Objective To evaluate the value of left ventricular Tei index for diagnosis of congestive heart failure(CHF)in elderly patients. Methods One hundred and thirty-eight elderly patients suggestive of CHF and 30 healthy middle-aged individuals were enrolled, Tei index, left ventricular ejection fraction (LVEF) and early to late diastolic mitral flow velocity ratio (E/A) were echocardiographically detected. Tei index in elderly patients with and without CHF, and healthy middle-aged individuals was determined, and then the diagnostic value of the above 3 parameters for CHF in elderly patients were evaluated. Results Tei index was singnificantly increased in patients with CHF compared with patients without CHF (0.77?0.14 vs 0.45?0.10,P

Objective:To evaluate the therapeutical effects of diplopore puncture of tympanum and intratympanic administration(DPTIA) on patients with acute secretory otitis media(ASOM).Method:One hundred and forty -one cases with ASOM were divided into two groups randomly,with 69 cases(80 ears) in group A(experimental group) and 72 cases(84 ears) in group B(control group).Group A was treated with DPTIA combined with medication, group B was treated with haplopore puncture of tympanum combined with medication. All patients accepted 1 to 3 courses of treament,and were observed during the period of treatment and 3 months after treatment.Result:The factors (including gender, age, side of ailing ear, course of disease, air-bone gap in the pure tone average,and acoustic immitance type in ailing ear) which may impact the prognosis were matched in two groups prior treatment(P＞0.05). While there was a significant difference in the cure rate and the total effective rate respectively between two groups after treatment(P＜0.05).No adverse reaction or complication was seen.Conclusion:DPTIA is a safe, reliable and effective way to manage patients with ASOM.

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stent in the treatment of portal hypertension in patients with hepatocellular carcinoma.Methods The clinical data of 46 patients with primary hepatocellular carcinoma and portal hypertension who received TIPS with stent treatment were retrospectively analyzed.After treatment,liver function,shunt patency,re-bleeding rate,hepatic encephalopathy,ascites,gastric intestinal symptoms, lifetime and causes of death were analyzed. Compare t test was performed for measurement data comparison among groups.The survival curves were used to analyse the cumulative stent shunt patency rate,the incidence of hepatic encephalopathy and the survival rate.Results After the operation,portal vein pressure significantly decreased compared with that before operation [(16.2 ± 4.6 )mmHg vs (28.3±5 .1)mmHg,1 mmHg=0.133 kPa],and the difference was statistically significant (t =21 .30, P <0.05).There was no significant difference in liver function before and after operation [(6.8 ±1 .8) score vs (6.9±1 .5)score,P >0.05].Cumulative stent shunt patency at 3,6,12,24,36 month after operation was 100.0%,95 .6%,93.5 %,91 .3% and 91 .3%,respectively.The cumulative incidence of hepatic encephalopathy was 6.5 %,8.7%,13.0%,17.4% and 26.1 %,respectively;cumulative survival rate was 95 .7%,82.6%,67.4%,43.5 % and 32.6%,respectively.In 10 cases of refractory ascites, ascites of all the patients reduced with different degree after operation and gastrointestinal uncomfortable symptoms were relieved.Conclusion In patients with primary hepatocellular carcinoma and portal hypertension,who have gastrointestinal bleeding or refractory ascites,treatment of TIPS with covered stents could effectively lower portal pressure,prevent re-bleeding and reduce the volume of ascites.

