Objective This study explored whether EPAS1 gene is involved in the proliferation of pulmonary arterial smooth muscle cells (PASMCs) during hypoxia when EPAS1 gene expression was interfered by small interfering RNA (siRNA).Methods The rat primary pulmonary artery smooth muscle cells were cultured and identified by immunofluorescence.The specific lipidosomes of EPAS1 siRNA were constructed and transfected into PASMCs,and the best targets were selected from the three interfering targets.The transfected PASMCs were cultured in hypoxia (37℃,5％ CO2,2％ O2) or normoxia (37℃,5％ CO2,20％ O2) for 24h,48h and 72h,respectively.The PASMCs proliferation was detected by CCK-8 assay.The protein expression of EPAS 1 and vascular endothelial growth factor (VEGF) were determined by Western blotting to investigate the effect of silencing EPAS1 gene expression on the proliferation of PASMCs under hypoxic condition.Results The specific liposomes ofEPAS1 siRNA were successfully constructed and transfected into PASMCs,and the best interfering target were selected from the three interference targets.The proliferation of PASMCs was increased and the protein expression of VEGF was up-regulated in the PASMCs under hypoxic condition.Under hypoxic or normoxic condition,PASMCs proliferation and VEGF protein expression of PASMCs were suppressed by EPAS 1 siRNA.Conclusion EPAS 1 gene might be involved in the proliferation of rat PASMCs by regulating VEGF protein level under hypoxic condition.

Objective To investigate the effects of subclinical hypothyroidism (SCH) on blood glucose and metabolic parameters in type 2 diabetes (T2DM) . Methods A total of 973 T2DM patients were recruited, and the clinical data, biochemical and thyroid function parameters were measured. One hundred and forty eight T2DM patients were diagnosed as SCH (SCH group) and 152 euthyroid patients were selected as control group (NSCH group) . Results (1) The prevalence of SCH in type 2 diabetes was 15.3% (148/973) . (2) Compared with the NSCH group, the prevalence of overweight/obesity was significantly higher in SCH group (54.1%vs 35.5%,<0.01) as well as hypertension (64.9%vs 52%, <0.05) . There was no significant difference in HbA1c control and prevalence of dyslipidemia and hyperuricemia between two groups. Conclusion SCH may have some adverse effects on blood pressure and BMI in T2DM.

BACKGROUND:Stem cel is a kind of pluripotent cels with self-replication ability, which can differentiate into various cels under certain conditions. Furthermore, stem cels are rich in a variety of growth factors, which can induce the generation of vessels and nerves, and improve the blood supply of lower limbs, thereby achieving the treatment and preventions of lower limb ischemia OBJECTIVE:To summarize and compare the recent achievements in the theory and therapeutic efficacy of stem cels from different sources in the treatment of diabetic foot. METHODS:The first and second authors retrieved PubMed, Sciencedirect and Medline databases for relevant articles published from January 2000 to January 2015. The key words were “diabetic foot, pathogenesis, stem cel therapy” in English. Initialy, 186 articles were retrieved, and finaly 44 articles were included in result analysis. RESULTS AND CONCLUSION:Stem cels can be a new choice for the treatment of diabetic foot. After stem cel therapy, corresponding symptoms have been aleviated, including the generation of new blood vessels and the reshaping of the colateral vessels, the improvement of motor nerve conduction velocity and nerve reflex, the improvement of the sense of skin pain and temperature, and pain relief. It is stil unclear whether alogeneic stem cels are safe or not, but autologous stem cels, especialy bone marrow mesenchymal stem cels, can be better able to repair damaged vessels and nerves and restore the microcirculation of blood supply. Currently, we need to do more basic and clinical researches to solve the folowing problems: to confirm the effectiveness and safety of stem cel therapy for diabetic foot; to identify whether there is a difference in the differentiation and secretory activity between stem cels in diabetic patients and ordinary people; to give ful play to the treatment of diabetic foot.

