OBJECTIVE:To observe therapeutic efficacy and safety of Milrinone injection in the treatment of hypertensive heart disease complicated with heart failure. METHODS:A total of 120 patients with hypertensive heart disease complicated with chronic heart failure were randomized into control group and observation group according to random number table,with 60 cases in each group. Control group received routine therapy,including blood pressure controlling,anti-heart failure and other symptomatic treatment;observation group was additionally given Milrinone injection 0.3 mg/kg,continuous pump,qd. A treatment course lasted for 5 d. Both groups received one course of treatment each month for consecutive 6 months. Both groups were followed up for one year. 6 min walking distance(6MWD),BNP,LVEF,CI,LVEDD,heart rate,sitting systolic blood pressure(SiSBP)and sitting diastolic blood pressure(SiDBP),re-hospitalization rate and cardiovascular mortality were observed in 2 groups before treatment, after 3,6 months and 1 year of treatment;therapeutic efficacy of heart function and the incidence of ADR were compared between 2 groups. RESULTS:Before treatment,there was no statistical significance in 6MWD,BNP,LVEF,CI,heart rate,SiSBP and SiDBP between 2 groups;after 3 months,6 months and 1 year of treatment,6MWD,LVEF and CI of 2 groups were increased significantly,while BNP,LVEDD,resting heart rate,SiSBP and SiDBP were decreased significantly;the observation group was significantly better than the control group,with statistical significance(P<0.05). Total response rate of heart function was 90.00%in observation group,which was significantly higher than 63.33% in control group,with statistical significance(P<0.05). After 1 year of follow-up,re-hospitalization rate of observation group was significantly lower than that of control group,with statistical sig-nificance (P<0.05);there was no statistical significance in cardiovascular mortality (P>0.05). There were no statistical signifi-cance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Milrinone injection shows good efficacy in the treatment of hypertensive heart disease complicated with heart failure,can significantly reduce BNP and re-hospitalization rate as well as improve prognosis with good safety.

AIM: To investigate the contribution of angiotensin-converting enzyme inhibitor (ACEI) to the regulation of calpain system in infarcted myocardium. METHODS: Rat myocardial infarction (MI) model was established by permanent ligation of the left coronary artery. The treatment with the ACEI inhibitor rampril (1 mg?kg~-1 ?d~-1 ) was started 7 days prior to surgery. On day 1, 3, 7 and 14 after MI, protein levels of calpainⅠ, Ⅱ and calpastatin were determined in left ventricular free wall (LVFW), interventricular septum (IS) and right ventricule. RESULTS: CalpainⅠprotein level was increased in IS 14 d post MI, whereas the protein level of calpainⅡ was maximally increased in LVFW 3 d post MI. Rampril decreased protein up-regulation of calpainⅠ and Ⅱ, and reduced infarct size and interstitial fibrosis. Calpastatin protein expression was not affected by ACEI. CONCLUSIONS: CalpainⅠ is involved in cardiac remodelling in the late and calpainⅡ contributes to cardiac tissue damage in the early phase of MI. The heart protective effect of ACEI may be related to the inhibition of calpain system in the pathogenesis of myocardial infarction.

Objective To observe the effect of rosuvastatin on serum hs-CRP,IL-18 levels in patients with acute myocardial infarction.Methods By randomized,double-blind,controlled study,102 patients with acute myocardial infarction were randomly divided into the treatment group(rosuvastatin 10mg/d,continuous medication 14d) and the control group(not used rosuvastatin,other treatment and care were same with the treatment group).Before treatment,24h after treatment,after 2 months of follow-up,the serum hs-CRP and IL-18 levels were detected and compared.Results After treatment,the serum hsCRP level increased and then decreased,24h after treatment,the serum hsCRP level of the treatment group increased to (15.54 ±2.51) mg/L,which was significantly lower than the control group (19.26 ±.2.92) mg/L (t =4.65,all P ＜ 0.05).2 months after treatment,the serum hs-CRP levels of the two groups were decreased to (3.21 ± 1.39) mg/L and (7.67 ± 2.07) mg/L,the difference was statistically significant (t =5.54,4.63,all P ＜ 0.05).After treatment,the serum IL-18 level decreased,24h after treatment,the serum IL-18 level ofthe treatment group decreased to (29.13 ±6.34)pg/L,which was significandy lower than the control group (33.01 ± 7.34) pg/L(t =3.59,P ＜ 0.05).2 months after treatment,serum IL-18 levels of the two groups were decreased to (27.52 ± 5.33) pg/L and (32.01 ± 6.24) pg/L,the difference was statistically significant (t =3.87,3.28,P ＜0.05).Conclusion Rosuvastatin can significantly reduce the serum hsCRP and IL-18 levels in patients with acute coronary syndrome,it has better anti-inflammatory effect and can be used as a new therapeutic target for acute myocardial infarction.

Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL

Objective To investigate whether myocardial dysfunction and perfusion impairment had happened in diabetes mellitus(DM)rats,and to assess the relationship between them by using myocardial contrast echocardiography(MCE)and velocity vector imaging(VVI).Methods MCE and VVI were performed from the short-axis views of the mid-left ventricular level both at rest and after dipyridamole stress in control rats and DM rafs(12 weeks after induction with streptozotocin).MCE-derived myocardial blood flow(MBF)and myocardial flow reserve(MFR)and VVI-derived circumferential strain rate(SRc)and SRc reserve were obtained.Results SRc(absolute value)and MBF in the DM group were significantly lower than those in the control group at rest(P =0.03 for SRc and P =0.005 for MBF).SRc reserve and MFR in the DM group were significantly lower than those in the control group after dipyridamole stress (P =0.000 for SRc reserve and P =0.014 for MFR).There was no significant correlation between SRc and MBF at rest in the DM group(r =0.189,P =0.453).However,significant negative correlation existed between SRc reserve and MFR(r =-0.658,P =0.003).Conclusions Both myocardial systolic function and perfusion are impaired in DM rats.The decrease of MBF might not be the predominant determinant of myocardial systolic dysfunction at rest.However,the impairment of MFR could be an important contributor to the decrease of myocardial contractile reserve.

Objective To study 18F-deoxyglueose positron emission tomography computed tomo graphy(18 FDG PET-CT) in the diagnosis of cervical lymph node(LN) metastasis from rabbit nasopharyngeal VX2 carcinoma.Methods Nasopharyngeal VX2 carcinoma model using 30 rabbits was established. 18 FDG PET-CT,MRI and pathological diagnosis were performed and compared.ResultsFifty-three cervi cal LNs were picked up from resected specimens of 30 rabbits with nasopharyngeal VX2 carcinoma.There were 42 pathologically confirmed positive LNs.Positivity rate was significantly correlated with the volume and the shortest diameter of the LNs (r = 9.18,P =0.007 ; r = 2.77,P = 0.008).The diagnostic sensitivity of PET-CT was 96% (24/25) and 29% (5/17) for LNs with volume >0.5 cm3 and ≤0.5 cm3 ,83% (25/30) and 33% (4/12) for LNs with the shortest diameter ≥0.5 cm and < 0.5 cm,respectively.The diagnostic sensitivity,specificity and accuracy of PET-CT was 69% (29/42) ,100% (11/11) and 95% (40/42) ,com paring with 60% (25/42) ,91% (10/11) and 83% (35/42) of MRl,respectively.The volume measured by PET-CT images was not significantly different from the pathologically measured volume (t =-1.23,P = 0.233) ,while the volume measured by MRI was significantly different from the pathologically measured vol ume (t =-3.99,P = 0.001).Conclusions The sensitivity,specificity and accuracy of PET-CT are better than those of MRl,especially for the cervical lymph nodes with volume >0.5 cm3 or the shortest diameter ≤ 0.5 cm.PET-CT also can be used to detect the smaller metastatic lymph nodes,though the false negative rate is higher.

Objective To investigate the feasibility and clinical effectiveness of interventional ventricular septal defect(VSD) occlusion using asymmetric occluders in patients whose VSD are adjacent to aortic valves.Methods One hundred and fifty-two patients from our hospital whose VSD were occluded with asymmetric occluders were examined by echocardiography.Dimensions,shapes and shunts of VSD,structures around defects were observed and aortic valve prolapse(AVP) degrees were accessed before the interventions.The patients were followed up periodically after the procedures.The longest follow-up was 6 years.Results Sizes of VSD measured from left ventricular side were larger than those measured from right ventricular side.Twenty-seven cases with VSD had mild AVP.Right sides of defects had adhesions with variable morphological patterns in 85% patients with perimembranous VSD.After occlusion,there were 7 cases showed residual shunt,2 cases with the third degree atrio-ventricular blockages,3 cases appeared aortic-valve regurgitations (AR) and 1 case with slightly increased AR.Conclusions Immediate and medium-term effects of interventional occlusion with asymmetric occluders were satisfactory in the patients with VSD and mild AVP whose aortic valve margin were insufficient to symmetric occluders.Surgical operation should be preferred to patients with VSD and moderate to severe AVP and to very young children.Pre-closure echocardiographic evaluation is critical to the success of interventional closure with asymmetric occluder and the long-term out coming.