Objective To evaluate the sensitive indicator of left ventricular rotation/torsion assessed by two-dimensional speckle tracking imaging (STI) and Logistic regression analysis,and to investigate the clinical value of the sensitive indicator for assessment of left ventricular dysfunction in patients with chronic cor pulmonale (CCP).Methods 36 patients with CCP (CCP group) and 38 healthy controls (control group) were included in this study.Imaging in parasternal short-axis view (in basal and apical level) were selected.Parasternal short-axis views at mitral valve and apical levels were collected.Basal peak rotation,apical peak rotation,peak torsion,basal end-systolic rotation,apical end-systolic rotation and end systolic torsion were measured with Echo PAC software.Relevant indicators of left ventricular rotation/torsion were selected by using logistic regression analysis and the regression equation was established.Optimal values of specific parameters (Peak torsion and end-systolic torsion) were calculated with receiver-operating characteristic (ROC) curve.Results Specific parameters of rotation/torsion were significantly reduced in patients with CCP as compared with controls (all P＜0.01).Logistic regression analysis showed that end-systolic torsion and peak torsion were correlated with CCP (OR=0.473 and 0.706,P=0.007 and 0.011).Cut-off value of peak torsion for predicting left ventricular dysfunction was 12.070°,the area under the ROC curve (AUC) was 0.819 (95％ CI:0.683-0.956),the sensitivity was 84.6％,and the specificity was 73.9 ％.Cut-off value of end-systolic torsion for predicting left ventricular dysfunction was 10.680°,AUC was 0.875(95％CI:0.744 1.000),the sensitivity was 84.6％,and the specificity was 91.3％.Conclusions Two-dimensional speckle tracking imaging can sensitively assess left ventricular torsion and evaluate the left ventricular dysfunction in patients with CCP.

Objective To observe the efficacy of Tongmai Acupoint Plaster combined with Alprostadil injection for treatment of lower extremity arteriosclerosis obliterans (ASO). Methods Totally 180 cases of ASO Ⅱ(intermittent claudication period) patients were randomly divided into acupoint sticking group, combination group, Western medicine group, with 60 cases in each group. All groups quit smoking, had diet control, proper exercise, control of blood sugar, stop hypolipidemic and anti-coagulation medicine. The acupoint sticking group was treated with Tongmai Acupoint Plaster, each selected with the efficacy of treatment of lower limbs paralysis acupoint 10-12, alternating dressing; dressing was changed 1 time a day, 40 day as a treatment course. Western medicine group was given Alprostadil injection 10 μg, with 10 mL of normal saline, intravenous infusion, once a day, 15 d as a treatment course, for two courses, with 10 d as interval. Combination group was treated with Tongmai Acupoint Plaster combined with Alprostadil injection, the same as the application method above. The clinical efficacy, the scores of symptoms and signs, the ankle brachial index, blood lipid, the peak value of blood flow in the tibial anterior,posterior tibial, and dorsalis pedis arteries were observed and compared between the 2 groups. Results The total effective rate was 78.33% (47/60) in the acupoint sticking group, 80.00% (48/60) in the Western medicine group, and 93.33%(56/60) in the combination group, with the combination group better than the acupoint sticking group and Western medicine group (P<0.05). There was no statistical significance between acupoint sticking group and Western medicine group (P>0.05). There was statistical significance in scores of symptoms and signs, ankle brachial index before and after treatment in the three groups (P<0.05, P<0.01); There was no statistical significance after treatment (P>0.05). There was statistical significance in blood lipids before and after treatment in acupoint sticking group and combination group (P<0.05). There was statistical significance in tibial anterior, posterior tibial, and dorsalis pedis artery peak before and after treatment in the three groups (P<0.05, P<0.01). Conclusion Tongmai Acupoint Plaster has good efficacy in the treatment of ASO, equivalent with the efficacy of Alprostadil injection, which can regulate blood lipids and improve arterial blood flow. Ther combination of them has better efficacy.

OBJECTIVETo observe the effects of electroacupuncture (EA) at different acupoints on apoptosis-related serum and expression of microRNA (miRNA) in rats with myocardial ischemia, so as to explore its mechanism of action.

METHODSA total of 48 male Wistar rats were randomly divided into a normal group, a model group, a Neiguan group and a acupoint compatibility group, 12 rats in each group. Isoprenaline hydrochloride (ISO) with a daily dose of 2 mg/kg was subcutaneously injected for 14 days to establish the myocardial ischemia model in the model group, Neiguan group and acupoint compatibility group. Rats in the normal group were subcutaneously injected with an equal volume of normal saline. After modeling, rats in the Neiguan group were treated with EA at "Neiguan" (PC 6), while rats in the acupoint compatibility group were treated with EA at "Guanyuan" (CV 4), "Zusanli" (ST 36) and "Neiguan" (PC 6). Rats in the normal group and model group were treated with immobilization, once day for 21 days. The contents of creatine kinase-MB (CK-MB), vascular cell adhesion molecule-1 (VCAM-1) and endothelin-1 (ET-1) in serum were detected by enzyme-linked immunosorbent assay (ELISA); apoptosis index (AI) of myocardial cells was detected by TUNEL method; the expressions of miRNA-1, miRNA-133, miRNA-208 and miRNA-499 were detected by real-time PCR method.

