Hypertrophic obstructive cardiomyopathy(HOCM)is a hereditary cardiac disorder characterized primarily by septal hypertrophy and left ventricular outflow tract obstruction.Traditional therapeutic modalities,such as medications and surgeries,do not yield satisfactory outcomes in a subset of patients.The advancements have been made in novel treatments,including new drugs and percutaneous intramyocardial septal radiofrequency ablation(PIMSRA),still need further observation to obtain long-term efficacy and safety.In recent years,stereotactic body radiation therapy(SBRT)has emerged as an innovative non-invasive approach for treating HOCM.Studies indicate that SBRT allows for precise targeting of the hypertrophied septal region,causing both direct and indirect damage to targeted myocardial cells.This can alleviate left ventricular outflow tract obstruction and myocardial ischemia,fulfilling the therapeutic objective.For those with HOCM who neither respond well to medications nor are surgical candidates,SBRT offers a potential new therapeutic alternative.However,the latent risks of radiation therapy persist,such as the onset of radiation-induced heart disease(RIHD).The preliminary investigations guarantee the safety and feasibility of SBRT in HOCM management,an increased volume of clinical studies and prolonged follow-up data are essential to evaluate its real efficacy and potential hazards.In addition,research regarding the therapeutic mechanisms of SBRT for HOCM,optimal dosages and treatment durations,indications and contraindications,prevention of complications,and enhancing the precision of radiation therapy,still needs to be further exploration,to determine the best therapeutic strategies.

OBJECTIVE To investigate the effect of vitamin D receptor(VDR) genetic polymorphism on the concentration of tacrolimus in renal transplant recipients at early stage after transplantation.METHODS The 360 cases of renal transplant recipients who received tacrolimus, mycophenolic acid, and glucocorticoid were recruited. CYP3A5(rs776746) and VDR(VDR ApaI rs7975232, VDR BsmI rs1544410, VDR FokI rs2228570 and VDR TaqI rs731236) genotypes were determined. The differences of concentration(C), dose(D) and the ratio of concentration to dose(C/D) of tacrolimus were compared among all of the genotype groups at the seventh day after renal transplantation. RESULTS The C and C/D of tacrolimus in CYP3A5 non-expresser(GG genotype) were all significantly higher than CYP3A5 expresser(AA and AG genotype)(P<0.05). When taking the different CYP3A5 genotypes in consideration, it was found that the C/D in patients with VDR ApaI rs7975232 AA genotype was significantly lower than those with AC and CC genotypes for CYP3A5 non-expresser(P<0.05). However, VDR ApaI rs7975232 gene polymorphism had no influence on C and C/D of tacrolimus in CYP3A5 expresser. Besides, no matter in CYP3A5 expresser or in non-expresser, VDR BsmI rs1544410, VDR TaqI rs731236 and VDR FokI rs2228570 had no effect on C, D and C/D of tacrolimus. CONCLUSION During the early stage of renal transplantation, the polymorphism of VDR ApaI rs7975232 show significant relevance with tacrolimus concentration in CYP3A5 non-expresser. The detection of the genotype might be helpful to guide individual therapy.

