Heart failure with preserved ejection fraction (HFpEF) is defined as having a left ventricular ejection fraction (LVEF) of ≥50% accompanied by elevated natriuretic peptide (BNP) levels or other evidence of congestion. HFpEF is characterized by high morbidity and mortality rates and has surpassed heart failure with reduced ejection fraction (HFrEF) to become the predominant form of heart failure. This article reviewed the definition, epidemiology, classification, diagnosis, pathology, comorbidities, and treatment of HFpEF, providing evidence for clinical research.

Objective To explore the key genes of cardiac aging by bioinformatic analysis,and conduce to prevent and treat cardio-vascular diseases in the elderly.Methods The gene expression of GSE8146 was downloaded from the Gene Expression Omnibus(GEO)database."R"software was used to screen out differentially expressed genes in the hearts of young and old mice,and DAVID online anal-ysis tool was used for Gene Ontology(GO)function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)signa-ling pathway enrichment analysis of differentially expressed genes.Hub genes were obtained by protein-protein interaction(PPI)analy-sis based on the STRING online database.Results A total of 55 differentially expressed genes were screened,including 22 up-regula-ted genes and 33down-regulated genes.The differentially expressed genes were significantly enriched in lipid metabolism,fatty acid me-tabolism and other processes,mainly involvded in peroxisome proliferators-activated receptor(PPAR)signaling pathway and Adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)signaling pathway.The hub genes such as Fasn,Pck1,Adipoq,Cpt1a,Pdk4,Pnpla2,Slc27a1,Hmgcs2,Cidec,Ucp3 were screened out.Conclusion Cardiac aging may be related to the disorder of cellular energy metabolism,and hub genes such as Fasn,Pck1,Adipoq,Cpt1a,Pdk4,Pnpla2,Slc27a1,Hmgcs2,Ucp3,PPAR signaling path-way and AMPK signaling pathway may play an important role in the development of cardiac aging.

Objective:To compare the clinical manifestations of ocular toxoplasmosis (OT) in adult and children, and to preliminarily explore the role of intraocular fluid detection in the early diagnosis of OT.Methods:A retrospective study. From January 2018 to October 2019, 60 cases of OT patients with 60 eyes diagnosed in the Department of Ophthalmology of Beijing Chaoyang Hospital Affiliated of Capital Medical University were included in the study. The medical history information of patients was collected in parallel with slit-lamp microscopy, indirect ophthalmoscope examination, and canine toxoplasma antibody detection in aqueous or vitreous fluid. Fifty-eight cases underwent visual inspection; 2 cases did not underwent visual inspection, who were children. The visual acuity examination was carried out using the new version of the standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution(logMAR) visual acuity during statistics. According to age, the patients were divided into adult group and child group, with 12 eyes in 12 cases and 48 eyes in 48 cases, respectively. The clinical characteristics and main points of diagnosis and treatment of the two groups of patients were compared and observed. The comparison among the measurement data groups conforming and the normal distribution was performed by the independent t test. The comparison between the measurement data groups of the skewed distribution was performed by the Kruskal- Wallis test. The qualitative data were compared with χ 2 test. Results:Among the adult group and the child group, 7 (58.3%, 7/12) and 34 (70.8%, 34/48) patients with a clear history of contact with dogs and cats were in the adult group and the child group, respectively. The adult group was significantly lower than the child group, however, there was no different statistical significance ( χ 2=0.236, P=0.627). At the first visit, the self-reported blurred vision of the adult group and the child group was 10 (83.3%, 10/12) and 22 (45.8%, 22/48) cases, respectively. In the adult group and the child group, 3 (25.0%, 3/12) and 20 (43.5%, 20/46) eyes with logMAR visual acuity greater than 1.85, 8 (66.7%, 8/12) and 22 (45.8%, 22/46) eyes with logMAR visual acuity less than 0.3. The visual acuity of the adult group was better than that of the child group, and the difference was statistically significant ( Z=2.162, P=0.031). There was no statistically significant difference in the composition ratio of different clinical types of the two groups of eyes ( χ 2=1.908, P=0.385). The incidence of inflammation in the anterior segment of the eye in the adult group and the child group were 25.0% (3/12) and 56.3% (27/48), respectively; there was no statistically significant difference between the two groups ( χ 2=3.750, P=0.053). The concentration of antibodies in the vitreous humor of the affected eye in the adult group and the child group was greater than that of aqueous humor. The antibody concentrations of vitreous humor and aqueous humor were 36.51 (22.58) and 19.94 (21.78) U/ml in the children group; 45.95 (56.44) and 32.20 (38.64) U/ml in the adult group. Comparison of antibody concentrations in the vitreous humor and aqueous humor of the affected eyes in the child group showed statistically significant differences ( Z=-1.984, P=0.047). Conclusions:Compared with children with OT, adult patients with OT have better vision and mild inflammation or hyperplasia of the vitreous cavity. The detection of antibodies related to toxoplasma in the intraocular fluid is helpful for early diagnosis.

