69.1± 7.1)to (65.1± 8.0),P<0.001;left atrial diameter was decreased from(44.0± 6.2)to(39.4± 7.2),P< 0.001. Conclusion Cardiac sympathetic anesthesia can effectively improve the ejection performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.

Objective To explore the feasibility of repairing the large area skin and soft tissue defect in thefront upper of tibia by free flap with anastomosis of saphenous vessels.Methods From June,2009 to April,2014,16 cases (10 males and 6 females) of large area skin and soft tissue defect in the front upper of tibia were treatedwith free flap.The ages ranged from 24 to 56 years old,averaged of 34.5 years old.The supportive therapy and repeated debridement combined with VSD,and designed to use free anterolateral thigh flap with anastomosis of saphenous vessels before repairing operation.Results Fourteen patients accorded with preoperative design,in which 2 cases were adopted cross leg flap anastomosis posterior tibia vessels of the healthy side (1 case of saphenous artery diameter too small,and 1 case of saphenous artery long injury degeneration,unsuitable for vascular anastomosis).All 14 flaps survived,expect 2 cases were part-necrosis in the end of the flap,and gradually healed by dressing exchange.Conclusion Reconstruction of large area skin and soft tissue defect in the front upper of tibia with free flap can use anastomosis of saphenous vessels.

The incidence of chronic pain is very high, which seriously affects the quality of life of patients.It is an important problem to be solved urgently in clinic. At present, people recognize the important role of biopsychology in the process of chronic pain management. Mindfulness intervention, as a cognitive and psychological intervention, has a positive effect on relieving the intensity of chronic pain, changing the perception of pain, improving the ability of pain management, and improving pain-related functional and emotional disorders. This paper reviews the clinical effect, mechanism and health economics of mindfulness intervention on chronic pain, and points out that network-based mindfulness intervention has broad prospects for development in the future, which is suitable for the current situation of large population base and few related practitioners in China.

Objective To evaluate the effectiveness and safety of varicella attenuated live vaccine ( VarV) produced by A Co. Ltd. Methods We selected 3 provinces in China and enrolled 15 002 children aged 3-<11 in this random, multicenter study. Participants were randomly divided into two groups: the ex-perimental group and the control group. Every varicella case was collected and recorded to calculate the vac-cine efficacy. Vaccine safety was assessed by means of spontaneous report and regular follow-up visits. Re-sults During the observation period, the incidence of varicella was 0. 147% in the experimental group and 1. 155% in the control group (P<0. 001). The vaccine efficacy was 87. 27%. The adverse reaction rate af-ter vaccination was lower than the rates reported in other literatures. Conclusion The VarV produced by A Co. , Ltd. in China was effective and safe in preventing varicella.

