OBJECTIVE:To compare the efficacy and safety of metoprolol and bisoprolol in the treatment of diastolic heart fail-ure. METHODS:150 patients with diastolic heart failure were randomly divided into group A(75 cases) and group B(75 cases). All patients received aspirin,angiotensin-converting enzyme inhibitors,angiotensin receptor antagonists,calcium antagonists,di-uretic and cardiac drugs and other conventional treatment;based on it,group A received Metoprolol tartrate tablet with initial dose of 6.25 mg,orally,twice a day,then increased to 100-200 mg based on improvement and tolerability;group B received 1.25 mg Metoprolol tartrate tablet,orally,once a day,then increased to 10 mg based on improvement and tolerability. The treatment course for 2 groups was 12 weeks. Clinical efficacy,and left ventricular end systolic diameter(LVESD),left ventricular ejection fraction (LVEF)and left ventricular end-diastolic diameter(LVEDD),myocardial performance index(LVTei index),brain natriuretic pep-tide(BNP),interleukin(IL)-1,IL-6,tumor necrosis factor(TNF)-α before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:The efficacy in group B was significantly higher than group A,incidence of adverse reac-tions were significantly lower than group A,the differences were statistically significant (P<0.05). Before treatment,there were no significant differences in the LVESD,LVEF,LVEDD,LVTei index,BNP,IL-1,IL-6 and TNF-α in 2 groups(P>0.05). Af-ter treatment,LVESD,LVEDD,LVTei index,BNP,IL-1,IL-6 and TNF-α in 2 groups were significantly lower than before,and group B was lower than group A,LVEF was significantly higher than before,and group B was higher than group A,the differenc-es were statistically significant(P<0.05). CONCLUSIONS:Based on the conventional treatment,bisoprolol is significantly superi-or to metoprolol in terms of efficacy,relieving clinical symptoms and improving cardiac functions in the treatment of diastolic heart failure,with better safety.

Objective To investigate the expression of WT1 in pedecyte of obesity- related glomerulopathy (ORG) rats and the mechanism of enalapril and weight reduction-induced renal protection. Methods After the ORG model was established by high lipid forage for 24 weeks, the rata were divided into control rats (group A), ORG rats (group B), enalapril-treated ORG rats (group C), ORG rats with weight reduction (group D) and enalapril -treated ORG rats with weight reduction (group E). At the 8th week, 24 hour urine albumen (24hUA1b) was assayed, and the pathological changes of kidney were detected by optics microscopy and transmission electronic microscopy. Immunohistochemistry was used to detect the expression of WT1, a marker of pedocyte injury. Results In ORG rats, pedocyte number and density were declined remarkably compared with group A (respectively, P<0.01), and 24 hour UA1b and obvious kidney damage were sig- nificantly higher than those of group A (respectively, P<0.01 ). After treatment, pedocyte number and density in group (C, D, E) were significantly increased compared with group B (respectively, P<0.05, P<0.01). Meanwhile, 24honr UA1b was reduced and kidney dam- age was alleviated ( respectively, P <0. 01 ), and therapeutic alliance effect in group E outweighed than that in group C and D. Conclusion Changes of pedocyte in ORG correlated with degree of proteinuria and renal function impairment. Enalapril and weight reduction can re- strain the expression of WT1 in ORG, which can reduce proteinuria and lessen kidney damage.

Objective: To explore the application value and safety of low-dose dobutamine stress echocardiogram (LDDSE) in patients of low-flow/low-gradient aortic stenosis combining left ventricular dysfunction with transcatheter aortic valve replacement (TAVR). Methods: A total of 5 eligible consecutive patients with contradiction of routine surgical valve replacement and going to receive TAVR in our hospital from 2013-10 to 2016-07 were enrolled. The mean aortic valvegradient, maximum flow velocity, each stroke volume and ejection fraction were recorded before and during LDDSE examination. The patients having confirmed diagnosis of true severe aortic stenosis with left ventricular contractile reserve received TAVR, for those without left ventricular contractile reserve received drug therapy or TAVR conditionally. The changes of cardiac function and NT-proBNP level were observed after TAVR. Results: All 5 patients showed positive finding in LDDSE; the mean aortic valve gradient ≥40mmHg and stroke volume≥20% implied that the patients had true severe aortic stenosis with left ventricular contractile reserve. No adverse reaction occurred during and after LDDSE. TAVR was performed in 4 patients and 1 was waiting for TAVR or balloon dilatation since temporary lacking of valve. The post-operative cardiac function was improved in all patients and NT-proBNP level was declined continuously. Conclusion: LDDSE examination could be considered in patients of aortic stenosis combining left ventricular dysfunction, low-flow and low-gradient to clarify ventricular contractile reserve and the severity of aortic stenosis. If the patients with ventricular contractile reserve, TAVR was recommended which was the effective treatment for relevant patients.