RESULTSCompared with the normal group, the serum CK-MB, VCAM-1 and ET-1 were significantly increased in the model group, Neiguan group and acupoint compatibility group (all P < 0.01), and the apoptosis index was significantly increased (all P < 0.01). The CK-MB, VCAM-1 and ET-1 in the Neiguan group and acupoint compatibility group were significantly lower than those in the model group (all P < 0.01); the AI was reduced, which was more significant in the acupoint compatibility group (P < 0.05). Compared with the normal group, the expression of miRNA-133 was reduced (P < 0.01) and those of miRNA-208, miRNA-1 and miRNA-499 were significantly increased in the model group (all P < 0.01). Compared with the model group, the expression of miRNA-133 was increased (both P < 0.01) and that of miRNA-208, miRNA-1 and miRNA-499 were significantly reduced (all P < 0.01) in the Neiguan group and acupoint compatibility group. Compared with the Neiguan group, the expression of miRNA-133 was increased (P < 0.01) and those of miRNA-208, miRNA-1 and miRNA-499 were significantly reduced in the acupoint compatibility group (P < 0.01, P < 0.05).

CONCLUSIONEA at acupoints, especially acupoint compatibility group, could effectively prevent and treat myocardial ischemia, and the protective effect is possibly correlated to the double regulation on increasing the expression of miRNA-133 and inhibiting the expression of miRNA-1, miRNA-208, miRNA-499.

Acupuncture Points ; Animals ; Apoptosis ; Disease Models, Animal ; Electroacupuncture ; Endothelin-1 ; genetics ; metabolism ; Humans ; Male ; MicroRNAs ; genetics ; metabolism ; Myocardial Ischemia ; genetics ; metabolism ; physiopathology ; therapy ; Myocytes, Cardiac ; metabolism ; Rats ; Rats, Wistar

Objective To investigate whether antihypertensive treatment is beneficial to patients with diabetes mellitus when their blood pressure (BP) is below 140/90 mm Hg(1 mm Hg =0.133 kPa).Methods MEDLINE,EMBASE,IPA database and secondary resources were searched with terms including blood pressure,hypertension and anti-hypertension drug.Inclusion criteria:random control study; subjects were patients with diabetes mellitus or impaired glucose tolerance; endpoint BP ≤ 140/90 mm Hg; endpoint BP between two groups had significant differences.There were 16 studies meet inclusive criteria with a total of 51 470 patients.RR and 95％ CI were used as index to judge the difference of clinical outcomes between aggressive antihypertensive treatment group and standard antihypertensive treatment group.RevMan5.0 software was used for statistical analysis.Results When BP of patients with diabetes mellitus were below 140/90 mm Hg,anti-hypertensive treatment could reduce incidence rate of cardiovascular event (RR 0.91,95％ CI 0.87-0.96,P =0.0004) and stroke (RR 0.75,95 ％ CI 0.63-0.88,P =0.0005),and increased incidence rate of symptomatic hypotension (RR 3.57,95％ CI 1.41-11.20,P =0.03) and hyperpotassemia (RR 1.57,95％ CI 1.05-2.33,P =0.03).There were no significant differences in all-cause mortality (RR 0.94,95％ CI 0.87-1.01,P =0.08),cardiovascular mortality (RR 0.95,95％ CI 0.85-1.08,P =0.05),myocardial infarction (RR 0.93,95％ CI 0.82-1.05,P =0.26),heart failure (RR 0.90,95％ CI 0.76-1.06,P =0.21) between the aggressive antihypertensive treatment group and standard antihypertensive treatment group.Conclusions When blood pressure of patients with diabetes mellitus was below 140 mm Hg,there was little benefit from aggressive antihypertensive treatment,and the risk of serious adverse events even increased.