Objective　To evaluate the anti-tumor effects of NDV and two genes of virus(HN and F) on athymic mice with human adenocarcinoma xenografts, and to investigate the mechanisms of its oncolytic role. Methods　The experimental model of lung adenocarcinoma xenograft was established. The two experimental groups of athymic mice were given intratumoral injections of NDV and plasmids only once, and compared with PBS controls in the same time. Measure the volume of tumors for 5 weeks and make a curve of the volume. These mice were killed after 5 weeks, and the weight of the tumors was measured. The histological and ultrastructral changes were observed by electromicroscope and microscope. Results　After one injection of live NDV and plasmids, the tumor growth was significantly suppressed (The median inhibitory rate was 71.62％ and 79.40％ respectively). The median weight of tumor of mice treated with NDV was remarkably lower than that of mice treated with PBS, and that of the mice treated with plasmids (P＜0.01). 14％ of the control group had liver and lung metastasis of the tumor, but no metastasis was found in the experimental groups. A great quantity of NDV viron budding was found in the NDV group. Conclusion　NDV could replicate in human lung adenocarcinoma xenografts, leading directly to a potent anti-tumor effect after one injection of live NDV. During the oncolytic process, the gene HN and gene F may play an important role.

Objective To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in the management of refractory hematuria of prostatic origin (RHPO). Methods This retrospective study from 6 hospitals in china consisted of 31 patients (mean age 75.0±7.5 years, range 58 to 84 years) who underent transcatheter arterial embolization (TAE) for RHPO between February 2011 and January 2017. Patients with RHPO who had complete imaging and clinical data were enrolled. Patients with incomplete clinical data, inability to assess hemostasis, and contraindications to TAE were excluded. The cause of RHPO was benign prostatic hyperplasia (BPH) in nine patients, prostate cancer in twelve, transurethral resection of prostate in four, open prostatectomy in two and prostatic sarcoma in four. Superselective arterial embolization, non-superselective arterial embolization or intra-arterial infusion chemotherapy was performed according to the etiology and angiography. Angiographic findings, technical success rate, clinical success rate, complications were recorded. Results Of the 31 patients, 6 patients (19.4％) were with active bleeding, 4 (12.9％) with aneurysm and 27 (87.1％) with abnormal neovascularization on the angiogram. The 31 patients underwent a totle of 37 TAE, the technical success rate was 100.0％(37/37) and the recent hemostasis success rate was 90.3％(28/31). The incidence of mild complications was 38.7％(13/31), there was no serious complication associated with TAE. Conclusion TAE is a safe and effective method for the treatment of refractory hematuria of prostatic origin.

Objective To summarize the MRI characteristics of fat-containing hepatocellular carcinoma (HCC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with fat-containing HCC who were admitted to the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between January 2015 and April 2016 were collected.All patients underwent MRI examination.Observation indicators:(1) imaging examination;(2) pathological features;(3) treatment and follow-up.Follow-up using outpatient imaging examination was performed to detect tumor recurrence once at 1 month postoperatively and once every 3 months postoperatively up to December 2016.Measurement data with normal distribution were represented as-x±s.Results (1) Imaging examination:plain scans of MRI:of 18 patients,lesions of 9,7 and 2 patients were respectively located in left,right and caudate lobes of liver,and lesions were round-like,with a diameter of 1.6-9.0 cm.Tumors were single,and tumor thrombosis in the hepatic vein was seen in 1 patient.T2WI on fat-suppression of 15 and 3 patients showed respectively high signals and iso-signal;MRI examination showed that out-phase signal on T1WI was variously decreased than in-phase signal,showing focal or diffuse signal decreasing;lipid phase on T1WI showed diffuse distribution in 10 patients,patchy fat-containing regions were scattered within the peritumoral zone in 7 patients,and lipid of 1 patient was located in the central area.Dynamic contrast enhancement MRI showed that fast-in and fast-out,fast-in and slow-out,and slow-in and slow-out types were detected in 16,1 and 1 patients,respectively.Sixteen patients had capsule-like enhancement in delayed phase.Diffusion weighted imaging (DWI) showed high signals in 10 patients,slightly high signals in 6 patients and iso-signal in 2 patients.Apparent diffusion coefficient (ADC) value was (1.19± 0.20)×10-3 mm2/s,including (1.37±0.20) × 10-3 mm2/s in lipid-rich type,(1.17±0.13) × 10-3 mm2/s in clear cell type and (1.11±0.17)× 10-3 mm2/s in thick beam type.Of 18 patients,2 were preoperatively misdiagnosed as hepatic angiomyolipoma and 1 as hepatic adenoma.(2) Pathological features:pathological types of 18 patients with fat-containing HCC:5 and 13 patients were respectively in lipid-rich and non-lipid-rich types (4 in clear cell type and 9 in thick beam type);steatosis tumor cells,rich and translucent cytoplasms and large vacuolated lipid droplets were seen under the microscope;steatosis tumor cells were diffused or scattered within the lesions,some of which showed plaque-like performance of different sizes.Degree of microvascular invasion:grade M0,M1 and M2 were found in 12,3 (2 in thick beam type and 1 in clear cell type) and 3 (2 in thick beam type and 1 in lipid-rich type) patients,respectively.(3) Treatment and follow-up:18 patients underwent surgery and were followed up for 6-13 months,with a median time of 8 months.During the follow-up,5 patients in lipid-rich type and 4 in clear cell type had no recurrence;among 9 patients in thick beam type,1 of 4 with microvascular invasion had no recurrence,2 and 1 of 4 with microvascular invasion had respectively recurrence at 3 months postoperatively and 4 months postoperatively,and 5 without microvascular invasion had no recurrence.The lesions of 3 patients with recurrence is single,3 patients received local minimally invasive therapy and continuous follow-up.Conclusion MRI characteristics of fat-containing HCC include that decreased out-phase signal on T1WI compared with in-phase signal,high signal on DWI,low ADC value,fast-in and fast-out enhancement and capsule-like enhancement in delayed phase.