Objective To investigate the clinical effect of Itopride and esomeprazole combining with deanxit in treating functional dyspepsia ( FD) .Methods Sixty-two patients meeting Rome Ⅲcriterion were randomly divided into the therapy groups which were treated with Itopride and esomeprazole combining with deanxit and the control groups which were treated with Itopride and esomeprazole for 4 weeks respectively .Symptom scoring was done before and after the treatment .Results The symptoms were remarkably improved , there was significant difference in the therapeutic effect between the two groups (P<0.05).The total efficiency was more obvious in the therapy group . Conclusion Itopride and esomeprazole combining with deanxit can produce an effect on the treatment of FD .Itopride and esomeprazole combining with deanxit has better clinical effect than Itopride and esomeprazole on the treatment of FD.

Objective To compare the efficacy of 10-day sequential therapy (including rabeprazole amoxillin clarithromycin tinidazole) and 7-day traditional trigeminy therapy (including rabeprazole amoxillin and clarithromycin) in patients with duodenobulbar ulcer and Hp infection. Methods Ninty-five patients with duodenobulbar ulcer and Hp infection were enrolled into the study and divided into two groups randomly:sequential therapy group and traditional trigeminy therapy group. Patients in the first group received 10-day sequential medications:rabeprazole 10 mg plus amoxillin 1 g for the first 5 days,followed by rabeprazole 10 mg plus clarithromycin 500 mg and tinidazole 500 mg for another 5 days;while in the second group patients received the standard 7-day traditional triple medications:rabeprazole 10 mg plus clarithromycin 500 mg and tinidazole 400 mg. All drugs were given twice daily. All patients received rabeprazole 10 mg daily following the two types of therapys for another four weeks. Hp statuses were assessed by rapid urease test and 14C urea breath test at baseline and 4 weeks after completion of the treatment. Ulcer cicatrization was assessed by gastroscope. Results The eradication rate of Hp infection was significantly higher in sequential group than triple group (89.5%vs. 70. 2%, P ＜ 0. 05 ), but we found no statistically significant difference in the comparison of the ulcer cicatrization rate between sequential group and triple group ( 87.5% vs. 82. 9%, P ＞ 0. 05 ). Conclusion Sequential therapy had a better Hp eradication effect than standard triple therapy, but the eradication rate was very close between the two therapys.

inal event.

Objective To analyze the cause of bile refluxing into stomach leading to stomach mucous membrane pathological changes and complications.To evaluate the accuracy of electronic gastroscope combining with clinical manifestation in diagnosis of bile reflux gastritis.Methods The extent of the bile refluxing,bile staining on muco sa and other pathological changes were observed by electronic gastroscope.Part of the patients underwent mucosa biopsy.Results Of the ten thousand patients who underwent electronic gastroscope,there were 1433 cases who presentedbile refluxing.The average age is 46.8 years-old,male and female ratio is 0.75 :1.Mucous membrane presented various degrees of erosion,congestion and edema.Part of the cases combined with peptic ulcer,reflux esophagitis or a trophic gastritis.None of them combined with gastric cancer or esophageal cancer.Conclusion Electronic gastroscope can be main means for diagnosis of bile reflux gastritis.If combined with bilirubin in gastral cavity determination,PH value of gastric juice determination and mucosa biopsy,it can be more scientific.

Objective To evaluate the clinical therapy effect of sclerosing agent and its safety on treatment of the patients with hemorrhage from esophageal varices.Methods The total of 114 patients with hemorrhage from varices were treated by three methods randomly.Among them,the number of groups of sclerosing agent,emergency treatment and prevential treatment were seventy-eight,forty-six and thirty-two respectively.Results There were forty-four emergency cases treateml by hemostasis.The positive bleeding rate of the patients with hemorrhage from esophageal vaxices after treatment and follow-up survey from one year to five years was 7.7%.The disappearance rate of varicose vein was 83%.Conclusion With the help of endoscope,the method of sclerosing agent on treatment of the patients with hemorrhage from esophageal varices was simple,safe and reliable.

Objective To evaluate the safety of mefformin in the treatment of elderly type 2 diabetes mellitus(T2DM). Methods Two hundred and forty-three cases of elderly T2DM hospitalized from Jan.1996 to Dec. 2006 were reviewed; the changes of fasting blood glucose(FBG), postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), liver and renal function and blood lactic acid were evaluate before and after treatment. Results The mean time of treatment with mefformin was (6.6±3.9) years (3 months-21 years)in these 243 cases. The levels of FBG, PBG and HbAlc significantly reduced after treatment with mefformin only in 43 cases (17.7%), mefformin combined with other oral hypoglycemic drugs in 124 cases (51.0%) and mefformin combined with insulin in 76 cases (31.3%). There was only 18.1% of the cases with normal range ( > 80 ml/min) of creatinine clearance rate (Ccr), and 25.8% of the cases with Ccr≤50 ml/min. The liver and renal function as well as the blood lactic acid had no significant change after treatment no matter in total cases or in different groups separated by Ccr.Conclusions Mefformin is safety in the treatment of elderly T2DM patients. Ageing is not the contraindication of mefformin. To the patients with high risk, we should monitoring the level of blood lactic acid.

Objective To study the significance of acute pancreatitis AP complications by acid-base distur-bance. Methods The arterial blood gas, serum electrolytes parameter and clinical data of 85 patients were analyzed.Results Acid-base disturbance of different types commonly existed in the early stage of AP patients. There are sig-nificant statistical differences in the indices of PaO2, PaCO2, SaO2 between group MAP and group SAP( P < 0.05 or P < 0.01 ). Conclusion Acid-base disturbance are very common in the AP patients and this-will make the condition worse,they should be treated promptly.