Objective To evaluate the clinical effect of endoscopic sphineterotomy (EST) and endoscopic sphincterotomy associated with traditional Chinese medicine in the treatment of intrahepafic duct stones.Methods Eighty patients with common bile duet stones and intrahepatic duct stone were randomly divided into a treatment group and a control group.EST associated with traditional Chinese medicine was performed in the treatment group,and EST only was used in the control group.Clinical effects were observed.Results Common bile Duet stone clearance was achieved in 94% patients in the treatment group,contrasting 88% in the control group.There was no significant difference between them (P＞0.05).While intrahepatic duct stone clearance was 74% and 28% respectively in the treatment group and the control group,showing significant difference (P＜0.05).Conclusion It is a good way that endoscopic sphincterotomy associated with traditional Chinese medicine treating intrahepatic duct stones.

Objective To evaluate the efficacy of mobile endospine system for sequested lumbar disc herniation.Methods From May 2007 to December 2009,31 patients of sequested lumbar disc herniation were treated with mobile endospine system,including 17 men and 14 women with a mean age of 46 years (32-59 years).Patients complained severe leg and low back pain with disability.According to MRI,the sequested nucleus herniated from the disc of L2-3 in 1 case,L3-4 in 1,L4-5 in 16 and L5S1 in 13;and the direction of herniation was caudal in 24 cases,cephalic in 6 and indistinguishable in 1.The patients were followed up for 12 months (range,6-24 months) ,and the results were evaluated according to Macnab scale.Results The procedure was technically successful in all the patients:the sequested nucleus was completely extracted.The protruded disc was treated with discectomy in 30 cases,and the nearly intact disc was left untouched in one patient.Among the 24 cases with caudal herniation,sequested nucleus situated ventrally beneath the dural theca and the transitional nerve root in 15 cases,between the nerve root and dural theca in 5,and dorsally on the nerve root and dural theca in 4.All the 6 cephalic herniation situated beneath the dural theca,1 of them reached the level of pedicle,and 2 herniated into the intervertebral canal.The sequested disc presented as indistinguishable signal on MRI included nucleus,annulus and cartilage endplate,and situated dorsally around the dural theca.The mean operative time was 50 min (range,40-70 min) with a mean blood loss of 80 ml (range,30-200 ml).There was no complication of nerve injury.Only too much facet was resected in 2 patients without clinical symptom.The results were excellent in 21 cases and good in 10 cases,and all of them were satisfied with this procedure.Conclusion The working canal and visual field of mobile endospine system is movable,so the sequested nucleus can be extracted completely with good results.

AIM:To investigate the influence of continuous subculturing of human umbilical cord mesenchymal stem cells (hUC-MSCs) on the mRNA expression of all 23 family members of NOD-like receptors (NLRs), and to search for the way of improving the subculture quality of hUC-MSCs and increasing the quantity and safety in the experimental and clinical application .METHODS:Neonatal umbilical cord was collected to isolate and purify the hUC-MSCs with the colla-genase II digestion and adherence screening methods .These cells were continuously subcultured .The hUC-MSCs at pas-sage 3 and passage 28 were identified by flow cytometry and induced differentiation .The mRNA expression of NLRs in the passage 3 and passage 28 hUC-MSCs was detected by RT-qPCR.RESULTS: The cell phenotypes of both passage 3 and passage 28 hUC-MSCs were CD29 +/CD44 +/CD105 +/CD31 -/CD34 -/CD40 -/CD45 -/CD106 -/HLA-DR-, and both of the cells were induced into osteoblasts and adipocytes , which were conformed to the criteria of International Society for Cellular Therapy to define MSCs .All the NLR family members were expressed in passage 3 hUC-MSCs.NOD1, NLRC4, NLRC5, NLRP1, NLRP3, NLRP10, NAIP, NLRX1 and APAF1 at mRNA levels were highly expressed , and the rest were lowly expressed.When hUC-MSCs were subcultured to passage 28, NLRP10 mRNA was increased, NLRC5 mRNA and NLRX1 mRNA were hardly changed , and all of the rest members were decreased .The difference of NLRP1 mRNA expres-sion between passage 3 and passage 28 hUC-MSCs was observed with statistical significance (P<0.05).CONCLU-SION:The effects of subculturing on the expression of NLR family in hUC-MSCs are pleiotropic .It requires further investi-gation to confirm whether these effects are related to the proliferation , differentiation and immunomodulation of MSCs .