Objective: To explore the curative effect and safety of botulintum toxin A (BTX-A) on depressive disorder in patients with Parkinson′s disease (PD). Methods: Forty-two cases of PD with depression prospectively recruited in the Second Hospital Affiliated to Soochow University from August 2016 to November 2018 were divided into two groups: 28 patients in BTX-A group (administered with 100 U BTX-A injection on patients′ eyebrow, forehead, bilateral lateral canthus and temporal region at 20 loci), 14 patients in sertraline (control) group (administered with 50-100 (55.36±14.47) mg/d sertraline). The scores of Hamilton Depression Rating Scale (HAMD), Self-rating Depression Scale (SDS), Hamilton Rating Scale for Anxiety (HAMA), Self-rating Anxiety Scale (SAS) after treatment for 2 weeks, 4 weeks, 8 weeks and 12 weeks were compared with the scores of each emotional rating scale for baseline respectively. Meanwhile, the differences in the scores of each emotional scale between the two treatment groups were compared. In addition, the remission rates of depression and anxiety (defined as HAMD, HAMA scores<7) at each follow-up time point between the two groups were compared to evaluate the efficacy and safety of BTX-A in the treatment of PD patients with depression. Results: The scores of HAMD, HAMA, SDS, SAS in the BTX-A group and the sertraline group reduced compared to baseline after treatment (at the 2nd, 4th, 8th, 12th weeks). The scores of HAMD and SDS in the BTX-A group (HAMD scores: F=12.930, P<0.01; SDS scores: F=5.022, P=0.001) and those in the sertraline group (HAMD scores: F=2.883, P=0.030; SDS scores: F=3.427, P=0.013) were significantly lower compared to baseline, but there was no statistically significant difference in the scores of HAMD and SDS between the two groups (P>0.05). HAMD score showed that the remission rate of depression in the BTX-A group (17.9% (5/28), 35.7% (10/28)) was higher than that of the sertraline group (2/14, 4/14) at the 2nd and 4th weeks. At the 8th and 12th weeks, the remission rate of depression in the sertraline group (7/14, 9/14) was higher than that of the BTX-A group (46.4% (13/28), 53.6% (15/28)). There was no statistically significant difference in remission rate of depression between the two groups at each follow-up time point (P>0.05). There was no statistically significant difference in HAMD scores between males and females in the BTX-A group (P>0.05). Two of the 28 patients in the BTX-A group had frown muscle stiffness, which lasted for two weeks and improved in one month. Two patients in the sertraline group had headache and dizziness, and two patients had dry mouth and nausea, which improved after two weeks. There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.197). Conclusion BTX-A intraocular facial muscle injection can significantly improve the depressive symptoms of PD patients, and the effect lasts for a long time, with low incidence of side effects and high safety, which can be considered as a safe and effective new method for PD patients with depressive symptoms.

Objective To explore the curative effect and safety of botulintum toxin A (BTX?A) on depressive disorder in patients with Parkinson′s disease (PD). Methods Forty?two cases of PD with depression prospectively recruited in the Second Hospital Affiliated to Soochow University from August 2016 to November 2018 were divided into two groups: 28 patients in BTX?A group (administered with 100 U BTX?A injection on patients′eyebrow, forehead, bilateral lateral canthus and temporal region at 20 loci), 14 patients in sertraline (control) group (administered with 50-100 (55.36±14.47) mg/d sertraline). The scores of Hamilton Depression Rating Scale (HAMD), Self?rating Depression Scale (SDS), Hamilton Rating Scale for Anxiety (HAMA), Self?rating Anxiety Scale (SAS) after treatment for 2 weeks, 4 weeks, 8 weeks and 12 weeks were compared with the scores of each emotional rating scale for baseline respectively. Meanwhile, the differences in the scores of each emotional scale between the two treatment groups were compared. In addition, the remission rates of depression and anxiety (defined as HAMD, HAMA scores<7) at each follow?up time point between the two groups were compared to evaluate the efficacy and safety of BTX?A in the treatment of PD patients with depression. Results The scores of HAMD, HAMA, SDS, SAS in the BTX?A group and the sertraline group reduced compared to baseline after treatment (at the 2nd, 4th, 8th, 12th weeks). The scores of HAMD and SDS in the BTX?A group (HAMD scores: F=12.930, P<0.01; SDS scores: F=5.022, P=0.001) and those in the sertraline group (HAMD scores: F=2.883, P=0.030; SDS scores:F=3.427, P=0.013) were significantly lower compared to baseline, but there was no statistically significant difference in the scores of HAMD and SDS between the two groups (P>0.05). HAMD score showed that the remission rate of depression in the BTX?A group (17.9% (5/28), 35.7% (10/28)) was higher than that of the sertraline group (2/14, 4/14) at the 2nd and 4th weeks. At the 8th and 12th weeks, the remission rate of depression in the sertraline group (7/14, 9/14) was higher than that of the BTX?A group (46.4% (13/28), 53.6% (15/28)). There was no statistically significant difference in remission rate of depression between the two groups at each follow?up time point (P>0.05). There was no statistically significant difference in HAMD scores between males and females in the BTX?A group (P>0.05). Two of the 28 patients in the BTX?A group had frown muscle stiffness, which lasted for two weeks and improved in one month. Two patients in the sertraline group had headache and dizziness, and two patients had dry mouth and nausea, which improved after two weeks. There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.197). Conclusion BTX?A intraocular facial muscle injection can significantly improve the depressive symptoms of PD patients, and the effect lasts for a long time, with low incidence of side effects and high safety, which can be considered as a safe and effective new method for PD patients with depressive symptoms.

