Objective: To analyze clinical features and prognosis of more than 75-year old patients with heart failure and preserved ejection fraction (HFPEF) through comparing with heart failure（HF）and reduced ejection fraction (HFREF), and provide reference for prevention and treatment of HFPEF. Methods: A total of 134 > 75 years HF inpatients admitted from Jan 2009 to Dec 2011 were selected. With left ventricular ejection fraction (LVEF) 50% as the critical point, patients were divided into HFPER group (n=63) and HFREF group (n=71). Clinical characteristics were compared between two groups. Clinical outcomes (all-cause death and rehospitalization caused by heart failure) were compared between two groups after follow up. Results: (1) Clinical features: compared with HFREF group, there were significant increase in LVEF [(36.46±6.84)% vs. (58.65±5.01)%], percentage of patients with hypertension (49.3% vs. 69.8%), left atrial diameter [(34.98±3.78) mm vs. (40.02±3.29) mm], and significant decrease in level of brain natriuretic peptide [BNP, (1005.62±458.99) pg/ml vs. (646.57±333.56) pg/ml], concentration of hemoglobin [(11.97±1.29) g/dl vs. (10.76±1.21) g/dl] and left ventricular diameter [(57.17±7.52) mm vs. (47.73±5.48) mm] in HFPEF group, P<0.01 all; (2) Patients were followed up for a mean 2.6 years. There were no significant difference in all-cause mortalities（17.5% vs. 19.7%）and mean time without heart failure event (286 d vs. 258 d) between HFPEF group and HFREF group. Conclusion: Compared with HF patients with reduced ejection fraction, hypertension and anemia are more frequent in HF patients with preserved ejection fraction, but there is no significant difference in clinical outcomes between them.

Objective:To learn and master the application of microwave technology in medical electron linear accelerator tube. Methods: Introduced the structure and principle of medical electron linear accelerator, traveling wave accelerating tube and standing wave accelerating tube;compared the structure, stable system and transport system of traveling wave accelerating tube standing wave accelerating tube. Results:standing wave accelerating cube have higher efficiency, shorter accelerating cube and electron gun, but have higher demand for pulse modulator, automatic frequency stabilization, the deflection system and microwave transmission systems. Traveling wave accelerating cube have lower efficiency, but have better energy spectrum and easy to adjust. Conclusion:Both traveling wave accelerating cube and standing wave accelerating cube were used in medical electron linear accelerator nowadays, it's easy to master medical electron accelerator after knowing the application of microwave in medical electron linear accelerator.

Objective To investigate the Preventive effect of sodium hyaluronate gel on postoperative adhesion of hysteroscopic intrauterine adhesions. Methods 84 cases of IUA patients undergoing hysteroscopy were retrospectively selected,and divided into two groups according to the different ways of prevention and control of IUA,42 cases in each group.The control group was treated with Foley balloon catheter after operation,the study group was treated with sodium hyaluronate gel prevention on the based of control group.The clinical signs of the patients before and after treatment one,two and three months were observed,the therapeutic effects and complication were compared between two groups. Results After treatment one,two and three months,the adhesion type score and the score scale of study group, were significantly decreased,and lower than the control group,the difference was statistically significant (P<0.05).The total effective rate of the study group was 90.48%,which was significantly higher than that of the control group (83.33%),the difference was statistically significant (P<0.05).In the course of treatment,the complication rate of the two groups was 11.90% (5/42),there was no significant difference between the two groups in the incidence of complications. Conclusion Hyaluronic acid sodium gel on hysteroscopic intrauterine adhesions in patients with postoperative adhesions have a significant preventive effect,can improve the treatment efficiency and clinical signs,and with high security.

Objective Using coded harmonic angiography to observe hepatocellular carcinoma blood perfusion features,further assess this modality clinical value in qualitative diagnosis of liver malignant tumor.Methods Through left forearm vein bolus injection of fluorine-carbon contrast agent,35 patients with 41 hepatocellular carcinoma lesions were examined with coded harmonic angiography,intratumoral vessel enhanced time,vascularity,blood perfusion were observed.All patients were simultaneously videotaped before and after contrast.Results It was about 15～20 s after the injection of contrast agent when the enhancement of tumor had just commenced,peak time about 60～90 s and persistence time about 240～300 s.Lesions were more obviously enhanced than normal liver tissue,several tumor vascularity was displayed from border to center,contrast agent gradually centripetal filled-in,formed "weeping-willow" echo.Pressed and rimlike peripheral vessel developments were earlier than normal liver tissue.Conclusions Coded harmonic angiography could real-timely display hepatocellular carcinoma blood perfusion,which has an important clinical value in qualitative diagnosis of liver malignant tumor.