Objective:To investigate the different types of renal artery involvement in Stanford type B aortic dissection (TBAD) and the comparison of clinical effecacy after thoracic endovascular aortic repair (TEVAR).Methods:This is a retrospective cohort study included 330 patients with TBAD and renal artery involvement treated with TEVAR from June 2002 to September 2021 in General Hospital of Northern Theater Command of the PLA. According to aortic CTA image, unilateral renal artery involvement conditions were divided into 5 types: the true lumen type (renal artery opening completely from the true lumen), false lumen type (renal artery opening completely from the false lumen), double lumen type (renal artery opening from the true and false double lumen), compression type (renal artery opening connected with the true lumen, but the renal artery opening was extremely squeezed by the inner membrane), open type (renal artery opening with intimal tear). There were seven types of bilateral renal artery involvement: true-true type (true lumen-true lumen type), true and false type (true lumen-false lumen type), true-double type (true lumen-double lumen type), true-opening type (true lumen-opening type), false-false type (false lumen-false lumen type), false-compression type (false lumen-compression type), double-double type (double lumen-double lumen type). The primary observation index of this study was the comparison of postoperative renal function and the incidence of clinical adverse events of different types of renal artery involvement. One-way ANOVA test, Kruskal-Wallis H test and paired sample rank sum test were used to compare postoperative renal function between different types of bilateral renal artery involvement. The Chi-square test or Fisher′s exact probability test were used to compare the near and long term adverse events between different types of bilateral renal artery involvement. Kaplan-Meier method was used to compare the all-cause mortality of patients with severe renal functional injury and non-severe renal functional injury before surgery. Results:The average age of the patients included in this study was (53±11) years, including 276 males (83.6%) and 54 females (16.4%). There were statistical difference in the level of serum creatinine (preoperative: H=18.686, P=0.005, postoperative: H=18.101, P=0.006) and cystatin C (preoperative: H=17.566, P=0.007, postoperative: H=10.433, P=0.016), pre-and post-operative, between the seven groups of TBAD patients with different renal artery involvement types ( P<0.05), and the false-false type group shown the worst kidney function. However, no statistically significant differences were shown when comparing their pre- and post-operative change values ( P>0.05). The 30-day follow-up result showed that there were statistically significant differences in the incidence of postoperative acute kidney injury ( χ2=15.623, P=0.007), aorta-related adverse events ( χ2=15.523, P=0.010), and intraoperative endoleak ( χ2=17.935, P=0.004) among the seven groups, and the false-false group was the highest (2/9, 5/9 and 5/9, respectively). In terms of long-term follow-up results, there were statistically significant differences in all-cause death ( χ2=14.772, P=0.011) and non-aortic death ( χ2=15.589, P=0.008) among the seven groups. Kaplan-Meier survival analysis showed that patients with worse pre-operative renal function showed higher long-term all cause death (17.7% vs. 4.8%, P=0.009). Conclusions:For TBAD patients with renal artery involvement, there were differences in renal function among different types, and TEVAR showed no significant effect on renal function in TBAD patients. The long-term all cause death was higher in patients with worse renal function pre-operative.

