Purpose:To eveluate the effect of liver function after TIPSS.Materials and methds:Ananalysis of 17 cases with laboratory data to study the liver function changes after TIPSS (transjugular intrahepatic portosystemic stent shunts).Results:There were 35 percent of cases whose liver function were worse than before,the others showed no change or better after TIPSS. Couclusion:It was important to choose the cases strictly before TIPSS so as to reduce the compli- cation and improve the survival rates.Although some cases liver function went worse after TIPSS but only temporarily.TIPSS can reduce bleeding retes effectively,thus simultaneously seve the lives.It is worthy to extend this procedue.

Objectives To explore the clinical effect of coupling meglumine cyclic adenylate (MCA)and the human granulocyte colony-ostimulating factor (G-CSF)on rat with diastolic heart failure(DHF).Methods Totally 60 rats of DHF model were evenly divided into 4 groups according to random number:Control group(n=15,control),Model group(n=15,DHF model),MCA group(n =15,treated with MCA)and MCA+GCSF group(n=15,treated with MCA plus G-CSF).MCA group were administered by intragastric injection of MCA 30 mg/kg/d for 15 d,MCA+G-CSF group were administered by intragastric injection of MCA 30 mg/kg/d and plus G-CSF 100 μg/kg/d for 15 d,while Control group and Model group were given same volume of saline solution.BIOPAC SYSTEM was used to analyze the model establishment.The mRNA levels of GATA-4 and Cx43 were measured by RT-PCR.The protein expressions of GATA-4,Cx43,cTNI and c-kit were measured with western blotting.ELISA and flow cytometry were used to detect cAMP and differentiation rate of bone marrow mesenchymal stem cells (BMSCs),respectively.Results Compared with MCA group,the denaturation degree of myocardial tissues in DHF rat was significantly improved than in MCA+G-CSF group.Moreover,the level of GATA-4 (1.62 ± 0.09),Cx43 (1.02 ± 0.07),cTNI (1.42 ± 0.12),c-kit (0.65±0.02),cAMP(283.67± 18.09)nmol/L and BMSCs cell differentiation rate(38.62 ± 1.52)％ in MCA + GCSF group were significantly promoted (all P＜ 0.05)than in MCA group,GATA-4 (0.82±0.07),Cx43 (0.52±0.05),cTNI(0.86 ± 0.13),c-kit (0.48 ± 0.03),cAMP(198.83 ± 16.03) nmol/L and BMSCs cell differentiation rate (19.82 ± 0.89)％.Conclusions The combination of MCA with G-CSF is significantly improved DHF than single MAC treatment,which may regulate BMSCs differentiation though cAMP/PKA signaling pathways.

Objective To explore the status and impact factors of hospitalized patients with coronary heart disease(CHD) accompanying depression disorders.Methods Adopt HRSD,SDS and general questionnaire for survey tools to evaluate the 300 hospitalized patients with CHD.Using SPSS13.0 software to build database,and the data was analyzed by descriptive statistics analysis and correlation analysis.Result There were 148 people accompanying depression disorders among the hospitalized·patients with CHD(47.30％ ),and 68 people were treated (47.89％).Multivariate logistic regression indicated that the age ( OR =-0.415,P ＜ 0.05,CI =0.443 ～0.984),smoking history( OR =0.384,P ＜ 0.05,CI =1.118 ～ 1.928 ),course of disease ( OR =-0.250,P ＜0.05,CI =0.608 ～ 0.996),myocardial infarction ( OR =0.676,P ＜ 0.05,CI =1.082 ～ 3.576 ),family history ( OR =-0.744,P ＜ 0.05,CI =0.231 ～ 0.978 ) were related to coronary artery disease accompanying depression disorders.Multivariate correlation analysis indicated that anxiety factor and gender were closely related,weight factor and age,educational level,myocardial infarction had closed relationship,cognitive factors were closely associated with the course of disease,day and night changes were in relation to age,block factor and gender,age,education,drinking history,smoking history were related closely,sleep factor and gender,onset form,hypertension relations closed,despair factor have closed relationship with gender,age,educational level,course of disease.Conclusion Age,smoking history,course of disease,myocardial infarction,family history were important risk factors of depression disorders in hospitalized patients with CHD.The HRSD's seven symptoms factors are closely associated with multipling influence factors.

