Objective To explore the application value of real time three-dimensional echocardiography (RT-3DE) on right ventricular systolic function in patients with moderate and severe pulmonary hypertension (PH).Methods Twenty-five patients with moderate PH (group Ⅱ) and 25 patients with severe PH(group Ⅲ) were selected,30 normal cases were selected to be control group(group Ⅰ).Tricuspid annular systolic peak velocity (S'),right ventricular Tei index(RIMP),tricuspid annular planet systolic excursion(TAPSE) and right ventricular fractional area change(RVFAC) were measured by conventional ultrasound echocardiography.Right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV),right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were measured by RT-3DE.The correlation between all the parameters and pulmonary artery systolic blood pressure (PASP),and the correlation between RVEF and S',RIMP,TAPSE,RVFAC were analyzed respectively.Results The differences of RVEDV,RVESV,TAPSE,RVFAC in each group were all statistically significant (all P ＜0.01);RIMP,RVEF between group Ⅰ and group Ⅱ,as well as between group Ⅰ and group Ⅲ were statistically significant (all P ＜0.01);S',RVSV only between group Ⅰ and group Ⅲ was statistically significant (P ＜0.01).The correlation coefficients of RVEF and RIMP,S',TAPSE,RVFAC were-0.707,0.402,0.574,0.763,respectively (all P ＜ 0.01).The best parameters associated with RVEF in each group were RVFAC,RIMP,RVFAC,which correlation coefficients were 0.787,-0.679,0.744,respectively (all P ＜0.01).Conclusions RT-3DE is a objective and accurate method to evaluate the right ventricular volume and RVEF in patients with moderate and severe PH,and it can select out the sensitive indicators to evaluate those patients' right ventricular systolic function from conventional echocardiographic parameters,provide important reference value for clinical.

Objective To investigate the feasibility and safety of using vasodilators in the treatment of neonates with patent ductus arteriosus (PDA) accompanied by acute heart failure and pulmonary edema. Methods The clinical data of a case of neonatal PDA accompanied by severe cardiac insufficiency and pulmonary edema in Department of Intensive Care Unit (ICU) of Hebei General Hospital, and the neonate's hemodynamic characteristics and the efficacy and adverse reactions of phentolamine, a vasodilator, in the treatment of PDA were retrospectively analyzed. Results In this neonate, on the 8th day after birth and the improvement of pulmonary hyaline membrane disease, the respiratory distress occurred again, which was related to the severe cardiac dysfunction caused by the opening of PDA. Phentolamine was given on the basis of routine treatment to reduce systemic circulatory resistance. Two hours later, the respiratory distress was relieved significantly, that was presumably related to the decline of the left to right shunt volume through the PDA. There were no adverse reactions such as blood pressure reduction and coronary insufficiency. Conclusion Neonatal PDA is easily to be complicated with severe cardiac insufficiency, and vasodilators can reduce systemic circulatory resistance, reduce left to right shunt volume through the ductus arteriosus, and reverse the acute cardiac insufficiency and pulmonary edema, the therapeutic effect of vasodilators is remarkable, safe and reliable in neonatal PDA.

Objective:To investigate the effect of rapamycin eluting coronary stent for inhibition of neointimal hyperplasia in diabetic porcine model.Methods:There were two groups in this study. Diabetic group, n=12, diabetic porcine model was established by a single dose of streptozotocin, and rapamycin eluting coronary stents were randomly implanted into 2 of the major epicardial coronary arteries. Control group, n=12, with non-diabetic porcine. The degree of neointimal hyperplasia evaluated by coronary angiography, intravascular ultrasound (IVUS) and histopathology were compared between two groups respectively at 6 months of the event. Results:The distribution of vessels received stents, reference vessel diameters and post-procedural minimal luminal diameter were comparable between two groups. All animals received angiographic follow-up at 6 months of time. In Diabetic group, the degree of stent stenosis (35.6%±9.2% vs. 7.9%±3.1%,P<0.001), late lumen loss (0.32±0.09 mm vs. 0.09±0.04 mm,P<0.001), the thickness of neointima by IVUS examination (0.35±0.12 mm vs. 0.11±0.08 mm,P<0.05) and area stenosis by IVUS (1.29±0.51 mm~2 vs. 0.26±0.11 mm~2, P<0.001); and histopathological examination (1.24±0.76 mm~2 vs. 0.19±0.08mm~2, P<0.05) were significantly higher than those in Control group. Conclusion: The neointimal hyperplasia after rapamycin eluting stent implantation was significantly severe in the diabetic porcine models than those in non-diabetic ones.

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.