Objective To evaluate the efficacy of cold preservation solution containing desferrioxamine (DFO) in protecting the rat hearts.Methods Pathogen-free male Sprague-Dawley rats,weighing 300-350 g,were used in the study.Thirty-two isolated rat hearts were equally and randomly divided into control group (C group) and DFO group using a random number table.Hearts of rats were stored for 6 h in 4 ℃ histidine-tryptophan-ketoglutarate (HTK) solution in group C.DFO was added to HTK solution (DFO concentration 100 μmol/L),and hearts of rats were stored for 6 h in 4 ℃ HTK solution in group DFO.At 6 h of cold storage,creatine kinase and lactate dehydrogenase activities in the cold preservation solution were determined.Myocardial specimens were obtained from the apex,cut into sections which were stained with haematoxylin and eosin,and examined under a microscope.The pathological changes of myocardial tissues were scored.The content of malondialdehydc in myocardial tissues was determined using thiobarbitnric acid method,and hypoxia-inducible factor-1α protein and mRNA expression in myocardial tissues was detected by real-time reverse transcriptase polymerase chain reaction and Western blot.Results Compared with group C,the creatine kinase and lactate dehydrogenase activities in the cold preservation solution,malondialdehyde content in myocardial tissues,and pathological scores were significantly decreased,and the expression of hypoxia-inducible factor-1α protein and mRNA expression in myocardial tissues was significantly up-regulated in group DFO (P＜ 0.05).Conclusion Cold preservation solution containing DFO can protect the rat hearts effectively,and the mechanism is related to up-regulation of the expression of hypoxia-inducible factor-1α.

Objective To investigate the influence of intensity-modulated radiation pattern on ra-diobiological effects of nasopharyngeal carcinoma cell line CNE2.Methods Colony formation assay was used to calculate cell surviving fraction, and compare the cell survival curves and the surviving fraction with single-hit multi-target model fitting survival curves to different delivery time and dose rates.Results ⑴Nasopharyngeal carcinoma cell line CNE2 was irradiated on two models:conventional radiation ( CR) mod-el;intensity modulated radiation model ( IMRT model, which was divided into 10 min IMRT irradiated group, 15 min irradiated group, and 20 min irradiated group) .Except that the parameters of radiation biol-ogy did no significantly differ between CR model and 10 min IMRT irradiated group ( P >0.05) , the other groups among radiobiology parameters surviving fraction (SF2), quasi-threshold dose(Dq) and extrapolation number(N) were all significant differences ( P <0.05) .⑵ They found that the SF2 300 Mu/min>SF2 600 Mu/min ( P <0.05) when the CNE2 cells were treated with dose rates of 300 Mu /min and 600 Mu/min.Conclusions ⑴There were not significant changes in the biological effects until the delivery time prolonged to more than 10 minutes.When the delivery time extended to more than 15 minutes, the survival fraction was increasing with the radiation time risen.⑵The dose rates used in the experiment did not show any effect on the radiobiology parameters without SF2 .

