Objective To retrospectively analyze the clinical features,diagnostic experience and therapy of pulmonary embolism for reduction of misdiagnosis and missed diagnosis,and for improving the cure rate.Methods The data of clinical features,findings by auxiliary examination and therapeutic efficacy of 67 patients with pulmonary embolism admitted to the First Affiliated Hospital of General Hospital of PLA were summarized.The usual clinical manifestations were summarized based on the clinical symptoms of and the frequency of objective signs in the patients with the correct diagnosis.Auxiliary examinations included routine and sophisticated examinations such as CT pulmonary angiography(CTPA) and emission computed tomography(ECT),which were specially emphasized for summing up and optimizing the diagnosis.Comparisons were made of the therapeutic efficacy and complications between the treatment with thrombolysis combined with anticoagulation and simple anticoagulation.Results The primary clinical manifestations of the patients with pulmonary embolism included dyspnea,cough,chest pain,fever and hemoptysis,etc.Findings of D-Dimer assay might serve as a sensitive but not specific indicator in screening the suspected patients.For the sophisticated examinations,CTPA confirmed the diagnosis in 28 out of 31(90.32%) patients,and ECT confirmed the diagnosis in 39 out of 51(76.47%).All the patients who had undergone lung angiography received the final diagnosis,but the majority of them were reluctant to accept this examination because of potential risk of the technique.The total cure rate of thrombolysis combining anticoagulation was 90.62%(29/32),in which the administration of recombinant tissue-type plasminogen activator(rt-PA)-2h was most efficacious(with 100% of cure rate).Simple anticoagulation therapy gave a lower cure rate(68.57%,24/35) but a higher incidence of hemorrhagic complication(31.25%).After the administration of thrombolysis combined with anticoagulation therapy,both PaO2 and CTPA examinations showed significant changes for the better after the treatment compared with that before the treatment(P

AIM: To investigate the plasma neurotensin(NT) concentration in patients with coronary heart disease: acute myocardial infarction(AMI),unstable angina(UA),stable angina pectoris(SAP), old myocardial infarction (OMI), and to study the relationship between the plasma NT level and the myocardial ischemia . METHODS: The plasma NT concentration of 30 patients with AMI,32 patients with UA,35 patients with SAP, 31 patients with OMI and 32 normal controls were determined by radioimmunoassay(RIA). RESULTS: The plasma NT level in patients with AMI(24 h),in patients with UA when angina attacked is significantly higher than that of healthy controls. The plasma NT level in patients with SAP, in patients with OMI is not significantly different from that of healthy controls. The NT level of patients with UA when angina attacked is significantly higher than that after 2 weeks treatment (P

Objective To observe the changes of plasma neuropeptide Y (NPY) and neurotensin (NT) levels in patients with heart failure and investigate their clinical significance. Methods The levels of plasma NPY, NT of 76 patients with heart failure and 28 normal controls were determined by radioimmunoassay (RIA). The color echocardiogram was used to evaluate the cardiac structure, function and left ventricular ejection fraction (LVEF). Results The level of plasma NPY in patients with heart failure [(159.7 ± 56.3) ng/L] was higher than that in normal controls [(120.8 ± 51.9) ng/L] (P < 0.05), the level of plasma NT [(69.5 ± 29.6) ng/L] was significantly lower than that in normal controls [(99.1 ± 19.3) ng/L] (P < 0.01). Following the severity of heart failure, the level of plasma NPY increased, and the level of plasma NT decreased. The level of LVEF had negative correlative relationship with the level of plasma NPY (γ = -0.31, P < 0.05) and positive correlative relationship with the level of plasma NT (γ = 0.28, P < 0.05). The level of plasma NPY and NT in patients with heart failure had negative correlative relationship (γ = -0.26, P < 0.05). Conclusions The levels of plasma NPY, NT in patients with heart failure are unbalanced. This unbalance may participate in the damage of cardiac function.