The purpose of this study was to explore the role of epithelial-mesenchymal transition in the pathogenesis of hepatolithiasis. Thirty-one patients with primary hepatolithiasis were enrolled in this study. Expressions of E-cadherin, alpha-catenin, alpha-SMA, vimentin, S100A4, TGF-beta1 and P-smad2/3 in hepatolithiasis bile duct epithelial cells were examined by immunohistochemistry staining. The results showed that the expressions of the epithelial markers E-cadherin and alpha-catenin were frequently lost in hepatolithiasis (32.3% and 25.9% of cases, respectively), while the mesenchymal markers vimentin, alpha-SMA and S100A4 were found to be present in hepatolithiasis (35.5%, 29.0%, and 32.3% of cases, respectively). The increased mesenchymal marker expression was correlated with decreased epithelial marker expression. The expressions of TGF-beta1 and P-smad2/3 in hepatolithiasis were correlated with the expression of S100A4. These data indicate that TGF-beta1-mediated epithelial-mesenchymal transition might be involved in the formation of hepatolithiasis.
Adult ; *Bile Ducts/cytology/metabolism/pathology ; Biological Markers/*metabolism ; Cell Differentiation/*physiology ; Epithelial Cells/cytology/*physiology ; Epithelium/physiology ; Female ; *Gallstones/metabolism/pathology ; Humans ; Liver Diseases/metabolism/*pathology ; Male ; Mesoderm/cytology/*physiology ; Middle Aged

Tryptophan (TRP) is an essential amino-acid and the precursor of many signaling molecules. Under the catalysis of indoleamine 2, 3-dioxygenase, kynurenine pathway can form its metabolites uroquinolinic acid and quinolinic acid, which is the main channel of TRP metabolism.Through different mechanisms in N-methyl-D-aspartate receptor, they participate in nervous modulation, affect cognitive processes and play an important role in many central nervous system diseases development. Kynurenine pathway is different under physiological and pathological conditions. In addition, there are many rate-limiting enzymes in the kynurenine pathway, which can interfere kynurenine pathway. This article reviews the relationship between tryptophan/kynurenine pathway and cognitive dysfunction.

Narrative medicine,as an interdisciplinary field at the intersection of humanistic education and medical edu-cation,is an effective means of implementing medical humanities.It not only fosters deeper empathy and communication between doctors and patients but also plays an important role in clinical practice and the cultivation of humanistic qualities.This study starts from the core connotation of integrating narrative medicine into the doctor-patient relationship,focusing on the value logic of narrative medicine empowering humanistic care.Utilizing a typical case from a hospital in Tianjin that practices humanistic care based on narrative medicine,the study examines the organizational structure,practical activities,humanistic care initiatives,health education,supportive measures,and outcomes of the narrative medicine healthcare management team.The conclusion drawn is that exploring mechanisms for medical communication and the cultivation of humanistic qualities can facilitate the mutual transformation of narrative and empathy skills,the organic combination of narrative medicine with evidence-based medicine,and the complementary relationship between clinical medicine and humanistic education.This approach aims to alleviate the increas-ingly prominent conflicts between doctors and patients,bridge the gap between humanity and technology,and promote the imple-mentation of medical humanities in clinical settings.

To systematically evaluate the expression of lymphovascular invasion (LVI) in predicting the clinical prognosis of patients after radical cystectomy.Methods The relevant search strategy,including and excluding criteria for the relevant literature were developed by two independent researchers.The study of tumor prognosis in the patients with LVI following radical cystectomy cancer were searched by computerized PubMed,EMBASE,Web of Science,Cochrane library,China National Knowledge Infrastructure (CNKI),Wanfang and VIP citation database.The search period was setted from the beginning of establishment of library until May 2017,and the search language was English and Chinese.The methodological quality of the included studies was assessed by the NOS.Besides,the relationship between LVI and the clinical outcome in patients following radical cystectomy was calculated by RevMan 5.3 and Stata 12.0 software.Results A total of 18 related clinical studies were included,published from 2008 to 2017.There were 12 354 patients with bladder cancer,of which 4 272 cases of LVI,with a proportion rate 34.6％.The results showed that the patients with LVI in pathological sections had a lower overall survival rate (HR =1.26,95％ CI 1.16-1.38,P ＜0.001),recurrence-free survival (HR =1.27,95％ CI 1.06-1.52,P ＜0.001),cancer-specific survival rate (HR =1.30,95％CI 1.18-1.42,P ＜0.001).Egger's publication bias analysis showed no significant publication bias in terms of overall survival(P =0.636),recurrence-free survival (P =0.077),and cancer-specific survival (P =0.342).Conclusions LVI had a significant poor outcome in patients with radical resection of bladder cancer.It can be used as an independent risk factor to evaluate the postoperative prognosis of those patients,but more randomized controlled studies are still needed to make a further conformity in our completion.

Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ²test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ²=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ²=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.

Objective To assess the left ventricular systolic function in young strength male athletes by three-dimensional speckle tracking echocardiography (3D-STE).Methods A total of 45 young strength male athletes (athlete group) and 30 healthy young men (control group)were enrolled.Traditional echocardiography combined with 3D-STE were applied for all the subjects to obtain heart rate (HR),left ventricular end-diastolic diameter (LVEDD),the thickness of interventricular septum (IVS) and posterior wall thickness (PWT),relative wall thickness (RWT),left ventricular end-diastolic volume (EDV),endsystolic volume (ESV),left ventricular ejection fraction(LVEF),stroke volume (SV),left ventricular mass (LVM),left ventricular global longitudinal strain (GLS),global circumferential strain (GCS),global area strain (GAS),global radial strain (GRS).Results There were a significant increase inLVEDD,IVS,PWT,RWT,EDV,ESV,SV,LVM and significant decrease in HR,GLS,GCS,GAS and GRS in athlete group compared with the control group (P ＜ 0.05).However,there was no significant difference in LVEF between two groups (P ＞0.05).Conclusions There are subclinical changes of left ventricular systolic functionin of young strength male athletes.3D-STE can accurately assess the changes,and provide reliable information for clinical assessment of athletes' heart function.