Objective To examine the serum von Willebrand factor (vWF) and soluble Pselectin levels in patients with non-valvular atrial fibrillation (NVAF), and to observe the influence of beta-blocker treatment on endothelial function and platelet activation in NVAF patients. Methods The 25 subjects, 17 males and 8 females, with persistent NVAF and left ventricular ejection fraction (LVEF)≥50%, were enrolled in NVAF group. Those with myocardial infarction, cardiomyopathy or hyperthyroidism were excluded. Another 35 subjects with sinus rhythm were as control (age,gender and LVEF matched with NVAF group, and with similar cardiovascular diseases). Serum vWF and soluble P-selectin levels were tested by enzyme-linked immunosorbent assay. Results The serum vWF level was significantly higher in NVAF group than in control group [(1945.2±111.3) g/L vs. (1862.3±101.6) g/L, P＜0.05]. However, there was no significant difference in serum soluble P-selectin level between NVAF group and control group [(24.32±9.21) g/L vs. (24.68±11.70) g/L, P＞0. 05]. After administration of beta-blocker, a down-regulation was found in serum vWF level [(1758. 3±152. 4) g/L, P＜0. 01], but not in soluble P-selectin level [(21.05±8. 94) g/L, P＞0. 05]. There was no relationship between serum level of vWF and soluble P-selectin (r=-0.008,P＞0. 05). Conclusions High serum level of vWF is found in patients with persistent NVAF as compared with control, indicating endothelial damage/dysfunction in those patients. After administration of beta-blocker, serum level of vWF drops dramatically in NVAF patients, indicating possible endothelial function protection of beta-blocker.

Heart Failure ; therapy ; Humans ; Practice Guidelines as Topic

Objective To investigate the feasibility of exposing cephalic vein with horizontal incision on the chest and the successful rate of implanting pacing leads using guide wire and split sheath. Methods Right cephalic vein was separated with horizontal incision on the right lateral upper part of chest in 220 patients with permanent pacing indication. The pacing lead was advanced through the cephalic vein directly or by using a guidewire and a split sheath if the direct approach was unsuccessful. The subclavian venous puncture through the incision was used finally to implant the endocardial lead when the cephalic approach failed. All pacemakers were placed in the subcutaneous package at the inner part of the incision. Results Cephalic vein was well exposed with horizontal incision. Additionally, it is safe and convenient to puncture the subclavian vein through this incision. The successful rate of implanting pacing leads directly through cephalic vein was only 71% with single lead and 58% with dual pacing leads, respectively. However, it increased to 94% with single lead and 88% ( P

Heart Failure ; Humans ; MicroRNAs

Objective To classify patients with pelvic pain and to improve the understanding of etiology and to guide treatment by using a clinical phenotype system (UPOINT) and to examine the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome. Methods From November 2009 to October 2011,54 IC/PBS patients including 42 female and 12 male patients were treated.The mean age was 41.0 ± 12.4 yrs (range from 21 to 76 yrs).Median symptom duration was 63.0 ± 59.2 months ( range from 6 to 240 months).54 patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT,that was urinary,psychosocial,organ specific,infection,neurological/systemic and tenderness.Symptoms were assessed using the Interstitial Cystitis Symptom Index,Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency.Clinically relevant associations were calculated. Results In the 54 IC/PBS patients,median ICSI score was 15.0 ± 1.84 points ( range from 9 to 19 points) ; Median PUF was 20.0 ± 2.3 points ( range from 14 to 25 points) ; Median pain associated with bladder score of VAS was 7.0 ± 1.0 points (range from 5 to 10 points).The percent positive for each domain was urinary 100％,psychosocial 44％,organ specific 96％,infection 33％,neurological/systemic 24％ and tenderness 28％,respectively.All patients were included in at least 2 domains,with 2 domains of 11％,3 domains of 38％,4 domains of 36％,5 domains of 13％ and 6 domains of 2％.The number of domains was associated with greater symptom duration ( Spearman r =0.76,P ＜0.01 ) but not age.The number of domains was also associated with poorer general interstitial cystitis and pain symptoms ( Spearman r =0.89,P ＜ 0.01 ) but not with frequency or urgency.The psychosocial domain was associated with increased pain,urgency and frequency,while tenderness was associated with increased ICSI score,PUF score and urgency.The neurological/systemic domain was associated with increased ICSI score while the infection domain was not associated with any increased symptoms. Conclusions The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains.The UPO1NT system can act as the guiding theoretical basis for directing multimodal therapy,it deserves clinical promotion.

Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor (TURBt) and find out solutions. Methods We retrospectively analyzed 118 cases (93 males and 25 females) of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection (TUR) or partial cystectomy (PC) or radical cystectomy (RC) from January 2006 to March 2011.The mean patient age was 63.0 ±8.6 yrs.The tumors located in lateral,dome and posterior wall were 71,23,24 respectively; 75 of them were with single and 43 were with multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥3.0 cm; The procedures performed by senior and junior urologist were 53 and 65 cases,respectively.In the study,we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging.The data were analyzed with x2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 38 ),T2 (36) and 39 cases (33.1 ％ ) were under staged ( P ＜ 0.01 ).There were 17 and 22 under-staged cases compared with the second-TUR group (60 cases) and PC/RC groups (58 cases),respectively.The reasons of under-staging were related to tissue morphology changes (63 cases) and the absence of the detrusor muscle (56 cases) in specimens collected during the first TURBt.Multivariate analyses revealed that large tumors ( ≥3 cm),and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR (95％ CI):3.766 ( 1.263 -11.225 ),and OR (95 ％ CI):5.951 (2.186 - 16.203 ),respectively.While surgery performed by senior surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

Objective To explore the correlation between anxiety,depression and the symptoms of interstitial cystitis/bladder pain syndrome (IC/PBS) patients,improving the psychological knowledge of IC/PBS patients,providing theoretical basis for psychological intervention.Methods During November 2009 to October 2011,54 IC/PBS patients including 42 women and 12 men patients were treated,with mean age of (41.0±12.4) years and mean course of the disease of (63.0±59.2) months.O'Leary-Sant questionnaire was used for IC/PBS symptoms assessment,and Visual Analogue Scale (VAS) was used to evaluate pain associated with bladder,Self-rating Anxiety Scale (SAS) was used for anxiety assessment,and Beck Depression Inventory Ⅱ (BDI-Ⅱ) was used for depression assessment.The relationship between depression,anxiety and the symptoms of IC/PBS patients was evaluated.Results Of the 54 IC/PBS patients,mean ICSI score was (15.0±1.84) points,mean ICPI score was (8.0±2.6) points,mean O'Leary-Sant questionnaire score was (24.0±3.9) points,mean VAS score was (7.0± 1.0) points,mean anxiety score was (52.0± 7.2) points,with 35 cases (64.8％) suffering from anxiety symptoms.Mean depression symptoms score was (16.0±4.5) points,with 41 cases (75.9％) suffering from depressive symptoms.The degree of anxiety and depression were associated with education level,the sleep quality and monthly income of IC/PBS patients.Anxiety and depression had no definite correlation with marital status and working conditions.Anxiety and depression were closely related (proportion) with the symptoms (frequency,urgency,pain or discomfortrelated to bladder) of IC/PBS patients.Conclusions Anxiety and depression are common in patients with IC/PBS,and they are related to symptom severity.In order to improve the quality of life,much attention must be paid to psychological condition assessment and treatment of IC/PBS patients.

Scientific and technological ability is one of the core competitiveness of the hospital.The hospital medical researchers are the main body of technological innovation activities.The establishment of scientific and effective incentive mechanism is an important way to stimulate the potential innovation of researchers and to promote the development of the hospital.In this article,we summarized the common problems on current research incentive mechanism in hospitals and proposed the corresponding strategies,in order to improve the research incentive mechanism.

Objective To observe the changes of serum soluble CD40 ligand (sCD40L) and fibrinogen in acute myocardial infarction (AMI) patients and to investigate the clinical predictive value of increased serum sCD40L and fibrinogen. Methods Serum sCD40L level of 60 AMI patients was determined by enzyme-linked im-munosorbent assay (ELISA). Plasma level of fibrinogen was measured. The patients were followed up for 2 years af-ter discharge from the hospital and were observed for cardiovascular event. Results AMI patients had higher sCD40L and fibrinogen levels than those of controls [(15.36±7.32) μg/L vs. (5.79±2.78) μg/L, (4.60±1.37)g/L vs. (3.03±0.82) g/L,P<0.001] ,which were significantly higher in the patients experiencing cardio-vascular event than those without cardiovascular event [(18.14±6.34) μg/L vs. (14.38±6.67) μg/L and (4.97±1.33)g/L vs. (4.20±1.24} g/L] (P<0.05). The patients with sCD40L≥14.5 μg/L or fibrinogen≥ 4.4 g/L experienced increased risk of adverse cardiovascular events (P<0.05). In AMI patients, sCD40L level was significantly higher in patients with diabetes than in nondiabetics [(18.38±6.71) μg/L vs. (14.46±6.48) μg/L, P<0.05)]. Fibrinogen level was related to sCD40L (r=0.27, P<0.05) and LVEF(r=-0.319, P<0.05). Conclusion Increased sCD40L and fibrinogen levels,which maybe related to the pathogenesis of AMI,can be found in AMI patients and can indicate an independent increased risk of major adverse cardiovascular events. Diabetes is independently associated with elevated sCD40L level in AMI patients.