Objective To measure right ventricular longitudinal strain (RVLS) of pulmonary hypertension(PH) patients by two-dimensional speckle tracking echocardiography,and explore its clinical application value on evaluating right ventricular function and hemodynamics in PH.Methods A total of 66 patients diagnosed as PH by right-heart catheterization were divided into Group Ⅰ (WHO FC Ⅰ / Ⅱ) and Group Ⅱ(WHO FC Ⅲ/Ⅳ) according to WHO pulmonary hypertension function classification.The right ventricular function parameters included:global right ventricular longitudinal strain (RVLSglobal),free-wall right ventricular longitudinal strain (RVLSFw),tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (FAC),tissue Doppler-derived tricuspid lateral annular systolic velocity (s') and right ventricular index of myocardial performance (RIMP).Systolic pulmonary artery pressure (sPAP) was calculated through tricuspid regurgitation pressure gradient.Hemodynamic parameters include:mean pulmonary arterial pressure (mPAP),pulmonary vascular resistance (PVR),pulmonary capillary wedge pressure (PCWP) and cardiac index (CI).Results ①Compared with Group Ⅰ,Group Ⅱ presented with higher sPAP (P ＜0.05).There also were significant differences between two groups in RVLSglobal,RVLSFw (P ＜0.01) and conventional right ventricular function parameters:TAPSE,RIMP and s' (P ＜0.05).②mPAP,PVR and CI had significant difference between two groups (P ＜0.01),while PCWP had no significant difference.mPAP and PVR increased more remarkable and CI decreased more significant in Group Ⅱ.③RVLSglobal had positive correlation with mPAP (r =0.646,P =0.000) and PVR (r =0.628,P =0.000) measured by right-heart catheterization;RVLSFW also had positive correlation with mPAP (r =0.652,P =0.000) and PVR (r =0.634,P =0.000).Conclusions Right ventricular longitudinal strain could evaluate the degree of decrease in right ventricular function of PH patients and reflex the change of hemodynamics at the same time,which may offer more reliable information to clinical treatment.

Objective To evaluate right ventricular systolic function in patients with pulmonary hypertension (PH) by real-time three-dimensional echocardiography (RT-3DE),and compared with cardiac magnetic resonance.Methods A total of 23 patients with PH who underwent MRI and echocardiography in the study.Right ventricular index of myocardial performance (RIMP),fractional area change (RVFAC),tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler-derived tricuspid lateral annular systolic velocity (S') were measured by echocardiography.RV end-diastolic volume (RVEDV) and endsystolic volume (RVESV) were measured by RT-3DE and cardiac magnetic resonance and RV ejection fraction (RVEF) was calculated.Results A positive correlation was found between RVFAC and RVEF (r =0.595,P =0.003),there was a negative correlation between RIMP and RVEF (r =-0.745,P =0.000),has no correlation between TAPSE and RVEF (r =-0.029,P =0.896),a positive correlation was found between S' and RVEF (r =0.489,P =0.018).There were close correlation between RVEDV,RVESV and RVEF measured by RT-3DE and MRI (P ＜0.001,respectively);Bland-Altman analyses showed good agreement between them.Conclusions RT-3DE can noninvasive,accurate assessment right ventricular systolic function in patients with PH,and provide prognosis and treatment choice for clinical demands.

Objective　To explore the expression of Fas ligan d (FasL) protein in human non-small cell lung cancer (NSCLC) and its clinic al significance. Methods　Expression of FasL protein was detecte d by immunohistochemical method in 32 resected tumors of NSCLC. Results 　FasL protein was detected in all of these 32 resected tumors with variant pos itive expression levels ranging from 3.0% to 98.7% ［mean (62.0±32.0)%］. T here wa s significant difference between the tumors of different pathological types no s ignificant difference was found between the tumors of different differentiation nor among the tumors of different pTNM stages (P>0.05). Conclusion　 The results indicated that NSCLC can counterattack the immune cells of t he body and may be the molecular basis for the easily metastasis of adenocarcino ma to in the early stage.