BACKGROUND:It has been reported that treatment with granulocyte-colony stimulating factor (G-CSF) increases the abundance of circulating CD34+ cells in rats. Data from the study, more important, suggested that mobilized by G-CSF may enhance rapid reendothelization and reduce neointimal formation after vascular injury.OBJECTIVE: To evaluate whether BM-derived CD34+ cells could enhance rapid reendothelization and reduce neointimal formation after balloon-injured carotid artery in an intact rat model.DESIGN: Randomized control animal study.SETTING: Nanjing First Hospital Affiliated to Nanjing Medical University.MATERIALS: The experiment was carried out in Nanjing First Hospital from December 2005 to April 2006. A total of 40 male Sprague-Dawley rats, weighing 200-250 g and of SPF grade, were purchased from National Rodent Laboratory Animal Resources, Shanghai Branch. The recombinant human G-CSF was purchased from Qilu Pharmaceutical. The 2F Fogarty arterial embolectomy catheters were purchased from Edwards Lifesciences. Anti-human CD34 and anti-human CD45 were purchased from Multi Sciences.METHODS: SD rats were divided randomly into treated group (n =20) and control group (n =20). Subcutaneous injection of recombinant human G-CSF (100 μg/kg/day) once daily for 8 days for treated group. Control group as treated with subcutaneous injection of saline. Five days after initiation of G-CSF treatment or saline, the rats were anesthetized by intraperitoneal injection with ketamine. The left common carotid artery was exposed through a midline incision of the ventral side of the neck. A 2F Fogarty arterial embolectomy catheter was inserted through the external carotid artery,inflated with 200 μL air, and passed 3 times along the length of the segment, which was defined proximally by the carotid bifurcation and distally by the edge of the omohyoid muscle. After removal of the catheter, the proximal ligature of the external carotid artery was tied off. ① An average of 1 mL venous blood per rat was collected for enumeration of the white blood wells (WBCs) and CD34+ cells before and 5 days after initiating G-CSF or saline treatment. ② Ten rats in each group were killed with overdose ketamine at 14 and 28 days after balloon injury and left common carotid arteries were harvested. The luminal surface of carotid arteries (n =5, each group) was exposed to calculate the reendothelialized area, which was manually traced with software (Image ProPlus). Reendothelialized area = non-stained with Evans blue area/the total area of balloon-injuried. The cross sections of carotid arteries (n =5, each group) were stained with hematoxylin and eosin (HE) and calculated intima-to-media area ratio (I/M) with software (Image ProPlus) to assess the extent of neointimal thickening. ③ To evaluate the extent of reendothelialization of arteries injury, sections were stained with CD31 and vWF by immunohistochemistry analysis.MAIN OUTCOME MEASURES: ① The number of WBCs and CD34+ cells; ② the extent of reendothelialization of arteries injury; ③ the extent of neointimal hyperplasia (I/M); ④ CD31 + and vWF+ endothelial cells.RESULTS: A total of 40 rats were involved in the final analysis. ① The number of WBCs and CD34+ cells: After 5 days of treatment, the number of WBCs in the treated rats increased more than 2.7-fold compared with control group [(27.60±2.45) ×109 L-1, (10.11±1.81) ×109 L-1, P ＜ 0.01], CD34+ cells increased more than 12.2-fold compared with control group (38.31×107 L-1, 3.14×107 L-1, P ＜ 0.01). ② The extent of reendothelialization: At 14 and 28 days after balloon injury,carotid artery of reendothelialization in the treated group were (68.3±8.3)％ and (97.6±4.1)％, superior than the control group (33.8±6.3)％ and (76.1±5.2)％ (P ＜ 0.01). ③ The extent of neointimal hyperplasia: At 14 and 28 days after balloon injury, the neointima-media (I/M) ratios in the treated rats were 0.39±0.11 and 0.45±0.09, less than the control group 0.87±0.15,1.26±0.16 (P ＜ 0.01). A highly significant inhibition of neointimal hyperplasia was observed in the treated group. ④ CD31+ and vWF+ endothelial cells: At 28 days after injury, sections from G-CSF treated group showed almost complete and continuous monolayer of CD31 and vWF positive cells.In contrast, a patchy and interrupted CD31 and vWF positive cells were found lining the lumen of control group.CONCLUSION:Treatment with G-CSF significantly increases the number of CD34+ cells and accelerates the rate of reendothelialization of injured vessels, leading to marked inhibition of neointimal formation after vascular injury in rats.

