Objective: To analyze clinical features and prognosis of more than 75-year old patients with heart failure and preserved ejection fraction (HFPEF) through comparing with heart failure（HF）and reduced ejection fraction (HFREF), and provide reference for prevention and treatment of HFPEF. Methods: A total of 134 > 75 years HF inpatients admitted from Jan 2009 to Dec 2011 were selected. With left ventricular ejection fraction (LVEF) 50% as the critical point, patients were divided into HFPER group (n=63) and HFREF group (n=71). Clinical characteristics were compared between two groups. Clinical outcomes (all-cause death and rehospitalization caused by heart failure) were compared between two groups after follow up. Results: (1) Clinical features: compared with HFREF group, there were significant increase in LVEF [(36.46±6.84)% vs. (58.65±5.01)%], percentage of patients with hypertension (49.3% vs. 69.8%), left atrial diameter [(34.98±3.78) mm vs. (40.02±3.29) mm], and significant decrease in level of brain natriuretic peptide [BNP, (1005.62±458.99) pg/ml vs. (646.57±333.56) pg/ml], concentration of hemoglobin [(11.97±1.29) g/dl vs. (10.76±1.21) g/dl] and left ventricular diameter [(57.17±7.52) mm vs. (47.73±5.48) mm] in HFPEF group, P<0.01 all; (2) Patients were followed up for a mean 2.6 years. There were no significant difference in all-cause mortalities（17.5% vs. 19.7%）and mean time without heart failure event (286 d vs. 258 d) between HFPEF group and HFREF group. Conclusion: Compared with HF patients with reduced ejection fraction, hypertension and anemia are more frequent in HF patients with preserved ejection fraction, but there is no significant difference in clinical outcomes between them.

Objective To improve diagnose and therapy of post-traumatic acute renal failure induced by rhabdomyolysis. Methods A total of 20 patients with post-traumatic acute renal failure induced by rhabdomyolysis were analyzed retrospectively in aspects of clinical manifestation, laboratory examination and treatment. Of all, there were 9 patients treated with continuous renal replacement therapy (CRRT), while the other 11 were set as control, receiving no CRRT. Results After treatment with CRRT, 7 patients obtained clinical curing, with 2 deaths. As for control patients, there were 5 patients with secondary chronic renal insufficiency, 1 with clinical curing and 5 deaths. Conclusions Early diagnosis, CRRT, sufficient hydration, hematedialysis and supportive treatment are key points to improve the cure rate. It is important to apply CRRT for patients with renal inadequacy.

Purpose To determine the effect of RNase MC2 purified from momordica charantia on cell growth of hepatocellular carcino-ma ( HCC) and its underlying mechanism. Methods MTT, colony formation and nude mice model were used to examine the activity of RNase MC2 in cell proliferation. Cell cycle analysis was done by flow cytometry. Autophagy induced by RNase MC2 treatment was observed via transmission electron microscope. Western blot was performed to detect the RNase MC2-mediated changes of proteins. Re-sults In vitro and in vivo data showed that RNase MC2 markedly inhibited HCC cell proliferation, arrested cells at G2/M phase by in-creasing expression of p53 and p21, induced autophagy via upregulating Beclin-1 and LC3-Ⅱ. Furthermore, combination of RNase MC2 and Sorafenib exerted enhanced lethal effect on HCC cells. Conclusion RNase MC2 manifests significant antitumor activities and enhances the killing effect of Sorafenib in HCC via inducing cell cycle arrest and autophagy.

Objective To investigate the clinicopathological significance of the expression of annexin A2 (ANXA2) in liver fibrosis and hepatocellular carcinoma (HCC).Methods The expression level of ANXA2 in normal liver,liver cirrhosis and HCC were examined by Western blot.The correlation between ANXA2 expression and clinicopathological parameters in liver fibrosis and HCC were analyzed by immunohistochemistry.Results Compared with the normal liver tissue,ANXA2 protein expression level increased significantly in HCC and liver cirrhosis,with the highest expression in HCC (P =0.000).There was significantly positive relationship between ANXA2 protein expression and stages for liver fibrosis (P ＜ 0.01).The expression of ANXA2 protein in HCC was closely associated with HBV infection,differentiation degree and the recurrence (P ＜ 0.05).In some cases,ANXA2-positive cancer cells were often dispersed in the periphery of cancer nodules and were adjacent to stromal cells.Conclusion Overexpression of ANXA2 may be involved in liver fibrosis and play a role in the development of HCC,indicating ANXA2 may serve as a diagnostic biomarker for liver fibrosis and tumor differentiation in HCC.

Objective To investigate the prediction function of preoperative B-type natriuretic peptide in patients to receive on-pump coronary artery bypass grafting with postoperative complications. Methods One hundred and thirty-two patients , including 78 males and 54 females , received on-pump coronary artery bypass grafting from January 2013 to November 2014 and were enrolled in the study. The patients were (63 ± 11.35) years old ( range from 35 to 82 years). The level of BNP was determined before operation, after operation, and on day 1, 2, 3 and 7 post-operation. Relationships were analyzed between BNP and LVEF,ventilation time, length of stay in ICU, the need for inotropic agents or intra-aortic balloon pump (IABP), incidence of postoperative atrial fibrillation, and acute renal failure. Receiver operating characteristic (ROC) curve analysis was also performed to predict the role of BNP in postoperative complications. Result A negative correlation between preoperative BNP level and preoperative LVEF(r = -0.512,P < 0.05) was found. The preoperative BNP level was positively correlated with a series of adverse events. The preoperative BNP was used to predict incidence of postoperative atrial fibrillation , the possibility of using IABP , renal failure , length of stay in ICU exceeding 48h or mortality at 28 days, and the area under the ROC curve (AUC) was 0.780, 0.893, 0.818 and 0.820, respectively. Conclusion The preoperative BNP level is well correlated with the cardiac function before CABG , which may be a good predictor of postoperative complications after CABG.