Objective To explore the imaging diagnostic method of Merkel cell carcinoma(MCC). Methods Imaging and pathologic features of MCC of 1 female and 44 years old patient were determinded by CT, MRI, pathologic examination and operative observation. Results MCC is a rare subepidermal carcinoma, and most located in the head, neck region and extrimities. Clinically, only a presumptive diagnosis of MCC can be established. The definite diagnosis of MCC can be made only by pathologic examination, especially immunohistological method. MCC is red and brown, and looks like rotten meat. MCC texture is middle with rich blood supply. MCC can invade occipital bone, occipital muscles, dura and cerebellar tissues. Optical microscope observation showed that MCC is located at dermis, and sometimes at subcutaneous tissues. MCC cells are gathered in groups, their sizes are unanimous, and their shapes look like lymphocytes. The cell nuclei of MCC looklike empty bubbles, and have many karyokinesis. The chromatin of MCC is very fine. The cytoplasms of MCC are little, and oxyphil staining. Immunohistological staining showed that both NSE (neuron-specific enolase) and CK(cytokeratin) are positive. The CT imaging of MCC is higher density. The MRI imaging of MCC is lower signals with unclear border in T1w and T2w, but becomes clear in enhanced MRI. Tumor cells invasion to soft tissues and bones could be seen on CT or MRI. Conclusion CT and MRI could clearly show the characteristics of MCC, and provide valuable information for operative treatment of MCC.

Objective To study the 6 year outcome following transjugular intrahepatic portosystemic shunt (TIPSS) for variceal bleeding due to portal hypertension. Methods 65 patients, 51 males, 14 females, aged 35～72 years old with averaged 4.5 years, have been undergone TIPSS because of portal hypertension due to cirrhosis or Budd Chiari syndrome. The portal pressures were measured before and after TIPSS. Follow up study was done by color Doppler sonography or Barium esophageal radiogaphy for 3 months to 6 years (averaged 18 months). Repeated interventional treatments were done in cases of restenosis of the shunts. Results There were 0,2,10,5,0 cases of recurrent bleeding after 3 months, 6 months, 1 year, 2 year and 3—6 year following TIPSS respectively. Stenosis occurred in shunt paths due to thrombosis or smooth muscle cell proliferation or neointimal hyperplasia were relieved after thrombolytic therapy and repeated balloon angioplasty or stent plant among most of them. 2 were failed due to serious stenosis. 7 cases died, 2 of massive bleeding, 1 of the other cause and 4 of hepatic cancer. The other patients are getting well. Conclusions Although there were very high rates of restenosis (34%), but most of them could be treated again with interventional therapy, and in kept patency effectively. TIPSS is a still practical valuable management for massive gastric bleeding.

Objective:To investigate the problems and improve the quality of clinical education.Method:A questionnaire was made among 200 medical students at Ji'ning medical college.Results:About eighty-eight percent of the students were satisfied with their clinical education,but there were still some problems:absence of clear objectives in clinical practice;shortage of enthusiasm of the students;lack of responsibility of some teachers and too many factors affecting clinical practice.Conclusion:The key points to improve clinical education quality are to set up clear education objectives,develop appropriate clinical practice methods,improve teaching staff quality and reform the teaching content.

Objective To further investigate the relationship between apolipoprotein E(APOE) genotype and trait anxiety in patients with coronary heart disease (CHD).Methods Use the state-trait anxiety inventory (STAI) to investigate the state anxiety and trait anxiety of 107 CHD patients.According the score of TAI,the CHD patients were divided into CHD with high trait anxiety group ( n=39)and low trait anxiety group(n=68).The genotypes and alleles of apolipoprotein E gene was detected in all CHD patients and 50 healthy control subjects with the polymerase reaction(PCR) and restriction fragment length polymorphisms(RFLP) technique.Correlation analysis and logistic regression analysis were used.Results Apolipoprotein E gene showed positive relationship with trait anxiety score( OR =9.251,95％ CI2.726 ～ 18.266).F4 allele entered the regression equaltion Y =30.252 + 0.048X3 (P ＜ 0.05 ).Conclusion The results suggest the polymorphisms of Apolipoprotein E e4 allele may be associated with the trait anxiety symptom.

