Central hiccup frequently occurs secondary to stroke and is not solely attributed to gastric disharmony with ascending counterflow qi disturbing the diaphragm.It is also associated with post-stroke orifice obstruction with spirit concealment and failure of the spirit to guide qi.In treatment,regulating qi movement and simultaneous brain-diaphragm intervention warrant attention.The foot shaoyang gallbladder meridian interconnects the head,neck,diaphragm,and thorax through its pathway,and as a shaoyang meridian,it plays a pivotal role in coordinating qi dynamics.This study investigates the theoretical and structural foundations for treating central hiccup via the gallbladder meridian,based on meridian-viscera theory and the reflex arc of hiccup.By analyzing the meridian-viscera relationships between the gallbladder meridian and the pathological loci of central hiccup,this study elucidates its etiology and pathogenesis,proposing a gallbladder meridian-oriented therapeutic approach to provide novel clinical insights.

Objective To analyze the correlation between plasma Pannexin-1(Panx-1)level and no-reflow after percutaneous coronary intervention(PCI)in patients with ST-segment elevation my-ocardial infarction(STEMI).Methods A prospective trial was performed on 218 STEMI patients who underwent PCI in our hospital from January 2019 to December 2021.According to the blood flow classification of myocardial infarction thrombolysis(TIMI)after PCI,they were divided into normal reflow group(110 cases),slow reflow group(69 cases)and no reflow group(39 cases).The plasma Panx-1 level was determined by ELISA,and the levels of P-selectin,activated glyco-protein Ⅱ b/Ⅲ a(aGP Ⅱ b/Ⅲ a)and platelet-leukocyte aggregates(PLA)were determined by flow cytometry.Results Older age,larger ratio of diabetes mellitus,longer time from symptom onset to PCI,higher platelet count and levels of LDL-C,D-dimer,P-selectin,GP Ⅱ b/Ⅲ a,PNA,PM A,PLyA and plasma Panx-1 were observed in the no-reflow group than the normal and slow reflow groups(P＜0.05).The plasma Panx-1 level in STEMI patients was positively correlated with P-selectin,GP Ⅱ b/Ⅲ a,PNA,PM A and PLyA(P＜0.05,P＜0.01).LDL-C ≥3.20 mmol/L and plasma Panx-1＞0.88 μg/mL were independent risk factors for no-reflow after PCI in STEMI pa-tients(OR=2.198,95％CI:1.252-3.858,P=0.006;OR=16.849,95％CI:4.481-63.357,P=0.000).The AUC value of Panx-1 was 0.826(95％CI:0.744-0.907,P＜0.01)in predicting no re-flux in STEMI patients after PCI.Conclusion The increase of plasma Panx-1 level is closely asso-ciated with the occurrence of no reflow in STEMI patients after PCI,and the protein can be used as a predictive biomarker for the phenomenon.

Objective: To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas. Methods: Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis. Results: This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms. Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.

Objective To induce the immune tolerance of heart grafts with infusion of isogeneic bone marrow mesenchymal stem cells (BMSCs) in heart transplant rats.Method Donor Wistar rats and recipient F344 rats were randomly divided into 4 groups:acute rejection group (group A),Wistar rats as the donors and F344 rats as the recipients for heart transplantation; low dose cyclosporin A(CsA) group (group B),recipient F344 rats given low dose CsA; BMSCs group (group C),recipient F344 rats given isogeneic BMSCs; BMSC and low dose CsA group (group D),the recipient F344 rats given isogeneic BMSCs and low dose CsA.The serum cytokine levels were determined,and the donor heart pathological changes and survival were observed postoperatively.The relative level of Foxp3 mRNA expression in the spleen of the recipient F344 rats was also observed.Result The blood levels of interleukin-2 (IL-2) and interferon-γ(INF-γ) were significantly reduced,but IL-4 and IL-10 levels were increased (P＜0.05),and the survival time of donor heart was significantly prolonged in group D as compared with groups A,B and C (P＜0.05 for all).Heart pathological examination revealed a mild acute rejection in group D,moderate acute rejection in groups B and C group,and severe acute rejection in group A respectively.The expression of Foxp3 mRNA was significantly lower in group A than in groups B,C and D (P＜0.05 for all),and that in group D was significantly higher than in groups B and C (P＜0.05 for both),but there was no significant difference between between groups B and C (P＞0.05).Conclusion Intravenous administration of BMSCs can alleviate immunorejection in heterotopic rat heart transplantation.Low-dose CsA acts synergistically with BMSCs to significantly inhibit acute rejection after heart transplantation.The partial mechanisms involve the suppressive effect of BMSCs on the expression of Foxp3 mRNA and modulation on cytokine.

Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.

Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.

With the development of mass spectrometer,protein and peptide separation technology,and data analysis tools,the study on protein expression profiling of various tissues,organs or cells has been developed rapidly.The most basic purpose of proteomics is qualitative and quantitative identification of the whole protein in a cell or tissue.Therefore,how to make full use of mass spectrometry data has an important significance in proteome.Recently years,proteomics has begun to be applied in allograft rejection and discovery of rejection related biomarkers in organ transplantation.Through the extensive application of the technology in organ transplantation,graft rejection can be earlier detection and treatment.Therefore,the proteomics research have potential application prospects in the diagnosis of the organ transplant rejection.

Objective To study the effect of intracoronary adenovirus vector-mediated transforming growth factor ?_1 (Ad.TGF-?_1) gene transfer on discordant cardiac xenograft in the setting of acute vascular rejection. Methods In a cervical heterotopic cardiac transplantation model by cuff technique, after harvest, guinea pig donor hearts’coronary arteries were perfused ex vivo with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart of Ad.TGF-?_1, then implanted in the necks of complement depleted and immunosuppressed rat recipients. As controls, other hearts were perfused with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart adenoviral blank-vector or with virus-free Stanford University solution by the same method.Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The number of inflammatory cells and macrophages and nature killer cell infiltration in the cardiac xenografts of Ad.TGF-?_1 infected grafts was less than that of other groups (P

OBJECTIVETo investigate the rehabilitation of the sexual function of male patients after heart transplantation.

METHODSEleven discharged adult male cardiac transplant recipients (ranging 32-54 years) with a normally functioning allograft for at least 9 months were questioned on their pre- and post-operative sexual function.

RESULTSAll the recipients complained of a significant pretransplantive decrease and 10 stated a significant posttransplantive increase in sexual function.

CONCLUSIONThe sexual function of the male recipients was significantly improved after cardiac transplantation. Psychosocial factors affecting the rehabilitation of sexual function should not be neglected.

Objective To study the effects of intracoronary transfer of adenovirus vector-mediated transforming growth factor ?_1 gene on acute rejection of cardiac allograft in rats. Methods In a cervical heterotopic cardiac transplantation model, donor hearts coronary arteries were perfused ex vivo after harvest with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart of donor heart of Ad. TGF-?_1, then implanted in the necks of recipients. As controls, other hearts were perfused with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart adenoviral bland-vector or with virus-free Stanford University solution by the same method. Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The expression of CD_ 68 and the apoptosis index in the cardiac allografts of Ad. TGF-?_1 group were less than that of other two groups (P