Objective To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for gastric diseases in physical examination of asymptomatic population.Methods Data of 211 asymptomatic individuals who received MCE examinations from July 2015 to December 2016 in Changhai Hospital were collected and rctrospectively analyzed.The tolerance and safety of MCE were studied by analyzing the detection rate for the focal lesions and the rate of endoscopy transfer.Results Among 211 patients,the detection rate of the gastric focal lesions was 9.5％ (20/211).The detection rate in male was higher than that in female (P＜0.05).All patients completed MCE examination successfully and no adverse event was reported.Conclusion MCE,a non-invasive endoscopic modality,is safe and better tolerated than conventional endoscopy,and can be used as a promising approach to screening the gastric diseases in asymptomatic population due to high detection rate of these diseases.

Objective:To explore the association between glutamyl transpeptidase (GGT) trajectories and new-onset metabolic syndrome to provide insights for the prevention and treatment of metabolic syndrome.Methods:A total of 3 209 subjects who met the inclusion criteria were enrolled in the study cohort of physical examination population. The GGT levels before follow-up were classified by R LCTMtools program into 3 GGT trajectory groups: low-stable group, medium-stable group and high-stable group. Cox proportional hazards regression model was used to analyze the correlation between different GGT trajectories and new-onset metabolic syndrome.Results:At the end of follow-up in 2020, the cumulative incidence of metabolic syndrome was 7.0%, and the incidence of metabolic syndrome in the low-stable group, medium-stable group and high-stable group were 3.9%, 11.4%, and 15.0%, respectively, showing a growth trend ( P<0.001). After adjusting for multiple confounding factors by Cox proportional hazards regression model, the risk of metabolic syndrome in medium-stable group and high-stable group increased in the total population. The hazard ratios (95% CI)for the high stable group in males and the medium-stable group in females were 1.67(1.07-2.60) and 3.29(1.14-9.53), respectively, compared with their respective low-stable group. Conclusion:Elevated longitudinal trajectory of GGT is a risk factor for new-onset metabolic syndrome, the risk of metabolic syndrome in the total population increased with the increase of long-term GGT level. It is recommended to maintain the long-term level of GGT at about 28 U/L in males and 14 U/L in females, respectively, to achieve the goal of early prevention of metabolic syndrome.

Objective:To explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT) level and metabolic associated fatty liver disease(MAFLD).Methods:A retrospective study was conducted on 6 864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province. The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model, and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.Results:Multi-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2, Q3, Q4 group was gradually higher than that in Q1 group; Compared with health status, non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal. The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level. The cross-lag effect of MAFLD→ALT level was 0.083(95% CI 0.078-0.087), and the cross-lag effect of ALT→MAFLD was 0.044(95% CI 0.039-0.050). And with the extension of time, the cross-lag effect gradually decreased. Conclusions:There is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD. The occurrence of MAFLD is more likely to increase the risk of elevated ALT level, emphasizing the need for enhanced early prevention and treatment of MAFLD.

Objective:To discuss the effects of transjugular intrahepatic portosystemic shunt (TIPS) procedure on hemodynamics in cirrhotic patients.Methods:A total of 23 cirrhotic patients for TIPS insertion were enrolled from January 2018 to October 2018. Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), transthoracic echocardiography and non-invasive cardiac output measurement based on impedance cardiogram were carried out before and 24h, 1 month, 6 months after TIPS in order to observe cardiac function and hemodynamic changes after TIPS.Results:Significant increases in right atrial area [(17.2±4.0) cm 2 vs. (15.0±3.4) cm 2, P<0.05], right ventricular area [(15.1±3.8) cm 2 vs. (13.7±3.5) cm 2, P<0.05] and left ventricular volume [(97.4±21.5) ml vs. (91.1±22.7) ml, P<0.05] were observed 24 h after TIPS. These changes were accompanied with significant reduction in collapsible index of inferior vena cava [(20.7± 8.1)% vs. (28.6±11.3)%, P<0.01] and elevation in pulmonary arterial systolic pressure [(36.0±8.4) mmHg (1 mmHg=0.133 kPa) vs. (31.8±5.4) mmHg, P<0.01]. There also existed significantly elevated serum NT-proBNP [(551.2±325.1) ng/L vs. (124.2±94.4) ng/L, P<0.01], cardiac output [(5.82±0.96) L/min vs. (5.12±1.28) L/min, P<0.01], cardiac index [(3.47±0.64) L·min -1·m -2 vs. (3.05±0.78) L·min -1·m -2, P<0.01], early diastolic filling rate [(59.0±14.3)% vs. (54.5±11.0)%, P<0.05], and reduced systemic vascular resistance index (SVRi) [(1 798.4±357.3) dyne·s·cm -5·m -2 vs. (2 195.7±508.7) dyne·s·cm -5·m -2, P<0.01] 24 h after TIPS. At the end of 6-month follow-up, all these parameters, but not SVRi, returned towards baseline values. Moreover, peak early to late diastolic tissue velocity ratio at the level of lateral mitral annulus (E′/A′) was significantly higher at the end of 6-month follow-up than that at baseline (1.06±0.32 vs. 0.90±0.45, P<0.05). Neither the right ventricular fractional area changes nor the left ventricular ejection fractions during the follow-up period were different from those at baseline ( P>0.05). Conclusion:Cirrhotic patients who had no cardiovascular pathologies had adequate adaptation and good compensation ability to reach a new hemodynamic homeostasis for the increased volume load after TIPS insertion.