Objective To investigate the therapeutic effects of botulinum toxin type A (BTX-A) in elderly patients with primary intractable trigeminal neuralgia.Methods 27 elderly patients with primary intractable trigeminal neuralgia were treated with BTX-A local multiple point injection.The efficacy was assessed by visual analog scores (VAS) before and 1 week,2 weeks,1 month,3 months and 6 months after the treatment.Results VAS scores was (9.2±1.1),(5.8±3.0),(3.6± 2.3),(2.3±2.3),(3.2±2.9) and (4.6±3.2) before and 1 week,2 weeks,1 month,3 months and 6 months after BTX-A treatment respectively.VAS score was gradually decreased,reached the lowest at 1 month after BTX-A injection,and then was gradually increased.There were significant differences in VAS scores between between pre-and post-treatment (P＜0.05).The efficiency was 37.0％,85.2％,92.6％,70.4％ and 59.3％ at 1 week,2 weeks,1 month,3 months and 6 months after the treatment respectively.There were significant differences in efficacy between different time points after the treatment (all P＜0.05).3 patients had the transient numbness of mouth askew and incomplete eyelid closure and recovered spontaneously after 4-8 weeks.No severe adverse effects were found in the other 27 patients.Conclusions BTX-A is safe and effective in the treatment of primary intractable trigeminal neuralgia in elderly patients.

Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.

Objective To observe the effects of lycopene on fibrinolytic activity and nitric oxide in atherosclerosis rabbits. Methods 30 New Zealand rabbits were randomly divided into three groups. They were individually housed in metal cages. Throughout the experimental period, they were given restricted amounts of food. Control group was fed with normal diet,model group was fed with 1% cholesterol,10% lard and 89% normal diet, lycopene group was fed with 1% cholesterol,10% lard and normal diet plus 6% lycopene.At the time of the first day and the 8th week, blood samples were drawn from ear edge vein of rabbits. The activity and content of plashaa tissue type plasminogen activator(t-PA)and plasminogen activator inhibitor(PAI-1)were detected. The levels of serum Nitric oxide (NO)were determined.At the end of the study, the plaque areas were measured. SPSS 10.0 software was used to evaluate the differences among the three groups. Results Compared with control group, atherosclerosis rabbits had lower content and activity of t-PA, higher content and activity of PAI-1 and lower content of NO. Compared with model group, lycopene group had no significant difference about the content and activity of tPA and PAI-1.But lycopen increased the levels of serum NO, significantly diminished the area of lipid plaque. Conclusions The experimental results suggested that lycopene had antiatherogenic effects. The possible mechanisms might be that lycopene could decrease lipid peroxidation injure, maintain the concentration of NO and protect vascular endothelium. The antiatherogenic effects of lycopene had no correlation with the fibrinolytic activity.

Objective To investigate the relationship between pregnancy-associated plasma protein A(PAPP-A)level and restenosis after elective coronary stenting by coronary artery angiography(CAG)and intravascular ultrasound(IVUS). Methods The study consisted of 132patients with successful coronary stent placement:left anterior descending coronary artery(LAD)62,left circumflex coronary artery(LCX)36,right coronary artery(RCA)34.The follow-up CAG and IVUS were Derformed at the 6th month after stent placement.Diameter stenosis≥50%on CAG was regarded as in-stent restenosis.Neointimal areas(IA),stent volume(SV)and neointimal volume(IV)were measured by IUVS during follow-up.According to the PAPP-A level,lesions were divided into 2groups:high PAPP-A group(PAPP-A level≥12.11 mIU/L)and low PAPP-A group(PAPP-A level＜12.11 mIU/L). Results Total restenosis rate was 31.8%.There were no significant differences in age.sex and risk factors of coronary heart disease(hypertension,diabetes,smoking)between restenotic and nonrestenotie groups(all P＞0.05).The restenotic group had higher PAPP-A level than nonrestenotic group[(18.14±2.26)mIU/L vs. (10.95±2.12)mlU/L,P＜0.01].Angiographic restenosis occurred in 28 of 66 lesions(42.4%)in the high PAPP-A group and in 14 of 66 lesions(21.2%)in the low PAPP-A group(P＜0.01).Plasma PAPP-A level was positively correlated with IA,IV(r=0.47 and 0.54 respectively,all P＜0.05). Conclusions Elevated PAPP-A level is correlated well with the severity of the intimal hyperplasia.Plasma PAPP-A level affects restenosis after elective stent placement by promoting intimal hyperplasia.