Objective To investigate the related factors of early angina after acute myocardial infarction,and to provide basis for the disease prevention and control.Methods 1 32 cases with acute myocardial infarction were selected.The clinical data were collected.The occurrence rate of early angina pectoris after acute myocardial infarc-tion,and clinical characteristics were analyzed.The related factors of acute myocardial infarction angina were explored.Results The incidence rate of early angina pectoris after acute myocardial infarction was 29.55%.Within 7 days after acute myocardial infarction occurred angina,the highest rate for 64.1 0%,followed by 7 -1 4 days in the occurrence of angina pectoris,28.21 %.34 cases were the original location of myocardial infarction ischemia and 5 cases were the far part of ischemia,21 cases showed ST segment elevation,1 8 cases showed ST lack blood group downward.Anterior wall,inferior wall infarction composite,successful thrombolytic therapy recanalization,myocardial infarction before episodes of angina pectoris,history of hypertension,heart function classification more than or equal to grade III in patients with acute myocardial infarction occurred after the proportion of early angina pectoris were signifi-cantly higher (all P <0.05).Conclusion Anterior wall,inferior wall infarction composite,successful thrombolytic therapy recanalization,myocardial infarction before episodes of angina pectoris,history of hypertension and cardiac functional grading more than or equal to grade III are related to early angina pectoris after acute myocardial infarction. We should actively take measures aimed at early prevention and treatment of early angina pectoris after acute myocar-dial infarction to avoid illness aggravating,improve the patients'prognosis.

Objective To analyze the polymorphisms of glycosylphosphatidylinositol-specific phospholipase D (GPI-PLD) gene Exon1 and Exon25,GPI-PLD activity of leucocyte in peripheral blood and their relationship in systemic lupus erythematosus patients of Han nationality in Hunan Chinese.Methods The polymorphisms were analyzed by PCR-SSCP and sequencing. GPI-PLD levels were determined by using glycosylphosphatidylinositol (GPI) anchored placental alkaline phosphatase (PLAP) as substrate and triton-X114 partioning.Results There were fourteen variations in the coverage of GPI-PLD gene Exon 1 of both 109 healthy persons' and 62 systemic lupus erythematosus patients',including seven variations at transcriptional start site upstream and seven variations at Exon1. The codons of variation were 14TTG→AAG (Leu14Lys),17CTC→GTC (Leu17Val),20AGA→AAA (Arg20Lys),21GGT→GGG (Gly21Gly),30GTA→ATA (Val30Ile),which leaded to four missense mutations and one synonymous mutation. In addition, the frequency of the variation at transcriptional start site upstream -24 C→T was significantly different between healthy control and systemic lupus erythematosus patients. At meanwhile, there was a variation in Exon25, the +60496 G→A, between two groups. The total various frequency, which was determined by SSCP, of healthy person was 33 03 percent and systemic lupus erythematosus patient was 25 81 percent. On the basis of the percentage of GPI-anchored PLAP conversion, the leucocyte GPI-PLD activities of total 62 systemic lupus erythematosus patients were measured. As compared with 109 healthy persons as control group, the leukocyte GPI-PLD activities of systemic lupus erythematosus patients were significantly raised, but GPI-PLD activities were not correlated with polymorphism sites significantly.Conclusions The leukocyte GPI-PLD gene in peripheral blood, which belongs to healthy persons and systemic lupus erythematosus patients of Han mationality in Hunan Chinses,is polymorphism.The frequency of transcriptional start site upstream -24 is significantly different between healthy control and systemic lupus erythematosus patients.The leukocyte GPI-PLD activeties of patients' also significantly increase.

Objective To discuss the correlation between right ventricular function and systolic pulmonary artery pressure (PASP ) in patients with chronic thromboembolic pulmonary hypertension (CTEPH)and explore the change of right ventricular function under different degree of PASP.Methods One hundred and thirty-seven CTEPH patients were divided into four groups by PASP:Group Ⅰ (50 mmHg≤PASP<70 mmHg),20 cases;Group Ⅱ (70 mmHg≤PASP<90 mmHg),35 cases;Group Ⅲ,55 cases (90 mmHg ≤ PASP < 1 10 mmHg);Group Ⅳ (PASP ≥ 1 10 mmHg),27 cases.Echocardiographic parameters include:PASP,tricuspid regurgitation area (ATR ),left ventricular transverse diameter (LVTD), right ventricular transverse diameter (RVTD),inner diameter of main pulmonary artery (DMPA ),inner diameter of left arterial branch (DLPA ),inner diameter of right pulmonary arterial branch (DRPA ).Right ventricular function parameters include:tissue Doppler-derived tricuspid lateral annular systolic velocity (s'),tricuspid annular plane systolic excursion (TAPSE),RV index of myocardial performance (RIMP)and right ventricular fractional area change (FAC).Results There were significant differences in RVTD, TAPSE,FAC and RIMP in CTEPH patients under different PASP(P <0.05).RV structure and function was significantly correlated with PASP in CTEPH patients.With the elevation of PASP,RV was significantly enlarged and RV function becomes worse.Conclusions Echocardiography may contribute to evaluate RV function in CTEPH patients and provide basis for clinical treatment and prognosis evaluation.