Objective: To explore the cardiac function and outcomes in patients of aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) within 6 months in order to provide the guidance for clinical treatment. Methods: A total of 49 consecutive severe AS patients with surgical contradiction or STS high risk score and received successful TAVR in our hospital from 2013-12 to 2015-12 were studied. Echocardiography and blood levels of NT-proBNP were examined at pre- and 1 month, 6 months after TAVR. Left ventricular ejection fraction (LVEF), aortic valve mean gradient (MG), peak gradient (PG) and peak velocity (PV) were recorded. Based on pre-operative LVEF, the patients were divided into 2 groups: Cardiac dysfunction group, LVEF<50%,n=15 (30.6%) and Normal cardiac function group, LVEF≥50%, n=34 (69.4%). Post-operative cardiac function and blood levels of NT-proBNP were compared between 2 groups. Results: In all 49 patients, the following parameters were significantly improved within 7 days after TAVR: LVEF (56.0±14.6) % vs (52.5±13.8)%, MG (11±5) mmHg vs (58±18) mmHg, PG (21.7±9.5) mmHg vs (93.0±28.6) mmHg, PV (2.3±0.5) m/s vs (4.8±0.7) m/s, blood NT-proBNP level [1831 (1098-3363)] pg/ml vs [3842 (1763-8664)] pg/ml and aortic valve area (1.57±0.43) cm2 vs (0.58±0.23) cm2 allP<0.05. Within 6 months after TAVR, LVEF was continuously increasing especially in Cardiac dysfunction group; MG, PV and NT-proBNP level were continuously decreasing, NYHA grade was continuously improving, allP<0.05. Conclusion: TAVR was an effective treatment in AS patients with surgical contradiction or STS high risk score; it may continuously improve cardiac function, especially in patients with left heart dysfunction.

OBJECTIVE:To improve the education quality of medical school,so as to provide the excellent human resources for the field of health.METHODS:2011-2014 grades of students majoring in pharmaceutical administration,pharmacy (marketing direction) and other non-medical interdisciplinary subjects were selected from our school to complete the questionnaire which conrained the questions about satisfaction and confidence for the major.The results of investigation were analyzed statistically.RESULTS:Totally 2 668 questionnaires were sent out,and 2 435 were recycled with effective recovery of 91.27％.Half of the students majoring in pharmaceutical administration or pharmacy (marketing) etc.were switched from other majors,and 38.40％(935 number) of the students wanted to change the major.The major of clinical,nursing and anesthesiology were most preferred by the students.Only 15.52％ (378 number),26.32％ (641 number) of the students thought that the school paid enough attention to them or had a positive attitude to their major,respectively.Students majoring in pharmacy (marketing) and health services administration had the lowest satisfaction about their major and the attention paid by the school (P＜0.001).With the growth of grade,the satisfaction of students in various aspects had declined (P＜0.001).Only 44.72％ (1 089 number),34.25％ (834 number) of the students had positive attitude towards the study or were optimistic about the future,respectively.With the growth of the grade,students' satisfaction in all aspects had declined (P＜0.001).Compared to other students,freshman had more positive attitude towards the study or were more optimistic about the future (P＜0.001).Besides,33.65％ (491 number)of the students planning to work immediately after graduation lacked confidence to find a good job.CONCLUSIONS:The lower degree of satisfaction and confidence are found in the students majoring in non-medical interdisciplinary subject in the medical school,and this should be treated seriously by the school.

Objective By comparing biomechanical properties of two-screw rod and three-screw rod for fixing pelvic fracture, the difference in mechanical effects of different screw rod fixation positions in pelvic minimally invasive surgery was studied.Methods The mechanical models of pelvis fixed by two-screw rod and three-screw rod were established, and biomechanical characteristics of the pelvis during standing on both legs, during single-legged standing on healthy side or affected side, as well as in sitting posture were compared and analyzed by finite element simulation, and the fixation effect of three-screw rod was verified by clinical experiments.Results Both fixation methods could restore mechanical transmission of the pelvis. But for three-screw rod fixation, the stress on both sides of the pelvis was more balanced, and the displacement of the whole body and fracture surface was also lower during single-legged standing.Conclusions The three-screw rod fixation has an excellent effect in stability, which is more beneficial for fracture recovery.