Objective To explore the outcome, recurrence rate and postoperative MRI of the modified microendoscopy discectomy (MED) and the conventional MED. Method A total of 107 patients with disc herniation treated from January 2005 to December 2009 were randomly divided into Group A (54 patients) and Group B (53 patients). The patients in Group A were treated with the modified MED that removed the prominent nucleus pulposus but did not access into the annulus. The patients in Group B were treated with traditional MED that removed the prominent nucleus pulposus and cut annulus fibrosus and removed the nucleus pulposus within the annulus fibrosus. The operation outcome, recurrence rate and lumbar spine MRI were compared for observing the morphological changes of intervertebral disc and its surrounding structures. Results All patients were followed up for 1-4 years ( average 2 years),which showed no recurrence in Group A but four patients with recurrence Group B. According to Japanese orthopedic association (JOA) scoring of low back pain, the efficacy was excellent in 51 patients (94%)and good in three (6%), with excellence rate of 100% in Group A; while the efficacy was excellent in 42 patients (79%), good in seven (13%) and poor in four (8%), with excellence rate of 92% in Group B. Videman semi-quantitative assessment of disc signal showed no significant difference of MRI in aspects of signal intensity, thickness, diameter of the spinal canal in Group A before and after operation but highlighted significant differences in protruding degree,spinal canal diameter and lateral recess diameter. Substantial differences of MRI in aspects of signal intensity, thickness, protruding degree, spinal canal diameter and width were observed before and after operation in Group B. There was no significant difference in spinal canal diameter. Conclusions Both methods have sound clinical efficacy. However, the modified MED procedures take advantages of minimizing the damage of disc structure, maintaining the relative stability of the spine and delaying the disc degeneration, which contributes to lower recurrence rate.

Objective To construct siRNA expression vector of XIAP,and study its effect on XIAP expression in Hep3B cells. MethodsThree XIAP siRNA sequences were designed,synthesized,and cloned to pRNAT-U6.1/Neo.The successfully constructed recombinant plasmid was determined by sequence analysis,and will be transfected into Hep3B.The best interference plasmid were analyzed by RTPCR,Western blot,and immunohistochemistry.Results The plasmid of pRNAT-U6.1/Neo-XIAP was constructed successfully,the trans-fected with different plasmid of siRNA XIAP can lower significantly XIAP.Conclusions The siRNA vector of XIAP gene was constructed successfully.It will be a basis for the study of XIAP function in apoptosis regulation of the Hepatoma cells.

Objective To investigate early changes of angiopoietin-2(Ang-2)in multiple trauma patients and assess its clinical significance.Methods Forty-five multiple trauma patients aged 2060 years admitted to the hospital within one hour after injury were randomly divided into three groups according to injury severity score(ISS).Blood specimens were obtained immediately upon arrival in the emergency department and plasma samples were assayed for comparing changes of Ang-2,TNF-a and IL-6.Meanwhile,plasma level of Ang-2 was measured and analyzed under different oxygenation index,shock index and base deficit.Results Plasma level of Ang-2 was positively correlated with ISS(P ＜ 0.01)and was concordant with the plasma levels of TNF-a and IL-6(P＜0.01).Furthermore,plasma level of Ang-2 was elevated upon increase of shock index or decrease of oxygenation index(P ＜ 0.01).Plasma level of Ang-2 was elevated with the increase of base deficit(P ＜ 0.01).Conclusions High level of Ang-2 is a marker of endothelial activation and dysfunction early after trauma.Ang-2 is related tightly with the injury severity,inflammation factors,systemic oxygenation and tissue hypoperfusion and may have a tight relation with pathophysiological development and clinical outcome after trauma.

Objective To quantify the concentration of peripheral blood plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with acute pancreatitis (AP) and to explore its value in assessment of the severity of AP.Methods From June 2011 to March 2012,83 patients with AP were selected,among those 43 cases were mild acute pancreatitis (MAP) and 40 were severe acute pancreatitis (SAP).The control group included 30 healthy individuals.The peripheral blood of patients with AP and healthy controls was collected,and plasma was isolated after centrifuged.The concentration of NGAL in plasma was detected by enzyme-linked immunosorbent assay (ELISA).The t-test was performed for comparison between groups.The correlation between the concentration of NGAL in plasma and clinical parameters of AP was analyzed by Spearman rank order correlation analysis.The diagnosis value of the concentration of NGAL in SAP was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).Results The concentration of plasma NGAL in AP group ((10.30± 5.97)nmol/L) was higher than that in healthy control group ((1.94±1.35) nmol/L) and the difference was statistically significant (t=11.924,P＜0.01).The concentration of plasma NGAL in SAP group ((14.61 ±5.28) nmol/L) was higher than that in MAP group ((6.27±-3.09) nmol/L) and healthy control group,the differences was statistically significant (t=8.677 and 14.539,both P＜0.01).The concentration of plasma NGAL of AP patients was positively correlated with acute physiology and chronic health evaluation-Ⅱ score,Ranson score,bedside index for severity in acute pancreatitis score,computed tomography (CT) severity index,C-reactive protein,white blood cells and the days of hospitalization (r=0.651,0.556,0.514,0.620,0.320,0.458 and 0.346,all P＜0.05).The area under the ROC curve of plasma NGAL concentration in diagnosis of SAP was 0.926 (95％CI:0,870-0.983).The cutoff value of plasma NGAL level in diagnosis of SAP was 8.44 nmol/L.The sensitivity and specificity was 87.5 ％ and 88.9％,respectively.Conclusions Plasma NGAL level is correlated with the severity of patients with AP.NGAL may be one of the markers for the early diagnosis of SAP.