Objective To study the impact of depression disorder in patients after coronary stent implantation on incidence rate of in-stent restenosis (ISR) in the coronary heart disease( CHD ), and its possible pathophysiological mechanisms. Methods According to the Hamilton Depression Scale (HAMD-24) and Self-rating Depression Scale(SDS) score,95 patients with unstable angina received coronary drug-eluting stent implantation combined with depression disorder were serve as the study group; randomly selecte 246 cases without depression due to unstable angina pectoris after coronary stent implantation as the control group in the same period. The incidence rate of ISR in these two group were observed, and serum aldosterone ( ALD), high-sensitivity C-reactive protein (hs-CRP) ,Leptin levels in two groups were compared. Results The incidence rate of ISR in study group were significantly higher than that of the control group (28/95 vs 46/246, P＜0. 05). Following with the aggravation of depression disorder,the incidence rate of ISR were elevated( χ2 =8. 148, P=0.017). Serum ALD,hs-CRP and Leptin levels of study group were significantly higher than the control group 7 days later after drug-eluting stent implantation ( ALD:277.4 ± 35.9 vs 258.9 ± 60.9, t= 3. 459, P= 0. 001; hs-CRP: 12.03 ± 3.06 vs 11.10 ±2. 806, t = 2.573, P = 0.008; Leptin:5.27 t 1.07 vs 4.98 ± 0.99, t= 2.323, P= 0.021 ). Pearson correlation analysis showed that its HAMA-24 score was positively correlated with serum ALD ,hs-CRP and Leptin( r=0.291,P=0.026; r=0.350, P=0.014; r=0. 312, P=0.023) ,and SDS score was positively correlated with hs-CRP( r=0. 302, P= 0. 020). Conclusion Serum ALD, hs-CRP and Leptin levels are higher in patients after coronary stent implantation combined with depression in patients, and the incidence rate of ISR is also higher in these patients, and the rates are elevated according to the aggravation of depression disorder.

Objective To investigate the relationship between the plasma levels of ET-1,TAT,and hs-CRP and slow coronary flow syndrome (SCFS),and explore effects of coronary endothelial function,coagulation function,and inflammatory reaction on blood flow of coronary artery.Methods A total of 400 cases with normal blood flow of coronary artery by coronary angiogram was randomly selected.The coronary flow patterns were determined by corrected thrombolysis in myocardial infarction frame count method (cT-FC).Among them,45 cases whose average cTFC more than 27 were assigned as SCFS group,the other 45 cases no SCFS.Plasma levels of ET-1,TAT and hs-CRPwere examined with enzyme-linked immunosorbent assay (ELISA),and were compared between two groups.Moreover,multivariate analysis evaluating predictors of SCFS was performed with regression test.Results No statistical difference was found between two groups concerning the gender,history of hypertension,diabetes mellitus,and cigarette alcohol percentage..The plasma level of HDL in SCFS group was lower than that of no SCFS [(1.22 ± 0.42) mmol/L vs (1.44±0.34) mmol/L,t =-2.731,P ＜0.01],but the plasma level of glucose in the former was higher than that of the latter [(5.68 ±0.62) mmol/L vs (5.10 ±0.84) mmol/L,t =3.727,P ＜0.01].However,Plasma levels of ET-1,TAT and hs-CRP in SCFS were higher than that of no SCFS [(94.3 ± 16.78) ng/Lvs (83.5±12.53) ng/L,t =3.051,P ＜0.01;(12.96±3.24)μg/Lvs (8.76 ±2.64)μg/L,t =5.945,P ＜ 0.01 ; (2.48 ± 0.35) μg/L vs (1.38 ± 0.46) μg/L,t =11.259,P ＜ 0.01].Furthermore,Logistic regression analysis showed that ET-1,TAT and hs-CRP were risk factors for SCFS (OR ＞ 1.22).Conclusions Due to coronary endothelial dysfunction,endothelial inflammatory reaction,and activated coagulation function,slow coronary flow of coronary artery occurs.

AIM:To observe the effects of astragaloside IV (AS-IV) on myocardial fibrosis in chronic heart failure ( CHF) rats and to explore the underlying mechanism preliminarily .METHODS:Chronic heart failure model rats established by abdominal aorta constriction (AAC) were divided into CHF group, valsartan group and AS-IV group.Sham operation group was also established .The rats in valsartan group and AS-IV group received valsartan and AS-IV at 2 and 30 mg· kg-1 · d-1 , respectively.The rats in sham operation group and CHF group received normal saline .After 8 weeks of treatment, the cardiac structure and the hemodynamic parameters were measured .The morphologic changes of myocardial tissue were observed after staining .The expression of long-chain acyl-CoA dehydrogenase ( LCAD) and 6-phosphofructoki-nase-1 (PFK1) at mRNA and protein levels was determined by RT-qPCR and Western blot.RESULTS:Compared with sham operation group , left ventricular mass index ( LVMI) , collagen volume fraction ( CVF) , left ventricular posterior wall depth (LVPWD), and the mRNA and protein of PFK1 in CHF group were increased (P<0.05), while the mRNA and protein levels of LCAD were decreased (P<0.05).Compared with CHF group, the LVMI, CVF, LVPWD, and the mRNA and protein levels of PFK1 in valsartan group and AS-IV group were decreased (P<0.05), while the mRNA and protein levels of LCAD were increased (P<0.05).CONCLUSION:AS-IV inhibits myocardial fibrosis in the CHF rats , the mechanism of which might be associated with up-regulating the expression of LCAD , down-regulating the expression of PFK1 and normalizing the myocardial energy metabolism .