Objective To investigate the expressions of transforming growth factor β1 (TGF-β1) and brain natrium peptide (BNP) in patients with diastolic heart failure (DHF),and to explore the correlation between plasma levels of TGF-β1,BNP and TGF-β1/BNP with parameter of diastolic function,diastolic dysfunction and New York Heart Association (NYHA) classification of cardiac function.Methods Hospitalized patients with DHF from October 2016 to November 2017 in Beijing Chaoyang Hospital were selected as subjects.At the same time,the age-and gender-matched non-heart failure hospitalized patients were selected as the control.The diastolic function index (E/e') was measured using cardiac ultrasound spectral Doppler and tissue Doppler methods.The diastolic dysfunction classification was evaluated according to the American Society of Echocardiography guidelines.Cardiac function was evaluated with NYHA classification.The levels of plasma TGF-β1 and BNP were measured with method of enzyme linked immunosorbent assay (ELISA).The correlation between the indicators was analyzed and the receiver operating characteristic (ROC) curve was drawn.Results A total of 186 patients were enrolled,including 114 patients as DHF group [54 males and 60 females,mean age (70.75 ± 11.45) years old] and 72 cases as control group [41 males and 31 females,mean age (68.74 ± 10.86) years old].The levels of TGF-β1 [(77.68 ± 42.31) ng/L] and BNP [(1 153.84 ± 564.96) ng/L] in patients with DHF were significantly higher than those of the control group [(18.76 ± 13.70),(264.07 ± 179.43) ng/L,t =15.62,13.77,P ＜ 0.01].Pearson correlation analysis showed that level of plasma TGF-β1 had a significant liner correlation with index E/e' (r =0.582,P ＜ 0.01),level of plasma BNP had a low-degree liner correlation with index E/e' (r =0.261,P ＜ 0.01),and TGF-β1/BNP had no correlation with index E/e' (r =0.081,P ＞ 0.05).Spearman correlation analysis showed that the levels of TGF-β1 and BNP were significantly correlated with diastolic dysfunction grading (r =0.473,0.417,P ＜ 0.01),while TGF-β1/BNP had no correlation with diastolic dysfunction grading (r =0.062,P ＞ 0.05).Plasma TGF-β1 and BNP had low-degree correlation with NYHA classification of heart failure (r =0.309,0.326,P ＜ 0.01),TGF-β1/BNP had no correlation with NYHA classification of heart failure (r =0.011,P ＞ 0.05).Logistic analysis showed that both plasma TGF-β1 and BNP were independent predictors of DHF (OR =1.264,2.283,P ＜ 0.05 or ＜ 0.01).The area under ROC curve (AUC) of BNP for prediction of DHF was 0.937 ± 0.064,and TGF-β1 was 0.597 ± 0.042.AUC areas of BNP and TGF-β1 were significantly different (P ＜ 0.01).Conclusions The expressions of plasma TGF-β1 and BNP in patients with DHF are higher than those without DHF.The levels of plasma TGF-β1 and BNP are significantly correlated with index E/e',diastolic dysfunction grading and NYHA classification.Both elevated BNP and TGF-β1 levels are independent predictors of DHF.Both plasma BNP and TGF-β1 have auxiliary diagnostic value on DHF and the diagnostic value of plasma BNP is greater than plasma TGF-β1.

OBJECTIVETo observe plasma vascular endothelial growth factor(VEGF) levels and related factors in patients with unstable angina pectoris(UAP).

METHODSA total of 108 consecutive patients with chest pain hospitalized in our department from October to December 2014 were included. They were divided into UAP (n=78) and non-CHD group (n=30) by the result of coronary angiography(CAG). Coronary artery lesion was assessed according to the Gensini score, serum lipids, homocysteine(Hcy) levels and other biochemical indicators were also determined. The peripheral arterial tonometry was evaluated by reactive hyperemia index(RHI) measured by Endo-PAT2000 Noninvasive Diagnostic System.The level of plasma VEGF was detected in patients with unstable angina pectoris. Multiple linear regression analysis was used to analyze the correlations between VEGF and various related factors.

RESULTSPercent of male gender, triglyceride (TG) and Hcy levels were significantly higher in UAP group than in no-CHD group(all P<0.05). VEGF values was significantly higher ((102.1 ± 55.7)ng/L vs.(80.9 ± 38.1)ng/L, P<0.05), while RHI was significantly lower (1.53 ± 0.27 vs.1.65 ± 0.32, P<0.05) in UAP group than in no-CHD group. Multiple linear regression analysis showed that VEGF value was significantly correlated with degree of coronary artery stenosis, Gensini score and RHI (β=38.03, P<0.01; β=0.51, P<0.01; β=-69.30, P=0.03; respectively).

CONCLUSIONVEGF levels are significantly increased in patients with unstable angina pectoris, and VEGF level is significantly associated with the degree of coronary artery stenosis, Gensini score and RHI. V EGF level might serve as a new biochemical indicator for coronary artery lesion in patients with UAP.

Angina, Unstable ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Humans ; Male ; Triglycerides ; Vascular Endothelial Growth Factor A