Objective To assess the right atrial(RA) function using two-dimensional speckle-tracking echocardiography(2D-STE) and the value of predicting WHO functional class in patients with pulmonary hypertension(PH).Methods Fifty-four consecutive PH patients were studied and compared with a control group of 24 healthy volunteers.RA function was evaluated by 2D-STE,and the following parameters were recorded:an average longitudinal strain (LS) curve that included LSpos during RA filling and LSneg representing RA active contraction (their summation is LStot),the phasic RA volumes,total RA emptying fraction (TotEF),RA passive(PassEF) and active emptying fraction(ActEF).The associations between these indices and the results of invasive pulmonary hemodynamics,cardiac structure and function level were evaluated.Results LStot,TotEF,LSpos,PassEF were significantly lower in PH patients than in controls(all P<0.01).ActEF/TotEF were significantly higher in WHO functional class (WHO-FC) Ⅱ and WHO-FC Ⅲ patients than in controls(all P<0.05),while were lower in WHO-FCIV patients than in controls(P<0.001).Among PH patients,LStot was negatively correlated with greater RA size and RA pressure (all P<0.01).LStot was also associated with right ventricular (RV) functional and overload parameters.In receiver-operator characteristic analysis,RA LStot was of optimal accuracy for prediction of WHO-FC≥Ⅲ in PH patients (P=0.002).Conclusions PH is associated with impaired reservoir and conduit function,but active contract function of RA is enhanced in WHO-FC Ⅱ and WHO-FC Ⅲ patients,and reduced in WHO-FCIV patients.RA LStot confers an optimal predictive effect of poor WHO-FC in PH patients and indicating prognosis.

With the continuous improvement of treatment ability in intensive care unit (ICU), many critically ill and complex patients have survived due to the development of technology. However, most of them suffer from the psychological and physiological problems of post-intensive care syndrome (PICS). Therefore, the early identification and prevention of PICS is particularly critical. We should understand the pathophysiological mechanism of PICS, strictly implement ABCDEFG bundle management measures [including airway management (A), breath (B), reasonable analgesia and sedation treatment (C), prevention of delirium (D), early rehabilitation (E), family engagement (F), good communication (G)] during ICU hospitalization, and pay attention to reasonable nutritional support, optimizing blood glucose management, providing positive psychological intervention and support to patients through family members' encouragement and accompanying, ICU diary and other forms, following up the health status of patients transferred out/discharged from ICU, providing multi-disciplinary and professional continuing medical services, finding the entry point and timing of traditional Chinese medicine intervention, and giving full play to the advantages of integrated traditional Chinese and Western medicine treatment, which can improve the quality of life of patients. This article reviews the pathophysiological mechanism, risk factors, prevention and management measures, traditional Chinese medicine syndrome differentiation and treatment of PICS, in order to improve the early identification, diagnosis and treatment of critical patients with PICS, and improve the prognosis of patients.