Objective:To study the diagnostic efficacy and prognostic evaluation value of QT interval dispersion (QTd) in children and adolescents with cardioinhibitory vasovagal syncope (VVS-CI).Methods:From July 2010 to January 2020, 80 children and adolescents who received their first visit or admission to the Pediatric Syncope Clinic of The Second Xiangya Hospital of Central South University and definite diagnosed of VVS-CI due to syncope or presyncope were selected as the VVS-CI group, meanwhile, 80 children and adolescents who had physical examination in the hospital were selected as the control group.QT interval were measured by 12-lead electrocardiogram at the baseline.Results:(1) Comparison between the two groups: Compared with the control group, the VVS-CI group had a significantly lower heart rate ( P<0.05) and significantly longer QT interval, such as the maximum QT interval (QTmax), minimum QT interval (QTmin), QTd, corrected maximum QT interval (QTcmax) and corrected QT interval dispersion (QTcd) ( P<0.05). After follow-up 84 (45, 127) days, compared with the responsive group, the non-responsive group had a significantly longer QT interval, such as QTmax, QTd, QTcmax, corrected minimum QT interval (QTcmin)and QTcd ( P<0.05). (2) Diagnostic efficiency: QTmax, QTmin, QTd, QTcmax and QTcd had a certain diagnostic value in children and adolescents with VVS-CI ( P<0.001). QTd had the largest area under the curve (AUC) (0.914), and had a sensitivity of 86.30% and a specificity of 84.95% at the optimal cut-off value of 28.50 ms for VVS-CI diagnosis.(3) Prognostic evaluation value: QTmax, QTd, QTcmax, QTcmin, QTcd had an estimated value for the prognosis of VVS-CI in children and adolescents ( P<0.05 or 0.01). QTd had the largest AUC (0.906) and the best cut-off value was 34.50 ms, the sensitivity to predict response to VVS-CI intervention was 90.00%, and the specificity was 82.35%. Conclusion:QTd of electrocardiogram has a good estimation value in the diagnosis and prognosis of VVS-CI in children and adolescents.

Objective To evaluate the clinical and coronary angiographic features of non-Q wave and Q wave myocardial infarction in the elderly. Methods The clinical history(including hypertension and diabetes), complication and in-hospital mortality, blood lipid, serum CK-Mb, LVEF, and the record of the coronary stenosis by angiography 3-4 weeks after infarction were investigated in non-Q wave and Q wave myocardial infarction patients. Results The clinical history and blood lipid did not differ significantly between the NQMI and QMI patients. NQMI patients had a significantly lower maximal peak 〔(68.7?18.6) mmol/L vs (108.6?17.3)mmol/L, P0.05), but occlusion rate of infarct-related vessels in NQMI patients were lower. Conclusions Prognosis of NQMI patients is better than that of QMI patients in acute-phase, and the occlusion rate of infarct-related vessels in NQMI patients were lower.

Objective To observe the changes of plasma neuropeptide Y(NPY) and neurotensin(NT) levels in patients with essential hypertension and the relationship between those changes and damage of cardiac function. Methods Eighty patients of essential hypertension and 28 normal controls were chosen. The cardiac function was divided into 3 classes on the standard of New York Heart Association(NYHA). The plasma NPY,NT concentration was determined by radioimmunoassay. Results The level of NPY in hypertension patients was higher than that of the normal controls(P

Objective To explore the familial genetic characteristics of twins syncope in children.Methods Four pairs of twins with unexplained dizziness,headache,chest tightness,chest pain,pre-syncope and syncope were received head-up tilt test (HUTT) and family history of syncope were inquired.The age,gender,clinical manifestations were analyzed and the HUTT hemodynamic response were performed,and interviewed via telephone.Results The onset age of 4 pairs of twins ranged from 7 to 12 years old,less than 15 years,the median age of the first syncope episodes.Cause of syncope was primarily standing(4/5 cases),2 pairs had syncope positive family history.HUTT hemodynamic response type was mainly vasodepressor syncope (4/5 cases).HUTT result and hemodynamic response type were not completely consistent in the same twins.One case of the first twins was vasodepressor syncope and postural orthostatic tachycardia syndrome.One case of the second twins was vasodepressor syncope,while the other was negative.The third twins were vasodepressor syncope.The fourth twins were negative.HUTT results of the 4 twins were diverse,indicating that environment,psychological factors may get involved in syncope episodes.Conclusions The familial genetic factors of the children with syncope may play an important role in the young age group.Environment and psychological factors may be induce syncope attack.HUTT results of twins are diverse.HUTT result and hemodynamic response type can be inconsistent in the same twin.