Objective To improve the diagnosis and treatment ot adrenocorticotropin-independent macornodular adrenal hyperplasia (AIMAH).Methods The clinical data of 17 cases with AIMAH from 2000 to 2011 were analyzed retrospectively,including 3 subclinical AIMAH,10 clinical AIMAH and 4 highrisk AIMAH patient,with common radiological characteristic of bilaterally enlarged adrenal glands with multiple nodules like ginger.The 3 cases of subclinical AIMAH patients presented with decreased serum ACTH,normal or slightly elevated plasma cortisol and urinary free cortisol level,no suppression following 1 mg overnight dexamethasone suppression test and absence of clinical signs of Cushing syndrome (CS).While clinical AIMAH and high-risk AIMAH presented with clinical signs of CS,elevated plasma cortisol and urinary free cortisol level,suppressed serum ACTH,loss of normal circadian rhythm in cortisol secretion and no suppression following the low-dose and high-dose overnight dexamethasone suppression test.Among the 4 cases of high-risk AIMAH,2 cases presented with osteoporosis,2 cases with hepatic dysfunction,3 cases with cardiopulmonary dysfunction,and 4 cases with severe hypertension.Three cases of subclinical AIMAH were treated with symptomatic treatment,10 cases of clinical AIMAH patients with surgical operation,4 cases of high-risk AIMAH patients with ketoconazole and surgical operation.Results Three subclinical AIMAH patients received symptomatic treatment and discharged from hospital with normal blood pressure and blood glucose.During the period of follow-up from 3 months to 3 years,endocrine results were normal.Seven clinical AIM AH patients underwent unilateral adrenal tumor resection plus ipsilateral partial adrenalectomy or total adrenalectomy.CS disappeared completely after 6 to 9 months.Two clinical AIMAH patients underwent simultaneous bilateral adrenalectomy.One case died of adrenal crisis after operation,and the other case presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy,no Nelson's syndrome happened during the follow-up for 5 years.One clinical AIMAH patient undertook unilateral adrenalectomy twice by interval,followed by routine corticosteroid replacement therapy.Followed up for 10 years,no Nelson's syndrome happened.Four high-risk AIMAH patients received ketoconazole and then underwent right total adrenalectomy.Cortisol levels returned to normal after 1 to 2 months and during the follow-up for 1 to 3 years,the laboratory examinations maintained normal.Conclusions Different treatment methods should be adapted to different subtypes of AIMAH.For subclinical AIMAH,the principal treatment is symptomatic,and close follow-up with regular adrenal imaging and endocrine examination is required.Surgical operation should be performed when clinical symptoms of AIMAH appear.Medical management is essential for high-risk AIMAH to inhibit the production of cortisol at first.Once these patients could stand the stimulation caused by operation,the adrenal glands should be resected as soon as possible.The unilateral adrenalectomy is an effective treatment for clinical AIMAH.

Objective To investigate the development of early myocardial perfusion with myocardial contrast echocardiography (MCE) combined with dipyridamole stress echocardiography in diabetic rats . Methods The diabetes mellitus (DM) group comprised 40 male diabetic rats ,induced with streptozotocin . The control group comprised 40 normal male rats ,comparable body weights with the DM group .The DM group was divided into four subgroups (0 week ,2 weeks ,4 weeks and 8 weeks after diabetic model established) and the control group was also divided into four subgroups matched with the DM group .Each rat was performed with conventional echocardiography ,MCE at baseline and after dipyridamole stress .The reserve parameters were compared between the control group and the DM group .In addition ,the differences among four subgroups in the control group and the DM group were compared ,respectively .Results MCE demonstrated that the 4 weeks and 8 weeks DM subgroup had lower myocardial blood velocity reserve and myocardial blood flow reserve than the control subgroup .The myocardial blood volume reserve was reduced in the 8 weeks DM subgroup ,too .Conclusions The impairment of myocardial perfusion in the DM rats are detected earlier with the MCE combined with dipyridamole stress .

Objective To evaluate the feasibility, therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy (3DCRT) for loco-regionally recurrent esophageal cancer after initial radiotherapy. Methods Between March 2001 and May 2007, 42 patients with loco-reigonal recurrent esophageal cancer after initial radiotherapy were treated with 3DCRT, including 27 male and 15 female with a median age of 67.5 years. Radiotherapy was delivered at 1.8 -2.0 Gy per fraction, 5 fractions per week, with a median total dose of 54 Gy. Treatment outcomes and normal tissue complications were assessed with WHO and RTOG/EORTC criteria. Results By December 31,2008, the follow-up rate was 100%. Twenty patients had follow-up time of 1 year and the remaining 22 had 2 years. The clinical symptom relief rate was 60%, and the response rate was 90.5% with a complete remission rate of 17% and partial remission rate of 74%. The overall 1- and 2-year survival (OS) rates were 60% and 24%. Grade 2 and grade 3 acute radiation esophagitis developed in 31% and 5% of the patients, respectively. Grade 2 and grade 3 acute radiation pneumonitis developed in 19% and 2% , respectively. Grade 2 and grade 3 acute radiation hematology toxicities developed in 5% and 2%, respectively. Conclusions For patients with loco-regional recurrences of esophageal cancer after initial radiotherapy, 3DCRT is feasible, with a good clinical symptom relief rate and immediate tumor response. However,the complication rate was high and the clinical indications should be strictly controlled.