Objective To investigate the ideal reconstruction methods after pelvic tumor resection and to assess the feasibility of three-dimensional (3D) printing technology for pelvic reconstruction,we performed a retrospective study of patients with pelvic tumors who received tumor resection and reconstruction using 3D-printed pelvic endoprostheses.Methods Thirty-five patients received tumor resection and functional reconstruction with 3D-printed pelvic endoprostheses in our center from Sep.2013 to Dec.2015.According to Enneking' s classification,there were 3 cases of Type Ⅰ,12 cases of Type Ⅱ+Ⅲ,5 cases of Type Ⅰ+Ⅱ,2 case of Type Ⅰ+Ⅱ+Ⅲ,10 cases of type Ⅰ+Ⅱ+Ⅳ and 3 cases of type Ⅰ+Ⅱ+Ⅲ+Ⅳ resection.Methods of reconstruction included 3 patients with 3D-printed iliac endoprosthesis,12 patients with 3D-printed standard hemipelvic endoprosthesis and 20 patients with 3D-printed screw-rod connected hemipelvic endoprosthesis.Results All 35 patients underwent en bloc resection.Margins were wide in 15 cases,marginal in 14 cases and intralesional in 6 cases.After a mean followed-up of 20.5 months (6 to 30),25 patients survived without evidence of disease,5 patients were alive with diseases and 5 patients died of distant metastasis.Complications included 7 cases of delayed wound healing,2 cases of hip dislocation and no cases of deep infection.The average MSTS 93 score was 19.1 (9-26) for all of the 30 alive patients,22.7 (20 to 25) for 3 patients with iliac endoprosthesis reconstruction,19.8 (15 to 26) for 12 patients with standard hemipelvic endoprosthesis reconstruction,and 17.7 (9 to 25) for 15 patients with screw-rod connected hemipelvic endoprosthesis at the last follow up.Conclusion The application of 3D-printing technology could facilitate precise matching and osseointegration between the implants and host bone.Our clinical results proved that application of 3D-printed pelvic endoprostheses for reconstruction of bony defect was safe without additional complications,and that good functional results could be expected during short-term follow-up.

Objective To investigate the role of hypoxia-inducible factor-1α/ hexokinase Ⅱ (HIF-1α/HKⅡ) signaling pathway in the inhibition of hypoxia/reoxygenation (H/R)-induced apoptosis in the rat cardiomyocytes by hypoxic preconditioning (HPC).Methods Primarily cultured cardiomyocytes obtained from the neonatal rats were seeded in culture dishes at the density of 5× 105cells/ml.The cardiomyocytes were attached to the wall for 72 h and then randomly divided into 6 groups (n=15 each) using a random number table:control group (group C);group H/R;group HPC;HIF-1o inhibitor YC-1 group (group YC-1);group HPC + YC-1;dimethyl sulfoxide (DMSO) group.The ceils were exposed to D-Hank solution saturated with 95％ N2 and 5％ CO2 for 4 h,and then cultured in the normal culture atmosphere for 2 h.The cells in YC-1 and DMSO groups were incubated in the culture medium containing 10 μmol/l YC-1 and 0.1％ DMSO (100 μl) for 24 b,respectively.HPC was induced by 3 cycles of 10 min hypoxia followed by 30 min reoxygenation,and H/R injury model was then established in group HPC.In group HPC+YC-1,the cells were incubated for 5 min in the M199 culture medium supplemented with 10 μmol/L YC-1 and 10％ fetal bovine serum,and the other treatments were similar to those previously described in group HPC.After the end of treatments,the apoptosis in cardiomyocytes was detected by TUNEL,the expression of HIF-1α,HKⅡ and cytochrome c was detected by Western blot,and the mitochondrial membrane potential was quantitatively measured using fluorescence.Apoptotic rate was calculated.Results Compared with group C,the apoptotic rate was significantly increased,the mitochondrial membrane potential was significantly decreased,and the expression of HIF-1α,HKⅡ and cytochrome c was significantly up-regulated in group H/R (P＜0.05).Compared with group H/R,the apoptotic rate was significantly decreased,and the mitochondrial membrane potential was significantly increased,and the expression of HIF-1αt and HKⅡ was significantly up-regulated,and the expression of cytochrome c was significantly down-regulated in group HPC (P＜0.05).Compared with group HPC,the apoptotic rate was significantly increased,the mitochondrial membrane potential was significantly decreased,the expression of HIF-1α and HKⅡ was significantly down-regulated,and the expression of cytochrome c was significantly up-regulated in group HPC+YC-1 (P＜0.05).Conclusion The mechanism by which HPC inhibits H/R-induced apoptosis in rat cardiomyocytes is associated with activation of HIF-1α/HKⅡ signaling pathway.