Objective To analyse the 24 h ambulatory blood pressure monitoring(ABPM)character-istics and effect of health education in children with orthostatic hypertension (OHT)retrospectively.Methods A total of 19 children[1 1 males and 8 females with mean age of (1 1.26 ±2.16)years]who were outpa-tients or had been hospitalized in the Second Xiangya Hospital of Central South University due to unexplained syncope,presyncope,and finally diagnosed as OHT after head up tilt test(HUTT).HUTT and ABPM were reexamined at 12 ~190(47 ±48 )days after receiving health education (including psychological guidance, avoiding sudden changes in posture,increasing the amount of water,avoiding syncope inducement,etc). Results (1 )ABPM parameters:there were no significant differences of ABPM parameters before and after health education respectively(P ﹥0.05,respectively).(2)After the health education,HUTT 3 min diastolic pressure[(71.89 ±1.60)mmHg vs.(76.47 ±8.49)mmHg,1 mmHg =0.133 kPa,t =2.785,P ﹤0.05]and diastolic blood pressure change[(7.37 ±4.98)mmHg vs.(12.42 ±3.27)mmHg,t =3.560,P ﹤0.05]de-creased than those before health education.(3 )Blood pressure pattern changes:after the health education,“dipper blood pressure”increased and “non-dipper blood pressure”decreased[42.1 %(8 /19)vs.31.6%(6 /19)and 57.9%(1 1 /19)vs.68.4%(13 /19),χ2 =0.452,P ﹥0.05,respectively].(4)OHT cure rate:after health education,to review the HUTT,within 3 minutes in HUTT,blood pressure changes of 14 cases were normal range.The cure rate was 73.7%.Conclusion OHT children's blood type is given priority to with “non-dipper blood pressure”,and the ratio of“dipper blood pressure”increase and the HUTT 3 min di-astolic pressure and diastolic blood pressure change decrease after health education.It suggests that the health education of OHT children has a certain clinical effect.

Objective To investigate the effect of adipose tissue-derived mesenchymal stem cells (ADMSCs) transplanted by different Methods on cardiac function of rabbits with dilated cardiomyopathy.Methods 50 white ears rabbits were given doxorubicin by intraperitoneal injection to induce dilated cardiomyopathy, and randomly divided into the model group 1, model group 2 and control group. The ADMSCs isolated and cultured in vitro were transplanted into dilated cardiomyopathy rabbits of model group 1 through multi-points injection in myocardium, and were transplanted into rabbits of model group 2 through coronary artery transplant. Those in the control group were treated with IMEM medium of the same volume through multi-points injection in myocardium. Rabbits were fed for 4 week successively and then were killed to obtain heart sample, and the survival and differentiation of transplanted cells were observed through fluorescence microscope. Before transplantation and 4 weeks after transplantation, all rabbits received ultrasonic cardiogram test and haemodynamics test to determine cardiac function.Results After transplant through the two different Methods , ADMSCs could survive and differentiate in myocardial cells. 4 weeks after transplantation, the left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) reduced more significantly in the model group 2 compared with the model group 1 ( P<0.05～0.01), and LVSV, ejection fraction (EF), left ventricular systolic pressure, +dp/dtmax, -dp/dtmax increased more significantly ( P<0.05～0.01).Conclusion Transplanted ADMSCs can survive and differentiate in myocardial cells, and improve the heart function in rabbits with dilated cardiomyopathy. It is more conducive to the effectiveness of ADMSCs to improve the heart function through the method of coronary artery transplant.

Objective To evaluate the clinical value of Multi-slice Spiral CT(MSCT) and coronary artery imaging in diagnosing coronary artery myocardial bridges (MBs). Methods Image data of 285 patients from July 2005 to July 2008 who accepted both the MSCT and coronary angiography CAG at our hospital were collected. Diagnostic performance of the two Methods were analysed and the diagnostic accuracy were compared. Results In 285 cases of patients with MSCT examinations, 82 coronary artery were diagnosed in 59 cases, the detection rate of which was 20.7%. In contrast, 16 cases were diagnosed by CAG and the detection rate was 5.6%. In the 82 coronary artery diagnosed by MSCT, 42 coronary artery were single vessel, the proportion was 71.19%. Others were two vessels or three vessels. There were 67 in left anterior descending artery (LAD),in which 52 were near the middle and 15 were distal. 26 MBs diagnosed by MSCT were included in the 28 MBs diagnosed by CAG. Put CAG as the gold standard of myocardial bridge detecting, then MSCT's sensitivity was 92.86%. Conclusion MSCT coronary artery imaging can accurately show the anatomical relationship between coronary artery and myocardial and it is one of the preferred method of diagnosing coronary artery.