Objective:To investigate the predictive value of cardiopulmonary exercise test (CPET) indexes for major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD).Methods:This study was a retrospective cohort study. CHD patients were consecutively enrolled who procedure CPET before discharge from the Department of Cardiology, General Hospital of Northern Theater Command from November 2015 to September 2021 were enrolled. Demographic information, past medical history, CPET indexes and other baseline data were collected and the patients were followed up. Patients were divided into a MACE group and a control group according to the presence or absence of MACE. A multivariate Cox proportional hazard regression model was used to analyze the CPET indexes with predictive value for MACE in CHD patients.Results:A total of 3 800 patients were eligible for the criterion, age (57.2±8.8) years, 2 920 (76.84%) males. During a follow-up of 1 237 (695, 1 596) days, 390 (10.26%) patients were in MACE group, and 3 410 (89.74%) patients were in control group. In adjusted multivariable analysis, higher metabolic equivalent of tasks (MET) at anaerobic threshold (AT) is an independent protective factor for MACE in patients with CHD ( HR=0.75, 95% CI 0.62-0.90, P=0.002), higher VE/VCO 2 is an independent risk factor for MACE in CHD patients ( HR=1.05, 95% CI 1.02-1.07, P=0.001). Conclusion:In CPET, high MET at AT is an independent protective factor for MACE in patients with CHD, and high VE/VCO 2 is an independent risk factor for MACE in CHD patients.

Objective:To investigate the changes in cardiopulmonary exercise testing (CPET) characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).Methods:This is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023. Based on the timeline of the COVID-19 pandemic, patients were divided into two groups: the pre-pandemic group and the during-pandemic group, with January 2020 as the dividing line. Clinical data were collected from both groups, and a comparative analysis was performed on their postoperative CPET outcomes, including peak oxygen uptake (peak VO 2), peak metabolic equivalents (peak MET), and other indicators. Weber′s classification was used to assess cardiac function. In addition, the 7-tiem generalized anxiety disorder scale (GAD-7) and the patient health questionnaire-9 (PHQ-9) were used to assess the patients′ psychological anxiety and depression states, respectively. Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI. Results:A total of 4 310 post-PCI ACS patients were included, with an average age of (58.7±9.1) years, and 3 464 (80.37%) were male. There were 1 698 patients in the pre-pandemic group and 2 612 patients in the during-pandemic group. The main indicator of the CPET, peak VO 2 (15.04±3.93) ml·min -1·kg -1 in the during-pandemic group, was lower than that in the pre-pandemic group (15.52±3.68) ml·min -1·kg -1, and the difference was statistically significant ( P<0.001). Multivariate logistic regression analysis showed that advanced age, female gender, high body mass index, elevated high-sensitivity C-reactive protein, reduced high-density lipoprotein cholesterol, smoking history, history of myocardial infarction, more severe ACS classification, and mild to moderate degree of depression were related to poor cardiopulmonary outcomes ( P<0.05). Conclusion:The COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI. Reduced physical activity, and increased psychological stress should be given consideration and attention regarding their impact on patients′ cardiopulmonary function.

Purpose/Significance To explore the feasibility of applying blockchain technology to the current healthcare system of hos-pitals,and to achieve the purpose of protecting patients'privacy to the greatest extent possible at a lower cost.Method/Process 505 questionnaires are randomly distributed and collected from people of different age groups in Beijing,Tianjin,Shanghai and Shenzhen who have a certain degree of understanding of blockchain technology,and the results are analyzed.Result/Conclusion Different age groups are highly concerned about personal privacy and privacy protection,and are willing to accept blockchain as an emerging technology.There is a greater demand and acceptance for the application of blockchain technology in the primary health care systems.