Objective To explore the clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study.Incidence rate and severity of PH were depicted.The study population was divided into two groups (PH group and control group),and the differences in clinical profile were elucidated.Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis.Results The incidence of PH was 12.3％ (37 cases),in which 48.6％ patients (18 cases) were mild PH,40.5％ patients (15 cases) were moderate PH,and patients with severe PH accounts for 10.8％ (4 cases).Multivariate logistic regression analysis indicated that female (OR =3.95,95％ CI 1.74-8.98,P =0.001),age ≥ 65 years (OR =3.87,95％ CI 1.16-12.97,P =0.030),history of atrial fibrillation (OR =2.76,95％ CI 1.01-7.57,P =0.049) and moderate or severe mitral regurgitation (OR =6.63,95％ CI 3.02-14.57,P =0.000) were independent risk factors of PH.Stratification according to sex showed that age ≥65 years(OR =7.79,95％ CI 1.35-47.26,P ＜ 0.05) and moderate or severe mitral regurgitation (OR =9.83,95 ％ CI 2.26-42.67,P ＜0.01)were independent risk factors of PH for male patients;while history of atrial fibrillation(OR =6.32,95％ CI 1.57-25.40,P =0.01) and moderate or severe mitral regurgitation (OR =5.23,95％ CI 1.92-14.26,P＜0.01)were independent risk factors of PH for female patients.Risk factors were similar between the mild PH group and moderate to severe PH groups.Conclusion Compared with patients without PH,HOCM patients complicated with PH were older and with higher percentage of female,and resting obstruction,history of atrial fibrillation and moderate or severe mitral regurgitation.Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female,advanced age,history of atrial fibrillation and moderate or severe mitral regurgitation.

Objective To analyze the expression level of YEATS2 in hepatocellular carcinoma(HCC)about its clinical prognosis and therapeutic value based on biological information from the cancer genome atlas(TCGA)and human protein atlas(HPA)databases.Methods The mRNA expression data and clinical information of HCC were downloaded from the TCGA database,the expression of YEATS2 between HCC tissues and normal tissues was analyzed by using the R software,and the protein expression differences were preliminary verified by the HPA database.The expression differences of YEATS2 between various clinical features of HCC were compared,and their effects on the survival of HCC patients by Kaplan-Meier method and COX regression analysis were then evaluated.Receiver operating characteristic(ROC)curves were plotted to evaluate their diagnostic values.The biological functions of YEATS2 in HCC were analyzed using gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis.The relationship between YEATS2 expression and tumor microenvironment(TME)was analyzed by the"ESTIMATE"algorithm,and its relationship with tumor-infiltrating immune cells(TIICs)was assessed by CIBERSORT.Analysis of YEATS2 expression levels to immune checkpoints and drug sensitivity was performed using the R package.Results The expression of YEATS2 was increased in HCC tissues(P=4.96e-21),and its expression level was correlated with age,clinical stage,pathological grade and T stage(all P＜0.05).Overall survival(OS)(P＜0.001)and progression-free survival(FPS)(P=0.016)were decreased in HCC patients with high expression of YEATS2,COX regression results showed that the expression level ofYEATS2 was associated with poor prognosis in HCC patients(OS:HR=2.167,95％CI:1.441～3.261,P=2.06e-04),and it was an independent risk factor for predicting poor prognosis in HCC patients(OS:HR=1.891,95％CI:1.243～2.877,P=0.003).The ROC curve suggested the AUCs for 1,3 and 5 years were 0.677,0.622 and 0.612,respectively,indicating good predictive ability.The TCGA database screened a total of 6 764 differential genes in the YEATS2 high and low expression groups,of which 4 094 genes were up-regulated and 2 670 genes were down-regulated in the YEATS2 high expression group.The results of GO and KEGG enrichment analyses showed that the differentially differentiated genes in the YEATS2 high expression group were mainly enriched in immunoregulation,and cell cycle regulation drug resistance pathway.The results of the TME score showed that the YEATS2 high expression group caused a decrease in immunity score(P＜0.01).The correlation between YEATS2 and TIICs showed that YEATS2 expression was positively correlated with the level of M0-type macrophage infiltration levels(r=0.48,P＜0.001)and 23 immune checkpoint genes(r=0.20～0.46,all P＜0.05),and was negatively correlated with the CD8+T-cells,plasma cells and monocyte(r=-0.26,-0.29,-0.30,P=0.021,0.011,0.008).Drug sensitivity analysis showed that the half maximal inhibitory concentration(IC50)of cabozantinib,lincitinib,doxorubicin,and cyclobenzaprine in patients with high expression of YEATS2 was higher than those in patients with low expression(all P＜0.01).Conclusion YEATS2 was highly expressed in HCC,and the expression level was associated with poor prognosis in HCC patients.YEATS2 can be used as a biomarker for the clinical early diagnosis,prognosis and immunotherapy of HCC,which may provide new ideas for clinical diagnosis and treatment.